Aspects Of Medical History Research Articles

(344) Evaluating Time to Conception Changes Over Two Decades

Abstract Introduction The time to conception is an essential factor that influences reproductive outcomes, and understanding its variance aids in appropriate family planning. Factors such as Body Mass Index (BMI), polycystic ovarian syndrome (PCOS), and maternal age significantly impact time to conception. Our study explores these factors in the light of the perceived increase in conception time over the last decade. Existing data show a decrease in births per woman worldwide over several decades; however, there is a lack evidence to prove if this trend is due to fertility or volition. Our goal was to observe whether or not a true increase in time to conception exists. Objective The study aimed to discern whether time to conception has increased over the past decade compared to the previous decade. The secondary aim was to explore the relationship between conception time and several variables, including BMI, PCOS, maternal age, and lifestyle habits. Methods We employed Amazon Mechanical Turk (MTurk) to conduct an online survey of 12 questions. The study population consisted of pregnant women from the year 2000 onwards. The survey assessed a range of factors: maternal and paternal age, pregnancy year, physical activity levels, tobacco and alcohol use, BMI, race/ethnicity, certain aspects of medical history, months to conception, and total number of gestations. Univariable logistic regression models were employed to assess the correlation between these factors and conception time. Results The results from 852 respondents showed no significant differences in time to conception when comparing individuals who became pregnant post-2012 versus pre-2012. However, several factors significantly influenced conception time. Mothers who exercised more than 150 minutes per week or had endometriosis, history of pelvic inflammatory disease (PID), or PCOS were 1.4, 1.7, 1.7, and 2.4 times more likely, respectively, to have longer times to conception (>= 6 months) (p < 0.05). Additionally, paternal factors such as undergoing chemotherapy, having testicular cancer, or varicocele were associated with 1.7, 1.6, and 3.5 times longer conception times, respectively (p < 0.05). Conclusions Although there was no apparent increase in time to conception over the past decade, several factors were significantly associated with extended conception time. These include maternal factors like physical activity, endometriosis, PID, and PCOS, as well as paternal factors like undergoing chemotherapy, having testicular cancer or varicocele. The current guidelines recommend a twelve-month period of attempting conception before pursuing fertility assessment. This study implies that a reevaluation of these guidelines may be warranted. It is plausible that women with one or more of these risk factors should be advised to seek medical attention earlier than twelve months, or even prior to attempting conception. Understanding these relationships provides valuable insights for family planning and infertility treatment, underscoring the importance of comprehensive health and lifestyle evaluation in couples planning to conceive. Future studies should focus on developing targeted interventions to optimize these factors and potentially reduce conception time. Disclosure No.

Paper Dolls

This article addresses the striking resemblance of a late nineteenth-century obstetrical simulator to contemporary commercial paper dolls. This period is often characterised in histories of medicine as one of increasing institutionalisation and professionalisation of childbirth through hospital training and state regulation. But this narrative is only part of the story. It marginalises the perspective of patients and midwives, and those outside of the geographic ‘West’, and it silences aspects of medical culture: social and caring relationships, emotion, play, and humour. While these aspects of medical history are less well represented in textual sources, material objects like Shibata Kōichi’s ‘Obstetrical Pocket-Phantoms’ can help to give a fuller picture. Beginning by situating Shibata’s phantoms in the conventional histories of obstetric training and the intermedial spaces of the clinic and lecture theatre, I then ask how the phantoms might have been used and understood differently outside of these spaces. Using Robin Bernstein’s concept of ‘scriptive things’, I employ a visual and material study of the objects, informed by the wider cultural contexts of dolls and popular print culture in Germany, the USA and Japan, to argue for a history of Shibata’s phantoms as paper dolls that encouraged many forms of play: from learning and explorative, to mothering and caring, to humorous and subversive. By acknowledging that Shibata’s phantoms would also have been recognised as paper dolls, I present a history that centres unrecorded aspects of, and under-studied agents in, medical culture.

Past: Imperfect; Future: Tense.

How should the field of bioethics grapple with a history that includes ethicists who supported eugenics, scientific racism, and even Nazi medicine and also ethicists who created the salutary policy and practice responses to those heinous aspects of medical history? Learning humility from studying historical errors is one path to improvement; finding courage from studying historical strengths is another, but these can be in tension. This commentary lays out these paths and seeks to apply them both to a contemporary challenge facing the field: why hasn't bioethics been more at the forefront of efforts to address inequities in health and health care?

Abstract #1413664: A Case of Familial Isolated Pituitary Adenoma Emphasizing an Often-Overlooked Aspect of Medical History

Familial Isolated pituitary adenoma (FIPA) is a rare cause of pituitary adenoma and underscores the importance of family history and the knowledge of screening guidelines in these patients. A 26-year-old female presented with secondary amenorrhea, galactorrhea, headaches and dizziness. Labs showed Prolactin 501 ng/ml (3.3-26.7 ng/mL) and IGF 391 ng/ml (96-301 ng/mL). MRI of the brain showed a 12 x 14 x 15 mm pituitary mass. Acromegaly was confirmed with glucose suppression test with growth hormone (GH) lowering to 1.08 ng/ml (< 0.8 ng/ml). Further history revealed a paternal cousin with gigantism diagnosed at the age of 17. She underwent transsphenoidal resection of the adenoma which stained positive for GH and prolactin. Post operative labs show improved levels: Prolactin 31 ng/mL (3.3-26.7 ng/mL) and IGF 317 ng/mL (96-301 ng/mL). Genetic evaluation showed a pathogenic mutation in AIP (aryl hydrocarbon receptor-interacting protein). Labs 4 months later- Prolactin 36.1 ng/mL (3.3-26.7 ng/mL), IGF 209 ng/mL (96-301 ng/mL), and GH 0.1 ng/mL (0.05-8.00 ng/mL). She was amenorrheic post surgery and with hormone replacement therapy, regular menstrual cycles ensued. Surveillance showed consistently normal IGF but prolactin levels were trending upwards. Prolactin: 80 ng/mL (3.3-26.7 ng/mL). A repeat MRI brain did not show any adenoma. She was started on Cabergoline and that helped with normalization of prolactin levels. FIPA is a rare hereditary disorder responsible for less than 2% of pituitary adenomas. Mutation of AIP is seen in 20% cases and associated with worse outcomes. The peak age of onset is between 10-30 years of age. Affected patients tend to have larger tumors than non-FIPA which increases the risk of pituitary apoplexy. GH secretion is the most common; followed by prolactin, GH-Prolactin co-secretion, non-functional and rarely TSH secreting. It has an autosomal dominant transmission but with incomplete penetrance often skipping generations making the diagnosis even more challenging. Obtaining detailed family history in any patient with pituitary adenoma is essential in uncovering the inheritance pattern of this disease. Screening for FIPA and AIP is recommended if patients are noted to have- 1. GH secreting adenoma diagnosed before the age of 18 2. Pituitary macroadenoma (>10 mm) diagnosed before the age of 30 3. Any pituitary adenoma with a family history of pituitary adenoma in more than one member First degree family members of patients with FIPA and AIP need to be tested for the mutation. Patients with positive mutation are recommended to undergo screening evaluation as follows- 1. Growth assessment and evaluation for signs and symptoms of pituitary adenoma with pituitary function tests a. Age 4-30 years: annually b. Age 30-50 years: every 5 years 2. Pituitary MRI a. Age 10-30 years: every 5 years Prospective observational data shows genetic testing followed by clinical screening leads to early detection of pituitary disease which results in early interventions and better outcomes. This highlights the importance of recognition of FIPA in patients presenting with any kind of pituitary adenomas.

Expression of PDGFR-&amp;lt;i&amp;gt;α&amp;lt;/i&amp;gt; in Patients with Valvular Atrial Fibrillation

Objective: To investigate the expression of Platelet-derived growth factor receptor alpha (PDGFR-α) in patients who have valvular atrial fibrillation. Methods: In this research, eighty-four patients with rheumatic heart disease who were going to undertake cardiac surgery were included. The subjects were divided into two groups: the AF group and the sinus rhythm group, the quantities are 39 and 45 respectively. Before the surgery, baseline demographics, physical examination, routine laboratory testing, echocardiography, echocardiographic data and additional clinical data were available for all patients. The right atrial tissue of the subjects was separated during surgery, with an area of approximately 0.3 - 0.5 mm3. Immunofluorescence staining was used to analyze the distribution of PDGFR-α of atrial tissue. mRNA of PDGFR-α in atrial tissue were determined by real-time quantitative PCR (Polymerase Chain Reaction); Western-Blot technique was used to measure the protein of PDGFR-α in atrial tissue. Results: There were no significant differences (P > 0.05) in sex ratio, age, blood pressure, blood biochemistry, and other aspects of medical history between the two groups. However, the right and left atrium diameters in the AF group were markedly larger than those in the SR group (P α from right atrial tissue were obviously higher in the AF group than that in the SR group (P α in the right atrial tissue of patients with atrial fibrillation was found to be significantly higher.

Survey of Lifestyle, Past Medical History and Complementary and Alternative Medicine Use Among Adult Patients Participating in the National Cancer Institute's Exceptional Responders Initiative

IntroductionThe Exceptional Responders Initiative (ERI) at the National Cancer Institute attempts to correlate unusually good outcomes in patients with cancer with genetic targets in tumors and the therapies the patients received. It is not known if other factors might contribute to exceptional responses or outcomes. We explored aspects of the medical history, lifestyle changes, complementary and alternative medicine (CAM) use and communication between health care practitioners and patients who experienced an exceptional response following cancer treatment. MethodsAll subjects whose case was submitted to the ERI were eligible to participate in the survey. A 121-question survey questionnaire was developed to assess aspects of the subject's past medical history, lifestyle (e.g., diet, exercise, spirituality) and use of CAM. ResultsThirty subjects completed and returned the questionnaire from approximately 88 patients invited to participate (approximate response rate = 34%). Approximately 68% were female and 32% were male. Fifty percent of subjects changed their diet after their cancer diagnosis. Eighteen patients (60%) reported using a CAM therapy (not including oral vitamins/minerals or spiritual practices) during their Exceptional Response (ER). ConclusionMultiple factors, including features of the tumor itself, the patient, or the environment, could affect tumor response or patient survival, either solely or in combination with the treatments received. Many patients use other medications, change their diet or physical activity or use CAM interventions after their cancer diagnosis. Investigators attempting to understand the exceptional response phenomenon should acquire rich data sets of their subjects that include information about these factors.

A Comparison of Perceived Lifetime Breast Cancer Risk to Calculated Lifetime Risk Using the Gail Risk Assessment Tool.

Background: Understanding the accuracy of a woman's perceived breast cancer risk can enhance shared decision-making about breast cancer screening through provider and patient discussion. We aim to report and compare women's perceived lifetime breast cancer risk to calculated lifetime breast cancer risk. Methods: Women presenting to Mayo Clinic in Arizona and Minnesota in July 2016 completed a survey assessing their perceived breast cancer risk. Lifetime Gail risk scores were calculated from questions pertaining to health history and were then compared with perceived breast cancer risk. Results: A total of 550 predominantly white, married, and well-educated (≥college) women completed surveys. Using lifetime Gail risk scores, 5.6% were classified as high risk (>20% lifetime risk), 7.7% were classified as intermediate risk (15%-20%), and 86.6% were classified as average risk (<15%). Of the 27 women who were classified as high risk, 18 (66.7%) underestimated their risk and of the 37 women who were intermediate risk, 12 (32.4%) underestimated risk. Women more likely to underestimate their risk had a reported history of an abnormal mammogram and at least one or more relative with a history of breast cancer. Surveyed women tended to overestimate risk 4.3 (130/30) times as often as they underestimated risk. Conclusion: In a group of predominantly white, educated, and married cohort of women, there was a large portion of women in the elevated risk groups who underestimated risk. Specific aspects of medical history were associated with underestimation including a history of abnormal mammogram and family history of breast cancer. Overall, in our sample, more women overestimated than underestimated risk.

Analysis of risk factors for prognostically unfavorable MI features as determined by cardiac MRI with contrast enhancement

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): A.L. Myasnikov Institute of Clinical Cardiology, Russian Cardiology Research and Production Complex, Ministry of Health of Russia, Moscow, Russia Background A growing number of publications describe the role of cardiac MRI in STEMI prognostic assessment. Infarct size, microvascular obstruction (MVO) and myocardial heterogeneity are among the most prognostically significant MRI parameters in MI. Primary PCI (pPCI) is the current standard of STEMI treatment. The impact of clinical factors on the development of MVO, myocardial heterogeneity and infarct size remains insufficiently investigated. Purpose To investigate the impact of certain medical history aspects, clinical and laboratory parameters on the most prognostically significant MRI measures of acute MI (MVO, infarct size, myocardial heterogeneity). Methods The study included 52 patients with first STEMI within &amp;lt;48 hours of onset. All patients urgently underwent coronary angiography with pPCI of infarct-related arteries (IRA). On Days 3-7 contrast-enhanced cardiac MRI was done. Tissue analysis of scans was performed using CVI 42 software evaluating infarct size, MVO, myocardial heterogeneity, and left ventricle (LV) ejection fraction (EF). Results 85% patients were men, with mean age of 59.09 ± 7.7 years. All patients underwent pPCI for reperfusion. The median time from symptom onset to pPCI was 3 hours. We analyzed the influence clinical and laboratory factors impacting cardiovascular prognosis on the development of MVO, infarct size, and myocardial heterogeneity. Odds ratios demonstrated no significant relationship between arterial hypertension (OR 2.10, CI 0.57-7.79 р=0,2), smoking (OR 1.01 CI 0.32-3.20, р=0.9), obesity defined as BMI &amp;gt;30 kg/m2) (OR 0.83 CI 0,50-1.39, р=0.16) and MVO development. However, diabetes mellitus had significant effect on MVO development (OR 4.34 CI 1.34-14.03, р=0.01). With regards to laboratory parameters, relationship between hs-Troponin elevation &amp;gt; &amp;gt;8400 pg/mL and MVO occurrence (OR 7.00, CI 0.79 – 61.74, р=0.04). Correlation analysis demonstrated association between myocardial heterogeneity and BNP (r 0.612, р&amp;lt;0.0001), as well as advanced age (r 0,544, р&amp;lt;0,0001). Inverse correlation was found between myocardial heterogeneity and LV EF (r -0.461, р=0.0006). We also analyzed the factors associated with infarct size and found correlation between this parameter and BNP levels (r 0,553, p = 0,0003), as well as MVO magnitude (r 0,383, p = 0,005). Inverse correlation was found between infarct size and history of hypertension (r -0.380, p = 0.0054) Conclusions Type 2 diabetes mellitus, was found to be an independent predictor of microvascular obstruction on MRI. Elevation of hs-Troponin &amp;gt;8400 pg/mL was found to be associated with MVO development. Correlation data analysis demonstrated that high BNP may indicate higher infarct size and myocardial heterogeneity values (r 0.612, р&amp;lt;0.0001).

Diacaustic examination of the iridocorneal angle : Video article

Several methods are available for the examination of the iridocorneal angle: gonioscopy and imaging techniques, such as ultrasound biomicroscopy, optical coherence tomography and Scheimpflug photography play an important role in the diagnostics of glaucoma. There is, however, aneed for simple, easily applicable methods for screening of the narrow iridocorneal angle in routine ophthalmological practice. To apply the diacaustic phenomenon in the examination of the iridocorneal angle, to describe the method and give its basic principles. This article provides areview of the literature and clinical observations with photographic and video documentation. The technique is demonstrated in detail with the help of avideo and which is available online. The formation and movement of the diacaustic phenomenon in the anterior chamber are observed and documented by photography or video when alight source is moved laterally from front to back. The movement of the diacaustic line on the anterior surface of the iris and the structures of the iridocorneal angle are analyzed in relation to other optical phenomena, such as the Purkinje images1 and2, iris shadowing by tangential illumination at the level of the frill and the limbal crescent of light. The diacaustic test can be used to determine the depth of the anterior chamber and the width of the iridocorneal angle. The problems are briefly represented from the perspective of anatomical, physical and medical history aspects and 4variants of the diacaustic line and 3phases of the movement of the diacaustic light spot are described. The diacaustic test is simple, quick and non-contact. It has potential as a screening examination of the narrow iridocorneal angle before medicinal pupil dilation. It can be integrated into the diagnostics of glaucoma for the assessment of the iridocorneal angle.

Visual History of Childhood– Medical History Aspects

Visual History of Childhood– Medical History Aspects

Benznidazole Use among Patients with Chronic Chagas' Cardiomyopathy in an Endemic Region of Brazil.

Chagas disease (CD) is a neglected tropical disease that affects individuals in almost every country in Latin America. There are two available drugs with antiparasitic profiles; however, only benznidazole (BZN) has been approved for commercialization in Brazil. The usefulness of prescribing BZN for patients with chronic Chagas cardiomyopathy (CCC) is controversial. There are no studies in the literature describing the extent of BZN use at this stage or the profile of patients using this drug. The present study aimed to determine the prevalence and factors associated with previous BZN use among individuals with CCC. This cross-sectional study was conducted with 1,812 individuals with CCC from 21 Brazilian cities endemic for CD. The dependent variable was "prior use of BZN" (no vs. yes). The independent variables were grouped into socioeconomic, lifestyle and medical history aspects. Binary logistic regression (α ≥ 0.05) was used. Among the evaluated individuals, 27.2% reported previous use of BZN. The likelihood of prior use of BZN was higher among younger individuals (OR = 2.7), individuals with a higher education (OR = 2.7), individuals with a lower monthly per capita income (OR = 1.3), individuals who practiced physical exercise (OR = 1.5), individuals who had prior knowledge of the CD diagnosis (OR = 2.5), individuals without hypertension (OR = 1.3) and individuals with a longer time to the CD diagnosis (OR = 6.1). The present study revealed a small proportion of therapeutic BZN use among Brazilian CCC patients. This finding suggests a late diagnosis and undertreatment of the disease. BZN use was higher among individuals with better clinical and demographic conditions but with a lower income and a longer time to the CD diagnosis. Knowledge of the BZN usage profile may help reduce the current state of neglect of this disease and pave the way for future studies.

Clinical and medical history aspects of gastroesophageal reflux disease with regard to the patient’s dental status

Gastroesophageal reflux disease (GERD) remains no less relevant today, as it affects many health and social issues. According to global and domestic statistics note the number of patients, particularly among socially active population tends to increase. The authors performed dental examination to detect inflammatory changes in the oral mucosa and periodontal tissues in 62 patients with non-erosive form of GERD and 23 patients with erosive form of GERD. The prevalence of the inflammatory process in the mucous membranes (in %) was confirmed by the results of a proven papillary-marginal alveolar index. Comprehensive periodontal index characterized the intensity of periodontal disease. We found signs of inflammation of the mucous membranes of the oral cavity in 81 % of relevant patients and they were more expressed in patients with erosive form of GERD. An analysis of the diagnosed changes made it possible to verify periodontitis of varying severity in 14% of patients, mostly erosive form of GERD.

Perioperative Pain Correlates and Prolonged Postoperative Pain Predictors: Demographic and Psychometric Questionnaires

IntroductionPerioperatively, patients are near-guaranteed to experience acute pain by virtue of the surgical tissue insult. The transition of acute pain to pathological chronic pain is a complex and poorly understood process. To study this, the prevalence of pain was examined preoperatively, and at 6 weeks and 3 months postoperatively.MethodsFifty-four patients undergoing moderate-major gynaecological surgery at Christchurch Women’s Hospital (Christchurch, New Zealand) were recruited over a period of 11 weeks. Follow-up by telephone was conducted at 6 weeks and 3 months following surgery. Demographic information including age, gender, ethnicity, work, and education status were collected, as well as aspects of medical history. Participants were subjected to psychometric questionnaires at each time-point.ResultsOf the participants, 15.7% experienced significant pain at 6 weeks postoperatively; 8.2% of participants experienced significant pain at 3 months postoperatively. The psychometric questionnaires used found differences between those experiencing pain and those not experiencing pain at given observation points. Only the Brief Illness Perception Questionnaire (BIPQ) appeared predictive of developing prolonged postoperative pain. The mean difference (7.4 on a 0–50) scale should assist in clinical decision-making regarding analgesia.ConclusionOnly the BIPQ was predictive of developing prolonged postoperative pain. While none of the demographic factors observed significantly predicted the development of ‘prolonged pain’, the not significant data followed expected trends. Several relationships were detected in this study that should further efforts in developing preoperative predictors to promote the secondary prevention of postoperative pain states.Electronic supplementary materialThe online version of this article (doi:10.1007/s40122-015-0037-7) contains supplementary material, which is available to authorized users.

A Report on the Hysteroscopic Removal of a Gräfenberg Ring After Almost Fifty Years in Utero.

A report on the hysteroscopic removal of a Gräfenberg ring after almost fifty years in utero. In addition to the differential diagnostic considerations, the medical history aspects of this case are particularly interesting.

Taking Care in the Air: Jet Air Travel and Passenger Health, a Study of British Overseas Airways Corporation (1940-1974)

This paper explores an aspect of medical history that has been overlooked in existing academic studies of commercial air travel, and advances a new historiography of airline passenger health and commercial aviation medicine. The introduction of jet-powered passenger aircraft by British Overseas Airways Corporation (B.O.A.C.) in 1952 presented a new set of epidemiological, chronobiological, and physiological passenger health concerns. These resulted from the increased size, speed, range, and cruising altitude of commercial jet aircraft. Drawing on extensive archival research, this paper explores the nature of these ‘new’ aeromedical challenges. It places them within the context of much earlier concerns about healthy travel, including military interest in the influence of flight on the human body. Focusing on B.O.A.C., the paper examines the ways in which one major airline responded to the passenger health challenges jet air travel posed, and assesses the extent to which B.O.A.C.’s responses transformed practices of aviation medicine.

Topics in Type 2 Diabetes and Insulin Resistance

This is the second of six articles based on presentations at the American Diabetes Association Scientific Sessions held 6–10 June 2008 in San Francisco, California. Frederick Brancati (Baltimore, MD) discussed diabetes screening. Approaches using age, sex, BMI, family history, hypertension, and lifestyle as predictive measures have shown good performance in cross-sectional and prospective studies, and capillary glucose measurement adds further value, although the public health impact of such approaches has not been determined. In the Diabetes Prevention Program (DPP), 158,177 individuals were screened, with 3,819 randomized. Those whose fasting capillary glucose was 90–115 mg/dl had increased risk of impaired glucose tolerance (IGT); levels ≥130 mg/dl were 250 times as likely as levels <90 mg/dl to be associated with IGT. Patrick O'Connor (Minneapolis, MN) pointed out that health plans have become very interested in identifying and treating diabetes and addressed the question of whether systematic identification of pre-diabetes by screening leads to better health outcomes than would occur without screening. Developing an approach to identification and subsequent interventions that would be cost-effective is an important priority. O'Connor reviewed responses to a survey of medical directors of 35 plans, caring for a total of 47 million individuals, focused on awareness of cardiometabolic risk. At-risk enrollees can be identified by age, BMI, sex, race, laboratory test results, physician diagnoses, smoking history, and prescription data based on pharmacy claims, although lack of electronic medical records is “a weak link.” Duration of treatment and of illnesses (including diabetes) and other aspects of medical history are not readily available. Nonetheless, using all the available information, it certainly is possible to identify individuals at increased diabetes risk. Two approaches are taken: 1 ) direct outreach to large numbers of people for prevention of adverse outcome or 2 ) case management of smaller numbers of people at much higher risk. …

Personal phenotypes to go with personal genomes

Mol Syst Biol. 5: 273 With the cost of DNA sequencing decreasing rapidly, it is likely that the genome sequences of many individuals will be determined. In fact, if half of the individuals in industrialized countries choose to have their genomes sequenced, then well over 500 million personal genome sequences will be determined. Currently, such genetic information is likely to be of limited value to the individual, as the number of loci that provide useful predictive information is quite small (probably less than 200). Indeed, recent analyses of common complex traits such as diabetes, body mass and height show that in each case the genetically identifiable contribution from multiple candidate loci (18 in the case of diabetes) is only a small percentage (less than 7%) of the total identifiable genetic load (Gaulton et al , 2008; Willer et al , 2009); thus, the interpretable genetic contributions that can be identified are quite minor. Presumably, either many low‐frequency alleles at different loci contribute to the genetic load or perhaps the many phenotypes are because of other phenomena such as synergistic effects between variants at more than one locus or between different loci and factors in the environment, recurrent spontaneous mutations, or epigenetic defects. Regardless of which proves to be correct (likely a differing mixture of effects for different diseases), the ability to accurately correlate all bases with precise phenotypes is likely to be powerful only if a common set of phenotypes are scored. The power of 500 million sequences correlated with 500 million phenotypes can show both small contributions as well as help identify potential causative mutations. Indeed, a data set of this size would greatly exceed that of even the large genome‐wide association studies that typically analyze thousands of individuals to tens of thousands …

First‐trimester screening markers are altered in pregnancies conceived after IVF/ICSI

To determine the levels of first-trimester screening markers and to assess the false-positive rate for first-trimester combined screening for Down syndrome in a large national population of women pregnant after assisted reproductive technology (ART), in order to decide whether or not to correct risk calculation for mode of conception. A national prospective cohort study of 1000 pregnancies achieved after ART was compared with a control group of 2543 pregnancies conceived spontaneously. All women completed a first-trimester combined screening program. Risk calculation was performed retrospectively based on the screening parameters to avoid bias due to the use of different algorithms of risk calculation. In chromosomally normal pregnancies conceived after in-vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI), the pregnancy-associated plasma protein-A multiples of the median value was significantly decreased when compared with that of pregnancies conceived spontaneously (0.78 and 0.79 vs. 0.98), while there was no difference in the group treated by frozen embryo replacement. There was no difference in the level of free beta-human chorionic gonadotropin between groups. The median nuchal translucency thickness was smaller in the overall ART group compared with controls. The false-positive rate of first-trimester combined screening in the overall ART group, adjusted for maternal age, was significantly higher when compared with controls (9.0% vs. 6.0%). It seems advisable to use a population of IVF/ICSI pregnancies to establish median curves for the first-trimester serum screening parameters and perhaps also for nuchal translucency thickness. However, care must be taken, as different ART treatment methods and aspects of medical history seem to alter the screening parameters in different ways.

Subjective Global Assessment—An independent predictor of survival in breast cancer

17541 Background: The Subjective Global Assessment (SGA) which is an easy-to-use, inexpensive, and non-invasive validated clinical instrument to assess nutritional status, combines data from subjective and objective aspects of medical history and physical examination. Since malnutrition can be a frequent manifestation in breast cancer, we investigated the prognostic role of SGA in patients with breast cancer treated in an integrative cancer treatment setting. Methods: We evaluated 305 histologically confirmed case series of breast cancer patients treated at Cancer Treatment Centers of America. Using SGA, patients were classified as well nourished (SGA A), moderately malnourished (SGA B) or severely malnourished (SGA C). Kaplan Meier method was used to calculate survival. Cox proportional hazard models were constructed to evaluate the prognostic effect of SGA independent of stage at diagnosis and prior treatment history. Results: Of 305 patients, 91 were newly diagnosed at our hospital while 214 had received prior treatment elsewhere. 69 had stage I disease at diagnosis, 131 had stage II, 51 had stage III and 41 had stage IV. The median age at diagnosis was 49 years (range 25 - 74 years). 216 patients were well-nourished (SGA A) while 89 were malnourished (SGA B or C). Well nourished patients had a median survival of 49.9 months (95% CI: 29.9 to 69.9), while malnourished patients had a median survival of 15.7 months (95% CI: 8.7 to 22.6); the difference being statistically significant (p < 0.001). Multivariate Cox modeling, after adjusting for stage at diagnosis and prior treatment history found that malnourished status was associated with a relative risk (RR) of 2.7 (95% CI: 1.8 to 4.0, p < 0.001). Stage at diagnosis was associated with a RR of 1.9 (95% CI: 1.3 to 3.0; p = 0.002) and prior treatment history was associated with a RR of 8.8 (95% CI: 4.6 to 16.9; p = 0.002). Conclusions: In this cohort, we found that low SGA scores (well-nourished status) versus high SGA scores (moderate to severe malnourished status) identified patients with better survival outcomes. At our center, we continue to investigate the role of nutritional intervention in improving prognosis in patients with breast cancer. No significant financial relationships to disclose.

Diagnosing and reporting of occupational diseases: a quality improvement study

To assess the need for quality improvement of diagnosing and reporting of noise-induced occupational hearing loss and occupational adjustment disorder. Performance indicators and criteria for the quality of diagnosing and reporting were developed. Self-assessment questionnaires were sent to all occupational physicians recorded on the Netherlands Centre for Occupational Diseases database. The performance of responding occupational physicians was then assessed by separate scores per performance indicator and by a total quality score. Twenty-three questionnaires on noise-induced occupational hearing loss and 125 questionnaires on occupational adjustment disorder were available for analysis. The mean quality score for diagnosing and reporting was 6.0 (SD: 1.4) for noise-induced occupational hearing loss and 7.9 (SD: 1.5) for occupational adjustment disorder on a scale of 0-10. For noise-induced occupational hearing loss, there was a need for quality improvement of the aspects of medical history, audiometric measurement, clinical diagnosis of the disease and reporting. For occupational adjustment disorder, the assessment of other non-occupational causes needed improvement. The quality of diagnosing and reporting could be improved for noise-induced occupational hearing loss and occupational adjustment disorders. Information, education and practical tools are proposed for quality improvements.