Quantifying Worry in the Face of Uncertainty: Radiation Exposure from Medical Imaging.

BACKGROUND: The degree to which people worry about radiation exposure from medical imaging has not been quantified. Such concern is important for clinical decision making and policy generation. OBJECTIVE: The aim of this study was to quantify the degree of worry as a consequence of radiation exposure. DESIGN: A time trade-off methodology was used to estimate health state utilities associated with radiation exposure from computed tomography scans in an inclusive sample of physicians. Health state utilities were elicited from in-person interviews using a software-guided, hypothetical scenario in which the subject is exposed to two separate computed tomography scans. RESULTS: One hundred and eighteen interviews were conducted. The overall mean and median utility values for the health state of concern due to radiation exposure were 0.95 (95% confidence interval: 0.94-0.96) and 0.98 (interquartile range: 0.91-1.00), respectively. The utility score distribution was highly skewed toward higher values. Five respondents (4.3%) recorded a utility score of ≤0.8 and 17 respondents (14.5%) were willing to sacrifice at least 5 or more years of life to live free of the radiation-exposure worry. CONCLUSIONS AND RELEVANCE: The physician respondents generally demonstrated low levels of disutility; however, a subset of physicians expressed much greater disutility for the future risk of malignancy. Given the potential for physicians to influence health care decisions and policies, further study of radiation-related concerns seems warranted. Physicians, patients, and the general public should be aware of the potential impact such differing views held by physicians may have on their clinical recommendations.

Health care worker exposures to the antibacterial agent triclosan.

OBJECTIVE: We sought to quantify absorption of triclosan, a potential endocrine disruptor, in health care workers with occupational exposure to soap containing this chemical. METHODS: A cross-sectional convenience sample of two groups of 38 health care workers at separate inpatient medical centers: hospital 1 uses 0.3% triclosan soap in all patient care areas; hospital 2 does not use triclosan-containing products. Additional exposure to triclosan-containing personal care products was assessed through a structured questionnaire. Urine triclosan was quantified and the occupational contribution estimated through regression modeling. RESULTS: Occupational exposure accounted for an incremental triclosan burden of 206 ng/mL (P = 0.02), while triclosan-containing toothpaste use was associated with 146 ng/mL higher levels (P < 0.001). CONCLUSIONS: Use of triclosan-containing antibacterial soaps in health care settings represents a substantial and potentially biologically relevant source of occupational triclosan exposure.

The risk of potential thromboembolic, renal and cardiac complications of sickle cell trait.

Many complications of sickle cell trait have been well-established, but associations with additional disease states remain controversial. We conducted a retrospective cohort study to examine the frequency of receiving a diagnosis of thromboembolism, pulmonary embolism (PE), ischemic stroke, renal disease (acute, chronic), coronary artery disease (CAD) and congestive heart failure (CHF) in patients with sickle cell trait. A total of 13,964 adult African Americans registered in the Kaiser Permanente Northern California (KPNC) health system (Oakland, CA, USA), were included based on laboratory and diagnostic code data for the years 1995-2008: 2642 with sickle cell trait, 11,183 with normal hemoglobin (Hb) and 139 with sickle cell disease. Disease outcomes were obtained from coded diagnoses. The adjusted relative risk of PE and chronic kidney disease in sickle cell trait patients compared to patients with normal Hb were 1.37 [95% confidence interval (CI) 1.07-1.75] and 1.13 (95% CI 1.03-1.23), respectively. There were no other significant differences in the outcomes for sickle cell trait patients compared to patients with normal Hb.