			Home About us Contact

Clinical Measures (clinical + measure)

Distribution by Scientific Domains

Medical Sciences	85%
Life Sciences	5%
Humanities and Social Sciences	5%
2 Other Domains	5%

Distribution within Medical Sciences

Periodontology	17%
Neurology	16%
Cardiovascular Disease	3%
20 Other Subdomains	58%

Selected Abstracts

Plasma Carboxymethyl-Lysine, an Advanced Glycation End Product, and All-Cause and Cardiovascular Disease Mortality in Older Community-Dwelling Adults

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 10 2009
Richard D. Semba MD
OBJECTIVES: To determine whether older adults with high plasma carboxymethyl-lysine (CML), an advanced glycation end product, are at higher risk of all-cause and cardiovascular disease (CVD) mortality. DESIGN: Prospective cohort study. SETTING: Population-based sample of adults aged 65 and older residing in Tuscany, Italy. PARTICIPANTS: One thousand thirteen adults participating in the Invecchiare in Chianti study. MEASUREMENTS: Anthropometric measures, plasma CML, fasting plasma total, high-density and low-density lipoprotein cholesterol, triglycerides, glucose, creatinine. Clinical measures: medical assessment, diabetes mellitus, hypertension, coronary heart disease, heart failure, stroke, cancer. Vital status measures: death certificates and causes of death according to the International Classification of Diseases. Survival methods were used to examine the relationship between plasma CML and all-cause and CVD mortality, adjusting for potential confounders. RESULTS: During 6 years of follow-up, 227 (22.4%) adults died, of whom 105 died with CVD. Adults with plasma CML in the highest tertile had greater all-cause (hazard ratio (HR)=1.84, 95% confidence interval) CI)=1.30,2.60, P<.001) and CVD (HR=2.11, 95% CI=1.27,3.49, P=.003) mortality than those in the lower two tertiles after adjusting for potential confounders. In adults without diabetes mellitus, those with plasma CML in the highest tertile had greater all-cause (HR=1.68, 95% CI=1.15,2.44, P=.006) and CVD (HR=1.74, 95% CI=1.00,3.01, P=.05) mortality than those in the lower two tertiles after adjusting for potential confounders. CONCLUSION: Older adults with high plasma CML are at higher risk of all-cause and CVD mortality. [source]

The relationship of stress and anxiety with chronic periodontitis

JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 5 2003
M.V. Vettore
Abstract Aim: This case,control study investigates the relationship of stress and anxiety with periodontal clinical characteristics. Method: Seventy-nine selected patients (mean age 46.8±8 years) were assigned to three groups in accordance with their levels of probing pocket depth (PPD): control group (PPD,3 mm, n=22), test group 1 (at least four sites with PPD ,4 mm and ,6 mm, n=27) and test group 2 (at least four sites with PPD >6 mm, n=30). An inclusion criterion of the study required that patients presented a plaque index (PI) with a value equal to or larger than 2 in at least 50% of dental surfaces. All subjects were submitted to stress and anxiety evaluations. Stress was measured by the Stress Symptom Inventory (SSI) and the Social Readjustment Rating Scale (SRRS), while the State,Trait Anxiety Inventory (STAI) was used to assess anxiety. Clinical measures such as PI, gingival index (GI), PPD and clinical attachment level (CAL) were collected. Patient's medical history and socioeconomic data were also recorded. Results: The mean clinical measures (PI, GI, PPD and CAL) obtained for the three groups, were: control group, 1.56±0.32, 0.68±0.49, 1.72±0.54 and 2.04±0.64 mm; group 1, 1.56±0.39, 1.13±0.58, 2.67±0.67 and 3.10±0.76 mm, group 2, 1.65±0.37, 1.54±0.46, 4.14±1.23 and 5.01±1.60 mm. The three groups did not differ with respect to percentage of clinical stress, scores of the SRRS, trait and state anxiety. Frequency of moderate CAL (4,6 mm) and moderate PPD (4,6 mm) were found to be significantly associated with higher trait anxiety scores after adjusting for socioeconomic data and cigarette consumption (p<0.05). Conclusions: Based on the obtained results, individuals with high levels of trait anxiety appeared to be more prone to periodontal disease. Zusammenfassung Die Beziehung von Stress und Angst bei chronischer Parodontitis Ziel: Diese Fall kontrollierte Studie untersuchte die Beziehung von Stress und Angst zu parodontal klinischen Charakteristika. Methoden: 79 ausgesuchte Patienten (mittleres Alter 46,8±8) wurden unter Berücksichtigung der Sondierungstiefen (PPD) in 3 Gruppen aufgeteilt: Kontrollgruppe (PPD,3 mm, n=22), Testgruppe 1 (mindestens 4 Flächen mit PPD,4 mm und 6 mm, n=27) und Testgruppe 2 (mindestens 4 Flächen mit PPD>6 mm, n=30). Ein Einschlusskriterium für die Studie erforderte, dass die Patienten einen Plaqueindex mit einem Wert gleich oder größer 2 an mindestens 50% der Zahnoberflächen hatten. Alle Personen wurden hinsichtlich Stress und Angst evaluiert. Stress wurde mit der Stress Symptom Aufnahme (SSI) und der sozialen Anpassungsrate Skala (SRRS) gemessen, während für die Erfassung der Angst der State Trait Anxiety Inventory (STAI) genutzt wurde. Die klinischen Messungen wie Plaque Index (PI), Gingivaindex (GI), PPD und klinisches Stützgewebeniveau (CAL) wurden aufgezeichnet. Die medizinische Anamnese der Patienten und die sozioökonomischen Daten wurden ebenso aufgezeichnet. Ergebnisse: Die mittleren klinischen Messungen (PI, GI, PPD und CAL) für die drei Gruppen waren: Kontrollgruppe 1,56±0,32, 0,68±0,49, 1,72±0,54 mm und 2,04± 0,64 mm; Gruppe 1 1,56±0,39, 1,13±0,58, 2,67±0,67 mm und 3,10±0,76 mm und Gruppe 2 1,65±0,37, 1,54±0,46, 4,14± 1,23 mm und 5,01±1,60 mm. Die drei Gruppen unterschieden sich nicht hinsichtlich der Prozentsätze für klinischen Stress, Werte des SRRS, Charakter- und Zustandsangst. Die Häufigkeit von moderatem CAL (4,6 mm) und moderaten PPD (4,6 mm) war signifikant verbunden mit höheren Charakterangst-Werten nach Adjustierung für sozio-ökonomische Daten und Zigarettenverbrauch (p<0,05). Zusammenfassung: Basierend auf den gewonnen Ergebnissen scheinen Individuen mit mehr Neigung zu parodontalen Erkrankungen höhere Werte von Charakterangst zu haben. Résumé Relation du stress et de l'anxiété avec la parodontite chronique Cette étude contrôle par cas a analysé la relation du stress et de l'anxiété avec les caractéristiques cliniques parodontales. Septante-neuf patients d'une moyenne d'âge de 46,8±8 ans ont été répartis en trois groupes suivant leur niveau de profondeur de poche au sondage (PPD) : groupe contrôle (PPD3 mm, n=22), groupe test 1 (au moins quatre sites avec PPD4 mm et 6 mm, n=27) et le groupe test 2 (au moins quatre sites avec PPD6 mm, n=30). Un critère d'inclusion dans cette étude exigeait que les patients montraient un indice de plaque d'une valeur égale ou supérieure à 2 sur au moins 50% des surfaces dentaires. Tous les sujets ont été soumis à des évaluations de stress et d'anxiété. Le stress a été mesuré par l'inventaire du symptôme de stress (SSI) et le niveau d'évaluation de réajustement social (SRRS), tandis que l'inventaire de l'état d'anxiété (STAI) était utilisé pour évaluer l'anxiété. Les mesures cliniques telles que l'indice de plaque (PlI), l'indice gingival (GI), PPD et le niveau d'attache clinique (CAL) ont été enregistrées. L'histoire médicale du patient et les données socio-économiques ont également été prises en considération. Les mesures cliniques moyennes (PlI, GI, PPD, CAL) obtenues pour les trois groupes étaient respectivement de : groupe contrôle 1,56±0,32, 0,68±0,49, 1,72± 0,54 mm et 2,04± 0,64 mm; groupe 1, 1,56± 0,39, 1,13±0,58, 2,67±0,67 mm et 3,10±0,76 mm et groupe 2, 1,65±0,37, 1,54±0,46, 4,14±1,23 mm et 5,01±1,60 mm. Les trois groupes ne différaient pas en ce qui concerne le pourcentage de stress clinique, des scores de SRRS, et le niveau d'anxiété. La fréquence de CAL modéré (4 à 6 mm) et de PPD modéré (4 à 6 mm) était constatée significativement en association avec les plus grands scores d'anxiété après l'ajustement pour les données socio-économiques et le tabagisme (p<0,05). Ces résultats indiquent que les individus avec de hauts niveaux d'anxiété semblent plus susceptibles à la maladie parodontale. [source]

Relationship of cigarette smoking to the subgingival microbiota

JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 5 2001
A. D. Haffajee
Abstract Background: The relationship of cigarette smoking to the composition of the subgingival microbiota is not clear. Some studies indicated higher levels of certain species in smokers, while other studies failed to detect differences in the microbiota between subjects with different smoking histories. Thus, the purpose of the present investigation was to examine the prevalence, proportions and levels of the subgingival species in adult subjects who were current, past or never smokers. Method: 272 adult subjects ranging in age from 20,86 years with at least 20 teeth were recruited for study. Smoking history was obtained using a questionnaire. Clinical measures were taken at 6 sites per tooth at all teeth excluding third molars at a baseline visit. Subgingival plaque samples were taken from the mesial surface of all teeth excluding third molars in each subject at baseline and assayed individually for counts of 29 subgingival species using checkerboard DNA-DNA hybridization. Subjects were subset according to smoking history into never (n=124), past (n=98) and current smokers (n=50). Uni-variate and multi-variate analyses were used to seek associations between smoking category and the counts, proportions and prevalence of subgingival species. Results: Greater differences were observed for the prevalence (% of sites colonized) of the test species in the 3 smoking groups than were observed for counts or proportions of total counts. Members of the orange and red complexes including E. nodatum, F. nucleatum ss vincentii, P. intermedia, P. micros, P. nigrescens, B. forsythus, P. gingivalis and T. denticola were significantly more prevalent in current smokers than in the other 2 groups. The difference in prevalence between smokers and non-smokers was due to greater colonization at sites with pocket depth <4 mm. Stepwise multiple linear regression analysis indicated that combinations of the prevalence of 5 microbial species and pack years accounted for 44% of the variance for mean pocket depth (p<0.000001), while the prevalence of 3 microbial taxa along with age, pack years, current smoking and gender accounted for 31% of the variance in mean attachment level (p<0.000001). The difference in prevalence between current and never smokers of all members of the red complex and 8 of 12 members of the orange complex was significantly greater in the maxilla than in the mandible. Conclusions: The major difference between the subgingival microbiota in subjects with different smoking history was in the prevalence of species rather than counts or proportions. The greater extent of colonization in smokers appeared to be due to greater colonization at pocket depths <4 mm. Differences in colonization patterns between current and never smokers were greater in the maxilla than in the mandible. Zusammenfassung Grundlagen: Die Beziehung zwischen dem Zigarettenrauchen und der Zusammensetzung der subgingivalen Mikroflora ist nicht klar. Einige Studien verweisen auf höhere Titer von bestimmten Spezies bei Rauchern, während andere Studien keine Unterschiede in der Mikroflora zwischen Personen mit unterschiedlichem Raucher- oder Nichtraucherverhalten nachweisen konnten. Daher war der Zweck der vorliegenden Studie die Untersuchung von Prävalenz, Anteil und Titer der subgingivalen Spezies bei erwachsenen Patienten, die zur Zeit, früher oder niemals Raucher waren. Methode: Für die Studie wurden 272 erwachsene Patienten im Alter zwischen 20 und 86 Jahren und wenigstens 20 Zähnen rekrutiert. Die Anamnese des Rauchverhaltens wurde under Verwendung eines Fragebogens durchgeführt. Bei einer Eingangsuntersuchung erfolgten die klinischen Messungen an 6 Stellen pro Zahn bei allen Zähnen außer den dritten Molaren. Bei der Eingangsuntersuchung wurden, bei allen Zähnen außer den dritten Molaren, von den Mesialflächen subgingivale Plaqueproben entnommen. Für die einzelnen Flächen wurde die Anzahl von 29 subgingivalen Spezies mittels Schachbrett-DNA-DNA-Hybridisierung bestimmt. Die Patienten wurden entsprechend der Rauchervorgeschichte in folgende Gruppen eingeteilt: niemals (n=124), früher (n=98) und zur Zeit (n=50). Um Assoziationen zwischen den Rauchkategorien und der Anzahl, dem Anteil und der Prävalenz der subgingivalen Spezies herauszufinden wurden eine uni-variate und multi-variate Analyse verwendet. Ergebnisse: Es wurden größere Unterschiede zwischen den 3 Gruppen hinsichtlich der Prävalenz der Testspezies (% der Taschen die kolonisiert waren) beobachtet als bei der Anzahl oder dem Anteil an der Gesamtzahl der Keime beobachtet wurde. Die Prävalenz der Keime des orangen und roten Komplexes einschließlich. E. nodatum, F. nucleatum ss vincentii, P. intermedia, P. micros, P. nigrescens, B. forsythus, P. gingivalis und T. denticola war bei den aktuellen Rauchern stärker prävalent als in den anderen beiden Gruppen. Die Differenz in der Prävalenz zwischen Rauchern und Nichrauchern wurde verursacht durch eine stärkere Kolonisation in Taschen mit einer Taschentiefe <4 mm. Die schrittweise multiple lineare Regressionsanalyse zeigte, dass Kombinationen der Prävalenz von 5 mikrobiellen Spezies und der Packungsjahre für 44% der Varianz der mittleren Taschentiefe verantwortlich waren (p<0.000001), während die Prävalenz von 3 mikrobiellen Taxa zusammen mit Alter, Packungsjahre, Raucherstatus und Geschlecht für 31% der Varizna im mittleren Attachmentniveau verantwortlich waren (p<0.000001). Die Differenz in der Prävalenz zwischen den aktuellen Rauchern und den die niemals rauchten war für alle Keime der roten Komplexes und 8 von 12 Keimen des orangen Komplexes im Oberkiefer signifikant größer als im Unterkiefer. Schlussfolgerung: Der Hauptunterschied zwischen der subgingivalen Mikroflora bei Patienten mit unterschiedlicher Rauchervorgeschichte lag mehr bei der Prävalenz der Spezies als bei der Anzahl der Keime oder den Anteilen an der Gesamtflora. Das größere Maß an Kolonisation bei den Rauchern schien durch eine stärkere Kolonisation in Taschen <4 mm verursacht zu sein. Differenzen im Kolonisationsmuster zwischen aktuellen Rauchern und Nichtrauchern die niemals rauchten waren im Oberkiefer größer als im Unterkiefer. Résumé Origine, but: La relation entre l'usage de la cigarette et la composition de la microflore sous gingivale n'est pas claire. Certaines études indiquent d'importants niveaux de certaines espèces chez les fumeurs, alors que d'autres études n'arrivent pas à détecter de différences dans la micrflore entre des sujets ayant des histoires tabagiques différentes. Aussi, le propos de cette recherche est d'examiner la prévalence, les proportions et le niveau des espèces sous gingivales chez des sujets adultes fumeurs, anciens fumeurs ou non-fumeurs. Méthodes: 272 sujets adultes, âgès de 20 à 86 ans, ayant au moins 20 dents furent recrutés pour l'étude. L'histoire tabagique fut obtenue à l'aide d'un questionnaire. Des mesures cliniques furent prises sur 6 sites par dents, sur toutes les dents à l'exception des troisièmes molaires lors de la première visite. Des échantillons de plaque sous gingivale étaient prélevés sur la face mésiale de chaque dent à l'exception des troisièmes molaires chez chaque sujet lors de la première visite et individuellement testés pour le comptage de 29 espèces sousgingivales par hybridisation en damier ADN-ADN. Les sujets étaient groupés en sous ensembles en fonction de leur histoire tabagique en non-fumeurs (n=124), ancien fumeurs (n=98), et fumeurs (n=50). Des analyses monovariées et multivariées furent utilisées pour rechercher des associations entre les catégories de fumerus et les comptages, proportions et prévalences des espèces bactériennes. Résultats: De plus grandes différences étaient observées pour la prévalence (% de sites colonisés) des expèces testées dans les 3 groupes, que pour le comptage ou la proportion des comptages totaux. Les membres des complexes orange et rouge dont E. nodatum, F. nucléatum ss vicentii, P. intermedia, P. micros, P. nigrescens, B. forsythus, P. gingivalis, et T. denticolaétait significativement plus prévalent chez les fumeurs que dans les 2 autres groupes. La différence de prévalence entre les fumeurs et les non-fumeurs était due à une plus grande colonisation des sites dont la profondeur de poche était <4 mm. L'analyse par régression linéaire multiple stepwise indiquait que les combinaisons de la prévalence de 5 espèces microbiennes et les paquets-années comptaient pour 44% de la variance pour la moyenne de profondeur de poche (p<0.000001), alors que la prévalence de 3 taxons microbiens avec l'âge, les paquets-années, le tabagisme présent et le sexe comptaient pour 31% de la variance pour le niveau d'attache moyen (p<0.000001). La différence de prévalence entre les fumerus en activité et les non-fumeurs (jamais fumé) de tous les membres du complexe rouge et de 8 des 12 membres du complexe orange était significativement plus élevée au maxillaire qu'à la mandibule. Conclusions: La différence majeure entre les microflores sous gingivales chez les sujets ayant des histoires tabagiques différentes se trouvaient dans la prévalence des expèces plutôt que dans leurs quantité ou leurs proportions. La plus grande importance de colonisation chez les fumerus apparaît être dûe à une colonisation plus grande dans les poches <4 mm. Des différences des caractéristiques de colonisation entre les fumerus actifs et les personnes n'ayant jamais fuméétaient plus importantes au maxillaire qu'à la mandibule. [source]

The effect of repeated professional supragingival plaque removal on the composition of the supra- and subgingival microbiota

JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 9 2000
Laurie Ann Ximénez-Fyvie
Abstract Background, aims: The purpose of the present investigation was to determine the effect of weekly professionally administered supragingival plaque removal on the composition of the supra and subgingival microbiota. Methods: 18 adult subjects with periodontitis who had been treated and were in a maintenance phase of therapy were clinically and microbiologically monitored at baseline, 3, 6 and 12 months. After the baseline visit, the subjects received scaling and root planing followed by professional supragingival plaque removal every week for 3 months. Clinical measures of plaque accumulation, bleeding on probing (BOP), gingival redness, suppuration, pocket depth and attachment level were made at 6 sites per tooth at each visit. Separate supra (N=1804) and subgingival (N=1804) plaque samples were taken from the mesial aspect of all teeth excluding third molars in each subject at each time point and evaluated for their content of 40 bacterial taxa using checkerboard DNA-DNA hybridization. Significance of changes in mean counts, prevalence and proportions of bacterial species over time in both supra and subgingival samples were determined using the Quade test and adjusted for multiple comparisons. Results: Mean % of sites exhibiting plaque, gingival redness and BOP were significantly reduced during the course of the study. Significant decreases in mean counts were observed in both supra and subgingival samples. Mean total DNA probe counts (×105, ±SEM) at baseline, 3, 6 and 12 months were: 133±19, 95±25, 66±6, 41±6 (p<0.001) for supragingival samples and 105±22, 40±10, 19±4, 13±3 (p<0.001) for subgingival samples. Mean counts of 22 of 40 and 34 of 40 species tested were significantly reduced in the supra and subgingival samples respectively over the monitoring period. For example, mean counts of Porphyromonas gingivalis×105 at baseline, 3, 6 and 12 months in the subgingival plaque samples were 2.0±0.4, 0.5±0.2, 0.6±0.3, 0.3±0.1 (p<0.001); Bacteroides forsythus 2.0±0.6, 0.4±0.1, 0.4±0.2, 0.1±0.2 (p<0.001); Treponema denticola 3.4±1.1, 0.8±0.3, 0.4±0.2, 0.3±0.3 (p<0.01). Similar reductions were seen in supragingival plaque samples. While counts were markedly reduced by professional plaque removal, the proportion and prevalence of the 40 test species were marginally affected. Conclusions: Weekly professional supragingival plaque removal profoundly diminished counts of both supra- and subgingival species creating a microbial profile comparable to that observed in periodontal health. This profile was maintained at the final monitoring visit, 9 months after completion of therapy. [source]

Experience of implementing an adult educational approach to treating anxiety disorders

JOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 1 2005
S. D. WOOD rmn rgn dms bsc pgce Lecturer Practitioner
This paper describes the background to the development and delivery of a self-help package for anxiety disorders. Evidence of effectiveness is summarized. The paper outlines the intervention and describes the experience of two mental health nurses, who set out to assess its acceptability, evaluate its outcomes in routine clinical practice and assess the feasibility of its delivery by mental health nurses. Acceptability of the intervention was high, judged by retention and attendance rates. The pilot study produced promising clinical outcomes, especially for people with depression secondary to anxiety. Clinical measures showed significant improvements from pre-course to 6-month follow-up in anxiety, psychological well-being and depression. The outcomes suggest that appropriately trained mental health nurses could deliver the intervention as a routine treatment. The paper concludes by discussing future plans, including a randomized controlled trial and implementation in primary care. [source]

Clinical measures of progression in Parkinson's disease,

MOVEMENT DISORDERS, Issue S2 2009
Werner Poewe MD
Abstract Despite all recent advances in symptomatic therapy Parkinson's disease (PD) continues to be a relentlessly progressive neurodegenerative disorder. Therefore therapies that will slow or hold disease progression are a major medical unmet need in PD. Clinical measures of disease progression that have been used in disease modification trials so far have focused on indices of progression of cardinal motor features like bradykinesia, rigidity, and tremor as captured by the UPDRS and the emerging need for effective dopaminergic symptomatic therapy. Progression of global disability in PD, however, is driven by additional factors beyond progressive nigrostriatal denervation leading to increasing severity of cardinal motor features. Progressive pathology in extranigral sites in the brain or peripheral autonomic nervous system contribute to poorly levodopa responsive motor symptoms like postural instability, freezing and falls or nonmotor symptoms. In addition treatment-induced motor complications also impact on PD disability. Although it is widely accepted that clinical progression of PD is multidimensional and in addition includes effects of aging, there is no consensus how to best implement more clinically meaningful endpoints for disease progression trials that would reflect these complex interactions impacting on the evolution of global disability in PD. There is an urgent need for biomarkers for disease progression that would faithfully reflect advancing neurodegeneration and resulted clinical disability in PD and that could be used in shorter term clinical trials testing putative disease modifying agents. © 2009 Movement Disorder Society [source]

The influence of medication beliefs and other psychosocial factors on early discontinuation of disease-modifying anti-rheumatic drugs

MUSCULOSKELETAL CARE, Issue 3 2007
DClinPsy, M. Wong MSc
Abstract Objective:,Although drug survival time might be a better measure of clinical effectiveness than drug adherence, there is little research literature in this area, in particular about the influence of medication beliefs and psychosocial factors. This study aimed to investigate the above relationships using patients who were newly diagnosed with rheumatoid arthritis (RA). Methods:,Sixty-eight RA patients starting their first disease-modifying anti-rheumatic drug (DMARD) were interviewed shortly after initiating therapy, and then one year later. Before each meeting, patients were asked to complete a set of questionnaires, including Beliefs about Medication, Spielberger State-Trait Anxiety Inventory , Short Form, the modified Stanford Health Assessment Questionnaire, Beck Depression Inventory-1 and the Significant Others Scale. Relevant sociodemographic background, disease activity and drug history were obtained. Clinical measures such as grip strength and joint count were assessed. Results:,A stepwise logistic regression analysis was applied to two patient groups: those who continued taking their DMARD one year later, and those who did not. No significant difference between the groups for levels of disability and disease activity were found. Only age and anxiety emerged as significant predictors of drug discontinuation at 52 weeks. Conclusions:,Contrary to expectation, this study demonstrated that older and less anxious patients were more likely to discontinue taking their initial DMARD within the first year. The study may have implications for counselling older and less anxious patients prior to DMARD therapy. However, there are limitations in generalizing the results because of the small population sample. It also did not take into account drug intolerance as a pertinent factor for early drug discontinuation. Copyright © 2007 John Wiley & Sons, Ltd. [source]

Comparing self-reported and measured high blood pressure and high cholesterol status using data from a large representative cohort study

AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 4 2010
Anne Taylor
Abstract Objective: To examine the relationship between self-reported and clinical measurements for high blood pressure (HBP) and high cholesterol (HC) in a random population sample. Method: A representative population sample of adults aged 18 years and over living in the north-west region of Adelaide (n=1537) were recruited to the biomedical cohort study in 2002/03. In the initial cross-sectional component of the study, self-reported HBP status and HC status were collected over the telephone. Clinical measures of blood pressure were obtained and fasting blood taken to determine cholesterol levels. In addition, data from a continuous chronic disease and risk factor surveillance system were used to assess the consistency of self-reported measures over time. Result: Self-report of current HBP and HC showed >98% specificity for both, but sensitivity was low for HC (27.8%) and moderate for HBP (49.0%). Agreement between current self-report and clinical measures was moderate (kappa 0.55) for HBP and low (kappa 0.30) for HC. Demographic differences were found with younger people more likely to have lower sensitivity rates. Self-reported estimates for the surveillance system had not varied significantly over time. Conclusion: Although self-reported measures are consistent over time there are major differences between the self-reported measures and the actual clinical measurements. Technical aspects associated with clinic measurements could explain some of the difference. Implications: Monitoring of these broad population measures requires knowledge of the differences and limitations in population settings. [source]

The Relationship between Hospital Volume and Mortality in Mechanical Ventilation: An Instrumental Variable Analysis

HEALTH SERVICES RESEARCH, Issue 3 2009
Jeremy M. Kahn
Objective. To examine the relationship between hospital volume and mortality for nonsurgical patients receiving mechanical ventilation. Data Sources. Pennsylvania state discharge records from July 1, 2004, to June 30, 2006, linked to the Pennsylvania Department of Health death records and the 2000 United States Census. Study Design. We categorized all general acute care hospitals in Pennsylvania (n=169) by the annual number of nonsurgical, mechanically ventilated discharges according to previous criteria. To estimate the relationship between annual volume and 30-day mortality, we fit linear probability models using administrative risk adjustment, clinical risk adjustment, and an instrumental variable approach. Principle Findings. Using a clinical measure of risk adjustment, we observed a significant reduction in the probability of 30-day mortality at higher volume hospitals (,300 admissions per year) compared with lower volume hospitals (<300 patients per year; absolute risk reduction: 3.4%, p=.04). No significant volume,outcome relationship was observed using only administrative risk adjustment. Using the distance from the patient's home to the nearest higher volume hospital as an instrument, the volume,outcome relationship was greater than observed using clinical risk adjustment (absolute risk reduction: 7.0%, p=.01). Conclusions. Care in higher volume hospitals is independently associated with a reduction in mortality for patients receiving mechanical ventilation. Adequate risk adjustment is essential in order to obtained unbiased estimates of the volume,outcome relationship. [source]

Maternal psychopathology and attachment in toddlers of heavy cocaine-using mothers

INFANT MENTAL HEALTH JOURNAL, Issue 3 2001
Michael Espinosa
The purpose of this study is to examine the relationships among maternal psychopathology, early sensitive caregiving, and security of attachment in a sample of cocaine-using women from environments with high contextual risks that include poverty, low educational attainment, minority status, and single parenthood. Thirty-five women and their offspring participated in the study. Maternal psychopathology, including Axis I and Axis II disorders, was assessed during the prenatal period via a self-report clinical measure. Maternal sensitivity was assessed at 1 month and 6 months postdelivery through rating scales. At 18 months postdelivery, toddlers' attachment to their mothers was assessed via the Strange Situation procedure. Also at 18 months, mothers' level of depression was assessed via a depression inventory. Maternal psychopathology during pregnancy was found to be associated with both early caregiving and attachment. Mothers demonstrating clinical levels of particular Axis II disorders provided less sensitive caregiving, and had toddlers who were more likely to be disorganized/disoriented in their attachments. For Axis I disorders, only clinical levels of prenatal dysthymia were found to be associated with a greater likelihood of secure attachment. ©2001 Michigan Association for Infant Mental Health. [source]

Onset of Depression in Elderly Persons After Hip Fracture: Implications for Prevention and Early Intervention of Late-Life Depression

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 1 2007
Eric J. Lenze MD
OBJECTIVES: To identify predictors of onset of major depressive disorder (MDD) and of depressive symptoms in subjects who suffered a hip fracture. DESIGN: Prospective naturalistic study. SETTING: University of Pittsburgh Medical Center,Shadyside, a large urban hospital in Pittsburgh, Pennsylvannia. PARTICIPANTS: One hundred twenty-six elderly patients who received surgical fixation for hip fracture and who were not experiencing a major depressive episode at the time of the fracture; severely cognitively impaired persons were excluded. MEASUREMENTS: Subjects were evaluated at the time of hospital discharge using a battery of clinical measures (including apathy measured using the Apathy Evaluation Scale (AES), delirium, cognitive measures, social support, and disability level). Depression was assessed at the end of the surgical stay, 2 weeks later, and then monthly for 6 months, using the Hamilton Rating Scale for Depression (Ham-D) to evaluate symptomatology and the Primary Care Evaluation of Mental Disorders to evaluate diagnosis of MDD. RESULTS: Eighteen of 126 subjects (14.3%) developed MDD after hip fracture. Of these, 11 developed MDD by the end of the hospitalization, and seven developed MDD between 2 and 10 weeks later. Logistic regression showed that baseline apathy score, as measured using the AES, was the only clinical measure associated with the development of MDD (odds ratio=1.09, 95% confidence interval=1.03,1.16, P=.003); 46.2% of those with high AES scores developed MDD, versus 10.9% of those with lower scores. In contrast, cognitive variables, delirium, disability after hip fracture, and other factors related to the fracture (e.g., fracture type) were not associated with MDD. A repeated-measures analysis with Ham-D over time as a dependent variable generally confirmed these findings; depressive symptoms were highest immediately after the fracture, and apathy and delirium scores were associated with higher depressive symptom levels. CONCLUSION: The onset of MDD is common after hip fracture, and the greatest period of risk is immediately after the fracture. Individuals with clinical evidence of apathy are at high risk for developing MDD, and evaluation and close follow-up of such individuals is warranted. However, further research is needed to examine other candidate variables (e.g., clinical measures or biomarkers) to model adequately the risk for MDD after hip fracture and other disabling medical events. [source]

Respiratory Function as a Marker of Bone Health and Fracture Risk in an Older Population,

JOURNAL OF BONE AND MINERAL RESEARCH, Issue 5 2009
Alireza Moayyeri
Abstract Identification of those at high risk of osteoporosis and fractures using clinically available tests beyond BMD measures is a major clinical challenge. We examined forced expiratory volume in 1 s (FEV1), an easily obtainable measure of respiratory function, as a clinical measure for fracture prediction. In the context of the European Prospective Investigation into Cancer-Norfolk Study, 8304 women and 6496 men 42,81 yr of age underwent a health check including spirometry and heel quantitative ultrasonography between 1997 and 2000 and were followed up for incident hip fractures until 2007. The main outcome measures were broadband ultrasound attenuation (BUA) of the heel (cross-sectional analysis) and hip fracture risk (prospective analysis). In multivariate regression models, a 1-liter increase in FEV1 was associated with a statistically significant 2.2-dB/MHz increase in BUA, independent of age, smoking, height, body mass index, history of fracture, and use of corticosteroids. Mean FEV1 was significantly lower among 84 women and 36 men with hip fracture compared with other participants. In multivariate proportional-hazard regression models, the relative risk (RR) of hip fracture associated with a 1-liter increase in FEV1 was 0.5 (95% CI, 0.3,0.9; p < 0.001) for both men and women. RR of hip fracture for a 1 SD increase in FEV1 was approximately equivalent to a 0.5 SD increase in BUA among women (1 SD among men) and an ,5-yr decrease in age among both men and women. Middle-aged and older people with low respiratory function are at increased risk of osteoporosis and hip fracture. FEV1, an easy, low-cost, and feasible clinical measure, may help improve the identification of high-risk groups. [source]

Glycocalyx volume: a critical review of tracer dilution methods for its measurement

MICROCIRCULATION, Issue 3 2009
CHARLES.
ABSTRACT A clinical measure of endothelial glycocalyx structure would have great potential importance, because lesions of the glycocalyx may be the first changes to occur in diabetes and in a wide range of vascular diseases. A method recently described by Nieuwdorp et al. for estimating the volume of the luminal glycocalyx of the entire human vascular system would seem to be the first attempt to develop a measure of this kind. It is based on the tracer dilution principle, and this review considers the principles and conditions that underlie this method and the extent to which the conditions appear to have been fulfilled in this case. Our analysis raises two questions about 1) the estimation of the concentration of the tracer (dextran 40) at zero time and 2) the estimation of plasma volume, both of which can be answered by changes in experimental protocol. A third question, concerning the partition coefficient of the tracer between plasma and the fluid within the glycocalyx, cannot be answered at the present time, and until it has been resolved, glycocalyx volume cannot be estimated from the dilution of a macromolecular tracer. [source]

The number needed to treat: a useful clinical measure or a case of the Emperor's new clothes?

PHARMACEUTICAL STATISTICS: THE JOURNAL OF APPLIED STATISTICS IN THE PHARMACEUTICAL INDUSTRY, Issue 2 2003
Andrew P. Grieve
The number needed to treat (NNT) was introduced into the medical literature as an easily understood and useful measure of treatment effect for clinical trials in which the main outcome variable is binary. It has been argued that it is more easily understood by practising physicians than more statistically based measures. In this paper we review the claims made for the NNT and question whether it is truly understandable to physicians, and look at issues around determining a confidence interval, or a Bayesian interval, for the NNT. Copyright © 2003 John Wiley & Sons, Ltd. [source]

Adolescent inhalant use, abuse and dependence

ADDICTION, Issue 7 2009
Brian E. Perron
ABSTRACT Aims To compare adolescent inhalant users without DSM-IV inhalant use disorders (IUDs) to youth with IUDs (i.e. abuse or dependence) across demographic, psychosocial and clinical measures. Design Cross-sectional survey with structured psychiatric interviews. Setting Facilities (n = 32) comprising the Missouri Division of Youth Services (MDYS) residential treatment system for juvenile offenders. Participants Current MDYS residents (n = 723); 97.7% of residents participated. Most youth were male (87%) and in mid-adolescence (mean = 15.5 years, standard deviation = 1.2, range = 11,20); more than one-third (38.6%, n = 279) reported life-time inhalant use. Measurements Antisocial behavior, temperament, trauma-exposure, suicidality, psychiatric symptoms and substance-related problems. Findings Among life-time inhalant users, 46.9% met criteria for a life-time DSM-IV IUD (inhalant abuse = 18.6%, inhalant dependence = 28.3%). Bivariate analyses showed that, in comparison to non-users, inhalant users with and without an IUD were more likely to be Caucasian, live in rural or small towns, have higher levels of anxiety and depressive symptoms, evidence more impulsive and fearless temperaments and report more past-year antisocial behavior and life-time suicidality, traumatic experiences and global substance use problems. A monotonic relationship between inhalant use, abuse and dependence and adverse outcomes was observed, with comparatively high rates of dysfunction observed among inhalant-dependent youth. Multivariate regression analyses showed that inhalant users with and without an IUD had greater levels of suicidal ideation and substance use problems than non-users. Conclusions Youth with IUDs have personal histories characterized by high levels of trauma, suicidality, psychiatric distress, antisocial behavior and substance-related problems. A monotonic relationship between inhalant use, abuse and dependence and serious adverse outcomes was observed. [source]

Psychopathological changes and quality of life in hepatitis C virus-infected, opioid-dependent patients during maintenance therapy

ADDICTION, Issue 4 2009
Arne Schäfer
ABSTRACT Aims To examine among maintenance patients (methadone or buprenorphine) with and without hepatitis C virus (HCV) infection (i) the frequency of psychopathological symptoms at baseline and 1-year follow-up; (ii) the association between antiviral interferon (IFN) treatment and psychopathological symptoms; and (iii) to explore whether IFN therapy has an effect on 1-year outcome of maintenance treatment. Design Naturalistic prospective longitudinal cohort design. Setting A total of 223 substitution centres in Germany. Participants A nationally representative sample of 2414 maintenance patients, namely 800 without and 1614 with HCV infection, of whom 122 received IFN therapy. Measures HCV infection (HCV+/HCV - ), IFN (IFN+/IFN - ) treatment status and clinical measures. Diagnostic status and severity (rated by clinician), psychopathology (BSI,Brief Symptom Inventory) and quality of life (EQ-5D,EuroQol Group questionnaire). Findings HCV+ patients revealed indications for a moderately increased psychopathological burden and poorer quality of life at baseline and follow-up compared to HCV - patients. HCV+ patients showed a marked deterioration over time only in the BSI subscale somatization (P = 0.002), and the frequency of sleep disorders almost doubled over time (12.8% at baseline; 24.1% at follow-up; P < 0.01). IFN treatment, received by 10% of HCV+ patients, did not impair efficacy or tolerability of maintenance therapy and was associated overall with neither increased psychopathological burden nor reduced quality of life. Conclusions Findings suggest no increased risk among HCV+ patients on maintenance therapy for depressive or other psychopathological syndromes. In our patient sample, IFN treatment was not associated with increased psychopathological burden, reduced quality of life or poorer tolerability and efficacy of maintenance treatment. [source]

The effects of natalizumab on inflammatory mediators in multiple sclerosis: prospects for treatment-sensitive biomarkers

EUROPEAN JOURNAL OF NEUROLOGY, Issue 4 2009
M. Khademi
Background:, Natalizumab affects systemic cytokine expressions and clinical course in relapsing,remitting multiple sclerosis (RRMS). We analyzed levels of inflammatory cytokines in cerebrospinal fluid (CSF) cells and peripheral blood mononuclear cells (PBMCs), levels of matrix metalloproteinase (MMP)-9 and osteopontin (OPN) in CSF, and clinical outcome measures in 22 natalizumab-treated RRMS patients. Methods:, mRNA levels of cytokines in cells were detected with real-time RT-PCR. Protein levels of OPN and MMP-9 were measured by ELISA. Results:, Natalizumab reduced CSF cell counts (P < 0.0001). Tumor necrosis factor (TNF) and interferon-, (IFN-,) mRNAs were significantly increased in PBMCs. In contrast, expressions of IFN-, and interleukin (IL)-23 were decreased but IL-10 increased in the CSF cells. OPN and MMP-9 were reduced in the CSF. Patients being in remission at baseline showed the same deviations of mediators as those in relapse after natalizumab treatment. The open label clinical outcome measures were either stable or improved during therapy. Conclusions:, Natalizumab attenuates pro-inflammatory mediators intrathecally and the reduced pro-inflammatory milieu may allow increased production of the anti-inflammatory mediator IL-10. The increased systemic cytokines may impede the improvement of certain clinical measures like fatigue. The affected mediators seem to be sensitive to an immune-modifying treatment which could be used as biomarkers for this therapy. [source]

Resting state sensorimotor functional connectivity in multiple sclerosis inversely correlates with transcallosal motor pathway transverse diffusivity

HUMAN BRAIN MAPPING, Issue 7 2008
Mark J. Lowe
Abstract Recent studies indicate that functional connectivity using low-frequency BOLD fluctuations (LFBFs) is reduced between the bilateral primary sensorimotor regions in multiple sclerosis. In addition, it has been shown that pathway-dependent measures of the transverse diffusivity of water in white matter correlate with related clinical measures of functional deficit in multiple sclerosis. Taken together, these methods suggest that MRI methods can be used to probe both functional connectivity and anatomic connectivity in subjects with known white matter impairment. We report the results of a study comparing anatomic connectivity of the transcallosal motor pathway, as measured with diffusion tensor imaging (DTI) and functional connectivity of the bilateral primary sensorimotor cortices (SMC), as measured with LFBFs in the resting state. High angular resolution diffusion imaging was combined with functional MRI to define the transcallosal white matter pathway connecting the bilateral primary SMC. Maps were generated from the probabilistic tracking employed and these maps were used to calculate the mean pathway diffusion measures fractional anisotropy ,FA,, mean diffusivity ,MD,, longitudinal diffusivity ,,1,, and transverse diffusivity ,,2,. These were compared with LFBF-based functional connectivity measures (Fc) obtained at rest in a cohort of 11 multiple sclerosis patients and ,10 age- and gender-matched control subjects. The correlation between ,FA, and Fc for MS patients was r = ,0.63, P < 0.04. The correlation between all subjects ,,2, and Fc was r = 0.42, P < 0.05. The correlation between all subjects ,,2, and Fc was r = ,0.50, P < 0.02. None of the control subject correlations were significant, nor were ,FA,, ,,1,, or ,MD, significantly correlated with Fc for MS patients. This constitutes the first in vivo observation of a correlation between measures of anatomic connectivity and functional connectivity using spontaneous LFBFs. Hum Brain Mapp, 2008. © 2008 Wiley-Liss, Inc. [source]

Reproductive stem cell research and its application to urology

INTERNATIONAL JOURNAL OF UROLOGY, Issue 2 2008
Takehiko Ogawa
Abstract: Germ cells are defined by their innate potential to transmit genetic information to the next generation through fertilization. Males produce numerous sperm for long periods to maximize chances of fertilization. Key to the continuous production of large numbers of sperm are germline stem cells and their immediate daughter cells, functioning as transit amplifying cells. Recently, it has become possible to expand germline stem cells of rodents in vitro. In addition, multipotent stem cells, which are functionally the same as embryonic stem cells, have been established from neonatal mouse testes. These stem cells derived from the testis should contribute to biological research and technologies. On the other hand, the nature of human spermatogenesis is largely unknown due to the lack of an appropriate experimental system. However, the prevailing testicular sperm extraction procedure unraveled hitherto unknown facets of human spermatogenesis. The establishment of a culturing method for human spermatogonial stem cells in hopefully the near future would be a great benefit for achieving further insight into human spermatogenesis and should lead to more sophisticated diagnostic and therapeutic clinical measures for male infertility. [source]

Onset of Depression in Elderly Persons After Hip Fracture: Implications for Prevention and Early Intervention of Late-Life Depression

The Identification of Seniors At Risk Screening Tool: Further Evidence of Concurrent and Predictive Validity

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 2 2004
Nandini Dendukuri PhD
Objectives: To evaluate the validity of the Identification of Seniors at Risk (ISAR) screening tool for detecting severe functional impairment and depression and predicting increased depressive symptoms and increased utilization of health services. Setting: Four university-affiliated hospitals in Montreal. Design: Data from two previous studies were available: Study 1, in which the ISAR scale was developed (n=1,122), and Study 2, in which it was used to identify patients for a randomized trial of a nursing intervention (n=1,889 with administrative data, of which 520 also had clinical data). Participants: Patients aged 65 and older who were to be released from an emergency department (ED). Measurements: Baseline validation criteria included premorbid functional status in both studies and depression in Study 2 only. Increase in depressive symptoms at 4-month follow-up was assessed in Study 2. Information on health services utilization during the 5 months after the ED visit (repeat ED visits and hospitalization in both studies, visits to community health centers in Study 2) was available by linkage with administrative databases. Results: Estimates of the area under the receiver operating characteristic curve (AUC) for concurrent validity of the ISAR scale for severe functional impairment and depression ranged from 0.65 to 0.86. Estimates of the AUC for predictive validity for increased depressive symptoms and high utilization of health services ranged from 0.61 to 0.71. Conclusion: The ISAR scale has acceptable to excellent concurrent and predictive validity for a variety of outcomes, including clinical measures and utilization of health services. [source]

Involvement of vascular endothelial growth factor, CD44 and CD133 in periodontal disease and diabetes: an immunohistochemical study

JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 1 2009
Guendalina Lucarini
Abstract Aim: The aim of this study was to investigate the relationship between expression of angiogenic and regeneration markers and periodontal disease in subjects with/without diabetes mellitus. Material and Methods: Immunohistochemical detection of vascular endothelial growth factor (VEGF), CD44 and CD133 was performed in 16 samples each of (1) healthy gingiva from non-diabetic subjects (controls), (2) gingiva from non-diabetic subjects with periodontitis, (3) gingiva from subjects with type 1 diabetes and periodontitis, (4) gingiva from subjects with type 2 diabetes and periodontitis. Results: Diseased gingivae from patients with diabetes and periodontitis had greater clinical measures of periodontal disease than those with periodontitis only. VEGF expression was significantly enhanced in epithelial and endothelial cells from patients with periodontitis compared with controls (p<0.05). Epithelial CD44 expression was strong in all groups, while CD44 was significantly enhanced (p<0.05) in connective tissue cells from both diabetic groups. Epithelial and endothelial CD133 expression was comparable in all patients except those with type 2 diabetes and periodontitis, where it was not detected. Stromal CD133 expression was significantly lower in patients with type 2 diabetes and periodontitis and was increased in periodontitis patients (p<0.05). Conclusions: The involvement and high expression of VEGF, CD44 and CD133 in periodontal disease may predict a greater regeneration capacity of gingival tissue. [source]

Compromised GCF total antioxidant capacity in periodontitis: cause or effect?

JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 2 2007
I. L. C. Chapple
Abstract Background: Oxidative stress is implicated in the pathogenesis of periodontitis. The total antioxidant capacity (TAOC) of gingival crevicular fluid volume (GCF) and plasma appears compromised in periodontitis, but it is unclear whether this predisposes to, or results from the inflammatory process. Aim: To investigate longitudinal changes in GCF and plasma TAOC following reductions in periodontal inflammation with successful non-surgical therapy. Materials and Methods: Two longitudinal studies were run in series on non-smokers with chronic periodontitis (CP). Study-1 (n=17) assessed index sites with mild disease; Study-2 (n=18) investigated deep sites. GCF sampling and clinical measures were performed at baseline and 3 months post-therapy. Plasma and GCF TAOC was determined by enhanced chemiluminescence and 32 age/sex-matched periodontally healthy controls were used. Results: Therapy improved clinical outcomes consistent with the literature. There were no differences in plasma TAOC between periodontitis patients (507±92 ,MTeq) and controls (520±100 ,MTeq; p=0.57) at baseline, but GCF TAOC was lower (p<0.0001) in CP patients (680±371 ,MTeq) than controls (1129±722 ,MTeq). Successful periodontal therapy did not alter plasma TAOC (p=0.56), but GCF TAOC increased (by 449±722 ,MTeq, p<0.001) to control subject levels (p=0.47) Conclusions: Local total antioxidant capacity in CP appears to reflect increased oxygen radical activity during periodontal inflammation and can be restored to control subject levels by successful non-surgical therapy. [source]

Plasma levels of tumour necrosis factor- , in patients with chronic periodontitis and type 2 diabetes

JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 1 2007
S. Engebretson
Abstract Objectives: Studies suggest that elevated circulating tumour necrosis factor- , (TNF- ,) may contribute to insulin resistance in patients with type 2 diabetes. The source of plasma TNF has been thought to be adipocytes associated with obesity, but inflammation and infection result in TNF- , production as well. Methods: We studied 46 patients with type 2 diabetes and chronic periodontitis to determine the relationship between plasma TNF- , levels and clinical measures of periodontitis, gingival crevicular fluid (GCF) interleukin-1, (IL-1,), plasma endotoxin, serum glucose, and glycated haemoglobin (HbA1c). TNF- , levels were measured using a high sensitivity enzyme-linked immunosorbent assay. Results: TNF- , showed a significant positive correlation with attachment loss (r=0.40, p=0.009), plasma endotoxin (r=0.33, p=0.03), and GCF IL-1, (r=0.33, p=0.035), but not probing depth (r=0.28, p=0.07), bleeding on probing (r=0.30, p=0.053), plaque index (r=0.22, p=0.17), serum glucose, HbA1c (r=0.10, p=0.50), or body mass index (r=0.077, p=0.62). A dose,response relationship was observed between periodontitis severity and TNF- , (p=0.012). Conclusion: The finding that chronic periodontitis is associated with plasma TNF- , levels in subjects with type 2 diabetes supports the hypothesis that periodontal infection and inflammation may contribute to insulin resistance. [source]

Longitudinal evaluation of GCF IFN-, levels and periodontal status in HIV+ patients

JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 11 2003
T. Alpagot
Abstract Background/Aim: Loss of periodontal support and related tooth loss is a common finding among HIV+ patients. The etiology of this destruction may be an increase in the levels of pro-inflammatory cytokines and subsequent increase in periodontal disease activity. The purpose of this study was to investigate the associations between gingival crevicular fluid interferon gamma (GCF IFN- ,) and clinical measures of periodontal disease in HIV+ individuals. We monitored GCF IFN- , and periodontal status of selected sites in 33 HIV+ subjects over a 6-month period. Method: Clinical measurements including gingival index, plaque index, bleeding on probing, probing depth, attachment loss (AL), and GCF samples were taken from four lower incisors and the upper right posterior sextant of each patient at baseline and 6-month visits by means of sterile paper strips. GCF levels of IFN- , were determined by sandwich ELISA assays. A progressing site was defined as a site that had 2 mm or more AL during the 6-month study period. Results: Twenty-five of the 264 examination sites showed 2 mm or more clinical AL during the 6-month study period. Significantly higher GCF levels of IFN- , were found at progressing sites than in nonprogressing sites (p<0.001). GCF levels of IFN- , were highly correlated with clinical measurements taken at baseline and 6-month visits (0.001[source]

Sharing specialist skills for diabetes in an inner city: A comparison of two primary care organisations over 4 years

JOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 5 2006
Abdu Mohiddin MFPHM Lecturer
Abstract Objective, To evaluate the effects of organizational change and sharing of specialist skills and information technology for diabetes in two primary care groups (PCGs) over 4 years. Methods, In PCG-A, an intervention comprised dedicated specialist sessions in primary care, clinical guidelines, educational meetings for professionals and a shared diabetes electronic patient record (EPR). Comparison was made with the neighbouring PCG-B as control. In intervention and control PCGs, practice development work was undertaken for a new contract for family doctors. Data were collected for clinical measures, practice organizational characteristics and professional and patient views. Results, Data were analysed for 26 general practices including 17 in PCG-A and nine in PCG-B. The median practice-specific proportions of patients with HbA1c recorded annually increased in both areas: PCG-A from median 65% to 77%, while PCG-B from 53% to 84%. For cholesterol recording, PCG-A increased from 50% to 76%, and PCG-B from 56% to 80%. Organizational changes in both PCGs included the establishment of recall systems, dedicated clinics and educational sessions for patients. In both PCGs, practices performing poorly at baseline showed the greatest improvements in organization and clinical practice. Primary care professionals' satisfaction with access and communication with diabetes specialist doctors and nurses increased, more so in the intervention PCG. Only 16% of primary care professional respondents used the diabetes EPR at least monthly. Patient satisfaction and knowledge did not change. Conclusions, Improvements in practices' organizational arrangements were associated with improvements in clinical care in both PCGs. Sharing specialist skills in one PCG was associated with increased professional satisfaction but no net improvement in clinical measures. A shared diabetes EPR is unlikely to be used, unless integrated with practice information systems. [source]

COUPLES THERAPY FOR WOMEN SURVIVORS OF CHILD SEXUAL ABUSE WHO ARE IN ADDICTIONS RECOVERY: A COMPARATIVE CASE STUDY OF TREATMENT PROCESS AND OUTCOME

JOURNAL OF MARITAL AND FAMILY THERAPY, Issue 1 2001
Barry Trute
Treatment for women who are survivors of child sexual abuse and who have a history of substance abuse has largely involved gender-specific interventions. This study examines the use of conjoint couple therapy with a cohort of women who were survivors of child sexual abuse and who are in addiction recovery and with their partners. A comparative case study analysis incorporated standardized clinical measures with client and therapist interviews. Brief conjoint therapy was found to assist couples in the specific relationship skill areas of communication and mutual problem solving. Further, substantive gains were found in the realm of affective relations. The women reported an increase in support from their male partners, and the men reported a decrease in negative emotional atmosphere in the relationship. [source]

Health-Related Quality of Life Issues in Women With Polycystic Ovary Syndrome

JOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 1 2005
Judy Griffin McCook
Objective: To evaluate the influence of obesity, fertility status, and androgenism scores on health-related quality of life in women with polycystic ovary syndrome (PCOS). Design: Cross-sectional, correlational. Setting: Private reproductive endocrinology practice in two southeast U.S. cities. Participants: Convenience sample of 128 women with PCOS, half of whom were attempting to conceive in addition to being treated for PCOS. Most were White (97%), married (78%), with a mean age of 30.4 years (SD ± 5.5). Main Outcome Measures: The Health-Related Quality of Life Questionnaire (PCOSQ) for women with polycystic ovary syndrome. A laboratory panel and clinical measures, including body mass index, waist-to-hip ratio, and degree of hirsutism. Results: The most common health-related quality of life concern reported by women with PCOS was weight, followed in descending order by menstrual problems, infertility, emotions, and body hair. Conclusions: The psychological implications of PCOS are easily underestimated and have been largely ignored. Nursing has a pivotal role in recognizing these concerns and implementing therapy to improve quality of life in women with PCOS. [source]

Management of TMD: evidence from systematic reviews and meta-analyses

JOURNAL OF ORAL REHABILITATION, Issue 6 2010
T. LIST
Summary, This systematic review (SR) synthesises recent evidence and assesses the methodological quality of published SRs in the management of temporomandibular disorders (TMD). A systematic literature search was conducted in the PubMed, Cochrane Library, and Bandolier databases for 1987 to September 2009. Two investigators evaluated the methodological quality of each identified SR using two measurement tools: the assessment of multiple systematic reviews (AMSTAR) and level of research design scoring. Thirty-eight SRs met inclusion criteria and 30 were analysed: 23 qualitative SRs and seven meta-analyses. Ten SRs were related to occlusal appliances, occlusal adjustment or bruxism; eight to physical therapy; seven to pharmacologic treatment; four to TMJ and maxillofacial surgery; and six to behavioural therapy and multimodal treatment. The median AMSTAR score was 6 (range 2,11). Eighteen of the SRs were based on randomised clinical trials (RCTs), three were based on case,control studies, and nine were a mix of RCTs and case series. Most SRs had pain and clinical measures as primary outcome variables, while few SRs reported psychological status, daily activities, or quality of life. There is some evidence that the following can be effective in alleviating TMD pain: occlusal appliances, acupuncture, behavioural therapy, jaw exercises, postural training, and some pharmacological treatments. Evidence for the effect of electrophysical modalities and surgery is insufficient, and occlusal adjustment seems to have no effect. One limitation of most of the reviewed SRs was that the considerable variation in methodology between the primary studies made definitive conclusions impossible. [source]

Measurement of varus,valgus and internal,external rotational knee laxities in vivo,Part II: relationship with anterior,posterior and general joint laxity in males and females

JOURNAL OF ORTHOPAEDIC RESEARCH, Issue 8 2007
Sandra J. Shultz
Abstract We examined sex differences in general joint laxity (GJL), and anterior,posterior displacement (ANT,POST), varus,valgus rotation (VR,VL), and internal,external rotation (INT,EXT) knee laxities, and determined whether greater ANT and GJL predicted greater VR,VL and INT,EXT. Twenty subjects were measured for GJL, and scored on a scale of 0,9. ANT and POST were measured using a standard knee arthrometer at 133 N. VR,VL and INT,EXT were measured using a custom joint laxity testing device, defined as the angular displacements (deg) of the tibia relative to the femur produced by 0,10 Nm of varus,valgus torques, and 0,5 Nm of internal,external torques, respectively. INT,EXT were measured during both non-weight-bearing (NWB) and weight-bearing (WB,=,40% body weight) conditions while VR,VL were measured NWB. All laxity measures were greater for females compared to males except for POST. ANT and GJL positively predicted 62.5% of the variance in VR,VL and 41.8% of the variance in WB INT,EXT. ANT was the sole predictor of INT,EXT in NWB, explaining 42.3% of the variance. These findings suggest that subjects who score higher on clinical measures of GJL and ANT are also likely to have greater VR,VL and INT,EXT knee laxities. © 2007 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 25:989,996, 2007 [source]