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Kinds of Complete Data Terms modified by Complete Data Selected AbstractsLongitudinal Diminution of Tumor Size for Basal Cell Carcinoma Suggests Shifting Referral Patterns for Mohs SurgeryDERMATOLOGIC SURGERY, Issue 1 2008ANDREW L. KAPLAN MD BACKGROUND The Mohs technique for removal of cutaneous malignancies offers tissue-sparing benefits compared with other treatment methods. With wider acceptance and availability of Mohs surgery, referral patterns may be shifting toward the treatment of smaller, lower-risk tumors. OBJECTIVE The objective was to examine whether referral patterns for basal cell carcinoma (BCC) at an academic Mohs surgery practice have shifted over recent years toward referral for smaller, lower risk tumors. METHODS A retrospective longitudinal comparison of tumor characteristics was performed for BCCs treated at our institution from a recent year (2004) and a past year (1996). Statistical analyses were used to identify differences in tumor size, distribution by anatomic site, and primary versus recurrent status. RESULTS Complete data were available for 603 BCCs treated in 1996 and 1,514 BCCs treated in 2004. A 24% decrease in preoperative tumor surface area was observed from 1996 (1.25 cm2) to 2004 (0.95 cm2). Tumors were twice as likely to be recurrent in 1996 (15.1%) than in 2004 (7.4%). There were no significant differences in the anatomic distribution of lesions in the years compared. CONCLUSIONS Findings at our institution suggest that in recent years, referral patterns have shifted toward a preference for Mohs surgery for the treatment of smaller, primary BCCs. This may be a result of increased awareness by the dermatologic and medical community of the numerous advantages of Mohs surgery and a greater appreciation of its tissue-sparing properties, which may result in less complex and more successful aesthetic reconstructions. [source] Road traffic accidents and the elderlyGERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 3 2009Suzan Abou-Raya Aim: To identify and evaluate the causes and characteristics of road traffic accidents (RTA) and to analyze injury patterns in elderly road traffic victims in order to apply appropriate measures for the prevention of RTA in the elderly. Methods: Two hundred and fifty-eight elderly road traffic victims admitted to the Emergency and Traumatology Departments of our institution were enrolled. Complete data about the circumstances surrounding the accident, mechanism of injury, specific injury, comorbid conditions and drug history were recorded. All subjects underwent a physical and mental function examination. Results: The majority of road traffic victims were pedestrians. Most elderly pedestrian accidents were due to falls. Accidents by elderly car drivers occurred frequently at intersections. Craniocerebral and extremity injuries formed the majority of the injuries in pedestrian and cyclist victims whereas chest injuries were commoner in car accident victims. Medical problems and medication usage was common among RTA victims. Conclusion: The fragility of elderly car occupants and pedestrians should be taken into consideration and strategies aimed at the road-user safety including periodic medical screening, improvement of road structure and facilities, and the improved design of motor vehicles should be implemented. [source] What is worse for your sex life: Starving, being depressed, or a new baby?INTERNATIONAL JOURNAL OF EATING DISORDERS, Issue 7 2007Dip Clin Psych, Frances A. Carter PhD Abstract Objective: To compare the current sexual functioning of women in an intimate relationship with anorexia nervosa, with major depression, and in the postpartum period. Method: Complete data were available for 76 women who reported being in an intimate relationship (anorexia = 10; depression = 24; postpartum = 42). Sexual functioning was assessed using the Social Adjustment Scale (Weissman and Bothwell, Arch Gen Psychiatry, 33, 1111,1115, 1976). Results: Significant differences were found among groups for the frequency of sex (p =.03) and problems with sex (p < .001), but not for enjoyment of sex (p = .55). In the previous 2 weeks, women with anorexia nervosa or major depression were more likely to have had sex than postpartum women, but were also more likely to have had sexual problems than postpartum women. Most women with anorexia nervosa, women with major depression, and postpartum women reported enjoying sex. Conclusion: Women with anorexia nervosa and women with major depression who are in an intimate relationship report a similar profile of current sexual functioning that is different from postpartum women both in the frequency of sexual encounters and in reported problems with sex. © 2007 by Wiley Periodicals, Inc. Int J Eat Disord 2007. [source] Validity of single-item parental ratings of child oral healthINTERNATIONAL JOURNAL OF PAEDIATRIC DENTISTRY, Issue 6 2008DAVID LOCKER Objective. The aim of this study was to assess the validity of single-item parental ratings of child oral heath. Methods. Data were collected during a study to assess the impacts of dental injury. Clinical examinations of children aged 11,14 years were undertaken that included measures of trauma, decay, treatment needs, and fluorosis. Children with trauma and a group of trauma-free children were followed-up. Parents were mailed a questionnaire along with a questionnaire for the child that contained a short form of the Child Perceptions Questionnaire 11,14 (CPQ11,14). Bivariate analyses examined associations between parents' ratings of their child's oral health, measures of dental disease, clinically defined treatment needs, and scores on the CPQ11,14. Logistic regression was used to see if the associations observed remained after controlling for access to dental care variables. Results. Complete data were collected from 370 children and their parents. Parental ratings showed significant associations with most of the clinical indicators used and CPQ11,14 scores. Similar results were obtained when the data were analysed for subgroups defined by household income and mother's education. These associations remained after controlling for access to dental services. Conclusion. The data suggest that single-item parental ratings of child oral health have adequate construct validity. [source] Chronic orchialgia: Consider gabapentin or nortriptyline before considering surgeryINTERNATIONAL JOURNAL OF UROLOGY, Issue 7 2007Andrew M Sinclair Objective: To establish if there is a role for gabapentin or nortriptyline in the treatment of chronic orchialgia. Methods: Twenty-six consecutive patients with chronic orchialgia were seen in the chronic pain clinic by a multidisciplinary team. A pain questionnaire was completed prior to commencing either gabapentin or nortriptyline. They were reviewed at 3 months and a repeat questionnaire completed. A 50% improvement in pain was considered successful. Results: Complete data was available for 19 patients. Overall, 61.5% of patients commenced on gabapentin and 66.6% of patients commenced on nortriptyline had a greater than 50% improvement in pain. Patients with post-vasectomy testicular pain were considered as a subgroup. None of these patients had a greater than 50% improvement in pain. However, 80% of patients in the subgroup with idiopathic chronic orchialgia had a greater than 50% improvement in pain. Conclusion: Although this is a small study, it appears that gabapentin and nortriptyline are effective in the treatment of idiopathic chronic orchialgia but not post-vasectomy pain. [source] A Pilot Study of Banxia Houpu Tang, a Traditional Chinese Medicine, for Reducing Pneumonia Risk in Older Adults with DementiaJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 12 2007Koh Iwasaki MD OBJECTIVES: To evaluate whether the traditional Chinese herbal medicine Banxia Houpu Tang (BHT, formula magnolia et pinelliae) prevents aspiration pneumonia and pneumonia-related mortality in elderly people. DESIGN: A prospective, observer-blinded, randomized, controlled trial. SETTING: Two long-term care hospitals for handicapped elderly patients in Japan from March 2005 to February 2006. PARTICIPANTS: One hundred four elderly patients (31 men and 73 women; mean age±standard deviation 83.5±7.8) with dementia and cerebrovascular disease, Alzheimer's disease, or Parkinson's disease. INTERVENTION: Ninety-five participants (mean age 84.0, M:F=28:67) were randomly assigned to the BHT treatment group (n=47) or the control group (n=48) and took BHT or placebo for 12 months. MEASUREMENTS: The occurrence of pneumonia, mortality due to pneumonia, and the daily amount of self-feeding. RESULTS: Complete data were available for analysis on 92 of the 95 subjects randomized. Four patients in the BHT group developed pneumonia, and one of them died as a result. Fourteen patients in the control group developed pneumonia, and six of them died as a result. There was a significant difference between the two groups in pneumonia onset (P=.008), and a tendency toward significance in pneumonia-related mortality (P=.05). The relative risk of pneumonia in the BHT group compared with the control group was 0.51 (95% confidence interval (CI)=0.27,0.84, P=.008) and that of death from pneumonia was 0.41 (95% CI=0.10,1.03, P=.06) according to the Cox proportional hazards model. No adverse events were observed from treatment with BHT. The BHT group was able to maintain self-feeding better than the control group (P=.006). CONCLUSION: Treatment with BHT reduced the risk of pneumonia and pneumonia-related mortality in elderly patients with dementia. [source] Evening Light Exposure: Implications for Sleep and DepressionJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 4 2002Geralyn M. Wallace-Guy MA OBJECTIVES: To examine whether dim illumination in the evening is a factor in sleep disturbances of aging, depression, and circadian phase advance. DESIGN: One-week continuous recordings were made to record illumination exposure and to infer 24-hour sleep patterns from wrist activity. SETTING: Recordings took place during normal home and community activities. PARTICIPANTS: Complete data of 154 postmenopausal women, mean age 66.7, were selected from a larger study of participants in the Women's Health Initiative. MEASUREMENTS: Illumination in lux was averaged for 4 hours before bedtime and over 24 hours. Mood was measured using a brief eight-item screen. RESULTS: Illumination in the 4 hours before bedtime was quite dim: median 24 lux. Nevertheless, evening light exposure was not significantly related to sleep amount (in bed or out of bed) sleep efficiency, sleep latency, wake within sleep, or mood. In contrast, the overall amount of light throughout the 24 hours was negatively correlated with sleep latency, wake within sleep, and depressed mood. CONCLUSIONS: Low evening lighting does not appear to be a crucial factor in sleep and mood disturbances of aging, but overall lighting may contribute to these disturbances. [source] Cigarette smoking and periodontal disease among 32-year-olds: a prospective study of a representative birth cohortJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 10 2007W. Murray Thomson Abstract Background: Smoking is recognized as the primary behavioural risk factor for periodontal attachment loss (AL), but confirmatory data from prospective cohort studies are scarce. Aim: To quantify the association between cigarette smoking patterns and AL by age 32. Methods: Periodontal examinations were conducted at ages 26 and 32 in a longstanding prospective study of a birth cohort born in Dunedin (New Zealand) in 1972/1973. Longitudinal categorization of smoking exposure was undertaken using data collected at ages 15, 18, 21, 26 and 32. Results: Complete data were available for 810 individuals of whom 48.9% had ever smoked (31.5% were current smokers). Compared with never-smokers, long-term smokers (and other age-32 smokers) had very high odds ratios (ORs of 7.1 and 5.7, respectively) for having 1 +sites with 5 +mm AL, and were more likely to be incident cases after age 26 (ORs of 5.2 and 3.2, respectively). Two-thirds of new cases after age 26 were attributable to smoking. There were no significant differences in periodontal health between never-smokers and those who had quit smoking after age 26. Conclusions: Current and long-term smoking in young adults is detrimental to periodontal health, but smoking cessation may be associated with a relatively rapid improvement in the periodontium. [source] Is the Child Oral Health Quality of Life Questionnaire Sensitive to Change in the Context of Orthodontic Treatment?JOURNAL OF PUBLIC HEALTH DENTISTRY, Issue 4 2008A Brief Communication Abstract Objective: This study aimed to assess the ability of the Child Oral Health Quality of Life Questionnaire (COHQoL) to detect change following provision of orthodontic treatment. Methods: Children were recruited from an orthodontic clinic just prior to starting orthodontic treatment. They completed a copy of the Child Perception Questionnaire, while their parents completed a copy of the Parents Perception Questionnaire and the Family Impact Scale. Normative outcomes were assessed using the Dental Aesthetic Index (DAI) and the Peer Assessment Rating (PAR) index. Change scores and effect sizes were calculated for all scales. Results: Complete data were collected for 45 children and 26 parents. The mean age was 12.6 years (standard deviation = 1.4). There were significant pre-/posttreatment changes in DAI and PAR scores and significant changes in scores on all three questionnaires (P < 0.05). Effect sizes for the latter were moderate. Global transition judgments also confirmed pre-/posttreatment improvements in oral health and well-being. Conclusion: The results provide preliminary evidence of the sensitivity to change of the COHQoL questionnaires when used with children receiving orthodontic treatment. However, the study needs to be repeated in different treatment settings and with a larger sample size in order to confirm the utility of the measure. [source] A Comparison of Correlates of DSM-IV Alcohol Abuse or Dependence Among More Than 400 Sons of Alcoholics and ControlsALCOHOLISM, Issue 1 2001M. A. Schuckit Background: Alcohol dependence and abuse are defined as separate disorders. However, relatively few data are available about whether the same characteristics predict both syndromes. Methods: Complete data were available from the 15 year follow-up of 411 men who originally had been evaluated from a university population at about age 20. Both baseline data gathered prospectively and the retrospective ratings in six domains of life functioning were analyzed for their relationship to the development of alcohol abuse or dependence during the follow-up. Results: Baseline characteristics of a family history of substance use disorders, the quantity and frequency of drinking, the history of alcohol-related problems, and the level of response to alcohol all predicted future alcohol abuse or dependence, but only an alcoholic second-degree relative or a first-degree drug-dependent family member differentially predicted dependence. Logistic regression analyses revealed that similar baseline characteristics combined to predict dependence and, separately, abuse. When the domains of functioning during the 15 years were included, positive alcohol expectancies, poor coping mechanisms, low level of social support, and drinking in the environment contributed to both dependence and abuse, although the relationship was stronger for dependence. Conclusions: The predictors and correlates of alcohol abuse and dependence in this group of men were similar. Further research in additional populations and on other drugs is needed to determine if the two syndromes overlap sufficiently to be combined. [source] Predictors of health-related quality of life in patients with chronic liver diseaseALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 5 2009A. AFENDY Summary Background, Patient-reported outcomes like health-related quality of life (HRQL) have become increasingly important for full assessment of patients with chronic liver diseases (CLD). Aim, To explore the relative impact of different types of liver disease on HRQL as well as predictors of HRQL domains in CLD. Methods, Our HRQL databases with Short-Form 36 (SF-36) data were used. Scores for each of SF-36 scales (PF , physical functioning, RP , role functioning, BP , bodily pain, GH , general health, VT , vitality, SF , social functioning, RE , role emotional and MH , mental health, MCS , mental component score, PCS , physical component score) were compared between different types of CLD as well as other variables. Results, Complete data were available for 1103 CLD patients. Demographic and clinical data included: age 54.2 ± 12.0 years, 40% female, 761 (69%) with cirrhosis. Analysis revealed that age correlated significantly (P < 0.05) with worsening HRQL on every scale of the SF-36. Female patients had more HRQL impairments in PF, RP, BP, GH, VT and MH scales of SF-36 (, scale score: 6.6,10.7, P < 0.05). Furthermore, cirrhotic patients had more impairment of HRQL in every scale of SF-36 (, scale score: 6.6,43.0, P < 0.05). In terms of diagnostic groups, non-alcoholic fatty liver disease patients showed more impairment of HRQL. Conclusions, Analysis of this large CLD cohort suggests that a number of important clinicodemographic factors are associated with HRQL impairment. These findings contribute to the full understanding of the total impact of CLD on patients' health. [source] Assessment of Adherence to Atovaquone-Proguanil Prophylaxis in TravelersJOURNAL OF TRAVEL MEDICINE, Issue 4 2010John C. DePetrillo MD Background. Malaria continues to be a serious, world-wide infection. Atovaquone-proguanil is one of the prophylactic agents recommended for travelers to endemic regions. However, little information is available regarding adherence with this medication. A large proportion of malaria cases reported from travelers is due to non-adherence to prescribed regimens. This study was undertaken to analyze adherence with atovaquone-proguanil prophylaxis and specific factors contributing to non-adherence. Methods. Men and non-pregnant women ,18 years of age were eligible for inclusion. Enrolled travelers received a prescription for atovaquone-proguanil prophylaxis and were contacted by telephone within 3 weeks of return to the United States. A questionnaire was prepared by the authors to determine if subjects were adherent with the medication. Additional data included demographics, duration of malarious travel, previous use of prophylactic agents, underlying medical conditions, concurrent medications, and reasons for non-adherence. Results. Complete data were available for 104/124 (84%) participants: 49 (47%) men, 55 (53%) women. Average duration of malarious travel was 12 days, and 19 (18%) travelers reported previous travel to a malarious region. Ninety-two (89%) subjects were completely adherent with their prophylactic atovaquone-proguanil course. Adverse effects were seen in 6 (5%) travelers. Conclusions. Adherence with atovaquone-proguanil malaria prophylaxis is high among travelers from a non-endemic region. Adverse effects are minimal. Non-adherence was primarily attributable to travelers' perception of need. [source] Rabies Antibody Seroprotection Rates Among Travelers in Nepal: "Rabies Seroprotection in Travelers"JOURNAL OF TRAVEL MEDICINE, Issue 6 2006Megan Ranney MD Background Rabies preexposure immunization is recommended for international travelers who are at risk for exposure to rabid animals, especially in areas where postexposure treatment may be limited. Rabies antibody seroprotection rates among international travelers has not been previously investigated. Objective To assess preexisting rabies seroprotection among travelers presenting to a health clinic in Nepal. Methods A prospective convenience sample of international travelers evaluated at a health center in Kathmandu, Nepal during a 2-month period. Subjects were eligible for inclusion if they had received rabies preexposure vaccination within the previous 5 years. Demographic information and vaccination records of rabies preexposure prophylaxis were obtained. Consenting subjects provided serum for rabies antibody measurement measured using the rapid fluorescent focus inhibition test. A dilution greater than or equal to 1:5 (0.5 IU/mL) was considered positive. Data were analyzed using chi-squares and two-sample t -tests with unequal variances. Results A total of 43 patients consented to enroll. Complete data were available for 38 patients. Subjects had received human diploid cell vaccine (HDCV) or purified Vero cell rabies vaccine (PVRV) vaccine, either via the intradermal or intramuscular route. All patients had adequate antibody titers except one, who had a titer below 0.5 IU/mL. There was no statistically significant relationship between antibody titer and type of vaccine, route of administration, time since vaccination, number of vaccinations, or patient age. Conclusions Among 38 travelers to Nepal who had received documented preexposure rabies HDCV or PVRV vaccination series, 37 demonstrated adequate titers of ,0.5 IU/mL and would be considered boostable if exposed to rabies virus. One traveler had a titer of <0.5 IU/mL. Type of vaccine, method of administration, number of vaccinations, and time since vaccination did not influence rabies antibody titer. Rabies vaccination with HDCV and PVRV vaccine was effective in stimulating adequate seroprotection in this sample of travelers. [source] Factors Related to In-House Agricultural Animal Caseloads in US Veterinary Teaching HospitalsJOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 1 2002Jeff W. Tyler A retrospective observational study was conducted to determine whether agricultural animal caseloads at veterinary teaching hospitals declined between 1995 and 1998. Thereafter, the effect of organizational and demographic factors on 1998 in-house agricultural animal caseloads was examined. Caseload data were obtained from the American Association of Veterinary Medical Colleges. Demographic and organizational data were obtained by surveys, telephone interviews, and web-based resources. Complete data were available from 25 veterinary colleges, and data from these schools were used in subsequent analyses. In 1998, in-house food animal caseload decreased relative to 1995 in 17 schools and increased relative to 1995 in 8 schools. This trend was not significant (P= .053); however, the power of the test was limited (.50). Mean 1998 caseload was 886± 504. Among schools with a discipline-based organizational structure, annual mean caseload was 464 ± 220. Among schools with a species-based organizational structure, mean caseload was 1,167 ± 463. The regression model that best predicted caseload was a forward-stepping model that included only organizational structure as an independent variable. No additional independent variable was significantly associated with caseload. [source] The safety profile of anti-tumour necrosis factor therapy in inflammatory bowel disease in clinical practice: analysis of 620 patient-years follow-upALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 3 2009C. W. LEES Summary Background, Anti-TNF agents are now widely used in Crohn's disease (CD), and in ulcerative colitis (UC). Aim, To review the safety profile of anti-TNF agents in all patients treated with infliximab in Edinburgh from 1999 to 2007. Methods, Complete data were available on 202/207 patients comprising 157 CD, 42 UC and three coeliac disease. Median follow-up was 2.4 years (1.0,4.9) with a total of 620 patient-years follow-up. About 19.1% of CD patients were subsequently treated with adalimumab. Results, Seven deaths (3.3%) occurred in follow-up; only one death was <1 year post-infliximab (at day 72, from lung cancer). A total of six malignancies (three haematological, three bronchogenic) and six cases of suspected demyelination (three with confirmed neurological disease) were reported. In the 90 days following infliximab, 95 adverse events (36 serious) occurred in 58/202 (28.7%) patients. In all, 42/202 (20.8%) had an infectious event (22 serious) and 27/202 (13.4%) of patients had an infusion reaction: 19 acute (four serious) and eight delayed (three serious). Conclusions, Serious infections, malignancies and neurological disease complicate anti-TNF use in clinical practice. Although evidence for causality is unclear, potential mechanisms and predisposing factors need to be explored. In individual patients, the risk/benefit analysis needs to be carefully assessed and discussed prior to commencement of therapy. [source] A randomized-controlled trial comparing an educational intervention alone vs education and biofeedback in the management of faecal incontinence in womenNEUROGASTROENTEROLOGY & MOTILITY, Issue 1 2005A. Ilnyckyj Abstract, Biofeedback (BF) training is an accepted therapy in the treatment of faecal incontinence (FI) despite a paucity of data demonstrating benefit. This study aims to determine whether BF has any specific effect above and beyond an educational intervention. Twenty-three women with regular and frequent idiopathic FI were randomized to education and pelvic exercise vs education and BF therapy. Complete data is available for 18 women. Overall, 61% of participants demonstrated a complete response. There was no difference in response rate between treatment arms. Women with FI demonstrate a good response to treatment with education and exercise and education plus BF thus questioning the specific effect of BF. [source] Breastfeeding as obesity prevention in the United States: A sibling difference modelAMERICAN JOURNAL OF HUMAN BIOLOGY, Issue 3 2010Molly W. Metzger In light of the growing prevalence of obesity in the United States, and the health risks associated with childhood obesity in particular, it is critical to identify avenues for obesity prevention. This study tests the hypothesis that breastfeeding serves as one protective factor against children's subsequent development of obesity. We used linear-, logistic-, and sibling fixed-effects regression models to evaluate the association between infant feeding history and body mass index (BMI) in late childhood or adolescence (9,19 years, mean = 14 years). Complete data were available for 976 participants (488 sibling pairs) in the 2002 Child Development Supplement of the Panel Study of Income Dynamics, a nationally representative survey of families in the United States. In sibling pairs in which only one sibling was breastfed, the breastfed sibling had an adolescent BMI that was 0.39 standard deviations lower than his or her sibling, controlling for child-specific factors that may have influenced parents' feeding decisions. This effect is equivalent to a difference of more than 13 pounds for a 14-year-old child of average height. Furthermore, fixed-effects logistic regressions predicting overweight and obese status showed that breastfed siblings were less likely to reach those BMI thresholds. We therefore conclude that breastfeeding in infancy may be an important protective factor against the development of obesity in the United States. The application of a sibling fixed-effects model provides stronger evidence of a causal relationship than prior research reporting similar patterns of association. Am. J. Hum. Biol. 2010. © 2009 Wiley-Liss, Inc. [source] Fear-avoidance beliefs and pain as predictors for low physical activity in patients with leg ulcerPHYSIOTHERAPY RESEARCH INTERNATIONAL, Issue 3 2009Kirsti Skavberg Roaldsen Abstract Background and Purpose.,Previous studies have shown that patients with chronic venous insufficiency are deconditioned and physically inactive. The present study aimed to examine the occurrence of fear-avoidance beliefs in patients with chronic venous insufficiency, and to investigate the role of fear-avoidance beliefs and pain severity in predicting the low level of physical activity in these patients.,Method.,Data were collected by a postal questionnaire sent to 146 patients with chronic venous insufficiency and current or previous venous leg ulcer. Complete data were collected from 98 patients aged 60,85 years , 63% women , giving a response rate of 67%. Fear-avoidance beliefs were assessed by the Fear-Avoidance Beliefs Questionnaire, physical activity subscale. Pain and physical activity were assessed by the Six-point Verbal Rating Scale of Pain Assessment and the Physical Activity Questionnaire, respectively.,Results.,Fear-avoidance beliefs were present in 81 (83%) of the patients with chronic venous insufficiency (range 0,24, median 12). Forty patients (41%) had strong fear-avoidance beliefs. One-third of the patients with healed ulcers had strong fear-avoidance beliefs. Patients with low physical activity had significantly stronger fear-avoidance beliefs and more severe pain than patients with high physical activity. Multiple logistic regression showed that the odds ratio (OR) for low physical activity were about three times higher for patients with strong fear-avoidance beliefs (OR 3.1, 95% confidence interval 1.1,8.3; p = 0.027) than for patients with weak fear-avoidance beliefs.,Conclusions.,Fear-avoidance beliefs were present in most patients with chronic venous insufficiency and were associated with low physical activity. Clinical implications ought to include a better recognition of fear-avoidance beliefs, early information about the negative consequences of such beliefs, and the importance of physical activity to counteract poor mobility. Copyright © 2009 John Wiley & Sons, Ltd. [source] Successful Long-Term Outcomes Using Pediatric En Bloc Kidneys for TransplantationAMERICAN JOURNAL OF TRANSPLANTATION, Issue 4 2002Jade S. Hiramoto Goal: The objective of our study was to determine whether acceptable long-term graft survival and function can be achieved using pediatric en bloc renal transplants by employing specific immunologic and selection strategies. Materials and Methods: A retrospective analysis of pediatric en bloc kidney transplants at a single institution was performed. A Kaplan-Meier analysis was used to evaluate graft survival. Findings: Fifty-seven adult recipients with at least a 1-year follow-up period were successfully transplanted using pediatric en bloc kidneys between 1993 and 1998. Complete data regarding immunosuppression were available for 53 patients. All patients had a cyclosporine (CsA)- or tacrolimus (TAC)-based regimen with either azathioprine (Aza) or mycophenolate mofetil (MMF) and corticosteroids. All but two received induction with OKT3. One-, 3-, 4-, 5- and 7-year graft survival was calculated to be 88%, 86%, 83%, 68% and 68%, respectively. The mean serum creatinine value at 3 years was 1.0 ± 0.4 mg/dL. Thirteen patients (23%) had biopsy-proven rejection. Ten of 19 (53%) patients treated with CsA/Aza had rejection, whereas 2/15 (13%) on CsA/MMF and 1/19 (5%) of patients on TAC/MMF had rejection. Nine patients (16%) had surgical complications. Conclusion: Excellent long-term results can be achieved in pediatric en bloc kidney transplantation using OKT3, TAC and MMF in carefully selected adult recipients. [source] A prospective longitudinal population-based study of clinical miscarriage in an urban Swedish populationBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 2 2008F Blohm Objective, To describe the incidence of clinical miscarriage and to investigate the factors influencing the occurrence of clinical miscarriage. Design, Prospective study with both cross-sectional and longitudinal comparisons. Setting, City of Göteborg, Sweden. Population, Population-based study in cohorts of 19-year-old women followed longitudinally. Main outcome measures, Incidence of miscarriage and pregnancy outcome. Material and methods, A postal questionnaire was sent to women born in 1962 and resident in the city of Göteborg in 1981 (n= 656) regarding pregnancy outcome, clinical miscarriage and other reproductive health factors. Responders in 1981 were contacted again and requested to answer a similar questionnaire every fifth year up to 2001. The same process was repeated in 1991 with women born in 1972 (n= 780) with follow up of these responders in 1996 and 2001. A third cohort of 19-year-old women born in 1982 (n= 666) was interviewed in 2001. The self-reported pregnancy data were verified from hospital files. Results, Complete data were available for 341 women born in 1962 and assessed up to the age of 39 years (ever pregnant, n= 320, 94%). There were in total 887 pregnancies (live birth, n= 590, 67%; miscarriage, n= 108, 12%; legal abortion, n= 173, 20% and ectopic pregnancy, n= 16, 2%). Of the 320 ,ever pregnant' women, 80 women (25%) had experienced a miscarriage. 76.3% had experienced one miscarriage, 16.3% had two miscarriages and 7.4% had three or more miscarriages. The clinical miscarriage rates in women at different ages were as follows: 20,24 years 13.5%, 25,29 years 12.3%, 30,34 years 10.3% and 35,39 years 17.5%. The corresponding miscarriage rate in the 1972 cohort followed from 19 to 29 years of age was 11%, and in the 1982 cohort assessed at 19 years of age, the miscarriage rate was 9%. No risk factor for miscarriage could be reliably identified. Conclusions, Clinical miscarriage constituted 12% of all pregnancies, and one in four women who had been pregnant up to 39 years of age had experienced a miscarriage. Three or more miscarriages were experienced by 7.4%. The occurrence of a miscarriage was not influenced by the order of the pregnancy. [source] The emotional burden of miscarriage for women and their partners: trajectories of anxiety and depression over 13 monthsBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 9 2007GP Cumming Objective, To identify the trajectories of anxiety and depression in women and in their partners over 13 months after miscarriage. Design, A prospective study with follow up at 6 and 13 months after miscarriage. Setting, Three Scottish Early Pregnancy Assessment Units. Sample, Of the 1443 eligible individuals approached, 686 (48.3%) consented to participate (432 women; 254 men). Complete data were obtained from 273 women and 133 men at baseline, 6, and 13 months. Methods, On completion of the management of the index miscarriage, eligible and consenting women and men underwent an initial assessment comprising a semi-structured interview and a standardised self-report questionnaire. The latter was readministered at the follow-up assessments. Main outcome measures, The hospital anxiety and depression scale (HADS), a reliable and valid measure of general psychopathology for use in nonpsychiatric samples. Results, Compared with depression, anxiety was overall the greater clinical burden. Over the 13-month period, women reported higher levels of anxiety and depression than men. Over time, a significantly greater level of adjustment was reported by women particularly with regards to the resolution of anxiety symptoms. The effect of time on HADS scores in either gender was similar between subgroups of socio-demographic and clinical factors. Conclusions, These findings verify that early pregnancy loss represents a significant emotional burden for women, and to some extent for men, especially with regards to anxiety. For many, the detrimental effects of miscarriage are enduring and display a complex course of resolution. These findings are discussed in terms of their clinical implications for early identification and management. [source] General obstetrics: Failing pregnancies of unknown location: a prospective evaluation of the human chorionic gonadotrophin ratioBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 5 2006G Condous Objective, To assess the performance of the human chorionic gonadotrophin (hCG) ratio (hCG 48 hours/hCG 0 hour) to predict spontaneous resolution of pregnancies of unknown location (PUL). Design, Prospective cohort study. Setting, Teaching Hospital Early Pregnancy Unit. Population, Women classified as having a PUL. Methods, The optimal cutoff value for hCG ratio (serum hCG at 48 hours/serum hCG at 0 hours) was calculated from data on 189 consecutive PULs (the ,training set'). This cutoff was tested prospectively on a further 200 consecutive PULs (the ,test set'). The hCG ratio was also compared to absolute levels of serum hCG at 0 and 48 hour for the prediction of failing PULs. Main outcome measures, hCG ratio in spontaneously resolving (,failing') PUL compared with those requiring intervention. Optimum cutoff determined and tested to predict spontaneously resolving PUL. Comparison of hCG ratio with absolute levels of serum hCG. Results, A total of 3996 consecutive women were scanned, of which 438 (11.0%) were classified as PULs. Complete data were available for 389 women: 189 in the training set and 200 in the test set. In the training set, there were 102 (54%) failing PUL, while 109 (55%) in the test set. hCG ratio of <0.87 predicted failing PUL, with a sensitivity of 93.1% (95% CI 85.9,97.0) and a specificity of 90.8% (95% CI 82.2,95.7) in the training set. In the test set, sensitivity was 92.7% (95% CI 85.6,96.5) and specificity was 96.7% (95% CI 90.0,99.1). The hCG ratio outperformed absolute serum hCG levels at 0 and 48 hours. Conclusions, We have defined the optimal hCG ratio for the prediction of failing PUL. Using this cutoff, clinicians can safely adopt a noninterventional approach in women with PUL. [source] Characteristics of incidental prostatic adenocarcinoma in contemporary radical cystoprostatectomy specimensBJU INTERNATIONAL, Issue 3 2007Mathias H. Winkler OBJECTIVES To investigate the relationship between prostate-specific antigen (PSA) level and tumour volume for incidental adenocarcinoma of the prostate found in cystoprostatectomy (CP) specimens, and to analyse the incidence of clinically significant prostate cancers in CP specimens and the biochemical recurrence of incidental prostate cancers on short-term follow up. PATIENTS AND METHODS Complete data from 97 of 105 prostates from CP specimens were available. Prostates were thoroughly analysed and sectioned at 2 mm intervals. PSA levels and the findings at digital rectal examination before surgery were obtained prospectively. None of the patients had any evidence of prostate cancer before CP. RESULTS Incidental prostate cancer was detected in 58 of 97 (60%) of the CP specimens; of these, 31 (53%) were significant according to the definition of Stamey et al. There was a weak correlation between tumour volume and PSA level, weighted solely by the four larger-volume cancers. The median PSA level for patients with and without prostate cancer was not significantly different (3.1 vs 1.1 ng/mL, P = 0.06). The follow-up of the 35 patients alive with prostate cancer showed four PSA recurrences (PSA >0.02 ng/mL) with one distant metastasis after a median follow-up of 3 years. None of the patients with insignificant tumours developed biochemical recurrence. CONCLUSIONS The weak correlation between PSA level and tumour volume in these patients supports the argument that PSA is largely produced by benign prostatic hyperplasia and is therefore a poor screening tool for asymptomatic healthy men. Most incidental prostate cancers in CP specimens are significant, contrary to previous analyses, but have little practical importance in terms of oncological outcome. [source] Are conventional pressure-flow measurements dependent upon filled volume?BJU INTERNATIONAL, Issue 3 2005Kanagasabai Sahadevan OBJECTIVE To determine, in a prospective study, whether detrusor pressure (pdet.Qmax) and maximum urinary flow rate (Qmax) measurements obtained after filling to maximum cystometric capacity (MCC) differ from those obtained with filling restricted to average voided volume (Vvoid), as standard protocols for pressure flow studies (PFS) mandate bladder filling until the subject has a strong desire to void, which aids standardization but further divorces the test from real-life experience. PATIENTS AND METHODS After calculating the appropriate sample size, 84 patients attending for PFS with an adequately completed 3-day frequency-volume chart were recruited. Each underwent two consecutive PFS with filling to MCC and average Vvoid in a random order, and measurements of pdet.Qmax and Qmax were compared. For men, the agreement for a diagnosis of obstruction between the tests was also assessed. RESULTS Complete data were obtained from 76 (90%) of the patients, with a mean (range) age of 64 (20,94) years. The mean (sd) difference between MCC and average Vvoid was 134 (113) mL (P < 0.01). There were no significant differences between estimates of Qmax, at ,,0.1 (3) mL/s (P = 0.75), and of pdet.Qmax, at ,,1 (13) cmH2O (P = 0.91), obtained within each patient. For men there was 91% agreement (32 of 35) in the classification of obstruction. CONCLUSIONS Restriction of filling to the average Vvoid during PFS allows a closer approximation to normal voiding and results in no clinically relevant change to the value of standard pressure-flow measurements or alters individual classification of obstruction. [source] Correlation between vision- and health-related quality of life scoresACTA OPHTHALMOLOGICA, Issue 3 2009Brighu N. Swamy Abstract. Purpose:, To examine the correlation between health-related quality of life (HRQOL) scores [assessed using the generic Short Form Health Survey (SF-36) questionnaire] and vision-related quality of life (VRQOL) scores [assessed using the National Eye Institute Visual Function Questionnaire (NEI-VFQ25)]. Methods:, Cross-sectional analytic study. All surviving participants of the Blue Mountains Eye Study (n = 1952, aged 60 years and older) were invited to attend comprehensive eye examinations 10 years after baseline examinations and were asked to complete both questionnaires. Results:, Complete data were available for 1436 participants. After controlling for age, sex and the presence of either unilateral or bilateral visual impairment, the number of hospital admissions, chronic medical conditions and disabilities, we found that the composite NEI-VFQ score was significantly associated with the two main domains of the SF-36 survey: the summary physical component score (P < 0.001) and the mental component score (P < 0.001). There was relatively low correlation (r < 0.3) between the NEI-VFQ25 subscales and SF-36 subscales including the physical and mental composite scores. Conclusion:, VRQOL is influenced by both general health and HRQOL. However, there is a relatively low correlation between the individual subscales of these two quality of life questionnaires. [source] Effects of prenatal cocaine exposure on special education in school-aged childrenCHILD: CARE, HEALTH AND DEVELOPMENT, Issue 5 2008Richard Reading Effects of prenatal cocaine exposure on special education in school-aged children . LevineT. P., LiuJ., DasA., LesterB., LagasseL., ShankaranS., BadaH. S., BauerC. R. & HigginsR. ( 2008 ) Pediatrics . Published online . DOI: 10.1542/peds.2007-2826 . Objective The objective of this study was to evaluate the effects of prenatal cocaine exposure on special education at age 7 with adjustment for covariates. Methods As part of the prospective, longitudinal, multi-site study of children with prenatal cocaine exposure (Maternal Lifestyle Study), school records were reviewed for 943 children at 7 years to determine involvement in special education outcomes: (1) individualized education plan; (2) special education conditions; (3) support services; (4) special education classes; and (5) speech and language services. Logistic regression was used to examine the effect of prenatal cocaine exposure on these outcomes with environmental, maternal and infant medical variables as covariates, as well as with and without low child IQ. Results Complete data for each analysis model were available for 737,916 children. When controlling for covariates including low child IQ, prenatal cocaine exposure had a significant effect on individualized education plan. When low child IQ was not included in the model, prenatal cocaine exposure had a significant effect on support services. Male gender, low birthweight, white race and low child IQ also predicted individualized education plan. Low birthweight and low child IQ were significant in all models. White race was also significant in speech and language services. Other covariate effects were model specific. When included in the models, low child IQ accounted for more of the variance and changed the significance of other covariates. Conclusions Prenatal cocaine exposure increased the likelihood of receiving an individualized education plan and support services, with adjustment for covariates. Low birthweight and low child IQ increased the likelihood of all outcomes. The finding that white children were more likely to get an individualized education plan and speech and language services could indicate a greater advantage in getting educational resources for this population. [source] Asthma tests in the assessment of military conscriptsCLINICAL & EXPERIMENTAL ALLERGY, Issue 2 2010D. Miedinger Summary Background Respiratory diseases such as asthma may affect individuals' fitness for military service. In order to assess fitness for military service in subjects with asthma symptoms at conscription, objective and reliable tests are needed. Objective To prospectively determine the diagnostic value of the mannitol and methacholine bronchial provocation test (BPT) as well as exhaled nitric oxide in assessing physician-diagnosed asthma in a group of Swiss Armed Forces conscripts. Methods Questionnaire, spirometry, BPT with methacholine and mannitol, exhaled nitric oxide (FeNO) and skin prick testing were conducted in 18,20-year-old male conscripts. Asthma was diagnosed by a military physician not involved in this study according to the medical record, results of BPT, current respiratory symptoms and use of asthma medication. Results Two hundred and eighty four subjects participated in the study. Complete data for the BPT with methacholine, mannitol and measurement of FeNO were available on 235 subjects. Forty-two conscripts (17.9%) had physician-diagnosed asthma. The sensitivity/specificity of mannitol to identify physician-diagnosed asthma was 41%/93% and for methacholine it was 43%/92%. Using a cut-off point of 36.5 p.p.b., FeNO had a similar negative predictive value to rule out physician-diagnosed asthma as BPT with mannitol or methacholine. Conclusion BPT with mannitol has a sensitivity and specificity similar to methacholine for the diagnosis of physician-diagnosed asthma in military conscripts but is less costly to perform without the need to use and maintain a nebulizer. Cite this as: D. Miedinger, N. Mosimann, R. Meier, C. Karli, P. Florek, F. Frey, K. Scherer, C. Surber, B. Villiger, F. Michel and J. D. Leuppi, Clinical & Experimental Allergy, 2010 (40) 224,231. [source] Bronchial hyper-responsiveness to hypertonic saline and blood eosinophilic markers in 8,13-year-old schoolchildrenCLINICAL & EXPERIMENTAL ALLERGY, Issue 8 2004G. De Meer Summary Background In adult asthma, bronchial hyper-responsiveness (BHR) to indirect stimuli reflects eosinophilic activation more closely than BHR to stimuli that directly cause smooth muscle contraction. Aim To assess the relationship between BHR to the indirect stimulus hypertonic saline (HS), blood eosinophil numbers, and serum eosinophilic cationic protein (ECP) in children with and without current wheeze. Methods A cross-sectional survey among 8,13-year-old schoolchildren, using the International Study of Asthma and Allergic disease in Childhood questionnaire, bronchial challenge with HS, skin prick tests, serum IgE, blood eosinophil counts and ECP (in a subset). Based upon the presence of current wheeze (WHE) and BHR, we defined three case groups (WHE+BHR+, WHE,BHR+, WHE+BHR,) and the reference group (WHE,BHR,). By regression analyses, each case group was compared with the reference group for differences in atopic sensitization, blood eosinophil counts and serum ECP. Results Complete data were obtained for 470 children. BHR was present in 103 children (22%), 66 being asymptomatic and 37 symptomatic. Children of all three case groups were more often atopic. Sensitization to indoor allergens particularly occurred in children with BHR, irrespective of symptoms (P<0.05). Children with WHE+BHR+ had highest values for blood eosinophils and serum ECP (P<0.05). Children with WHE,BHR+ had less severe responsiveness. In atopic children with WHE,BHR+, serum ECP was higher than in children with WHE-BHR-(P<0.05). Conclusions BHR to HS is associated with blood markers of eosinophilic activation, particularly in atopic children. [source] Paediatric utilization of a general emergency department in a developing countryACTA PAEDIATRICA, Issue 8 2003AY Goh Aim: Knowledge of the spectrum and frequencies of paediatric emergencies presenting to an emergency department (ED) of individual developing countries is vital in optimizing the quality of care delivered locally. Methods: A prospective 6 wk review of all paediatric (< 18y) attendees to an urban ED was done, with patient age, presenting complaints, diagnoses, time of arrival and disposition recorded. Results: Complete data were available on 1172 patients, with an age range of 4 d to 18 y (mean ± SD 6.9 ± 5.6 y); 43% were aged ,4 y. The main presenting complaints were injuries (26.9%), fever (24%) and breathing difficulties (16.6%). The most common diagnosis was minor trauma (24.2%), with soft-tissue injuries predominating (80.6%). The other diagnoses were asthma (12.6%), upper respiratory infections (12.1%), other infections (12.1%) and gastroenteritis (11.8%). Equal proportions of patients were seen throughout the day. 25% of patients were admitted. Young age (<1 y); presence of past medical history, general practitioner referrals, diagnosis of bronchiolitis and pneumonia were significantly associated with risk of admission. Conclusion: A wide spectrum of paediatric illnesses was seen in the ED, with an overrepresentation of young children. This supports the decision to have either a separate paediatric ED or paediatric residents on the staff. The training curricula should emphasize the management of paediatric trauma, infections and asthma. Alternatively, developing guidelines for the five most common presenting complaints would account for 82% of all attendees and could be directed towards all staff on the ED. [source] Does the need to self-digitate or the presence of a large or nonemptying rectocoele on proctography influence the outcome of transanal rectocoele repair?COLORECTAL DISEASE, Issue 2 2003S. G. Stojkovic Abstract Introduction Transanal repair of anterior rectocoele is a well described technique with variable success rate. In our department we offer repair to patients who fit the following criteria; the need to self digitate (transvaginal or perineal); a large rectocoele; a nonemptying rectocoele. Using these selection criteria previous authors have shown excellent results. The aim of our study was to review our results using this selective approach and also to determine whether the need to self digitate, the presence of a large rectocoele and the degree of emptying could predict which patients would achieve a successful result. Methods Fifty-five patients underwent repair over a three-year period. The main presenting symptom was noted for each patient and also whether self-digitation was required in order to achieve successful evacuation. Dynamic evacuation proctography was performed on all patients. Size of rectocoele, percentage of paste expelled and other proctographic abnormalities were noted for each patient. Follow up was at 6 weeks and 6 months at which point patients were asked whether their symptoms had resolved, improved, remained the same or had worsened. Results Complete data were available for 48 of the patients (median age 52 years, IQR 43,63). The presenting complaint was constipation in 22 patients, obstructive defeacation in 15, incomplete evacuation in 5, postdefaecation soiling in 4 and dyspareunia in 2. Thirty-eight patients noted the need to self-digitate, 10 did not. Proctography revealed a large rectocoele (> 4 cm) in 22 patients and a medium or small rectocoele (< 4 cm) in 26 patients. There was a rectocoele alone in 34 patients, in combination with perineal descent in 11 and with intussusception in 3. Median percentage of paste expelled was 70% (range 20,95). At 6 weeks postoperatively, 43 patients had complete resolution of their symptoms whilst 5 reported only some or no improvement. At 6 months, 37 patients sustained complete resolution of their symptoms and 11 did not. Pre-operative factors were compared for these two groups of patients. There was no difference in age (P > 0.05, Mann,Whitney U -test) between the two groups There was also no difference in size of rectocoele, degree of emptying, the presence of another proctographic abnormality and the need to self-digitate between the two groups (P > 0.05, Fisher's exact test). Discussion No factors were seen to distinguish between the successful and unsuccessful groups of patients following rectocoele repair, however, an overall success rate of 75% was achieved using our selection criteria. This figure is in keeping with reported success rates in the literature. [source] | |||||||||||||||||||||||||||||||||||||