SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Problems in estimating change in state poverty rates in the United States are discussed. In particular, the author tests the reliability of data from the Current Population Survey (CPS) and uses 1980 U.S. census data as a basis for comparison. "The results of the test for statistical significance call into question sole reliance on the CPS in estimating state poverty rates, for which its sample design was not intended."
"The data used in this study are from the 1989 Bangladesh Fertility Survey (1989 BFS), which was conducted...by the National Institute of Population Research and Training (NIPORT)....A two-stage probability sample design was used for the survey.... It has been found that female age at marriage has a significant direct negative influence on fertility. Thus, raising the age at marriage by implementing a minimum-age marriage law is likely to lower fertility on a national scale. Duration of breast-feeding is also found to have a significant direct negative effect on fertility....Fetal loss appears to have a significant direct positive effect on fertility...which means that mothers who have experienced fetal loss are found to have higher fertility.... Maternal mortality is also high in Bangladesh. Therefore, it is essential to provide primary health care, particularly maternal and child health care, for surviving children."
PURPOSE: Parathyroid hormone-related protein (PTHRP) is in part responsible for the clinical syndrome of hypercalcaemia of malignancy and has been implicated as an important factor in the development of bone metastases. The aim of this study was to determine the coexpression of PTHRP and its receptor in early breast cancer (EBC) and bone metastases (BM), and correlate these findings to clinical outcome. EXPERIMENTAL DESIGN: Samples of surgically excised EBC (n = 176) and BM (n = 43) were collected and stored in liquid nitrogen. PTHRP protein was determined using immunohistochemistry and receptor mRNA using in situ hybridization (n = 107) or semiquantitative reverse transcription-PCR (n = 69). RESULTS: PTHRP protein was expressed in 115 of 170 (68%) EBC compared with 100% of BM (P < 0.001), whereas its receptor mRNA was expressed in 88 of 176 (50%) EBC compared with 35 of 43 (81%) BM (P < 0.001). Coexpression of both PTHRP and its receptor was present in 62 EBC samples (37%) and in 35 BM samples (81%; P < 0.001). The PTHRP receptor correlated well with increasing patient age, but not with tumor size, grade, estrogen receptor, progesterone receptor, or lymph node status. Individually PTHRP and PTHRP receptor both correlated well with a reduced disease-free survival (P < 0.004) and receptor alone with reduced overall survival (P < 0.003). Coexpression of both PTHRP and receptor predicted the worst clinical outcome at 5 years, with a mortality rate of 20 of 62 (32%) compared with the ligand and receptor-negative group with 2 of 32 (6%; P < 0.004). CONCLUSIONS: Overall these results show that the PTHRP receptor is expressed more frequently in BM than EBC, and is associated with poor clinical outcome and survival.
Using graph theory, we present a theoretical basis for mapping oligogenes in the joint presence of multiple phenotypic measurements of both quantitative and qualitative types. Various statistical models proposed earlier for several traits of solely single type are special cases of the unified approach given here. Our emphasis is on the generality of the framework, without specifying explicit assumptions about a sampling design. When information about environmental factors potentially affecting the traits is available, it can be incorporated into the genetic model. We adopt the Bayesian inferential machinery due to its firm theoretical basis and its capability of handling uncertain quantities; such as unobserved model parameters, missing marker data, and even different putative genetic models, probabilistically within a single framework. It is shown here that biological hypotheses about single gene affecting simultaneously multiple traits (pleiotropy) can be intuitively imposed as parameter constraints, leading to pleiotropic models for which posterior probabilities can be calculated. Outline of the possible implementation of the Bayesian method is described using the general reversible-jump Markov chain Monte Carlo algorithm. Some future challenges and extensions are also discussed.
Traumatic brain injury (TBI) is a major cause of disability in children. Along with other neurological clinical sequelae, children often exhibit motor skill impairment and limitations in functional mobility following TBI. The purpose of this annotated bibliography is to: (1) familiarize therapists with the literature available regarding motor skill and mobility recovery outcomes for children and adolescents with TBI; (2) assist therapists in the selection of motor skill and mobility outcome assessments for use in clinical practice; and (3) provide therapists with comparisons of outcomes for external benchmarking. A number of reports document motor and mobility recovery outcomes as well as recovery in other domains. Studies vary, however, in design, sample size, number and type of outcome assessments used, time since injury at assessment(s), and the consideration of correlating factors such as age at time of injury and injury severity. Further research is needed to describe clinical, satisfaction and resource utilization outcomes, determine outcome predictors, and provide evidence for therapeutic intervention effectiveness.
PURPOSE: The purpose is to identify biological markers that predict brain metastasis and treatment outcome in non-small cell lung cancer (NSCLC). EXPERIMENTAL DESIGN: Samples were obtained from the primary tumors, lymph nodes, and brain metastases of 29 patients with NSCLC who had undergone resection of both the pulmonary tumors and the brain lesions. Samples from 29 patients matched for age, sex, and histology whose pulmonary tumors were resected served as controls. Samples were stained with H&E as well as immunohistochemical stains for epidermal growth factor receptor (EGFR), cyclooxygenase 2 (COX-2), and BAX. Comparisons were made between patients with and without brain metastasis. Independent investigators determined the percentage of positive cells. RESULTS: There was positive correlation in expression of all three biomarkers between primary lung tumors and lymph node metastases. Significantly higher levels of EGFR were found in lymph node metastases in the control group (P = 0.0147). COX-2 expression in brain lesions correlated with expression in primary tumors (P = 0.023). BAX levels were lower in poorly differentiated tumors in lymph node metastases in the control group (P = 0.01) and in brain metastases (P = 0.045). Low EGFR expression and high COX-2 expression in lymph node metastasis were associated with poorer treatment outcome. CONCLUSIONS: Expression of EGFR, COX-2, and BAX in primary lung tumors did not differ between patients with brain metastases from NSCLC and those without brain metastases. These three biomarkers cannot be used to predict brain metastasis. Studies of other biomarkers are under way in an effort to predict brain metastasis among patients with NSCLC.
The overall objective of the Nepal Micronutrient Status Survey (NMSS) was to assess the distribution and severity of micronutrient malnutrition, and to measure the progress achieved by different interventions. Data presented in this paper concern the prevalence of vitamin A deficiency (VAD) and the outreach and coverage of the National Vitamin A Supplementation activity. A multi-stage cluster sample design was employed that provided statistically representative data for each of thirteen eco-development strata (because of low population density, the West Mountains, Mid-west Mountains and Far-west Mountains were combined into a single stratum). The design allowed for aggregate estimates to be made at the national and ecological zone level. The survey showed a significant improvement in the status of clinical vitamin A deficiency in Nepal. The prevalence of both Bitot's spots and night-blindness among preschool children decreased from levels observed in surveys conducted in the previous twenty years. However, the prevalence of night-blindness was found to be 5% among women, and over 1% among school-aged children, which indicates that the entire population is vulnerable to VAD. These observations support findings from other surveys that have noted a high prevalence of maternal night-blindness in Nepal. Biochemical data collected as part of the survey indicated a high prevalence of low serum retinol (< 0.70 mumol/l), particularly among preschool children. Almost one of every three children (32.3%) and one of every six women (16.6%) had low serum retinol values. Low serum retinol among preschool children was associated with young age (6-11 months), rural location, wasting, presence of night-blindness and Bitot's spots, and residence in the Terai or Mountains. Similarly, sub-clinical VAD in women was associated with age (less than 20 years), pregnancy, the presence of night-blindness and residence in the Terai or Mountains. In the 42 districts covered by the National Vitamin A Programme (NVAP), more than 87% of preschool children were reached with vitamin A capsules. In addition to this, the National Immunisation Day (NID) provided oral polio vaccine drops to an estimated 95.7% of children 12-59 months. Awareness of the importance of vitamin A was, however, much higher in the NVAP districts than in non-programme districts. As would be expected, clinical VAD was most prevalent among children who had not received vitamin A during the most recent vitamin A capsule distribution. Indeed, the data show that vitamin A capsule receipt among children conferred a 59% protective effect for night-blindness and a 51% effect for Bitot's spots. These results point to significant progress having been achieved by the NVAP and NID capsule distribution activities.
OBJECTIVE: To investigate the associations between angiotensin converting enzyme inhibitors (ACEIs) related cough and ACE I/D and bradykinin beta(2) receptor (BDKRB2) C/T polymorphism. METHODS: A case-control study, nested in a 3-year community-based postmarketing surveillance of benazepril in 1 831 Chinese hypertensives was carried out. Three hundred and fifty-one cases having suffered benazepril related cough were identified and genotyped. Genotyped controls were selected through a stratified sampling design by age, sex and kidney function status. RESULTS: The allele frequencies in cases were I 65.4%, D 34.6% and T 53.0%, C 47.0% and the genotype frequencies were II 42.2%, ID 46.4%, DD 11.4% (ACE) and CC 21.6%, CT 50.9%, TT 27.6% (BDKRB2), respectively. Genotype frequencies were both in Hardy-Weinberg equilibrium. According to stratified analyses by sex, kidney function status and age, no association was found between BDKRB2 C/T polymorphism and cough. For ACE I/D polymorphism, in men with decompensated kidney function, patients with ID or DD genotype having 4.805 times the risk of those with II genotype in developing cough. In women aged 35 to 49 years with normal or compensated kidney function, the OR of DD genotype was 5.128. No associations were detected in other subgroups. CONCLUSION: It was suggested that kidney function status and some specific characteristics surrogated by age and sex had modified the effect of ACE I/D variant on cough.
OBJECTIVE: This paper examines trends in vigorous physical activity participation among students enrolled in grades 7, 9, 11 and 13 in Ontario between 1997 and 2001. Patterns in participation by gender and grade level are also described. METHODS: Data were derived from the Ontario Student Drug Use Survey for 1997, 1999, and 2001. Three outcomes of vigorous physical activity were included in self-report questionnaires completed by more than 5,000 students over a three-year period. They responded to the survey in classroom groups during school time. Estimates were weighted and variance and statistical tests have been corrected for the complex sample design. RESULTS: Comparisons between 1997 and 2001 indicated that, overall, patterns of vigorous physical activity remained stable. However, there were significant declines in vigorous physical activity participation by females and 11th grade students between 1997 and 2001. INTERPRETATION: The trends for females and 11th graders are disturbing, since they indicate that the normal gender and age differences in vigorous physical activity participation, found in numerous previous studies, are compounded by declining levels over time for these groups.
BACKGROUND: Chronic illness in a family member can cause emotional distress throughout the family, and may impair the family's ability to support the patient. OBJECTIVES: We compare the familial impact of mental illness to other common chronic conditions. We examine the impact of a person's chronic illness on the psychological health of all persons in his or her family and identify both individual and family-level risk factors associated with psychological spillovers. METHODS: Our analysis is based on data from the 1996 Medical Expenditure Panel Survey (MEPS) that, because of its sample design, can be used to model both individual and family health status. Psychological distress is measured using responses to the general mental health question for each family member. The chronic conditions considered include cancer, diabetes, stroke-related disorders, arthritis, asthma, and mental illness (including dementia). We estimate the relationships of interest using a semi-parametric method, the discrete random effects probit model. RESULTS: Brain-related conditions, including mental illness, impose the most significant risk to the psychological well-being of family members. The effects of the other chronic conditions studied, while not as significant, are notable in that their negative impacts on the psychological health of family members are sometimes larger than their direct psychological impacts on the patient. Economic distress not only directly increases the chance that an individual will experience emotional distress, but it appears it also reduces the family's ability as a whole to cope psychologically with chronic illness. DISCUSSION: Our analysis suffers from problems common to all cross-sectional designs, although the impact of selection bias appeared to be small in sensitivity analysis. While health conditions were based on unverified self-reports, condition categories were broadly defined to reduce the required precision of such reports. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: Because psychological distress is fairly contagious in families confronted with chronic illness, effective treatment strategies may need to be targeted to all members of the primary patient's family. Providers should be particularly vigilant for intra-family effects when their patients come from families that lack the financial resources that might protect against the stress of caring for a family member with a chronic illness. IMPLICATIONS FOR HEALTH POLICIES: Results suggest that, of the chronic conditions considered, priority for respite care and supportive services should be given to families in which a member has a brain-related disorder, particularly in families with limited financial resources and inadequate insurance coverage. IMPLICATIONS FOR FURTHER RESEARCH: The use of the discrete random effects probit model identified important interpersonal health effects that could not have been detected with standard analytical methods. The potential clinical relevance of the resulting findings underlies the need for additional data collection efforts that, like the MEPS, consider individuals in a family context.
PURPOSE: The purpose of this study was to investigate the mechanism of altered retinoic acid receptor beta (RARbeta) expression during esophageal squamous carcinogenesis. EXPERIMENTAL DESIGN: Samples were collected from Linzhou, China. The hypermethylation of CpG islands in the promoter region of the RARbeta gene was examined by methylation-specific PCR in human esophageal squamous cell carcinoma (ESCC) samples, as well as in neighboring tissues with normal epithelium, basal cell hyperplasia, and dysplasia. RARbeta mRNA expression was determined by in situ hybridization. The DNA methyltransferase inhibitor 2'-deoxy-5-azacytidine was used to treat the ESCC cell line, and the DNA hypermethylation status and mRNA expression level were examined. RESULTS: Two of 17 (12%) normal, 9 of 21 basal cell hyperplasia (43%), 7 of 12 dysplasia (58%), and 14 of 20 ESCC (70%) samples had hypermethylation of the RARbeta promoter region. The loss of RARbeta mRNA expression was highly concordant with RARbeta promoter CpG island hypermethylation when individual samples were considered in the correlation analysis. Good statistical correlation between hypermethylation and loss of RARbeta expression was revealed. Frequencies of hypermethylation appeared to increase with the progression of carcinogenesis. In samples from the same patients, if hypermethylation was detected in earlier lesions, it was usually observed in more severe lesions. In the ESCC cell line KYSE 510, 2'-deoxy-5-azacytidine partially reversed CpG island hypermethylation and restored RARbeta mRNA expression. CONCLUSIONS: The results suggest that hypermethylation of RARbeta promoter region is an important mechanism for RARbeta gene silencing in esophageal squamous carcinogenesis.
PURPOSE: The adenoma-carcinoma sequence theory is accepted in carcinogenesis of colorectal carcinoma. To elucidate the nature and genetic alterations in colorectal mucinous carcinoma (MC), we analyzed clinical and pathological characteristics of colorectal MC and nonmucinous carcinoma (NMC), and, furthermore, we compared the prognoses and the statuses of the Wnt signaling pathway, Ki-ras, and p53 in these two subtypes. EXPERIMENTAL DESIGN: Samples of colorectal MC obtained by surgical resections from 41 patients during the period from 1980 to 1999 were classified into fixed (FIX) type and floating (FLO) type (22 and 19 cases, respectively). The statuses of the Wnt signaling pathway and p53 protein were estimated by immunohistochemistry of beta-catenin and p53 proteins, respectively. The mutations in the Ki-ras gene were examined by direct sequencing. RESULTS: The prognosis of colorectal MC was poorer than that of NMC at both stage II and stage III (P = 0.0037 and <0.0001, respectively). The survival rate of patients with the FLO type of MC was lower than that of patients with the FIX type (P = 0.021). Although the results of immunohistochemistry of beta-catenin and mutational analysis of the Ki-ras gene in the two subtypes were not significantly different; the rate of positive nuclear staining of p53 was lower in the FLO type than in the FIX type (P = 0.04). CONCLUSIONS: Colorectal MC, particularly the FLO type, has a more aggressive nature than does colorectal NMC. The FLO type of colorectal MC may develop through different mechanisms from those through which NMC and the FIX type develop.
The aim of this study was first, to investigate the prevalence of obesity, abdominal obesity, and clustering of cardiovascular (CVD) risk factors, and secondly, to identify the BMI or waist circumference (WC) level at which clustering increases in South Koreans. A population-based, cross-sectional National Health Examination Survey was carried out in 1998. A total of 8,816 subjects (4,029 men and 4,787 women) aged 15-79 y were selected by stratified multistage probability sampling design. The measurements taken of the subjects included: height, weight, waist and hip circumference, blood pressure, fasting glucose, and lipids. The prevalence of BMI > or = 25 kg/m2 was 25.3% for men and 28.3% for women. The prevalence of WC >90 cm in men, and >80 cm in women was 18.5%, and 38.5%, respectively. Clustering of 3 or more CVD risk factors was 22.7% in men ad 21.7% in women. Using <21 kg/m2; as a referent, subjects with BMI of 23 kg/m2; and 27 kg/m2; had an odds ratio of 3.5 and 10.2 in men, and 3.1 and 6.7 in women, respectively for clustering of CVD risk factors. Using <65 cm as a referent, subjects with a WC of > or = 90 cm in men and > or = 85 cm in women had an odds ratio of 13.4, and 13.6, respectively for clustering of CVD risk factors. Considering the significant associations between clustering of CVD risk factors and BMI or WC, the present study suggests that high prevalence of overweight may have important implications for the health care system, even at a lower level of BMI or WC.
OBJECTIVE: To determine whether tumor marker pi glutathione transferase (GST-pi) is expressed in hepatocellular carcinoma (HCC) and other chronic liver diseases and to compare its expression with that of alpha-fetoprotein (AFP). STUDY DESIGN: Samples used were formalin-fixed, paraffin-embedded liver tissues: normal (n = 3), chronic hepatitis B (n = 15), cirrhosis (n = 15) and HCC (n = 30). The expression of AFP and GST-pi was detected by using immunohistochemistry with the peroxidase-antiperoxidase method. AFP immunoreactivity was based on the cytoplasm of the hepatocytes, while GST-pi immunoreactivity was based on the nuclei of hepatocytes. RESULTS: In normal liver tissues, AFP was not expressed. However, there was strong staining of GST-pi in bile duct epithelium cells and weak staining in hepatocytes. Our results showed higher AFP immunoreactivity in cases of HCC (36.7%) as compared to cirrhosis (6.7%) and hepatitis B (0%), whereas GST-pi immunoreactivity was lower in cases of HCC (53.3%) as compared to cases of cirrhosis (100.0%) and hepatitis B (93.3%). Percent sensitivity of AFP determination for HCC was 36.7% as compared to 53.3% for GST-pi, thus making GST-pi a more sensitive marker for detection of HCC. This study showed a significant relationship between the intensity and percentage of cells stained in hepatitis B, cirrhosis and HCC for GST-pi immunoreactivity (P < .001, .001 and .05, respectively) but not for AFP (P > .05). Statistical analysis showed that there was no significant relationship between expression of AFP and GST-pi in cirrhosis and HCC cases. Hepatitis B virus infection in HCC cases showed a positive rate of 46.7%, with AFP staining positively in 42.9% of tissues and GST-pi staining positively in 57.1% of tissues. CONCLUSION: AFP is a diagnostic but rather insensitive tissue marker for HCC. However, the absence of AFP in benign chronic liver disease makes this marker useful in differentiating between HCC and other chronic liver diseases, whereas GST-pi can be used as a diagnostic marker for HCC as well as in detecting other chronic liver diseases.
We determined the prevalence of hypertension and the level of awareness, treatment and control of hypertension among Malaysian adults in a population based cross-sectional survey. Twenty-one thousand and three hundred ninety-one adults aged 30 or older in all 13 states of Malaysia in 1996 were sampled using a stratified two-stage cluster sampling design. Thirty-three percent of adults had hypertension with a higher percentage among women. Among hypertensives, 33% were aware of their hypertension, 23% were currently on treatment and a mere 6% had controlled hypertension. There was practically no difference in mean BP between treated and untreated hypertensives. Concerted public health effort is urgently required to improve the detection, treatment and control of hypertension in Malaysia.
The coral reef fish community was studied in Playa Mero, Morrocoy National Park, after the mass mortality of January, 1996 with a systematic sampling design. Transects and quadrates were used for corals, and a visual census for fishes. The coral community is highly disturbed with extensive areas of dead coral covered by algae, and low coverage and richness of coral species, gorgonians, sponges and briozooans. These factors have generated a relatively homogeneous environment with respect to the fish community, which was dominated by Scaridae and Pomacentridae that represented 75% of fish. Dominant fishes were mainly herbivorous (75.4% of all fish) apparently because of the disturbance that caused the settling of algae.
PURPOSE: The purpose of this study was to describe dental caries experience in the primary and permanent dentitions of Maryland schoolchildren in kindergarten and third grade, with an emphasis on untreated disease. METHODS: Data came from the Survey of the Oral Health Status of Maryland Schoolchildren, 2000--2001. Outcome variables were measures of dental caries experience for primary and permanent teeth. Dental caries was scored only for lesions that were >0.5 mm, measured with a periodontal probe. Radiographs were not used. Descriptor variables included grade level, gender, race/ethnicity, eligibility for free or reduced meals at school, parent/ guardian education, dental insurance status, and region. The statistical software program SUDAAN was used to produce weighted estimates and account for the complex sampling design. RESULTS: More than 2 in 10 schoolchildren had a history of dental caries. In children with a history of disease, approximately half of the experience was due to untreated decay. Controlling for confounders, disparities in untreated dental caries were significantly associated with region, race/ethnicity, and parent/guardian education. CONCLUSIONS: Success in meeting the dental caries treatment needs in children will require attention to multiple family-level, community-level, and system-level barriers, especially among low socioeconomic status populations. Unless barriers are overcome, dental caries disparities will continue in Maryland.
PURPOSE: Expression of erythropoietin (Epo) and its receptor (Epo-R) has been shown in various normal and neoplastic nonhematopoietic tissues. This study, in non-small cell lung carcinoma, was designed to investigate the previously unreported expression of Epo and Epo-R as well as hypoxia-inducible factor-1alpha (HIF-1alpha), which is known to control Epo expression. EXPERIMENTAL DESIGN: Samples from lung squamous cell carcinomas (n = 17) and adenocarcinomas (n = 12) were obtained from patients undergoing curative surgery. mRNA transcripts of Epo, Epo-R, soluble Epo-R (sEpo-R), HIF-1alpha, and factor inhibiting HIF-1 (FIH-1) were evaluated by reverse transcription-PCR, whereas localization of Epo, Epo-R, and HIF-1alpha was assessed by immunohistochemistry. RESULTS: Epo, Epo-R, sEpo-R, HIF-1alpha, and FIH-1 transcripts were detected by reverse transcription-PCR in all samples tested, but with heterogeneous levels of expression for Epo, Epo-R, and sEpo-R. Coordinated levels of mRNA were observed for HIF-1alpha and FIH-1.Epo was detected in carcinomatous cells by immunohistochemistry in 50% of samples and Epo-R was detected in 96% of samples. Co-expression of Epo and Epo-R was observed on contiguous sections from 50% of tumors. HIF-1alpha was immunolocalized in 80% of non-small cell lung carcinomas. CONCLUSION: Epo-R was expressed in almost all samples and Epo was expressed in one half of samples on immunohistochemistry and in 100% of samples by mRNA detection, suggesting a potential paracrine and/or autocrine role of endogenous Epo in non-small cell lung carcinoma. The detection of stabilized HIF-1alpha suggests a possible role in Epo expression. Moreover, in the light of these results, the potential interactions between therapeutic recombinant Epo and the putative neoplastic Epo/Epo-R signaling pathways must be considered.