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Only Significant Predictor (only + significant_predictor)
Selected AbstractsPrevalence and risk of traumatic gingival recession following elective lip piercingDENTAL TRAUMATOLOGY, Issue 1 2006Jonathan W. Leichter Abstract,,, The aims of this study were to evaluate the prevalence, risk and odds ratios of gingival recession defects associated with elective lip piercing and wearing of stud jewelry, and to attempt to identify risk factors that might permit the incidence of recession and its severity to be predicted, using Miller's classification. Ninety-one subjects with lip piercing and labrets were evaluated with regard to gender, age, smoking history, orthodontic history, and labret characteristics. An age-matched group of 54 individuals without peri-oral piercing provided the control. Gingival recession was recorded on teeth opposing a labret in 68.13% of pierced subjects. By contrast, only 22.2% of unpierced individuals demonstrated recession. The odds ratio between pierced and control groups indicates a likelihood of recession 7.5 times greater in a pierced individual wearing a labret than in an unpierced individual. Logistical regression analysis showed that age, gender, smoking and labret configuration did not significantly influence the development of recession. Furthermore, an illustrative example indicates that piercing and provision of a labret might typically increase the risk of recession occurring from 34.4% (pre-piercing) to 80.8 %. Recession severity was greater in the pierced group, with Miller's class 2 and 3 defects observed in 18.7% of the pierced but not at all in the unpierced group. Ordinal regression identified previous orthodontic treatment as the only significant predictor of Miller's grade. We concluded that a clear link exists between lip piercing, labret use and gingival recession. Belief that labret placement and configuration can be modified to provide protection is unfounded. [source] Oral piercing and oral trauma in a New Zealand sampleDENTAL TRAUMATOLOGY, Issue 5 2005J. A. Kieser Abstract,,, This study investigated the periodontal and dental trauma resultant from tongue and lip piercings in a convenience sample of 43 adult dental patients. Patients underwent an intra-oral examination followed by the administration of a questionnaire. Each patient was examined for lingual or buccal recession of the upper and lower incisors as well as the extent of abnormal toothwear or trauma on these teeth. Following bivariate analyses, regression analyses were conducted to test the study hypotheses and derive adjusted estimates for the dependent variables. Of the 43 individuals who participated (93.0% females; mean age 21 years; age range 14,34 years) 76.7% had a tongue piercing, 34.9% had a lip piercing, and 11.6% had both. Only four had had their piercing procedure provided by a doctor or dentist. Postpiercing complications were reported by 34.9%. Most of those with a labial piercing (80.0%) had 1+ labial site with gingival recession (GR), and almost one-third of those with a tongue piercing had at least one lingual site with GR. Age was a significant predictor of the prevalence of lingual recession, with the odds of having lingual recession increasing by 1.17 (95% CI 1.01, 1.35) for every year older than 14. Age was the only significant predictor of the number of lingual sites with recession, but was not a predictor of the prevalence of labial recession or the number of affected sites. There were no significant associations between piercings and abnormal toothwear or trauma. These findings suggest that oral piercings are associated with localized gingival recession, and that the providers of such procedures should ensure that, as part of the informed consent process, prospective patients are informed of the likelihood that their periodontal health may be compromised. [source] How many well vs. unwell days can you expect over 10 years, once you become depressed?ACTA PSYCHIATRICA SCANDINAVICA, Issue 4 2009T. A. Furukawa Objective:, Prognostic studies of major depression have mainly focused on episode remission and relapse, and only a limited number of studies have examined long-term course of depressive symptomatology at threshold and subthreshold levels. Method:, The Group for Longitudinal Affective Disorders Study has conducted prospective serial assessments of a cohort of heretofore untreated major depressive episodes for 10 years under naturalistic conditions. Results:, Of the 94 patients in the cohort, the follow-up rate was 70% of the 11 280 person-months. Around 77% of the follow-up months were spent in euthymia, 16% in subthreshold depression and 7% in major depression. Duration of the index episode before reaching recovery was the only significant predictor of the ensuing well time. Conclusion:, On average, patients with major depression starting treatment today may expect to spend three quarters of the next decade in euthymia but the remaining one quarter in subthrehold or threshold depression. [source] Elevated fasting plasma C-peptide occurs in non-diabetic individuals with fatty liver, irrespective of insulin resistanceDIABETIC MEDICINE, Issue 9 2009G. Perseghin Abstract Aims Studies have pointed to insulin resistance as a pathogenic factor in fatty liver. Although pancreatic B-cell function is believed to be involved, its role is unclear. This study was undertaken to test whether fasting C-peptide, an index of fasting B-cell function, was related to intra-hepatic fat (IHF) content in non-diabetic humans. Methods We assessed, retrospectively, fasting plasma C-peptide concentration in 31 patients with fatty liver and 62 individuals without fatty liver. The IHF content was measured by proton magnetic resonance spectroscopy (1H-MRS), while insulin sensitivity was estimated based on fasting plasma glucose and insulin with the homestasis model assessment (HOMA) 2 method. Results Age, sex and body mass index (BMI) were not different between groups. Patients with fatty liver had higher fasting insulin (P < 0.01), C-peptide (P < 0.005) and lower insulin sensitivity (HOMA2-%S). Fasting insulin alone explained 14% of the IHF content variability (P < 0.001); inclusion of fasting C-peptide in multivariate regression explained up to 32% (P < 0.001). A subgroup analysis was performed by matching 1 : 1 for HOMA2-%S. These data were analysed by conditional logistic regression which showed that, when HOMA2-%S was matched between groups, fasting C-peptide remained the only significant predictor of fatty liver. Conclusions Non-diabetic individuals with fatty liver are characterized by increased fasting plasma C-peptide concentration, irrespective of their insulin resistant state. [source] The role of migratory ducks in the long-distance dispersal of native plants and the spread of exotic plants in EuropeECOGRAPHY, Issue 6 2009Anne-Laure Brochet Little is known about the role of migratory waterfowl in the long-distance dispersal (LDD) of seeds. We studied the gut contents of 42 teals Anas crecca collected in the Camargue, southern France, and found intact seeds of 16 species. There was no relationship between the probability that a given seed species was found intact in the lower gut, and the seed hardness or size. The number of seeds found in the oesophagus and gizzard (a measure of ingestion rate) was the only significant predictor of the occurrence of intact seeds in the lower gut, so studies of waterfowl diet can be used as surrogates of dispersal potential. In a literature review, we identified 223 seed species recorded in 25 diet studies of teal, pintail Anas acuta, wigeon A. penelope or mallard A. platyrhynchos in Europe. We considered whether limited species distribution reduces the chances that a seed can be carried to suitable habitat following LDD. Overall, 72% of plant species recorded in duck diets in southern Europe (36 of 50) were also recorded in the north, whereas 97% of species recorded in duck diets in the north (137 of 141) were also recorded in the south. This suggests a great potential for LDD, since most dispersed plants species occur throughout the migratory range of ducks. Migratory ducks are important vectors for both terrestrial and aquatic plant species, even those lacking the fleshy fruits or hooks typically used to identify seeds dispersed by birds. Finally, we show ducks are important vectors of exotic plant species. We identified 14 alien to Europe and 44 native to Europe but introduced to some European countries whose seeds have been recorded in duck diet. [source] Evaluating the validities of different DSM-IV-based conceptual constructs of tobacco dependence,ADDICTION, Issue 7 2008Peter S. Hendricks ABSTRACT Aim To compare the concurrent and predictive validities of two subsets of DSM-IV criteria for nicotine dependence (tolerance and withdrawal; withdrawal; difficulty controlling use; and use despite harm) to the concurrent and predictive validity of the full DSM-IV criteria. Design Analysis of baseline and outcome data from three randomized clinical trials of cigarette smoking treatment. Setting San Francisco, California. Participants Two samples of cigarette smokers (n = 810 and 322), differing with regard to baseline characteristics and treatment received, derived from three randomized clinical trials. Measurements DSM-IV nicotine dependence criteria were measured at baseline with a computerized version of the Diagnostic Interview Schedule for DSM-IV (DIS-IV). Additional baseline measures included the Fagerström Test of Nicotine Dependence (FTND), number of cigarettes smoked per day, breath carbon monoxide (CO) level, the Minnesota Nicotine Withdrawal Scale (MNWS), the Michigan Nicotine Reinforcement Questionnaire (M-NRQ) and the Profile of Mood States (POMS). Seven-day point-prevalence abstinence was assessed at week 12. Findings Full DSM-IV criteria displayed greater concurrent validity than either of the two subsets of criteria. However, DSM-IV symptoms accounted for only a nominal amount of the variance in baseline smoking-related characteristics and were unrelated to smoking abstinence at week 12. Cigarettes smoked per day was the only significant predictor of abstinence at week 12. Conclusions Although the findings do not provide a compelling alternative to the full set of DSM-IV nicotine dependence criteria, its poor psychometric properties and low predictive power limit its clinical and research utility. [source] The clinically related predictors of dental fear in Taiwanese childrenINTERNATIONAL JOURNAL OF PAEDIATRIC DENTISTRY, Issue 6 2008CHEN-YI LEE Background. Dental fear has been singled out as one of the most troublesome problems facing paediatric dentistry today. Children with dental fear may avoid visiting dentists; therefore, their oral health protection is often compromised. However, the aetiology of dental fear is still not entirely understood. Objective. This study investigated the dental visiting habit, the previous dental experiences, the conditioning pathway, and the clinically related predictors of dental fear in children. Design., The dental history of 247 children (2,10 years old) was obtained when they came to a dental clinic for treatment. The level of dental fear in these children was assessed using the Children's Fear Survey Schedule,Dental Subscale (CFSS-DS). Observers rated the clinically anxious responses and uncooperative behaviour towards dental treatment in these children. Three stepwise regression analyses were performed to determine significant predictors of CFSS-DS score, clinically anxious responses, and uncooperative behaviour of children, respectively. Results. We found that the CFSS-DS score and clinical anxiety have different predictors, but age , 3.99 years old and cooperativeness in the first dental visit were important predictors for both the CFSS-DS score and the clinical anxiety. Furthermore, the other predictors of the CFSS-DS score were maternal dental fear, unbearable pain during the first dental visit, and visiting dentists in a regular dental clinic; the other predictors of clinical anxiety were first-born, regular dentist, and CFSS-DS score. Finally, the only significant predictor for uncooperative behaviour was clinical anxiety. Conclusion. Children's dental fear and their anxious response during dental treatment were dynamic processes that consisted of many different factors. The direct conditioning of subjective experience of pain was more important than the objective pathway of child dental fear, and the indirect conditioning does not seem influential in this study sample. [source] Assessing the antecedents of transfer intentions in a training contextINTERNATIONAL JOURNAL OF TRAINING AND DEVELOPMENT, Issue 3 2004M. Anthony Machin This study examined the underlying structure of transfer climate and those aspects of transfer climate that were related to pre-training self-efficacy, pre-training motivation, and post-training transfer implementation intentions. Positive and negative affectivity (PA and NA) were also measured in order to better understand the relationship of these variables to trainees' perceptions of the transfer climate and the other training-related variables. Transfer climate was best represented by two underlying constructs, although these were correlated. After controlling for PA and NA, none of the transfer climate variables were significantly related to pre-training self-efficacy, while only positive reinforcement was significantly related to pre-training motivation. Pre-training self-efficacy was also a significant predictor of pre-training motivation, even after controlling for PA and NA. Negative affectivity was the only significant predictor of post-training transfer implementation intentions. Further research needs to clarify whether PA and NA are contributors to the trainees' perceptions of the transfer climate or are a product of these perceptions. [source] Newly Detected Atrial Fibrillation Following Dual Chamber Pacemaker ImplantationJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 12 2006JIM W. CHEUNG M.D. Introduction: Pacemaker (PPM)-detected atrial high-rate episodes (AHREs) of even 5-minute duration may identify patients at increased risk for stroke and death. In this study, we sought to determine the incidence of newly detected atrial fibrillation (AF defined as an AHRE ,5 minutes) in patients following dual-chamber PPM implantation and to define the clinical predictors of developing AF. Methods and Results: We evaluated 262 patients (142 male; age 74 ± 12 years) without documented AF who underwent PPM implantation for sinus node dysfunction (n = 122) or atrioventricular block (n = 140). Information regarding patient demographics, cardiovascular diseases, and medication history was obtained. The cumulative percentages of ventricular pacing as well as the frequency, duration, and time to first episode of an AHRE were also determined. During follow-up of 596 ± 344 days, an AHRE ,5 minutes was detected in 77 (29%) patients. Of these, 47 (61%) patients had an AHRE ,1 hour, 22 (29%) patients had an AHRE ,1 day, and 12 (16%) patients had an AHRE ,1 week. An AHRE ,5 minutes was seen in 24% and 34% of patients at 1 year and 2 years, respectively. Among patients with sinus node dysfunction, ,50% cumulative ventricular pacing was the only significant predictor of an AHRE ,5 minutes (HR 2.2; CI 1.0,4.7; P = 0.04). Conclusions: Within 1 year of PPM implantation, AF is detected in 24% of patients without history of AF. In patients with sinus node dysfunction, ,50% cumulative right ventricular pacing is associated with a 2-fold increase in risk of developing AF. [source] Patterns of Treatment Services and Costs for Young Offenders with Mental DisordersJOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING, Issue 3 2005Deborah Shelton PhD PROBLEM:,This study describes mental health treatment service delivery patterns and costs for youth in a juvenile justice system. METHODS:,A secondary data analysis on a random sample of juvenile offenders (N = 312) was completed. Service patterns and costs were described. Selected variables were examined for their ability to predict who received treatment. FINDINGS:,Only 23% of youth diagnosed with a mental disorder received any treatment. Older youth and African American youth received fewer services, and race was the only significant predictor for receiving treatment (p = .001). CONCLUSIONS:,Mental health treatment services were scarce, and the data reflects a race bias in the provision of services. Although the law protects the right to treatment for these individuals, provision of services remains a challenge. [source] Charitable giving: the effectiveness of a revised theory of planned behaviour model in predicting donating intentions and behaviourJOURNAL OF COMMUNITY & APPLIED SOCIAL PSYCHOLOGY, Issue 5 2007Joanne R. Smith Abstract A revised theory of planned behaviour (TPB) model was used to determine the influence of attitudes, norms (injunctive, descriptive and moral norms), perceived behavioural control, and past behaviour on intentions to donate money to charitable organisations. Respondents (N,=,227) completed a questionnaire assessing the constructs of the revised TPB model. Four weeks later, a subsample of respondents (N,=,67) reported their donating behaviour. Hierarchical multiple regression analyses revealed support for the revised TPB model. Attitudes, perceived behavioural control, injunctive norms, moral norms and past behaviour all predicted charitable giving intentions; however, descriptive norms did not predict donating intentions. Donating intentions were the only significant predictor of donating behaviour at Time 2. In addition, a number of beliefs differentiated between those who did and did not intend to donate to charity. Theoretical and applied implications of the results are discussed. Copyright © 2007 John Wiley & Sons, Ltd. [source] Prevalence of metabolic syndrome and its association with obesity indices in a Chinese populationJOURNAL OF DIABETES, Issue 1 2009Yun HUANG Abstract Background:, To investigate the prevalence of metabolic syndrome in an urbanizing community in Qingpu, a suburb of Shanghai, and to determine which obesity indices, including body mass index, waist circumference (WC), and waist:hip (WHpR), and waist:height (WHtR) ratios, are most closely associated with metabolic syndrome. Methods:, We conducted a cross-sectional health survey of 1634 individuals (age 15,87 years) in the Jinhulu community located in Qingpu. The National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (NCEP ATP III) criteria were used to define metabolic syndrome, with central obesity defined according to Asia,Pacific (APC) region criteria. Results:, The age-standardized prevalence of metabolic syndrome was 3.6% in men and 7.2% in women. Using the criterion of central obesity in the APC, the age-standardized prevalence of metabolic syndrome increased to 8.3% in men and 10.9% in women. Regardless of age, WHtR consistently showed a higher odd ratios (OR) after adjustment for confounding factors of 2.17 (95% confidence interval [CI] 1.12,4.20; P = 0.022) in subjects<52 years of age and 1.92 (95% CI 1.18,3.11; P = 0.008) in those ,52 years of age. In men, the WHtR was the only significant predictor (OR 2.42; 95% CI 1.15,5.08; P = 0.02) of metabolic syndrome after adjustment, whereas in women WHtR (OR 1.87; 95% CI 1.37,2.85; P =0.0088) was slightly inferior to WHpR and WC. Conclusion:, Metabolic syndrome is prevalent in an urbanizing rural area in Qingpu. Of the anthropometric parameters commonly used to identify metabolic syndrome, WHtR may be the best. [source] CT Coronary Angiography Predicts the Outcome of Percutaneous Coronary Intervention of Chronic Total OcclusionJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 5 2007F.R.A.C.P., KEAN H. SOON M.B.B.S. Background: The success rate of percutaneous coronary intervention (PCI) of chronic total occlusions (CTO) is relatively low. Further evaluation of CTO lesion with CT coronary angiography (CT-CA) may help to better select patients that would benefit from percutaneous revascularization. We aimed to test the possible association between failed PCI and transluminal calcification of CTO as assessed by CT-CA. Methods: Patients with CTO awaiting PCI were scanned with a 16-slice CT. A cardiologist and a radiologist assessed transluminal calcification of CTO lesions on CT images while an interventional cardiologist at a core laboratory assessed conventional variables of invasive fluoroscopic coronary angiography (FCA) associated with failed PCI of CTO. The significance of CT and FCA variables in association with failed PCI were analyzed. Results: In a cohort of 39 patients with 43 CTO lesions, 24 lesions were successfully revascularized. Transluminal calcification ,50% as assessed on CT-CA was strongly associated with failed PCI (odds ratio [OR] of PCI success = 0.10, 95% confidence interval [CI]: 0.02,0.47, P = 0.003). Blunt stump as seen on FCA was also associated with failed PCI (OR of PCI success = 0.24, 95% CI: 0.07,0.86, P = 0.029). There was no significant evidence to support that the duration of CTO, presence of side branch and bridging collaterals, and the absence of microchannels as assessed with FCA were associated with failed PCI. On multivariate analysis, transluminal calcification ,50% on CT-CA was the only significant predictor of failed PCI. Conclusions: Heavy transluminal calcification as assessed with CT-CA is an independent predictor of failed PCI of CTO. CT-CA may have a role in the work-up of CTO patients prior to PCI. [source] Management of well-differentiated thyroid carcinoma presenting within a thyroglossal duct cystJOURNAL OF SURGICAL ONCOLOGY, Issue 3 2002Snehal G. Patel MD Abstract Background and Objective Well-differentiated thyroid carcinoma (WDTC) is diagnosed in approximately 1.5% of thyroglossal duct cysts (TGDC). No clear consensus exists regarding further management after adequate excision of the cyst, especially the role of total thyroidectomy and postoperative radioactive iodine therapy. The current review was undertaken in an attempt to clarify these issues. Methods Demographic, clinical, tumor, treatment, pathology, and outcome data on 57 eligible patients reported in recent literature were pooled together with 5 patients treated at our institution for this analysis. Results A Sistrunk operation was performed for resection of the thyroglossal duct cyst in the majority (90%) of patients. Histologic examination of the tumor in the cyst revealed that papillary carcinoma was the most frequent (92%) histologic type. A total thyroidectomy was performed consequent to the diagnosis of thyroglossal duct cyst carcinoma in approximately half of the 62 patients. A malignant tumor was reported in 27% of the thyroidectomy specimens. Postoperative radioactive iodine therapy was administered in 16 (26%) patients. With a median follow-up of 71 months (range 1,456 months), the 5- and 10-year Kaplan,Meier overall survival was 100 and 95.6%, respectively. There were no disease-related deaths reported in any of the patients. Univariate analysis revealed that the only significant predictor of overall survival was the extent of primary surgery for the thyroglossal cyst. The addition of total thyroidectomy to Sistrunk operation did not have a significant impact on outcome (P,=,0.1). Patients treated with postoperative radioactive iodine (RAI) fared significantly worse than those that did not need RAI, which may be explained by the fact that this modality would generally be used in patients with higher risk tumors. Conclusions The Sistrunk operation is adequate for most patients with incidentally diagnosed TGDC carcinoma in the presence of a clinically and radiologically normal thyroid gland. Results of adequate excision using the Sistrunk operation are excellent and the concept of risk-groups should be used to identify patients, who would benefit from more aggressive treatment. J. Surg. Oncol. 2002;79:134,139. © 2002 Wiley,Liss, Inc. [source] Risk factors for readmission after initial diagnosis in children with acute lymphoblastic leukemia,PEDIATRIC BLOOD & CANCER, Issue 3 2008Tamra L. Slone MD Abstract Background Specific hospital discharge criteria following the initial diagnosis of children with acute lymphoblastic leukemia (ALL) have not been reported. This retrospective cohort study was designed to identify risk factors for readmission during induction therapy, to assist with development of discharge guidelines. Procedure We reviewed the records of 142 consecutive children with newly diagnosed B-precursor ALL and found 129 eligible patients. Chi square, t -test, and multivariate logistic regression analysis were used to compare differences in absolute neutrophil count (ANC), NCI risk status, age, type of corticosteroid administered, and other potential risk factors for readmission during induction therapy. Results ANC at initial hospital discharge was the only significant predictor of readmission for fever during induction therapy (P,=,0.006) by multivariate analysis. Specifically an ANC ,200/mm3 at discharge had the strongest association with readmission for fever (OR 3.3, 95% CI 1.422, 7.729). Conclusion An ANC >200/mm3, in a clinically stable patient, is associated with minimal risk of readmission during induction therapy following the initial diagnosis of ALL. Pediatr Blood Cancer 2008;51:375,379. © 2008 Wiley-Liss, Inc. [source] Poor hematopoietic stem cell mobilizers: A single institution study of incidence and risk factors in patients with recurrent or relapsed lymphomaAMERICAN JOURNAL OF HEMATOLOGY, Issue 6 2009Chitra Hosing The purpose of this retrospective study was to determine the incidence and predictive factors if any, of mobilization failure in lymphoma patients referred for autologous stem cell transplantation. A total of 588 lymphoma patients were referred for transplant consultation from January 2003 to December 2004. Predictors of mobilization failure were evaluated using logistic regression analysis including diagnosis, mobilization regimen, age, sex, type and number of prior chemotherapies, bone marrow cellularity, platelet count, white count, prior bone marrow involvement with malignancy, and prior radiation therapy. Two hundred and six patients were eligible for transplantation and underwent stem cell mobilization. Twenty-nine (14%) patients failed to mobilize adequate stem cells after the first attempt. For the entire group age (,60 versus <60 years), diagnosis (Hodgkin's versus non-Hodgkin's lymphoma), use of cytokines alone, platelet count <150 × 109/L, and bone marrow cellularity <30% were significant predictors for mobilization failure on univariate analysis. In view of small number of patients multivariate analysis was not possible. However, a low platelet count (150 × 109/L) was the only significant predictor when the analysis was restricted to non-Hodgkin's lymphoma patients who were mobilized with chemotherapy. Mobilization failure rates are higher in patients with non-Hodgkin's lymphoma compared with those with Hodgkin's lymphoma. In the subset of patients who undergo chemomobilization for non-Hodgkin's lymphoma platelet count at the time of mobilization is a predictor of mobilization failure. Am. J. Hematol. 2009. © 2009 Wiley-Liss, Inc. [source] Prognostic factors in rapidly progressive interstitial pneumoniaRESPIROLOGY, Issue 2 2010Yasuhiro KONDOH ABSTRACT Background and objective: The aim of the present study was to examine clinical and other features that might allow prognostic distinctions between histological patterns in presentations with rapidly progressive interstitial pneumonia (RPIP), and to assess prognostic factors for survival. Methods: Patients with RPIP among 425 consecutive patients with diffuse lung disease, who underwent surgical lung biopsy, were studied retrospectively. The discriminatory value of clinical and investigative features for identifying disease with a better outcome was evaluated. An a priori comparison was made between diffuse alveolar damage (DAD)/usual interstitial pneumonia with DAD pattern (Group A), and organizing pneumonia/non-specific interstitial pneumonia pattern (Group B). Results: Twenty-eight patients (6.6%) fulfilled the criteria for RPIP. The diagnosis was Group A disease in 15 (DAD in 10, usual interstitial pneumonia with DAD in 5), and Group B disease in 13 (organizing pneumonia in 8, non-specific interstitial pneumonia in 5). There were no significant differences in initial findings between the groups. Prognosis was significantly better for Group B patients than for Group A patients (P = 0.021). Neither BAL nor parenchymal high-resolution CT score was indicative of therapeutic responsiveness or outcome. Distinction between Group A and Group B on the basis of disease pattern was the only significant determinant of prognosis. Conclusions: RPIP included varied histological patterns with different outcomes, and in many cases these could not be predicted using baseline clinical data. Histology was the only significant predictor of ultimate prognosis. [source] In Newly Diagnosed Breast Cancer, Screening MRI of the Contralateral Breast Detects Mammographically Occult Cancer, Even in Elderly Women: The Mayo Clinic in Florida ExperienceTHE BREAST JOURNAL, Issue 2 2010Johnny Ray Bernard Jr MD Abstract:, The role of magnetic resonance imaging (MRI) in patients with newly diagnosed breast cancer is somewhat controversial. The purpose of this study was to evaluate the prevalence of synchronous, occult contralateral breast cancer detected by MRI but not by mammography or clinical breast examination in women with newly diagnosed breast cancer, including those aged 70 years or older at our institution. MRI results for women with newly diagnosed breast cancer who underwent bilateral breast MRI after negative mammography and clinical examination between February 2003 and November 2007 at Mayo Clinic in Florida were reviewed. The prevalence of pathologically confirmed contralateral carcinoma diagnosed solely by MRI was determined and analyzed in the context of age, family history, menopausal status, breast density, and primary-tumor characteristics. Logistic regression was used to explore the association between contralateral carcinoma and potential patient risk factors. A total of 425 women were evaluated, of whom 129 (30%) were aged 70 years or older. A contralateral biopsy was recommended and performed solely on the basis of MRI in 72 of the 425 women (17%). Sixteen of these 72 women (22%) had pathologically confirmed carcinoma, including seven in the older subgroup. The prevalence of clinically and mammographically occult contralateral carcinoma detected by MRI was 3.8% (16/425) overall and 5.4% (7/129) in the group of older women. When potential risk factors for contralateral breast cancer were evaluated, postmenopausal status was the only significant predictor of contralateral cancer detected by MRI (p = 0.016). We concluded that contralateral breast screening with MRI should be considered in postmenopausal women with newly diagnosed breast cancer, even those aged 70 years or older at diagnosis. [source] The Effect of treatment on survival in patients with advanced laryngeal carcinoma,THE LARYNGOSCOPE, Issue 7 2009Christine G. Gourin MD Abstract Objectives/Hypothesis: Over the last 2 decades, survival from laryngeal cancer has decreased. We sought to identify factors associated with decreased survival in laryngeal cancer. Methods: Patients diagnosed with laryngeal squamous cell carcinoma from 1985 to 2002 were retrospectively reviewed. Results: A total of 451 patients met study criteria. Five-year survival rates were 85% for stage I, 77% for stage II, 51% for stage III, and 35% for stage IV disease. Survival for patients with stage I,III disease was similar for patients treated operatively or nonoperatively (P = .4). However, patients with stage III disease treated nonoperatively had worse survival with radiation alone (XRT) compared to chemoradiation (CR) (P = .006). Patients with stage IV disease had significantly better survival with surgery (49%) than CR (21%) or XRT alone (14%) (P < .0001). Analysis by primary tumor stage demonstrated that survival for T1,T3 disease was independent of treatment modality (P = .2); however, for T4 patients, operative treatment was associated with significantly better survival (55%) than CR (25%) or XRT (0%) (P < .0001). Proportional hazards models confirmed significantly worse survival for stage IV, T4, N2 or N3 disease, and nonoperative treatment. For T4 disease, after controlling for nodal status, nonoperative treatment was the only significant predictor of worse survival. Conclusions: Primary surgical treatment is associated with improved survival for patients with stage IV disease and specifically T4 primary tumors. These data suggest that the observed national decrease in survival from laryngeal cancer may be due to a shift toward nonoperative treatment in that subset of patients with advanced primary disease. Laryngoscope, 2009 [source] Elucidation of the relationship between synovitis and bone damage: A randomized magnetic resonance imaging study of individual joints in patients with early rheumatoid arthritisARTHRITIS & RHEUMATISM, Issue 1 2003Philip G. Conaghan Objective To simultaneously image bone and synovium in the individual joints characteristically involved in early rheumatoid arthritis (RA). Methods Forty patients with early, untreated RA underwent gadolinium-enhanced magnetic resonance imaging (MRI) of the second through fifth metacarpophalangeal joints of the dominant hand at presentation, 3 months, and 12 months. In the first phase (0,3 months), patients were randomized to receive either methotrexate alone (MTX) or MTX and intraarticular corticosteroids (MTX + IAST) into all joints with clinically active RA. The MTX-alone group received no further corticosteroids until the second phase (3,12 months), when both groups received standard therapy. Results In the first phase, MTX + IAST reduced synovitis scores more than MTX alone. There were significantly fewer joints with new erosions on MRI in the former group compared with the latter. During the second phase, the synovitis scores were equivalent and a similar number of joints in each group showed new erosions on MRI. In both phases, there was a close correlation between the degree of synovitis and the number of new erosions, with the area under the curve for MRI synovitis the only significant predictor of bone damage progression. In individual joints, there was a threshold effect on new bone damage related to the level of synovitis; no erosions occurred in joints without synovitis. Conclusion In early RA, synovitis appears to be the primary abnormality, and bone damage occurs in proportion to the level of synovitis but not in its absence. In the treatment of patients with RA, outcome measures and therapies should focus on synovitis. [source] Women who miscarry: The effectiveness and clinical utility of the Kessler 10 questionnaire in screening for ongoing psychological distressAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 1 2010Helen M. STALLMAN Background:, Early pregnancy loss has been linked to enduring psychological morbidity. Aims:, This study aimed to investigate the utility of the Kessler 10 (K10) questionnaire as a brief screening instrument to identify women at risk for the development of psychiatric diagnoses three months post-miscarriage. Method:, Participants were 117 consecutive women presenting at a public hospital emergency department and receiving a diagnosis of miscarriage. Main outcome measures:, K10 screen for psychological distress and the Structured Clinical Interview for DSM Disorders to determine psychiatric diagnoses. Results:, A majority of women (81.2%) experienced elevated levels of distress initially, 24.8% in the very high range. They were not at increased risk of psychiatric diagnoses at three months compared with the general population; however, they were significantly more likely to report subsyndromal symptoms at this time compared with the general population. The baseline K10 score was the only significant predictor of distress at follow-up (r = 0.45, P < 0.001). The receiver operating characteristic curve shows that a cut-off of 14 on the K10 has suitable sensitivity (97%) and specificity (82%) for predicting ongoing psychological distress in women who miscarry. Conclusions:, The K10 is effective in identifying women at risk for ensuring psychological symptoms following miscarriage. [source] Influence of Knowledge and Attitudes on Exclusive Breastfeeding Practice Among Rural Jamaican MothersBIRTH, Issue 4 2004Leia M. Chatman BS The impact of knowledge about and attitude toward breastfeeding on the duration of exclusive breastfeeding is also poorly understood. The objective of this study was to gather information about factors that influence exclusive breastfeeding and its duration. Method: A cross-sectional study was conducted in 11 health centers within the parish of Saint Ann, Jamaica. A pretested questionnaire collected information on breastfeeding knowledge and attitudes toward intention to breastfeed and other relevant sociodemographic characteristics. Results: Information was documented for 599 mother-child pairs. The prevalence of breastfeeding initiation was 98.2 percent; of mothers who initiated breastfeeding, 22.2 percent practiced it exclusively (at least 6 months). No difference occurred between exclusive and nonexclusive breastfeeding mothers in terms of knowledge about and attitudes toward breastfeeding. Of potential predictors assessed, the male partner's role as the main source of income for the family was the only significant predictor for exclusive breastfeeding. Women whose male partner was the main source of income for the family were twice as likely to exclusively breastfeed their infants compared with the referent group (mothers as main source of income)(OR = 2.0; 95% CI = 1.4,3.0). In addition, the dominant reason for partial breastfeeding was maternal anxiety that breastmilk alone might not provide sufficient nourishment. Conclusion: The level of exclusive breastfeeding was extremely low at the study site. Formulation of strategies to aggressively promote exclusive breastfeeding practices is urgently needed there. Such interventions should consider involvement of the male partner, especially, with respect to the financial support, as well as alleviating maternal anxiety regarding nutritional adequacy of breastmilk. [source] Detection rate and factors predictive the presence of prostate cancer in patients undergoing ultrasonography-guided transperineal saturation biopsies of the prostateBJU INTERNATIONAL, Issue 9 2010Giacomo Novara Study Type , Diagnostic (case series) Level of Evidence 4 OBJECTIVES To assess the prostate cancer detection rate and predictive factors for prostate cancer after transrectal ultrasonography (TRUS)-guided transperineal saturation re-biopsies of the prostate, using a 24-core scheme. PATIENTS AND METHODS We evaluated 143 consecutive patients undergoing TRUS-guided transperineal saturation re-biopsy of the prostate using a 24-core scheme. The inclusion criteria were a previous negative biopsy and a prostate-specific antigen (PSA) level of ,10.0 ng/mL, or of 4.0,10.0 ng/mL with a free/total ratio of <20% or an abnormal digital rectal examination or previous high-grade prostatic intraepithelial neoplasia (HGPIN) or atypical small acinar proliferation (ASAP). RESULTS The mean (sd) age of the patients was 66.5 (6.1) years and the median (interquartile range) PSA level was 9.0 (6.1,12.8) ng/mL. The number of previous biopsies was one in 59% of patients, two in 26% and three or more in 15%. We detected prostate cancer in 26%, ASAP in 5.6% and HGPIN in 2.1%. The cancer detection rate was 47%, 25.5% and 14% for prostate volumes of <40, 40,60 and ,60 mL, respectively (P = 0.002). On a multivariate analysis the total prostate volume (40,60 vs <40 mL, hazard ratio 5.683; >60 vs <40 mL, hazard ratio 6.965; P = 0.01) was the only significant predictor of prostate cancer at saturation biopsy. CONCLUSIONS TRUS-guided transperineal saturation re-biopsy of the prostate using a 24-core scheme resulted in a high cancer detection rate also in patients who had had two or more previous biopsies. The total prostate volume was the only predictor of prostate cancer. [source] Predictors of seizure outcome after temporal lobectomy for intractable epilepsyACTA NEUROLOGICA SCANDINAVICA, Issue 4 2004K. Stavem Objectives , To assess predictors of outcome of temporal lobectomy for intractable epilepsy. Material and methods , In 63 adult patients operated with anterior temporal lobectomy during 1988,92, we used logistic regression analysis to assess predictors of being seizure-free (Engel's class I) 2 years after surgery. As potential predictors, we included the following variables: gender, age at operation, age at onset of seizures, epilepsy duration, etiology, generalized vs not generalized seizures, seizure frequency, intelligence quotient, ictal electroencephalography, magnetic resonance imaging (MRI), single-photon emission computed tomography (SPECT), side of resection, and extent of the resection. Results , About 44% of the surgery patients were seizure-free (Engel's class I) 2 years after surgery. In multivariate analysis (n = 55), MRI pathology defined as atrophy in the temporal lobe, angioma, tumor or mesial temporal sclerosis (odds ratio, OR 7.4, 95%CI: 1.7,32.9) and extent of the hippocampal resection (increase of 1 cm) (OR 2.2, 95%CI: 1.1,4.6) predicted being seizure-free. Conclusion , Focal pathology in preoperative MRI and the extent of the hippocampal resection were the only significant predictors of being seizure-free after 2 years. [source] Maternal IgG anti-A and anti-B titres predict outcome in ABO-incompatibility in the neonateACTA PAEDIATRICA, Issue 12 2009Egil Bakkeheim Abstract Aim:, To evaluate predictors for risk of severe hyperbilirubinaemia and kernicterus in ABO-incompatible neonates with emphasize on maternal IgG anti-A/-B titres. Methods:, Blood group O women in labour at Oslo University Hospital, Ullevål, were included in the years 2004,2006. Offspring with blood group A or B had direct antiglobulin test performed and IgG anti-A/-B levels measured in maternal plasma. Blood group A or B infants developing severe hyperbilirubinaemia, received in addition to phototherapy, immunoglobulin treatment and/or exchange transfusion (EXT). Results:, Of 253 neonates, 61.3% had blood group O, 29.6% blood group A and 9.1% blood group B. Twenty neonates with blood group A or B received at least one immunoglobulin treatment. In multivariate analysis, maternal antibody-titres were the only significant predictors for immunoglobulin treatment (p < 0.0001), EXTs (p < 0.05) and duration of phototherapy (p < 0.0001). The need for invasive treatment increased sharply for antibody titres ,512. Receiver operating characteristic analyses demonstrated that titres ,512 had a sensitivity of 90% and a specificity of 72% for predicting immunoglobulin treatment and thus severe hyperbilirubinaemia. Conclusion:, Maternal IgG anti-A/-B titres contribute to the prediction of risk of severe hyperbilirubinaemia in ABO-incompatible neonates, in addition to blood-grouping and direct antiglobulin-testing, especially following early discharge after delivery. [source] | |||||||||||||||||||||||||