RESUMEN

OBJECTIVE: To identify how demographic factors, stone-associated medical comorbidities, and treatment predict compliance with 24-hour urine collection. MATERIALS AND METHODS: A retrospective medical record review of patients treated for urolithiasis between August 2014 and March 2017 was performed. Patient demographics, medical characteristics, stone factors, type of treatment, and compliance data were included for patients requested to submit a collection. Variables that were statistically significant on bivariate analysis were then used to formulate a model predicting submission of a 24-hour urine sample. RESULTS: Of the 303 patients who met inclusion criteria, 183 (60.4%) submitted an initial 24-hour urine collection. On bivariate analysis, patients older than 50 were more likely to submit a 24-hour urine collection (71.4% vs 51.5%; P <.001), patients with a metabolic predisposition for stones were more likely to submit a 24-hour urine collection (70.6% vs 53.1%; P <.003), and patients who did not have surgery were more likely to submit a 24-hour urine collection (97.9% vs 53.5%; P <.001). Our 3-variable prediction model found that not undergoing surgery was a strong predictor of 24-hour urine collection. CONCLUSIONS: We suspect that patients perceive surgery as a more definitive treatment for kidney stones than conservative management. Patient education on the natural history and role of metabolic management in the prevention of nephrolithiasis is essential in improving compliance with 24-hour urine collection.

Asunto(s)

RESUMEN

BACKGROUND: While much effort has been devoted to correcting intraoperative hypothermia, less attention has been directed to preventing redistribution hypothermia. In this study, we compared three different anesthetic induction techniques to standard IV propofol inductions (control) in their effect on reducing redistribution hypothermia. METHODS: Elective, afebrile patients, age 18 to 55 years, were randomly assigned to one of four groups (n = 50 each). Group "INH/100" was induced with 8% sevoflurane in 100% oxygen, Group "INH/50" with 8% sevoflurane in 50% oxygen and 50% nitrous oxide, Group "PROP" with 2.2 mg/kg propofol, and Group "Phnl/PROP" with 2.2 mg/kg propofol immediately preceded by 160 mcg phenylephrine. Patients were maintained with sevoflurane in 50% nitrous oxide and 50% oxygen in addition to opioid narcotic. Forced air warming was used. Core temperatures were recorded every 15 min after induction for 1 h. RESULTS: Compared to control group PROP, the mean temperatures in groups INH/100, INH/50, and Phnl/PROP were higher 15, 30, 45 and 60 min after induction (p < 0.001 for all comparisons), averaging between 0.39 °C and 0.54 °C higher. In group PROP, 60% of patients had at least one temperature below 36.0 °C in the first hour whereas only 16% did in each of groups INH/100, INH/50, and Phnl/PROP (p < 0.0001 in each group compared to PROP). CONCLUSIONS: In this effectiveness trial, inhalation inductions with sevoflurane or with prophylactic phenylephrine bolus prior to propofol induction reduced the magnitude of redistribution hypothermia by an average of 0.4 to 0.5 °C in patients aged 18 to 55 years. TRIAL REGISTRATION: Retrospectively registered on clinical-trials.gov as NCT02331108 , November 20, 2014.

Asunto(s)

RESUMEN

PURPOSE: Results of a study to determine whether routine use of a multifaceted medication-focused intervention at a safety-net hospital was feasible and could reduce hospital readmissions in a Medicare fee-for-service population are reported. METHODS: A quality-improvement cohort study of 1,059 admissions of 667 patients at an inner-city hospital was conducted. Patients in the intervention groups received some or all components of the multifaceted "Medication REACH" intervention, with direct pharmacist involvement from admission through postdischarge aftercare. A pharmacist reconciled medications, provided patient-centered education, collaborated with healthcare providers to optimize therapy, ensured access to medications, and followed up with patients at home as needed. Rates of unplanned readmissions within 30 days of discharge in the full- and partial-intervention groups and in patients who received standard discharge care were compared. RESULTS: Among patients who received the full Medication REACH intervention, 30 of 305 admissions (9.8%) resulted in unplanned readmissions within 30 days, as compared with a readmission rate of 20.4% (110 of 538 patients) among patients who received standard discharge care (p < 0.001). Linear regression modeling, with adjustments for patient age, sex, ethnicity, and case-mix index, indicated an adjusted risk difference favoring the full-intervention group of 9.4 percentage points (95% confidence interval, 4.3-14.6 percentage points; p < 0.001). CONCLUSION: Rates of 30-day readmission were substantially lower with pharmacist involvement and collaboration with other healthcare team members during patient transitions from the hospital to the home setting.

Asunto(s)

RESUMEN

Having access to adequate and appropriate food is a major population health issue. This study investigated food insecurity in patients with high rates of inpatient hospitalization ("super-utilizers"). Forty adults with ≥3 hospital inpatient admissions within a 12-month period were interviewed in an urban hospital in Philadelphia, Pennsylvania, between March 2015 and May 2015. Inpatient admission history was obtained from hospital billing data. The majority had ≥5 hospitalizations in the past 12 months and ≥6 chronic conditions. Using the USDA definition of food insecurity, 30% (95% CI, 17% to 47%) were food insecure and 25% (95% CI, 13% to 41%) were marginally food secure. Forty percent responded that, in the past 30 days, they worried that their food would run out; 35% that their food would not last; 17.5% that they did not eat for a full day; and 10% that they were hungry but did not eat some or all of the time. Additionally, 75% were unable to shop for food on their own and 58% were unable to prepare their own food. More than half reported using food pantries or other community food resources. The impact of unmet food needs on hospital super-utilization warrants further investigation. Interventions that educate and connect patients with unmet food needs to community resources can help engage patients in their own health and well-being. Communication with patients about whether they have enough nutritionally appropriate food for their health conditions is an important starting point.

Asunto(s)

RESUMEN

Objectives. We assessed the impact of a rewards-based incentive program on fruit and vegetable purchases by low-income families. Methods. We conducted a 4-phase prospective cohort study with randomized intervention and wait-listed control groups in Philadelphia, Pennsylvania, in December 2010 through October 2011. The intervention provided a rebate of 50% of the dollar amount spent on fresh or frozen fruit and vegetables, reduced to 25% during a tapering phase, then eliminated. Primary outcome measures were number of servings of fruit and of vegetables purchased per week. Results. Households assigned to the intervention purchased an average of 8 (95% confidence interval [CI] = 1.5, 16.9) more servings of vegetables and 2.5 (95% CI = 0.3, 9.5) more servings of fruit per week than did control households. In longitudinal price-adjusted analyses, when the incentive was reduced and then discontinued, the amounts purchased were similar to baseline. Conclusions. Investigation of the financial costs and potential benefits of incentive programs to supermarkets, government agencies, and other stakeholders is needed to identify sustainable interventions.

RESUMEN

BACKGROUND: Recent pharmacokinetic studies have demonstrated that proton pump inhibitors (PPI) reduce exposure of mycophenolic acid. However, the clinical significance of this drug-drug interaction on transplantation outcomes has not been determined. METHODS: This was a retrospective cohort study in kidney transplant recipients who were prescribed rabbit antithymocyte globulin, calcineurin inhibitor, mycophenolate mofetil, and steroids. We evaluated the impact of PPI use on the 1-year rates of biopsy-proven acute rejection (BPAR). RESULTS: Two hundred thirteen patients who were prescribed PPI were compared with 384 patients who were on standard acid-suppressive therapy with ranitidine. BPAR occurred in similar rates in both groups (15% vs. 12%; P=0.31). In a multivariable analysis, black race was associated with a higher risk of rejection (risk ratio [RR], 2.38; 95% confidence interval [CI], 1.41-4.03). While controlling for rejection risk factors, PPI exposure was associated with an increased risk of rejection in black patients (RR, 1.93; 95% CI, 1.18-3.16) but not in non-black patients (RR, 0.54; 95% CI, 0.19-1.49). At 1 year, BPAR type, BPAR grade, patient and graft survival, graft function, and time to BPAR were not associated with PPI exposure. CONCLUSION: In this retrospective study, PPI use in the first transplant year was associated with an increased risk for BPAR in black patients but not in non-black patients. It is possible that a reduction in mycophenolic acid exposure contributed to the increased risk.

Asunto(s)

RESUMEN

Identifying effective strategies to promote healthier eating in underserved populations is a public health priority. In this pilot study, we examined the use of financial incentives to increase fresh fruit and vegetable purchases in low-income households (N=29). Participants received pre-paid coupons to buy fresh produce at the study store during the intervention period. Purchases were compared among the three study phases (baseline, intervention, and follow-up). A financial incentive provided by study coupons increased the average weekly purchase of fresh fruit but was less successful with fresh vegetables. These findings underscore the need for specific targeting of vegetable selection and preparation to exploit this strategy more fully.

Asunto(s)

RESUMEN

BACKGROUND: In low-renin hypertension (LRH), serum aldosterone levels are higher in those subjects with primary aldosteronism and may be lower in those with non-aldosterone mineralocorticoid excess or primary renal sodium retention. We investigated the hypothesis that the frequency distribution of aldosterone in LRH is bimodal. METHODS: Of the 3,532 attendees at the sixth examination cycle of the Framingham Offspring Study, 1,831 were included in this cross-sectional analysis after we excluded those with conditions or taking medications such as antihypertensive drugs that might affect renin or aldosterone. RESULTS: Three hundred three subjects (17%) had untreated hypertension (SBP ≥140 mm Hg or DBP ≥90 mm Hg). LRH, defined as plasma renin ≤5 mU/L, was present in 93 of those 303 hypertensive subjects (31%). Aldosterone values were adjusted statistically for age, sex, and the urinary sodium/creatinine ratio. In the subjects with LRH, the adjusted aldosterone distribution was bimodal (dip test for unimodality, P = 0.008). The adjusted aldosterone distribution was unimodal in the normal subjects (P = 0.98) and in the hypertensive subjects with normal plasma renin (P = 0.94). CONCLUSIONS: In this community-based sample of white subjects, those with low-renin hypertension had a bimodal adjusted aldosterone distribution. Subjects with normal-renin hypertension and subjects with normal blood pressure had unimodal adjusted aldosterone distributions. These findings suggest 2 pathophysiological variants of LRH, one that is aldosterone-dependent and one that is non-aldosterone-dependent.

Asunto(s)

RESUMEN

OBJECTIVE: This study assessed the degree to which women's intention to breastfeed prior to delivery translates to actual breastfeeding at hospital discharge and to investigate predictors of breastfeeding in a minority inner-city population. STUDY DESIGN AND METHODS: We conducted a retrospective cohort study of consecutive mother-infant dyads born July-September 2010 and discharged from the nursery at an academic community hospital in Philadelphia. RESULTS: The demographics of the 578 women who participated included a mean age of 25.3 years (SD 6.1), 61% African American and 18% Latina, 85% covered by Medicaid, and a mean postpartum hospital stay of 2.3 days. Overall, 60% expressed an intention to breastfeed prior to delivery (exclusively or with formula), but only 50% were breastfeeding at discharge. Of those who intended to breastfeed (exclusively or with formula), 75% were breastfeeding at discharge. Of those who intended to breastfeed exclusively, 40% were doing so at discharge. Of those who intended to bottle feed, 11% were breastfeeding at discharge. In multivariable analysis, older mothers and those with lower parity were more likely to breastfeed at discharge and also to breastfeed exclusively, controlling for ethnicity, parity, insurance, pregravida body mass index, score on the Edinburgh Postpartum Depression Scale, type of delivery, infant birth weight and gestational age. CONCLUSIONS: In a minority inner-city population, only three in four women who intended to breastfeed prior to delivery were breastfeeding at hospital discharge. However, one in 10 women previously not intending to breastfeed did so. Strategies are needed to promote and strengthen women's intention to breastfeed and to help women's breastfeeding outcomes meet their intentions.

Asunto(s)

RESUMEN

OBJECTIVE: To investigate the predictors of fresh fruit and vegetable purchases in a low-income population and identify subgroups in which interventions to increase such purchases might prove useful. METHODS: Retrospective analysis of 209 shopping transactions from 30 households. Individual and household characteristics obtained from primary shopper. Data collected covered April 1-June 30, 2010. Primary outcome was number of servings of fresh produce purchased per week. Bivariate and multivariable analyses were conducted. RESULTS: Controlling for household size, the average number of servings of fresh produce per week was higher in families with more children (P = .008) and in families with a wider age range of children (P = .04). CONCLUSIONS AND IMPLICATIONS: Households with more children purchased more fresh produce. Purchase data combined with shopper household characteristics helped to distinguish relatively high from low purchasers of fresh produce among low-income families.

Asunto(s)

RESUMEN

OBJECTIVE: To report the design and baseline results of a rewards-based incentive to promote purchase of fruit and vegetables by lower-income households. DESIGN: A four-phase randomized trial with wait-listed controls. In a pilot study, despite inadequate study coupon use, purchases of fresh fruit (but not vegetables) increased, but with little maintenance. In the present study, credits on the study store gift card replace paper coupons and a tapering phase is added. The primary outcome is the number of servings of fresh and frozen fruit and vegetables purchased per week. SETTING: A large full-service supermarket located in a predominantly minority community in Philadelphia, Pennsylvania, USA. SUBJECTS: Fifty-eight households, with at least one child living in the home. RESULTS: During the baseline period, households purchased an average of 3·7 servings of fresh vegetables and an average of less than 1 serving of frozen vegetables per week. Households purchased an average of 1·9 servings of fresh fruit per week, with little to no frozen fruit purchases. Overall, the range of fresh and frozen produce purchased during this pre-intervention period was limited. CONCLUSIONS: At baseline, produce purchases were small and of limited variety. The study will contribute to understanding the impact of financial incentives on increasing the purchases of healthier foods by lower-income populations.

Asunto(s)

RESUMEN

INTRODUCTION: Patient photos and silhouettes are commonly used in clinical evaluations and orthodontic research to evaluate profile esthetics. The purpose of this study was to determine whether the use of photos or silhouettes is a more appropriate method of evaluating African American profile esthetics and whether there are different profile esthetic preferences among clinicians when using photos compared with silhouettes. METHODS: Pretreatment records of 20 adolescent African American patients were selected (10 male, 10 female) from the orthodontic clinic at the Albert Einstein Medical Center in Philadelphia. Each patient's profile photo was digitally changed with imaging software (Dolphin Imaging and Management Solutions, Chatsworth, Calif) to fabricate a series of 7 photos and 7 silhouettes with lip positions at uniform distances relative to Ricketts' E-line standard. Fifteen raters consisting of orthodontic faculty and residents were asked to select the most esthetically pleasing profile from each patient's photo series and silhouette series. RESULTS: More rater preferences for the photographs (86%) were within the acceptable esthetic range (within 2 mm of the E-line in either direction) than were their preferences for silhouettes (66%) (P <0.001). Flatter profiles with less lip projection than the esthetic norm were more often preferred in the silhouettes than in the photos. Thirty-one percent of the silhouettes preferred by the raters were flatter than the norm compared with 9% of the photos (P = 0.003). Fuller profiles were preferred in only 3% of the silhouettes and 5% of the photos (P = 0.6). CONCLUSIONS: Esthetic attractiveness of faces of African American orthodontic patients is rated differently in photos and silhouettes. When evaluating soft-tissue esthetic profile preferences, rater preferences in the photographs were closer to the established esthetic norm than were their preferences in the silhouettes. Using silhouettes to evaluate patient esthetics could influence clinicians or researchers to select profiles that are flatter than the established esthetic norm.

Asunto(s)

RESUMEN

Osteoporosis ("secondary" osteoporosis) and avascular necrosis (AVN) of the femoral head are well-known adverse effects of corticosteroid therapy. Statins have been reputed to increase bone strength and bone density. In this study, we evaluated the effect of atorvastatin calcium on the flexural properties (3-point bending strength and modulus) of corticosteroid (methylprednisolone acetate) treated rabbit femurs and tibias. Our study hypothesis was that the use of statins would counteract the loss of bone strength caused by corticosteroid treatment. The 40 rabbits were divided into 5 groups: control, corticosteroid alone and corticosteroid combined with oral doses of atorvastatin calcium (2, 10, or 20 mg/day). A daily oral dose of atorvastatin calcium treatment for 70 days weakened the long bones of methylprednisolone acetate treated rabbits irrespective of the dosage (2, 10, or 20 mg). Cortical bone strength was assessed using the 3-point bending test at the end of the study period. A daily oral dose of atorvastatin calcium did not attenuate the loss of cortical bone strength caused by corticosteroid treatment in rabbits. It appeared to decrease that bone strength. If these results hold true in humans, they would have wide applicability given the frequent combined use of corticosteroids and statins in many patients.

Asunto(s)

RESUMEN

BACKGROUND: Saddle pulmonary embolism represents a large clot and a risk for sudden hemodynamic collapse. However, the clinical presentation and outcomes vary widely. On the basis of the findings of right heart dysfunction on echocardiograms, computed tomography angiography, or cardiac enzyme elevation, some argue for the use of thrombolytics or catheter thrombectomy even for hemodynamically stable patients. OBJECTIVE: To investigate the outcomes and management of patients with saddle pulmonary embolism, including radiographic appearance (estimate of clot burden) and echocardiographic features. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: This study is a retrospective evaluation of all patients with computed tomography angiography positive for pulmonary embolism from June 1, 2004, to February 28, 2009. Two radiologists selected those with saddle pulmonary embolism and evaluated the clot burden score. The clinical information, echocardiography, treatments, and outcomes of these patients were extracted via chart review. Saddle pulmonary embolism was found in 37 of 680 patients (5.4%, 95% confidence interval 4% to 7%) with documented pulmonary embolism on computed tomography angiography. For patients with saddle pulmonary embolism, the median age was 60 yrs and 41% were males. Major comorbidities were neurologic (24%), recent surgery (24%), and malignancy (22%). Transient hypotension occurred in 14% and persistent shock in 8%. One patient required mechanical ventilation. Echocardiography was performed in 27 patients (73%). Right ventricle enlargement and dysfunction were found in 78% and elevated pulmonary artery systolic pressure in 67%. Computed tomography angiography demonstrated a high median pulmonary artery clot burden score of 31 points. The median right ventricle to left ventricle diameter ratio was 1.39. Inferior vena cava filters were placed in 46%. Unfractionated heparin was administered in 33 (87%) and thrombolytics in four (11%). The median hospital length of stay was 9 days. Two of 37 saddle pulmonary embolism patients (5.4%) died in the hospital (95% confidence interval 0.7% to 18%). CONCLUSIONS: Most patients with saddle pulmonary embolism found on computed tomography angiography responded to the standard management for pulmonary embolism with unfractionated heparin. Although ominous in appearance, most patients with saddle pulmonary embolism are hemodynamically stable and do not require thrombolytic therapy or other interventions.

Asunto(s)

RESUMEN

INTRODUCTION: Enamel decalcification during orthodontic treatment is a persistent problem. Resin-based sealants have been developed to protect enamel from decalcification. The purpose of this in-vivo study was to compare the effect of a fluoride-releasing filled enamel sealant with that of an unfilled nonfluoride control. METHODS: A total of 177 teeth in 18 patients were evaluated over a period of 12 to 18 months. A split-mouth design was used; half the teeth were treated with the fluoride-releasing sealant (Pro Seal, Reliance Orthodontic Products, Itasca, Ill), and the contralateral teeth received the control (Transbond MIP, 3M Unitek, Monrovia, Calif). The teeth were photographed before (T1) and after (T2) treatment. A panel of 12 orthodontic faculty and residents evaluated the photographs for decalcification on a graded scale. RESULTS: Sixty-nine percent of the teeth treated with Pro Seal showed progressive decalcification from T1 to T2 vs 72% of those treated with Transbond MIP. In the comparison of the contralateral paired teeth, there was a small average net disadvantage of -0.06 of a tooth per patient (95% CI, -0.97 to 0.85) for Pro Seal compared with Transbond MIP. That difference of 0.06 of a tooth is neither statistically significant (P = 0.90) nor clinically important. CONCLUSIONS: The 2 products tested were equivalent in their inhibition of decalcification during orthodontic treatment. The additional time and expense of using the fluoride-releasing sealant to prevent decalcification does not appear to be justified.

Asunto(s)

RESUMEN

Mitral annular calcium (MAC) is a common finding at echocardiography, although it is an unusual cause of severe mitral stenosis. Although MAC is known to be associated with atherosclerosis and chronic kidney disease, little is known about its natural history as affects mitral valve function. This report describes a cohort of 37 outpatients with severe MAC (>5 mm) of whom 32 were followed longitudinally with echocardiography (mean follow-up 2.6 + or - 1.6 years). Progression of the mitral valve gradient occurred in 16 of 32 (50%). There was wide variation in rate of progression with a few subjects demonstrating a rapid increase in gradient, up to 9 mm Hg/year. Progression of mitral valve gradient correlated with baseline gradient at rest and with severity of overall cardiac calcification as measured by a semiquantitative echocardiographic score. Age at index echocardiogram was inversely related to mitral valve gradient after baseline, suggesting that calcification may proceed at a greater rate in younger patients. In conclusion, although severe mitral stenosis is uncommon in patients with MAC, those with a pre-existing gradient at rest and severe overall cardiac calcification appear to be at greater risk for development of this disease state.

Asunto(s)

RESUMEN

BACKGROUND: The standard analysis of bariatric surgery weight outcomes data (using t tests) is well known. However, these uncontrolled comparisons may yield misleading results and limit the range of research questions. The aim of the study was to develop a valid approach to the longitudinal analysis of weight loss outcomes after bariatric surgery using multivariable mixed models. This study has a multi-institutional setting. METHODS: We developed a mixed-effects model to examine weight after gastric bypass surgery while controlling for several independent variables: gender, anastomotic technique, age, race, initial weight, height, and institution. We contrasted this approach with traditional uncontrolled analyses using percent excess weight loss (%EWL). RESULTS: One thousand one hundred sixty-eight gastric bypass procedures were performed between 2000 and 2006. The average %EWL at 1, 2, and 3 years was 71%, 79%, and 76%, respectively. Using weight as the outcome variable, initial weight and gender were the only independent predictors of outcome (p<0.001). %EWL was substantially less accurate than weight as an outcome measure in multivariable modeling. Including initial weight and height as separate independent variables yielded a more accurate model than using initial body mass index. In a traditional uncontrolled analysis, average %EWL was higher in women than men. However, average weight loss was lower, not higher, in women (p<0.001) in our multivariable mixed model. Height, surgical technique, race and age did not independently predict weight loss. CONCLUSIONS: Multivariable mixed models provide more accurate analyses of weight loss surgery than traditional methods and should be used in studies that examine repeated measurements.

Asunto(s)

RESUMEN

BACKGROUND: All current methods of core temperature monitoring have limitations. There is at least one skin temperature probe that can be modified to a nasal temperature probe (NP). This study was conducted to validate this modified skin temperature probe as an accurate surrogate measure of core temperature by comparing the temperature measurements obtained from NP to those from the esophageal stethoscope (ES). METHODS: In 45 adult patients undergoing general anesthesia, one pair of simultaneous temperature measurements were obtained from the ES (E (temp)) and the NP (N (temp)). RESULTS: The NP was easily inserted in all patients. No patient developed epistaxis. The magnitudes of the differences between N (temp) and E (temp) measurements were 0.2 degrees C or less in 43 out of 45 patients (95.6%); 0.1 degrees C or less in 33 patients (73.3%). On average, the E (temp) was 0.05 degrees C higher than the N (temp). The 95% prediction interval for the E (temp)-N (temp) difference was -0.2 degrees C to +0.3 degrees C. Thus we expect the magnitude of the temperature difference to be less than 1/3 degrees C in the next future individual patient. CONCLUSION: In adults, the NP readings closely match the core temperature readings obtained by ES and thus can be used as a reliable surrogate measure of core temperature. This technique may be useful and advantageous in various situations, particularly when other methods of core temperature monitoring are not available or reliable.

Asunto(s)

RESUMEN

AIMS AND OBJECTIVES: This study investigates how long-term colon cancer survivors evaluate their health, functional status and quality of life, and whether there are differences based on age, gender or ethnicity. METHODS: Thirty long-term survivors of at least stage I colon cancer were interviewed in person between December 2004 and May 2005. The interview protocol included the Medical Outcomes Study 36-Item Short Form, Quality of Life--Cancer Survivor, and study-specific questions that asked about physical and non-physical problems they attributed to colon cancer. RESULTS: Substantial percentages of survivors attributed their problems with lack of energy (83%), sexual functioning (67%), bowel problems (63%), poor body image (47%) and emotional problems (40%) to having had colon cancer. Of those problems attributed to colon cancer, sexual functioning and pain were given the highest severity rankings by survivors. The majority of long-term colon cancer survivors reported distress regarding future diagnostic tests, a second cancer, and spread of cancer. Women reported greater problems completing daily activities as a result of physical problems (P = 0.003) and more pain (P = 0.07) than men. African Americans appear to report marginally better overall quality of life (P = 0.07) and psychological well-being than whites (P = 0.07). CONCLUSION: The majority of long-term colon cancer survivors with resected colon cancer and disease-free for 5 years reported problems with low energy, sexual functioning and bowel problems.

Asunto(s)