Search

Background: Questionnaires can be used to assess perceived indoor air quality and symptoms in schools. Questionnaires for primary school aged children have traditionally been parent-administered, but self-administered questionnaires would be easier to administer and may yield as good, if not better, information. Our aim was to compare the repeatability of self- and parent-administered indoor air questionnaires designed for primary school aged pupils., Methods: Indoor air questionnaire with questions on child's symptoms and perceived indoor air quality in schools was sent to parents of pupils aged 7-12 years in two schools and again after two weeks. Slightly modified version of the questionnaire was administered to pupils aged 9-12 years in another two schools and repeated after a week. 351 (52%) parents and 319 pupils (86%) answered both the first and the second questionnaire. Test-retest repeatability was assessed with intra-class correlation (ICC) and Cohen's kappa coefficients (k)., Results: Test-retest repeatability was generally between 0.4-0.7 (ICC; k) in both self- and parent-administered questionnaire. In majority of the questions on symptoms and perceived indoor air quality test-retest repeatability was at the same level or slightly better in self-administered compared to parent-administered questionnaire. Agreement of self- and parent administered questionnaires was generally < 0.4 (ICC; k) in reported symptoms and 0.4-0.6 (ICC; k) in perceived indoor air quality., Conclusions: Children aged 9-12 years can give as, or even more, repeatable information about their respiratory symptoms and perceived indoor air quality than their parents. Therefore, it may be possible to use self-administered questionnaires in future studies also with children.

Aim: To investigate whether seasonal changes had an effect on the incidence of acute appendicitis (AA) or nonspecific abdominal pain (NSAP)., Methods: We carried out a national register study of all patients with a hospital discharge diagnosis of AA and acute NSAP in Finland. Data were analyzed for the whole country and correlated to seasonal and weather parameters (temperature, humidity). Moreover, additional sub-analyses were performed for five geographically different area of Finland., Results: The observation period spanned 21 years, with 186558 appendectomies, of which 137528 (74%) cases were reported as AA. The incidence of AA declined for 32% over the study period. The average incidence of the NSAP was 34/10000 per year. The mean annual temperature, but not relative humidity, showed clear geographical variations. The incidence of AA decreased significantly during the cold months of the year. No correlation was detected between temperature and incidence of NSAP. Humidity had a statistically significant impact on NSAP., Conclusion: The incidence of acute appendicitis is declining in Finland. We detected a clear seasonality in the incidence of AA and NSAP.

Background: Nonspecific abdominal pain is the commonest cause of a patient presenting to a doctor with abdominal pain of less than one week's duration. The differential diagnosis of NSAP is not always easy due to many similarities in the clinical presentation at onset and many cases may be misdiagnosed in the initial situation. To the Authors' knowledge, the diagnostic accuracy of history-taking is rarely considered in NSAP, and therefore the aim of the present study was to investigate the contribution of history-taking to correctly diagnosing NSAP in the clinical situation., Patients and Methods: The accuracy of clinical diagnosis of NSAP was studied in connection with the survey of acute abdominal pain by the Research Committee of the World Organization of Gastroenterology (OMGE). In an extension of the OMGE acute abdominal pain study, 1333 patients presenting with acute abdominal pain were included in the study. The clinical symptoms of each patient were recorded in detail, using a predefined structured data collection sheet, and the collected data were compared with the final diagnosis of the patients., Results: The most significant symptoms of NSAP in univariate analysis were: vomiting (Usefulness Index, UI=0.11, Risk Ratio, RR=2.01), progression of pain (UI=0.10, RR=1.90), location of pain at diagnosis (UI=0.05, RR=1.75), intensity of pain (UI=0.05, RR=1.57) and previous indigestion (UI=0.05, RR=1.44). The sensitivity of the doctors' initial decision in detecting NSAP was 0.70, with a specificity of 0.83 and an efficiency of 0.77., Conclusion: The results of this study do not support a specific link between any one clinical symptom and NSAP diagnosis. However, patients with midline pain, without any increase in pain and without vomiting, and those with weak or moderate pain tended to be at risk for NSAP.

Background: The incidence of acute appendicitis has declined in many countries. The aim of this study was to determine the trends in incidence of acute appendicitis (AA), appendectomies for AA, and nonspecific abdominal pain (NSAP) in Finland between 1987 and 2007., Methods: We carried out a national register study. Demographic features were investigated. Diagnoses and procedures were classified according to the World Health Organization International Classification of Diseases. Data were analyzed for each of all five University Hospital districts (UHD) of Finland., Results: During the observation period of 21 years, 186,558 appendectomies were performed in Finland, of which 137,528 (74%) cases were reported as AA. The incidence of acute appendicitis declined 32%. The diagnostic accuracy improved from 73 to 82% and was higher in men. The accuracy rate among the male patients was stable throughout the two decades; among the female patients it rose from 63 to 75%. The incidence of appendicitis was highest in patients aged 15-24 years. The average incidence of NSAP was 34/10,000/year, and it was higher in older age groups. There was a large geographical disparity in the incidence of NSAP., Conclusion: The incidence of acute appendicitis as well as the incidence of appendectomies is declining in Finland. The incidence of the NSAP has also been declining but we did not find any correlations between the incidences of the acute appendicitis and NSAP. There were clear geographical differences in the incidence of NSAP but not in the incidence of AA.

The use of an artificial neural network system was studied in the diagnosis of acute abdominal pain, especially acute appendicitis, with patients from Finland and Germany. Separate Learning Vector Quantization (LVQ) neural networks were trained with a training set from each database and also with a combined database. Each neural network was evaluated separately with a test set of cases from each database. With the combined database different neighborhood methods were compared to find the optimal choice for this decision-making problem. The acute appendicitis cases of the Finnish test data set were classified well with all the networks, but the cases of the German test set were difficult to classify for the Finnish network. The use of larger neighborhoods increased the sensitivity of the classification by nearly 10%. The differences in the results of the Finnish and German databases suggest that there are differences in the data collection or patient populations between centers. Therefore, care must be taken when using decision-support systems which have been developed in other centers. Neural networks offer a method to evaluate differences between databases. With the use of larger neighborhoods, the effects of the differences on the accuracy of the classification can be partly diminished.

The role of clinical and computer based decision in the diagnosis of acute appendicitis in the elderly was studied in connection with the Research Committee of the World Organization of Gastroenterology (OMGE) survey of acute abdominal pain. A total of 220 patients over the age of 65 years presenting with acute abdominal pain were included in the study at the Central Hospital of Savonlinna and at the University Hospital of Tampere. Twenty-two preoperative clinical history variables, 14 clinical signs and three tests were evaluated in a single variable and multivariate analysis to find the best combination of predictors of acute appendicitis in the aged. In order to sum up the contributions of independent diagnostic factors, a diagnostic score (DS) was built: DS = 2.81 x (rectal digital tenderness; 1 = yes, 0 = no) + 2.54 x (rigidity; 1 = yes, 0 = no) + 2.06 x (renal tenderness; 1 = no, 0 = yes) + 2.33 x (bowel sounds; 1 = normal, 2 = absent/abnormal) - 8.13. The sensitivity of preoperative clinical decision in detecting acute appendicitis in the aged was 0.79 with a specificity of 0.92, an efficiency of 0.90 and usefulness index (UI) of 0.56. At a cut-off level of -2.78 the DS reached a sensitivity of 0.84 in detecting acute appendicitis with a specificity of 0.87, an efficiency of 0.87 and UI of 0.68. When the patients with a DS value between -2.78 and -0.45 were considered as non-defined (n = 28, follow-up required before the decision to operate), the sensitivity of the computer-aided diagnosis in detecting acute appendicitis in the elderly was 0.77 with a specificity of 0.97, an efficiency of 0.96 and UI of 0.57. In the elderly patients where a leucocyte count was available (n = 157), location of pain, rectal digital tenderness and leucocyte count predicted significantly acute appendicitis. At a cut-off level of -2.62 the DS reached a sensitivity of 0.81 in detecting acute appendicitis with a specificity of 0.92, an efficiency of 0.91 and UI of 0.59. When the patients with a DS value between -2.62 and 0.06 were considered as nondefined (n = 12, follow-up required before the decision to operate), the sensitivity of the computer-aided diagnosis (leucocyte count available) in detecting acute appendicitis in the elderly improved to 0.86 with a specificity of 0.94, an efficiency of 0.93 and UI of 0.69. In our study the diagnostic scoring system for the elderly performed well considering the simple nature of its structure.(ABSTRACT TRUNCATED AT 400 WORDS)