A multinational study of the factorial structure and other characteristics of the Dartmouth COOP Functional Health Assessment Charts/WONCA

BACKGROUND: The 'Dartmouth COOP Functional Health Assessment Charts/WONCA' constitute a relatively new derived instrument for assessing health status that is specifically intended for use in primary care on a world-wide basis. It needs further validation in its special area of use. OBJECTIVES: Over a range of countries, social backgrounds and case mixes, our aim was (i) to examine the factorial structure of the instrument; (ii) to explore how well it was understood; (iii) to check its acceptability; and (iv) to assess the value of the pictures on the charts. METHODS: The charts themselves, accompanied by a short questionnaire about the charts, were administered to 1719 patients at eight varied types of treatment centre in Canada, Japan, Nepal and Spain. The responses to the instrument were subjected to standard factor analysis and a special Q-type principal components analysis. The responses to direct questions about the charts were compared with the answers to open-ended questions. RESULTS: Factor analysis suggested a shared factorial pattern for all sites, with the first two factors accounting for 88.5% of the variability in correlations between the charts across the sites. The individual questions were understood by most patients, but a substantial minority did not appear to grasp the underlying purpose of the instrument. The instrument was well accepted. The pictures were considered to be helpful by most respondents, especially those at the Nepal sites. The variability in the scores for the individual charts across sites was less than expected and not always in the expected direction. CONCLUSIONS: The COOP/WONCA system continues to show promise, but needs more validation.     

Generalizability of the limits of stability test in the evaluation of dynamic balance among older adults

OBJECTIVE: Reliability of platform posturography tests is essential for the identification and treatment of balance-related disorders. The purposes of this study were to establish the reliability of the limits of stability (LOS) test and to determine the relative variance contributions from identified sources of measurement error. DESIGN: Generalizability theory was used to calculate (1) variance estimates and percentage of variation for the sources of measurement error, and (2) generalizability coefficients. Random effects repeated measures analysis of variance (RM ANOVA) was used to assess consistency of measurements across both days and targets. PARTICIPANTS: Thirty-eight community-dwelling older adults with no recent history of falls. MAIN OUTCOME MEASURES: Outcome measures derived from the LOS tests included movement velocity (MV), maximum center of gravity (COG) excursion (ME), end point COG excursion (EE), and directional control (DC). RESULTS: Estimated generalizability coefficients for 2 and 3 days of testing ranged from .69 to .91. Relative contributions of the day facet were minimal. The RM ANOVA results indicated that for three of the movement variables, no significant differences in scores were observed across days. CONCLUSIONS: The 75% and 100% LOS tests are reliable tests of dynamic balance when administered to healthy older adults with no recent history of falls. Dynamic balance measures were generally consistent across multiple evaluations.     

Elastase-induced hydrolysis of synthetic solid substrates: poly(ester-urea-urethane) and poly(ether-urea-urethane)

Human neutrophil elastase (HNE) and porcine pancreatic elastase (PPE) were incubated with two radiolabelled model poly(urethane), a poly(ester-urea-urethane) containing [14C]toluene diisocyanate ([14C]TDI), poly(caprolactone)(PCL) and ethylenediamine (ED), and a poly(ether-urea-urethane) containing [14C]TDI, poly(tetramethylene oxide) (PTMO) and ED. Ten-fold more radioactive carbon was released when PPE was incubated with [14C]TDI/PCL/ED than when HNE was used. The PPE-induced radioactive carbon release was significantly reduced by a specific elastase inhibitor. Ten-fold less radioactive carbon was released when [14C]TDI/PTMO/ED was incubated with PPE as compared to [14C]TDI/PCL/ED. Since neutrophils, which contain elastolytic activity, are present during the inflammatory response, the stability of biomaterials used in implanted devices may be affected.     

Effects of epidermal growth factor and dimethylhydrazine on crypt size, cell proliferation, and crypt fission in the rat colon. Cell proliferation and crypt fission are controlled independently

Crypt fission is now established as an important mechanism of intestinal growth and regeneration. It has been proposed that increased crypt size is the stimulus for crypt fission, because crypts preparing for fission are generally larger. Consequently, we investigated the effects of epidermal growth factor (EGF) and dimethylhydrazine, which are both known to stimulate crypt cell proliferation, on crypt fission in the rat intestine. We also examined whether the effects of EGF on both proliferation and crypt fission are modified by the pretreatment with dimethylhydrazine for 16 weeks, dimethylhydrazine was then discontinued for 8 weeks, followed by intravenous infusion of EGF for 1 week. There were four groups: vehicle alone, EGF alone, dimethylhydrazine alone, and dimethylhydrazine followed by EGF infusion. The rats were killed at 25 weeks and rates of intestinal crypt cell production, crypt size, and crypt fission were determined. Intravenously infused EGF significantly increased crypt cell production rate, but the magnitude of the effect decreased from the proximal to the distal colon. EGF caused an increase in crypt area, possibly reflecting an increase in crypt size. Importantly dimethylhydrazine had no significant effect on crypt cell production rate nor on crypt area in the distal colon, but it did cause an increase in crypt area in the mid-colon. The crypt fission index was significantly decreased by EGF and increased by dimethylhydrazine. There was no qualitative interaction between EGF and dimethylhydrazine. These results demonstrate the marked proliferative effect of intravenously infused EGF in the colon of orally fed rats, with significant site effects (P = 0.0007); the effect was greatest in the proximal colon and disappeared in the distal colon. The observation that EGF reduced crypt fission indicates that increased cell proliferation, per se, is not a stimulus for crypt fission. This is further supported by the observation that dimethylhydrazine increases crypt fission in crypts of normal size in the distal colon without significantly increasing cell proliferation. These results suggest that increasing crypt cellularity by proliferation is not sufficient to induce crypt fission, and factors other than increased crypt size by proliferation can control crypt fission. It is also probable that cell proliferation and crypt fission are independently regulated. Crypt fission appears to play a considerable role in the intestinal response to carcinogens.     

Psychological and social predictors of motorcycle use by young adult males in New Zealand

Motorcycle riding is a significant cause of serious injuries to young males. Little is known about the psychological and social characteristics of these riders, despite such knowledge being potentially important for the targeting of appropriate injury prevention interventions. Using problem-behaviour theory to broadly guide and structure the research, the present study focused on identifying predictors of motorcycle riding. Previous research investigating differences between riders and non-riders has tended to be inconclusive, methodologically limited, and lacking in explicit theoretical foundations. The present research was based on the birth cohort enrolled in the Dunedin Multidisciplinary Health and Development Study (DMHDS), a comprehensive New Zealand longitudinal study of health, development, attitudes, and behaviours. Logistic regression models were built using prior measures of health risk behaviour, other psychological and social factors, and motorcycle riding history as potential predictors of any motorcycle use at the age of 18 years. The strongest predictors were early motorcycle riding, including illegal on-road driving at age 13 (OR 4.0; 95% CI 1.7, 9.1), below average reading skills (OR 2.4; 95% CI 1.3, 4.6) and fighting in a public place at age 15 (OR 2.9; 95% CI 1.2, 6.9). It was of particular interest that this profile tended to fit less well those subgroups of riders with greatest exposure to on-road motorcycle driving. Although based on small numbers, this finding was consistent with earlier cross-sectional research that linked casual and unlicensed driving with less protective motorcycling opinions and behaviours. Some implications for injury prevention and public policies regarding motorcycling are discussed. In particular, stricter enforcement of present licensing regulations and stronger penalties for their violation could help to reduce the number of less responsible riders.     

The practice of obstetrics in Mongolia

Sponsored by the US Department of State and the US Army Pacific as part of a Medical Readiness Training Exercise, 17 physicians from Tripler Army Medical Center traveled to Outer Mongolia during September 1995 to examine the practice of medicine in the country. The obstetrical care observed was delivered at Third Women's Hospital in Ulanbataar. Prenatal care in Mongolia is provided mainly by family physicians, with the family doctor visiting each pregnant patient every month for the first 5 months, increasing to weekly visits at 7 months. The patient is taken to an obstetrical or women's and children's hospital when she reaches term or goes into labor. The staff at Third Women's Hospital deliver approximately 2000 babies annually and perform approximately 1000 pregnancy terminations through sharp curettage. The cesarean section rate is reported to be 10%. The hospital has no laboratory or X-ray capability, but can send out for such tests on rare occasions. During labor, patients are fully ambulatory on an as-needed basis. Fetal monitoring is not routinely available, except for occasional auscultation, patients in labor were not given IV fluid, delivery rooms were bleak and with only antiquated equipment, lighting was poor, and gloves were reused until they were too tattered for reuse. The authors discuss their experience with 3 cesarean sections and 1 ectopic pregnancy performed while in the country.     

Hepatic cystadenoma: an unusual presentation

A 53-yr-old woman with a history of hepatic cystadenoma 25 yr before presented with a simple hepatic cyst, which evolved over 9 yr into a complex cystadenoma with septations and internal bleeding. She was treated with a left hepatectomy. Review of the literature shows that hepatic cystadenomas, although rare, frequently can recur years later and have potential for malignant transformation. Histologic similarities of one variant with ovarian stroma raises interesting possibilities regarding the origin of these lesions. The best treatment results are obtained with radical excision.