Accuracy of a PDA-based dietary assessment program

OBJECTIVE: Study objectives were to assess the accuracy of a food record delivered on a personal digital assistant (PDA) and to examine sources of error from the PDA-based food record. METHODS: Thirty-nine adults recruited with a newspaper advertisement were trained to record food intake using DietMatePro, a dietary assessment program delivered on a PDA. After 3 d of use, subjects returned for a follow-up visit in which a 24-h recall was conducted. Subjects also were timed while recording an observed, weighed lunch. Recalled and actual food intakes were compared with estimates recorded by the subjects when using the PDA. Paired sample t tests and Pearson's correlations assessed means and measurements of association between DietMatePro data compared with the 24-h recall data and observed meal data. Bland-Altman plots were used to assess bias in food recording. Sources of error were quantified by using calories as the unit for comparison. RESULTS: There were no significant differences in daily totals for calories and macronutrients between DietMatePro data and comparison measurements. Pearson's correlations of associations between DietMatePro data and the comparison measurement ranged from 0.505 to 0.797 (P < 0.005, n = 28) for the 24-h recall and from 0.419 to 0.786 (P < 0.005, n = 33) for the observed lunch, depending on the nutrient measured. The largest source of absolute error in caloric estimation was attributable to portion size estimation error (49%). CONCLUSIONS: DietMatePro, a PDA-based dietary assessment program, provides a method of assessing energy and macronutrient intakes comparable to the 24-h recall in samples lacking dietary restrictions.     

Factors influencing the choice of specialty of Australian medical graduates

OBJECTIVE: To identify the relative importance of extrinsic determinants of doctors' choice of specialty. DESIGN: A self-administered postal questionnaire. SETTING: Australian vocational training programs. PARTICIPANTS: 4259 Australian medical graduates registered in September 2002 with one of 16 Australian clinical colleges providing vocational training programs. MAIN OUTCOME MEASURES: Choice of specialist vocational training program; extrinsic factors influencing choice of program, and variation by sex, age, marital status and country of birth. RESULTS: In total, 79% of respondents rated "appraisal of own skills and aptitudes" as influential in their choice of specialty followed by "intellectual content of the specialty" (75%). Extrinsic factors rated as most influential were "work culture" (72%), "flexibility of working arrangements" (56%) and "hours of work" (54%). We observed variation across training programs in the importance ascribed to factors influencing choice of specialty, and by sex, age and marital status. Factors of particular importance to women, compared with men, were "appraisal of domestic circumstances" (odds ratio [OR], 1.9), "hours of work" (OR, 1.8) and "opportunity to work flexible hours" (OR, 2.6). Partnered doctors, compared with single doctors, rated "hours of work" and "opportunity to work flexible hours" as more important (OR, 1.3), while "domestic circumstances" was more important to doctors with children than those without children (OR, 1.7). In total, 80% of doctors had chosen their specialty by the end of the third year after graduation. CONCLUSIONS: Experience with discipline-based work cultures and working conditions occurs throughout medical school and the early postgraduate years, and most doctors choose their specialty during these years. It follows that interventions to influence doctors' choice of specialty need to target these critical years.     

The risk of second primaries subsequent to irradiation for cervix cancer

A review of 1048 patients with cancer of the cervix treated with radiation, either alone or combined with surgery, disclosed 32 cases of second primary malignancies occurring from 1 to 16 years subsequent to treatment. Using the person years approach, the incidence rate of second primaries was 5.49 per 1000 person years, which is not significantly different from population based rates. The anatomic locations of the new malignancies and the times from treatment of the cervix cancer to diagnosis of a new primary are presented; the possible carcinogenic effects of radiation are discussed. In this group of patients, it was concluded that under the period of observation irradiation administered at therapeutic doses did not increase the probability of second malignancy in the pelvis or at other sites.     

An outbreak of borderline oxacillin-resistant Staphylococcus aureus (BORSA) in a dermatological unit

From February through July, 2000, there was an accumulation of mecA-negative borderline resistant Staphylococcus aureus (BORSA) in the Department of Dermatology. BORSA was isolated in 37 samples from 11 patients. The isolates were typed by antibiogram, phage type, pulsed-field gel electrophoresis (PFGE), and spa genotyping that confirmed that they were indistinguishable from one another. In May, 2000, an intervention was initiated focusing on infection control. In-patients with BORSA were discharged and antibiotic treatment was stopped, if possible. Emphasis was put on disinfection of shared utensils and individualization of previously shared creams and lotions. After the intervention, BORSA was isolated from another 3 patients before the outbreak was terminated. A case-control study was undertaken to identify possible risk factors for being a BORSA patient. Compared to the controls, the patients with BORSA had more severe skin disease, were more often hospitalized, and had more bed days.     

Fatal toxic shock syndrome associated with Clostridium sordellii after medical abortion

Endometritis and toxic shock syndrome associated with Clostridium sordellii have previously been reported after childbirth and, in one case, after medical abortion. We describe four deaths due to endometritis and toxic shock syndrome associated with C. sordellii that occurred within one week after medically induced abortions. Clinical findings included tachycardia, hypotension, edema, hemoconcentration, profound leukocytosis, and absence of fever. These cases indicate the need for physician awareness of this syndrome and for further study of its association with medical abortion.     

Prevalence, course, and predictors of emotional distress in pregnant and parenting adolescents

This study examines trajectories and correlates of emotional distress symptoms in pregnant adolescents (n = 203) and nulliparous adolescents (n = 188) from economically disadvantaged communities over an 18-month period. For both groups, the prevalence of significant emotional distress exceeded expectation based on adolescent norms; however, the severity of symptoms did not differ between the 2 groups. Results from growth curve modeling revealed a significant decline in symptoms during the study period for both groups, but pregnant adolescents experienced a different pattern of decline. Also, certain interpersonal factors (e.g., history of physical maltreatment, partner support) appeared to play a more important role in the emotional well-being of pregnant and parenting adolescents relative to nulliparous adolescents. Implications for early identification and intervention are discussed.     

Postnatal onset of craniosynostosis in a case of Saethre-Chotzen syndrome

Saethre-Chotzen syndrome is a craniosynostosis syndrome characterized by facial and limb abnormalities. It is caused by mutations in the TWIST gene on chromosome 7p21. To date, more than 80 different mutations in TWIST have been reported in the literature.Recently, large deletions of chromosome 7p, encompassing the TWIST locus, have been detected in patients with clinical features of Saethre-Chotzen syndrome. Strikingly, all these patients were severely mentally retarded, which is otherwise a rare finding in Saethre-Chotzen syndrome. The authors report a patient with a large TWIST/7p deletion but with normal development. Furthermore, craniosynostosis was not present at birth or at the age of 4 months. However, skull radiographs taken at the age of 14 months showed stenosis of both coronal sutures, as well as of part of the sagittal suture. Reports on postnatal onset of craniosynostosis have been made in Crouzon syndrome but, to the authors' knowledge, never in Saethre-Chotzen syndrome.     

Sentinel node staging of resectable colon cancer: results of a multicenter study

OBJECTIVE AND SUMMARY BACKGROUND DATA: Sentinel lymph node (LN) sampling, a technique widely used to manage breast cancer and melanoma, seeks to select LNs that accurately predict regional node status and can be extensively examined to identify nodal metastatic disease not detected by standard histopathological staging. For patients with resectable colon cancer, improved identification of LN disease would significantly advance patient care by identifying patients likely to benefit from adjuvant therapy. This study, conducted by 25 surgeons at 13 institutions, examined whether sentinel node (SN) sampling accurately predicted LN status for patients with resectable colon cancer. METHODS: SN sampling involved peritumor injection of 1% isosulfan blue, followed by identification of all LN visualized within 10 minutes. SN sampling was performed on 79 of 91 patients enrolled, followed by multilevel sectioning (MLS) of the nodes and examination by a single study pathologist. RESULTS: By standard histopathology, 7 patients had primary disease that was either benign or not colon cancer and were therefore excluded from further studies. Of 72 colon cancer cases studied, 48 (66%) were node-negative and 24 (33%) contained nodal metastases. SNs were successfully located in 66 cases (92%), with an average of 2.1 nodes per patient. SNs were negative in 14 of 24 node-positive cases (58%). MLS revealed tumor in a SN in 1 of these cases, bringing the false-negative rate of SN examination to 54%. CONCLUSION: This multi-institutional study found that for patients with node-positive colon cancer, SN examination with MLS failed to predict nodal status in 54% of cases. We conclude that SN sampling with MLS, used alone, is unlikely to improve risk stratification for resectable colon cancer.