The Role of Remote Diagnostics to Better Assess Uroflow Variability: Insights From Combining at Home Uroflows and Frequency Volume Charts From 19,868 Voids Using a Novel, Hand Held, Cellular Embedded Device.

Objective: To examine how representative 24-hour data collection is of the overall patient experience utilizing a home uroflow device in men with benign prostatic hyperplasia (BPH).

Materials And Methods: Home uroflow data were collected with the iO Urology CarePath device from men at a single urology clinic and retrospectively analyzed. Void characteristics were summarized for data collected over 24 hours compared to data collected over several days or weeks with the device (overall study excludes the 24-hour data).

Diabetes and peripheral arterial disease in men: trends in prevalence, mortality, and effect of concomitant coronary disease.

Background: Recent data on trends in diabetes mellitus (DM) prevalence and long-term effect on mortality in peripheral arterial disease (PAD) subjects is lacking.

Methods: All subjects discharged from any VA medical center between October 1990 to September 1997 with an International Classification of Diseases (ICD)-9 code for PAD and DM in the discharge summary were retrospectively identified. Demographic data were extracted from the database.

Prevalence rates for dementia and Alzheimer's disease in African Americans: 1992 versus 2001.

Background: This study compares age-specific and overall prevalence rates for dementia and Alzheimer's disease (AD) in two nonoverlapping, population-based cohorts of elderly African Americans in Indianapolis in 2001 and 1992.

Methods: We used a two-stage design. The first stage involves the Community Screening Interview for Dementia (CSI-D).

Selenium level is associated with apoE epsilon4 in rural elderly Chinese.

Objective: Se is an essential trace element in human nutrition associated with antioxidant activity. Previous studies on predictors of toenail Se or serum Se have mostly concentrated on demographic factors such as age and gender. The present paper examines the association between apoE genotype and Se levels in nail samples in a rural elderly Chinese cohort.

A Solution to Separation and Multicollinearity in Multiple Logistic Regression.

In dementia screening tests, item selection for shortening an existing screening test can be achieved using multiple logistic regression. However, maximum likelihood estimates for such logistic regression models often experience serious bias or even non-existence because of separation and multicollinearity problems resulting from a large number of highly correlated items. Firth (1993, Biometrika, 80(1), 27-38) proposed a penalized likelihood estimator for generalized linear models and it was shown to reduce bias and the non-existence problems.

Long term postischemic stroke mortality in diabetes: a veteran cohort analysis.

Background And Purpose: Recent data on stroke mortality in diabetics in the United States is lacking. We investigated trends in diabetes prevalence and stroke morality among diabetics in a large veteran cohort.

Methods: The Patient Treatment File was used to identify all patients discharged from any Veterans hospital between October 1990 and September 1997 with a diagnosis of ischemic stroke (ICD-9-CM codes 434, 436) listed as primary diagnosis.

Trace element levels and cognitive function in rural elderly Chinese.

Background: Trace elements are involved in metabolic processes and oxidation-reduction reactions in the central nervous system and could have a possible effect on cognitive function. The relationship between trace elements measured in individual biological samples and cognitive function in an elderly population had not been investigated extensively.

Methods: The participant population is part of a large cohort study of 2000 rural elderly Chinese persons.

Academic underachievement among children with epilepsy: proportion exceeding psychometric criteria for learning disability and associated risk factors.

This study assessed rates of learning disabilities (LD) by several psychometric definitions in children with epilepsy and identified risk factors. Participants (N = 173, ages 8-15 years) completed IQ screening, academic achievement testing, and structured interviews. Children with significant head injury, chronic physical conditions, or mental retardation were excluded.

Factorial invariance found in survey instrument measuring arthritis-related health beliefs among African-Americans and Whites.

Objective: Reliable and valid instruments for measuring health beliefs related to arthritis and total joint arthroplasty (TJA) are lacking. The present study examined the factorial invariance of an Arthritis-related Health Belief Instrument (AHBI) that measures four constructs: severity of arthritis, susceptibility of arthritis to get worse, and perceived benefits and barriers of TJA.

Study Design And Setting: In an urban primary care clinic setting, African-American (AA) and White (W) patients (n=664) with at least a moderately severe degree of osteoarthritis completed the AHBI.

Impact of pain on the outcomes of depression treatment: results from the RESPECT trial.

Objective: Pain is prevalent in patients with depression. The purpose of this study was to determine the impact of pain on depression treatment outcomes.

Methods: Data was analyzed from a randomized controlled trial comparing a collaborative care intervention to usual care for the treatment of depression in 60 primary care practices.

Renal disease in an antiretroviral-naïve HIV-infected outpatient population in Western Kenya.

Background: Several commonly used antiretrovirals (ARVs) require dose adjustments to prevent toxicities in the presence of renal insufficiency. Because no prospective studies of the prevalence or risk factors for kidney disease in stable outpatient human immunodeficiency virus (HIV)-infected indigenous African populations have been published to date, it is not known if already scarce resources should be allocated to detect renal dysfunction, in those without risk factors for kidney disease, prior to initiation of increasingly available antiretrovirals in developing countries.

Methods: A cross-sectional study to determine the prevalence of and risk factors for renal disease in a cohort of medically stable, HIV-infected, antiretroviral-naïve adults, without diabetes or hypertension, presenting to an HIV clinic in western Kenya.

Primary care physician treatment of low HDL: Rational approach or Pandora's Box?

Background: Guidelines for treating high low-density lipoproteins are clear, whereas guidelines for treating low high-density lipoproteins (HDL) are less so. Physicians approach to treating low HDL cholesterol is not known.

Objective: To determine primary care physicians approach to managing low HDL.

Stroke mortality and race: does access to care influence outcomes?

Background: Stroke is the third leading cause of death in the United States. We investigated racial differences in death after hospital discharge for ischemic stroke in a large cohort of Veterans Health Affairs (VHA) stroke patients. We hypothesized that having access to VA care would ameliorate the excess stroke mortality rates in African-Americans (AA) reported in non-VA studies.

Declining stroke burden among white and black male veteran subjects.

The prevalence of hypertension and diabetes is increasing. We hypothesized that this could contribute to increasing burden of stroke-the third leading cause of mortality-and investigated national trends in stroke burden among blacks and whites. From October 1990 to October 1997, 55,094 veterans were admitted with diagnosis of ischemic stroke (International Classification of Diseases [ICD] code 434 or 436) at any veterans hospital in the country were included in the study.

Selenium level and cognitive function in rural elderly Chinese.

Selenium is a trace element associated with antioxidant activity and is considered to be a protective agent against free radicals through enhanced enzyme activity. Studies on selenium and cognitive function or Alzheimer's disease have yielded inconsistent results. A cross-sectional survey of 2,000 rural Chinese aged 65 years or older from two provinces in the People's Republic of China was conducted from December 2003 to May 2005 by use of the Community Screening Instrument for Dementia, the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) Word List Learning Test, the Indiana University Story Recall Test, the Animal Fluency Test, and the Indiana University Token Test.

Youth With Epilepsy: Development of a Model of Children's Attitudes Toward Their Condition.

A model of children's attitudes toward their epilepsy was tested in 173 children (9-14 years) with epilepsy and their parents. Predictor variables tested were child characteristics, family mastery, child worry, child self-efficacy for seizure management, child psychosocial care needs, and seizure variables. Data were analyzed using structural equation modeling, leading to a revised model in which less child worry, greater family mastery, and greater child seizure self-efficacy were directly related to more child positive attitudes.

Validation analysis of informant's ratings of cognitive function in African Americans and Nigerians.

Objectives: To examine informant validity using the Community Screening Interview for Dementia (CSI 'D') both cross-sectionally and longitudinally in two very different cultures and to explore the effects of informants and study participants' characteristics on the validity of informants' reports.

Methods: Elderly African Americans age 65 years and older residing in Indianapolis, USA and elderly Yoruba Nigerians age 65 years and older residing in Ibadan, Nigeria were assessed on cognitive functioning using the CSI 'D' at baseline (1992-1993) and five-year follow-up (1997-1998). At baseline, the informant validity in both samples was evaluated against participants' cognitive tests using Pearson correlation and regular regression models.

Neuropsychological predictors of academic underachievement in pediatric epilepsy: moderating roles of demographic, seizure, and psychosocial variables.

Purpose: Academic underachievement is common in pediatric epilepsy. Attempts to identify seizure and psychosocial risk factors for underachievement have yielded inconsistent findings, raising the possibility that seizure and psychosocial variables play a complex role in combination with other variables such as neuropsychological functioning. This study cross-validated a neuropsychological measurement model for childhood epilepsy, examined the relation between neuropsychological functioning and academic achievement, and tested the degree to which demographic, seizure, and psychosocial variables moderate that relation.

Measuring stigma in children with epilepsy and their parents: instrument development and testing.

Purpose: The goal of this work is to describe psychometric properties of two scales measuring perceived stigma in children with epilepsy and their parents.

Methods: Data were collected for the parent scale in two samples: parents of 173 children with epilepsy and of 224 children with new-onset seizures. The child scale was tested in the chronic sample.

Selecting pre-screening items for early intervention trials of dementia--a case study.

Our goal was to review and extend statistical methods for discriminating between normal subjects and those with dementia or cognitive impairment. We compared six different methods to one constructed by expert opinion, in their brevity and predictive power. The methods include logistic regression and neural networks, with standard and least absolute shrinkage and selection operator (LASSO) variable selection, as well as decision trees with and without boosting.

A latent variable model approach for assembling and scoring screening tests for dementia.

In dementia studies, the diagnosis of dementia often relies on results of screening tests aimed at measuring various dimensions of cognitive functions. The current practice of scoring a screening test involves simply summing the correct responses from each item. However, this method may be imprecise and inefficient in the predictive power of the score for dementia.

Behavior and mental health problems in children with epilepsy and low IQ.

The purpose of this cross-sectional descriptive study was to describe the particular types of behavioral problems, self-concept, and symptoms of depression experienced by children with both low IQ and epilepsy. Three groups of children (83 males, 81 females; mean age 11 years 10 months, SD 1 year 10 months; age range 9 to 14 years) with epilepsy were compared: (Group 1) Low IQ (<85), n=48, 25 males, 23 females; (Group 2) Middle IQ (85 to 100), n=58, 24 males, 34 females; and (Group 3) High IQ (>100), n=58, 34 males, 24 females. The Child Behavior Checklist, Piers-Harris Self-Concept Scale, and Children's Depression Inventory were used to measure behavior, self-concept, and depression respectively.

Assessment of quality of life in outpatients with advanced cancer: the accuracy of clinician estimations and the relevance of spiritual well-being--a Hoosier Oncology Group Study.

Purpose: To evaluate the association between quality-of-life (QOL) impairment as reported by patients and QOL impairment as judged by nurses or physicians, with and without consideration of spiritual well-being (SWB).

Patients And Methods: A total of 163 patients with advanced cancer were enrolled onto a therapeutic trial, and cross-sectional data were derived from clinical and demographic questionnaires obtained at baseline, including assessment of patient QOL and SWB. Clinicians rated the QOL impairment of their patients as mild, moderate, or severe.

Fluoxetine versus placebo in advanced cancer outpatients: a double-blinded trial of the Hoosier Oncology Group.

Purpose: To determine whether fluoxetine improves overall quality of life (QOL) in advanced cancer patients with symptoms of depression revealed by a simple survey.

Patients And Methods: One hundred sixty-three patients with an advanced solid tumor and expected survival between 3 and 24 months were randomly assigned in a double-blinded fashion to receive either fluoxetine (20 mg daily) or placebo for 12 weeks. Patients were screened for at least minimal depressive symptoms and assessed every 3 to 6 weeks for QOL and depression.

Improved patient survival after acute variceal bleeding: a multicenter, cohort study.

Objective: Existing literature indicates that the mortality rate with each variceal bleeding episode is 30-50%. Over the past 2 decades, there have been significant developments in the management of variceal bleeding. The effect of these developments on the natural history of variceal bleeding is unclear.