Background: In 2001, the National Cancer Institute (NCI) funded a project to develop methods to recruit American Indian and Alaska Native (AI/AN) adults for a prospective cohort study of chronic disease risk and protective factors.Objective: We describe how the use of community-based participatory research (CBPR) principles led to more effective study design and implementation in a study in Alaska.Methods: CBPR elements included collaboration between researchers and tribes at all stages of the project, capacity building through training AI/AN staff in research methods, and knowledge dissemination through presentations, newsletters, and individual and community health feedback based on results of the study.Results: Between March 2004 and August 2006, 3,821 AI/ AN adults from 26 Alaskan communities enrolled in the study. Retention in the study is high, with over 88% of participants successfully completing a 2-year follow-up questionnaire.Conclusion: CBPR methods have facilitated effective development of study methods, recruitment and retention. Efforts are on-going to continue work with this unique AI/AN research participant community.
Results from epidemiologic studies on the association between circulating carotenoid concentrations and the risk of prostate cancer are still inconsistent. We studied whether serum concentrations of carotenoids were associated with the risk of developing prostate cancer. The study population consisted of 997 middle-aged Finnish men (56.1 ± 6.6 yr) in the Kuopio Ischaemic Heart Disease Risk Factor (KIHD) cohort. Serum concentrations of carotenoids were measured by high-performance liquid chromatography. Subjects were classified into tertiles according to their serum concentrations of antioxidants. Relative risks (RRs) were estimated by using the Cox proportional hazard models. During the mean follow-up time of 15 yr, a total of 68 prostate cancer cases occurred. After adjusting for age, examination yr, family history of cancer, BMI, pack-yr of smoking, alcohol consumption, education, physical activity, serum total cholesterol, and serum a-linolenic acid, men in the highest tertile of serum concentrations of ß-carotene had 2.3-fold higher risk of prostate cancer as compared to those in the lowest tertile (RR = 2.29, 95% CI: 1.12-4.66; P = 0.023). a-Tocopherol and retinol were not associated with prostate cancer. This prospective study suggests that high-serum ß-carotene concentrations may increase the risk of prostate cancer in middle-aged men.
Cutaneous human papillomaviruses (HPVs) have been associated with squamous cell carcinoma (SCC) in case-control studies, but there are limited data from prospective studies assessing whether virus exposure predicts risk of future cancer development. Two major biobanks, the Southern Sweden Microbiology Biobank (1971-2003) and the Janus Biobank (1973-2003) in Norway, containing samples from 850,000 donors, were searched for incident skin cancer for up to 30 years using registry linkages. Altogether, 2,623 donors with samples taken before diagnosis of SCC or basal cell carcinoma (BCC) of the skin were identified. Prediagnostic samples and samples from 2,623 matched controls were tested for antibodies against 33 types of HPV. Baseline seropositivity to HPV types in genus ß species 2 was associated with SCC risk (odds ratio = 1.3, 95% confidence interval: 1.1, 1.7); this was also the case for samples taken more than 18 years before diagnosis (odds ratio = 1.8, 95% confidence interval: 1.1, 2.8). Type-specific persistent seropositivity entailed elevated point estimates for SCC risk for 29 HPV types and decreased point estimates for only 3 types. After multiple hypothesis adjustment, HPV 76 was significantly associated with SCC risk and HPV 9 with BCC risk. In summary, seropositivity for certain HPV types was associated with an increased risk for future development of SCC and BCC.
Meeting patient's preferences is an important outcome in palliative care. No Scandinavian study has reported systematically collected preferences from patients regarding place of care (POC) and place of death (POD). The extent of possible incongruence between patients' preferences and reality remains unknown.
The aim of this study was to describe patients' preferred POC and POD and changes in preferences over time and to evaluate congruence between preferences and reality. Furthermore, the aim was to search for predictive factors regarding patients' wishes and fulfilment of these.
This is a prospective interview and questionnaire study.
The study was conducted in the former Aarhus County, Denmark and 96 end-stage cancer patients participated.
Of the patients, who stated a preference, 84% preferred home care and 71% preferred home death. A positive association between living with a partner and both wishing for home care and home death was observed (prevalence ratio (PR): 1.66 (95% confidence intervals (CI): 1.07, 2.58), p = 0.02 and PR: 2.33 (95% CI: 1.14, 4.77), p = 0.02, respectively). Marked changes in preferences were observed. Overall, preferences were met for approximately half of the patients, although kappa values were low (?=0.132 for POC and ?=0.034 for POD).We found a significant association between being cared for in the preferred place and having contact with a palliative care team (PR: 2.01 (95% CI: 1.02, 3.98), p = 0.045).
Regular discussions with patients on this subject are needed. Social and professional support is of importance in meeting patients' preferences. Larger scaled studies and research focusing on meeting patients' preferences are needed.
The Broselow Pediatric Emergency Tape (Armstrong Medical Industries, Inc., Lincolnshire, IL) (BT) is a well-established length-based tool for estimation of body weight for children during resuscitation. In view of pandemic childhood obesity, the BT may no longer accurately estimate weight. We therefore studied the BT in children from Ontario in a large recent patient cohort.
Actual height and weight were obtained from an urban and a rural setting. Children were prospectively recruited between April 2007 and July 2008 from the emergency department and outpatient clinics at the London Health Science Centre. Rural children from junior kindergarten to grade 4 were also recruited in the spring of 2008 from the Avon Maitland District School Board. Data for preschool children were obtained from three daycare centres and the electronic medical record from the Maitland Valley Medical Centre. The predicted weight from the BT was compared to the actual weight using Spearman rank correlation; agreement and percent error (PE) were also calculated.
A total of 6,361 children (46.2% female) were included in the study. The median age was 3.9 years (interquartile range [IQR] 1.56-7.67 years), weight was 17.2 kg (IQR 11.6-25.4 kg), and height was 103.5 cm (IQR 82-124.4 cm). Although the BT weight estimate correlated with the actual weight (r ?=? 0.95577, p
The purposes of this study were to measure the prevalence of clinical and radiographic hip osteoarthritis (OA) and first-time diagnosis of hip OA in consecutive patients presenting to chiropractic practices in Denmark and to report the components of the initial treatment rendered by the chiropractic practitioner.
A total of 2000 patient records and 1000 radiographs were reviewed retrospectively in 20 chiropractic clinics throughout Denmark. Information obtained included patients' primary complaint, physical examination and radiographic findings of hip OA, and treatment. Subsequently, the 20 clinics participated in a prospective survey where they collected equivalent information over a 2-week period.
Retrospective review of records revealed that 1.4% of patients in Danish chiropractic practice had signs of clinical hip OA. Of these, 59% demonstrated radiographic signs of hip OA. Prospective data collection revealed that 3.4% of new patients had signs of clinical hip OA. Fifty-four percent of these demonstrated radiographic signs of hip OA, and of these 70% were diagnosed as having OA of the hip for the first time. Initial treatment involved manual treatment and advice on over-the-counter pain medication and/or supplements. Of all 1000 retrospectively reviewed radiographs in patients 40 years or older, 19.2% demonstrated radiographic signs of hip OA.
Osteoarthritis of the hip is diagnosed and managed in primary care chiropractic practice in Denmark; however, it is likely underdiagnosed. In those newly presenting to chiropractic practitioners, first-time diagnosis with clinical and radiographic signs of hip OA appears to be common.
To examine the association between diet quality and the diagnosis of an internalizing disorder in children and adolescents.
A prospective study examining the relationship between diet quality and mental health. FFQ responses of 3757 children were used to calculate a composite score for diet quality and its four components: variety, adequacy, moderation and balance. Physicians' diagnoses on internalizing disorders were obtained by linking the children's dietary information to administrative health data. Negative binomial regression models were used to examine the association between diet quality and diagnosis of an internalizing disorder.
The Canadian province of Nova Scotia.
A provincially representative sample of grade 5 students (age 10-11 years).
Diet quality was not found to be associated with internalizing disorder in a statistically significant manner (incidence rate ratio = 1.09; 95 % CI 0.73, 1.63). However, relative to children with little variety in their diets, children with greater variety in their diet had statistically significant lower rates of internalizing disorder in subsequent years (incidence rate ratio = 0.45; 95 % CI 0.25, 0.82).
These findings suggest the importance of variety in children's diet and opportunities in the prevention of adolescent depression and anxiety.
Studies that compare health-related quality of life (HRQOL) and other patient-reported outcomes in different populations rest on the assumption that the measure has equivalent psychometric properties across groups. This study examined the measurement equivalence (ME) of the 36-item Medical Outcomes Study Short Form Survey (SF-36), a widely-used measure of HRQOL, by sex and race in a population-based Canadian sample.
SF-36 data were from the Canadian Multicentre Osteoporosis Study, a prospective cohort study that randomly sampled adult men and women from nine sites across Canada. Confirmatory factor analysis (CFA) techniques were used to test hypotheses about four forms of ME, which are based on equality of the factor loadings, variances, covariances, and intercepts. Analyses were conducted for Caucasian and non-Caucasian females (n = 6,539) and males (n = 2,884). CFA results revealed that a measurement model with physical and mental health factors provided a good fit to the data. All forms of ME were satisfied for the study groups.
The results suggest that sex and race do not influence the conceptualization of a general measure of HRQOL in the Canadian population.
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Human parechoviruses (HPeVs) are common viruses mainly infecting young children. Most infections are mild, but HPeV3 causes severe CNS infections in new-born infants.
The aim was to study the epidemiology of HPeVs in Finnish general population in the period 1996-2007, with special emphasis on the different types circulating in Finland.
A total of 2236 stool specimens were collected from 200 healthy Finnish children in a prospective birth cohort study, most before the age of 2 years. Samples were tested for the presence of HPeV RNA using a specific RT-PCR. The genotype of HPeV was determined by sequencing the VP1 genomic region.
HPeV RNA was detected in 144 (6.4%) specimens from 78 (39%) children. The dominant type was HPeV1 (93% of the type-identified 105 samples), although types 3 and 6 were also identified. HPeV was found sequentially in more than one sample in 43 infections lasting up to 93 days. The positive findings were distributed equally in young ages and declined towards the age of 2 years. Infections clustered around the autumn months with no obvious change between years. No significant differences were seen between boys and girls.
HPeV is a common virus infecting Finnish children under 2 years of age. HPeVs circulate throughout the year with clear accumulation on autumn, also seen in individual years over the 11-year study period. The virus deserves increased attention and should be included in the test panel of clinical virus laboratories.
Posttraumatic growth (PTG) is frequently reported after the strike of a serious medical illness. The current study sought to: 1) assess the relationship between degree of cardiac "threat" and PTG one-year post-hospitalization; and 2) to explore the association between PTG and healthcare utilization.
In a cohort study, 2636 cardiac inpatients from 11 Ontario hospitals completed a sociodemographic survey; clinical data were extracted from charts. One year later, 1717 of these outpatients completed a postal survey, which assessed PTG and healthcare utilization. Morbidity data were obtained retrospectively through probabilistic linkage to administrative data. The predicted risk of recurrent events for each participant was calculated using a logistic regression model, based on participants' sociodemographic and clinical characteristics. The relationship among PTG, trauma and health service use was examined with multiple regression models.
Greater PTG was significantly related to greater predicted risk of recurrent events (p