Why Should I? Examining How Childhood Callous-Unemotional Traits Relate to Prosocial and Affiliative Behaviors and Motivations

Childhood callous-unemotional (CU) traits are characterized by low empathy, limited prosocial behavior, and restricted social affiliation. However, few studies have investigated whether CU traits are associated with different subtypes of prosocial and affiliative behavior or the specific motivational difficulties underlying these behaviors. We addressed these questions using data from 135 young children (M = 5.48 years old; 58% female) who viewed depictions of adults or children in instrumental need, emotional need, or neutral situations. We assessed recognition, suggested initiation of, and motivation for prosocial or affiliative behavior in response to each depiction. We distinguished between subtypes of prosocial (instrumental and emotional) and affiliative (parallel, cooperative, associative) behavior, as well as self- versus other-orientated motivations. Parents reported on child CU traits and conduct problems. Overall, children accurately recognized prosocial and neutral situations, offered help, and expressed other-orientated motivations for prosocial behavior and social motivations for affiliative behavior. Higher CU traits were related to lower overall recognition accuracy, which was more pronounced for emotional need. Higher CU traits were also related to fewer offers of help and more denial of prosocial behavior, particularly for instrumental need. Finally, CU traits were related to lower probability of initiating affiliative behavior. CU traits were not differentially related to self- versus other-orientated motivations for prosocial or affiliative behavior. Findings demonstrate difficulties of children with CU traits in recognizing need and offering help. Interventions for CU traits could include modules that explicitly scaffold and shape prosociality and social affiliation.

Core surgical field camps: a new deanery-based model for enhancing advanced skills in core surgical trainees through simulation

Hands-on wet lab simulation training is a vital part of modern surgical training. Since 2010, surgical 'boot camps' have been run by many UK deaneries to teach core surgical trainees basic entry level skills. Training in advanced skills often requires attendance at national fee-paying courses. In the Wessex Deanery, multiple, free of charge, core surgical 'field camps' were developed to provide more advanced level teaching in the particular specialty preference of each core surgical trainee. After the COVID-19 pandemic, national hands-on courses will be challenging to provide and deanery-based advanced skills training may be the way forward for craft-based specialties. The experiences over 2 years of delivering the Wessex core surgical field camps are shared, giving a guide and advice for other trainers on how to run a field camp.

A hip fracture nurse specialist has a positive outcome on the length of stay for patients with hip fractures

AIM

To determine if recruitment of a hip fracture nurse specialist has a reduction in length of stay for hip fracture patients.

METHOD

Primary data was extracted from the National Hip Fracture Database (NHFD). The length of stay of hip fracture patients from 2011-2014 was compared to the period 2014-17, following appointment of a hip fracture nurse specialist in 2014.

RESULTS

The average length of stay in the first group (2011-2014) was 19.94 days and in the second group (2014-2017) was 16.52 days. There was a reduction of 3.42 days (17.15%) and was statistically significant. There was also a reduction in the time to surgery (1.38 days versus 1.15 days) and the crude 30-day mortality (10% versus 6.06%) both of which were statistically significant. The two groups were well-matched with regards to age, female: male ratio and severity of co-morbidities (based on American Society of Anaesthesiologists physical status classification system).

CONCLUSION

The introduction of a dedicated hip fracture nurse specialist has a positive outcome on hip fracture patients by reducing length of stay, time to surgery and the crude 30-day mortality.

Effectiveness of “OralDETECT”- A Spaced Repetitive Learning Method - As a Competency Assessment Tool for Early Detection of Oral Cancer

Background: Head and neck cancer is the sixth most common cancer worldwide. It is generally acknowledged that the early diagnosis of oral cancer may result in higher 5-year survival rates, less need for aggressive treatment and improved quality-of-life. There is therefore a need for a quantifiable, reliable and competency-based educational tool which can be used to train dentists and other health care providers in the early detection of oral cancers. Aim: To assess the effectiveness of “OralDETECT” spaced repetitive learning method for training dental professionals to become competent in the early detection of oral cancer. Methods: The current study involved training three dental professional groups: Oral Pathology/Oral Medicine/Oral Surgery specialists (x), Periodontists/Restorative dentists (y), General Dental Practitioners (z) and four undergraduate cohorts comprising 259 dental students from 3 different Malaysian dental schools. A structured one-day training program “OralDETECT” was conducted, consisting of a well-planned series of lectures, tests and discussions of the test answers. During the spaced discussions participants were trained on how to ask appropriate questions and look for clinical clues to arrive at the correct diagnosis of target [oral potentially malignant disorders/oral cancer (OPMD/OC)] and other nontarget lesions. The tests comprised one pretest and 4 posttests for the dental professional group, and one pretest and 3 posttests for the student groups. The overall and group mean scores were analyzed for all the tests conducted. The statistical evaluation was based on the percentage of correct answers (scores) for each test given by the participants. Repeated-measure ANOVA and post hoc Bonferroni´s test were carried out to examine the differences between test scores overall and for each group. All statistical analysis was carried out using SPSS software, where P values < 0.005 were considered significant. Results: The overall percentage of correct responses for both the dental professional and student groups increased from a minimum of 30% to above 80% from the pretest to the final posttest. There were significant differences in overall scores between all 4 posttests and the pretest for dental professional groups, and between all 3 posttests and the pretest for all student groups. The percentage of accuracy of diagnosis for the individual lesions (leukoplakia, lichen planus, erythroplakia, oral submucous fibrosis and suspicious of oral cancer) increased to > 80% for the Dental Professional groups. The percentage of diagnostic accuracy for the individual lesions also increased to > 80% (except for erythroplakia) for the student groups. Conclusion: Based on the results of our study the “OralDETECT” spaced repetitive learning method is an efficient and effective competency-based learning tool for teaching the early detection of OPMD and oral cancer among dental professionals and dental students.

Does the volume of supplemental intraligamentary injections affect the anaesthetic success rate after a failed primary inferior alveolar nerve block? A randomized-double blind clinical trial

AIM

To investigate the efficacy of 0.2 mL vs. 0.6 mL of 2% lidocaine when given as a supplementary intraligamentary injection after a failed inferior alveolar nerve block (IANB).

METHODOLOGY

Ninety-seven adult patients with symptomatic irreversible pulpits received an IANB and root canal treatment was initiated. Pain during treatment was recorded using a visual analogue scale (Heft-Parker VAS). Patients with unsuccessful anaesthesia (n = 78) randomly received intraligamentary injection of either 0.2 mL or 0.6 mL of 2% lidocaine with 1 : 80 000 epinephrine. Root canal treatment was reinitiated. Success after primary injection or supplementary injection was defined as no or mild pain (HP VAS score ≤54 mm) during access preparation and root canal instrumentation. Heart rate was monitored using a finger pulse oximeter. The anaesthetic success rates were analysed with Pearson chi-square test at 5% significance levels. The heart rate changes were analysed using t-tests.

RESULTS

The intraligamentary injections with 0.2 mL solution gave an anaesthetic success rate of 64%, whilst the 0.6 mL was successful in 84% of cases with failed primary IANB. (χ²  = 4.3, P = 0.03). There was no significant effect of the volume of intraligamentary injection on the change in heart rate.

CONCLUSIONS

Increasing the volume of intraligamentary injection improved the success rates after a failed primary anaesthetic injection.

The autogenous graft versus transport distraction osteogenesis for reconstruction of the ramus-condyle unit: a prospective comparative study

This study aimed to compare the joint function and morphology achieved following condylar reconstruction using sternoclavicular grafts (SCG) versus transport distraction osteogenesis (TDO) in temporomandibular joint (TMJ) ankylosis patients. Twenty-two patients with TMJ ankylosis underwent TMJ reconstruction with SCG or TDO (n=11 each). Radiographic and clinical evaluations were performed at 1 week and at 1, 3, and 6 months post-surgery. Clinical criteria examined included the duration of surgery, mean postoperative mouth opening, excursive jaw movements, and pain scores. The radiographic evaluation 6 months postoperatively (computed tomography) included subjective assessment of joint morphology and measurements of the mean condylar height, width achieved, and amount of condylar resorption. The χ² test and Student t-test were used to compare qualitative and quantitative variables, respectively. Similar mean mouth opening (SCG=31.8mm, TDO=32.1mm at 6 months), excursive movements, and pain scores were observed in the two groups throughout follow-up. Mean condylar resorption was significantly greater in the TDO group (TDO=7.0mm, SCG=2.7mm; P=0.005). The duration of reconstruction surgery was greater in the SCG group (P=0.035). A greater incidence of complications was observed with TDO. In conclusion, based on the protocols used in this study, SCGs are superior to TDO in terms of condylar morphology, stability, and surgical safety.

Direct-to-physician and direct-to-consumer advertising: Time to have stringent regulations

BACKGROUND

Direct to physician advertisements and direct to consumer advertisement (DTCA) is a well-known marketing strategy of pharmaceutical companies. Studies from the West and also from the Indian sub-continent revealed several lacunae in such advertisements.

OBJECTIVES

The present study was carried out to understand the international and national scenario regarding the lacunae in drug advertisements and the opinion of both physicians and patients regarding DTCA.

METHODS

The present study was conducted after obtaining approval from the institutional ethics committee. Warning letters (WLs) issued to pharmaceutical companies by United States Food and Drug Administration (USFDA) and Therapeutic Goods Administration (TGA) due to discrepancies in the advertisements were analyzed for reasons that were grouped into one of the following categories: overstatement of efficacy; unapproved indication; lack of adequate directions to use; omission of adverse effects; misleading claims; advertisement made for an unapproved drug (investigational new product). Drug advertisements in Current Index of Medical Specialties (CIMS) April-July 2014 issue was also analyzed for lacunae depending on categories as mentioned above. Physicians and patients in a tertiary care medical college and hospital were administered a validated questionnaire exploring their views about crucial aspects of DTCA. Descriptive statistics was used for each of the categories.

RESULTS

A total of 93 WLs issued by USFDA and 36 by TGA were assessed. Majority of the WLs by USFDA were issued for omission of adverse effects (61/93, 65.6%) followed by misleading claims (54/93, 58.1%). Similarly, WLs by TGA were also mainly issued for the presence of misleading claims (35/36, 97.2%) followed by overstatement of efficacy (26/36, 72.2%) and CIMS evaluation had revealed that 78/92 (84.8%) advertisements omitted adverse effects, 20/92 (21.7%) had misleading claims, 9/92 (9.8%) had unapproved indications and 7/92 (7.6%) overstated the efficacy. With regard to the opinion regarding DTCA, 69.9% physicians had a patient discussing DTCA that was clinically inappropriate. One hundred (64.5%) out of 155 physicians opined that DTCA encourage patients to attend physicians regarding preventive healthcare. On the contrary, 82/155 (52.9%) physicians felt that DTCA would damage the same. Similarly, 69 out of the total 100 patients felt that drug advertisements aid them to have better discussions with their treating physicians. Surprisingly, a large majority (91/100) were of the opinion that only safe drugs are allowed to be advertised.

CONCLUSION

To conclude, from the findings of this study both the physicians and patients should be cautious and not overzealous while dealing with drug advertisements or promotional literature. More stringent scrutiny and issue of WLs or blacklisting of indulging pharmaceutical companies are mandatory by the regulatory agency to contain the same.

Synthesis, Semiempirical, Stereoselectivity and Pharmacological Activity of a New Class of Spiro Pyrrolidine and Isoquinoline Derivatives

1,3-Dipolar cycloaddition of azomethine ylides derived from acenaphthylene-1,2-dione and 5- methyl-benzo[b]-thiophene-2,3-dione with L-proline, thiazolidine-4-carboxylic acid and 1,2,3,4- tetrahydroisoquinoline-3-carboxylic acid with various electron deficient dipolarophiles leads to the formation of novel spiroheterocycles having two or more chiral centers. Semiempirical studies have been performed to understand the stereochemical course of the reaction. The synthesized cycloadducts have been screened for antimicrobial and toxicological activity.

Comparison of the anaesthetic efficacy of epinephrine concentrations (1 : 80 000 and 1 : 200 000) in 2% lidocaine for inferior alveolar nerve block in patients with symptomatic irreversible pulpitis: a randomized, double-blind clinical trial

AIM

The aim of this randomized controlled, double-blind trial was to comparatively evaluate the anaesthetic efficacy and injection pain of 1.8 mL of 2% lidocaine with different concentrations of epinephrine (1 : 80 000 and 1 : 200 000) in patients with symptomatic irreversible pulpitis.

METHODOLOGY

Sixty-two adult volunteers, actively experiencing pain, were randomly allocated into 2 groups and received 1.8 mL of 2% lidocaine with either 1 : 80 000 or 1 : 200 000 epinephrine concentration. Endodontic access preparation was initiated 15 min after the initial IANB. Pain during treatment was recorded using the Heft-Parker visual analogue scale (HP VAS). The primary outcome measure, and the definition of 'success', was the ability to undertake pulp access and canal instrumentation with no or mild pain (HP VAS score <55 mm). Secondary outcome measure was the pain experienced during LA solution deposition. Statistical analysis was performed using Mann-Whitney U-test and chi-square test.

RESULTS

The anaesthetic success rates of 2% lidocaine solutions containing 1 : 80 000 and 1 : 200 000 epinephrine concentrations were 20% and 28%, respectively. The difference was not statistically significant. There was also no significant difference in the pain experienced during deposition of the solutions.

CONCLUSIONS

Two percent lidocaine solution used for IANB achieved similar success rates when used with 1 : 80 000 or 1 : 200 000 epinephrine concentration.

Abolition of endocrine dimorphism in hyperthyroid males? An argument for the positive feedback effect of hyperoestrogenaemia on LH secretion

Our aim was (i) to investigate the hypothalamo-hypophyseal-gonadal axis in hyperthyroid Indian males, (ii) to rule out the modulatory role of adrenal steroids on it and (iii) to determine if the simultaneous rise in oestradiol and luteinising hormone (LH) in hyperthyroid males is due to a positive feedback action of oestradiol on pituitary LH release. Age- and BMI-matched men were divided into two groups, I, euthyroid subjects (n = 17) and II, hyperthyroid patients (n = 12) on the basis of their thyroid hormone levels. Serum levels of thyroid-stimulating hormone, triiodothyronine, thyroxine, LH, follicle-stimulating hormone (FSH), prolactin, E(2), T, P(4), sex hormone binding globulin and dehydroepiandrosterone sulphate (DHEAS) were assayed. Mean levels of T and E(2) were approximately two times higher in group II in comparison with group I. DHEAS levels were similar in both groups ruling out any adrenal involvement. Mean serum LH level was 2.6 folds higher in group II in comparison with group I. Mean serum levels of FSH were higher in group II, it was marginally nonsignificant. On the basis of these and previous observations, we hypothesise that endocrinological dimorphism in human male and female is not rigid; a sustained rise in serum oestradiol probably induces a positive feedback action on pituitary leading to elevated gonadotrophin levels.

Anxiety, locus of control, and coping strategies among end-stage renal disease patients undergoing maintenance hemodialysis

End-stage kidney disease (ESKD) patients on maintenance hemodialysis (MHD) have a lot of anxiety. Anxiety and coping are associated with the locus of control; the present investigation aimed to study the state and trait anxiety, locus of control, and active and passive coping among patients on MHD. Thirty MHD patients and 30 controls were administered State-Trait Anxiety Inventory, Rotter's Locus of Control Scale, and Coping Responses Inventory. There were significantly higher scores on state and trait anxiety, respectively (67.53 ± 10.89 vs. 59.40 ± 6.97, P < 0.01, and 62.97 ± 8.45 vs. 58.07 ± 7.06, P < 0.05), and locus of control (11.27 ± 3.55 vs. 9.04 ± 1.86, P < 0.01) in patients as compared to controls. On coping responses, patients and controls differed on positive reappraisal (54.33 ± 4.67 vs. 51.17 ± 3.12, P < 0.01), seeking guidance and support (58.07 ± 5.51 vs. 53.27 ± 4.22, P < 0.01), problem solving (51.03 ± 4.70 vs. 47.57 ± 4.73, P < 0.01), cognitive avoidance (60.27 ± 6.76 vs. 56.80 ± 4.08, P < 0.05), acceptance or resignation (61.67 ± 6.30 vs. 58.83 ± 4.23, P < 0.01), emotional discharge (68.07 ± 6.78 vs. 64.30 ± 4.50, P < 0.05), approach coping (205.57 ± 10.55 vs. 189.70 ± 11.37, P < 0.01), and avoidance coping (255.30 ± 16.45 vs. 241.10 ± 10.50, P < 0.01). A higher prevalence of anxiety trait could be the cause of anxiety in MHD patients besides the medical problems. The locus of control among patients though a mixed one was significantly more toward externalism. Thus, there is a need to identify this group well in advance and prepared not only medically but also psychologically for MHD.

A modified Gaines procedure for spondyloptosis

We present an illustrative case using a modification of the Gaines procedure for the surgical management of patients with spondyloptosis. It involves excision of the inferior half of the body of L5 anteriorly combined with posterior reduction and fusion.

Longitudinal assessment of cognitive impairment among lung cancer survivors

9609

Background: Patients undergoing treatment for cancer often report problems with their cognitive function (CF), which is an essential component in maintaining Quality of Life (QoL). We conducted a longitudinal study of lung cancer (LC) patients to systematically evaluate changes in QOL including changes in CF, over time. Methods: Between 2005–2008, we followed 1757 primary LC patients who responded to CF questions at least once within 8 years of diagnosis. Overall QoL measured by LCSS and LASA (scores 0–100 from worst to best) were assessed among 1,604 of 1,757 (91%) who completed the questionnaire at one or both of two time periods: short-term (T1-within 3 years of diagnosis) and long-term follow-up (T2-beyond 5 years of diagnosis). Questions rated overall CF and problems in thinking clearly. Results: The median age at the time of LC diagnosis was 68 years in men (n=834) and 65 years in women (n=770), p<0.0001. At T1, the mean score of patients reporting problems with CF was 63.2 (±22.45) vs 74.4 (±20.38) who reported no problems (p<0.0001). At T2, the mean score was 62.2 (±24.18) for patients who reported CF problems and 78.1 (±18.28) who reported no changes with their CF (p<0.0001). At T1, the mean score of patients reporting problems thinking clearly was 66.1 (±21.65) vs 75.6 (±20.21) reporting no problems with their thinking (p<0.0001). At T2, the mean score was 70.4 (±20.95) for patients reporting problems thinking clearly vs 82.6 (±17.76) who reported no problems (p<0.0001). Conclusions: Self-reported QoL of lung cancer survivors showed substantial deficits with their cognitive function. Prospective and objective assessments are needed to determine if cancer treatments are positively associated with cognitive decline, to identify the patients at risk, and to test appropriate interventions. Funding Source: NIH grants: CA 115857, CA 84354, CA 80127 and CA 77118.

No significant financial relationships to disclose.

Retrospective analysis and chemotherapy results in extra-nodal NHL patients in a large super-speciality hospital in North India

e19566

Background: We retrospectively analysed records of the Patients visiting the pathology department of Sir Ganga Ram Hospital, New Delhi a super-speciality hospital, between February 2007- February 2008. Out of a total of 16,500 cases, NHL was reported in 154 (0.93%)cases. The median age was 52 yrs and the no. of male patients were 104 and female were 50 making M:F = 2:1. The type of NHL was B-Cell type (CD-20+ve) in 132(85%) and T-Cell type (CD 3+ve) in 22 (15%) cases. Out of 154 patients, 77 were nodal and 77 were extra nodal. Additional features - HIV positivity in 2 patients, autoimmune haemolytic disease in 1 patient and thalessemia major in 1 patient. In extra-nodal group of NHL patients the no. Of male and female patients were 55 & 22 respectively (M:F=2.5:1). Out of 77 extra-nodal cases, 31(20%) were GIT NHL (Stomach -16, Colon-8, Ileum-4, and Duodenum-3) and out of the rest 46 extra-nodal cases the site of origin was - head & neck-14, skin n soft tissues -8, primary CNS-6, testicular-4, para-spinal- 3, breast mass-3, perinephric-2, bones-2 and 1 each in cervix, lung mass, liver and cervical plexus. Methods: A detailed analysis of 31 GIT NHL cases was carried out. 28 out of 31 were B-Cell type and 3 were T-Cell type. 26 out of 31 were diffuse large cell variety, 2 were mixed small & large cell variety and 1 MALT variety. In 2 patients the type of lymphoma could not be ascertained. Bone marrow infiltration was present in 2 out of 31 cases of GIT Lymphoma. Surgery was carried out in 15 of 31 GIT NHL cases and these were arising from Colon, Ileum and Duodenum. No surgery was performed in patients with stomach lymphoma. Results: Of all the extra-nodal cases chemotherapy was given to 39 patients - R-CHOP = 20 patients, CHOP = 13 patients, high dose MTX in primary CNS NHL = 6 patients. CR was achieved 16 out of 20 R-CHOP patients (80%), 8 out of 13 CHOP Patients (61 %) and 4 out of 6 high dose MTX patients (66%).

No significant financial relationships to disclose.

Development of mesophasic microreservoir-based transdermal drug delivery system of propranolol

The mesophasic microreservoir comprises lyotrophic liquid crystals. The liquid crystals were prepared of Brij-35, cetosteryl alcohol and propranolol and evaluated for parameters viz. anisotropy, size and size distribution and drug entrapment efficiency. Subsequent to this liquid crystals based transdermal drug delivery system (TDS) was prepared by incorporating liquid crystals in previously prepared matrix based transdermal patch and evaluated for stability studies like temperature, humidity and aging. The system was also studied for tensile strength, moisture content, water vapor transmission, drug content, anisotropy and In vitro drug release studies.

The cognitive effects of modafinil in breast cancer survivors: A randomized clinical trial

9004

Background: Patients receiving treatment for cancer can experience a diminution of their cognitive abilities which can persist for many years after. The present study examined the potential of modafinil as a cognitive enhancer on memory and attention in a randomized clinical trial in breast cancer patients following completion of treatment. Methods: Breast cancer patients who reported a score of = 2 on the Brief Fatigue Inventory (BFI) an average of 22.8 months following completion of chemotherapy were enrolled. In Phase 1, patients received 200mg modafinil open-label once daily for 4 weeks. In Phase 2, patients with a positive response following Phase 1 were randomized either to an additional 4 weeks of modafinil or to placebo. Tests of memory and attention selected from the Cognitive Drug Research (CDR) computerized cognitive assessment were performed at baseline (before modafinil) and after completing Phase 1 and 2. The difference between scores at baseline and scores at Phase 1 and Phase 2, were subjected to a Wilcoxon's signed rank test. Results: Of the 82 women enrolled, 68 completed all 3 CDR assessments in the study (range=33–83 years, median age=54 years). At the end of Phase 1 (week 4), modafinil had a significant effect on the Speed of Memory Index (p=0.0047) and the Digit Vigilance Test (p=0.0014) but showed no significant effect on Quality of Working Memory (p=0.3528) nor on Power of Attention (p=0.8953). At the end of phase 2 (week 8), the group that continued modafinil demonstrated improved Mean Continuity of Attention (p=0.0002) compared with the placebo group and also demonstrated significantly greater improvements in Quality of Episodic Secondary Memory relative to placebo (p<0.005). This improvement was observed at week 4, and was maintained throughout the study. Finally, continued modafinil demonstrated significantly greater improvement in Speed of Memory relative to placebo (p=0.009). Conclusions: Modafinil provides significant improvements in attention and speed of memory for breast cancer patients following their treatment of cancer. Although further study is needed, these findings suggest that modafinil may enhance quality of life in this patient population. Supported by a grant from Cephalon, Inc and NCI Grants U10-CA37420 and R25- CA102618.

No significant financial relationships to disclose.

A brief measure of patients self-reported chemotherapy-related memory problem: Psychometric studies

19655

Background: Memory is a central component of individuals’ functional systems of behavior, (i.e., cognition, emotionality, and executive functioning) that can be deleteriously affected by cancer treatment. It is important to identify and understand the effects of cancer treatment on memory in order to develop effective interventions to ameliorate these problems. This study involves structural and reliability analyses of a brief measure of chemotherapy-related memory problem to facilitate prompt and reliable preliminary assessments in oncology research and practice. Methods: Patients (N = 821) included in this analysis were part of a larger randomized clinical trial on cancer-related fatigue. These patients completed the Fatigue Symptom Checklist (FSCL) at four time points. Five items from the FSCL that assess memory problems were aggregated into a brief self-report memory problem measure (SRMP). Results: Reliability assessment of the SRMP revealed a Cronbach coefficient alpha of 0.90. The data was found suitable for latent structure analysis using various criteria: Kaiser-Myer-Olkin, Bartlett’s Test of sphericity, Kaiser’s (1959) simplest criterion test of γ >1, and the presence of item-correlation coefficients of r = .30. Principal components analysis showed one component with eigenvalue (γ) exceeding 1, that explained 72% of the variance. Subsequent reliability assessments of the SRMP revealed Cronbach coefficients alpha of 0.90 and above, all with a single component explaining 71.36% to 73.36% of the variances. Conclusions: The results supported the use of the SRMP as a reliable one- dimensional measure of cancer treatment-related memory problem. The SMRP could be used for preliminary assessment of possible underlying memory problems that might need further examinations. Studies to establish the construct validity of the SRMP are under way. Supported by NCI grant R25CA102618.

No significant financial relationships to disclose.

Effect of familial breast cancer outcomes on health behaviors of relatives

1521

Background: While the disease outcomes of breast cancer probands do not affect the objective risk of first degree relatives (FDR), the morbidity and mortality experience may impact their subsequent perceptions and health behaviors. This study examines the influence of a proband’s disease course on screening behaviors, perceived risk, self-efficacy, traumatic stress and related mood disturbances of FDR. Methods: A cross-sectional sample of 149 FDR was recruited (79% of respondents) by invitations distributed by 545 probands. Respondents were categorized into a ‘high impact’ group whose familial proband had expired, relapsed or undergone intensive chemotherapy (n=55), and a ‘low impact’ group whose proband was disease-free after surgery ± radiation (n=94). This sample provided a power of 84% for detection of a 1.5 unit difference in screening indices and a 10% difference in perceived risk between groups with a two-sided alpha level of 0.05. Parameters were measured by self-administered, mailed surveys of newly-developed and established instruments. Objective risk assessments were completed by a genetic counselor. Statistical analyses included parametric and non-parametric methods, as appropriate. Results: While the high impact group reported perceptions of greater familial proband suffering (8.6 vs.5.8) and greater anxiety and doubt regarding mammography benefits (11% vs. 1%) (p<0.01), there was no statistically significant difference between groups in screening behaviors or perceived risk. The high impact group experienced sleep disturbances (28%), emotional stress (52%), and mood swings (61%) more often than the comparison group (p<0.001). FDR with the highest objective risk had significantly higher scores on screening indices and perceived risk (p<0.01) but significantly lower knowledge regarding breast cancer (p=0.04). Conclusions: This study suggests that while morbidity and mortality of familial probands is not associated with screening practices of FDR, it does have a negative impact on their psychological well-being. Enhanced strategies to educate and support FDR regarding familial breast cancer risk and potential psychological repercussions of the proband’s experience are warranted.

No significant financial relationships to disclose.

Effect of HRT and slurry concentration on biogas production in cattle dung based anaerobic bioreactors

The effect of three different cattle dung slurry concentrations (1:1, 1:4 and 1:9) at three different HRTs of 20, 30 and 40 days was studied at pilot scale for one year. The results showed that both biogas yield and methane content of gas obtained in 1:4 and 1:9 slurry concentrations were significantly higher than those at 1:1 concentration for a given HRT. This was observed for all the three HRTs studied. At 1:1 and 1:4 slurry concentrations, methane yield was found to increase with HRT. However, at higher dilution of 1:9, increase in HRT from 30 to 40 days resulted in decrease in methane yield.

Self-reported cognitive impairment in cancer patients: A URCC CCOP longitudinal study of 595 patients

8502

Background: Patients undergoing cancer treatment often report cognitive impairment, manifested as problems with concentration and memory. Such cognitive problems may be noticed only by the patient. The purpose of this multicenter longitudinal study was to investigate the frequency and severity of self-reported problems with memory and concentration over time. Methods: Patients undergoing treatment for solid tumors self-rated problems with memory and concentration using an 11-point Likert Scale (0 = Not present to 10 = “As bad as you can imagine”) at baseline before treatment began (T1), at their worst during treatment (T2), and at 6 months following treatment (T3). Any symptom level ≥ 7 was classified as “severe.” T-tests, paired or independent as appropriate, were used to examine differences in symptoms over time and between patients treated with and without chemotherapy. Results: Of 595 participants, 356 (60%) received chemotherapy, with or without radiation and 239 (40%) radiation alone. Concentration problems were reported by 48% of all participants at T1 (5% severe), 67% at T2 (18% severe) and 58% (8% severe) at T3 (p < .001). Memory loss was reported by 53% at T1 (4% severe), 67% (18% severe) at T2 and 68% (11% severe) at T3 (p < .001). The average frequency and severity of both symptoms in patients receiving chemotherapy increased significantly between T1 and T2 (p<.001). Both symptoms were less severe in patients receiving radiation alone at all three measurements (all ps<.001). Symptoms at T3 were significantly higher than T1 for both groups (p<.001). Conclusion: Self-reported problems with memory and concentration are experienced by the majority of cancer patients who receive chemotherapy and radiation. The cognitive problems get worse during treatment and persist at least 6 months following. Controlled studies of interventions for problems of memory loss and concentration are warranted. Supported in part by a supplement from the Division of Cancer Control and Population Sciences, NCI, to Public Health Service grant U10 CA37420 and by NCI grant 1R25CA102618.

No significant financial relationships to disclose.

Childhood leukaemia in areas with different radon levels: a spatial and temporal analysis using GIS

OBJECTIVES

To evaluate the relation between exposure to ground radon levels and leukaemia among children using existing population and disease registers.

DESIGN

Ecological correlation study.

SETTING

The county of Ostergötland in Sweden.

METHODS

Every child born in the county between 1979 and 1992 was mapped to the property centroid coordinates by linking addresses in the population and property registers. Population maps were overlaid with radon maps and exposure at birth and each subsequent year was quantified as high, normal, low or unknown. This was analysed with data from the tumour registry. Standardised mortality ratios (SMRs) were calculated using the age and sex specific rates for Sweden for the year 1995.

RESULTS

90 malignancies occurred among 53 146 children (498 887 person years) who formed the study population. SMRs for acute lymphatic leukaemia (ALL) among children born in high, normal and low risk areas were 1.43, 1.17 and 0.25 respectively. The relative risk for the normal risk group and high risk group as compared with the low risk group was 4.64 (95% CI 1.29, 28.26) and 5. 67 (95% CI 1.06, 42.27). The association between ALL and continued residence at normal or high risk areas showed a similar trend. No association between radon risk levels and any other malignancy was seen.

CONCLUSION

Children born in and staying at areas where the risk from ground radon has been classified as low are less likely to develop ALL than those born in areas classified as normal and high risk.

Individuals living in areas with high background radon: a GIS method to identify populations at risk

OBJECTIVE

to identify and link populations and individuals that live within high risk areas.

DESIGN

census registers and disease registers which contain data on individuals can only give aggregate statistics relating to postal code districts, town, county or state boundaries. However environmental risk factors rarely, if ever, respect these man-made boundaries. What is needed is a method to rapidly identify individuals who may live within a described area or region and to further identify the disease(s) occurring among these individuals and/or in these areas.

METHOD

this paper describes a method for linking the standard registers available in Sweden, notably the residence-property addresses they contain and the geographical coordinate setting of these, to map the population as a point coverage. Using standard GIS methods this coverage could be linked, merged or intersected with any other map to create new subsets of population. Representation of populations down to the individual level by automatised spatialisation of available census data is in its simplicity a new informatics method which in the designated GIS medium adds a new power of resolution.

RESULTS

We demonstrate this using the radon maps provided by the local communes. The Swedish annual population registration records of 1991 for the county of Ostergötland and the property register available at the Central Statistical Bureau of Sweden formed the main data sources. By coupling the address in the population register to the property register each individual was mapped to the centroid of a property. By intersecting the population coverage with the radon maps, the population living in high, normal or low risk areas was identified and then analysed and stratified by commune, sex and age. The resulting tables can be linked to other database registers, to visualise and analyse geographical and related patterns. The methodology can be adapted for use with any other environmental map or small area. It can also be expanded to the fourth dimension by linking likewise available migration information to generate immediately coordinate-set, accumulated exposition and similar data.

Bhorugram (India): revisited. A 4 year follow-up of a computer-based information system for distributed MCH services

Impact of a health informatics research project on the management and delivery of primary health care, focusing on maternal and child health care (MCH), was reported earlier in 1992, with encouraging results in terms of increased antenatal care coverage and decrease in Immunisation drop-outs. The software (MCHS) was based on essential data sets (EDS) to assist the care providers in information management for MCH care. The site was revisited after four years to evaluate the status of the project and to ascertain whether computers were still in use and was the dispensary staff using the MCHS package or not? The results are presented in this paper to demonstrate that 'information is a difference that makes a difference'. Information generated by the MCHS acted as a catalyst for behavioural change in the community from indifferent users to active users of the health care services. This is reflected by the increased acceptance of antenatal care, 80% fully immunised child (FIC) and participation in other primary health care activities.

Primary care informatics: Bhorugram, India: revisited

A Primary Health Care Informatics project was initiated in 1990 at Bhorugram, Rajasthan, India. It was reported in MIE91 with initial, encouraging results. The evaluation of the information system has been successful in all operational terms, and the Fully Immunised Child (FIC) could be used as a local cardinal index to monitor and evaluate the quality of care, cost-effectiveness and community participation. Health Systems and Health Economy Research alike have long searched for apt quality and performance markers that in themselves could embrace and express a number of aspects and factors. The FIC index is shown to well meet the criteria of such a cardinal measure in the MCHC services. We, also, demonstrate an implementation strategy for establishing Information Systems in Primary Health Care Centres in Developing countries.

Cardiovascular and metabolic effects of insulin-like growth factor I at rest and during exercise in humans

To determine whether insulin-like growth factor I (IGF-I) has systemic cardiovascular effects in humans, 60 micrograms/kg IGF-I or saline were injected sc in a cross-over, randomized, double blind fashion into eight healthy male volunteers. Cardiac function and performance were evaluated by echocardiography and exercise test. In parallel, the metabolic effects of IGF-I during exercise were investigated. IGF-I improved cardiac performance with a significant increase in stroke volume and cardiac output by 14% and 18% (P < 0.03 and P < 0.04), respectively. Ejection fraction increased by 9% after IGF-I treatment (P < 0.05). Heart rate was not significantly increased at rest or during exercise. Systolic blood pressure was slightly increased by IGF-I, whereas diastolic blood pressure was slightly decreased, resulting in a continuous increase in the blood pressure amplitude at rest and during exercise, but without reaching statistical significance. Maximal exercise duration and peak oxygen consumption were not changed. Exercise was uneventful, without pathological changes on electrocardiogram records. Glucose levels were unchanged, whereas insulin and C peptide levels were decreased by IGF-I at rest. During exercise, insulin levels were further decreased, and the insulin-sparing effect of exercise resulted in a further enhancement of tissue sensitivity to insulin. GH levels were suppressed by IGF-I treatment at rest, but were still stimulated by exercise. In conclusion, IGF-I has positive inotropic effects in man. Further investigation of the potential role of IGF-I in cardiac conditions such as heart failure appears to be warranted.

Distance from the Primary Health Center: a GIS method to study geographical access to health care

Aerial distance from the dependent Primary Health Center is a crude but objective measure of geographical accessibility to Primary Health care facilities. This report describes a method for calculation of distances between the PHC and the population it serves using the data available from the local health authorities and the Swedish Central Statistical Bureau. The Swedish annual population registration records of 1991 and the property register available with the Central Statistical Bureau of Sweden formed the main data sources. By coupling the address in the population register to the property register each individual was mapped to the centroid of a property. The location of the PHCs as well as the areas covered by each were obtained from the local health authorities and mapped. By intersecting the population coverage with the PHC coverage the population for each PHC area was identified. Subsequently the distance to the PHC was calculated for each individual (property centroid). The population maps so generated can be linked to other databases to visualize and analyze the spatial dimension of health and disease. The methodology can be adapted for use with postal code districts, census enumeration tracts, or any other small area.

Energy Partition to the Workpiece for Grinding with Aluminum Oxide and CBN Abrasive Wheels

An experimental investigation is reported of the energy partition to the workpiece for grinding of steels with aluminum oxide and cubic boron nitride (CBN) abrasive wheels. The energy input to the workpiece was obtained by measuring the temperature distribution in the workpiece using an embedded thermocouple technique and matching the results with analytically computed values. It was found that 60-75 percent of the grinding energy is transported to the workpiece as heat with an aluminum oxide abrasive wheel, as compared to only about 20 percent with CBN wheels. An analysis of the results indicates that the much lower energy partition to the workpiece with CBN can be attributed to its very high thermal conductivity whereby a significant portion of the grinding heat is transported to the abrasive instead of to the workpiece. The much lower energy partition to the workpiece with CBN wheels results in much lower grinding temperatures and a greatly reduced tendency for thermal damage to the workpiece.