Months Of Entry Research Articles

143 Diffusion Tensor and Susceptibility-weighted Imaging in Concussion Assessment of National Football League Players

INTRODUCTION: Standard magnetic resonance imaging (MRI) is normal following the vast majority of concussions. Diffusion tensor imaging (DTI) and susceptibility-weighted imaging (SWI) are advanced MRI techniques hypothesized to be more sensitive in detecting subtle evidence of structural brain injury. Using DTI and SWI in National Football League (NFL) players, we aim to elucidate and localize the presence of such injury following concussions. METHODS: This ongoing prospective study has recruited active NFL players with and without history of concussion within six months prior to entry. Neurological and neurocognitive examination, DTI, and SWI were performed on each subject. Blinded neuroradiologists performed radiographic analysis. Fractional anisotropy (FA) values were measured for eleven distinct white matter tracts on DTI. A global FA value was calculated. SWI was utilized to assess for microhemorrhage. Statistical comparisons between players with and without recent concussion, and to civilian controls, were made. RESULTS: Seven of eighteen evaluated players to date had a concussion within six months of entry. On DTI, of the eleven tracts evaluated, a significant decrease in FA for concussed players was seen in one tract. There was no significant difference in global FA assessment between players with and without recent concussions. Civilian control comparisons are ongoing. SWI was negative in all players. CONCLUSION: To our knowledge this is the largest prospective brain imaging study, and the first utilizing DTI and SWI to assess anatomical injury secondary to concussion, in NFL players. Minimal changes have been observed in players with recent concussion. The clinical significance of these findings remains under investigation.

Adjunctive naturopathic care for type 2 diabetes: patient-reported and clinical outcomes after one year

BackgroundSeveral small, uncontrolled studies have found improvements in self-care behaviors and reductions in clinical risk in persons with type 2 diabetes who received care from licensed naturopathic physicians. To extend these findings and determine the feasibility and promise of a randomized clinical trial, we conducted a prospective study to measure the effects of adjunctive naturopathic care (ANC) in primary care patients with inadequately controlled type 2 diabetes.MethodsForty patients with type 2 diabetes were invited from a large integrated health care system to receive up to eight ANC visits for up to one year. Participants were required to have hemoglobin A1c (HbA1c) values between 7.5-9.5 % and at least one additional cardiovascular risk factor (i.e., hypertension, hyperlipidemia or overweight). Standardized instruments were administered by telephone to collect outcome data on self-care, self-efficacy, diabetes problem areas, perceived stress, motivation, and mood. Changes from baseline scores were calculated at 6- and 12-months after entry into the study. Six and 12-month changes in clinical risk factors (i.e., HbA1c, lipid and blood pressure) were calculated for the ANC cohort, and compared to changes in a cohort of 329 eligible, non-participating patients constructed using electronic medical records data. Between-cohort comparisons were adjusted for age, gender, baseline HbA1c, and diabetes medications. Six months was pre-specified as the primary endpoint for outcome assessment.ResultsParticipants made 3.9 ANC visits on average during the year, 78 % of which occurred within six months of entry into the study. At 6-months, significant improvements were found in most patient-reported measures, including glucose testing (P = 0.001), diet (P = 0.001), physical activity (P = 0.02), mood (P = 0.001), self-efficacy (P = 0.0001) and motivation to change lifestyle (P = 0.003). Improvements in glucose testing, mood, self-efficacy and motivation to change lifestyle persisted at 12-months (all P < 0.005). For clinical outcomes, mean HbA1c decreased by −0.90 % (P = 0.02) in the ANC cohort at 6-months, a −0.51 % mean difference compared to usual care (P = 0.07). Reductions at 12-months were not statistically significant (−0.34 % in the ANC cohort, P = 0.14; -0.37 % difference compared to the usual care cohort, P = 0.12).ConclusionsImprovements were noted in self-monitoring of glucose, diet, self-efficacy, motivation and mood following initiation of ANC for patients with inadequately controlled type 2 diabetes. Study participants also experienced reductions in blood glucose that exceeded those for similar patients who did not receive ANC. Randomized clinical trials will be necessary to determine if ANC was responsible for these benefits.

Cardiorespiratory endurance, muscular flexibility and strength in first‐episode schizophrenia patients: use of a standardized fitness assessment

This study determined the fitness status and examined potential correlates of fitness in first-episode schizophrenia patients using a standardized fitness test protocol. A certified fitness instructor administered the Young Men's Christian Association (YMCA) fitness test to 70 recent-onset schizophrenia participants within 3 months of entry into the study. Percentile ranks of scores on muscular strength and endurance, muscular flexibility and cardiorespiratory fitness in our sample were all below the 50th percentile when compared with national norms in the United States. As expected, patients with a higher body mass index and those who smoked had poorer cardiorespiratory fitness. A non-significant trend indicated that patients with a longer duration of illness had worse cardiorespiratory fitness. Exposure to antipsychotic medication was unrelated to cardiorespiratory fitness. Results suggest that physical fitness is impaired and might decline over time in first-episode schizophrenia patients, but this needs to be confirmed in a longitudinal study.

Associations between vitamin D and cardiovascular outcomes; Tehran Lipid and Glucose Study

BackgroundVitamin D status seems to have an association with cardiometabolic risk factors and its deficiency may negatively affect the cardiovascular outcomes. The aim of this study was to determine the possible association between vitamin D status and cardiovascular outcomes. MethodWe performed a nested case control study within the Tehran Lipid and Glucose Study (TLGS), which followed a representative sample of Tehranian adults. A total of 251 matched pairs, aged>30 years, were selected. Cases were TLGS individuals that were free of cardiovascular disease (CVD) at the beginning of study and developed CVD during assessments of 5.7 year follow up. Each case was matched by age, sex and the month of entry to study with a randomly selected control (risk-set sampling). Prespecified cut points were used to characterize varying degrees of 25-OH D deficiency (<10, between 10 and 14.9, and ≥15ng/ml). Conditional logistic regression was used to investigate the association between 25-OH-D concentration and the incident cardiovascular outcomes. ResultsThe mean age of participants was 56.84±11.17 years and 244 (48.6%) were women. The median (IQ: 25–75) of serum 25-OH-D was 14.1ng/ml (9.6–29ng/ml) and 306 (61%) of participants had serum 25-OH-D<15g/ml. Median serum 25-OH-D was lower in cases (12.5 vs. 18.1, P<0.001). After adjustment for potential confounders, the odds ratio of serum 25-OH-D<10ng/ml for having CVD outcomes was 2.90 compared with 25-OH-D≥15 (95% confidence interval (CI): 1.67–5.12, P<0.001). ConclusionOur results indicate that serum 25-OH-D concentration has an independent association with cardiovascular outcomes in adult Tehranians.

From food to fuel

Objective: An investigation of the discussion surrounding the relationship between food and exercise in one community of photography-based food blogs that past research has identified as exhibiting characteristics of dietary restraint. Design: Forty-five blogs written by young adult women belonging to a food-blogging community were selected for study. All selected blogs had been publicly posted online. Method: Using a qualitative approach of constant comparative analysis, two months of entries from food blogs created by young women were analyzed and coded for entries discussing food before, during and after exercise. Results: Analysis revealed that bloggers discussed three themes, mainly prior to and following exercise: food as fuel, food restricted and worked off through exercise, and food intake as justified by exercise. Conclusion: These findings provide insight into how a community of food bloggers views the relationship between food and exercise, suggest ways that women practising dietary restraint perceive food and exercise, and encourage further research on food blogging.

The STICH trial unravelled

The STICH trial unravelled

Epidemiology of tuberculosis among US- and foreign-born children and adolescents in the United States, 1994-2007.

We examined trends in tuberculosis (TB) cases and case rates among US- and foreign-born children and adolescents and analyzed the potential effect of changes to overseas screening of applicants for immigration to the United States. We analyzed TB case data from the National Tuberculosis Surveillance System for 1994 to 2007. Foreign-born children and adolescents accounted for 31% of 18,659 reported TB cases in persons younger than age 18 years from 1994 to 2007. TB rates declined 44% among foreign-born children and adolescents (20.3 per 10,000 to 11.4 per 100,000 population) and 48% (2.1 per 100,000 to 1.1 per 100,000) among those who were born in the United States. Rates were nearly 20 times as high among foreign-born as among US-born adolescents. Among foreign-born children and adolescents with known month of US entry (88%), more than 20% were diagnosed with TB within 3 months of entry. Marked disparities in TB morbidity persist between foreign- and US-born children and adolescents. These disparities and the high proportion of TB cases diagnosed shortly after US entry suggest a need for enhanced pre- and postimmigration screening.

Healthy Habits or Damaging Diets: An Exploratory Study of a Food Blogging Community

This exploratory study describes the virtual socialization, behaviors, and attitudes being promoted in one community of food bloggers. Two months of entries from 45 blogs created by young women belonging to a photography-based food blogging community were analyzed and coded using a qualitative approach. Analysis revealed widespread group practices as well as the promotion of attitudes and behaviors associated with dietary restraint. The present study highlights the need for further research using food-blogging communities, and concludes with a cautionary note about blogs as sources of health information in view of the consequences of dietary restraint.

A classification and regression tree for predicting recurrent falling among community-dwelling seniors using home-care services.

A prospective, observational study was undertaken to identify risk profiles of subjects regarding the recurrence of falling among community-dwelling seniors using home-care services. A convenience sample of 868 community-dwelling older persons, aged 65 years or older, who use home-care services offered by public community-based centres in the province of Québec. Subjects were recruited between 2002 and 2005, assessed for fall-related risk factors, and monitored for prospective falls. Data were examined by a classification and regression tree (CART) and survival analyses. Ninety-nine participants reported two falls within six months of entry to the study. Thus, the incidence of recurrent fallers was 11.4%. The tree analysis classified the population into five groups differing in risk of recurrent falling, based on history of falls in the three months prior to the initial interview, Berg balance score, type of housing, and usual alcohol consumption in the six months preceding study entry. The relative risks varied from 0.7 to 5.1. The survival analysis showed that the length of time before becoming a recurrent faller varies among risk profiles. The study permitted the construction of easily interpretable risk profiles of recurrent falling. These can guide clinicians and public health practitioners to identify high-risk individuals and to decide on the appropriate intervention and follow-up.

Family Education and Support Services in Systems of Care

This study examines the use of family education and support (FES) services within community-based mental health systems. Using data from the national evaluation of the Children’s Mental Health Initiative (CMHI), 2,853 caregivers and their children ages 6 to 18 years from 39 communities participated in this study. The findings indicated that during the first 6 months of entry into services, one third of families received FES services, and the clinical characteristics of children whose families received FES services were found to be more severe at intake into services with significantly higher internalizing and externalizing problems and significantly lower strengths than those families who did not. Similarly, caregivers who received FES services entered services experiencing more strain. The findings have implications for the impact of FES services on children.

Phase II study of lenalidomide in distantly metastatic, rapidly progressive, and radioiodine-unresponsive thyroid carcinomas: preliminary results

6027 Background: Rapidly-progressive, distantly metastatic thyroid cancers, unresponsive to I-131, are lethal and haven't known effective systemic therapies. Disease modifying cytostatic agents may prevent or delay disease progression. Our prior thalidomide trial in this context had 50% response rate (PR + SD), 6 months mean durability and significant toxicity (Thyroid 17:663, 2007). Our preclinical studies of related derivatives in thyroid cancer xenografts showed lenalidomide with significant activity. We are studying efficacy of lenalidomide in such patients, correlating response with angiogenesis markers. Methods: In this open-label phase II trial, 25 adult patients with distantly metastatic, I-131-unresponsive (papillary, follicular, or insular) thyroid cancers with >30% tumor volume progression documented within 12 months of entry, receive 25 mg oral lenalidomide daily. Bimonthly CT scans, thyroglobulin levels, & angiogenic markers (VEGF-A, sVEGFR-1, sVEGFR-2 & TSP-1; plasma banked for later analysis) assess responses. Pre-study rapid progression, makes SD a positive response, with responders as: SD, PR, or CR defined by total tumor volumes measured on CT scans. Attributable grade 3 toxicities evoked dose reductions to minimum of 5 mg daily in 5 mg decrements. Primary endpoint is overall response rate; secondary endpoints: toxicity, progression free survival, overall survival & tumor/angiogenic marker response. Results: From 4/06 - 12/07, 21 subjects (60% male, 30–71 yrs old; 65% papillary, 15% follicular, 20% Hürthle cell; 89% lung metastases) enrolled with 18 evaluable patients (treated >6 months) to date. 67% are responders (44% SD, 22% PR). Of 10 patients enrolled by 1/07, 6 were responders (2 PR, 4 SD) with 3 maintaining response to date (>12 months). Treatment failures were in skull base, pleural, & mediastinal tumor sites. Lenalidomide is well tolerated (grade 3 toxicities are hematological: 44% neutropenia, 22% thrombocytopenia, respond to dose reduction) with mean dosage 20 mg daily. Conclusion: Lenalidomide is a potent, well-tolerated suppressor of rapidly progressive thyroid carcinoma. Full accrual and long-term data analysis will be more informative. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Expert Testimony Other Remuneration Celgene Celgene

Prediction of twelve‐month service disengagement from an early intervention in psychosis service

AbstractAim: The aim is to examine disengagement in an early psychosis treatment service and contrast clinical and demographic variables of patients who disengage against those who do not.Methods: Those with termination of treatment, despite therapeutic need within 12 months of entry (disengagers) (n = 57; 24.6%), were compared with those who remained in treatment at 12 months (n = 175) on a range of clinical and demographic variables collected at admission. After testing the difference between proportions, data analysis was conducted using methods of logistic regression.Results: Alcohol and/or cannabis abuse/dependence, initial diagnosisother than mood disorder, long duration of untreated psychosis, lower Positive and Negative Syndrome Scale total symptoms, and lower insight at referral accounted for 27% of variance in patient ‘disengagement’ within 12 months.Conclusion: A significant proportion of patients with first episode psychosis disengage from treatment within 12 months. Despite a number of factors being associated with disengagement, prediction using admission factors was poor. Early Intervention in Psychosis Services would benefit from increased attention to alcohol and drug problems, trying to reduce the duration of untreated psychosis, improving psychiatric symptoms and increasing insight in all patients to decrease service disengagement.

Illness in Returned Travelers and Immigrants/Refugees: The 6‐Year Experience of Two Australian Infectious Diseases Units

Data comparing returned travelers and immigrants/refugees managed in a hospital setting is lacking. We prospectively collected data on 1,106 patients with an illness likely acquired overseas who presented to two hospital-based Australian infectious diseases units over a 6-year period. Eighty-three percent of patients were travelers and 17% immigrants/refugees. In travelers, malaria (19%), gastroenteritis/diarrhea (15%), and upper respiratory tract infection (URTI) (7%) were the most common diagnoses. When compared with immigrants/refugees, travelers were significantly more likely to be diagnosed with gastroenteritis/diarrhea [odds ratio (OR) 8], malaria (OR 7), pneumonia (OR 6), URTI (OR 3), skin infection, dengue fever, typhoid/paratyphoid fever, influenza, and rickettsial disease. They were significantly less likely to be diagnosed with leprosy (OR 0.03), chronic hepatitis (OR 0.04), tuberculosis (OR 0.05), schistosomiasis (OR 0.3), and helminthic infection (OR 0.3). In addition, travelers were more likely to present within 1 month of entry into Australia (OR 96), and have fever (OR 8), skin (OR 6), gastrointestinal (OR 5), or neurological symptoms (OR 5) but were less likely to be asymptomatic (OR 0.1) or have anaemia (OR 0.4) or eosinophilia (OR 0.3). Diseases in travelers were more likely to have been acquired via a vector (OR 13) or food and water (OR 4), and less likely to have been acquired via the respiratory (OR 0.2) or skin (OR 0.6) routes. We also found that travel destination and classification of traveler can significantly influence the likelihood of a specific diagnosis in travelers. Six percent of travelers developed a potentially vaccine-preventable disease, with failure to vaccinate occurring in 31% of these cases in the pretravel medical consultation. There are important differences in the spectrum of illness, clinical features, and mode of disease transmission between returned travelers and immigrants/refugees presenting to hospital-based Australian infectious diseases units with an illness acquired overseas.

The GABAergic control of the hungry. Topiramate in the treatment of obesity without binge eating disorders (BED). Preliminary data

Background: Topiramate is an antiepileptic drug, with anoressant effect, known to positively modulate GABA receptors. There are some published data concerning the use of topiramate in mood disorders (especially BED), while there are not know data on its use in obese patients without BED. Aim: This is a preliminary study to explain the effectiveness and tolerability of topiramate in non-BED obese patients. Method: We described the effects of topiramate (150mg daily), without a low-calorie diet, on weight and metabolic control in 6 subjects (1 male and 5 females, aged 38 to 68 years) treated for consecutively 6 months (between November 2002 to April 2003). The inclusion criteria is BMI above 30kg/m2, abdominal obesity, hypertriglyceridemia, high fasting glucose and low HDL-cholesterol levels. The exclusion criteria included: BED and others mood disorders, epilepsy, pregnancy, lactation, any kind of psychotherapy and psychiatric drug or antiobesity agents within 3 months of entry to the study. The dosage of topiramate was gradually increased in increments of 25mg every week from 25mg twice daily in the first two weeks to the target dosage of 75mg twice daily at the end of second month of treatment. This dosage was maintained until the end of this study. Results: Topiramate induced significant weight loss. The mean weight loss was 6,8kg and was present significativelly descrease of visceral fat (mean 2,1cm in waist circumference). Subjects who lost 10% of the weight showed significant decreases in fasting plasma glucose (mean 21,6mg/dl) and in plasma triglycerides (mean 33,4mg/dl). In general topiramate was well tolerated. The most adverse events reported were transient (paresthesias 1 case, fatigue 1 case, somnolence 1 case). In 3 cases there were not adverse effects. Discussion: Treatment with topiramate decreased BMI and visceral fat, decreased triglycerides and fasting plasma glucose levels, but had not improved HDL-cholesterol blood levels. Topiramate at 150mg daily had not increased diastolic blood pression and pulse rate and may be a suitable option to sibutramine in obese patients with high blood pressure. In conclusion our preliminary data suggests that topiramate may be an effective and well-tolerated agent for the control of the hungry in the treatment of obese patients, but this is a study with very few patients. Other controlled study need to be performed to evaluate the use of topiramate in obese population and, in particular, the benefits of topiramate therapy in patients with metabolic syndrome without BED.

Phase IIA Clinical Trial to Test the Efficacy and Safety of Toremifene in Men with High-Grade Prostatic Intraepithelial Neoplasia

Men with high-grade prostatic intraepithelial neoplasia (PIN) evident on prostate biopsy are at high risk for the eventual development of prostate cancer. The ability to reverse high-grade PIN may reduce the incidence or delay the development of prostate cancer. Toremifene (GTx-006, Acapodene™) is a selective estrogen receptor modulator that has been shown in the transgenic mouse model of prostate cancer to eliminate high-grade PIN and reduce the incidence of prostate cancer. This study was aimed at the evaluation of the safety and efficacy of toremifene in men diagnosed with high-grade PIN. This was an open-label, phase IIA clinical trial that enrolled 21 men (mean age, 64.7 years) with evidence of high-grade PIN on biopsy within 6 months of entry into the study. Eighteen of these men (86%) completed toremifene treatment (60 mg/day orally for 4 months) and then underwent follow-up prostate biopsy (8 cores) to determine high-grade PIN status. The effect of the drug on serum prostate-specific antigen (PSA), percentage of free PSA, testosterone, estradiol, and quality of life was also measured. After toremifene treatment, 72% of these 18 men (vs. 17.9% of historical controls) had no high-grade PIN on subsequent prostate biopsies. Mean PSA trended higher, and percentage of free PSA was increased. Quality of life was not significantly affected by treatment. There were 3 mild adverse events, and no serious adverse events. Toremifene appeared to reduce high-grade PIN in this small, exploratory trial. The drug was well tolerated. A double-blind, dose-finding, randomized, placebo-controlled phase IIB/III study is currently open to further study toremifene's activity against high-grade PIN and prostate cancer incidence.

Marketing Literature Review

This section is based on a selection of article abstracts from a comprehensive business literature database. Marketing-related abstracts from more than 125 journals (both academic and trade) are reviewed by JM staff. Descriptors for each entry are assigned by JM staff. Each issue of this section represents three months of entries into the database. Each entry has an identifying number. Cross-references appear immediately under each subject heading.

Comparative effects of rosuvastatin and atorvastatin across their dose ranges in patients with hypercholesterolemia and without active arterial disease

The lipid-lowering effects of rosuvastatin and atorvastatin were determined across their dose ranges in a 6-week, randomized, double-blind trial. Three hundred seventy-four hypercholesterolemic patients with fasting low-density lipoprotein (LDL) cholesterol ≥160 but <250 mg/dl (≥4.14 but <6.47 mmol/L) and fasting triglycerides <400 mg/dl (<4.52 mmol/L) and without active arterial disease within 3 months of entry received once-daily rosuvastatin (5, 10, 20, 40, or 80 mg [n = 209]) or atorvastatin (10, 20, 40, or 80 mg [n = 165]). The percentage decrease in plasma LDL cholesterol versus dose was log-linear for each drug, ranging from −46.6% to −61.9% for rosuvastatin 10 and 80 mg, compared with −38.2% to −53.5% for atorvastatin 10 and 80 mg. The dose curve for rosuvastatin yielded an 8.4% greater decrease in LDL cholesterol compared with atorvastatin at any given dose (p <0.001). Similarly greater decreases were observed for rosuvastatin across the dose range in total cholesterol (−4.9%), non–high-density lipoprotein (non-HDL) cholesterol (−7.0%), apolipoprotein B (−6.3%), and related ratios versus atorvastatin (all p <0.001). Because dose responses for HDL cholesterol, triglycerides, and apolipoprotein A-I were non–log-linear and nonparallel between the 2 drugs, percentage changes from baseline were compared at each dose. Significantly greater increases for rosuvastatin compared with atorvastatin were observed for HDL cholesterol at 40 and 80 mg, and for apolipoprotein A-I at 80 mg. Significantly greater triglyceride decreases were seen at 80 mg with atorvastatin over rosuvastatin. Both rosuvastatin and atorvastatin were well tolerated over 6 weeks.

Marketing Literature Review

This section is based on a selection of article abstracts from a comprehensive business literature database. Marketing-related abstracts from more than 125 journals (both academic and trade) are reviewed by JM staff. Descriptors for each entry are assigned by JM staff. Each issue of this section represents three months of entries into the database. Each entry has an identifying number. Cross-references appear immediately under each subject heading. The following article abstracts are available online from the ABI/INFORM database, which is published and copyrighted by ProQuest Information and Learning. For additional information about access to the database or about obtaining photocopies of the articles abstracted here, please call (800) 521-0600 or write to ProQuest, 300 N. Zeeb Rd., Ann Arbor, MI 48106.

Marketing Literature Review

This section is based on a selection of article abstracts from a comprehensive business literature database. Marketing-related abstracts from more than 125 journals (both academic and trade) are reviewed by JM staff. Descriptors for each entry are assigned by JM staff. Each issue of this section represents three months of entries into the database. Each entry has an identifying number. Cross-references appear immediately under each subject heading. The following article abstracts are available online from the ABI/INFORM database, which is published and copyrighted by ProQuest Information and Learning. For additional information about access to the database or about obtaining photocopies of the articles abstracted here, please call (800) 521-0600 or write to ProQuest, 300 N. Zeeb Rd., Ann Arbor, MI 48106.

Marketing Literature Review

This section is based on a selection of article abstracts from a comprehensive business literature database. Marketing-related abstracts from more than 125 journals (both academic and trade) are reviewed by JM staff. Descriptors for each entry are assigned by JM staff. Each issue of this section represents three months of entries into the database. Each entry has an identifying number. Cross-references appear immediately under each subject heading. The following article abstracts are available online from the ABI/INFORM database, which is published and copyrighted by ProQuest Information and Learning. For additional information about access to the database or about obtaining photocopies of the articles abstracted here, please call (800) 521-0600 or write to ProQuest, 300 N. Zeeb Rd., Ann Arbor, MI 48106.