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PubMedDate not supplied

Acute health reference values: overview, perspective, and current forecast of needs.

A number of organizations have developed acute inhalation health reference values, each with (1) a specific purpose, (2) populations to protect, (3) exposure scenarios (accidental releases, workplace, routine excursions of ambient levels), and (4) severity of adverse health effects considered in their development. The first section of this article reviews the existing values from different organizations and describes their purposes and method of development. The second part of the article provides a comparative review of how the values were derived, the critical endpoints considered for each value, the populations being protected by each value, and the potential for use outside of their intended purpose (e.g., Homeland Security, regulatory analysis, etc.). Additionally, an analysis of the acute inhalation reference values that was developed in support of the Office of Air and Radiation's residual risk assessment for hazardous air pollutants is presented and reviewed. The third and final part of the article focuses on the efforts of the U.S. Environmental Protection Agency (EPA) to develop a set of less-than-lifetime reference values, along with a discussion of how that effort fits with the existing sets of values described in the prior sections.

Air Pollutants↗
PubMed2006

Predicting coronary heart disease mortality--assessing uncertainties in population forecasts and death probabilities by using Bayesian inference.

BACKGROUND: Predictions concerning people and their health are influenced by many factors and have many sources of uncertainty. Even so predictions can give useful guidelines for health care planning. We present a Bayesian model based on past observations and prior knowledge to predict coronary heart disease (CHD) mortality in selected areas of Finland until the year 2030. METHODS: CHD mortality data are based on official statistics. The study area consists of one western and two eastern parts of Finland. The modelling of the probability of death follows a Bayesian age-period-cohort model. Two models are used, one assuming that the trend from 1970 to 2002 will continue and the other that mortality will stay at the attained level. RESULTS: If the observed trend in CHD mortality were to continue, death probabilities would decrease significantly among men aged 50-69 and women aged 50-59. In the older age groups (men aged 70 and women 60 years or more) the changes were found to be negligible. If the trend continues, the number of CHD deaths will decrease from 2002 to 2030 significantly among men [81% decrease; 95% credible interval (95% CI) 54-96%] and women (90%; 67-100%) aged 50-59. In the age group 60-79 the changes will be smaller and non-significant. In the oldest age group (80-99 years) the predicted increase in the number of deaths will be great, from 284 to 1297 (95% CI 474-2620) in men and from 722 to 1970 (717-4017) in women. CONCLUSIONS: Our predictions emphasize the significance of maintaining the recent decline of CHD mortality among middle-aged adults. Special attention should be paid to CHD mortality among men and women aged 80 and over. Considerable improvements in prevention and treatment are needed to compensate for the effects of ageing of the population.

Age Factors↗
PubMed1977

Forecasting the development of primary hepatocellular carcinoma by the use of risk factors: studies in West Africa.

An association between hepatitis B virus (HBV) and primary hepatocellular carcinoma (PHC) has been found in several studies in Africa, Asia, and elsewhere. In this paper we considered the interrelations between several events related to HBV infection, which include the presence of: 1) hepatitis B surface antigen (HBsAg), 2) antibody to hepatitis B core antigen (anti-HBc), 3) antibody to the surface antigen (anti-HBs), 4) chronic liver disease, 5) elevated alpha-fetoprotein, and 6) PHC. With the use of preliminary epidemiologic data, risk factors related to these events were calculated. We suggested that the interactions between these events and HBV infection in parents be used to estimate the risk of PHC for an individual in this environment.

Adolescent↗
PubMed1984

Differential susceptibility of inbred mouse strains forecast by acute colonic proliferative response to methylazoxymethanol.

The proliferative response of colonic epithelial cells to methylazoxymethanol (MAM) was followed in 1,2-dimethylhydrazine (DMH)-sensitive SWR/J, moderately resistant C57BL/6J, and resistant AKR/J strains. Untreated AKR mice had a significantly lower labeling index (L1) a shorter proliferative compartment (PC), and a smaller percentage of DNA synthesizing cells in the middle third of the crypts than did the SWR strain. SWR had the highest Ll, the widest PC, and the largest percentage of DNA synthesizing cells in the middle third of the crypts. C57BL/6 mice had characteristics that lay between the sensitive and resistant strains. Pooled data from 1 week after the fifth and sixth injections and 12 weeks after the first MAM injection revealed that extension of the PC had occurred in all strains, but it was only the DMH-sensitive SWR strain that showed extension of the PC to the upper third of the crypt, the greatest shift of proliferating cells to the middle and upper third of crypts, and the greatest increase in Ll. The AKR strain demonstrated these proliferative alterations least, and the C57BL/6 strain fell between them. This differential response to MAM among the strains mimicked that previously reported by us when DMH was investigated. The similarity in response of the colonic epithelial cells of each strain to either a direct-acting (MAM) or indirect-acting carcinogen (DMH) would support the concept that susceptability to this family of carcinogens is directly related to the genetically controlled indigenous proliferative characteristics of the colon.

1,2-Dimethylhydrazine↗
PubMed1997

Age-period-cohort effects on ischaemic heart disease mortality in Sweden from 1969 to 1993, and forecasts up to 2003.

AIMS: Mortality from ischaemic heart disease has been decreasing in most industrialized countries since the 1960s. The aim of this study was to analyse ischaemic heart disease mortality during 1969-1993 in Sweden, and to predict mortality trends until 2003. METHODS AND RESULTS: Age-period cohort models were used to analyse ischaemic heart disease mortality in Sweden between 1969 and 1993, and to predict age-specific death rates and total number of deaths for the periods 1994-1998 and 1999-2003. Mortality rates in the age group 25-89 years decreased from 719 to 487 per 100,000 for men, and from 402 to 215 per 100,000 for women over the study period (average annual decrease of 1.5% for men and 2.2% for women). The decline started earlier for women than for men. The ratio of age-adjusted mortality between men and women increased steadily over the study period. Predictions based on the full age-period cohort model for the period 1999-2003 gave mortality rates of 346 and 155 per 100,000 for men and women, respectively. Despite the ageing of the population, the total numbers of ischaemic heart disease deaths in Sweden are predicted to decline by approximately 25% in both men and women from 1989-93 to 1999-2003. CONCLUSION: A major decline in ischaemic heart disease mortality has been observed in the last 15 years in Sweden. Both factors, cohort and calendar period, contain information which helps explain the decline in ischaemic heart disease mortality trends in Sweden. Predictions indicate that the decline of both age-specific and total mortality is to continue.

Adult↗
PubMed1992

Accelerated disappearance of ovarian follicles in mid-life: implications for forecasting menopause.

Menopause is triggered by the number of ovarian follicles falling below a threshold number and is irreversible because oogonial stem cells disappear after birth. Since it is the result of programmed disappearance of a limited store of follicles, menopause can be predicted using mathematical models based on total follicle counts at different ages. Our model shows follicle numbers decline bi-exponentially rather than as a simple exponential function of age, as had been assumed, with a first exponential rate parameter of -0.097 and a second of -0.237. The change occurred when numbers had fallen to the critical figure of 25,000 at age 37.5 years. The unexpectedly faster rate of ovarian ageing afterwards lowers the follicle population to 1000 at approximately 51 years, and was adopted as the menopausal threshold because it corresponds to the median age of menopause in the general population. Had the earlier rate persisted menopause would not be expected until 71 years. The impact of step reductions of follicle numbers on the prospective span of menstrual life was predicted by the model. A reduction by 50% before age 30 years resulted in the threshold being reached at 44 years and 0.6 year later for every subsequent year until age 37.5 years after which it is reached at 48 years. A reduction of 90% in childhood before age 14 years could result in menopause as early as 27 years, with increments of 0.6 year per year afterwards until after 37.5 years when it is expected at age 41 years.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1999

Management forecast: optimizing the use of organizational and individual knowledge.

Knowledge management provides a means for sharing data, lessons learned, and accumulated knowledge throughout an organization or within an entire industry. Gone are the days of hoarding knowledge to ensure job security; today's workers and managers must work together to find new and innovative ways to use what they know and optimize how that knowledge is accessed. Knowledge management's new approach to shared intellectual resources has implications for workers and managers in all fields and promises to redraw the management landscape. But are healthcare organizations setting the stage for reengineering themselves all over again?

Administrative Personnel↗