Can the case-control method be used to assess the impact of water supply and sanitation on diarrhoea? A study in the Philippines.

This study had 2 objectives: 1) to determine whether a case-control approach is an effective measure for assessing the effect of improved sanitation on bacterial diarrhea, and 2) to assess the effects of environmental sanitation on diarrheal disease in Cebu. The study took place during the warm, rainy months (July-September) of 1985. The study population consisted of 281 children under 2 who were treated at 1 of 16 clinics for diarrhea due to Escherichia coli, salmonella, shigella, and Vibrio cholerae. The controls were 384 children under 2 who were brought to the clinics for respiratory ailments and did not have diarrhea. Environmental sanitation was classed as "good" if the bacterial count in the water supply was low (i.e., water was obtained from the municipal water supply or bore holes) and if excreta disposal was adequate (i.e., there were flush toilets, sealed latrines, or pit latrines). Water quantity was measured by the number of times the child was bathed. The effects of the exposure variables on the study children were determined by logistic regression analyses adjusted for confounding variables, which included sex, educational level of the household, breast feeding, attendance at well-baby clinics, number of children under 5 in the household, and frequency of bathing the child. The results of the study showed that improved sanitation reduced the episodes of bacterial diarrhea by 40%, and that case-control studies with sample sizes of about of about 500 cases and 500 controls are adequate to detect disease reductions of 33% or more.     

Can quality of life questionnaires be used in diabetics to assess the relation between HbA1c and patients' domain aspects?

Over the past few decades, quality of life (QOL) has become an important concept in medical researches and treatments. Different meaningful reasons are given for this development. In the current research two standard questionnaires for evaluating of QOL were selected. First one, was a questionnaire from The World Health Organization (WHOQOL-BREF 26) and the second one, The Iranian Diabetics' Quality of Life (IRDQOL). The goal of this study is to assess the relation between different domains of these questionnaires and HbA1c in diabetics. A random sample of Iranian adult outpatient diabetics (n=76) was selected and they completed the WHOQOL and IRDQOL assessment instruments. In addition HbA1c was measured in these patients by calorimetric method. Comparisons were made between scores of "questionnaires' domains" and "HbA1c". Data analysis was carried out by the use of T-test, Spearman correlation coefficient, Pearson's correlation coefficient, and non-parametric statistical methods including Spearman correlation coefficient. Data analysis shows Psychological domain score in IRDQOL is lower than in WHOQOL and it is significant (P<0.0001). Physical domain score in IRDQOL is lower than WHOQOL and it is significant (P<0.0001). In WHOQOL questionnaire, analysis data showed when the patient's age increased, physical and psychological domain's score decreased. There is probably no relation between questionnaire domains and HbA1c in diabetics. Based on the findings in this research, there was obviously almost no difference between the two questionnaires for checking the QOL, but in IRDQOL spiritual domain is a very unreliable domain.     

Can data-driven benchmarks be used to set the goals of healthy people 2010?

OBJECTIVES: Expert panels determined the public health goals of Healthy People 2000 subjectively. The present study examined whether data-driven benchmarks provide a better alternative. METHODS: We developed the "pared-mean" method to define from data the best achievable health care practices. We calculated the pared-mean benchmark for screening mammography from the 1994 National Health Interview Survey, using the metropolitan statistical area as the "provider" unit. Beginning with the best-performing provider and adding providers in descending sequence, we established the minimum provider subset that included at least 10% of all women surveyed on this question. The pared-mean benchmark is then the proportion of women in this subset who received mammography. RESULTS: The pared-mean benchmark for screening mammography was 71%, compared with the Healthy People 2000 goal of 60%. CONCLUSIONS: For Healthy People 2010, benchmarks derived from data reflecting the best available care provide viable alternatives to consensus-derived targets. We are currently pursuing additional refinements to the data-driven pared-mean benchmark approach.     

Can the vaccine adverse event reporting system be used to increase vaccine acceptance and trust?

Vaccine refusal has an impact on public health, and the human pappillomavirus (HPV) vaccine is particularly underutilized. Research suggests that it may be difficult to change vaccine-related attitudes, and there is currently no good evidence to recommend any particular intervention strategy. One reason for vaccine hesitancy is lack of trust that vaccine harms are adequately documented and reported, yet few communication strategies have explicitly attempted to improve this trust. This study tested the possibility that data from the vaccine adverse event reporting system (VAERS) can be used to increase trust that vaccine harms are adequately researched and that potential harms are disclosed to the public, and thereby improve perceptions of vaccines. In the study, participants were randomly assigned to one of three communication interventions. All participants read the Centers for Disease Control (CDC) vaccine information statement (VIS) for the HPV vaccine. Two other groups were exposed to additional information about VAERS, either summary data or full detailed reports of serious adverse events from 2013. Results showed that the CDC's VIS alone significantly increased perceptions of vaccine benefits and decreased perceived risks. Participants who were also educated about VAERS and given summary data about the serious adverse events displayed more trust in the CDC and greater HPV vaccine acceptance relative to the VIS alone. However, exposure to the detailed VAERS reports significantly reduced trust in the CDC and vaccine acceptance. Hence, general information about the VAERS data slightly increased trust in the CDC and improved vaccine acceptance, but the specific VAERS reports negatively influenced both trust and acceptance. Implications for communicating about vaccines are discussed.     

Can household dishwashers be used to disinfect medical equipment?

In hospitals, medical instruments are usually cleaned and disinfected in a washer/disinfector. However, it is not efficient for small hospitals or general practitioners to purchase such machines as they would not be working to capacity. We investigated the possibility of cleaning and disinfecting medical equipment in a conventional household dishwasher modified to achieve a temperature of 71 degrees C. For this purpose we contaminated screws with different test soils containing either bacterial (100 screws) or viral (106 screws) suspensions. Test organisms were re-isolated from 2% of the screws after bacterial contamination and 4.7% of those with viral contamination. In both cases we found dishwasher-processing to be a suitable means of disinfecting medical instruments.     

Can self-reported height and weight be used to calculate 10 year risk of osteoporotic fracture?

AObjectives

1) To determine the magnitude of error between self reported height and weight and measured height and weight, 2) To measure what affect this has on calculating 10 year probability of osteoporotic fracture using the World Health Organisation Fracture Risk Assessment Tool (FRAX®).

Design

Data collection from a nurse led community osteoporosis clinic.

Participants

214 post-menopausal women with at least one risk factor for osteoporosis.

Measurements

Self reported and measured height and weight, risk factors for osteoporosis, demographic details, and 10 year probability of hip fracture or any major osteoporotic fracture as measured by FRAX®.

Results

Patients over-reported their height by a mean (95% confidence interval) of 2.8 (2.3–3.2) cm and under reported their weight by a mean of 2.1 (1.3–2.6) Kg. The resulting underestimation of body mass index was 1.8 (1.3–2.0) units. Using self reported height and weight resulted in a significant over-estimation of 10 year risk of hip fracture and any major osteoporotic fracture when compared to measured height and weight; Median 10 probability of hip fracture 3.75% Vs 3.25% (p < 0.001 ), median 10 year probability of any major osteoporotic fracture 15% Vs. 14% (p < 0.001).

Conclusion

When calculating 10 year risk of fracture using the FRAX on line assessment tool, measured height and weight should be used instead of self-reported height and weight.

     

Can routinely collected laboratory and health administrative data be used to assess influenza vaccine effectiveness? Assessing the validity of the Flu and Other Respiratory Viruses Research (FOREVER) Cohort

BackgroundLinking data on laboratory specimens collected during clinical practice with health administrative data permits highly powered vaccine effectiveness (VE) studies to be conducted at relatively low cost, but bias from using convenience samples is a concern. We evaluated the validity of using such data for estimating VE.MethodsWe created the Flu and Other Respiratory Viruses Research (FOREVER) Cohort by linking individual-level data on respiratory virus laboratory tests, hospitalizations, emergency department visits, and physician services. For community-dwelling adults aged > 65 years, we assessed the presence and magnitude of information and selection biases, generated VE estimates under various conditions, and compared our VE estimates with those from other studies.ResultsWe included 65,648 unique testing episodes obtained from 54,434 individuals during the 2010–11 to 2015–16 influenza seasons. To examine information bias, we found the proportion testing positive for influenza for patients with unknown interval from illness onset to specimen collection was more similar to patients for whom illness onset date was ≤ 7 days before specimen collection than to patients for whom illness onset was > 7 days before specimen collection. To assess the presence of selection bias, we found the likelihood of influenza testing was comparable between vaccinated and unvaccinated individuals, although the adjusted odds ratios were significantly greater than 1 for some healthcare settings and during some influenza seasons. Over 6 seasons, VE estimates ranged between 36% (95%CI, 27–44%) in 2010–11 and 5% (95%CI, –2, 11%) in 2014–15. VE estimates were similar under a range of conditions, but were consistently higher when accounting for misclassification of vaccination status through a quantitative sensitivity analysis. VE estimates from the FOREVER Cohort were comparable to those from other studies.ConclusionsRoutinely collected laboratory and health administrative data contained in the FOREVER Cohort can be used to estimate influenza VE in community-dwelling older adults.     

Health complaints and satisfied with the job? A cross-sectional study on work environment, job satisfaction, and subjective health complaints

OBJECTIVE: The aim of this study was to examine the prevalence of subjective health complaints (SHCs) among satisfied and dissatisfied workers. The second aim was to evaluate whether any SHC differences were attributable directly to the work environment or mediated by the individual perception of the environment (satisfactory or not). METHOD: In a cross-sectional study of 458 employees (56% women) in 5 different organizations, work environment, job satisfaction, and SHC were measured. RESULTS: Satisfied workers reported an average of five to six subjective health complaints that correspond to the prevalence found in a Norwegian general population. Work environment explained 43% of the variance for job satisfaction and 9% of the variance in SHCs. CONCLUSION: SHCs are common among satisfied workers. Work environment has only a limited influence on this validated health indicator.     

Can survey data be used to estimate physician practice costs?

Health policy makers rely on survey estimates of physician practice costs to set reimbursement rates. The Health Care Financing Administration has just funded a multimillion dollar effort to collect survey data that will be used to revise payments under the Medicare Fee Schedule. However, the ability of large-scale physician surveys to obtain accurate information about practice costs is not apparent. This article examines several of the key obstacles encountered when trying to obtain accurate estimates. Rates of both unit and item nonresponse over time are described; in general, there is a trend toward lower unit response rates and higher item response rates. The article also examines logical inconsistencies in data. The results suggest that physician surveys may not be the most appropriate source of data about physician practice expenses. Health policy makers concerned about provider reimbursement issues should seriously scrutinize the accuracy of results from physician practice cost surveys. This article concludes by suggesting alternative methodologies for incorporating physician practice costs into reimbursement rates.     

The future of work environment reforms: does the concept of work environment apply within the new economy?

"Work environment," as a conceptual framework for reforming working life, may not be readily transferable from the tangible conditions of the industrial context in which it was conceived to the more flexible conditions of modern labor. Since the flexible conditions of work generally presuppose an increased responsibility and some sort of personal commitment on the part of the worker, isolating the environmental conditions from the personal abilities of the worker is becoming more difficult. As a consequence, only to a limited extent can the problems of modern labor be interpreted as work environment issues and subjected to work environment measures. With the propagation of flexible working conditions, work environment institutions and their reform ambitions will be passed by. And work environment reforms, rather than being a practical task of coordinating different protective measures at workplaces, will be reduced to an argument within the ideologically motivated rejection of an increasingly polarized labor market.     

Can a reward-based behavioural test be used to investigate the effect of protein-energy malnutrition on hippocampal function?

Our laboratory is investigating the effects of protein-energy malnutrition (PEM) on cognitive outcome following global ischemia. Here, we investigated whether PEM independently impairs working memory in the T-maze and if the associated food reward reverses PEM. Gerbils were fed 12.5% (control diet) or 2% protein. A loss of body weight (20.1%) in the 2% protein group and decreased food intake and serum albumin concentration compared to controls (17.5% and 18.2%, respectively) indicated that PEM was achieved. Based on T-maze criterion frequently used in ischemia studies, no difference was observed in the mean (+/- SEM) number of trials required (control 5.2 +/- 0.7; PEM 4.9 +/- 0.4; p = 0.758) or the number of animals reaching criterion (control 10/12; PEM 12/12; p = 0.140). Using more stringent criterion, PEM animals required fewer trials (control 7.3 +/- 0.7; PEM 5.4 +/- 0.4; p = 0.035), and more reached criterion (control 8/12; PEM 12/12; p = 0.028). PEM may increase motivation to obtain a food reward.     

Can we modify the intrauterine environment to halt the intergenerational cycle of obesity?

Child obesity is a global epidemic whose development is rooted in complex and multi-factorial interactions. Once established, obesity is difficult to reverse and epidemiological, animal model, and experimental studies have provided strong evidence implicating the intrauterine environment in downstream obesity. This review focuses on the interplay between maternal obesity, gestational weight gain and lifestyle behaviours, which may act independently or in combination, to perpetuate the intergenerational cycle of obesity. The gestational period, is a crucial time of growth, development and physiological change in mother and child. This provides a window of opportunity for intervention via maternal nutrition and/or physical activity that may induce beneficial physiological alternations in the fetus that are mediated through favourable adaptations to in utero environmental stimuli. Evidence in the emerging field of epigenetics suggests that chronic, sub-clinical perturbations during pregnancy may affect fetal phenotype and long-term human data from ongoing randomized controlled trials will further aid in establishing the science behind ones predisposition to positive energy balance.     

Can extracorporeal shock-wave therapy be used for the management of lateral elbow tendinopathy?

Lateral elbow tendinopathy (LET) is one of the two most common tendinopathies of the upper limb. The most effective treatment in the management of LET is the exercise program. Clinicians combine exercise program with other physiotherapy, electrotherapeutic and no, techniques. Extracorporeal shock wave therapy (ESWT) is one of the most common recommended electrotherapeutic modalities for the management of LET. Further research is needed to find out the optimal treatment protocol of ESWT in the management of LET     

Can a food frequency questionnaire be used to capture dietary intake data in a 4 week clinical intervention trial?

Collecting dietary data in the clinical research setting is labour intensive and can be burdensome for study participants. The aim of this study was to assess the agreement between data obtained from 2 different dietary assessment methods, a 74-item semi-quantitative food frequency questionnaire (FFQ) and 3-day weighed food records (WFR) used to estimate dietary intake over the preceding month. One hundred and fifty nine subjects, aged between 31 and 74 years (53 males, 65 females), enrolled in a clinical trial at the Commonwealth Scientific and Industrial Research Organisation, Division of Health Sciences and Nutrition, (CSIRO HSN) Adelaide, Australia. Group mean intakes and individual mean intakes estimated by the two measures were compared. One hundred and eighteen (91%) three-day WFR and their corresponding FFQ were analysed. Pearson correlation coefficients ranged from 0.22 for cholesterol to 0.78 for alcohol (median 0.41). Mean energy and nutrient intakes were within +/- 20% difference. The FFQ gave lower carbohydrate intake estimates, percentage energy from carbohydrate (P <0.001) and dietary fibre (P <0.05) and gave higher percentage energy from saturated fat estimates, poly-unsaturated fatty acids (P <0.001) and mono-unsaturated fatty acids (P <0.05). Subjects were also ranked into quintiles and the quintiles cross-tabulated. The FFQ classified more than two thirds of the subjects within +/-1 quintile difference for all nutrients. We conclude that this FFQ can capture similar information as WFR and may be used for estimation of dietary intakes over a relatively short time in clinical intervention trials.