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ABSTRACT: BACKGROUND: Conventional screening for hypothyroidism is controversial. Although hypothyroidism is underdiagnosed, many organizations do not recommend screening, citing low disease prevalence in unselected populations. We studied attendees at a thyroid health fair, hypothesizing that certain patient characteristics would enhance the yield of testing. METHODS: We carried out an observational study of participants at a Michigan health fair that focused on thyroid disease. We collected patient-reported symptoms and demographics by questionnaire, and correlated these with the TSH values obtained through the health fair. RESULTS: 794 of 858 health fair attendees participated. Most were women, and over 40% reported a family history of thyroid disease. We identified 97 (12.2%) participants with previously unknown thyroid dysfunction. No symptom or combination of symptoms discriminated between hypothyroid and euthyroid individuals. Hypothyroid and euthyroid participants in the health fair reported each symptom with a similar prevalence (p > 0.01), a prevalence which was very high. In fact, when compared with a previously published case-control study that reported symptoms, the euthyroid health fair participants reported a higher symptom prevalence (range 3.9% to 66.3%, mean 31.5%), than the euthyroid individuals from the case-control study (range 2% to 54%, mean 17.4%). CONCLUSIONS: A high proportion of previously undiagnosed thyroid disease was identified at this health fair. We initially hypothesized symptoms would distinguish between thyroid function states. However, this was not the case in this health fair screening population. The prevalence of reported symptoms was similar and high in both euthyroid and hypothyroid participants. Because attendees were self-selected, it is possible that this health fair that focused on thyroid disease attracted participants specifically concerned about thyroid health. Despite the lack of symptom discrimination, the much higher prevalence of hypothyroidism in this study (12%) compared with the general population (<2%) suggests that screening may be appropriate and effective in certain circumstances such as thyroid health fairs.
BMC Public Health 04/2013; 13(1):351. · 2.00 Impact Factor
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ABSTRACT: Eighty-eight long-billed dowitchers, Limnodromus scolopaceus, were examined for helminth parasites, 62 from Texas and 26 from Mexico. In total, 3,558 helminth parasites were obtained from this host, 2,273 from Texas birds and 1,285 from birds from Mexico. The component communities consisted of 22 species of helminths in Texas, and 19 in Mexico. Of a total of 26 helminth species recorded from the 2 localities, 15 were common to both, 7 found only in Texas, and 4 only in Mexico. Fifty-nine of 62 Texas birds and 25 of 26 birds from Mexico were infected. The most prevalent helminth for Texas was the cestode Shipleya inermis. The cestode Aploparaksis retroversa was the most abundant, accounting for 37% of the total abundance, and was second highest in prevalence. Five species of cestodes, A. retroversa, Aploparaksis diagonalis, Aploparaksis occidentalis, Aploparaksis rissae, and Shipleya inermis accounted for 79% of total abundance. In the sample from Mexico, S. inermis was also highest in prevalence, followed by the nematode Hystrichis tricolor. The cestode A. retroversa was highest in abundance at 50% of the total, and was third highest in prevalence. Mean species richness, diversity, and evenness were similar among the component communities of Texas and Mexico. A predictable suite of aploparaksid cestodes, together with the cestode S. inermis, constituted 79%, and 61%, of total abundance for the component communities of Texas and Mexico, respectively, and were present in all component communities for locality, season, and year. The cestodes, A. retroversa and S. inermis, were the dominant species in all component communities. Differences among component communities and low similarities for all other comparisons were largely caused by less predictable suites of helminth species. A checklist of helminth parasites reported for long-billed dowitchers is included.
Journal of Parasitology 12/2010; 96(6):1060-5. · 1.40 Impact Factor
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ABSTRACT: Men and women communicate differently, but it is unclear whether this influences health care outcomes.
Because women patients frequently choose women health care providers, we examined whether this preference was affected by communication styles. We focused on communication of disease-specific symptoms, hypothesizing that symptom agreement between women patients and women health care providers would be greater than between other patient-provider gender combinations.
Patients attending outpatient clinics were recruited as part of a study of respiratory illness at 7 university-affiliated sites during 3 consecutive influenza seasons (2000-2003). Individuals aged > or = 19 years were offered enrollment if they sought care for cold or flu symptoms at a participating study site. Patients were eligible to participate in the study if they reported any 1 of 6 symptoms: cough, runny nose, fever (subjective), muscle aches, sore throat, and/or exhaustion. Using separate questionnaires, patients and their health care providers recorded the patients' respiratory symptoms (as present or absent). Patients recorded their symptoms before visiting their health care provider, and providers recorded patient symptoms after the visit. Symptom agreement was compared using general estimating equations across all gender combinations.
A total of 327 patients (220 women, 107 men) and 84 health care providers (37 women, 47 men) participated in the study. Overall symptom agreement for all patient-provider gender combinations was 81.9% (95% CI, 79.6%-84.2%). For each symptom, the observed agreement significantly exceeded the agreement expected by chance alone (P < 0.001 for all symptoms except "no energy," which was P = 0.023). The male-male pairing of patient and provider was more likely to agree on a symptom than were the other gender combinations, although not statistically significantly more so than the female-female pairing.
In this survey of patients with respiratory illness, there was no significant difference in symptom agreement for most symptoms between the male-male and female-female patient-provider combinations. Based on these findings, symptom agreement alone does not explain why women patients select women health care providers.
Gender Medicine 07/2008; 5(2):186-93. · 2.10 Impact Factor
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ABSTRACT: Among women who present with urinary complaints, only 50% are found to have urinary tract infection. Individual urinary symptoms and urinalysis are not sufficiently accurate to discriminate those with and without the diagnosis.
We used artificial neural networks (ANN) coupled with genetic algorithms to evolve combinations of clinical variables optimized for predicting urinary tract infection. The ANN were applied to 212 women ages 19-84 who presented to an ambulatory clinic with urinary complaints. Urinary tract infection was defined in separate models as uropathogen counts of > or =10(5) colony-forming units (CFU) per milliliter, and counts of > or =10(2) CFU per milliliter.
Five-variable sets were evolved that classified cases of urinary tract infection and non-infection with receiver-operating characteristic (ROC) curve areas that ranged from 0.853 (for uropathogen counts of > or =10(5) CFU per milliliter) to 0.792 (for uropathogen counts of > or =10(2) CFU per milliliter). Predictor variables (which included urinary frequency, dysuria, foul urine odor, symptom duration, history of diabetes, leukocyte esterase on urine dipstick, and red blood cells, epithelial cells, and bacteria on urinalysis) differed depending on the pathogen count that defined urinary tract infection. Network influence analyses showed that some variables predicted urine infection in unexpected ways, and interacted with other variables in making predictions.
ANN and genetic algorithms can reveal parsimonious variable sets accurate for predicting urinary tract infection, and novel relationships between symptoms, urinalysis findings, and infection.
International Journal of Medical Informatics 04/2007; 76(4):289-96. · 2.41 Impact Factor
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ABSTRACT: Although microscopic urinalysis (micro UA) is commonly used in clinical practice, and residents are trained in micro UA, proficiency in this procedure has not been studied.
In 1996-97, 38 residents in the University of Nebraska Medical Center's internal medicine (IM) residency program were evaluated on their technical ability to perform micro UA, and on their cognitive skills in recognizing common micro UA findings. After identifying deficits in the residents' cognitive competency, two educational interventions were applied and residents were tested after each intervention.
A total of 24 residents (63%) correctly prepared the specimen for analysis (the technical portion). On the cognitive portion, only one of the 38 residents correctly identified 80% of all micro UA findings in the urinary sediment, although 11 (29%) residents identified UA findings specific to urinary tract infection (UTI). The first educational intervention did little to improve residents' performance. A second more intensive intervention resulted in 10 (45%) residents identifying 80% of all micro UA findings, and 19 (86%) residents correctly identifying UTI findings.
Many residents were not proficient in performing micro UA, even after intensive educational interventions. Although micro UA is a simple procedure, residents' mastery cannot be assumed. Residency programs should assess competency in this procedure.
Academic Medicine 06/2003; 78(5):525-9. · 3.52 Impact Factor
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ABSTRACT: This study aims to determine whether residents are influenced by clinical information when interpreting microscopic urinalysis (UA) and estimating the probability of a urinary tract infection (UTI), and to determine the accuracy and reliability of UA readings.
Residents estimated the UA white blood cell count and the probability of a UTI in vignettes using a fractional factorial design, varying symptoms, gender, and the white blood cell count on preprepared urine slides.
Individual-level results indicated a clinical information bias and poor accuracy. Seventeen of 38 residents increased the white blood cell count in response to female gender; 14 increased the white blood cell count in response to UTI symptoms. Forty-nine percent of the readings were inaccurate; agreement ranged from 50% to 67% for white and red blood cells and bacteria.
Many residents gave inaccurate UA readings, and many readings varied with clinical information. A significant portion of residents needs assistance in objectively and accurately interpreting the UA.
Medical Decision Making 22(4):318-25. · 2.33 Impact Factor
