Search PubMed⌕ Search

Biomedical subjects

H A Guess

Publications and source records attributed to H A Guess.

At least 55 records · Page 3Linked to original sources
PubMed1995

A brief male sexual function inventory for urology.

OBJECTIVES: To develop a brief questionnaire to measure male sexual function. METHODS: An initial set of questions was refined and reduced through cognitive testing and two serial validation studies. In each study, men were recruited from a sexual dysfunction clinic and a general medicine practice to complete the instrument. Test-retest reliabilities, internal consistencies, and construct validities were examined. RESULTS: The final instrument covers sexual drive (two items), erection (three items), ejaculation (two items), perceptions of problems in each area (three items), and overall satisfaction (one item). Psychometric performance was generally very satisfactory, although self-assessments of ejaculate volume are problematic. Translations have been developed and pilot tested in a number of languages. CONCLUSIONS: The Brief Sexual Function Inventory may be useful for measuring male sexual function in practice and research.

Coitus↗
PubMed1995

Validation of the Minimum Data Set Cognitive Performance Scale: agreement with the Mini-Mental State Examination.

BACKGROUND: Almost all nursing homes in the United States are required by the 1987 Omnibus Budget Reconciliation Act to assess each resident's functional, medical, psychosocial, and cognitive status using a standard instrument known as the Minimum Data Set (MDS). We report a validation study to show that the MDS Cognitive Performance Scale (CPS), a cognitive measure generated from 5 MDS items (comatose status, decision making, short-term memory, making self understood, and eating) can be used to detect cognitive impairment as defined by the Mini-Mental State Examination (MMSE). METHODS: Two hundred subjects were randomly recruited from 8 nursing home facilities in North Carolina. Two medical students administered the MMSE, while a geriatric research nurse was responsible for collecting MDS cognitive items, which included the 5 items required for generating CPS scores. Cognitive impairment was defined by MMSE scores adjusted for education. Agreement between the CPS and the MMSE in identifying cognitively impaired subjects was then evaluated. RESULTS: The CPS showed substantial agreement with the MMSE in the identification of cognitive impairment; the sensitivity was .94 (95% confidence interval [CI]: .90, .98), the specificity was .94 (95% CI: .87, .96), and the diagnostic accuracy as measured by the area under the receiver operating characteristics (ROC) curve was .96 (95% CI: .88, 1.0). CONCLUSIONS: The MDS Cognitive Performance Scale, when performed by a trained research nurse using recommended protocols, provides a valid measure of cognitive status in nursing home residents.

Aged↗
PubMed1995

Using repeated measures of symptom score, uroflowmetry and prostate specific antigen in the clinical management of prostate disease. Benign Prostatic Hyperplasia Treatment Outcomes Study Group.

Measurements of American Urological Association symptom score, peak urine flow rate and prostate specific antigen (PSA) are often followed over time in urological management. However, their interpretation is confounded by within-patient variability due to chance. Data from 2 clinical trials are used to examine the magnitude of this variation. When these measures are repeated at a short interval variation is modest and might easily be misinterpreted as a true change in patient condition. For example, approximately 20% of patients might be expected to have a chance increase or decrease in symptom score by at least 4.9 points, in peak urine flow rate by at least 4.1 ml. per second or in PSA by at least 1.6 ng./ml. Clinicians can use these data to help interpret repeated measures of these variables in patients, and can consider obtaining paired measurements to decrease the effect of chance variation when they plan on following them over time.

Aged↗
PubMed1995

Prevalence of prostatism in Japanese men in a community-based study with comparison to a similar American study.

PURPOSE: We estimate the prevalence of urinary symptoms in Japanese men. MATERIALS AND METHODS: A total of 289 eligible residents 40 to 79 years old completed a questionnaire with questions worded similarly to those of the international prostate symptom score (response rate 42%). RESULTS: The ratio of moderate-to-severe symptoms was 41%, 29%, 31% and 56% for each age decade from ages 40 to 79 years, respectively, after adjusting for nonresponse. Within each age decade the median international prostatic symptom score was higher for Japanese men than for United States men with little difference in rates of increase with participant age or bother. CONCLUSION: Lower urinary tract symptoms were common in Japanese men, with age-related increases similar to those of United States men.

Adult↗
PubMed1995

Serum prostate-specific antigen in a community-based population of healthy Japanese men: lower values than for similarly aged white men.

OBJECTIVE: To determine whether the age-specific reference ranges for serum prostate-specific antigen (PSA) concentration generated for white men are applicable to other races. PATIENTS AND METHODS: Three-hundred and thirty-five healthy Japanese men, aged 40-79 years, residing in the small fishing village of Shimamaki-mura, Japan, agreed to enter this prospective, community-based study. All underwent a detailed clinical evaluation that included a serum PSA determination, a digital rectal examination and a transrectal ultrasound. Two-hundred and eighty-six (85%) completed the prostatic evaluation and had no evidence of prostate cancer by any one of the three diagnostic tests; these men formed the study population on which all analyses were performed. RESULTS: The serum PSA concentration correlated directly with patient age (r = 0.33; P < 0.001) and prostatic volume (r = 0.57; P < 0.001). PSA density (PSAD) also was directly proportional to age (r = 0.30; P < 0.001). Adjusting for age, the serum PSA concentration was lower for Japanese men than for white men (P < 0.001). Thus, the recommended age-specific reference ranges (95th percentile) for serum PSA for Japanese were lower as well: 0.0-2.0 ng/mL for 40-49 years; 0.0-3.0 ng/mL for 50-59 years; 0.0-4.0 ng/mL for 60-69 years; and 0.0-5.0 ng/mL for 70-79 years. Based on transrectal ultrasound-volume determinations, the lower serum PSA concentrations in Japanese men are due in large part to their smaller prostate glands as compared with white men (P < 0.001). CONCLUSIONS: These findings confirm the earlier observations that serum PSA, prostatic volume and PSAD are age-dependent. However, because of physiological differences among the two races, partly due to the size of the prostate gland, the age-specific reference ranges for serum PSA are lower for Japanese men than for white men. Because of these racial differences, it is now crucial to conduct a similar investigation among black men.

Adult↗
PubMed1995

Sexual function of men ages 40 to 79 years: the Olmsted County Study of Urinary Symptoms and Health Status Among Men.

OBJECTIVES: Knowledge of male sexual function is somewhat limited because of a lack of current population-based data. This study provides information on sexual function and satisfaction in a population-based sample of men. METHODS: Men aged 40 to 79 years (n = 2115) were selected randomly from the Olmsted County population for the baseline component of a prospective cohort study (the Olmsted County Study of Urinary Symptoms and Health Status Among Men) during 1989-1990. The men completed a self-administered questionnaire that included questions about sexual concerns, performance, satisfaction, drive, and erectile dysfunction. RESULTS: For all five sexual parameters queried, the prevalence of problems and dysfunction increased with age. A comparison of men aged 70 to 79 years with men aged 40 to 49 years suggested that older men were more worried about sexual function (46.6% vs 24.9%), had worsened performance compared with a year ago (30.1% vs 10.4%), expressed extreme dissatisfaction with sexual performance (10.7% vs 1.7%), had absent sexual drive (25.9% vs 0.6%), and reported complete erectile dysfunction when sexually stimulated (27.4% vs 0.3%). Logistic regression analyses suggested that sexual dissatisfaction was significantly associated with erectile dysfunction, decreased libido, and the interaction between erectile dysfunction and libido, but not age. CONCLUSIONS: These population-based cross-sectional data corroborate the previously reported age-related decrease in sexual function. The age-related increase in dissatisfaction could, however, be accounted for primarily by the age-related increase in erectile dysfunction, decreased libido, and the interaction between erectile dysfunction and decreased libido.

Adult↗
PubMed1995

The role of community-based longitudinal studies in evaluating treatment effects. Example: benign prostatic hyperplasia.

To determine the appropriateness and effectiveness of medical interventions, it is necessary to understand both the natural history of the conditions the interventions are intended to treat or prevent, and the normal reference ranges of tests used in diagnosis and management. The acquisition of this information through clinic-based studies can yield misleading conclusions owing to selection bias. What appears to be intervention-related variation in outcomes may be variation in the magnitude and form of selection bias. To minimize selection bias, population-based studies are required. Results from the Olmsted County Study of Urinary Symptoms and Health Status Among Men were used to show how a population-based longitudinal study of the natural history of benign prostatic hyperplasia (BPH) can complement research programs of the BPH Patient Outcomes Research Team. Population-based studies of disease natural history are a necessary part of medical outcomes research, and deserve greater emphasis in the medical treatment effectiveness research initiative of the Agency for Health Care Policy and Research.

Community Health Planning↗
PubMed1995

Epidemiology and natural history of benign prostatic hyperplasia.

Clinical manifestations of BPH include the symptoms, signs, and sequelae of urinary obstruction caused by the abnormal growth of non-malignant nodules that arise in a small region around the proximal segment of the prostatic urethra. Although the pathologic diagnostic criteria are relatively specific, clinical diagnostic criteria are much less specific, and no single BPH case definition has gained wide acceptance for use in epidemiologic studies.

Humans↗
PubMed1994

Reduction in burden of illness: a new efficacy measure for prevention trials.

A new efficacy measure is developed for use in prevention trials of interventions which may affect both disease incidence and disease severity. We assign a severity score to each incident case and sum severity scores over all incident cases within each treatment group to create a burden-of-illness score for each treatment group. Efficacy is evaluated by the difference between the burden-of-illness per randomized subject in the two randomized treatment groups. Since the numbers of summands in each burden-of-illness score is a random variable, standard methods of analysis are not directly applicable. The asymptotic distribution and sampling properties of the net reduction in the burden-of-illness score are derived for trials designed to stop either after a fixed length of follow-up or after the occurrence of a fixed number of cases. We illustrate the method with data from a clinical trial of a human rotavirus vaccine.

Data Interpretation, Statistical↗
PubMed1994

Prostate cancer in Rochester, Minnesota (USA), from 1935 to 1989: increases in incidence related to more complete ascertainment.

Prostate cancer incidence among White men in the United States climbed steadily from 45 per 10(5) person-years (PY) during 1945-54 to 102 per 10(5) PYs in 1988. To determine whether this increase might be the result of changing diagnostic practices, we examined trends in incidence and method of diagnosis in Rochester, Minnesota (US), from 1935 to 1989. We found a parallel increase in Rochester in non-autopsy diagnoses from 44 (95 percent confidence interval [CI] = 29-58) cases per 10(5) PYs in 1935-44 to 71 (CI = 52-89) cases per 10(5) PYs in 1985-87 which was driven by diagnoses prompted by digital rectal examination. There was no evidence that an increasing proportion of cases was found as the result of procedures to treat the symptoms of benign prostatic hyperplasia. Including autopsy diagnoses, incidence was stable over this extended interval and was 77 per 10(5) PYs (CI = 58-97) in 1935-44 and 72 per 10(5) PYs (CI = 53-91) in 1985-87. Incidence more than doubled after introduction of diagnostic serum prostate-specific antigen (PSA) assay and was 179 per 10(5) PYs (CI = 145-214) in 1988-89. We conclude that prostate-cancer incidence rates are influenced strongly by diagnostic practices and that national increases could reflect, to a large extent, more complete and earlier ascertainment rather than more frequent disease.

Adult↗
PubMed1994

Cigarette smoking and prostatism: a biphasic association?

OBJECTIVE: To evaluate the association between cigarette smoking and prostatism in a community-based setting using standardized urinary symptom scores, peak urinary flow rates, and prostatic volume as indicators of disease. METHODS: A population-based cohort of 2,115 Caucasian men aged forty to seventy-nine years from Olmsted County, Minnesota, was administered a previously validated questionnaire that elicited information on frequency of urinary symptoms (approximating the American Urological Association's symptom index), and a detailed history on cigarette smoking, including both amount and pack-years of smoking. Peak urinary flow rates were measured by a standard uroflowmeter (Dantec 1000). The prostatic volume was measured for a subsample of 471 men by transrectal ultrasound. RESULTS: Compared to never-smokers, smokers were less likely to have moderate to severe urinary symptoms (age-adjusted odds ratio 0.82; 95% confidence interval [CI] 0.61 to 1.08). This varied by smoking intensity, however; in men who smoked less than 1 pack a day the age-adjusted odds ratio was 0.53 (95% CI 0.33 to 0.83) and among men smoking 1 to 1.4 packs a day, the odds ratio was 0.87 (95% CI 0.56 to 1.36). For men who smoked 1.5 packs or more a day, the odds ratio was elevated at 1.32 (95% CI 0.84 to 2.07). Smokers were less likely to have peak flow rates less than 15 mL/sec compared with never-smokers (age- and voided volume-adjusted odds ratio 0.48; 95% CI 0.35 to 0.66), or prostatic volume greater than 40 mL (odds ratio 0.54; 95% CI 0.19 to 1.55). CONCLUSIONS: These data from a community-based sample suggest that light or moderate smokers are less likely to have moderate to severe prostatism, whereas heavy smokers are at least as likely to have moderate to severe prostatism compared with never-smokers.

Adult↗
PubMed1994

Effect of several recruitment strategies on response rates at baseline in a prospective cohort investigation. The Olmsted County Study of Urinary Symptoms and Health Status among Men.

Epidemiologic survey response rates were studied in relation to maneuvers introduced to improve acceptance: (a) variation in invitation letters, (b) the use of a brochure with the recruitment mailing, and (c) options for interview location. The baseline population-based survey of a prospective cohort investigation of the natural history of benign prostatic hyperplasia was used. Invitations to participate were mailed to eligible, randomly selected men aged 40 to 79 years from the Olmsted County, Minnesota, population during 1989 to 1991. Of the 3874 men identified, 2119 (55%) participated. Overall, there was no difference in response rate according to invitation characteristics (chi 2(5) = 8.02, P = 0.16). Nevertheless, response rates varied with age (chi 2(7) = 30.9, P < 0.001) and home location (rural versus Rochester city; chi 2(1) = 76.9, P < 0.001). This suggests the innovations used to bolster acceptance did not materially improve response rates. Further, since response rates were highest for men aged 60 to 74 years, men with more symptoms and free time may have joined the cohort more often than others.

Adult↗
PubMed1994

Natural history of prostatism: impact of urinary symptoms on quality of life in 2115 randomly selected community men.

OBJECTIVES: To assess the impact of urinary symptoms on health-related quality of life (QoL), including degree of bother, worry, interference with daily activities, psychological well-being, sexual function, and general health in a community-based cohort of men. METHODS: Eligible white men (n = 2115) aged 40 to 79 years who had not undergone previous prostate surgery or had prostate cancer were randomly selected from county residents. These subjects completed a questionnaire, which asked them about frequency and bother of urinary symptoms, interference with daily activities, psychological well-being, worry about urologic disease, sexual functioning, and general health. RESULTS: Men with moderate to severe voiding symptoms reported, on average, four to six times the degree of bother and interference with daily activities and twice the level of worry of men with mild symptoms. Nearly five times the degree of bother and interference was reported for those with mild than with no symptoms. A higher percentage of men with moderate to severe symptoms (26% to 33%) than mild symptoms (< 8%) reported limiting fluids before bed, travel, or driving 2 hours. Receiver operating characteristic curves support the recommended symptom index cutpoint for moderate symptoms (= 8) by differentiating men with and without bother, interference with daily living, or dissatisfaction with urinary condition. CONCLUSIONS: Moderate to severe urinary symptoms have a significant impact on men's lives in terms of degree of bother, worry, interference with daily living, and psychological well-being. The recommended cutpoint on symptom index differentiates men with and without decrement in health-related quality of life.

Activities of Daily Living↗
PubMed1994

The natural history of prostatism: the effects of non-response bias.

BACKGROUND: In epidemiological studies, non-response may raise the question of generalizability to the target population. Most investigations have not been able to access data that could provide information about the potential impact of non-response bias. METHODS: A 55% response rate was realized at baseline for a prospective cohort investigation of the natural history of benign prostatic hyperplasia in Olmsted County, Minnesota, during 1989-1991 (the Olmsted County Study of Urinary Symptoms and Health Status Among Men). This prompted a preliminary study of potential non-response bias among full participants, partial participants and complete non-responders. The medical diagnostic index maintained by the Rochester Epidemiology Project was used to ascertain the prevalence of specific conditions in the 9 years prior to study inception. RESULTS: The age-adjusted period prevalence rate for benign prostatic hyperplasia (%) was 9.6 (95% confidence interval [CI]: 8.1-11.0) for full participants, 8.2 (95% CI: 5.8-10.6) for partial participants and 5.3 (95% CI: 3.6-6.9) for complete non-responders. Other urologic diagnoses followed the same pattern. However, age-adjusted prevalence rates for general medical examination history and major non-urologic morbidities were decidedly similar across response groups. CONCLUSIONS: These data suggest response may have been driven, in part, by concerns about urologic disease. However, the similarity in non-urologic diagnoses and general medical examinations provide some preliminary reassurance that the 55% response rate did not necessarily compromise generalizability.

Adult↗
PubMed1994

The MDS Cognition Scale: a valid instrument for identifying and staging nursing home residents with dementia using the minimum data set.

OBJECTIVE: We report the development and validation of an MDS-based cognitive index, the MDS Cognition Scale (MDS-COGS), by evaluating it against two popular dementia rating scales, the Global Deterioration Scale (GDS) and the Mini-Mental State Examination (MMSE). DESIGN: A Cross-sectional study. PARTICIPANTS: Two hundred nursing home residents. MEASUREMENTS: Each study participant was assessed on the GDS and the MMSE by trained medical students. At the same time, but independent of the medical students, a geriatric nurse completed the Minimum Data Set (MDS) instrument on each participant. MAIN RESULTS: The Cognitive Performance Scale (CPS), a categorical measure of cognition that uses MDS items, was compared with the GDS in 133 subjects, using a split-sample technique. The GDS was found to be more appropriate as a 4-stage than a 7-stage scale, with GDS stages 1-4 acting as a single stage. The CPS showed very poor percent agreement with GDS stages 5 and 7 (50% or less) and, therefore, was revised by adding other MDS predictors. The new instrument, designated MDS-COGS, is a 0-10 point scale generated from eight MDS cognitive items. The MDS-COGS was then validated against the 4-stage GDS and MMSE in the remaining 67 nursing home residents. Chance-corrected agreement (kappa) between the MDS-COGS and GDS in the 67 subjects was 0.80 (95% CI = 0.70, 0.88), and percent agreement with GDS stages 5 and 7 was 60% and 85%, respectively. The MDS-COGS was also demonstrated to be a valid measure of cognitive impairment as defined by the MMSE, with sensitivity, specificity, chance-corrected agreement (kappa), and area under the ROC curve, all above 0.80. CONCLUSIONS: The MDS Cognition Scale, the MDS-COGS, provides a valid measure of the presence and severity of cognitive impairment in nursing home residents using items from the Minimum Data Set.

Aged↗
PubMed1994

The natural history of benign prostatic hyperplasia: implications for patient care and clinical trial design.

Benign prostatic hyperplasia (BPH) is a nearly universal concomitant of male aging, yet its natural history is largely undocumented. Most information on the clinical course of untreated prostatism has come from a limited number of studies. This lack of information makes it difficult for urologists to know when, how, and in whom to intervene. This is reflected by the controversy surrounding surgical indications and by the considerable variability in rates of prostatectomy. Over the last 2 years, information on the natural history of BPH has been obtained from analyses of limited data from long-term, general-purpose, government-sponsored prospective studies of human aging. This paper briefly reviews these studies and discusses implications for patient care decisions and clinical trial design.

Aging↗
PubMed1994

Incidence of cluster headaches: a population-based study in Olmsted County, Minnesota.

The epidemiology of cluster headache is virtually unknown. Using the unique resources of the Rochester Epidemiology Project for population-based studies, we identified 26 Olmsted County, Minnesota, residents who fulfilled the International Headache Society criteria for newly diagnosed cluster headache between 1979 and 1981. As part of a large study of migraine and cluster headache, we screened more than 6,400 patient records from several diagnostic rubrics to obtain this cohort, accomplished case ascertainment exclusively through medical record review, and assigned diagnoses by the consensus of two neurologists. The age-adjusted incidence was 15.6 per 100,000 person-years (p-y) (95% CI, 8.9 to 22.3) for males and 4.0 per 100,000 p-y for females (95% CI, 0.4 to 7.6). The overall age- and sex-adjusted incidence was 9.8 per 100,000 p-y (95% CI, 6.0 to 13.6) or approximately 1/25 that of migraine. The peak incidence was among men aged 40 to 49 years and women 60 to 69 years. There was a higher than expected prevalence of history of smoking among males with cluster headaches (p < 0.05), supporting the possibility that smoking predisposes to the development of cluster headaches in men.

Adolescent↗