Estimation of safe doses: critical review of the hockey stick regression method.

Yanagimoto, Takemi; Yamamoto, Etsuhide

doi:10.1289/ehp.7932193

Cited by 41 publications

(27 citation statements)

References 7 publications

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“…The hockey stick model can treat a logtransformed outcome variable, as shown in Fig. 1, but can also provide a 95% lower confidence limit 28) ; regrettably, none of the studies cited in the present review calculated this 50,75) . Also, a model of multivariate regression could control for possible confounders such as age, inasmuch as the polynomial regression models are frequently used when the linear regression model does not fit well 28) .…”

Section: Methods For Estimation Of Critical Dosementioning

confidence: 82%

“…We used P 0 of 5% and BMR of 5% as mentioned above, and the cutoff value for an average subject was computed by using the normalized value (i.e., [X i -X mean ]/SD) for each confounder (X i ). The BMD calculation, along with hockey stick regression analysis, i.e., a regression model using segmented curves 28) , was performed using the Statistical Package for the Biosciences (SPBS V9.54) 29,30) .…”

Section: Data Sources and Extractionmentioning

confidence: 99%

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Lead Toxicity: Does the Critical Level of Lead Resulting in Adverse Effects Differ between Adults and Children?

Murata

Iwata

Dakeishi

et al. 2009

Journal of Occupational Health

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µg/dl for industrial workers and 5 µg/dl for children. To examine whether the critical level of lead producing adverse effects truly differs between workers and children, we provided an overview of studies addressing the critical level of lead in workers, together with a perspective on lead toxicity in children. Data sources and extraction: In 25 reports published in English with keywords of "benchmark dose (BMD)," "lead" and "humans," only five studies proved to be relevant to lead toxicity. Four more studies with figures illustrating significant relationships between lead and neurotoxic outcomes were selected. Data synthesis: Based on data from previous reports using a BMD approach, the critical organ of lead in workers was thought to be the nervous system and the critical BPb level (numberweighted mean) was between 10.7 and 17.5 µg/dl. The neurotoxic effects of lead exposure at such levels seemed reversible. The BPb level at which leadassociated intellectual deficits occurred in children was as low as the critical level of BPb (below 5 µg/dl) for inhibited heme synthesis in workers. Conclusions: The neurotoxic effects of lead in workers appear to be initiated at BPb levels below 18 µg/dl, which are somewhat higher than the critical level of lead neurotoxicity in children. Each national institute for risk Review management should take evidence-based preventive action against subclinical lead poisoning in workers, as well as in children. (J Occup Health 2009; 51: 1-12)

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Section: Methods For Estimation Of Critical Dosementioning

confidence: 82%

Section: Data Sources and Extractionmentioning

confidence: 99%

Lead Toxicity: Does the Critical Level of Lead Resulting in Adverse Effects Differ between Adults and Children?

Murata

Iwata

Dakeishi

et al. 2009

Journal of Occupational Health

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show abstract

“…We tested each study year as a potential inflection point by fitting a model with separate linear slopes in the years preceding and the years after that point. 24,33 Within each plan and age group, the year for which the model had the smallest Akaike information criterion was designated the most likely year for a change in slope. If this 2-slope model fit significantly better than the single-slope model (P , .05), we calculated the percent year-to-year decline preinflection and postinflection.…”

mentioning

confidence: 99%

Recent Trends in Outpatient Antibiotic Use in Children

et al. 2014

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WHAT'S KNOWN ON THIS SUBJECT: Antibiotic use for children has decreased dramatically over the last 20 years. Programs encouraging judicious antibiotic use have focused both on decreasing overall antibiotic use and appropriate prescribing of broad-spectrum agents. WHAT THIS STUDY ADDS:Large declines in antibiotic rates were prominent in the early 2000s. This trend has attenuated, and use has leveled off in some age groups and locales; continued improvement in the use of broad-spectrum agents is possible.abstract OBJECTIVE: The goal of this study was to determine changes in antibiotic-dispensing rates among children in 3 health plans located in New England [A], the Mountain West [B], and the Midwest [C] regions of the United States. METHODS: Pharmacy and outpatient claims from September 2000 toAugust 2010 were used to calculate rates of antibiotic dispensing per person-year for children aged 3 months to 18 years. Differences in rates by year, diagnosis, and health plan were tested by using Poisson regression. The data were analyzed to determine whether there was a change in the rate of decline over time.RESULTS: Antibiotic use in the 3-to ,24-month age group varied at baseline according to health plan (A: 2.27, B: 1.40, C: 2.23 antibiotics per person-year; P , .001). The downward trend in antibiotic dispensing slowed, stabilized, or reversed during this 10-year period. In the 3-to ,24-month age group, we observed 5.0%, 9.3%, and 7.2% annual declines early in the decade in the 3 plans, respectively. These dropped to 2.4%, 2.1%, and 0.5% annual declines by the end of the decade. Third-generation cephalosporin use for otitis media increased 1.6-, 15-, and 5.5-fold in plans A, B, and C in young children. Similar attenuation of decline in antibiotic use and increases in use of broadspectrum agents were seen in other age groups.CONCLUSIONS: Antibiotic dispensing for children may have reached a new plateau. Along with identifying best practices in low-prescribing areas, decreasing broad-spectrum use for particular conditions should be a continuing focus of intervention efforts. 22 For children aged ,5 years, in whom antibiotic utilization is highest, an impressive 36% reduction in the use of antibiotics for RTIs occurred between 1995 and 2006. 23 It is unknown whether the previous downward trend in antibiotic use will continue or if a leveling off of prescribing will soon be reached. Stabilization of antibiotic use rates may be appropriate if principles of judicious use are being followed or it may signal the need for new interventions. A recent study from a limited number of communities in Massachusetts indicated that stabilization of dispensing has occurred in children aged ,6 years. 24 Because geographic variation exists in antibiotic prescribing, 21,25-27 we investigated trends in community antibiotic dispensing in children aged ,18 years insured by 3 geographically distinct health plans to examine whether rates have leveled off at these sites. We also explored trends in antibiotic utilization for common infect...

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“…We used "hockey stick" regression 23 within each age group to fit 2 distinct linear trends over time. Briefly, this method allows detection of a deviation from a simple linear trend, by dividing the overall study period into 2 subperiods with different linear slopes.…”

Section: Discussionmentioning

confidence: 99%

Trends in Antibiotic Use in Massachusetts Children, 2000-2009

2012

PEDIATRICS

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Estimation of safe doses: critical review of the hockey stick regression method.

Cited by 41 publications

References 7 publications

Lead Toxicity: Does the Critical Level of Lead Resulting in Adverse Effects Differ between Adults and Children?

Lead Toxicity: Does the Critical Level of Lead Resulting in Adverse Effects Differ between Adults and Children?

Recent Trends in Outpatient Antibiotic Use in Children

Trends in Antibiotic Use in Massachusetts Children, 2000-2009

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