Surfactant therapy improves gas exchange in the majority of patients with GBS pneumonia. The response to surfactant is slower than in infants with RDS, and repeated surfactant doses are often needed. The mortality and morbidity are substantial, considering the relatively high mean birth weight of the treated infants.
The concept of attributable risk has been developed to quantify that proportion of disease events in a population that can be ascribed to an exposure factor under study. Typically, several exposures have to be considered simultaneously in observational epidemiological studies when assessing their impact on the disease load. Whenever these exposures are subject of complex interactions the question arises, what contribution should be assigned to each of them. The paper points out that the epidemiological problem of finding "sensible" risk allocation methods can,be formalized in a way that is equivalent to the game-theoretic description of several players that act together in a gnnd coalition and are faced with the problem of dividing their profit "fairly" among them. The transfer of game-theoretic results to epidemiology yields a unique method of allocating shares of the joint attributable risk, called partial attributable risks, to each exposure factor. Application and justification of the method are illustrated using data from the G.R.1.P.-study (Gottinger Risikcr, Inzidenz-und Pravalenzstudie).
There is conflicting evidence concerning seasonal variability of patch test results and no evidence concerning the influence of season on weak-positive, possibly false-positive, irritant reactions, which was analysed in the present study. Data collected in the German Information Network of Departments of Dermatology (IVDK) 1992 to 1997 were combined with external environmental data on temperature and absolute humidity in Germany, and bivariate as well as logistic regression analyses performed concerning the association between reactivity to selected allergens and air temperature and absolute humidity on the respective days of patch testing. Between 39,239 and 41,629 patients had been tested with the 4 allergens considered here. Only formaldehyde exhibited a distinct increase in questionable or irritant as well as weak-positive reactions associated with dry, cold weather. Methylchloroisothiazolinone/methylisothiazolinone and lanolin alcohol showed only a weak, and epoxy resin no, association with climatic conditions. The results indicate that weak-positive reactions, at least to formaldehyde as a prototype of an allergen which is at the same time a marginal irritant, may sometimes be irritant rather than allergic. Patients showing these should be re-tested to improve the poor reproducibilty observed with this allergen.
The epidemiological problem of risk attribution in the framework of multiple exposures has been the subject of intensive research activities in the last decade. In particular, partitioning methods have been developed to define new multidimensional measures of attributable risk putting the task of quantifying a proportion of disease events in a population that can be ascribed to the adverse health effects of certain risk factors into a multifactorial perspective. The parameters generalize the concept of attributable risk to different multifactorial frameworks in which multiple exposures might be arranged in hierarchically ordered classes or in equally ranking groups. Partitioning methods are reviewed and differences between the multifactorial variants of attributable risk are illustrated by a component causes model.
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