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PubMed1992

Respiratory symptoms as predictors of airways lability in an elderly population.

In an attempt to identify patterns of symptoms which might predict treatable airways obstruction in the elderly, we measured respiratory function and airways lability in 296 men and women aged 65 and over. Subjects were selected to represent eight symptom groups as ascertained in a postal survey of patients randomly selected from three general practice lists. Airways obstruction was strongly associated with smoking, but bronchial hyperresponsiveness to methacholine and reversibility of airways obstruction with salbutamol (measured when hyperresponsiveness could not be assessed) were not. There was evidence of bronchial hyperresponsiveness or salbutamol reversibility in 37% of symptomatic non-smokers. This points to a substantial component of obstructive lung disease in the elderly that is characterized by labile airways and unrelated to smoking. Symptoms of the 'bronchial irritability syndrome' were more strongly associated with airways lability than other symptoms, but their predictive value for airways lability (32%) was much lower than has been reported in younger adults.

Aged↗

PubMedDate not supplied

Nurse-midwives' knowledge and promotion of lactational amenorrhea and other natural family-planning methods for child spacing.

The purpose of this study was to describe and assess certified nurse-midwives' (CNMs) knowledge and promotion of two modalities for child spacing, natural family-planning (NFP) and the lactational amenorrhea method (LAM). One thousand two hundred CNMs were randomly selected from a national membership list and mailed a 24-item questionnaire on NFP and LAM. Of the 514 respondents (42.8% return rate), 450 (87.5%) were currently practicing as CNMs. Respondents had an average age of 46 years, with an average of 10 years of practice. CNMs ranked NFP as the ninth most used and the eighth most effective family-planning method in their practice, with an average perceived method-effectiveness of 88% and use-effectiveness of 70%. Although most respondents felt somewhat prepared during their education program to provide NFP, only 22% would offer NFP as a family-planning option for child spacing.

Amenorrhea↗

PubMed2004

Can clinical pharmacy services have a positive impact on drug-related problems and health outcomes in community-based older adults?

BACKGROUND: Although pharmacotherapy can be beneficial in the elderly, it can also lead to drug-related problems (DRPs), including untreated indications, drug use without an indication, improper drug selection, subtherapeutic dosage, overdosage, medication error, medication nonadherence, drug interactions, adverse drug reactions, adverse drug withdrawal events, and therapeutic failure. OBJECTIVE: The goal of this article was to review evidence from randomized controlled studies to determine whether DRPs and the related health outcomes can be modified by providing clinical pharmacy services for the elderly in community-based settings. METHODS: Randomized controlled studies that assessed DRPs and health outcomes in persons aged > or =65 years after pharmacist interventions were identified through searches of MEDLINE (1970-March 2003), the Cochrane Database of Systematic Reviews (through March 2003), and International Pharmaceutical Abstracts (1966-March 2003). The search combined the terms clinical pharmacists, aged, outcomes, and randomized controlled trial. A manual search of the reference lists of identified articles and the authors' own materials was also conducted. RESULTS: This literature review included 14 randomized controlled studies: 5 involved interventions in the home health setting, 3 were instituted at hospital discharge with home follow-up, 3 were clinic based, 1 was conducted in the community pharmacy setting, and 2 were conducted in long-term care facilities. These studies provided considerable evidence that clinical pharmacy interventions reduced the occurrence of DRPs in the elderly but showed limited evidence that such interventions reduced morbidity, mortality, or health care costs. CONCLUSIONS: Future large multicenter studies are necessary to test the cost-effectiveness of clinical pharmacy services for the community-based elderly and the impact of these services on such health outcomes as use of health services, timed functional-status measures, and adverse drug reactions.

Aged↗

PubMed1999

The relation of breast size to breast cancer risk in postmenopausal women (United States).

OBJECTIVE: Breast size has been hypothesized to predict a woman's risk of breast cancer although studies in the main have not supported an association. In a large, population-based case-control study we examined whether breast size might emerge as a significant risk factor among very lean women in whom breast size might be a truer reflection of the volume of gland mass at risk for malignant change. METHODS: The data derive from a population-based case-control study of women aged 50 to 79 years conducted in several New England states and Wisconsin. Incident cases of invasive breast cancer (n = 2015) were identified through state tumor registries and controls (n = 2556) were selected at random within age strata from population lists. Telephone interviews were conducted to obtain information on known and suspected risk factors which included bra dimensions (cup and back size) prior to a first birth, or at the age of 20 for nulliparous women. RESULTS: We observed a significant positive association for cup size which was limited to women who were the most lean as young adults based on chest circumference. Among those reporting a chest size under 34 inches multivariate-adjusted relative risks were 1.34 (95% CI: 1.04 to 1.74) for cup size B, and 1.76 (95% CI: 1.04 to 3.01) for cup size C and larger, compared to a cup size smaller than B, and the trend for increasing cup size was statistically significant (P = 0.005). There was no relation with breast size among women reporting an average or larger back circumference (34 inches or larger). CONCLUSION: Breast size before a pregnancy is a positive predictor of postmenopausal breast cancer, but this association is limited to those who were especially lean as young women.

Adipose Tissue↗

PubMed1999

A survey of general dental practitioners' postgraduate education activity and demand for extended modular postgraduate programmes.

The aim of this paper is to assess the level of involvement of general dental practitioners in postgraduate education and training, identify their speciality interests, preferred format of course presentation and assess the potential demand for modular postgraduate programmes. A questionnaire analysis of a one in three random sample of general dental practitioners on Health Authority lists in the North West of England and North Wales was designed and carried out. Out of a random sample of 799, 552 GDPs completed an anonymous questionnaire in 1998 which investigated their current postgraduate activity, the areas of specialist interest and their interest in extended modular postgraduate education courses with associated summative assessment. Fifty three percent of respondents attended more than four postgraduate sessions per year of whom the majority (59%) were in 35-44 year old age group. 79% identified Section 63 courses as their first preference and 63% preferred mixed didactic and 'hands on' courses. Seventy five percent of respondents expressed an interest in attending modular programmes which might lead to a postgraduate qualification. In conclusion, an enthusiasm to attend existing postgraduate courses was identified but a demand was also perceived for courses of longer duration possibly leading to additional postgraduate qualifications.

Adult↗

PubMed2004

Whole genome expression profiling of advance stage papillary serous ovarian cancer reveals activated pathways.

Ovarian cancer is the most lethal type of gynecologic cancer in the Western world. The high case fatality rate is due in part because most ovarian cancer patients present with advanced stage disease which is essentially incurable. In order to obtain a whole genome assessment of aberrant gene expression in advanced ovarian cancer, we used oligonucleotide microarrays comprising over 40,000 features to profile 37 advanced stage papillary serous primary carcinomas. We identified 1191 genes that were significantly (P < 0.001) differentially regulated between the ovarian cancer specimens and normal ovarian surface epithelium. The microarray data were validated using real time RT-PCR on 14 randomly selected differentially regulated genes. The list of differentially expressed genes includes ones that are involved in cell growth, differentiation, adhesion, apoptosis and migration. In addition, numerous genes whose function remains to be elucidated were also identified. The microarray data were imported into PathwayAssist software to identify signaling pathways involved in ovarian cancer tumorigenesis. Based on our expression results, a signaling pathway associated with tumor cell migration, spread and invasion was identified as being activated in advanced ovarian cancer. The data generated in this study represent a comprehensive list of genes aberrantly expressed in serous papillary ovarian adenocarcinoma and may be useful for the identification of potentially new and novel markers and therapeutic targets for ovarian cancer.

Carcinoma, Papillary↗

PubMed2001

The prevalence and pattern of nursing caries in Saudi preschool children.

OBJECTIVES: To determine the prevalence and pattern of nursing caries in Saudi preschool children of Riyadh area. DESIGN: Cross-sectional. SUBJECTS AND METHODS: A list of kindergartens was derived through random selection of one kindergarten from every area of Riyadh. A sample of 1,016 children with primary dentition only was examined for dental caries. The criterion used for nursing caries was presence of caries on the labial or lingual surfaces of at least two maxillary incisors with absence of caries in mandibular incisors. RESULTS: Two hundred and seventy-seven (27.3%) children were diagnosed as having nursing caries. The mean dmft of nursing caries children was 8.6 (+/- 3.4), with dt component of 7.6 (+/- 3.5), mt of 0 4 (+/- 0.9) and ft of 0.6 (+/- 1.7). The older children had significantly higher mean dmft as compared with younger children. The teeth most affected by caries were maxillary central incisors (93.9%), whereas the least affected were mandibular canines (9.6%). A great majority of children (95.7%) had caries in both anterior and posterior teeth. The probability of bilateral molar caries was very high in nursing caries children; highest (94.7%) in mandibular first molars. CONCLUSIONS: The caries prevalence was high in the study population. The maxillary central incisors were most affected by caries. The probability of bilateral molar caries was very high.

Bottle Feeding↗

PubMed2003

A comparison of acute phase proteins and traditional risk factors as markers of combined plaque and intima-media thickness and plaque density in carotid and femoral arteries.

OBJECTIVES: To test the hypothesis that some acute phase proteins may be better independent predictors of objective measures of arterial wall impairment than traditional risk factors. DESIGN: Cross-sectional study. MATERIALS AND METHODS: C-reactive protein (CRP), fibrinogen, C3 complement and traditional risk factors were measured in 288 men aged 55-64 years, randomly chosen from the local registry lists. By ultrasound assessment of the bifurcations of carotid and femoral arteries, maximum combined plaque/intima-media thickness (CPIMTmax) and mean plaque density (MPD, in a grey scale from 0 to 255) were also measured. RESULTS: In multivariate analysis only traditional risk factors remained associated with the overall CPIMTmax: smoking (r = 0.35, p < 0.0001), cholesterol (r = 0.23, p = 0.0001), age (r = 0.22, p = 0.0002), glucose (r = 0.18, p = 0.002) and systolic blood pressure (r = 0.13, p = 0.02). However, with regard to carotid disease only, fibrinogen was the strongest covariate of CPIMT (r = 0.18, p = 0.002). The overall MPD was independently associated with CRP (r = 0.25, p = 0.0008), physical activity (r = 0.19, p = 0.009), triglycerides (r = -0.18, p = 0.02) and body mass index (r = 0.15, p = 0.04). CRP was mainly associated with femoral MPD, while triglycerides were the major (inverse) covariate of carotid MPD. CONCLUSIONS: Traditional risk factors are the main determinants of CPIMTmax, although fibrinogen seems to play a role in carotids. CRP was associated with high density femoral plaques. Finally, no acute phase protein was independently associated with low density, potentially vulnerable, plaques.

Acute-Phase Proteins↗

PubMed2005

[Treatment of Alzheimer's disease utilising the best available evidence-based medicine -- utopia?].

STUDY OBJECTIVES: To practice evidence-based medicine is considered to improve health care, particularly of chronically ill patients. Taking Alzheimer's as an example the objective of this study is to explore as to how far ambulatory Alzheimer's patients receive the medical treatment with the best evidence available. METHOD: In 2000 and 2002 the health care situation of Alzheimer's disease patients was assessed by conducting telephone interviews with one hundred randomly selected general practitioners and specialists listed in the panel of the Institut fur Medizinische Statistik (IMS -- Institute for Medical Statistics). By means of a standardised questionnaire the interviewees' prescriptions were assessed as well as their knowledge of the medical therapy for Alzheimer's and the use of non-medical therapeutic measures. Besides, the interviewees' prescriptions were checked on the basis of quantitative data taken from the IMS panel. Cholinesterase inhibitors (ChE-I), which are accorded the best evidence presently available in the medical treatment of Alzheimer's, were seen as a marker for the improvement of health care in the course of the study. RESULTS AND CONCLUSIONS: The interviewed physicians considered the evidence of medical Alzheimer's disease therapy with cholinesterase inhibitors high. 67 % of the interviewees would use ChE-I as the drug of first choice if a near relative fell ill with Alzheimer's. However, the ChE-I prescriptions were limited to 13 % in the base year 2000 and to 24 % in the base year 2002. Obviously, the implementation of this medical therapy is hampered by budgetary regulations. The interviewees find it particularly disadvantageous that the prescription of ChE-I may overstrain the budgets allocated to their practices. As a consequence, the effort to improve the quality of health care by implementing evidence-based medicine is thwarted by the increasing pressure on German physicians to prescribe drugs according to economic viability.

Adult↗

PubMed1993

Professional courtesy--current practices and attitudes.

BACKGROUND: Physicians have long provided care free of charge or at a reduced rate as a professional courtesy to other physicians and their families. We conducted a stratified national mail survey to assess the extent to which this practice has changed in recent years. METHODS: Using the American Medical Association's 1991 master list of physicians, we selected a random sample of 4800 practicing physicians from 12 direct-care specialties. These physicians were asked about their current policy and opinions regarding professional courtesy. RESULTS: Of the 2224 respondents, 2127 (96 percent) offered professional courtesy, defined as providing free or discounted health care to physicians and their families. Psychiatrists were less likely to offer professional courtesy than physicians in any of the other specialties (80 percent vs. 91 to 99 percent, P < 0.05). The forms of free or discounted care offered as a professional courtesy included billing only the insurance company (75 percent), providing care at no charge (49 percent), and giving a partial discount (23 percent). Twenty-three percent of the respondents reported that they had changed their policy regarding professional courtesy since starting to practice. Among those who had changed their policy, the most common changes were to increase the practice of billing only the insurance company (67 percent) and to provide care at no charge less often (58 percent). The majority of physicians responding to the survey thought that professional courtesy solidified bonds between physicians (79 percent) and was sound business practice (62 percent); 12 percent believed that it was too expensive to offer free or discounted care as a professional courtesy, and 14 percent thought that the practice had negative effects on the physician-patient interaction. CONCLUSIONS: Our survey of physicians involved in direct patient care indicates that, with the exception of psychiatrists, almost all American physicians offer free or discounted care as a professional courtesy and support the practice.

Adult↗

PubMed2003

Vitamin A supplementation and childhood morbidity from diarrhea and respiratory infections: a meta-analysis.

OBJECTIVES: To perform an updated meta-analysis of the effect of vitamin A supplementation on childhood morbidity from respiratory tract infections and diarrhea. Study design A comprehensive search of the 1966 to 2000 MEDLINE database and review of the reference lists of relevant articles identified 9 randomized controlled trials dealing with morbidity from respiratory infections and diarrhea in children 6 months to 7 years of age and provided "intention-to-treat" data. RESULTS: The combined results indicated that vitamin A supplementation has no consistent overall protective effect on the incidence of diarrhea (relative risk, 1.00; 95% CI, 0.94-1.07) and that it slightly increases the incidence of respiratory tract infections (relative risk, 1.08; 95% CI, 1.05-1.11). CONCLUSIONS: High-dose vitamin A supplements are not recommended on a routine basis for all preschool children and should be offered only to individuals or populations with vitamin A deficiency.

Child↗

PubMed2001

Manipulating the mammalian genome by homologous recombination.

Gene targeting in mammalian cells has proven invaluable in biotechnology, in studies of gene structure and function, and in understanding chromosome dynamics. It also offers a potential tool for gene-therapeutic applications. Two limitations constrain the current technology: the low rate of homologous recombination in mammalian cells and the high rate of random (nontargeted) integration of the vector DNA. Here we consider possible ways to overcome these limitations within the framework of our present understanding of recombination mechanisms and machinery. Several studies suggest that transient alteration of the levels of recombination proteins, by overexpression or interference with expression, may be able to increase homologous recombination or decrease random integration, and we present a list of candidate genes. We consider potentially beneficial modifications to the vector DNA and discuss the effects of methods of DNA delivery on targeting efficiency. Finally, we present work showing that gene-specific DNA damage can stimulate local homologous recombination, and we discuss recent results with two general methodologies--chimeric nucleases and triplex-forming oligonucleotides--for stimulating recombination in cells.

Animals↗

PubMed2001

Preoperative bowel preparation with meglumine and sodium diatrizoate (Gastrografin): a prospective randomised comparison.

OBJECTIVE: To test the use of meglumine and sodium diatrizoate (Gastrografin) as an agent for preoperative mechanical bowel preparation. DESIGN: Prospective randomised comparison. SETTING: County general hospital, Greece. SUBJECTS: 58 patients listed for elective colorectal operations were randomly divided into 2 groups. The first (n = 30) was given Gastrografin 200 ml orally for 2 consecutive days before operation, and the second (n = 28) was given Ringer's solution through a nasogastric tube. MAIN OUTCOME MEASURES: Tolerability, acceptability, quality of cleansing, and complications. RESULTS: There were no disturbances in electrolyte concentrations, and other laboratory variables also remained unchanged. Two patients treated with Ringer's solution had appreciable increases in arterial blood pressure, but there were no significant overall changes. About half the patients given Ringer's felt nauseated and a third vomited. Such symptoms were uncommon in patients treated with Gastrografin (p < 0.01). 28/30 and 26/28 (93%) had a clean colonic lumen at operation, whereas in the reminder the lumen was evaluated as containing "slight residue". There were no operation-related complications. CONCLUSIONS: Gastrografin can be used successfully as an agent for mechanical bowel preparation before elective colorectal surgery, as it gives equally good cleansing results compared with the established method of whole gut irrigation. It also seems to be better tolerated and accepted by patients.

Aged↗

PubMed2006

Care burden and self-reported health status of informal women caregivers of HIV/AIDS patients in Kinshasa, Democratic Republic of Congo.

We conducted a cross-sectional study on women who were caregivers of HIV/AIDS-affected spouses in Bumbu in Kinshasa, Democratic Republic of Congo. The sample consisted of 80 women randomly selected from a client visitation list of the home-based care program for AIDS patients. A semi-structured questionnaire was applied. A self-reported health status was calculated with five items from the questionnaire. The self-reported health status score of participants indicated poor health. The study highlights the great burden on caregivers in sub-Saharan Africa.

Adolescent↗

PubMed2006

Cognitive behavioural therapy for depression, panic disorder and generalized anxiety disorder: a meta-regression of factors that may predict outcome.

OBJECTIVE: To determine which factors impact on the efficacy of cognitive behavioural therapy (CBT) for depression and anxiety. Factors considered include those related to clinical practice: disorder, treatment type, duration and intensity of treatment, mode of therapy, type and training of therapist and severity of patients. Factors related to the conduct of the trial were also considered, including: year of study, country of study, type of control group, language, number of patients and percentage of dropouts from the trial. METHOD: We used the technique of meta-analysis to determine an overall effect size (standardized mean difference calculated using Hedges' g) and meta-regression to determine the factors that impact on this effect size. We included randomized controlled trials with a wait list, pill placebo or attention/psychological placebo control group. Study participants had to be 18 years or older and all have diagnosed depression, panic disorder (with or without agoraphobia) or generalized anxiety disorder (GAD). Outcomes of interest included symptom, functioning and health-related quality of life measures, reported as continuous variables at post-treatment. RESULTS: Cognitive behavioural therapy for depression, panic disorder and GAD had an effect size of 0.68 (95% CI=0.51-0.84, n=33 studies, 52 comparisons). The heterogeneity in the effect sizes was fully explained by treatment, duration of therapy, inclusion of severe patients in the trial, year of study, country of study, control group, language and number of dropouts from the control group. Disorder was not a significant predictor of the effect size. CONCLUSIONS: Cognitive behavioural therapy is significantly less effective for severe patients and trials that compared CBT to a wait-list control group found significantly larger effect sizes than those comparing CBT to an attention placebo, but not to a pill placebo. Further research is needed to determine whether CBT is effective when provided by others than psychologists and whether it is effective for non-English-speaking patient groups.

Anxiety Disorders↗

PubMed2001

Fund-raising on the web: the effect of an electronic foot-in-the-door on donation.

In an attempt to test the foot-in-the-door (FITD) technique in a computer-mediated communication context, 1,008 men and women taken at random in various e-mails lists were solicited to visit a web site for the profit of a humanitarian organization. In the FITD condition, subjects were first solicited to sign a petition form and, after that, they were solicited for a donation. In the control condition, the donation solicitation was formulated directly. In all cases, the formulation of the requests was manipulated by the order of the successive HTML pages of the site. Results show that the FITD procedure increases compliance to the final request.

Female↗

PubMed2000

Attitudes to lifestyle risk factors for coronary heart disease amongst South Asians in Leicester: a focus group study.

BACKGROUND: South Asians have a significantly higher risk of mortality from coronary heart disease (CHD) compared with the general population in the UK. There is a lack of evidence on attitudes to and knowledge of risk factors for CHD amongst South Asians. Such information is important for the provision of effective health promotion services. OBJECTIVES: The aim of the study was to identify key issues relating to knowledge of and attitudes to lifestyle risk factors for CHD amongst South Asians aged over 40 years in Leicester, UK. METHOD: A qualitative focus group analysis was carried out using randomly selected South Asians from GP lists and South Asians attending community centres. Group discussions were taped, translated and transcribed. The transcripts were analysed using qualitative methodology to identify key issues and themes. RESULTS: Participants expressed a range of attitudes to and different levels of knowledge of lifestyle risk factors for CHD. Barriers to improving lifestyle with respect to diet and exercise were identified; these included lack of information (e.g. of how to cook traditional Indian food more healthily) and cultural barriers, such as lack of women-only exercise facilities. Participants perceived stress as an important cause of CHD, and stress directly related to ethnic minority status was described frequently. Language was identified as a key barrier to accessing health services. CONCLUSION: Health professionals need to provide individually tailored health promotion for South Asians which avoids stereotyping, but recognizes potential cultural obstacles to change. The issue of stress amongst South Asians requires more research and needs to be recognized as an important issue by health professionals. South Asians still face problems accessing health and leisure services due to language and cultural issues.

Adult↗

PubMed2005

Weight change and risk of endometrial cancer.

BACKGROUND: Obesity is an established risk factor for endometrial cancer. Less well understood is the role of weight gain and weight change in determining risk. METHODS: We analysed data from a population-based case-control study to evaluate the associations of body mass index (BMI), weight gain, and weight cycling with risk of endometrial cancer. Cases (n=740) under age 80 with a new diagnosis of endometrial cancer were identified from Wisconsin's cancer registry. Controls (n=2342) were randomly selected from driver's license lists and Medicare beneficiary files. Body size at three time points and other risk factor information were ascertained by interview in 1992-95. RESULTS: Endometrial cases were more likely than controls to be nulliparous, have early ages at menarche and late ages at menopause, be diabetic, smoke cigarettes, and use post-menopausal hormones. After adjustment for these factors, increasing BMI was associated with increased risk (P-trend<0.001); women in the top quartile of BMI (>29 kg/m2) had a 3-fold greater risk of endometrial cancer [95% confidence interval (95% CI) 2.4-4.2] compared with women in the lowest quartile (<23 kg/-m2). For each 5 kg weight gain, the odds ratio (OR) for endometrial cancer risk equalled 1.2 (95% CI 1.2-1.3). History of weight cycling modestly increased risk after adjustment for BMI and other factors (OR=1.3; 95% CI 1.0-1.6). In addition, women who reported sustained weight loss had a reduced risk of endometrial cancer (OR=0.7; 95% CI 0.6-0.9). CONCLUSIONS: These results suggest that weight gain and lack of weight stability are associated with risk of endometrial cancer.

Adult↗