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Biomedical subjects

Catherine Hill

Publications and source records attributed to Catherine Hill.

34 records · Page 2Linked to original sources
PubMed2004

Emotions--the 3rd dimension of fertility and reproduction work.

This paper considers the developing interest and understanding in emotional intelligence and the emotional components of work that are occurring in many areas of occupation and industry. Key insights which present a challenge to organizational and professional cultures that require emotions to stay outside the workplace are summarised. Recent research in neuro-psychology is then used to demonstrate the centrality and complexity of emotional work in health care. The relative absence of research and scholarship that locates the emotions as a central and challenging dimension of health and social care work is discussed.

Emotions↗
PubMed2004

[Frequency of cancer in France: 2004 update].

The most recent cancer mortality and morbidity data available for France are presented. In 1999, cancers are the first cause of death among men (87,000 deaths) and the second most common among women (57,000 deaths) after cardiovascular diseases. Lung cancer is the most common cause of cancer death (21,000) in the male population, and breast cancer is the most common cause of death (11 000) in the female population. Cancer mortality rates decrease both in the male population since 1987 and in the female population since 1950, but the different sites present different trends. The total number of cancers diagnosed in 2000 is estimated to be equal to 280,000, 160,000 in the male population and 120,000 in the female population. The most frequent cancer sites are prostate among men (40,000 cases) and breast among women (42,000 cases), two sites for which screening activities are in widespread use. The tobacco-related lung cancer epidemic is accelerating markedly in the female population and is beginning to decrease in the male population.

Breast Neoplasms↗
PubMed2003

Analgesic effect of auricular acupuncture for cancer pain: a randomized, blinded, controlled trial.

PURPOSE: During the last 30 years, auricular acupuncture has been used as complementary treatment of cancer pain when analgesic drugs do not suffice. The purpose of this study is to examine the efficacy of auricular acupuncture in decreasing pain intensity in cancer patients. PATIENTS AND METHODS: Ninety patients were randomly divided in three groups; one group received two courses of auricular acupuncture at points where an electrodermal signal had been detected, and two placebo groups received auricular acupuncture at points with no electrodermal signal (placebo points) and one with auricular seeds fixed at placebo points. Patients had to be in pain, attaining a visual analog score (VAS) of 30 mm or more after having received analgesic treatment adapted to both intensity and type of pain, for at least 1 month of therapy. Treatment efficacy was based on the absolute decrease in pain intensity measured 2 months after randomization using the VAS. RESULTS: The main outcome was pain assessed at 2 months, with the assessment at 1 month carried over to 2 months for the eight patients who interrupted treatment after 1 month. For three patients, no data were available because they withdrew from the study during the first month. Pain intensity decreased by 36% at 2 months from baseline in the group receiving acupuncture; there was little change for patients receiving placebo (2%). The difference between groups was statistically significant (P <.0001). CONCLUSION: The observed reduction in pain intensity measured on the VAS represents a clear benefit from auricular acupuncture for these cancer patients who are in pain, despite stable analgesic treatment.

Acupuncture, Ear↗
PubMed2003

Bone marrow edema and its relation to progression of knee osteoarthritis.

BACKGROUND: While factors affecting the course of knee osteoarthritis are mostly unknown, lesions on bone scan and mechanical malalignment increase risk for radiographic deterioration. Bone marrow edema lesions on magnetic resonance imaging correspond to bone scan lesions. OBJECTIVE: To determine whether edema lesions in the subarticular bone in patients with knee osteoarthritis identify knees at high risk for radiographic progression and whether these lesions are associated with limb malalignment. DESIGN: Natural history study. SETTING: A Veterans Administration hospital in Boston, Massachusetts. PATIENTS: Persons 45 years of age and older with symptomatic knee osteoarthritis. MEASUREMENTS: Baseline assessments included magnetic resonance imaging of the knee and fluoroscopically positioned radiography. During follow-up at 15 and 30 months, patients underwent repeated radiography; at 15 months, long-limb films were obtained to assess mechanical alignment. Progression was defined as an increase over follow-up in medial or lateral joint space narrowing, based on a semi-quantitative grading. Generalized estimating equations were used to evaluate the relation of medial bone marrow edema lesions to medial progression and lateral lesions to lateral progression, before and after adjustment for limb alignment. RESULTS: Of 256 patients, 223 (87.1%) participated in at least one follow-up examination. Medial bone marrow lesions were seen mostly in patients with varus limbs, and lateral lesions were seen mostly in those with valgus limbs. Twenty-seven of 75 knees with medial lesions (36.0%) showed medial progression versus 12 of 148 knees without lesions (8.1%) (odds ratio for progression, 6.5 [95% CI, 3.0 to 14.0]). Approximately 69% of knees that progressed medially had medial lesions, and lateral lesions conferred a marked risk for lateral progression. These increased risks were attenuated by 37% to 53% after adjustment for limb alignment. CONCLUSION: Bone marrow edema is a potent risk factor for structural deterioration in knee osteoarthritis, and its relation to progression is explained in part by its association with limb alignment.

Aged↗
PubMed2003

Risk of secondary leukemia after a solid tumor in childhood according to the dose of epipodophyllotoxins and anthracyclines: a case-control study by the Société Française d'Oncologie Pédiatrique.

PURPOSE: To estimate the risk of secondary leukemia as a function of the dose of epipodophyllotoxins and anthracyclines. METHODS: We conducted a case-control study of the risk of secondary leukemia or myelodysplasia after a solid tumor in childhood within the Société Française d'Oncologie Pédiatrique, including 61 patients with leukemia matched with 196 controls. The characteristics of the first cancer, the patient's family history of cancer, and the treatment (type, cumulative dose of chemotherapy, schedule of etoposide administration, and radiation dose delivered to active bone marrow) were compared in the two groups. RESULTS: Only two factors were found to increase the risk of leukemia in multivariate analysis, namely, the type of the first tumor, with an excess risk in patients with Hodgkin's disease (relative risk 6.4; 95% confidence interval [CI], 1.6 to 24) or osteosarcoma (relative risk 5; 95% CI, 1.3 to 19), and exposure to epipodophyllotoxins and anthracyclines. The risk of leukemia increased regularly with the cumulative dose of etoposide. In summary, patients who received between 1.2 and 6 g/m(2) of epipodophyllotoxins or more than 170 mg/m(2) of anthracyclines had a seven-fold higher risk (95% CI, 2.6 to 19) compared with patients who received lower doses or none of these drugs. The risk of leukemia in patients who received more than 6 g/m(2) of epipodophyllotoxins was multiplied by 197 (95% CI, 19 to 2,058). The risk of leukemia was not increased by exposure to alkylating agents or radiotherapy. CONCLUSION: Both epipodophyllotoxins and anthracyclines increase the risk of secondary leukemia. The current challenge is to minimize the mutagenic effects of these drugs by diminishing cumulative doses without losing the therapeutic benefits.

Adolescent↗
PubMed2003

[Frequency of cancer in France].

The most recent cancer mortality and morbidity data available for France are presented. In 1999, tumours are the first cause of death among men (87,000 deaths) and the second most common among women (57,000 deaths) after cardiovascular diseases. It is also the most common cause of death in both the male and female populations aged 35 to 74. Lung cancer is the most common cause of cancer death (21,000) in the male population, and breast cancer is the most common cause of death (11,000) in the female population. Cancer mortality rates decrease both in the male population since 1987 and in the female population since 1950, but the different sites present different trends. The total number of cancers diagnosed in 2000 is estimated to be equal to 260,000: 149,000 in the male population and 108,000 in the female population. The most frequent cancer sites are prostate among men (28,000 cases) and breast among women (37,000 cases), two sites for which screening activities are in widespread use.

Age Distribution↗
PubMed2003

[Hormone replacement therapy in menopause and risk of breast cancer].

Many studies have analysed the relation between hormone replacement therapy use and breast cancer risk. We performed a synthesis of their results based on a meta-analysis published in 1997, on fifteen observational studies published afterwards, and on a recent randomised trial. The accumulated evidence shows a higher risk of breast cancer among HRT ever users compared to non users. The risk increases with treatment duration and disappears a few years after the end of the treatment. Furthermore, recent observational studies showed that this risk may be higher when progestational agents are added to estrogens than when estrogens are used alone. This may be important in terms of public health since combination therapy with estrogen and progestational agents have become the standard of care among women with an intact uterus and are now commonly used. The effects of the treatments used in France, that are not those widely studied until now, must be evaluated, ideally through a randomized trial.

Aged↗
PubMed2003

[Breast cancer screening after age 70].

Today, mammographic screening for breast cancer is recommended in France in the female population age 50 to 74. This recommendation is based on the analysis of all randomised studies. However, the available data show the risk of cancer to increase markedly with age. One excludes therefore from the screening programme, the women who are most likely to present with breast cancer. Should not one consider screening among older women?

Age Factors↗
PubMed2002

Modeling the atmospheric transport and deposition of PCDD/F to the Great Lakes.

Atmospheric deposition is a significant loading pathway for polychlorinated dibenzo-p-dioxins and dibenzofurans (dioxin) to the Great Lakes. An innovative approach using NOAA's HYSPLIT atmospheric fate and transport model was developed to estimate the 1996 dioxin contribution to each lake from each of 5,700 point sources and 42,600 area sources in a U.S./Canadian air emissions inventory. These unusually detailed source-receptor modeling results show that deposition to each lake arises from a broad geographical region, with significant contributions from up to 2,000 km away. The source categories contributing most significantly to 1996 dioxin deposition appear to be municipal waste incineration, iron sintering, medical waste incineration, and cement kilns burning hazardous waste. Model-predicted air concentrations and deposition fluxes were consistent with ambient measurement data, within the uncertainties in each, but there may be a moderate tendency toward underestimation using midrange emissions estimates. The most likely reason for this tendency appears to be missing or underestimated emissions sources, but in-situ atmospheric formation of octachlorinated dibenzo-p-dioxin (OCDD) and heptachlorinated dibenzo-p-dioxin (HpCDD) may have also contributed. Despite uncertainties, the findings regarding the relative importance of different sources types and source regions appear to be relatively robust and may be useful in prioritizing pollution prevention efforts.

Air Movements↗
PubMed2002

A graphical method for exploring heterogeneity in meta-analyses: application to a meta-analysis of 65 trials.

Heterogeneity can be a major component of meta-analyses and by virtue of that fact warrants investigation. Classic analysis methods, such as meta-regression, are used to explore the sources of heterogeneity. However, it may be difficult to apply such a method in complex cases or in the absence of an a priori hypothesis. This paper presents a graphical method to identify trials, groups of trials or groups of patients that are sources of heterogeneity. The contribution of these trials to the overall result can also be evaluated with this method. Each trial is represented by a dot on a 2D graph. The X-axis represents the contribution of the trial to the overall Cochran Q-test for heterogeneity. The Y-axis represents the influence of the trial, defined as the standardized squared difference between the treatment effects estimated with and without the trial. This approach has been applied to data from the Meta-Analysis of Chemotherapy in Head and Neck Cancer (MACH-NC) comprising 10,850 patients in 65 randomized trials. The graphical method allowed us to identify trials that contributed considerably to the overall heterogeneity and had a strong influence on the overall result. It also provided useful information for the interpretation of heterogeneity in this meta-analysis. The proposed graphical method identifies trials that account for most of the heterogeneity without having to explore all possible sources of heterogeneity by subgroup analyses. This method can also be applied to identify types of patients that explain heterogeneity in the treatment effect.

Clinical Trials as Topic↗
PubMed2002

Prediction of the long-term survival in breast cancer patients according to the present oncological status.

After a breast cancer diagnosis, single or multiple events can occur during follow-up (recurrence, metastasis, and death). An analysis of long-term survival should take into account not only the initial characteristics of the patient, but also her oncological status (that is, her history) after surgery. For this purpose, we used a technique proposed by Klein, Keiding and Copelan (1994), to predict the probability of a patient being alive 20 years after surgery for a breast cancer, based on data concerning her oncological status at time t. The first step of the model was to estimate the hazard function for each event of interest (recurrence, metastasis, and death) in a Cox model including initial patient characteristics (age, tumour size, number of involved axillary lymph nodes and the Scarff, Bloom and Richardson (SBR) histo-prognostic grade) and time-dependent covariates representing the occurrence of intermediate events (recurrence and metastasis). The second step was to use these estimations to calculate the conditional probability of being alive 20-t years later for a patient, given her oncological status at time t (t<10 years). In this second step, the method presented by Klein, Keiding and Copelan was extended to include non-proportional hazards. This model has been applied to a population of 3180 patients operated on for a breast cancer at the Institut Gustave Roussy between 1 January 1954 and 31 December 1983. At the time of surgery, the probability of survival at 20 years is 0.78 for all patients. Ten years after surgery, if no recurrence or metastasis are observed, the probability of survival at 20 years will rise to 0.89. If only a recurrence is observed, the probability of a patient being alive at 20 years will drop to 0.72. If a metastasis and no recurrence is observed, the probability of survival at 20 years will be only 0.18. If both recurrence and metastasis are observed the probability of survival at 20 years will be equal to 0.09. In conclusion, the model used dynamically appraises the prognosis and represents a new approach for studying the outcome of breast cancer patients having undergone surgery.

Adult↗
PubMed2002

[The method of conducting randomized trials in cancerology must be changed].

Most new treatments in oncology lead to modest improvements. To demonstrate these moderate progresses, trials ought to be much larger than what is currently done. The results of the small trials presently published do not represent reliable information but reflect the play of chance. To solve the problem, much larger trials are required. These trials need to be much simpler, for instance by giving up restrictive inclusion criteria. It is often stated that the patient population in a trial must be "homogeneous". This is a mistake : the population of trial patients must be the population of patients for whom the therapeutic question is relevant. Any a priori restriction in the population included in the trial gives up all hopes to evaluate the treatment in practical situations. In the mean time, while we are waiting for the required large trials, we can gather the data from several trials of the same question in a meta-analysis.

Humans↗
PubMedDate not supplied

Prediction of cancer outcome with microarrays: a multiple random validation strategy.

BACKGROUND: General studies of microarray gene-expression profiling have been undertaken to predict cancer outcome. Knowledge of this gene-expression profile or molecular signature should improve treatment of patients by allowing treatment to be tailored to the severity of the disease. We reanalysed data from the seven largest published studies that have attempted to predict prognosis of cancer patients on the basis of DNA microarray analysis. METHODS: The standard strategy is to identify a molecular signature (ie, the subset of genes most differentially expressed in patients with different outcomes) in a training set of patients and to estimate the proportion of misclassifications with this signature on an independent validation set of patients. We expanded this strategy (based on unique training and validation sets) by using multiple random sets, to study the stability of the molecular signature and the proportion of misclassifications. FINDINGS: The list of genes identified as predictors of prognosis was highly unstable; molecular signatures strongly depended on the selection of patients in the training sets. For all but one study, the proportion misclassified decreased as the number of patients in the training set increased. Because of inadequate validation, our chosen studies published overoptimistic results compared with those from our own analyses. Five of the seven studies did not classify patients better than chance. INTERPRETATION: The prognostic value of published microarray results in cancer studies should be considered with caution. We advocate the use of validation by repeated random sampling.

Gene Expression Profiling↗
PubMedDate not supplied

Multi-detector row CT and postprocessing techniques in the assessment of diffuse lung disease.

Many acute and chronic lung diseases are characterized by diffuse infiltration of the lung parenchyma. High-resolution computed tomography (CT) has been widely accepted as the imaging standard of reference for the assessment of these diseases. However, only approximately 10% of the lung parenchyma is scanned with high-resolution CT, and characteristic foci of disease may be missed. With use of the established characteristic high-resolution CT patterns, multi-detector row chest CT has revolutionized the evaluation of diffuse lung disease. Multi-detector row CT generates isotropic volumetric high-resolution data, allowing contiguous three-dimensional (3D) visualization of the lung parenchyma, with the capacity to create high-quality two-dimensional (2D) and 3D reformatted images. Minimum intensity projection is the postprocessing technique of choice for the detection and characterization of most patterns of diffuse lung disease. Maximum intensity projection (MIP) allows the detection and characterization of micronodules; the recognition of enlarged pulmonary veins, which is extremely useful in the diagnosis of pulmonary edema and the assessment of mosaic perfusion; and differentiation between perilymphatic, miliary, and centrilobular distribution. MIP can also help differentiate between constrictive bronchiolitis and mixed emphysema. Two-dimensional reformatted images are now of equal importance with the 2D axial images in diagnosing specific diffuse lung diseases. In the future, 3D reformatted images may be used to help quantify these disorders.

Adult↗