Interview versus questionnaire symptom reporting in people with the postconcussion syndrome.

OBJECTIVE: To compare spontaneous, interview-based, postconcussion symptom reporting to endorsement of symptoms on a standardized questionnaire. PARTICIPANTS: Sixty-one patients referred to a concussion clinic following mild traumatic brain injury. PROCEDURE: Patients recalled their current symptoms and problems via open-ended interview and then completed a structured postconcussion checklist. MAIN OUTCOME MEASURES: Open-ended interview and the British Columbia Postconcussion Symptom Inventory (BC-PSI). RESULTS: On average, patients endorsed 3.3 symptoms (SD = 1.9) during open-ended interview and 9.1 symptoms (SD = 3.2) on the BC-PSI (P < .001). Approximately 44% endorsed 4 or more symptoms during interview compared with 92% on the BC-PSI. The percentage of patients endorsing items on the BC-PSI compared with interview was significantly greater on all 13 items. It was common for patients to endorse symptoms as moderate-severe on the BC-PSI, despite not spontaneously reporting those symptoms during the interview. CONCLUSIONS: Clinicians need to be cautious when interpreting questionnaires and be aware of the possibility of nonspecific symptom endorsement, symptom overendorsement, symptom expectations influencing symptom endorsement, and the nocebo effect.

Does familiarity with computers affect computerized neuropsychological test performance?

The purpose of this study was to determine whether self-reported computer familiarity is related to performance on computerized neurocognitive testing. Participants were 130 healthy adults who self-reported whether their computer use was "some" (n = 65) or "frequent" (n = 65). The two groups were individually matched on age, education, sex, and race. All completed the CNS Vital Signs (Gualtieri & Johnson, 2006b) computerized neurocognitive battery. There were significant differences on 6 of the 23 scores, including scores derived from the Symbol-Digit Coding Test, Stroop Test, and the Shifting Attention Test. The two groups were also significantly different on the Psychomotor Speed (Cohen's d = 0.37), Reaction Time (d = 0.68), Complex Attention (d = 0.40), and Cognitive Flexibility (d = 0.64) domain scores. People with "frequent" computer use performed better than people with "some" computer use on some tests requiring rapid visual scanning and keyboard work.

Superficial incisional infection in arthroplasty of the lower limb. Interobserver reliability of the current diagnostic criteria.

The Department of Health and the Public Health Laboratory Service established the Nosocomial Infection National Surveillance Scheme in order to standardise the collection of information about infections acquired in hospital in the United Kingdom and provide national data with which hospitals could measure their own performance. The definition of superficial incisional infection (skin and subcutaneous tissue), set by the Center for Disease Control (CDC), should meet at least one of the defined criteria which would confirm the diagnosis and determine the need for specific treatment. We have assessed the interobserver reliability of the criteria for superficial incisional infection set by the CDC in our current practice. The incisional site of 50 patients who had an elective primary arthroplasty of the hip or knee was evaluated independently by two orthopaedic clinical research fellows and two orthopaedic ward sisters for the presence or absence of surgical-site infection. Interobserver reliability was assessed by comparison of the criteria for wound infection used by the four observers using kappa reliability coefficients. Our study demonstrated that some of the components of the current CDC criteria were unreliable and we recommend their revision.

Rey Complex Figure Test performance after traumatic brain injury.

The influence of factors such as a cerebral injury characteristics, education, perceptual organization skills, and speed of information processing on performance on the Rey Complex Figure Test & Recognition Trial (RCF) was examined by means of hierarchical regression analyses in 100 consecutively referred persons with traumatic brain injury at a median of 2.5 months post-injury. Patients with premorbid (e.g., psychiatric history) or comorbid (e.g. financial compensation seeking) complicating factors were excluded. Perceptual organization skills and the presence of a diffuse intracranial lesion but not education or speed of processing were statistically significant predictors of the variance in RCF variables. A large proportion of the sample improved by at least a standard deviation from independent delayed recall to multiple-choice recognition, and this was mediated by perceptual organization skills but not by injury parameters. It is concluded that performance on the RCF after traumatic brain injury is affected relatively more by perceptual organization skills than by injury severity characteristics.

Dietary advice for treatment of type 2 diabetes mellitus in adults.

BACKGROUND: While initial dietary management immediately after formal diagnosis is an 'accepted' cornerstone of treatment of type 2 diabetes mellitus, a formal and systematic overview of its efficacy and method of delivery is not currently available. OBJECTIVES: To assess the effect of type and frequency of different types of dietary advice to all adults with type 2 diabetes on weight, measures of diabetic control, morbidity, total mortality and quality of life. SEARCH STRATEGY: We carried out a comprehensive search of The Cochrane Library (The Cochrane Library Issue 3, 2003), MEDLINE (1966 to October Week 1, 2003), EMBASE (1980 to Week 40, 2003), CINAHL (1982 to October Week 1, 2003), AMED (1985 to October 2003), bibliographies and contacted relevant experts. SELECTION CRITERIA: All randomised controlled trials, of six months or longer, in which dietary advice was the main intervention in adults with type 2 diabetes mellitus. DATA COLLECTION AND ANALYSIS: The lead investigator performed all data extraction and quality scoring with duplication being carried out by one of the other six investigators independently with discrepancies resolved by discussion and consensus. Authors were contacted for missing data. For continuous outcomes, endpoint data were preferred to change data. MAIN RESULTS: Thirty-six articles reporting a total of eighteen trials following 1467 participants were included. Dietary approaches assessed in this review were low-fat/high-carbohydrate diets, high-fat/low-carbohydrate diets, low-calorie (1000 kcal per day) and very-low-calorie (500 kcal per day) diets and modified fat diets. Two trials compared the American Diabetes Association exchange diet with a standard reduced fat diet and five studies assessed low-fat diets versus moderate fat or low-carbohydrate diets. Two studies assessed the effect of a very-low-calorie diet versus a low-calorie diet. Six studies compared dietary advice with dietary advice plus exercise and three other studies assessed dietary advice versus dietary advice plus behavioural approaches. The studies all measured weight and measures of glycaemic control although not all studies reported these in the articles published. Other outcomes which were measured in these studies included mortality, blood pressure, serum cholesterol (including LDL and HDL cholesterol), serum triglycerides, maximal exercise capacity and compliance. The results suggest that adoption of regular exercise is a good way to promote better glycaemic control in type 2 diabetic patients, however all of these studies were at high risk of bias. REVIEWERS' CONCLUSIONS: There are no high quality data on the efficacy of the dietary treatment of type 2 diabetes, however the data available indicate that the adoption of exercise appears to improve glycated haemoglobin at six and twelve months in people with type 2 diabetes. There is an urgent need for well-designed studies which examine a range of interventions, at various points during follow-up, although there is a promising study currently underway.

Dietary advice for treatment of type 2 diabetes mellitus in adults.

BACKGROUND: While initial dietary management immediately after formal diagnosis is an 'accepted' cornerstone of treatment of type 2 diabetes mellitus, a formal and systematic overview of its efficacy and method of delivery is not currently available. OBJECTIVES: To assess the effect of type and frequency of different types of dietary advice to all adults with type 2 diabetes on weight, measures of diabetic control, morbidity, total mortality and quality of life. SEARCH STRATEGY: We carried out a comprehensive search of The Cochrane Library (The Cochrane Library Issue 3, 2003), MEDLINE (1966 to October Week 1, 2003), EMBASE (1980 to Week 40, 2003), CINAHL (1982 to October Week 1, 2003), AMED (1985 to October 2003), bibliographies and contacted relevant experts. SELECTION CRITERIA: All randomised controlled trials, of six months or longer, in which dietary advice was the main intervention in adults with type 2 diabetes mellitus. DATA COLLECTION AND ANALYSIS: The lead investigator performed all data extraction and quality scoring with duplication being carried out by one of the other six investigators independently with discrepancies resolved by discussion and consensus. Authors were contacted for missing data. For continuous outcomes, endpoint data were preferred to change data. MAIN RESULTS: Thirty-six articles reporting a total of eighteen trials following 1467 participants were included. Dietary approaches assessed in this review were low-fat/high-carbohydrate diets, high-fat/low-carbohydrate diets, low-calorie (1000 kcal per day) and very-low-calorie (500 kcal per day) diets and modified fat diets. Two trials compared the American Diabetes Association exchange diet with a standard reduced fat diet and five studies assessed low-fat diets versus moderate fat or low-carbohydrate diets. Two studies assessed the effect of a very-low-calorie diet versus a low-calorie diet. Six studies compared dietary advice with dietary advice plus exercise and three other studies assessed dietary advice versus dietary advice plus behavioural approaches. The studies all measured weight and measures of glycaemic control although not all studies reported these in the articles published. Other outcomes which were measured in these studies included mortality, blood pressure, serum cholesterol (including LDL and HDL cholesterol), serum triglycerides, maximal exercise capacity and compliance. The results suggest that adoption of regular exercise is a good way to promote better glycaemic control in type 2 diabetic patients, however all of these studies were at high risk of bias. REVIEWERS' CONCLUSIONS: There are no high quality data on the efficacy of the dietary treatment of type 2 diabetes, however the data available indicate that the adoption of exercise appears to improve glycated haemoglobin at six and twelve months in people with type 2 diabetes. There is an urgent need for well-designed studies which examine a range of interventions, at various points during follow-up, although there is a promising study currently underway.

Tolerability of transvaginal ultrasonography as an ovarian cancer screening test.

OBJECTIVE: To evaluate the acceptability of transvaginal ultrasonography as a screening tool. DESIGN: Prospective survey of women attending for screening within a randomised controlled trial. SETTING: University Hospital in Teesside. PARTICIPANTS AND METHODS: 54 women completed a questionnaire immediately after their first transvaginal ultrasound scan. RESULTS: 52 of 54 (96%) questionnaires were suitable for full analysis. The women were unlikely to find the scan was painful, 47 vs three (p<0.001), or embarrassing 45 vs five (p<0.001). Women were more likely to find both a smear, 42 vs eight (p<0.001) and a mammogram, 47 vs two (p<0.001) was more uncomfortable than transvaginal ultrasonography. CONCLUSIONS: Transvaginal ultrasonography is an acceptable tool for screening for ovarian cancer. It is better tolerated than other screening tools such as cervical smear and mammography.

Interventions for treating obesity in children.

BACKGROUND: The prevalence of overweight and obesity is increasing in child populations throughout the world. Obesity in children has significant short and long term health consequences. OBJECTIVES: To assess the effects of a range of lifestyle interventions designed to treat obesity in childhood. SEARCH STRATEGY: We searched CCTR, MEDLINE, EMBASE, CINAHL, PsychLIT, Science Citation Index, Social Science Citation Index. Each database was searched from 1985 to July 2001. We also contacted experts in child obesity treatment. SELECTION CRITERIA: We selected randomised controlled trials of lifestyle interventions for treating obesity in children with a minimum of six months duration. Examples of lifestyle interventions include dietary, physical activity and/or behavioural therapy interventions, with or without the support of associated family members. Interventions from any setting and delivered by any professional were considered. However, interventions that specifically dealt with the treatment of eating disorders were excluded. DATA COLLECTION AND ANALYSIS: Two of our research team independently assessed trial quality and extracted data. Authors of the included studies were contacted for additional information where this was appropriate. MAIN RESULTS: We included 18 randomised controlled trials with 975 participants. Many studies were run from a specialist obesity clinic within a hospital setting. Five studies (n=245 participants) investigated changes in physical activity and sedentary behaviour. Two studies (n=107 participants) compared problem-solving with usual care or behavioural therapy. Nine studies (n=399 participants) compared behavioural therapy at varying degrees of family involvement with no treatment or usual care or mastery criteria and contingent reinforcement. Two studies (n=224 participants) compared cognitive behavioural therapy with relaxation.Most of the studies included in this review were too small to have the power to detect the effects of the treatment. We did not conduct a meta-analysis since so few of the trials included the same comparisons and outcomes. Therefore, we synthesised the results in a narrative format. REVIEWER'S CONCLUSIONS: Although 18 research studies were found, most of these were very small studies drawn from homogenous, motivated groups in hospital settings and so generalisable evidence from them is limited. In conclusion, there is a limited amount of quality data on the components of programs to treat childhood obesity that favour one program over another. Further research that considers psychosocial determinants for behaviour change, strategies to improve clinician-family interaction, and cost-effective programs for primary and community care is required. We conclude that no direct conclusions can be drawn from this review with confidence.

Auditory cues can modify the gait of persons with early-stage Parkinson's disease: a method for enhancing parkinsonian walking performance?

OBJECTIVE: To investigate whether systematically adjusting the rate of auditory cues induces corresponding modulations of the temporal and spatial parameters of gait of patients with early-stage Parkinson's disease. DESIGN: Subjects performed a series of 15 9-metre walks along a level floor under uncued and four cued conditions; the order of cued conditions was randomized. SETTING: A physiotherapy gymnasium, Manchester, UK. SUBJECTS: Eleven subjects with early-stage idiopathic Parkinson's disease. INTERVENTIONS: Preferred pace was established from the initial three uncued walks. The rate of auditory cues delivered throughout subsequent walks was systematically adjusted for each subject, representing 85, 92.5, 107.5 and 115% of their mean cadence at preferred walking pace. MAIN OUTCOME MEASURES: Mean cadence, mean stride length and mean velocity. RESULTS: Repeated measures ANOVA indicated that the mean velocity and mean cadence of subjects' gait significantly (p < or = 0.01) increased relative to baseline values at cue rates of 115 and 107.5% of cadence at preferred pace and decreased at cue rate of 85%. Mean stride length was unaffected by variations in cue rate. CONCLUSION: The rate of auditory cues, within the range tested, can modulate cadence and thus velocity of gait of subjects with early-stage Parkinson's disease. The provision of auditory cues provides a potential strategy for enhancing walking performance in these patients.

Does screen-detected breast cancer have better survival than symptomatic breast cancer?

OBJECTIVES: Evidence obtained from several randomized control trials suggest that mortality from breast cancer could be reduced by mammographic screening. However, a recent meta-analysis questioned the general acceptance that screening for breast cancer is beneficial. The purpose of the study was to analyze prospectively collected data from our unit and produce overall and comparative 5-year survival rates for screen-detected and symptomatic breast cancer. METHODS: Prospectively collected data on all patients diagnosed with invasive breast cancer between January 1993 and December 1994 (24 months), and monitored until the end of 1999, were collated and analyzed. Five-year survival was estimated and broken down by age at diagnosis, tumour size, grade and nodal status. The overall 5-year survival for women with screen-detected cancers was compared with that for women with symptomatically presenting cancers. RESULTS: Between January 1993 and December 1994, 308 patients with invasive breast cancer were referred to the unit (162 via the breast screening programme and 146 presenting symptomatically). The overall 5-year survival was 85.5% (confidence interval [CI], 80.8-89.1). Small tumour size, low grade and negative nodal status were associated with higher survival rates. Five-year survival of the screen-detected cancer patients (91.7%; CI, 85.8-95.2) was higher than that of patients presenting symptomatically (78.6%; CI, 70.6-84.6; p < 0.001). CONCLUSIONS: These findings suggest that patients with screen-detected breast cancer may have better survival compared to those with symptomatically detected breast cancer. The results support the argument in favour of a beneficial impact of breast screening programmes on patients' survival.

A comparison of two methods for detection of Chlamydia trachomatis in the male urethra.

Several methods have been put forward for screening people for Chlamydia trachomatis infection of the urogenital tract. It is often believed that culture is the gold standard. However, newer and faster methods are being developed. This study reports the result from the comparison of two methods.

Are preventive drugs preventive enough? A study of patients' expectation of benefit from preventive drugs.

OBJECTIVES: The study aimed to find the threshold of benefit for a hypothetical cholesterol-lowering drug below which the subject would not be prepared to take the drug. We also looked at whether proximity to the target event (myocardial infarction) and the subjects' views on drug taking affected this threshold. DESIGN: We studied 307 subjects using a written questionnaire and interview. Group 1 (102 subjects) had just been discharged from the coronary care unit. Group 2 (105 subjects) were taking cardio-protective drugs but had no recent history of myocardial infarction. Group 3 (100 subjects) had no history of myocardial infarction and were taking no cardio-protective drugs. RESULTS: Median values for the threshold of benefit below which the subject would not take the preventive drug were 20%, 20%, and 30% absolute risk reduction for Groups 1, 2 and 3 respectively. Median values for expectation of average prolongation of life were 12, 12 and 18 months respectively. Only 27% of subjects would take a drug offering 5% or less absolute risk reduction over five years. Subjects' views on medicinal drug taking in general and proximity to the target event were predictors of the acceptance of preventive drugs. Eighty percent of subjects wished to be told the numerical benefit of a preventive drug before starting on it. CONCLUSION: For the majority, the expectation of benefit from a preventive drug is higher than the actual benefit provided by current drug strategies. There is a tension between the patient's right to know about the chance of benefiting from a preventive drug and the likely reduction in uptake if they are so informed.

The relationship between attitudes toward corporal punishment and the perception and reporting of child maltreatment.

OBJECTIVE: This study examined the effect of workers' attitudes toward corporal punishment on the workers' perception and reporting of child maltreatment. Three hundred twenty-five (325) potential entry level workers participated in this study. METHOD: Responding to vignettes in multi-item scales, study participants 1) rated their approval of parental discipline involving corporal punishment; 2) rated the seriousness of incidents of probable maltreatment; and 3) indicated whether or not they would report the incidents of maltreatment to child protective services. Data were analyzed using correlation analyses and multiple regression procedures. RESULTS: 1) Respondents with higher scores for approval of corporal punishment were less likely to perceive maltreatment; 2) respondents with higher scores for approval of corporal punishment were less likely to report maltreatment; 3) the likelihood that a respondent would report maltreatment was a joint function of the respondent's perception of the seriousness of an incident and approval of corporal punishment. CONCLUSION: Attitudes about corporal punishment are important predictors of reporting behavior. Social service agencies face a challenge to provide workers with training which will enable them to detect and report maltreatment despite workers' individual beliefs about discipline and punishment.

Outbreak of Norwalk-like virus infection associated with salad provided in a restaurant.

Preliminary enquiries following the reporting of some cases of suspected food poisoning by members of the public revealed that they had all eaten at the same restaurant during the preceding weekend. Subsequent investigation, including a merged cohort study, identified 49 people with gastrointestinal symptoms, six of whom showed evidence of infection with Norwalk-like virus (NLV). Over a four day period all had eaten at the restaurant. Eating salad was strongly associated with infection. One of the chefs, who handled salad in the food preparation area and who had been absent from work with symptoms of gastrointestinal illness, had returned to work the day before the four-day period, reporting that he was 48-hours symptom free. He was subsequently shown to have been infected with NLV by reverse transcriptase polymerase chain reaction (RT-PCR) assay. The NLV belonged to the same genogroup as that infecting the cases who had eaten at the restaurant.

Reappraising the role of immediate intervention following thrombolytic recanalization in acute myocardial infarction.

Early studies indicated that after successful thrombolytic recanalization, adjunctive percutaneous transluminal coronary angioplasty (PTCA) was not appropriate, even when a significant residual stenosis was present. The aim of this study was to assess in-hospital clinical outcomes of patients with acute myocardial infarction (AMI) who underwent successful recanalization after thrombolytic therapy. The relation between repeat AMI/unstable angina and the severity of the stenosis, as well as other angiographic and clinical features was also examined. One hundred patients with AMI of <10 hours underwent coronary angiography 2 hours after receiving thrombolytic therapy. Salvage PTCA +/- stenting was performed if recanalization was unsuccessful (Thrombolysis In Myocardial Infarction [TIMI] trial grade 0 to 2), and no PTCA was undertaken if there was brisk anterograde flow (TIMI 3). Angiographic analysis was performed to assess the severity of the residual lesion, as well as the presence or absence of thrombus. Forty patients had unsuccessful recanalization, and of these, 36 underwent attempted PTCA. Of the 60 patients with TIMI 3 flow, 15 required repeat angiography and PTCA after repeat AMI (n = 13) or unstable angina (n = 2) within 5 days. Receiver-operating characteristic analysis indicated an optimum percent diameter stenosis predictor of 85% for repeat AMI/unstable angina. There was no additional relation to age, gender, time to thrombolysis, the infarct-related artery, or the presence of culprit lesion thrombus. After recanalization, a high-grade stenosis >85% is common (n = 25, 42.4%). This is associated with a 54% repeat AMI/unstable angina risk-a ninefold increase in the incidence of such events than in patients with lesions <85%. Thus, patients with narrowings >85% may benefit from early intervention rather than a conservative approach. Narrowings <85% have a 94% probability of no repeat AMI/unstable angina and do not require early intervention.

Expression of cyclin-dependent kinase inhibitor p21(WAF1) and p53 tumour suppressor gene in laryngeal cancer.

The prognostic value of the expression of the cyclin-dependent kinase inhibitor p21 and the p53 tumour suppressor gene was examined using immunohistochemistry in 60 patients with laryngeal cancer. Multivariate analysis using Cox's proportional hazard method, showed that p21 expression (P = 0.02) and advanced T stage (P = 0.003) significantly predicted survival. It was concluded that p21 expression may be a useful prognostic indicator in laryngeal cancer.

Worker judgements of seriousness about and reporting of suspected child maltreatment.

OBJECTIVE: This study examined the relationship between judgements about the seriousness of incidents of suspected maltreatment and the reporting of those incidents. METHOD: Eighty-six graduate social work students were given 12 vignettes depicting problematic parental behaviors. Students were asked to rate each vignette according to how serious they perceived the parental behavior to be with "1" being "not serious" and "7" being "very serious." Students were also asked to indicate whether or not they would report the incident to child protective services. Data were analyzed by case and by individual. RESULTS: All 12 vignettes were serious with mean incident ratings ranging from a low of 6.0 to a high of 6.9. However, not all incidents were reported with similar frequency. Only incidents that were collectively very serious were reported by nearly all respondents (Spearman rank order correlation coefficient = .94). Among worker characteristics, the worker's judgement of seriousness was the only predictor of reporting. CONCLUSION: The results suggest that beginning human service workers are unsure of their legal responsibility to report suspected maltreatment. The results also point to a need for closer collaboration between mandated reporters and child protective services.

Vasculitis and glomerulonephritis: a subgroup with an antineutrophil cytoplasmic antibody.

Four subjects whose plasma produced positive staining of neutrophil cytoplasm, on testing for antinuclear factor, have been found over eight years (and over 10,000 antinuclear factor studies). All four had evidence of diffuse systemic disease with polyarthralgia and lung involvement. Three of four (at least) had evidence of renal involvement and two of four skin biopsy evidence of vasculitis. Defining such a subgroup may help in defining etiology(s) and treatment regimes in diffuse vasculitic disease.

The left: lateral eye movements and ideology.

The lateral eye movements of 24 college students were videotaped as they reflected on spatial and analytical questions. As predicted, participants with more initial movements to the left had significantly higher scores on the leftist (or humanistic) index of the Tomkin's Polarity Scale. The direction of this relationship was reversed for the rightist index (right movers scoring higher) but this difference was not significant. Results are interpreted as additions to evidence which suggests a connection between the left and right sides of the human body and more global dichotomies of ideology or personality.