Assessing the Acceptability, Feasibility, and Effectiveness of a Tablet-Based Cervical Cancer Educational Intervention.

Cervical cancer is a common and deadly disease, especially in developing countries. We developed and implemented an interactive, tablet-based educational intervention to improve cervical cancer knowledge among women in rural Malawi. Chichewa-speaking adult women in six rural villages participated. Each woman took a pretest, participated in the lesson, and then took a posttest. The lesson included information on cervical cancer symptoms, causes, risk factors, prevention, and treatment. Over the 6-month study period, 243 women participated. Women ranged in age from 18 to 77 years. Only 15 % had education beyond primary school. Nearly half of participants (48 %) had heard of cervical cancer prior to viewing the lesson. For these women, the median number of correct responses on the pretest was 11 out of 20; after the lesson, they had a median of 18 correct responses (p < 0.001). After the intervention, 93 % of women indicated a desire for cervical cancer screening. Despite lack of familiarity with computers (96 %), most women (94 %) found the tablet easy to use. A tablet-based educational program was an effective, feasible, and acceptable strategy to disseminate cervical cancer information to women with low education in rural Malawi. This method may be appropriate to distribute health information about other health topics in low-resource settings.

Ultra fast identification of Aspergillus species in pulmonary cytology specimens by in situ hybridization.

The cytologic diagnosis of pulmonary aspergillosis infection is typically made on a presumptive basis and later confirmed by fungal culture, which may take up to one week to complete. An in situ hybridization (ISH) probe specific for Aspergillus for use in surgical pathology specimens has been developed which has not been used on cytology preparations. We describe a supra-threshold adapted testing (STAT) in situ hybridization test for cytology specimens, which takes less than one hour to finish. We performed ISH on three cases of culture-proven pulmonary aspergillosis and one case with Aspergillus fungal forms but negative cultures to test the feasibility of using this same Aspergillus probe on cytology specimens. Four patients with pulmonary aspergillosis were initially diagnosed by cytologic examination of their respective specimens. The presumptive diagnosis was confirmed by culture to be Aspergillus fumigatus on three cases. ISH on both cytology cytospin and Thin-Prep specimens was performed using an rRNA Aspergillus specific probe. All four cytology specimens exhibited positive staining with the Aspergillus probe. Most, but not all, fungal hyphae were stained with the probe. Even though ISH is more expensive than culture, in situ hybridization can be performed in less than one hour on cytology specimens and may be beneficial for patients in selected clinical circumstances.

Kikuchi-Fujimoto disease: a benign cause of fever and lymphadenopathy.

PURPOSE: To describe 6 cases of Kikuchi-Fujimoto disease and to review the literature. PATIENTS AND METHODS: Review of 6 patients with biopsy-proven Kikuchi-Fujimoto disease detected at a university hospital over a 5-year period. RESULTS: Six patients presented with localized, mild lymph node enlargement. In 3 cases, dramatic fever, chills, weight loss and systemic complaints were present. These features prompted prolonged antibiotic therapy and extensive evaluations of fever of unknown origin before the diagnosis was made by biopsy of the minimally enlarged lymph nodes. The 3 remaining patients were otherwise asymptomatic and well. All 6 subjects recovered without specific therapy. CONCLUSIONS: Kikuchi-Fujimoto disease is a recently described cause of benign, self-limited lymphadenopathy that is easily confused histologically and clinically with lymphoma and systemic lupus erythematosis. Clinicians and pathologists must be aware of this condition. Although it is an uncommon cause of fever of unknown origin, early recognition of KFD will minimize potentially harmful and unnecessary evaluations and treatments.

Chloramphenicol for the treatment of vancomycin-resistant enterococcal infections.

A retrospective study of patients who received chloramphenicol for the treatment of serious vancomycin-resistant enterococcal infections between 1 January 1993 and 31 August 1993 was conducted at the University of Pennsylvania Medical Center (Philadelphia). Antimicrobial susceptibilities as well as the clinical course of infection, adverse events, and response to therapy of 16 patients were reviewed. Forty-seven percent of enterococcal isolates were susceptible only to chloramphenicol, tetracycline, and nitrofurantoin. Types of infection included bacteremias (n = 7), abscesses (n = 7), and others (n = 5). Of 14 patients for whom a clinical response could be ascertained, eight (57%) showed improvement after treatment. Of 11 patients for whom a microbiological response could be ascertained, eight (73%) had sterile cultures after treatment. No lasting adverse effect related to the drug occurred. In-hospital mortality was 56%, but only one death could be directly attributed to vancomycin-resistant enterococcal infection. Chloramphenicol appears to be a useful and well-tolerated agent for the treatment of serious vancomycin-resistant enterococcal infections.

Community-acquired Pseudomonas aeruginosa pneumonia in patients with HIV infection.

OBJECTIVE: To describe the clinical and radiographic presentation, risk factors, response to therapy and outcome of 16 patients with HIV infection and pulmonary infections caused by Pseudomonas aeruginosa. DESIGN: Retrospective review of medical records. SETTING: An academic tertiary-care hospital. PATIENTS: Sixteen patients who met the case definition were included for retrospective review. RESULTS: P. aeruginosa pneumonia was community-acquired in 15 patients (94%). The majority of patients (94%) had a diagnosis of AIDS with a mean CD4 cell count of 27 x 10(6)/l cells. Traditional risk factors for the development of P. aeruginosa were missing in most patients. Cavitary infiltrates were present on admission chest radiograph in eight patients (50%). An additional three patients (19%) presented with pulmonary infiltrates that cavitated subsequently. Clinical course was extremely varied with an in-hospital mortality of only 19%, but with an additional 25% of patients developing chronic or recurrent disease. CONCLUSIONS: Community-acquired pneumonia caused by P. aeruginosa occurs in patients with end-stage HIV infection. The presence of cavitary pulmonary infiltrates on chest radiograph in a patient with a low CD4 count should raise suspicion of P. aeruginosa infection. Obvious risk factors for P. aeruginosa infection may be absent. While the initial mortality rate is lower than that observed in other immunocompromised hosts, the potential for chronic or recurrent infection should be recognized and patients should be followed closely.

A longitudinal study of nutritional intake in men.

Seven-day dietary diaries were provided by 180 male participants in the Baltimore Longitudinal Study of Aging during each of three time periods (1961 to 1965, 1966 to 1970, and 1971 to 1975). These men are a highly educated, upper-middle class group. At the time of their first diary, they were aged 35 to 74 years. The data were analyzed for aging, cohort, and time effects on diet by utilizing three types of research designs concurrently: cross-sectional, longitudinal, and time series. The nutrients considered were calories, protein, carbohydrate, fat, saturated fatty acids, polyunsaturated fatty acids, and cholesterol. Aging had a negative effect on intake of calories, fat, saturated fatty acids, and cholesterol. Cohort effects were not observed for any of these nutrients. Over time, intake of carbohydrates and cholesterol declined, while intake of polyunsaturated fatty acids rose.

Cortical bone loss and measurements of the second metacarpal bone. I. Comparisons between adult Guamanian Chamorros and American Caucasians.

The amount of radiographically detectable cortical bone, as determined by measurements of the second metacarpal, was evaluated in 42 male and 45 female Guamanian Chamorros and compared with the degree of bony demineralization in U.S. Caucasians participating in the Baltimore Longitudinal Study on Aging of the Gerontology Research Center. All Chamorros were individually matched to the Caucasian participants for age, sex, and menopause status. Chamorros of both sexes showed bilateral asymmetry in bone measurements and in the amount of cortical bone. Both Chamorro and Caucasian males had longer second metacarpals and more cortical bone than females. Caucasian males, however, had longer and larger second metacarpals than Chamorro males. Despite differences in the length and total width, Chamorro and Caucasian participants generally showed no significant differences in the amount of cortical bone or percent cortical area in the second metacarpal, suggesting that larger bones may not always indicate greater cortical mass. Although cross-sectional data suggested apparent age differences in the onset and rate of bone loss between Chamorros and Caucasians, the numbers of participants were too small to allow meaningful age-by-age statistical comparisons.

Comparison of visually estimated age with physiologically predicted age as indicators of rates of aging.

The commonly held view that people age at different rates derives largely from visual estimates of age. Although most people "look their age' everyone can cite examples of individuals in middle and late adulthood who appear to be aging very slowly or very rapidly. Efforts to quantify aging rates scientifically require measurement of a large number of physiological parameters in a large population sample. This paper compares visual estimates of age with physiologically predicted measures to determine their value as indicators of the rate of aging. This study used data from 1086 male participants in the Baltimore Longitudinal Study of the Gerontology Research Center, NIA. These men have provided comprehensive biomedical and psychosocial data at one and one-half years intervals for as long as 20 years. The visual estimate of age was made by the examining physician at the first study visit of each participant, without knowledge of the man's actual age. The error of this estimate was determined by subtracting actual age from estimated age. Correlation analysis of error in estimated age with an objective assessment of biological age based on physiological variables indicated a significant association between the two approaches. When men who have died since their study participation were compared with survivors, the former were found to have been significantly 'older for their age' than the latter using both visual and physiological estimate approaches. To determine whether certain lifestyle traits were associated with variation in these two indicators, multiple regression analyses were performed. These showed that men who smoked, who were fatter, or who were in poor health were predicted as older than their chronological age peers using both approaches. Results of this study suggest that the easily determined visual estimate of age may be a useful indicator of aging rate within a population.

Personal adjustment to aging: longitudinal prediction from neuroticism and extraversion.

Personal adjustment to aging as measured by scales from the Chicago Attitude Inventory (CAI) was examined longitudinally in a community-dwelling sample of 557 men aged 17 to 97. Concurrent and predictive relations between this age-appropriate measure of well-being and personality were examined by correlating the CAI variables with three factors from the Guilford-Zimmerman Temperament Survey identified as Neuroticism, Extraversion, and "Thinking Introversion." As hypothesized, Neuroticism was related negatively and Extraversion was related positively to most concurrent measures of well-being in both younger and older subsamples. "Thinking Introversion" was related only to positive attitudes toward religion. Predictive correlations between personality and subjective well-being over two-to-ten (M = 5.3) and ten-to-seventeen (M = 12.6) year intervals confirmed earlier research, and showed that enduring personality disposition antedate and predict measures of personal adjustment to aging.

Assessment of biological age using a profile of physical parameters.

The present study describes a new approach to the assessment of biological age in adults using a profile of physical parameters. The investigation was based on data from 1086 adult male participants in the aging study of the Gerontology Research Ctr., Baltimore, MD. For each of 24 age-related variables, data were transformed into biological age scores reflecting a man's status relative to his chronological age peers. Analysis of the mean biological age profiles of men who were estimated by physicians as looking older than their age showed them to be biologically older on the profile parameters as well. Comparison of age-corrected scores of 166 men who have died with those of survivors reveals the deceased group to have been biologically older than the survivors at the time they were measured. These results suggest the value of this technique in investigating interindividual variation in the aging process.

Bilateral asymmetry in bone measurements of the hand and lateral hand dominance.

Two hundred thirty-five (235) normal male participants of the Baltimore Longitudinal Study were classified as right handed, left handed, and ambidextrous on the basis of their grip-strength performance. Their left and right hands were also radiographed and the measurements of the second metacarpal bones were evaluated on the basis of hand dominance. The results indicated that, as a rule, the right hand measurements are higher than those of the left hand, regardless of hand dominance. The bilateral differences in total width, length, total area and cortical area are significant among the right hand dominant and nonsignificant among the left hand dominant. Regardless of hand dominance the bilateral differences in medullary width are nonsignificant. These results suggest an inherent tendency of the right second metacarpal to have more bone than the left regardless of hand dominance. Differential stress due to hand dominance will increase the bilateral difference in the right handed and reduce it in the left handed.

Osteoarthritis of the hand: longitudinal studies.

Evaluation of the osteoarthritic grades of the hands of 478 participants of the ongoing Baltimore Longitudinal Study suggests that: 1) Joint degeneration due to osteoarthritis is a relatively slow process. The maximum rate of degeneration is seen in the distal interphalangeal joints where the average increase is about 1 grade per individual in an interval of 12 to 16 years between visits in each age group. The rate of degeneration in the proximal interphalangeal joints is much lower than that of the distal interphalangeal joints. 2) The progress of the degeneration in the distal interphalangeal joints of an individual (longitudinally evaluated) follows closely that which is observed at the population level (cross-sectional joint-digit study). That is, it is directly related to the age and the interval between visits. This is not always seen in the proximal interphalangeal joint data. 3) The rate of change in the osteoarthritic grade of individual hands agrees closely with that of their distal interphalangeal joints. This further supports the conclusions reached in a first report that what has been referred to as osteoarthritic grade of the hand of an individual may actually be the higher grade among the distal interphalangeal joints.

Age-related differences in lactate distribution kinetics following maximal exercise.

Lactate concentrations were determined at 3, 5, and 7 min of recovery following maximal, continuous, multi-stage treadmill work in 180 men, aged 20-80 years, who were participants of the Baltimore Longitudinal Study of Aging. Each subject was placed into one of six age groups, e.g., 20-29, 30-39, etc. As expected, average concentrations decreased consistently with age. All three sampling times were similar in characterizing maximal lactates for the youngest men. For each older group, except for the oldest, the later values were significantly (p less than 0.01) higher than the 3-min values. For subjects in their 50's and 60's mean concentrations continued to rise through the 7th min. These data suggest that in man there is a progressive, age-related diminution of ability to diffuse lactate from muscle and/or distribute it into its space. This may result in decreased endurance and work capacity and a prolongation of recovery. As an alternative to multiple sampling and analyses for maximal lactate, single blood samples should be obtained no sooner than 5 min of recovery for men up to age 50, and at 7 min for those between 50 and 70 years. Variability among the men over 70 years of age was large enough to preclude single-sample alternatives.

Osteoarthritis of the hand: age-specific joint-digit prevalence rates.

The left hand of each of 903 white males, most of them well-educated professionals, was evaluated for osteoarthritis, in the ongoing Baltimore Longitudinal Study of the Gerontology Research Center. The results of the joint-digit prevalence study indicated that: 1) the prevalence of osteoarthritis varies from one digit to the other; 2) osteoarthritis is considerably more prevalent in the distal than the proximal interphalangeal joints, regardless of digit or age group; 3) this disease is not only more prevalent in the distal interphalangeal joints, but it usually appears in a more severe form in the distal than in the proximal interphalangeal or the metacarpophalangeal joints. 4) Assuming that the presence of osteoarthritis in one joint is independent of the presence of the disease in the other joint of the same digit, there is an excess of digits with osteoarthritis in both the distal and proximal interphalangeal joints. This is suggestive of either a common etiology or that the presence of the disease in one joint enhances the development of osteoarthritis in the other joint of the same digit.