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At least 1,063 records · Page 59Linked to original sources
PubMed2005

A look at the (near) future based on the (recent) past - how our patients have changed and how they will change.

Remedies for dental diseases have been in use for as long as 4,000 years, and various materials and methods have been used over the millennia. Dentistry continues to change in response to changes in the age distribution, origins, financial means and health of the population, as well as to changes within the profession itself. The Canadian population is very unevenly distributed geographically and ethnically. Furthermore, it is aging rapidly and life expectancy is increasing. Although the average income of Canadians has increased, the increase was unevenly distributed, and the gap between rich and poor continues to expand. There has been a steady rise in the number of Canadians with dental insurance, although the proportion of the population with insurance varies from one province to another. Not surprisingly, people with dental insurance compared to those without are more frequent users of dental services. The rate of caries attack has diminished in industrialized countries, but people are keeping their teeth longer, so caries will remain a significant public health problem, particularly among elderly people. In addition, smoking tobacco is strongly associated with periodontal disease; thus, there should be more action within the dental community in support of smoking cessation programs. The composition of the dental care community is also changing. The ratios of dentists and dental hygienists to the population have increased, the services offered by dental technicians have expanded greatly, and the services offered by denturists have also increased as these services gain more widespread acceptance. Use of dental services in Canada remains reasonably broad; however, denture-wearers continue to regard uncomfortable dentures as a normal part of aging. The pattern of uneven distribution of disease and access to service remains the major challenge facing the dental profession.

Aged↗
PubMedDate not supplied

The promise of PROMIS: using item response theory to improve assessment of patient-reported outcomes.

PROMIS (Patient-Reported-Outcomes Measurement Information System) is an NIH Roadmap network project intended to improve the reliability, validity, and precision of PROs and to provide definitive new instruments that will exceed the capabilities of classic instruments and enable improved outcome measurement for clinical research across all NIH institutes. Item response theory (IRT) measurement models now permit us to transition conventional health status assessment into an era of item banking and computerized adaptive testing (CAT). Item banking uses IRT measurement models and methods to develop item banks from large pools of items from many available questionnaires. IRT allows the reduction and improvement of items and assembles domains of items which are unidimensional and not excessively redundant. CAT provides a model-driven algorithm and software to iteratively select the most informative remaining item in a domain until a desired degree of precision is obtained. Through these approaches the number of patients required for a clinical trial may be reduced while holding statistical power constant. PROMIS tools, expected to improve precision and enable assessment at the individual patient level which should broaden the appeal of PROs, will begin to be available to the general medical community in 2008.

Diagnosis, Computer-Assisted↗
PubMedDate not supplied

Transdermal progesterone cream as an alternative progestin in hormone therapy.

OBJECTIVE: To evaluate the endometrial effects and determine patients' acceptance of transdermal progresterone cream compared to standard hormone therapy. METHODS: Healthy menopausal women were recruited and received a pretreatment endometrial biopsy (EMB). They were randomized to 0.625 mg conjugated equine estrogen (CEE) daily and 2.5 mg medroxyprogesterone acetate (MPA) (Prempro, Wyeth USA) or daily 0.625 mg CEE and twice daily 20 mg transdermal PC (Pro-gest, Transitions for Health USA). At the end of 6 months, a repeat EMB was obtained, and the women were crossed over to other treatment. A final EMB was performed after the final 6 months. RESULTS: Twenty-six women completed both arms of the study. Seventy-seven percent of women preferred the CEE/PC to the CEE/MPA (P<.001). Of the 52 post-treatment endometrial biopsies: 40 revealed atrophic endometrium and 12 proliferative endometrium (7 in the oral progestin group and 5 in the PC group). There was no evidence of endometrial hyperplasia in any of the specimens. The incidence of vaginal spotting was similar in both groups. CONCLUSION: Patients preferred transdermal PC over oral MPA. This preliminary data indicate that CEE/PC has a similar effect on the endometrium as standard oral HT over a 6-month period.

Administration, Cutaneous↗
PubMed2004

Dietary fat and breast cancer in Saudi Arabia: a case-control study.

A case-control study investigated the association between dietary fat and breast cancer in Saudi Arabian women attending a specialist hospital in Riyadh. Women with breast carcinoma (n= 499) newly diagnosed between 1996-2002, and control women (n = 498) randomly selected from patients' attendants and relatives, completed a food frequency questionnaire. Serum levels of triglycerides and total cholesterol were measured. A significant positive association was found between risk of breast cancer and intake of fats, protein and calories. Adjusted odds ratios for the highest quartile of intake versus the lowest were 2.43 for saturated fat, 2.25 for animal protein, 2.12 for polyunsaturated fat, 1.88 for cholesterol and 2.69 for total energy from dietary intake. For serum triglycerides the adjusted odds ratio was 2.16 for the highest quartile.

Adult↗
PubMed2004

Food habits of the Egyptians: newly emerging trends.

Accelerated changes are taking place in the food habits of the present day Egyptians. Examples are drawn from foods that continue to be consumed by those considered guardians of the Egyptian tradition (Coptic Christians and isolated farming communities) and from interpretation of archaeological evidence. Recent decades have witnessed the progressive erosion of the traditional Egyptian diet and the introduction of new foods and eating habits. Sociocultural and economic changes are accelerating this erosion. The main features of the traditional Egyptian way of eating are presented along with a review of the emerging trends and of some of the important factors underlying food consumption patterns. Attention is drawn to the potential risk to health that these new trends represent, in particular to child nutrition and development.

Agriculture↗
PubMedDate not supplied

In the wake of structural adjustment programs: Exploring the relationship between domestic policies and health outcomes in Argentina and Uruguay.

BACKGROUND: The implementation of structural adjustment programs (SAPs) in developing countries has been followed by a marked reduction in their progress on economic growth, health outcomes, and social indicators. Comprehensive and contextualized explorations of the effects of SAPs are needed to assist health and social policy-makers in better determining responses to such programs that continue to dominate global trade, aid and debt cancellation negotiations. METHODS: A comparative case study of Argentina and Uruguay was developed exploring the effects of SAPs on health. Using a framework developed to analyze the relationship between globalization and health, changes in domestic policies resulting from SAPs and the corresponding economic, social and health outcomes of the countries were explored. RESULTS: In general, SAPs were implemented with greater severity and speed in Argentina than in Uruguay, with the greatest differences occurring over the 1980s. The more gradual and modest reforms implemented in Uruguay were associated with better economic, social and health outcomes. CONCLUSIONS: Findings support those of previous studies demonstrating that countries that have maintained more dynamic public social and health programming while applying SAPs have been better able to protect the health of the most vulnerable sectors of society.

Argentina↗
PubMed2005

Decline of brugian filariasis in Cherthala taluk, Alappuzha district, Kerala.

A total of 4492 persons from 5 panchayats and 1 town were investigated from the Brugia malayi most endemic taluk of Cherthala, Alappuzha district of Kerala state. The urban area in Cherthala taluk only revealed mf carriers; mf rate was 0.13%. Rural areas in Cherthala taluk were free from infection. Microfilaria rate had declined by 99.5% and disease rate by 90.7% in Cherthala compared to 1934 prevalence. Shedding of sheath by B. malayi microfilariae was recorded for the first time in India. The youngest person with microfilaria and disease manifestation was 4 1/2 and 9 years respectively. All the 3 major vectors, Mansonia annulifera, Ma.uniformis and Culex quinquefasciatus were prevalent throughout. Complete disappearance of brugian filariasis from this taluk is a distinct possibility. The reasons for the drastic decline are discussed.

Adolescent↗
PubMedDate not supplied

Self-identified needs of patients with cancer at home and their home caregivers: a descriptive study.

Increasing numbers of patients with cancer are being cared for at home by family caregivers because of the chronicity of cancer and the transition of health care from hospital to home. This study describes the needs of 15 patients with cancer at home and 15 home caregivers. Using the Objects Content Test (OCT), 505 need statements were collected from the subjects. Three hundred patient needs and 192 caregiver needs were identified. Nurse researchers and oncology experts computer Q-sorted the 505 need statements into need categories previously established by Wingate and Lackey. Patients' greatest needs were psychological, physical, and informational. Caregivers' greatest needs were psychological, informational, and those related to household duties. Qualitative data reflected that both patients and caregivers needed support from family or friends, hope, and a sense of the future. Patients indicated a need for purposeful activities.

Adult↗
PubMed1989

[Prevalence of esophageal and gastrointestinal symptoms in Chilean adults].

We surveyed 300 randomly selected presumable healthy adults for previously defined gastrointestinal and esophageal symptoms. Heartburn was the most common symptom, more frequent in females than in males (p less than 0.01). An association of esophageal symptoms to heartburn but not to smoking habit was found. Constipation was frequent in females and diarrhea in males. We conclude that esophageal symptoms are frequent in presumable healthy individuals.

Adult↗
PubMed1994

Parametric approaches to quality-adjusted survival analysis. International Breast Cancer Study Group.

We present a parametric methodology for performing quality-of-life-adjusted survival analysis using multivariate censored survival data. It represents a generalization of the nonparametric Q-TWiST method (Quality-adjusted Time without Symptoms and Toxicity). The event times correspond to transitions between states of health that differ in terms of quality of life. Each transition is governed by a competing risks model where the health states are the competing risks. Overall survival is the sum of the amount of time spent in each health state. The first step of the proposed methodology consists of defining a quality function that assigns a "score" to a life having given health state transitions. It is a composite measure of both quantity and quality of life. In general, the quality function assigns a small value to a short life with poor quality and a high value to a long life with good quality. In the second step, parametric survival models are fit to the data. This is done by repeatedly modeling the conditional cause-specific hazard functions given the previous transitions. Covariates are incorporated by accelerated failure time regression, and the model parameters are estimated by maximum likelihood. Lastly, the modeling results are used to estimate the expectation of quality functions. Standard errors and confidence intervals are computed using the bootstrap and delta methods. The results are useful for simultaneously evaluating treatments in terms of quantity and quality of life. To demonstrate the proposed methods, we perform an analysis of data from the International Breast Cancer Study Group Trial V, which compared short-duration chemotherapy versus long-duration chemotherapy in the treatment of node-positive breast cancer. The events studied are: (1) the end of treatment toxicity, (2) disease recurrence, and (3) overall survival.

Breast Neoplasms↗