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PubMedDate not supplied

Duration of optimal therapy for idiopathic focal segmental glomerulosclerosis.

We conducted a retrospective study to evaluate the duration of optimal steroid therapy in idiopathic focal segmental glomerulosclerosis (FSGS). We evaluated 93 adult patients (n=65 males) with biopsy proven FSGS. Mean proteinuria was 5.4 +/- 2.8 gm/dL. Twelve patients were lost at follow-up. Of the remaining 81 patients, nephrotic range proteinuria was present in 48 (59%), and 21 (26%) presented with renal insufficiency. Of these patients, three (3.9%) experienced spontaneous remission. Seven patients were managed symptomatically with ACE inhibitors and never received steroids. Of the 71 patients, 32 received >16 weeks of steroid therapy, while 39 received <16 weeks of steroid therapy. Twenty-four patients (75%) who received >16 weeks of steroid therapy had a complete or partial remission, while only 18 (46%) of those with <16 weeks of steroid therapy had a steroid response (p=0.001). Patients with more than 25% interstitial fibrosis at biopsy also showed significantly lower remission rates (p=0.02). Hypertension, hematuria and degree of proteinuria did not significantly affect the response to steroid therapy. Univariate logistic regression analysis showed that the factors predictive of remission were: (1) steroid therapy duration (p=0.001); (2) serum creatinine (Cr) at onset (p=0.001) and; (3) presence of interstitial fibrosis (>25%) at initial biopsy (p=0.02). Multivariate logistic regression analysis showed that the only factor predictive of remission was steroid therapy duration >16 weeks (p=0.001). Therefore, we concluded that patients with idiopathic FSGS required treatment for at least 16 weeks, before labeling them as steroid non-responsive. Patients with interstitial fibrosis have a significantly poor response to therapy.

Adolescent↗

PubMedDate not supplied

P-glycoprotein expression is a marker for chemotherapy resistance and prognosis in advanced ovarian cancer.

BACKGROUND: It was our aim to study the prevalence and possible prognostic and predictive significance of the expression of P-glycoprotein, a transmembrane transport protein related to classical multidrug resistance, in patients with advanced ovarian cancer. STUDY DESIGN: Tumor tissue from 73 previously untreated patients with FIGO stage 3 ovarian cancer was examined with immunohistochemistry for the expression of P-glycoprotein before and after chemotherapy. Response to 4 cycles of combination chemotherapy with cisplatin and epirubicin was assessed with second look laparotomy. The log rank test was used for univariate survival and the Cox proportional hazards regression model for multivariate survival analysis. RESULTS: P-glycoprotein expression was detected in 47% of untreated cases, and correlated with unfavourable prognostic factors such as advanced age, presence of ascites and larger residual disease deposits after primary surgery. P-glycoprotein negative cases responded significantly better to chemotherapy (P < .001). In the multivariate survival analysis P-glycoprotein expression was an independent predictor of both overall (P = .045) and progression free (P = .006) survival. When P-glycoprotein expression and residual disease status were considered together, the patients could be divided in three clearly distinct prognostic groups (P = .0009). CONCLUSION: P-glycoprotein expression is a predictor of response and survival in a uniformly treated and followed cohort of advanced ovarian cancer patients.

ATP Binding Cassette Transporter, Subfamily B, Mem↗

PubMed2003

Perspectives on advance directives in Japanese society: A population-based questionnaire survey.

BACKGROUND: In Japan, discussion concerning advance directives (ADs) has been on the rise during the past decade. ADs are one method proposed to facilitate the process of communication among patients, families and health care providers regarding the plan of care of a patient who is no longer capable of communicating. In this paper, we report the results of the first in-depth survey on the general population concerning the preferences and use of ADs in Japan. METHOD: A self-administered questionnaire was sent via mail to a stratified random sampling of 560 residents listed in the residential registry of one district of Tokyo, Japan (n = 165,567). Association between correlating factors and specific preferences toward ADs was assessed using contingency table bivariate analysis and multivariate regression model to estimate independent contribution. RESULTS: Of the 560 questionnaires sent out, a total of 425 participants took part in the survey yielding a response rate of 75.9 %. The results of the present study indicate that: 1) the most important components to be addressed are the specifics of medical treatment at the end of life stage and disclosure of diagnosis and prognosis; 2) the majority of participants found it suitable to express their directives by word to family and/or physician and not by written documentation; 3) there is no strong need for legal measures in setting up an AD; 4) it is permissible for family and physician to loosely interpret one's directives; 5) the most suitable proxy is considered to be a family member, relative, or spouse. Multivariate analysis found the following five factors as significantly associated with preferences: 1) awareness regarding living wills, 2) experience with the use of ADs, 3) preferences for end-of-life treatment, 4) preferences for information disclosure, and 5) intentions of creating a will. CONCLUSIONS: Written ADs might be useful in the Japanese setting when the individual either wishes: 1) to not provide a lot of leeway to surrogates and/or caregivers, and/or 2) to ensure his or her directives in the cases of terminal illness, brain death, and pain treatment, as well as regarding information disclosure.

Advance Directives↗

PubMed2003

Obesity and estrogen as risk factors for gastroesophageal reflux symptoms.

CONTEXT: Gastroesophageal reflux and obesity are both increasing in prevalence. The scientific evidence for an association between these conditions is sparse and contradictory. A difference between sexes concerning this relation has been proposed. OBJECTIVE: To evaluate the relation between body mass and gastroesophageal reflux symptoms and determine how this relation is influenced by female sex hormones. DESIGN: Population-based, cross-sectional, case-control study. SETTING: Two consecutive public health surveys within the county of Nord-Trondelag, Norway, conducted in 1984-1986 and 1995-1997. PARTICIPANTS: Among 65 363 adult participants in the second survey, 3113 individuals who reported severe heartburn or regurgitation during the last 12 months were defined as cases, whereas 39 872 persons without reflux symptoms were defined as controls. MAIN OUTCOME MEASURE: Risk of reflux, estimated using multivariate logistic regression, with odds ratios (ORs) and 95% confidence intervals (CIs) as measures of association. RESULTS: There was a dose-response association between increasing body mass index (BMI) and reflux symptoms in both sexes (P for trend <.001), with a significantly stronger association in women (P<.001). Compared with those with a BMI less than 25, the risk of reflux was increased significantly among severely obese (BMI >35) men(OR, 3.3; 95% CI, 2.4-4.7) and women (OR, 6.3; 95% CI, 4.9-8.0). The association between BMI and reflux symptoms was stronger among premenopausal women compared with postmenopausal women (P<.001), although use of postmenopausal hormone therapy increased the strength of the association (P<.001). Reduction in BMI was associated with decreased risk of reflux symptoms. CONCLUSIONS: There is a significant association between body mass and symptoms of gastroesophageal reflux. The association is stronger among women, especially premenopausally, and use of hormone therapy strengthens the association, suggesting that estrogens may play an important role in the etiology of reflux disease.

Adult↗

PubMed1999

Physical activity patterns in a diverse population of women.

BACKGROUND: Demographic and psychosocial correlates of activity in domains other than recreational activity have not been well characterized and may be particularly relevant for health promotion efforts aimed at women. METHODS: Cross-sectional relationships between recreational, occupational, and household/caregiving physical activity and demographic and psychosocial factors were assessed with a mail survey in a random sample of 2,636 ethnically diverse women members of a large health maintenance organization, ages 20-65. Activity was assessed with a modified Baecke questionnaire that uses categorical responses regarding frequency of domain-specific activities to create four semicontinuous activity indices (sports/exercise, active living, occupational, household/caregiving). RESULTS: Multivariable logistic regression analysis showed that the likelihood of being in the highest quartile of the sports/exercise and active-living indices, compared with the other three quartiles, was decreased among older, nonwhite, less well educated, heavier women who had young children at home, lacked motivation to exercise, and perceived external obstacles to exercise behavior. The odds ratios (ORs) ranged from 0.38, 95% confidence interval (CI) 0.33-0.45, associated with low motivation, to 0.95, 95% CI 0.93-0.98, associated with increasing body mass index. Social support and confidence in one's ability to continue to exercise, even when faced with other pressures and demands (termed self-efficacy), were associated with increased likelihood of high levels of sports/exercise and active living (OR = 2.34, 95% CI 1. 83-2.98 and OR = 3.96, 95% CI 2.92-5.38, respectively). In contrast, the highest quartile of household/caregiving activity was positively associated with increasing age (OR = 1.28, 95% CI 1.16-1.42), Hispanic ethnicity (OR = 1.58, 95% CI 0.55-1.01), being married (OR = 1.70, 95% CI 1.33-2.18), having young children at home (OR = 6.99, 95% CI 4.33-11), and greater time constraints as a barrier to exercise (OR = 1.55, 95% CI 1.38-1.74) and was negatively associated with employment (OR = 0.38, 95% CI 0.30-0.47). Increased likelihood of the highest quartile of occupational activity was associated with high school education or less (OR = 2.26, 95% CI 1.74-2.94) and current smoking (OR = 1.66, 95% CI 1.23-2.23), while self-efficacy regarding exercise was associated with decreased likelihood (OR = 0. 77, 95% CI 0.61-0.96). CONCLUSIONS: These findings suggest that demographic and psychosocial correlates of physical activity vary by domain and that initiatives to promote physical activity in the population need to take these differences into account.

Adult↗

PubMed2003

The rate of fibrosis progression is an independent predictor of the response to antiviral therapy in chronic hepatitis C.

The response to antiviral therapy and the rate of fibrosis progression in chronic hepatitis C virus (HCV) infection are related to common factors, including age and gender. The aim of this study was to evaluate the relationship between the rate of fibrosis progression and the sustained virologic response (SVR) to interferon (IFN)-based treatment. A total of 332 patients treated for chronic HCV infection were evaluated. Using multivariate logistic regression analysis, the impact of the rate of fibrosis progression (defined as the stage of liver fibrosis according to the Metavir system/duration of infection) on the rate of SVR (negative HCV RNA at least 6 months following the end of treatment), was determined. The median age of the patients was 44 (range 25-77) years, 64% were male, and 66% were infected with genotypes 1, 4, 5 or 6. The median rate of fibrosis progression was 0.083 (range 0-2) Metavir units/year; 158 patients (48%) had F2-F4 fibrosis. After a median of 48 (range 2-126) weeks of therapy (IFN, n=190; IFN and ribavirin, n=96; pegylated IFN, n=20; pegylated IFN and ribavirin, n=26), 93 patients (28%) achieved an SVR. In univariate analysis, the rate of SVR was higher in slow [< 0.083 Metavir units/year (n=162)] than rapid progressors [> or = 0.083 Metavir units/year (n=170)] (35%vs 22%, P=0.01). After controlling for age, gender, genotype, viral load, and treatment regimen and duration, the rate of fibrosis progression remained an independent predictor of SVR (slow vs rapid progressors, OR 2.74; 95% CI 1.27-5.92; P=0.01). Hence the rate of fibrosis progression is an independent predictor of SVR to IFN-based therapy in patients with chronic hepatitis C. This additional factor should be considered in economic models evaluating this condition.

Adult↗

PubMed1990

[Measuring the vascular caliber in diabetic retinopathy before and following photocoagulation].

The calibers of 4 retinal arterioles and 4 venoles of each of 58 patients with diabetic retinopathy (DR) were measured on fundus photographs before and after photocoagulation (PC). The measurements were repeated at approximately one-year intervals following photocoagulation (PC) of one eye of each patient. The mean caliber of arterioles and venoles of DR patients was 15.4% greater than in nondiabetic subjects. This finding may be interpreted as an autoregulatory response to relative tissue hypoxia. Following PC there was a significant reduction in both arterial and venous vessel caliber. In a multivariate regression analysis, the reduction in venous caliber correlated significantly with the number of coagulation spots. A weak correlation was found with arterial hypertension, change in visual acuity, and change in a calculated DR score. The reduction in pathologic vessel calibers following PC is indicative of an improvement in retinal hemodynamics. Photographic quantification of retinal vessel changes may be of prognostic value, i.e., for assessing the course of DR before and after treatment by PC.

Diabetic Retinopathy↗

PubMed2000

Who needs a gatekeeper? Patients' views of the role of the primary care physician.

BACKGROUND: The primary care physician serving as a 'gatekeeper' can make judicious decisions about the appropriate use of medical services, and thereby contribute to containing costs while improving the quality of care. However, in Israel, sick funds competing for members have not adopted this model for fear of endangering their competitive stance. The purpose of this study was to examine, for the first time, the stated preferences and actual behaviour of a national sample of members of the four Israeli sick funds regarding self-referral to specialists, and to identify the characteristics of patients who prefer the gatekeeper model. METHODS: Data were derived from a national telephone survey carried out in 1997. A random representative sample of 1084 of all adult sick fund members were interviewed, with a response rate of 81%. Bivariate analysis was conducted using over all chi-square tests, and multivariate analysis was performed using logistic regression models. RESULTS: A third of all respondents prefer self-referral to a specialist, 40% prefer their family physician to act as gatekeeper and 19% prefer the physician to co-ordinate care but to refer themselves to a specialist. Independent variables predicting preference for the gatekeeper model are: living in the periphery, sick fund membership, low level of education, being male, fair or poor health status, having a permanent family physician and being satisfied with the professional level of the family physician. A significant correlation was found between practising self-referral and preference for self-referral. CONCLUSIONS.: The findings indicate the importance of surveying patients' attitudes as an input in policy formulation. The study identified specific population groups which prefer the gatekeeper model, and explored the advantages of a flexible model of gatekeeping.

Adult↗

PubMed2005

Gamma-glutamyl transferase (GGT) as an independent predictive factor of sustained virologic response in patients with hepatitis C treated with interferon-alpha and ribavirin.

BACKGROUND: Recently, gamma-glutamyl transferase (GGT) has been investigated as a predictive factor for therapy response in hepatitis C patients, but so far its value in pretreatment screening has not been established. Therefore, this study aimed at evaluating GGT as an independent predictive factor for the response to treatment with interferon-alpha and ribavirin in hepatitis C virus (HCV)-infected patients. METHODS: Naive chronic hepatitis C patients undergoing a 6-month follow-up after interferon-alpha and ribavirin therapy had their sustained virologic response (SVR) analyzed according to age, sex, body mass index, GGT levels, genotype, and liver histology by use of a multivariate logistic regression model. RESULTS: Of the 211 patients studied with a mean age of 48+/-10 years, 125 (59%) were males. Overweight was detected in 47% of patients. Genotype 1 was detected in 141 (75%) of the 187 patients tested. Cirrhosis was present in 67 (32%). A high pretreatment GGT level was observed in 134 (63%). SVR was obtained in 84 (40%) patients. In the final logistic regression model, the variables independently associated with SVR were GGT (P<0.001), genotype (P<0.001), and liver histology (P<0.001). CONCLUSION: A normal GGT level is an independent predictive factor for SVR in HCV-infected patients and should be considered for pretreatment screening.

Adult↗

PubMed2004

Willingness to donate blood samples for genetic research: a survey from a community in Singapore.

Studies on the public's willingness to donate blood specimens for genetic research are few and are conducted mainly among Western countries. Little is known about the Asian community's willingness to participate in genetic research. A community-based survey was conducted on 548 adult Singaporeans to examine their willingness to donate blood samples for genetic research and its associated factors. The response rate was 70.3%. About 49.3% (95% CI, 45.1-53.5%) were willing to donate blood for genetic research. In the multivariable Cox regression analysis, willingness was significantly associated with belief in the benefits of genetic research; intention to participate in government studies; having no fear of pain, blood, injections, and needles; and non-concern about the loss of confidentiality. Reasons against donating blood were fear of pain, blood, injections, and needles (38.1%); no self-benefits (24.8%); fear of finding out about having a disease (22.3%); fear of discrimination (18.7%); and concerns about weakness (15.1%) and weight gain (9.4%). Public education programs to promote participation in genetic research should stress its benefits and address people's fears and concerns.

Adult↗

PubMed2005

Work ethics and general work attitudes in adolescents are related to quality of life, sense of coherence and subjective health - a Swedish questionnaire study.

BACKGROUND: Working life is an important arena in most people's lives, and the working line concept is important for the development of welfare in a society. For young people, the period before permanent establishment in working life has become longer during the last two decades. Knowledge about attitudes towards work can help us to understand young people's transition to the labour market. Adolescents are the future workforce, so it seems especially important to notice their attitudes towards work, including attitudes towards the welfare system. The aim of this study was to describe and analyse upper secondary school students' work attitudes, and to explore factors related to these attitudes. METHODS: The sample consisted of 606 upper secondary school students. They all received a questionnaire including questions about quality of life (QOL), sense of coherence (SOC), subjective health and attitudes towards work. The response rate was 91%. A factor analysis established two dimensions of work attitudes. Multivariate analyses were carried out by means of logistic regression models. RESULTS: Work ethics (WE) and general work attitudes (GWA) were found to be two separate dimensions of attitudes towards work. Concerning WE the picture was similar regardless of gender or study programme. Males in theoretical programmes appeared to have more unfavourable GWA than others. Multivariate analyses revealed that good QOL, high SOC and good health were significantly related to positive WE, and high SOC was positively related to GWA. Being female was positively connected to WE and GWA, while studying on a practical programme was positively related to GWA only. Among those who received good parental support, GWA seemed more favourable. CONCLUSION: Assuming that attitudes towards work are important to the working line concept, this study points out positive factors of importance for the future welfare of the society. Individual factors such as female gender, good QOL, high SOC and good health as well as support from both parents, positive experience of school and work contacts related positively to attitudes towards work. Further planning and supportive work have to take these factors into account.

Adolescent↗

PubMed1999

Prognostic and predictive factors for patients with metastatic breast cancer undergoing aggressive induction therapy followed by high-dose chemotherapy with autologous stem-cell support.

PURPOSE: We performed a retrospective review to determine predictive and prognostic factors in patients with metastatic breast cancer who received induction therapy, and, if they responded to treatment, high-dose chemotherapy. PATIENTS AND METHODS: Patients with metastatic breast cancer received induction therapy with doxorubicin, fluorouracil, and methotrexate (AFM). Partial responders then received immediate high-dose chemotherapy, whereas those who achieved complete remission were randomized to immediate or delayed high-dose chemotherapy with hematopoietic stem-cell support. We performed a retrospective review of data from these patients and used Cox proportional hazards regression models for analyses. RESULTS: The overall response rate for the 425 patients enrolled was 74% (95% confidence interval, 70% to 78%). Multivariate analysis of data from all 425 patients revealed that positive estrogen receptor status (P =.0041), smaller metastatic foci (</= 2 v > 2 cm) (P =. 0165), a longer disease-free interval from initial diagnosis to diagnosis of metastases (</= 2 v > 2 years) (P =.0051), and prior treatment with tamoxifen (P =.0152) were good prognostic signs for overall survival. Patients who had received prior adjuvant therapy (P =.0001) and those who developed liver metastases (P =.0001) had decreased long-term survival. In the subgroup of responders to AFM induction, multivariate analysis showed that those with visceral metastases did less well (P =.0006), as did patients who had received prior adjuvant therapy (P =.0023). However, those who had received tamoxifen therapy in the adjuvant setting did better (P =. 0143). CONCLUSION: The chance for long-term remission with induction therapy with AFM and high-dose chemotherapy is increased for hormone receptor positive-patients with nonvisceral metastases who have not received prior adjuvant chemotherapy and have long disease-free intervals.

Adult↗

PubMed2000

p53 gene status as a predictor of tumor response to induction chemotherapy of patients with locoregionally advanced squamous cell carcinomas of the head and neck.

PURPOSE: To determine whether p53 gene status predicts tumor responses to platinum- and fluorouracil-based induction chemotherapy in locoregionally advanced squamous cell carcinomas of the head and neck. PATIENTS AND METHODS: Tumor responses of 105 patients were measured at the primary tumor site. Objective response and major response were defined by a 50% and 80% reduction in tumor size, respectively. All coding parts of p53 gene were directly sequenced. p53 expression in tumor cells was determined by immunohistochemistry. Human papillomavirus infection was detected by polymerase chain reaction. Odd ratios were adjusted by stepwise logistic regression analysis. RESULTS: p53 mutations, p53 expression, and tumor stage were sufficient to explain the variation in tumor responses to chemotherapy in multivariate models. p53 mutation was the only variable to significantly predict objective response (odds ratio, 0. 23; 95% confidence interval, 0.10 to 0.57; P =.002) and was the strongest predictor of major response (odds ratio, 0.29; 95% confidence interval, 0.11 to 0.74; P =.006). p53 expression (odds ratio, 0.39; 95% confidence interval, 0.16 to 0.98) and tumor stage (odds ratio, 0.31; 95% confidence interval, 0.10 to 0.96) also predicted major response. Specific mutations (contact mutations) accounted for much of the reduction in the risk of major response associated with overall mutations. In complementary analyses, p53 expression was weakly predictive of major response in the subgroup with wild-type p53, and p53 mutations also predicted histologic response. CONCLUSION: p53 gene mutations are strongly associated with a poor risk of both objective and major responses to chemotherapy. Contact mutations are associated with the lowest risk of major response to chemotherapy.

Adult↗

PubMed2004

How do primary care physicians manage children with possible developmental delays? A national survey with an experimental design.

OBJECTIVE: Although early detection and treatment of developmental delays can improve outcome, little is known about factors that influence how primary care physicians manage young children with probable developmental delays. The objective of this study was to describe physician referral practices for children with developmental delays and to test whether the probability of referral is increased by 1) the expression of parental concern; 2) female gender in a child with language delay; 3) disruptive, as opposed to avoidant behaviors; and 4) physician characteristics, including female gender or being a pediatrician. METHODS: A cross-sectional survey was mailed to a national random sample of 800 pediatricians and 800 family practice physicians in primary care practice, using an experimental randomized block design. Recipients randomly received alternative variants of clinical vignettes, which differed only in regard to the variable specific to each of the first 3 hypotheses. Physicians answered questions about the likelihood of referral on a 5-point scale for listed referral options. Hypotheses were tested using multivariable logistic regression modeling. A total of 55% of pediatricians and 43% of family practice physicians returned the survey, for an overall response rate of 49%. RESULTS: A girl with language delay was 60% more likely to be referred to audiology than a boy (odds ratio: 1.6; 95% confidence interval: 1.1-2.3), and respondents who were female or pediatricians were more likely to refer patients. The expression of parental concern did not increase the probability of referral to diagnostic and treatment services, and avoidant rather than disruptive patient behaviors were associated with an increased probability of referral. CONCLUSIONS: Patient gender and type of behavioral presentation seem to influence referrals to diagnostic and treatment services for young children with probable developmental delays described in clinical vignettes. These findings can guide targeted educational interventions to increase rates of detection and referral for young children with developmental delays.

Child, Preschool↗

PubMed1996

High-dimensional multivariate probit analysis.

A computationally practical form of probit analysis for multiple response variables based on an assumed common factor model for the latent tolerances is proposed. Numerical integration over the factor space provides maximum likelihood estimation of the probit regression parameters and of the probabilities of response combinations under the model. The procedure is applied to five variables from the Pneumoconiosis Field Trial, two variables of which were previously analyzed by Ashford and Sowden (1970, Biometrics 26, 535-546).

Algorithms↗

PubMed1997

Generalized efficacy of t-PA for acute stroke. Subgroup analysis of the NINDS t-PA Stroke Trial.

BACKGROUND AND PURPOSE: We sought to identify subgroups of stroke patients in whom thrombolytic therapy is particularly hazardous or efficacious. METHODS: We conducted a post hoc subgroup analysis of a randomized, double-blind, placebo-controlled clinical trial of intravenous tissue plasminogen activator (t-PA) for stroke patients presenting within 3 hours after symptom onset. Before treatment, historical, physical, and laboratory findings were summarized. We identified variables that might predict outcome and/or differential response to t-PA therapy. Outcome was measured with four stroke rating scales administered 3 months after treatment. Statistical significance was assessed with a global outcome procedure that considers the results of all four scales simultaneously. Using regression analysis, we compared the information collected before treatment with the global outcome. Multivariable procedures were used to find information that could guide selection of patients for t-PA therapy. RESULTS: No pretreatment information significantly affected patients response to t-PA. The power of the model to detect a treatment interaction was greater than 90%, and therefore the probability of a type II error is very low. Apart from t-PA therapy, outcome was related to age-by-deficit severity interaction, diabetes, age-by-blood pressure interaction, and early CT findings. These variables and interactions altered long-term patient outcome irrespective of t-PA treatment but did not alter the likelihood of responding favorably to t-PA therapy. CONCLUSIONS: Patients should be selected for t-PA thrombolysis according to the guidelines published in the report of the NINDS t-PA Stroke Trial. Further subselection of patients, such as by age or stroke severity, is not supported by our post hoc analysis.

Acute Disease↗

PubMed1993

[A study to predict the clinical efficacy of house dust mite immunotherapy in bronchial asthmatics].

To predict the clinical efficacy of house dust mite immunotherapy (IT), clinical factors before IT were analyzed in relation to clinical efficacy in bronchial asthmatics treated by standard IT method. In 111 asthmatics treated by IT, 88 cases (80%) obtained favorable results over a one-year period, while only 39% of asthmatics without IT showed clinical improvement (p < 0.05, chi 2 test). Factors including severity, skin test threshold, age, age at which IT was started, duration of asthma, onset of asthma, FEV1.0% and serum IgE levels before IT were analyzed. Severity showed the most significant influence on clinical efficacy (r = 0.412, p < 0.01). A study to determine whether some specific criteria could be used to predict the clinical efficacy of IT was then carried out. Using multivariate analysis with the factors above mentioned, the clinical efficacy ranging from deteriorated to good response could be expressed as a formula with a multi-regression coefficient of 0.56, p < 0.05. Moreover, the application of linear discriminating analysis gave an 80% true positive discriminating rate in 75 asthmatics. In both methods, severity seemed to be the most important factor, skin test threshold next and FEV1.0% third. The other factors were not significant. Hopefully, the use of this formula in clinical practice will improve the efficacy of IT, thus providing further therapeutic benefits to bronchial asthmatics.

Adult↗

PubMed2003

Health related quality of life and related factors in 539 persons with amputation of upper and lower limb.

PURPOSE: Limb amputation is followed by an important rehabilitation process, especially when a prosthesis is involved. The objective of this study is to assess the nature of factors related to health related quality of life (HRQL) of persons with limb amputation. METHOD: The Nottingham Health Profile (NHP) treated 1011 subjects with major amputation of one or several limbs. Correlations were sought in multivariate regression model analyses between the six categories of distress explored by the NHP and age, sex, cause and level of amputation and rehabilitation programme. RESULTS: Response rate was 53.3%. HRQL measured by the NHP was mostly impaired in the categories of physical disability, pain and energy level. Controlling for sex and age, young age at the time of amputation, traumatic origin and upper limb amputation were independently associated with better HRQL. CONCLUSION: It is concluded that HRQL is largely related to factors which are inherent to the patient and the amputation.

Age Factors↗