Common Significant Predictors Research Articles

Predictors of health-related quality of life (HRQoL) for caregivers of children with developmental disabilities in Saudi Arabia: An observational study.

To examine predictors of health-related quality of life (HRQoL) for caregivers of children with developmental disabilities, a cross-sectional design was used. Participants were primary caregivers of children with developmental disabilities. Caregivers completed a demographic form about the child and the family, and the Arabic version of Patient-Reported Outcomes Measurement Information System-Profile 29 (PROMIS-29 v2.0). Descriptive statistics were used to report on demographic data, 1-sample Z tests to compare PROMIS domain scores with the general population, and multiple linear regression analyses to identify predictors of each domain. Participants were 111 primary caregivers, mostly mothers (65.8%). Caregivers reported higher levels of anxiety, depression, fatigue, sleep disturbance, and pain interference, and lower levels of physical function and social participation compared to the general population, P < .05. The regression models for predicting the HRQoL accounted for 12.3% of the variance in the physical function domain (P = .016), 13.9% in the anxiety domain (P = .009), 24.7% in the ability to engage in social activities and roles (P < .001), and 11.4% in the pain interference domain (P = .02). In these models, the severity of the child's disability and/or the child's age were common significant predictors. Specifically, child's age was the only significant predictor in 2 domains, the anxiety domain (β = -.29, P < .01) and ability to participate in social activities and roles domain (β = .42, P < .05). The severity of the child's disability was the only significant predictor in the physical function domain (β = -.52, P < .01). Both the severity of the child's disability and the child's age were significant predictors in the pain interference model (β = .40, P < .05), and (β = -.23, P < .05), respectively. However, the models did not significantly predict depression, fatigue, or sleep disturbance, P > .05. HRQoL is a complex construct and is influenced by multiple child and family factors. Implications of the study emphasize the importance of regular HRQoL screening for caregivers, the development of efficient referral systems for support services, and the exploration of respite care options.

Retrospective Analysis of Risk Factors in Geriatric Hip Fracture Patients Predictive of Surgical Intensive Care Unit Admission.

Although numerous risk factors and prediction models affecting morbidity and mortality in geriatric hip fracture patients have been previously identified, there are scant published data on predictors for perioperative Surgical Intensive Care Unit (SICU) admission in this patient population. Determining if a patient will need an SICU admission would not only allow for the appropriate allocation of resources and personnel but also permit targeted clinical management of these patients with the goal of improving morbidity and mortality outcomes. The purpose of this study was to identify specific risk factors predictive of SICU admission in a population of geriatric hip fracture patients. Unlike previous studies which have investigated predominantly demographic, comorbidity, and laboratory data, the present study also considered a frailty index and length of time from injury to presentation in the Emergency Department (ED). A total of 501 geriatric hip fracture patients admitted to a Level 1 trauma center were included in this retrospective, single-center, quantitative study from January 1, 2019, to December 31, 2022. Using a logistical regression analysis, more than 25 different variables were included in the regression model to identify values predictive of SICU admission. Predictive models of planned versus unplanned SICU admissions were also estimated. The discriminative ability of variables in the final models to predict SICU admission was assessed with receiver operating characteristic curves' area under the curve estimates. Frailty,serum lactate > 2, andpresentation to the ED > 12 hours after injurywere significant predictors of SICU admission overall (P = 0.03, 0.038, and 0.05 respectively). Additionally, the predictive model for planned SICU admission had no common significant predictors with unplanned SICU admission. Planned SICU admission significant predictors included an Injury Severity Score (ISS) of 15 and greater, a higher total serum protein, serum sodium <135, systolic blood pressure (BP) under 100, increased heart rate on admission to ED, thrombocytopenia (<120), and higher Anesthesia Society Association physical status classification (ASA) score (P = 0.007, 0.04, 0.05, 0.002, 0.041, 0.05, and 0.005 respectively). Each SICU prediction model (overall, planned, and unplanned) demonstrated sufficient discriminative ability with the area under the curve (AUC) values of 0.869, 0.601, and 0.866 respectively.Finally, mean hospital Length of Stay (LOS) and mortality were increased in SICU admissions when compared to non-SICU admissions. Of the three risk factors predictive of SICU admission identified in this study, two have not been extensively studied previously in this patient population. Frailty has been associated with increased mortality and postoperative complications in hip fracture patients, but this is the first study to date to use a novel frailty index specifically designed and validated for use in hip fracture patients. The other risk factor, time from injury to presentation to the ED serves as an indicator for time a hip fracture patient spent without receiving medical attention. This risk factor has not been investigated heavily in the past as a predictor of SICU admissions in this patient population.

Baseline prevalence of high blood pressure and its predictors in a rural adult population of Bangladesh: Outcome from the application of WHO PEN interventions.

This cross‐sectional study estimated the prevalence of high blood pressure (BP) and examined its predictors at baseline following protocol 1 (actions 1 and 2) of World Health Organization (WHO) Package of Essential Noncommunicable Disease (PEN) Interventions in a selected rural area of Bangladesh. A total of 11 145 adults (both sex and age ≥ 18 years) completed both the questionnaire and clinical measurements at the household and community clinics, respectively. We defined high BP as systolic BP ≥ 120 mmHg or diastolic BP ≥ 80 mmHg, prehypertension (pre‐HTN) as systolic BP 120–139 mmHg or diastolic BP 80–89 mmHg, and hypertension (HTN) as systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg and/or anti‐hypertensive drug intake for the raised BP. The prevalence of high BP was 51.2% (pre‐HTN, 25.3%; HTN, 25.9%). Among them, the proportion of pre‐HTN was higher among men (28.7%) while HTN was higher among women (27.4%). Other than fast food intake (pre‐HTN, OR: 1.110, P = .063) and women sex (HTN, OR: 1.236, P < .001), the pre‐HTN and HTN had higher odds for having same predictors as follows: age ≥ 40 years, family history of HTN, physical inactivity, central obesity, generalized obesity, and diabetes. In conclusion, the application of WHO PEN protocol 1 detected one‐fourth of the rural adult population had pre‐HTN and HTN respectively, and the common significant predictors of those were the age, family history of HTN, physical inactivity, generalized obesity, and diabetes.

Independently validated sex-specific nomograms for predicting survival in patients with newly diagnosed glioblastoma: NRG Oncology RTOG 0525 and 0825

Background/purposeGlioblastoma (GBM) is the most common primary malignant brain tumor. Sex has been shown to be an important prognostic factor for GBM. The purpose of this study was to develop and independently validate sex-specific nomograms for estimation of individualized GBM survival probabilities using data from 2 independent NRG Oncology clinical trials.MethodsThis analysis included information on 752 (NRG/RTOG 0525) and 599 (NRG/RTOG 0825) patients with newly diagnosed GBM. The Cox proportional hazard models by sex were developed using NRG/RTOG 0525 and significant variables were identified using a backward selection procedure. The final selected models by sex were then independently validated using NRG/RTOG 0825.ResultsFinal nomograms were built by sex. Age at diagnosis, KPS, MGMT promoter methylation and location of tumor were common significant predictors of survival for both sexes. For both sexes, tumors in the frontal lobes had significantly better survival than tumors of multiple sites. Extent of resection, and use of corticosteroids were significant predictors of survival for males.ConclusionsA sex specific nomogram that assesses individualized survival probabilities (6-, 12- and 24-months) for patients with GBM could be more useful than estimation of overall survival as there are factors that differ between males and females. A user friendly online application can be found here—https://npatilshinyappcalculator.shinyapps.io/SexDifferencesInGBM/.

Effects of Community-Based Programs on Integration into the Mental Health and Non-Mental Health Communities.

Aims: The purpose of this study was to verify how integration into the mental health community, a subculture of persons with mental illness, affects the integration into the non-mental health community. Thus, we analyzed the effect of community-based mental health service programs on non-mental health community integration, mediated by mental health community integration. Methods: In total, 190 persons with mental illness (M age = 42.78; SD = 11.3; male, 54.7%; female, 45.3%), living in local communities and using community-based mental health programs, participated in the study. We measured their sociodemographic and clinical variables, the environmental variables of mental health service programs, and the level of integration of the mental health and non-mental health communities. The data collected were analyzed to test the proposed hypotheses using Structural Equation Modeling (SEM). Results: The common significant predictors affecting the two types of community integration were symptoms and resource accessibility: the more accessible the various community resources and the less severe the psychiatric symptoms were, the higher the level of the two types of community integration was. In path analysis, the program’s atmosphere and the participation of people with mental illness (program involvement) significantly predicted the level of integration into the mental health community. This, in turn, had a positive effect on their physical integration, social contact frequency, and psychological integration into the non-mental health community, mediated by the integration of the mental health community. Conclusion: Based on the results, we emphasize the importance of mental health communities and suggest strategies to support the integration of mental health communities.

Prevalence and Risk Factors of Human Papillomavirus Infection among Japanese Female People: A Nationwide Epidemiological Survey by Self-Sampling.

Background:Nationwide epidemiological surveys of behavioral factors and human papillomavirus (HPV) infection among Japanese women are scarce. This study aimed to determine the prevalence, genotype distribution, and significant predictive factors of HPV infection using self-collected vaginal samples from Japanese female people. Methods:The study population consisted of 1,050 female subjects aged 16–75 years (median 30 years). The participants were asked to provide self-collected samples from the vaginal wall using cotton swabs for genotyping of HPV. We compared the participants’ characteristics and detected HPV genotypes to determine significant predictors of HPV infection. Results:After excluding 47 participants (34 participants of unknown age, 11 virgin participants, 1 participant who engaged in sex with another woman, and 1 participant who did not undergo β-globin detection), 1,003 participants were included in the analysis. Of the 1,003 participants, 426 (42.5%) participants had at least one HPV genotype, 282 (28.1%) participants had high-risk HPV genotypes, 306 (30.5%) had low-risk HPV genotypes, and 162 (16.2%) participants had both HPV genotypes. HPV-16/18 positivity was found in 5.4% (54/1,003) participants. The most frequently detected high-risk HPV genotype was HPV-52 (86/1,003; 8.6% participants). The number of lifetime sex partners (≥6) and a present history of sexually transmitted infection (STI) were significant predictors of high-risk HPV infection. The number of lifetime sex partners (≥6), age of coitarche (≥20 years of age), unmarried status, and a present history of STI were significant predictors of low-risk HPV infection. Conclusions:The prevalence of high-risk and low-risk HPV infection among Japanese female subjects was 28.1% and 30.5%, respectively. The number of lifetime sex partners (≥6) and present history of sexually transmitted infection were the common significant predictors of high-risk and low-risk HPV infection.

Drivers of Personal Safety in Agriculture: A Case Study with Pesticide Operators

Agriculture is a hazardous occupational industry for farmers and farm workers; therefore, decisions to improve safety in the working place require understanding behavior of farmers and farm workers and factors affecting it. This study examined factors influencing perceived importance of personal safety and safe behavior of farmers in terms of personal protective equipment (PPE) use in pesticide spraying. Data were collected from a previous survey of farmers in rural areas of northern Greece. Over half of the farmers (55.4%) perceived low importance of personal safety in pesticide spraying. Perceived importance of personal safety increased in young farmers, with high education level, and large land area as well as with high perception of risk, knowledge of pesticide toxicity, seminar in pesticide use, access to internet, and perceived usefulness of PPE. Most farmers showed unsafe behavior in PPE use in terms of using long-sleeved shirt, long pants, chemical resistant gloves, socks, and shoes (58.9%). Farmers perceived low risk of pesticides (65.2%), despite the fact that two out of three farmers (66.1%) perceived high usefulness of PPE. Safe behavior in pesticide use increased in young farmers, with high education level, and small land area as well as with high perception of risk, knowledge of pesticide toxicity, seminar in pesticide use, access to internet, and perceived usefulness of PPE. Binary logistic regression analysis showed that knowledge of pesticide toxicity, education, age, and farm size were significant predictors of perceived importance of personal safety. In addition, self-confidence in spraying, following colleagues’ behaviors, risk perception, knowledge of pesticide toxicity, and farm size were significant predictors of safe behavior in terms of PPE use during pesticide spraying. Findings highlight differences in how farmers perceive personal safety and how they finally respond in daily action with respect to personal safety measures. Perception of risk, knowledge of pesticide toxicity, and farm size were common significant predictors for both variables. Lifelong education targeting promotion of knowledge about pesticide risks among farmers should be always a priority.

Predictors of Postpartum Return to Smoking: A Systematic Review.

Finding effective ways to help pregnant women quit smoking and remain abstinent is a major public health issue. Approximately half of UK women who smoke attempt cessation after conception; unfortunately, up to 75% return to smoking within 12 months postpartum. Interventions for preventing postpartum return to smoking (PPRS) have not been found to be effective. It is important to identify factors associated with PPRS, to inform development of alternative interventions. Identify by systematic review factors associated with PPRS. Systematic searches of electronic databases (MEDLINE, EMBASE, PsychINFO, CINAHL), trials registers, and conference proceedings were conducted to November 2016. Studies statistically examining factors associated with PPRS were included. Modified versions of the Newcastle Ottawa Quality Assessment Scale were used to assess studies' quality and a narrative synthesis focused on those judged of high quality. Thirty-nine studies (12 trials, 27 observational studies) were included. Thirty-one (79.5%) studies were high-quality. Among these, the most common significant predictors of PPRS were being less well educated, younger, multiparous, living with a partner or household member who smoked, experiencing higher stress, depression or anxiety, not breastfeeding, intending to quit only for pregnancy and low confidence to remain abstinent postpartum. Of the factors found to be associated with PPRS, intending to quit smoking only for the duration of pregnancy, partner/household member smoking and confidence to remain abstinent are those most likely to have a direct, causal impact on smoking behavior after childbirth, and need to be considered when designing interventions to prevent PPRS. This is the first systematic review of factors that may facilitate or inhibit PPRS. Considering how having a partner or household member who smokes, intending to quit smoking only for pregnancy, having self-efficacy to quit long term, breastfeeding and depression exert direct or indirect impacts on women's relapse to smoking and how such impacts could successfully be manipulated will inform development of new interventions to prevent PPRS.

Moderating Role of Gender between Job Characteristics and Job Satisfaction

This study examines the moderating role of gender between job characteristics and job satisfaction among Indian software employees which has received less attention in the Indian context. Additionally, it also examines difference in the job characteristics that affect male and female employee's job satisfaction. Structural Equation Modeling (SEM) and chi-square difference in multi group moderation analysis, used to test the hypothesized relationships. Chi-square difference test showed invariant moderation effect of gender on the relationship between job characteristics and job satisfaction. It has been also found that five job characteristics (skill variety, task significance, task identity, autonomy and feedback) have a significant positive impact on job satisfaction among male employees, whereas in case of female, only two job characteristics task significance and task identity were significant predictors of job satisfaction. Interestingly, task significance and task identity were common significant positive predictors of job satisfaction for both male and female software employees.

Putting words into action: A simple focused education improves prescription label comprehension and functional health literacy

ObjectivesTo assess the effectiveness of an educational intervention on prescription (Rx) label comprehension and functional health literacy (FHL) in older adults. Outcomes were compared between current and redesigned Rx labels. Additional objectives were to examine the correlation between 2 outcome measures and to determine the characterizing variables that are predictors for the outcome measures. SettingSouthern California, January 2013 to March 2015. Practice descriptionOlder adults (>55 y) taking 2 or more Rx medications daily were recruited at senior and community centers by a trained data collection team. Practice innovationThe validated Modified LaRue Tool (MLT) tested Rx label comprehension before and after a short, focused educational intervention and correlated it with FHL. InterventionsA simple one-on-one education provided by student pharmacists that was focused on critical elements of an Rx label. EvaluationShort Test of Functional Health Literacy in Adults (STOFHLA) and MLT scores of all current and redesigned label participants at baseline and follow-up. ResultsParticipants using redesigned Rx labels (n = 90) showed significantly higher MLT scores than with current Rx labels (n = 28) both before (23.0 ± 2.3 vs. 21.0 ± 2.4; P <0.001) and after educational intervention (23.8 ± 1.7 vs. 22.1 ± 3.1; P <0.001). With the use of analysis of covariance, intervention participants using redesigned label (n = 48) showed significant improvement in both MLT (23.1 ± 2.0 to 24.3 ± 1.0; P <0.001) and STOFHLA (29.8 ± 7.5 to 31.5 ± 5.7; P = 0.011) scores, whereas intervention participants using current Rx label (n = 16) did not show significant improvement in either MLT (P = 0.530) or STOFHLA (P = 0.215) scores. Effect size of intervention (redesigned label) was 0.77, indicating practical significance. MLT and STOFHLA scores were significantly correlated with each other, and age and education level were common significant predictors for both outcomes. ConclusionOlder adults using redesigned Rx labels showed improved Rx label comprehension and FHL after educational intervention, as well as higher comprehension compared with those using current Rx labels. Use of a redesigned Rx label and a simple educational intervention should be encouraged to improve Rx label comprehension and FHL.

Passing on: Personal attributes associated with midlife expressions of intended legacies.

Expressions of the intent to leave behind something when we die can contain elements of both selflessness and selfishness. In this paper, we identify 3 different types of expressed legacy (personal, broader, and composite), and distinguish between them by examining their correlates (generativity, narcissism, and community involvement), as well as differences in expressed legacies for midlife African Americans and European Americans. Quantitative and qualitative data from surveys and interviews were drawn from the Foley Longitudinal Study of Adulthood (FLSA; N = 138; aged 55-58). We examined the contributions of generativity, narcissism, community involvement, and SES to each legacy, as well as the comparative levels of common significant predictors for each legacy, and the comparative likelihood of expressing particular legacies by race. Quantitative analyses showed that a different constellation of correlates predicted each legacy. Additionally, African Americans were more likely than European Americans to express legacies that indicated community involvement. Qualitative analyses showed that legacy groups (and races) also differed in open-ended responses encompassing personal concerns, talents, and goals. These findings highlight some of the mechanisms and correlates of how the intent to leave a legacy can provide meaning and purpose for midlife African Americans and European Americans. Results are discussed in light of previous research concerning how legacies are transmitted, and potential differences in cultural roots and meaning for African Americans and European Americans.

Risk factors of infected sternal wounds versus sterile wound dehiscence

BackgroundSterile sternal dehiscence (SSD) and sternal wound infections (SWIs) are two complications of median sternotomy with high rates of morbidity. Sternal wound complications also carry significant economic burden, almost tripling patients' hospital costs and are considered a nonreimbursable “never event” for Medicare. Historically, SDD and SWI have been recognized as discrete entities, but nonetheless continue to be categorized as a singular complication in literature. The purpose of this study was to determine specific patient demographic and perioperative predictors of SSD and SWI. Materials and methodsAn institutional review board–approved, retrospective study of 8098 consecutive patients who underwent cardiac surgery at Columbia University Medical Center between January 2008 and December 2013 was conducted. Patients were categorized into three groups: no sternal wound complication, SSD, or SWI. Statistical analysis was performed using univariate and multivariate logistic regression analysis. ResultsOf 8098 patients, there were 73 patients (0.9%) with SSD and 40 (0.5%) with SWI who required plastic surgical consultation, debridement, and flap closure. In univariate analysis of SSD, positive predictors (i.e., “risk” factors) were age >42 years, prior surgery this admission, ≥2 arterial conduits, internal mammary artery (IMA) grafting with or without previous IMA grafting, body mass index (BMI) >30 (obese), CHF, diabetes requiring medication, respiratory failure, and unplanned cardiac reoperation; negative predictors (i.e., “protective” factors) were no arterial conduits and extubation within 24 h. In univariate analysis of SWI, positive predictors were IMA grafting with or without previous IMA grafting, postoperative hematocrit urgent/emergent surgical priority, BMI >30 (obese), cardiac ejection fraction <40%, and respiratory failure; negative predictors were no arterial conduits and elective surgical priority. In multivariate regression, BMI >30, diabetes requiring medication, and respiratory failure were determined to be significant positive predictors of SSD, and IMA grafting with or without prior IMA grafting and respiratory failure were significant positive predictors for SWI; no significant negative predictors were identified. ConclusionsThis study found that SSD and SWI have many common significant predictors consistent with findings that increased BMI, use of IMA grafts, poor cardiac reserve, and postoperative respiratory failure confer increased risk of sternal wound complications. Additionally, this study also found that there were predictors unique to each entity supporting that SSD and SWI may be related but are not a singular entity. Recognition and prevention of significant positive and negative predictors of SSD and SWI may be valuable in preoperative counseling, operative planning, and postoperative management. Although sternal wound complications can be successfully managed by plastic surgical intervention, preventing the development of median sternotomy complications may curb costs incurred by both patients and health care systems.

Factors Affecting Sexually Transmitted Infections in South Korean High School Students.

This study identified factors affecting sexually transmitted infections (STIs) among high school students in South Korea. This study was a secondary data analysis using data from the eighth annual Korea Youth Risk Behavior Web-based Survey conducted in 2012. Data from 2,387 high school students who reported having sexual intercourse were analyzed using descriptive statistics, chi-square tests, and logistic regression by gender. The survey questionnaire measured drug experience, Internet pornography preference, age at first intercourse, and method of contraception. Overall, 7.2% of participants had experienced STIs. The common significant predictors of STIs in male and female students were drug experience, Internet pornography preference, and age at first intercourse. Contraceptive methods were statistically significant only for males; living arrangements and Internet usage were significant only for females. Drug experiences, Internet pornography preference, and age at first intercourse were strong factors that affected both male and female students, suggesting the necessity to reinforce laws and regulations prohibiting drug use and pornography. Moreover, precise and detailed information on intercourse, sexual behaviors, and STIs offered by public health nurses should be officially provided starting in elementary school. For male students, the practice of condom use should be emphasized.

Criteria-specific long-term survival prediction model for hepatocellular carcinoma patients after liver transplantation.

To establish a model to predict long-term survival of hepatocellular carcinoma (HCC) patients after liver transplantation (MHCAT). Two hundred and twenty-three patients with HCC were followed for at least six years to identify independent risk factors for long-term survival after liver transplantation (LT). The criteria for HCC liver transplantation included the Milan, University of California San Francisco, Hangzhou and Shanghai Fudan criteria. The Cox regression model was used to build MHCAT specifying these criteria. A survival analysis was carried out for patients with high or low risk. The one-, three- and five-year cumulative survival of HCC patients after LT was 78.9%, 53.2% and 46.4%, respectively. Of the HCC patients, the proportion meeting the Hangzhou and Fudan criteria was significantly higher than the proportion meeting the Milan criteria (64.6% vs 39.5%, 52.0% vs 39.5%, P < 0.05). Moreover, the proportion meeting the Hangzhou criteria was also significantly higher than the proportion meeting other criteria (P < 0.01). Pre-operative alfa-fetoprotein level, intraoperative blood loss and retransplantation were common significant predictors of long-term survival in HCC patients with reference to the Milan, University of California San Francisco and Fudan criteria, whereas in MHCAT based on the Hangzhou criteria, total bilirubin, intraoperative blood loss and retransplantation were independent predictors. The c-statistic for MHCAT was 0.773-0.824, with no statistical difference among these four criteria. According to the MHCAT scoring system, patients with low risk showed a higher five-year survival than those with high risk (P < 0.001). MHCAT can effectively predict long-term survival for HCC patients, but needs to be verified by multi-center retrospective or randomized controlled trials.

Depression as a predictor of work resumption following myocardial infarction (MI): a review of recent research evidence

BackgroundDepression often coexists with myocardial infarction (MI) and has been found to impede recovery through reduced functioning in key areas of life such as work. In an era of improved survival rates and extended working lives, we review whether depression remains a predictor of poorer work outcomes following MI by systematically reviewing literature from the past 15 years.MethodsArticles were identified using medical, health, occupational and social science databases, including PubMed, OVID, Medline, Proquest, CINAHL plus, CCOHS, SCOPUS, Web of Knowledge, and the following pre-determined criteria were applied: (i) collection of depression measures (as distinct from 'psychological distress') and work status at baseline, (ii) examination and statistical analysis of predictors of work outcomes, (iii) inclusion of cohorts with patients exhibiting symptoms consistent with Acute Coronary Syndrome (ACS), (iv) follow-up of work-specific and depression specific outcomes at minimum 6 months, (v) published in English over the past 15 years. Results from included articles were then evaluated for quality and analysed by comparing effect size.ResultsOf the 12 articles meeting criteria, depression significantly predicted reduced likelihood of return to work (RTW) in the majority of studies (n = 7). Further, there was a trend suggesting that increased depression severity was associated with poorer RTW outcomes 6 to 12 months after a cardiac event. Other common significant predictors of RTW were age and patient perceptions of their illness and work performance.ConclusionDepression is a predictor of work resumption post-MI. As work is a major component of Quality of Life (QOL), this finding has clinical, social, public health and economic implications in the modern era. Targeted depression interventions could facilitate RTW post-MI.

Clinical significance of lymph node dissection in renal cell carcinoma

To identify the role of lymph node dissection in renal cell carcinoma (RCC). A total of 100 patients (66 males, 34 females) were enrolled in the study. The mean age and tumor size were 61.4 years and 5.8 cm, respectively. A total of 41 patients (41%) had tumors <4 cm in diameter. The pathological status was pT1, pT2 and pT3 in 60, 11 and 29 patients, respectively. In total, lymph node metastases were found in seven cases (7%). Of 40 patients with pT1a tumors (tumor size <4 cm), one (2.5%) had lymph node metastasis. Patients with lymph node metastases had significantly larger tumors than those without (8.9 vs 5.5 cm; p<0.05). Regarding patient outcome, 33 (33%) had tumor progression (alive with disease, n=14; disease-specific death, n=19) after a median follow-up period of 54.0 months. In univariate analysis, 15/18 prognostic markers [tumor size, tumor grade, pT, pN and M categories, stage, microscopic venous invasion (V category), microscopic lymphatic invasion (Ly category), pathological tumor infiltration pattern (INF category), plasma fibrinogen, C-reactive protein, immunosuppressive acidic protein, alpha-2 globulin and erythrocyte sedimentation rates at 1 and 2 h] were common significant predictors of tumor progression. A Cox hazard model revealed tumor size, tumor grade and pathological stage to be independent prognostic factors. Tumor size is a crucial prognostic factor for tumor progression, and lymph node dissection may be omitted in T1a tumors.

Predictors of sexual health in women after a breast cancer diagnosis.

To identify variables that might be predictive of sexual health (interest, dysfunction, and satisfaction) in a large sample of breast cancer survivors, with a validation conducted in a second, independent sample. On the basis of a conceptual framework of sexual health in breast cancer survivors, we performed multivariable regression analyses to estimate sexual interest, dysfunction, and satisfaction in both samples. Additional analyses were performed using stepwise regression and recursive partitioning to explore in each sample the relative contributions of the independent variables toward predicting the outcome measures. The models for sexual interest accounted for at least 33% of the variance, and the significant predictors common to the two samples were having a new partner since the diagnosis of breast cancer, mental health score, and body image score. For sexual dysfunction, the models in the two samples explained at least 33% of the variance, and the common significant predictors were vaginal dryness, past chemotherapy use, and having a new partner since diagnosis. The sexual satisfaction models explained at least 27% of the variance, with the common significant predictors being the quality of the partnered relationship and sexual problems in the partner. Among the predictors of sexual health, several are mutable (vaginal dryness, emotional well-being, body image, the quality of the partnered relationship, and sexual problems in the partner), and these should be considered for future interventions to address the sexual health and well-being of breast cancer survivors.