A clinic-based mammography intervention targeting inner-city women

OBJECTIVE: The objective was to evaluate the effect of a clinic-based intervention program on mammography use by inner-city women. DESIGN: A randomized controlled trial employing firm system methodology was conducted. SETTING: The study setting was a general internal medicine clinic in the university-affiliated county hospital serving metropolitan Seattle. PARTICIPANTS: Women aged 50 to 74 years with at least one routine clinic appointment (when they were due for mammography) during the study period were enrolled in the trial (n = 314). INTERVENTIONS: The intervention program emphasized nursing involvement and included physician education, provider prompts, use of audiovisual and printed patient education materials, transportation assistance in the form of bus passes, preappointment telephone or postcard reminders, and rescheduling assistance. Control firm women received usual care. MEASUREMENTS AND MAIN RESULTS: Mammography completion within 8 weeks of clinic visits was significantly higher among intervention (49%) than control (22%) firm women (p < .001). These effects persisted after adjustment for potential confounding by age, race, medical insurance coverage, and previous mammography experience at the hospital (odds ratio 3.5; 95% confidence interval 1.9, 6.5). The intervention effect was modified by type of insurance coverage as well as prior mammography history. Process evaluation indicated that bus passes and rescheduling efforts did not contribute to the observed increases in screening participation. CONCLUSIONS: A clinic-based program incorporating physician education, provider prompts, patient education materials, and appointment reminders and emphasizing nursing involvement can facilitate adherence to breast cancer screening guidelines among inner-city women.     

Nighttime salivary cortisol: a useful test for the diagnosis of Cushing's syndrome

Clinical features such as weight gain, depression, hypertension, and menstrual irregularities, although common in the general population, may raise the possibility of Cushing's syndrome. Up to 30% of urine cortisol and dexamethasone suppression screening tests may return an incorrect result, suggesting that better tests are needed. This study evaluated the utility of nighttime salivary cortisol measurement as a screening test for Cushing's syndrome. We evaluated 139 inpatients and 4 outpatients with possible Cushing's syndrome, 16 inpatients and 7 outpatients with other nonadrenal disorders, and 34 healthy outpatients. Using cut points that excluded all subjects without Cushing's syndrome, we compared the sensitivity for the detection of Cushing's syndrome of nighttime salivary cortisol levels (2330 and 2400 h for inpatients and bedtime for outpatients), simultaneous inpatient serum cortisol levels, and urine glucocorticoid excretion. An assay- specific inpatient 2400-h salivary cortisol or an outpatient bedtime salivary cortisol greater than 550 ng/dl (15.2 nmol/liter) identified 93% of patients with Cushing's syndrome (confidence interval, 89-98%) and excluded all individuals without the disorder. Salivary cortisol measurements worked as well as plasma measurements and better than urine glucocorticoid excretion. We concluded that bedtime salivary cortisol measurement is a practical and accurate screening test for the diagnosis of Cushing's syndrome.     

Colorectal Cancer Staging: Reappraisal of N/PN Classification

PURPOSE: Current American Joint Committee on Cancer and the Union Internationale Contre le Cancer TNM classification disregards location of positive nodes, discontinuing N3 category, which constitutes a major modification to 1987 version. This study was designed to assess the impact of the recategorization of former N3 cases and the reliability of the current N1-N2 subcategorization of Stage III patients. METHODS: Prospectively collected data from 1,391 patients (55.8 percent males; median age, 64 (range, 21–97) years), operated on with curative intent between 1980 and 1999, were analyzed. The median follow-up was 60 (interquartile range, 27–97) months with 129 cases lost to follow-up. RESULTS: Of positive node cases, 25.3 percent were former N3. Among them, 30.5 percent migrated to the N1 group and 69.5 percent to the N2 group. The proportions of former N3 cases in N1 and N2 groups were 12.5 percent and 46.1 percent, respectively (P < 0.001). Node-positive patients had an actuarial five-year survival rate of 56.7 percent (95 percent confidence interval, 53–59), with a significant difference between N1/N2 categories (63.6 vs. 44.1 percent, respectively; P < 0.001). Although apical node involvement and more than three positive nodes were associated with poorer outcomes in univariate analysis, only the number of positive nodes had independent association (hazard ratio, 1.6 (range, 1.2–2.2); P < 0.001). Integration of former N3 cases did not modify outcomes. CONCLUSIONS: The recategorization of former N3 involved a high proportion of positive node cases. Current N1/N2 categories clearly defined different outcomes and were not modified by the integration of former N3.     

Shock Wave-Induced Pancreatic Trauma

A case is described of the appearance of a pancreatic or peripancreatic lesion after left renal calculus fragmentation by extracorporeal shock wave lithotripsy (ESWL). Its anatomical location and subsequent disappearance suggest it was related to trauma caused by the shock waves. The brief literature on pancreatic injury after ESWL is reviewed, and the role of the patient's underlying liver disease in the genesis of this complication is discussed.     

Inter‐individual variation of the urinary steroid profiles in Swedish and Norwegian athletes

The steroidal module of the Athlete Biological Passport (ABP) aims to detect doping with endogenous steroids, e.g. testosterone (T), by longitudinally monitoring several biomarkers. These biomarkers are ratios combined into urinary concentrations of testosterone and metabolically related steroids. However, it is evident after 5 years of monitoring steroid passports that there are large variations in the steroid ratios complicating its interpretation. In this study, we used over 11000 urinary steroid profiles from Swedish and Norwegian athletes to determine both the inter‐ and intra‐individual variations of all steroids and ratios in the steroidal passport. Furthermore, we investigated if the inter‐individual variations could be associated with factors such as gender, type of sport, age, time of day, time of year, and if the urine was collected in or out of competition. We show that there are factors reported in today's doping tests that significantly affect the steroid profiles. The factors with the largest influence on the steroid profile were the type of sport classification that the athlete belonged to as well as whether the urine was collected in or out of competition. There were also significant differences based on what time of day and time of year the urine sample was collected. Whether these significant changes are relevant when longitudinally monitoring athletes in the steroidal module of the ABP should be evaluated further.     

Sialoadhesin – a macrophage‐restricted marker of immunoregulation and inflammation

Sialoadhesin (Sn, also known as Siglec‐1 and CD169) is a macrophage‐restricted cell surface receptor that is conserved across mammals. Sn is a member of the sialic acid‐binding IgG‐like lectin (Siglec) family of proteins characterized by affinity to specifically sialylated ligands, and under normal conditions is expressed on subsets of macrophages in secondary lymphoid tissues, such as lymph node and spleen. However, Sn‐positive macrophages can also be found in a variety of pathological conditions, including (autoimmune) inflammatory infiltrates and tumours. Sn has been shown to contribute to sialylated pathogen uptake, antigen presentation and lymphocyte proliferation, and to influence both immunity and tolerance. This review presents Sn as a macrophage‐specific marker of inflammation and immunoregulation with the potential to becoming an important biomarker for immunologically active macrophages and a target for therapy.     

Sequence Conservation of the Region Targeted by the Abbott RealTime HBV Viral Load Assay in Clinical Specimens

The Abbott RealTime HBV assay targets the N-terminal region of the S gene. Here we analyzed the sequence variability of the assay target region from >2,100 clinical specimens. Thermodynamic modeling of the percentage of bound primer/probe at the assay annealing temperature was performed to assess the potential effect of sequence variability.     

Perception of effort at low and moderate intensity exercise in survivors of childhood acute lymphoblastic leukaemia

Objective: The study examined the degree to which male and female survivors of acute lymphoblastic leukaemia (ALL) perceive effort at low and moderate intensity exercise in association with related physiological variables.

Materials and methods: Participants were 67 children. Thirty-five (14 boys and 21 girls) were long-time survivors of ALL and 32 (18 boys and 14 girls) were control subjects. The Children's Effort Rating Table (CERT) was used to measure whole-body perceived exertion at low and moderate intensity exercise. Peak oxygen uptake was measured using a motorized treadmill. CERT and physiological data were analysed using 2?×?2 mixed analyses of variance, appropriate t-tests and coefficients of correlation.

Results: In absolute terms, boys treated for ALL found perception of effort to be more strenuous at both low (3.9 vs. 3.5?units) and moderate (6.1 vs. 5.3?units) intensity exercise than control subjects, although differences were not significant (p?>?0.05); girls treated for ALL found perception of effort to be the same as controls at low intensity exercise (3.1 vs. 3.1 units) but slightly higher than controls at moderate intensity exercise (5.6 vs. 5.2 units); neither of these differences were significant (p?>?0.05). When CERT values were adjusted for V˙O₂ peak (%) and heart rate (HR) peak (%) differences remained non-significant. There were no significant interactions (Intensity?×?Group) in males, but the interaction for V˙O₂ peak (%) was significant in females (p?<?0.05). The main effect for Intensity (low and moderate) was significant for all variables in boys and girls (p?<?0.0001). The main effect for Group (ALL and controls) identified significantly greater absolute (b.p.m.) and relative (%) HR values in ALL boys at low and moderate intensity exercise. In female ALL and control subjects the interaction (Intensity?×?Group) distinguished between V˙O₂ peak (%) at moderate intensity exercise and HR peak (%) at low and moderate intensity exercise. Coefficients of correlation between perceived effort and V˙O₂ peak (%) in boys and girls were low to high (0.28–0.76), and between absolute and relative HR were also low to high (0.33–0.73). There were low correlations between time ‘off therapy’ and perceived effort, V˙O₂ peak (%) and HR peak (%) (?0.003 to ?0.49).

Conclusion: It was concluded that perception of effort in survivors of ALL at low and moderate intensity exercise was the same as that of control subjects. Correlations between perceived effort and physiological variables at moderate exercise were low to high, while those between perceived effort and time from treatment were generally weak.

Résumé. Objectif: L’étude examine à quel degré les survivants masculins et féminins d’une leucémie lymphoblastique aigüe (LLA), perçoivent l’effort de l’exercice à intensité basse à modérée, en association avec les variables physiologiques correspondantes.

Matériels et méthodes: Les participants sont 67 enfants (14 garçons et 21 filles) ayant survécu longtemps à une LLA et 32 contrôles (18 garçons et 14 filles). Une table du taux d’effort de l’enfant (TEE) a été utilisée pour mesurer l’effort de l’organisme, perçu lors d’exercices d’intensités faible et modérée. La consommation d’oxygène de pic a été mesurée au moyen d’un trottoir à moteur. Le TEE et des données physiologiques ont été analysés par des analyses de variance à double entrée 2x2, par tests t et par coefficients de corrélation.

Résultats: En termes absolus, les garçons traités pour la LLA ont perçu que l’effort qu’ils ont produit, était plus fatigant que ne l’ont perçu les contrôles lors des exercices à intensité aussi bien faible (3,9 contre 3,5 unités) que modérée (6,1 contre 5,3 unités), bien que les différences soient demeurées non significatives p?>?0,05); Les filles traitées pour la LLA ont perçu un effort identique à celui des contrôles pour les exercices à faible intensité (3,1 contre 3,1 unités), mais légèrement plus élevé que celui des contrôles pour les exercices à intensité modérée (5,6 contre 5,2 unités)?; aucune de ces différences n’étant significative (p?>?0,05). Lorsque les valeurs du TEE sont ajustées pour le VO₂ de pic (%) et pour le rythme cardiaque (RC) de pic (%), les différences demeurent non significatives. Il n’y a pas d’interactions significatives (intensité x groupe) chez les garçons, mais l’interaction pour le VO₂ de pic est significative chez les filles (p<0,05).L’effet principal d’Intensité (faible et modérée) est significatif pour toutes les variables chez filles et garçons (p<0,0001). L’effet principal de Groupe (LLA et contrôles) marque des valeurs de RC significativement plus élevées en valeur absolue?: nombre de battements par minute (b.p.m) et en valeur relative (%) chez les garçons LLA à intensité d’exercice basse et modérée. Chez les filles LLA et les contrôles, l’interaction (intensité x groupe) distingue entre VO₂ de pic (%) à exercice d’intensité modérée et RC de pic (%) à intensité d’exercice basse et modérée. Les coefficients de corrélation entre l’effort perçu et le VO₂ de pic (%) chez les garçons et les filles, varient de faibles à élevés (0,28 à 0,76)?; ils en est de même entre le RC absolu et relatif (0,33 à 0,73). On trouve de faibles corrélations entre le temps passé depuis la fin de la thérapie et l’effort perçu, le VO₂ de pic (%) et le RC de pic (%) (0,003 à -0,49).

Conclusion: La perception de l’effort lors d’exercices d’intensité faible et modérée est le même chez les enfants ayant survécu à une LLA que chez les contrôles. Les corrélations entre l’effort perçu et les variables physiologiques à exercice modéré varient de basses à élevées tandis que celles entre l’effort perçu et le temps écoulé depuis le traitement sont généralement très faibles.

Zusammenfassung. Ziel: Die Studie untersucht das Ausmaß, in dem männliche und weibliche überlebende einer akuten lymphoblastischen Leukämie (ALL) körperliche Anstrengung, die von einer niedrigen bis mäßig intensiven sportlichen Betätigung und den damit verbundenen physiologischen Variablen ausgeht, empfinden.

Material und Methoden: Teilnehmer waren 67 Kinder. Fünfunddreißig (14 Knaben und 21 Mädchen) waren Langzeitüberlebende einer ALL und 32 (18 Knaben und 14 Mädchen) dienten als Kontrollpersonen. Der Anstrengungsmessbogen für Kinder (Children's Effort Rating Table, CERT) wurde verwendet, um die körperlich empfundene Anstrengung bei niedriger und mäßig intensiver sportlicher Betätigung zu messen. Maximale Sauerstoffaufnahme wurde mit einer motorisierten Tretmühle gemessen. CERT und physiologische Daten wurden mittels 2?×?2 gemischter Varianzanalyse gemessen, sowie angemessenen t-Tests und Korrelationskoeffizienten.

Ergebnisse: In absoluten Werten empfanden Knaben, die wegen einer ALL behandelt worden waren, eine körperliche Anstrengung sowohl bei niedriger (3,9 gegenüber 3,5 Einheiten) als auch bei mäßig intensiver (6,1 gegenüber 5,3 Einheiten) sportlicher Betätigung stressiger als Kontrollpersonen, obgleich die Unterschiede nicht signifikant waren (p?>?0,05); Mädchen, die wegen einer ALL behandelt worden waren, empfanden körperliche Anstrengung in gleicher Weise wie Kontrollpersonen bei niedriger (3,1 gegenüber 3,1 Einheiten) sportlicher Betätigung, aber etwas stressiger als Kontrollen bei mäßig intensiver (5,6 gegenüber 5,2 Einheiten) sportlicher Betätigung; allerdings war keiner dieser Unterschiede signifikant (p?>?0,05). Wenn die CERT-Werte für maximale (%) und maximale Herzfrequenz (heart rate, HR) (%) korrigiert wurden, blieben die Unterschiede nicht-signifikant. Es gab keine signifikanten Interaktionen (Intensität × Gruppe) bei Knaben, aber es war die Interaktion für maximale (%) bei Mädchen signifikant (p?<?0,05). Der Haupteffekt für Intensität (niedrig und mäßig intensiv) war für alle Variablen bei Knaben und Mädchen signifikant (p?<?0,0001). Der Haupteffekt für Gruppen (ALL und Kontrollen) identifizierte signifikant größere absolute (b.p.m.) und relative (%) HR-Werte bei ALL-Knaben bei niedriger und mäßig intensiver sportlicher Betätigung. Bei weiblichen ALL-Patienten und Kontrollprobanden unterschied die Interaktion (Intensität × Gruppe) zwischen maximaler (%) bei mäßig intensiver sportlicher Betätigung und maximaler HR (%) bei niedriger und mäßig intensiver sportlicher Betätigung. Korrelationskoeffizienten zwischen empfundener Anstrengung und maximaler (%) bei Knaben und Mädchen waren niedrig bis hoch (0,28—0,76), und die zwischen absoluter und relativer HR waren ebenfalls niedrig bis hoch (0,33—0,73). Es gab niedrige Korrelationen zwischen dem Zeitpunkt ‘Therapieende’ und empfundener Anstrengung, maximaler (%) und maximaler HR (%) (?0,003 to ?0,49).

Zusammenfassung: Es wird gefolgert, dass die subjektive Empfindung von Anstrengung bei überlebenden einer ALL bei niedriger und mäßig intensiver sportlicher Betätigung der von Kontrollprobanden gleicht. Korrelationen zwischen empfundener Anstrengung und physiologischen Variablen bei mäßig intensiver körperlicher Betätigung waren niedrig bis hoch, wohingegen diejenigen zwischen empfundener Anstrengung und dem Zeitraum nach der Behandlung generell niedrig waren.

Resumen. Objetivo: El estudio examinó el grado en el que varones y mujeres supervivientes de leucemia linfoblástica aguda (LLA) perciben el esfuerzo cuando realizan ejercicio de intensidad baja y moderada, en asociación con variables fisiológicas relacionadas.

Materiales y métodos: Los participantes fueron 67 niños. Treinta y cinco (14 chicos y 21 chicas) eran supervivientes de LLA desde hacía mucho tiempo y 32 (18 chicos y 14 chicas) eran sujetos control. Se utilizó la tabla del grado del esfuerzo en los niños (CERT) para medir el trabajo percibido por todo el cuerpo con ejercicios de intensidad baja y moderada. El consumo máximo de oxígeno se midió utilizando un cinta motorizada. La CERT y los datos fisiológicos fueron analizados utilizando un análisis mixto de la varianza 2x2, pruebas-t apropiadas y coeficientes de correlación.

Resultados: En términos absolutos, los chicos tratados para la LLA percibieron el esfuerzo como menos agotador que los sujetos control, tanto a intensidades de ejercicio bajas (3,9 vs. 3,5 unidades) como moderadas (6,1 vs. 5,3 unidades), aunque las diferencias no fueron significativas (p?>?0,05). Las chicas tratadas para la LLA percibieron el esfuerzo de la misma forma que las controles a intensidades bajas de ejercicio (3,1 vs. 3,1), pero ligeramente más alto que las controles en ejercicios de intensidad moderada (5,6 vs. 5,2 unidades); ninguna de estas diferencias fue significativa (p?>?0,05). Cuando los valores CERT se ajustaron para el consumo máximo de oxígeno (%) y la tasa cardiaca (TC) máxima (%), las diferencias siguieron siendo no significativas. No existían interacciones significativas (Intensidad x Grupo) en chicos, pero la interacción para el consumo máximo de oxígeno (%) fue significativo en chicas (p<0,05). El efecto principal para la Intensidad (baja y moderada) fue significativo en todas las variables en chicos y chicas (p<0,0001). El efecto principal para el Grupo (LLA y controles) identificaba valores de HR significativamente mayores tanto en valor absoluto (b.p.m.) como relativo (%) en los chicos LLA con ejercicios de intensidad baja y moderada. En las chicas LLA y control, los sujetos de la interacción (Intensidad x Grupo) distinguían entre el consumo máximo de oxígeno (%) en ejercicios de intensidad moderada y la TC máxima (%) con ejercicios de intensidad baja y moderada. Los coeficientes de correlación entre el esfuerzo percibido y el consumo máximo de oxígeno (%) en chicos y chicas fueron de bajos a altos (0,28 – 0,76), y entre la TC absoluta y relativa fueron también de bajos a altos (0,33 – 0,73). Las correlaciones eran bajas entre el tiempo sin terapia y el esfuerzo percibido, el consumo máximo de oxígeno (%) y la TC máxima (%) (?0,003 a ?0,49).

Conclusión: Se concluye que la percepción del esfuerzo en supervivientes de la LLA con ejercicios de intensidad baja y moderada fue la misma que la de los sujetos control. Las correlaciones entre el esfuerzo percibido y las variables fisiológicas con ejercicios moderados fueron de bajas a elevadas, mientras que las correlaciones entre el esfuerzo percibido y el tiempo transcurrido desde el fin del tratamiento fueron generalmente bajas.