Diagnostic value of ferritin and glycosylated ferritin in adult onset Still's disease.

OBJECTIVE: To determine the usefulness of serum ferritin and glycosylated ferritin (GF) levels in diagnosing adult onset Still's disease (AOSD). METHODS: We performed a retrospective multicenter study of 205 patients who had ferritin and GF assays in one hospital laboratory. Records of all patients were reviewed, and a standardized questionnaire used to extract all data available at the time of the assay. The clinicians' final diagnosis was also recorded. Patients were classified as having "certain AOSD" (based on Yamaguchi's criteria) or a control disease. The concordance of ferritin and GF levels with final diagnosis was evaluated. RESULTS: In total 49 AOSD and 120 control patients were eligible. The mean ferritin value was significantly higher in the AOSD group (4,752 +/- 9,599 microg/l) than in the control group (1,571 +/- 3,807 microg/l), p = 0.029. GF was significantly lower in AOSD patients (15.9 +/- 11.9%) than in the control group (31.5 +/- 18.7%), p < 0.001. The combination of a GF level of < or = 20% with ferritin above the upper limit of normal yielded a sensitivity of 70.5% and specificity of 83.2%. The combination of a GF level < or = 20% with ferritin 5 times normal produced a sensitivity of 43.2% and specificity of 92.9%. This latter combination allowed an AOSD diagnosis to be ruled out for 6 of the 8 control patients who met Yamaguchi's positive criteria. CONCLUSION: Ferritin and GF levels are powerful diagnostic markers of AOSD. They may be helpful in clinical practice for excluding differential diagnoses.

Effectiveness of a school-based substance abuse prevention program.

A grade five through eight substance abuse prevention program, later incorporated into the Michigan Model for Comprehensive School Health Education, was developed, implemented, and evaluated. Results focus on students who received seven lessons on alcohol in grade six, and eight lessons on tobacco, alcohol, marijuana, and cocaine in grade seven taught by their regular classroom teachers (after a 6-hour training in the social pressures resistance skills curriculum). Students (N = 442) received either two years of the program or none, and completed individually-coded questionnaires. Repeated measures analysis of variance resulted in significant treatment by occasion interactions on the use of alcohol, cigarettes, marijuana, cocaine, and other drugs, as well as on knowledge. At the end of grade seven, program students' rates of substance use had increased significantly less and knowledge of alcohol pressures, effects, and skills to resist had increased significantly more than those of comparison students.

Interventions to enhance breast self-examination practice: a review.

Breast self-examination (BSE) is an important component of any program for the early detection of breast cancer. Compared to clinical breast examination and mammography, BSE is relatively safe, low cost, offers monthly assessment, and does not require overcoming barriers associated with access to the medical care system (unless an abnormality is discovered). Over the past decade, considerable research has been directed at encouraging women to perform BSE. This paper reviews 33 intervention studies that vary in the type and intensity of strategies employed, and in the BSE behaviors assessed. In general, more-intensive interventions result in better outcomes. With regard to BSE frequency, the provision of information seems sufficient to obtain BSE initiation but not necessarily adequate to maintain practice or to establish proficiency. The addition of skills training and corrective feedback leads to significantly improved BSE proficiency. Prompts and reminder aids seem also to contribute to long-term frequency. The search should continue for motivational mechanisms regarding BSE frequency, and for creative approaches to teaching and maintaining proficiency.

Clinical experience and cognition of a physical therapy procedure.

This investigation was designed to determine if clinical experience influences cognition of a physical therapy procedure. We hypothesized that experience in the application of a physical therapy procedure on patients would increase the student's cognition of that procedure. Twenty-two junior students in a physical therapy baccalaureate program were study subjects. A multiple-choice test pertaining to gait training was administered to all subjects as a pretest and posttest. The pretest was given after classroom instruction and laboratory practice in gait training; posttest was administered eight weeks later. During the interim eight weeks, 11 subjects completed 32 hours of clinical experience and 11 subjects had no clinical experience. Analysis of the results of posttest compared with pretest indicated that for these subjects, clinical experience did not increase cognition of gait training.