Case-Crossover Analysis of Air Pollution Health Effects: A Systematic Review of Methodology and Application

10 pages, 2 figures, 5 tables.-- PMID: 20356818 [PubMed].--PMCID: PMC2920078.-- Printed version published Aug 2010.BACKGROUND: Case-crossover is one of the most used designs for analyzing the health-related effects of air pollution. Nevertheless, no one has reviewed its application and methodology in this context.OBJECTIVE: We conducted a systematic review of case-crossover (CCO) designs used to study the relationship between air pollution and morbidity and mortality, from the standpoint of methodology and application.DATA SOURCES AND EXTRACTION: A search was made of the MEDLINE and EMBASE databases.Reports were classified as methodologic or applied. From the latter, the following information was extracted: author, study location, year, type of population (general or patients), dependent variable(s), independent variable(s), type of CCO design, and whether effect modification was analyzed for variables at the individual level.DATA SYNTHESIS: The review covered 105 reports that fulfilled the inclusion criteria. Of these, 24 addressed methodological aspects, and the remainder involved the design's application. In the methodological reports, the designs that yielded the best results in simulation were symmetric bidirectional CCO and time-stratified CCO. Furthermore, we observed an increase across time in the use of certain CCO designs, mainly symmetric bidirectional and time-stratified CCO. The dependent variables most frequently analyzed were those relating to hospital morbidity; the pollutants most often studied were those linked to particulate matter. Among the CCO-application reports, 13.6% studied effect modification for variables at the individual level.CONCLUSIONS: The use of CCO designs has undergone considerable growth; the most widely used designs were those that yielded better results in simulation studies: symmetric bidirectional and time-stratified CCO. However, the advantages of CCO as a method of analysis of variables at the individual level are put to little use.This study was supported by grant CIBERESP-MET-007 from the Consortium for Biomedical Research in Epidemiology and Public Health [CIBER en Epidemiología y Salud Pública (CIBERESP)], Spain. A.T. was funded by project PI080354 [Fondo de Investigaciones Sanitarias (FIS)] of the Subdirectorate-General for Research Evaluation and Development and by project 200930I008 [Consejo Superior de Investigaciones Científicas (CSIC)].This study was supported by grant CIBERESP-MET-007 from the Consortium for Biomedical Research in Epidemiology and Public Health [CIBER en Epidemiología y Salud Pública (CIBERESP)], Spain. A.T. was funded by project PI080354 [Fondo de Investigaciones Sanitarias (FIS)] of the Subdirectorate-General for Research Evaluation and Development and by project 200930I008 [Consejo Superior de Investigaciones Científicas (CSIC)].Peer reviewe

Surgical bacterial infections and antimicrobial susceptibility patterns at Lilongwe Central Hospital

A cross sectional study was done between October 1999 and February 2000 to determine antimicrobial susceptibility patterns of consecutive bacterial isolates of 102 clinical samples among surgical in-patients at Lilongwe Central hospital (LCH), Malawi. Antimicrobial susceptibility was determined using comparative disc diffusion techniques. 83 (81.4%) samples were culture positive for bacterial growth while 19 (18.6%) grew nothing. Of the 93 culture positive specimens, Staphylococcus aureus was the predominant organism 43(51.8%) followed by Proteus species 8(9.6%) and E. coli 7(8.4%). Overall, 98.6% of all isolates tested against ciprofloxacin were susceptible, and against gentamicin and flucloxacin were 84.8% and 66.7% respectively. 59.3% of isolates tested against chloramphenicol were resistant. We recommend a review on the use of chloramphenicol as first-line antimicrobial therapy among surgical in-patients at Lilongwe Central Hospital. We also recommend restricted use of antimicrobials so as to minimise development of drug resistance. Periodic susceptibility studies are necessary to guide judicious use of antibiotics. Malawi Medical Journal Vol 13, No.3 (Sept 2001): pp27-2