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Medical Sciences	93%

Selected Abstracts

Mycobacterium tuberculosis transmission among high school students in Greece

PEDIATRICS INTERNATIONAL, Issue 2 2005
Christos Hadjichristodoulou
AbstractBackground:,The aim of this study was to investigate the requirements and practical steps for screening of Mycobacterium tuberculosis (MTB) transmission among high school student populations in two regional high schools of central Greece. Case-matched control populations from other regional schools were included. Methods:,Case study of two indexed cases, 61 close contacts, 212 casual contacts and 369 controls were investigated. Detailed questionnaires, tuberculin-skin test (PPD test), chest radiography, medical evaluation and DNA fingerprinting of sputum isolates were used. Results:,In case A, three (1.97%) of 152 close and casual contacts developed tuberculosis, and a further 25 (16.4%) were classified as infected. In contrast, none of the 121 close or casual contacts investigated for Case B developed tuberculosis or were classified as infected. None of the control populations contained infected individuals. Contacts of case A had a much higher risk (3.08 < RR = 22.29 < 161.69, P < 0.001) of being infected than contacts of case B. Two different strains of MTB were found responsible for these outbreaks. Conclusion:,There was a considerable difference in the infectivity of the two cases presumably due to environmental and clinical factors, although two different MTB strains were responsible. It is proposed that the extent of case investigation should be individualized with particular emphasis placed among close contacts. [source]

Follow-Up of 1 mg Finasteride Treatment of Male Pattern Baldness,Difference between Clinical Trials and Private Office Follow-Up: Influences on Prescribing Habits Evaluated

DERMATOLOGIC SURGERY, Issue 5 2004
Marvin J. Rapaport MD
Background. Finasteride (Propecia) was approved by the FDA in 1998 for treating men with androgenetic alopecia. The published clinical trials demonstrated statistical differences between drug and placebo. Rarely do new drugs undergo further non-drug-company-sponsored studies of efficacy. Concerns about clinical studies and marketing of drugs prompted this evaluation of a large group of patients taking this medication. Objective. Finasteride usage offered an opportunity not only to understand the acceptance of a cosmetically oriented medication, but also to evaluate subjective comments and compliance after a long period of time. Methods. A total of 1261 patients were monitored with phone calls every 3 months after finasteride was initially prescribed. After 12 months, a detailed questionnaire was sent to all patients with an additional letter and two telephone calls if no response was received. Statistical analysis of the patients' data was made. Results. Thirty-two percent or 414 men continued to take finasteride daily for 1 to 3 years. Twenty-four percent or 297 men discontinued the drug between 3 and 15 months owing to poor results. The remaining 44% or 549 men were lost to follow-up despite numerous attempts to contact them. Conclusion. A total of 414 men continued to take the medication, but only 211 returned detailed questionnaires. A small percentage of this group felt that they grew hair. The remaining patients noted poor results. [source]

How does early developmental assessment predict academic and attentional,behavioural skills at group and individual levels?

DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 10 2009
RIITTA VALTONEN LICPSYCH
The main aim of the study was to explore the ability of a brief developmental assessment to predict teacher-rated learning and attentional and behavioural skills in the first grade of school at both the group and individual levels. A sample of 394 children (181 males, 213 females) aged 4 years were followed to the age of 6 years, and 283 of the children (145 males, 138 females; mean age 7y 11 mo) were followed further to the first grade (age 7y) at school. The children were administered a brief but comprehensive developmental assessment (Lene , a neurodevelopmental screening method) at their local child health-care centres at ages 4 and 6 years. In the first grade, teachers completed a detailed questionnaire (JLD Teacher Questionnaire) on the children's (mean age 7y 11mo, SD 3.1mo, range 7y 3mo,8y 4mo) performance and behaviour. Structural equation modelling showed that no single developmental area predicted development during the follow-up. Instead, a comprehensive developmental outcome at age 4 years significantly predicted skills in the first grade at the group level. Developmental status at age 4 and 6 years together explained 66% of the variance of academic skills and 40% of the variance of attentional and behavioural skills in the first grade. Age-specific logistic regression analyses were constructed to produce the risk indices. At the individual level it was possible to reach acceptable levels of sensitivity and specificity for academic skills at age 4 and age 6 years. Identification of attentional and behavioural problems at the individual level was possible at age 6 years, but the number of false positives was high. [source]

Older patients' experiences of treatment for colorectal cancer: an analysis of functional status and service use

EUROPEAN JOURNAL OF CANCER CARE, Issue 5 2004
C. BAILEY msc, rgn
Age and ageing are an important part of the context within which the care and treatment of people with cancer is provided. More information is needed about the effects of cancer treatment on the lives of older people following inpatient care. We conducted a 3-year study in which older people with colorectal cancer completed a detailed questionnaire on multidimensional function and service use before and after elective treatment. Here we present an analysis of changes in functional status and service use over the pre- to post-treatment period, and set out a detailed picture of older people's experiences before and after treatment. In total, 337 patients with colorectal adenocarcinoma aged 58,95 years were interviewed before treatment using the OARS Multidimensional Functional Assessment Questionnaire (OMFAQ), Rotterdam Symptom Checklist (RSCL) and a severity of morbidity score. Study end points were defined as post-treatment functional status, symptom distress, severity of morbidity and frequency of service use. Pre- and post-treatment data were compared using matched analyses. Logistic regression was used to assess associations between age and the main outcome measures, and frequency of service use after treatment was compared between age groups using the ,2 test. Overall, patients experienced both positive and negative outcomes following treatment. It was notable that patients aged ,,75 years showed improvement in only one of the principal outcome measures. Patterns of service use following treatment suggest that support at home is a key issue for patients. With the exception of nursing care, however, help at home is provided on a majority of occasions by families themselves. This raises important questions about how much preparation patients and families receive or would like before they leave hospital after treatment for cancer. A collaborative, family-centred approach to meeting people's needs is called for in the months following inpatient care. [source]

Factors influencing the caries decline in Lithuanian adolescents , trends in the period 1993,2001

EUROPEAN JOURNAL OF ORAL SCIENCES, Issue 1 2004
Jolanta Aleksej
The study aimed to relate a number of factors to the numbers of decayed, missing and filled teeth (DMFT) in 12- and 15-yr-olds examined and interviewed in 1993 and 2001. A total of 1250 children in 1993 and 935 in 2001 were clinically examined and completed a detailed questionnaire on dental health-related topics. Factors were related to the DMFT count applying multiple regression analysis. From 1993 to 2001, the mean DMFT decreased approximately 30% in both age cohorts. Despite an observed improvement in dental health in Lithuanian children, the number of Lithuanian children reporting frequent sugar consumption, brushing teeth irregularly and visiting the dentist only in case of emergency was still high compared with Western countries. The DMFT values were related to the fluoride content in the drinking water, oral hygiene, residency and year of examination. [source]

The European Male Ageing Study (EMAS): design, methods and recruitment

INTERNATIONAL JOURNAL OF ANDROLOGY, Issue 1 2009
David M. Lee
Summary Life expectancy is increasing in most developed countries, in part due to improved socioeconomic conditions and in part to advances in healthcare. It is widely acknowledged that the promotion of healthy ageing by delaying, minimizing or preventing disabilities or diseases is one of the most important public health objectives in this century. In contrast to the menopausal transition in females, we know relatively little about the contribution of androgens and anabolic hormones to the quality of ageing in men. The European Male Ageing Study (EMAS) is a multicentre prospective cohort designed to examine the prevalence, incidence and geographical distribution of gender-specific and general symptoms of ageing in men, including their endocrine, genetic and psychosocial predictors. Men aged 40,79 years were recruited from eight European centres: Florence (Italy), Leuven (Belgium), Lodz (Poland), Malmö (Sweden), Manchester (UK), Santiago de Compostela (Spain), Szeged (Hungary) and Tartu (Estonia). Subjects were recruited from population registers and those who agreed to take part completed a detailed questionnaire including aspects of personal and medical history, lifestyle factors and sexual function. Objective measures of body size, cognition, vision, skeletal health and neuromuscular function were obtained. Blood and DNA specimens were collected for a range of biochemical and genetic analyses. After an average of 4 years, it is planned to resurvey the participants with similar assessments. A total of 3369 men with a mean age of 60 ± 11 years were recruited. The mean centre response rate was 43%, and highest in those aged 50,59 years. Those who participated were marginally younger than those who were invited but declined to participate (60.0 vs. 61.1 years). Participants left education slightly later than a sample of non-participants, though there were no consistent differences in levels of general health, physical activity, or smoking. EMAS will provide new population-based data concerning the main features that characterize ageing in men and its critical determinants, particularly with reference to age-related changes in hormone levels. Such information is an important prerequisite to develop effective strategies to reduce age-related disabilities and optimise health and well-being into old-age. [source]

Involving consumers in peer-facilitated home-based food hygiene training

INTERNATIONAL JOURNAL OF CONSUMER STUDIES, Issue 3 2003
L. Stevenson
A community-based food hygiene initiative was piloted in the Toxteth,Granby area of Liverpool between December 2001 and March 2002. The project aimed to increase awareness and behaviour, related to poor food purchase, storage and handling practices, by actively involving members of the local community in home-based peer-facilitated training. Facilitators (23) were actively recruited from within the Toxteth,Granby community, and undertook a 4-day induction and training programme, which included successful completion of the CIEH Basic Food Hygiene course. Facilitators subsequently recruited and visited nearly 1000 households (992) within the Toxteth,Granby electoral ward, undertook an observation sheet, a detailed questionnaire, and spent approximately 1 hour delivering food hygiene training. Facilitators returned to all households within an 8-week period, and completed further observation sheets and questionnaires, for use in a comparative analysis. Facilitators and householders received incentives for their involvement in the project. Analysis of the data collected showed that general awareness of a range of food hygiene issues was high (such as hand washing before handling food), and most participants (73.8%) were able to recognise the main symptoms of food borne disease. As a result of the home-based hygiene training there were significant changes in knowledge, attitudes, and food handling practices, including the use of refrigerators, purchase of chilled and frozen foods, washing or peeling of fruits and vegetables, and the cooking of meat-based products. The project demonstrates that it is possible for communities to improve their food hygiene awareness and food handling behaviours through home-based peer-facilitated training programmes, with minimal input from professionals. [source]

Long-term results of Burch colposuspension

INTERNATIONAL JOURNAL OF UROLOGY, Issue 4 2000
Haluk Akpinar
Abstract Background: We aimed to determine the long-term results of Burch colposuspension. Methods: Patients who had undergone Burch colposuspension due to stress urinary incontinence (SUI) in our department between 1991 and 1995 were asked to participate in the study by telephone or mail. Fifty of 78 patients (64%) responded and these formed the study group. Patients were evaluated by a detailed questionnaire, pelvic examination, uroflowmetry and postvoid residual urine determination. Provocative stress test and urodynamic evaluations were performed in those who claimed leakage. Additionally, follow-up charts were retrospectively reviewed from the patients' files. Results: Mean follow-up time was 50.6 months. The subjective cure rate was 52% and the surgical success rate was 84%. The patient satisfaction rate in terms of incontinence was 86%. No correlation was found between pre-operative patient characteristics (i.e. age, number of vaginal deliveries and pregnancies, menopause, previous anti-incontinence surgery and presence of detrusor instability) and outcome of surgery. Although no patient was performing clean intermittent catheterization in the long term, two patients had significant residual urine and obstructive flows. Three patients had severe pelvic prolapse that required surgical correction. Conclusions: Our results indicate that Burch colposuspension operation is an effective and durable choice of treatment with low complication rates for the treatment of SUI. [source]

Serological and clinical characteristics of children with peanut sensitization in an Asian community

PEDIATRIC ALLERGY AND IMMUNOLOGY, Issue 2p2 2010
Wen Chin Chiang
Chiang WC, Pons L, Kidon MI, Liew WK, Goh A, Wesley Burks A. Serological and clinical characteristics of children with peanut sensitization in an Asian community. Pediatr Allergy Immunol 2010: 21: e429,e438. © 2009 John Wiley & Sons A/S In the past two decades, peanut allergy prevalence has increased in the West but has been perceived as having remained low in Asia. To review the clinical presentation of Asian children with peanut hypersensitivity and measure their IgE responses to major peanut allergens. We enrolled 31 children presenting with various allergies and a positive skin prick test to peanut from the Children's hospital outpatient allergy clinic in Singapore. A detailed questionnaire was completed by parents. The children's serum IgE specific to native Ara h 1, native Ara h 2, and recombinant Ara h 3 were detected using ELISA. Of the 31 patients, 19 had previously documented reactions to peanuts, while 12 had no previous clinical reaction. Most, 89.5% (17/19) of first reactions featured skin changes (urticaria, erythema, angioedema), but only 36.8% (7/19) involved skin symptoms alone. Respiratory symptoms and GI symptoms occurred in 42.1% and 26.3% of patients respectively and did not occur as the sole manifestation of reaction. The most common GI manifestation was emesis, present in 26.3% (5/19) of subjects. Two children experienced impaired consciousness with systemic, anaphylactic events. Although most sought treatment for their first peanut reaction only one patient received epinephrine. Half of our patients reported a subsequent accidental ingestion after the diagnosis of peanut allergy, with a median time from diagnosis to first accidental ingestion of 4 months and a reported increased severity of reaction in approximately half of the repeat exposures. Eighty-seven percent of children had specific IgE directed against at least one of the major peanut allergens. Among all patients, 87.1% had IgE specific to both Ara h 1 and Ara h 2 and 54.8% to rAra h 3. Asian children with peanut sensitization have clinically similar presentations and respond to the same major allergenic proteins as their Western counterparts. The perceived differences between the populations in this context do not stem from divergent clinical or immunological responses. [source]

Diabetes in Victoria, Australia: the Visual Impairment Project

AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 6 2000
Rob McKay
Objectives:To establish the prevalence and characteristics of self-reported diabetes in a representative sample of Victorian residents aged 40 years and older, and to compare the vision between people with and without self-reported diabetes. Design:Cross-sectional survey. Setting:Nine randomly selected suburban Melbourne clusters and four randomly selected rural Victorian clusters. Participants:4,744 subjects (86% participation rate) aged ,40 years. Main outcome measures:Subjects answered a detailed questionnaire which provided demographic details, body mass index, and the duration and treatment of any diagnosis of diabetes. Refraction was performed and best-corrected visual acuity was measured. Results:The prevalence of self-reported diabetes was 5.1%. In a multivariate analysis, self-reported diabetes was positively associated with age (p<0.01), male sex (p=0.01), higher body mass index (p=0.01), Mediterranean ethnicity (p=0.01), unemployment (p=0.05) and lack of private health insurance (p<0.05). People with self-reported diabetes were more likely to have mild or moderate levels of visual impairment than people who reported no previous diagnosis of diabetes (p<0.01). Conclusions:Diabetes in Victoria is more prevalent among men and among people of Mediterranean origin. When planning educational programs and health service delivery, it is also important to consider that, compared with the general population, people with diabetes are less likely to be employed or to have private health insurance, and are more likely to have impaired vision. [source]

A serological and virological survey for evidence of infection with Newcastle disease virus in Australian chicken farms

AUSTRALIAN VETERINARY JOURNAL, Issue 6 2007
VG Kite
Objective, To determine the prevalence and distribution of antibodies to Newcastle disease virus on Australian chicken farms and to determine the pathotype and relationships of the Newcastle disease viruses present on those farms. Design, A cross-sectional survey of 753 commercial chicken farms. Procedure, The survey comprised a detailed questionnaire and collection of venous blood samples. The titre of antibodies to Newcastle disease virus was determined by haemagglutination inhibition. Virus isolation was conducted from cloacal and tracheal swabs taken from chickens in serologically positive flocks. Virus isolates were pathotyped on the basis of the deduced Fusion protein cleavage site determined by nucleotide sequencing of a 265 bp region of the genome in the region of the cleavage site. Results, Antibody evidence of Newcastle disease virus infection was found on 300 of the 753 surveyed farms throughout all 11 geographic regions of the survey. The highest prevalence occurred in the Sydney basin, New South Wales and Victoria east regions. Antibody titres were also highest in the regions where serologically positive flocks were most prevalent. The 259 virus isolates revealed nine different RNA sequences. Of the nine virus groups isolated, the most common group W was identical in sequence to the V4 vaccine strain. Five of the other groups had novel RNA sequences in the region of the F protein cleavage site. Conclusions, Antibodies to Newcastle disease virus are highly prevalent in the Australian chicken flock but all identified strains were avirulent in nature. [source]

Vertical reduction rectoplasty: a new treatment for idiopathic megarectum

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 9 2000
Professor N. S. Williams
Background The aetiology of idiopathic megarectum is unknown and the results of surgery are often unsatisfactory. Rectal hyposensation is common and poor perception of rectal filling may contribute to the poor evacuatory function. By reducing the capacity of the rectum, it was hypothesized that sensory thresholds to rectal distension and perception of urge to defaecate would be improved. Methods Vertical reduction rectoplasty (VRR) and concomitant sigmoid colectomy was performed on six patients with idiopathic megarectum. Patients were evaluated before and after operation by detailed questionnaire and anorectal physiology. Postoperative rectal compliance was also studied by means of a programmable electronic barostat. Where appropriate, physiological data were compared with those obtained in eight healthy volunteers. Results Bowel frequency increased from a preoperative median of 2·5 to 16 per month after operation. Four patients reported improved rectal perception of the urge to defaecate. Thresholds for defaecatory urge and maximum tolerated volume were significantly reduced following VRR (P < 0·05). Post-VRR rectal compliance was no different from that in healthy volunteers. Colonic transit time decreased significantly after VRR (P < 0·05) and evacuation on proctography increased from a median of 30 per cent to 50 per cent. At a median of 57 weeks' follow-up five of the six patients expressed continued satisfaction with the results. Conclusion VRR is a new approach to the treatment of idiopathic megarectum. Clinical and physiological studies confirm that it can improve sensory feedback and defaecation. The procedure needs further evaluation as the number of patients undergoing the procedure increases. © 2000 British Journal of Surgery Society Ltd [source]

Specialized intestinal metaplasia in patients with gastro-oesophageal reflux disease

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 1 2000
E. Carton
Background: There is an increasing awareness that short (less than 3 cm) segments of Barrett's epithelium and macroscopically normal cardia epithelium may harbour specialized intestinal metaplasia (SIM), a premalignant phenotype. The prevalence of SIM was studied prospectively in an unselected population of patients attending for endoscopy, and the association of SIM with symptoms, lifestyle, medication, endoscopic oesophagitis and carditis was investigated. Methods: Two hundred consecutive patients underwent endoscopy. Biopsies taken from just below the squamocolumnar junction were stained for SIM, and were analysed for carditis and Helicobacter pylori infection. A detailed questionnaire of symptoms, tobacco consumption and the use of proton pump inhibitors was completed. Results: Forty-two patients (21 per cent) had SIM: 19 (15 per cent) of 126 in an endoscopically normal oesophagus, 15 (24 per cent) of 63 in a short segment of Barrett's epithelium and eight of 11 in classical Barrett's oesophagus. There was a significant association between SIM and carditis (P < 0·0001) and endoscopic oesophagitis (P = 0·03). Conclusion: SIM is prevalent in patients undergoing endoscopy, does not correlate with symptoms or H. pylori infection, but is significantly associated with endoscopic and pathological markers of gastro-oesophageal reflux. © 2000 British Journal of Surgery Society Ltd [source]

Invasive group A, B, C and G streptococcal infections in Denmark 1999,2002: epidemiological and clinical aspects

CLINICAL MICROBIOLOGY AND INFECTION, Issue 7 2005
K. Ekelund
Abstract Group A streptococci (GAS) have been described frequently as an emerging cause of severe invasive infections in population-based surveillance studies, whereas the descriptions of group B, C and G streptococci (GBS, GCS and GGS) have been less frequent. Enhanced surveillance for invasive GAS, GBS, GCS and GGS was performed in Denmark in 1999,2002. A detailed questionnaire was completed for 1237 (98%) of 1260 invasive infections. GAS infections dominated (40%), followed by GGS (32%), GBS (23%) and GCS (6%). Most (74%) patients had predisposing factors, and there were no significant differences between the four serogroups when comparing the prevalence of cancer, diabetes mellitus, chronic heart or lung diseases, immunodeficiency or alcohol abuse. The overall case fatality rate at day 30 was 21%, increasing significantly to 59% for patients with streptococcal toxic shock syndrome (STSS). STSS was significantly more frequent in GAS patients (10%) than in GCS (4%), GBS (2%) and GGS (2%) patients. Regression analyses showed that, despite a younger median age among GAS patients, the probability of developing septic shock and mortality was significantly higher among GAS patients than among GBS and GGS patients. These analyses showed no significant differences between GAS and GCS infections. Invasive infections caused by GAS, GBS, GCS and GGS are still a major challenge for clinicians. Continued epidemiological and microbiological surveillance is important to assess the development of these infections and to improve preventative strategies. [source]

Follow-Up of 1 mg Finasteride Treatment of Male Pattern Baldness,Difference between Clinical Trials and Private Office Follow-Up: Influences on Prescribing Habits Evaluated