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PubMed2002

The benefits of comprehensive surgical staging in the management of early-stage epithelial ovarian carcinoma.

OBJECTIVE: The management of understaged patients with apparent clinically early ovarian cancer is difficult. Options include offering chemotherapy based on histopathologic factors or reoperation to obtain the necessary information needed to assign an accurate surgical stage. This study aims to compare these two approaches and to define the role of staging surgery in this common patient population. METHODS: Retrospective chart reviews were carried out at the Universities of Manitoba and Saskatchewan over the period 1975 to 1999. Demographic data and surgical findings were abstracted and entered into a computerized database for analysis. Patients not having surgical staging procedures were offered platinum-based chemotherapy based on high tumor grades, dense adhesions, and presence of surface excrescences or large necrotic areas. Patients with surgically proven stage I disease were treated with no further therapy regardless of histopathologic factors. Descriptive statistics are used to summarize the data. Logistic and Cox regression models are used to identify significant predicting factors for recurrences and progression-free intervals. RESULTS: One hundred and thirty-eight patients presented with tumor macroscopically confined to the ovary at the time of laparotomy. The median age at presentation is 56.5 (18-90). The histology distribution was serous tumor in 28.3%, mucinous in 26.1%, endometrioid in 23.2%, clear cell in 14.5%, anaplastic in 2.2%, and mixed types in 5.8%. The grade distribution was 47.1% grade 1, 27.5% Grade 2, and 25.4% Grade 3. Sixty-eight percent of the patients had a comprehensive surgical staging procedure initially. Thirty-six percent of these patients were found to have extraovarian metastases and were subsequently treated with adjuvant chemotherapy. Forty-three percent of those not having staging laparotomy were offered chemotherapy based on high risk factors only. At a median follow-up of 58 months. 77% of patients remained disease-free and 23% had recurrent disease. Of 60 patients with surgically proven stage I treated expectantly, 6 (10%) recurred, whereas of 25 unstaged patients treated expectantly due to lack of risk factors 7 (28%) recurred (P = 0.036). In patients treated expectantly, a significant survival advantage was noted in the staged group. Logistic regression showed age (OR 1.032, P = 0.043), high grade (OR 4.16, P = 0.003), and lack of a proper staging surgery (OR 2.62, P = 0.032) to be important factors predicting recurrence. In terms of progression-free interval, only age (OR 1.027, P = 0.048) and tumor grade (OR 3.62, P = 0.05) are significant predictors. CONCLUSION: Absence of surgical pathologic high-risk factors is inferior to comprehensive staging laparotomy findings in guiding recommendations for subsequent adjuvant therapy. Patients who have not been properly staged stand a significant risk of recurrent disease despite more frequent use of chemotherapy. All clinically early-stage ovarian cancer patients should be considered for comprehensive staging surgery prior to further treatment recommendations.

Adolescent↗

PubMedDate not supplied

[Attempts to divide the high-frequency range (40-200 cycle/sec) of the brain electrical activity in dogs into frequency bands].

The work was aimed to reveal the functional significance of separate narrow-frequency bands in the high-frequency range (40-200 Hz) of brain electrical activity of dogs in the process of lever-pressing instrumental conditioning. In order to divide this range into separate bands we applied one of the methods of multivariate statistics, factor analysis (FA) with varimax rotation. Values of function of spectral density in the wide range (1-200 Hz) were factorized. The structure of factors reflected both regional cortical characteristics of electrical activity and individual features. Conditioning induced changes in factor description of brain electrical activity mainly in the high-frequency part of the spectra. A number of new factors appeared which divided high-frequency band of the brain activity into narrower parts with definite functional significance.

Animals↗

PubMed2001

Psychometric evaluation of the exercise self-efficacy scale among Korean adults with chronic diseases.

The purpose of this study was to assess the psychometric properties, appropriateness, and demographic response patterns of an exercise self-efficacy scale for Korean adults with chronic diseases. After assessment of face validity by an expert Korean panel, 249 Korean adults with chronic diseases, ages 18-79 years, were recruited from hospitals or health centers in five Korean cities and surrounding rural areas to complete the questionnaire. In a factor analysis the original 18-item exercise self-efficacy scale converged to one factor without rotation and to three subfactors with rotation: situational/interpersonal factor, competing demands factor, and internal feelings factor. Descriptive analysis showed that Korean adults with chronic diseases perceived they had relatively low exercise self-efficacy, with the situational/interpersonal factor as the lowest factor. Exercise self-efficacy was significantly correlated with gender, education, regular exercise, and frequency of exercise. The exercise self-efficacy scale was shown to be a useful measure of exercise beliefs of Korean adults with chronic diseases.

Adolescent↗

PubMedDate not supplied

Patterns of risk of depressive symptoms among HIV-positive women in the southeastern United States.

Depressive symptoms are a common response to HIV disease, and women appear to be at particularly high risk. The authors report results from a cross-sectional analysis of data collected from 280 rural women with HIV/AIDS in the Southeastern United States aimed at identifying risk factors of depressive symptoms. Stress theory provided a framework for identification of potential risk factors. Descriptive statistics, measures of association, and regression analyses were used to systematically identify patterns of risk. The final regression model included 22 factors that accounted for 69% of the variance in depressive symptoms. The majority of variance in depressive symptoms was accounted for by only six variables: the frequency of HIV symptoms, recent experiences of sadness/hopelessness, the availability of social support, and the use of three coping strategies: living positively with HIV, isolation/withdrawal, and denial/avoidance. The results suggest a number of intervention strategies for use with rural women with HIV/AIDS.

Adaptation, Psychological↗

PubMed1963

FACTORS RELATING TO ACADEMIC PERFORMANCE OF MEDICAL STUDENTS AT THE UNIVERSITY OF BRITISH COLUMBIA.

The performance of medical students enrolled at the University of British Columbia from 1952 to 1961 is reviewed and related to certain descriptive factors available to the screening committee at the time of application. Almost 40% of enrolled students had academic difficulty in medical school; 16.4% failed a complete year. Since 91% of students who failed out, did so after freshman medicine examinations, these grades were examined for significant association with certain intellectual and non-intellectural factors. Sex and year of registration were not significantly associated with freshman performance, but permanent home address was: students from other Commonwealth countries did not perform as well as Canadians. Significant correlations were observed between both pre-medical grades and Medical College Admission Test scores and first-year medicine marks. By multiple regression analysis four factors were found to be predictive: age, number of pre-medical years completed at the time of application, overall pre-medical grade average and "Science" M.C.A.T. score. From the resulting equation, 77.4% of the grades of medical students who completed their freshman year in 1962 were predicted within one standard error. Students on the whole were noted to perform consistently in pre-medicine and medicine.

Canada↗

PubMed1998

Anticipatory postural adjustments in conditions of postural instability.

OBJECTIVES: The purpose of this study was to investigate anticipatory postural adjustments (APAs) in standing subjects who performed a standard motor action triggering a standard postural perturbation (releasing a 2.2 kg load from extended arms) in conditions of different stability requirements. METHODS: The degree of stability was varied either by balancing on special boards with long and narrow support beams or by instructions to the subjects. In the first series of experiments 13 subjects stood on the board facing either perpendicular to the beam (instability in a sagittal plane) or along the beam (instability in frontal plane); different widths of the beam were used to vary the degree of instability. During the second series of experiments (6 subjects) inclined and one-legged postures were used to induce instability in sagittal and frontal planes respectively. EMG activity of rectus abdominis, erector spinae, rectus femoris, biceps femoris, tibialis anterior, and soleus muscles were recorded. Statistical methods included repeated measures analysis of variance (ANOVA) with direction of instability and level of instability being major factors, descriptive statistics, and post hoc Student's t tests. RESULTS: The integral measure of changes in the background electromyographic activity of postural muscles during APAs depended on two factors related to the postural task: (1) standing on a platform with a narrow support area led to an attenuation of the APAs; and (2) these effects were stronger when instability was in a sagittal rather than in the frontal plane. The anticipatory component in the displacement of the center of pressure did not show a clear attenuation that would depend on the direction of instability. CONCLUSIONS: We suggest a hypothesis that, in conditions of high stability demands, the central nervous system may suppress APAs as a protection against their possible destabilizing effects. These effects are more pronounced when the direction of an expected perturbation is in the plane of instability.

Adult↗

PubMed1985

Factors influencing blood pressure in children and adolescents.

The relationship between blood pressure, height-weight-obesity, high density lipoprotein (HDL) and total cholesterol was investigated in a population of 871 children and adolescents. The structure of the data was also analysed and a comprehensive control of the model was undertaken. A mean blood pressure (MBP) with minimum variance was used as an integrated measure for the blood pressure. A new children's body mass index CBMI = log weight -0.008 X height was used to measure the obesity of the children. This index was proved to be independent of the children's height. The best single descriptive factor for MBP in boys is HDL/total cholesterol (HDLI). In girls, the CBMI is the most descriptive. Weight contributes significantly to the description of MBP in both sexes. In girls, the HDLI also improves the description of MBP. In boys, age is of no significance when weight is included in the analysis. Heart rate (HR) depends significantly on weight in both sexes. In girls, HR furthermore is correlated to cholesterol. None of the parameters; circumference of arm, consumption of tobacco or licorice, serum triglyceride, and diabetes in family were found to contribute significantly to the description of MBP or HR when CBMI, weight, HDLI and total cholesterol are included in the analysis.

Adolescent↗

PubMed1985

The use of pediatric medical care: a critical review.

The problems of who uses medical services and why, are important ones for investigators interested in studying chronic diseases, particularly if they wish to avoid systematic error when assembling a study population. These issues are important when studying pediatric diseases due to the uneven use of medical services by children and the tendency of lower socioeconomic groups to use hospital facilities rather than private practitioners. In order to address these problems, we must understand why families seek medical care for young children. Utilization research shows that a number of descriptive factors such as child's age, birth order, parental education, financial resources and perceived symptoms are related to service use. Additionally, psychosocial variables, such as distress, also predict utilization. Neither the descriptive nor psychosocial variables explain much of the variance in utilization. While some of this lack of explanatory power can be attributed to problems in measurement or study design, there are also conceptual and methodological issues that are not addressed in pediatric utilization research. This paper discusses four of these issues. It is our conclusion that two of these problems, the need for a new utilization taxonomy and the ambiguity of cause and effect, can be remedied. While more difficult to address, the inadequate conceptualization of social stress, psychological distress, and social support can be improved. However, measuring health status independently of utilization represents a major methodologic problem for which we currently have no ideal solution.

Birth Order↗

PubMed2006

[Serious bacterial keratitis: a retrospective clinical and microbiological study].

AIM: To define clinical and microbiological characteristics of patients with bacterial keratitis hospitalized in the Bordeaux University Hospital Department of Ophthalmology. METHODS: A retrospective study of patients presenting serious bacterial keratitis was conducted over 32 months. Clinical features (age, risk factors, description, and visual acuity), progression, and bacteriological characteristics were statistically analyzed. RESULTS: Seventy-three patients were hospitalized from January 2000 to August 2003. The mean age was 43.6 years old. The mean delay for referral was 6 days. Risk factors were noted in 93.1% of cases: contact lens wear (50% of risk factors); keratopathy (25%); corneal trauma (8.8%); general disease (8.8%); and corneal surgery (7.3%). Bacteriological cultures of corneal smears isolated an organism in 57.7% of cases. Pseudomonas aeruginosa (29.2%) and coagulase-negative Staphylococcus (22.9%) were the most frequent species. Gram-negative bacilli and Gram-positive cocci were also present. Gram-negative bacilli were largely dominant when associated with contact lenses (59.3% of bacteria in contact lens-related keratitis). Visual outcome was significantly correlated with anterior chamber inflammation and initial poor visual acuity. DISCUSSION: In this study, Gram-negative bacilli keratitis appeared to be clearly dominant in cases of contact lens wear. This fact is complementary to the increase in Gram-positive cocci in developed countries, even with contact lens wear.

Adolescent↗

PubMedDate not supplied

Patients' sensations after breast cancer surgery. A pilot study.

PURPOSE: The purpose of this study was to obtain information about the prevalence and characteristics of breast sensations after breast cancer surgery, the impact they had on patients, and aggravating and relieving factors. DESCRIPTION OF STUDY: Within 1 month after the date of their surgery, 132 patients with breast cancer completed an instrument rating the prevalence, severity, and level of distress of breast sensations. Information also was obtained on the impact that those sensations had on activities of daily living and factors that triggered and provided relief from sensations. RESULTS: Certain sensations remain prevalent (numb, tender), severe (burning, sharp), and distressing (cramping, painful). Overall these sensations significantly interfered with patients' activities of daily living. Certain activities (movement, position change) triggered sensations, while others (position change, medication) provided relief. CLINICAL IMPLICATIONS: Healthcare professionals can use the information learned from this pilot study to educate patients both preoperatively and postoperatively about prevalent breast sensations after surgery for breast cancer and about the types of activities that may aggravate or relieve these sensations. As patient educators and advocates, oncology professionals must continue to explore the long-term effects and treatment options to provide optimal care and support to patients who have or are likely to have post-surgical breast sensations. More studies are needed to explore long-term effects and treatment options.

Activities of Daily Living↗

PubMedDate not supplied

Health conditions and risk factors of sheltered persons displaced by Hurricane Katrina.

INTRODUCTION: During disasters, public health departments assume the role of maintaining the health of displaced persons. Displaced persons arrive with acute and chronic conditions as well as other risk factors. Descriptions of these conditions may aid future shelter planning efforts. METHODS: Approximately 4000 individuals from New Orleans, displaced by Hurricane Katrina, were sheltered in Austin, Texas. A stratified random sample of the population was selected using individual beds as the primary sampling unit. Adults were interviewed about their acute symptoms, chronic diseases, and other risk factors. RESULTS: The results indicate a substantial proportion of adults arrived with some symptoms of acute illness (49.8%). A majority of the adults reported living with a chronic condition (59.0%), and the prevalence of some chronic conditions was higher than that of the general population. Also, several factors that could complicate service delivery were prevalent. DISCUSSION: Acute illnesses present transmission risks within the shelter. Furthermore, chronic diseases must be managed and may complicate care of acute illnesses. Risks like activity limitation or substance abuse may complicate shelter operations. Defining the potential scope of the illness burden may be used to help public health departments better plan the services they must deliver to displaced populations.

Adolescent↗

PubMed1998

[Psychological stress factors in erectile dysfunctions. Causal models and empirical results].

In this paper the role of psychosocial factors in erectile dysfunction is examined in two different ways: (1) Current approaches to the causation of psychogenic erectile dysfunctions are reviewed and discussed. (2) Empirical results from a large unselected sample of sexually dysfunctional men are presented and compared to a sample of functional men. Concerning etiological models the traditional unidimensional dichotomous concepts (psychogenic versus organic) of erectile dysfunction have to be abandoned and replaced by two-dimensional models that are able to take the clinical reality into account that many patients have both significant psychological and organic factors in their disorder. The main causes of psychogenic erectile disorders can be divided into three groups, each belonging to a different phase of time: (i) immediate factors (performance anxiety), (ii) antecedent life events from recent history, (iii) developmental vulnerabilities from childhood and adolescence. The specific interplay as well as the importance of the different groups is different in primary and secondary erectile disorders. The empirical results presented here are based on a sample of 751 patients from our interdisciplinary outpatient unit for sexually dysfunctional men and a group of 55 sexually functional men. Both groups completed a self-developed, multidimensional questionnaire addressing a variety of psychosocial and descriptive factors concerning erectile disorders. The results prove the heterogeneity of patients and their respective erectile problems and show a number of highly significant group differences. The frequent comorbidity of erectile disorders and premature ejaculation and disorders of desire is worth mentioning as well as the high prevalence of depression and the extreme extent of performance anxiety in the patient group. The results are discussed with respect to future treatment strategies. The necessity of combined psychosomatic approaches optimizing the efficacy of all available therapeutic options is particularly stressed.

Adolescent↗

PubMedDate not supplied

Precursors of preterm birth: comparison of three ethnic groups in the middle East and the United States.

OBJECTIVE: To examine factors related to preterm birth in three ethnic groups and in three different countries. DESIGN: Data were obtained on a convenience sample of 118 Lebanese mothers, 104 Egyptian mothers, 40 Mexican American mothers, and 32 White American mothers from Southern California. About half of each cohort had delivered a preterm newborn and half a full-term newborn. Mothers with premature or full-term newborns completed a questionnaire by interview. Analysis compared ethnic groups and preterm- versus full-term birth groups. Multiple logistic regression determined relatedness to outcome. RESULTS: Descriptive factors differed among groups, but not for preterm versus full-term newborn groups. Significant factors for premature birth were vaginal infections, stress, smoking, drug use, and protein intake. Factors significantly related to preterm birth in the Middle-Eastern and American groups were almost identical: social support, stress, and exercise. Smoking was related only in the American group. CONCLUSIONS: These data suggest risk factors are similar across nations and ethnic groups. Prenatal counseling and programs should address these four issues.

Adult↗

PubMed2005

Universal use of nonionic iodinated contrast medium for CT: evaluation of safety in a large urban teaching hospital.

OBJECTIVE: We evaluated the safety of the universal use of the nonionic iodinated contrast agent iopromide in patients undergoing CT in a large urban teaching hospital. SUBJECTS AND METHODS: For 2 years, we prospectively recorded all adverse events temporally associated with the administration of iopromide in 29,508 consecutive patients undergoing contrast-enhanced CT at our institution. The types, intensities, treatments, and outcomes of adverse events were recorded along with relevant patient history, including risk factors. Descriptive analyses of the variables, comparisons of means, and proportions using Student's t and chi-square tests, and logistic regressions were conducted. RESULTS: Adverse events were observed in 211 patients (0.7%) and were categorized as follows: urticaria (n = 161), facial or laryngeal edema (n = 13), bronchospasm (n = 8), severe nausea or vomiting (n = 10), or other (n = 19). One hundred eighty-eight adverse events (89%) were rated mild, 19 moderate (9%), and four severe (2%), including one fatality. Adverse events required treatment in 89 patients (42%). A history of allergy was present in 92 patients (44%), and 29 (14%) had a prior contrast reaction. Other relevant risk factors were identified in 63 patients (30%). No relationship existed between the occurrence of adverse events and any of the following: patient age, dose of iodine administered, or time of study (i.e., month, season, and year). Women (p < 0.001) and outpatients (p < 0.001) had a statistically significant higher incidence of adverse events. CONCLUSION: The universal use of iopromide as an IV CT contrast agent has a favorable safety profile.

Adult↗

PubMed2006

MvirDB--a microbial database of protein toxins, virulence factors and antibiotic resistance genes for bio-defence applications.

Knowledge of toxins, virulence factors and antibiotic resistance genes is essential for bio-defense applications aimed at identifying 'functional' signatures for characterizing emerging or engineered pathogens. Whereas genetic signatures identify a pathogen, functional signatures identify what a pathogen is capable of. To facilitate rapid identification of sequences and characterization of genes for signature discovery, we have collected all publicly available (as of this writing), organized sequences representing known toxins, virulence factors, and antibiotic resistance genes in one convenient database, which we believe will be of use to the bio-defense research community. MvirDB integrates DNA and protein sequence information from Tox-Prot, SCORPION, the PRINTS virulence factors, VFDB, TVFac, Islander, ARGO and a subset of VIDA. Entries in MvirDB are hyperlinked back to their original sources. A blast tool allows the user to blast against all DNA or protein sequences in MvirDB, and a browser tool allows the user to search the database to retrieve virulence factor descriptions, sequences, and classifications, and to download sequences of interest. MvirDB has an automated weekly update mechanism. Each protein sequence in MvirDB is annotated using our fully automated protein annotation system and is linked to that system's browser tool. MvirDB can be accessed at http://mvirdb.llnl.gov/.

Bacterial Proteins↗

PubMed1994

Titers to Leptospira species in horses in Alberta.

Sera from horses in Alberta, submitted to Agriculture and Agri-Food Canada for routine testing for equine infectious anemia from January 1987 to June 1989, were tested for antibody against 13 serovars of pathogenic Leptospira spp., using the microscopic agglutination test. The purpose of the study was to investigate the prevalence of serum titers to those serovars in horses in Alberta, and to analyze the associated risk factors. Descriptive statistics were compiled and logistic regressions were computed. Titers to L. interrogans serovars icterohaemorrhagiae, bratislava, copenhageni, and autumnalis were common (94.6%, 56.6%, 46.5%, and 43.5%, respectively). The prevalence of titers to other serovars ranged from 0.8% to 27.2%. Age was almost always significantly associated with the presence of titers. In general, the chances of being seropositive rose by approximately 10% with each year of life. Horses managed individually (eg, track horses) were approximately half as likely to be seropositive as were horses managed in groups (eg, rodeo horses).

Alberta↗

PubMed2006

Prevalence of diabetes and cardiovascular comorbidity in the Canadian Community Health Survey 2002-2003.

Diabetes mellitus is a major risk factor for heart disease (heart attack, angina, and heart failure), stroke, and hypertension, which shorten the average life expectancy. The main objective of this study was to describe the prevalence of heart disease, hypertension, and stroke among Canadians with diabetes compared to those without diabetes in the Canadian general population aged 12 years and over. It also estimated the strength of association between diabetes, heart disease, hypertension, and other factors such as age, gender, cigarette smoking, alcohol drinking, education status, body mass index (BMI), and other socioeconomic factors. Descriptive statistics were used initially to estimate the prevalence of related comorbidities by age and gender. Logistic regression was then employed to determine the potential strength of association between various effects. Data included 127,610 individuals who participated in the 2.1 cycles of the Canadian Community Health Survey (CCHS) in 2002-2003. The prevalence of self-reported hypertension, heart disease, and stroke among individuals with diabetes were 51.9, 21.7, and 4.8%, respectively. By comparison, prevalence among those without diabetes was 12.7, 4.2, and 0.9%. Adjusted Odds Ratios (OR) were 4.15, 5.04, and 6.75 for males', and 4.10, 5.29, and 4.56 for females' hypertension, heart disease, and stroke, respectively. Lower income (OR from 1.27-1.94) and lower education (OR from 1.23-1.86) were independently associated with a high prevalence of hypertension, heart disease, and stroke among diabetics. Alcohol consumption (OR from 1.06-1.38), high BMI (OR from 1.17-1.40), physical inactivity (OR from 1.21-2.45), ethnicity, and immigration status were also strongly associated with hypertension, heart disease, and stroke. The adjusted prevalence of hypertension, heart disease, and stroke in the CCHS-2003 health survey in Canada was significantly higher among those with diabetes compared to those without. Other factors such as age, gender, BMI, lifestyle, family incomes, physical activity levels, and socioeconomic status also affected the strength of association between diabetes and resulting comorbidities.

Adolescent↗

PubMed1985

A gliding space between the femoral artery and inguinal ligament: mechanism of formation of false aneurysm.

False aneurysms preferentially arise in the inguinal region subsequent to aorto-femoral bypass. This finding suggests that the position of the inguinal ligament against the anterior surface of the prosthesis may be an etiological factor. Description of the inguinal region, forming a borderline between the trunk and thigh and specific to the erect posture, has been the subject of many anatomical studies. These papers describe mainly the relations between the vascular sheath of the femoral artery, the fascia transversalis and inguinal ligament. Based on a series of anatomical dissections we have found a gliding space between the femoral artery and inguinal ligament. This finding has led us to propose section of the fibrous portion of the inguinal ligament and the insertion of free omentum between the arch of the ligament and prosthesis in order to prevent false aneurysm. Preliminary results obtained with this technique are satisfactory.

Aneurysm↗