Predicting fluctuations in annual risk of Lyme disease would be useful in focusing public health efforts. However, several competing hypotheses have been proposed that point to weather variables, acorn production, or mouse abundance as important predictors of Lyme disease risk. We compared the ability of acorn production, mouse density, and four relevant weather variables to predict annual Lyme disease incidence (detrended) between 1992 and 2002 for Dutchess County, New York, and seven states in the northeastern United States. Acorn production and mouse abundance measured in Dutchess County were the strongest predictors (r ≥ 0.78) of Dutchess County Lyme disease incidence, but the increase in mouse abundance from 1991 to 1992 was contrary to a decrease in Lyme disease in the following years. The Palmer Hydrologic Drought Index (PHDI) was a significant positive predictor of Lyme disease incidence two years later for three states (0.58 ≤ r ≤ 0.88), but summer precipitation was generally negatively correlated with Lyme disease incidence the next year (−0.79 ≤ r ≤ 0.02). Mean temperatures for the prior winter or summer showed weak or inconsistent correlations with Lyme disease incidence. In four states, no variable was a statistically significant predictor of Lyme disease incidence. Synchrony in Lyme disease incidence between pairs of states was not significantly concordant with synchrony in any weather variable that we examined (0.02 ≤ r ≤ 0.21). We found that acorns and mice were strong predictors of Dutchess County Lyme disease incidence, but their predictive power appeared to be weaker spatially. Moreover, evidence was weak for causal relationships between Lyme disease incidence and the weather variables that we tested. Reliable prediction of Lyme disease incidence may require the identification of new predictors or combinations of biotic and abiotic predictors and may be limited to local scales.
Many previous studies have considered patient re-admission rates alone as the true rate of secondary haemorrhage following adult tonsillectomy. We aimed to determine the true rate of secondary haemorrhage following tonsillectomy in adults by performing a telephone interview with 60 consecutive patients. Whilst 40% (n = 24) of our patients reported a significant episode of bleeding (blood actively flowing from their mouth for more than 1 min) following discharge, only 8% (n = 5) were re-admitted and only 3% (n = 2) required return to theatre. Review of the current literature suggests that return-to-theatre rates are more consistent than hospital re-admission rates in large studies. We would suggest that although secondary haemorrhage can occasionally be very serious, the majority is minor, and it would therefore be more useful when comparing different techniques for tonsillectomy to consider numbers of patients returning to theatre rather than re-admission rates.
L yme disease is an emerging zoonosis caused by the spirochete bacterium Borrelia burgdorferi, which is transmitted between vertebrate hosts, including humans, by ticks in the Ixodes ricinus complex. Annual cases of Lyme disease in the United States, as reported to the Centers for Disease Control and Prevention (1), have grown from a few hundred in the early 1980s to >30,000 in recent years. A recent study estimated that actual clinician diagnoses of Lyme disease in the past decade exceed 450,000 per year (2,3). Increasing incidence over the past few decades reflects both upward trends in case numbers within Lyme diseaseendemic locations and a dramatic geographic spread from both northeastern and Midwestern foci (4-6). Beyond the effects of Lyme disease on human health, economic costs of patient care are estimated at ≈$1 billion/year in the United States (7).Preventing exposure to B. burgdorferi and other tickborne pathogens can be aided by personal practices such as applying repellents, checking for ticks, and avoiding tick habitats. However, the efficacy of these methods is unclear, and considerable differences in effects have been reported (8,9). Although specific methods of property and wildlife management (e.g., deer hunting) are advocated by some agencies (10), knowledge of the effectiveness of these recommendations in reducing human encounters with ticks and incidence of tickborne diseases (TBDs) is limited (11-13).
The objective of the study was to review referral practice, overall management, and survival in women with suspected ovarian cancer in Wales. This study was done prior to introduction of cancer management guidelines in the region. A confidential study questionnaire was sent to 20 participating hospitals. Data on 287 consecutive women with suspected ovarian cancer were collected, of which 250 women underwent primary laparotomy. Information was obtained on referral pattern, preoperative investigations, place of primary surgery, specialty of the primary surgeon, surgical parameters recorded at the time of operation, a final overall stage, adjuvant treatment, and survival outcome. There was a wide variation in referral practice and management of ovarian cancer in Wales. Stage of the disease, attempt at optimal debulking, residual disease, management by a cancer centre multidisciplinary team, and platinum-based chemotherapy were associated with improved overall survival and progression-free survival. More women were alive if managed in the cancer centre at 1 and 3 year after diagnosis (P = 0.022). This study has highlighted the acute issue of the standards of clinical care in the area of ovarian cancer management and will emphasize the implementation of better care pathways for ovarian cancers.
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