The objective of this study was to explore the protein expression pattern in normal endometrial mucosa (n = 5) and endometrial carcinoma (n = 15) of low (diploid) and high (aneuploid) malignancy potential by two-dimensional gel electrophoresis (2-DE). The specimens were evaluated for histopathologic subtype, stage and grade in relation to DNA ploidy. A match-set consisting of five samples from normal endometrium, eight diploid and seven aneuploid tumours was created. All the diploid and three of the aneuploid tumours were of endometrioid subtype, while the remaining four were of uterine seropapillary type. There were 192 protein spots differentiating diploid tumours from normal endometrium and 238 protein spots were separating aneuploid tumours from normal endometrium (p
To measure the effectiveness of fluoride varnish (FV) (Duraflor), 5% sodium fluoride, Pharmascience Inc., Montréal, QC, Canada) and caregiver counseling in preventing early childhood caries (ECC) in Aboriginal children in a 2-year community-randomized controlled trial.
Twenty First Nations communities in the Sioux Lookout Zone (SLZ), Northwest Ontario, Canada were randomized to two study groups. All caregivers received oral health counseling, while children in one group received FV twice per year and the controls received no varnish. A total of 1275, 6 months to 5-year-old children from the SLZ communities were enrolled. In addition, a convenience sample of 150 primarily non-Aboriginal children of the same age were recruited from the neighboring community of Thunder Bay and used as comparisons. Longitudinal examinations for the dmft/s indices were conducted by calibrated hygienists in 2003, 2004 and 2005.
Aboriginal children living in the SLZ or in Thunder Bay had significantly higher caries prevalence and severity than non-Aboriginal children in Thunder Bay. FV treatment conferred an 18% reduction in the 2-year mean 'net' dmfs increment for Aboriginal children and a 25% reduction for all children, using cluster analysis to adjust for the intra-cluster correlation among children in the same community. Adjusted odds ratio for caries incidence was 1.96 times higher in the controls than in the FV group (95% CI = 1.08-3.56; P = 0.027). For those caries-free at baseline, the number (of children) needed to treat (NNT) equaled 7.4.
Findings support the use of FV at least twice per year, in conjunction with caregiver counseling, to prevent ECC, reduce caries increment and oral health inequalities between young Aboriginal and non-Aboriginal children.
OBJECTIVE: To assess the efficacy of a school-based intervention programme to reduce the prevalence of overweight in 6 to 10-year-old children. DESIGN: Cluster-randomized, controlled study. SUBJECTS: A total of 3135 boys and girls in grades 1-4 were included in the study. METHODS: Ten schools were selected in Stockholm county area and randomized to intervention (n=5) and control (n=5) schools. Low-fat dairy products and whole-grain bread were promoted and all sweets and sweetened drinks were eliminated in intervention schools. Physical activity (PA) was aimed to increase by 30 min day(-1) during school time and sedentary behaviour restricted during after school care time. PA was measured by accelerometry. Eating habits at home were assessed by parental report. Eating disorders were evaluated by self-report. RESULTS: The prevalence of overweight and obesity decreased by 3.2% (from 20.3 to 17.1) in intervention schools compared with an increase of 2.8% (from 16.1 to 18.9) in control schools (P
The aim of the study was to assess the association of abdominal symptoms in a random sample of a general population and to find whether the associations could be confirmed at follow-up 5 years later. The study population was a sex- and age-stratified random sample of people living in the western part of Copenhagen County, Denmark. Of 4807 eligible subjects 79% attended the study and filled in a questionnaire on abdominal symptoms. Five years later the study was repeated and 85% of the survivors participated. Data from both studies were analysed separately for sex, age group and the following pain variables: unspecified abdominal pain, pain located to the epigastrium, pain provoked by stress or hunger, pain relieved by eating and pain relieved by defecation. Three clusters of symptoms occurred in all the analyses: borborygmi/altering stool consistency/distension; acid regurgitation/heartburn and nausea/vomiting. Unspecified pain was associated with all three clusters, pain provoked by stress or hunger and pain relieved by defecation associated with the borborygmi/altering stool/distension cluster, whereas pain in the epigastrium and pain relieved by eating did not show consistent relationships to any of the clusters. Additionally, the clusters associated with each other more often than could be expected by chance. As a consequence of our findings we suggest that the three clusters of symptoms constitute three common abdominal syndromes.
BACKGROUND: Dementia is a chronic illness associated with a progressive loss of cognitive and intellectual abilities, such as memory, judgment and abstract thinking.The objective of this study was to assess the health utilities of patients with dementia in Europe and identify the key factors influencing their Health-Related Quality of Life (HRQol). METHODS: This study used cross-sectional data from the Odense study; a Danish cohort of patients aged 65-84 living in Odense, Denmark. A total of 244 patients with mild to severe dementia were interviewed together with a caregiver about their health status and activities of daily living (ADL). Alzheimer's disease was diagnosed according to the NINCDS-ADRDA criteria for probable dementia. Vascular dementia and other types of dementia were diagnosed according to the DSM-IIIR criteria. Severity of dementia was defined by score intervals on the Mini Mental State Examination score: mild (MMSE 20-30), moderate (MMSE 10-19), and severe (MMSE 0-9). Based on the ADL information, the patients' dependency level was defined as either dependent or independent. Questions from the Odense Study were mapped into each of the five dimensions of the EQ-5D in order to assess patients' HRQol. Danish EQ-5D social tariffs were used to value patients' HRQol.A regression analysis of EQ-5D values was conducted with backward selection on gender, age, severity, ADL level and setting in order to determine the main factor influencing HRQoL. RESULTS: The EQ-5D weight in patients independent upon others in ADL was 0.641 (95% CI: [0.612-0.669]), and in those dependent upon others was 0.343 (95% CI: [0.251-0.436]). CONCLUSION: Dependency upon others to perform ADL was the main factor affecting HRQoL.
Birch and Abelson  argue that non-income based barriers might explain differences in utilization of health services within and between income groups. Databases which contain utilization data rarely allow for the modelling of geographic variation. In the Ontario Health Survey (OHS), individual observations are georeferenced at the Public Health Unit (PHU) scale, but PHUs cannot easily be used because of the large coefficients of variation. To overcome this problem, a cluster analysis is performed to create a service environment variable, which reflects differences in service availability, population size and rurality. Utilization of health services is then modelled as a logistic regression equation where the independent variables are age, sex, service environment and income to test the Birch and Abelson argument. This argument is then extended by controlling for age, health and income status. Based on the modelling results, the importance of geography to access and utilization is assessed.
This prospective dynamic-population-based study investigated factors involved in the accident process preceding overexertion back injuries among nursing personnel.
The study covered all reported occupational overexertion back injuries due to accidents among of the approximately 24 500 nurses in the Stockholm County hospitals during 1 year. It was assumed that several factors interact in the accident process. Detailed information was obtained for each injury by interviews with the injured nurse and head nurse. Risks in the physical environment were identified using an ergonomic checklist.
During the study 136 overexertion back injuries were reported. Of the 130 nurses participating in the study, 125 had been injured in connection with patient work. Cluster analysis yielded 6 clusters and their pattern of contributing factors. The most frequent injury occurred during patient transfer in the bed or to or from the bed, without the use of transfer devices, when the patient suddenly lost his or her balance or resisted during the transfer and the nurse had to make a sudden movement. However, there were physical conditions, such as shortcomings in the physical work environment or a lack of a transfer device, that compelled the nurses to perform the tasks under unsafe conditions.
The clusters showed a complexity of different kinds of accidents and indicated that the measures for preventing accidents, or for blocking an accident process once started, have to be of different kinds and placed at several different levels in the organization of a workplace.
Trials in which intact communities are the units of randomization are increasingly being used to evaluate interventions which are more naturally administered at the community level, or when there is a substantial risk of treatment contamination. In this article we focus on the planning of community intervention trials in which k communities (for example, medical practices, worksites, or villages) are to be randomly allocated to each of an intervention and a control group, and fixed cohorts of m individuals enrolled in each community prior to randomization. Formulas to determine k or m may be obtained by adjusting standard sample size formulas to account for the intracluster correlation coefficient rho. In the presence of individual-level attrition however, observed cohort sizes are likely to vary. We show that conventional approaches of accounting for potential attrition, such as dividing standard sample size formulas by the anticipated follow-up rate pi or using the average anticipated cohort size m pi, may, respectively, overestimate or underestimate the required sample size when cluster follow-up rates are highly variable, and m or rho are large. We present new sample size estimation formulas for the comparison of two means or two proportions, which appropriately account for variation among cluster follow-up rates. These formulas are derived by specifying a model for the binary missingness indicators under the population-averaged approach, assuming an exchangeable intracluster correlation coefficient, denoted by tau. To aid in the planning of future trials, we recommend that estimates for tau be reported in published community intervention trials.
Low back pain (LBP) is common already in adolescence, and many risk indicators including both psychosocial and lifestyle factors have been recognized. Our purpose was to assess whether the co-occurrence of psychosocial (externalizing and internalizing) problems and lifestyle factors (leisure time physical activity, sedentary behaviour, sleep, smoking, and overweight/obesity) associate with LBP at 16 years cross-sectionally or with new LBP at 18-year follow-up.
The study population, drawn from the Northern Finland Birth Cohort 1986, consisted of 1625 participants (712 boys and 913 girls) who completed a questionnaire on potential explanatory factors at 16 years and on LBP at 16 and 18 years. The outcome measure was 'reporting LBP' or 'consultation for LBP' during the past 6 months. Latent Class Analysis (LCA) was utilized to study the co-occurrence of the explanatory factors.
Among both genders, four clusters were found. Externalizing behaviour problems were associated with 'reporting LBP' (RR 1.5, boys 1.4, girls) and 'consultation for LBP' (RR 1.6 for both genders) at baseline among both genders. In addition, the cluster of multiple risk behaviours was associated with both 'reporting LBP' (RR 1.3) and 'consultation for LBP' (RR 2.5) and the obese cluster with 'consultation for LBP' (RR 1.7) among girls. Externalizing behaviour problems at 16 years predicted 'consultation for LBP' at 18 years among girls (RR 3.6).
Our results stress the role of psychosocial factors in reporting and seeking care for adolescent LBP.