The Brief Environmental Exposure and Sensitivity Inventory (BREESI) An International Validation Study

2021 ◽  
Author(s):  
Raymond F Palmer ◽  
Rudy Rincon ◽  
Roger F Perales ◽  
Tatjana F Walker ◽  
Carlos F Jaén ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Environmental Exposure ◽  
Performance Metrics ◽  
Fold Increase ◽  
Population Based ◽  
Likelihood Ratios ◽  
Predictive Values ◽  
Chemical Intolerance ◽  
Practical Tool ◽  
The U.S

Abstract Background Chemical intolerance is a condition that may result in multisystem symptoms triggered by low levels of exposure to xenobiotics such as chemicals, foods, and drugs. The prevalence of chemical intolerance is estimated to be between 8% and 33% across several countries. Clinicians and researchers require a brief, practical tool for identifying chemical intolerance. Objectives This 5-country, population-based study investigates the validity of a three-item screening questionnaire, the Brief Environmental Exposure and Sensitivity Inventory (BREESI), against the 50-item Quick Environmental Exposure and Sensitivity Inventory (QEESI). Methods One thousand individuals (n = 1,000) in each of 5 countries, the U.S., Japan, Italy, Mexico, and India responded to both the QEESI and the BREESI on a Qualtrics platform by Dyanata, a survey company that provides recruitment services for researchers. We determined performance metrics for BREESI responses comparing the number of items chosen on the BREESI with QEESI scores for chemical intolerance. We used logistic regression to determine the likelihood of chemical intolerance based on scoring 0, 1, 2 or 3 items on the BREESI. We report BREESI sensitivity and specificity, positive and negative predictive values, and positive and negative likelihood ratios. Results Compared to the QEESI reference standard, the BREESI had excellent sensitivity, specificity, positive and negative likelihood ratios, and positive and negative predictive values for chemical intolerance in all countries except Japan. In Japan, the BREESI had poor sensitivity and a poor negative predictive value. Logistic regression shows that in all countries, with each increase in BREESI items endorsed, there is 4- to 5-fold increase in the odds of CI. Although the samples are relatively small for estimating population prevalence, our results suggest interesting differences and overall high prevalence of chemical intolerance. Applying QEESI criteria, India appears to have very high rates of chemical intolerance—over 50% of those sampled (54.7%, 95% CI = 52–58) followed by Japan (40.3%, 95% CI = 40–77), Italy (34.3%, 95% CI = 32–37), U.S. (31.2%, 95% CI = 28–34) and Mexico (26.0%, 95% CI = 23–29). Discussion This study confirms the results of a two recently published validation papers in the U.S. The BREESI performs well as a screening tool for chemical intolerance. The BREESI is a practical tool for researchers, clinicians, and epidemiologists seeking to understand and address this important and prevalent condition.

scholarly journals Validation of a Brief Screening Instrument for Chemical Intolerance in a Large U.S. National Sample

2021 ◽  
Vol 18 (16) ◽  
pp. 8714
Author(s):  
Raymond F. Palmer ◽  
Tatjana Walker ◽  
David Kattari ◽  
Rudy Rincon ◽  
Roger B. Perales ◽  
...  
Keyword(s):  
Likelihood Ratio ◽  
Environmental Exposure ◽  
Screening Tool ◽  
Large Population ◽  
Food Additives ◽  
Positive Likelihood Ratio ◽  
Negative Likelihood Ratio ◽  
Population Based ◽  
Chemical Intolerance ◽  
The U.S

Background: Chemical intolerance (CI) is characterized by multisystem symptoms triggered by low levels of exposure to xenobiotics including chemicals, foods/food additives, and drugs/medications. Prior prevalence estimates vary from 8–33% worldwide. Clinicians and researchers need a brief, practical screening tool for identifying possible chemical intolerance. This large, population-based study describes the validation of a three-item screening questionnaire, the Brief Environmental Exposure and Sensitivity Inventory (BREESI), against the international reference standard used for assessing chemical intolerance, the Quick Environmental Exposure and Sensitivity Inventory (QEESI). Methods: More than 10,000 people in the U.S. responded to the BREESI and the QEESI in a population-based survey. We calculated the overall prevalence of CI in this sample, as well as by gender, age, and income. Common statistical metrics were used to evaluate the BREESI as a screener for CI against the QEESI. Results: The prevalence estimate for QEESI-defined chemical intolerance in the U.S. was 20.39% (95% CI 19.63–21.15%). The BREESI had 91.26% sensitivity (95% CI: 89.20–93.04%) and 92.89% specificity (95% CI: 91.77–93.90%). The positive likelihood ratio was 12.83 (95% CI: 11.07–14.88), and the negative likelihood ratio was 0.09 (95% CI: 0.08–0.12). Logistic regression demonstrates that the predicted probability of CI increased sharply with each increase in the number of BREESI items endorsed (Odds Ratio: 5.3, 95% CI: 4.90–5.75). Conclusions: Chemical intolerance may affect one in five people in the U.S. The BREESI is a new, practical instrument for researchers, clinicians, and epidemiologists. As a screening tool, the BREESI offers a high degree of confidence in case ascertainment. We recommend: screen with the BREESI, confirm with the QEESI.

scholarly journals Value and Diagnostic Efficacy of Fetal Morphology Assessment Using Ultrasound in A Poor-Resource Setting

Diagnostics ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. 109 ◽  
Author(s):  
Ukweh ◽  
Ugbem ◽  
Okeke ◽  
Ekpo
Keyword(s):  
Predictive Value ◽  
Performance Metrics ◽  
Area Under The Curve ◽  
Youden Index ◽  
Likelihood Ratios ◽  
Diagnostic Efficacy ◽  
Predictive Values ◽  
Resource Setting ◽  
Post Test ◽  
Sensitivity Specificity

Background: Ultrasound is operator-dependent, and its value and efficacy in fetal morphology assessment in a low-resource setting is poorly understood. We assessed the value and efficacy of fetal morphology ultrasound assessment in a Nigerian setting. Materials and Methods: We surveyed fetal morphology ultrasound performed across five facilities and followed-up each fetus to ascertain the outcome. Fetuses were surveyed in the second trimester (18th–22nd weeks) using the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) guideline. Clinical and surgical reports were used as references to assess the diagnostic efficacy of ultrasound in livebirths, and autopsy reports to confirm anomalies in terminated pregnancies, spontaneous abortions, intrauterine fetal deaths, and still births. We calculated sensitivity, specificity, positive and negative predictive values, Area under the curve (AUC), Youden index, likelihood ratios, and post-test probabilities. Results: In total, 6520 fetuses of women aged 15–46 years (mean = 31.7 years) were surveyed. The overall sensitivity, specificity, and AUC were 77.1 (95% CI: 68–84.6), 99.5 (95% CI: 99.3–99.7), and 88.3 (95% CI: 83.7–92.2), respectively. Other performance metrics were: positive predictive value, 72.4 (95% CI: 64.7–79.0), negative predictive value, 99.6 (95% CI: 99.5–99.7), and Youden index (77.1%). Abnormality prevalence was 1.67% (95% CI: 1.37–2.01), and the positive and negative likelihood ratios were 254 (95% CI: 107.7–221.4) and 0.23 (95% CI: 0.16–0.33), respectively. The post-test probability for positive test was 72% (95% CI: 65–79). Conclusion: Fetal morphology assessment is valuable in a poor economics setting, however, the variation in the diagnostic efficacy across facilities and the limitations associated with the detection of circulatory system anomalies need to be addressed.

scholarly journals Three Questions to Screen your Patients for Chemical, Food, and Drug Intolerances the Brief Environmental Exposure and Sensitivity Inventory (BREESI)

2020 ◽  
Author(s):  
Raymond F Palmer ◽  
Carlos Roberto Jaén ◽  
Roger B. Perales ◽  
Rodolfo Rincon ◽  
Jacqueline Viramontes ◽  
...  
Keyword(s):  
Primary Care ◽  
Positive Predictive Value ◽  
Environmental Exposure ◽  
Health Care Professionals ◽  
Predictive Value ◽  
Primary Care Clinic ◽  
Diagnostic Tools ◽  
Care Clinic ◽  
Predictive Values ◽  
Chemical Intolerance

Abstract Background: The 50-item Quick Environmental Exposure and Sensitivity Inventory (QEESI) is a validated questionnaire used worldwide to assess intolerances to chemicals, foods, and/or drugs and has become the gold standard for assessing chemical intolerance (CI). Despite a reported prevalence of 8-33%, CI often goes undiagnosed in epidemiological studies and routine primary care. To enhance the QEESI’s utility, we developed the Brief Environmental Exposure and Sensitivity Inventory (BREESI) as a 3-item CI screening instrument. We tested the BREESI’s potential to predict whether an individual is likely to respond adversely to structurally unrelated chemicals, foods, and drugs. Methods: We recruited 286 adult participants from a university-based primary care clinic and through online participation. The positive and negative predictive values of the BREESI items were calculated against the full QEESI scores. Results: 90% of participants answering “yes” to all three items on the BREESI were classified as very suggestive of CI based upon the QEESI chemical intolerance and symptom scores both ≥ 40 (positive predictive value = 90%). For participants endorsing two items, 92% were classified as either very suggestive (39%) or Suggestive (53%) of CI (positive predictive value = 87%). Of those endorsing only one item, only 13% were found to be very suggestive of CI. However, 70% were classified as Suggestive. Of those answering “No” to all of the BREESI items, 99% were classified as not suggestive of CI (i.e., negative predictive value = 99%). Conclusions: The BREESI is a versatile screening tool for rapidly determining potential CI, with clinical and epidemiological applications. Together, the validated BREESI and QEESI provide much needed diagnostic tools that will help inform treatment protocols and teach health care professionals about Toxicant Induced Loss of Tolerance – the mechanism driving CI.

scholarly journals Comparative Analysis of Molecular and Serologic Testing for Primary Syphilis: A Population-Based Cohort Study

2021 ◽  
Vol 11 ◽  
Author(s):  
Caley Bryce Shukalek ◽  
Bonita Lee ◽  
Sumana Fathima ◽  
Angel Chu ◽  
Kevin Fonseca ◽  
...  
Keyword(s):  
Adult Population ◽  
Population Based ◽  
Likelihood Ratios ◽  
Transmitted Infection ◽  
Predictive Values ◽  
Sexually Transmitted ◽  
Primary Syphilis ◽  
Study Population ◽  
Syphilis Serology ◽  
Large Adult

Rising rates of syphilis (T. pallidum; Tp) requires rapid diagnosis and treatment to manage the growing epidemic. Syphilis serology is imperfect and requires interpretation of multiple tests while molecular diagnostics allows for potential yes-no identification of highly infective, primary anogenital lesions. Accuracy of this testing modality has thus far been limited to small, highly selective studies. Therefore, we retrospectively assessed a large, adult population of patients with anogenital lesions seen at Sexually Transmitted Infection (STI) clinics in Alberta, Canada who were screened for syphilis and herpes simplex (HSV) 1/2 using PCR to evaluate Tp-PCR versus serology to diagnose primary syphilis. 114 (3.1%) of the 3,600 adult patients had at least one Tp-PCR+ anogenital lesion with 99 (2.8%) patients having newly positive syphilis serology (new INNO-LIA positive or 4-fold RPR increase). Tp-PCR had a sensitivity of 49.3% (95% CI 42.6-56.1) and specificity of 99.9% (99.7-100.0). Positive predictive values and negative predictive values in the study population or when corrected for provincial prevalence were 97.4% (92.5-99.5) or 0.4% (0.4-1.2) and 96.7% (96.1-97.3) or 100.0% (100.0-100.0), respectively. Positive and negative likelihood ratios were estimated at 555 (178-1733) and 0.5 (0.4-0.6), respectively. Review of all Tp-PCR performed with or without exclusion of HSV-positive lesions resulted in no significant change in Tp-PCR characteristics. Interestingly, 12 of the Tp-PCR+ samples had negative serology at time of lesion sampling but became positive within our 28-day testing window. Overall, this study further supports the use of Tp-PCR as an accurate assay to rapidly identify, treat, and prevent the spread of primary syphilis.

Association of Neutrophil-Lymphocyte Ratio with Mild Cognitive Impairment in Elderly Chinese Adults: A Case-control Study

2020 ◽  
Vol 16 (14) ◽  
pp. 1309-1315
Author(s):  
Peilin An ◽  
Xuan Zhou ◽  
Yue Du ◽  
Jiangang Zhao ◽  
Aili Song ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Cognitive Function ◽  
Predictive Values ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Elderly Chinese ◽  
Normal Cognitive Function ◽  
The Absolute

Background: Inflammation plays a significant role in the pathophysiology of cognitive impairment in previous studies. Neutrophil-lymphocyte ratio (NLR) is a reliable measure of systemic inflammation. Objective: The aim of this study was to investigate the association between NLR and mild cognitive impairment (MCI), and further to explore the diagnostic potential of the inflammatory markers NLR for the diagnosis of MCI in elderly Chinese individuals. Methods: 186 MCI subjects and 153 subjects with normal cognitive function were evaluated consecutively in this study. Neutrophil (NEUT) count and Lymphocyte (LYM) count were measured in fasting blood samples. The NLR was calculated by dividing the absolute NEUT count by the absolute LYM count. Multivariable logistic regression was used to evaluate the potential association between NLR and MCI. NLR for predicting MCI was analyzed using Receiver Operating Characteristic (ROC) curve analysis. Results: The NLR of MCI group was significantly higher than that of subjects with normal cognitive function (2.39 ± 0.55 vs. 1.94 ± 0.51, P < 0.001). Logistic regression analysis showed that higher NLR was an independent risk factor for MCI (OR: 4.549, 95% CI: 2.623-7.889, P < 0.001). ROC analysis suggested that the optimum NLR cut-off point for MCI was 2.07 with 73.66% sensitivity, 69.28% specificity, 74.48% Positive Predictive Values (PPV) and 68.36% negative predictive values (NPV). Subjects with NLR ≥ 2.07 showed higher risk relative to NLR < 2.07 (OR: 5.933, 95% CI: 3.467-10.155, P < 0.001). Conclusion: The elevated NLR is significantly associated with increased risk of MCI. In particular, NLR level higher than the threshold of 2.07 was significantly associated with the probability of MCI.

scholarly journals Early-life environmental exposure determinants of child behavior in Europe: A longitudinal, population-based study

2021 ◽  
Vol 153 ◽  
pp. 106523
Author(s):  
Léa Maitre ◽  
Jordi Julvez ◽  
Monica López-Vicente ◽  
Charline Warembourg ◽  
Ibon Tamayo-Uria ◽  
...  
Keyword(s):  
Child Behavior ◽  
Environmental Exposure ◽  
Early Life ◽  
Population Based ◽  
Population Based Study ◽  
Exposure Determinants

scholarly journals Use of Antiplatelet Agents Decreases the Positive Predictive Value of Fecal Immunochemical Tests for Colorectal Cancer but Does Not Affect Their Sensitivity

2021 ◽  
Vol 11 (6) ◽  
pp. 497
Author(s):  
Yoonsuk Jung ◽  
Eui Im ◽  
Jinhee Lee ◽  
Hyeah Lee ◽  
Changmo Moon
Keyword(s):  
Colorectal Cancer ◽  
Large Scale ◽  
Screening Program ◽  
Antiplatelet Agents ◽  
Population Based ◽  
Small Sample ◽  
Antithrombotic Agents ◽  
Predictive Values ◽  
Prescription Rates ◽  
Small Sample Sizes

Previous studies have evaluated the effects of antithrombotic agents on the performance of fecal immunochemical tests (FITs) for the detection of colorectal cancer (CRC), but the results were inconsistent and based on small sample sizes. We studied this topic using a large-scale population-based database. Using the Korean National Cancer Screening Program Database, we compared the performance of FITs for CRC detection between users and non-users of antiplatelet agents and warfarin. Non-users were matched according to age and sex. Among 5,426,469 eligible participants, 768,733 used antiplatelet agents (mono/dual/triple therapy, n = 701,683/63,211/3839), and 19,569 used warfarin, while 4,638,167 were non-users. Among antiplatelet agents, aspirin, clopidogrel, and cilostazol ranked first, second, and third, respectively, in terms of prescription rates. Users of antiplatelet agents (3.62% vs. 4.45%; relative risk (RR): 0.83; 95% confidence interval (CI): 0.78–0.88), aspirin (3.66% vs. 4.13%; RR: 0.90; 95% CI: 0.83–0.97), and clopidogrel (3.48% vs. 4.88%; RR: 0.72; 95% CI: 0.61–0.86) had lower positive predictive values (PPVs) for CRC detection than non-users. However, there were no significant differences in PPV between cilostazol vs. non-users and warfarin users vs. non-users. For PPV, the RR (users vs. non-users) for antiplatelet monotherapy was 0.86, while the RRs for dual and triple antiplatelet therapies (excluding cilostazol) were 0.67 and 0.22, respectively. For all antithrombotic agents, the sensitivity for CRC detection was not different between users and non-users. Use of antiplatelet agents, except cilostazol, may increase the false positives without improving the sensitivity of FITs for CRC detection.

scholarly journals Using Convolutional Neural Network and Candlestick Representation to Predict Sports Match Outcomes

2021 ◽  
Vol 11 (14) ◽  
pp. 6594
Author(s):  
Yu-Chia Hsu
Keyword(s):  
Neural Network ◽  
Time Series ◽  
Pattern Recognition ◽  
Logistic Regression ◽  
Regression Model ◽  
Convolutional Neural Network ◽  
Logistic Regression Model ◽  
National Football League ◽  
Performance Metrics ◽  
Betting Market

The interdisciplinary nature of sports and the presence of various systemic and non-systemic factors introduce challenges in predicting sports match outcomes using a single disciplinary approach. In contrast to previous studies that use sports performance metrics and statistical models, this study is the first to apply a deep learning approach in financial time series modeling to predict sports match outcomes. The proposed approach has two main components: a convolutional neural network (CNN) classifier for implicit pattern recognition and a logistic regression model for match outcome judgment. First, the raw data used in the prediction are derived from the betting market odds and actual scores of each game, which are transformed into sports candlesticks. Second, CNN is used to classify the candlesticks time series on a graphical basis. To this end, the original 1D time series are encoded into 2D matrix images using Gramian angular field and are then fed into the CNN classifier. In this way, the winning probability of each matchup team can be derived based on historically implied behavioral patterns. Third, to further consider the differences between strong and weak teams, the CNN classifier adjusts the probability of winning the match by using the logistic regression model and then makes a final judgment regarding the match outcome. We empirically test this approach using 18,944 National Football League game data spanning 32 years and find that using the individual historical data of each team in the CNN classifier for pattern recognition is better than using the data of all teams. The CNN in conjunction with the logistic regression judgment model outperforms the CNN in conjunction with SVM, Naïve Bayes, Adaboost, J48, and random forest, and its accuracy surpasses that of betting market prediction.

scholarly journals Effect of fluid administration on scene to traffic accident patients by EMS personnel: a propensity score-matched study using population-based ambulance records and nationwide trauma registry in Japan

2021 ◽  
Author(s):  
Yusuke Katayama ◽  
Tetsuhisa Kitamura ◽  
Kosuke Kiyohara ◽  
Kenichiro Ishida ◽  
Tomoya Hirose ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Propensity Score ◽  
Hospital Mortality ◽  
Regression Model ◽  
Traffic Accident ◽  
Logistic Regression Model ◽  
Cardiopulmonary Arrest ◽  
Population Based ◽  
Fluid Administration ◽  
Secondary Outcome

Abstract Purpose The aim of this study was to assess the effect of fluid administration by emergency life-saving technicians (ELST) on the prognosis of traffic accident patients by using a propensity score (PS)-matching method. Methods The study included traffic accident patients registered in the JTDB database from January 2016 to December 2017. The main outcome was hospital mortality, and the secondary outcome was cardiopulmonary arrest on hospital arrival (CPAOA). To reduce potential confounding effects in the comparisons between two groups, we estimated a propensity score (PS) by fitting a logistic regression model that was adjusted for 17 variables before the implementation of fluid administration by ELST at the scene. Results During the study period, 10,908 traffic accident patients were registered in the JTDB database, and we included 3502 patients in this study. Of these patients, 142 were administered fluid by ELST and 3360 were not administered fluid by ELST. After PS matching, 141 patients were selected from each group. In the PS-matched model, fluid administration by ELST at the scene was not associated with discharge to death (crude OR: 0.859 [95% CI, 0.500–1.475]; p = 0.582). However, the fluid group showed statistically better outcome for CPAOA than the no fluid group in the multiple logistic regression model (adjusted OR: 0.231 [95% CI, 0.055–0.967]; p = 0.045). Conclusion In this study, fluid administration to traffic accident patients by ELST was associated not with hospital mortality but with a lower proportion of CPAOA.

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