Efficacy and stability of the alar base cinch suture

The alar base cinch suture is designed to prevent excessive flaring of the nose after Le Fort 1 osteotomy of the maxilla. However, it is difficult to measure the effect of the suture on nasal width during the operation in the presence of a nasal endotracheal tube, and the long-term stability of the manoeuvre has not been well-documented. We have investigated the efficacy and stability of the alar base cinch suture by measuring nasal width in 36 patients before, during, and 12 months after, bimaxillary surgery with submental intubation. The use of submental intubation facilitated accurate measurement of the changes in nasal width produced by the osteotomy and the cinch suture. Intraoperative measurements showed that there was a mean increase in the width of the base of the nose of 3.0 mm, 9% (right and left alar points, al-al) and 3.6 mm, 11% (right and left alar curvature points, ac-ac) after the osteotomy, and that the cinch suture produced a reduction in these increases of 1.6 mm, 53% (al-al), and 2.1 mm, 58% (ac-ac). Measurements taken after the operation at 3, 6, and 12 months showed no significant changes. This indicates that our method of cinch suturing is effective in mitigating the increase in nasal width that is produced by the osteotomy, and that this effect is stable in the medium term.

Differences in characteristics between people with lower limb amputations who died before 12 weeks and those who survived: Short Report

The baseline determinants of survival following a non-traumatic lower limb amputation (LLA) in participants in the Johannesburg metropolitan area are unknown.The aim of the study was to establish the characteristics of participants who had died by three months after LLAA longitudinal pre- test- post test study utilized participant interviews (n=73).  Consecutive  sampling  was  used  to  select  participants  who  met  the  inclusion criteria. Ethical clearance was obtained. Permission was obtained from the hospitals. Participants gave consent before taking part in the study. A demographic questionnaire, the EQ-5D, the Modified Household Economic and Social Status Index (HESSI) and the Barthel Index (BI) were used, to collect data. Participants  were  interviewed  preoperatively  and  then  followed  up  three  months  post-operatively  to  establish survival/ existence. Twenty-four  participants  (33%)  had  died.  The  preoperative  median  Visual  Analogue  Scale  (VAS)  of  the  EQ-5D was 60 and 70 showing no significant difference in quality of life (QOL) between those who survived and those who  died  respectively.  The  preoperative  median  total  BI  score  was  20  and  19  showing  significantly  inferior  function for the deceased (p=0.01). The deceased were significantly older (p=0.009) used alcohol (p=0.02) and smoked tobacco (p=0.03).Being older, having poorer function, being a smoker and drinking alcohol preoperatively seem to decrease the chance of survival following LLA in Johannesburg.

Room for improvement? The adoption of multimodal esophageal cancer care in the United States

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Background: Consensus guidelines recommend neoadjuvant chemo- or chemoradiation therapy as the preferred treatment for locally advanced esophageal adenocarcinoma; however, it is unknown if this recommendation has been widely adopted in the U.S. Our objective was to examine esophageal cancer multimodal therapy and identify factors associated with the use of neoadjuvant therapy.

Methods: From the National Cancer Data Base, patients with middle third, lower third and GE junction (GEJ) adenocarcinomas were identified. Patients who were clinical stage I-III and underwent surgical resection were included. Separate logistic regression models were developed to identify predictors of neoadjuvant therapy utilization and outcomes.

Results: From 1998 to 2007, 8,051 patients underwent surgical resection for esophageal cancer: 16.3% stage I, 45.0% stage II and 38.7% stage III. For stage II/III tumors, neoadjuvant use increased (49.0% to 77.8%, p<0.001). After adjustment, factors associated with underuse of neoadjuvant therapy in stage II/III patients were older age, Black or Hispanic ethnicity, more severe comorbidities, tumor location (GEJ and middle vs. lower third), tumor size ≥ 2cm, stage II (vs. III) and geographic region. Stage II/III patients not receiving neoadjuvant had an over two fold increased risk of positive lymph nodes (OR 2.14. 95% CI 1.79 – 2.55, p<0.001). In addition, the positive surgical margin rate increased almost three fold (OR 2.80 95% CI 2.17-3.62, p<0.001) but 30-day postoperative mortality risk was not significantly affected (OR 1.50 95% CI 0.94-2.39; p=0.090). For stage I patients, neoadjuvant therapy decreased over time (38.0% to 11.4%, p<0.001). The overuse of neoadjuvant therapy was associated with higher tumor grade, larger tumor size, and low surgical case volume (all p<0.05).

Conclusions: The adoption of neoadjuvant therapy has increased in the past decade; however, opportunity exists to improve guideline treatment for locally advanced esophageal cancer. Registry-based feedback to individual hospitals, such as benchmark comparison tools, could help institutions provide care in concordance with national guidelines.

No significant financial relationships to disclose.

Creating an e-learning module from learning objects using a commentary or 'personal learning assistant'

The use of learning objects (LOs), small chunks of learning stored digitally and reused or referenced to support learning, was described as a promising approach to the creation of e-learning modules or programmes. In practice, however, the early enthusiasm has waned and the approach has not been widely adopted. It is argued that this was due, at least in part, to a neglect of the pedagogy and an emphasis on the technical aspects of interoperability and reusability. This article describes a practical approach to constructing a learning module using LOs where a commentary links LOs selected for inclusion in the programme. The commentary tells the story of the e-learning module and provides the learner with a context for an LO. It can be viewed as a 'personal learning assistant' that advises students about the management of their learning and relates the e-learning module to the overall learning outcomes for the curriculum. The commentary also allows the lecturer to comment on LOs selected for inclusion in the programme which otherwise might have to be adapted or excluded when the programme was constructed. The use of a commentary to link and introduce LOs has been successfully adopted in the development of e-learning programmes. Teachers are encouraged to consider the approach and to look again at the use of LOs to create e-learning resources.

Psychiatric disorders and sexual risk among adolescents in mental health treatment

OBJECTIVE

To examine the relationship between psychiatric disorders and sexual behaviors among adolescents receiving mental health treatment. Adolescents in mental health treatment have been found to have higher rates of HIV risk behavior than their peers, but data concerning the relationship between psychopathology and risk are inconsistent and limited.

METHOD

Eight hundred and forty adolescents (56% female, 58% African American, mean age = 14.9 years) and their parents completed computerized assessments of psychiatric symptoms via the Computerized Diagnostic Interview Schedule for Children (Shaffer, 2000a, 2000b). Adolescents also reported on sexual risk behaviors (vaginal/anal sex, condom use at last sex) and completed urine screens for a sexually transmitted infection (STI).

RESULTS

Adolescents meeting criteria for mania, externalizing disorders (oppositional defiant, conduct, and attention-deficit/hyperactivity disorders), or comorbid for externalizing and internalizing disorders (major depressive, generalized anxiety, and posttraumatic stress disorders) were significantly more likely to report a lifetime history of vaginal or anal sex than those who did not meet criteria for any psychiatric disorder (odds ratio [OR] = 2.0, 2.3, and 1.9, respectively). Adolescents meeting criteria for mania were significantly more likely to have 2 or more partners in the past 90 days (OR = 3.2) and to test positive for a STI (OR = 4.3) relative to adolescents who did not meet criteria for a psychiatric disorder.

CONCLUSIONS

The presence of internalizing and externalizing disorders, especially mania, suggests the need for careful screening and targeting of adolescent sexual behavior during psychiatric treatment.

Prevalence and correlates of diabetes in South asian indians in the United States: findings from the metabolic syndrome and atherosclerosis in South asians living in america study and the multi-ethnic study of atherosclerosis

BACKGROUND

Individuals from South Asia have high diabetes prevalence despite low body weight. We compared the prevalence of diabetes among South Asian Indians with other U.S. ethnic groups and explored correlates of diabetes.

METHODS

This was a cross-sectional study of 150 South Asian Indians (ages 45-79) in California, using similar methods to the Multi-Ethnic Study of Atherosclerosis (MESA). Type 2 diabetes was classified by fasting plasma glucose (FPG) >or=126 mg/dL, 2-h postchallenge glucose >or=200 mg/dL, or use of hypoglycemic medication.

RESULTS

A total of 29% of Asian Indians had diabetes, 37% had prediabetes, and 34% had normal glucose tolerance. After full adjustment for covariates, Indians still had significantly higher odds of diabetes compared to whites and Latinos, but not significantly different from African Americans and Chinese Americans in MESA: Indians [odds ratio (OR), 1.0], whites [OR, 0.29; 95% confidence interval (CI), 0.17-0.49], Latinos (OR, 0.59; CI, 0.34-1.00) African Americans (OR, 0.77; CI 0.45-1.32), Chinese Americans (OR, 0.78, CI, 0.45-1.32). Variables associated with prediabetes or diabetes among Indians included hypertension, fatty liver, visceral adiposity, microalbuminuria, carotid intima media thickness, and stronger traditional Indian beliefs.

CONCLUSIONS

Indian immigrants may be more likely to have diabetes than other U.S. ethnic groups, and cultural factors may play a role, suggesting that this is a promising area of research.

Environmental-enrichment-related variations in behavioral, biochemical, and physiologic responses of Sprague-Dawley and Long Evans rats

The behavioral, biochemical, and physiologic consequences of 6 wk of environmental enrichment were evaluated in male Long Evans and Sprague-Dawley rats and compared with those of rats in standard single-housing conditions. Standard housing provided little or no social or physical stimulation whereas environmental enrichment comprised group housing for 8 h daily in a 3-story cage equipped with novel stimuli. Dependent measures included performance in the forced swim test, thresholds for brain-stimulation reward, sucrose intake and preference, determination of corticosterone levels before and after brief restraint stress, and rate of weight gain. In forced swimming tests, active behaviors (diving, swimming with struggling, and climbing) tended to dominate over passive behaviors (sinking, floating) in both groups and outbred rat stocks (especially in enriched groups) on the first day. These behaviors were replaced with maintenance behaviors such as grooming and swimming without struggling on the second exposure, with enriched Long Evans rats showing the largest decline in activity. Baseline plasma corticosterone levels were elevated in both rat stocks after 6 wk of enrichment. After restraint stress, hormone levels in enriched animals tended to peak earlier and approach or exceed baseline values more quickly than was observed in the comparable control groups. Rate of body weight gain was greater in enriched Long Evans rats than Sprague-Dawley or control rats. Our observations indicate that stock- and group-associated differences in several indices occur in association with enrichment. The data support the claim that environmental enrichment may render animals more resilient to challenges.

The role of paracetamol in the pathogenesis of asthma

Paracetamol use represents a putative risk factor for the development of asthma. There is convincing epidemiological evidence that the risk of asthma may be increased with exposure to paracetamol in the intrauterine environment, infancy, later childhood and adult life. A dose-dependent association has also been observed in these different age groups in different populations world-wide. An association has also been shown between paracetamol use in both rhinoconjunctivitis and eczema. There is biological plausibility with paracetamol use leading to decreased glutathione levels resulting in increased oxidant-induced inflammation and potentially enhanced T-helper type 2 responses. At the population level, patterns of paracetamol use might explain, to some extent, the world-wide variation in the prevalence of asthma and related disorders, particularly the high rates in English-speaking countries, which have high per capita prescription and over-the-counter use of paracetamol. A temporal association also exists between the international trends of increasing paracetamol use and increasing prevalence of asthma over recent decades. Further research is urgently required, in particular randomized-controlled trials (RCTs) into the long-term effects of frequent paracetamol use in childhood, to determine the magnitude and characteristics of any such risk. Importantly, RCTs will also enable evidence-based guidelines for the recommended use of paracetamol to be developed.

Americans With Disabilities Act Amendments of 2008

During the past decade, the U.S. Supreme Court has ruled on three cases, generally referred to as the “Sutton trilogy,” that sharply narrowed the scope of Americans With Disabilities Act (ADA) protection. Specifically, the Court ruled that mitigating and/or corrective measures must be taken into account in determining whether an individual is eligible for protection under the ADA. The authors briefly review the Sutton trilogy case law, summarize the ADA 2008 amendments, and provide recommendations for employers concerning policy development that will proactively address the major modifications of ADA 2008 amendment.

Mainstreaming genetics: a comparative review of clinical services for inherited cardiovascular conditions in the UK

Inherited cardiovascular conditions (ICCs) are a group of monogenic disorders caused by mutations in the components of the electrical and contractile system of the heart or its vasculature. ICCs include arrhythmias, cardiomyopathies, inherited arteriopathies such as Marfan syndrome, muscular dystrophies, and familial hypercholesterolaemia. Epidemiological data on ICCs are sparse but a survey of the available literature suggests that there are approximately 340,000 prevalent cases of these conditions in the UK (population 61 million). As a result of dramatic advances in understanding of the molecular pathology of ICCs, more than 50 ICCs have been recognised, and diagnostic genetic tests are increasingly available. As part of a needs assessment and review of provision of ICC services, a survey of all UK ICC services was undertaken focusing on both quantitative and qualitative aspects. Service provision was found to be highly inequitable, with typically a 10-20-fold variation in referral and genetic testing rates between different UK regions. Service levels per million population are much higher in London than in all but one of the regions. The review concluded that capacity of services is inadequate to meet current or future demand and many services lack the critical mass to provide the full range of services. Recommendations are made for the development of services appropriate for the future. Services should be led by cardiology but have close links with clinical genetics services, which should provide support with specialist genetics advice and cascade testing. Finally, the international relevance of this review is considered.

Population screening for osteoporosis risk: a randomised control trial of medication use and fracture risk

Randomised control trial of osteoporosis screening in 4,800 women aged 45-54 years was carried out. Screened group observed an increase of 7.9% in hormone replacement therapy (HRT) use (p < 0.001), 15% in other osteoporosis treatments (p < 0.001) and a 25.9% reduction in fracture risk compared with control. Screening for osteoporosis significantly increases treatment use and reduces fracture incidence.

INTRODUCTION

Population screening programmes can identify menopausal women with low bone mineral density (BMD) and elevated risk of future fracture but require to be proven effective by a randomised control trial.

METHODS

A total of 4,800 women, 45-54 years, were randomised in equal numbers to screening or no screening (control) groups. Following screening, those in the lowest quartile of BMD were advised to consider HRT. Nine years later, the effect of screening on the uptake of treatment and the incidence of fractures were assessed by postal questionnaire. Categorical differences were assessed using chi(2) test. Cox regression was used to assess hazard ratio (HR).

RESULTS

Of the screened and the control groups, 52.4% vs 44.5%, respectively, reported taking HRT (p < 0.001). In addition, 36.6% of the screened vs 21.6% of the control groups reported the use of vitamin D, calcium, alendronate, etidronate or raloxifene (p < 0.001). In a per protocol analysis of verified incident fractures, a 25.9% reduction in risk of fractures (of any site) in the screened group was observed (HR = 0.741, 95% CI = 0.551-0.998 adjusted age, weight and height).

CONCLUSIONS

Screening for osteoporosis as assessed by low bone density significantly increases the use of HRT and other treatments for osteoporosis and reduces fracture incidence.

Association between vitamin D receptor gene polymorphisms, falls, balance and muscle power: results from two independent studies (APOSS and OPUS)

SUMMARY

Fall prevention is a key strategy for reducing osteoporotic fractures. We investigated the association between vitamin D receptor (VDR) polymorphisms and reported falls in postmenopausal women. Bsm1 polymorphisms were associated with falls, balance and muscle power measurements. These results may explain some of the excess fracture risk associated with VDR in some studies.

INTRODUCTION

Fall prevention is a key strategy for reducing osteoporotic fractures. It has been suggested that vitamin D supplementation may reduce the incidence of falls by reducing body sway and increasing muscle power. The vitamin D receptor gene is a well-studied candidate gene for osteoporosis. We investigated the association between VDR polymorphisms and reported falls in postmenopausal women.

METHODS

Falls data were collected in two separate population cohorts. Five polymorphisms of the VDR gene were analysed (Cdx-2, Fok-1, BsmI, Taq1 and Apa1) in the Aberdeen Prospective Osteoporosis Screening Study (APOSS) cohort. Results found in APOSS were then validated in an independent cohort--the Osteoporosis and Ultrasound (OPUS) study (Bsm1 and Fok1 only), where muscle power and balance were also measured.

RESULTS

Carriers of the 'B' allele (Bsm1) showed an increased risk for falls. In APOSS, this was statistically significant for visit 3 multiple falls (p = 0.047) and for recurrent falls (p = 0.043). Similar results were found in OPUS for visit 1 falls (p = 0.025) and visit 1 multiple falls (p = 0.015). Bsm1 polymorphisms were also associated with balance and muscle power measurements.

CONCLUSIONS

In conclusion, these results demonstrate an association between the Bsm1 polymorphism and risk of falling that may explain some of the excess fracture risk associated with VDR in some studies.

Intra- and inter-rater reliability of the Knee Society Knee Score when used by two physiotherapists in patients post total knee arthroplasty

Background and Purpose: It has yet to be shown whether routine physiotherapy plays a role in the rehabilitation of patients post totalknee arthroplasty (Rajan et al 2004). Physiotherapists should be using validoutcome measures to provide evidence of the benefit of their intervention. The aim of this study was to establish the intra and inter-rater reliability of the Knee Society Knee Score, a scoring system developed by Insall et al(1989). The Knee Society Knee Score can be used to assess the integrity of theknee joint of patients undergoing total knee arthroplasty. Since the scoreinvolves clinical testing, the intra-rater reliability of the clinician should be established prior to using the scores as datain clinical research. W here multiple clinicians are involved, inter-rater reliability should also be established.Design: This was a correlation study.Subjects: A  sample of thirty patients post total knee arthroplasty attending the arthroplasty clinic at Johannesburg Hospital between six weeks and twelve months postoperatively.M ethod: Recruited patients were evaluated twice with a time interval of one hour between each assessment. Statistical A nalysis: The intra- and inter-rater reliability were estimated using Intraclass Correlation Coefficient (ICC). R esults: The intra-rater reliability showed excellent reliability (h= 0.95) for Examiner A  and good reliability (h= 0.71)for Examiner B. The inter-rater reliability showed moderate reliability (h= 0.67 during test one and h= 0.66 during test two).Conclusion: The KSKS has good intra-rater reliability when tested within a period of one hour. The KSKS demonstrated moderate agreement for inter rater reliability.

Evaluation of a cancer exercise program: patient and physician beliefs

OBJECTIVE

Participation in an exercise intervention during cancer treatment diminishes the side effects associated with cancer therapies, although such benefits vary according to the disease and the patient characteristics. A structured exercise program providing an individualized fitness program tailored to the patients' illness, treatment, and fitness level would address this variability. However, the need, desired components, and anticipated barriers of such a program have not been systematically explored from either the point of view of cancer patients or treating oncologists.

METHODS

Sixty-six cancer patients and 18 medical and radiation oncologists were surveyed on the above variables.

RESULTS

Cancer patients and oncologists alike perceived a need for a structured exercise program during and after medical treatment for cancer. Among cancer patients, the most commonly preferred feature was access to consultation with an exercise specialist who could take into account the patient's previous exercise and medical history. Over a third of patients reported interest in a hospital-based fitness program. Oncologists were in favor of appropriate supervision of patients during exercise, and noted insufficient time to discuss exercise in their practice. Respondents noted time and parking as barriers to participation.

CONCLUSION

Overall, results support the need for a supervised exercise program during active treatment for cancer and highlight the desired features of such a program.

A review of HIV prevention interventions for juvenile offenders

OBJECTIVE

To conduct a critical review of all HIV prevention intervention studies conducted with adolescents in juvenile justice settings to inform future intervention development.

METHOD

PubMed and PsycInfo database searches were conducted for peer-reviewed, published HIV prevention intervention studies with juvenile offenders.

RESULTS

Sixteen studies were identified (N = 3,700 adolescents). Half of the projects utilized rigorous methodologies to determine intervention effect on behavior change, such as conducting a randomized controlled trial (n = 8). Nine studies reported behaviors at least 3 months post-intervention and five out of nine showed decreases in sexual risk behavior.

CONCLUSIONS

Several HIV prevention programs with juvenile offenders have led to sexual risk reduction, although effect sizes are modest. Most existing programs have neglected to address the impact of family, mental health, and substance use on HIV risk. More work is needed to develop evidence-based interventions that include HIV prevention strategies relevant and appropriate for the juvenile justice setting.

Development of a New Zirconia-Toughened Alumina: Promising Mechanical Properties and Absence of In Vitro Carcinogenicity

High purity alumina as well as zirconia ceramics have been widely used as orthopaedic implant biomaterials and dental devices displaying optimal, but sometimes exclusive, mechanical properties. In order to combine the advantages of alumina and zirconia ceramic materials different types of composites have been developed in which either zirconia is dispersed in an alumina matrix or vice versa. Orthopaedic and dental implant biomaterials are expected to be in contact with living tissues for a long period of time and their long term toxicity must be carefully evaluated. In this study we report the development of a high performance chromia-doped Zirconia Toughened Alumina (ZTA) material which displays promising mechanical properties in terms of hardness, strength and fracture toughness that make it suitable for prosthesis even for small joints. The long-term biocompatibility of this material was also evaluated, mainly in terms of DNA damage, mutagenicity and cancerogenetic potential in mammalian cells. The results obtained suggest that this new ZTA material does not display any long-term carcinogenic effect and it is suitable for biomedical applications from a cancerogenetic point of view. In conclusion, we report the development of a new chromia-doped ZTA material with interesting properties both from a mechanical and a biocompatibility point of view which warrant further studies on its suitability as a candidate biomaterial for orthopaedic implants and dental devices.

Comparison of event rates among three MONICA centres

Data from three MONICA centres in Auckland (New Zealand) and Newcastle and Perth (Australia) are used to explore some of the issues involved in comparing event rates and case fatality among MONICA centres. Auckland and Newcastle follow the "hot pursuit" method of identifying and interviewing patients while they are still in hospital. Perth follows the "cold pursuit" method, in which patients are identified by search of computerized hospital records after discharge and all data are abstracted retrospectively from case notes. Fatal cases are identified by the same method in the three centres. The distribution of events by MONICA diagnostic classification varied among centres, with Perth having the highest proportion of definite myocardial infarction events and the lowest proportion of possible myocardial infarction events. These differences appear to be due to the different methods of event ascertainment and data collection, and to variations in post mortem rates between centres. For comparisons among these three centres, the categories of non-fatal definite myocardial infarction and of all coronary heart disease deaths (that is those in the MONICA categories fatal definite myocardial infarction, fatal possible myocardial infarction, and fatal cases with insufficient data) appear to be the most useful.

The effects of isometric exercises and stretching on postural stability in Non–Insulin Dependent Diabetes Mellitus patients with diffuse symmetrical sensory motor neuropathy

The purpose of this study was to explore the effects of isometric exercises and stretching on postural stability in Non – Insulin Dependent Diabetes Mellitus (NIDDM) patients with diffuse symmetrical sensory motor neuropathy. Patients were assigned to an experimental group and amatched control group. The experimental group received isometric exer-cises and stretching three times weekly for 12 weeks in addition to routine medication and dietary advice. A t the end of this period, this group wascompared with the control group, which received routine medication anddietary advice only. Measurements of muscle strength of quadriceps, ham-strings, ankle plantar and dorsiflexors, and Romberg’s test for postural sta-bility were carried out before and after the 12 weeks intervention. The study showed that isometric exercises and stretching for the lower extremities improved postural stability (p = 0.00)and strength of the quadriceps (p = 0.001) hamstrings (p = 0.001) dorsiflexors (p = 0.001) plantarflexors (p = 0.001)in NIDDM patients with diffuse symmetrical sensory motor neuropathy. This exercise regimen also had a loweringeffect on blood glucose level (p = 0.00).  In conclusion it seems that the simple exercise intervention described in thisstudy may be of benefit to these patients if incorporated into their management programmes.

The effect of exercising with manual compression foot pumps, on dialysis efficiency, in patients with end stage renal disease

Aim: This study aimed to establish if exercising with manual compressionfoot-pumps, could be used as an intervention to improve dialysis efficacy. A  pre test -post test design was used to test the intervention. Subjects were invited to participate in the study depending on whether they fitted the eligibility criteria of the study. Eight weeks after entry into the study pre-test values of dialysis efficacy (Kt/V ) were established prior to the implementation of an eight-week exercise programme followed by the collection of post intervention dialysis efficacy values. Subjects performed seated heel raises with manual compression foot-pumps on their feet (Venous A nti-stasis Slippers) for 20 continuous minutes per hour for the first three hours of their dialysis sessions (two or three times per week). Twelve subjects finished the programme. During the eight weeks of exercise an increaseof 8.7% was noted in Kt/V  values with a mean change of 0.12 (p=0.04). It appears that an eight week exercise programme using manual compression foot pumps (Venous A nti-stasis Slippers) may be effective in improving dialysisefficiency. These findings need to be tested in a study with an appropriate sample size.

Tswana speaking South Africans’ understanding of pain scales

Aim: The aim of this study was to establish the validity and reliability of the Tswanatranslations of three pain scales.Design: This was a cross–sectional study to validate and test the reliability of threepain scales.Participants:   One hundred subjects participated in the study. They were selectedfrom the back schools of five hospitals in the North -West Province of South A frica andfrom workers in these hospitals who were employed as kitchen workers, laundryworkers and cleaners.Method: Translation of the pain scales and the stages of cross-cultural adaptation were followed as recommended byBeaton et al (2000). Pain tolerance of the subjects was measured using a P.T.M. (pressure threshold meter). The painscales used were the V.A .S. (visual analogue scale) one (nought and ten only), the V.A .S. (visual analogue scale) two(nought through to ten), the W.B.F. (Wong-Baker Faces pain measure) and the V.R.S. (verbal rating scale).  The V.R.S.used came in two forms. The first form was written on cue cards which the subjects arranged in order and the second form was the questionnaire version of the V.R.S.The subjects were interviewed and asked five questions relating to their back pain. Upon completion of the interviewthe pressure threshold of the painful area (back) was tested. Subjects then filled in the three pain scales, namely the (V.A .S. one, V.A .S. two, the V.R.S. and lastly the W.B.F. pain scale). Approximately a third of the sample (37) was retested the following day following the same procedure asdescribed above. Results: There was no correlation between the pressure threshold meter readings and the pain scale measurements.  Conclusion: From the statistical analysis of the results, it became apparent that the subjects tested did not have anunderstanding of any of the three pain scales. Future research needs to be done in developing entirely different scales for peoples of low literacy and differentlanguage and cultural groups in South Africa.

Administrative claims: a novel approach in monitoring long term adherence to anti-hormonal therapy in breast cancer

Abstract #1135

Background:&#x2028; Anti-hormonal therapy (AHT) is a key component of therapy that improves survival in breast cancer. However, many women do not complete the prescribed treatment course. There is currently limited reliable information regarding long-term adherence to AHT. We hypothesize that health payer administrative claims for prescription benefits may allow more reliable monitoring of AHT use.&#x2028; Methods:&#x2028; Claims for women diagnosed with breast cancer between 2001 and 2003 from a single insurance carrier covering about 1/3 of the regional population were matched to disease stage and treatment information from the National Cancer Data Base (NCDB) for women treated at NCDB hospitals in Western New York. Claims were searched for AHT drugs identified by National Drug Codes (NDC). Start date, end date, type of agent, switch in drugs, patterns of discontinuation, and dates of insurance coverage eligibility were recorded. A compliance index was attributed to each patient, reflecting the ratio of AHT claims identified, over the ideal number of claims that should have been recorded based on treatment start date.&#x2028; Results: &#x2028; AHT was initiated in 230 women at a median of 165 days from breast cancer diagnosis. Stage was 0: 3.5%; I: 54.3%; II: 33.4%; III: 7%; unknown: &lt;2%. Tamoxifen was the first AHT agent in 66.5% of cases. A switch in agents occurred in 36.1% women. There was a gap in prescription renewal in 57% of patients. The average gap length was 5.9 months. The maximum gap duration was 1 month in 27% of cases; however 16% of patients had a treatment gap of 6 months or more. The annual compliance rate for the study population was 79.6%, 60.9%, 52.7%, 24.1% and 6.9% for each of the 5 consecutive years of treatment. After adjusting for time from start of AHT, the compliance index was ≤0.66 in 50% of women. Less than 20% of patients had an index of 1.0 .&#x2028; Discussion: &#x2028; Administrative claims data combined with cancer stage data proved to be effective at defining gaps in use of AHT among breast cancer patients. By applying this strategy, we found that over 50% of women treated with AHT had gaps in treatment averaging 6 months. The annual compliance rate to AHT decreased steadily over each of the 5 years of treatment. Real time monitoring of administrative claims for patients who start AHT can identify those who discontinue treatment and may allow counseling on side effects and benefits and improve treatment compliance and outcome.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 1135.

Fauna assemblages in regrowth vegetation in tropical open forests of the Northern Territory, Australia

Context. World-wide, primary forest is in decline. This places increasing importance on understanding the use by biodiversity of regrowth (secondary) forest, and on the management of such regrowth. Aims. This study aimed to compare the terrestrial vertebrate assemblages in tropical eucalypt forests, regrowth in these forests (following clearing for pastoral intensification) and cleared land without regrowth, to provide evidence for developing management guidelines for regrowth vegetation in a region (the Daly catchment of the Northern Territory) subject to increasing demands for land-use intensification. Methods. The terrestrial vertebrate fauna was surveyed consistently at 43 quadrats sampling forest, 38 sampling regrowth and 19 sampling cleared land (formerly forest), and the faunal composition was compared with ordination and analysis of variance. Further analysis used generalised linear modelling to include consideration of the relative importance of disturbance (condition) of quadrats. Key results. Faunal assemblages in regrowth vegetation were found to be intermediate between cleared land and intact forest, and converged towards the faunal assemblage typical of intact forest with increase in the canopy height of the regrowth. However, even the tallest regrowth quadrats that were sampled supported relatively few hollow-associated species. The management of fire, weeds and grazing pressure substantially affected the faunal assemblages of the set of regrowth and intact forest quadrats, in many cases being a more important determinant of faunal attributes than was whether or not the quadrat had been cleared. Conclusions. In this region, regrowth vegetation has value as habitat for fauna, with this value increasing as the regrowth structure increases. The convergence of the faunal composition of regrowth vegetation to that of intact forest may be substantially affected by post-clearing management factors (including fire regime and level of grazing pressure and weed infestation). Implications. Regrowth vegetation should be afforded appropriate regulatory protection, with the level of protection increasing as the regrowth increases in stature.