General Clinic Population Research Articles

High-risk human papillomavirus (HPV) screening and detection in healthy patient saliva samples: a pilot study

BackgroundThe human papillomaviruses (HPV) are a large family of non-enveloped DNA viruses, mainly associated with cervical cancers. Recent epidemiologic evidence has suggested that HPV may be an independent risk factor for oropharyngeal cancers. Evidence now suggests HPV may modulate the malignancy process in some tobacco- and alcohol-induced oropharynx tumors, but might also be the primary oncogenic factor for inducing carcinogenesis among some non-smokers. More evidence, however, is needed regarding oral HPV prevalence among healthy adults to estimate risk. The goal of this study was to perform an HPV screening of normal healthy adults to assess oral HPV prevalence.MethodsHealthy adult patients at a US dental school were selected to participate in this pilot study. DNA was isolated from saliva samples and screened for high-risk HPV strains HPV16 and HPV18 and further processed using qPCR for quantification and to confirm analytical sensitivity and specificity.ResultsChi-square analysis revealed the patient sample was representative of the general clinic population with respect to gender, race and age (p < 0.05). Four patient samples were found to harbor HPV16 DNA, representing 2.6% of the total (n = 151). Three of the four HPV16-positive samples were from patients under 65 years of age and all four were female and Hispanic (non-White). No samples tested positive for HPV18.ConclusionsThe successful recruitment and screening of healthy adult patients revealed HPV16, but not HPV18, was present in a small subset. These results provide new information about oral HPV status, which may help to contextualize results from other studies that demonstrate oral cancer rates have risen in the US among both females and minorities and in some geographic areas that are not solely explained by rates of tobacco and alcohol use. The results of this study may be of significant value to further our understanding of oral health and disease risk, as well as to help design future studies exploring the role of other factors that influence oral HPV exposure, as well as the short- and long-term consequences of oral HPV infection.

Substance Use Disorders Assessed Using the Kreek–McHugh–Schluger–Kellogg (KMSK) Scale in an Urban Low‐Income and Predominantly African American Sample of Primary Care Patients

The Kreek–McHugh–Schluger–Kellogg (KMSK) scale was developed to quantify self-exposure to opiates, cocaine, alcohol, and tobacco. The original study was limited by a relatively small sample that was not representative of general clinical populations, and did not include marijuana exposure. For the current study, participants were recruited from primary care outpatient clinics in an urban public hospital. The primary measure was the KMSK scale. The Structured Interview for Diagnosis for DSM-IV (SCID) was used as the “gold standard” for substance dependence diagnoses, and the results of KMSK assessments were evaluated using receiver operator characteristic (ROC) analysis. The sample (n = 439) was predominantly African American (90.6%), with mean age (±SD) of 43.1 ± 12.8 years. ROC analyses found that the optimal cutoff scores for alcohol dependence were the same as suggested previously (11), while they were lower for cocaine dependence (10 vs. 11) and opiate dependence (4 vs. 9). The analysis suggested a cutoff score of 8 for marijuana. The KMSK performed well in the current study as a brief tool for evaluating dependence on alcohol, cocaine, marijuana, and opiates in this nonpsychiatric clinic sample of predominantly poor urban African Americans. (Am J Addict 2011;20:292–299)

Evaluation of Beliefs About Hypertension in a General Population

Hypertension affects millions of people in the United States, yet many do not reach their blood pressure goals. Existing data indicate that self-management skills improve chronic disease management. Beliefs and attitudes are an important component of self management. This pilot study was designed to evaluate the beliefs of the general public on hypertension. One hundred patients of Duke Family Medicine were verbally consented to receive a survey consisting of 16 true/false questions. Included subjects were 18 years and older and comfortable answering questions in English. The questions addressed self-management behaviors, definition, and complications of hypertension. Basic demographic data were collected. Descriptive statistics were performed on the data. Of 120 patients screened, 100 met inclusion criteria and agreed to participate in the study. Demographic data indicated that surveyed subjects were similar to the general clinic population: 69% were women, 51% African American, and 55% age 45 years and older. A total of 79% of subjects answered 13 or more questions correctly. The 3 most commonly missed questions addressed fatality of hypertension, adverse effects of medications, and potential for curing hypertension. Hypertension is a prevalent issue affected by many factors. Beliefs of the general population, including the role of self-management, seem consistent with current medical knowledge. However, this study only evaluated beliefs not behaviors of patients. Further study is needed to elucidate patient-oriented factors that may limit control of hypertension.

Assessing the reproducibility of asthma genome-wide association studies in a general clinical population

Assessing the reproducibility of asthma genome-wide association studies in a general clinical population

Do men with mild erectile dysfunction have the same risk factors as the general erectile dysfunction clinical trial population?

• To compare the underlying risk for diseases associated with erectile dysfunction (ED; i.e. cardiovascular disease and diabetes) in a population of men with mild ED relative to a general ED clinical trial population. • Men enrolled in a randomized, double-blind placebo-controlled (DBPC) trial of sildenafil for the treatment of mild ED were compared with a database of men enrolled in 67 of the manufacturer's other DBPC sildenafil trials. • The main outcome measures were baseline demographics, comorbidities and concomitant medications. • In both populations, most men were white, approximately one quarter were smokers, and most had an organic component to their ED etiology. • In the mild ED population (N = 176) versus the database population (N = 14,537), mean ± sd (range) age was 50 ± 12 (19-84) versus 55 ± 11 (18-89) years, body mass index was 29 ± 5 (20-48) versus 28 ± 5 (11-64) kg/m² and ED duration was 3.5 ± 3.2 (< 1-18) versus 4.6 ± 4.7 (< 1-45) years. • The prevalence of comorbidities associated with ED was similar (hypertension 26.1% (n = 46) vs 32.8%; diabetes mellitus 13.6% (n = 24) vs 22.1%; dyslipidemias 12.5% (n = 22) vs 11.7%; hypercholesterolemia 12.5% (n = 22) vs 9.5%; gastro-esophageal reflux disease 10.8% (n = 19) vs 6.0%; benign prostatic hyperplasia 9.7% (n = 17) vs 9.9%; depression 6.3% (n = 11) vs 5.6%; and anxiety 4.0% (n = 7) vs 1.6%), as was the rate of use of medications for those comorbidities. • Men with mild ED have similar risk factors to a general ED clinical trial population. Thus, mild ED is an important indicator of risk for underlying disease associated with ED. • Inquiry into ED should be part of routine clinical evaluation to facilitate rapid identification and early intervention. • Men complaining of mild ED should be evaluated adequately for underlying cardiovascular risk.

Sociocognitive Factors Associated with Nonadherence to Medication After Hospital Discharge

Poor adherence to prescribed medication is a well-known problem and continues to be a major challenge in all medical specialties. Unlike previous studies that have mainly focused on nonadherence behaviors in specific diseases, this study sought to examine socio-cognitive factors associated with nonadherence behavior in a sample of a general clinical population. A questionnaire investigating socio-demographic and cognitive factors and a telephone follow-up interview were administered to 84 patients recruited in a General Medicine Unit before their discharge. Half of the participants were informed about that follow-up procedure. One month after hospital discharge, 42% of uninformed patients reported nonadherence behaviors, as against 21% of informed patients. Middle-aged patients and short-term treatments were associated significantly more often with nonadherence. Among cognitive factors, patients’ perceived risks and benefits of nonadherence, personal susceptibility to diseases, subjective health value, and reported memory failures were significantly associated with adherence. We conclude that a patient's perception may be more important than medication load, illness severity, and complexity of regimen in influencing medication adherence, and that a telephone call follow-up helps in monitoring medication adherence after hospital discharge.

Diabetes due to exocrine pancreatic disease--a review of patients attending a hospital-based diabetes clinic

Diabetes secondary to underlying exocrine pancreatic disease is a specific, but heterogeneous, type of diabetes mellitus. Studies such as UKPDS and DCTT excluded patients with pancreatic diabetes, so there is a paucity of evidence regarding best clinical practice in this group. To characterize the clinical features of patients with diabetes secondary to underlying pancreatic disease attending general diabetes clinics in a single hospital. A cross-sectional observational cohort study, identifying patients with pancreatic diabetes from clinic letters and medical notes at the University Hospital of Wales, Cardiff, UK. The notes of 38 patients with pancreatic diabetes were reviewed. Of these, six had pancreatic malignancy and the remainder had a range of benign disorders. The majority (29/38) had diabetes diagnosed at or shortly after the pancreatic diagnosis was made. There was a lack of consistency regarding initial hypoglycaemic therapy, with metformin alone being the most common initial therapy, but with 30/38 taking insulin within 12 months of diagnosis. Similarly, a broad range of insulin regimens were employed with twice daily pre-mixed insulin being most prevalent. Sixty-three percent of patients were prescribed lipid lowering therapy and 42% were taking anti-hypertensives. Glycaemic control, as estimated by the latest HbA1C, was no different in patients with pancreatic diabetes compared to the general clinic population and there were no reports of severe hypoglycaemia. There is great variability in how patients with pancreatic diabetes are currently managed. Future clinical trials should specifically address this group.

The plausibility of maternal nutritional status being a contributing factor to the risk for fetal alcohol spectrum disorders: The potential influence of zinc status as an example

There is increasing evidence that human pregnancy outcome can be significantly compromised by suboptimal maternal nutritional status. Poor diet results in a maternal-fetal environment in which the teratogenicity of other insults such as alcohol might be amplified. As an example, there is evidence that zinc (Zn) can interact with maternal alcohol exposure to influence the risk for fetal alcohol spectrum disorders (FASD). Studies with experimental animals have shown that the teratogenicity of alcohol is increased under conditions of Zn deficiency, whereas its teratogenicity is lessened when animals are given Zn-supplemented diets or Zn injections before the alcohol exposure. Alcohol can precipitate an acute-phase response, resulting in a subsequent increase in maternal liver metallothionein, which can sequester Zn and lead to decreased Zn transfer to the fetus. Importantly, the teratogenicity of acute alcohol exposure is reduced in metallothionein knockout mice, which can have improved Zn transfer to the conceptus relative to wild-type mice. Consistent with the above, Zn status has been reported to be low in alcoholic women at delivery. Preliminary data from two basic science and clinical nutritional studies that are ongoing as part of the international Collaborative Initiative on Fetal Alcohol Spectrum Disorders support the potential role of Zn, among other nutritional factors, relative to risk for FASD. Importantly, the nutrient levels being examined in these studies are relevant to general clinical populations and represent suboptimal levels rather than severe deficiencies. These data suggest that moderate deficiencies in single nutrients can act as permissive factors for FASD, and that adequate nutritional status or intervention through supplementation may provide protection from some of the adverse effects of prenatal alcohol exposure.

ETriage – a novel, web-based triage and booking service: enabling timely access to sexual health clinics

In recent years, the sexual health of the nation has risen in profile. We face increasing demands and targets, in particular the 48-hour waiting time directive, and as a result clinic access has become a priority. eTriage is a novel, secure, web-based service designed specifically to increase access to our clinics. It has proved a popular booking method, providing access to 10% of all appointments across the Directorate within six months of introduction. KC60 analyses revealed that the majority of users (58%) underwent asymptomatic screening with the remainder having some degree of pathology. There was a greater percentage prevalence of human papilloma virus, chlamydia, non-specific urethritis, gonorrhoea, herpes and trichomonas in the eTriage population when compared with the general clinic population. A notes review illustrated a high degree of concordance between data entered on eTriage registration and clinical review (97%). A patient survey revealed high levels of patient satisfaction with the service. As an adjunct to our existing booking services, eTriage has served to increase patient choice and has proved itself to be a safe, efficient and effective means of improving patient access.

Measuring Preferred Role Orientations for Patients and Providers in Veterans Administration and University General Medicine Clinics

Congruence between patients' and providers' preferred healthcare role orientations has been shown to be important for improved clinical outcomes and patient satisfaction. Thus, it is important to know how different patient and provider populations might vary in preferred role orientations. To measure the range of role orientation preferences among patients and providers in two different general medicine clinic populations. Role orientation preferences of patients (n = 319) and providers (n = 151) in six Veterans Administration (VA) primary care clinics and two university-based primary care clinics were measured in a cross sectional survey using the 9-item Patient-Practitioner Orientation Scale (PPOS) sharing subscale among patients and providers. VA patients had lower mean PPOS scores (i.e. more provider-centered role preference) than the university clinic patients (31.2 vs 39.7, respectively; p < 0.001). The difference remained significant even after adjusting for age, sex, and education. VA and university clinic providers had similar mean PPOS scores (41.5 vs 42.6, respectively; p = 0.27). Greater differences were found in mean PPOS scores between VA patients and their providers (31.2 vs 41.5, respectively; p < 0.001) than university clinic patients and their providers (39.7 vs 42.6, respectively; p = 0.12). VA patients reported preferences for a more provider-centered role than university clinic patients and there was greater mean difference in preferred role orientations between VA patients and their providers than between university clinic patients and their providers. Differences in preferred role orientations by patients and providers should be considered when designing clinical initiatives and research to improve patient care.

Effect of baseline plasma fatty acids on eicosapentaenoic acid levels in individuals supplemented with α-linolenic acid

We previously reported a >50% increase in mean plasma eicosapentaenoic acid levels in a general medicine clinic population after supplementation with α-linolenic acid. In the current analysis, we evaluate the variability of changes in eicosapentaenoic acid levels among individuals supplemented with α-linolenic acid and evaluated the impact of baseline plasma fatty acids levels on changes in eicosapentaenoic acid levels in these individuals. Changes in eicosapentaenoic acid levels among individuals supplemented with α-linolenic acid ranged from a 55% decrease to a 967% increase. Baseline plasma fatty acids had no statistically significant effect on changes in eicosapentaenoic levels acid after α-linolenic acid supplementation. Changes in eicosapentaenoic acid levels varied considerably in a general internal medicine clinic population supplemented with α-linolenic acid. Factors that may impact changes in plasma eicosapentaenoic acid levels after α-linolenic acid supplementation warrant further study.

Valores personales y autoestima en población general y clínica

The aim of this study is to investigate the association between personal values and self-esteem in general population and clinical population. The sample was composed of a group of patients with a diagnosis of anxiety disorders and/or depression (n = 60) and a comparison group, paired by sex and age, of general population (n = 60). The Portrait Values Questionnaire of Schwartz (PVQ) and the Autoe Self-esteem Scale were used. T-tests were performed to compare the scores of both instruments between the two groups. The clinical sample scored significantly lower in Self-esteem, Self- direction, Hedonism, and Openness to Change. For this reason, Pearson correlations were calculated in differential groups (clinical and general) between the PVQ and the Self-esteem Scale. In the general population group self-esteem was associated to one value: Self-direction. In the clinical group, self-esteem was associated mainly to Self- direction, but also to Hedonism, Power and Security; and to the axis Self-promotion and Openness to Change. Both in the clinical and general population samples it was found a significant association between the interest in having independent thought, freedom of action and exploring with higher levels of self-esteem.

Recurrence of Skin and Soft Tissue Infection Caused by Methicillin-Resistant Staphylococcus aureus in a HIV Primary Care Clinic

Recurrence of Skin and Soft Tissue Infection Caused by Methicillin-Resistant Staphylococcus aureus in a HIV Primary Care Clinic

Multi-slice computed tomography coronary angiography for ruling out suspected coronary artery disease: what is the prevalence of a normal study in a general clinical population?

To assess the prevalence of a normal multi-slice computed tomography (MSCT) in patients with suspected coronary artery disease (CAD) and to relate these observations to clinical presentation and pre-test likelihood of CAD. In total, 340 consecutive patients (182 men, 55 +/- 12 years) without a history of CAD who were referred for MSCT angiography were included in the study. Based on patient characteristics and the referral reason for MSCT angiography, patients were classified as having a low, intermediate, or high pre-test likelihood of CAD. Patients were evaluated for the presence of coronary artery calcium as well as the presence of atherosclerosis. Overall, 157 (46%) patients did not have coronary artery calcium and 133 (40%) patients had a completely normal MSCT angiogram. In 58% of the patients with low pre-test likelihood, no coronary atherosclerosis was observed when compared with 33 and 17% of the patients with intermediate and high pre-test likelihood, respectively. MSCT ruled out coronary atherosclerosis in 40-46% of patients without known CAD who were referred for MSCT. Accordingly, in patients with low-to-intermediate pre-test likelihood, MSCT may be an attractive modality to exclude coronary atherosclerosis and may prevent unnecessary additional functional testing or invasive angiography.

Post-Essure Hysterosalpingography Compliance in a Clinic Population

Study Objective To determine the follow-up rate for post-Essure hysterosalpingography (HSG) in a non-study, general clinic population in an urban environment. Design Retrospective chart review (Canadian Task Force classification II-2). Setting University teaching hospital. Patients Eighty-three University Health Center (UHC) patients who underwent attempted placement of the Essure permanent birth control device at the ambulatory surgery center at Hutzel Women's Hospital from January 2003 through June 2007. Intervention Hysteroscopic placement of the Essure permanent birth control device. Measurements and Main Results Placement of the Essure permanent birth control device was attempted in 83 patients, of which 79 were successfully completed (95.2%). Of the 79 patients, 10 underwent post-Essure HSG (12.7%). HSG was performed 3 to 6 months after placement of the Essure device. Bilateral tubal occlusion was documented in all 10 patients. Conclusion Despite preoperative and postoperative counseling, the follow-up rate for post-Essure HSG for this clinic population was only 12.7%. For those in whom HSG was performed, bilateral tubal occlusion was confirmed in all. Steps or approaches to promote compliance with postprocedural confirmation of tubal occlusion should be utilized to improve future follow-up rates.

5: Adolescent Intimate Partner Violence and Contraceptive Nonuse among Adolescent Females Utilizing Teen Clinics

study agreed to HIV testing; perceptions of risk appeared to be a motivating factor in decision to be tested. The availability of oral fluid testing may improve acceptability and thus rates of HIV testing. Rapid, point-of-care testing in a general adolescent clinic population appears to improve receipt of test results, which ultimately could improve knowledge of HIV serostatus among adolescents. Sources of Support: National Research Service Award Training Grant 1T32PE10027.

Anxiété et dépression chez l’enfant et l’adolescent migraineux : revue de la littérature

The authors review the literature on anxiety and depression in children and adolescents who experience migraine headaches. For over a century, clinicians and researchers have noticed potential links between migraine and certain psychopathological traits. More recently, rigorous methodological studies have confirmed some of those links. For example, several reviews have shown a strong comorbidity in adults between migraine, major depression and certain anxiety disorders. As for children and adolescents, no recent work has thoroughly reviewed the literature specifically on the topic of migraine, anxiety, and depression. For the purposes of this study, research published between January 1980 and January 2007 was examined. In order to be included in the review, studies had to specify the diagnostic criteria used to indicate migraine headaches and also use validated measures for anxiety and depression. Of the eleven remaining articles, ten used a control group matched for age and sex. Only three of the studies used a representative sample of the general population. Carrying out a meta-analysis was not possible due to the dearth of articles and the wide variety of methodologies applied. The studies included in this review do not provide conclusive findings for the comorbidity of migraine, anxiety and depression in children. The majority of the studies with clinical populations show slightly higher scores on at least one of the anxiety or depression scales in the migraine group as compared to the control group. However, in all eleven studies, the average score on the anxiety and depression scales obtained by children with migraine did not reach a pathological level, according to the norms established by the validated scales. Findings point to above average levels of anxiety or depression, rather than diagnosed psychopathologies. Therefore, certain authors use the term "sub-clinical." One study of a clinical population, paired dimensional assessment with tests and categorical assessment, using diagnostic interviews. In this particular study, children with highly predictive anxiety or depression scores were interviewed by a psychiatrist or psychologist, in order to confirm or deny a diagnosis. No categorical difference was found. Moreover, none of the three studies carried out in the general population revealed differences between the anxiety and depression scores in children with migraine as opposed to children in the control group. The difference in results from studies in the general population and clinical populations can most likely be explained by a recruitment bias. Studies conducted with clinical populations recruit subjects from specialised medical consultations for children and adolescents with migraine, who are probably not representative of the general population. These results contradict those found in the adult population. More studies are needed to better clarify the links between anxiety, depression, and migraine in children, adolescents and adults. To ensure the validity of future studies, the following remarks should be taken into account. The distinction between headache and migraine is not always clear, even when ICHD criteria are used. The children considered to have migraines often have a variety of diagnoses. Future studies should only use the ICHD 2nd edition criteria. Children suffering from migraine are almost always recruited from specialized headache centres in hospitals. This is a very specific population and probably not representative of children with migraine in the general population. In the future, researchers should do their best to avoid this recruitment bias. The questionnaires used in these studies often contain questions related to migraine symptoms such as headache, nausea, vomiting, etc. Several authors have therefore questioned the validity of results from these questionnaires with migraine patients. Questionnaires created specifically for a research project, or containing vague terminology, such as "psychosocial disorders", should never be used. Future studies should rely on assessment tools validated for the specific population.

Negative affectivity and social inhibition in cardiovascular disease: Evaluating type-D personality and its assessment using item response theory

Objective Individuals with increased levels of both negative affectivity (NA) and social inhibition (SI)—referred to as type-D personality—are at increased risk of adverse cardiac events. We used item response theory (IRT) to evaluate NA, SI, and type-D personality as measured by the DS14. The objectives of this study were (a) to evaluate the relative contribution of individual items to the measurement precision at the cutoff to distinguish type-D from non-type-D personality and (b) to investigate the comparability of NA, SI, and type-D constructs across the general population and clinical populations. Methods Data from representative samples including 1316 respondents from the general population, 427 respondents diagnosed with coronary heart disease, and 732 persons suffering from hypertension were analyzed using the graded response IRT model. Results In Study 1, the information functions obtained in the IRT analysis showed that (a) all items had highest measurement precision around the cutoff and (b) items are most informative at the higher end of the scale. In Study 2, the IRT analysis showed that measurements were fairly comparable across the general population and clinical populations. Conclusions The DS14 adequately measures NA and SI, with highest reliability in the trait range around the cutoff. The DS14 is a valid instrument to assess and compare type-D personality across clinical groups.

Treating Diabetic Nephropathy

An irrefutable body of evidence from multiple well-powered clinical trials and numerous clinical studies in patients with type 1 and type 2 diabetes mellitus (DM) has demonstrated that inhibition of the renin-angiotensin system (RAS) retards the progression of diabetic nephropathy (1–11). The consistency of these clinical trial outcomes has resulted in guidelines from diabetes and renal societies to treat all patients with diabetes and diabetic nephropathy with drugs that inhibit the RAS (angiotensin-converting enzyme inhibitors [ACEI]) and/or angiotensin receptor antagonists (ARB) (12,13). The article by Ficociello et al. in this issue of CJASN documents the challenges and pitfalls of transporting these clinical trial and study results to a general population of patients (14). It is disheartening to read that, even in the most recent time of observation, 33% of patients with diabetic nephropathy did not receive any ACEI therapy despite current guideline recommendations. The transportability of clinical trial results is affected by differences between the study population and the general clinic population. By design, patients in clinical trials are judged to be compliant, do not have diseases other than diabetic nephropathy that could affect their kidney function, have clearly defined and accurately measured kidney function, and must meet many other inclusion and exclusion criteria. Certainly the general population of patients differs from those in a clinical trial, and those differences can affect the perceived efficacy of the intervention. The large number of patients in the observational study by Ficociello et al. with HgAIC levels far above those recommended by guidelines despite attendance in a dedicated diabetes clinic would suggest noncompliance. Interventions cannot benefit patients if they are not compliant or if the interventions are not properly implemented. Patients entering clinical trials are likely more compliant on average than a general clinic population. In addition, important …

Systematic Screening for Subtelomeric Anomalies in a Clinical Sample of Autism

High-resolution karyotyping detects cytogenetic anomalies in 5-10% of cases of autism. Karyotyping, however, may fail to detect abnormalities of chromosome subtelomeres, which are gene rich regions prone to anomalies. We assessed whether panels of FISH probes targeted for subtelomeres could detect abnormalities beyond those identified by karyotyping in 104 individuals with Pervasive Developmental Disorders (PDDs) drawn from a general clinical population. Four anomalies were detected by karyotyping, while no additional anomalies were detected by subtelomere FISH or by probes targeted for 15q11.2q13 or 22q11.2 in subgroups of our sample. We conclude that while karyotyping may be more broadly indicated for autism than previously supposed, subtelomere FISH appears less likely to be a useful screening tool for unselected PDD populations.