Evaluation of pregnancy outcome records in the German Pharmacoepidemiological Research Database (GePaRD).

PURPOSE: Routine health care data are a valuable source for the assessment of risks of drugs during pregnancy. Therefore, the aim of the current analysis was the evaluation of pregnancy outcome records in German health insurance data. METHODS: We used the German Pharmacoepidemiologic Research Database including data of more than 15 million insurants (about 18% of the German population). Among 10-49 year-old women, we identified six categories of pregnancy outcomes: term births, preterm births, stillbirths, induced abortions, spontaneous abortions and ectopic pregnancies. In order to assess the validity of these records, we have set our results in relation to representative data for the corresponding outcomes in Germany. We also investigated whether pregnancy markers (diagnoses, procedures or medical services which indicate an existing pregnancy) can be used to identify pregnancies. RESULTS: In total, we identified 94 261 pregnancy outcomes in 2005. The percentage of births outside hospital (1.2%) and of preterm births (11.6%), the rate of stillbirths (3 per 1000 live births) and the rate of ectopic pregnancies (20 per 1000 live births) agreed well with representative data for Germany. Compared to epidemiological data, the occurrence of spontaneous abortions was underestimated (5.4% of all pregnancies). There were 4.1 induced abortions per 100 live births, compared to 18.1 in national data. Positive predictive values and sensitivities of markers varied across marker categories and for different pregnancy outcomes. CONCLUSIONS: Completeness of pregnancy outcomes recorded in the database varied by pregnancy outcome. This should be taken into account in studies of drug safety in pregnancy.

Skin and respiratory symptoms among workers with suspected work-related disease.

BACKGROUND: Many workers are exposed to chemicals that can cause both respiratory and skin responses. Although there has been much work on respiratory and skin outcomes individually, there are few published studies examining lung and skin outcomes together. AIMS: To identify predictors of reporting concurrent skin and respiratory symptoms in a clinical population. METHODS: Patients with possible work-related skin or respiratory disease were recruited. An interviewer- administered questionnaire collected data on skin and respiratory symptoms, health history, smoking habits, workplace characteristics and occupational exposures. Predictors of concurrent skin and respiratory symptoms were identified using multiple logistic regression models adjusted for age, sex and atopy. RESULTS: In total, 204 subjects participated; 46% of the subjects were female and the mean age was 45.4 years (SD = 10.5). Most subjects (n = 167, 82%) had possible work-related skin disease, compared with 37 (18%) subjects with possible work-related respiratory disease. Subjects with a history of eczema (OR 3.68, 95% CI 1.7-7.8), those from larger workplaces (OR 2.82, 95% CI 1.8-7.4) and those reporting respirator use at work (OR 2.44, 95% CI 1.2-4.8) had significantly greater odds of reporting both work-related skin and respiratory symptoms. Current smoking was also associated with reporting concurrent skin and respiratory symptoms (OR 2.57, 95% CI 1.2-5.8). CONCLUSIONS: Workers reported symptoms in both systems, and this may be under-recognised both in the workplace and the clinic. The association between history of eczema and concurrent skin and respiratory symptoms suggests a role for impaired barrier function but needs further investigation.

Multi-disciplinary assessment of the entrustable professional activities of surgery residents.

Purpose: Medicine is practiced in a collaborative and interdisciplinary manner. However, medical training and assessment remain largely isolated in traditional departmental silos. Two Entrustable Professional Activities (EPAs) developed by the American Board of Surgery are multidisciplinary in nature and offer a unique opportunity to study interdisciplinary assessment. Methods: EPA microassessments were collected from Surgery and Emergency Medicine (EM) faculty between July 2018 and May 2020. Differences in feedback provided by faculty were assessed using natural language processing (NLP) techniques, (1) automated algorithms; and (2) topic modeling. Summative content analysis was used to identify themes in text feedback. We developed automated coding algorithms for these themes using regular expressions. Topic modeling was performed using latent Dirichlet allocation. Results: 549 assessments were collected for two EPAs: 198 for GS Consultation and 351 for Trauma. 27 EM and 27 Surgery faculty provided assessments for 71 residents. EM faculty were significantly more likely than Surgery faculty to submit feedback coded as Communication, Demeanor, and Timeliness, (all chi-square test p-values < 0.01). No significant differences were found for Clinical Performance, Skill Level, or Areas for Improvement. Similarly, topic modeling indicated that assessments submitted by EM faculty focused on communication, timeliness, and interpersonal skills, while those submitted by Surgery faculty focused on the residents' abilities to effectively gather information and correctly diagnose the underlying pathology. Conclusions: Feedback from EM and Surgery faculty differed significantly based on NLP analyses. EPA assessments should stem from multiple sources to avoid assessment gaps and represent a more holistic picture of performance.

Impact of diabetes on employment and income in Manitoba, Canada.

OBJECTIVE: To compare employment and income of working-age (18-64 years) people with and without diabetes. RESEARCH DESIGN AND METHODS: We conducted a prospective population-based cohort study based in Manitoba, Canada, consisting of 25,554 individuals without diabetes and 608 with diabetes, of whom 242 had a complication of the disease. Adjusted odds ratios (ORs) of employment and income variables were determined. RESULTS: Diabetic individuals with complications were twice as likely not to be in the labor force (OR 2.07 [95% CI 1.49-2.87]) than nondiabetic individuals. This difference was not evident for diabetic individuals without complications (OR 1.20 [0.93-1.56]). Diabetic individuals without complications had incomes similar to those of nondiabetic individuals. The total income of diabetic individuals with complications was 72% of the income of nondiabetic individuals. When the analysis was limited to only those in the labor force, diabetic workers with complications still had only 85% the employment income of nondiabetic people. Diabetic individuals with complications received 58% more social support income. In a separate analysis of aboriginal individuals, complicated diabetes was not associated with an increased likelihood of not working or a decrease in employment income. CONCLUSIONS: In general, complications of diabetes and the absence of the disease affect the ability to earn income in Manitoba, Canada. This effect was not identified in the aboriginal population of the province.

Chemical pneumonitis due to exposure to bromine compounds.

A 60-year-old laboratory technician developed pulmonary infiltrates consistent with chemical pneumonitis following accidental exposure to a mixture of hydrogen bromide and phosphorus tribromide. A protracted clinical course ensued consistent with bronchiolitis obliterans. These problems may have been avoided if the potential for subsequent damage had been realized at the time of the initial exposure. Health personnel must be aware of the potentially delayed effects of accidental exposures to respiratory irritants.

Christmas candy maker's asthma. IgG4-mediated pectin allergy.

We evaluated a 29-year-old candy maker with no history of asthma who developed asthma after exposure to pectin, a compound manufactured from fruits and fruit rinds. Following eight years of employment during which he added pectin to a recipe for Christmas candies, the candymaker developed acute respiratory symptoms. Challenge testing with the pectin mixture caused a 40 percent decrease in FEV1. Skin prick testing was positive to the pectin extract. Total IgE was normal and pectin-specific IgE antibodies were not detected. A strongly positive pectin-specific IgG4 antibody response was present that was not detected in a control serum and could be inhibited by the addition of pectin. Antigen-specific IgG4 should be sought in IgE negative cases of occupational asthma.

Occupational asthma induced by inhaled egg lysozyme.

A 26-year-old man employed in a company which manufactured hen egg white derived lysozyme for use in the pharmaceutical industry was evaluated for occupational asthma. The worker began to experience immediate-onset asthmatic symptoms two months after starting to work with egg lysozyme powder. The work process involved the production of approximately 1,000 kg of purified dried lysozyme powder per week. Prick skin testing was positive to egg lysozyme (50 mg/ml) and other egg protein components, but negative to whole egg white and egg yolk reagents. Serum specific IgE to egg lysozyme was documented. Decrements in serial peak expiratory flow rates were associated with lysozyme exposure at work. A specific bronchoprovocation challenge to lysozyme powder was positive demonstrating an isolated immediate asthmatic response (48 percent decrease from baseline FEV1). This is the first reported case of lysozyme-induced asthma specifically caused by inhalational exposure to egg lysozyme.

A two-factor theory of stimulus-repetition effects.

It is a well-documented finding that children respond more slowly to a stimulus that has been presented repeatedly just before test than to a novel stimulus. The effect, for which a two-factor theory has recently been proposed, did not occur in the only previous study of adults using a comparable procedure. Experiment 1 demonstrated the effect with adults. The previous negative finding may have been the result of too few repetitions of the stimulus. Experiment 2 provided additional support for the two-factor theory. The theory suggests that the effect is the net result of partially counteracting changes in two attentional processes. One process, the alertness elicited by a stimulus, is held to decrease as a result of repeated presentation of the stimulus, while the second process, encoding, is facilitated. The hypothesis tested in Experiment 2 was that the alertness decrement dissipates over a brief passage of time, while the facilitation of encoding does not. Subjects exposed to a repeatedly presented color were tested either immediately thereafter or after a 15-min or 30-min interval. As predicted, the observed effect shifted from one of flower response to one of faster response to the repeated stimulus as the delay interval increased.

Stimulus repetition effects on attention to words and colors.

Mere observation of 30 presentations of a colored form results in slower reaction time responses to the familiarized stimulus than to a comparable novel stimulus. Prior research suggest that this result is due to two subsidiary effects of repetition: alertness decrement and encoding facilitation. Four experiments were conducted to compare the effects of stimulus repetition on colors and words. The two-factor theory of repetition was found to hold for words as well as for colors; for words, in contrast to colors, encoding facilitation was found to be stronger than alertness decrement.

Acanthamoeba corneal infection in a contact lens wearer.

Corneal infections cause by micro-organisms are the most serious complications of wearing contact lenses. The paper presents the first case of contact lens-associated keratitis caused by the protozoon Acanthamoeba sp. identified in Slovenia so far. The identification of Acanthamoeba as a cause of keratitis in a soft contact lens wearer alerted us to the fact that this health issue should be given more attention in the future.

Unemployment and health care utilization.

OBJECTIVES: This study attempted to determine whether prior use of health services predicts a subsequent risk of unemployment and also to describe the acute effects of exposure to unemployment on the use of health care services. MATERIAL AND METHODS: The 1986 census records were linked with comprehensive health care information for the period 1983-1989 for over 44629 randomly selected residents of Manitoba, Canada. All cause and cause-specific rates of hospital admission and ambulatory physician contacts were compared between 1498 unemployed and 18272 employed persons across 4 consecutive time periods related to the onset of unemployment. RESULTS: The adjusted rates of hospital admission and physician contacts were higher among the unemployed across all 4 periods. When persons with a history of mental health treatment were excluded, health care use in the period prior to the onset of unemployment was equivalent among the employed and unemployed. When a history of mental health treatment was controlled for, all-cause and cause-specific health care use was elevated among the unemployed during the unemployment spell. CONCLUSIONS: Unemployed persons had increased hospitalization rates before their current spell of unemployment. Much of this difference was due to the subgroup with prior mental health treatment. For persons without prior mental health care, hospitalization increased after a period of unemployment.

Instillation of mitomycin C after recurrent pterygium surgery.

PURPOSE: The aim of the study was to evaluate the safety and effectiveness of postoperative instillation of Mitomycin C eye drops in patients with recurrent pterygium. METHODS: Between October 1993 and November 1994, we operated 12 patients with recurrent pterygium using the conjunctival autografting technique, and after the operation patients instilled 0.02% or 0.04% Mitomycin C eye drops two or four times a day for one or two weeks. RESULTS: Early complications were 2 wound dehiscences, 7 corneal epithelial defects, 5 reported eye discomforts and 2 glaucoma. Late, there were 2 recurrences of pterygium after 6 and 9 months, one simplex glaucoma, one cataract and one alopecia areata. CONCLUSIONS: In cases of aggressive or severe pterygia, postoperative use of Mitomycin C eye-drops appears to be safe, effective and acceptable, but good surgical technique, careful observation and a long follow-up is indispensable for these patients.

An alertness decrement hypothesis of response inhibition to repeatedly presented stimuli.

Both inhibitory and facilitative effects of repeated stimulus presentation have been observed. Two-factor theory attributes both kinds of effects to changes in specific components of attention. The theory claims that repeated exposure (a) decreases the alerting capacity of a stimulus and (b) facilitates encoding. The purpose of the present research was to provide further evidence that alertness decrement underlies the inhibitory effects of stimulus repetition. Adults were exposed to 30 presentations of a colored circle prior to performing a choice-reaction time (RT) task on which the targets were the familiarized stimulus and a novel stimulus. A warning signal occurred at one of three intervals prior to target onset. It was predicted from the literature on the temporal characteristics of alertness that the relative speed of responding to the familiarized stimulus would vary as a function of the warning signal-target interval. As predicted, responses to the familiarized stimulus were (a) slower than to the novel stimulus at intervals of 0 and 2,500 ms, but (b) faster than to the novel stimulus at 450 ms. The convergence of these findings with the alertness literature suggests an alertness decrement interpretation of response decrements to repeatedly presented stimuli.

Residential electric consumption and childhood cancer in Canada (1971-1986)

Concern has focused recently on the association between exposure to magnetic fields emanating from electrical equipment and the development of childhood cancer. An ecological study was undertaken to determine the correlation over time between childhood cancer rates and residential electric consumption (REC) in Canada. Significant increases in REC and in overall childhood cancer rates (0.14 cases/100,000 children.y) and brain cancer (0.05 cases/100,000 children.y) were observed, but a similar increase in leukemia was not observed. The average of the yearly provincial ranking of REC and cancer rates was used to determine whether provinces that have, on the average, higher REC also have higher childhood cancer ranks. Stronger correlations were observed between provincial REC rank and brain cancer and leukemia ranks than with lymphoma and other cancer rankings. These findings are consistent with, but do not prove, a causal association between childhood brain cancer and leukemia and REC.

Neurotoxic effects of solvent exposure on sewage treatment workers.

Nineteen Sewage Treatment Workers (STWs) exposed to industrial sewage that contained benzene, toluene, and other organic solvents at a primary sewage treatment plant in New York City (Plant A) were examined for evidence of solvent toxicity. Fourteen (74%) complained of central nervous system (CNS) symptoms consistent with solvent exposure, including lightheadedness, fatigue, increased sleep requirement, and headache. The majority of these symptoms resolved with transfer from the plant. Men working less than 1 yr at Plant A were more likely to complain of two or more CNS symptoms than men who were working there longer than 1 yr (p = .055). Objective abnormalities in neurobehavioral testing were found in all 4 men working longer than 9 yr at this plant, but in only 5 of 15 employed there for a shorter period (p = .03). These results are consistent with the known effects of solvent exposure. Occupational health personnel must be aware that STWs can be exposed to solvents and other industrial wastes.

Determinants of tuberculin reactivity among health care workers: Interpretation of positivity following BCG vaccination.

OBJECTIVE: To determine the extent to which a history of Bacille Calmette-Guerin (BCG) vaccination influences the likelihood of positive tuberculin skin test (TST) results. DESIGN: Cross-sectional survey using a hospital-based tuberculosis surveillance program. SETTING: Health Sciences Centre, a tertiary care hospital in Winnipeg, Manitoba. METHODS: The 476 health care workers (HCWs) who had TST as part of the surveillance program between 1993 and 1997 constituted the study population. The two-step test was done in 91% of the participants who did not have a positive initial test, defined as 10 mm or greater of induration. Data were gathered through chart review supplemented by a short questionnaire administered to the HCWs. MAIN RESULTS: One hundred and thirty-eight HCWs (29%) had a positive TST. In a stepwise, multiple logistic model controlling for age, sex, job title, work area, age of receiving BCG, time since BCG and duration of employment, only a history of BCG vaccination (odds ratio [OR] 22; 95% CI 12 to 41) and birth outside of Canada (OR 2.6; 95% CI 1.4 to 5.8) were significantly associated with a positive TST. When the definition of a positive TST was modified by increments of 1 mm, from 10 mm up to 20 mm of induration in BCG recipients, BCG was associated with positive reactions with indurations up to 19 mm but not 20 mm or greater. The OR declined with each increment. Of the 84 HCWs who were documented to have at least 20 years between BCG vaccination and testing, 41 (49%) had positive reactions. CONCLUSIONS: BCG vaccination can produce lasting tuberculin reactivity, and indurations of 19 mm or less may be due to the effects of the vaccine.

Infectious diseases on a general internal medicine clinical teaching unit.

OBJECTIVE: To describe the spectrum of infectious diseases and characteristics of patients admitted with infections on a general internal medicine clinical teaching unit. DESIGN: Retrospective review of patients admitted to one general internal medicine unit at a tertiary care teaching hospital during two three-month periods. METHODS: Data collection through chart review. OUTCOME MEASURES: DESCRIPTIVE ANALYSIS OF TYPES OF INFECTIONS: therapeutic interventions; consultations and outcomes, including death; hospital-acquired infection; and length of stay. RESULTS: During the two three-month periods, 76 of 233 (33%) and 52 of 209 (25%) admissions were associated with a primary diagnosis of infection. An additional 23 (10%) and 24 (12%) patients had infection at the time of admission, but this was not the primary admitting diagnosis. Pneumonia, urinary infection, and skin and soft tissue infection were the most frequent diagnosis at the time of admission, but these accounted for only about 50% of admissions with infection. Patients admitted with infection were characterized by a younger age, greater number of therapeutic interventions in the first 24 h, and increased medication costs, entirely attributable to antimicrobial therapy, but patients admitted with infection did not differ in comorbidity, death, nosocomial infection or length of stay compared with patients without infection. CONCLUSIONS: A wide variety of infections contribute to admissions to general internal medical clinical teaching units. Patients with infection have more interventions and an increased cost of care, but do not differ in outcome.

Completeness of case ascertainment of the State Cancer Registry.

The authors evaluated the ability of the New Jersey State Cancer Registry to detect known cancer cases during an investigation of a cancer cluster occurring in professional football players. The Registry was found to be a valuable tool for the detection of cancer cases for New Jersey residents.