Trend Χ2 Research Articles

Incidence and Associated Factors for Single and Recurrent Falls among the Elderly in an Urban Community of Beijing

ObjectiveTo investigate the incidence of falls and recurrent falls, and explore associated factors for single and recurrent falls among urban community-dwelling elderly in Beijing. MethodsA cross-sectional study was conducted in 472 elderly in the Longtan community of Dongcheng district, Beijing in 2009. Data regarding the incidence of fall and recurrent falls in the previous year, as well as associated factors were collected from the elderly through face-to-face interviews. ResultsThe incidence of falls and recurrent falls was 17.8% and 6.1%, respectively, and it increased with age (χ2for trend=21.06, 19.20, P=0.001, 0.002). Binary logistic stepwise regression analysis showed that age (OR=2.20), living alone (OR=4.67) and gait disturbance (OR=1.27) were risk factors, while housing with elevators (OR=0.35), appropriate width/height of stair steps (OR=0.78), sufficient lighting for stairway (OR=0.45) and regular exercise (OR=0.12) could lower the risk for single fall; factors such as low monthly family income (OR=1.39), poor vision (OR=1.83), low physical ability (OR=4.47), abnormal static balance (OR=2.48), and fear of falls(OR=2.23) were risk factors, while appropriate width/height of stair steps (OR=0.49) and easiness of access to daily supplies (OR=0.41) were protective factors for recurrent falls. ConclusionThe incidence of falls in community-dwelling elderly people in Beijing is common, and falls and their related injuries have been associated with both intrinsic and extrinsic factors.

Abstract 188: Temporal Changes in Morphological Characteristics of Ventricular Fibrillation from Out-of-Hospital Cardiac Arrest in an Asian Community

Introduction: Ventricular fibrillation (VF) is the most common arrhythmia causing out-of-hospital cardiac arrest (OOHCA) and defibrillation remains the mainstay of its treatment. Successful defibrillation is linked to VF morphology characteristics, and is affected by VF duration, quality of cardiopulmonary resuscitation (CPR) and emergency medical service (EMS) responsiveness. This study aimed at comparing VF morphology characteristics and their relationships with patients and EMS characteristics, as well as outcomes, in an Asian community. Method: Electrocardiographic recordings of VF signals from automated external defibrillators (AEDs) in 2008 to 2012 were obtained from OOHCA subjects in Taipei city, a metropolitan with 2.65 million residents in 272km2. Amplitude spectrum analysis (AMSA) and DFAα2 were calculated and compared year by year in the study period. Results: A total of 612 OOHCA subjects with VF were included for analysis. Both DFA and AMSA changed significantly over time (χ 2 for trend: -0.128 for DFA, p<0.01; 0.092 for AMSA, p=0.02). There was no change in gender, age, and bystander CPR rates; however, in later years there were more witnessed arrests, shortened EMS responses, and better sustained (>2 hr) return of spontaneous circulation (ROSC) and neurological outcomes (CPC 1&2). The time trend for DFAα2 (OR 0.98, CI 0.96-0.99, p=0.003), but not for AMSA (OR 1.07, CI 0.99-1.14), remained after adjustment for confounders. Both DFAα2 and AMSA were associated with sustained ROSC (DFA OR 0.08, CI 0.04-0.18, p<0.001; AMSA OR 1.18, CI 1.01-1.38, p=0.03) and CPC 1&2 (DFA OR 0.04, CI 0.01-0.16, p<0.001; AMSA OR 1.30, CI 1.07-1.57, p=0.008) in multiple regression models. Conclusions: DFAα2 and AMSA, two important VF characteristics, changed significantly over time in an Asian community, and were associated with improved outcomes. This might reflect improvement in community chain of survival especially among EMS responses and community quality of CPR.

A New pN Staging System Based on Both the Number and Anatomic Location of Metastatic Lymph Nodes in Gastric Cancer

BackgroundOur aim was to establish a new pN staging system for gastric cancer based on the number and location of metastatic lymph nodes (MLNs) and to compare it with other systems. MethodsWe retrospectively analyzed the prognostic data of 521 gastric cancer patients who underwent curative resection. Survival analyses were used to establish a pN staging system that considers both the number and location of MLNs and to compare discriminatory ability and monotonicity of gradients (linear trend χ2 score), homogeneity ability (likelihood ratio test), and prognostic stratification ability (Akaike information criterion) between Japanese Gastric Cancer Association (JGCA) and Union for International Cancer Control (UICC) systems. ResultsCut-point survival analysis divided pN+ patients into two groups: Nxn1~6 and Nxn≥7. N0, N1, N2, and N3 (the previous classifications) were replaced by N0, N1n1~6, N2n1~6, and N1n≥7 + N2n≥7 + N3n1~6 + N3n≥7, respectively. Compared with two widely used staging systems, the new system had the highest likelihood ratio test [106.06 (new) vs 95.09 (JGCA) vs 94.33 (UICC)] and linear trend χ2 scores [102.30 (new) vs 89.12 (JGCA) vs 86.97(UICC)] and the lowest Akaike information criterion (AIC) score [2,283.88 (new) vs 2,285.31 (JGCA) vs 2,299.88 (UICC)]. ConclusionA new pN staging system based on the number and location of MLNs is an efficient prognostic indicator of the survival of patients with gastric cancer following radical surgery.

Using SCC antigen and CRP levels as prognostic biomarkers in recurrent oral cavity squamous cell carcinoma.

Squamous cell carcinoma antigen (SCC-Ag) and C-reactive protein (CRP) levels have been successfully used to stratify risk groups in primary oral squamous cell carcinoma (OSCC) patients; however, related biomarkers have rarely been investigated in recurrent OSCC. The purpose of the present study was to analyze the relationships of SCC-Ag and CRP levels at the time of recurrence with clinical factors and prognosis. We retrospectively recruited patients with recurrence in a cohort of 534 OSCC patients between March 2001 and July 2013. One hundred patients had recurrence. The serum SCC-Ag and CRP levels were measured at the time of cancer diagnosis, 3 to 6 months after treatment with clinical disease-free, and at the time of recurrence. The SCC-Ag levels were significantly lowered after treatment (paired t-test: p = 0.001) and re-elevated at the time of recurrence (paired t-test: p = 0.027). An SCC-Ag level ≥2.0 ng/ml and a CRP level ≥5.0 mg/L at the time of recurrence were significantly associated with recurrent tumor status (P<0.001), recurrent nodal metastasis (χ2 trend test: P = 0.020), distant metastasis (P<0.001), and overall survival (P<0.001). Moreover, the influence of both elevated SCC-Ag and CRP levels on overall survival (P<0.001, H.R. [95% CI]: 5.406 [2.210–13.222]) still existed after adjusting for the recurrent tumor stage and patient age. The present study demonstrates that concurrent high levels of both SCC-Ag and CRP at the diagnosis of recurrence acts as a predictor of recurrent tumor status, recurrent advanced tumor stage, distant metastasis, and survival after the diagnosis of recurrence. This study expands the applicability of these two markers in the risk stratification in recurrent OSCC.

The first stage of toxicology evaluation and analysis of 1502 pesticide samples

To analyze the results of the first-stage toxicological evaluation of 1 502 pesticide samples. The classification of the 1 502 pesticide samples was analyzed, and the experimental results of the samples in different years were compared. Most of the 1 502 pesticide samples were insecticides, accounting for 52.5% of all, followed by bactericides and herbicides. In the 5 years, the proportion of biogenic insecticides showed a significant rising trend (χ² = 11.426, P < 0.05). The proportion of single pesticides was 65.8%; mixed pesticides accounted for 32.7%; original pesticides accounted for only 1.5%. From 2008 to 2012, most pesticides had low toxicity, regardless of the exposure route (via the mouth, skin, or respiratory tract). Acute oral and dermal toxicity tests showed that pesticides with moderate toxicity declined year by year (oral exposure χ² = 18.036, P < 0.01; dermal exposure χ² = 40.482, P < 0.01). There was a small proportion of pesticides with high toxicity. We did not detect any pesticide with extreme toxicity. Acute skin irritation and eye irritation test showed an upward trend in proportion of non-irritating pesticides (χ² = 77.110, P < 0.01; χ² = 12.693, P < 0.05), while the proportion of medium-irritation pesticides decreased significantly (χ² = 18.941, P < 0.01; χ² = 13.129, P < 0.05). Sensitization test showed that all samples were weak sensitizers. The major type of investigated pesticides was insecticide. Most samples were single pesticides, and there was a certain proportion of mixed pesticides. Novel pesticides such as bio-pesticides are the development tendency. The tested pesticides were mainly low-toxicity pesticides, with a certain proportion of medium- and high-toxicity pesticides. Personal protection should be strengthened during production and use of pesticides.

Exploratory analysis of the relationship between home health agency engagement in a national campaign and reduction in acute care hospitalization in US home care patients.

To determine whether US home health agencies that intensively engaged with the 2010 Home Health Quality Improvement National Campaign were more likely to reduce acute care hospitalization (ACH) rates than less engaged agencies. We included all Medicare-certified agencies that accessed Campaign resources in the first month of the Campaign and also responded to an online survey of resource utilization at month two. We used the survey data and item response theory to estimate a latent construct we called engagement with the campaign. ACH rates were calculated from the Centers for Medicare & Medicaid Services Outcome and Assessment Information Set for pre- and post-intervention periods (March-November 2009 and 2010, respectively). Staff from 1077 agencies accessed resources in the first month of the Campaign. Of these, 382 provided information about resource use and had 10 or more monthly discharges throughout the measurement periods. Dividing these agencies into quartiles based on engagement score, we found an association between engagement and reduction in ACH rates, P=0.049 (χ(2) for trend). Exploratory path analysis revealed the effect of engagement score on reduction in ACH rate to be partially mediated through reduction in average length of service rates. We found evidence that early intensity of engagement with the Campaign, as measured through use of activities and resources, was positively associated with improvement. To continue the investigation of this relationship, future work in this and other campaigns should focus on further development of engagement measures.

The rise of obstetric anal sphincter injuries (OASIS): 11-year trend analysis using Patient Episode Database for Wales (PEDW) data

The aim of this study was to establish the trend of obstetric anal sphincter injuries (OASIS) in Wales. A retrospective search of Patient Episode Database for Wales (PEDW) data was carried out. Data were available for 11 years from 1999 to 2009. The incidence of OASIS steadily increased from 1.81% in 1991 to 5.62% in 2009 (χ2 for trend p < 0.001), which is more than a three-fold increase. This was observed alongside a significant increase in resort to episiotomy (χ2, p < 0.001) and forceps delivery (χ2, p < 0.001), drop in the use of ventouse delivery (χ2, p < 0.001) as well as increase in caesarean delivery (χ2, p < 0.001) over the same period. This showed the incidence of OASIS in Wales to have risen significantly and steadily over the period 1999–2009. This necessitates a look to identify and deal with the cause(s) of this rise and monitor its future course.

Physical activity and inactivity patterns in India – results from the ICMR-INDIAB study (Phase-1) [ICMR-INDIAB-5

BackgroundThe rising prevalence of diabetes and obesity in India can be attributed, at least in part, to increasing levels of physical inactivity. However, there has been no nationwide survey in India on physical activity levels involving both the urban and rural areas in whole states of India. The aim of the present study was to assess physical activity patterns across India - as part of the Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) study.MethodsPhase 1 of the ICMR-INDIAB study was conducted in four regions of India (Tamilnadu, Maharashtra, Jharkhand and Chandigarh representing the south, west, east and north of India respectively) with a combined population of 213 million people. Physical activity was assessed using the Global Physical Activity Questionnaire (GPAQ) in 14227 individuals aged ≥ 20 years [urban- 4,173; rural- 10,054], selected from the above regions using a stratified multistage design.ResultsOf the 14227 individuals studied, 54.4% (n = 7737) were inactive (males: 41.7%), while 31.9% (n = 4537) (males: 58.3%) were active and 13.7% (n = 1953) (males: 61.3%) were highly active. Subjects were more inactive in urban, compared to rural, areas (65.0% vs. 50.0%; p < 0.001). Males were significantly more active than females (p < 0.001). Subjects in all four regions spent more active minutes at work than in the commuting and recreation domains. Absence of recreational activity was reported by 88.4%, 94.8%, 91.3% and 93.1% of the subjects in Chandigarh, Jharkhand, Maharashtra and Tamilnadu respectively. The percentage of individuals with no recreational activity increased with age (Trend χ2: 199.1, p < 0.001).ConclusionsThe study shows that a large percentage of people in India are inactive with fewer than 10% engaging in recreational physical activity. Therefore, urgent steps need to be initiated to promote physical activity to stem the twin epidemics of diabetes and obesity in India.

Proposal to modify the International Union Against Cancer staging system for perihilar cholangiocarcinomas

The International Union Against Cancer (UICC) staging system for perihilar cholangiocarcinoma changed in 2009. The aim of this study was to validate and optimize the UICC system for these tumours. This retrospective study was conducted in eight Japanese hospitals between 2001 and 2010. Perihilar cholangiocarcinoma was defined as a cholangiocarcinoma that involves the hilar bile duct, independent of the presence or absence of a liver mass component. The stratification ability of the UICC tumour node metastasis (TNM) system was compared with that of a modified system. Of 1352 patients, 35.9, 44.8 and 12.6 per cent had Bismuth type IV tumours, nodal metastasis (N1) and distant metastasis (M1) respectively. T4 tumours (43.2 per cent) and stage IVA (T4 Nany M0; 36.3 per cent) disease were most common. Survival was not significantly different between patients with T3 versus T4 tumours (P = 0.284). Survival for patients with stage IVA disease was comparable to that for patients with stage IIIB tumours (T1-3 N1 M0) (P = 0.426). Vascular invasion, pancreatic invasion, positive margin, N1 and M1 status were identified as independent predictors of survival. When Bismuth type IV tumours were removed from the T4 determinants and N1 tumours grouped together, the modified grouping had a higher linear trend χ2 and likelihood ratio χ2 compared with the original system (245.6 versus 170.3 respectively and 255.8 versus 209.3 respectively). The present data suggest that minimal modification with removal of Bismuth type IV tumours from the T4 determinants and bundling of N1 disease may enhance the prognostic ability of the UICC system. However, this requires validation on an independent data set.

Dor e analgesia pós-operatória: análise dos registros em prontuários

JUSTIFICATIVA E OBJETIVOS: Apesar de ser o tipo mais prevalente de dor aguda e de sua expressão clínica estar associada à morbimortalidade, a dor pós-operatória persiste subdiagnosticada e subtratada. O objetivo deste estudo foi analisar registros sobre dor e analgesia pós-operatória em prontuários de pacientes internados. MÉTODOS: Estudo documental, transversal, de natureza quantitativa, realizado em hospital privado de Fortaleza/CE. Analisaram-se 60 prontuários de pacientes nas primeiras 24 horas de pós-operatório. Utilizou-se check-list para avaliação dos registros sobre avaliação da dor em três momentos (pós-operatório imediato na sala de recuperação pós-anestésica, após uma hora de cirurgia e nas horas subsequentes). Também foram analisadas prescrições médicas e de enfermagem, evoluções diárias e folha de monitorização clínica. Realizou-se análise estatística descritiva e aplicou-se teste Qui-quadrado de tendência linear (χ2) para comparar respostas dos pacientes à analgesia nos diferentes momentos de avaliação da dor. RESULTADOS: Encontrou-se registro sobre dor e analgesia em 46,6% dos prontuários, limitado à descrição de intensidade, localização e analgesia. Prevaleceram pacientes do gênero feminino (55%), maiores de 59 anos (31,6%), submetidos a cirurgias gerais (46,6%), com dor abdominal (45%) moderada a intensa na primeira avaliação, evoluindo para dor leve ou ausência de dor nas horas subsequentes à analgesia. Daqueles que apresentaram dor, 45% não receberam analgesia. Comprovou-se relação estatisticamente significativa entre intensidade da dor e tempo de pós-operatório (p<0,001). CONCLUSÃO: São preocupantes os achados relacionados à subprescrição de analgésicos no pós-operatório. Os profissionais devem se envolver no manuseio e no registro apropriado desse tipo de dor, promovendo melhores condutas analgésicas e maior satisfação aos pacientes.

Persons with disabilities, cancer screening and related factors

The scope of this article is to describe persons with disabilities (PwD) being subjected to cancer screening and the relationship between some social variables and inequalities in performing these tests. A cross-sectional study of cancer screening among PwD was conducted in 2007 with 333 participants interviewed in residence in 4 cities of São Paulo. Variables in the practice of cancer screening, disabilities, gender, age, income of main family breadwinner, ethnicity, use of health services, assistance required, private health insurance, and coverage by the family health program were studied. Frequencies, χ²-test, trend χ² percentages and the Odds Ratios (OR) were used for data analysis. 44% of PwD attended at least one cancer screening at the appropriate time. Persons with visual disabilities and with hearing disabilities were subjected to more screening examinations than those with mobility disabilities and women were attended in screening exams more than men. Persons between the ages of 21 and 60 reported cancer screening more frequently than those between 80 and 97 years of age. The outcomes indicate that PwD have different attitudes toward cancer screening according to the type of disability, gender, and age, which were the variables that directly influenced cancer screening exams.

Hospitalization Rates of Complicated Pneumococcal Community-Acquired Pneumonia is Increasing in Tuscan Children

To provide epidemiological data on community-acquired pneumonia (CAP) and complicated CAP, a retrospective study was conducted on a partially vaccinated paediatric population. Data from children hospitalized for CAP in Tuscan hospitals between January 1st, 1999 and December 31st, 2009 were analysed. A total of 5,450 children with CAP were hospitalized. Annual hospitalization rates for CAP did not change significantly over the study period (X2 for trend= 0.652; p=0.419). The total annual hospitalization rate for pneumococcal CAP varied according to age (28.04 per 100,000 children aged less than 5 years, 10.06 per 100,000 children aged 6-12 years and 0.98 per 100,000 children aged greater than13years). Hospitalization rates for pneumococcal CAP increased from12.84 (95 percent CI:7.35-18.34) in 2001 to 45.4 (95 percent CI:35.93-54.90) per 100,000 children aged less than 5 years in 2009 (p less than 0.0001). In addition, a significant increase of hospitalization rates for complicated CAP (from 6.07 in 1999 to 13.66 in 2009 per 100,000 children; P less than 0.0001) and pneumococcal complicated CAP (from 0.19 in 1999 to 3.41 in 2009 per 100,000 children) over the study period were highlighted. Our epidemiological data confirm the decision to introduce the PCV13 vaccine, to satisfy the need to prevent a wider group of pneumococcal serotypes.

Effects of soy isoflavones on mammographic density and breast parenchyma in postmenopausal women

This study aims to evaluate the effects of soy isoflavones on breast tissue in postmenopausal women. In this randomized, double-blind, placebo-controlled study, 80 women (aged ≥ 45 y and with amenorrhea >12 mo) with vasomotor symptoms were randomized to receive either 250 mg of standardized soy extract corresponding to isoflavone 100 mg/day (n = 40) or placebo (n = 40) for 10 months. Breasts were evaluated through mammographic density and breast parenchyma using ultrasound (US) at baseline and 10-month follow-up. Independent t test, analysis of variance, Mann-Whitney U test, and χ2 trend test were used in statistical analysis. Baseline clinical characteristics showed no significant differences between the isoflavone group and the placebo group, with mean (SD) age of 55.1 (6.0) and 56.2 (7.7) years, mean (SD) menopause duration of 6.6 (4.8) and 7.1 (4.2) years, and mean (SD) body mass index of 29.7 (5.0) and 28.5 (4.9) kg/m2, respectively (P > 0.05). The study was completed by 32 women on isoflavone and 34 women on placebo. The groups did not differ in mammographic density or breast parenchyma by US (P > 0.05). Within each group, the baseline and final moments did not differ in mammography or US parameters significantly (P > 0.05). The use of soy isoflavone extract for 10 months does not affect breast density, as assessed by mammography and US, in postmenopausal women.

Mutation of TGF-β receptor II facilitates human bladder cancer progression through altered TGF-β1 signaling pathway

Tumor cells commonly adapt survival strategies by downregulation or mutational inactivation of TGF-β receptors thereby reversing TGF-β1-mediated growth arrest. However, TGF-β1-triggered signaling also has a protumor effect through promotion of tumor cell migration. The mechanism(s) through which malignant cells reconcile this conflict by avoiding growth arrest, but strengthening migration remains largely unclear. TGF-βRII was overexpressed in the bladder cancer cell line T24, concomitant with point mutations, especially the Glu269 to Lys mutation (G → A). Whilst leaving Smad2/3 binding unaffected, TGF-βRII mutations resulted in the unaffected tumor cell growth and also enhanced cell mobility by TGF-β1 engagement. Such phenomena are perhaps partially explained by the mutated TGF-βRII pathway deregulating the p15 and Cdc25A genes that are important to cell proliferation and CUTL1 gene relevant to motility. On the other hand, transfecting recombinant TGF-βRII-Fc vectors or smad2/3 siRNA blocked such abnormal gene expressions. Clinically, such G → A mutations were also found in 18 patients (n=46) with bladder cancer. Comparing the clinical and pathologic characteristics, the pathologic T category (χ2 trend = 7.404, P<0.01) and tumor grade (χ2 trend = 9.127, P<0.01) tended to increase in the G → A mutated group (TGF-βRII point-mutated group). These findings provide new insights into how TGF-β1 signaling is tailored during tumorigenesis and new information into the current TGF-β1-based therapeutic strategies, especially in bladder cancer patient treatment.

Longitudinal study of correlates of modern contraceptive use and impact of HIV care programmes among HIV concordant and serodiscordant couples in Rakai, Uganda

ObjectiveTo assess trends and determinants of family planning use and impact of HIV serostatus among couples.MethodsCouples’ data were retrospectively linked from cohort surveys in Rakai, Uganda between 1999 and 2011,...

Changing emergence of Shigella sero-groups in Bangladesh: observation from four different diarrheal disease hospitals.

BackgroundShigellosis continues to be a public health challenge for developing countries, including Bangladesh. The aim of the study is to demonstrate recent changes in Shigella sero-groups and their geographical diversity.MethodsData were extracted from data archive of four diarrheal disease surveillance systems. A 2% sub sample from urban Dhaka Hospital (2008–2011; n = 10,650), and 10% from urban Mirpur Treatment Centre (2009–2011; n = 3,585), were enrolled systematically; whereas, all patients coming from the Health and Demographic Surveillance System area in rural Matlab (2008–2011; n = 6,399) and rural Mirzapur (2010–2011; n = 2,812) were included irrespective of age, sex, and disease severity. A fresh stool specimen was collected for identification of Shigella spp. Of them, 315 (3%) were positive for Shigella in Dhaka, 490 (8%) from Matlab, 109 (3%) from Mirpur and 369 (13%) from Mirzapur and considered as analyzable sample size.ResultsAmong all Shigella isolates regardless of age, significant decreases in percentage of S. flexneri over time was observed in Mirpur (55→29%; p value of χ2-for trend = 0.019) and Mirzapur (59→47%; p = 0.025). A non-significant decrease was also seen in Dhaka (58→48%), while in Matlab there was a non-significant increase (73→81%). Similar patterns were observed among under-5 children at all sites. Emergence of S. sonnei was found in Dhaka (8→25%; p<0.001) and Mirpur (10→33%; p = 0.015), whereas it decreased in Mirzapur (32→23%; p = 0.056). The emergence of S. boydii was seen in all ages in Mirzapur [(3→28%; p<0.001); (3→27%; p<0.001)]. On the other hand, we saw non-significant percent reductions in S. boydii in Dhaka [overall (25→16%); under-5 (16→9%)]. Decreasing rates of Shigella dysenteriae were observed in Matlab, Mirpur and Mirzapur; whereas, in Dhaka it remained unchanged.Conclusion and SignificanceEmergence of S. sonnei and S. boydii as important infectious diarrhea etiologies and variations in geographical diversity underscore the need for monitoring, with possible implications for vaccine development.

Outcome Predictors of Allogeneic Hematopoietic Stem Cell Transplant

Acute kidney injury (AKI) is a significant complication after hematopoietic stem cell transplantation (HSCT) and frequently limits treatment success. Patients suffering complications with AKI often have high mortality. This investigation analyzed the outcomes of patients receiving allogeneic HSCT and identified the association between prognosis and RIFLE (risk of renal failure, injury to kidney, failure of kidney function, loss of kidney function and end-stage renal disease) classification. This study reviewed the medical records of 101 patients receiving allogeneic HSCT during an 8-year period at a specialized hematology ward in a university hospital in Taiwan. Demographic, clinical and laboratory variables were retrospectively gathered as predicators. Overall 6-month mortality was 36.6% (37/101). Mortality progressively and significantly increased (χ2 for trend, P<0.001) based on RIFLE classification severity. Multiple variable Cox regression analysis identified maximum RIFLE score on day 7 to 14 post-HSCT, occurrence of hepatic veno-occlusive disease and respiratory failure during admission as independent risk factors for 6-month mortality. Using the area under the receiver operating characteristic curve, the RIFLE classification on day 7 to 14 post-HSCT has the best discriminative power (area under the receiver operating characteristic curve: 0.696±0.057, P<0.001) compared with day 0 to 7, 14 to 30 and 30 to 60 post-HSCT. Cumulative survival rates at 6-month follow-up differed significantly (P<0.05) among non-AKI, RIFLE-R versus RIFLE-I and RIFLE-F. Hepatic veno-occlusive disease, respiratory failure and severity of maximum RIFLE score on day 7 to 14 post-HSCT were independent predictors for 6-month mortality. RIFLE classification on day 7 to 14 post-HSCT can improve the accuracy of 6-month mortality in patients who received allogeneic HSCT.

Physician Assistants in Primary Care: Trends and Characteristics

Physician assistants (PAs) have made major contributions to the primary care workforce. Since the mid-1990s, however, the percentage of PAs working in primary care has declined. The purpose of this study was to identify demographic characteristics associated with PAs who practice in primary care. We obtained data from the 2009 American Academy of Physician Assistants' Annual Census Survey and used univariate analyses, logistic regression analyses, and χ(2) trend tests to assess differences in demographics (eg, age, sex, race) between primary care and non-primary care PAs. Survey respondents had graduated from PA school between 1965 and 2008. Of 72,433 PAs surveyed, 19,608 participated (27% of all PAs eligible to practice). Incomplete questionnaires were eliminated resulting in a final sample of 18,048. One-third of PAs reported working in primary care. Female, Hispanic, and older PAs were more likely to work in primary care practice. Trend tests showed a decline in the percentage of PAs working in primary care in the sample overall (average 0.3% decrease per year; P <.0001). In the cohort of 2004-2008 graduates, however, the percentage of primary care PAs increased slightly by an average of 0.9% per year (P = .02). Nonetheless, the low response rate of the census limits the ability to generalize these findings to the total population of PAs. Demographics associated with an increased likelihood of primary care practice among PAs appear to be similar to those of medical students who choose primary care. Knowledge of these characteristics may help efforts to increase the number of primary care PAs.

Trends in treatment outcome of smear-positive pulmonary tuberculosis in Southeastern Nigeria, 1999 - 2008

Background: the Directly Observed Treatment Short Course (DOTS) strategy was introduced into the tuberculosis control programme of Ebonyi, Southeastern, Nigeria in 1996. The impact of the programme on the treatment outcomes for smear-positive tuberculosis has not been assessed ever since. We assessed the trends in treatment outcome for new smear-positive pulmonary tuberculosis between 1999 and 2008. Methods: we conducted a retrospective analysis of the Ebonyi state Ministry of Health quarterly smear-positive tuberculosis statistical returns. Patients were treated and treatment outcome categories computed according to the WHO/National Tuberculosis Control Programme’s guidelines. Chi-square for trends was used to determine significance. Results: the number of smear-positive cases who registered for treatment fell from 1 361 patients in 1999 to 977 in 2008 (Trend χ2=349; P&lt;0.001). The follow-up smear results at month two were not available for 16% of the patients in 1999; this unavailability decreased to 1.7% in 2008. The negative conversion rate at month two increased from 77.5% in 1999 to 95.9% in 2008 (Trend χ2=16.5; P&lt;0.001). Treatment success rose from 74.9% in 1999 to 88.7% in 2008 (Trend χ2=12.8; P&lt;0.001), whilst default rate declined from 12% to 4.3% (Trend χ2=55.6; P&lt;0.001). Though decreasing (Trend χ2=4.64; P=0.031), the annual death rate remained at around 5% during the study period. Conclusions: monitoring, supervision and home visits have improved, and our DOTS programme has achieved an 85% treatment success and declining default rates. However, with the current low case notification and high mortality rates, alternative mechanisms are needed to achieve global stop-TB targets in the State.

Estudio de contactos según círculos concéntricos en un caso de tuberculosis laríngea

ObjectiveTo describe the census and contact investigation in a case of laryngeal tuberculosis. MethodsBased on a patient with laryngeal tuberculosis and through interviews and ocular inspection, we established three circles of contacts. The tuberculin test was performed (positive ≥5mm). Persons testing positive were invited to undergo a chest x-ray. The association of the infection was calculated with the odds ratio. The exposure-response relationship was determined with the linear trend χ2 test. ResultsThe overall prevalence of infection was 39.9% (67/168). The prevalence among coworkers was 60.0% (24/40), that among frequenters of the town bar was 43.3% (13/30) and the conversions rate was 12.9%. There was a relationship with the degree of exposure (p <0.0001). ConclusionsLaryngeal tuberculosis involved high transmission to coworkers and frequenters of the town bar. In-depth studies through concentric circles and good communication with exposed individuals should be carried out.