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Biomedical subjects

L Peters

Publications and source records attributed to L Peters.

At least 37 records · Page 2Linked to original sources
PubMed1999

Acute toxicity and cost analysis of a phase III randomized trial of accelerated and conventional radiotherapy for squamous carcinoma of the head and neck: a Trans-Tasman Radiation Oncology Group study.

The primary purpose of the present analysis was to assess the feasibility and acute toxicity of a pure accelerated fractionation regimen in a cooperative group setting. This analysis included the first 320 patients entered on to the Trans-Tasman Radiation Oncology Group (TROG) randomized controlled trial which compared accelerated radiotherapy (ART) with conventional radiotherapy (CRT) in stage III and IV squamous cell carcinoma (SCC) of the head and neck. Patients were randomized to either 59.4 Gy in 33 fractions over 24 days (ART) or to 70 Gy 35 fractions over 49 days (CRT) after being stratified for site and stage. Accrual began in 1991 and the trial was closed on 3 April 1998 with the targeted 350 patients. The 3-year survival for the whole group was 54%, and the 3-year disease-free survival was 41%. Toxicity data were available on 303 patients (148 ART; 155 CRT). Mucosal toxicity was worse in the accelerated arm, and it peaked approximately 3 weeks earlier than the conventional arm. Skin toxicity was equivalent but occurred approximately 7 days earlier in the accelerated arm. Acute effects in both arms healed completely. Hospitalization was more common in the ART arm (71 vs 52 patients; P = 0.01) but the total bed days in hospital was not greatly different (1707 bed days for ART and 1607 bed days for CRT). Patients were more likely to require nasogastric (NG) feeding in the ART arm (49 vs 33 patients; P = 0.02). There were 1157 NG feeding days for ART and 1154 NG feeding days for CRT. The average cost of radiation treatment per patient including hospitalization, NG feeding and accommodation was $11,750 in the ART arm and $11,587 in the CRT arm. The accelerated arm has been shown to be a tolerable, practical and cost-equivalent regimen. The assessment of the therapeutic ratio of this accelerated protocol (ART) will be determined when the analysis of late effects and loco-regional control is made when the data are more mature.

Adult↗
PubMed1999

Trends in HIV-related consultation in Dutch general practice.

New medicine against AIDS and a possible changing attitude towards AIDS will affect the role of the general practitioner (GP). We aim to explore and assess the changing role of the GP in preventing and detecting AIDS, which will be done by providing insight into the changing numbers and content of HIV-related consultations in the general practice. Since 1988 a representative sample of 63 Dutch GPs have participated in a network. They recorded all face-to-face consultations with non HIV-infected patients in which the subject of AIDS was brought up. Timetrend analysis is used to investigate variations over time in the number and content of the consultations, GPs' actions and patients' characteristics. The influence of a rural or urban setting and the characteristics of the patients who are involved are also taken into account. Until 1994 a significant increase was found in the number of consultations. In highly urban areas the number of consultations is higher and still growing, whereas physicians in rural areas see fewer patients every year. The most important topic of conversation was the request for an HIV test (74%). This figure grew over the years, as did the number of tests performed. GPs became less passive and restrictive in advising tests. The group of patients has also changed, e.g. patients do not mostly belong to traditional risk groups anymore, and are significantly younger. AIDS seems to have become more familiar to patients and doctors. A lot of general information is available from different sources. Because of this change in attitude and knowledge of patients, the GPs' role as it relates to AIDS is becoming more specific in tracing infected patients and giving customized information to individuals. Patients visit their physicians less often because of concerns about AIDS, but the GP continues to fulfil a very important role in the prevention and detection of AIDS.

Adult↗
PubMed1998

The psychometric properties of the Composite International Diagnostic Interview.

The Composite International Diagnostic Interview, or CIDI, is a fully structured interview that maps the symptoms elicited during the interview onto DSM-IV and ICD-10 diagnostic criteria and reports whether the diagnostic criteria are satisfied--nothing more, nothing less. The inter-rater reliability has been demonstrated to be excellent, the test-retest reliability good, and the validity has been demonstrated to be good, given the methodological constraints. The CIDI is available in lifetime and 12-month versions, and in both paper-and-pencil and computer-administered forms. The latter version is suitable for self-administration in cooperative subjects. The CIDI is available in many languages. It is supported by ten centres around the world, which conduct regular training programmes for interviewers. The training programmes are standardised and the training materials are comprehensive. The data from the CIDI is entered into standard data entry and scoring programmes that give as output the diagnostic criteria satisfied. The interviews, the training materials, and the scoring programmes are copyright by the World Health Organization (WHO) and are supervised by an advisory committee on behalf of WHO. That committee and the training centres welcome enquiries from researchers and clinicians who are interested in using the CIDI.

Humans↗
PubMed1998

'Being there': learning through active participation.

Students engagement in learning is predicated not only on interest but on the perception of relevance to their needs. A hermeneutic interpretation of narrative student evaluation data from an introduction to nursing lecture course that was taught by means of a practice-based phenomenological approach revealed a pattern of student learning in which students moved from detachment to active participation in their learning. The stories shared by nurses in the practice setting were instrumental in introducing students to the world of nursing and facilitating a sense of belonging. Once engaged in the experience, students looked for opportunities to become active participants in their learning. A practice-based phenomenological approach to a theory course maximizes opportunities for student participation. Active reflection and integration allow students to make their own connections between theory and practice.

Curriculum↗
PubMed1998

Are computerized interviews equivalent to human interviewers? CIDI-Auto versus CIDI in anxiety and depressive disorders.

BACKGROUND: The equivalency of the Composite International Diagnostic Interview delivered by human interviewers (CIDI) and its computerized version (CIDI-Auto) was examined for anxiety and depressive disorders. METHODS: Subjects were 40 patients at an Anxiety Disorders Clinic and 40 general medical practice attenders. The CIDI-Auto and CIDI were administered in counterbalanced order on the same day and measures of computer attitudes and the acceptability of the two interview formats were also taken. RESULTS: The CIDI-Auto and the CIDI were found to be equally acceptable to subjects on the dimensions of comfort and preference, while the CIDI-Auto was rated as less embarrassing but too long in comparison with the CIDI. The agreement between the two formats was acceptable with kappa values for ICD-10 diagnoses being above 0.65 and for DSM-III-R diagnoses above 0.5 except for two diagnoses (generalized anxiety disorder and dysthymia). Discrepancies between the two formats were predicted by computer attitudes and not by computer experiences or the tendency to respond in a socially desirable fashion. CONCLUSIONS: It is concluded that the CIDI-Auto in its self-administered form is an acceptable substitute for the CIDI for suitable subjects.

Adult↗
PubMed1998

Assessing patients' priorities and perceptions of the quality of health care: the development of the QUOTE-Rheumatic-Patients instrument.

Patient views on the quality of care have always been assessed by means of patient satisfaction questionnaires. The objectives of this study were to develop an instrument that would: (1) produce more specific data on health care services; (2) produce data that are related to the needs and expectations of individual clients; (3) contain items that had been formulated in collaboration with patients; (4) measure quality of health care services from the perspective of customers; (5) produce data on generic items and on disease-specific items of health care services. The instrument, developed for measuring the quality of care from the perspective of non-institutionalized rheumatic patients (QUOTE-Rheumatic-Patients), was evaluated in 425 non-institutionalized patients suffering from rheumatic diseases. The internal consistency of the subscales, the presumed factor structure and the feasibility of the instrument were evaluated. The development of this instrument resulted in a self-administered questionnaire on the quality of health care from the perspective of non-institutionalized rheumatic patients, which contains proper scientific characteristics and provides specific information for practical quality assurance policies.

Adolescent↗
PubMed1998

Susceptibility to skin stinging, non-immunologic contact urticaria and acute skin irritation; is there a relationship?

Adverse skin reactions cover many types of response: toxic, irritant, allergic, urticarial, sensory, etc. The relationships between an individual's tendency to develop different types of skin response are not well-described. We examined whether those who perceive stinging might be more likely to experience urticarial, sensory and irritation reactions in skin. A panel of 86 volunteers was tested with 10% lactic acid in the nasolabial fold to assess their ability to perceive stinging. At the same time, their capacity to develop non-immunologic contact urticaria was evaluated using chemicals of different structural type and urticant ability: methyl nicotinate, benzoic acid, cinnamic acid, cinnamaldehyde and dimethyl sulfoxide (DMSO). DMSO was also used to assess sensory effects and skin irritation. 44 were classes as "stingers" and 42 as "non-stingers". The pattern of urticant reactivity in the stingers and non-stingers was essentially the same, with neat DMSO generating the strongest reactions in both groups. Sensory reactions to DMSO (stinging, itching, tingling or burning) were similar in stingers and non-stingers; although the former may have reacted more quickly, a smaller proportion reacted (64% versus 76%). The skin irritation response to DMSO was also identical in stingers and non-stingers and the intensity of the urticant response in an individual did not correlate with the intensity of their subsequent irritant reaction. In conclusion, this study demonstrated that an individual's ability to perceive skin stinging does not give a general indication of their susceptibility to other types of non-immunologic skin response. Indeed, there appeared to be little evidence of correlations between any of the skin effects studied.

Acrolein↗
PubMed1998

Canadian National Survey on Sun Exposure & Protective Behaviours: methods.

This article describes the methods used for the 1996 Canadian National Survey on Sun Exposure & Protective Behaviours. A 55-item random-digit-dialling telephone household survey of people 15 years of age or more was completed in 1996. Items assessed were daily sun exposure and protective behaviours, as well as other sun-related behaviours and attitudes. Data were collected regarding sun-related behaviours during leisure, work time and winter holidays, as well as for children 12 years of age or less (as reported by parents). To test for an effect on the survey response rate, a letter of introduction was sent to 40% of the households. The survey response rate was 69% (4023 successfully completed surveys out of 5847 households included in the sample). The response rate achieved in the subset that received the introductory letter was 75%. This survey is the first to establish national population estimates for sun exposure and protective behaviours in Canada.

Adolescent↗
PubMed1998

Canadian National Survey on Sun Exposure & Protective Behaviours: adults at leisure.

OBJECTIVE: To describe the prevalence of sun exposure and protective behaviours during leisure time among Canadian adults 25 years of age or more. DESIGN: A random-digit-dialling telephone household survey of 4023 people 15 years of age or more was completed; 3449 adults 25 years of age or more responded to questions about sun exposure and protective behaviours from June to August 1996. RESULTS: Many of the adults (51%) reported getting 30 minutes to 2 hours of daily sun exposure, and 26% reported getting more than 2 hours. Half (50%) reported having one or more sunburns during the study period; 21% said they actively spent time suntanning. Less than half reported taking adequate protective actions. Women, light-complexioned and adults 65 years or more were more likely than men, medium- or dark-complexioned adults and adults in younger groups to protect themselves. Nearly two-thirds (63%) of the adults said they forgot to take protective actions, 47% felt it was inconvenient to do so, and 29% were not concerned about sun exposure. DISCUSSION: Canadian adults, especially younger men, are exposed to significant amounts of sun during summer leisure time, but they do not always protect themselves adequately. Interventions should emphasize and facilitate convenient, effective sun protection strategies.

Adolescent↗
PubMed1998

Canadian National Survey on Sun Exposure & Protective Behaviours: youth at leisure.

OBJECTIVE: To describe the prevalence of sun exposure and protective behaviours during leisure time among Canadian youth 15 to 24 years of age. DESIGN: A random-digit-dialling telephone household survey of 4023 people 15 years of age or more was completed in 1996; 574 youth responded to questions about their sun exposure and protective behaviours from June to August 1996. RESULTS: Half of the youth (51%) reported 30 minutes to 2 hours of daily sun exposure, and 36% reported more than 2 hours. A large proportion (68%) reported sunburns. The prevalence of sun protective actions ranged from 38% for wearing a hat to 26% for both seeking shade and avoiding the sun between 11 am and 4 pm. There were sex differences in sun-related behaviours among youth. DISCUSSION: The large proportion of Canadian youth who reported sun exposure and the small proportion who reported taking protective actions suggest the need for primary prevention. Interventions should address sex differences and focus on multiple methods of protection.

Adolescent↗
PubMed1998

Canadian National Survey on Sun Exposure & Protective Behaviours: parents' reports on children.

OBJECTIVE: To describe the prevalence of sun exposure and protective behaviours among Canadian children 12 years of age or less, as reported by their parents. DESIGN: A random-digit-dialling telephone household survey of 4023 people 15 years of age or more was completed in 1996; 1051 parents responded to questions about their children's sun-related behaviours from June to August 1996. RESULTS: Most children (89%) had 30 minutes or more of daily sun exposure, and many of them (45%) had sunburns. The prevalence of sun protective actions ranged from 36% for avoiding the sun to 76% for using sunscreen. Parental reports on sun protection for children 5 years of age or less differed significantly from reports for children 6 to 12 years old. DISCUSSION: High levels of sun exposure among Canadian children suggests the need for protection. Use of multiple methods of sun protection should be emphasized to parents, school personnel, recreation staff and child-care workers.

Adult↗
PubMed1997

WHO Study on the reliability and validity of the alcohol and drug use disorder instruments: overview of methods and results.

The WHO Study on the reliability and validity of the alcohol and drug use disorder instruments in an international study which has taken place in centres in ten countries, aiming to test the reliability and validity of three diagnostic instruments for alcohol and drug use disorders: the Composite International Diagnostic Interview (CIDI), the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) and a special version of the Alcohol Use Disorder and Associated Disabilities Interview schedule-alcohol/drug-revised (AUDADIS-ADR). The purpose of the reliability and validity (R&V) study is to further develop the alcohol and drug sections of these instruments so that a range of substance-related diagnoses can be made in a systematic, consistent, and reliable way. The study focuses on new criteria proposed in the tenth revision of the International Classification of Diseases (ICD-10) and the fourth revision of the diagnostic and statistical manual of mental disorders (DSM-IV) for dependence, harmful use and abuse categories for alcohol and psychoactive substance use disorders. A systematic study including a scientifically rigorous measure of reliability (i.e. 1 week test-retest reliability) and validity (i.e. comparison between clinical and non-clinical measures) has been undertaken. Results have yielded useful information on reliability and validity of these instruments at diagnosis, criteria and question level. Overall the diagnostic concordance coefficients (kappa, kappa) were very good for dependence disorders (0.7-0.9), but were somewhat lower for the abuse and harmful use categories. The comparisons among instruments and independent clinical evaluations and debriefing interviews gave important information about possible sources of unreliability, and provided useful clues on the applicability and consistency of nosological concepts across cultures.

Adult↗
PubMed1997

Assessing noninstitutionalized asthma and COPD patients' priorities and perceptions of quality of health care: the development of the QUOTE-CNSLD instrument.

Patient judgments on the quality of health care services have become increasingly important. This research describes the development and empirical testing of an instrument that measures quality of health care services from the perspective of noninstitutionalized patients. The instrument was developed in close collaboration with noninstitutionalized patients with chronic nonspecific lung diseases (asthma and COPD), rheumatic diseases, and disabled and elderly patients. Four instruments were developed with a common generic part and four disease-specific parts. This article focuses on the psychometric properties and the practical use of outcomes for quality assurance policies of the instrument for patients with chronic nonspecific lung diseases.

Adolescent↗
PubMed1996

The carcinogenic potency of carbon particles with and without PAH after repeated intratracheal administration in the rat.

The role of carcinogenic PAH in soot- and carbon black-related lung tumour induction in rats was investigated after intratracheal administration of carbon blacks (CB) and two types of diesel soot (DS), either as original or as toluene extracted particles. The total particle dose per animal was 15 mg subdivided into 16-17 weekly applications. There was one vehicle control and two groups were treated with a total dose of either 30 or 15 mg pure BaP as positive control. The main tumour results were: (a) original DS induced a higher tumour rate than extracted DS; (b) the carcinogenic potency of extracted CB probably depends on the size of the primary carbon particles and on the specific surface area of the particles; (c) extracted DS covered with 11 micrograms BaP per mg carbon particles caused a lower lung tumour rate than original DS containing only 0.9 ng BaP per mg, but a variety of other PAH and NO2-PAH; (d) a total dose of 15 mg pure BaP caused a lung tumour rate very similar to that of 30 mg extracted DS, 15 mg original DS or 15 mg Printex 90T CB extracted or covered with approximately 29.5 micrograms BaP per mg CB.

Animals↗
PubMed1996

Planned development and evaluation of AIDS/STD education for secondary school students in The Netherlands: short-term effects.

This study evaluated the effects of an AIDS/STD curriculum for 9th- and 10th-grade students in the Netherlands. Curriculum development was based on (1) theory-based need assessments among students and teachers, (2) pilot testing of data-based and theory-based methods and materials, and (3) cooperation between researchers and students, teachers, and gatekeepers within the school system. Using a quasi-experimental design, program effects on students' attitudes, beliefs, and sexual behavior were compared with those of current AIDS/STD education practice. The results indicated that the experimental curriculum had a stronger favorable impact on students' attitudes and beliefs regarding using condoms consistently. Regarding sexual risk behavior, a differential curriculum effect could be demonstrated. These findings support the contention that current AIDS/STD education can be improved by (1) using empirical data, (2) applying multiple theories from the social sciences, and (3) involving representatives within the school system in the development process.

Acquired Immunodeficiency Syndrome↗