Qualitative Environmental Health Research: An Analysis of the Literature, 1991-2008

BACKGROUND. Recent articles have advocated for the use of qualitative methods in environmental health research. Qualitative research uses nonnumeric data to understand people's opinions, motives, understanding, and beliefs about events or phenomena. OBJECTIVE. In this analysis of the literature, I report the use of qualitative methods and data in the study of the relationship between environmental exposures and human health. DATA SOURCES. A primary search on ISI Web of Knowledge/Web of Science for peer-reviewed journal articles dated from 1991 through 2008 included the following three terms: qualitative, environ*, and health. Inclusion and exclusion criteria are described. DATA EXTRACTION. Searches resulted in 3,155 records. Data were extracted and findings of articles analyzed to determine where and by whom qualitative environmental health research is conducted and published, the types of methods and analyses used in qualitative studies of environmental health, and the types of information qualitative data contribute to environmental health. DATA SYNTHESIS. Ninety-one articles met inclusion criteria. These articles were published in 58 different journals, with a maximum of eight for a single journal. The results highlight a diversity of disciplines and techniques among researchers who used qualitative methods to study environmental health, with most studies relying on one-on-one interviews. Details of the analyses were absent from a large number of studies. Nearly all of the studies identified increased scientific understanding of lay perceptions of environmental health exposures. DISCUSSION AND CONCLUSIONS. Qualitative data are published in traditionally quantitative environmental health studies to a limited extent. However, this analysis demonstrates the potential of qualitative data to improve understanding of complex exposure pathways, including the influence of social factors on environmental health, and health outcomes.National Institute of Environmental Health Sciences (R25 ES012084, P42ES007381

Pressure injury progression and factors associated with different end-points in a home palliative care setting : a retrospective chart review study

CONTEXT: Patients with advanced illnesses show the highest prevalence for pressure injuries. In the palliative care setting, the ultimate goal is injury healing, but equally important is wound maintenance, wound palliation (wound-related pain and symptom management), and primary and secondary wound prevention. OBJECTIVES: To describe the course of healing for pressure injuries in a home palliative care setting according to different end-points, and to explore patient and caregiver characteristics and specific care activities associated with their achievement. METHODS: Four-year retrospective chart review of 669 patients cared for in a home palliative care service, of those 124 patients (18.5%) had at least one pressure injury with a survival rate less than or equal to six months. RESULTS: The proportion of healed pressure injuries was 24.4%. Of the injuries not healed, 34.0% were in a maintenance phase, whereas 63.6% were in a process of deterioration. Body mass index (P = 0.0014), artificial nutrition (P = 0.002), and age <70 years (P = 0.022) emerged as predictive factors of pressure injury complete healing. Artificial nutrition, age, male caregiver (P = 0.034), and spouse (P = 0.036) were factors significantly associated with a more rapid pressure injury healing. Continuous deep sedation was a predictive factor for pressure injury deterioration and significantly associated with a more rapid worsening. CONCLUSION: Pressure injury healing is a realistic aim in home palliative care, particularly for injuries not exceeding Stage II occurring at least two weeks before death. When assessing pressure injuries, our results highlight the need to also pay attention to artificial nutrition, continuous deep sedation, and the caregiver's role and gender

Exposure to benzene at work and the risk of leukemia: a systematic review and meta-analysis

Background A substantial number of epidemiologic studies have provided estimates of the relation between exposure to benzene at work and the risk of leukemia, but the results have been heterogeneous. To bridge this gap in knowledge, we synthesized the existing epidemiologic evidence on the relation between occupational exposure to benzene and the risk of leukemia, including all types combined and the four main subgroups acute myeloid leukemia (AML), acute lymphocytic leukemia (ALL), chronic lymphocytic leukemia (CLL), and chronic myeloid leukemia (CML). Methods A systematic literature review was carried out using two databases 'Medline' and 'Embase' from 1950 through to July 2009. We selected articles which provided information that can be used to estimate the relation between benzene exposure and cancer risk (effect size). Results In total 15 studies were identified in the search, providing 16 effect estimates for the main analysis. The summary effect size for any leukemia from the fixed-effects model was 1.40 (95% CI, 1.23-1.57), but the study-specific estimates were strongly heterogeneous (I2 = 56.5%, Q stat = 34.47, p = 0.003). The random-effects model yielded a summary- effect size estimate of 1.72 (95% CI, 1.37-2.17). Effect estimates from 9 studies were based on cumulative exposures. In these studies the risk of leukemia increased with a dose-response pattern with a summary-effect estimate of 1.64 (95% CI, 1.13-2.39) for low (< 40 ppm-years), 1.90 (95% CI, 1.26-2.89) for medium (40-99.9 ppm-years), and 2.62 (95% CI, 1.57-4.39) for high exposure category (> 100 ppm-years). In a meta-regression, the trend was statistically significant (P = 0.015). Use of cumulative exposure eliminated heterogeneity. The risk of AML also increased from low (1.94, 95% CI, 0.95-3.95), medium (2.32, 95% CI, 0.91-5.94) to high exposure category (3.20, 95% CI, 1.09-9.45), but the trend was not statistically significant. Conclusions Our study provides consistent evidence that exposure to benzene at work increases the risk of leukemia with a dose-response pattern. There was some evidence of an increased risk of AML and CLL. The meta-analysis indicated a lack of association between benzene exposure and the risk of CML

Assessment of the usefulness of a diagnostic test: A survey of patient preference for diagnostic techniques in the evaluation of intestinal inflammation

BACKGROUND: In order to assess the usefulness of radiolabeled white cell scanning in the diagnosis of intestinal inflammation, subjects were asked to rank several dimensions of preference for white cell scanning in relation to other diagnostic tests. Two groups were surveyed: one known to have inflammatory bowel disease and the second not familiar in most cases with the tests. Subjects were asked to rank preference for each of seven tests: radiolabeled white cell scan, colonoscopy, barium enema, sigmoidoscopy, enteroclysis, stool analysis and laparotomy for the diagnosis of IBD and impressions of discomfort, embarrassment, inconvenience and danger related to each test. Mean rank scores were calculated, test ranks compared within groups and significance determined by the Wilcoxon rank test. RESULTS: Significant differences were seen in overall preference for white cell scan over barium enema and colonoscopy (p < 0.01) in both survey groups. Perceived discomfort and embarrassment demonstrated similar rankings. CONCLUSION: This patient preference combined with the reported accuracy of white cell scanning further establishes the usefulness of this means of IBD diagnosis

Metabolic, inflammatory and haemostatic effects of a low-dose continuous combined HRT in women with type 2 diabetes: potentially safer with respect to vascular risk?

BACKGROUND Conventional hormone replacement therapy (HRT) containing conjugated equine oestrogen (CEE) and medroxyprogesterone acetate (MPA) increases triglyceride, C- reactive protein (CRP) and coagulation Factor VII concentrations, potentially explaining their increased coronary heart disease (CHD) and stroke risk. OBJECTIVE To assess the metabolic effects of a continuous combined HRT containing 1 mg oestradiol and 0.5 mg norethisterone or matching placebo. DESIGN Double-blind, randomized placebo-controlled trial. PATIENTS Fifty women with type 2 diabetes. MEASUREMENTS Classical and novel risk factors for vascular disease. RESULTS Triglyceride concentration was not altered (P = 0.31, change in active arm relative to placebo) and low-density lipoprotein (LDL) cholesterol concentration declined 13% (P = 0.018). IL-6 concentration (mean difference -1.42 pg/ml, 95% CI: -2.55 to - 0.29 IU/dl, P = 0.015), Factor VII (-32 IU/dl, -43 to -21 IU/l, P lt 0.001) and tissue plasminogen activator antigen (by 13%, P = 0.005) concentrations fell, but CRP was not significantly altered (P = 0.62). Fasting glucose (P = 0.026) also declined significantly, but there are no significant effects on HBA1c, Factor IX or APC resistance. CONCLUSIONS HRT containing 1 mg oestradiol and 0.5 mg norethisterone may avoid the adverse metabolic effects potentially implicated in the elevated CHD and stroke risk induced by conventional higher dose HRT. This type of preparation may therefore be more suitable than conventional HRT for women at elevated CHD risk such as those with type 2 diabetes. Large randomized controlled trials of such low dose preparations, powered for cardiovascular end points, are now needed

Towards an integrated crowdsourcing definition

Crowdsourcing is a relatively recent concept that encompasses many practices. This diversity leads to the blurring of the limits of crowdsourcing that may be identified virtually with any type of internet-based collaborative activity, such as co-creation or user innovation. Varying definitions of crowdsourcing exist, and therefore some authors present certain specific examples of crowdsourcing as paradigmatic, while others present the same examples as the opposite. In this article, existing definitions of crowdsourcing are analysed to extract common elements and to establish the basic characteristics of any crowdsourcing initiative. Based on these existing definitions, an exhaustive and consistent definition for crowdsourcing is presented and contrasted in 11 cases.Estelles Arolas, E.; González-Ladrón-De-Guevara, F. (2012). Towards an integrated crowdsourcing definition. Journal of Information Science. 32(2):189-200. doi:10.1177/0165551512437638S189200322Vukovic, M., & Bartolini, C. (2010). Towards a Research Agenda for Enterprise Crowdsourcing. Leveraging Applications of Formal Methods, Verification, and Validation, 425-434. doi:10.1007/978-3-642-16558-0_36Brabham, D. C. (2008). Crowdsourcing as a Model for Problem Solving. Convergence: The International Journal of Research into New Media Technologies, 14(1), 75-90. doi:10.1177/1354856507084420Vukovic, M. (2009). Crowdsourcing for Enterprises. 2009 Congress on Services - I. doi:10.1109/services-i.2009.56Doan, A., Ramakrishnan, R., & Halevy, A. Y. (2011). Crowdsourcing systems on the World-Wide Web. Communications of the ACM, 54(4), 86. doi:10.1145/1924421.1924442Brabham, D. C. (2008). Moving the crowd at iStockphoto: The composition of the crowd and motivations for participation in a crowdsourcing application. First Monday, 13(6). doi:10.5210/fm.v13i6.2159Huberman, B. A., Romero, D. M., & Wu, F. (2009). Crowdsourcing, attention and productivity. Journal of Information Science, 35(6), 758-765. doi:10.1177/0165551509346786Andriole, S. J. (2010). Business impact of Web 2.0 technologies. Communications of the ACM, 53(12), 67. doi:10.1145/1859204.1859225Denyer, D., Tranfield, D., & van Aken, J. E. (2008). Developing Design Propositions through Research Synthesis. Organization Studies, 29(3), 393-413. doi:10.1177/0170840607088020Egger, M., Smith, G. D., & Altman, D. G. (Eds.). (2001). Systematic Reviews in Health Care. doi:10.1002/9780470693926Tatarkiewicz, W. (1980). A History of Six Ideas. doi:10.1007/978-94-009-8805-7Cosma, G., & Joy, M. (2008). Towards a Definition of Source-Code Plagiarism. IEEE Transactions on Education, 51(2), 195-200. doi:10.1109/te.2007.906776Brabham, D. C. (2009). Crowdsourcing the Public Participation Process for Planning Projects. Planning Theory, 8(3), 242-262. doi:10.1177/1473095209104824Alonso, O., & Lease, M. (2011). Crowdsourcing 101. Proceedings of the fourth ACM international conference on Web search and data mining - WSDM ’11. doi:10.1145/1935826.1935831Bederson, B. B., & Quinn, A. J. (2011). Web workers unite! addressing challenges of online laborers. Proceedings of the 2011 annual conference extended abstracts on Human factors in computing systems - CHI EA ’11. doi:10.1145/1979742.1979606Grier, D. A. (2011). Not for All Markets. Computer, 44(5), 6-8. doi:10.1109/mc.2011.155Heer, J., & Bostock, M. (2010). Crowdsourcing graphical perception. Proceedings of the 28th international conference on Human factors in computing systems - CHI ’10. doi:10.1145/1753326.1753357Heymann, P., & Garcia-Molina, H. (2011). Turkalytics. Proceedings of the 20th international conference on World wide web - WWW ’11. doi:10.1145/1963405.1963473Kazai, G. (2011). In Search of Quality in Crowdsourcing for Search Engine Evaluation. Advances in Information Retrieval, 165-176. doi:10.1007/978-3-642-20161-5_17La Vecchia, G., & Cisternino, A. (2010). Collaborative Workforce, Business Process Crowdsourcing as an Alternative of BPO. Lecture Notes in Computer Science, 425-430. doi:10.1007/978-3-642-16985-4_40Liu, E., & Porter, T. (2010). Culture and KM in China. VINE, 40(3/4), 326-333. doi:10.1108/03055721011071449Oliveira, F., Ramos, I., & Santos, L. (2010). Definition of a Crowdsourcing Innovation Service for the European SMEs. Lecture Notes in Computer Science, 412-416. doi:10.1007/978-3-642-16985-4_37Porta, M., House, B., Buckley, L., & Blitz, A. (2008). Value 2.0: eight new rules for creating and capturing value from innovative technologies. Strategy & Leadership, 36(4), 10-18. doi:10.1108/10878570810888713Ribiere, V. M., & Tuggle, F. D. (Doug). (2010). Fostering innovation with KM 2.0. VINE, 40(1), 90-101. doi:10.1108/03055721011024955Sloane, P. (2011). The brave new world of open innovation. Strategic Direction, 27(5), 3-4. doi:10.1108/02580541111125725Wexler, M. N. (2011). Reconfiguring the sociology of the crowd: exploring crowdsourcing. International Journal of Sociology and Social Policy, 31(1/2), 6-20. doi:10.1108/01443331111104779Whitla, P. (2009). Crowdsourcing and Its Application in Marketing Activities. Contemporary Management Research, 5(1). doi:10.7903/cmr.1145Yang, J., Adamic, L. A., & Ackerman, M. S. (2008). Crowdsourcing and knowledge sharing. Proceedings of the 9th ACM conference on Electronic commerce - EC ’08. doi:10.1145/1386790.1386829Brabham, D. C. (2010). MOVING THE CROWD AT THREADLESS. Information, Communication & Society, 13(8), 1122-1145. doi:10.1080/13691181003624090Giudice, K. D. (2010). Crowdsourcing credibility: The impact of audience feedback on Web page credibility. Proceedings of the American Society for Information Science and Technology, 47(1), 1-9. doi:10.1002/meet.14504701099Stewart, O., Huerta, J. M., & Sader, M. (2009). Designing crowdsourcing community for the enterprise. Proceedings of the ACM SIGKDD Workshop on Human Computation - HCOMP ’09. doi:10.1145/1600150.1600168Maslow, A. H. (1943). A theory of human motivation. Psychological Review, 50(4), 370-396. doi:10.1037/h0054346Veal, A. J. (Ed.). (2002). Leisure and tourism policy and planning. doi:10.1079/9780851995465.0000Dahlander, L., & Gann, D. M. (2010). How open is innovation? Research Policy, 39(6), 699-709. doi:10.1016/j.respol.2010.01.01

Mortality following development of breast cancer while using oestrogen or oestrogen plus progestin: a computer record-linkage study

The literature on the relationship between breast cancer mortality and postmenopausal oestrogen and combined oestrogen/progestin therapy is seemingly contradictory. This study explored survival after exposure to oestrogen or oestrogen plus progestin at or in the year prior to breast cancer diagnosis. Information on patients first diagnosed with invasive breast cancer between 1993 and 1998 was linked with outpatient pharmacy data from 1992 to 2000. Patients were classified according to use of oestrogen alone or oestrogen plus progestin at or in the year prior to diagnosis. Compared to nonusers, and adjusting for age at diagnosis, race/ethnicity, tumour size and grade, oestrogen receptor status, surgery status, and chemotherapy and hormone therapy for breast cancer treatment, oestrogen plus progestin users had lower all-cause mortality (stage I hazard ratio (HR)=0.69, 95% confidence interval (CI)=0.48–0.99; stage II HR=0.53, 95% CI=0.39–0.72) and breast cancer mortality (stage I HR=0.52, 95% CI=0.26–1.04; stage II HR=0.69, 95% CI=0.48–0.98). Oestrogen users experienced little or no survival benefit for all-cause mortality (stage I HR=1.04, 95% CI=0.77–1.42; stage II HR=0.86, 95% CI=0.65–1.14) or breast cancer mortality (stage I HR=1.23, 95% CI 0.72–2.10; stage II HR=1.01, 95% CI 0.72–1.41). Our findings suggest, relative to nonusers, a lower risk of death from all causes and from breast cancer in patients who were diagnosed with breast cancer while exposed to oestrogen plus progestin, but not in patients exposed to oestrogen only

Lipid and Lipoprotein Profiles in Youth With and Without Type 1 Diabetes: The SEARCH for Diabetes in Youth Case-Control Study

OBJECTIVE—The purpose of this study was to compare the lipid profile and the prevalence of lipid abnormalities in youth with and without type 1 diabetes and explore the role of glycemic control on the hypothesized altered lipid profile in youth with type 1 diabetes

Dental management considerations for the patient with an acquired coagulopathy. Part 1: Coagulopathies from systemic disease

Current teaching suggests that many patients are at risk for prolonged bleeding during and following invasive dental procedures, due to an acquired coagulopathy from systemic disease and/or from medications. However, treatment standards for these patients often are the result of long-standing dogma with little or no scientific basis. The medical history is critical for the identification of patients potentially at risk for prolonged bleeding from dental treatment. Some time-honoured laboratory tests have little or no use in community dental practice. Loss of functioning hepatic, renal, or bone marrow tissue predisposes to acquired coagulopathies through different mechanisms, but the relationship to oral haemostasis is poorly understood. Given the lack of established, science-based standards, proper dental management requires an understanding of certain principles of pathophysiology for these medical conditions and a few standard laboratory tests. Making changes in anticoagulant drug regimens are often unwarranted and/or expensive, and can put patients at far greater risk for morbidity and mortality than the unlikely outcome of postoperative bleeding. It should be recognised that prolonged bleeding is a rare event following invasive dental procedures, and therefore the vast majority of patients with suspected acquired coagulopathies are best managed in the community practice setting

Physical Activity Before and During Pregnancy and Risk of Gestational Diabetes Mellitus: A meta-analysis

OBJECTIVE: Gestational diabetes mellitus (GDM) is one of the most common complications of pregnancy and is associated with a substantially elevated risk of adverse health outcomes for both mothers and offspring. Physical activity may contribute to the prevention of GDM and thus is crucial for dissecting the vicious circle involving GDM, childhood obesity, and adulthood obesity, and diabetes. Therefore, we aimed to systematically review and synthesize the current evidence on the relation between physical activity and the development of GDM. RESEARCH DESIGN AND METHODS: Medline, EMBASE, and Cochrane Reviews were searched from inception to 31 March 2010. Studies assessing the relationship between physical activity and subsequent development of GDM were included. Characteristics including study design, country, GDM diagnostic criteria, ascertainment of physical activity, timing of exposure (prepregnancy or early pregnancy), adjusted relative risks, CIs, and statistical methods were extracted independently by two reviewers. RESULTS: Our search identified seven prepregnancy and five early pregnancy studies, including five prospective cohorts, two retrospective case-control studies, and two cross-sectional study designs. Prepregnancy physical activity was assessed in 34,929 total participants, which included 2,813 cases of GDM, giving a pooled odds ratio (OR) of 0.45 (95% CI 0.28–0.75) when the highest versus lowest categories were compared. Exercise in early pregnancy was assessed in 4,401 total participants, which included 361 cases of GDM, and was also significantly protective (0.76 [95% CI 0.70–0.83]). CONCLUSIONS: Higher levels of physical activity before pregnancy or in early pregnancy are associated with a significantly lower risk of developing GDM