PubMed · 7802807
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R C Etches. 1994. Patient satisfaction.. https://doi.org/10.1007/bf03015633
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BACKGROUND: Growth deficit has been reported as a frequent complication of the treatment of acute lymphoblastic leukemia (ALL). PROCEDURE: Longitudinal analysis of the growth of 129 children, from a total of 351 cases diagnosed between 1987 and 1994 in Brazil, was determined. Height data were converted into standard deviation Z scores. Only girls younger than 10 and boys younger than 12 years old at diagnosis were included. Patients were treated according to a German BFM-83 based protocol. Fifty-eight children received 18 Gy cranial irradiation, four 12 Gy, and two 24 Gy. Patients were aggregated into five non-excluding groups according to availability of height data at diagnosis, during the treatment, at the end of it, and several years after; 35 children reached their final height. RESULTS: Height deficit at the end of the therapeutic treatment was evident (P < 0.0001). Catch-up occurred 1 year after stopping treatment (P = 0.016). At the last follow-up, over 5 years after the end of treatment (n = 83) or at final height (n = 35), impressive height deficits were recorded (P < 0.0001 for both end points). Multivariate analysis demonstrated that growth impairment was more severe in children younger than 4 years at diagnosis and in those who received cranial irradiation. No significant effect of gender was observed. Children who were treated solely with chemotherapy also had significant height loss. CONCLUSIONS: Treatment of ALL in children is associated with growth deficit during the treatment and several years after it, affecting the final height negatively, particularly in patients younger than 4 and in those who received cranial irradiation.
UNLABELLED: The WHI was stopped prematurely because of an increased risk of breast cancer, stroke and cardiovascular diseases (CVD) in the hormone replacement therapy (HRT) arm of the trial. Changes in the use of HRT are expected. OBJECTIVE: To assess the impact of the Women's Health Initiative (WHI) publication on the rate of HRT prescription, and the clinical characteristics and persistence rate of new users and its determinants. METHODS: From the RAMQ databases, the total numbers of HRT prescriptions, and of new HRT's users were calculated between 2 January 1998 and 31 May 2003. To assess the clinical characteristics of women, two retrospective cohorts of new HRT's users were constructed before (pre-WHI) and after (post-WHI) the WHI study publication. The persistence rate after 1 year of follow-up was estimated using a Kaplan-Meier analysis. Cox regression models were used to estimate the rate ratio of HRT cessation. RESULTS: The total numbers of HRT users and of new users declined respectively by 28% and 50% in post-WHI. The standard dosage of HRT was significantly less used, while the proportion of women with risk factors of CVD or at very high risk of coronary artery disease (CAD) did not change. The rate of persistence in the pre-WHI cohort was 59% compared to 45% in the post-WHI (p < 0.0001), and women with risk factors of CVD or at very high risk of CAD were less likely to cease their HRT. CONCLUSION: One year after publication, significant changes had already occurred in the trends of use, women's characteristics and estrogen dosage. No change in the proportion of new users with CVD risk factors or at very high risk of CAD was seen.
AIM: To describe the expected fluctuation in the mean deviation (MD) scores on a large, long-term series of stable visual field reports for particular grades of defect in order to give clinicians an aid to the correct diagnosis of glaucomatous progression. METHOD: Visual field reports of subjects with five reliable consecutive Humphrey 24-2 visual fields, recorded over a period of at least 3 years, were scored using the Advanced Glaucoma Intervention Study (AGIS) system. The AGIS scores of the first and last visual fields were required to be identical. RESULTS: A total of 202 eyes from 202 patients were used in the study, with a total of 1010 visual fields being used in the analysis. Visual fields with no defect (AGIS score 0) had a 99% confidence interval (CI) of 0.3 dB, mild defects 0.4 dB, moderate defects 0.8 dB, severe 1 dB, and 1.3 dB for end-stage defects when considering variation of MD scores. Using a one-way ANOVA incorporating all stages showed very little fluctuation throughout the series (P=0.96). The correlation between the CI and grade of field defect showed a good positive correlation (r=0.7, P=0.0003) indicating an increase in CI as field defects worsen. CONCLUSION: When considering a series of reliable visual fields in a stable eye, one should expect only very little fluctuation in the MD, indicating that an increase in the MD beyond that of the 99% CI described may suggest progression. The reliability indices of the visual field test should be regarded as a primary consideration when assessing visual fields.