scholarly journals Epidemics from the population perspective

2022 ◽  
pp. 1-38
Author(s):  
Jonathan Fuller
Keyword(s):  
High Risk ◽  
Population Characteristics ◽  
Contrastive Analysis

Abstract Many epidemics consist in individuals spreading infection to others. From the population perspective, they also have population characteristics important in modeling, explaining and intervening in epidemics. I analyze epidemiology’s contemporary population perspective through the example of epidemics by examining two central principles attributed to Geoffrey Rose: a distinction between the causes of cases and the causes of incidence, and between ‘high-risk’ and ‘population’ strategies of prevention. Both principles require revision or clarification to capture the sense in which they describe distinct perspectives on the same phenomenon (such as an epidemic), each perspective capturing a different level of contrastive analysis.

scholarly journals Lab-Based and Self-Reported Indices of Fitness Show Lowered Fitness and Insight into Fitness in Individuals at Clinical High Risk for Psychosis

2020 ◽  
Author(s):  
Katherine S. F. Damme ◽  
Richard P. Sloan ◽  
Matthew N. Bartels ◽  
Alara Ozsan ◽  
Luz H. Ospina ◽  
...  
Keyword(s):  
High Risk ◽  
Healthy Volunteers ◽  
Negative Symptoms ◽  
Population Characteristics ◽  
Self Report ◽  
Positive Symptoms ◽  
Clinical High Risk ◽  
Laboratory Findings ◽  
Exercise Interventions ◽  
Intensity Of Exercise

AbstractIntroductionExercise is a promising intervention for clinical high-risk for psychosis (CHR) populations, who have attenuated positive symptoms, but evidence suggests that these youth may require tailored exercise interventions. Presently, the scope of the problem is unknown, as these youth may not be reliable reporters on fitness. This issue is compounded by the fact that there have been no investigations that utilized a formal fitness assessment in this critical population. The present study aims to determine the level of fitness in CHR youth with lab-based measures, test how effectively self-report measures characterize objective fitness indices, and explore clinical factors that may be interrupting reliable self-report-an important tool if these interventions are to be taken to scale.MethodsForty CHR individuals completed an exercise survey and lab-based indices of fitness (i.e., VO2max and BMI). Forty healthy volunteers completed lab indices of fitness and a structured clinical interview ruling out the presence of psychiatric illness.ResultsCHR youth showed greater BMI and lower VO2max compared to healthy volunteers. In the CHR group, abstract self-report items (perceived fitness) did not reflect lab indices of fitness, whereas specific exercise behaviors (intensity of exercise) showed stronger correlations with laboratory-based fitness measurements. Exploratory analyses suggested that positive symptoms involving grandiosity, and negative symptoms such as avolition, correlated with discrepancy between self-perception and laboratory findings of fitness.DiscussionResults suggest that CHR individuals are less objectively fit than matched controls, and that it will be important to consider unique population characteristics when weighing self-report data.

scholarly journals The Brighton Spondylodiscitis Score Does Not Accurately Predict the Need for Surgery: A Retrospective Cohort Study in New Zealand

2021 ◽  
pp. 219256822198929
Author(s):  
Sarah Hunter ◽  
Hasanga Fernando ◽  
Joseph F. Baker
Keyword(s):  
Cohort Study ◽  
High Risk ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Surgical Intervention ◽  
Predictive Accuracy ◽  
External Validation ◽  
Population Characteristics ◽  
Calibration Plot ◽  
Pyogenic Spondylodiscitis

Study Design: Retrospective cohort study. Objectives: Despite pyogenic spondylodiscitis potentially conferring significant morbidity, there is no consensus on optimal treatment. The Brighton Spondylodiscitis Score (BSDS) was developed to identify patients who would likely fail conservative management and therefore benefit from earlier surgical intervention. In this study, we attempt external validation of the BSDS. Methods: We carried out a retrospective review of all patients treated at our institution, 2010-2016, for pyogenic spondylodiscitis. 91 met inclusion criteria and 40 progressed to require surgical intervention. The BSDS was calculated for each patient allowing stratification into low-, moderate- and high-risk groups. Calibration and discrimination was assessed with ROC curve analysis and calibration plot. Results: Area under the curve (AUC) was 0.469 (0.22-0.71) in our external validation, compared with AUC 0.83 and 0.71 (CI 0.50-0.88) in the original study and test populations respectively. Only 60% of patients in the high-risk group required surgery, 50% in the moderate, and 38% of the low indicating poor calibration and predictive accuracy. Operative intervention was not higher overall in our cohort (44% vs. 32%, p = 0.14). We found greater rates of bacteraemia, more distal infection, and more advanced MRI findings in our cohort. The incidence of spondylodiscitis in our region is higher (4/100 000/year). Conclusion: We failed to externally validate the BSDS in our population which is likely a result of unique population characteristics and the inherently variable pathology associated with spondylodiscitis. Clinicians must be cautious in adopting treatment algorithms developed in other health care systems that may comprise significantly different patient and pathogen characteristics.

scholarly journals Secondary CNS Relapse in DLBCL in the Rituximab Era - an Analysis of Prospective Studies

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 1644-1644 ◽  
Author(s):  
Abhimanyu Ghose ◽  
Harold Kunal Elias ◽  
Gunjan Guha ◽  
Mahender Yellu ◽  
Ria Kundu ◽  
...  
Keyword(s):  
Bone Marrow ◽  
High Risk ◽  
Prospective Studies ◽  
T Test ◽  
Population Characteristics ◽  
Cns Prophylaxis ◽  
Cns Relapse ◽  
Study Population ◽  
The Mean ◽  
One Way Anova

Abstract INTRODUCTION CNS relapse in DLBCL carries poor prognosis. Some studies have suggested decreased incidence with rituximab, but there are several others reporting otherwise. We analyzed prospective studies in literature to understand the role of rituximab and CNS prophylaxis in DLBCL, in comparison to CHOP based therapy. METHOD Extensive searches using PUBMED, EMBASE, CENTRAL and major hematology conferences were conducted for prospective studies. The keywords “CNS”, “diffuse large B-cell lymphoma”, “relapse”, “prophylaxis”, “rituximab”, “CHOP” were used. Inclusion: (i) prospective or randomized trials (ii) Entire study population or a significant majority of patients were newly diagnosed DLBCL, (iii) no evidence of CNS involvement at baseline, (iv) use of rituximab-chemotherapy or CHOP-based chemotherapy, (v) have data relevant to our study. Exclusion: (i) retrospective studies, review article or case reports, (ii) exclusively testicular, mediastinal or double hit lymphoma, (iii) HIV positive patients. Data is presented as mean ± standard error of mean. Significant differences (at P<0.05) between groups and couplets were determined by one-way ANOVA and by two-tailed unpaired t-test respectively. Significance of the Kaplan-Meier survival curves was determined using Log-rank (Mantel-Cox) and Gehan-Breslow-Wilcoxon tests. RESULTS The study population characteristics are shown in Table. The mean incidence of CNS relapse with rituximab-chemotherapy (R-CHOP/R-CHOEP) was found to be 5.52% (3.21%-7.73%), while that with CHOP-based chemotherapy alone was 4.43% (3.53% -5.33%). No significant difference was observed by two-tailed unpaired t test (P = 0.94). The median time from diagnosis to CNS relapse was 6.5-7 months. The mean incidence of leptomeningeal, parenchymal and both relapses in the rituximab-chemotherapy group were 38.62(±1.93)%, 57.32(±3.06)%, 5.36(±1.79)% compared to 16.17(±0.44)%, 66.17(±0.44)%, 22.06(±0.41)% with chemotherapy alone. One-way ANOVA also showed that use of rituximab resulted in statistically significant (P<0.0001) differences between the patterns of CNS relapse. About 74.1% of CNS relapses among patients receiving rituximab-chemotherapy were isolated CNS relapse, compared to 69.2% for those receiving CHOP chemotherapy. The mean incidence of CNS relapse with the use of any prophylactic CNS directed therapy was observed to be a significantly (P = 0.044) lower [2.97% (2.32%-3.62%)] compared to that without [6.12% (5.91%-6.335]. Median survival following CNS relapse of 365 days following rituximab based chemotherapy and 75 days after CHOP were significantly different (HR for CHOP use 4.867±0.77 at P<0.05). CONCLUSION Rituximab hasn't significantly decreased overall incidence, but causes less parenchymal CNS relapse. CNS prophylaxis has a definite role in high risk population. There is significantly better survival after CNS relapse in the rituximab era. Abstract 1644. TABLE STUDY Age (yr) Sex (M:F) No. Stage 3/4 IPI int-high/ high (>=3 IPI or >=2 aa IPI) Extranodal (>=2) high LDH Follow up (m) Criteria for CNS prophylaxis Patients receiving CNS prophylaxis (IT=intrathecal, S=systemic) Chemo Tilly 2003 61-69 ACVBP vs CHOP : M 182 vs 177 F 141 vs 135 635 (501 DLBCL) 267 vs 253 210 vs 207 (aa IPI) 155 VS 156 231 VS 241 68 None for CHOP VS ACVBP (IV methotrexate, etop + IT mtx) 323 (ACVBP) 323 ACVBP vs 312 CHOP Feugier 2004 69 M 92 (CHOP-R) vs 107 (CHOP) 202 vs 197 161 vs 157 121 vs 120 61 vs 51 131 vs 132 24 NA no prophylaxis 202 R-CHOP Vs 197 CHOP Bernstein 2009 97/ 225 for CHOP were >60 yrs NR 899 aggressive lymphoma 191/ 225 CHOP 95/ 225 CHOP 81/225 CHOP 146/ 225 CHOP 20 years none for CHOP 121 IT MTX or radiation (24 Gy) 225 CHOP vs ProMACE-CytaBOM vs mBACOD vs MACOP-B Boehme 2009 68 648 vs 569 1217 (944 DLBCL) 687 507 212 602 24 bone marrow, testes, sinuses, orbits, oral cavity, tongue, salivary glands. 475/1217 (IT-MTX) 608 RCHOP Vs 609 CHOP Kim 2012 59.5 NR 564 276 192 193 NR 10.5 ≥1 risk factor 59 IT RCHOP Kumar 2012 56 (prophylaxis) VS 58 (no prophylaxis) male: 74 vs 476 female: 43 vs 396 989 85 vs 454 55 vs 240 66 vs 220 57 vs 372 30 High risk site involvement : orbit, testis, peripheral blood, vertebra, bone marrow, nasal/paranasal sinuses 117/989 IT- 84/117 (AraC/MTX) S--33/117 (MTX) R-CHOP Holte 2013 54 97 vs 59 156 (145 DLBCL) 150 156 41 151 36 everyone 156/156 (S- Ara-c+ MTX) 1 dose of IT-MTX RCHOEP Figure 1 Figure 1. Figure 2 Figure 2. Disclosures No relevant conflicts of interest to declare.

scholarly journals Molecular Screening of 28 Genes in Mexican Patients with Acute Myeloid Leukemia a Series of 70 Patients from the Instituto Nacional De Cancerologia, Mexico

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 5197-5197
Author(s):  
Nidia Zapata ◽  
Espinoza Ramiro ◽  
Eduardo Cervera ◽  
Judith Cruz ◽  
Diana Arcos ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
High Risk ◽  
Myeloid Leukemia ◽  
Conflicts Of Interest ◽  
The Elderly ◽  
Mexican Population ◽  
Population Characteristics ◽  
First Line ◽  
Monosomy 7 ◽  
Acute Myeloid

Abstract Introduction: Acute Myeloid Leukemia is a clonal heterogeneous disease, where age is an important risk factor to develop theses disease, PCR studies and next generation sequence have proven the diversity of these disease. A lot of genes mutations have been identifying to play a role in the DNA metilation, epigenetics a transcription. We initiate a screening to all acute myeloid leukemias that where the novo or relapse with a 28 gene panel of HEMAVISION a 28q; DNA diagnostic, for the detection al ARN gene fusion and alternatives of the: PML-RAR ALFA (bcr2,V), CBF-MYH11, RUNX1-RUNX1T1, PML-RAR alfa(bcr1,L), KMT2A-MLT3, PML-RAR alfa (bcr3,S), KMT2A-ELL, FUS-ERG, ETV6-MN1, DEK-NUP214, KMT2A-EPS15, KMT2A-AFDN, TCF3-PBX1, ETV6-RUNX1, KMT2A-MLLT1, KMT2A-AFF1, TCF3-HLF, STIL-TAL1, BCR/ABL(p190), SET-NUP214, BCR/ABL(p210), BCR/ABL(p230), ZBTB16-RARalfa, ETV6-ABL1, ETV6-PDGFRB, KMT2A-MLLT10, KMT2A-MLLT11,KMT2A-FOXO4, KMT2A-MLLT6, RUNX1-MECON, NPM1-RAR alfa, NMP1-MLF1, RUNX1-MECON. FLT3 ITD mutation and D385 by PCR electrophoresis by Invivoscribe was also perform. And the regular cytogenetics and FISH mutations for BCR/ABL, PML/RAR alfa, Inv16, MLL, +8, ETO, BCR, ABL, monosomy 7, monosomy8 Objectives The main objective is the know the mutation in the Mexican population and the prognostic in these group of patients Results These study was perform at Instituto Nacional de Cancerologia, Mexico, randomized patient from 2016-2018 where screen. A total of 70 patients, 37 females and 33 males, ages from 18-85years old, 54 patients where newly diagnosis of acute myeloid leukemia, 4 where relapses and 12 where secondary leukemias, the most frequent FAB morphologic classification where M4:22 cases, M2:15 cases, M3:8 cases, M1:4cases, M0 and M5:3 cases each. Of the 70 patients: 56 patients where negative to all of the panel screen, FLT3 where only perform in 14 patients 12 where negative and 2 where insufficient to perform the test, the most common FISH translocation was PML/RAR alfa, follow by MLL, ETO and +8. For the cytogenetics we had 21 cases that didn´t have enough metaphases, 7 normal, 28 cases with more than 2 cytogenetics alterations and 9 with only 1. With a Cytogenetics risk: high risk 44, intermedium:10 and low12. Of the 70 patient, 14 have some genes mutations +: t(9;11)(p22;q23) KMT2A-MLLT3, t(6;11)(q27;q23) KMT2A-AFDN, t(5;12)(q33;p13) ETV6-PDGFRB, t(8;21)(q22;q22) RUNX1RUNX1T1, inv16(p13q;22q) CBFB-MYH11, t(6;11)(q27;q23) KMT2A-AFDN, t(3;21)(q26:q22) RUNX1-MECOM, inv16(p13q;22q) CBFB-MYH11, t(15;17)(q24;q21) PML-RARA (bcr2,V) t(15;17)(q24;q21) PML-RARA (bcr1,L) t(15;17)(q24;q21) PML-RARA (bcr3,S), t(8;21)(q22;q22) RUNX1RUNX1T1, t(8;21)(q22;q22) RUNX1RUNX1T1, t(15;17)(q24;q21) PML-RARA (bcr3,S) Out of 70 patients: 38 receive 7+3 (cytarabine + Daunorubicin) for first line of treatment, 41 received high doses of cytarabine at 3g /m2. Our first option for relapse treatment is MEC (mitoxantrone, cytarabine and etoposide) because of costs and the second line of rescued treatment is Flag- Ida (idarubicin, fludarabine and cytarabine) and not all patient can afford it. For the elderly patients the first line of treatment is low dose of cytarabine and only in those who can pay azacytidine it is use. The correlation between high risk cytogenetics with mortality is 12 cases out 70. And genes with morality only 4 patients with: t(9;11)(p22;q23) KMT2A-MLLT3, t(6;11)(q27;q23) KMT2A-AFDN, t(5;12)(q33;p13) ETV6-PDGFRB, t(6;11)(q27;q23) KMT2A-AFDN Conclusion We need to know our population characteristics, we don´t have the incidence and prevalence of the gene mutation in the Mexican population. In the market there are several screening panels with different genes. We need to have more genes and more patient to be analyzed to learn our molecular risk, to have a better approach to these patients and better techniques. There is no paper publish with the genetics and gene alteration in the Mexican Population, it is important to continuing working and to use panels with genes as ASXL1, FLT-TKD, CEBPA, KIT, KRAS, IDH1,2, TET2 and others. And other important issue that we found is the high number of patient that abandon treatment 4 cases, because of money issues. And the time of these population 24 patient where death. The incidence of FLT3 mutation ITD and D385 is low in theses population but it was performed only 14/70 patients, we need a large number of patient to know the real incidence. Table. Table. Disclosures No relevant conflicts of interest to declare.

scholarly journals Selecting the optimal risk threshold of diabetes risk scores to identify high-risk individuals for diabetes prevention: a cost-effectiveness analysis

2019 ◽  
Vol 57 (4) ◽  
pp. 447-454 ◽  
Author(s):  
Kristin Mühlenbruch ◽  
Xiaohui Zhuo ◽  
Barbara Bardenheier ◽  
Hui Shao ◽  
Michael Laxy ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cost Effectiveness ◽  
High Risk ◽  
Risk Score ◽  
Cost Effectiveness Analysis ◽  
Diabetes Risk ◽  
Population Characteristics ◽  
Risk Scores ◽  
Effectiveness Analysis

Abstract Aims Although risk scores to predict type 2 diabetes exist, cost-effectiveness of risk thresholds to target prevention interventions are unknown. We applied cost-effectiveness analysis to identify optimal thresholds of predicted risk to target a low-cost community-based intervention in the USA. Methods We used a validated Markov-based type 2 diabetes simulation model to evaluate the lifetime cost-effectiveness of alternative thresholds of diabetes risk. Population characteristics for the model were obtained from NHANES 2001–2004 and incidence rates and performance of two noninvasive diabetes risk scores (German diabetes risk score, GDRS, and ARIC 2009 score) were determined in the ARIC and Cardiovascular Health Study (CHS). Incremental cost-effectiveness ratios (ICERs) were calculated for increasing risk score thresholds. Two scenarios were assumed: 1-stage (risk score only) and 2-stage (risk score plus fasting plasma glucose (FPG) test (threshold 100 mg/dl) in the high-risk group). Results In ARIC and CHS combined, the area under the receiver operating characteristic curve for the GDRS and the ARIC 2009 score were 0.691 (0.677–0.704) and 0.720 (0.707–0.732), respectively. The optimal threshold of predicted diabetes risk (ICER < $50,000/QALY gained in case of intervention in those above the threshold) was 7% for the GDRS and 9% for the ARIC 2009 score. In the 2-stage scenario, ICERs for all cutoffs ≥ 5% were below $50,000/QALY gained. Conclusions Intervening in those with ≥ 7% diabetes risk based on the GDRS or ≥ 9% on the ARIC 2009 score would be cost-effective. A risk score threshold ≥ 5% together with elevated FPG would also allow targeting interventions cost-effectively.

A Community Based High Risk Register for Hearing Loss

1982 ◽  
Vol 47 (4) ◽  
pp. 373-375 ◽  
Author(s):  
James L. Fitch ◽  
Thomas F. Williams ◽  
Josephine E. Etienne
Keyword(s):  
Hearing Loss ◽  
System Identification ◽  
High Risk ◽  
Language Learning ◽  
Education Program ◽  
Communication System ◽  
Auditory Signal ◽  
Early Age ◽  
Community Based ◽  
Children With Hearing Loss

The critical need to identify children with hearing loss and provide treatment at the earliest possible age has become increasingly apparent in recent years (Northern & Downs, 1978). Reduction of the auditory signal during the critical language-learning period can severely limit the child's potential for developing a complete, effective communication system. Identification and treatment of children having handicapping conditions at an early age has gained impetus through the Handicapped Children's Early Education Program (HCEEP) projects funded by the Bureau of Education for the Handicapped (BEH).

A Community Based High Risk Register for Hearing Loss

1983 ◽  
Vol 48 (1) ◽  
pp. 110-110
Keyword(s):  
Hearing Loss ◽  
High Risk ◽  
Community Based

For the November 1982 JSHD article, "A Community Based High Risk Register for Hearing Loss," the author would like to acknowledge three additional individuals who made valuable contributions to the study. They are Marie Carrier, Gene Lyon, and Bobbie Robertson.

The development of allergy in high-risk children

1997 ◽  
Vol 27 (11) ◽  
pp. 1247-1253 ◽  
Author(s):  
M. L. BURR ◽  
T. G. MERRETT ◽  
F. D. J. DUNSTAN ◽  
M. J. MAGUIRE
Keyword(s):  
High Risk ◽  
High Risk Children
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