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PubMed2000

Systemic corticosteroids in infant bronchiolitis: A meta-analysis.

OBJECTIVE: To determine whether corticosteroids are efficacious in treating bronchiolitis in hospitalized infants. METHODS: Online bibliographic databases (Medline, Embase, and Cochrane Clinical Trials Registry) were searched for: 1) bronchiolitis or respiratory syncytial virus, and 2) corticosteroid or glucocorticoid or steroidal antiinflammatory agents or adrenal cortex hormones. Reference lists from all selected articles were also examined. Randomized, placebo-controlled trials of systemic corticosteroids in treatment of infants hospitalized with bronchiolitis were selected by 2 investigators. Of 12 relevant publications identified in the literature search, 6 met the selection criteria and had relevant data available. Investigators independently extracted data for 3 outcomes: length of stay (LOS), duration of symptoms (DOS), and clinical scores. RESULTS: In the pooled analysis, infants who received corticosteroids had a mean LOS or DOS that was.43 days less than those who received the placebo treatment (95% confidence interval: -.81 to -.05 days). The effect size for mean clinical score was -1.60 (95% confidence interval: -1.92 to -1.28), favoring treatment. Secondary analyses of mean LOS or DOS were performed on 5 trials that had clearly identified methods of randomization, 5 trials that measured LOS, and 4 trials that clearly excluded infants with previous wheezing. The estimates of effect were similar to the primary analysis but were not statistically significant. CONCLUSIONS: Combined, published reports of the effect of systemic corticosteroids on the course of bronchiolitis suggest a statistically significant improvement in clinical symptoms, LOS, and DOS.

Anti-Inflammatory Agents↗
PubMed2004

A mixed-model approach for the analysis of cDNA microarray gene expression data from extreme-performing pigs after infection with Actinobacillus pleuropneumoniae.

We proposed a novel statistical approach for the analysis of cDNA experiments based on mixed-model methodology combined with mixtures of distributions. Our objective was to detect genes that may be involved in conferring heritable differences in susceptibility to common infections in intensive pig production. We employed a microarray expression profiling strategy and a mixed-model approach to the analysis of the expression data. A cDNA microarray of pig with 6,420 probes from immune tissues and cells was used to compare gene expression in peripheral blood leukocytes of two pigs showing extreme performance in their response to infection with Actinobacillus pleuropneumoniae. Principal components analyses were used to identify the two most extreme-performing pigs after infection (i.e., pigs whose measured responses to infection fell at the extremes). Blood samples and expression profiles from 0 to 24 h after infection were compared using a bivariate, mixed-model approach, in which the effect gene x immunological status interaction was treated as a random effect. Bayesian model-based clustering via mixtures of normal distributions of the resulting BLUP of the random interaction was approached and resulted in a list of 307 differentially expressed genes, of which 179 were down-regulated in the susceptible pig. The majority of the differentially expressed genes were derived from a cDNA library of leukocytes of A. pleuropneumoniae-challenged pigs that were subtracted against leukocytes before the challenge. These results provide evidence that the proposed statistical approach was useful in enhancing the knowledge of the mechanisms involved in the genetics of the immune response.

Actinobacillus Infections↗
PubMed1995

Do out-of-office laboratory tests affect diagnoses in general practice?

OBJECTIVE: To find out whether the GP diagnosis changed by out-of-office laboratory test results and whether his diagnosis became more certain. DESIGN: Descriptive study. SETTING: Dutch survey of morbidity and interventions in general practice: stratified random sample of 161 GPs with a total list of 335,000 patients. SUBJECTS: 2,081 episodes of illness with at least one consultation with clinical chemistry, haematology, or serology tests and at least one follow-up consultation. MAIN OUTCOME MEASUREMENTS: Change in ICPC component or chapter between the consultation in which a laboratory test was ordered and the follow up contact; change in exact ICPC code in cases with important diseases (infectious diseases, haematological disorders, endocrine abnormalities, auto-immune processes and malignancies (n = 330)); change in certainty of a diagnosis and change in somatic/psychosocial orientation. RESULTS: After laboratory tests done in the first consultation the ICPC component changed in 46% of the diagnoses. Of the diagnoses made in first consultations without laboratory tests 41% changed in the follow up consultation. The diagnosis after laboratory tests was the same as before in 51% of the consultations with important diseases. Certainty about a diagnosis increased significantly after laboratory tests (p < 0.001). An abnormal laboratory result did not affect the clinical certainty of the general practitioner or the percentage of altered diagnoses. CONCLUSION: The usefulness of tests should be assessed not only in terms of the number of diagnoses changed or of the percentage of abnormal results, but also in terms of the changed certainty concerning a diagnosis.

Clinical Laboratory Techniques↗
PubMedDate not supplied

A study of professional nurses' perceptions of patient education.

BACKGROUND: The purpose of this study was to describe the professional nurses' perception of the role of patient educator and to determine factors inhibiting and enhancing patient teaching. METHOD: One hundred and twenty-four hospital-based, acute-care professional nurses were randomly selected from a State Board of Nursing list and surveyed by mail. RESULTS: Ninety-two percent of nurses reported that patient education was a priority in their nursing care. The top three factors inhibiting patient education were time, staffing, and receptiveness of the patient. The top three enhancers were providing more time to teach, providing inclusive teaching guidance sheets, and making resources more accessible. CONCLUSION: Patient education is a valuable part of professional nurses' practice, but many factors impede this nursing function. Key recommendations to enhance patient teaching were suggested, including improving efficiencies in patient care, supporting the staff nurse educational role, and providing essential resources based on survey results.

Adult↗
PubMed2006

Visual acuities and manifest refractions prior to LASIK retreatments.

PURPOSE: To demonstrate that patients undergoing LASIK retreatments generally have good uncorrected vision and small refractive errors prior to retreatment surgery. METHODS: A list was generated of all refractive surgery retreatments performed in our four laser centers from August 2003 to July 2004. From this list, a total of 100 patient charts were randomly chosen. Only eyes that had full distance correction with LASIK as the primary surgery were included. The last uncorrected visual acuity (UCVA) and manifest refraction spherical equivalent (MRSE) prior to retreatment were recorded. RESULTS: For a total of 109 eyes studied, the average UCVA prior to retreatment was 20/36. Eighty-one percent (88/109) of the retreated eyes were already seeing > or = 20/40. The average MRSE prior to retreatment was -0.43 +/- 0.98 D. CONCLUSIONS: The majority of patients receiving LASIK retreatments have relatively good uncorrected vision and minimal refractive errors prior to retreatment.

Adult↗
PubMed2003

Clinical impact of bleeding in patients taking oral anticoagulant therapy for venous thromboembolism: a meta-analysis.

BACKGROUND: Clinicians should consider the clinical impact of anticoagulant-related bleeding when deciding on the duration of anticoagulant therapy in patients with venous thromboembolism. PURPOSE: To provide reliable estimates of the clinical impact of anticoagulant-related bleeding, defined as the case-fatality rate of major bleeding and the risk for intracranial bleeding. DATA SOURCES: MEDLINE (January 1989 to May 2003), Cochrane Controlled Trial Registry, thromboembolism experts, and reference lists; English-language literature only. STUDY SELECTION: Randomized, controlled trials and prospective cohort studies that investigated patients with venous thromboembolism who received oral anticoagulant therapy (target international normalized ratio, 2.0 to 3.0) for at least 3 months and that reported major bleeding and death as primary study outcomes. DATA EXTRACTION: Two reviewers independently extracted data on the number of anticoagulant-related major and intracranial bleeding episodes and on whether these events were fatal or nonfatal. DATA SYNTHESIS: The authors analyzed 33 studies involving 4374 patient-years of oral anticoagulant therapy. For all patients, the case-fatality rate of major bleeding was 13.4% (95% CI, 9.4% to 17.4%) and the rate of intracranial bleeding was 1.15 per 100 patient-years (CI, 1.14 to 1.16 per 100 patient-years). For patients who received anticoagulant therapy for more than 3 months, the case-fatality rate of major bleeding was 9.1% (CI, 2.5% to 21.7%), and the rate of intracranial bleeding was 0.65 per 100 patient-years (CI, 0.63 to 0.68 per 100 patient-years) after the initial 3 months of anticoagulation. CONCLUSION: The clinical impact of anticoagulant-related major bleeding in patients with venous thromboembolism is considerable, and clinicians should take this into account when deciding whether to continue long-term oral anticoagulant therapy in an individual patient.

Administration, Oral↗
PubMed1999

A metaanalysis on the use of bisphosphonates in corticosteroid induced osteoporosis.

OBJECTIVE: To conduct a metaanalysis on the use of bisphosphonates in corticosteroid induced osteoporosis. METHODS: A Cochrane systematic review including electronic database searching (MEDLINE and EMBASE), and selected hand searching of reference lists and scientific abstracts was conducted. Metaanalysis using random and fixed effects modeling was used on the selected trials to calculate summary effect measures. All controlled clinical trials dealing with prevention or treatment of corticosteroid induced osteoporosis with bisphosphonates of any type and reporting the outcome of interest were assessed. Trials had to involve adults only, and subjects had to be taking a mean steroid dose of 7.5 mg/day or more. Outcomes of interest were change in bone mineral density (BMD) at the lumbar spine and femoral neck at 6 and 12 months. If present, data on number of new fractures and adverse effects were also extracted. The extraction was performed by 2 independent reviewers. RESULTS: Results are reported as a weighted mean difference in the percentage change in BMD between the treatment and placebo groups, with trials being weighted by the inverse of their variance. At the lumbar spine the weighted mean difference between the treatment and placebo groups was 4.0% (95% CI 2.5, 5.5). At the femoral neck the weighted mean difference was 2.1% (95% CI 0.2, 4.0). Although there was a 24% reduction in spinal fractures, this result did not reach statistical significance. CONCLUSION: Bisphosphonates are effective at preventing and treating corticosteroid induced bone loss at the lumbar spine. Efficacy regarding fracture prevention cannot be concluded from this analysis, although bone density changes are correlated with fracture risk. Bisphosphonates are less efficacious at preventing or treating corticosteroid induced osteoporosis at the femoral neck.

Adrenal Cortex Hormones↗
PubMed2000

A systematic review of treatments for infant colic.

OBJECTIVE: To conduct a systematic review of rigorously evaluated treatments for infant colic. METHODS: Online bibliographic databases were searched for the term "colic" in articles classified as clinical trials or randomized controlled trials and conducted in infants. Reference lists from review articles, meta-analyses, and the selected articles were also reviewed for potential studies. The abstracts or full-text articles of 57 relevant studies were examined, of which 22 met the selection criteria. The methodology and findings of all retrieved articles were critically evaluated. Data were extracted from each article regarding study methods, intervention studied, outcomes measured, and results. RESULTS: Four of the interventions studied had data of adequate quality and statistically significant numbers needed to treat (NNT): hypoallergenic diet (NNT = 6), soy formula (NNT = 2), reduced stimulation (NNT = 2), and herbal tea (NNT = 3). CONCLUSIONS: There are some effective therapies for infant colic, but additional rigorous studies of existing and alternative therapies are needed.

Colic↗
PubMed2001

What data determine whether a plant taxon is distinct enough to merit legal protection? A case study of Sedum integrifolium (Crassulaceae).

Measures of molecular and morphological genetic variation are often used to set conservation priorities and design management strategies for plant taxa. Evaluated together they can give insights into a taxon's evolutionary status that neither data type alone can achieve. We investigated the distinctness and variability of Sedum integrifolium ssp. leedyi, a federally and state-listed taxon, from its conspecific relatives using 33 random amplified polymorphic DNA (RAPD) markers (253 plants) and 37 morphological characters from 1308 common-garden-grown plants. We included S. integrifolium ssp. leedyi (four populations), its conspecific relatives (11 populations), and S. rosea and S. rhodanthum populations in our study. The morphological and molecular data correspond in showing that S. integrifolium ssp. leedyi populations are highly distinct. However, the data sets differ in their estimates of the relatedness of some S. integrifolium ssp. leedyi populations and in the percentage variation detected due to differences among them (25 and 9-13% for the molecular and morphological data, respectively) suggesting little gene flow among populations and some differentiation, possibly from selective pressures. Given our data, we recommend that S. integrifolium ssp. leedyi merits protection under the U.S. Endangered Species Act and that its populations be managed as distinct units.

Journal Article↗
PubMedDate not supplied

[Dental caries and socioeconomic conditions: a cross-sectional study among 18 years-old male in Florianópolis, Santa Catarina State, Brazil].

The aim of this study was to assess the prevalence and severity of dental caries and need for treatment among 18 years-old males in Florianópolis, Southern Brazil. In addition, the associations between dental caries and socioeconomic conditions were tested. A cross sectional study was carried out. A random sample of 300, was selected from a list of Brazilian Army conscripts. Clinical data were collected according to World Health Organization criteria. Socioeconomic data (years of education of the subjects, their fathers and mothers and family income) were collected through interviews. The statistical significance of associations between socioeconomic indicators and dental caries prevalence were tested using the chi-square test whilst for severity of dental caries Mann-Whitney test was used. The prevalence of dental caries was 81% and the mean DMF-T was 4.5. The mean number of teeth that needed treatment was 1.2. Both dental status and treatment need were statistically significantly associated with socioeconomic indicators. Those with low levels of education and income experienced more disease and needed more treatment than those from high levels of education and income.

Adolescent↗
PubMed2003

Hypertension in Ghana: a cross-sectional community prevalence study in greater Accra.

OBJECTIVES: To determine the prevalence of hypertension, and the extent to which it is treated and controlled, among adult Ghanaians. DESIGN: 6300 adults, aged 25 years and older, were selected by random cluster sampling, using electoral enumeration areas and listings of adults. SETTING: Three communities in the greater Accra region of Ghana. SUBJECTS AND METHODS: A total of 4733 subjects (male to female ratio = 1:1.5) participated, representing a response rate of 75%. The analysis used the mean of 2 blood pressure readings, taken with a mercury sphygmomanometer after a 10-minute rest. Hypertension was defined as having blood pressure > or = 140/90 mm Hg, or currently undergoing anti-hypertensive treatment. RESULTS: The mean ages for males and females were 44.9 +/- 14.7 years, and 44.0 +/- 14.6 years, respectively. The crude prevalence of hypertension was 28.3%. The age-standardized prevalence, to the new standard world population, was 28.4%. Mean systolic and diastolic blood pressures increased with age. Of 1337 subjects with hypertension, 34% were aware of their condition, 18% were treated, and 4% were controlled (blood pressure < 140/90 mm Hg). CONCLUSION: Hypertension is a major public health problem, and is associated with relatively low levels of awareness, drug treatment, and blood pressure control. Population-based prevention strategies, such as reduction in salt intake and integration of hypertension care into primary care, may prove beneficial; however, the determinants of hypertension remain to be ascertained.

Adult↗
PubMed2003

Risk factors for early-onset group B streptococcal disease in neonates: a population-based case-control study.

BACKGROUND: Infection with group B streptococcus (GBS) is a major cause of neonatal illness and death. We examined the antenatal and perinatal risk factors for early-onset GBS disease among neonates. METHODS: We identified cases by population-based surveillance in all microbiology laboratories serving Alberta. A case was defined as any instance of a positive sterile-site GBS culture in an infant born between 1993 and 1997 who was either less than 7 days old or stillborn after 20 weeks' gestation. We randomly selected controls from a computer-compiled list of all hospital births, including stillbirths after 20 weeks' gestation, in Alberta during the study period. To increase power, we chose 5 or 6 control infants born in the same year as each case infant. We reviewed hospital, prenatal clinic and physician health records and, between 1997 and 1999, conducted maternal interviews by telephone. RESULTS: There were no differences between the 90 cases and 489 controls in sociodemographic variables or in many reproductive and behavioural variables. Case infants were more likely than control infants to be of low birth weight (odds ratio [OR] 3.60, 95% confidence interval [CI] 1.68-7.65), to have been delivered preterm (OR 3.89, 95% CI 2.08-7.27), or to have a mother with amnionitis (OR 15.03, 95% CI 5.58-41.89), intrapartum fever (OR 4.65, 95% CI 2.48-8.69) or premature rupture of the membranes (OR 2.39, 95% CI 1.38-4.14). After adjustment for potential confounders, intrauterine fetal monitoring was associated with a more than 2-fold increase in the risk of neonatal GBS disease (OR 2.24, 95% CI 1.22-4.13). INTERPRETATION: Intrauterine fetal monitoring should be added to the list of risk factors in risk-based screening. Since many of the cases had no identifiable maternal risk factors, universal screening for GBS may be appropriate.

Alberta↗
PubMed2003

Obesity in adult residents of Accra, Ghana.

OBJECTIVES: To determine the prevalence of obesity in Ghanaian adults. DESIGN: 6300 adults, aged 25 years and older, were selected by random cluster sampling using electoral enumeration areas and listings of adults. SETTING: Two urban and one rural community in the Greater Accra region of Ghana. SUBJECTS AND METHODS: 4733 (males=1860, females=2873) adult Ghanaians participated. Height and weight were determined for subjects wearing light clothing and without shoes. RESULTS: The mean age and BMI were 44.3 years and 24.4 kg/m2, respectively. Women, though younger, had higher BMI values compared to males (25.6 vs 22.6 kg/m2, respectively; P<.001). The overall crude prevalence of overweight (25.0-29.9 kg/m2) and obesity (> or = 30 kg/m2) were 23.4% and 14.1% for females and males, respectively. The rates of overweight (27.1% vs 17.5%) and obesity (20.2% vs 4.6%) were both higher in women than men. The age-standardized prevalence of obesity in Ghanaians was 13.6%. Obesity increased with age, peaking in the 55-64-year age group. The first to fourth BMI quartiles were: < or = 20.6, 20.7-23.3, 23.4-27.2, and > or = 27.3 kg/m2, respectively. At all ages, more females (32.9%) than males (12%) were placed within the 4th BMI quartile. Residents from the high-class residential area had higher BMI, compared to subjects from the lower class suburb. Also, urban residents had higher BMI compared to rural subjects. CONCLUSION: Overweight and obesity are common in Ghanaians, particularly among females, the elderly, and urban dwellers. Further work is needed to ascertain the determinants of overweight and obesity in Ghanaians.

Adult↗
PubMedDate not supplied

Cigarette use among Arab Americans in the Detroit metropolitan area.

Use of cigarette tobacco by large proportions of the population of Middle Eastern countries has been reported; however, little is known about smoking behavior in one of America's fastest growing minorities, the Arab Americans. The purpose of this study was to examine cigarette smoking behavior of 237 randomly selected Arab American adults from a telephone listing in the Detroit area. Participants lived in the geographic Arab American community and identified with a Middle Eastern cultural heritage. Nurses, who spoke both English and Arabic, interviewed one adult family member using the 59-item self-report from the Cardiovascular Risk Factor Survey developed by Rice. Mean age of respondents was 40.4 years, 97 percent had been born in the Middle East, and 67 percent had been living in the United States 15 years or less. Current smokers rate was 38.9 percent, former smokers rate was 11.1 percent, never smokers rate was 50 percent, and the quit ratio (proportion of ever smokers who are former smokers) was 22.2 percent. Fifty-four percent of the current smokers were between 25 and 34 years of age; fewer women than men were former smokers, and the highest proportion of current smokers were Lebanese. Subjects who had smoked for the longest time were the least well educated. Arab Americans in this sample had a higher smoking rate, a lower quitting rate, and a much lower quit ratio when compared with national and State of Michigan data. With the growing numbers of Middle Eastern immigrants, there is potential for a dramatic increase in smoking-related health problems.

Adolescent↗
PubMed2004

Age and sex variation in measures of body composition among the elderly Bengalee Hindus of Calcutta, India.

In the present cross-sectional study we examined 332 (171 men and 161 women) elderly (60 years and above) urban Bengalee Hindu resident in south Calcutta, India. Individuals were selected by random sampling procedure using local voter's registration list. Skin folds measures were used to compute body composition measures among them. There existed significant sex differences in various anthropometric body composition measures. Age had significant (p < 0.001) negative association with all anthropometric body composition measures namely percentage of body fat (PBF), fat mass (FM), arm muscle circumference (AMC), arm muscle area (AMA) and arm fat area (AFA) in both sexes. Fat free mass (FFM) in contrast had negative but not significant age impact. Regression analyses demonstrated that age had explained substantial amount of variance of PBF (men = 32%; women = 18.2%), FM (men = 18.2%; women = 12.8%), AMC (men = 23.4%; women = 19.2%), AMA (men = 22.2%; women = 10.2%) and AFA (men = 34%; women = 31%) in both sexes. Two-way ANOVA revealed age-sex interaction only had significant effect on FFM. The present investigation vindicated that there is a significant inverse age trends in anthropometric body composition measures among the Bengalee Hindus. Moreover, there existed sexual dimorphism in the effect of age on various anthropometric body composition measures.

Aged↗
PubMed2006

Effects of socio-economic and behavioural characteristics in explaining central obesity--a study on adult Asian Indians in Calcutta, India.

The present cross-sectional study on adult Asian Indians in Calcutta, India was undertaken to look into the effects of socio-economic and behavioural characteristics in explaining waist-hip ratio (WHR). A total of 500 apparently healthy individuals (300 men and 200 women) were subjects in the study. A random sampling procedure using local voter's registration list was followed to select the subjects. Only one adult (> or = 30 years) from each household was considered as participant. A total of 24 items, 14 socio-economic and 10 behavioural characters were considered. For socio-economic characters, a number of items namely employment status, types of occupation, education status, nature of housing and marital status were taken into consideration. Smoking status, physical exercise by means of outdoor activity, drinking habits and diets on the other hand were considered as behavioural characters. Information on socio-economic and behavioural characteristics was collected using an open-ended schedule specifically designed in this regard. Anthropometric measures namely height, weight and circumference of waist and hip were obtained from participants using standard techniques. The median WHR for men and women was 0.94 and 0.90 respectively. Analysis of variance revealed significant sex difference for all anthropometric measures. It was observed that more women were leading sedentary (outdoor activity not housework was considered) life than men (85.4% vs. 75.4%). Furthermore, women were predominantly nonsmokers (98.8%) whereas 40.2% men were smokers as against 51.4% ex-smokers (those who have quitted smoking during past two years). Multiple regression analysis (adjusted for age and sex) of WHR by socio-economic and behavioural characters revealed that occupation, housing, marital status, smoking condition, physical exercise, drinking habits and diets pattern cumulatively explains 75% (R2=0.75) of total variation of WHR in the study population.

Adult↗
PubMed1991

Levamisole and 5-fluorouracil therapy for resected colon cancer: a new indication.

OBJECTIVE: To evaluate the benefits and risks of postoperative treatment with levamisole plus 5-fluorouracil (5-FU) in patients with colon cancer. DESIGN: Computerized searches of MEDLINE and CANCERLIT were performed, and the reference list of each retrieved article was checked. Only randomized trials of therapy with levamisole alone or combined with 5-FU for colon cancer without distant metastases were included. The studies were then evaluated with the use of four criteria. RESULTS: We reviewed six randomized trials, of which three satisfied our criteria. Two studies demonstrated a significant improvement in the survival rate with levamisole plus 5-FU among patients with colon cancer and pathologically confirmed metastases to adjacent lymph nodes (Dukes' stage C). A subgroup analysis in another study demonstrated a similar benefit. The toxic effects of the drugs were generally mild. The three other studies showed no difference in survival rates between the treatment groups; however, the samples were too small to detect a clinically or statistically important difference. CONCLUSIONS: Because many patients with colon cancer will suffer a relapse we recommend that they be offered the opportunity to participate in clinical trials of adjuvant therapy. For those with stage C disease not entering a clinical trial levamisole plus 5-FU is appropriate adjuvant therapy.

Colonic Neoplasms↗