Fatigue and functional impairment in early-stage non-small cell lung cancer survivors.

CONTEXT: Fatigue is the most common sequela among non-small cell lung cancer (NSCLC) survivors one to six years post-treatment and is associated with functional limitations. OBJECTIVES: This study examined the prevalence, severity, and correlates of fatigue among early stage NSCLC survivors. METHODS: Three-hundred fifty individuals diagnosed and surgically treated for Stage IA or IB NSCLC completed a survey that included the Brief Fatigue Inventory (BFI) to assess the prevalence and severity of fatigue. The Karnofsky Self-Reported Performance Rating scale (SR-KPS) was used as a measure of functional status and was compared with the severity of fatigue through Chi-squared analyses. Demographic, psychological, and medical correlates of fatigue were examined using logistic regression. RESULTS: The prevalence of fatigue was 57%. Forty-one percent (n=142) of participants had mild fatigue and 16.8% (n=59) had moderate or severe fatigue (BFI≥4). Among the individuals reporting moderate or severe fatigue, 23.7% (n=14) had significant functional impairment (SR-KPS≤70%) compared with 2.8% (n=8) with mild or no fatigue (χ(2)=58.1, P<0.001). In the multivariate analysis, NSCLC survivors with pulmonary disease (odds ratio [OR]=2.28), depressive symptoms (OR=6.99), and anxiety symptoms (OR=2.31) were more likely to report experiencing clinically significant fatigue, whereas those who met physical activity guidelines (OR=0.29) reported less fatigue. CONCLUSION: Fatigue is highly prevalent among NSCLC survivors and associated with more functional impairment. A comprehensive approach to the treatment of fatigue includes the screening and management of anxious and depressive symptoms, and pulmonary disorders such as chronic obstructive pulmonary disease.

Precipitation and temperature as predictors of the local abundance of Ixodes scapularis (Acari: Ixodidae) nymphs.

Populations of Ixodes scapularis Say nymphs were surveyed at a Lyme disease- endemic area for 8 consecutive yr (1998-2005) to characterize annual changes in abundance. Precipitation and temperature were also monitored over the period 1998-2004 to determine their potential value as predictors of tick abundance. Although both parameters showed annual variation, no statistical differences in the annual abundance of I. scapularis nymphs were observed over the 8-yr period. Our results suggest that precipitation and temperature were not predictive of the abundance of I. scapularis nymphs.

Effectiveness of the 4-Poster passive topical treatment device in the control of Ixodes scapularis and Amblyomma americanum (Acari: Ixodidae) in New Jersey.

Twenty-five "4-Poster" feeders were placed throughout a 5.2 km(2) study area within a secured military facility situated in a hyperendemic area for Lyme disease in central Monmouth County, New Jersey. Calculated levels of control, relative to untreated areas, peaked at 82.7%, 77.3%, and 94.2% for of host-seeking Ixodes scapularis Say larvae, nymphs, and adults, respectively, within 5 years of deployment. Control of host-seeking Amblyomma americanum (L.) peaked at 99.2%, 89.5%, and 96.9% for larvae, nymphs, and adults, respectively, during the treatment period. Tick burdens on hunter-killed deer were significantly reduced on deer harvested from the treatment area and on deer that had consumed bait corn. Populations of subadult I. scapularis and A. americanum demonstrated some rebound effect following the removal of 4-Posters, but treatment area tick populations remained lower than control area populations 2 years following withdrawal of the 4-Posters. However, control of I. scapularis adults declined to 20.7% by the third fall activity period following removal of the 4-Posters. The posttreatment phase of the study was of insufficient duration to evaluate continued population rebound of adults and subadults during subsequent activity periods.

Student perspectives on diversity and the cultural climate at a U.S. medical school.

PURPOSE: To obtain the perspectives of medical students at one school on racial/ethnic campus diversity and cultural competence and to gain their perceptions of the institutional climate around diversity at their university and of reasons for minority underrepresentation at their medical school. METHOD: A student-driven survey of all medical students (N = 398) at a single medical school in the spring of 2003, supplemented by four focus groups from all racial and ethnic groups on the campus. RESULTS: A large majority of the responding students (n = 216; 54%) endorsed the value of campus diversity and the importance of cultural competence to the process of becoming a clinician. Most students felt their university had achieved a positive cultural climate, characterized by openness to diverse perspectives and attention to equity. Most students also felt that the university's programs and policies reflected a commitment to diversity, but fewer students--those from underrepresented minorities (URMs) in particular--felt that the university truly valued having a diverse student body and faculty. Most students felt that the lack of diversity on campus was a barrier to recruiting and retaining minority candidates. Some minority students also blamed the medical school's limited social, academic, and financial support, as well as inadequate efforts to recruit minority students. CONCLUSIONS: Medical students generally place a high value on campus diversity and cultural competence. URM students in particular felt that their university could do more to implement its commitment to diversity, including making greater efforts to recruit and retain URM students. These views constitute a barometer for medical schools to gauge and track their efforts to enhance campus diversity, incorporate cultural competence education, and create an inclusive and welcoming climate for students of all backgrounds.

Prevalence of Borrelia burgdorferi (Spirochaetales: Spirochaetaceae) in Ixodes scapularis (Acari: Ixodidae) adults in New Jersey, 2000-2001.

Using polymerase chain reaction, we analyzed 529 Ixodes scapularis Say adults collected from 16 of New Jersey's 21 counties for the presence of Borrelia burgdorferi, the etiological agent of Lyme disease. Overall, 261 (49.3%) were positive. B. burgdorferi was detected in ticks obtained from each county and from 53 of the 58 (93.1%) municipalities surveyed. The observed statewide prevalence in New Jersey is similar to those reported from other northeastern and mid-Atlantic states.