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Background Comprehensive vision screening programmes for children are an important part of public health strategy, but do not exist in many countries, including Tonga. This project set out to assess: (1) the functional vision of children attending primary schools in Tonga and (2) how a new recognition acuity test (The Auckland Optotypes displayed on a tablet computer) compares to use of a standardised eye chart in this setting. Methods Children from three Tongan primary schools were invited to participate. Acuity testing was conducted using a standardised recognition acuity chart (Lea symbols) and the tablet test displaying two formats of The Auckland Optotypes. Measures of ocular alignment, stereo acuity and non-cycloplegic photorefraction were also taken. Results Parents of 249 children consented to participate. One child was untestable. Only 2.8 per cent of testable children achieved visual acuity worse than 0.3 logMAR in the weaker eye. Results from the Spot Photoscreener suggested that no children had myopia or hyperopia, but that some children had astigmatism. The tablet test was practical in a community setting, and showed ±0.2 logMAR limits of agreement with the Lea symbols chart. Conclusion The sample of children in Tongan primary schools had good functional vision. A modified version of the tablet acuity test is a promising option for vision screening in this context.

BACKGROUND: Screening for dementia in relevant healthcare settings may help in identifying low cognitive functioning for comprehensive cognitive assessments and subsequent dementia treatment after diagnosis. AIMS: This study sought to estimate the prevalence of no reported dementia-related diagnosis in a nationally-representative sample of older Americans with a cognitive impairment consistent with dementia (CICD) by healthcare utilization. METHODS: The unweighted analytical sample included 1514 Americans aged ≥ 65 years that were identified as having a CICD without history of stroke, cancers, neurological conditions, or brain damage who participated in at least one-wave of the 2010–2016 waves of the Health and Retirement Study. An adapted Telephone Interview of Cognitive Status assessed cognitive functioning. Those with scores ≤ 6 had a CICD. Dementia-related diagnosis was self-reported. Respondents indicated if they visited a physician, received home healthcare, or experienced an overnight nursing home stay in the previous two years. RESULTS: The prevalence of no reported dementia-related diagnosis in persons with a CICD who visited a physician was 89.9% (95% confidence interval (CI): 85.4%−93.1%). Likewise, the prevalence of no reported diagnosis in those with a CICD who received home healthcare was 84.3% (CI: 75.1–90.5%). For persons with a CICD that had an overnight nursing home stay, the prevalence of no reported dementia-related diagnosis was 83.0% (CI: 69.1–91.4%). DISCUSSION: Although the prevalence of no reported dementia-related diagnosis in individuals with a CICD differed across healthcare settings, the prevalence was generally high nonetheless. CONCLUSIONS: We recommend increased awareness and efforts be given to dementia screenings in various clinical settings.

PurposePeople who are distinct from the dominant ethnic group within a country can experience a variety of barriers to accessing eyecare services. We conducted a scoping review to map published interventions aimed at improving access to eyecare for non-Indigenous, non-dominant ethnic groups residing in high-income countries.MethodsWe searched MEDLINE, Embase and Global Health for studies that described an intervention to promote access to eyecare for the target population. Two authors independently screened titles and abstracts followed by review of the full text of potentially relevant sources. For included studies, data extraction was carried out independently by two authors. Findings were summarised using a combination of descriptive statistics and thematic analysis.ResultsWe screened 5220 titles/abstracts, of which 82 reports describing 67 studies met the inclusion criteria. Most studies were conducted in the USA (90%), attempted to improve access for Black (48%) or Latinx (28%) communities at-risk for diabetic retinopathy (42%) and glaucoma (18%). Only 30% included the target population in the design of the intervention; those that did tended to be larger, collaborative initiatives, which addressed both patient and provider components of access. Forty-eight studies (72%) evaluated whether an intervention changed an outcome measure. Among these, attendance at a follow-up eye examination after screening was the most common (n=20/48, 42%), and directly supporting patients to overcome barriers to attendance was reported as the most effective approach. Building relationships between patients and providers, running coordinated, longitudinal initiatives and supporting reduction of root causes for inequity (education and economic) were key themes highlighted for success.ConclusionAlthough research evaluating interventions for non-dominant, non-Indigenous ethnic groups exist, key gaps remain. In particular, the paucity of relevant studies outside the USA needs to be addressed, and target communities need to be involved in the design and implementation of interventions more frequently.

We investigated motivational regulation involving adjustment of recovery goals in post-stroke rehabilitation via standard in-clinic physiotherapy and in-home telerehabilitation (TR). We used a secondary dataset collected at 11 US sites as part of a clinical trial using video games and game control pads designed to induce certain arm movements required for recovery (n = 124; Mage = 61.44, SD = 13.30). Participants were randomly assigned to either the TR or in-clinic condition and underwent 36 therapy sessions, reporting on their activity-inherent enjoyment for 6-8 weeks. Compared with the in-clinic patients and TR patients with high game performance, TR patients with lower game performance reported lower activity-inherent enjoyment, which is an important motivational resource for successful recovery. The results suggest that these differences occur because TR patients become discouraged by low game score feedback, which may have signaled a poor prospect for recovery. However, the results also suggest that low game performers who successfully adjusted their recovery goals were resilient to the impact of low game score feedback on their motivational resources and satisfaction with therapy. The findings suggest that goal adjustment may be particularly beneficial when patients are discouraged by feedback indicating suboptimal recovery prospects.

IntroductionThe shape of the glucose curve during an oral glucose tolerance test (OGTT) reflects β-cell function in populations without diabetes but has not been as well studied in those with diabetes. A monophasic shape has been associated with higher risk of diabetes, while a biphasic pattern has been associated with lower risk. We sought to determine if phenotypic or metabolic characteristics were associated with glucose response curve shape in adults with type 2 diabetes treated with metformin alone.Research design and methodsThis is a cross-sectional analysis of 3108 metformin-treated adults with type 2 diabetes diagnosed ResultsThe monophasic profile was the most common (67.8% monophasic, 5.5% biphasic, 26.7% continuous rise). The monophasic subgroup was younger, more likely male and white, and had higher body mass index (BMI), while the continuous rise subgroup was more likely female and African American/black. HOMA2-S and fasting glucose did not differ among the subgroups. The biphasic subgroup had the highest early, late, and total insulin and C peptide responses (all pConclusionsBased on the large multiethnic GRADE cohort, sex, race, age, and BMI were found to be important determinants of the shape of the glucose response curve. A pattern of a continuously rising glucose at 2 hours reflected reduced β-cell function and may portend increased glycemic failure rates.Trial registration numberNCT01794143.

In patients with anisometropic or strabismic amblyopia, interocular suppression can be minimized by presenting high contrast stimulus elements to the amblyopic eye and lower contrast elements to the fellow eye. This suggests a structurally intact binocular visual system that is functionally suppressed. We investigated whether suppression can also be overcome by contrast balancing in children with deprivation amblyopia due to childhood cataracts. To quantify interocular contrast balance, contrast interference thresholds were measured using an established dichoptic global motion technique for 21 children with deprivation amblyopia, 14 with anisometropic or mixed strabismic/anisometropic amblyopia and 10 visually normal children (mean age mean=9.9years, range 5-16years). We found that interocular suppression could be overcome by contrast balancing in most children with deprivation amblyopia, at least intermittently, and all children with anisometropic or mixed anisometropic/strabismic amblyopia. However, children with deprivation amblyopia due to early unilateral or bilateral cataracts could tolerate only very low contrast levels to the stronger eye indicating strong suppression. Our results suggest that treatment options reliant on contrast balanced dichoptic presentation could be attempted in a subset of children with deprivation amblyopia.

PurposeGlobally, there are ~370 million Indigenous peoples. Indigenous peoples typically experience worse health compared with non-Indigenous people, including higher rates of avoidable vision impairment. Much of this gap in eye health can be attributed to barriers that impede access to eye care services. We conducted a scoping review to identify and summarise service delivery models designed to improve access to eye care for Indigenous peoples in high-income countries.MethodsSearches were conducted on MEDLINE, Embase and Global Health in January 2019 and updated in July 2020. All study designs were eligible if they described a model of eye care service delivery aimed at populations with over 50% Indigenous peoples. Two reviewers independently screened titles, abstracts and full-text articles and completed data charting. We extracted data on publication details, study context, service delivery interventions, outcomes and evaluations, engagement with Indigenous peoples and access dimensions targeted. We summarised findings descriptively following thematic analysis.ResultsWe screened 2604 abstracts and 67 studies fulfilled our eligibility criteria. Studies were focused on Indigenous peoples in Australia (n=45), USA (n=11), Canada (n=7), New Zealand (n=2), Taiwan (n=1) and Greenland (n=1). The main disease focus was diabetic retinopathy (n=30, 45%), followed by ‘all eye care’ (n=16, 24%). Most studies focused on targeted interventions to increase availability of services. Fewer than one-third of studies reported involving Indigenous communities when designing the service. 41 studies reflected on whether the model improved access, but none undertook rigorous evaluation or quantitative assessment.ConclusionsThe geographical and clinical scope of service delivery models to improve access to eye care for Indigenous peoples in high-income countries is narrow, with most studies focused on Australia and services for diabetic retinopathy. More and better engagement with Indigenous communities is required to design and implement accessible eye care services.

e14024 Background: Despite recommendations from premier institutions such as NCCN that all cancer patients should be entered on clinical trials, only 3 – 5 % of adult cancer patients are enrolled on clinical trials in North America. The reason for this is multi-factorial and includes poor trial design, inappropriate endpoints, inappropriate inclusion/exclusion factors, attitudes about trial participation held by patient and/or treating physician and lack of trial availability. Methods: To address issues of trial availability, in March 2019, we initiated a novel service to help Canadian patients find clinical trial options. The service compares patient demographic and health status information provided against potential opportunities sourced using clinicaltrials.gov and Canadian clinical trials websites. A report presenting outcomes of CTN review is developed for the requesting patient or physician. An interview is provided for the self-referring patient by supporting physicians. Results: To date 96 patients have used this service. Most (94%) were stage IV or refractory/ relapsed. Smaller disease sites represented 23% of our patient population (brain, sarcoma, pancreas). Our turn-around-time from request of services to delivery of report to patient or physician improved over time and is currently 24 hours during the working week. Of those eligible, 25% of patients died before referral, the median time from referral to the CTN to the patient’s death was 109 days (3 – 188 days). Conclusions: Significant interest from both physicians and patients for this service was identified. Strategies are being developed to encourage earlier referrals to clinical trials would improve number of patients entering clinical trials as 25% of our patients. [Table: see text]

Ziel: Kann die bei der Routinesonografie ermittelbare Schallgeschwindigkeit Hinweise auf den Fettgehalt der Leber bei Kindern geben? Material und Methode: Bei 75 Kindern und Jugendlichen wurde bei einer klinisch indizierten Sonografie durch den Bildoptimierungsalgorithmus des verwendeten Schallgerates die Schallgeschwindigkeit der Leber bestimmt und diese mit Gewicht, Korpergrose, Alter und Body Mass Index (BMI) der Patienten verglichen. Ergebnisse: Die Schallgeschwindigkeit bei normalgewichtigen Kindern betrug im Mittel 1 566 m/s (Standardabweichung (STD) 29 m/s), bei Kindern mit Ubergewicht und/oder Adipositas 1 501 m/s (STD 22 m/s) und den Kindern mit Adipositas 1 497 m/s (STD 24 m/s). Die beste Korrelation bestand hierbei zum BMI der Kinder. Der Unterschied zwischen normalgewichtigen und ubergewichtigen Kindern war statistisch signifikant. Schlussfolgerung: Die Ergebnisse weisen auf einen messbaren Zusammenhang zwischen dem Fettgehalt der Leber und der ermittelten Schallgeschwindigkeit hin. Weitergehende Untersuchungen sollten erfolgen.

Clinicians rely heavily on stereoacuity to measure binocular visual function, but stereo-vision represents only one aspect of binocularity. Lab-based tests of sensory eye dominance (SED) are commonplace, but have not been translated to wider clinical practice. Here we compare several methods of quantifying SED in a format suitable for clinical use. We tested 30 participants with ostensibly normal vision on eight tests. Seven tests (#1-7) were designed to quantify SED in the form of an interocular balance-point (BP). In tests #1-6, we estimated a contrast-BP, the interocular difference in contrast required for observers to be equally likely to base their judgement on either eye, whereas in test #7 we measured binocular rivalry (interocular ratio of sensory dominance duration). We compare test-retest reliability (intra-observer consistency) and test-validity (inter-observer discriminatory power) and compare BP to stereoacuity (test #8). The test that best preserved inter-observer differences in contrast balance while maintaining good test-retest reliability was a polarity judgement using superimposed opposite-contrast polarity same-identity optotypes. A reliable and valid measure of SED can be obtained rapidly (20 trials) using a simple contrast-polarity judgement. Tests that use polarity-rivalrous stimuli elicit more reliable judgments than those that do not. SIGNIFICANCE STATEMENT: Although sensory eye dominance is central to understanding normal and disordered binocular vision, there is currently no consensus as to the best way to measure it. Here we compare several candidate measures of sensory eye dominance and conclude that a reliable measure of SED can be achieved rapidly using a judgement of stimulus contrast-polarity.

Clinicians rely heavily on stereoacuity to measure binocular visual function, but stereo-vision represents only one aspect of binocularity. Lab-based tests ofsensory eye dominance(SED) are commonplace, but have not been translated to wider clinical practice. Here we compare several methods of quantifying SED in a format suitable for clinical use. We tested 30 participants with ostensibly normal vision on 8 tests. Seven tests (#1-7) were designed to quantify SED in the form of an interocularbalance-point(BP). In tests #1-6, we estimated acontrast-BP, the interocular difference in contrast required for observers to be equally likely to base their judgement on either eye, whereas in test #7 we measured binocular rivalry (interocular ratio of sensory dominance duration). We compare test-retest reliability (intra-observer consistency) and test-validity (inter-observer discriminatory power) and compare BP to stereoacuity (test #8). The test that best preserved inter-observer differences in contrast balance while maintaining good test-retest reliability was a polarity judgement using superimposed opposite-contrast polarity same-identity optotypes. A reliable and valid measure of SED can be obtained rapidly (20 trials) using a simple contrast-polarity judgement. Tests that use polarity-rivalrous stimuli elicit more reliable judgments than those that do not.Significance StatementAlthough sensory eye dominance is central to understanding normal and disordered binocular vision, there is currently no consensus as to the best way to measure it. Here we compare several candidate measures of sensory eye dominance and conclude that a reliable measure of SED can be achieved rapidly using a judgement of stimulus contrast-polarity.

Background Children with deprivation amblyopia due to childhood cataract have been excluded from much of the emerging research into amblyopia treatment. An investigation was conducted to determine whether contrast-balanced binocular treatment - a strategy currently being explored for children with anisometropic and strabismic amblyopia - may be effective in children with deprivation amblyopia. Methods An unmasked, case-series design intended to assess proof of principle was employed. Eighteen children with deprivation amblyopia due to childhood cataracts (early bilateral n = 7, early unilateral n = 7, developmental n = 4), as well as 10 children with anisometropic (n = 8) or mixed anisometropic and strabismic amblyopia (n = 2) were prescribed one hour a day of treatment over a six-week period. Supervised treatment was available. Visual acuity, contrast sensitivity, global motion perception and interocular suppression were measured pre- and post-treatment. Results Visual acuity improvements occurred in the anisometropic/strabismic group (0.15 ± 0.05 logMAR, p = 0.014), but contrast sensitivity did not change. As a group, children with deprivation amblyopia had a smaller but statistically significant improvement in weaker eye visual acuity (0.09 ± 0.03 logMAR, p = 0.004), as well a significant improvement in weaker eye contrast sensitivity (p = 0.004). Subgroup analysis suggested that the children with early bilateral deprivation had the largest improvements, while children with early unilateral cataract did not improve. Interestingly, binocular contrast sensitivity also improved in children with early bilateral deprivation. Global motion perception improved for both subgroups with early visual deprivation, as well as children with anisometropic or mixed anisometropic/strabismic amblyopia. Interocular suppression improved for all subgroups except children with early unilateral deprivation. Conclusion These data suggest that supervised contrast-balanced binocular treatment should be further investigated as a treatment option for children with deprivation amblyopia. However, for children with more severe deprivation amblyopia due to early unilateral cataracts, supplementary or alternative options should also be explored.

ZusammenfassungEine chronische subklinische Entzündung des Fettgewebes, charakterisiert durch ein proinflammatorisches Adipokin-Sekretionsmuster und durch die Infiltration von Entzündungszellen, trägt zu verschiedenen mit der Adipositas verbundenen Stoffwechselstörungen bei. Die langkettigen Omega-3-Fettsäuren Eicosapentaensäure (EPA) und Docosahexaensäure (DHA) wirken inflammatorischen Prozessen im Fettgewebe entgegen, und zwar sowohl auf Stufen der Entwicklung als auch bei der Auflösung der Entzündung. EPA und DHA stellen Substrate für kürzlich identifizierte Familien von entzündungsauflösenden Lipid-Mediatoren dar, speziell von Resolvinen, Protektinen und Maresinen, denen eine wesentliche Rolle in der Begrenzung von Entzündungen zukommt.Als eine Strategie zur Prävention systemischer, mit der Adipositas assoziierter Komplikationen ist es notwendig, die inflammatorischen Prozesse im Fettgewebe günstig zu beeinflussen. Zahlreiche Untersuchungen haben ergeben, dass langkettige Omega-3-Fettsäuren hierzu beitragen und dass die Verfügbarkeit von EPA und DHA das Risiko von Adipositas-assoziierten Stoffwechselerkrankungen verringert. Deshalb ist die Versorgung mit langkettigen Omega-3-Fettsäuren sowohl auf Bevölkerungsebene als auch speziell für adipöse Personen bedeutsam.

PurposeTo understand how we might improve the provision of medical care for children with cataracts.DesignA phenomenological design was employed. Semi-structured interviews were conducted to capture rich descriptions of the phenomena. Our goal in the interview and the analysis was to understand the sources of distress associated with treatment for cataract and deprivation amblyopia which (1) could be addressed by the medical community and (2) related to treatment adherence.SettingInterviews were conducted by a non-clinician researcher in New Zealand (NZ) in a location chosen by informants. In NZ, the red reflex screening test is performed shortly after birth, and surgery to remove paediatric cataracts is publicly funded.ParticipantsFamilies of children who had a history of cataract in Auckland, NZ were posted an invitation to participate. Twenty families were interviewed.ResultsOur analysis illustrated that informants described a wide range of experiences, from declined cataract surgery to full adherence to medical advice including years of patching for more than 4 hours a day. Across these experiences, we identified three relevant themes; timing of diagnosis, communication between the parent and clinician, and parental social support networks.ConclusionThe medical community may be better placed to support families dealing with childhood cataract by improving detection of childhood cataract, building appropriate communication pathways and promoting social support, with an emphasis on empathetic, individualised care.

The purpose of this study was to investigate the extent to which correlated neural inputs, quantified as EMG-EMG coherence across intrinsic and extrinsic hand muscles, varied as a function of wrist angle during a constant force precision grip task. Eight adults (5 males; mean age 29 years) participated in the experiment. Subjects held an object using a two-digit precision grip at a constant force at a flexed, neutral, and extended wrist posture, while the EMG activity from intrinsic and extrinsic hand muscles was recorded through intramuscular fine-wire electrodes. The integral of z-transformed coherence computed across muscles pairs was greatest in the flexed wrist posture and significantly greater than EMG-EMG coherence measured in the neutral and extended wrist posture (P < 0.01 and 0.05, respectively). Furthermore, EMG-EMG coherence did not differ statistically between the extrinsic and intrinsic muscle pairs, even though it tended to be greater for the extrinsic muscle pair (P ≥ 0.063). These findings lend support to the notion of a functional role of correlated neural inputs to hand muscles for the task-dependent coordination of hand muscle activity that is likely mediated by somatosensory feedback.

Introduction Chronic lower back pain (CLBP) is a major healthcare problem with wide ranging effects. It is a priority for appropriate management of CLBP to get individuals back to work as early as possible. Interventions that identify biopsychosocial barriers to recovery have been observed to lead to successfully reduced pain-related work absences and increased return to work for individuals with CLBP. Modern conceptualisations of pain adopt a biopsychosocial approach, such as the flags approach. Biopsychosocial perspectives have been applied to judgements about future adjustment, recovery from pain and risk of long-term disability; and provide a helpful model for understanding the importance of contextual interactions between psychosocial and biological variables in the experience of pain. Medical students and general practitioner (GP) trainees are important groups to target with education about biopsychosocial conceptualisations of pain and related clinical implications. Aim The current study will compare the effects of an e-learning intervention that focuses on a biopsychosocial model of pain, on the clinical judgements of medical students and trainees. Methods and analysis Medical student and GP trainee participants will be randomised to 1 of 2 study conditions: (1) a 20 min e-learning intervention focused on the fundamentals of the flags approach to clinical judgement-making regarding risk of future pain-related disability; compared with a (2) wait-list control group on judgement accuracy and weighting (ie, primary outcomes); flags approach knowledge, attitudes and beliefs towards pain, judgement speed and empathy (ie, secondary outcomes). Participants will be assessed at preintervention and postintervention. Ethics and dissemination The study will be performed in agreement with the Declaration of Helsinki and is approved by the National University of Ireland Galway Research Ethics Committee. The results of the trial will be published according to the CONSORT statement and will be presented at conferences and reported in peer-reviewed journals. Trial registration number ISRCTN53670726; Pre-results.

Research has established the health benefits of psychological factors, including the way individuals appraise outcomes. Although many studies confirm that appraising outcomes as controllable is adaptive for health, a paradoxical possibility is largely ignored: Perceived control may be detrimental under some conditions. Our premise was that appraising health as controllable but at the same time ascribing little value to it might signal a dysfunctional psychological mindset that fosters a mistaken sense of invincibility. During face-to-face interviews with a representative sample of older adults (age range = 72–99), we identified individuals with such a potentially maladaptive “invincible” mindset (high perceived control and low health value) and compared them to their counterparts on several outcomes. The findings were consistent with our hypotheses. The invincibles denied future risks, they lacked the activating emotion of fear, and they visited their physicians less often over a subsequent five-year period. Moreover, in contrast to their counterparts, the invincibles did not appear strategic in their approach to seeking care: Even poor health did not prompt them to seek the counsel of a physician. The recognition that psychological appraisals are modifiable highlights the promise of remedial methods to alter maladaptive mindsets, potentially improving quality of life.

Background: Breast cancer is an important public health issue within the American Indian (AI) community in Oklahoma; however, there is limited information to explain the low screening mammography rates among AI women. Purpose: To identify the motivational factors affecting an AI woman's decision to obtain a mammogram. Methods: Through the use of the Theory of Planned Behavior, 24 elicitation interviews were conducted with eligible for mammography AI women obtaining services at an Oklahoma-based tribal clinic. Results: Most women had mixed attitudes toward screening mammography. Environmental-related factors also were cited as barriers in getting a screening mammogram and women recommended improved accessibility to mammography screening. Participants identified family members, friends and their personal physician as critical social referents. No specific culturally related beliefs or taboos were noted. Discussion: This study provides new theoretically guided insights into the motivation of AI wome...

Fingertip force control requires fine coordination of multiple hand muscles within and across the digits. While the modulation of neural drive to hand muscles as a function of force has been extensively studied, much less is known about the effects of fatigue on the coordination of simultaneously active hand muscles. We asked eight subjects to perform a fatiguing contraction by gripping a manipulandum with thumb, index, and middle fingers while matching an isometric target force (40% maximal voluntary force) for as long as possible. The coordination of 12 hand muscles was quantified as electromyographic (EMG) muscle activation pattern (MAP) vector and EMG-EMG coherence. We hypothesized that muscle fatigue would cause uniform changes in EMG amplitude across all muscles and an increase in EMG-EMG coherence in the higher frequency bands but with an invariant heterogeneous distribution across muscles. Muscle fatigue caused a 12.5% drop in the maximum voluntary contraction force ( P < 0.05) at task failure and an increase in the SD of force ( P < 0.01). Although EMG amplitude of all muscles increased during the fatiguing contraction ( P < 0.001), the MAP vector orientation did not change, indicating that a similar muscle coordination pattern was used throughout the fatiguing contraction. Last, EMG-EMG coherence (0–35 Hz) was significantly greater at the end than at the beginning of the fatiguing contraction ( P < 0.01) but was heterogeneously distributed across hand muscles. These findings suggest that similar mechanisms are involved for modulating and sustaining digit forces in nonfatiguing and fatiguing contractions, respectively.

Background: NOD2 single nucleotide polymorphisms have been associated with increased risk of ileal Crohn's disease (CD). This exploratory study was conducted to compare ileal mucosal gene expression in CD patients with and without NOD2 risk alleles. Methods: Ileal samples were prospectively collected from 18 nonsmoking CD patients not treated with anti-TNF-α biologics and 9 nonsmoking control patients without inflammatory bowel disease undergoing initial resection and genotyped for the 3 major NOD2 risk alleles (Arg702Trp, Gly908Arg, Leu1007fs). Microarray analysis was performed in samples from 4 NOD2R (at least 1 risk allele) CD patients, 4 NOD2NR (no risk alleles) CD patients, and 4 NOD2NR controls. Candidate genes selected by significance analysis of microarrays (SAM) were confirmed by quantitative reverse transcriptase polymerase chain reaction (qRT-PCR) assays of all the samples. Results: SAM detected upregulation of 18 genes in affected ileum in NOD2R compared to NOD2NR CD patients, including genes related to lymphocyte activation. SAM also detected altered ileal gene expression in unaffected NOD2NR ileal mucosal CD samples compared to NOD2NR control samples. qRT-PCR conducted on all the samples confirmed that increased CD3D expression in affected samples was associated with NOD2R status, and that increased MUC1, DUOX2, DMBT1 and decreased C4orf7 expression in unaffected samples was associated with CD, independent of NOD2 status. Conclusions: The results support the concept that NOD2 risk alleles contribute to impaired regulation of inflammation in the ileum. Furthermore, altered ileal gene expression, independent of NOD2 status, is detected in the unaffected proximal margin of resected ileum from CD patients. (Inflamm Bowel Dis 2010)

In Hinblick auf die Bedeutung der Proteinzufuhr wahrend korperlicher Aktivitat stehen Erhalt und Aufbau der Muskelmasse, Optimierung der Muskelkraft und Korperkomposition, Vermeidung einer katabolen Stoffwechsellage und Sicherstellung einer optimalen Regeneration in der Nachbelastungsphase im Mittelpunkt. Eine ausreichende und qualitativ hochwertige Proteinzufuhr stellt nicht nur das reine Ausgangssubstrat fur die de novo-Proteinsynthese dar, sondern induziert vielfaltige metabolische und hormonelle Stoffwechselprozesse. So stimulieren Proteine bzw. Aminosauren in unterschiedlicher Auspragung die Sekretion verschiedener Hormone wie Insulin, Wachstumshormon und Insulin like growth factor 1 (IGF-1). Es ist jedoch unbestritten, dass erst durch die Kombination von Training und Proteinzufuhr die optimale Basis fur eine gesteigerte muskulare Proteinbiosynthese in der Nachbelastungsphase geschaffen wird. Allerdings profitieren nicht nur Sportler von einer eiweisbetonten Ernahrung, sondern auch altere Personen sowie Patienten mit diabetischer Stoffwechsellage oder Gewichtsproblemen. Diese kann je nach Menge nicht nur zu einer Gewichtsreduktion und besseren Korperkomposition, sondern auch zur Erhohung der mitochondrialen Kapazitat und Verbesserung der Insulinsensitivitat sowie zum Erhalt der Muskelkraft und –funktion im hoheren Alter fuhren.

Background: Persistent infection with high-risk types of human papillomavirus (HPV) is associated with cervical and other anogenital cancers. Purpose: This paper reports results of awareness of an HPV diagnosis and HPV knowledge from a multi-site study of HPV knowledge, attitudes and behavior, and the impact of an HPV diagnosis on women and their partners. Methods: During September 2003 - November 2005, a survey containing shared and site-specific items was administered to 736 women who had received HPV DNA testing in conjunction with cytology for cervical cancer screening. Results: Overall, there was low knowledge about HPV transmissibility, curability and the effects of an HPV diagnosis across all sites regardless of a woman's racial/ethnic and/or socio-demographic background. Further, only about 50% of the women were aware of their HPV diagnosis even after receiving their results and counseling from a health care professional. Discussion: There is need for consistent and clear information abou...

2) und arbeitet interdisziplinar mit qualifizierten Fachkraften aus den Bereichen Bewegung/Sport, Psychologie/Padagogik, Ernahrung und Medizin. Die korperliche Aktivitat steht mit 40praktischen Einheiten zwar im Fokus des einjahrigen Gruppenprogramms; Ernahrungsumstellung und Verhaltensanderung sind aber ebenso zentrale Themen der insgesamt 20 theoretischen Sitzungen. Aufgrund einer Rahmenvereinbarung zwischen M.O.B.I.L.I.S. und der Barmer GEK ist eine pauschalisierte Kostenerstattung des Programms moglich. Fur 2720Teilnehmer liegen Ergebnisse der Prozessevaluation vor. Diese belegen die Effizienz und Wirksamkeit des M.O.B.I.L.I.S.-Konzepts, das eine kostengunstige und nicht pharmakologische Therapieoption bei der Behandlung von adiposen Erwachsenen ist. Stichworte: Adipositas, Lebensstilintervention, Gewichtsreduktion, M.O.B.I.L.I.S.

ZusammenfassungDas vom Universitätsklinikum Freiburg und der Deutschen Sporthochschule Köln im Jahr 2004 initiierte M.O.B.I.L.I.S.-Schulungsprogramm wird zwischenzeitlich an über 100 Standorten in Deutschland angeboten. Es richtet sich an stark übergewichtige Erwachsene (BMI 30–40 kg/m2) und arbeitet interdisziplinär mit qualifizierten Fachkräften aus den Breichen Bewegung/Sport, Psychologie/Pädagogik, Ernährung und Medizin. Die körperliche Aktivität steht zwar mit 35 praktischen Einheiten im Fokus des einjährigen Gruppenprogramms, Ernährungsumstellung und Verhaltensänderung sind aber ebenso zentrale Themen der insgesamt 21 theoretischen Sitzungen. Auf Grund einer Rahmenvereinbarung zwischen M.O.B.I.L.I.S. und der BARMER ist eine pauschalisierte Kostenerstattung des Programms möglich. Für ca. 1000 Teilnehmer liegen mittlerweile Ergebnisse der Prozessevaluation vor; diese belegen Effizienz und Wirksamkeit des M.O.B.I.L.I.S.-Konzepts.

Objective To describe the prevalence of inadequately evaluated and treated psychopathology among insured workers making workers' compensation claims for psychiatric disability whose cases were reviewed by one forensic psychiatrist. To assess the relationship of inadequate evaluation and treatment to the outcomes of these workers' compensation claims. Methods Records of a series of 185 workers' compensation cases reviewed in 1998 and 1999 by a California forensic psychiatrist were abstracted. Patient factors (gender, Axis II pathology, psychosocial circumstances, substance abuse), case factors (psychiatric injury secondary to physical injury, or secondary to psychological stresses), type of provider (mental health, or other), adequacy of evaluation and treatment, forensic psychiatrist's recommendation, and claim outcome were categorized. The relationships between case characteristics, adequacy of care, and claim outcome were described. Results 22% of cases had adequate evaluation, 48% superficial, and 30% had no evaluation. 11% had adequate treatment, 67% superficial, and 22% had no treatment. Compared to claims for psychiatric disability related to a physical injury, claims related to psychosocial stresses more often had superficial diagnostic evaluations and treatments. Those with superficial treatment were less likely to have their claim granted (19.3%) than those with no treatment (47.5%) or those with adequate treatment (36.8%). Success of claim was not related to provider type. Conclusions The majority of the studied workers with employer-provided health insurance who sought workers' compensation for disability due to mental illness did so inappropriately, in that the workplace did not cause the psychopathology. Their seeking workers' compensation was plausibly due to the observed inadequate evaluation and treatment available through their employer-provided health insurance. The adequacy of their care influenced the likelihood their claim would be granted. The relations observed here merit further research to establish their generality and to determine their causes.

While motor clumsiness is frequently described as an associated feature of Asperger's Disorder, little research has examined specific motor skills and the relation among aspects of motor performance in this population. The present purpose was to present preliminary findings for three aspects of Asperger's: the presence and magnitude of gross motor and fine motor deficits, the presence and magnitude of visuomotor deficits, and the relation between motor functioning and visuomotor skills. 17 boys, 6 to 13 years old, with Asperger's were tested using standardized measures of gross, fine, and visuomotor skills. Statistically significant deficits were found for the sample's scores compared with values for the general population (using one-sample t tests), but none for fine motor vs gross motor skills (using a dependent sample t test). Significant positive correlations were found for gross motor skills with visuomotor skills (.73) and for fine motor skills with visuomotor skills (.71). Tentative suggestions for clinical assessment were proposed.

Background: A previous experiment with 70 interrupted monosyllabic words demonstrated that recognition performance was influenced by the location of an interruption pattern (Wilson, 2014). The interruption paradigm (10 interruptions/sec, 50% duty cycle periodic interruption) was referenced to word onset. The words were interrupted such that alternate 50-msec segments were parsed to separate files. In the 0-msec condition the first on-segment coincided with the word onset, whereas in the 50-msec condition the first on-segment occurred 50 msec after word onset. The 0- and 50-msec conditions were complementary halves. Recognition performance by young listeners was 19% better on the 0-msec condition (86%) than on the 50-msec condition (68%); there were a minority number of words on which the results were just the opposite. A second study using the same interruption paradigm but 300 different words reported similar relations, with 63% correct recognition on the 0-msec condition and 48% on the 50-msec condition (Wilson and Irish, 2015). Both studies suggest the importance that the first 50 msec of the target word has on intelligibility. Purpose: To define in detail the effects that interruption patterns have on word recognition as the interruption pattern was incremented with reference to word onset from 0 to 90 msec in 10-msec steps. Research Design: A repeated-measures design with ten interruption patterns (onset conditions). Study Sample: Twenty-four young listeners (19–29 yr) with normal hearing for pure tones participated in this study. Data Collection and Analyses: Seventy consonant-nucleus-consonant words formed the corpus of materials with 25 additional words used for practice. For each participant, the 700 stimuli (70 words by ten onset conditions) were interrupted (10 interruptions/sec; 50% duty cycle), randomized, and recorded on compact disc in 28, 25-word tracks. Results: The overall mean recognition performance was 80.4% with mean performances for the ten conditions ranging from 73.0% (50-msec condition) to 87.7% (90-msec condition). The mean recognition performances changed systematically, decreasing from the 0-msec condition to the 50-msec condition and then increasing to the 90-msec condition, which formed a U-shaped function of the means. Of the 45 mean paired comparisons (post hoc t-tests with Bonferroni corrections), there were 17 significant differences at the p ≤ 0.001 level, increasing to 31 significant differences when the significance level was increased to the p ≤ 0.01 level. Visual inspection of the 70-word performance functions revealed that 32 words had flat functions, 34 words had U-shaped functions, two functions were rising, one was an inverted V-shape, and one was irregular. Conclusions: First, some words (utterances of those words) were immune to any differential effects of the ten interruption patterns. These words with flat performance functions constituted 46% of the word corpus. Second, 49% of the words exhibited U-shaped performance functions that were always systematic, going from maximum to minimum and back to maximum. These words were thought to be more dependent on the initial consonant to attain maximum performance. The conclusion is that some words are not affected by the location of the interruption pattern (those with flat functions) whereas other words are substantially affected (those with U-shaped functions).

Resume Introduction Nocardia brasiliensis est une cause tres rare de plaie torpide de la jambe en France metropolitaine. Nous rapportons un cas autochtone bressan simulant un pyoderma gangrenosum. Observation Une femme âgee de 75 ans originaire de la Bresse etait adressee pour une ulceration post-traumatique de jambe, a evolution phagedenique evoquant un pyoderma gangrenosum. Un bilan etiologique etait realise. Alors que la malade etait traitee par une corticotherapie locale, et que tous les prelevements bacteriologiques etaient restes non significatifs jusque-la, un frottis bacteriologique realise systematiquement montrait une colonisation massive par Nocardia brasiliensis, associee a un staphylocoque dore, tous deux sensibles au sulfamethoxazole-trimethoprime et a l’association amoxicilline-acide clavulanique. Douze heures apres l’introduction de sulfamethoxazole-trimethoprime survenait une toxidermie imposant l’arret du traitement. Alors que l’etat s’aggravait avec la survenue d’une lymphangite nodulaire febrile, d’une alteration de l’etat general et d’une infiltration des tissus mous du genou, le traitement par amoxicilline-acide clavulanique s’averait definitivement efficace. Discussion La discussion porte sur la difficulte du diagnostic, la relative rarete de ce type de nocardiose, l’importance a accorder a sa recherche meme dans un contexte peu evocateur et les possibilites therapeutiques.

Als Folge davon, dass die Arbeitsteilung zwischen Urologen und Anasthesisten seit Jahrzehnten klar definiert ist, haben operativ tatige Urologen — dies gilt fur alle anderen Disziplinen in gleicher Weise — die Sensibilitat dafur verloren, dass sie es sind, die Schmerzen verursachen und daher primar dafur Verantwortung tragen,sie zu lindern bzw. komplett auszuschalten. Dieser Tatsache tragt die Rechtsprechung dadurch Rechnung, dass die Vernachlassigung von Schmerzvermeidung und -ausschaltung als genuin arztlicher Verpflichtung zu strafrechtlichen Konsequenzen fuhrt, die an § 323 c StGB (unterlassene Hilfeleistung), § 223 und § 230 StGB (vorsatzliche oder fahrlassige Korperverletzung durch Unterlassung) festgemacht werden. Es ist jedoch falsch, daraus ableiten zu wollen, dass der fur die Schmerztherapie seiner Patienten primar verantwortliche Operateur sie auch selbst durchfuhren muss. Er hat allerdings fur Organisationsstrukturen bzw.dafur zu sorgen, dass eine kompetente postoperative Analgesie durch Kolleginnen und Kollegen anderer Facher — in erster Linie der Anasthesie — ermoglicht wird.

An experiment was conducted to examine the impact of patients' freedom to choose a physician and health locus of control on patient satisfaction. The experiment was set within the scenario of a patient suffering from a lengthy viral infection after visiting a health clinic for the first time. All constructs with corresponding measurements are discussed and their relationships with satisfaction are examined. Hypotheses are developed and tested for each relationship using pencil and paper scenarios of a patient's service encounter at a health clinic. A 2 x 2 full factorial between subjects experimental design was used with 99 subjects. Results of the experiment indicated different patterns of satisfaction among subjects based on measures of health locus of control (HLC). Individuals with an internal HLC were more satisfied with having a choice of a physician than not having a choice and were also more satisfied than external HLC individuals who had a choice. In contrast, individuals with an external HLC did not discriminate between having or not having the opportunity to choose a physician.

An experiment was conducted to examine the relationship between patient satisfaction and patients’ freedom to choose a physician and the outcome of a health service encounter. Each construct with corresponding measurements is discussed and their relationship with satisfaction is reviewed. Hypotheses were developed and tested for each relationship using pencil and paper scenarios of a patient’s service encounter at a health clinic. The study yielded four major findings. First, patients who experienced a good health outcome were significantly more satisfied than patients who received a bad health outcome. Second, patient satisfaction ratings differed significantly only in the bad outcome condition, suggesting an outcome bias. Third, patients who were given the freedom to select a physician but did not receive their chosen physician were least satisfied. Fourth, there was no difference in satisfaction between patients who had a choice of physician and those who did not.

Zum Thema Die nicht-invasive Beatmung (NIV) über eine Maske ermöglicht bei vielen Patienten eine effiziente Beatmung unter Vermeidung der Risiken und Nebenwirkungen der endotrachealen Intubation. Für die chronisch-obstruktive Lungenerkrankung (COPD) sind die Vorteile der Maskenbeatmung im Hinblick auf Beatmungsdauer, Dauer der Intensivbehandlung, Prognose und Behandlungskosten inzwischen relativ gut durch Studien belegt. Bei anderen Indikationen –“Nicht-COPD-Patienten”– erlauben die verfügbaren Daten noch kein gesichertes Urteil, rechtfertigen aber einen Behandlungsversuch auch außerhalb von Studien in klinischer Routine. Nachteilig sind der initial höhere personelle Betreuungsaufwand bei NIV sowie die stark von der Erfahrung abhängige Erfolgsrate. Die wichtigste Voraussetzung für eine erfolgreiche nicht-invasive Beatmung in der Intensivmedizin ist die Bereitschaft von Ärzten und Pflegepersonal, eine ungewohnte Beatmungsphilosophie zu akzeptieren und die relativ einfache Technik der Maskenbeatmung zu erlernen. Bei Beherrschung der Technik kann die NIV aber eine wertvolle Hilfe vom Notarztwagen bis zur Intensivstation sein.

Die nichtinvasive Beatmung uber eine Maske ermoglicht bei vielen Patienten eine effiziente Beatmung unter Vermeidung der Risiken und Nebenwirkungen der endotrachealen Intubation. Fur die chronisch-obstruktive Lungenerkrankung sind die Vorteile der Maskenbeatmung im Hinblick auf Beatmungsdauer, Dauer der Intensivbehandlung, Prognose und Behandlungskosten inzwischen relativ gut durch Studien belegt. Bei anderen Indikationen erlauben die verfugbaren Daten noch kein gesichertes Urteil, rechtfertigen aber einen Behandlungsversuch auch auserhalb von Studien in der taglichen klinischen Routine. Nachteilig sind der tendenziell hohere personelle Betreuungsaufwand bei der nichtinvasiven Beatmung sowie die starke Erfahrungsabhangigkeit der Ergebnisse. Die wichtigste Voraussetzung fur eine erfolgreiche nichtinvasive Beatmung in der Intensivmedizin ist die Bereitschaft von Arzten und Pflegepersonal, eine ungewohnte Beatmungsphilosophie zu akzeptieren und die relativ einfache Technik der Maskenbeatmung zu erlernen.

A case of malignant mesothelioma of the tunica vaginalis testis is reported in a 77-year-old male patient. There was no history of asbestos exposure. Recurrent right hydrocele with a papillar inguinal mass was the main clinical feature. An inguinal radical orchiectomy with en bloc resection of the surrounding tissue was performed. The therapeutic options for this rare, but aggressive neoplasm are discussed. Because of the disappointing results of antineoplastic chemotherapy or radiation therapy, the importance of initial radical surgical treatment with complete excision is emphasized.

We present our experiences with the approach of placing 2 parallel ureteral Double-J stents simultaneously in extrinsically obstructed ureters. In all 5 reported patients therapy with single ureteral stents had failed despite correct stent position. With the increased stiffness of 2 parallel ureteral silicon 7F Double-J stents ureteral kinking and luminal compression could be reduced leading to sufficient reduction of hydronephrosis. This approach with potential space between the stents preserves urinary flow through as well as around the stents which is considered to be the most important mechanism in stented ureters. In cases of extrinsic ureteral obstruction with failure of a single stent the simultaneous use of 2 parallel Double-J ureteral stents should be taken into account as a technically easy therapeutic option. It may obviate percutaneous nephrostomy tube placement or more invasive therapy.

We report the case of a 71-year-old man, who was transferred to our clinic with rapidly increasing dyspnea. On examination by flexible bronchoscopy the trachea was found to be almost completely obstructed by metastatic masses of a malignant melanoma. After endoscopic removal of the obstruction, we inserted a covered nitinol stent which led to instantaneous relief of symptoms. Chemotherapy and local radiotherapy were instituted. During the next 9 months there were no signs of recurrence of the tumour in regular pneumological control exams.

Bei einem 71 jahrigen Patienten mit einem seit 8 Wochen bestehenden schmerzlosen Verschlusikterus war sonographisch und computertomographisch eine 7 × 6 cm grose Raumforderung im Bereich des Pankreaskopfes nachweisbar, die in Zusammenhang mit einem CA 19–9 von 329 U/l hochgradig verdachtig auf ein Pankreascarcinom war. Nach endoskopischer Einlage einer Pigtail-Drainage in den mit 2,7 cm deutlich dilatierten Ductus hepatocholedochus (DHC) machte eine anhaltende kreislaufwirksame Blutung aus dem DHC eine notfallmasige partielle Duodenopankreatektomie nach Whipple erforderlich. Die histopathologische Untersuchung ergab ein sklerosierendes folliculares centroblastisch-centrocytisches Lymphom i. S. eines niedrig malignen Non-Hodgkin-Lymphoms (NHL) des B-Zell-Systems. Eine sichere Abgrenzung des primaren NHL des Pankreas zum Pankreascarcinom ist weder klinisch noch durch laborchemische oder bildgebende Verfahren sicher moglich. Die Impression des Ductus pancreaticus ohne Infiltration bei relativ grosen Tumorprozessen sollte an eine extranodale Manifestation eines NHL denken lassen und eine histologische Abklarung herbeifuhren.

Das Pancreas anulare ist eine seltene kongenitale Anomalie des Pankreas, welche in der Halfte der Falle erst im Erwachsenenalter symptomtisch wird. Wir berichten uber einen 52jahrigen Patienten mit einer subtotalen Duodenal- und Pylorusstenose, bei dem eine partielle Duodenopankreatektomie nach Whipple durchgefuhrt wurde. Die Histologie ergab ein Pancreas anulare, wobei die entzundlichen Komplikationen dieser Fehlbildung mit tryptischer Sialadenitis des Caput pancreatis zu einer zusatzlichen Stenose gefuhrt haben. Bei der Duodenalstenose des Erwachsenen sollte das Pancreas anulare in die Differentialdiagnose einbezogen werden. Obwohl die endoskopisch retrograde Cholangiopankreatikographie (ERCP) das diagnostische Mittel der Wahl darstellt und in Kombination mit der Computertomographie (CT) die Diagnose praoperativ in vielen Fallen moglich ist, kann ein Pancreas anulare derzeit teilweise erst intraoperativ diagnostiziert werden, insbesondere wenn entzundliche Pseudotumoren vorliegen oder eine subtotale Stenosierung die ERCP unmoglich macht.

Bei der pollenassoziierten Form einer Nahrungsmittelallergie treten Unvertraglichkeitsreaktionen nach dem Genus von pflanzlichen Nahrungsmitteln und Gewurzen auf, die an eine gleichzeitig vorhandene Pollenallergie gebunden sind. Die Ursache ist eine immunologische Kreuzreaktion. Neben Listen mit Nahrungsmitteln geringer und hoher allergener Potenz wird auch eine Liste mit den Pflanzenfamilien und den jeweiligen Kreuzreaktionen/Antigengemeinschaften vorgestellt. Weiterhin wird auf den Einflus von Erhitzen, enzymatischer Braunung sowie Sorte und Reifegrad auf die Allergenitat von vegetabilen Nahrungsmitteln hingewiesen.

Zur alimentaren Atopiepravention wird heute bei Sauglingen mit erhohtem Atopierisiko neben dem Stillen die Verwendung sog. hypoallergener Nahrungen empfohlen. Der Restallergengehalt dieser Nahrungen ist z.T. unterschiedlich und kann bei sensibilisierten Personen klinische Reaktionen auslosen. Es sollte deshalb dieser Restallergengehalt mit standardisierten Methoden erfast und genau deklariert sein und seine Bedeutung fur die Atopiepravention durch klinische Studien geklart werden.

Ein verrukoses Karzinom der Harnblase (pT 4N0M0, G1) entwickelte sich bei einer 66 jahrigen Patientin, die seit 10 Jahren an einer chronisch interstitiellen Zystitis (IC) mit Hunner-Ulzera litt. In der Weltliteratur sind bislang 7 Fallberichte des nicht Bilharziose-assoziierten verrukosen Karzinoms der Harnblase veroffentlicht worden. Obwohl die Entwicklung eines verrukosen Karzinoms der Harnblase als Komplikation einer IC bislang nicht beschrieben ist, scheint der Pathomechanismus der Entwicklung des verrukosen Karzinoms in der chronischen Irritation der Harnblase zu liegen. Nach Ausschopfen der konservativen Therapiemoglichkeiten erfolgte die radikale Zystektomie und supravesikale Harnableitung. Neben Diagnostik, Therapie und Komplikationen der IC werden die Charakteristika des verrukosen Karzinoms der Harnblase und die Indikation zu organerhaltenden Operationsverfahren bei der IC diskutiert.

We report a case of congenital retroperitoneal fibrosarcoma presenting in a 17-day-old male in which surgical tumor debulking was followed by chemotherapy. His clinical course was complicated. Intraoperatively, 80% of the tumor was removed and he experienced massive blood loss and significant cardiac arrhythmias. Following surgery he received chemotherapy and suffered life-threatening hepatic, hematological and gastrointestinal toxicity. The treatment resulted in clinical remission after 9 months of follow-up. A review of the current literature revealed the changing opinion of the optimal treatment of fibrosarcomas in children. Chemotherapy is playing an increasingly important role in the treatment of fibrosarcoma, both preoperatively and postoperatively.

OBJECTIVE: To determine current family physician beliefs concerning prostate cancer screening. DESIGN: Two hundred eighty-six Oklahoma family physicians were surveyed by mail. Fifty-three percent of physicians returned the questionnaire. Physicians were questioned on what tests they order for prostate screening, the reasons for ordering a serum prostate-specific antigen (PSA) test, what test results would cause a urologic referral for further evaluation of prostate cancer, and whether prostate cancer screening would decrease the patient's mortality or improve quality of life. RESULTS: Most physicians (74%) believed that both a digital rectal examination and a serum PSA determination are appropriate for prostate cancer screening. Physicians' primary reasons for ordering a PSA test were to decrease patient mortality and morbidity. Sixty-two percent of physicians believed that prostate cancer screening would decrease mortality and 69% agreed that screening would improve quality of life. Approximately 90% of physicians would refer patients with a PSA level greater than 12 micrograms/L or a PSA level of 5 micrograms/L and an indurated prostate. Significant variation was found between groups of physicians in their beliefs about prostate cancer screening. CONCLUSION: Although the literature has been inconclusive on the benefit of prostate cancer screening, the majority of Oklahoma family physicians would choose to screen their patients and believe that patients' mortality and morbidity are decreased by early identification of prostate cancer.

Objective To determine whether the ratio of PSA and prostate volume provides additional useful information for the discrimination of benign prostatic hyperplasia from prostatic carcinoma. Patients and methods Since 1989, a prospective study has been in progress involving 229 patients (49 with locally confined prostatic carcinoma, 180 with benign prostatic hyperplasia) to establish whether the ratio of prostate-specific antigen (PSA) and prostate volume, determined by transrectal ultrasound (longitudinal × anterior-posterior × transverse diameter × 0.52), allows a better differentiation than the absolute PSA values. Results In this population of patients with prostatic disease, the positive predictive value for diagnosis of a prostatic carcinoma was 26% with an absolute PSA threshold value of 4.0 ng/ml, and 36% at a threshold value of 10 ng/ml. With a threshold value of the PSA/prostate volume ratio of 0.25 ng/(ml × cm3), the positive predictive value was 56% compared with 93% for a threshold value of 0.4 ng/(ml × cm3). Conclusion The ratio PSA/prostate volume is a superior method for the diagnosis of prostatic carcinoma both with regard to its sensitivity and its specificity in patients with absolute PSA values in excess of 4 ng/ml.

The serum half-life of prostate-specific antigen (PSA) was calculated in 66 patients subsequent to radical prostatectomy. Comparing serum half-life to disease outcome in 37 patients after a minimum follow-up of two years, it was found that PSA serum half-life identifies patients with residual disease earlier and more reliably than the presence or absence of detectable PSA levels postoperatively. It is suggested that residual tumor affects the half-life by contributing to the serum level of PSA. When PSA serum half-life was calculated solely in potentially cured patients, we found a half-life of 1.6 days, which is considerably shorter than in previous reports based on patient populations regardless of the outcome of disease in the follow-up. To elucidate the route of PSA elimination, serial urine PSA levels were determined before and after radical prostatectomy, revealing strong evidence for the assumption that PSA is not eliminated by the kidneys in its unchanged form.