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PubMed1999

Exercise training-induced blood pressure and plasma lipid improvements in hypertensives may be genotype dependent.

Exercise training improves cardiovascular disease risk, but individual responses are highly variable. We hypothesized that common polymorphic gene variations would affect these responses. Sedentary obese hypertensive older men who had undergone exercise training were typed at the apolipoprotein (apo) E, angiotensin-converting enzyme (ACE), and lipoprotein lipase (LPL) loci. Individuals of all genotype subgroups were generally similar before training; they also changed body weight, body composition, and &f1;O(2)max similarly with training. ACE insertion/insertion (II) and insertion/deletion (ID) genotype individuals (n=10) tended to reduce systolic blood pressure more with training than deletion/deletion (DD) individuals (n=8) (-10 versus -5 mm Hg, P=0. 16). ACE II and ID individuals decreased diastolic blood pressure more with training than DD individuals (-10 versus -1 mm Hg, P<0. 005). Systolic blood pressure reductions with training were also larger in apoE3 and E4 (n=15) than apoE2 men (n=3) (-10 versus 0 mm Hg, P<0.05). The same trend was evident for diastolic blood pressure (-7 versus -3 mm Hg), but the difference was not significant. Systolic (14 versus -6 mm Hg, P=0.08) and diastolic (-9 versus -5 mm Hg, P=0.10) blood pressure reductions tended to be greater in LPL PvuII +/+ (n=4) than +/- and -/- individuals (n=14). Systolic (-10 versus 3 mm Hg, P<0.05) and diastolic (-9 versus 2 mm Hg, P<0.05) blood pressure reductions were larger in LPL HindIII +/+ and +/- (n=15) than -/- persons (n=3), respectively. LPL PvuII -/- individuals (n=3) had larger increases in HDL cholesterol (11 versus 2 mg/dL, P<0.05) and HDL(2) cholesterol (8 versus 0 mg/dL, P<0.05) than LPL PvuII +/- and +/+ individuals (n=15). These results are consistent with the possibility that apoE, ACE, and LPL genotypes may identify hypertensives who will improve blood pressure, lipoprotein lipids, and cardiovascular disease risk the most with exercise training.

Apolipoproteins E↗
PubMed2004

Functional assessment of injured workers: a profile of assessor practices.

BACKGROUND: Considerable controversy and limited information surrounds the use of performance-based functional assessments for determining an injured worker's ability to function at work. PURPOSE: Amidst a variety of protocols, philosophies and tools, the key aspects of different assessment approaches are described and compared across a range of assessment provider organizations. METHOD: Qualitative and quantitative strategies were used to generate an in-depth understanding of the different assessment practices among 23 Southern Ontario assessment providers. RESULTS: Assessment approaches share common elements and variations that can be described along the continua of five dimensions: nature of assessor-evaluee interactions, fixed or flexible protocol delivery, efforts to contextualize, perceptions and use of evidence, and provider organizational environment. These approach dimensions are offered as a focus for appraising practices. PRACTICE IMPLICATIONS: Assessors need to reflect upon to what extent they are using a whole person, client-centred approach directed by clinical reasoning amidst a market driven industry.

Adult↗
PubMed1989

Relationships between the size, position, and angulation of human jaw muscles and unilateral first molar bite force.

Human subjects commonly show large variations in bite force produced at the first molar teeth. To evaluate the role of muscle cross-sectional sizes and lever arms in bite-force production, we correlated these variables in 11 healthy adults. Axial and coronal images obtained by magnetic resonance were combined with conventional lateral cephalograms and dental cast data to reconstruct the craniomandibular morphology in each subject. The cross-sectional sizes of the right masseter and medial pterygoid muscles, their lever arms, and the bite-point lever arms were measured directly from these reconstructions. Physiological recordings of bite force were made in the region of the right first molar by means of a customized transducer aligned perpendicular to the functional occlusal plane. The average bite force for the sample as a whole was 189 +/- 78 N. The coefficients of variance were greater for bite forces, and for the cross-sectional sizes of the two muscles, than for their respective lever arms. Highly significant Pearson Product Moment correlation coefficients (p less than 0.005) were found between masseter and medial pterygoid cross-sectional size, and between the cross-sectional size of each muscle and bite force. No significant correlations (p greater than 0.1) were found between muscle or bite-point lever arms and bite force. Despite the fact that craniofacial spatial morphology may differ among subjects, jaw muscle size alone seems to explain most of the variation in bite force reported by ourselves and others.

Adult↗
PubMed2005

Complementary therapies and childhood cancer.

BACKGROUND: The use of complementary and alternative therapies by children with cancer is common. Up to 84% of children have used complementary therapies along with conventional medical treatment for cancer. METHODS: We reviewed the PubMed and CINAHL databases for studies published between 1994 and 2004 on the use of complementary and alternative therapies by children with cancer and reports from any publication year through 2004 of clinical trials involving complementary and alternative therapies for children with cancer. RESULTS: Fourteen studies were retrieved reporting the results of survey or interview data collected from parents on children's use of complementary and alternative therapies during or after childhood cancer. Across studies, the use of such therapies ranged from 31% to 84%. Common reasons for using complementary and alternative therapies were to do everything possible for their child, to help with symptom management, and to boost the immune system. Many parents indicated they also hoped to treat or cure the cancer. In most cases, the child's treating physician had not been informed of the child's use of complementary and alternative therapies. CONCLUSIONS: Use of complementary therapies by children with cancer is common, although methodological variations limit the ability to compare results across studies. Treating physicians often do not know the child is using complementary therapies in addition to medical treatments. The scientific evidence is limited regarding the effects and mechanisms of action of complementary or alternative therapies, but research is being conducted on these topics.

Child↗
PubMed2006

Food composition database development for between country comparisons.

Nutritional assessment by diet analysis is a two-stepped process consisting of evaluation of food consumption, and conversion of food into nutrient intake by using a food composition database, which lists the mean nutritional values for a given food portion. Most reports in the literature focus on minimizing errors in estimation of food consumption but the selection of a specific food composition table used in nutrient estimation is also a source of errors. We are conducting a large prospective study internationally and need to compare diet, assessed by food frequency questionnaires, in a comparable manner between different countries. We have prepared a multi-country food composition database for nutrient estimation in all the countries participating in our study. The nutrient database is primarily based on the USDA food composition database, modified appropriately with reference to local food composition tables, and supplemented with recipes of locally eaten mixed dishes. By doing so we have ensured that the units of measurement, method of selection of foods for testing, and assays used for nutrient estimation are consistent and as current as possible, and yet have taken into account some local variations. Using this common metric for nutrient assessment will reduce differential errors in nutrient estimation and improve the validity of between-country comparisons.

Agriculture↗
PubMed1990

Anatomical variations of the carotid bifurcation: implications for digital subtraction angiography and ultrasonography.

Intravenous digital subtraction angiography was used to determine prospectively the positional variations of the common carotid bifurcation in 100 consecutive patients with clinically suspected arteriosclerotic disease. The most common position (97/200, 48.5%) of the external carotid artery was anteromedial to the internal carotid artery. Position of the external carotid artery anterolateral to the internal carotid artery was noted in 26/200 (13%) bifurcations, but this anatomical variant was more common on the right (21/100) than on the left (5/100) (p less than 0.01). Practical implications may be drawn from this study. For digital subtraction angiography, the left anterior oblique view has to be considered the projection of choice and the right common carotid bifurcation is less likely to be adequately displayed than the left one; for duplex ultrasonography, optimal visualization is obtained from a posterolateral orientation of the transducer.

Adult↗
PubMed1986

A reappraisal of acute traumatic central cord syndrome.

A review of 77 patients with traumatic central cord syndrome revealed that atypical variations are more common than the existing literature suggests and that these may be seen in a wide variety of acute injuries to the cervical spine. In general the outcome is good; a favourable prognosis on admission is suggested by good hand function, hyperpathia, Lhermitte's sign and normal perianal sensation. The study has highlighted the value of regular muscle charting and has cast doubt on previous neuroanatomical assumptions about the syndrome.

Accidents, Traffic↗
PubMed2005

Impact of a common CV evaluation scheme on overall laboratory performance: 8-year experience of a large national proficiency testing program in Japan.

In proficiency testing (PT), it is difficult to set rational criteria for determining target values and allowable limits. In Japan, the largest national PT program has for the past 8 years used an evaluation scheme based on a "common coefficient of variation" (cCV) to overcome this difficulty. The cCV, the average within-method variation, is derived by one-way analysis of variance from data of peer groups after excluding those with large variations. A unit interval used for grading participants is obtained by multiplying the cCV by the peer-group mean which is computed using an iterative method featuring repeated removal of a large portion of the tails of the distribution and reinflation of the standard deviation (SD) to compensate for the trimming. The evaluation scheme gives a relatively better grade to those participants in peer groups with small CVs, compared to use of individual peer-group CVs. The scheme has expedited the transition to more reproducible methods, resulting in a notable overall improvement in laboratory performance. The cCV evaluation scheme is uniformly applicable to any analyte measured quantitatively. The iterative method, an integral part of the scheme, effectively precludes bias in the evaluation.

Amylases↗
PubMed2005

Perlegen sciences, inc.

For years we have recognized that using genetics to target the right medicines to the right patients at the right time could improve health care; however, technical and financial constraints have prevented researchers from conducting the comprehensive, whole-genome association studies required to make such advances. Now, Perlegen and its collaborators are making personalized medicine and high density whole-genome association studies a reality. Perlegen quickly and cost-effectively analyzes millions of unique genetic variations in thousands of patients to identify the genetic differences associated with efficacy and side effects. This enables the pharmaceutical drug response to be predicted, and the therapeutic window of a treatment to be expanded. Perlegen licenses compounds that may benefit from this approach, and collaborates with pharmaceutical companies to rescue and better position medicines in their portfolios. Furthermore, the company collaborates with researchers in the public sector to discover the genetic variations associated with common diseases, paving the way for new therapeutics and diagnostics.

Drug Delivery Systems↗
PubMed1991

Organisation of veterinary public health in the western Pacific region.

Information on veterinary public health organisation and activities was obtained from government sources in countries located in the Western Pacific region. This region has a wide range of geographical features, population densities, farming practices, social structures and disease prevalences. In spite of this variation, there is common agreement on the importance of veterinary public health both for the provision of safe food and for the control of zoonotic diseases. Not all countries, however, are able to put all the resources they would wish into these activities; financial, social and personnel constraints are recognised.

Animals↗
PubMed2000

Ultrasound in dermatology. Part I. High frequency ultrasound.

This paper addresses the basic terminology of modern ultrasound equipment for the examination of the skin, the technical limitations of currently available equipment and the normal skin structure. Different applications for dermatosonography are discussed, and the paper summarises current knowledge about common sources of variation in the ultrasound image of the skin, such as skin tumours and selected skin diseases.

Skin↗
PubMed2000

Heritability of self-reported health.

OBJECTIVE: To explore the contribution of genes and environmental factors to variation in a common measure (i.e., a five-point--excellent, very good, good, fair, and poor--Likert scale) of self-reported health. DATA SOURCES: Data were analyzed from 4,638 male-male twin pair members of the Vietnam Era Twin (VET) Registry who responded to a 1987 health survey. STUDY DESIGN: Varying models for the relationship between genetic and environmental influences on self-reported health were tested in an attempt to explain the relative contributions of additive genetic, shared and nonshared environmental effects, and health conditions reported since 1975 to perceived health status. DATA COLLECTION: A mail and telephone survey of health was administered in 1987 to VET Registry twins. PRINCIPAL FINDINGS: Variance component estimates under the best-fitting model included a 39.6 percent genetic contribution to self-reported health. In a model which included the effect of health condition, genes accounted for 32.5 percent and health condition accounted for 15.0 percent of the variance in self-reported health. The magnitude of the genetic contribution to perceived health status was not significantly different in a model with or without health condition. CONCLUSIONS: These data suggest over one-third of the variability of self-reported health can be attributed to genes. Since perceived health status is a major predictor of morbidity, mortality, and health services utilization, future analyses should consider the role of heritable influences on traditional health services variables.

Aged↗
PubMed2000

Occlusion: what it is and what it is not.

Dental occlusion is much more than the physical contact of the biting surfaces of opposing teeth or their replacements. Occlusion is more comprehensively defined biologically as the coordinated functional interaction between the various cell populations forming the masticatory system as they differentiate, model, remodel, fail, and repair. Morphologic variations are very common and represent the norm. Even though the occlusal or musculoskeletal relationship may not meet the definition of the clinician's concept of an optimum or ideal occlusion, it must be appreciated that for that particular patient, the tissues of the masticatory system may have developed a stable, functional, healthy, and comfortable equilibrium. However, when the functional equilibrium is perturbed or when the occlusion is being re-established, specific treatment criteria are as important today, if not more important with the rapid growth of implant placements, as ever before. Treatment of the occlusion should be considered on an individual basis based on the specific physiologic needs of the various tissue systems within the masticatory system rather than on a preconceived, stereotyped or universal basis. It has long been established and recently proven that proper management of the occlusion is directly correlated to the successful treatment and maintenance of the teeth and, at times, the supporting tissues. On the other hand, it has not, to date, been scientifically proven that occlusion is directly correlated to the musculoskeletal disorders that affect the jaw (temporomandibular joint or masticatory muscle disorders).

Centric Relation↗
PubMed2002

Cancer death rates--Appalachia, 1994-1998.

Cancer is the second leading cause of death in the United States. Although descriptive analyses of mortality data are used often to identify variations by time and person, analyses that focus on regional variations are less common. Appalachia is a U.S. region with a high prevalence of risk factors for cancer (e.g., tobacco use, physical inactivity, and inadequate access to medical care). Analyses that focus on Appalachia provide valuable information for cancer control, research, and intervention. To assess the impact of cancer in Appalachia, researchers from the University of Kentucky and Pennsylvania State University, in collaboration with CDC, analyzed mortality data from CDC's National Center for Health Statistics for 1994-1998. This report summarizes the results of that analysis, which indicate elevated cancer mortality, underscoring the need for ongoing cancer prevention and control programs as a major public health priority in this region.

Appalachian Region↗
PubMed2002

Corneal pigmentation in overnight orthokeratology: a case series.

BACKGROUND: Iron deposition within the basal corneal epithelium, or a Hudson-Stahli line, is a common physiological finding. Variations of this deposition can be seen after surgical refractive procedures and as a result of comeal disease. This case series provides evidence of comeal deposition of a similar nature in patients who wear reverse geometry rigid gas-permeable contact lenses for overnight orthokeratology. To date, similar findings associated with orthokeratology have not been published. CASE REPORTS: Deposition-presumably of iron-was found in the corneal epithelium in a small sample of patients who have been undergoing treatment with overnight orthokeratology for a duration of 6 months to 2 years. Paragon CRT lenses were worn by four patients, the DreimLens was worn by one patient, and one patient initially began treatment in the FARGO 6 lens design and ultimately was refitted into Paragon CRT lenses. The finding was more prominent in patients with dark irides and in patients with higher baseline refractive errors. CONCLUSIONS: Although this is an interesting finding, it does not appear to affect visual acuity nor does it appear to be adverse in nature. No treatment has been necessary in any of the cases presented. All six patients are still undergoing treatment with overnight orthokeratology.

Adult↗
PubMed2002

[Repeated tuberculin skin tests in nurse students--observation for 3 years].

In Japan, two-step tuberculin skin test (two-step TST) is recommended for health care workers (HCWs) if the diameter of erythema in the first test is less than 30 mm, and to detect new infection if there is 10 mm or more increase from the base-line diameter. We observed TST in nurse students from the entrance to the graduation for 3 years, and analyzed the change of TST reaction to discuss the usefulness of two-step TST and the criteria for detecting new tuberculous infection among BCG vaccinated HCWs. Mean +/- S.D. (mm) in erythema and induration in each occasion were: in a group with single TST at entrance (T1) and before graduation (TG) (n = 99, group I); T1 = 19.8 +/- 11.3, TG = 23.6 +/- 14.3 for erythema and T1 = 12.5 +/- 5.3, TG = 13.8 +/- 5.0 for induration: in a group with two-step TST at entrance (T1 and T2) (n = 40, group II); T1 = 11.9 +/- 7.8, T2 = 20.4 +/- 10.6, TG = 22.1 +/- 13.5 for erythema and T1 = 8.6 +/- 6.1, T2 = 12.0 +/- 5.1, TG = 13.4 +/- 5.4 for induration: in a group BCG vaccinated after single negative TST (less than 10 mm of erythema and/or less than 5 mm of induration) (n = 12, group I-B); T1 = 4.0 +/- 3.5, TB = 19.8 +/- 5.8, TG = 16.3 +/- 7.6 for erythema and T1 = 0.5 +/- 1.5, TB = 14.1 +/- 3.7, TG = 11.9 +/- 4.4 for induration: in a group BCG vaccinated after two negative TST (n = 10, group II-B); T1 = 3.6 +/- 3.1, T2 = 6.2 +/- 2.4, TB = 23.9 +/- 8.5, TG = 14.1 +/- 6.9 for erythema and T1 = 1.7 +/- 2.7, T2 = 3.2 +/- 1.8, TB = 16.0 +/- 3.2, TG = 7.5 +/- 7.8 for induration. One student in the group II was diagnosed as tuberculosis before the graduation. If we exclude this case form the group II, mean +/- S.D. (mm) of TG in group II were 20.7 +/- 11.2 for erythema and 13.1 +/- 5.0 for induration. Booster phenomenon was significant on two-step TST. There was moderate booster phenomenon even after 34 months from the previous single TST. There was also significant waning of reaction 27 to 31 months after BCG vaccination. But there were no significant waning nor booster after two-step TST. Concerning the difference between the reaction before graduation and at entrance, mean +/- S.D. (mm) in erythema and induration, [TG-T1] in the group I were +3.8 +/- 11.4 and +1.6 +/- 5.8, respectively, [TG-T2 or 1] in the group II were +0.7 +/- 11.4 and +0.4 +/- 5.6, respectively, [TG-TB] in the group I-B and II-B were -6.4 +/- 9.9 and -5.0 +/- 6.5. If we exclude one case who got tuberculosis from the group II, mean +/- S. D. (mm) in erythema and induration of [TG-T2] in group II were -0.6 +/- 8.1 and +0.2 +/- 5.4, respectively. According to the criteria in Japan of more than 10 mm increase in erythema and more than 6 mm increase in induration, recommended by Menzies, significant values of [TG--(T1, T2 or TB)] was observed in 24 (24%) by erythema and 22 (22%) by induration in the group I, while in the group II only in 4 (10%) by erythema and 5 (12.5%) by induration, which included case diagnosed as active tuberculosis. The criterion of 10 mm increase in erythema seems to correspond to that of 6 mm increase in induration. 95% confidential limit in the differences between two tests were 15.6 mm (mean plus 2 standard deviation) in erythema and 11.0 mm in induration in the group II. Considering that these data may include some newly infected persons, appropriate criteria for detecting new tuberculosis infection is estimated to be between 10 to 15 mm increase in erythema and 6 to 11 mm increase in induration from the baseline by two-step TST. Among BCG vaccinated, TST two months after vaccination is useful as the base line. As there is moderate booster phenomenon even after three years from the previous single test and variation is more common, the detection of new tuberculous infection can be made more accurately with the two-step TST in HCWs.

Adult↗
PubMed2005

[Present status and problems of external quality assurance program of Japan Medical Association].

The external quality assurance (EQA) program of the Japan Medical Association was started in 1967. This program had just 70 laboratory institutes of 15 examination items in 1967 and has 2917 laboratory institutes of 47 items in 2004. This program is thought to be the most reliable EQA program in Japan and is used as marker for the evaluation of laboratory institutes. Each laboratory institute gets marks according to the basis of common coefficient of variation (CV) of each examination item. This program has the following problems: (1) examination items (urine tests and bacteriological tests are not performed), (2) number of programs in a year, (3) examination sample (matrix of the examination sample is similar to the native sample), and (4) valuation basis (valuation basis is getting strict and some laboratories may have cheated the program). This program has to change by improving these issues.

Clinical Laboratory Techniques↗
PubMed1992

Consent for dental therapy in severely ill patients.

This article provides an overview of legal standards for informed consent, and discusses this in the context of dental care for elderly or severely ill patients. Legal analysis is made on variations in state common law and legislation, focusing on the difference between a practitioner-oriented approach versus a patient-oriented approach to informed consent. Analysis is also made regarding advance health care directives in cases of patient incapacity. The purposes of this article are to provide interested dental educators with an understanding of the important legal concepts in this area and the nuances of state law, and to discuss how these can be properly applied in facilities that treat severely ill or geriatric patients.

Aged↗