胎儿纤维连接蛋白及宫颈长度测量在早产预测中的评价

目的研究胎儿纤维连接蛋白（fetal fibroneetin，fFN）和宫颈长度测量单独及二者联合对先兆早产孕妇最终发生早产的预测价值。方法对2007年1月至5月，在北京市海淀妇幼保健院门诊定期产检的有先兆早产症状的孕妇176例，测定其阴道分泌物中fFN及超声测量子宫颈长度，追踪其妊娠结局，统计学分析，采用单独及联合使用两种方法预测早产的敏感性、特异性、阳性预测值和阴性预测值等指标。结果①进行fFN检测的176例先兆早产孕妇中，24例fFN呈阳性，152例呈阴性。24例fFN检测呈阳性的孕妇在从阴道分泌物中取出标本后的7d，14d和37周内分娩，分娩率分别为20．8％（5／24），29．2％（7／24），33．3％（8／24）；152例呈阴性的孕妇在7d，14d和37周内无1例分娩。②同时超声测量宫颈长度的124例先兆早产孕妇中，9例孕妇的宫颈长度≤2．6em，其中6例在7d，14d，37周内分娩，分娩率分别为55．6％（5／9），11．1％（1／9），0；115例宫颈长度〉2．6cm的孕妇，无1例发生早产。③本研究结果显示，fFN预测孕37周前发生早产的敏感性、特异性、阳性预测值和阴性预测值分别为100％，90．5％，33．3％，100％；而宫颈长度预测孕37周前发生早产的敏感性、特异性、阳性预测率、阴性预测率分别为100％，97．5％，66．7％，100％；二者联合预测，则上述指标均为100％。结论①fFN呈阳性对预测早产有一定价值，而呈阴性的预测价值更高，并有积极意义。②宫颈长度超声测量也是一种有价值的早产预测手段，它和fFN联合使用，可以提高先兆早产孕妇的阳性预测率。     

联合检测fFN和TNF-α预测早产的临床价值

目的:探讨联合检测胎儿纤维连接蛋白(fFN)和肿瘤坏死因子(TNF-α)预测早产的价值。方法:使用ELISA法测定45例孕28～36周先兆早产的孕妇(研究组)和43例同期同孕龄的正常孕妇(对照组)的阴道后穹窿分泌物中的fFN和TNF-α水平。结果:①研究组fFN和TNF-α的含量高于对照组(P<0.05),妊娠结局为早产的孕妇fFN和TNF-α含量高于足月产孕妇(P<0.05);②fFN预测早产和1周内分娩的敏感度和阳性预测值高于TNF-α。结论:fFN和TNF-α水平与是否早产相关;fFN和TNF-α均是预测早产较为敏感的指标,二者联合检测可提高早产和1周内分娩的预测结果。     

胎儿纤维连接蛋白与宫颈长度测量预测早产的分析

目的 探讨胎儿纤维连接蛋白（fFN）与宫颈长度测量在预测早产中的价值. 方法 选择本院门诊的出现先兆早产孕妇118例,检测阴道分泌物（fFN）,同时实施B超测量宫颈长度,比较其临产的时间及孕周情况. 结果 fFN对14 d内分娩的阴性和阳性预测值分别是97.6％、26.5％；fFN联合宫颈长度测量对14 d内分娩的敏感性、特异性、阴性和阳性预测值分别为100％、86％、100％、38.1％,对37周内分娩的敏感性、特异性、阴性和阳性预测值分别为70.8％、91.3％、81.0％、94.8％. 结论 fFN对预测14 d内分娩有很高的阴性预测值,fFN测定联合B超测量宫颈长度可以提高37周前早产阳性预测结果.     

胎儿纤维连接蛋白联合宫颈长度检测对双胎妊娠早产的预测价值

目的:探讨胎儿纤维连接蛋白(fFN)、宫颈长度(CL)单独和联合检测对双胎妊娠早产的预测价值。方法:收集在荆州市第一人民医院进行产检的80例双胎妊娠孕妇的临床资料,于妊娠22～30周检测孕妇宫颈阴道分泌物fFN、B超检测宫颈长度并随访妊娠结局。结果:宫颈阴道分泌物fFN阳性预测双胎妊娠早产的敏感度为70.6%、特异度为82.8%、阳性预测值为87.8%、阴性预测值为61.5%、准确度为75.0%。宫颈长度<20 mm预测双胎妊娠早产的敏感度为66.7%、特异度为93.1%、阳性预测值为94.4%、阴性预测值为61.4%、准确度为76.2%。两者联合检测预测双胎妊娠早产的敏感度为82.3%、特异度为82.7%、阳性预测值为89.4%、阴性预测值为72.7%、准确度为82.5%。结论:对于双胎妊娠孕妇,fFN及宫颈长度联合检测较两项单独检测预测早产的敏感度、准确度提高,提示可联合应用于临床筛查双胎妊娠早产高风险孕妇。     

超声评估孕中晚期宫颈形态预测妊娠结局的价值

目的探讨超声评估孕中晚期宫颈形态预测妊娠结局的价值。方法选取2018年1月至2019年4月于南昌大学第四附属医院接受常规产检的孕妇300例作为研究对象,所有孕妇分别在孕24、28、32、36周为其开展超声检查,对宫颈长度进行测量,观察宫颈内口形态,并随访妊娠结局,计算宫颈长度、宫颈内口形态预测早产的准确度、灵敏度与特异度,比较早产组与足月组的宫颈长度与宫颈指数,观察宫颈内口形态对妊娠结局的影响。结果通过随访可知,共114例孕妇早产,186例孕妇足月分娩。宫颈长度预测早产的准确度为95.67%,灵敏度为97.37%,特异度为94.62%;宫颈内口形态预测早产的准确度为95.33%,灵敏度为92.98%,特异度为96.77%。早产组孕24、28、36周的宫颈长度短于足月组,孕24、28、32、36周的宫颈指数大于足月组,差异均有统计学意义(P<0.05);早产组孕36周的宫颈长度短于孕24、28周,差异均有统计学意义(P<0.05)。宫颈内口形态正常孕妇的早产率低于宫颈内口形态异常孕妇,差异有统计学意义(P<0.05)。结论超声评估孕中晚期宫颈形态,可有效预测早产的发生,有利于临床及时开展安胎治疗。     

联合筛查在预测早产中的应用研究

目的:探讨联合筛查在早产预测中的应用。方法:检测孕妇宫颈阴道分泌物中胎儿纤连蛋白(fFN)、人绒毛膜促性腺激素(β-HCG)、胰岛素样生长因子结合蛋白1(IGFBP-1)含量以及血清中C反应蛋白(CRP)和白细胞数量(WBC),并利用Herrera模型进行调查。结果:早产组孕妇fFN、β-HCG、IGFBP-1、血CRP、WBC较足月产组均明显上升,差异有统计学意义(P<0.01),且fFN、IGFBP-1及β-HCG 3项指标联合对早产的预测准确度为91.2%,敏感度为91.7%,特异性为90.7%,阳性预测值为89.8%,阴性预测值为92.5%。另外焦虑和社会经济状况差与早产有明显关系。结论:孕妇宫颈阴道分泌物fFN、β-HCG及IGFBP-1联合筛查对早产预测的准确度较高,此外孕妇的焦虑情绪也与早产有关。     

胎儿纤维连接蛋白检测在早产预测中的价值

目的：探讨胎儿纤维连接蛋白( fFN)与经阴道宫颈管长度( CL)的测定在早产预测中的价值。方法将101例临床诊断为先兆早产及有早产高危因素的孕妇分别测定其阴道分泌物中fFN的含量,并同时经阴道测量宫颈管长度,以宫颈管长度>2.5cm为阴性,≤2.5cm为阳性;fFN≥50ng/mL为阳性,<50ng/mL为阴性。结果在101例患者中,fFN与CL均为阳性者34例,发生早产28例;两者均为阴性者57例,发生早产2例。 fFN阳性预测的价值与fFN阴性预测的价值比较,差异有统计学意义(χ2=51.46,P=0.000)。 fFN与CL联合预测早产的敏感性为93.33%,特异性为90.16%;阳性预测值为82.35%,阴性预测值为96.49%。结论 fFN与CL均可用于早产的预测,但两者联合应用可提高早产的预测敏感性、特异性及阳性预测值和阴性预测值,值得临床推广使用。     

胎儿纤维连接蛋白对宫颈环扎术后早产的预测

目的:研究胎儿纤维连接蛋白(fFN)对宫颈环扎术后早产的预测价值。方法:选择31例诊断为宫颈机能不全需行宫颈环扎术的住院保胎孕妇,取阴道后穹窿分泌物应用Rapid fFN TLiIQ System进行检测,追踪2周内和34周内分娩的情况。结果:31例患者中,2周内分娩2例,fFN阳性预测宫颈环扎术后孕妇2周内发生早产的敏感性、特异性、阳性预测值、阴性预测值分别为100.0%、69.0%、18.2%、100.0%。34周内分娩6例,fFN阳性预测宫颈环扎术后孕妇34周内发生早产的敏感性、特异性、阳性预测值、阴性预测值分别为66.7%、72.0%、36.4%、90.0%。早产6例占全部分娩孕妇的19.4%,均为34周内分娩,其中2例孕周<28周;剖宫产7例,阴道分娩22例,新生儿均转NICU观察,全部存活,均已出院。结论:宫颈环扎术后行fFN检测可预测早产,其阴性预测价值较高,阳性预测价值低,fFN检测阳性者需结合患者临床表现。     

经阴道超声宫颈弹性成像参数联合宫颈前角预测高危孕妇早产价值

目的：探究经阴道超声宫颈弹性成像(E-cervix)参数联合宫颈前角对高危孕妇早产的预测价值。方法：收集本院2021年1月-2022年6月收治的高危孕妇82例临床资料，根据妊娠结局分为早产组(n=14)和足月产组(n=68)。分别在孕16～18周和孕22～24周进行应变超声弹性成像和经阴道二维超声检查，对比两组宫颈弹性参数[弹性对比指数(ECI)、宫颈外口应变率/宫颈内口应变率(IOS/EOS)、硬度比(HR)]和宫颈前角；绘制受试者工作特征曲线(ROC)分析ECI、IOS/EOS、HR以及宫颈前角预测高危孕妇早产价值。结果：孕16～18周时，ECI、IOS/EOS、HR和宫颈前角两组比较无差异(P>0.05);孕22～24周时，早产组ECI、IOS/EOS低于足月产组，HR和宫颈前角高于足月产组(P<0.05);ECI、IOS/EOS、HR以及宫颈前角预测高危孕妇早产的曲线下面积(AUC)分别为0.731、0.776、0.834、0.816,灵敏度分别为71.4%、64.3%、78.6%和78.6%,特异度分别为88.2%、85.3%、82.4%和80.9%,4项联合预测...     

宫颈环扎术治疗自发性早产的临床分析

<正>传统的早产定义是指妊娠满28周~37周分娩者。由于早产儿的治疗及监护手段不断进步,其生存率明显提高,伤残率明显下降,有些国家已将早产时间的下限定义为妊娠24周或20周[1]。早产是大多数非遗传性围生儿死亡和致残的首要原因,70%~80%的围生儿死亡与早产有关[2]。目前较多研究为预测早产的发生,其中胎儿纤连蛋白(fFN)联合宫颈长度测量是较为成熟的预测自发性早产的方法[3]。笔者对于已经明确fFN检测阳性且伴有宫颈管长度缩短的自发性早产孕妇,进行宫颈环扎术,现将结果报告如下。     

Spatial,Ecologic, and Clinical Epidemiology of Community-Onset,Ceftriaxone-Resistant Enterobacteriaceae,Cook County,Illinois, USA

We performed a spatial and mixed ecologic study of community-onset Enterobacteriaceae isolates collected from a public healthcare system in Cook County, Illinois, USA. Individual-level data were collected from the electronic medical record and census tract–level data from the US Census Bureau. Associations between individual- and population-level characteristics and presence of ceftriaxone resistance were determined by logistic regression analysis. Spatial analysis confirmed nonrandom distribution of ceftriaxone resistance across census tracts, which was associated with higher percentages of Hispanic, foreign-born, and uninsured residents. Individual-level analysis showed that ceftriaxone resistance was associated with male sex, an age range of 35–85 years, race or ethnicity other than non-Hispanic Black, inpatient encounter, and percentage of foreign-born residents in the census tract of isolate provenance. Our findings suggest that the likelihood of community-onset ceftriaxone resistance in Enterobacteriaceae is influenced by geographic and population-level variables. The development of effective mitigation strategies might depend on better accounting for these factors.     

Occurrence,exposure, effects,recommended intake and possible dietary use of selected trace compounds (aluminium,bismuth, cobalt,gold, lithium,nickel, silver)

Background: Minerals, metals, clays and rocks were widely used by physicians in the past. However, it was and it is well known that some inorganic elements at high dosage may have curative effects but also serious toxicity. The effects at low or ultra-low concentrations, on the contrary, are less documented, but the idea that low dosage supplementation might be beneficial to human health is widespread even in the present period. Methods: The main information about aluminium, bismuth, cobalt, gold, lithium, nickel and silver was selected and evaluated from a vast body of medical literature. Results: In modern times, most elements are proposed for human use at levels comparable with normal dietary intake, probably for precautionary considerations. Conclusion: Some inorganic trace compounds might have unexpected effects at extremely low dosages, but scientific demonstrations of beneficial effects of supplementation are mostly not available in the medical literature.     

Lead, mercury, cadmium, chromium, and arsenic levels in eggs, feathers, and tissues of Canada geese of the New Jersey Meadowlands

The New Jersey Meadowlands are located within the heavily urbanized New York/New Jersey Harbor Estuary and have been subject to contamination due to effluent and runoff from industry, traffic, and homes along the Hackensack River and nearby waterways. These extensive wetlands, though heavily impacted by development and pollution, support a wide array of bird and other wildlife species. Persistent contaminants may pose threats to birds in these habitats, affecting reproduction, egg hatchability, nestling survival, and neurobehavioral development. Metals of concern in the Meadowlands include arsenic, cadmium, chromium, lead, and mercury. These metals were analyzed in eggs, feathers, muscle, and liver of Canada geese (Branta canadensis) breeding in four wetland sites. We sampled geese collected during control culling (n=26) and collected eggs from goose nests (n=34). Levels of arsenic were below the minimum quantification level (MQL) in most samples, and cadmium and mercury were low in all tissues sampled. Chromium levels were high in feather samples. Mercury levels in eggs of Canada geese, an almost exclusively herbivorous species, were lower (mean ±SE 4.29±0.30 μg/g wet weight) than in eggs of omnivorous mallards (Anas platyrhynchos), and insectivorous red-winged blackbirds (Agelaius phoeniceus) and marsh wrens (Cistothorus palustris) from the Meadowlands, consistent with trophic level differences. However, lead levels were higher in the goose eggs (161±36.7 ng/g) than in the other species. Geese also had higher levels of lead in feathers (1910±386 ng/g) than those seen in Meadowlands passerines. By contrast, muscle and liver lead levels were within the range reported in waterfowl elsewhere, possibly a reflection of metal sequestration in eggs and feathers. Elevated lead levels may be the result of sediment ingestion or ingestion of lead shot and sinkers. Finally, lead levels in goose liver (249±44.7 ng/g) and eggs (161±36.7 ng/g) may pose a risk if consumed frequently by humans. Mill Creek, the site with the most documented prior contamination, had significantly elevated cadmium, chromium, mercury, and lead in goose tissues.     

Incidence of cancer among bookbinders, printers, photoengravers, and typesetters

OBJECTIVES—To to study the risk of cancer, particularly of lung cancer and bladder cancer, among workers in the printing industry according to different occupations.
METHODS—This is a population based retrospective cohort study. The cohort comprised 1332 men and 426 women employed in the printing industry in Iceland according to a published union registry. A computerised file of the cohort was record linked to the Cancer Registry by making use of personal identification numbers. Expected numbers of cases of cancer were calculated on the basis of number of person-years and specific incidences of cancer sites for men and women provided by the Cancer Registry.
RESULTS—Among the men (36 217.5 person-years at risk) there were 125 observed cancers versus 123.66 expected, standardised incidence ratio (SIR) 1.01, 95% confidence interval (95% CI) was 0.84 to 1.20. The SIR (95% CI) for liver cancer was 1.97 (0.55 to 5.20) and the SIR for non-Hodgkin's lymphoma was 2.26 (0.96 to 4.41). No excess risk for cancer was found among women (8631.0 person-years at risk). The SIR (95% CI) for liver cancer was 4.21 (0.47 to 15.20) and for non-Hodgkin's lymphoma it was 4.99 (1.61 to 11.63) among the typesetters. A survey on smoking habits among active and retired union members showed that they smoked less than a random sample of the general population.
CONCLUSION—The cancer site most often reported to show excess risk among printing industry workers has been the lung and the urinary bladder; however, this was not found in the present study. This may be explained by difference in smoking habits among union members compared with the general population. There is a high occurrence of non-Hodgkin's lymphoma, particularly among typesetters, which warrants further studies.


Keywords: printing industry; non-Hodgkin's lymphoma; smoking habits     

The determination of metals (antimony, bismuth, lead, cadmium, mercury, palladium, platinum, tellurium, thallium, tin and tungsten) in urine samples by inductively coupled plasma-mass spectrometry

 Objective: An analytical method has been established to determine the concentration of antimony (Sb), bismuth (Bi), lead (Pb), cadmium (Cd), mercury (Hg), palladium (Pd), platinum (Pt), tellurium (Te), tin (Sn), thallium (Tl) and tungsten (W) in urine. The aim was to develop a method which is equally suitable for the determination of environmentally as well as occupationally caused metal excretion. Methods: Inductively coupled plasma-mass spectroscopy (ICP-MS) was used for the determination of metals. Calibration was done using aqueous solutions and standard addition respectively. Results: Urine samples of 14 persons occupationally non-exposed to metals were analysed. With the exception of Pt and Bi all the metals were found in these urine samples. The detection limits for these metals lie between 5 and 50 ng/l. Conclusions: For some metals, which are important from an occupational as well as an environmental viewpoint, ICP-MS is more sensitive than atomic absorption spectrometry (AAS). ICP-MS, moreover, is welcome as a reference method for AAS with the additional advantage of multi-element measurement. Received: 5 February 1996/Accepted: 23 August 1996     

The basis of screening - definitions, aims, principles, evaluation of methods, and classification]

Résumé Dans le cadre conceptuel de la détection précoce, le dépistage apparaît comme un moyen d'action très prometteur pour la prévention secondaire (tableau 1).II apparaît judicieux que son objectif porte sur un triple aspect relevant à la fois de la santé publique, de l'économie et de la recherche (tableau 2).Sa mise en uvre est tributaire de six principes (dont cinq sont classiques) et qui devraient servir plus régulièrement de références, voire de recommandations, aux initiateurs de tout nouveau dépistage et de tout programme ou campagne se servant de tests connus, voire éprouvés.Pour évaluer les méthodes, il existe cinq critères (acceptabilité, simplicité, fidélité, validité et rentabilité économique) dont la connaissance est indispensable à la mise à l'épreuve de tout nouveau test, mais dont les résultats restent encore controversés pour des tests de dépistage même appliqués de longue date [4].Enfin, une classification anglo-saxonne est présentée (tableau 5) dont les avantages sont tels qu'elle devrait supplanter les précédentes.

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The basis of screening — Detinitions, aims, principles, evaluation of methods, and classification

Summary Within the conceptual framework of early detection, screening appears as a very promising means for secondary prevention (table 1).It appears useful to think of its objectives in the three terms of public health, economics and research (table 2).In instituting a screening project, six principles have to be taken into account, five of which have become classical. They should more regularly serve as reference, or recommandations, whenever new screening programs or campaigns using known tests are to be introduced.There are five criteria for evaluation of the methods (acceptability, simplicity, reliability, validity, and economy). Their knowledge is indispensable in examining any newly-to-introduce test — especially so, as the results even of screening tests that have been applied for a long time remain controversial [4].Finally, an Anglo-Saxon classification is presented (table 5), the advantages of which are such as to justify replacement of its predecessors.

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Die Grundlagen der Filteruntersuchungen — Definitionen, Ziele, Prinzipien, Evaluation der Methoden und Klassitikation

Zusammenfassung Im konzeptuellen Rahmen der Früherfassung erscheint die Filteruntersuchung als eine vielversprechende Methode zur sekundären Prävention (Tabelle 1).Es erscheint angezeigt, ihre Ziele in dreifacher Weise zu definieren, nämlich im Sinne der Volksgesundheit, der Volkswirtschaft und der Forschung (Tabelle 2).Ihre Durchführung richtet sich nach sechs Prinzipien, wovon fünt klassischen. Es wäre wünschbar, dass diese bei der Einführung neuer Filteruntersuchungen neuer Programme oder Kampagnen mit bekannten Tests regelmässiger als bisher als Referenzpunkte oder Empfehlungen benützt würden.Zur Evaluation der Methoden stehen fünf Kriterien zur Verfügung (Annehmbarkeit, Einfachheit, Zuverlässigkeit, Gültigkeit und Wirtschaftlichkeit). Ihre Kenntnis ist unentbehrlich, um einen neueinzuführenden Test zu prüfen, um so mehr als die Resultate sogar für seit langer Zeit angewandte Filtertests noch umstritten sind [4].Schliesslich wird eine englisch-amerikanische Klassifikation vorgestellt, deren Vorteile so eindeutig sind, dass sie alle früheren ersetzen sollte.

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Basé sur un rapport présenté aux Journées d'automne de la Société suisse de médecine sociale et préventive, Lausanne, 4/5 octobre 1974.     

糖尿病血糖 血脂及钾 钠 氯 镁元素的相关性分析

目的:探讨两组血糖、血脂水平、血清K、Na、Cl、Mg之间的相关性。方法:以231例已确诊的糖尿病患者为糖尿病组,以121例非糖尿病患者为非糖尿病组比较分析各指标之间的相关性。结果:①两组TC、HDL—C、LDL—C水平存在差异(P<0.05)。两组间K、Na、Cl、Mg、TG、ApoA1、ApoB、Apo(a)差异无统计学意义(P>0.05);②空腹血糖与Na,HDL—C呈负相关(P<0.01);TC与TG、LDL—C呈正相关(P<0.01);TC与ApoB呈正相关(P<0.05);TG与ApoA1、ApoB呈正相关(P<0.05);LDL—C与Apo(a)呈正相关(P<0.05);ApoA1与ApoB呈正相关(P<0.01)。结论:①糖尿病组K、Na、Cl、Mg微量元素水平与血糖无相关性;②血糖与Na负相关,可能是高血糖渗透利尿导致Na丢失;③脂代谢紊乱与糖尿病联系密切,脂代谢可作为判断糖尿病患者血糖控制好坏的标准;④脂类中各成分水平有相关性,ApoA1可作为动脉粥样硬化发生的间接指标。     

Toxicity of mercury,copper, nickel,lead, and cobalt to embryos and larvae of zebrafish,Brachydanio rerio

The toxicity of mercury (HgCl₂), copper (CuCl₂: 5 H₂O), nickel (NiSO₄: 6 H₂O), lead (Pb(CH₃COO)₂: 3 H₂O) and cobalt (CoCl₂: 6 H₂O) was studied under standardized conditions in embryos and larvae of the zebrafish,Brachydanio rerio. Exposures were started at the blastula stage (2–4 h after spawning) and the effects on hatching and survival were monitored daily for 16 days. Copper and nickel were more specific inhibitors of hatching than cobalt, lead, and mercury. Nominal no effect concentrations determined from the dose-response relationships (ZEPs, Zero Equivalent Points) for effect on hatching time were 0.05 g Cu/L, 10 g Hg/L, 20 g Pb/L, 40 g Ni/L and 3,840 g Co/L, and those for effect on survival time were 0.25 g Cu/L, 1.2 g Hg/L, 30 g Pb/L, 80 g Ni/L, and 60 g Co/L. The no effect concentrations for Ni, Hg and Pb are consistent with previously reported MATC values for sensitive species of fish. The no effect concentrations for copper are 1–2 orders of magnitude lower than previously reported values. The major reason for the latter discrepancy was considered to be the absence of organics that can complex copper ions in the reconstituted water that we used, which had a hardness of 100 mg/L (as CaCO₃) and a pH of 7.5–7.7. Unexposed controls were started with embryos from different parental zebrafishes and the parental-caused variability in early embryo mortality, median hatching time and median survival time were estimated.     

A Longitudinal,Randomized, Controlled Trial of Advance Care Planning for Teens With Cancer: Anxiety,Depression, Quality of Life,Advance Directives,Spirituality

PurposeTo test the feasibility, acceptability and safety of a pediatric advance care planning intervention, Family-Centered Advance Care Planning for Teens With Cancer (FACE-TC).MethodsAdolescent (age 14–20years)/family dyads (N = 30) with a cancer diagnosis participated in a two-armed, randomized, controlled trial. Exclusion criteria included severe depression and impaired mental status. Acceptability was measured by the Satisfaction Questionnaire. General Estimating Equations models assessed the impact of FACE-TC on 3-month post-intervention outcomes as measured by the Pediatric Quality of Life Inventory 4.0 Generic Core Scale, the Pediatric Quality of Life Inventory 4.0 Cancer-Specific Module, the Beck Depression and Anxiety Inventories, the Spiritual Well-Being Scale of the Functional Assessment of Chronic Illness Therapy–IV, and advance directive completion.ResultsAcceptability was demonstrated with enrollment of 72% of eligible families, 100% attendance at all three sessions, 93% retention at 3-month post-intervention, and 100% data completion. Intervention families rated FACE-TC worthwhile (100%), whereas adolescents' ratings increased over time (65%–82%). Adolescents' anxiety decreased significantly from baseline to 3 months post-intervention in both groups (β = −5.6; p = .0212). Low depressive symptom scores and high quality of life scores were maintained by adolescents in both groups. Advance directives were located easily in medical records (100% of FACE-TC adolescents vs. no controls). Oncologists received electronic copies. Total Spirituality scores (β = 8.1; p = .0296) were significantly higher among FACE-TC adolescents versus controls. The FACE-TC adolescents endorsed the best time to bring up end-of-life decisions: 19% before being sick, 19% at diagnosis, none when first ill or hospitalized, 25% when dying, and 38% for all of the above.ConclusionsFamily-Centered Advance Care Planning for Teens With Cancer demonstrated feasibility and acceptability. Courageous adolescents willingly participated in highly structured, in-depth pediatric advance care planning conversations safely.     

Blood Lead Survey of Children,Pregnant Women,Professional Drivers,Street Workers,and Office Workers in Trujillo,Peru

In this pilot study, conducted in summer 2002, the authors measured blood lead levels (BLLs) for 118 subjects in the city of Trujillo, Peru, where leaded gasoline is in the process of being phased out. Subjects included bus drivers, combi (minivan) drivers, street vendors, newspaper vendors, traffic police, taxi drivers, gas station attendants, children living both near and distant from gas stations, pregnant women, and office workers (controls). The highest BLLs were 9.2 μg/dl and 9.3 μg/dl from a child who lived near a gas station and from a traffic policeman, respectively; however, all BLLs were below the U.S. Centers for Disease Control and Prevention's advisory level of concern (10 μg/dl). Office workers (n = 8) and pregnant women (n = 36) had significantly lower BLLs (geometric mean ± standard deviation = 2.1 ± 0.7 μg/dl, p < 0.022; and 2.5 ± 1.1 μg/dl, p < 0.008, respectively) than total traffic-exposed workers (n = 48; 3.2 ± 1.8 μg/dl). BLLs of children living near gas stations (n = 17; 3.7 ± 2.2 μg/dl) were marginally higher (p = 0.07) than for children not living near gas stations (n = 9; 2.9 ± 1.1 μg/dl). The study was limited by small sample size and the fact that the data were based on a convenience sample not fully representative of the cohorts studied. Nevertheless, the authors' findings suggest that leaded gasoline use in Trujillo continues to affect BLLs in traffic-exposed populations.