Validity, Reliability, and Diagnostic Accuracy of Ratings of Perceived Exertion to Identify Dependence in Performing Self-care Activities in Older Women.

BACKGROUND: Dependence in self-care activities among older women has been previously evaluated through performance-based tests. However, these tests have presented inability to accurately distinguish between dependent and independent older adults in performing activities of daily living. AIM: To examine the validity, reliability, and diagnostic accuracy of rating of perceived exertion (RPE) to identify dependence in performing self-care activities in older women. METHODS: Thirty-five older women performed two different constant-load tasks (walking on treadmill at 4 km/h for five minutes and arm curls with two kg for one minute), reporting RPE at the end, in four sessions. Performance-based tests (30-second chair stand and 6-minute walk) were also evaluated. Katz Index and Lawton and Brody questionnaires were applied to evaluate the dependence level in performing basic and instrumental activities of daily living. RESULTS: RPE was greater on the first session (RPE 14 ± 2) than second session (RPE 13 ± 2), while it was similar through other sessions, with high values of intraclass coefficient correlation (0.96-0.99). Basic activities of daily living and instrumental activities of daily living presented high correlations with RPE measures (0.75-0.82), whereas performance-based tests presented moderate correlations (0.47-0.59). RPE responses explained the most variance in identifying dependence in self-care activities and presented high diagnostic accuracy to differentiate dependent from independent older women. So the hypotheses had been confirmed that RPE responses in constant-load exercise are better predictors of dependence in self-care activities than performance-based tests. CONCLUSIONS: RPE of constant-load physical tasks was valid, reliable, and accurate in identifying dependence in performing self-care activities in older women; therefore, it is possible to use the perceived exertion to identify dependence in performing activities of daily living in older women.

The sequential use of endocrine treatment for advanced breast cancer: where are we?

BACKGROUND: Hormone receptor-positive advanced breast cancer is an increasing health burden. Although endocrine therapies are recognised as the most beneficial treatments for patients with hormone receptor-positive advanced breast cancer, the optimal sequence of these agents is currently undetermined. METHODS: We reviewed the available data on randomised controlled trials (RCTs) of endocrine therapies in this treatment setting with particular focus on RCTs reported over the last 15 years that were designed based on power calculations on primary end points. RESULTS: In this paper, data are reviewed in postmenopausal patients for the use of tamoxifen, aromatase inhibitors and fulvestrant. We also consider the available data on endocrine crossover studies and endocrine therapy in combination with chemotherapy or growth factor therapies. Treatment options for premenopausal patients and those with estrogen receptor-/human epidermal growth factor receptor 2-positive tumours are also evaluated. CONCLUSION: We present the level of evidence available for each endocrine agent based on its efficacy in advanced breast cancer and a diagram of possible treatment pathways.

Gingival salivary gland choristoma. A case report.

Gingival salivary gland choristoma is an extremely rare disturbance of glandular development. A review of the literature disclosed only 5 reported cases of this entity and 7 gingival salivary gland tumors or alterations. We present a case of this condition present in a 43-year-old female patient, which was found while reviewing casts for the design of a prosthetic appliance. This case suggests that embryonal pluripotentiality of gingival epithelial cells is retained and that development of salivary glands in gingival tissue is feasible. An additional discussion about its histogenesis is presented.

Odontogenic tumors in Mexico: a collaborative retrospective study of 349 cases.

Reports about the frequency of odontogenic tumors are scarce, and diagnostic criteria used in the reports are not uniform. This article presents the results of a retrospective study of odontogenic tumors recorded in four services of diagnostic pathology in Mexico City (two dental schools, one cancer hospital, and one private oral pathology service). The final diagnosis in each case was based on the 1992 histologic criteria of the World Health Organization. The frequency of odontogenic tumors, expressed as a percent of all oral and maxillofacial specimens, ranged from 0.8% in the cancer hospital (0.02% of all biopsies) to 3.7% in the private oral pathology service. The frequency was identical for the two dental schools (2.5%). We found a total of 349 odontogenic tumors; of these, 345 were benign (98.8%), and 4 (1.1%) were malignant (3 were primary intraosseous carcinomas and 1 was a malignant ameloblastoma). The most frequently occurring tumors were odontoma (34.6%), ameloblastoma (23.7%), myxoma (17.7%), adenomatoid odontogenic tumor (7.1%), and calcifying odontogenic cyst (6.8%). Although relatively rare, odontogenic tumors are still an important cause of extensive surgical procedures in Mexico.

Immunoexpression of epidermal growth factor in odontogenesis of the offspring of alcoholic mice.

Several forms of cell perturbation have been associated with ethanol ingestion. Fetal alcohol syndrome (FAS) as well as diminished maxillofacial development and inhibition of cell regeneration in vitro and in vivo have been described. Epidermal growth factor (EGF) stimulates maxillofacial growth, DNA synthesis, and it is a potent mitogen for a number of various cell types. EGF exerts its effects on cells through binding to a specific cell surface receptor which leads to activation of a thyrosine kinase in the intracellular part of the receptor. The inhibitory effect of alcohol on EGF in the mouse dental follicle was studied in the offspring of alcoholic mothers using immunocytochemistry. Adult female mice were given 22% alcohol in their drinking water and fed a pelleted diet before and during pregnancy. Maternal blood alcohol levels were 262 +/- 1.3 mg/100 ml on gestation day 12.5. The offspring of the alcoholic and control mice were sacrificed on postnatal day 1.5, their mandibles were dissected, weighed and processed by routine immunocytochemistry with the following results. 1) Significant differences were found in mandible weight p < 0.01 after parturition. 2) The tooth germs in the offspring of ethanol treated mice were morphometrically smaller than those of control littermates. 3) Immunoexpression of EGF in the mandibular first molar of the control group was strong and homogeneous while in the experimental group the expression was light and heterogeneous. It is concluded that maternal alcoholism reduces EGF in the offspring.

Interleucina-2: una terapia alternativa en cáncer / Interleukin-2: an alternative therapy for cancer

Recientemente, se ha demostrado que la manifestación de inmunidad antitumoral resulta de las interacciones entre varias poblaciones celulares del sistema inmune. La inmunoterapia con interleucina-2 (IL-2) y células destructoras de linfocinas activadas generadas por linfocitos análogos ha producido regresiones significativas en tumore de pacientes con cáncer avanzado. El efecto mitogénico de la IL-2 en linfocitos T citolíticos de tumores-reactivos (CTL), destructores naturales y LAK puede incrementar el potencial de defensa en la expansión de tumores. A diferencia del tratamiento sistémico, la administración de IL-2 en la vecindad del tumor puede ofrecer ciertas ventajas, tales como: uso de dosis bajas y menos anticuerpos anti IL-2 y proveer un cambio de confrontación mucho mejor con inhibidores IL-2 y mecanismos de retroalimentación, los cuales podrán limitar sustancialmente los posibles efectos terapéuticos de la IL-2 en pacientes con tumores

Utah Growth Study: growth standards and the prevalence of growth hormone deficiency.

Serial measurements of elementary-school children were conducted for 2 consecutive years to assess height and growth velocity and to determine the prevalence of growth hormone deficiency (GHD) in American children. Trained volunteers measured 114,881 children the first year; 79,495 growth rates were calculated after the second measurements. The height and growth velocity curves generated were very similar to the currently used charts. We examined 555 children with short stature (< 3rd percentile) and poor growth rates (< 5 cm/yr). Five percent had an endocrine disorder. The presence of GHD (peak level, < 10 ng/dl with two provocative tests) was found in 16 previously unrecognized children; 17 children from this school population were already known to have GHD. Boys outnumbered girls 2.7:1 (p = 0.006). Six girls with Turner syndrome also were identified. We conclude that (1) the growth curves generated in the 1960s and 1970s are valid for children of the 1990s; (2) most children growing < 5 cm/yr (a commonly used threshold rate) will not have an endocrine disorder; (3) many children (48% in this study) with GHD and others with Turner syndrome may currently be unrecognized and untreated; (4) GHD appears to be more common in boys; and (5) the prevalence of GHD in the United States is at least 1:3480.

Effect of human immunodeficiency virus infection on the growth of young children. Duke Pediatric AIDS Clinical Trials Unit.

We retrospectively analyzed the growth of 170 children less than 25 1/2 months of age who were referred for evaluation of human immunodeficiency virus (HIV) antibody status. By the age of 4 months, the 62 HIV-infected children were significantly smaller than the 108 uninfected children in both weight-for-age and length-for-age measurements; linear growth and weight gain were proportionally decreased.

[Complex compound odontoma cystic eruption]. / Odontoma compuesto complejo quístico erupcionado.

An erupted cystic complex odontoma's case is reported. Histological, radiographic and clinic/fractures were considered. Erupted odontomas are unusual lesions; we did not find similar case reported in the literature.

Passive euthanasia of defective newborn infants: legal considerations.

The recent increase in reporting of passive euthanasia of defective newborn infants has not been accompanied by extensive analysis of the legality of the practice or the appropriateness of current law. There appears to be criminal liability on several grounds for parents, physicians, nurses, and administrators. Such liability may include charges of homicide by omission, child neglect, and failure to report child neglect. Increasing public exposure of the practice increases the probability that such prosecutions may be brought. Individuals involved in such decisions should be aware of their possible legal liability. If existing legal policy is inappropriate, it sould be changed through open discussion and not subverted through private action. Two alternative policies are described: establishment of criteria for the class of infants who can be allowed to die or a better process of decision making. We conclude that a committment to process would be preferable.