Empirical and fully Bayes estimation of small area disease risks places a prior distribution on area-specific risks. Several forms of priors have been used for this purpose including gamma, log-normal and non-parametric priors. Spatial correlation among area-specific risks can be incorporated in log-normal priors using Gaussian Markov random fields or other models of spatial dependence. However, the criterion for choosing one prior over others has been mostly logical reasoning. In this paper, we evaluate empirically the various priors used in the empirical Bayes estimation of small area disease risks. We utilize a Spanish mortality data set of a 12-year period to give the underlying true risks, and estimate the true risks using only a 3-year portion of the data set. Empirical Bayes estimates are shown to have substantially smaller mean squared errors than Poisson likelihood-based estimates. However, relative performances of various priors differ across a variety of mortality outcomes considered. In general, the non-parametric prior provides good estimates for lower-risk areas, while spatial priors provide good estimates for higher-risk areas. Ad hoc composite estimates averaging the estimates from the non-parametric prior and those from a spatial log-normal prior appear to perform well overall. This suggests that an empirical Bayes prior that strikes a balance between these two priors, if one can construct such a prior, may prove to be useful for the estimation of small area disease risks.

Adult↗

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Intraperitoneal seeding of ruptured hepatocellular carcinoma: case report.

We report a solitary intraperitoneal recurrence in a long-term survivor after rupture of hepatocellular carcinoma. Ultrasonography demonstrated the finding of a lobulated mass with a "mosaic" appearance. The patient underwent resection of this implant and is currently disease free. We emphasize the importance of periodic surveillance of disseminated metastases of this condition.

Aged↗

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How women label and respond to symptoms of acute myocardial infarction: responses to hypothetical symptom scenarios.

OBJECTIVE: To investigate how women label and intend to respond to common and less common symptoms of acute myocardial infarction (AMI). DESIGN: Telephone interviews were conducted with 862 women older than age 50 years in the state of Washington. OUTCOME MEASURES: Intended coping strategies, labeling of hypothetical symptoms, perceived risk of AMI, knowledge of AMI symptoms, medical and family history of AMI and demographics. RESULTS: Women who labeled common or less common symptoms as a heart attack (65% and 36%, respectively) were more likely to report they would call 911 or go to a hospital right away than women who labeled these symptoms as something else. The results of a multiple logistic regression analysis suggests that knowledge of less common AMI symptoms, AMI information seeking, and personal risk perceptions were significant predictors of labeling less common symptoms as a heart attack. CONCLUSIONS: The findings suggest that many women might be in danger of mislabeling their symptoms and not taking appropriate action. Women need to be educated about the less common symptoms of AMI and need to be encouraged to seek out information regarding AMI.

Adaptation, Psychological↗

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Use of disposable stapler in operative cystogastrostomy for pancreatic pseudocyst.

Surgical stapling techniques are widely used in gastrointestinal surgery. These procedures are excellent in convenience and safety. We describe here a new practical application of the surgical disposable stapler, Auto Suture Premium Plus CEEA 34 circular stapler, for the operative drainage of a large symptomatic pancreatic pseudocyst. A 68 year-old man underwent an operative cystogastrostomy using this instrument. His post-operative recovery was uneventful. He is free from symptoms, and abdominal tomography shows complete disappearance of the cystic cavity. We believe that this is the first clinical paper that reports on the stapled cystogastrostomy. This instrument is very useful for creating a stapled cystogastrostomy, similar to one created in the standard open approach.

Aged↗

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Cyclophosphamide, epirubicin, vincristine, prednisone, bleomycin, etoposide (CEOP-BE) therapy for intermediate- and high-grade non-Hodgkin's lymphomas.

To improve the response and decrease toxicity of the treatment non-Hodgkin's lymphomas, a prospective single-arm trial was initiated using cyclophosphamide, epirubicin, vincristine, prednisone, bleomycin, eoposide (CEOP-BE). From March 1994 to August 1997, 29 previously untreated patients with intermediate- or high-grade non-Hodgkin's lymphomas, stage II to IV, were included in the study. Complete remissions (CR) were observed in 26 patients. The 4-year overall survival (OS) was 71.3%, and the 4-year disease free survival (DFS) was 61.8%. Recurrences occurred in 11 of 26 patients. Seven of 11 patients with recurrences showed bone marrow or other extranodal lesions. CEOP-BE is an active and feasible regimen for most patients with intermediate- and high-grade non-Hodgkin's lymphomas.

Adult↗

PubMedDate not supplied

Pap Testing Stages of Adoption among Cambodian Immigrants.

PURPOSE: We examined levels of Pap testing and factors associated with screening participation among Cambodian refugees. METHODS: A community-based, in-person survey was conducted in Seattle during late 1997 and early 1998. Interviews were completed by 413 women; the estimated response rate was 73%. We classified respondents into four Pap testing stages of adoption: precontemplation/contemplation (never screened), relapse (ever screened but did not plan to be screened in the future), action (ever screened and planned to be screened in the future), and maintenance (recently screened and planned to be screened in the future). Bivariate and multivariate techniques were used to examine various factors. FINDINGS: About one-quarter (24%) of the respondents has never been screened, and a further 22% had been screened but did not plan to obtain Pap tests in the future. Fifteen percent were in the action stage and 39% were in the maintenance stage. The following factors were independently associated with cervical cancer screening stages: previous physician recommendation; younger age; beliefs about Pap testing for post-menopausal women, screening for sexually inactive women, and regular checkups; provider ethnicity; prenatal care in the US; and problems finding interpreters. CONCLUSIONS: Our findings confirm low Pap testing rates among Cambodian immigrants, and suggest that targeted interventions should be multifaceted.

Journal Article↗

PubMedDate not supplied

Facilitators and barriers to cervical cancer screening among Chinese Canadian women.

BACKGROUND: Chinese Canadian women have higher cervical cancer incidence, and lower Pap testing, rates than the general Canadian population. Predisposing, enabling and reinforcing factors associated with ever having a Pap test, and having a recent Pap test within the last 2 years, were assessed in Chinese women in British Columbia using the PRECEDE-PROCEED model. METHOD: Chinese women (n=512) between the ages of 20 and 79 years and residing in Greater Vancouver were interviewed about Pap testing, health care, traditional health beliefs, acculturation and sociodemographic characteristics. Two analyses were done, comparing women who had ever and never had a Pap test, and comparing women who had and had not received a recent Pap test. Focus groups and qualitative interviews ensured cultural sensitivity in the survey questionnaire. RESULTS: Seventy-six percent reported ever having a Pap test and 57% reported having a Pap test within the last 2 years. Traditional health beliefs were not associated with ever or recent Pap testing. However, belief that Pap testing prevented cancer and general knowledge about the Pap test were associated with screening. Concern about pain/discomfort with the test, availability of time, culturally sensitive health care services and recommendation for Pap testing by a physician were also associated with screening. Factors differed for ever, and recently, having a Pap test. INTERPRETATION: Pap testing is less common among Chinese Canadian women. Continuing education about Pap testing is recommended for physicians serving underscreened Chinese women. Culturally and linguistically appropriate educational materials are needed for the Chinese community.

Adult↗