Significant Lower Scores Research Articles

T49. THE NEURAPRO STUDY: ADHERENCE TO STUDY MEDICATION

BackgroundAdherence to a medication is generally defined as the extent to which patients take medications as prescribed by their health care providers. Poor adherence to study medication is not uncommon posing a major challenge to treatment trails. However, poor adherence may not be randomly distributed but rather be associated with demographic or illness factors. The aim of the present study was to identify factors associated with adherence to study medication in young people at ultrahigh risk of psychosis who participated in the NEURAPRO study.MethodsSecondary analysis of data collected in a multi-centre, double-blind, placebo-controlled, randomized clinical trial to prevent or delay the onset of psychosis in participants at ultrahigh risk of psychosis testing omega-3 polyunsaturated fatty acids (omega-3 PUFAs) vs. placebo, in combination with cognitive behavioural case management (NEURAPRO) were included in this analysis. Measures included the Brief Psychiatric Rating Scale (BPRS), the Scale for the Assessment of Negative Symptoms (SANS), the Montgomery Asberg Depression Rating Scale (MADRS), the Young Mania Rating Scale (YMRS), the Social and Occupational Functioning Assessment Scale (SOFAS), and the Global Functioning: Social and Role scales. Adherence to the study medication was assessed monthly for each participant based on capsule count. The mean adherence rating over the 6-month intervention period was then computed and categorized as either adherent (≤25% of capsules returned) or non-adherent (>25% of capsules returned). Transition to psychosis was defined on the basis of operationalized criteria and assessed with the Comprehensive Assessment of the At-Risk Mental State. Levels of ω-3 PUFAs in fish oil, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) (amongst other fatty acids) were measured as percentage of total fatty acids in erythrocytes at baseline and at month 6 (end-of-intervention).ResultsOf 304 randomised participants, 57.9% (N = 176) were non-adherent (>25% of capsules returned) and 128 (42.1%) were adherent (≤25% capsules returned) to the study medication.No sex differences were observed for adherence rates. At baseline the omega-3 index (EPA+DHA) was significantly lower in the non-adherent group (P = 0.018). The non-adherent group had significant lower scores on the SOFAS (P = 0.001) and the Global Functioning: Social and Role Scale at baseline assessment (P < 0.001 and P = 0.020, respectively) compared to the adherent group. No statistically significant differences were observed on symptom measures at baseline (BPRS, SANS, MADRS, YMRS). The cumulative transition to psychosis rate at month 12 was significantly higher in the non-adherent group compared to the adherent group (14.8% vs. 4.7%; Log rank test: P < 0.001).DiscussionAdherence to study medication was relatively low in NEURAPRO. Poor functioning and lower levels of ω-3 PUFAs at baseline were associated with non-adherence. Young people who were non-adherent had a significantly higher risk of progressing to first episode psychosis. Knowledge about factors associated with adherence could help to improve the delivery of interventions in young people at risk of psychosis.

Health related quality of life of gynaecologic cancer patients attending at Tikur Anbesa Specialized Hospital (TASH), Addis Ababa, Ethiopia

BackgroundBeing diagnosed with gynaecologic malignancy certainly will have different sequelae which can hamper quality of life (QOL).This study aimed to assess health related quality of life (HRQOL) among gynaecologic cancer patients attending at Tikur Anbesa Specialized Hospital (TASH), Addis Ababa, Ethiopia.MethodsThis study employed facility-based cross-sectional study design on 153 gynaecological cancer patients attending TASH using the Amharic version of the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire (EORTC QLQ-C30). We used descriptive statistics, independent t test and one way analysis of variance (ANOVA) in statistical analysis.ResultsThe mean Global Health Status (GHS) was 40.95(SD ± 24.35) and of the functional scores, social function was most affected (42.26, SD ± 32.08), whereas cognitive function is the least affected domain (mean = 88.21, SD ± 18.49). The highest score on the symptom scores was found to be financial difficulties (mean = 64.76, SD ± 32.43) followed by pain (mean = 55.12, SD ± 29.64) and fatigue (mean = 53.97, SD ± 28.54); the lowest score on the contrary was scored for diarrhea (mean = 1.19, SD ± 7.38). As stage increases there was a statistically significant reduction in GHS (p = 0.005) and in all functional score domains except the physical and emotional function. Advancement in stage of the disease has also affected significantly the symptom score domains except financial difficulties, nausea /vomiting and diarrhea. Patients who never went to school have scored a statistically significant lower score in GHS, physical function, role function and social function (p < 0.05).ConclusionGHS, social function, financial difficulties, pain and fatigue were the most affected domains; however, cognitive function and diarrhea were less affected components of HRQOL of gynaecologic cancer patients. Place of residence, educational status, marital status, payment type, cancer type and stage of the disease were associated with different quality of life scores.

The Internal Coherence of Breast Cancer Patients Is Associated with the Decision-Making for Chemotherapy and Viscum album L. Treatment.

Objective In the present observational study, the influence of internal coherence on shared decision-making for chemotherapy (CTX) and Viscum album L. extracts (VA) treatment in breast cancer patients was evaluated. Methods Breast cancer patients with a guideline-oriented advice from the tumor board for CTX were included in the study. At first diagnosis (T0) and 6 months later (T1), a questionnaire, the internal coherence scale (ICS), was administered and evaluated. Prior to analysis, patients were classified retrospectively depending on their treatment decision. Results 64 primary nonmetastasized breast cancer patients (median age 54.8 years, IQR: 46.3-65.3) were analyzed in this study. At T0, adjusted multivariable linear regression analyses revealed significant low ICS scores in patients rejecting CTX, especially in the ICS subscale “thermo coherence” (p = 0.006). The decision for add-on VA-therapy was associated with low scores for the ICS subscale “inner resilience coherence”, in particular low for the item “courage”. At T1, in the CTX+VA-group the thermo coherence increased significantly (p(d) < 0.01), while in contrast, in the CTX-only group the thermo coherence decreased significantly (p(d) = 0.02). Conclusion Add-on VA-applications in CTX treatment support the thermo coherence of breast cancer patients, revealing a decision option to encourage patients to undergo CTX in combination with additional VA-treatments.

Selected aspects of quality of life and household cost of care among patients with genital warts attending selected STD clinics in the Western Province of Sri Lanka

Introduction: Genital warts being a common STI in the country, its impact on quality of life, and cost of care associated with it need to be studied within the current STI context in Sri Lanka. Objective: To assess selected aspects of disease specific quality of life and its associated factors, response to treatment and household cost of care in-patient with genital warts attending selected STD clinics in the Western Province of Sri Lanka. Method: Study consisted of descriptive study of 240 patients with genital warts and a longitudinal follow up component to assess response to treatment, disease specific quality of life and household costing associated with genital warts by an interviewer administered questionnaire. Disease specific quality of life among patient with genital warts was assessed with a questionnaire validated by an expert panel. It consisted of 21 items that assess physical, emotional and sexual dimensions separately. Result: Study sample consisted of 151(62.9%) males and most (93.8%, n=225) of participants were Sinhalese. Majority of participants (79.9%, n=192) were from age group between 20 to 39 years. More of females (78.7%, n=70) in the sample were married than males (46.4% , n=70). Cauliflower type of genital warts were the most common type (56.2% , n=135) and prepuce and labia majora were the commonly involved sites. There was no statistically significant difference in response to treatment among different treatment. It showed that physical discomfort caused by genital warts and treatment in subsequent visits had not affected their daily activities. However, some of the items in emotional and sexual dimension were affected significantly to most of the participants. Being a male, unmarried, and an idea of having children in future showed statistically significant lower median scores for emotional dimension. They showed similar statistically significant lower scores for sexual dimension except for being unmarried. Median spending for a clinic day among males was Rs 175 and among females was Rs 441.56. Median total time spent by males for complete cure was 35 hours with IC range of 21 - 49 hours compared to 35 hours with IC range of 21 to 56 hours among females. Conclusion: Patients with genital warts showed significant impairment of disease specific quality of life in relation to emotional and sexual dimensions. It was clear that treatment of genital warts is associated with considerable time loss and expenditure to patients.

Prevalence of Delirium in a Population of Elderly Outpatients with Dementia: A Retrospective Study.

Delirium is a multifactorial geriatric syndrome and often occurs in patients with cognitive impairment. It also remains under-recognized, specifically in elderly outpatients, because signs of delirium might overlap with symptoms of dementia. The aim of the present study is to retrospectively apply the chart-based delirium instrument on a cohort of elderly outpatients with dementia, to assess prevalence and features of delirium in this population. We randomly selected 650 medical records of outpatients referred to the "Neurogenetic Regional Centre" (CRN) of Lamezia Terme. Each evaluation included demographics, medical history, drugs, type and severity of dementia, and cognitive and functional status. Delirium was identified by the application of the chart-based delirium instrument. The prevalence of delirium was 13.3%. The study population was divided, according to the presence of delirium, into two subgroups. Compared to the no delirium group, the delirium group was significantly older and had greater cognitive impairment with lower MMSE scores both at baseline and at the end of the follow up. They also had a significant lower score on the ADL and IADL. In this group, a higher intake of antihypertensive and antipsychotic drugs, together with a lower intake of cholinesterase inhibitors and memantine, was observed. In this study, the chart-based delirium instrument was applied to an outpatient population affected by dementia and followed for a long time. Our data confirm the importance that age and frailty play on the genesis of delirium and suggest attention should be paid to the pharmacological treatment of these patients.

Insights on insight

This study examined the reliability, validity and internal structure of the newly developed, interview-based Schedule for the Assessment of Insight in Eating Disorders (SAI-ED) and the relationships of insight with demographic and clinical characteristics in EDs. Ninety-four female patients – 44 with anorexia nervosa (AN) and 50 with bulimia nervosa (BN) – were assessed with SAI-ED. The Brown Assessment of Beliefs Scale was used to evaluate convergent validity of SAI-ED. Hierarchical cluster analysis and multidimensional scaling were used to identify insight components and assess their inter-relationships. The final 8-item SAI-ED demonstrated good psychometric properties. Inter-rater and test-retest reliabilities were high. Three subscales of SAI-ED were identified which measure major insight components: awareness of illness, awareness of symptoms, and treatment engagement. Patients with AN had significant lower score on SAI-ED than patients with BN. Impaired insight was associated with: (a) lower current and lowest lifetime BMI and more severe dietary restrain in AN, (b) illness duration, severity of overall ED symptoms, body-related concerns and obsessionality in BN. Insight is a multidimensional construct in EDs associated with different clinical aspects in AN and BN. The SAI-ED is a valid and reliable tool for the assessment of insight in EDs patients.

Neuropsychological functioning and brain energetics of drug resistant mesial temporal lobe epilepsy patients

Interictal hypometabolism is commonly measured by 18-fluoro-deoxyglucose Positron Emission Tomography (FDG-PET) in the temporal lobe of patients with mesial temporal lobe epilepsy (MTLE-HS). Left temporal lobe interictal FDG-PET hypometabolism has been associated with verbal memory impairment, while right temporal lobe FDG-PET hypometabolism is associated with nonverbal memory impairment. The biochemical mechanisms involved in these findings remain unknown. In comparison to healthy controls (n=21), surgically treated patients with MTLE-HS (n=32, left side=17) had significant lower scores in the Rey Auditory Verbal Learning Test (RAVLT retention and delayed), Logical Memory II (LMII), Boston Naming test (BNT), Letter Fluency and Category Fluency. We investigated whether enzymatic activities of the mitochondrial enzymes Complex I (C I), Complex II (C II), Complex IV (C IV) and Succinate Dehydrogenase (SDH) from the resected samples of the middle temporal neocortex (mTCx), amygdala (AMY) and hippocampus (HIP) were associated with performance in the RAVLT, LMII, BNT and fluency tests of our patients. After controlling for the side of hippocampus sclerosis, years of education, disease duration, antiepileptic treatment and seizure outcome after surgery, no independent associations were observed between the cognitive test scores and the analyzed mitochondrial enzymatic activities (p>0.37). Results indicate that memory and language impairment observed in MTLE-HS patients are not strongly associated with the levels of mitochondrial CI, CII, SDH and C IV enzymatic activities in the temporal lobe structures ipsilateral to the HS lesion.

Noncongruence between Audiologist and Patient Preferences for Patient-Centeredness.

Trends in preferences of both healthcare providers and patients to patient-centeredness have been emphasized in research. However, an understanding of the nature of preferences to patient-centeredness within the context of the audiologist-patient relationship is needed. The purpose of this study is to explore the congruence between audiologist and patient preferences for patient-centeredness. A cross-sectional survey design was used to gather data from audiologists and patients with hearing loss. Participants included 75 audiologists and 105 consecutive patients with hearing loss. Participants completed the modified Patient-Practitioner Orientation Scale (PPOS) and provided selected demographic information. Data were analyzed using an independent sample t test to evaluate the differences between audiologist and patient congruence. Regression analysis was performed to evaluate factors contributing to preferences for patient-centeredness. Patients had significantly lower scores in PPOS full scale when compared to the audiologists [t(170) = 0.78; p ≤ 0.001] with a very large effect size (Cohen's d = 1.43). Patients also had significantly lower scores when compared to the audiologists on both the sharing [t(170) = 1.01; p ≤ 0.001] and caring [t(170) = 0.56; p ≤ 0.001] subscales. Statistically significant lower scores were noted for patients when compared to audiologists on 12 items on the PPOS. No relationship between any demographic factors and preferences for patient-centeredness were found. The current study results indicated noncongruence in preferences for patient-centeredness among audiologists and patients with hearing loss. Results point toward the need for more research considering the nature and impact of patient-centered audiology practice.

Health-related quality of life in non-paraplegic (ambulatory) children with myelomeningocele.

Evaluation of the effects of ventriculoperitoenal shunt and incontinence presence on health-related quality of life of ambulatory myelomeningocele patients. The study group included 35 myelomeningocele patients, between 5 and 18years old (mean age=9.6), who were neonatally operated. All patients were ambulatory. The Child Edition of the Child Health and Illness Profile (CHIP-CE) used to evaluate the patient group. Seventeen patients were using clean intermittent catheterization and nine patients had ventriculoperitoneal shunt. The CHIP-CE has five domains, and in satisfaction, resilience and achievement domains, significant lower scores were obtained from our study group. In terms of clean intermittent catheterization use, we got significantly lower scores on satisfaction, resilience and achievement domains (p<0.05). According to the presence of ventriculoperitoneal shunt, we found lower scores in satisfaction, resilience, risk avoidance and achievement domains but the differences were not significant (p>0.05). No significant difference was spotted according to gender and age. Continence problems have important effects on life quality of myelomeningocele patients. Incontinency should always be considered as a major variable in health-related quality of life evaluations.

Association of Helicobacter pylori infection with olfactory function using smell identification screening test

The aim of the present study is to investigate the role of Helicobacter pylori in olfactory function. Thirty-six patients (mean age 38.5) aged between 18 and 55years who were diagnosed with H. pylori by gastric biopsies and age- and sex-matched 30 healthy adults (mean age 33.6) were included in the study. All participants underwent a detailed ear-nose-throat examination including endoscopic examination of the nasal cavity and laryngeal area, and olfactory tests were performed using the Sniffin' Sticks, a 12-item screening test (Sniffin'Sticks; Burghart, Wedel, Germany) and odor scores were recorded. The mean odor score was 7.9±1.7 (range 2-10) in the patient group and 10.3±1.4 (range 6-12) in the control group. There were significant lower scores in the patient group compared to the control group (p<0.05). In conclusion, it is apparent that there is an association of H. pylori infection with olfactory dysfunction. H. pylori infection should be considered as possible etiological factors in patients with olfactory dysfunction.

Abstract A16: Asian immigrants' perception of clinical trials

Abstract Background Racial/ethnic minorities constitute more than 30% of the U.S. population, and yet represent less than 18% of clinical trial (CT) participation. The participation of minorities in CTs is a critical link between scientific innovation and improvement in health care delivery, as well as the provision of evidence-based medicine. Although Asian Americans (AAs) are the fastest growing minority group in the U.S., they are the least represented in CTs. Specifically, more than 65% of AAs are foreign-born, and greater than 30% have limited English proficiency. Little is known about AA immigrants' willingness to participate in CTs. The purpose of this study was to examine (1) AA immigrants' perception of CTs and (2) how sociodemographic factors might influence their perception. Methods This study used a cross-sectional design and quota sampling. Participants were recruited through seven AA community-based organizations and from six AA subgroups (Cambodian, Chinese, Filipino, Korean, Laotian, South Asians, and Vietnamese). An eight-item survey tool was developed to measure perceived benefits and cost of participating in CTs. The survey tool consisted of four positive statements and four negative statements. Participants were asked to rate each statement on a 5-likert scale. A total perception score was calculated by adding all eight items. A higher score indicates a more positive perception. The score can range from 0 to 40. The survey tool was translated, back translated in participants' native language. Results 470 participants completed the survey and 459 (98%) were immigrants. 48% of the participants had family income less than $20,000/year, 32% had less than 9 years of education, 39% reported less than average English proficiency. 26% of the participants were less than 50 years old (mean age = 56) and 27% were in the U.S. less than 10 years (mean years = 20). The Cronbach's Alpha for the perception scale was 0.64. The average perception score was 28.5 (SD = 4.03) and ranged from 18 to 40. There was a significant differences in the perception score across the seven subgroups. Both Vietnamese and Cambodian communities had the lowest perception scores (mean = 26.58 and 26.83, respectively); while Filipinos community had the highest perception score (mean = 30.20). The majority believed CTs could be beneficial to their community (83%) and helpful to advance medical knowledge and improve treatment (87%), as well as provide patients with an opportunity to try new treatment (86%). 70% of participants indicated that they would consider participation in clinical trials if they knew more about it. Participants who had less than 9 years education had significantly lower perception score than participants who had more than 9 years education (p &amp;lt;.0005). Participants whose family income &amp;lt; $20,000/years had significantly lower perception score, compared to participants with family income &amp;gt;$20,000/year (p = .003). Participants whose English proficiency less than average also had significantly lower perception score (p &amp;lt; .0005). While age did not have significant effect on CT perception, participants who lived in the U.S. less than 10 years had a significant lower score than participant who lived in the U.S. longer (p =.017). Conclusion The inclusion of AAs in clinical trials is critical for the mitigation of disparities and for realizing the true promise of precision medicine in cancer prevention and treatment. It is often argued that racial/ethnic minorities do not participate in CTs because they don't understand the importance of CTs or distrust the system. However, our findings challenge these assumptions. It will require greater effort and commitment on the part of institutions and researchers to recruit and enroll hard-to-reach populations in CTs. Steps must be taken to assure the inclusion and representation of racial/ethnic minorities. Citation Format: Helen Lam, Michael Quinn, Edwin Chandrasekar, Reena Patel, Karen Kim. Asian immigrants' perception of clinical trials. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A16.

Hearing aid fitting for visual and hearing impaired patients with Usher syndrome type IIa.

ObjectivesUsher syndrome is the leading cause of hereditary deaf‐blindness. Most patients with Usher syndrome type IIa start using hearing aids from a young age. A serious complaint refers to interference between sound localisation abilities and adaptive sound processing (compression), as present in today's hearing aids. The aim of this study was to investigate the effect of advanced signal processing on binaural hearing, including sound localisation.Design and participantsIn this prospective study, patients were fitted with hearing aids with a nonlinear (compression) and linear amplification programs. Data logging was used to objectively evaluate the use of either program. Performance was evaluated with a speech‐in‐noise test, a sound localisation test and two questionnaires focussing on self‐reported benefit.ResultsData logging confirmed that the reported use of hearing aids was high. The linear program was used significantly more often (average use: 77%) than the nonlinear program (average use: 17%). The results for speech intelligibility in noise and sound localisation did not show a significant difference between type of amplification. However, the self‐reported outcomes showed higher scores on ‘ease of communication’ and overall benefit, and significant lower scores on disability for the new hearing aids when compared to their previous hearing aids with compression amplification.ConclusionsPatients with Usher syndrome type IIa prefer a linear amplification over nonlinear amplification when fitted with novel hearing aids. Apart from a significantly higher logged use, no difference in speech in noise and sound localisation was observed between linear and nonlinear amplification with the currently used tests. Further research is needed to evaluate the reasons behind the preference for the linear settings.

IFNGR2 genetic polymorphism associated with sex-specific paranoid schizophrenia risk

Background: Considering current scientific evidence about the significant role of chronic low grade inflammation in the physiopathology of schizophrenia, it has been hypothesized that changes in pro-inflammatory cytokines such as interferon gamma may have a significant role in the predisposition to schizophrenia.Aim: This study focuses on identifying whether the functional polymorphism of interferon gamma receptor 2 (IFNGR2) is a risk factor for the development of schizophrenia.Methods: This study was conducted by the RFLP-PCR on a Tunisian population composed of 225 patients with different sub-types of schizophrenia and 166 controls.Results: The IFNGR2 (Q64R) polymorphism analysis showed higher frequencies of minor homozygous genotype (RR) and allele (R) in all patients compared to controls (21.8% vs 10.2%; p = .006, OR = 2.54) and (44% vs 34.9%; p = .01; OR = 1.46), respectively. This correlation was confirmed only for males. This study also noted a significant increase of the mutated homozygous (RR) genotype and (R) allele frequencies of IFNGR2 in paranoid schizophrenics compared to controls (31.4% vs 10.2%; p = .001; OR = 3.34 and 47.2% vs 34.9%; p = .009; OR = 1.66, respectively). This increase remains significant after using binary logistic regression to eliminate confounding factors such as age and sex. Additionally, carriers of RR genotype have significant lower scores on the Scale of Assessment of Positive (SAPS) and negative (SANS) symptoms comparatively to the carrier of the QQ + QR genotypes, suggesting that the R recessive allele carriers could have milder symptoms.Conclusion: The IFNGR2Q64R polymorphism is correlated with male sex and paranoid schizophrenia. It is suggested that a chronic neuroinflammation may predispose to the paranoid schizophrenia development in men.

Sub-Lethal Dose of Shiga Toxin 2 from Enterohemorrhagic Escherichia coli Affects Balance and Cerebellar Cytoarchitecture.

Shiga toxin producing Escherichia coli may damage the central nervous system before or concomitantly to manifested hemolytic–uremic syndrome symptoms. The cerebellum is frequently damaged during this syndrome, however, the deleterious effects of Shiga toxin 2 has never been integrally reported by ultrastructural, physiological and behavioral means. The aim of this study was to determine the cerebellar compromise after intravenous administration of a sub-lethal dose of Shiga toxin 2 by measuring the cerebellar blood–brain barrier permeability, behavioral task of cerebellar functionality (inclined plane test), and ultrastructural analysis (transmission electron microscope). Intravenous administration of vehicle (control group), sub-lethal dose of 0.5 and 1 ηg of Stx2 per mouse were tested for behavioral and ultrastructural studies. A set of three independent experiments were performed for each study (n = 6). Blood–brain barrier resulted damaged and consequently its permeability was significantly increased. Lower scores obtained in the inclined plane task denoted poor cerebellar functionality in comparison to their controls. The most significant lower score was obtained after 5 days of 1 ηg of toxin administration. Transmission electron microscope micrographs from the Stx2-treated groups showed neurons with a progressive neurodegenerative condition in a dose dependent manner. As sub-lethal intravenous Shiga toxin 2 altered the blood brain barrier permeability in the cerebellum the toxin penetrated the cerebellar parenchyma and produced cell damaged with significant functional implications in the test balance.

How much do celiac patients know about gluten free diet?

BACKGROUND: Adherence to gluten free diet (GFD) has been the object of many studies but few have investigated its essential requisite: a thorough knowledge of gluten sources. OBJECTIVE: Our aim was to measure celiac patients’ knowledge of GFD and assess its determinants. METHODS: A 20-item questionnaire was submitted to our celiac outpatients who were asked to indicate which foods or situations might be at risk of gluten intake. A 20-point rating scale was built giving one point for each correct answer. RESULTS: 154 patients were enrolled. The mean score of the knowledge test was 14.3 ± 2.9. Focusing on the incorrect responses, only 20.8% of them would have placed patients at risk of consuming gluten while the other 79.2% concerned foods or situations that were unnecessarily avoided by the patients. A statistically significant lower score was obtained by patients aged over 60 years (p = 0.0002), without a degree or diploma (p = 0.0016), non-members of the Italian Celiac Association (p = 0.043), who never visited the Association website (p = 0.0002) and never ate outside (p = 0.0009). CONCLUSIONS: We identified some categories of celiac patients at risk of less knowledge of GFD who deserve special training and attention.

Study on Flash scan combined with iterative reconstruction in chest CT scan: image quality and radiation dose

Objective To assess radiation dose and image quality of chest CT examinations that acquired with Flash scan technique combined with iterative reconstruction. Methods Thirty continuous patients required no-contrast chest CT with Flash scan mode and contrast enhanced chest CT with conventional CT scan mode. For each examination, the images were reconstructed by filter back projection (FBP) and sinogram affirmed iterative reconstruction (SAFIRE). The volume CT dose index (CTDIvol), dose-length product (DLP), and effective dose (ED) were estimated. The image noise, signal to noise ratio (SNR), overall subjective image quality, and respiratory motion artifacts were evaluated blindly by two radiologists. Results For Flash scan and conventional scan, SAFIRE reduced the image noise 35% and 16%, respectively; and increased SNR 21.9% and 25% compared to FBP, respectively (P<0.05). There was significant lower subjective image scores acquired by SAFIRE than by FBP. Flash scan reduced the CTDIvol (mGy) 40.9%, DLP 32.1%, and ED 26.9% compared to conventional CT scan mode. The motion artifact scores were reduced significantly with Flash scan mode compared to conventional scan mode. Conclusions Flash scan technique of the chest can obtain image with minimum respiratory motion artifact due to dramatically increased scan speed, and when SAFIRE was combined with, it reduces significantly radiation dose and image noise. Key words: Tomography, X-ray computed; Image processing, computer-assisted; Radiography, thoracic; Radiation dosage

Injection site diversity influences sodium hyaluronate distribution on knee cartilage surface: a cadaveric study

Objective To elucidate whether and how injection site diversity influences on the sodium hyaluronate(HA) distribution on cartilage surface of the knee joint. Methods From September 2014 to December 2014, 32 human cadaveric knees were sorted from small to large based on femoral condyle width(FCW) and divided into group I(n=16, odd number, the patella medial approach) and group II(n=16, even number, injected through the medial joint line approach). Knees of both groups were interfused with a 5%(mg∶ml) methylene blue tracer. Each specimen was then simulated a 5°-45° alternating walking for 2 h in the Electro Force platform. Afterwards, all the knee cavities were cut open to examine the range of HA distribution. Based on the eight-zoning classification law for the knee cartilage surface, the coverage area of HA in each zone was scored and the characteristics of HA distribution was depicted, as well as HA zonal distribution diversity between groups were statistically analyzed. Results HA of both patella medial and medial joint line subgroups showed analogical distribution in all zones except the lateral tibial plateau at the time of FCW ≤ 7.0 cm. However, HA coverage through the patella medial approach showed significantly higher distribution scores in the patella zone and the femoral trochlear zone, but significant lower distribution scores in the antero-lateral/postero-lateral femoral condyle, the medial posterior femoral condyle zone and the lateral tibial plateau zone compared with medial joint line approach at the time of FCW > 7.0 cm. Conclusion When delivered through different injection approaches, HA showed analogical distribution characteristics in most zones of the knee cavity in population with a small bodily shape(FCW ≤ 7.0 cm), but significant diverse distribution characteristics in population with a big bodily shape(FCW >7.0 cm). When FCW > 7.0 cm, HA injected through the medial-patellar approach tended to be distributed mainly over the patella-femoral articulation and the anterior knee cavity, while HA injected through the joint line approach tended to be distributed mainly over the tibio-femoral articulation and the posterior knee cavity. Key words: Osteoarthritis, knee; Hyaluronic acid; Patellofemoral joint

Abstract P2-12-05: Psychological status of early breast cancer (EBC) patients (pts) after surgery and before the starting of aromatase Inhibitors (AIs). Results of a single-institution, prospective study

Abstract BACKGROUND AIs are the milestone adjuvant treatment for postmenopausal early HR+ BC pts. Non-steroidal AIs induce a significant oestrogen deprivation, responsible in approximately 40% of the pts for muscle-skeletal adverse events (MSKs) and for discontinuation in 25%. The present study aims to evaluate the impact of the diagnosis communication and of the need for AI therapy on the future development of MSKs events in a prospective cohort of EBC pts. PATIENTS AND METHODS The analysis of patients’ psychological attitude was conducted by using 3 different tests: SCL 90-r for psychological symptoms, SF-36 for the self-perception of the health status and COPE-NVI for evaluation of coping. After a full explanation of the AIs potential adverse events by the oncologist, the questionnaires were self-administered with the support of a dedicated psychologist at the moment of the first visit (T0). For the future correlation between baseline psychological attitude and the development of AI-related events, the presence and the intensity of pain were measured by NRS 11-points scale and by Tender Points (TPs) evaluation. Pearson correlation analysis was used to calculate correlations between Pain Scale, Physical Synthetic Index of Sf-36 and NRS/TRPs scores. Wilcoxon’s Test was used to compare baseline scores with subsequent ones. RESULTS From October 2012 to April 2013, 70 EBC pts entered the study. Exclusion criteria included severe osteoporosis or other co morbidities that contraindicate therapy with AIs and documented diagnosis of psychosis or cognitive deterioration. Median age was 64.8 years (43-88). The vast majority of the pts (584.3%) presented stage IA-IIA disease. Fifteen pts aged less than 55 years were menopausal, 13 have previously received chemotherapy as part of the planned adjuvant programme. Thirty-four pts (48.6%) had a baseline NRS&amp;gt;0 and 18 NRS&amp;gt;5; 26 pts presented at least 1 positive TP. Regarding the SCL 90-r analysis, all the pts have reported standardized scores within the normal ranges for somatization, anxiety and phobic anxiety. The analysis of SF-36 questionnaires indicated that pts showed a significant lower score in comparison to the reference population in the ISF Index (44.17 vs 48.7) and in the Physical Health Scale (47.5 vs 74.13). These differences could suggest a greater difficulty to do daily activities and a worse global index of self physical perception At baseline, there was a statistically significant correlation between Physical Pain Scale of SF-36 and NRS Pain score (p=0.001) and between Physical Synthetic Index of SF-36 and NRS Pain Score (p&amp;lt;0.001). No differences have been observed in the COPE NVI questionnaires between the studied population and the reference one. CONCLUSION Early BC pts who are candidate for endocrine adjuvant therapy with AIs often present an impairment in terms of physical activity (daily and working) and perception of physical pain. The analysis of these parameters along the 1st year of AI therapy and their correlation with MSK adverse events onset is ongoing. Citation Format: Marina E Cazzaniga, Annalisa Valentini, Francesca Gallina, Francesca Riva, Alessandra Crippa, Marco Tagliabue, Federica Cicchiello, Diego Cortinovis, Paolo Bidoli. Psychological status of early breast cancer (EBC) patients (pts) after surgery and before the starting of aromatase Inhibitors (AIs). Results of a single-institution, prospective study [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P2-12-05.

Motor Disturbances in Autistic Children.;case Control Study

Background Children with autism have developmental motor profile that differ from other healthy children. This is evident since early childhood, sometime noted by parents and neglected by clinicians. These motor deficits are related to other domains of dysfunction in children with autism as social and language skills. Improving motor deficits can help better prognosis for these children. Aim To detect motor deficits in a sample of autistic children and correlate them with the severity of autistic symptoms. Methods We recruited 20 autistic children ranging from 3 to 6 yrs from the Institute of psychiatry outpatient child psychiatry and rehabilitation clinics of Ain-Shams university hospital. We excluded patient with total intelligence less than 75 or having other developmental disorder. We matched them with healthy controls for age and sex and compared both motor development and self help skills using Brigance scale. We confirmed diagnosis of autism in each patient by applying ICD-10 criteria of autism by a senior psychiatrist and by having a Childhood Autism Rating Scale (CARS) score above 30. Relation of autism severity and motor deficits was assessed later by Correlation co-efficient test. Results Compared to controls, autistic children showed statistically significant low Brigance test scores on; gross movement, fine movement and self-help skills subdomains. Motor delay was significantly correlated with the severity of autism. Conclusions Motor deficits were evident in autistic patients and could indicate severity

A Brief Learning Experience Designed to Increase Nursing Students’Knowledge of and Attitudes Toward LGBT Health Care

This study examined the effect of a brief learning experience on nursing students’ knowledge of and attitudes toward providing care to Lesbian, Gay, Bisexual and Transgender (LGBT) individuals. The Nursing Students’ Knowledge of and Attitudes toward LGBT Healthcare (NKALH) survey was administered to a convenience sample of 41 senior nursing students enrolled in a community health course. At pretest, there were significant knowledge deficits (20% of the questions were answered correctly) and low attitude scores toward LGBT healthcare needs existed. At posttest, students’ knowledge scores increased to 84%; attitude scores increased slightly, but not significantly (p = 0.07). Among the students who participated in the study, none felt they would be unable to care for an LGBT individual.