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T To

Publications and source records attributed to T To.

87 records · Page 5Linked to original sources
PubMed1987

The significance of the tuberculin skin test in elderly persons.

Study of 49,467 persons over age 50 in Arkansas nursing homes afforded insight into the significance of the tuberculin skin test in the elderly. Whereas only 15% to 20% of persons showed a significant (10 mm or more) reaction to tuberculin on admission, 2% to 3% of these developed tuberculosis. Persons having no reactions comprised two subsets: a small group who died at an increased rate and were probably anergic, and a larger group who survived as well as persons who had reactions. Minor increases in reaction size with repeated testing appeared to be due to immunologic recall. However, conversions of 12 mm or more from a documented negative result indicated spread of infection. When not treated preventively, 7.6% (women) to 12.7% (men) of definite converters developed tuberculosis. The increase in number of persons showing positive reactions after entry may have been due to rapid demise of the anergic subset, improvement in nutrition of survivors, or unsuspected spread of tuberculous infection.

Aged↗
PubMed1987

Benefit-risk considerations in preventive treatment for tuberculosis in elderly persons.

Of 2135 elderly residents of nursing homes in Arkansas (mean age, 79.4 years) who have been treated with isoniazid for prevention of tuberculosis, data from 1935 were suitable for analysis. About 12 months of therapy was successfully completed in 1600 persons. Therapy could not be completed in 84 persons (4.4%) because of incipient hepatic toxicity and in 116 (6.0%) because of other types of drug intolerance. Although 135 persons (7.0%) died during the course of therapy, no evidence was found that isoniazid contributed to any death. The ratio of benefit (reduction of risk for tuberculosis) to risk (for nonfatal isoniazid-related hepatitis) was clearly favorable in persons who had definite conversions (1.6 for women, 3.4 for men) but less so for persons who had tuberculin reactions of unknown duration and for persons with minor increases in size of tuberculin reaction (less than 12 mm increase from an initially negative reaction).

Aged↗
PubMed1986

Carcinoma in situ of the vulva. A clinicopathologic study of 50 cases.

The authors reviewed 50 cases of carcinoma in situ of the vulva treated at the University of Texas Medical Branch, Galveston, from 1975 to 1984. Sixty-two percent of the patients were premenopausal. The most frequent complaint was vulvar itching. Twenty-six percent of the patients were asymptomatic. Recurrences were frequent (25%) and were associated with multifocal lesions, involved surgical margins and the bowenoid histologic type. Superficially invasive carcinoma was detected in 8% of patients, mostly postmenopausal women with simplex histologic types. Immunohistochemical studies failed to detect papillomavirus- or herpesvirus-associated antigens in any of the cases. Follow-up of 48 patients from six months to ten years revealed no mortality from invasive cancer.

Adult↗
PubMed1984

Baseline characteristics of patients in the National Heart, Lung, and Blood Institute Percutaneous Transluminal Coronary Angioplasty Registry.

The efficacy of PTCA was evaluated in several subgroups of patients. Of special clinical interest were the comparisons between subgroups of patients with multivessel disease vs 1-vessel disease, unstable angina vs stable angina, older age vs younger age, and female sex vs male sex. As a prerequisite for such comparisons, baseline characteristics of patients in the subgroups were examined. Compared with the subgroup with 1-vessel CAD, the subgroup with multivessel CAD had more elderly patients (age 65 years and older) and more of these patients had previous MI or CABG. PTCA was more often unsuccessful in patients with multivessel CAD because of inability to pass the catheter across the lesion. The subgroup of women tended to be older than men, and more women had severe and unstable angina, although fewer had multivessel CAD, previous MI or previous CABG. The PTCA success rate was 5% lower in women because of a greater frequency of inability to pass the lesion. Compared with younger patients, older patients had a higher prevalence of severe angina, multivessel CAD and lesions with larger diameters. The older patients had a 5% lower PTCA success rate, once again because of a greater frequency of inability to pass the lesion. The learning experience with PTCA was measured by the overall success rate as well as by the rate of ability to pass the lesion and the rate of dilating it once it was passed. These rates improved significantly by the investigators' case accumulations and independently by calendar year. Multivariate prediction of crossing the lesion and of overall success showed that favorable lesion characteristics and increasing physician experience were more important than the patient characteristics just discussed, although both female sex and multivessel CAD remained significant independent risk factors.

Age Factors↗
PubMed1984

Efficacy of repeat percutaneous transluminal coronary angioplasty for coronary restenosis.

The short- and long-term outcome of patients within the NHLBI PTCA Registry who underwent repeat PTCA for coronary restenosis were analyzed. Of 1,880 patients in whom an initial PTCA was successful, 203 had a repeat PTCA attempted after restenosis developed. Repeat PTCA was usually performed within 6 months of the first procedure. The success rate of repeat PTCA was 85.2%. As a direct result of repeat PTCA, 1.5% of patients had an MI and 2% required emergency CABG. No patient died as a result of the attempted second procedure. One to 3 years of follow-up information was available in 94% of eligible patients. Most patients (75.9%) did not have a subsequent (third) PTCA, CABG or an MI. The late mortality rate was 0.8%. Angiographic follow-up information was available in 62 patients. Sustained enhancement of the diameter of the redilated lesion was observed in 66%. Thus, repeat PTCA has a high success and a low complication rate. Most patients did not have subsequent restenosis and are free of angina. Hence, repeat PTCA should be recommended for patients who have restenosis and should be considered as an integral component of PTCA therapy.

Angina Pectoris↗
PubMedDate not supplied

Residues of chlorinated phenols and phenoxy acid herbicides in the urine of Arkansas children.

Urine samples from 197 Arkansas children were analyzed for eight chlorinated phenols and four chlorinated phenoxy herbicides by using a new procedure that combined gas chromatography with tandem mass spectrometry. With the detection limit of 1 part per billion (ppb), six of these pesticides were detected in more than 10% of the samples. 2,5-Dichlorophenol (a metabolite of p-dichlorobenzene), and pentachlorophenol were detected in 96% and 100%, respectively, of the children's urine at median concentrations of 9 ppb and 14 ppb, respectively. 2,4,5-Trichlorophenol was detected in 54% of the children's urine at a median concentration of 1 ppb. One trichlorophenol and three other dichlorophenols were found in 3% to 27% of the samples. The herbicide 2,4-dichlorophenoxyacetic acid was observed in 20% of all samples. The concentrations of all analytes are reported as background or reference levels for use in future studies. The finding of 2,5-dichlorophenol as a ubiquitous contaminant merits further study.

2,4-Dichlorophenoxyacetic Acid↗
PubMedDate not supplied

Hospital procedure volume and teaching status do not influence treatment and outcome measures of rectal cancer surgery in a large general population.

A clear benefit of increased hospital procedure volume or teaching hospital status on outcomes of rectal cancer surgery has yet to be shown. Few have examined treatment differences that may lead to varying outcomes. This study assessed the impact of hospital procedure volume and teaching status on both treatment and outcome measures of rectal cancer surgery in a large general population. Data were obtained for 1072 incident cases of rectal adenocarcinoma diagnosed in 1990 from Ontario, Canada, and treated with a major resection. Hospitals were classified by teaching status and procedure volume. Pathology reports were examined for 418 procedures. Abdominoperineal resections accounted for 31.0% of all procedures. There were no clinically significant differences in treatment measures, operative mortality, and long-term survival among the hospital groups according to both univariate and multivariate analyses. In conclusion, the absence of a hospital volume or teaching status effect on treatment and outcome measures suggests that for rectal cancer surgery in Ontario, centralization of procedures into high-volume or teaching centers is unlikely to improve surgical quality.

Adenocarcinoma↗
PubMedDate not supplied

Child care arrangement and preschool development.

Baseline data from the Canadian National Longitudinal Survey of Children and Youth were used to evaluate the associations between child care arrangement and poor developmental attainment (PDA). A weighted total of 521,800 children aged 2 to 3 years were studied (N = 2,709). PDA was assessed by age-standardized motor and social development score. Children were grouped by the predominant type of arrangement: care by someone in the child's own home, in another home (family child care), at a child care centre, or none (child care exclusive to parents). Controlling for socioeconomic status, biological factors and maternal immigration, family dysfunction, hostile parenting and low neighbourhood safety were correlated with PDA and positive parent-child interaction decreased the odds of PDA. Whereas centre child care arrangements were beneficial to development overall (OR = 0.41, 99% CI = 0.18, 0.93), an interaction existed between type of child care and maternal depression; among children with depressed mothers, centre child care was associated with increased odds of PDA. Findings suggest that the associations between child care arrangement and child development involve interactions of factors that influence a child's home environment. Future child development studies exploring these interactions are warranted.

Canada↗
PubMedDate not supplied

Measuring population health: correlates of the Health Utilities Index among English and French Canadians.

This study used cross-sectional data from the 1994/95 National Population Health Survey (NPHS) in Canada. The objective of the study was to examine the relationship between several established correlates of health status in the general population and the Health Utilities Index (HUI), a multi-dimensional, preference-based measure of health status. Analyses were carried out separately for the English-speaking (n = 9,853) and French-speaking (n = 1,519) respondents. The index correlated strongly with self-ratings of health status and functional disability and varied as expected according to age, sex, and income. Subjects classified to different categories of chronic conditions reported different levels of health, as predicted. The HUI was also associated with the use of drugs and recent history of hospitalization. No major differences in the findings were observed between the two cultural groups. The results should be treated with caution due to the cross-sectional design and other methodological limitations of the study.

Activities of Daily Living↗
PubMedDate not supplied

Health care utilization and disability of migraine: the Ontario Health Survey.

OBJECTIVE: To measure the prevalence of migraine, associated functional disabilities, use of medications and visits to physicians. DESIGN: 135,062 migraineurs in Ontario were estimated from the Ontario Health Survey (OHS). The population demographics, use of medications and visits to physicians were compared with these measures in individuals without migraine. RESULTS: The prevalence of migraine was estimated at 1.4% in Ontario. The migraineurs were heavy users of both prescription and non prescription drugs (98.0%). They were heavier users of pain relievers than the comparison group (91.2% versus 58.2%, p < 0.0000). According to the two-week disability reports, 11% of them were bedridden for an average of 1.6 days and 9.3% were restricted from normal activities for an average of 2.4 days because of migraine. CONCLUSIONS: Severe migraine headaches may result in a $31 million loss in productivity and $2 million in hospitalization costs. The findings of this study highlight both the medical and financial impact of migraine on the individual and the health care systems.

Absenteeism↗
PubMedDate not supplied

Hospitalization rates of children with gastroenteritis in Ontario.

PURPOSE: To calculate hospitalization rates of gastroenteritis among children in Ontario and to determine the association of hospitalization of gastroenteritis with sociodemographic indicators and the availability of hospital beds. METHODS: Ontario admission rates were calculated from hospital discharge data for fiscal year 1991/92. Small area variations, correlations between sociodemographic indicators and admission rates were studied. RESULTS: The age- and sex-adjusted admission rate in 1991/92 was 411.1/100,000 with a 14-fold variation in Ontario. The availability of paediatric beds was the only significant factor associated with high admission rates, with an estimated relative risk of 6.75 (95% confidence interval: 1.26, 36.09, p < 0.027). CONCLUSION: Since most children with gastroenteritis can be successfully managed as outpatients, high admission rates may be an indication of unnecessary hospitalization.

Adolescent↗