Medicine and Health Sciences Commons^™

Shifting From Hypofractionated To "Conventionally" Fractionated Thoracic Radiotherapy: A Single Institution's 10-Year Experience In The Management Of Limited-Stage Small-Cell Lung Cancer Using Concurrent Chemoradiation, Gregory Videtic, Pauline Truong, A. Dar, Edward Yu, Larry Stitt

Edward Yu

PURPOSE: To perform a retrospective review of a single institution's 10-year experience in treating limited-stage small-cell lung cancer (LS-SCLC) with a concurrent chemoradiation regimen modeled after the experimental arm of a randomized National Cancer Institute of Canada trial in which hypofractionated radiotherapy started with cycle 2 of chemotherapy. We then looked at the impact on patient outcomes of changing the RT during the course of the decade to a "conventionally" (2 Gy) fractionated regimen, with a focus on toxicity and survival rates. METHODS AND MATERIALS: Between 1989 and 1999, 215 LS-SCLC patients received six cycles of chemotherapy consisting of cyclophosphamide, …

The Natural Course Of Bulimia Nervosa And Eating Disorder Not Otherwise Specified Is Not Influenced By Personality Disorders, Carlos M. Grilo, Charles A. Sanislow, M. Tracie Shea, Andrew E. Skodol, Robert L. Stout, Maria E. Pagano, Shirley Yen, Thomas H. Mcglashan

Charles A. Sanislow, Ph.D.

Objective: To examine prospectively the natural course of bulimia nervosa (BN) and eating disorder not otherwise specified (EDNOS) and to test the effects of personality disorder (PD) comorbidity on the outcomes.

Method: Ninety-two female patients with current BN (N ¼ 23) or EDNOS (N ¼ 69) were evaluated at baseline enrollment in the Collaborative Longitudinal Personality Disorders Study (CLPS). Eating disorders (EDs) were assessed with the Structured Clinical Interview for DSM-IV Axis I Disorders. Personality disorders (PDs) were assessed with the Diagnostic Interview for DSM-IV PD (DIPD-IV). The course of BN and EDNOS was assessed with the Longitudinal Interval Follow-up …

Clinical Features And Impairment In Women With Borderline Personality Disorder (Bpd) With Post-Traumatic Stress Disorder (Ptsd), Bpd Without Ptsd, And Other Personality Disorders With Ptsd, Caron Zlotnick, Dawn M. Johnson, Shirley Yen, Cynthia Battle, Charles A. Sanislow, Andrew E. Skodol, Carlos M. Grilo, Thomas H. Mcglashan, John G. Gunderson, Donna S. Bender, Mary C. Zanarini, M. Tracie Shea

Charles A. Sanislow, Ph.D.

The aims of this study were to examine differences in clinical features, impairment, and types of childhood traumas among women with borderline personality disorder (BPD), women with BPD and posttraumatic stress disorder (PTSD), and those with other personality disorders and PTSD. Using baseline data from the Collaborative Longitudinal Study of Personality Disorders, 186 women were divided into 3 groups (BPD+PTSD, BPD, PTSD), based on structured diagnostic interviews for Axis I and Axis II disorders and compared on selected clinical variables. The additional diagnosis of PTSD in borderline women did not significantly increase the degree of borderline pathology and psychiatric morbidity …

The Representation Of Four Personality Disorders By The Schedule For Nonadaptive And Adaptive Personality Dimensional Model Of Personality, Leslie C. Morey, Megan B. Warner, M. Tracie Shea, John G. Gunderson, Charles A. Sanislow, Carlos M. Grilo, Andrew E. Skodol, Thomas H. Mcglashan

Charles A. Sanislow, Ph.D.

This study examined the relationships of the Schedule for Nonadaptive and Adaptive Personality (SNAP) model of personality to 4 targeted personality disorders (PDs) in a large multisite sample of patients. Data were examined from 529 patients, who were assigned 1 of 5 primary diagnoses: borderline, schizotypal, avoidant, and obsessive–compulsive PDs and major depression without PD. Patients were administered the SNAP questionnaire and results were compared among diagnostic groups and between patient groups and nonclinical norms. Results indicated that the dimensions of the model appear to have considerable promise in differentiating normal from abnormal personality, particularly in the propensity of individuals …

Geographical And Temporal Distribution Of Human Giardiasis In Ontario, Canada., Agricola Odoi, S W. Martin, P Michel, J Holt, D Middleton, J Wilson

Agricola Odoi

BACKGROUND: Giardia is the most frequently identified intestinal parasite in North America. Although information on geographical distribution of giardiasis is critical in identifying communities at high risk, little has been done in this area. Therefore, the objective of this study was to investigate the geographical and temporal distribution of human giardiasis in Ontario in order to identify possible high risk areas and seasons. Two spatial scales of analyses and two disease measures were used with a view to identifying the best of each in assessing geographical patterns of giardiasis in Ontario. Global Moran's I and Moran Local Indicators of Spatial …

Diagnosing Patients With Tiredness In General Practice, Jenny Doust

Jenny Doust

Trying to sort out which patients have a relatively simple problem that will resolve spontaneously from those that require medical treatment and those that require urgent attention is one of the aspects of general practice that makes it interesting and challenging. Patients who present with tiredness in general practice can have any of a long list of diagnoses ranging from the trivial to the life threatening, and knowing how to determine who has which is an essential skill for competent practice.

Axis I And Ii Disorders As Predictors Of Prospective Suicide Attempts: Findings From The Collaborative Longitudinal Personality Disorders Study, Shirley Yen, M. Tracie Shea, Maria Pagano, Charles A. Sanislow, Carlos M. Grilo, Thomas H. Mcglashan, Andrew E. Skodol, Donna S. Bender, Mary C. Zanarini, John G. Gunderson, Leslie C. Morey

Charles A. Sanislow, Ph.D.

This study examined diagnostic predictors of prospectively observed suicide attempts in a personality disorder (PD) sample. During 2 years of follow-up, 58 participants (9%) reported at least 1 definitive suicide attempt. Predictors that were examined include 4 PD diagnoses and selected Axis I diagnoses (baseline and course). Multivariate logistic regression analyses indicated that baseline borderline personality disorder (BPD) and drug use disorders significantly predicted prospective suicide attempts. Controlling for baseline BPD diagnosis, proportional hazards analyses showed that worsening in the course of major depressive disorder (MDD) and of substance use disorders in the month preceding the attempt were also significant …

Gender Differences In Borderline Personality Disorder: Findings From The Collaborative Longitudinal Personality Disorders Study, Dawn M. Johnson, M. Tracie Shea, Shirley Yen, Cynthia L. Battle, Caron Zlotnick, Charles A. Sanislow, Carlos M. Grilo, Andrew E. Skodol, Donna S. Bender, Thomas H. Mcglashan, John G. Gunderson, Mary C. Zanarini

Charles A. Sanislow, Ph.D.

A majority of the literature on borderline personality disorder (BPD) focuses on its occurrence in women or does not specifically assess for gender differences in clinical presentations. Some studies report that men with BPD may be more likely to be diagnosed with substance use disorders, as well as paranoid, passive-aggressive, narcissistic, sadistic, and antisocial personality disorders (PDs). Additionally, women with BPD appear to be more likely to report histories of adult physical and sexual abuse and to meet diagnostic criteria for post-traumatic stress disorder (PTSD) and eating disorders. The purpose of the present study was to further examine gender differences …

Obstructive And Restrictive Lung Disease And Markers Of Inflammation: Data From The Third National Health And Nutrition Examination, David M. Mannino, Earl S. Ford, Stephen C. Redd

David M. Mannino

Although chronic obstructive pulmonary disease (COPD) and restrictive lung diseases are important causes of morbidity and mortality in the United States 1, 2 and 3, a large proportion of the morbidity and mortality is not pulmonary (4). This raises the possibility that lung disease may be an indicator of susceptibility to the development of other diseases or may be associated with systemic inflammation that leads to other diseases 5 and 6. Previous analyses of the relation between lung function and markers of inflammation 7 and 8 have not looked at restrictive lung disease separately.

We applied spirometric criteria to define …

Tobacco Smoke Exposure And Decreased Serum And Red Blood Cell Folate Levels: Data From The Third National Health And Nutrition Examination Survey, David M. Mannino, Joseph Mulinare, Earl S. Ford, Joel Schwartz

David M. Mannino

The aim of this cross-sectional study was to determine the effects of smoke exposure on serum and red blood cell folate levels. Data collected as part of the Third National Health and Nutrition Examination Survey were analyzed. Serum and red blood cell folate levels were measured in active smokers and nonsmokers with high, moderate, and low exposure to environmental tobacco smoke. After adjusting for dietary intake of folate and other covariates, we found that both smokers and nonsmokers with high smoke exposure had lower red blood cell folate levels than did nonsmokers with low smoke exposure (−86 nmol/l [95% confidence …

The Love And Belonging Healthcare Needs Of Hiv Infected African-American Men Upon Admission To An Aids Dedicated Nursing Home., Sheldon Fields

Sheldon D. Fields

The purpose of this study was to describe the love and belonging healthcare needs of HIV infected African-American men upon admission to an AIDS dedicated nursing home. Subjects were 73 (N=73) African-American men 26 to 60 years of age that were admitted to an AIDS dedicated nursing home in the Southern New England area between 1995 and 1999. Most of the men were single (n = 39) and estranged from their immediate families. Many of these men did not have a family member supportive of discharge (n = 60) and did not desire discharge back out into the community (n …

Educating The Public About Stroke: Role In Improving Outcomes, Richard N. Bradley

Richard N Bradley

Acute stroke affects large numbers of people worldwide. It causes significant morbidity and mortality. Data support the hypothesis that the public is not familiar with either the risk factors or the signs of stroke. Educating the public about stroke may result in a lower incidence of the disease as individuals modify their risk factors, and in improved outcomes as a result of reductions in delays to treatment. There is clear and convincing evidence that reducing delays to treatment of patients with acute stroke results in improved outcomes. Public education programs should be broad-based, tailored to individual audiences, and carry a …

New Statistics On The Us Epidemic In "Copd Mortality: That Was Then - This Is Now!", David M. Mannino

David M. Mannino

No abstract provided.

The Epidemiology Of Sepsis In The United States From 1979 Through 2000, Greg S. Martin, David M. Mannino, Stephanie Eaton, Marc Moss

David M. Mannino

BACKGROUND

Sepsis represents a substantial health care burden, and there is limited epidemiologic information about the demography of sepsis or about the temporal changes in its incidence and outcome. We investigated the epidemiology of sepsis in the United States, with specific examination of race and sex, causative organisms, the disposition of patients, and the incidence and outcome.

METHODS

We analyzed the occurrence of sepsis from 1979 through 2000 using a nationally representative sample of all nonfederal acute care hospitals in the United States. Data on new cases were obtained from hospital discharge records coded according to the International Classification of …

Continued Cigarette Smoking By Patients Receiving Concurrent Chemoradiotherapy For Limited-Stage Small-Cell Lung Cancer Is Associated With Decreased Survival, Gregory Videtic, Larry Stitt, A. Dar, Walter Kocha, Anna Tomiak, Pauline Truong, Mark Vincent, Edward Yu

Edward Yu

PURPOSE: To determine the impact of continued smoking by patients receiving chemotherapy (CHT) and radiotherapy (RT) for limited-stage small-cell lung cancer (LSCLC) on toxicity and survival. PATIENTS AND METHODS: A retrospective review was carried out on 215 patients with LSCLC treated between 1989 and 1999. Treatment consisted of six cycles of alternating cyclophosphamide, doxorubicin, vincristine and etoposide, cisplatin (EP). Thoracic RT was concurrent with EP (cycle 2 or 3) only. Patients were known smokers, with their smoking status recorded at the start of chemoradiotherapy (CHT/RT). RT interruption during concurrent CHT/RT was used as the marker for treatment toxicity. RESULTS: Of …

Fatal Injuries In The United States Involving Respirators, 1984-1995, Anthony Suruda, William Milliken, Dale Stephenson, Richard Sesek

Dale J. Stephenson

There is little published information concerning the epidemiology of fatal injuries involving respiratory protection. We compiled a case series from U.S. Occupational Safety and Health Administration investigation reports from 1984 through 1995. For the 12-year period there were 41 incidents resulting in 45 deaths due to asphyxiation or chemical poisoning while wearing a respirator. There were 23 deaths related to airline respirators, 17 deaths involving use of negative pressure (air purifying) respirators, and 5 deaths involving self-contained breathing apparatus. Among the 23 deaths involving airline respirators, 15 were associated with compatible connection couplings for breathable air and inert gases. Three …

Global Challenges Show, Nat Quansah

Nat Quansah

No abstract provided.

Do Eating Disorders Co-Occur With Personality Disorders? Comparison Groups Matter., Carlos M. Grilo, Charles A. Sanislow, Andrew E. Skodol, John G. Gunderson, Robert L. Stout, M. Tracie Shea, Mary C. Zanarini, Donna S. Bender, Leslie C. Morey, Ingrid R. Dyck, Thomas H. Mcglashan

Charles A. Sanislow, Ph.D.

OBJECTIVE: To assess and compare lifetime rates of occurrence of eating disorders (ED) with four Axis II personality disorders (PD) and with major depressive disorder (MDD) without PD. The eating disorders met criteria outlined in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).

METHOD: Six hundred sixty-eight patients recruited for the Collaborative Longitudinal Personality Disorders Study (CLPS) were reliably assessed with the Structured Clinical Interview for DSM-IV Axis I Disorders and the Diagnostic Interview for DSM-IV Personality Disorders. The distribution of ED diagnoses was compared among four PD study groups (schizotypal, borderline, avoidant, obsessive-compulsive) and …

Correlates Of Suicide Risk In Juvenile Detainees And Adolescent Inpatients, Charles A. Sanislow, Carlos M. Grilo, Dwain C. Fehon, Seth R. Axelrod, Thomas H. Mcglashan

Charles A. Sanislow, Ph.D.

OBJECTIVE: To compare correlates of risk for suicidal behavior in juvenile detainees with those in another high-risk group, adolescent psychiatric inpatients.

METHOD: Eighty-one adolescents in a short-term juvenile detention center were contrasted with a matched group of 81 adolescent psychiatric inpatients on a clinical assessment battery of established instruments including a measure for risk of suicidal behavior.

RESULTS: Juvenile detainees and adolescent psychiatric inpatients reported similar levels of distress on measures of suicide risk, depression, impulsivity, and drug abuse. After controlling for depression, impulsivity and drug abuse remained significantly associated with suicide risk scores in the juvenile detention group, but …

A Premiere Example Of The Illusion Of Harm Reduction Cigarettes In The 1990s, Richard W. Pollay

Richard W. Pollay

No abstract provided.

Impact Of Clinical Experience On Quantification Of Clinical Signs At Physical Examination, Luciano F. Drager, Paulo A. Lotufo, Isabela M. Bensenor

Paulo A Lotufo

Purpose. Although physical examination is a fundamental component of medical decision making, relatively few studies have evaluated how physicians quantify clinical signs and whether different methods of assessment have different effects on clinical practice. Objectives. To evaluate a possible impact of clinical experience when attending physicians, medical residents and medical students quantify qualitative signs of physical examination in a teaching hospital. Setting. Hospital das Clı´nicas, University of Sa˜o Paulo, Brazil. Subjects. A total of 244 randomly selected physicians and medical students completed a reliable and consistent eight-item questionnaire. Main outcome measures. To compare how they quantified clinical signs of cyanosis, …

The Educational Interaction Between Physical Therapy And Occupational Therapy Students, Kimberly K. Cleary, Dana M. Howell

Dana Howell

The objectives of this study were to identify the prevalence of shared learning in U.S. physical therapy (PT) and occupational therapy (OT) education programs; determine what terminology is used for these courses; and identify perceived barriers, benefits, and challenges of the educational interactions. A survey, designed to collect information about the educational interaction between PT and OT students, was mailed to all program directors (n = 206) at each of the academic institutions (N = 103) in the United States with accredited or developing entry-level programs in PT and OT. A census study was conducted, and the entire study population …

Will You Remember Me In The Morning? Test-Retest Reliability Of A Social Network Analysis Examining Hiv-Related Risky Behavior In Urban Adolescents And Young Adults, Scott Clair, Jean J. Schensul, Monika Raju, Edward J. Stanek, Raul Pino

Edward J. Stanek

In recent years there has been a growing interest in applying social network models to the problem of adolescent substance use. However, there has been little research conducted examining the reliability of social network information within this population. The current study attempts to address this gap, specifically by examining social network test-retest reliability over a two week period among a sample of adolescent substance users. The results of the current study suggest that for social network variables dealing with substance use, reliabilities are at least moderate with correlations of.6 or above. However, there is a large degree of turnover with …

Are We Parent-Friendly? Social Workers’ Views Of Parents Of Children With Emotional And Behavioral Disabilities, Harriette C. Johnson University Of Connecticut, David E. Cournoyer University Of Connecticut, June Filri, Miriam Flynn, Andrea M. Grant, Maryanne A. Lant, Spero Parasco, Edward J. Stanek

Edward J. Stanek

A current model of family-centered practice emphasizes empowerment of parents, an approach that brings together a strengths perspective, a constructivist emphasis on consumer voices, and knowledge derived from neuroscience of the last two decades. This study explored the extent to which a national random sample of National Association of Social Workers members hold beliefs and attitudes congruent with the parent empowerment perspective. Two profiles emerged from the data. Respondents who disagree with statements attributing blame to parents agree with sharing information openly with parents; believe that parents are doing their best, are credible reporters, and are experts about their own …

Human Health Effects Of A Changing Global Nitrogen Cycle, A R. Townsend, R W. Howarth, F A. Bazzaz, M S. Booth, C C. Cleveland, S K. Collinge, A P. Dobson, P R. Epstein, E A. Holland, D R. Keeney, M A. Mallin, Christine A. Rogers, P Wayne, A Wolfe

Christine A. Rogers

Changes to the global nitrogen cycle affect human health well beyond the associated benefits of increased food production. Many intensively fertilized crops become animal feed, helping to create disparities in world food distribution and leading to unbalanced diets, even in wealthy nations. Excessive air- and water-borne nitrogen are linked to respiratory ailments, cardiac disease, and several cancers. Ecological feedbacks to excess nitrogen can inhibit crop growth, increase allergenic pollen production, and potentially affect the dynamics of several vector-borne diseases, including West Nile virus, malaria, and cholera. These and other examples suggest that our increasing production and use of fixed nitrogen …

The Treatment Of Hypnotic Dependent Sleep Disorder: A Case Study, Theodore V. Cooper, K. L. Lichstein, N. Aguillard

Theodore V. Cooper

No abstract provided.

A Prospective Evaluation Of The Relationships Between Smoking Dosage And Body Mass Index In An Adolescent, Biracial Cohort., Theodore V. Cooper, R. C. Klesges, L. Robinson, S. Zbikowski

Theodore V. Cooper

No abstract provided.

The Observatory Of The Americas As A Network In Environmental And Worker Health In The Americas, Carlos Eduardo Siqueira, Fernando Martins Carvalho

C. Eduardo Siqueira

This article reviews the scope of several Observatories found by a search in the Internet through the Google search engine. After examining these observatories, it describes the aims and initial accomplishments of the Observatory of the Americas as a network of professionals and activists from different countries in the Americas. The article concludes with a discussion of the pattern identified among these observatories: they may be clearinghouses or networks, or both.

Environmental Health In Public Health, R. Konkel, Darryl Barnett, Joe Beck, Worley Johnson

Steve Konkel

A most intriguing question, and one that leads to many debates both inside and outside of the environmental health field, is a definition of environmental health. The answer given is often tempered by one's political slant (i.e., liberal, moderate, or conservative) and by one's professional training (e.g., public health sanitation, chemistry, nursing, ecology, planning, public administration, etc). Although agreement is needed to effectively address the challenges in the field, disagreement often centers on what constitutes environmental health and even on the name or nickname that should be applied to individuals whose primary focus is on one or many aspects of …

Diagnostic And Management Strategies For Anaemia In Adults, Jenny Doust

Jenny Doust

BACKGROUND Anaemia is often an incidental finding or is discovered when patients present with nonspecific symptoms such as tiredness. OBJECTIVE This article presents strategies to identify the cause of anaemia and uses four case studies to illustrate these principles. DISCUSSION Few diagnostic tests can completely rule in or rule out causes of anaemia. This makes the investigation of anaemia complex. An understanding of the limitations of tests in aiding diagnosis is required.