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Adequate Assessment (adequate + assessment)
Selected AbstractsThe adrenal cortex and steroidogenesis as cellular and molecular targets for toxicity: critical omissions from regulatory endocrine disrupter screening strategies for human health?JOURNAL OF APPLIED TOXICOLOGY, Issue 2 2003Philip W. Harvey Abstract Current testing strategies to assess the endocrine disrupting properties of chemicals have omitted examination of the adrenal gland and do not adequately cover the process of steroidogenesis. Steroidogenesis is critical for adrenocortical function as well as that of the testes and ovaries, and presents multiple molecular targets for toxicity, ranging from general effects on all steroidogenic tissues (e.g. via StAR protein or CYP11A1 cholesterol side-chain cleavage) through to speci,c targets affecting only adrenocortical function (e.g. CYP11,/18 and glucocorticoid synthesis). Numerous chemicals of environmental relevance are now being shown to affect adrenocortical function both in vivo in aquatic species and in vitro in human cell lines, and given the vital role of the adrenal gland to human health and development, there is a strong case for including dedicated assessment techniques in screening batteries for endocrine-disrupting chemicals, not least to assist in general data interpretation (e.g. whether adrenal hypertrophy is due to stress or to a more sinister adrenocortical insuf,ciency). Cell lines such as H295R (derived from a human adrenocortical adenocarcinoma) currently exist that will allow assessment of cortisol production and most of the major enzymes and functional proteins in the steroidogenic pathway (e.g. StAR; CYP11A1/scc; CYP11,/18; CYP17; CYP19; CYP21; 3, -hydroxysteroid dehydrogenase). Adequate assessment of adrenocortical function, as with any component of the integrated endocrine system, probably also will require the development of speci,c in vivo methodology to include effects on hypothalamo-pituitary function. Finally, although there is currently no direct evidence that environmental exposure to endocrine-disrupting (oestrogenic) chemicals has actually caused adverse human health effects, lessons have been learned on their potential from the diethylstilboestrol case. Similar evidence exists from aminoglutethimide and etomidate on the lethal impact of unpredicted chemically induced adrenal insuf,ciency in sensitive human subgroups, and it would seem prudent to incorporate relevant tests for adrenal function and steroidogenesis into current regulatory validation programmes. Published in 2003 by John Wiley & Sons, Ltd. [source] Late-life insomnia: A reviewGERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 3 2009Arne Fetveit Aging is associated with substantial changes in sleep patterns, which are almost always negative in nature. Typical findings in the elderly include a reduction in the deeper stages of sleep and a profound increase in the fragmentation of nighttime sleep by periods of wakefulness. The prevalence of specific sleep disorders increases with age, such as a phase advance in the normal circadian sleep cycle, restless legs syndrome, and obstructive sleep apnea, which is increasingly seen among older individuals and is significantly associated with cardio- and cerebrovascular disease as well as cognitive impairment. Elderly patients with sleep disturbances are often considered difficult to treat; yet, they are among the groups with the greatest need of treatment. Management of sleep disturbances begins with recognition and adequate assessment. Hypnotic drugs have clearly been shown to improve subjective and objective sleep measures in short-term situations, but their role in chronic insomnia still remains to be further defined by research evidence. Non-pharmacological treatments, particularly stimulus control and sleep restriction, are effective for conditioned aspects of insomnia and are associated with a stable, long-term improvement in sleep. This review delineates the common causes of disordered sleep in older individuals, and effective diagnostic approaches and treatments for these conditions. [source] Motor acquisition rate in Brazilian infantsINFANT AND CHILD DEVELOPMENT, Issue 2 2009Virlaine Bardella Lopes Abstract This study used the Alberta Infant Motor Scale (AIMS) with the aim of characterizing motor acquisition rate in 70 healthy 0,6-month-old Brazilian infants, as well as comparing both emergence (initial age) and establishment (final age) of each skill between the study sample and the AIMS normative data. New motor skills were continuously acquired from 0 to 6 months of age by the Brazilian infants, but their acquisition rate was non-linear. When compared to the AIMS sample, Brazilian infants achieved lower percentiles, and their initial age to acquire skills requiring greater antigravity demand was higher. In contrast, Brazilian infants stopped exhibiting primitive patterns earlier, and their final age to acquire antigravity skills was lower. These differences in motor development are suggested to be a consequence of different parental practices and not necessarily indicate motor delay. Thus, the AIMS normative values should be adapted to cultural particularities so as to avoid that infants are misclassified as at risk for motor delay. Furthermore, an adequate assessment of motor development should consider not only the age at which a skill is emerged, but also the age at which such a skill is established in the infant's motor repertoire. Copyright © 2009 John Wiley & Sons, Ltd. [source] Follow up of surgical repair of female pelvic floor disorders by a mailed questionnaireINTERNATIONAL JOURNAL OF UROLOGY, Issue 4 2006HIDEYASU MATSUYAMA Background:, This study was conducted to determine whether surgical repair of pelvic prolapse enhances patients' quality of life (QOL) in the long term. Methods:, A total of 91 patients (median age, 68.0 years) with pelvic prolapse including cystoceles underwent bladder neck suspension with anterior/posterior colporrhaphy between 1997 and 2003. Postoperative QOL was longitudinally assessed by three disease-specific items (sensation of vaginal bulging, obstructive symptoms, urinary incontinence), and one overall health-related QOL (HR-QOL) item. Results:, A longitudinal study demonstrated that a significant improvement in these symptoms was sustained at a median follow up of 65.5 months, although poor HR-QOL was significantly higher in patients whose age was more than 70 years at surgery (P = 0.0234, Fisher's test). Multivariate analysis revealed update urinary incontinence, update obstructive symptoms, and basic comorbidity to be independent prognostic factors for predicting postoperative moderate-to-poor HR-QOL. Conclusions:, Longer follow up with adequate assessment of patients' QOL may be crucial for the management of postoperative patients, in particular those having basic comorbidity and aged 70 years or more at surgery. [source] The Efficacy of Acamprosate in the Maintenance of Abstinence in Alcohol-Dependent Individuals: Results of a Meta-AnalysisALCOHOLISM, Issue 1 2004Karl Mann Abstract: Background: A number of clinical trials have been undertaken to determine the efficacy of acamprosate in the maintenance of abstinence in alcohol-dependent individuals. However, the reported differences in patient populations, treatment duration, and study endpoints make comparisons difficult. An assessment of the efficacy of treatment with acamprosate was, therefore, undertaken using meta-analytical techniques. Methods: All randomized, placebo-controlled trials (RCTs) that fulfilled predetermined criteria were identified using (1) a language unrestricted search of 10 electronic databases; (2) a manual search of relevant journals, symposia, and conference proceedings; (3) cross-referencing of all identified publications; (4) personal communications with investigators; and (5) scrutiny of Merck-Santé's internal reports of all European trials. Study quality was assessed, independently, by three blinded workers. Key outcome data were identified; some outcome variables were recalculated to ensure consistency across trials. The primary outcome measure was continuous abstinence at 6 months; abstinence rates were determined by estimating Relative Benefit (RB). Results: A total of 19 published 1 unpublished RCTs were identified that fulfilled the selection criteria; 3 were excluded because the documentation available was insufficient to allow adequate assessment. The remaining 17 studies, which included 4087 individuals, 53% of whom received active drug, were of good quality and were otherwise reasonably comparable. There was no evidence of publication bias. Continuous abstinence rates at 6 months were significantly higher in the acamprosate-treated patients (acamprosate, 36.1%; placebo, 23.4%; RB, 1.47; [95% confidence intervals (CI): 1.29,1.69]; p < 0.001). This effect was observed independently of the method used for assigning missing data. The effect sizes in abstinent rates at 3, 6, and 12 months were 1.33, 1.50, and 1.95, respectively. At 12 months, the overall pooled difference in success rates between acamprosate and placebo was 13.3% (95% CI, 7.8,18.7%; number needed to treat, 7.5). Acamprosate also had a modest but significant beneficial effect on retention (6.01%; [95% CI, 2.90,8.82]; p= 0.0106). Conclusion:: Acamprosate has a significant beneficial effect in enhancing abstinence in recently detoxified, alcohol-dependent individuals. [source] | ||||||||||