Characterization of initial clinical symptoms and risk factors for sinonasal adenocarcinomas: results of a case–control study

Purpose  

Sinonasal adenocarcinoma is a rare cancer, frequently associated with occupational exposure to inhalable wood dust. Among the EU member States, Germany was reported to have the highest number of exposed workers. Location and long latency make early diagnosis difficult. This case–control study was aimed at assessing potential risk factors and at characterizing initial clinical symptoms, both serving as matrix to identify persons at increased risk and to improve management of this cancer.     

Predictors of frailty in old age–results of a longitudinal study

Objectives

To investigate time-dependent predictors of frailty in old age longitudinally.

Design

Population-based prospective cohort study.

Setting

Elderly individuals were recruited via GP offices at six study centers in Germany. The course of frailty was observed over 1.5 years (follow up wave 4 and follow up wave 5).

Participants

1,602 individuals aged 80 years and older (mean age 85.4 years SD 3.2, with mean CSHA CFS 3.5 SD 1.6) at follow up wave 4.

Measurements

Frailty was assessed by using the Canadian Study of Health and Aging Clinical Frailty Scale (CSHA CFS), ranging from 1 (very fit) to 7 (severely frail).

Results

Fixed effects regressions revealed that frailty increased significantly with increasing age (ß=.2) as well as the occurrence of depression (ß=.5) and dementia (ß=.8) in the total sample. Changes in marital status and comorbidity did not affect frailty. While the effects of depression and dementia were significant in women, these effects did not achieve statistical significance in men.

Conclusion

Our findings highlight the role of aging as well as the occurrence of dementia and depression for frailty. Specifically, in order to delay frailty in old age, developing interventional strategies to prevent depression might be a fruitful approach.

     

Ebm@school – a curriculum of critical health literacy for secondary school students: results of a pilot study

Objectives:  Increasingly, patients and consumers are taking responsibility for their diagnostic and therapeutic decisions. This requires a certain amount of health literacy in order to critically assess the various procedures and products. The aim of this study was to develop and pilot test a curriculum of critical health literacy for secondary school students. Methods:  The curriculum is based on the concept of evidence-based medicine and consists of six modules. Development and pilot testing was performed with two classes of secondary school students (n = 45) in Grade 11. The Metaplan method was used to document feedback regarding teaching methods, worksheets, satisfaction and individually perceived benefits. Additionally, systematic observations by researchers were documented and students’ presentations assessed. A sample of untrained students (n = 218) served as a control group. The Critical Health Competency Test was employed for evaluating competencies in critical health literacy. Data were analyzed qualitatively and person parameters were calculated. Results:  Overall, the pilot courses were well-accepted and have been proven to be feasible. Students’ feedback guided revision of the curriculum. Trained students achieved significantly higher person parameters (± SD) than the control group: 597 (± 79) versus 483 (± 94), p < 0.01, indicating enhancement of critical health competencies. Conclusion:  Teaching critical health literacy to secondary school students is feasible and is likely to enhance the competence of critical health literacy. Further studies are needed to show the effectiveness of the intervention. Submitted: 31 March 2007; revised: 11 February 2008, 13 June 2008, 26 August 2008; accepted: 26 August 2008     

Intestinal helminthiasis among school children: preliminary results of a prospective study in Agboville in Southern Côte d'Ivoire

Intestinal helminthiasis affects the health and academic performance of children in developing countries. To highlight a few socio-economic factors that impact the presence and upholding of intestinal helminthiasis, a cohort study was performed from February to June 2001. This study took place in Agboville in Southern C?te d'Ivoire on 363 children, under the age of 15, regularly enrolled in school and selected by two-step clustered sampling. After the survey was completed, their stools were examined using 3 methods: direct exam, Kato's technique, and Graham's anal scotch-test. Infected students received an appropriate anti-helminthic treatment. After performing a test two weeks later, a new sample of 348 parasite-free children was made up and re-examined after three months, through the aforementioned techniques. In this sample, we assumed that students who were infested in the initial exam were "exposed", while those who were not infested in the first place were deemed to be "not exposed". The results showed that 135 students out of the 360 admitted for the first exam were infested; or a 37.5% of intestinal helminthiasis prevalence (IC95%=30.5-45). The prevalent parasite species were Necator americanus (15%), Trichuris trichiura (13.6%), Schistosoma mansoni (10%). Twenty-eight per cent of 135 infested students were infected by more than one parasite. After three months, the incidence rate of intestinal helminthiasis calculated out of the remaining 336 students was 7.7% (IC95%=4.4-13.1). The likelihood of re-infestation amounted to 3.4 (IC95%=1.5-7.3). The pattern of re-infestation rates according to socio-economic factors differed from that of infested prevalence. The prevalent parasites in re-infested patients were Trichuris trichiura (16.3%), Schistosoma mansoni (12.5%). All intestinal nematodes and Schistosoma mansoni were observed. The most frequent parasites species where those transmitted cutaneously. The high re-infestation rate suggests that intestinal helminthiasis in this region affects roughly the same children. These results show the necessity to continue our investigations in order to highlight essential hygienic factors in our long-term fight against intestinal helminthiasis.     

The new Stark rules: what does Stark II Phase III mean for healthcare providers?

Senator Pete Stark, sponsor of the Physician Self-Referral Law, was recently quoted as saying he wished he had never sponsored the law due to its now complex requirements and iterations imposed by the Centers for Medicare & Medicaid Services. The new Stark II Phase III rules further muddy the waters. This article reviews the basic Stark prohibitions and provides an overview of Stark II Phase III.     

Cancer on the Island of Réunion: results of a survey preliminary to the creation of a tumor registry

Before the organization of a cancer registration in "l'Ile de la Réunion" a retrospective survey about cases notified by public and private physicians was setted in 1981. 1128 cases were notified and 618 were new cases. The estimation of the total incidence of cancer is 1.2 cases by 1000 inhabitants in "l'Ile de la Réunion".     

Efficacy and safety of nedaplatin-based concurrent chemoradiotherapy for FIGO Stage IB2–IVA cervical cancer and its clinical prognostic factors

Cisplatin-based concurrent chemoradiotherapy (CCRT) is a standard treatment for cervical cancer, but nedaplatin-based CCRT is not routinely administered. We evaluated the efficacy and safety of nedaplatin-based CCRT (35 mg/m² weekly) and analyzed prognostic factors for survival among 52 patients with International Federation of Gynecology and Obstetrics (FIGO) Stage IB2–IVA cervical cancer treated from 1999 to 2009. Patients were treated with a combination of external beam radiotherapy of 40–56 Gy (in 20–28 fractions) and 13.6–28.8 Gy (in 2–4 fractions) of high-dose-rate (HDR) intracavitary brachytherapy or 18 Gy (in 3 fractions) of HDR interstitial brachytherapy. Overall survival (OS), progression-free survival (PFS), and local control (LC) were estimated using the Kaplan–Meier method. The Cox proportional hazard model was used for multivariate analysis. Acute and late toxicities were evaluated using the Common Terminology Criteria for Adverse Events version 4.0. The median follow-up period was 52 months. The median patient age was 63 years. The 5-year OS, PFS and LC rates were 78%, 57% and 73%, respectively. Multivariate analysis showed that histologic type, maximum tumor diameter, and pretreatment hemoglobin level were independent risk factors for PFS. Regarding adverse effects, 24 patients (46%) had acute Grade 3–4 leukopenia and 5 (10%) had late Grade 3 gastrointestinal toxicities. No patient experienced renal toxicity. Nedaplatin-based CCRT for FIGO Stage IB2–IVA cervical cancer was efficacious and safe, with no renal toxicity. Histologic type, maximum tumor diameter, and pretreatment hemoglobin level were statistically significant prognostic factors for PFS.     

Low back pain and lumbago–sciatica in nurses and a reference group of clerks: results of a comparative prevalence study in Germany

OBJECTIVES: To gain more conclusive evidence on the question of work-related low-back disorders in German nurses, a comprehensive study with several methodological approaches was performed. METHODS: As part of this project, a cross-sectional study on working conditions and prevalence of low back pain, a sample of 3,332 nurses and 1,720 clerks as reference group was investigated by a questionnaire. In this article, final results referring to a sub-sample of 2,207 nurses and 1,177 clerks who had always worked in their profession, so that we could exclude confounding effects of former occupations, will be presented. Excluding the confounding effects of several covariates by logistic regression, we computed relative risks for different pain symptoms. RESULTS: The data suggest a considerably higher risk of low back pain for nurses than for the reference population of clerks. Results, however, differ markedly when specific pain symptoms are considered. With respect to lumbago-sciatica and sciatica - which have to be regarded as indicators for possible disc herniation - the study group's relative risk is the most elevated (2.88 for point prevalence of lumbago-sciatica/sciatica). Adjusting the results for several confounders and covariates leads to still higher estimations of nurses' relative risk.     

Safety and immunogenicity of a tetravalent dengue vaccine in healthy children aged 2–11 years in Malaysia: A randomized,placebo-controlled,Phase III study

Background

Dengue disease is a major public health problem across the Asia-Pacific region for which there is no licensed vaccine or treatment. We evaluated the safety and immunogenicity of Phase III lots of a candidate vaccine (CYD-TDV) in children in Malaysia.

Methods

In this observer-blind, placebo-controlled, Phase III study, children aged 2–11 years were randomized (4:1) to receive CYD-TDV or placebo at 0, 6 and 12 months. Primary endpoints included assessment of reactogenicity following each dose, adverse events (AEs) and serious AEs (SAEs) reported throughout the study, and immunogenicity expressed as geometric mean titres (GMTs) and distribution of dengue virus (DENV) neutralizing antibody titres.

Results

250 participants enrolled in the study (CYD-TDV: n = 199; placebo: n = 51). There was a trend for reactogenicity to be higher with CYD-TDV than with placebo post-dose 1 (75.4% versus 68.6%) and post-dose 2 (71.6% versus 62.0%) and slightly lower post-dose 3 (57.9% versus 64.0%). Unsolicited AEs declined in frequency with each subsequent dose and were similar overall between groups (CYD-TDV: 53.8%; placebo: 49.0%). Most AEs were of Grade 1 intensity and were transient. SAEs were reported by 5.5% and 11.8% of participants in the CYD-TDV and placebo groups, respectively. No deaths were reported. Baseline seropositivity against each of the four DENV serotypes was similar between groups, ranging from 24.0% (DENV-4) to 36.7% (DENV-3). In the CYD-TDV group, GMTs increased post-dose 2 for all serotypes compared with baseline, ranging from 4.8 (DENV-1) to 8.1-fold (DENV-3). GMTs further increased post-dose 3 for DENV-1 and DENV-2. Compared with baseline, individual titre increases ranged from 6.1-fold (DENV-1) to 7.96-fold (DENV-3).

Conclusions

This study demonstrated a satisfactory safety profile and a balanced humoral immune response against all four DENV serotypes for CYD-TDV administered via a three-dose regimen to children in Malaysia.     

Immunogenicity and safety of a new meningococcal A conjugate vaccine in Indian children aged 2–10 years: A Phase II/III double-blind randomized controlled trial

This study compares the immunogenicity and safety of a single dose of a new meningococcal A conjugate vaccine (PsA-TT, MenAfriVac™, Serum Institute of India Ltd., Pune) against the meningococcal group A component of a licensed quadrivalent meningococcal polysaccharide vaccine (PsACWY, Mencevax ACWY^®, GSK, Belgium) 28 days after vaccination in Indian children. This double-blind, randomized, controlled study included 340 Indian children aged 2–10 years enrolled from August to October 2007; 169 children received a dose of PsA-TT while 171 children received a dose of PsACWY. Intention-to-treat analysis showed that 95.2% of children in PsA-TT group had a ≥4-fold response in serum bactericidal titers (rSBA) 28 days post vaccination as compared to 78.2% in the PsACWY group. A significantly higher rSBA GMT (11,209, 95%CI 9708–12,942) was noted in the PsA-TT group when compared to PsACWY group (2838, 95%CI 2368–3401). Almost all children in both vaccine groups had a ≥4-fold response in group A-specific IgG concentration but the IgG GMC was significantly greater in the PsA-TT group (89.1 μg/ml, 95%CI 75.5–105.0) when compared to the PsACWY group (15.3 μg/ml, 95%CI 12.3–19.2). Local and systemic reactions during the 4 days after immunization were similar for both vaccine groups except for tenderness (30.2% in PsA-TT group vs 12.3% in PsACWY group). None of the adverse events or serious adverse events was related to the study vaccines. We conclude that MenAfriVac™ is well tolerated and significantly more immunogenic when compared to a licensed polysaccharide vaccine, in 2-to-10-year-old Indian children.     

Phase II trial in adults of concurrent or sequential 2009 pandemic H1N1 and 2009–2010 seasonal trivalent influenza vaccinations

BackgroundDuring the 2009 influenza pandemic both seasonal and 2009 pandemic vaccines were recommended. We conducted a randomized trial of monovalent 2009-H1N1 vaccine and seasonal trivalent inactivated influenza vaccine (IIV3) given sequentially or concurrently to adults.MethodsAdults randomized to 4 study groups and stratified by age (18–64 and ≥65 years) received 1 dose of seasonal IIV3 or placebo and 2 doses of 2009-H1N1 vaccine or placebo in one of 4 combinations, i.e., H1N1 + Placebo/H1N1 + Placebo/IIV3 (HP/HP/V3), H1N1 + IIV3/H1N1 + Placebo/Placebo (HV3/HP/P), H1N1 + Placebo/H1N1 + IIV3/Placebo (HP/HV3/P), and IIV3 + Placebo/H1N1 + Placebo/H1N1 (V3P/HP/H). Intramuscular injections were given three times at 21 day intervals. Sera for antibody assays were obtained prior to and 21 days after each vaccination. Reactogenicity and adverse events were monitored.ResultsEight hundred-five (805) adults were enrolled. All combinations of vaccines were safe and well tolerated. In general, one dose of 2009-H1N1 and one dose of IIV3, regardless of sequence or concurrency of administration, were immunogenic in adults. There were no significant differences in geometric mean titers (GMT) or the proportions of subjects with ≥4-fold rise in antibody responses and titers ≥40 for any vaccine group or between age strata for 2009-H1N1 after the first or second dose, although the vaccine sequence affected the titers to the IIV3 antigens. Hemagglutination inhibition antibody (HAI) GMTs against 2009-H1N1 for the combined age strata 21 days after the first 2009-H1N1 dose were 190.4, 182.1, 232.9 and 157.5 for HP/HP/V3, HV3/HP/P, HP/HV3/P and V3P/HP/H, respectively. While IIV3 GMTs were adequate they were generally lower than the 2009-H1N1 GMTs. In a subset of subjects, there was good correlation between HAI and microneutralization (MN) titers (Spearman's correlation coefficient 0.92).ConclusionsAll vaccine combinations were generally well tolerated. Immune responses to one dose of 2009-H1N1 were adequate regardless of the sequence of vaccination in all age groups, but the sequence affected titers to IIV3 antigens.     

Efficacy and safety of a quadrivalent influenza vaccine in children aged 6–35 months: A global,multiseasonal, controlled,randomized Phase III study

BackgroundChildren are an important target group for influenza vaccination, but few studies have prospectively evaluated influenza vaccine efficacy (VE) in children under 3 years of age. This was a randomized Phase III trial to assess the efficacy, immunogenicity, and safety of an inactivated quadrivalent influenza vaccine (QIV) in young children (EudraCT: 2016–004904–74).MethodsInfluenza-naïve children aged 6–35 months were randomized during three influenza seasons to receive vaccination with QIV or a non-influenza control vaccine. One group of participants was revaccinated with QIV in the subsequent influenza season. The primary efficacy endpoint was the absolute VE of QIV against influenza caused by any circulating strain. Key secondary efficacy endpoints included the absolute VE of QIV against influenza due to antigenically matching strains and immunogenicity. Safety and reactogenicity were also evaluated.ResultsIn total, 1005 children received QIV and 995 received control vaccine. Influenza A/B infection due to any circulating influenza strain occurred less frequently in children who received QIV versus children receiving a control vaccine. The absolute VE of QIV against any circulating influenza strain was 54% (95% confidence interval [CI]: 37%, 66%). The absolute VE of QIV against antigenically matching influenza strains was 68% (95% CI: 45%, 81%). Mean hemagglutination inhibition titers for all influenza strains in the QIV group increased post-vaccination, whereas increases were minimal in the control vaccine group; results from virus neutralization and neuraminidase-inhibition assays were generally consistent with the hemagglutination inhibition assay findings. Approximately 12 months after primary vaccination with QIV, antibody titers remained higher than pre-vaccination titers for most strains. In participants who were revaccinated, QIV elicited strong antibody responses. The overall safety profile and reactogenicity of QIV was comparable with control vaccine.ConclusionPrimary vaccination with QIV was well tolerated and effective in protecting children aged 6–35 months against influenza.     

Dose–volume histogram parameters of high-dose-rate brachytherapy for Stage I–II cervical cancer (≤4cm) arising from a small-sized uterus treated with a point A dose-reduced plan

We investigated the rectal dose-sparing effect and tumor control of a point A dose-reduced plan in patients with Stage I–II cervical cancer (≤4 cm) arising from a small-sized uterus. Between October 2008 and August 2011, 19 patients with Stage I–II cervical cancer (≤4 cm) were treated with external beam radiotherapy (EBRT) for the pelvis and CT-guided brachytherapy. Seven patients were treated with brachytherapy with standard loading of source-dwell positions and a fraction dose of 6 Gy at point A (conventional brachy-plan). The other 12 patients with a small uterus close to the rectum or small intestine were treated with brachytherapy with a point A dose-reduction to match D2cc of the rectum and <6 Gy as the dose constraint (‘point A dose-reduced plan’) instead of the 6-Gy plan at point A (‘tentative 6-Gy plan’). The total doses from EBRT and brachytherapy were added up and normalized to a biological equivalent dose of 2 Gy per fraction (EQD2). The median doses to the high-risk clinical target volume (HR-CTV) D90 in the conventional brachy-plan, tentative 6-Gy plan and point A dose-reduced plan were 62 GyEQD2, 80 GyEQD2 and 64 GyEQD2, respectively. The median doses of rectal D2cc in the corresponding three plans were 42 GyEQD2, 62 GyEQD2 and 51 GyEQD2, respectively. With a median follow-up period of 35 months, three patients developed Grade-1 late rectal complications and no patients developed local recurrence. Our preliminary results suggested that CT-guided brachytherapy using an individualized point A dose-reduced plan might be useful for reducing late rectal complications while maintaining primary tumor control.     

Work-related lesions of the supraspinatus tendon: a case–control study

Objectives  

To examine the dose–response relationship between cumulative duration of work with highly elevated arms (work above shoulder level) as well as of manual material handling and ruptures of the supraspinatus tendon in a population-based case–control study.     

Prospective european multi-center study of natural family planning (1989–1992): Interim results

Since 1989 an international multicenter prospective study to evaluate the effectiveness and acceptability of natural family planning (NFP) methods in Europe has been conducted by the NFP Research Center at the University of Düsseldorf in collaboration with the European Zone of the International Federation for Family Life Promotion (IFFLP). Fourteen NFP-organizations from nine European countries participate in the study. Cycle data from women in the fertile age group are transferred to a special standard computer sheet by the respective organizations and forwarded at three-monthly intervals to the study center for analyses.To date, 10 045 cycles from 900 women aged between 19 and 54 years have been analyzed. This paper presents the pregnancy rate for the women aged between 19 and 45 years of age, who contributed 9284 cycles. In the analyses the cycles were subdivided into two categories consequent to sexual practices during the fertile phase: group I (NFP only-4277 cycles) use only NFP to avoid a pregnancy; group II (FA/mix-5007 cycles) where barrier methods or coitus interruptus during the fertile phase, at least in some cycles, were used to avoid a pregnancy. The women used different clinical indicators such as basal body temperature during the fertile phase, at least in some cycles, were used to avoid a pregnancy.The women used different clinical indicators such as basal body temperature (BBT), cervical mucus, calculations, cyclical cervical changes or combinations of these to determine the beginning and the end of the fertile phase necessitating a further division into four subgroups, A, B, C, D, and different efficiency rates for each of these groups.

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Resumen El Centro de Investigaciones de Planificación Familiar Natural (NFP) de la Universidad de Düsseldorf realiza desde 1989, en colaboración con la Zona Europea de la Federación Internacional de Planificación Familiar (IFFLP), un estudio prospectivo multicentro para evaluar la eficacia y aceptabilidad de métodos de planificación familiar natural en Europa. Catorce organizaciones NFP de nueve, países europeos participan en el estudio. Los datos de los ciclos de mujeres de edad fecunda son trasladados a una hoja especial de ordenador estándar por las respectivas organizaciones y enviados a intervalos, de tres meses al centro del estudio, donde son analizados.Hasta la fecha se han analizado 10045 ciclos de 900 mujeres de 19 a 54 años de edad. Este trabajo presenta la proporción de embarazos de las mujeres de 19 a 45 años de edad, que representaron 9284 ciclos. En los análisis, los ciclos se subdividieron en dos categorías según las prácticas sexuales durante la fase fecunda: el Grupo I (NFP solamente-4277 ciclos) utilizó solamente NFP para prevenir, el embarazo; el Grupo II (mezcla/FA-5007 ciclos) utilizó el método de barrera o el coito interrumpido durante la fase fecunda al menos en algunos ciclos para prevenir el embarazo. Las mujeres utilizaron diferentes indicadores clínicos tales como la temperatura corporal basal (BBT, moco cervical, cálculos, cambios cervicales cíclicos), o combinaciones de éstos para determinar el comienzo, y la finalización de la fase fecunda, lo cual requirió una división adicional en cuatro subgrupos, A, B, C, D, y diferentes proporciones de eficacia para cada uno de estos grupos.En el grupo A (método sintotérmico, doble verificación) hubo 15 embarazos no intencionales (UIP) en 7404 ciclos, lo cual representa una proporción de embarazos de 2,4 Pearl Index (P.I.); en el grupo B (método mucotérmico) hubo 12 UIP en 1352 ciclos con una proporción de embarazos de 10,6 (P.I.); en el grupo C (moco para detectar el comienzo y moco y BBT para determinar el final de la fase fecunda) hubo un UIP en 434 ciclos y en el grupo D (método del moco solamente) hubo un UIP en 70 ciclos. Los números del grupo, C y D son demasiado bajos como para calcular una proporción de embarazos (P.I.). No se registró ningún embarazo entre las mujeres de más de 40 años.De estos resultados preliminares concluimos que en el continente de Europa el método sintotérmico, utilizado con la abstinencia periódica (grupo NFP solamente=grupo I) y percepción de la fecundidad con el uso de barreras durante la fase fecunda (mezcla/Fa=grupo II) son métodos eficaces de planificación familiar. Los resultados indican asimismo que el(los) indicador (es) clínico(s) utilizado(s) por la mujer para determinar los límites de la fase fecunda es(son) la variable más importante para determinar la eficacia de la NFP, siendo la doble, verificación (subgrupo A) el método NFP más eficaz.

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Resumé Une étude prospective internationale faisant intervenir plusieurs centres a été entreprise en 1989 par le Centre de recherche sur le planning familial naturel (PFN) de l'université de Düsseldorf, en collaboration avec la branche européenne de la Fédération internationale pour la promotion de la vie familiale. Cette étude a pour but d'évaluer l'efficacité et l'acceptabilité des méthodes de PFN en Europe. Quatorze organismes de PFN de neuf pays européens participent à l'étude. Les données concernant les cycles, recueillies par des femmes en âge de procréer, sont transcrites sur des formulaires informatiques normalisés par les organismes respectifs et envoyées pour analyse au centre chargé, de l'étude tous les trois mois.A ce jour, 10.045 cycles de 900 femmes âgées de 19 à 54 ans ont été analysés. Cet article présente le taux de grossesse chez les femmes âgées de 19 à 45 ans qui ont communiqué les données de 9.284 cycles. Dans les analyses, les cycles ont été divisés en deux catégories en fonction des pratiques sexuelles durant la phase de fécondité: le Groupe I (uniquement PFN-4.277 cycles) n'utilise, que la méthode du PFN pour éviter une grossesse; le Groupe II (connaissance des conditions de fécondité/méthodes diverses-5.007 cycles) fait appel à une méthode de barrière ou au coïtus interruptus durant la phase de fécondité au moins dans certains cycles pour éviter une grossesse. Les femmes s'appuyant sur différents indicateurs cliniques tels que la température basale, le mucus cervical, les calculs, les modifications cervicales durant le cycle, ou une combinaison de ces indicateurs pour déterminer le début et la fin de la phase de fécondité ont d être divisées en quatre sous-groupes A, B, C, D; des taux d'efficacité différents ont été attribués pour chaque groupe.Dans le groupe A (méthode sympto-thermique, double contrôle), 15 grossesses involontaires pour 7.404 cycles correspondent à un taux de grossesse de 2,4 de l'échelle de Pearl (E.P.); dans le groupe B (méthode muco-thermique), 12 grossesses involontaires pour 1.352 cycles correspondent à un taux de grossesse de 10,6 (E.P.); dans le groupe C (mucus pour déterminer le début de la phase de fécondité, et mucus et température basale pour déceler la fin de cette phase), il s'est produit une seule grossesse involontaire pour 434 cycles; et dans le groupe D (mucus seulement) il s'est produit une grossesse pour 70 cycles. Les nombres des groupes C et D sont trop faibles pour permettre de calculer un taux de grossesse (E.P.). Aucune grossesse n'a été signalée chez les femmes âgées de plus de 40 ans.Ces résultats préliminaires nous permettent de conclure, que, sur le continent européen, la méthode sympto-thermique appliquée avec les périodes d'abstinence (PFN=groupe I) et la connaissance des conditions de fécondité avec l'emploi de barrières durant la phase de fécondité (connaissance des conditions de fécondité/méthodes diverses=groupe II) sont des méthodes de planning familial efficaces. Les résultats montrent aussi que les indicateurs cliniques sur lesquels les femmes se fondent pour déceler les limites de la phase de fécondité sont les variables les plus importantes permettant de déterminer l'efficacité du PFN, la méthode du double contrôle (sous-groupe A) étant la méthode de PFN la plus efficace.

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Part of the results were presented at the VIII Annual Meeting of the Society for the Advancement of Contraception, Barcelona, Spain, October 28–31, 1992     

Axial rigidity and quality of life in patients with Parkinson’s disease: a preliminary study

Purpose  

Rigidity is a cardinal symptom of Parkinson’s disease (PD) and is often clinically assessed by passively flexing and extending a patient’s limb. Objective measurements had been employed to examine rigidity in PD subjects, including wrist, elbow, knee and trunk. This study aimed to investigate the relationship between an objective measurement of trunk rigidity and health-related quality of life (HRQoL) and functional status in patients with mild to moderate PD.     

EpiHealth: a large population-based cohort study for investigation of gene–lifestyle interactions in the pathogenesis of common diseases

The most common diseases affecting middle-aged and elderly subjects in industrialized countries are multigenetic and lifestyle related. Several attempts have been made to study interactions between genes and lifestyle factors, but most such studies lack the power to examine interactions between several genes and several lifestyle components. The primary objective of the EpiHealth cohort study is to provide a resource to study interactions between several genotypes and lifestyle factors in a large cohort (the aim is 300,000 individuals) derived from the Swedish population in the age range of 45–75 years regarding development of common degenerative disorders, such as cardiovascular diseases, cancer, dementia, joint pain, obstructive lung disease, depression, and osteoporotic fractures. The study consists of three parts. First, a collection of data on lifestyle factors by self-assessment using an internet-based questionnaire. Second, a visit to a test center where blood samples are collected and physiological parameters recorded. Third, the sample is followed for occurrence of outcomes using nationwide medical registers. This overview presents the study design and some baseline characteristics from the first year of data collection in the EpiHealth study.     

Inequalities in out-of-pocket payments for health care services among elderly Germans – results of a population-based cross-sectional study

Introduction

In order to limit rising publicly-financed health expenditure, out-of-pocket payments for health care services (OOPP) have been raised in many industrialized countries. However, higher health-related OOPP may burden social subgroups unequally. In Germany, inequalities in OOPP have rarely been analyzed. The aim of this study was to examine OOPP of the German elderly population in the different sectors of the health care system. Socio-economic and morbidity-related determinants of inequalities in OOPP were analyzed.

Methods

This cross-sectional analysis used data of N?=?3,124 subjects aged 57 to 84 years from a population-based prospective cohort study (ESTHER study) collected in the Saarland, Germany, from 2008 to 2010. Subjects passed a geriatric assessment, including a questionnaire for health care utilization and OOPP covering a period of three months in the following sectors: inpatient care, outpatient physician and non-physician services, medical supplies, pharmaceuticals, dental prostheses and nursing care. Determinants of OOPP were analyzed by a two-part model. The financial burden of OOPP for certain social subgroups (measured by the OOPP-income-ratio) was investigated by a generalized linear model for the binomial family.

Results

Mean OOPP during three months amounted to €119, with 34% for medical supplies, 22% for dental prostheses, 21% for pharmaceuticals, 17% for outpatient physician and non-physician services, 5% for inpatient care and 1% for nursing care. The two-part model showed a significant positive association between income (square root equivalence scale) and total OOPP. Increasing morbidity was associated with significantly higher total OOPP, and in particular with higher OOPP for pharmaceuticals. Total OOPP amounted to about 3% of disposable income. The generalized linear model for the binomial family showed a significantly lower financial burden for the wealthiest quintile as compared to the poorest one.

Conclusions

This is the first study providing evidence of inequalities in OOPP in the German elderly population. Socio-economic and morbidity-related inequalities in OOPP and the resulting financial burden could be identified. The results of this study may contribute to the discussion about the mechanisms causing the observed inequalities and can thus help decision makers to consider them when adapting future regulations on OOPP.     

US EPA particulate matter research centers: summary of research results for 2005–2011

The US Environmental Protection Agency funded five academic research centers in 2005 to address uncertainties in the health effects caused by airborne particulate matter (PM) as suggested by the 1998 National Research Council report, “Research Priorities for Airborne Particulate Matter.” The centers employed multidisciplinary teams of epidemiologists, toxicologists, atmospheric scientists, engineers, and chemists to approach four key research themes: susceptibility to PM, biological mechanisms of PM response, exposure–response relationships, and source linkages. This review presents selected accomplishments in these categories from the past 5-year period. Publications from the centers are summarized to provide both an overview of the accomplishments to date and easy reference to much of the original literature published by the centers. Numerous investigators worked together within and across centers to investigate the relationships between atmospheric PM and health effects, including (a) the role of reactive oxygen species, inflammation, the nervous system, and the cardiovascular system, (b) particle characteristics such as size, composition, source, and temporal pattern of exposure, and (c) phenotypic and genotypic characteristics of the population that influence the level of exposure and risk in response to a given exposure.