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INTRODUCTION: The management of intracranial aneurysms has evolved in the recent years, and endovascular coiling has become the first treatment option in many countries. In Tunisia, this neuroendovascular treatment meets a progressive but slow development, slowed down, by the economic component. AIM: This study aimed to evaluate the global cost of endovascular treatment of cerebral aneurysms and determine the factors influencing the variation of direct medical cost. METHODS: A prospective study including patients who underwent interventional neuroradiology procedures for intracranial aneurysms between March 2019 and June 2019. Total cost (direct medical and non medical cost) was assessed using the micro-costing method. Statistical analysis (descriptive followed by a multivariate analysis) was performed by PSPP software with a p-value< 0.05 considered statistically significant. RESULTS: Twenty-nine patients were included (mean age 54±14 years). The average overall cost of treatment was 15 877 DT (5 081), ranging from 8 005 DT (2 562 ) to 36 325 DT (11 624 ). The average cost of medical devices used during the procedure was 13 548 DT (4 335 ) which represents 85.3% of the total cost. The direct medical cost was particularly influenced by aneurysm's and neck's size, and by the total cost of coils. CONCLUSIONS: The medical devices used during the procedure greatly influenced the direct medical cost of the management of intracranial aneurysms.
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Aneurisma Roto , Procedimientos Endovasculares , Aneurisma Intracraneal , Humanos , Adulto , Persona de Mediana Edad , Anciano , Aneurisma Intracraneal/cirugía , Estudios Prospectivos , Resultado del Tratamiento , Procedimientos Endovasculares/métodos , Costos y Análisis de CostoRESUMEN
Hormone receptor-positive (HR+) breast cancers express the estrogen (ERα) and/or progesterone (PgR) receptors. Inherited single nucleotide polymorphisms (SNPs) in ESR1, the gene encoding ERα, have been reported to predict tamoxifen effectiveness. We hypothesized that these associations could be attributed to altered tumor gene/protein expression of ESR1/ERα and that SNPs in the PGR gene predict tumor PGR/PgR expression. Formalin-fixed paraffin-embedded breast cancer tumor specimens were analyzed for ESR1 and PGR gene transcript expression by the reverse transcription polymerase chain reaction based Oncotype DX assay and for ERα and PgR protein expression by immunohistochemistry (IHC) and an automated quantitative immunofluorescence assay (AQUA). Germline genotypes for SNPs in ESR1 (n = 41) and PGR (n = 8) were determined by allele-specific TaqMan assays. One SNP in ESR1 (rs9322336) was significantly associated with ESR1 gene transcript expression (P = 0.006) but not ERα protein expression (P > 0.05). A PGR SNP (rs518162) was associated with decreased PGR gene transcript expression (P = 0.003) and PgR protein expression measured by IHC (P = 0.016), but not AQUA (P = 0.054). There were modest, but statistically significant correlations between gene and protein expression for ESR1/ERα and PGR/PgR and for protein expression measured by IHC and AQUA (Pearson correlation = 0.32-0.64, all P < 0.001). Inherited ESR1 and PGR genotypes may affect tumor ESR1/ERα and PGR/PgR expression, respectively, which are moderately correlated. This work supports further research into germline predictors of tumor characteristics and treatment effectiveness, which may someday inform selection of hormonal treatments for patients with HR+ breast cancer.
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Neoplasias de la Mama/genética , Receptor alfa de Estrógeno/genética , Regulación de la Expresión Génica/genética , Polimorfismo de Nucleótido Simple/genética , Receptores de Progesterona/genética , Alelos , Femenino , Expresión Génica/genética , Genotipo , Humanos , Estudios ProspectivosRESUMEN
The impact of religiosity in adolescent romantic partnerships on sexual behavior was assessed. Data were obtained from the National Longitudinal Study of Adolescent Health reciprocated couples database using religious- and relationship-oriented variables to predict sexual involvement in 374 couples (748 participants). We found that individual- and couple-based religiosity impacted sexual behavior. These findings provide evidence for dyad religiosity as a component involved in the expression of sexual behavior in romantic relationships. The current results highlight the importance of incorporating a broad social perspective in order to understand the expression of adolescent sexual behavior.
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Religión y Sexo , Conducta Sexual , Sexualidad/psicología , Adolescente , Niño , Cortejo , Bases de Datos Factuales , Femenino , Humanos , Estudios Longitudinales , Masculino , Investigación Cualitativa , Conducta Sexual/estadística & datos numéricos , Encuestas y Cuestionarios , Estados Unidos , Adulto JovenRESUMEN
Most models exploring adolescent health behavior have focused on individual influences to understand behavior change. The goal of the current study was to assess the role of adolescent romantic partners on the expression of health behavior. Our sample utilized two waves of data from the U.S. National Longitudinal Study of Adolescent Health, which included 80 romantic dyads (160 individuals). A longitudinal multilevel analysis was conducted. We assessed individual and romantic partner health-harming behaviors (i.e., delinquency, alcohol use, smoking, and marijuana use), health-protective behaviors (i.e., physical activity, physical inactivity, sleep patterns, seatbelt use, and contraception motivations), as well as the role of gender and age. Participants average age was 16 years at baseline. We found evidence for partner similarity and partner influence with the majority of health-harming behaviors. Specifically, partner influence was evident for smoking and alcohol use with partner influence approaching significance for marijuana use. We found limited evidence for partner similarity and partner influence for health-protective behaviors. The importance of assessing romantic dyads was evident in these data. Interventions focusing on health-harming behavior for adolescent populations are important public health goals. It is recommended that future intervention efforts with adolescent health-harming behaviors should target not only peers, but also consider the role of romantic partners.
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Conducta del Adolescente , Conductas Relacionadas con la Salud , Grupo Paritario , Asunción de Riesgos , Parejas Sexuales , Adolescente , Femenino , Humanos , Estudios Longitudinales , Masculino , Estados UnidosRESUMEN
PURPOSE: Aromatase inhibitors (AIs) are effective for treatment of hormone receptor-positive breast cancer, but adherence and persistence with therapy are poor. Predictors of treatment discontinuation are not clearly defined. It is unknown whether patients with intolerable toxicity from one AI are able to tolerate another. PATIENTS AND METHODS: Women with early-stage breast cancer initiating AI therapy were enrolled onto a multicenter, prospective, open-label randomized trial of exemestane versus letrozole. Patients completed symptom questionnaires at baseline and serially during therapy. Patients who developed AI-associated intolerable symptoms and discontinued treatment were given the option to switch to the other study AI after a 2- to 8-week washout period. RESULTS: Of the 503 enrolled women, 32.4% discontinued initial AI therapy within 2 years because of adverse effects; 24.3% discontinued specifically because of musculoskeletal symptoms. Median time to treatment discontinuation as a result of any symptom was 6.1 months (range, 0.1 to 21.2 months) and was significantly shorter in patients randomly assigned to exemestane (hazard ratio [HR], 1.5; 95% CI, 1.1 to 2.1; P = .02). Younger age and taxane-based chemotherapy were associated with higher likelihood of treatment discontinuation (HR, 1.4; 95% CI, 1.02 to 1.9; P = .04; and HR, 1.9; 95% CI, 1.00 to 3.6; P = .048, respectively). Of the 83 patients who chose to switch to the second AI, 38.6% continued the alternate AI for a median of 13.7 months. CONCLUSION: Premature discontinuation of initial AI therapy as a result of symptoms is common, although more than one third of patients may be able to tolerate a different AI medication. Additional research is needed to identify predictive tools and interventions for AI-associated treatment-emergent symptoms.
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Androstadienos/uso terapéutico , Inhibidores de la Aromatasa/uso terapéutico , Neoplasias de la Mama/tratamiento farmacológico , Cumplimiento de la Medicación , Neoplasias Hormono-Dependientes/tratamiento farmacológico , Nitrilos/uso terapéutico , Triazoles/uso terapéutico , Privación de Tratamiento , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/patología , Comorbilidad , Femenino , Estudios de Seguimiento , Humanos , Letrozol , Persona de Mediana Edad , Neoplasias Hormono-Dependientes/patología , Pronóstico , Estudios ProspectivosRESUMEN
CONTEXT: The childhood precursors of adult bipolar disorder (BP) are still a matter of controversy. OBJECTIVE: To report the lifetime prevalence and early clinical predictors of psychiatric disorders in offspring from families of probands with DSM-IV BP compared with offspring of control subjects. DESIGN: A longitudinal, prospective study of individuals at risk for BP and related disorders. We report initial (cross-sectional and retrospective) diagnostic and clinical characteristics following best-estimate procedures. SETTING: Assessment was performed at 4 university medical centers in the United States between June 1, 2006, and September 30, 2009. PARTICIPANTS: Offspring aged 12 to 21 years in families with a proband with BP (n = 141, designated as cases) and similarly aged offspring of control parents (n = 91). MAIN OUTCOME MEASURE: Lifetime DSM-IV diagnosis of a major affective disorder (BP type I; schizoaffective disorder, bipolar type; BP type II; or major depression). RESULTS: At a mean age of 17 years, cases showed a 23.4% lifetime prevalence of major affective disorders compared with 4.4% in controls (P = .002, adjusting for age, sex, ethnicity, and correlation between siblings). The prevalence of BP in cases was 8.5% vs 0% in controls (adjusted P = .007). No significant difference was seen in the prevalence of other affective, anxiety, disruptive behavior, or substance use disorders. Among case subjects manifesting major affective disorders (n = 33), there was an increased risk of anxiety and externalizing disorders compared with cases without mood disorder. In cases but not controls, a childhood diagnosis of an anxiety disorder (relative risk = 2.6; 95% CI, 1.1-6.3; P = .04) or an externalizing disorder (3.6; 1.4-9.0; P = .007) was predictive of later onset of major affective disorders. CONCLUSIONS: Childhood anxiety and externalizing diagnoses predict major affective illness in adolescent offspring in families with probands with BP.
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Trastorno Bipolar/etiología , Trastornos del Humor/etiología , Adolescente , Trastorno Bipolar/psicología , Estudios de Casos y Controles , Niño , Trastorno Depresivo Mayor/etiología , Trastorno Depresivo Mayor/psicología , Femenino , Humanos , Estimación de Kaplan-Meier , Estudios Longitudinales , Masculino , Trastornos del Humor/psicología , Escalas de Valoración Psiquiátrica , Trastornos Psicóticos/etiología , Trastornos Psicóticos/psicología , Riesgo , Factores de RiesgoRESUMEN
BACKGROUND: Variation in polyp detection among endoscopists has been used to justify the need for establishing quality standards for colonoscopy performance. OBJECTIVE: To measure variation in polyp detection rates (PDRs) among endoscopists who perform screening colonoscopy and to identify associated factors. DESIGN: Cross-sectional analysis of summary-level data. SETTING: Endoscopy practices in central Indiana. SUBJECTS: Twenty-five endoscopists and their patients. MAIN OUTCOME MEASUREMENTS: Mean procedure time (MPT); proportions of patients with any polyp, any adenoma, any polyp > or =1.0 cm, and multiple adenomas; and variation in PDRs and identification of outliers. Multiple linear regression analysis identified factors that accounted for the variation in PDRs. RESULTS: A total of 2664 screening colonoscopies (1108 women and 1556 men) were performed. The mean patient age was 59 years; the mean proportion of women was 42%; the MPT was 17.1 minutes. Adenoma detection rates ranged from 7% to 44% (P < .001) and from 0% to 13% for large polyps, which was not statistically significant (P = .07). For all polyp categories, only 1 to 3 high outlier endoscopists (ie, higher than mean PDRs) were identified. Models that included the number of procedures, mean age, percentage of women, and MPT accounted for 36% to 56% of the variation in PDRs. In all models, only MPT was significantly associated with PDRs. LIMITATIONS: Whether each endoscopist's cohort was at comparable risk for colorectal neoplasia was uncertain. In comparison with individual-level data, analysis of summary-level data is limited. CONCLUSIONS: PDRs vary widely among endoscopists, although only a few (high) outliers were identified. Variation in PDRs was associated only with MPT. Further research is needed to determine the clinical importance of and reasons for this variation.
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Adenoma/diagnóstico , Pólipos del Colon/diagnóstico , Colonoscopía/normas , Neoplasias Colorrectales/diagnóstico , Competencia Clínica , Estudios Transversales , Detección Precoz del Cáncer , Femenino , Humanos , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Calidad de la Atención de Salud , Estudios RetrospectivosRESUMEN
OBJECTIVE: Hot flashes are valuable indicators of physiological condition and drug effect; however, subjective and objective measures do not always agree. No study has examined both subjective and objective hot flashes in women prescribed aromatase inhibitors. The study (1) compared subjective and objective hot flash measures, (2) examined changes in subjective and objective hot flashes over time, and (3) evaluated predictors of change in hot flashes in aromatase inhibitor-treated women. METHODS: Participants (n = 135) were enrolled in a randomized clinical trial comparing exemestane and letrozole for the treatment of breast cancer. Hot flashes were assessed before the start of the drug therapy and 1, 3, and 6 months later. Participants wore a sternal skin conductance monitor for 24 hours or longer at each time point. With each perceived hot flash, women pressed an event button and rated intensity and bother in a paper diary. RESULTS: Participants had a mean age of 60 years and were mainly white (92%). Across time points, monitor hot flashes were (1) significantly more frequent than diary and/or event button flashes (P < 0.05) and (2) moderately correlated with subjective measures (0.35 < r < 0.56). Monitor hot flashes did not significantly change over time with aromatase inhibitor therapy, whereas both diary and event button frequencies significantly varied but in dissimilar patterns (51% nonlinear). No consistent predictors of hot flashes across measures or time points were identified. CONCLUSIONS: Findings indicated dissimilarities between subjective and objective measures of hot flashes. Despite statistical significance, there was little clinically meaningful change in hot flashes after initiating aromatase inhibitor therapy.
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Inhibidores de la Aromatasa/uso terapéutico , Neoplasias de la Mama/tratamiento farmacológico , Sofocos/fisiopatología , Androstadienos/efectos adversos , Androstadienos/uso terapéutico , Inhibidores de la Aromatasa/efectos adversos , Índice de Masa Corporal , Neoplasias de la Mama/fisiopatología , Femenino , Respuesta Galvánica de la Piel , Sofocos/inducido químicamente , Humanos , Letrozol , Modelos Lineales , Persona de Mediana Edad , Nitrilos/efectos adversos , Nitrilos/uso terapéutico , Sensibilidad y Especificidad , Triazoles/efectos adversos , Triazoles/uso terapéuticoRESUMEN
Women with reduced CYP2D6 activity have low endoxifen concentrations and likely worse long term benefits from tamoxifen. We investigated the association between CYP2D6 genotype and tamoxifen-induced hot flashes in a prospective cohort. We collected hot flash frequency and severity data over 12 months from 297 women initiating tamoxifen. We performed CYP2D6 genotyping using the AmpliChip CYP450 test and correlated inherited genetic polymorphisms in CYP2D6 and tamoxifen-induced hot flashes. Intermediate metabolizers had greater mean hot flash scores after 4 months of tamoxifen therapy (44.3) compared to poor metabolizers (20.6, P = 0.038) or extensive metabolizers (26.9, P = 0.011). At 4 months, we observed a trend toward fewer severe hot flashes in poor metabolizers compared to intermediate plus extensive metabolizers (P = 0.062). CYP2D6 activity may be a modest predictive factor for tamoxifen-induced hot flashes. The presence or absence of hot flashes should not be used to determine tamoxifen's efficacy.
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Citocromo P-450 CYP2D6/genética , Predisposición Genética a la Enfermedad , Sofocos/genética , Moduladores Selectivos de los Receptores de Estrógeno/efectos adversos , Tamoxifeno/efectos adversos , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/prevención & control , Estudios de Cohortes , Femenino , Genotipo , Sofocos/inducido químicamente , Humanos , Polimorfismo GenéticoRESUMEN
In translational research, a genetic association study of a binary outcome has a twofold aim: test whether genetic/environmental variables or their combinations are associated with a clinical phenotype, and determine how those combinations are grouped to predict the phenotype (i.e., which combinations have a similarly distributed phenotype, and which ones have differently distributed phenotypes). The second part of this aim has high clinical appeal, because it can directly facilitate clinical decisions. Although traditional logistic regression can detect gene-gene or gene-environmental interaction effects on binary phenotypes, they cannot decisively determine how genotype combinations are grouped to predict the phenotype. Our proposed mixture model approach is valuable in this context. It concurrently detects main and interaction effects of genetic and environmental variables through a likelihood ratio test (LRT) and conducts phenotype cluster analysis based on genetic and environmental variable combinations. The theoretical distribution of the proposed mixture model's likelihood ratio test is robust not only to small sample size but also to unequal sample size in various genotype and environmental subgroups. Hypothesis testing through a likelihood ratio test results in a fast algorithm for p-value calculations. Extensive simulation studies demonstrate that mixture model, overall test in logistic regression, and Monte Carlo based logic regression constantly possess the best power to detect multi-way gene/environmental combinations. The mixture model approach has the highest recovery probability to recover the true partition in the simulation studies. Its applications are exemplified in interim data analyses for two cancer studies.
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Ambiente , Genotipo , Modelos Genéticos , Modelos Estadísticos , Farmacogenética/estadística & datos numéricos , Fenotipo , Algoritmos , Antineoplásicos/farmacocinética , Antineoplásicos/uso terapéutico , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/genética , Neoplasias de la Mama/metabolismo , Análisis por Conglomerados , Simulación por Computador , Docetaxel , Femenino , Regulación Neoplásica de la Expresión Génica , Humanos , Funciones de Verosimilitud , Modelos Logísticos , Masculino , Método de Montecarlo , Neoplasias de la Próstata/tratamiento farmacológico , Neoplasias de la Próstata/genética , Neoplasias de la Próstata/metabolismo , Reproducibilidad de los Resultados , Tamoxifeno/efectos adversos , Tamoxifeno/farmacocinética , Taxoides/farmacocinética , Taxoides/uso terapéutico , Resultado del TratamientoRESUMEN
The purpose of this secondary analysis was to describe the relationships of friend, family, and health care provider social support to pain, fatigue, depressed mood, and insomnia in adolescents and young adults with cancer using the Adolescent Resilience Model. Specific aims of the study were to describe the relationships of 3 separate sources of perceived support-friends, family, and health care providers to the symptom-related distress of pain, fatigue, depressed mood, and insomnia.
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Neoplasias/fisiopatología , Neoplasias/psicología , Apoyo Social , Adolescente , Adulto , Depresión , Familia , Fatiga , Amigos , Humanos , Dolor , Trastornos del Inicio y del Mantenimiento del SueñoRESUMEN
The frequency of cerebral palsy, degree of disability, and predictors of disability were assessed in children in a perinatal arterial stroke database. Risk factors were assessed at the univariate level using the Pearson chi(2) and Fisher exact test and at the multivariate level using logistic regression analysis. Seventy-six of 111 children with perinatal stroke (68%) had cerebral palsy, most commonly hemiplegic (66/76; 87%). Multivariate analysis of the entire cohort showed both delayed presentation (OR,9.96; 95% CI, 3.10-32.02) and male sex (OR, 2.55; 95% CI, 1.03-6.32) were associated with cerebral palsy. In subgroup multivariate analyses: in children with neonatal presentation, bilateral infarcts were associated with triplegia or quadriplegia (OR, 5.33; 95% CI, 1.28-22.27); in children with unilateral middle cerebral artery infarcts, delayed presentation (OR, 10.60; 95% CI, 2.28-72.92) and large-branch infarction (OR, 8.78; 95% CI, 2.18-43.67) were associated with cerebral palsy. These data will aid physicians in planning long-term rehabilitative care for children with perinatal stroke.
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Isquemia Encefálica/complicaciones , Infarto Cerebral/complicaciones , Parálisis Cerebral/etiología , Niños con Discapacidad , Accidente Cerebrovascular/complicaciones , Isquemia Encefálica/epidemiología , Arterias Cerebrales/patología , Infarto Cerebral/epidemiología , Parálisis Cerebral/epidemiología , Distribución de Chi-Cuadrado , Preescolar , Estudios de Cohortes , Evaluación de la Discapacidad , Femenino , Lateralidad Funcional , Hemiplejía/epidemiología , Hemiplejía/etiología , Humanos , Indiana/epidemiología , Lactante , Recién Nacido , Modelos Logísticos , Masculino , Estudios Retrospectivos , Accidente Cerebrovascular/epidemiologíaRESUMEN
BACKGROUND: Coping theorists argue that environmental factors affect how children perceive and respond to stressful events such as cancer. However, few studies have investigated how particular interventions can change coping behaviors. The active music engagement (AME) intervention was designed to counter stressful qualities of the in-patient hospital environment by introducing three forms of environmental support. METHOD: The purpose of this multi-site randomized controlled trial was to determine the efficacy of the AME intervention on three coping-related behaviors (i.e. positive facial affect, active engagement, and initiation). Eighty-three participants, ages 4-7, were randomly assigned to one of three conditions: AME (n = 27), music listening (ML; n = 28), or audio storybooks (ASB; n = 28). Conditions were videotaped to facilitate behavioral data collection using time-sampling procedures. RESULTS: After adjusting for baseline differences, repeated measure analyses indicated that AME participants had a significantly higher frequency of coping-related behaviors compared with ML or ASB. Positive facial affect and active engagement were significantly higher during AME compared with ML and ASB (p<0.0001). Initiation was significantly higher during AME than ASB (p<0.05). CONCLUSION: This study supports the use of the AME intervention to encourage coping-related behaviors in hospitalized children aged 4-7 receiving cancer treatment.
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Adaptación Psicológica , Musicoterapia , Neoplasias/psicología , Rol del Enfermo , Afecto , Niño , Preescolar , Femenino , Hospitalización , Humanos , Masculino , Neoplasias/terapia , Conducta Social , Medio Social , Resultado del TratamientoRESUMEN
BACKGROUND: Patients receiving intensive chemotherapy can experience increased distressed related to both the cancer diagnosis and treatment isolation. If not addressed, distress can lead to anxiety, depression, and post-traumatic stress disorder. The purpose of this study was to determine the feasibility and possible benefits of a music imagery intervention for patients hospitalized in a protective environment for the treatment of acute leukemia or high-grade non-Hodgkin's lymphoma. MATERIALS AND METHODS: Adults receiving intensive myelosuppressive chemotherapy in a protective environment were randomized to standard care or standard care plus music imagery. The music imagery sessions occurred twice weekly for up to eight sessions. Patients were encouraged to use the music imagery daily. RESULTS: The principal criteria of feasibility were rate of consent, rate of completion of scheduled sessions, and rate of questionnaire completion. Forty-nine out of 78 patients consented, a 63% consent rate. Seventy-two percent of all scheduled music imagery sessions were completed. The rate of questionnaire completion was 60% with missing data because of illness severity and early discharge. The principal outcomes of benefit (e.g., efficacy) were positive and negative affects, fatigue, and anxiety. Both groups improved over time on all outcomes (all p < 0.001). However, a subgroup of individuals with low baseline negative affect who received the intervention reported significantly less anxiety at discharge than individuals with low baseline negative affect who did not receive the intervention. CONCLUSIONS: Music imagery is feasible for adults with acute leukemia in protected environments. Patients with lower initial distress may benefit from a music imagery program in terms of reduced anxiety at discharge.
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Ansiedad/psicología , Imágenes en Psicoterapia , Leucemia/psicología , Linfoma no Hodgkin/psicología , Musicoterapia , Enfermedad Aguda , Adulto , Afecto , Anciano , Fatiga , Estudios de Factibilidad , Femenino , Neoplasias Hematológicas , Humanos , Leucemia/tratamiento farmacológico , Linfoma no Hodgkin/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Terapia por Relajación , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios , Resultado del TratamientoRESUMEN
The association of cerebral palsy with other disabilities in children with perinatal stroke has not been well-studied. We examined this association in 111 children with perinatal stroke: 67 with neonatal presentation, and 44 with delayed presentation. Seventy-six children (68%) had cerebral palsy, which was hemiplegic in 66 and tri- or quadriplegic in 10. Fifty-five (72%) children with cerebral palsy had at least one other disability: 45 (59%) had a cognitive/speech impairment (moderate-severe in 20), and 36 (47%) had epilepsy (moderate-severe in 11). In children with neonatal presentation, cerebral palsy was associated with epilepsy (P = 0.0076) and cognitive impairment (P = 0.0001). These associations could not be tested in children with delayed presentation because almost all children in this group had cerebral palsy. In another analysis with multivariate logistic regression for children with cerebral palsy, children who had both neonatal presentation and history of cesarean-section delivery were more likely to have epilepsy (P = 0.001). Children with cerebral palsy after perinatal stroke who had neonatal presentation were more likely to have severe cognitive impairment (odds ratio, 7.78; 95% confidence interval, 1.80-47.32) or severe epilepsy (odds ratio, 6.64; 95% confidence interval, 1.21-69.21) than children with delayed presentation. Children with cerebral palsy after perinatal stroke are likely to have an additional disability; those with neonatal presentation are more likely to have a severe disability.
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Isquemia Encefálica/complicaciones , Parálisis Cerebral/complicaciones , Parálisis Cerebral/etiología , Accidente Cerebrovascular/etiología , Isquemia Encefálica/diagnóstico por imagen , Cesárea/efectos adversos , Trastornos del Conocimiento/etiología , Bases de Datos Factuales , Epilepsia/etiología , Humanos , Recién Nacido , Radiografía , Factores de RiesgoRESUMEN
BACKGROUND: In the elderly, the increased prevalence of colorectal neoplasia and the protective effect of colonoscopy may be offset by advancing age and comorbidity. OBJECTIVE: To describe and quantify the endoscopic findings, survival, and predictors of mortality of elderly persons after colonoscopy. DESIGN, SETTING, AND PATIENTS: Retrospective cohort study of persons aged>or=75 years who underwent colonoscopy in 1999 and 2000 at a U.S. Veterans Affairs facility and urban county hospital. MAIN OUTCOME MEASURES: Advanced neoplasms were defined as colorectal cancer (CRC), polyp with high-grade dysplasia, villous histologic features, or tubular adenoma>or=1 cm. Comorbidity was measured with the Charlson comorbidity index. Subjects were followed until death or study closure. RESULTS: Of 469 eligible subjects, 65 were excluded and 404 were included in the study. Fifty-nine of 404 (15%) had an advanced neoplasm, including 8 (2%) with CRC. There were 167 deaths (41%); the mean overall survival was 4.1+/-0.1 years (median 5.95 years). A symptomatic indication for colonoscopy was not predictive of death. Mortality was predicted by age (hazard ratio 1.16 for each year increase beyond age 75 years, 95% CI 1.07-1.3, P=.0003) and Charlson score (hazard ratio 8.3 for each point increase, 95% CI 1.4-48.5, P=.02). The median survival of patients aged 75 to 79 years was >5 years if the Charlson score was
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Causas de Muerte , Colonoscopía , Neoplasias Colorrectales/mortalidad , Tamizaje Masivo , Adenoma Velloso/diagnóstico , Adenoma Velloso/mortalidad , Adenoma Velloso/patología , Adenoma Velloso/cirugía , Factores de Edad , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Pólipos del Colon/diagnóstico , Pólipos del Colon/mortalidad , Pólipos del Colon/patología , Pólipos del Colon/cirugía , Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/patología , Neoplasias Colorrectales/cirugía , Comorbilidad , Femenino , Humanos , Tablas de Vida , Masculino , Estadificación de Neoplasias , Sangre Oculta , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Factores de Riesgo , Análisis de SupervivenciaRESUMEN
The Herth Hope Index (HHIndex), originally developed for adults, was examined for appropriateness in two studies of adolescents and young adults with cancer-those at various stages of treatment (N = 127) and those newly diagnosed (N = 74). The internal consistency reliability (Cronbach's alpha) of the index was .84 and .78, respectively, in the two samples. Construct validity was supported by discriminant correlations in the moderate to low range between the HHIndex and measures of uncertainty in illness and symptom distress, and by moderate convergent correlations with measures of resilience (self-esteem, self-confidence, and self-transcendence) and quality of life (index of well-being). A four-step factor analysis procedure was done, and confirmatory factor analysis suggested that a one-factor solution best fit the data in this population. Findings indicate that the HHIndex is a reliable measure of hope in adolescents and young adults with cancer. Evidence of discriminant and convergent validity in measuring hope in adolescents and young adults with cancer was also generated. Further exploration of the HHIndex factor structure in adolescents and young adults is needed.
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Actitud Frente a la Salud , Moral , Neoplasias/psicología , Encuestas y Cuestionarios/normas , Adaptación Psicológica , Adolescente , Adulto , Análisis Discriminante , Análisis Factorial , Femenino , Objetivos , Humanos , Estudios Longitudinales , Masculino , Modelos Psicológicos , América del Norte , Evaluación en Enfermería/métodos , Investigación en Evaluación de Enfermería , Psicometría , Calidad de Vida/psicología , Religión y Psicología , Autoeficacia , IncertidumbreRESUMEN
BACKGROUND: Uncertainty about the outcome of acute upper gastrointestinal bleeding often results in a longer-than-necessary hospital stay. METHODS: We derived and internally validated clinical prediction rules (CPRs) to predict outcome from upper gastrointestinal bleeding. This multisite, prospective cohort study involved consecutive patients admitted for acute upper gastrointestinal bleeding. Multivariate logistic regression was used to derive CPRs on two thirds of the cohort (derivation set) that predicted bleeding-specific outcomes (rebleeding, need for urgent surgery, or hospital death [poor outcome 1]) and bleeding-specific outcomes plus new or worsening comorbidity (poor outcome 2). Both CPRs were then tested on the remaining third of the cohort (validation set). RESULTS: A total of 391 individuals (99% men; mean age, 63.4 years) were enrolled, of which 4.6% rebled and 3.1% died. Independent predictors of poor outcome 1 were APACHE (Acute Physiology and Chronic Health Evaluation) II score of 11 or greater, esophageal varices, and stigmata of recent hemorrhage. Predictors of poor outcome 2 were these 3 factors plus unstable comorbidity on admission. Of patients with no risk factors, only 1 (1.1%) of 92 experienced poor outcome 1 and only 6 (6.2%) of 97 experienced poor outcome 2. Risks in the validation set were comparable. The CPRs identified 37.8% and 32.2% of patients in the derivation and validation sets, respectively, who were eligible for a shorter hospital stay. CONCLUSIONS: Patients admitted with acute upper gastrointestinal bleeding were unlikely to have a poor outcome if these risk factors were absent. These CPRs might make hospital management more efficient by identifying low-risk patients for whom early hospital discharge is possible.
Asunto(s)
Hemorragia Gastrointestinal , Enfermedad Aguda , Anciano , Endoscopía Gastrointestinal , Femenino , Estudios de Seguimiento , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/mortalidad , Hemorragia Gastrointestinal/terapia , Mortalidad Hospitalaria , Humanos , Indiana/epidemiología , Tiempo de Internación , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos , Recurrencia , Factores de Riesgo , Índice de Severidad de la Enfermedad , Tasa de Supervivencia , Washingtón/epidemiologíaRESUMEN
BACKGROUND: Although venlafaxine reduces self-reported hot flashes, no data have established the drug's impact on physiologically documented hot flashes. Two randomized, double-blind, placebo-controlled crossover trials examined the efficacy of two doses of venlafaxine in relation to physiological and self-reported hot flashes and other outcomes, including negative affect, fatigue, sleep, and quality of life. SAMPLE: 57 breast cancer survivors in the low-dose study; 20 in the high-dose study. SETTING: university cancer clinics in the Southeast and Midwest. INTERVENTION: 37.5 mg of venlafaxine (low-dose study) or 75 mg of venlafaxine (high-dose study). MEASURES: hot flash frequency (physiological monitor, diary, and event marker), hot flash severity (diary), hot flash bother (diary), and questionnaires for hot flash impact on daily life, negative affect, fatigue, sleep, and quality of life. RESULTS: Subjective but not physiological hot flash measures showed placebo effects. Venlafaxine resulted in modest decreases in hot flashes, but only hot flash interference improved differentially at the higher dose. The timing of venlafaxine's effects on hot flashes varied by dose. Only women with a > or =50% decrease in physiological hot flashes experienced significant improvement in fatigue, sleep quality, and quality of life. Although side effects were mild, most patients discontinued venlafaxine long-term. CONCLUSIONS: Although venlafaxine resulted in modest and acute reductions in hot flashes with few side effects, it may not be tolerable to some patients long-term. At least 50% relief in physiological hot flashes may be needed for patients to demonstrate improvement in other outcomes, including decreased fatigue, improved sleep, and improved quality of life.
Asunto(s)
Neoplasias de la Mama/complicaciones , Ciclohexanoles/uso terapéutico , Sofocos/tratamiento farmacológico , Inhibidores Selectivos de la Recaptación de Serotonina/uso terapéutico , Adulto , Supervivencia sin Enfermedad , Método Doble Ciego , Femenino , Sofocos/etiología , Humanos , Placebos , Resultado del Tratamiento , Clorhidrato de VenlafaxinaRESUMEN
PURPOSE: Research on prostate cancer and quality of life (QOL) has focused on the effects of treatment type on subsequent QOL, without considering effects of depressive symptoms. The present purpose is to test the independent contribution of depressive symptoms (measured within 4 weeks after treatment) and treatment type in predicting QOL measured 4, 7, and 12 months following treatment for clinically localized prostate cancer. METHODS: The 105 patients (all Stage I-II) were newly treated with radical prostatectomy, external beam radiation (EBR) or brachytherapy. Age ranged from 42 to 80 (mean = 64); 88% Caucasian and 9% African American. Repeated measures mixed linear models were adjusted for age, race, education, and marital status. RESULTS: Depressive symptoms significantly (p < 0.01) predicted 8 of 10 disease-specific and 7 of 7 generic QOL outcomes. Treatment type significantly (p < 0.01) predicted urinary function and bowel bother but no generic QOL outcomes. CONCLUSIONS: Depressive symptoms appears to predict a wider range of QOL outcomes (measured 4-12 months after treatment) than treatment type; however, when treatment is significant its effect sizes are slightly larger than depressive symptoms. Health care providers should (1) assess depressive symptoms in prostate cancer patients before and after treatment, and (2) provide psychosocial (e.g., counseling, support groups) and pharmacologic treatment options for improving depressive symptoms.