Population differences in familial adenomatous polyposis may be an expression of geographic differences in APC mutation pattern.
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Adenomatous Polyposis Coli↗
Biomedical subjects
Julie A Stoner
Publications and source records attributed to Julie A Stoner.
Prospective study of survival outcomes in Non-Hodgkin's lymphoma patients with rheumatoid arthritis.
PURPOSE: Although preliminary studies suggest that non-Hodgkin's lymphoma (NHL) complicating rheumatoid arthritis (RA) may be a clinically distinct entity compared with that occurring in the general population, studies examining the impact of antecedent RA on survival are limited. In this prospective study, we examined the association of RA with survival in patients with NHL. PATIENTS AND METHODS: Using two large lymphoma registries, we identified patients with evidence of RA preceding NHL. Survival in RA patients was compared with that of controls using proportional hazards regression, adjusting for the effects of age, sex, lymphoma diagnosis-to-treatment lag time, calendar year, International Prognostic Index score, and NHL grade. RESULTS: The frequency of NHL subtypes was similar in RA patients (n = 65) and controls (n = 1,530). Compared with controls, RA patients with NHL had similar overall survival (hazard ratio [HR] = 0.95; 95% CI, 0.70 to 1.30) but were at lower risk of lymphoma progression or relapse (HR = 0.41; 95% CI, 0.25 to 0.68) or death related to lymphoma or its treatment (HR = 0.60; 95% CI, 0.37 to 0.98), but were more than twice as likely to die from causes unrelated to lymphoma (HR = 2.16; 95% CI, 1.33 to 3.50). CONCLUSION: RA is associated with improved NHL-related outcomes, including a 40% reduced risk of death occurring as a result of lymphoma or its treatment and approximately a 60% lower risk of lymphoma relapse or progression compared with non-RA controls. However, the survival advantage gained in RA from the acquisition of lymphomas with favorable prognoses is negated through an increased mortality from other comorbid conditions.
Aged↗
Alcohol intake is associated with altered pulmonary function.
Little is known about the effect of moderate alcohol intake on lung function in the general population. Because moderate alcohol intake appears to reduce cardiovascular disease risk, we hypothesized that moderate alcohol intake is associated with better pulmonary function. To test this hypothesis, we examined the association between alcohol intake and pulmonary function, measured by spirometry, in a representative sample of U.S. adults who participated in the Third National Health and Nutrition Examination Survey. A stratified multistage clustered probability design was used to select a population-based sample. Data analyzed included alcohol intake, smoking status, education, body mass, sex, age, race, diabetes status, and CHF status. The Third National Health and Nutrition Examination Survey was conducted from 1988 to 1994 by the National Center for Health Statistics of the Centers for Disease Control and Prevention, Atlanta, GA. We analyzed data from 15,294 study participants who completed extensive questionnaires in the household and a comprehensive physical examination, including pulmonary function testing, either in the household or at a specially equipped mobile examination center. Low-to-moderate alcohol intake was not associated with reduced odds of obstructive lung function. In fact, increased odds for obstructive lung pattern were observed only in former heavy drinkers. In contrast, low-to-moderate alcohol intake was associated with better forced vital capacity and forced exhaled volume in 1s in the absence of obstruction, consistent with reduced odds for lung restriction. Using a logistic regression model, we found that individuals reporting alcohol consumption had a lower risk of lung restriction both before and after adjusting for confounding factors including smoking (P< or =.001). Alcohol intake-related reduced risk for restriction was associated with lower risk of CHF, diabetes, obesity, and lower markers of inflammation (white blood cell, fibrinogen, and C-reactive protein) consistent with less lung congestion, external restriction, and/or lung inflammation. Our analyses indicate that alcohol consumption, even at very modest intake levels, is associated with less lung restriction.
Adolescent↗
Subjective outcomes following sural nerve harvest.
PURPOSE: The goal of this study was to assess subjective patient recovery of donor site sensory deficit following sural nerve harvest for trigeminal nerve repair surgery. PATIENTS AND METHODS: A review of 42 consecutive sural nerve graft patient records yielded 26 patients, at least 20 months following sural nerve grafting for trigeminal nerve repair, who participated in a telephone questionnaire survey to assess subjective outcomes. The association between donor site outcome and other factors, including nerve graft recovery, age, gender, pain, cold sensitivity, scar cosmesis and tactile sensitivity, and legal involvement were analyzed, and presurgical and present levels of donor and nerve graft site sensibility were compared. RESULTS: The perceived area of donor site sensory deficit decreased significantly over time. Postoperative donor site pain and cold sensitivity at low levels were reported by few patients, and the majority have completely resolved. Most patients reported no problems with scar cosmesis or pain. There was a moderate agreement between donor site recovery and nerve graft recovery (kappa = 0.32). Few patients reported satisfaction with one site and not the other or complete dissatisfaction with both sites. Other factors such as age, gender, or legal involvement were not found to correlate with satisfaction level. CONCLUSIONS: The use of a questionnaire for subjective assessment of neurosensory recovery following nerve graft repair yields outcomes information that is generally not considered in the traditional clinical patient assessment. The majority of patients tolerate sural nerve harvest without significant donor site morbidity.
Adult↗
Comparison of CT and dual-energy DEXA using a modified trunk compartment in the measurement of abdominal fat.
The quantification of abdominal fat is a marker of health risk. While dual-energy x-ray absorptiometry (DEXA) is easily applied, it measures overall fat, although abdominal fat may be a better indicator of health risk from obesity. We have evaluated whether a subcomponent of DEXA measurements correlates better with computed tomography (CT) for body fat than those traditionally used. Forty-seven healthy adults (22 M/25 F), aged 54.5+/-15.8 yr (mean+/-SD), with BMI of 27.1+/-4.6 kg/m2 participated in a cross-sectional study. Body fat was measured using abdominal CT and DEXA for total fat, trunk fat, and a modified trunk measurement that excludes the chest, termed "lower trunk," and compared. The coefficient of variation for DEXA measurements for trunk, lower trunk, and total body were 1.98, 3.12, and 0.85%, respectively. Mean DEXA for percentage fat ranged from 31.7% to 34.1% for trunk, lower trunk, and total body, compared to 54.2% for abdominal CT (p<0.003 for each pairwise comparison). Lower trunk, whole trunk, and total body DEXA measurements were not different. Measurement of subcomponents of fat content by DEXA is not superior to whole body measurements and remains consistently lower than measurements by CT.
Abdominal Fat↗
Challenges and opportunities for combination therapy in chronic obstructive pulmonary disease.
Advances in the understanding of chronic obstructive pulmonary disease have presented a number of novel therapeutic opportunities. More extensive use of drug combinations is likely, but the development of these therapies presents a number of challenges. In clinical trials, a combination must be tested not only against placebo but also against each of its components, and the false-positive error rate increases rapidly with multiple comparisons. Thus, more groups of subjects must be studied, and more individuals within each group must be studied, in order to ensure statistical significance. Another challenge is that the relatively slow progression of chronic obstructive pulmonary disease and the lack of specificity of commonly used outcome variables complicate the evaluation of all therapies, including combinations. In analogy to genomics and proteomics (evaluation of the pattern of expression of many things simultaneously), it may be more useful to adopt an approach that is here dubbed "clinicomics": consideration of multiple features of chronic obstructive pulmonary disease that are evaluated routinely, for example, with a well-done history and physical examination. The use of a truly multidimensional outcome parameter promises an entirely novel paradigm for the assessment of novel combinations of therapies.
Drug Therapy, Combination↗
Influence of gender on the titration of medications for chronic heart failure.
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Cardiovascular Agents↗
Results of treatment of fifty-six patients with localized retroperitoneal and pelvic rhabdomyosarcoma: a report from The Intergroup Rhabdomyosarcoma Study-IV, 1991-1997.
BACKGROUND: We reviewed 56 IRS-IV patients with localized rhabdomyosarcoma [RMS] of the retroperitoneum/pelvis to assess outcome and prognostic factors, including the value of initially excising >or=50% of the tumor (debulking) before chemotherapy. METHODS: Patients had embryonal RMS [N=38], alveolar RMS [N = 7], RMS not otherwise specified [NOS, N = 7], or undifferentiated sarcoma [N = 4]. Fifteen patients were debulked; 41 patients were biopsied. All received VAC; most received radiotherapy. RESULTS: Estimated 5-year failure-free survival [FFS] and overall survival rates were 70 and 75%, respectively. FFS rates were better for patients <10 years old and those with embryonal RMS compared to alveolar RMS/undifferentiated sarcoma. After adjusting for age and histological differences, FFS was better for patients whose tumor was debulked prior to beginning therapy [P = 0.02]. CONCLUSIONS: These results are superior to those of previous protocols for patients with RMS of the retroperitoneum/pelvis. Initial excision of >or=50% of the tumor may be associated with increased FFS.
Antineoplastic Combined Chemotherapy Protocols↗
Multicenter experience with upper gastrointestinal polyps in pediatric patients with familial adenomatous polyposis.
BACKGROUND: Familial adenomatous polyposis (FAP) is a hereditary cancer syndrome that includes gastro-duodenal involvement, polyposis, and a propensity to adenocarcinoma necessitating endoscopic surveillance. There are few data describing pediatric upper gastrointestinal FAP resulting in conflicting screening recommendations. OBJECTIVES: To characterize pediatric gastroduodenal FAP and to investigate the association between symptoms at endoscopy and APC mutation analysis with endoscopic-histologic findings warranting surveillance. METHOD: A retrospective chart review was performed, including all children with FAP who underwent upper endoscopy (EGD) at two institutions; (UNMC: 1992-2002, JHH: 1983-2002), all biopsies were reviewed and the APC mutations present in the cohort of patients were correlated to the pattern of severity of endoscopic findings and the frequency of APC mutations identified through commercially available testing for FAP (Labcorp: 1998-2002). RESULTS: Twenty-four patients from 21 families underwent 49 EGDs. Eighty-three percent were asymptomatic at the time of endoscopy. The most common finding was fundic gland polyposis (FGP) (51%), of which 42% and 15% harbored dysplasia and changes indefinite for dysplasia, respectively. Periampullary duodenal adenomata were present in 41% of patients with one patient necessitating ampullectomy. Symptoms at endoscopy were not predictive of premalignant changes. In 15 patients where the APC mutation was known patients with dysplastic FGP, gastric, or duodenal adenoma were more likely to harbor a mutation between codons 1225-1694 than the reference population (p= 0.006). CONCLUSIONS: All pediatric patients with FAP warrant upper gastrointestinal screening and surveillance endoscopy from the time of initial colonoscopy irrespective of referable symptoms. Patients with APC mutation between codon 1225-1694 may be more susceptible to aggressive gastroduodenal involvement in FAP.
Adenomatous Polyposis Coli↗
Patterns of adherence to antiretroviral medications: the value of electronic monitoring.
OBJECTIVE: To investigate the patterns of intra-subject (between medication) adherence to antiretroviral therapy. DESIGN: A prospective, observational, 3-month study of adherence to antiretroviral therapy at an inner-city clinic in 40 HIV-infected subjects. METHODS: Adherence was monitored monthly by the use of medication event monitoring system (Aprex) caps placed on each antiretroviral drug in a subject's regimen. Agreement between different drug classes and dosing schedules, for each subject, was quantified by estimating the mean difference in adherence, with 95% limits of agreement. An analysis of variance model was used to estimate the variance of the differences. Individual dosing calendars were examined for each subject. RESULTS: The dosing schedule was a strong predictor of intra-subject adherence. Regardless of the subject's overall adherence rate, high or low, when subjects missed a dose of one medication, they missed a dose of both medications taken at that dosing time. Conversely, when medications were scheduled to be taken together, regardless of the drug class, the medications were taken at the same times. The majority of the subjects took medications at obviously incorrect times. Problematical adherence was related to thrice-daily dosing and food restrictions. CONCLUSION: This is the first report objectively to quantify intra-subject adherence to antiretroviral therapy and report the findings in detail. We observed clear patterns of drug-taking behavior among the subjects in our study. To the extent that medication scheduling is a controllable factor, our report provides an insight into specific patterns of behavior that may be targets for adherence counseling.
Antiretroviral Therapy, Highly Active↗
Ethanol consumption decreases the synthesis of the mannose 6-phosphate/insulin-like growth factor II receptor but does not decrease its messenger RNA.
The mannose 6-phosphate/insulin-like growth factor II receptor (M6P/IGF-IIR) is a protein that facilitates the transport of acid hydrolases into the lysosome. We have shown that chronic ethanol consumption lowers the M6P/IGF-IIR content in rat hepatocytes. Here, we determined the steady-state level of mRNA encoding M6P/IGF-IIR, as well as the rate of receptor synthesis, to ascertain whether the ethanol-elicited reduction in receptor protein content is related to changes in either or both of these parameters. Rats were pair-fed the normal carbohydrate (NC) or low carbohydrate high-fat (LC) liquid diets containing either ethanol or isocaloric maltose-dextrin for 7-8 weeks. RNA was isolated from hepatocytes and from whole livers of these animals and subjected to reverse transcription-polymerase chain reaction (RT-PCR) to determine the mRNA levels encoding M6P/IGF-IIR. Hepatocytes isolated from these animals were also radiolabeled with Pro-mix L-[35S] in vitro cell labeling mix to measure incorporation into total cellular protein and the immunoprecipitated M6P/IGF-IIR protein. The steady-state levels of M6P/IGF-IIR mRNA in both hepatocytes and whole livers from ethanol-fed rats were the same as those from their respective controls regardless of whether they were fed the NC or the LC diets. Hepatocytes from ethanol-fed rats showed a 36% lower rate of total protein synthesis and an even greater reduction (70%) in receptor synthesis. When the relative rate of receptor synthesis was calculated, hepatocytes from ethanol-fed rats had a 53% lower relative rate of receptor synthesis compared with controls. Autoradiographic analysis of the immunoprecipitated receptor protein from ethanol-fed rats also indicated a 79% decline in the total M6P/IGF-IIR protein synthetic rate compared with pair-fed controls. We conclude that the ethanol-elicited reduction of M6P/IGF-IIR content was, in part, related to a concomitant reduction of receptor protein synthesis but not to a decline in its mRNA level. Thus, the ethanol-elicited decline in receptor protein synthesis may be due to defective M6P/IGF-IIR mRNA translation.
Alcohol Drinking↗
The significance of social network in a geriatric assessment population.
BACKGROUND AND AIMS: There has long been speculation that socially-involved individuals suffer less illness, overcome sickness more readily, and experience better health outcomes than more socially isolated persons. This study describes social network characteristics, and determines whether social network affects health outcomes in the geriatric population. METHODS: Data from 1270 consecutive patients seen in the outpatient Geriatric Assessment Clinic (GAC) of the University of Nebraska Medical Center between August 1988 and May 1999 were analyzed. Social network was measured by the Social Network Index (SNI). RESULTS: Younger age, higher income and higher education were related to a broader social network. A larger social network was generally associated with lower caregiver burden, higher functional status and better cognition. Men with the smallest social networks were found to be at significantly higher risk of death than women with larger social networks (HR 4). After adjusting for age (HR 1.04, CI 1.03-1.06), income (HR 1.00, CI 1-1), education (HR, NS), IADL (HR 0.97, CI 0.95-0.99), CIRS (HR 1.08, CI 1.05-1.10) and informal service use (HR, NS), the risk of death for subjects based on SNI is only significant in the comparison between SNI III and SNI I (HR 0.67, CI 0.50-0.91). CONCLUSIONS: SNI I males are at significantly increased risk of death compared with all other groups. The average number of years from initial visit to death for SNI I males is only 2.8 years. These results are consistent with the literature, which suggests men are more affected by social isolation and have decreased survival compared with females. The influence of SNI on mortality in this frail, elderly group appears to be diluted by the presence of functional disability and a high degree of comorbid illness.
Activities of Daily Living↗
A method for identifying places in rural America at risk of not being able to support adequate health services.
CONTEXT: Public policymakers and their advisers struggle with the problem of specifying criteria by which health care providers in rural areas are eligible for special consideration in payment policies and for special grant programs. A means of designating places can provide a basis for assistance and can help target public resources for any providers who deliver services in those places. PURPOSE: This paper provides the details underlying a place-based approach to identifying rural areas that are at risk for not being able to provide requisite health services. METHODS: A population size criterion is utilized first to eliminate metropolitan areas and other large agglomerations from consideration. Any territory not included in a place of 3500 or more people, including a 25-mile buffer around that place, is a priori considered to be at risk. All places, including buffers, that have populations between 3500 and 100,000 are further analyzed using population compositional data and principal components analysis. FINDINGS: In 10 states and 24 bordering states selected for developing and testing the method, there were 1907 block groups outside the boundaries of any place with a population of at least 3500. In addition, the analysis suggested that 66 out of 236 places and buffers with populations between 3500 and 100,000 also should be classified as vulnerable. CONCLUSIONS: The results are discussed in regard to how a place-based approach can advance the study of rural health needs. By focusing on the needs of the people residing in a defined area, as determined from the aggregate characteristics of the population, a model is generated that can be used to predict special circumstances confronting any service provider. The public policy implications of the findings are also considered. Special payment policies could be written on the basis of place instead of provider characteristics, and grant programs providing technical assistance could be targeted to places of greatest need.
Adult↗
Resolution of depression among victims of intimate partner violence: is cessation of violence enough?
The objective of this article is to assess the effect of abuse cessation on depressive symptoms among women abused by a male intimate partner. This prospective cohort study of Seattle women with a history of intimate partner violence (IPV) who were classified by history of abuse and abuse status at 3 month, 9 month, and 2 year follow-up interviews. Relative risks (RR) were calculated using generalized estimating equations. Among subjects with a history of psychological abuse only, cessation of abuse was associated with a nonsignificant reduction in the likelihood of depression compared to subjects whose abuse continued (aRR = 0.88; 95%CI: 0.75,1.03). Among subjects with a history of physical/sexual abuse and psychological abuse, cessation of physical/sexual abuse only was associated with a 27% decline, and cessation of both types of abuse was associated with a 35% decline in the likelihood of depression (aRR = 0.73, 95%CI: 0.63,0.86; and aRR = 0.65; 95%CI: 0.55,0.76; respectively). Cessation of abuse among victims of IPV is associated with a decreased prevalence of depression.
Adolescent↗
Health services at risk in "vulnerable" rural places.
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Humans↗
Comparing two methods of rehabilitation for risk factor modification after a cardiac event.
Because fewer than half of cardiac patients in the United States enroll in cardiac rehabilitation (CR) programs, there is a critical need to test alternative strategies of delivering CR services. This study tested whether a home-based CR (home-CR) program was at least as effective as traditional-CR (trad-CR) in the modification of coronary heart disease risk factors from the beginning of CR (baseline) to 2 and 4 months later. A repeated measures non-inferiority quasi-experimental design was used to examine changes in risk factors. Participants selected which CR program, traditional versus home-based, in which to participate: 37 patients chose trad-CR and 24 patients chose home-CR. The following indicators of risk factors were measured: smoking, blood pressure, frequency of aerobic exercise, cholesterol, amount of dietary fat, frequency of anger, body mass index (BMI), and waist circumference. Home-CR was found to be as effective as trad-CR in modification of cardiac risk factors including BMI, waist circumference, blood pressure, frequency of aerobic exercise, total cholesterol, and a low fat diet. Home-CR was not as effective as trad-CR in reducing the frequency of anger. These findings provide support for an alternative method of delivering cardiac rehabilitation services.
Adult↗
A conceptual model for understanding effective coalitions involved in health promotion programming.
Funding agencies are increasingly focused on community coalitions as effective entities for promoting public health programs. Yet, there has been no conceptual model for understanding how effective coalition infrastructure works to facilitate a learning environment, wherein coalition members and leaders receive ongoing training and technical assistance needed to accomplish their external programming goals. This article presents a conceptual model for measuring the internal effectiveness of coalitions [Internal Coalition Outcome Hierarchy (ICOH)]. The ICOH model served as the basis for development of the evaluation instrument, Internal Coalition Effectiveness, which measures internal coalition effectiveness based on achievement of organizational outcomes at each of the model's seven hierarchical levels. The ICOH conceptual model has broad application for public health nurses who are frequently called on to serve as evaluators for community coalitions engaged in health programming. The model has implications for evaluators to use in teaching coalition members and leaders about their internal strengths and areas for improvement, so that coalitions can develop more effective internal structures and thereby promote long-term sustainability.
Community Participation↗
Measuring community coalition effectiveness using the ICE instrument.
This article presents the development and psychometric testing of the Internal Coalition Effectiveness (ICE) instrument, which was based on the conceptual model Internal Coalition Outcome Hierarchy. Sixty-one items were derived from literature about successful coalitions, and the ICE instrument was tested for reliability and validity. A national panel of eight experts conducted content validity. Remaining tests involved a sample of 61 members and leaders of a large midwestern coalition (77% response rate, n=47). Content validity involved a two-stage process for rigorous item development and quantification (0.88, p<0.05). Internal consistency was based on bivariate Pearson's correlation of 0.30-0.70 for two-item scales and Cronbach's alpha(alpha=0.70). Construct validity was assessed by correlation analysis, independent Student's t tests, and informal coalition feedback. The final 30-item version of ICE is psychometrically sound. Findings were shared with the local coalition, and, in support of the instrument's validity, members and leaders found this information useful for promoting coalition sustainability by identifying internal strengths and areas for improvement. The ICE instrument adds to the body of literature by measuring critical constructs of coalition effectiveness and has significant application for public health nurses working as evaluators for coalitions engaged in community health programming.
Health Care Coalitions↗