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PubMed2004

Blood pressure variability and stress management training for essential hypertension.

The purpose of this study was to determine whether stress management training reduces blood pressure (BP) variability in hypertensive patients. Previous literature suggests that cardiovascular risk is not only a function of BP levels, but also of BP variability, and this partially depends on changes induced by the stress of everyday life. The authors reanalyzed data from a previous study of 43 male patients with essential hypertension who were randomly assigned to 2 groups (stress management training and waiting list). Patients in the stress management group lowered their self-measured BP variability significantly from pretreatment to the 4-month follow-up examination, showing a mean reduction of 2.6/1.5 mm Hg in the standard deviation of systolic/diastolic BP (SBP/DBP), and a mean decrease of 1.84/1.59% in the coefficient of variation of SBP/DBP. For SBP, these reductions were significantly greater than those showed by the control group. These results suggest that stress management training is effective in reducing day-to-day BP variability, providing an additional reduction in cardiovascular risk for hypertensive patients.

Cardiovascular Diseases↗

PubMedDate not supplied

Self-efficacy and consumption of fruit and vegetables: validation of a summated scale.

PURPOSE: To develop and validate a scale to assess self-efficacy for increasing fruit and vegetable consumption, and to assess the ability of the scale to discriminate individuals at different stages of readiness to change. METHODS: Data were collected using a combination of self-administered mail questionnaires and phone interviews from a sample of 1200 Chinese Singaporeans randomly selected from residential phone listings. Principal-components analysis was conducted with half the sample, and model fit was measured using structural modeling procedures on the other half. Analyses of variance were used to determine whether self-efficacy differed across the stages of change. SETTING: Data were collected as part of a larger study investigating factors influencing consumption of fruit, vegetables, and cereal foods. MEASURES: Fruit and vegetable intake was measured using a validated seven-item food frequency questionnaire. Subjects were assigned to stages using a phone-administered staging algorithm. Self-efficacy items were scored on a five-point Likert scale from very confident to not at all confident. RESULTS: Principal-components analysis revealed a two-factor structure that was highly stable across two split-half samples and gender, and accounted for 57% of the variance in self-efficacy. The two factors demonstrated good internal consistency (Cronbach's alpha = 0.77 and 0.89), with loadings ranging from 0.59 to 0.86 (mean = 0.70). Confirmatory factor analysis demonstrated good model fit (goodness-of-fit index = 0.99), with all parameters significant. Scores on the scale were significantly higher among subjects assigned to maintenance than among those assigned to precontemplation, contemplation, and preparation. CONCLUSIONS: Results of this study provide preliminary evidence for the utility of the scale to guide development and monitoring of community programs and therapeutic interventions.

Adult↗

PubMed2006

Meta-analysis of mobile phone use and intracranial tumors.

OBJECTIVES: A summary of epidemiologic evidence regarding the effect of mobile phone use on intracranial tumor risk was obtained by means of a meta-analysis. METHODS: Reports of published studies on mobile phone use and intracranial tumors were sought. Altogether 12 relevant publications were identified from the PubMed database and reference lists of articles. Fixed or random effects analysis was carried out depending on the presence of heterogeneity between studies. Risk estimates were obtained for people who had used mobile phones for the longest periods of time (>5 years in most reports). A pooled estimate was calculated for all intracranial tumors combined and also separately for different histological tumor types. Separate analyses were conducted also based on the tumor location and type of mobile telephone network (NMT or GSM). RESULTS: Twelve studies with 2780 cases gave a pooled odds ratio (OR) of 0.98 [95% confidence interval (95% CI) 0.83-1.16] for all intracranial tumors related to mobile phone use. For gliomas, the pooled OR was 0.96 (95% CI 0.78-1.18), for meningiomas it was 0.87 (95% CI 0.72-1.05), and for acoustic neuromas it was 1.07 (95% CI 0.89-1.30). Little indication was found for increased risks of analogue or digital phone use or temporal or occipital tumors. CONCLUSIONS: The totality of evidence does not indicate a substantially increased risk of intracranial tumors from mobile phone use for a period of at least 5 years.

Brain Neoplasms↗

PubMed2004

Generating pre-test probabilities: a neglected area in clinical decision making.

OBJECTIVE: To assess the accuracy and variability of clinicians' estimates of pre-test probability for three common clinical scenarios. DESIGN: Postal questionnaire survey conducted between April and October 2001 eliciting pre-test probability estimates from scenarios for risk of ischaemic heart disease (IHD), deep vein thrombosis (DVT), and stroke. PARTICIPANTS AND SETTING: Physicians and general practitioners randomly drawn from College membership lists for New South Wales and north-west England. MAIN OUTCOME MEASURES: Agreement with the "correct" estimate (being within 10, 20, 30, or > 30 percentage points of the "correct" estimate derived from validated clinical-decision rules); variability in estimates (median and interquartile ranges of estimates); and association of demographic, practice, or educational factors with accuracy (using linear regression analysis). RESULTS: 819 doctors participated: 310 GPs and 288 physicians in Australia, and 106 GPs and 115 physicians in the UK. Accuracy varied from about 55% of respondents being within 20% of the "correct" risk estimate for the IHD and stroke scenarios to 6.7% for the DVT scenario. Although median estimates varied between the UK and Australian participants, both were similar in accuracy and showed a similarly wide spread of estimates. No demographic, practice, or educational variables substantially predicted accuracy. CONCLUSIONS: Experienced clinicians, in response to the same clinical scenarios, gave a wide range of estimates for pre-test probability. The development and dissemination of clinical decision rules is needed to support decision making by practising clinicians.

Adult↗

PubMed1999

Activated protein C resistance and factor V Leiden mutation are independent risk factors for venous thromboembolism.

BACKGROUND: Resistance to activated protein C due to the factor V R506Q (Leiden) mutation is the most common clotting abnormality in patients with venous thromboembolism. OBJECTIVE: To evaluate the risk for venous thromboembolism associated with the factor V Leiden mutation or with resistance to activated protein C in the general population. DESIGN: Cross-sectional survey. SETTING: General community of Vicenza, Italy. PATIENTS: A population-based sample of 15,109 white persons 18 to 65 years of age who were randomly selected from the census list. MEASUREMENTS: Sequential validated approach based on participants' reports and Doppler ultrasonography. Resistance to activated protein C was investigated in all participants; 2134 participants with resistance to activated protein C were screened for the factor V Leiden mutation. RESULTS: Carriers of the factor V Leiden mutation had a relative risk of 3.3 (95% CI, 1.7 to 6.1) for venous thromboembolism before 65 years of age. The fraction of cases attributable to the factor V Leiden mutation was 6.6%. By 65 years of age, 5.7% of carriers of the mutation had had venous thromboembolism, mostly after surgery. Participants with a reduced response to activated protein C were at higher risk even if they did not carry the mutation (odds ratio, 1.7 [CI, 1.0 to 2.7]); the attributable risk for venous thromboembolism was 5.1%. CONCLUSIONS: The factor V Leiden mutation and resistance to activated protein C are important, independent risk factors for venous thromboembolism. Screening strategies for the factor V Leiden mutation in patients undergoing surgery or experiencing major trauma cannot be recommended, but phenotypic evaluation of resistance to activated protein C should be encouraged in patients with venous thromboembolism.

Activated Protein C Resistance↗

PubMed1998

Risk factors for contracting plague in Nkayi district, Zimbabwe.

OBJECTIVE: To identify risk factors for contracting plague among the three to 16 year old age group. DESIGN: A matched case control study, carried out in two parts. SETTING: Nkayi District--a plague endemic area in Zimbabwe. SUBJECTS: A total of 86 cases were randomly selected from a line listing of all reported plague cases in the district. Two neighbourhood controls were selected from households at least 500 m on either side of the case household. MAIN OUTCOME MEASURES: Maximum likelihood estimate of the odds ratio (OR) for the 17 risk factors studied (grouped as personal, environmental, domestic animals and rat reports). RESULTS: Risk factors which were significantly associated with contracting plague were having a sick cat in the household (OR 3.4, 95% CI 1.1 to 13.0), herding cattle (OR 1.7, 95% CI 1.0 to 3.0), and age 10 years or older (OR 2.2, 95% CI 1.2 to 4.1). In a logistic model, only having a sick cat was found to be independently associated with being a case (OR 3.9, 95% CI 1.3 to 12.2). CONCLUSION: The presence of a sick domestic cat was identified as a risk factor for acquiring bubonic plague during this outbreak. Communities should be informed that sick cats may act as a warning of potential plague, and that if cats become sick they should be removed from the household.

Adolescent↗

PubMed2000

Poison prevention counseling: a comparison between family practitioners and pediatricians.

OBJECTIVES: To compare the current opinions and practices of family practitioners with those of pediatricians regarding poison prevention anticipatory guidance (PPAG) and to further assess which factors, if any, are associated with providing counseling on this topic. DESIGN: Cross-sectional mail survey. PARTICIPANTS: Family practitioners and pediatricians throughout the United States and Puerto Rico, randomly selected from the membership list of the American Medical Association. MAIN OUTCOME MEASURE: Reported frequency of providing parents with PPAG. RESULTS: Of the 1000 physicians surveyed, 975 were eligible and 500 returned surveys that could be analyzed (227 family practitioners and 273 pediatricians), for a response rate of 51.3%. The majority of physicians in each field (family practice, 81.9%; pediatrics, 87.2%) reported that they believe it is their responsibility to provide PPAG to parents (P = .08). Family practitioners, however, were less likely than pediatricians to provide parents with PPAG (66.5% vs 91.9%; P<.001). When adjusted for other variables, such as age and sex, family practitioners were 5.4 times less likely than pediatricians to provide parents with PPAG (odds ratio, 0.19; 95% confidence interval, 0.09-0.37). Family practitioners, more often than pediatricians, cited lack of training on poisoning prevention as a reason for not providing parents with PPAG (46.1% vs 18.2%; P = .02). Among all physicians, those who received postresidency training on PPAG were more likely to provide PPAG than those who had not received postresidency training on this topic (odds ratio, 3.21; 95% confidence interval, 1.44-7.18). Having received residency training on poisoning prevention, however, did not increase the likelihood of providing PPAG (odds ratio, 1.69; 95% confidence interval, 0.86-3.30). CONCLUSIONS: Although it is currently recommended to include PPAG as part of the routine preventive pediatric care, this study shows that one third of family practitioners do not provide parents with PPAG. Family practitioners should increase their efforts aimed at poisoning prevention. Those involved with training residents in family practice and pediatrics should place greater emphasis on this topic to increase the impact of this training on actual PPAG practices.

Adult↗

PubMed2000

A case-control study of galactose consumption and metabolism in relation to ovarian cancer.

Consumption or metabolism of dairy sugar and ovarian cancer have been linked based on evidence that galactose may be toxic to ovarian germ cells and that ovarian cancer is induced in animals by depletion of oocytes. We assessed consumption of dairy products and obtained blood for biochemical and molecular genetic assessment of galactose metabolism in 563 women with newly diagnosed epithelial ovarian cancer and 523 control women selected either by random digit dialing or through lists of residents in eastern Massachusetts and New Hampshire. We observed no significant differences between cases and controls in usual consumption of various types of dairy products or total daily lactose (the principal source of galactose in the diet); nor did we find that RBC activity of either galactose-1-phosphate uridyl transferase (GALT) or galactokinase differed. The mean (and SE) activity of uridine diphospho-galactose 4'-epimerase (in micromoles per hour per gram of hemoglobin) was, however, significantly lower (P < 0.005) in cases compared with controls, 20.32 (0.31) versus 21.64 (0.36). Ovarian cancer cases were also more likely to carry the N314D polymorphism of the GALT gene, generally predisposing to lower GALT activity. The difference was most evident for endometrioid and clear cell types of ovarian cancer, in which 3.9% of cases were found to be homozygous for N314D compared with 0.4% of controls, yielding an odds ratio and 95% confidence interval of 14.17 (2.62-76.60). We conclude that, whereas adult consumption of lactose carries no clear risk for the disease, certain genetic or biochemical features of galactose metabolism may influence disease risk for particular types of ovarian cancer.

Adenocarcinoma, Clear Cell↗

PubMedDate not supplied

[Epidemiology and economics of chemotherapy combinations in the treatment of advanced breast cancer].

125 oncologists, taken at random from a French professional list, followed up a cohort of 836 patients suffering from advanced breast cancer and treated by chemotherapy. The following data were collected prospectively: socio-demographics of patients and practitioners, disease history, characteristics of one chemotherapy cycle (type, utility and cost). A total of 89 chemotherapy combinations were described during the first-line treatment, independently of doses, eight combinations representing 70 per cent of all the prescriptions. No statistically significant differences were found when comparing the utility of the most often used combinations. Chemotherapy was the main cost driver of administration, rising to 90 per cent of the total cost when using taxans, followed by CSF. The cost price of taxan administration was twice to three times that of FEC or vinorelbine associations. These differences were poorly taken into account by the French budget allocation system as based on Diagnosis Related Groups.

Antineoplastic Agents, Phytogenic↗

PubMed2001

[Risk factors for nosocomial sepsis: a case-control study].

BACKGROUND: The objective of this study was to identify the risk factors associated with the nosocomial sepsis syndrome according to the criteria of the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference. PATIENTS AND METHOD: A 1-year prospective case-control study matched for sex, age (+/- 5 years), and pre-infection hospital stay (+/- 1 day) was performed in a 1,200-bed university hospital. Cases were selected according to the above criteria. Controls were randomly selected from the daily list of hospitalized patients. Crude and adjusted odds ratios (OR) were determined. RESULTS: 346 cases and 346 controls were included. Multivariate analysis identified the following intrinsic risk factors: coma in the 48 hours before sepsis (OR: 15.1; CI 95%, 5.6-41.2), renal failure (OR: 3.4; CI 95%; 1.5-10.8), neoplasm (OR: 2.4; CI 95%, 1.1-5.1), prosthesis material (OR: 2.7; CI 95%, 1.0-7.8), and serum albumin concentration at admission lower than 3.1 g/dl (OR: 5.3; CI 95%, 2.3-12.4). Main extrinsic risk factors were: previous nosocomial infection (OR: 12.5; CI 95%, 1.61-96.3), intensive care unit (ICU) stay (OR: 10.6; CI 95%, 3.1-36.2), naso-gastric tube (OR: 8.4; CI 95%, 2.3-31.3), indwelling urinary catheter (OR: 5.0; CI 95%, 1.4-18.9), H2 blockers treatment (OR: 5.0; CI 95%, 1.6-15.2), and IV central line (OR: 4.1; CI 95%, 1.2-14.0). CONCLUSION: In our study, main risk factors for development of nosocomial sepsis were presence of coma in the 48 hours before sepsis, ICU stay, and prior cross infection during hospitalization.

Adolescent↗

PubMed2001

ECG Wave-Maven: a self-assessment program for students and clinicians.

Proficiency in the interpretation of electrocardiograms (ECGs) is an essential skill for medical students, house officers, and attending physicians. However, resources to develop and upgrade the necessary high level of "ECG literacy" are limited. A small number of centers have attempted to address this challenge by developing "ECG of the week" internet sites. These resources are difficult to maintain and update, and many of them quickly become stagnant. We present "ECG Wave-Maven," an innovative web-based tutorial that overcomes these obstacles via a direct link to the hospital's extensive and increasing clinical ECG repository. By interfacing our educational tool to live data, we can greatly decrease the time and effort required from the time a practitioner notes an interesting case to its inclusion in the program. Users can opt to encounter the test cases sequentially or randomly, or by reviewing a list of questions or diagnoses, making this not just a quiz, but a basic educational reference. This tool may be useful in meeting the challenge of reducing serious medical errors related to ECG misinterpretation.

Boston↗

PubMed2002

Early life factors in relation to breast cancer risk in postmenopausal women.

We evaluated the role of early life factors in a large, population-based, case-control study of breast cancer risk in postmenopausal women. Case women in Massachusetts, New Hampshire, and Wisconsin were ascertained through state cancer registries; control women were randomly selected from drivers license lists (50-65 years of age) or Medicare beneficiary lists (65-79 years of age). Information concerning factors of interest was obtained through structured telephone interviews. Overall, 83% of eligible cases and 78% of eligible controls participated, and data from more than 2900 women were available for this analysis. We observed a weak J-shaped relationship between birth weight and breast cancer risk; the increased risk was not statistically significant for either the lowest or the highest birth weight. Parental smoking during the pregnancy was not associated with risk of breast cancer in the adult daughter. Breast cancer risk increased significantly with father's education (P = 0.01). Risk also increased with greater age of the mother at the time of the subject's birth (P = 0.04). The subject's birth rank was inversely associated with risk (P = 0.03), as was the number of older sisters (P = 0.03), but the number of older brothers, number of younger siblings, sibship gender ratio, and total sibship size were unrelated to risk. Overall, our results are consistent with previous studies and suggest that these early life factors have a modest influence on breast cancer risk in postmenopausal women.

Aged↗

PubMed2002

[Water contacts in dracunculiasis-infected patients in Mali: transmission risk activities].

The aim of this study lies in the identification of human activities responsible for the transmission of the Guinea worm in an endemic village in Diema Region in Mali. Human water contacts observations started after a census followed by the implementation of a bi-monthly notification system, carried out from May to November 1993. Water contacts were noticed and observed from the mid-July to the end of November of the same year. The first case of dracunculiasis observed was randomly drawn out of a list of the families with obvious cases. The patent case activities involving either surface water, traditional wells or bore-hole water were recorded for 10 consecutive days. During this observation period, contacts made by other patients with the same water sources were also recorded. After 14 days, the case list was updated and a new case selected out of families previously selected. This cycle was repeated until the end of the study period. A "contact at risk for transmission" was defined by a close correspondence between the location of the worm's emergence and the surface of the skin exposed to water, within two weeks following emergence. Contacts were described according to water sources, activities in relation to water, date, gender and age. Observations were made on 103 patients who had 2506 activities in relation with a water body: 1132 of these activities implied a skin contact with the water. Only 133 (9%) of these water contacts were at risk for transmission, 75% took place during the months of August and September, 80% were related to surface waters and 20% to traditional wells. Woman household activities and boys games were the major activities at risk, in contrast to economic activities (watering cattle). The low proportion of "at risk activities" evaluated in this study suggests that a small number of water contacts is sufficient to maintain the transmission. The case implications of the current eradication strategy might not be sufficient alone to break the transmission and should therefore be associated with a reinforcement of the use of filters for drinking water together with an health education.

Activities of Daily Living↗

PubMed2003

[Lifestyle differences between conjugal bereaved women and non-bereaved women in later life].

PURPOSES: In Japan, there has been limited research regarding lifestyle of elderly bereaved. The present study was conducted to clarify lifestyle characteristics in conjugal bereaved women compared to non-bereaved women. METHODS: Subjects consisted of 872 bereaved and 643 non-bereaved elderly women aged 65 or over in T prefecture. Bereaved subjects experienced the death of a spouse in 1994 and their family structure remained unchanged after the bereavement. Non-bereaved subjects were randomly selected from community registration lists in 1995 and matched for age and area of residence. Lifestyle characteristics were obtained by home visit and interview. For the analysis, we divided the subjects into 4 groups by age and family structure. Multiple logistic regression analysis was performed to identify lifestyle characteristics of bereaved elderly women, after adjustment for physical ability and disease, as confounding factors. RESULTS: Bereaved elderly women were significantly associated with no roles at home, no hobbies, lack of contact with friends, physical inactivity, sleeplessness and irregular meal patterns compared to the non-bereaved. Analysis of the 4 groups revealed bereaved women living with family members have more unfavorable lifestyle characteristics than bereaved women living alone. Bereaved women living with family members had no roll at home and sleeplessness. CONCLUSION: Bereaved women have unfavorable lifestyle characteristics. Those living with family members had more unfavorable lifestyle than bereaved women living alone. From the preventive point of view, interventions for bereaved women are needed. This is particularly the case for bereaved women living with family members. Not only health services but also social welfare services are needed to reconstruct favorable lifestyles and maintain health and well-being.

Aged↗

PubMedDate not supplied

[Adolescence at risk: a health survey among pre-university students].

The present study investigates the level of health education in a representative sample of 804 pre-university Asturian students, randomly selected from the official list of the Ministry of Education and Science. We used a questionnaire (designed by us) in order to measure the knowledge, attitudes and behaviour related to some of the most important health determining factors. The survey was carried out by interviewing small groups of students in the classroom situation. Although it was found that the majority perceived themselves as healthy or very healthy, these young people are widely exposed to risk factors: 12% have suffered from more than 25 episodes of drunkenness during the previous year; 43.53% smoked to some extent and only 3.86% identified the days of maximum risk of pregnancy in a supposed menstrual cycle, although 31% maintained sexual relationships. Theoretically, 92% selected health as the most important factor among the three most fundamental values for life. They also think that illegal drugs are the most important health problem at present for young people. There is a contradiction between the high theoretical importance given to health, the good self-qualification of it, and the observed presence of important risk factors. A certain failure of the educational system with respect to primary prevention can be claimed.

Adolescent↗

PubMed2003

Job stress and occupational status in a French cohort.

BACKGROUND: The goal of this study was to examine a large, varied occupational French cohort for possible relationships between various dimensions of occupational stress, on the one hand, and the occupational status and socio-demographic characteristics of workers on the other. METHODS: Data was taken from the first, cross-sectional phase of the VISAT study (aging, health, and work), which took place in 1996. Participants were randomly drawn from the patient lists of about one hundred occupational physicians in three regions of southern France. The current study concerned 2,768 wage earners born in 1944, 1954, or 1964. The material consisted of 59 questions aimed at assessing a broad set of working conditions, some of which were proxy measures of the dimensions described in the Karasek and Siegrist models. RESULTS: From a principal component analysis, three main factors were extracted that accounted for 40% of the total variance. The first factor (a=0.79) included items that referred to the decision latitude in the Karasek model and items that referred to the reward dimension in the Siegrist model. The second factor (a=0.77) was made up of items tapping physical stressors, while the third factor (a=0.71) pooled items that corresponded fairly well to psychological demands in the Karasek model. Highly significant relationships (p<10(-4)) were found between the mean factor scores and both occupational status and educational level, with a lower occupational status and educational level being associated with greater lack of job control and rewards, higher physical stress, but lower psychological demands. Less job control and fewer rewards were also found to be greater in older workers (p<10(-3)) and females (p<10(-4)). CONCLUSION: Our results thus confirm the existence of a strong association, in a French cohort, between occupational status and dimensions of job stress known to be associated with adverse health outcomes.

Adult↗

PubMed2002

[Methodologic difficulties in measuring patient satisfaction--discrepancy coming from formulating questions].

Reports concerning methodology of studies on patients' satisfaction suggest that the way questions are composed may have significant effect on the received answers. For example responses to closed-ended questions are usually positive, while in contrast, the responses to open-ended questions tend to be negative. This is described as "leniency effect". The aim of the present study was to compare the difference in patients' answers to open and closed questions in a survey on patients' satisfaction with family doctor services. The study was carried out in two general practices in Białystok, Poland and participants were randomly chosen from the patients' lists of their physicians. The survey was conducted by the technique of mailed questionnaire. Of the total 1000 questionnaires sent out, 579 were filled in and returned, and 560 were eligible for further analysis. The results show the discrepancy between the rating given by patients in a five-grade scale and their own answers to open questions. Among 216 individuals grading family doctor's care as fairly good in an answer to a closed question, 42 persons (19.4%) used phrases expressing negative feelings in an answer to an open question asking for justification of their opinion. Most frequently negative comments were related to short time of consultation, difficulty with obtaining referral to a specialist and lack of holistic approach to a patient. The results of our study suggest that questionnaires are not sufficiently precise tools in a complex evaluation of doctors' care by their patients. In practice this may mean that questionnaire surveys, which are often used because of the ease of administration, may require to be complemented or replaced by other more qualitative research tools, such as in depth interviews and open questions.

Adult↗

PubMed2004

Physician assistant vocational satisfaction.

Physician assistants (PAs) are known to be highly satisfied with their vocational choices, but the reasons for this high degree of satisfaction are not known. The author mailed a survey to 2,323 PAs whose names were randomly chosen from the mailing list of the American Academy of Physician Assistants (AAPA) to examine the factors that PAs feel contribute to vocational satisfaction. The survey response rate was 50%. PAs were found to be highly satisfied with their careers, specialty choices, and jobs. From qualitative data, 21 factors for vocational satisfaction and 29 factors for dissatisfaction were identified. The identified variables could be used to guide PA professional policy development and aid PA employers in making organizational and management decisions.

Adult↗