Significant Differences In History Research Articles

Celiac disease in patients with type-1 diabetes mellitus screened by tissue transglutaminase antibodies in southern Kerala, India

BACKGROUND: High prevalence rates of celiac disease (CD) in patients with type-1 diabetes mellitus (T1DM) have been reported in several countries. However, the data regarding this association are scarce in Southern Kerala, India. In this study, we report the prevalence of CD in patients with T1DM in southern Kerala using tissue transglutaminase antibodies (tTGA) as a screening test. METHADOLOGY: One hundred patients with T1DM (58 women and 42 men) aged 21.8 ± 8.86 years (age range: 7-50 years) were compared with 150 healthy people (82 women and 68 men) aged 28.9 ± 9.07 years (age range: 4-50 years). All subjects were serologically screened for the presence of tTGA. Total immunoglobin A (IgA) was obtained to investigate IgA deficiency. Subjects positive for tTGA and deficient for IgA were submitted to upper gastrointestinal endoscopy. RESULTS: Eight patients with T1DM (8%) and three of the controls (2%) were positive for tTGA (P=0.023), while only 3% of the tTGA positive T1DM patients underwent duodenal biopsy and all of them showed partial or total villous atrophy. The mean age of tTGA, positive cases were significantly lower than tTGA negative ones (mean difference 7.17; 95% CI: 0.82-13.52). None of the tTGA positive T1DM patients had a history of chronic diarrhea, but one out of eight tTGA positives reported history of dermatitis (P=0.001). In addition, none of the tTGA positive subjects presented IgA deficiency. There was a significant difference in history of chronic diarrhea (P= 0.006) and autoimmune diseases (P =0.001) between patients with T1DM and controls. CONCLUSION: This study showed higher prevalence of CD in patients with T1DM than in general population of southern Kerala and the data lend support to recommend regular screening for CD in all patients with T1DM.

Transrectal EUS-guided FNA biopsy of a presacral chordoma-report of a case and review of the literature

To evaluate the value of plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) level for predicting postoperative atrial fibrillation (AF) in patients undergoing surgery for esophageal carcinoma. NT-proBNP levels were measured in 142 patients 24 h before and 1 h after surgery for esophageal carcinoma. All patients having a preoperative cardiac diagnosis by electrocardiogram (ECG), remained under continuous monitoring for at least 48 h after surgery, and then underwent clinical cardiac evaluation until discharge. Postoperative AF occurred in 11 patients (7.7%). AF patients were significantly older (69.6 +/- 12.2 years vs 63.4 +/- 13.3 years, P = 0.031) than non-AF patients. There were no significant differences in history of diabetes mellitus, sex distribution, surgical approach, anastomosis site, intraoperative hypotension and postoperative fever. The preoperative plasma NT-proBNP level was significantly higher in patients who developed postoperative AF (121.3 +/- 18.3 pg/mL vs 396.1 +/- 42.6 pg/mL, P = 0.016). After adjustment for age, gender, chronic obstructive pulmonary disease (COPD), history of cardiac diseases, hypertension, postoperative hypoxia and thoracic-gastric dilation, NT-proBNP levels were found to be associated with the highest risk factor for postoperative AF (odds ratio = 4.711, 95% CI = 1.212 to 7.644, P = 0.008). An elevated perioperative plasma BNP level is a strong and independent predictor of postoperative AF in patients undergoing surgery for esophageal carcinoma. This finding has important implications for identifying patients at higher risk of postoperative AF who should be considered for preventive antiarrhythmic therapy.

Celiac disease in patients with type-1 diabetes mellitus screened by tissue transglutaminase antibodies in northwest of Iran

BACKGROUND:High prevalence rates of celiac disease (CD) in patients with type-1 diabetes mellitus (T1DM) have been reported in several countries. However, the data regarding this association are scarce in Iran. In this study, we report the prevalence of CD in patients with T1DM in northwest of Iran using tissue transglutaminase antibodies (tTGA) as a screening test.METHODOLOGY:One hundred patients with T1DM (58 women and 42 men) aged 21.8 ± 8.86 years (age range: 7–50 years) were compared with 150 healthy people (82 women and 68 men) aged 28.9 ± 9.07 years (age range: 4–50 years). All subjects were serologically screened for the presence of tTGA. Total immunoglobin A (IgA) was obtained to investigate IgA deficiency. Subjects positive for tTGA and deficient for IgA were submitted to upper gastrointestinal endoscopy.RESULTS:Eight patients with T1DM (8%) and three of the controls (2%) were positive for tTGA (P = 0.023), while only 3% of the tTGA positive T1DM patients underwent duodenal biopsy and all of them showed partial or total villous atrophy. The mean age of tTGA positive cases was significantly lower than tTGA negative ones (mean difference 7.17; 95% CI: 0.82–13.52). None of the tTGA positive T1DM patients had a history of chronic diarrhea, but one out of eight tTGA positives reported history of dermatitis (P = 0.001). Also, none of the tTGA positive subjects presented IgA deficiency. There was a significant difference in history of chronic diarrhea (P = 0.006) and autoimmune diseases (P = 0.001) between patients with T1DM and controls.CONCLUSION:This study showed higher prevalence of CD in patients with T1DM than in general population of northwest Iran and the data lend support to recommend regular screening for CD in all patients with T1DM.

都市部在住の高齢女性肥満者における老年症候群の有症状況および関連要因―介護予防のための包括的健診―

To evaluate the prevalence of geriatric syndrome and risk factors associated with obesity in community-dwelling elderly women. The baseline survey was conducted in November 2006. Subjects were 925 women aged 70 years and older who participated in a comprehensive health examination which included a face-to-face interview, body composition, and physical fitness tests. The participants were classified, the based on percentage of body fat, as normal (<30.0), mild obesity (30.0 to 34.9), and obesity (>or=35.0) groups. To evaluate the differences among the groups with regard to the physical fitness and the interview data, one-way analysis of variance performed for continuous variables and the chi-square test for categorical variables. Multivariate logistic regression models were used to assess the factors associated with obesity in elderly women. Although obese women had a higher prevalence of urinary incontinence than the normal and mild obese women, there were no significant differences in history of falls during the last year, or fear of falling. A high percentage of body fat was significantly associated with a higher level of instrumental activities of daily living (IADL) and intellectual activity disability, use of 3 or more medications, pain, and circumference (abdominal, hip, calf), and was associated with a lower level of balance and walking ability. According to the logistic model, history of hypertension (odds ratio (OR)=1.70, 95%confidence intervals (CI)=1.25-2.32), pain (OR=1.46, 95%CI=1.07-2.01), urinary incontinence (OR=1.44, 95%CI=1.08-1.92), SBP (OR=1.02, 95%CI=1.01-1.03), and usual walking speed (OR=0.43, 95%CI=0.24-0.75) were independent variables significantly associated with obesity. These cross-sectional data show that a higher percentage of body fat is associated with high prevalence of urinary incontinence, IADL and intellectual activity disability, and is related to lower level of walking ability and balance. The present study suggests that regular physical activity and weight control may contribute to the prevention of IADL disability and improvement of physical fitness in obese elderly women.

Use of oral contraceptives in Germany: Prevalence, determinants and use-associated health correlates: Results of National Health Surveys from 1984 to 1999

Objectives To describe oral contraceptive (OC) use, its determinants and use-associated health correlates from 1984 to 1999 in Germany. Study design Cross-sectional comparison was performed for socioeconomic factors, personal lifestyle and use-associated health correlates between 1862 OC users and 2625 age-matched nonusers identified from five German National Health Surveys. Regression models were used to obtain the determinants of OC use. Results While in women aged 25–49 years OC use remained nearly constant in the western part of Germany from 1984 to 1999 (17.3–20.1%), it declined greatly in the eastern part from 43.0% in 1991 to 32.3% in 1999. Cross-sectional comparison and regression analysis suggested that OC users did not differ from nonusers in most selected personal and socioeconomic factors. OC users showed generally a better health profile than age-matched nonusers with more satisfaction with health, higher quality of life and no significant difference in history of cardiovascular diseases despite slightly higher prevalence of hypertension and hyperlipidemia that are of little clinical significance. Conclusions OC use seems to be generally safe. Whether the better health profiles found in OC users are the results of OC use or effects of healthy users, or both, should be further studied.

Laparoscopic management of benign adnexal mass in obese women

Study objective To compare complications and rate of conversion to laparotomy between normal-weight, preobese, and obese women who underwent laparoscopic management of benign adnexal mass. Design Retrospective chart review (Canadian Task Force classification II-3). Setting Tertiary care teaching hospital. Patients One hundred seventy women who underwent laparoscopic surgery because of benign adnexal mass were placed in three groups on the basis of their body mass index (BMI) using the World Health Organization’s classification (normal-weight [BMI 18.5–24.9 kg/m 2], preobese [BMI 25–29.9 kg/m 2], and obese [BMI ≥ 30 kg/m 2]). Intervention Retrospective comparison of conversions from laparoscopy to laparotomy, operative time, estimated blood loss, complications, history of pelvic inflammatory disease, endometriosis, and length of hospital stay was carried out among the different groups. Measurements and main results Overall, 170 laparoscopic cases were evaluated (64 with normal-weight, 67 preobese, and 39 obese women). The rate of conversion to laparotomy was significantly higher in the obese and preobese groups compared with the normal-weight women (17.9%, 17.9% vs 1.5%, p < .01). Obese women were 13 times more likely to undergo conversion than normal-weight women (OR 13.78; 95% CI 1.76–29.1). In addition, obese women had significantly longer surgeries (143 ± 87 minutes vs 114 ± 41 minutes [p = .04]) and longer hospital stay (1.07 ± 1.83 days vs 0.51 ± 1.06 days [p = .04]) when compared with normal-weight women. There was no significant difference in history of pelvic inflammatory disease, endometriosis, and adhesions at the time of laparoscopy between obese, preobese, and normal-weight women. The rate of complications was similar among the groups. Conclusion Obese and preobese women undergoing laparoscopic management of benign adnexal mass were found to be at an increased risk for conversion to laparotomy, longer surgery and longer hospital stay. Obese and preobese women should be counseled extensively on morbidity associated with laparoscopy.

Analysis of the Evaluation for Clinical Performance Examination using Standardized Patients in one Medical School

Purpose: Analysis of the evaluation for clinical performance examination(CPX) using standardized patient(SP) in one medical school was done to compare the evaluations between the staffs and SPs, among the staffs, and among the SPs, and to investigate the correlation between the evaluation scores and the school record. Methods: Clinical performance examination was done to seventy-nine 4th grade medical students. Checklist was modified from the existing reference and added more items. Three SPs who were non-physician volunteers were trained by authors about what is the disease and how to act the patient and how to evaluate the students. Three staffs and three SPs both filled up the checklist at the same time right after each student's performance. Results: Agreements between the staffs and the SPs were relatively high enough in the items of physical examination and management but low in the history taking related items although they were statistically significant. In the evaluation between the staffs and the SPs, the mean scores in the management and overall attitude were not significantly different, but, mean scores in the history taking, physical examination and overall skill were significantly different. Among the staffs there were no significant differences in history taking, physical examination, overall attitude, and there were significant differences in patient management and overall skill. Among the SPs there were no significant differences in physical exam, patient management and overall skill, and there were significant differences in history taking and overall attitude. The correlation coefficients between the evaluation scores and school records, between the evaluation scores and written report were relatively low respectively. Conclusion: To increase the agreement rates between the staffs and SPs, more training for the staffs and SPs are necessary

Lesbian and Bisexual Women's Experiences of Victimization: Mental Health, Revictimization, and Sexual Identity Development

SUMMARY The prevalence and correlates of a variety of victimization experiences among a large, ethnically diverse national sample of 2,431 lesbian, bisexual, and gay women (LBG) is examined. Most participants (62.3%) report experiencing bias related victimization because they are LBG. Overall, 30.8% of participants report being harshly beaten or physically abused in childhood and 21.2% in adulthood; 39.3% report sexual victimization before the age of sixteen and 36.2% at age sixteen or older. Each type of victimization was significantly related to current psychological distress, and the more types of victimization (sexual or physical, in childhood or adulthood) a participant experienced, the greater her psychological distress. Participants who were victimized in childhood were four times more likely to experience the same type of victimization (sexual or physical) as an adult and about twice as likely to experience the other type of victimization in adulthood. In addition, there were significant differences in history of victimization by race/ethnicity. Native American participants reported the highest rates followed by Latinas, African Americans, Asian Americans, and Whites.

Orthopaedic manifestations of Ehlers-Danlos syndrome.

Ehlers-Danlos syndrome is the most prevalent heritable disorder of connective tissue. Musculoskeletal problems include joint pain, swelling and instability, and spinal deformity. This study was undertaken to assess functional orthopaedic problems of patients with Ehlers-Danlos syndrome. Sixty patients with genetically verified Ehlers-Danlos syndrome (range, 8-60 years; mean, 34 years) who attended a National Ehlers-Danlos Syndrome Foundation learning conference were evaluated by questionnaire, clinical examination, and when indicated, radiographs. A database of 250 items per patient was constructed and statistically assessed using analysis of variance. Because of rarity of Types VII and VIII, these two patients were dropped from the analysis. Fifty-eight patients had Ehlers-Danlos syndrome Types I, II, III, or IV and form the study cohort. Among these four types, there were no significant differences in history of joint dislocation, swelling, or types of orthopaedic surgical procedures experienced. Thirty patients with Type III Ehlers-Danlos syndrome reported joint pain more frequently than did patients with Types I, II, or IV. Ambulation was impaired significantly in patients with Type III disorder as a whole, as was functional hand strength and upper extremity function. Back or neck pain was a common (67.2%) report among patients with all types of disease but did not correlate with the presence or absence of spinal deformity. Contrary to most previous reports, the patients in this study showed that Type III Ehlers-Danlos syndrome was the most debilitating form with respect to musculoskeletal function.

Which comes first in the pathogenesis of bulimia nervosa: dieting or bingeing?

Clinical experience has indicated that dieting usually precedes the onset of binge eating in the development of bulimia nervosa (BN). However, data confirming this in nonclinical, representative samples are lacking. Using results obtained from the National Women's Study (NWS), we were able to determine the chronological relationship between age of onset of significant dieting (attempting to lose 15 lbs) and onset of bingeing in 85 respondents who met DSM-III-R criteria for BN. These respondents were a subset of over 3,000 female adult U.S. women who completed a random telephone interview (averaging 40 min and including screenings for rape, sexual molestation, aggravated assault, posttraumatic stress disorder [PTSD], and BN). We found that the age of first serious attempt to diet preceded the age of first binge in 46% of cases. There were no significant differences in histories of victimization experiences among the groups. First binge preceded first serious diet in 37% of cases, and these behaviors occurred during the same age in 17% of cases. These data confirm that dieting is more likely to precede binge eating, although binge eating precedes significant dieting in a substantial proportion of bulimic respondents.

The Role of Chlamydia Trachomatis Infection in Female Infertility

The incidence of positive Chlamydia cultures in females undergoing laparoscopy for tubal patency is high. We advocate routine screening for Chlamydia infection in females with infertility. Of seventy-five patients undergoing laparoscopy for infertility, 49 grew Chlamydia on tissue culture of material from the cervix, an incidence of 65.3%. of these 49 cases, 33 (67.3%) had tubal blockage. In asymptomatic patients, 22 out of 50 had positive cultures from the cervix, an incidence of 44%. Peritoneal fluid culture was negative in all infertile patients. When compared to populations studied elsewhere, the incidence of Chlamydia appears to be high in our population and significantly higher in the infertile patients. In the management of infertility, pelvic inflammatory disease, and neonatal conjunctivitis, Chlamydia should be routinely investigated and treated.

Exporting Democracy: Fulfilling America's Destiny (review)

BOOK REVIEWS 179 ofLatin America. This theme would have added a more personal, human dimension tothebook thatismissing—howdidLatin Americansfeeltowardsthe Commission? Did the presence of the Commission empower the citizens of each country? After all, both systems were developed for the victims of human rights abuses. Insight from such individuals is often forgotten and is in dire need. These criticisms aside, Mower's book is a thoughtful, contextual comparison ofboth regional organizations. Exporting Democracy: Fulfilling America's Destiny. By Joshua Muravchik. The AEI Press, The American Enterprise Institute: Washington, D.C, 1991. 258 pp. 1991. Reviewed by Jennifer A. Lind, SAIS MA., 1992. The end of the Cold War has allowed democracy to flourish in much of what was its central battleground: Eastern Europe. Since the fall of the Berlin Wall, many ofthe former Warsaw Pact countries have already held internationally monitored, free and fair elections. The Third World, however, will pose a much more difficult challenge to those who strive to establish pluralist political institutions in undemocratic states. Many Third World governments are increasingly vulnerable to domestic pressures to reform their political and economic systems. However, the sudden end of superpower rivalry has left former recipients of American and Soviet aid without the funds to secure their power base. Democracies are not created quickly or easily: they require stable institutions and processes such as electoral and constitutional codes, a free press, voter protection laws, civil rights legislation, and an impartial judicial system. The United States is currently in a unique position to encourage the success of this worldwide wave of democracies. Exporting Democracy, by Joshua Muravchik, is a counter-revisionist account ofAmerican foreign policy since 1945. According to Muravchik, U.S. foreign policy during the Cold War was aimed not only at the containment ofcommunist aggression through military deterrence, but also at the suppression and annihilation of communist ideology through the promotion of democratic ideals. He argues that the peaceful end of this fifty year old rivalry was America's greatest triumph. Muravchik's thesis is that democracy is the "natural centerpiece" ofAmerican foreign policy. He takes his argument one step further, suggesting that U.S. purposes are not only morally justified, but that they also coincide with its national interest. He draws two conclusions from the relationship between democracy and American foreign policy. First, the spread ofdemocracy would create a world more congenial to the U.S. since democracies are both pro-peace and pro-American. Second, as the world's leading example of democracy, the U.S. would gain support for both its domestic and international policies more easily. For these reasons, the author argues that post-Cold War American foreign policy should be based on democratic principles. Exporting Democracy clearly challenges the traditional realist notion that international relations are determined by independent states pursuing national self-interest. Muravchik begins by stating his case as to why promotion ofdemocracy is the centerpiece ofAmerican foreign policy. Placed in the context ofAmerican diplomatic history, Muravchik's argument refutes realism, neo-realism and ideal- 180 SAIS REVIEW ism as doctrines that underestimate the role ofideology in policy-making. Specific examples of how the promotion ofdemocracy entered into American foreign policy during the Cold War, however, are not offered. The author devotes considerable attention to the likelihood that democracy will spread across large parts ofthe globe, notwithstanding significant differences in history, culture, and levels of industrial development. The U.S. has contributed to this trend in a variety of ways, including the military occupations of Germany, Japan, and the Philippines, the conduct of covert action in Eastern Europe and the Third World, and the rendering of economic assistance to under-developed countries. Muravchik, however, misjudges the extent to which these policies were motivated by the goal ofspreading democracy. Although moral considerations were not irrelevant to policy formulation, U.S. foreign policy during the Cold War was primarily concerned with its strategic and economic interests. The text concludes with the notion that in order to make democracy the centerpiece ofits foreign policy, the U.S. should simply increase its support for newly democratic and democratizing countries through diplomatic, military, and economic assistance. Muravchik's conclusion is weakened by his failure to specify how...

Intervention into the 1990s: U.S. Foreign Policy in the Third World (review)

180 SAIS REVIEW ism as doctrines that underestimate the role ofideology in policy-making. Specific examples of how the promotion ofdemocracy entered into American foreign policy during the Cold War, however, are not offered. The author devotes considerable attention to the likelihood that democracy will spread across large parts ofthe globe, notwithstanding significant differences in history, culture, and levels of industrial development. The U.S. has contributed to this trend in a variety of ways, including the military occupations of Germany, Japan, and the Philippines, the conduct of covert action in Eastern Europe and the Third World, and the rendering of economic assistance to under-developed countries. Muravchik, however, misjudges the extent to which these policies were motivated by the goal ofspreading democracy. Although moral considerations were not irrelevant to policy formulation, U.S. foreign policy during the Cold War was primarily concerned with its strategic and economic interests. The text concludes with the notion that in order to make democracy the centerpiece ofits foreign policy, the U.S. should simply increase its support for newly democratic and democratizing countries through diplomatic, military, and economic assistance. Muravchik's conclusion is weakened by his failure to specify how such an idealistic policy would further America's national interest. For example, his argument calls into question the propriety of American diplomatic ties to Arab allies in the Middle East. Should the U.S. stop supporting such undemocratic states as Egypt, Saudi Arabia, and Kuwait? Muravchik avoids such difficult questions. During the Gulf War, the U.S. sought to secure its oil supply, not promote democracy in the Middle East. Despite Muravchik's idealism, the enormous American effort and risk to American lives undertaken to guarantee the sovereignty of Kuwait and Saudi Arabia (two very undemocratic states) confirms that even in the postCold War era, democracy will not and cannot be the centerpiece ofAmerican foreign policy. As John Quincy Adams said in the 1820s, we are the friends of liberty everywhere, but the guardians only ofour own. American foreign policy has proven John Quincy Adams correct. Intervention into the 1990s: U.S. Foreign Policy in the Third World. Edited by Peter J. Schraeder. Boulder, Colorado: Lynne Rienner Publishers, Inc., 1992. 453 pp. $14.95/Paperback. Reviewed by Jonathan L. Schwarz, MA. Candidate, SAIS. In this second edition of Intervention into the 1990s, Peter Schraeder adapts a comprehensive collection of essays first published in 1989 to the developing aftermath of the Cold War. Added to this edition are more complete analyses of the Bush administration's policy to pursue a "new world order," the American interventions in Panama and Kuwait, the tumultuous situation in Iran, the Philippines, Nicaragua and South Africa, and case studies of Panama, the Persian Gulf and the Arab-Israeli conflict. According to Schraeder, the primary aim of this book is to assess the failings ofpast American policies in the Third World, in the hope that the analyses might provide the foundation for new, improved policy. The author's focus on the future is evident in the sweeping definition of intervention as the "calculated use of BOOK REVIEWS 181 political, economic, and military instrumentsby one countrytoinfluencethe domestic or the foreign policies ofanother country." This expansion ofthe scopeofanalysis of power politics clearly seeks to enhance the relevance of the book by providing an analytical framework which anticipates the future direction and nature of interventions. Several themes guide the collected essays toward this objective. United States policy has overemphasized a "globalist" approach to international politics while it should have pursued a more "regionalist" position. Military force has become significantly less relevant and fungible. The United States has been powerless to regulate nationalist impulses in the Third World, and must be more tolerant of social change. To support these assertions, the text begins with an examination ofthe historical development of the American interventionist mindset which regarded itself as universalist and just, followed by a similar discussion of historical background since the Second World War, especially the development of low-intensity conflict doctrine. A chapter on the globalist-regionalist debate supports the theme that the regionalist approach more satisfactorily deals with issues relating to the status and problems of the Third World. The analysis then...

Low-level arsenic exposure in wood processing plants.

In October 1978, seven construction workers building a pier in Monterey, California, developed symptoms consistent with arsenic intoxication and had elevated urinary levels of arsenic. The wood used for the pier had been pressure-treated with an arsenic preservative. To evaluate the potential acute medical hazards of preserving wood with arsenic, we evaluated employees at three California plants where arsenic preservatives are mixed and applied to wood. Histories, physical examinations, and urine specimens for arsenic analysis were collected from 44 workers exposed to arsenic and from 37 controls in three woodworking plants where arsenic is not used. A comparison of the groups failed to show any significant differences in history or physical examination. Adjustment for age, length of employment, and smoking histories did not alter the pattern. Urinary arsenic concentration was found to increase with increased exposure. These results do not imply absence of chronic or delayed toxicity, nor do they preclude the presence of a more subtle toxicity such as nerve conduction deficits. The data indicate existence of an arsenic exposure hazard in wood processing.U