European journal of epidemiology
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In order to assess the interaction between alcohol intake, tobacco smoking and coffee consumption in determining the risk of liver cirrhosis we carried out a hospital-based case-control study involving 115 patients at their first diagnosis of cirrhosis and 167 control patients consecutively enrolled in the General Hospitals of the Province of L'Aquila (Central Italy). The mean life-time daily alcohol intake (as g ethanol consumed daily) was measured by direct patient interviews, whose reproducibility was > 0.80 and similar for cases and controls, as checked by interviewing the relatives of a sample of 50 cases and 73 controls. During the same patient's interview we also measured the mean consumption of coffee (daily number of cups of filtered coffee) and tobacco (life-time daily number of cigarettes smoked). ⋯ By contrast, coffee consumption had a protective effect on the risk of cirrhosis and significantly improved the goodness-of-fit of such a model. Abstaining from coffee consumption determined both a significantly increased risk of cirrhosis, even for daily alcohol intake below 100 g, and a multiplicative effect with alcohol intake on this risk. In patients drinking > or = 101 g ethanol daily the relative risk increased from 5.5 (95% confidence interval: 1.4-22.0) for coffee consumers to 10.8 (95% confidence interval: 1.3-58.1) for coffee abstainers.(ABSTRACT TRUNCATED AT 250 WORDS)
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Noise exposure of a population sample living in a city in northern Italy (Genoa) was assessed by measuring the noise in the area as well as with personal sound detectors. Sampling was conducted during a standard day and covered a period of time spent out-of-doors, at work (service sector) and at home. Ambient noise at home and at work was assessed with sound-level meters, personal exposure levels were assessed with personal sound-level/dosimeters. ⋯ A further distinction was made between noise exposure at home (Leq 74.4), work (Leq 74.0) and during city transfers (Leq 79.3). Leq values for individual hours, Leq daytime (Leq, d), Leq nighttime (Leq,n) and Leq day-night (Ldn) indices calculated in the different environments, i.e. at work, home and out-of-doors, are reported here. Individual noise levels have then been compared with environmental data and with subjective noise exposure judgement.
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The concept of likelihood ratio has been advocated for several years as one of the better means to evaluate diagnostic tests and as a practical and valuable tool in clinical decision making. In this paper we review the basic concepts underlying the evaluation of diagnostic tests and we explore the properties and usefulness of both positive and negative likelihood ratios compared with sensitivity and specificity. Particular attention is given to the use of likelihood ratios in the clinical setting. ⋯ Disadvantages are the non-linearity and the necessity to recalculate probabilities in odds. Although they summarize the information contained in sensitivity and specificity, these characteristics are still necessary for certain clinical decisions. Since likelihood ratios have been promoted among physicians and medical students, we discuss examples of inappropriate use and misunderstandings in the medical literature: the frequent omission of confidence intervals, the choice of cut-off points based on likelihood ratios for positive test results only and the confusion between likelihood ratios for ranges and those for cut-off points.
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A questionnaire of respiratory symptoms and diseases completed by 6610 adults in 3 age cohorts (35-36 y; 50-51 y and 65-66 y) in northern Sweden was followed-up by interview and lung function testing of 1243 subjects with asthmatic or bronchitic symptoms and 263 subjects assessed from the postal questionnaire as being healthy. We report the results of this follow-up study. According to the criteria used, 292 subjects (5.1% of the original study sample) were diagnosed as having asthma. ⋯ Among subjects with attacks of breathlessness and wheezing, diagnostic criteria often used for asthma in questionnaire studies, 70% were diagnosed as having asthma. Of those with chronic productive cough, 62% were diagnosed as having chronic bronchitis. We consider that trained nurses provide reliable data that may be used in epidemiological surveys of obstructive lung diseases.
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Risk factors were studied in 801 children with congenital heart disease (CHD) coming from 105,374 consecutive births of known outcome. The incidence of CHD was 7.60%. Diagnosis was performed in 66.5% of the cases during the perinatal period. ⋯ One out of four children with CHD had an extracardiac malformation, which is ten times the rate of incidence of malformation in our population. The incidence of CHD in first degree relatives of these infants was 3.0%. These first degree relatives also had more non-cardiac malformations than did those of the controls.