Martin D. Keller

Respiratory illness in households using gas and electricity for cooking. I. Survey of incidence.

Abstract A 12-month study was undertaken to determine the incidence of respiratory illness in households in a midwest upper-middle-class community. The sample included 441 families, divided into two groups; those utilizing gas and those utilizing electricity in cooking. Family health and demographic data were obtained from the participants. Reports of acute respiratory illness were obtained through biweekly telephone calls to each household. Respondents were asked to report respiratory illness in any member of the household, and to indicate the presence or absence of a set of signs and symptoms. Ambient air was analyzed indoors and outdoors in a sample of the households, and pulmonary function tests were conducted on a subsample of the participants representing both types of households. AID analysis and multiple regression were carried out to determine the predictors of respiratory illness incidence. Comparison was made with data obtained in a similar study in Long Island, New York. There was no evidence to suggest that cooking with gas is associated with an increase in respiratory disease or a decrease in pulmonary function (FVC and FEV-75).

Reduction of mortality from prehospital myocardial infarction by prudent patient activation of mobile coronary care system

Numerous recent studies have documented the fact that lives are saved by prehospital mobile coronary care units (MCCU).lm6 As a result, such units, of various designs and types, have proliferated in the United States and in Europe.7v8 In spite of this development in emergency medical services (EMS), there is still some uncertainty regarding its impact on death from acute myocardial infarction (AMI) and sudden death in patients with coronary artery disease (CAD). Furthermore, arguments have been raised that MCCU often serve patients at low risk of death, who could well be treated by other means? This presentation is concerned with our S-year experience with a mobile coronary care system in Columbus, Ohio. A single advanced life support (ALS) vehicle manned by a physician and paramedics (Heartmobile) was added to a long-standing and well-utilized EMS system in April, 1969. Over the next 8 years the ALS system as well as the entire EMS system grew dramatically.‘O With respect to cardiac emergencies, it had been our impression that persons served by the ALS units were predominantly those with high risk of death. This was clearly true of an original cohort of 214 consecutive cases analyzed in 1970 when the Heartmobile was in use. However, we had no data concerning those patients with AM1 not seen by the EMS system. As a result, factors influencing patient decisions to use the

Differences in pulmonary function tests among whites, blacks, and American Indians in a textile company.

Normal standards for pulmonary function in nonwhite populations are not presently available to occupational health workers. The present study examined differences in %FVC, FVC, FEV1/FVC, FEF 200-1200 and FEF 25-75% among whites, blacks, and American Indians. The sample consisted of 4209 job applicants to a textile company in southeastern United States. Multiple regression and analyses of covariance were employed to control differences in age, height, weight, and smoking status. Blacks were significantly lower in five of the six comparisons but higher in FEV1/FVC%. The pulmonary function measures of Indians fell generally between those of whites and blacks. Differences were observed between blacks and whites of both sexes regarding the effects of cigarette smoking. The need for race specific stardards was confirmed and the question of using smokers in the acquisition of normative data was raised.

Quality of life in nurse case management of persons with AIDS receiving home care

Effects of case management on quality of life were tested with 57 home care patients with AIDS, randomly assigning individuals to either usual care or case-managed care over the duration of home services (ranging from 5 days to over 2 years). Participants were primarily male (93%), white (79%), and never married (82%). Quality of life was measured monthly using the quality of Well-Being Index (QWB). Case-managed patients showed advantages over the usual care group in descriptive analyses of quality of life and survival. Large standard deviations in the QWB scores resulting from high fatality among subjects impeded statistical analyses of effects.

Hyperuricemia and chronic renal disease.

Abstract Simultaneous serum creatinine and enzymatic spectrophotometric uric acid determinations were performed in a group of 25 patients with known renal disease. The presence or absence of six other factors associated with hyperuricemia was also documented. A group of 41 middle-aged white male volunteers, who had been found to have hyperuricemia by a community screening program, were similarly evaluated. A weakly positive relationship between serum creatinine and uric acid levels was found in the group with renal disease but no correlation could be demonstrated in the hyperuricemic volunteers. The frequent occurrence of other factors associated with hyperuricemia was documented in both groups. It was concluded that, in patients with chronic renal disease and serum creatinine elevation, hyperuricemia remains a complex phenomenon often associated with multiple factors. In the group of middle-aged male volunteers, found to be hyperuricemic on screening, chronic renal disease with unequivocal creatinine retention could not be documented as a frequent associated factor.

Concepts of sensitivity and specificity in the evaluation of emergency medical services

Abstract The concept of sensitivity, in relating service to need, refers to a measure of the proportion of the individuals requiring a given service who actually receive it. Specificity, on the other hand, refers to a measure of the proportion of individuals who do not require a given service and who indeed do not receive it, in spite of the fact that they may be in the system in which the service is available. These concepts are applied to the sequence of services in emergency medical care systems.

Mobile Pre-Hospital Coronary Care — Columbus, Ohio

The City of Columbus, Ohio, USA has a population of approximately 565, 000 residing within an area of 184 square miles. It exceeds the population of Denver and Atlanta by at least 50 000 people, and over the past twenty years has grown faster than any other city in the northeastern industrial quadrant of the United States [1]. It is a city constructed on flat terrain with efficient surface transportation related to criss-crossing major arteries in the center of the city and a surrounding ‘outerbelt’. The most readily recognizable feature of the city is the Ohio State University, which contributes 54462 students to the overall population. The Ohio State University Hospital is but one of eight hospitals that are capable of taking care of the coronary patient.

Quality Assurance A New Role for the Hospital Epidemiologist

Quality assurance may be viewed as a method for the surveillance of healthcare provided in hospitals and other settings. The processes involved in quality assurance are in many ways analogous to the concepts and techniques that comprise the discipline of epide miology. As yet, there has been little interaction be tween these specialty areas, and the lack of recogni tion of their relevance to one another is exemplified by the fact that hospital epidemiologists are rarely called upon to assist in the planning and operation of quality assurance programs. This loss of opportunity may be remedied by the inclusion of quality assurance methodology in the training of epidemiologists, and the introduction of certain epidemiologic concepts and methods into the quality assurance curricula. The intersection of these two disciplines will enlarge the scope of both and foster advances in theory and prac tice in this field.