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PubMed1992

Combined chemotherapy and radiotherapy compared with radiotherapy alone in patients with cancer of the esophagus.

BACKGROUND: The efficacy of conventional treatment with surgery and radiation for cancer of the esophagus is limited. The median survival is less than 10 months, and less than 10 percent of patients survive for 5 years. Recent studies have suggested that combined chemotherapy and radiation therapy may result in improved survival. METHODS: This phase III prospective, randomized, and stratified trial was undertaken to evaluate the efficacy of four courses of combined fluorouracil (1000 mg per square meter of body-surface area daily for four days) and cisplatin (75 mg per square meter on the first day) plus 5000 cGy of radiation therapy, as compared with 6400 cGy of radiation therapy alone, in patients with squamous-cell carcinoma or adenocarcinoma of the thoracic esophagus. The trial was stopped after the accumulated results in 121 patients demonstrated a significant advantage for survival in the patients who received chemotherapy and radiation therapy. RESULTS: The median survival was 8.9 months in the radiation-treated patients, as compared with 12.5 months in the patients treated with chemotherapy and radiation therapy. In the former group, the survival rates at 12 and 24 months were 33 percent and 10 percent, respectively, whereas they were 50 percent and 38 percent in the patients receiving combined therapy (P less than 0.001). Seven patients in the radiotherapy group and 25 in the combined-therapy group were alive at the time of the analysis. The patients who received combined treatment had fewer local (P less than 0.02) and fewer distant (P less than 0.01) recurrences. Severe and life-threatening side effects occurred in 44 percent and 20 percent, respectively, of the patients who received combined therapy, as compared with 25 percent and 3 percent of those treated with radiation alone. CONCLUSIONS: Concurrent therapy with cisplatin and fluorouracil and radiation is superior to radiation therapy alone in patients with localized carcinoma of the esophagus, as measured by control of local tumors, distant metastases, and survival, but at the cost of increased side effects.

Adenocarcinoma↗
PubMed1998

Effects of a school-based smoking prevention program among subgroups of adolescents.

In autumn 1995 The Norwegian Cancer Society in cooperation with The Research Center for Health Promotion, University of Bergen started a study of school-based interventions aiming at preventing smoking among pupils in Norwegian secondary schools. The study comprised a nationwide sample of 4441 students at 99 schools (195 classes). This panel of students is followed through annual data collections till they graduate in spring 1997. Written consensus from students and parents was obtained from 95%. Schools were systematically allocated to one of four groups: Group A, control; Group B, intervention, containing classroom program, involvement of parents and teacher courses; Group C, like B, but without teacher courses; Group D, like B, but without parental involvement. Baseline data were collected by questionnaires administered in class in November 1994 and the first follow-up survey was carried out in May 1995. At follow-up the proportion of smokers had increased by 8.3 percentage points in Group A (control) and by 1.9 percentage points in Group B (most extensive intervention). As expected, the recruitment of smokers was higher in Groups C and D than in the ideal intervention, but lower than in the control group. Effects of the most extensive program among subgroups of students were examined by comparing Groups A and B. Students are categorized as high risk or low risk based on scores on scales measuring sensation seeking, physical maturity, antisocial behavior and parental smoking. The effect of the program on recruitment of smokers seems to have been at least as strong or even stronger among 'high-risk' students than among other students.

Adolescent↗
PubMed2002

Total costs and predictors of costs in individuals with early inflammatory polyarthritis: a community-based prospective study.

OBJECTIVE: To estimate the health service, non-health service and total costs and predictors of costs in individuals with early inflammatory polyarthritis (IP). METHODS: We conducted a prospective longitudinal study over a 6-month period. The participants were a random sample of 133 individuals who had enrolled with the community-based Norfolk Arthritis Register (NOAR) database between 1994 and 1999. The main outcome measures were the mean (per person) 6-month health service cost, non-health-service cost and total cost associated with IP. RESULTS: One hundred and fifteen of the 133 individuals who were recruited into the study completed 6 months of follow-up. The mean 6-month total cost was estimated to be 2800 pounds sterling per person, of which 14% was health service costs and the remainder non-health-service costs. Higher total costs were associated with lower health status and rheumatoid factor positivity. CONCLUSIONS: Early IP has a considerable impact on both the health-care system and, more importantly, society. Non-health-service costs (i.e. costs incurred by the individual with the disease, their family and friends) account for a substantial proportion (86%) of the total costs associated with early IP.

Adolescent↗
PubMed1991

We are all people living with AIDS: myths and realities of AIDS in Brazil.

Although AIDS was expected in Brazil, no serious efforts were undertaken to prevent AIDS from taking root. Irresponsible press and media coverage highlighted the spread of AIDS within the gay community of the United States, creating an aura of immunity in Brazil to what was characterized as a "foreign" disorder. When AIDS did surface in 1983, the official response was to adopt an abstract, inappropriate, and ideological "Western" model, in which only stigmatized "others" and "minorities" were at risk of HIV infection. Brazilian health authorities subsequently downplayed the significance of the sale of contaminated blood in HIV transmission, and likewise ignored the rising rates of AIDS among Brazil's one unarguable majority group: the poor. An analysis of efforts to force the "facts" of AIDS to fit a false model's predictions leads to a clearer definition of the broader context of the Brazilian epidemic: we all are people living with AIDS, precisely because we live in this age of AIDS; it is sheer folly to discriminate against persons infected by HIV and to obstruct their participation in efforts to curtail the epidemic's spread; and the necessary response to AIDS is solidarity, not because it is poetic, but because no other response will suffice.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Conflicting and cooperating cues: perception of cues to final consonant voicing by infants and adults.

Three experiments were conducted to ascertain the relative salience of two cues for final consonant voicing in infants and adults. Experiment 1 was designed to investigate infant perception of periodicity of burst, vowel duration, and the two cues combined in a cooperating pattern. Experiment 2 was designed to examine infant perception of these same cues but in a conflicting pattern, that is, with extended duration associated with the voiceless final plosive. Experiment 3 examined perception of the stimuli from Experiments 1 and 2 with adult subjects. Results indicate that in both adults and infants combined cues facilitate discrimination of the phonemic contrast regardless of whether the cues cooperate or conflict. The three experiments taken together do not support a phonetic interpretation of conflicting/cooperating cues for the perception of final stop consonant voicing. Potential psychoacoustic explanations are discussed.

Adult↗
PubMed1984

A randomized trial on the effect of decreased dietary sodium intake on blood pressure in adolescents.

A randomized crossover trial on the effect of salt restriction on blood pressure was carried out involving 124 adolescents (mean age 16 years). Dietary sodium was reduced from approximately 110 to 45 mEq/24 h for a period of 24 days. Blood pressure was non-significantly lower at the end of the experimental diet for all participants. A slight (0.7 kg), yet statistically significant fall in weight was observed (P less than 0.05). Subgroup analysis demonstrated that participants whose body mass index was below the median had a statistically significant fall in systolic blood pressure (P less than 0.05); fall in weight and increase in heart rate were also more pronounced in the less obese individuals. It would appear that moderate sodium reduction does not have an overall short-term effect on blood pressure in normotensive adolescents. However, body size as reflected in body mass index may influence blood pressure response to sodium reduction.

Adolescent↗
PubMed1999

Tension-free laparoscopic and open hernia repair: randomized controlled trial of early results.

The aim of the study was prospectively to compare the early results and outcome in 105 patients randomly allocated to undergo tension-free laparoscopic hernia repair (LHR) with transabdominal preperitoneal technique (53 patients) or open hernia repair (OHR) with mesh apposition (52 patients). The mean (SD) operation time was longer in the LHR group than in the OHR group: 49.6 (5.4) versus 33. 9 (6.2) minutes; p < 0.001. One laparoscopic case was converted to open repair to deal with a hemorrhage from an aberrant obturatory artery at the level of Cooper's ligament. Groin discomfort or pain was the most common complication after both procedures. The patients requiring none, one, two, or more than two doses of intramuscular diclofenac were, respectively, 40.4%, 40.4%, 15.4%, and 3.8% after LHR and 50.0%, 30.8%, 17.3%, and 1.9% after OHR (p = 0.69; NS). The mean +/- SEM (range) postoperative visual analog scale score, ranging from 0 (no pain) to 10 (worst pain imaginable), was 3.1 +/- 0.2 (1-7) in the LHR subset and 2.7 +/- 0.2 (1-5) in the OHR group (p = 0.14; NS); on the second postoperative day the score was 2.3 +/- 0.2 (1-6) and 1.8 +/- 0.1 (1-4), respectively (p < 0.03). The time +/- SEM (range) of resumption of pain-free normal activities and work was faster in OHR group: 6.1 +/- 0.2 (4-8) weeks versus 6.5 +/- 0.1 (4-8) weeks; p < 0.03. Our results showed that tension-free open hernia repair is superior to LHR in terms of postoperative pain with no important differences in recovery. </HEA

Disease-Free Survival↗
PubMed2002

Kin competition within groups: the offspring depreciation hypothesis.

Where relatives compete for the same resources (kin competition) and each obtains an equal share, this can favour the evolution of elevated dispersal rates, such that most resource competition is among non-relatives. We show that this effect evaporates as among-sibling dominance increases to the point where the allocation of resources is maximally unequal. We restore a kin-competition effect on emigration rates from dominance-ranked family groups by showing that where siblings form queues to inherit the breeding positions, the length of the queue affects the fitness of all individuals by depreciating the rank of subsequent offspring. Incorporating this 'offspring depreciation' effect decreases optimal queue lengths, increases dispersal rates and explains the otherwise paradoxical use of sinks by cooperatively breeding birds in stable environments. The offspring depreciation effect also favours the evolution of small, but consistent, clutch sizes and high reproductive skew, but constrains the evolution of alloparenting.

Animals↗
PubMedDate not supplied

Persantine Aspirin Trial in cerebral ischemia. The American-Canadian Co-operative Study Group.

The Persantine Aspirin Trial is a double-blind multi-centered cooperative study focusing primarily on the question of whether the administration of the combination of aspirin and dipyridamole (Persantine) will result in a greater reduction of cerebral or retinal infarction or death than the administration of aspirin alone. Fifteen centers in the United States and Canada are participating. More than 750 individuals with a history of recent carotid territory transient ischemic attacks (TIAs) have been admitted over the past four years and randomly allocated to either aspirin (325 mg) plus placebo four times daily or aspirin (325 mg) plus Persantine (75 mg) four times daily. It is anticipated that the study will continue through 1983. Analysis and publication of results are planned for 1984.

Animals↗
PubMed1985

PolioPlus programme: criteria for funding of polio immunization programmes.

To date, the Rotary Foundation of Rotary International has allocated over US$12 million for polio immunization programs in 26 countries to protect more than 87 million children and has pledged to raise US$120 million within 3 years. The 1st major polio immunization project assisted was launched in the Philippines in 1980. On 14 May 1985, Rotary joined PAHO/WHO in the goal to eradicate polio in the Americas by 1990. Rotarians have provided support to many recent accelerated immunization programs in cooperation with governments, UNICEF, and WHO.

Delivery of Health Care↗
PubMed2003

[Management of laboratory for clinical physiology].

Physiological examination has the following characteristics: 1. Patient understanding and cooperation are required. 2. Accuracy of the results of examination is influenced by technician skill and experience. 3. Accidents may occur during examination. 4. Examination and judgment of the results proceed under cooperation between doctors and technicians. 5. Examination can be performed at patient's bedside. Recently, laboratories for clinical physiology have been required to provide high-quality examinations with an efficient cost-performance. They must not only integrate and conduct various physiological tests on demand, but also arrange the proper number of staff for the proper number of instruments. It is important to reinforce the risk management against unexpected accidents and to allocate a chief technician for flexible management of the laboratory. Equipment should be purchased according to systematic planning, novel technology should be actively introduced into laboratory medicine, and excellent technicians to handle it should be brought up. Standardization of the test methods and the quality control are necessary to guarantee the quality of the test results. These are issues to be solved by the society of laboratory medicine and not by a single institution.

Clinical Laboratory Techniques↗
PubMed1989

Comparative efficacy of terbutaline administered by Nebuhaler and by nebulizer in young children with acute asthma.

We compared the use of terbutaline sulphate that was delivered by a nebulizer with its delivery by a Nebuhaler at two dose levels in 27 children (nine children per group) of between three and six years of age with acute asthma. No significant difference was found in the mean baseline clinical score among the three groups, and a significant decline occurred in the mean clinical scores in all groups by 15 minutes which was maintained to 60 minutes after the dose was administered. The decline that was achieved with delivery of the drug by way of a Nebuhaler (at either dose level) was not significantly different from that with a nebulizer, although cooperation with Nebuhaler usage was not universal in the age-group.

Acute Disease↗
PubMed1987

[Maternal effects and perinatal safety of labetalol in the treatment of hypertension in pregnancy. Comparison with methyldopa in a randomized cooperative trial].

Labetalol was compared with methyldopa in a randomised trial involving 176 pregnant women with mild to moderate hypertension. Effective blood pressure control (diastolic pressure below 86 mmHg) was obtained in a similar proportion of mothers given labetalol or methyldopa, but the addition of a complementary treatment to achieve control was less frequently needed in the labetalol than in the methyldopa group (12/91 vs 22/85 p less than 0.05). Side effects were mild and resulted in discontinuation of the randomised treatment in 1 mother given labetalol. Pregnancy was terminated by intrauterine death in 4 mothers given methyldopa, and one neonate born to a patient allocated to labetalol died at day 1. The average birthweight and the proportion of premature delivery or of small for gestational age newborns were similar in both treatment groups. Heart rate, blood pressure, respiratory rate and blood glucose did not differ between infants born to the mothers of the labetalol and the methyldopa groups, irrespective of gestational age at birth or birthweight. Blood pressure control is more frequently achieved in hypertensive pregnancies with labetalol than with methyldopa as a first line treatment. Labetalol is safe to the fetus and newborn and might offer a better prevention of intrauterine death than methyldopa.

Adult↗
PubMedDate not supplied

Lack of effect of gliclazide on early diabetic nephropathy and retinopathy: a two-year controlled study.

This study has attempted to document a specific haemovascular action of gliclazide on the reversal of early diabetic microangiopathy. A prospective double-blind controlled study was performed over 2 years, comparing gliclazide versus placebo in insulin-treated and gliclazide versus glibenclamide in non-insulin-treated diabetic subjects, after a 1-year run-in period. Glycaemic control was not significantly different in gliclazide- and non-gliclazide-treated subjects before or after the commencement of active therapy. Following treatment with gliclazide in 17/32 insulin-treated and 8/17 non-insulin-treated subjects with Albustix-negative proteinuria, there was no difference in retinopathy score, total proteinuria or the renal clearance of creatinine, albumin, transferrin and immunoglobulin G. In the insulin-treated group, progression of retinopathy was observed in approximately one-third of subjects, but no parameter of proteinuria progressed over 2 years. Thus, this study did not detect a reversal of the parameters measured and does not support an action of gliclazide on diabetic microangiopathy, independent of its hypoglycaemic action.

Blood Pressure↗