Head and neck cancer-specific quality of life: instrument validation.

BACKGROUND: The disfigurement and dysfunction associated with head and neck cancer affect emotional well-being and some of the most basic functions of life. Most cancer-specific quality-of-life assessments give a single composite score for head and neck cancer-related quality of life. OBJECTIVE: To develop and evaluate an improved multidimensional instrument to assess head and neck cancer-related functional status and well-being. METHODS: The item selection process included literature review, interviews with health care workers, and patient surveys. A survey with 37 disease-specific questions and the SF-12 survey were administered to 253 patients in 3 large medical centers. Factor analysis was performed to identify disease-specific domains. Domain scores were calculated as the standardized score of the component items. These domains were assessed for construct validity based on clinical hypotheses and test-retest reliability. RESULTS: Four relevant domains were identified: Eating (6 items), Communication (4 items), Pain (4 items), and Emotion (6 items). Each had an internal consistency (Cronbach alpha value) of greater than 0.80. Construct validity was demonstrated by moderate correlations with the SF-12 Physical and Mental component scores (r=0.43-0.60). Test-retest reliability for each domain demonstrated strong reliability between the 2 time points. Correlations were strong for each individual question, ranging from 0.53 to 0.93. Construct validity testing demonstrated that the direction of differences for each domain were as hypothesized. CONCLUSION: The Head and Neck Quality of Life questionnaire is a promising multidimensional tool with which to assess head and neck cancer-specific quality of life.

Sex ratios in fetuses and liveborn infants with autosomal aneuploidy.

Ten data sources were used substantially to increase the available data for estimating fetal and livebirth sex ratios for Patau (trisomy 13), Edwards (trisomy 18), and Down (trisomy 21) syndromes and controls. The fetal sex ratio estimate was 0.88 (N = 584) for trisomy 13, 0.90 (N = 1702) for trisomy 18, and 1.16 (N = 3154) for trisomy 21. All were significantly different from prenatal controls (1.07). The estimated ratios in prenatal controls were 1.28 (N = 1409) for CVSs and 1.06 (N = 49427) for amniocenteses, indicating a clear differential selection against males, mostly during the first half of fetal development. By contrast, there were no sex ratio differences for any of the trisomies when comparing gestational ages < 16 and > 16 weeks. The livebirth sex ratio estimate was 0.90 (N = 293) for trisomy 13, 0.63 (N = 497) for trisomy 18, and 1.15 (N = 6424) for trisomy 21, the latter two being statistically different than controls (1.05) (N = 3660707). These ratios for trisomies 13 and 18 were also statistically different than the ratio for trisomy 21. Only in trisomy 18 did the sex ratios in fetuses and livebirths differ, indicating a prenatal selection against males > 16 weeks. No effects of maternal age or race were found on these estimates for any of the fetal or livebirth trisomies. Sex ratios for translocations and mosaics were also estimated for these aneuploids. Compared to previous estimates, these results are less extreme, most likely because of larger sample sizes and less sample bias. They support the hypothesis that these trisomy sex ratios are skewed at conception, or become so during embryonic development through differential intrauterine selection. The estimate for Down syndrome livebirths is also consistent with the hypothesis that its higher sex ratio is associated with paternal nondisjunction.

Influence of ivermectin and clorsulon treatment on productivity of a cow-calf herd on the southern Oregon coast.

The reproductive performance of beef cows and the weight gain of their calves was evaluated after oral administration of clorsulon or clorsulon in combination with the subcutaneous administration of ivermectin. One hundred and fifty pregnant cows harboring infections of Fasciola hepatica were assigned to one of three treatment groups: Group 1 comprising 50 unmedicated controls; Group 2, 50 cows treated with clorsulon orally at 7 mg kg-1; Group 3, 50 cows treated with clorsulon orally at 7 mg kg-1 and ivermectin subcutaneously at 200 micrograms kg-1. Weights and body condition scores of the cows were measured and fecal and blood samples were taken at trial initiation and days 158 and 270. Pregnancy status was also determined at day 270. Weights and body condition scores were measured for the calves at days 158 and 270. Adjusted 205 day weaning weight of the calves was calculated and analyzed for differences between treatment groups. Four sets of tracer calves were used periodically throughout the trial to monitor the helminth challenge to the herd. Both gastro-intestinal nematodes and liver flukes were transmitted to the tracer calves during the entire trial. Even in the face of continual helminth challenge, beef cows treated with combined clorsulon/ivermectin conceived approximately 2 weeks earlier than their untreated counterparts and their calves had better body condition scores and weights than untreated calves.

Host influence on the banding profiles of whole-body protein and excretory-secretory product of Fasciola hepatica (Trematoda) by isoelectric focusing.

Various protein separation techniques have been used as alternative means of differentiating species and strains of parasites. Of these techniques, isoelectric focusing (IEF) has proved to be specific and reproducible with cestodes, protozoa and trematodes. As with the traditional morphological approach, there is, however, the potential for host influence. For a particular separation technique to be useful, it is important that banding profiles differentiating parasites be consistent, regardless of host species. To test for host influence, Fasciola hepatica were maintained in four definitive hosts. Soluble proteins of flukes from different hosts and their respective excretory-secretory product (ESP) were then subjected to IEF together with respective host tissues, and the resulting banding patterns were compared. Protein banding profiles of fluke body protein from llama, rat and mouse were very similar, while those of flukes from calves were distinct. Banding patterns of fluke ESP from different hosts were dissimilar. Overall banding patterns of body protein and ESP of flukes from different hosts were distinct from those of respective host tissues. The unique banding patterns of the body protein of flukes from calves indicate that there was host influence in their protein banding patterns, and the uniqueness of the calf fluke is discussed relative to host's resistance to the fluke.

Redescription of Trichuris tenuis Chandler, 1930, from llamas (Lama glama) in Oregon with a key to the species of Trichuris present in North American ruminants.

Whipworms collected from llamas (Lama glama) in Oregon were identified as Trichuris tenuis Chandler, 1930. A redescription, based on the specimens collected from llamas and examination of the paratypes, is presented. The unique form of the cloaca in T. tenuis separates males of this species from all other species of Trichuris known to occur in ruminants. Among species of Trichuris for which adequate descriptions of the female exist, T. tenuis can be distinguished using an array of characters including an uneverted, aspinous vulva and a highly convoluted vagina with papillalike spines in the proximal one-fourth and a small egg chamber located approximately midway along its length. This constitutes only the second report of T. tenuis in North America and brings to 7 the number of species of Trichuris known to occur in sylvatic and domestic ruminants in North America.

Anthelmintic efficacies of fenbendazole, ivermectin, and levamisole against Nematodirus battus infections in lambs.

Anthelmintic efficacies of fenbendazole, ivermectin, and levamisole were evaluated against naturally acquired infections of Nematodirus battus in lambs. Four groups of 10 lambs each were used. Oral administration of 8 mg of levamisole/kg of body weight or 5 mg of fenbendazole/kg significantly (P less than 0.01) reduced the degree of infection by N battus (adults) by greater than 99%. An oral formulation of 200 micrograms of ivermectin/kg was 98% effective (P less than 0.01). Numbers of other Nematodirus spp (including N filicollis and N spathiger) were significantly reduced.

Prevalence of Eimeria spp. (Apicomplexa: Eimeriidae) in Oregon llamas.

Eimeria alpacae, E. punoensis, E. lamae, and E. macusaniensis were identified in fecal samples from 189 llama (Lama glama (L.] adults and 50 llama crias (animals less than one year of age of any species in the genus Lama) from central and western Oregon. In both adults and crias, E. alpacae was the most common species found. The least common was E. macusaniensis, which was found in only two adults. Overall prevalence and numbers of animals with mixed infections was approximately twice as high in crias as in adults.

Fecal survey of llamas (Lama glama) in Oregon: incidental recovery of Nematodirus battus.

Between September 1985 and March 1987, 243 fecal specimens from llamas (195 adults, 48 crias) were examined for parasite eggs. Of the adults, 78% had at least one type of egg. Trichostrongyles were found in 67% of the adults, Nematodirus spp in 23%, Strongyloides spp in 9%, Capillaria spp in 8%, and Trichuris spp in 5%. Of the crias, 90% had at least one kind of egg. Trichostrongyles were found in 71% of the crias, Nematodirus spp in 52%, Strongyloides spp in 17%, and Trichuris spp and Capillaria spp in 4% each. Most important, N battus eggs were observed in fecal specimens from 2 crias.