Agrobiodiversity and smallholder resilience: A scoping review

Agrobiodiversity is often touted as a crucial adaptation strategy to mitigate risks linked to climate change by increasing the response capability of a system to external shocks and, consequently, the smallholder's resilience. This scoping review, conducted following the PRISMA protocol, aims to elucidate how agrobiodiversity's effect on resilience has been conceptualized, analyzed, and reported in the literature and to identify knowledge gaps. We systematically examined 193 articles, with 63 selected for full review based on predefined criteria. Notably, only 16 studies featured actual measurements of the effect of agrobiodiversity on resilience. Our findings indicate that articles often operationalize these complex theoretical concepts using limited variables. Agrobiodiversity is typically measured by crop count, while resilience is assessed through economic, ecological, and/or social dimensions. We identified key attributes expected in resilient systems and found that agrobiodiversity's impact on resilience was positive in 10 cases, negative in 9, and contingent on production types and system shocks in others. This review emphasizes the context-dependent agrobiodiversity-resilience relationship and the need for tailored agricultural diversification strategies. We discuss how inconsistencies between theoretical concepts and practical measures may compromise study validity and comparability and how smallholder context can influence resilience conceptualization. Based on our findings, we propose guidelines for future research and emphasize the need for improved metrics, empirical evidence generation, and mixed-method approaches. Our findings prompt further exploration of key questions to advance our understanding of agrobiodiversity's role in fostering agricultural resilience.

Effects of Rosemary and Green Tea Antioxidants on Ground Beef Patties in Traditional and Modified Atmosphere Packaging

The objective of this study was to analyze the effects of rosemary (RSM) and green tea (GT) added to groundbeef to extend shelf life. Four antioxidant treatments were used: control, 2,500 ppm RSM, 300 ppm GT, and 2,500 ppm RSM + 300 ppm GT (RSM + GT). Patties from each treatment (n = 42) were randomly packaged into one of 3 types: polyvinyl chloride (PVC) overwrap, modified atmospheric packaging (MAP), or master packages (MP). Packages of MAP and MP were flushed with 0.4% CO, 69.6% nitrogen (N2), and 30% carbon dioxide (CO2). Patties in PVC and MAP were placed directly into display cases for 7 d, and MP patties were placed in dark storage for 7 d and then in display cases for another 7 d. Instrumental and subjective color, lipid oxidation, and sensory panel scores were measured. In MAP, patties with GT had increased (P < 0.05) a* and chroma values by day 6 of retail display. In MP at 3 d of retail display, GT patties exhibited increased (P < 0.05) L* values (lighter), display color (deeper red), and surface discoloration (greater discoloration) scores compared with RSM + GT patties. However, GT and RSM patties were not different (P > 0.05) for these parameters. Trained sensory panelists did not detect a difference between control and GT patties for the green-hay attribute; however, RSM patties had highly detectable (P < 0.05) green-hay flavor. Panelists were unable to detect any differences (P > 0.05) for rancid or fatty flavors regardless of treatment. Patties in MAP were more color stable than those in PVC after 6 d of retail display. In conclusion, patties in MP with GT showed positive instrumental and objective color measurements, as well as lipid oxidation values after 3 d of display, combined with undetectable flavor, warranting further research.

Education and Support: Tilting the Scale Toward Exclusive Breastfeeding

The Hispanic population in the United States is growing, and healthcare providers are challenged to design targeted, culturally appropriate programs to improve health outcomes related to breastfeeding.

Objectives

This study was designed to detect the exclusive breastfeeding (EBF) rate among Hispanic women who chose education plus peer support versus peer support only. In addition, this study further evaluates ¡Tengo Leche!, an educational program previously evaluated in the literature.

Methods

The sample (n = 103) consisted of Hispanic pregnant, low-income, and uninsured women. A two-group quasi-experimental design was used to test the educational intervention combined with peer support (n = 35) versus stand-alone peer support (n = 68). The education-plus group (n = 35) voluntarily participated in the education portion. All participants received the inpatient peer counseling. The participants' breastfeeding intention was gathered through chart review.

Results

EBF at discharge was significantly higher (c2 = 4.51, p = .02) among mothers in the education plus peer support group, who were more likely to be exclusively breastfeeding at discharge (46.7%) versus the peer-support-only group (24.6%).

Conclusions

The outcomes of this study may provide guidance for designing culturally competent interventions with a focus on cost-effective and outcome-driven interventions to increase EBF.

110 Metmyoglobin reducing activity and oxygen consumption properties of atypical dark-cutting beef

Deviation from characteristic bright-red color during grading leads to discounted carcass price and value. Dark-cutting carcasses are examples of color deviation due to high-pH. However, atypical dark-cutters are not discounted at grading but have a dark color compared to normal-pH beef. Limited knowledge is currently available on the biochemical properties of atypical dark cutting beef compared with normal-pH beef. Therefore, the objective of the study was to determine metmyoglobin reducing activity and oxygen consumption of atypical dark-cutting beef. Strip loins from atypical dark-cutting (ADC; selected based on HunterLab L* values and pH less than 5.8 and not discounted by grader) and USDA Low Choice (C) carcasses were selected from a commercial beef processing plant and transported to the Food and Agricultural Products Center in Stillwater, Oklahoma. pH, color, oxygen consumption, and metmyoglobin reducing activity of atypical dark cutters and normal pH loins were determined on d3 postmortem. The surface color was determined using a HunterLab Miniscan spectrophotometer. Reflectance-based methods using K/S ratios were utilized to determine oxygen consumption and metmyoglobin reducing activity. The data were analyzed using the Mixed Procedure of SAS and the experiment was replicated 10 times (n = 10). There were no differences in initial pH (C = 5.46 and ADC = 5.6 atypical dark-cutter; P = 0.05) between normal-pH and atypical dark cutters. However, atypical dark cutters had lower lightness (L* values; C = 44.2 and ADC = 38.4), redness (a* values; C = 28.6 and ADC = 25.2), and red intensity (chroma; C = 40.2 and ADC = 36.4) compared with normal-pH. Further, atypical dark cutters had greater (P < 0.05) oxygen consumption and metmyoglobin reducing activity than normal-pH. The results suggest that atypical dark cutters and normal-pH beef have different biochemical properties.

Modified Atmospheric Packaging and Antioxidant Enhancement Improves Redness of Atypical Dark-Cutting Beef

ObjectivesDark-cutting carcasses occur when muscle pH does not decrease sufficiently during rigor mortis because of antemortem glycogen depletion. Typical dark-cutting beef have a pH > 6.0, however, atypical dark-cutting (ADC) beef have a pH around 5.7- 5.9 but have a darker lean color similar to dark-cutting beef. Previous studies noted that greater muscle pH in dark-cutting beef increase oxygen consumption and decrease myoglobin oxygenation. However, limited research has determined the biochemical basis of ADC. Therefore, the objectives of this study were to characterize the biochemical basis of ADC beef carcasses and to utilize modified atmosphere packaging (MAP) and rosemary enhancement to improve appearance during retail display.Materials and MethodsStrip loins from ADC and USDA Low Choice (C) carcasses were selected from a commercial beef processing plant and transported to the Food and Agricultural Products Center in Stillwater, OK. Control (C) and ADC steaks (prior to enhancement and packaging) were utilized to measure pH, color, oxygen consumption, and proximate compositions. Loin sections were cut into halves and randomly assigned to combinations of packaging types and enhancement treatment. Packaging included high-oxygen MAP (HiOx-MAP; 80% oxygen and 20% carbon dioxide), carbon monoxide MAP (CO-MAP; 0.4% CO, 69.6% N, and 30% CO2), and PVC. Enhancement includes 0.1% rosemary oleoresin pumped to 10% of loin green weights. Following enhancement and packaging, steaks were displayed under retail conditions for 6 d to measure color changes using a HunterLab spectrophotometer. The data were analyzed using the Mixed Procedure of SAS, and the experiment was replicated 13 times (n = 13).ResultsThere were no differences for initial pH or proximate compositions (P < 0.05) between C and ADC. However, ADC had lower initial lightness (L* values), redness (a* values), and red intensity (chroma) compared with C. Further, ADC had greater (P < 0.05) oxygen consumption than C. There was a significant packaging × enhancement × display time interaction resulted for L*, a*, and chroma. CO-MAP and HiOx-MAP in combination with rosemary enhancement improved (P < 0.05) redness of ADC by 61.7% and 42.3%, respectively, compared with ADC in PVC packaging. Similarly, MAP and enhancement improved lightness (L* values) and chroma compared with ADC in PVC. By Day 6 of display, enhanced ADC steaks packaged in both HiOx-MAP and CO-MAP had similar color parameters to control choice steaks; however, non-enhanced ADC steaks had significantly lower a* (P < 0.0001) and chroma (P < 0.01) values when packaged in HiOx-MAP when compared to both C and enhanced ADC.ConclusionThe results suggest that ADC beef has greater oxygen consumption than C steaks even at similar muscle pH. Use of modified atmospheric packaging in combination with enhancement has the potential to improve surface color of ADC beef.

Food Melt in Consumer Food Environments in Low-income Urban Neighborhoods

OBJECTIVES

We systematically evaluated changes in availability, price, and quality of perishable food items from the beginning to the end of the month in lowincome, urban neighborhoods.

METHODS

The sample included grocery stores or supermarkets in Cleveland, Ohio, within neighborhoods with >30% of population receiving food assistance. We collected data for 2 sequential months during the first and fourth weeks of each month. Two coders evaluated stores, collecting measures of availability, price, and quality for 50 items. We examined difference in number and proportion of items available at the beginning of the month (BOM) to items remaining available at the end of the month (EOM), as well as quality and price of those items.

RESULTS

Across 48 stores, availability at EOM was lower than BOM; as store size increased, reduction in availability (ie, food melt) was significantly (p < .01) less pronounced. Overall, items became less expensive at the EOM whereas quality remained consistent; we noted no statistically significant differences by store type for price or quality.

CONCLUSIONS

Food melt differentially affects individuals in neighborhoods without grocery stores. Findings reveal composition of food environments is dynamic rather than static, influencing food-purchasing choices among lowincome consumers.

Evaluation of an Initiative to Increase Exclusive Breastfeeding Among Rural Hispanic Women

Background: There is a growing Hispanic population in the U.S. healthcare providers, and lactation consultants are challenged to design targeted, culturally competent programs to support immigrant populations.

Objective: To evaluate a prenatal education program using intercultural communication strategies designed to increase the number of Hispanic women who choose to exclusively breastfeed their newborns

Methods: A 2-group quasi-experimental design was used to test the educational intervention. The sample consisted of 71 Hispanic women who were pregnant, low income, and uninsured. Participation in the class was voluntary and used a convenience sample. Data regarding intention to breastfeed and breastfeeding during hospitalization was gathered through chart review.

Results: Reaching statistical significance, 41% of the mothers who attended the educational intervention achieved exclusive breastfeeding at discharge from the hospital, compared to only 3.1% of the usual care group.

Conclusions: The outcomes of this program evaluation can add to the body of knowledge on successful breastfeeding interventions in the Hispanic population and may provide a model for others who are designing culturally competent interventions in their communities.

Validation of food-grade salts of organic acids as ingredients to control Listeria monocytogenes on pork scrapple during extended refrigerated storage

This study was conducted to investigate control of Listeria monocytogenes on pork scrapple during storage at 4°C. In phase I, scrapple was formulated, with or without citrate-diacetate (0.64%), by a commercial processor to contain various solutions or blends of the following antimicrobials: (i) lactate-diacetate (3.0 or 4.0%), (ii) lactate-diacetate-propionate (2.0 or 2.5%), and (iii) levulinate (2.0 or 2.5%). Regardless of whether citrate-diacetate was included in the formulation, without the subsequent addition of the targeted antimicrobials pathogen levels increased ca. 6.4 log CFU/g within the 50-day storage period. In the absence of citrate-diacetate but when the targeted antimicrobials were included in the formulation, pathogen numbers increased by ca. 1.3 to 5.2 log CFU/g, whereas when citrate-diacetate was included with these antimicrobials, pathogen numbers increased only by ca. 0.7 to 2.3 log CFU/g. In phase II, in the absence of citrate-diacetate, when the pH of the lactate-diacetate-propionate blend (2.5%) was adjusted to pH 5.0 or 5.5 pathogen numbers remained unchanged (≤0.5 log CFU/g increase) over 50 days, whereas when citrate-diacetate was included with the lactate-diacetate-propionate blend adjusted to pH 5.0 or 5.5, pathogen numbers decreased by 0.3 to 0.8 log CFU/g. In phase III, when lower concentrations of the lactate-diacetate-propionate blend (1.5 or 1.94%) were adjusted to pH 5.5, pathogen numbers increased by ca. 6.0 and 4.7 log CFU/g, respectively, whereas when the mixture was adjusted to pH 5.0, pathogen numbers increased by ≤0.62 log CFU/g. Thus, scrapple formulated with lactate-diacetate-propionate (1.5 and 1.94% at pH 5.0) is an unfavorable environment for outgrowth of L. monocytogenes.

Leprosy acquired by inoculation from a knee injury

This case study reports on the development of clinical leprosy in a young Caucasian female from a non-endemic country who contracted the disease while living in a leprosy endemic country. In the presentation and discussion, some relevant factors will be reviewed and discussed that may play a role in the transmission, susceptibility and clinical development of the disease.

Prevalence of Campylobacter within a swine slaughter and processing facility

In this work, the occurrence of Campylobacter in a swine slaughter and processing facility was studied. Thirty composite carcass samples, representing 360 swine carcasses, were taken immediately after exsanguination, immediately after polishing, after the final wash, and after overnight chilling at 2 degrees C. Thirty matching composite rectal samples were also taken immediately after exsanguination, and 60 nonmatching individual colon samples were collected from the same lot of swine during evisceration. Also, 72 environmental samples were collected from equipment used in the slaughter operation (42 samples) and the processing operation (30 samples). Campylobacter was isolated by direct plating on Campy-Line agar (CLA) or Campy-Cefex agar (CCA), as well as by Bolton broth enrichment and subsequent inoculation onto CLA or CCA. For all four recovery methods combined, Campylobacter was detected on 33% (10 of 30) of the composite carcasses immediately after exsanguination, 0% (0 of 30) after polishing, 7% (2 of 30) immediately before chilling, and 0% (0 of 30) after overnight chilling. The pathogen was recovered from 100% (30 of 30) of the composite rectal samples and 80% (48 of 60) of the individual colon samples. Campylobacter was detected in 4.8% (2 of 42) and 3.3% (1 of 30) of the slaughter and processing equipment samples, respectively. The recovery rate achieved with direct plating on CLA was significantly higher (P < 0.05) than those achieved with the other three recovery methods. For the 202 isolates recovered from all of the various samples tested, Campylobacter coli was the predominant species (75%) and was followed by Campylobacter spp. (24%) and Campylobacter jejuni (1%). These results indicate that although Campylobacter is highly prevalent in the intestinal tracts of swine arriving at the slaughter facility, this microorganism does not progress through the slaughtering operation and is not detectable on carcasses after overnight chilling.

Salmonella spp. and Escherichia coli biotype I on swine carcasses processed under the hazard analysis and critical control point-based inspection models project

The present study examined the prevalence of Salmonella spp. and the prevalence and quantity of generic (biotype I) Escherichia coli on carcasses or in pig feces at a pork processing plant operating under the hazard analysis and critical control point-based inspection models project (HIMP) program. The surfaces of carcasses were sponged on 10 separate days over a 30-day period at two processing steps: (i) immediately following exsanguination (100 carcasses), and (ii) after the carcasses were washed, eviscerated, and chilled overnight (122 carcasses). Feces were also collected from 60 of the 100 sponged, postexsanguinated pigs. Salmonella spp. were detected on 73.0% of the 100 postexsanguinated pigs, in 33.3% of the 60 fecal samples, and on 0.7% of the 122 chilled carcasses. E. coli was found on 100.0% of the postexsanguinated pigs and on 30.1% of chilled carcasses tested. The mean concentration of E. coli on carcasses was 1,700 CFU/cm2 immediately after the exsanguination step and 1.1 CFU/cm2 at the chilled carcass stage. Previous studies at this processing plant showed that the pre-HIMP baseline level of Salmonella spp. on the chilled carcasses was 0.8%, indicating that the present HIMP inspection system produced an equivalent level of bacteriological performance.

Practice environment for nurse practitioners in California. Identifying barriers

Barriers exist that prevent nurse practitioners from using their primary health care knowledge and skills. We present the incidence of and specific barriers experienced by nurse practitioner respondents in California, the state with the largest number of nurse practitioners in the nation. A January 1995 survey was sent to all nurse practitioners certified in California to elicit their experiences regarding legal or social barriers in their practice, with space for an open-ended response. Of an estimated 3,895 nurse practitioners in California, 2,741 (70%) returned surveys. Most nurse practitioner (65%) respondents in California are providing primary care. Perceived barriers to practice are lack of prescriptive authority, lack of support from physicians, reimbursement difficulties, and lack of public awareness. Current barriers to nurse practitioner practice in California are similar to national barriers discovered in 1992 data. The development of interprofessional dialogue and the recognition of the contributions of all primary care professionals are some of the steps that can be taken to reduce these barriers and increase the use and effectiveness of nurse practitioners in primary care.

International population and development: the United Nations' Cairo Action Plan for women's health

The report of the International Conference on Population and Development (Cairo Action Document) was sponsored by 180 national governments and 1,200 nongovernmental organizations during the United Nations' conference on women, population, and development in Cairo, Egypt 1994. Many international conferences preceded the one in Cairo but it was there that women participated at an unprecedented level in shaping the debate. The resulting document represents a quantum leap for women's health. Nurses can play a major role in using the principles in the Cairo Action Document by empowering women and enhancing their health care. To invite dialogue, the authors provide an analysis of the Cairo Plan from a nursing perspective and identify three paradoxes that may hinder progress: Universal values and local cultures, global policy and local implementation, and national development and women's empowerment. Clinicians, scholars, and members of professional organizations are asked to consider the assumptions that underlie the recommendations for action and to propose ways to resolve the problems that may evolve during implementation.

Comfort and consolation: a nursing perspective on parental bereavement

The death of a child is the most potentially devastating event that a family can ever experience (Lundin, 1984). The death of a child also has a significant impact on the lives of health care professionals who must provide care both for the child and for the grieving family members. Nurses can assume a critical role in supporting bereaved families by becoming cognizant of parental grief responses and by developing an awareness of the needs of families in planning appropriate interventions.

Alternate Oucher form testing: gender, ethnicity, and age variations

This study was part of a project to improve pain assessment and management for a multiethnic group of children. Based on its visual appeal for the clinical team, the Oucher was selected for trial. A reduced size and shortened screening technique were introduced. Children (N = 79) aged 3 to 12 years were randomly assigned to use the original or a reduced-size Oucher first. Scale scores were highly correlated regardless of size or presentation order. There were no differences attributable to age, gender, or ethnicity (Black, White, Hispanic). There is preliminary support for using the more convenient size and screening process.

Olfaction: the neglected sense

Although olfactory complaints prompt an estimated 200,000 people each year to seek medical consultation in the U.S., there is a dearth of information available in the nursing literature. Recent research links olfaction to degenerative processes in Alzheimer's disease, Parkinson's disease and human immunodeficiency virus infection. This article reviews anatomy and physiology of the olfactory system, describes alterations in smell function and reviews assessment with the University of Pennsylvania Smell Identification Test and odor detection threshold testing. Nurses can advocate thorough assessment and prompt treatment of associated conditions, and educate the patient and family regarding ways to maximize current functioning when olfaction is impaired.

The epidemiology of cervical cancer and its precursors

Cervical cancer is considered to be a preventable disease because of its lengthy preinvasive state, the effectiveness of screening programs, and the availability of effective treatment options for preinvasive lesions. Thus, identifying women with a greater probability of developing the disease is important to promoting early detection and instituting prompt treatment. Questions concerning risk factors that influence a woman's chances of developing cervical cancer are being addressed through research. Nurses who understand the epidemiology of cervical cancer and who are skilled in taking comprehensive health histories can play a major role in early detection and prompt treatment of cervical cancer by educating all women, including sexually active teenagers, about obtaining regular gynecologic screening exams.

Skin pigmentation from clofazimine therapy in leprosy patients: a reappraisal

Skin biopsy specimens from two lepromatous leprosy patients with dark brown pigmentation who were receiving long-term clofazimine therapy were studied. Ceroid-lipofuscin pigment was demonstrated inside macrophages that contained numerous phagolysosomes. These contained lipids and clofazimine that appeared as electron-lucent vacuoles and a lipofuscin pigment that was electron dense, granular, and lamellated. Although the presence of the drug in tissues contributed to the skin pigmentation, the main cause was a drug-induced, reversible ceroid lipofuscinosis.

Leukopenia secondary to mycobacterium leprae

Hansen's disease (HD) is one of the major infectious diseases in the world with an estimated total of 12 million cases. Physicians in North America, however, rarely see HD or its manifestations. Hematological manifestations of HD have been reported but are not well appreciated. We report a patient with leukopenia while under treatment for active HD who demonstrated mycobacterial involvement of the bone marrow.

Lesional modulation of peripheral monocyte leucotactic responsiveness in leprosy

Because the accumulation and activation of mononuclear phagocytes are critical to the host response to intracellular microbial pathogens, we evaluated mechanisms of peripheral monocyte leucotactic regulation in leprosy. Plasma from 53 of 67 patients was found to inhibit the locomotion of normal human monocytes. Neither the prevalence nor the magnitude of plasma leucotactic inhibitory activity correlated with disease histology or duration, type or duration of chemotherapy, or history of erythema nodosum leprosum. Plasma leucotactic inhibitory activity resided principally in a non-immunoglobulin, cell-directed inhibitor of 230,000 daltons molecular weight. Fractionation of plasma from patients with lepromatous leprosy revealed an additional, immunoglobulin-containing inhibitor of approximately 400,000 daltons weight, possibly an IgG-IgA immune complex. Production of leucotactic inhibitors by unstimulated and concanavalin A-stimulated peripheral mononuclear cells was normal; however, cutaneous explants from these patients spontaneously produced the 230,000 dalton leucotactic inhibitor in vitro. The ability of the lesions of leprosy to impede monocyte traffic may be an important pathogenetic mechanism.

Modifying the Type A behavior pattern

The Type A behavior pattern (TABP), a complex of personality traits characterized by insecurity of status, hyperaggressiveness, sense of time urgency, free-floating hostility, and a tendency toward self-destruction, has been linked to coronary heart disease in both prospective and clinical studies. Attempts to modify the TABP are complicated by conceptual understandings of the behavioral complex. However, intervention studies, such as the San Francisco Recurrent Coronary Prevention Project, have shown that modification is possible. Both psychological and religious factors need to be taken into consideration when exploring the modification of the TABP.

The funeral meal: A significant funerary ritual

Historically, a meal in association with funerary ritual has been a reality in many cultural and religious settings. Our society has experienced a gradual demise of formal funerary ritual, with an accompanying psychological and social impoverishment. Both the immediate bereaved and the larger social community can benefit from a funeral meal which functions as a group experience that focuses on the needs of the living. It can be a shared experience in a familiar structured setting which enables the living to do significant grief work. Practical implications and potential problems will need to be, taken into consideration.

Hospital location as a determinant of emergency room utilization patterns

The use of the emergency rooms of three private, acute care, nonprofit hospitals was investigated in relation to each hospital's location. The emergency room of the hospital located in an urban poverty area served as the "poor man's doctor," whereas the emergency rooms of the two hospitals in more affluent areas served more traditional emergency room patients. Investigation showed that even when patient populations were similar in demographic characteristics, the hospitals' locations influenced emergency room utilization patterns. Thus, one emergency room is not the same as another, and one standard model for dealing with emergency room issues will not work in every facility.

Experience with germ cell tumors of testicle at University of Iowa

Between 1964 and 1979, 219 patients with germ cell testicular tumors were treated at the University of Iowa. In 79 nonseminomatous germ cell tumors various chemotherapeutic regimens were used. The response, salvage, and survival rates are compared. There is a definite trend toward better response rates and survival using the combination cisplatinum, vinblastine (Velban), and bleomycin. With this combination, 75 per cent of Stage II and III patients survived two years. The over-all response rate was 85 per cent, and 87 per cent of those with a complete response survived two years. Eighty per cent of deaths occurred within two years and 90 per cent within three years.

Analysis of bladder tumor recurrence in 178 patients

The identification of bladder tumor characteristics which may affect tumor recurrence has been of interest to the clinician for a long time. Previous attempts to identify predictive factors of recurrence involved comparisons based on the twelve-month recurrence rate in a prospective clinical investigation of bladder tumor patients observed over a five-year period. A statistical regression model known as the proportional hazards model was employed to identify these factors using the disease-free interval as the outcome variable. Prior bladder cancer history, age at admission, initial tumor stage, grade, number, size, shape, and site were examined. The results confirm that a patient's prior history of bladder cancer must be considered in evaluating his likelihood of tumor recurrence. The analysis then focuses on patients with no prior history for predictive factors of recurrence.

Factors influencing the recurrence rate of bladder cancer

A prospective analysis was done on 318 patients with bladder cancer observed during a 4-year period. We examined the predictive value for tumor recurrence of the initial grade, stage, number and size of bladder tumors. None of the observed parameters alone or in combination could predict tumor recurrence. Cystoscopy and cytology, as well as random bladder and tumor biopsies, were part of the diagnostic studies.

Longitudinal study of bladder cancer with cytology and biopsy

A study of urinary cytology and selected mucosal biopsies in conjunction with cystoscopy provided additional information of value in the management of 318 patients with bladder cancer. These procedures were especially helpful in patients with no visible lesions on follow-up cystoscopies in assessing the bladder epithelium, the behaviour of which may be unpredictable in that no further tumours may occur, or they may arise at irregular intervals.