Sentinel Marker Research Articles

Estudio clínico y epidemiológico de la criptococosis en Colombia: resultados de nueve años de la encuesta nacional, 1997-2005

A national survey on cryptococcosis has been conducted in Colombia since 1997. The survey data recorded over a 9-year period, 1997 to 2005, was summarized.The format provided by the European Confederation of Medical Mycology was adapted with the correspondent permission.Over the 9 year period, 931 surveys were received from 76 centers. The associated disease syndromes were as follows: 891 (95.7%) were neurocryptococosis cases, 27 (2.9%) pulmonary disease, 5 (0.5%) cutaneous lesions, 2 (0.2%) ganglionar forms, 2 (0.2%) oropharyngeal lesions and one case (0.1%) each from peritonitis, liver lesion, cellulitis and urinary tract infection. Demographic data indicated 82.7% of the subjects were males, and 59.4% were between 20-39 years old; 25 children less than 16 years old were reported. The prevalent risk factor was HIV infection (78.1%). The mean annual incidence rate of cryptococcosis in the general population was 2.4 X 106 inhabitants, but in AIDS patients the rate rose to one in 3 X 103. The most frequent clinical features were headache (85.2%), nausea and vomiting (59.1%), fever (59.0%), mental changes (46.2%), meningeal signs (33.4%), cough (23.6%) and visual alterations or loss of vision (20.9%). Laboratory data showed that direct examination of cerebrospinal fluid (CSF) was positive in 92.8% cases and Cryptococcus was recovered in 90.3% of the cases. Cryptococcal antigen reactivity was 98.9% in CSF and 93.7% in serum samples. From 788 isolates submitted, 95.9% were C. neoformans var. grubii serotype A, 0.3% var. neoformans serotype D, 3.3% C. gattii serotype B and 0.5% C. gattii serotype C. The majority of patients were treated initially with amphotericin B.Cryptococcosis incidence has increased dramatically in Colombia with the AIDS pandemic and it can be considered as a sentinel marker for HIV infection.

Results of nine years of the clinical and epidemiological survey on cryptococcosis in Colombia, 1997-2005

A national survey on cryptococcosis has been conducted in Colombia since 1997. The survey data recorded over a 9-year period, 1997 to 2005, was summarized. The format provided by the European Confederation of Medical Mycology was adapted with the correspondent permission. Over the 9 year period, 931 surveys were received from 76 centers. The associated disease syndromes were as follows: 891 (95.7%) were neurocryptococosis cases, 27 (2.9%) pulmonary disease, 5 (0.5%) cutaneous lesions, 2 (0.2%) ganglionar forms, 2 (0.2%) oropharyngeal lesions and one case (0.1%) each from peritonitis, liver lesion, cellulitis and urinary tract infection. Demographic data indicated 82.7% of the subjects were males, and 59.4% were between 20-39 years old; 25 children less than 16 years old were reported. The prevalent risk factor was HIV infection (78.1%). The mean annual incidence rate of cryptococcosis in the general population was 2.4 X 106 inhabitants, but in AIDS patients the rate rose to one in 3 X 103. The most frequent clinical features were headache (85.2%), nausea and vomiting (59.1%), fever (59.0%), mental changes (46.2%), meningeal signs (33.4%), cough (23.6%) and visual alterations or loss of vision (20.9%). Laboratory data showed that direct examination of cerebrospinal fluid (CSF) was positive in 92.8% cases and Cryptococcus was recovered in 90.3% of the cases. Cryptococcal antigen reactivity was 98.9% in CSF and 93.7% in serum samples. From 788 isolates submitted, 95.9% were C. neoformans var. grubii serotype A, 0.3% var. neoformans serotype D, 3.3% C. gattii serotype B and 0.5% C. gattii serotype C. The majority of patients were treated initially with amphotericin B. Cryptococcosis incidence has increased dramatically in Colombia with the AIDS pandemic and it can be considered as a sentinel marker for HIV infection.

Erectile dysfunction: a sentinel marker for cardiovascular disease in primary care.

Erectile dysfunction (ED) is a common, age-related disorder that diminishes quality of life for affected men and their partners. While most ED is now recognized as organic in origin, both organic and psychogenic causes often conspire to reduce sexual function in men with ED. Vasculopathy has come to be recognized as the most common cause of ED, which has elevated ED's importance in the primary care setting as a sentinel to underlying cardiovascular disease. Identification of cardiovascular risk factors should be a routine part of the evaluation for ED and is as important as taking the patient's sexual, medication, and psychosocial histories. Involving the patient's partner in evaluation and management is often valuable. Treatment with phosphodiesterase type 5 inhibitors is effective in restoring sexual function for most men with ED, but patients and their partners should be encouraged to make an informed choice from among all available treatment options.

Engaging Patients in Cardiovascular Disease Risk Reduction: From Empathy to Erectile Dysfunction

Six of the major risk factors for coronary heart disease involve lifestyle practices, often not discerned in primary care. Differing paradigms for preventive care and modification for risk are thereby addressed. Motivational interviewing is one technique of reflective listening and nonjudgmental concern to engage patients in behavioral change. As an example of the rationale for intervention to reduce the risk of coronary artery disease, the Commonwealth Study of 2000 is highlighted, noting the failure of men to address warning signals of cardiovascular disease risk and the relationship of erectile dysfunction in men as a possible sentinel marker for early detection of coronary artery disease. A recent article in Journal of the American Medical Association addressed the relationship of incident erectile dysfunction and presence of cardiovascular disease over an 11-year period in more than 4000 men. Therefore, the penis may be an appropriate barometer to determine cardiovascular health and risk and allow partnering with a clinician to modify risk because it is easily identifiable. This is an example of gender-based risk stratification and education that will be addressed in a series of articles on cardiovascular disease risk.

An ethno-epidemiological model for the study of trends in illicit drug use: reflections on the ‘emergence’ of crack injection

Public health, including the prevention of drug use, has long relied upon sentinel marker data obtained from national and regional tracking systems in order to forecast changes in patterns of drug abuse. More recently, these types of data have also played an important role in monitoring particular types of medical consequences associated with drug use, including the spread of HIV, HBV, HCV and other viral infections prevalent in IDU populations. While these types of data may provide an important sources of information about changes in drug use and its consequences, the limits of these sources of data have also become widely apparent. Based on a patchwork of institutionally-derived sources of data (e.g. emergency departments, drug treatment admissions, and law enforcement data on drug seizures and arrests), sentinel marker data typically fail to capture a number of “hidden populations” evidencing “hidden” drug-related risk behaviours. Many of these populations and behavioural practices only become apparent well after they have become diffused across regions and diverse drug user subpopulations, making prevention more difficult and more expensive. Furthermore, these systems cannot capture patterns of episodic use, such as those evidenced in crack injection. Ethnographic methods, including field-based community assessment, semi-structured qualitative interviews, and targeted observation of “natural” venues in which drugs are bought, sold, and used, have the potential to overcome some of the limitations from which “systems data” often suffer. Drawing on an ethno-epidemiological approach, our ongoing multi-site research on the use of injection as a mode of administration in the use of crack cocaine is a case in point, and illustrates the potential utility an ethnographic model for the identification and tracking of emergent and ongoing drug use practices.

HIV-related oral disease epidemiology among women: year 2000 update.

The goals of this literature review were to (1) update a prior review [Shiboski CH (1997) The epidemiology of HIV-related oral manifestations in women: a review. Oral Dis 3: S18-S27] of studies on the epidemiology of HIV-related oral manifestations in women prior to the availability of highly active antiretroviral therapy (HAART); (2) explore the effect of HAART on HIV-related oral disease among women; and (3) explore future research directions with respect to HIV-related oral disease epidemiology among African women. A computer-assisted search was conducted to identify studies on the prevalence of oral conditions in HIV-infected women in relation to immunological markers and HAART [excluding studies reviewed in Shiboski CH (1997) The epidemiology of HIV-related oral manifestations in women: a review. Oral Dis 3: S18-S27]. Results were summarized and discussed for (1) studies conducted in the developed world prior to and during the era of HAART; and (2) studies conducted in sub-Saharan Africa. Candidiasis (OC) is the most common oral lesion among HIV-infected women, and has been found to be associated with a low CD4 count and a high plasma viral load. Preliminary findings suggest that HAART is associated with a decreasing OC incidence. The few studies identified on HIV-related oral disease in African women suggest that OC is also a common condition in this setting. Future oral epidemiology research efforts in Africa should focus on the potential role of OC as sentinel marker of HIV infection and disease progression, to improve detection and prevention of selected opportunistic illnesses.

Lumbar transverse process fractures — a sentinel marker of abdominal organ injuries

Fractures of lumbar vertebrae may be associated with abdominal organ injuries. Lumbar transverse process fractures are commonly thought of as minor injuries compared with body, pedicle and lamina fractures. To determine the significance of transverse process fractures as opposed to other lumbar vertebral fractures in relation to abdominal organ injury, a retrospective study was performed. One hundred and ninety-one patients with lumbar spine fractures were reviewed. One hundred and thirty-five (71%) of these had non-transverse process (NTP) fractures only (including vertebral body, pedicle, or spinous process fractures). Fourty-two patients (22%) had transverse process fractures only. Fourteen patients (7%) had both transverse process and NTP fractures. Twenty (48%) of the 42 patients with transverse process fractures had abdominal organ injuries identified. This was a significantly ( P<0.05) higher rate than for the patients with NTP fractures, eight of 135 (6%). Patients with transverse process fractures and abdominal organ injuries had a median injury severity score (ISS) of 29 compared with a median ISS of 17 for patients with NTP fractures and abdominal organ injuries. If a transverse process has been fractured, there is likely to have been very large forces involved in the incident. The data strongly suggest that lumbar transverse process fractures should not be thought of as minor injuries but regarded as a significant marker for abdominal organ injuries and should alert the doctor caring for the injured patient of the high probability of these injuries.

Recognition and Use of Sentinel Markers in Preventing Industrial Disasters

AbstractWorkers, managers, occupational health and safety inspectors, and the general community can be trained to detect and promote action by the use of sentinel markers for detecting industrial disasters. A sentinel marker is a pre-disaster warning sign of impending failure in prevention. Administration sentinel markers are: weak occupational health and safety programs; lack of spontaneous access to top management; failure to accept responsibility for sub-contractors; absence of written disaster plans and drills for emergency response in the factory and in the adjacent community; non-investigation of prodromal leaks, exposures, spills, or injuries; punishment of “trouble-some” individuals (“whistleblowers”) reporting prodromal events; non-use or misuse of data on illness, injury, and absenteeism; and sub-optimal work conditions and supervision of shift workers. Information sentinel markers are: absence of worker and community right-to-know programs; non-use of data on earlier mishaps from similar technologies; and failure to provide toxicologic data to hospitals in the pre-disaster phase. Technological sentinel markers include the absence of fail-safe controls, interlocks, and automated alarm systems driven by real-time monitoring. Transportation sentinel markers include sub-optimal vehicle standards, alcohol and drug abuse, and fatigue in drivers. Preventive programs based on identification of all sentinel markers by workers and others outside a narrow spectrum of specialists are suggested to be more effective than are selective actions based on risk assessment analysis.