Computer administration of a school-based adolescent health survey

Objective : To examine the utility of notebook computers in the collection of data in large scale surveys.
Methodology : A notebook computer administered survey of health in adolescents was conducted in 1992 using a multi-instrument questionnaire. Students in school years 7,9 and 11 in private and government schools in Melbourne and rural Victoria participated.
Results : Parental consent was obtained with an 83% response rate. Each student answered questions directly onto the computer taking an average of 68 min to complete the highly branched confidential but not anonymous questionnaire. Students were presented with on average 33% of the 897 possible questions. Over 90% of students reported enjoying using the computer. Those who reported answering the questions honestly all the time ranged from 68 to 85%, increasing with grade level.
Conclusions : The use of computers in survey research provides many advantages in data collection including exposure only to relevant questions and the opportunity of asking sensitive questions.     

Primary aldosteronism due to adrenal carcinomas

Summary In the present study two patients with aldosterone-producing adrenal carcinomas are reported. The clinical features were characterized by hypertension and severe hypokalemia with muscular weakness, flaccid paralysis of arms and legs, diarrhea and polyuria. In both cases excessively high plasma aldosterone levels and suppressed plasma renin activity were found. In contrast to most other cases with aldosterone-secreting tumours plasma cortisol, urinary free cortisol excretion, 17-hydroxy- and 17-ketosteroids were in the normal range. There was no clinical evidence of oversecretion of sex hormones. After adrenalectomy blood pressure and serum potassium normalized and the clinical symptoms disappeared. Plasma aldosterone and urinary aldosterone secretion returned to normal, while plasma renin activity remained low. Three and a half and 6 months later primary aldosteronism and the associated clinical symptoms reappeared due to hormonally active metastases. After introducing the antitumour drug o,p-DDD in patient 1 aldosterone secretion normalized and the clinical status of the patient markedly improved. However, 10 months after diagnosis the patient died due to a haemorrhage from a liver metastasis. In patient 2 tumour-invaded regional lymph nodes were surgically removed with only minor changes in the hormone pattern.     

Age of the uterus does not affect pregnancy or implantation rates; a study of egg donation in women of different ages sharing oocytes from the same donor

The importance of age of the recipient (uterine age) with regards to pregnancy rate, delivery rate and miscarriage rate following oocyte donation was evaluated using retrospective data analysis of cases where two recipients from different age groups shared oocytes from a single donor and had equal numbers of embryos transferred. A total of 104 women (21-52 years of age) underwent a total of 104 cycles of oocyte donation. They were divided into groups according to age (group A: age 39 years or less and group B: age between 40 and 52 years). The minimum age difference between a pair of recipients was five years. Hormone replacement therapy (HRT) was given using oestradiol valerate (6 mg daily) for at least 10 days, followed by a combination of oestradiol with either intramuscular progesterone (100 mg daily), or vaginally administered micronized progesterone (300 microg daily). Women with ovarian function received down-regulation using a luteinizing hormone- releasing hormone (LHRH) analogue before hormone replacement was commenced. A total of 52 transfer cycles was performed in each age group and pregnancy, delivery and miscarriage rates were analysed as outcome measures; 20 pregnancies were achieved in each group (an identical pregnancy rate of 38.5%). In group A seven pregnancies miscarried out of 20 (35%), which was not significantly different from the rate in the older population, group B, where eight out of 20 pregnancies miscarried (40%). The delivery rate in group A was 25% (13 out of 52), again not significantly different from the delivery rate in group B of 23.1% (12 out of 52). In conclusion, using egg donation as a model, the decline in fecundity with age cannot be explained by uterine factors alone.      

How Much Ulcer is Ulcer-like? Diagnostic Determinants of Peptic Ulcer in Open Access Gastroscopy

A cross-sectional diagnostic prevalence study was carried outwithin a multi-centre experiment with open access gastroscopyin Utrecht, The Netherlands. The objective of the study wasto contribute to improvement of patient selection for open accessgastroscopy and to evaluate diagnostic determinants for pepticulcer. Data were analysed in all 861 patients who were consecutivelynewly referred during the experiment to undergo gastroscopy.Patient characteristics and outcomes of gastroscopies were recorded.Univariate and multivariate (logistic) analyses were carriedout and the results were evaluated with ROC (receiver operatingcharacteristic) analysis. The most important clinical characteristicsto be used for prediction of peptic ulcer are pain on an emptystomach, absence of pain after a meal and absence of obstructivecomplaints. The scoring list derived from the full model, comprisingthese characteristics together with age, sex, information onformer dyspeptic diseases, medication and smoking (‘basiccharacteristics’), predicted peptic ulcer with an AUCof 0.78. The ‘ulcer-like’ model, with characteristicsknown from the literature, had an AUC of 0.76. The amount ofgastroscopy requests on patients suspected of a peptic ulcercould have been reduced from 60 to 44%. Forcing ‘basiccharacteristics’ into scoring lists on peptic ulcer improvedthe pre-diagnostic test capacities. The presented scoring listmay improve gastroscopy requesting by GPs aiming at findingpeptic ulcers. Practical manageability of the list should beprospectively evaluated in future experiments.