Duncan Hunter

Prevalence of prostatitis-like symptoms in a population based study using the National Institutes of Health chronic prostatitis symptom index.

PURPOSE The National Institutes of Health (NIH) chronic prostatitis symptom index was used to determine the prevalence of prostatitis-like symptoms among men (age 20 to 74 years) at risk in a community based study. MATERIALS AND METHODS The study was a cross-sectional postal survey of men age 20 to 74 years in Lennox and Addington counties, which included a large rural area, 1 major town and a suburban area with a stable population of men representative of Canadian demographics. The questionnaire collected information on 2 domains of chronic prostatitis identified in the NIH chronic prostatitis symptom index, including pain (location, severity and frequency), voiding function (irritative, obstructive), demographics, quality of life, general health and health seeking behavior. The self-reported pain score was used to identify prostatitis-like symptoms in the most discriminating domain. Based on analysis of the index final validation study comparing patients with prostatitis to normal controls and those with benign prostatic hyperplasia, the 2 questions most specific for prostatitis, including perineal and/or ejaculatory pain/discomfort, and a total pain score (0 to 21) 4 or greater were used to identify men with significant prostatitis-like symptoms. RESULTS A total of 2,987 eligible men received the survey, and it was completed by 868 (29%). Of the men 84 (9.7%) were identified as having chronic prostatitis-like symptoms (mean NIH chronic prostatitis symptom index pain score 9.1 +/- 0.3). The average age of the prostatitis population was 50 years compared with 52 years for men without prostatitis-like symptoms. Prevalence was 11.5% in men younger than 50 years and 8.5% in men 50 years or older. Of the sampled population 57 (6.6%) men had prostatitis-like symptoms and an index pain score 8 or greater (moderate to severe). The index voiding score (0 to 10) was 4.1 +/- 0.5 in men younger than 50 years compared with 1.5 +/- 0.1 for normal controls, and 4.7 +/- 0.4 in those 50 years or older compared with 1.9 +/- 0.1 for normal controls. Of the prostatitis group 60% sought medical help for their symptoms. CONCLUSIONS In our opinion this community based study using the new prostatitis symptom index confirms that chronic prostatitis-like symptoms are common.

Influence of psychological coping on survival and recurrence in people with cancer: systematic review

Abstract Objective: To summarise the evidence on the effect of psychological coping styles (including fighting spirit, helplessness/hopelessness, denial, and avoidance) on survival and recurrence in patients with cancer. Design: Systematic review of published and unpublished prospective observational studies. Main outcome measures: Survival from or recurrence of cancer. Results: 26 studies investigated the association between psychological coping styles and survival from cancer, and 11 studies investigated recurrence. Most of the studies that investigated fighting spirit (10 studies) or helplessness/hopelessness (12 studies) found no significant associations with survival or recurrence. The evidence that other coping styles play an important part was also weak. Positive findings tended to be confined to small or methodologically flawed studies; lack of adjustment for potential confounding variables was common. Positive conclusions seemed to be more commonly reported by smaller studies, indicating potential publication bias. Conclusion: There is little consistent evidence that psychological coping styles play an important part in survival from or recurrence of cancer. People with cancer should not feel pressured into adopting particular coping styles to improve survival or reduce the risk of recurrence. What is already known on this topic Survival from cancer is commonly thought to be influenced by a persons psychological coping style Some studies have shown that a coping style involving fighting spirit rather than helplessness/hopelessness is associated with survival and recurrence, though the evidence is inconsistent What this study adds This systematic review suggests that there is no consistent association between psychological coping and outcome of cancer Publication bias and methodological flaws in some of the primary studies may explain some of the previous positive findings There is no good evidence to support the development of psychological interventions to promote particular types of coping in an attempt to prolong survival

ABSORPTION OF ALKALIZED INTRAVESICAL LIDOCAINE IN NORMAL AND INFLAMED BLADDERS: A SIMPLE METHOD FOR IMPROVING BLADDER ANESTHESIA

PURPOSE Pharmacokinetic studies have shown that intravesical lidocaine is not sufficiently absorbed by human bladders to achieve significant serum levels and it only provides a superficial local anesthetic effect. We investigated the pharmacokinetics of alkalized intravesical lidocaine in healthy volunteers and patients with interstitial cystitis to determine a safe dose of buffered lidocaine, the effect of interstitial cystitis on lidocaine uptake and the acute local anesthetic effect on bladder pain in interstitial cystitis. MATERIALS AND METHODS An initial dose finding study was done in 12 healthy volunteers using 4, 5 and 6 mg./kg. 5% lidocaine buffered with 8.4% sodium bicarbonate. Serial lidocaine levels were measured for 3 hours. Serum measurement was repeated in 12 patients with interstitial cystitis using 5 mg/kg. 5% lidocaine with sodium bicarbonate daily for 2 days. Patients rated pain before and during treatment. RESULTS Healthy volunteers and patients with interstitial cystitis had similar lidocaine absorption profiles with a peak of 1.06 microg/ml. (range 0.66 to 1.71) and 1.3 (range 0.2 to 2.0) at about 30 minutes. Mean pain score in the interstitial cystitis group decreased from a baseline of 6.0 to 1.8 on day 1 and 0.6 on day 2. There were complaints of urethral discomfort after voiding the buffered lidocaine in each group. CONCLUSIONS Alkalization provides safe and predictable lidocaine absorption into the bladder, as indicated by therapeutic systemic levels in healthy and inflamed bladders. Furthermore, the decrease in acute pain scores in the interstitial cystitis group indicated a concentration of local anesthetic within the bladder wall that was sufficient to block the sensory neurons within the submucosal plexus.

Physical mobility limitations in adults with intellectual disabilities: a systematic review

BACKGROUND Mobility limitations increase with age in the general population. Despite a growing population of older adults with intellectual disabilities (ID), mobility is rarely studied in the ID literature. The specific aim of this study was to identify and summarise primary literature investigating mobility limitations in adults with ID. METHODS This study was a systematic review of the epidemiological literature (incidence and prevalence) of mobility limitations among adults with ID. Four electronic databases were searched from January 1980 to May 2007 for publications according to predefined inclusion/exclusion criteria. Additional sources were consulted. Two reviewers extracted data from each of the included articles. RESULTS Thirty-two publications representing 31 studies were ultimately included. In general, studies did not focus on mobility but were conducted for other purposes. All studies were conducted in industrialised countries. Only one study used a longitudinal design; the remainders were cross-sectional. Few investigators reported on the representativeness of the sample or the validity of the measurement tool. Study samples differed substantially and investigators used numerous definitions of mobility limiting comparability between studies. CONCLUSIONS There is a need for increased research on mobility limitations among adults with ID, particularly longitudinal research. Researchers investigating mobility limitations should use validated measurement tools and offer detailed descriptions of the study sample and how it compares with an identifiable population.

Unmet Needs of Families of School-Aged Children with an Autism Spectrum Disorder.

BACKGROUND To aid decision making regarding the allocation of limited resources, information is needed on the perceived unmet needs of parents of school-aged children with an autism spectrum disorder. MATERIALS AND METHODS A cross-sectional survey was conducted of 101 Canadian families of school-aged children with an autism spectrum disorder. RESULTS Commonly reported unmet needs were for social activities for the child (78.2%), information about services (77.2%) and continuous service provision (74.3%). CONCLUSIONS This study provides insight into needs which have not been met by the service system. Information about the unmet needs of children with an autism spectrum disorder and their families may help policy makers and service providers to develop resources and services that are responsive to their client group.

Family physician views about primary care reform in Ontario: a postal questionnaire

BackgroundPrimary care reform initiatives in Ontario are proceeding with little information about the views of practicing family physicians.MethodsA postal questionnaire was sent to 1200 randomly selected family physicians in Ontario five months after the initial invitation to join the Ontario Family Health Network. It sought information about their practice characteristics, their intention to participate in the Network and their views about the organization and financing of primary care.ResultsThe response rate was 50.3%. While many family physicians recognize the need for change in the delivery of primary care, the majority (72%) did not expect to join the Ontario Family Health Network by 2004, or by some later date (60%). Nor did they favour capitation or rostering, 2 key elements of the proposed reforms. Physicians who favour capitation were 5.5 times more likely to report that they expected to join the Network by 2004, although these practices comprise 5% of the sample.ConclusionsThe results of this survey, conducted five months after the initial offering of primary care reform agreements to all Ontario physicians, suggest that an 80% enrollment target is unrealistic.

Women’s knowledge of hormone therapy

The aim of this study was to assess womens knowledge of hormone therapy. Two hundred and seven women were interviewed by telephone. The median score to 24 questions concerning the benefits, risks and side effects of therapy was 54.2%. Almost three-quarters of women knew that hormone therapy may decrease the risk of osteoporosis, but half were unaware that it should be taken for at least 10 years for maximum protection against bone loss. While many women knew that hormone therapy may increase the risk of breast cancer, 13.5% believed that it would decrease their risk. Many women overestimated the potential reduction in lifetime risk of hip fracture and the potential increase in lifetime risk of breast cancer with hormone therapy. Women may have insufficient knowledge to make informed choices about hormone therapy. This has implications for physicians who wish to ensure that women are able to participate in informed decision-making.

Access and Quality of Primary Care for People With Disabilities: A Comparison of Practice Factors:

This study shows how practice factors, particularly payment type, affect quality and accessibility of primary care for adults with disabilities. The study consisted of: (a) a survey of practice characteristics, including accessibility, accommodations for disabled patients, and payment type; and, (b) a retrospective chart audit for quality of care indicators. The sample consisted of 513 patients within 73 doctors within 47 practices. The study show that there are significant differences between payment types on location, number of physicians and other health professionals, caseloads and patient contacts. Salaried practices scored significantly higher on accessibility and willingness to make accommodations for patients with disabilities. Salary practices scored significantly higher than FFS or capitation for the treatment of diabetes, hypertension and urinary tract infections. Capitation practices scored significantly lower than the other two payment types on preventive care. These findings raise questions regarding the mix of salary to other models of practice, and incentives for ensuring that those with the greatest need receive the best possible primary care.

Father of all bias

The minimisation of bias, the systematic deviation of results or inferences from truth, is a fundamental principle of medical research.1 Special care is taken by researchers to avoid and control for the 56 distinct types of bias catalogued.2 Yet the origin of the term “bias” remains obscure.3 Might it have originated from Bias of Priene, who lived in the 6th century BC? Bias of Priene was one of the seven sages of classical antiquity. These were the jet-setting academics of the …

St Columba's case book

Was St Columba of Iona a doctor or a saint? St Columba was an early Christian saint who founded a monastery on Iona, but his Life , published at the end of the fifth century by Adomnan, suggests that he was also one of Britains early GPs.1 Written a century after his death, the stories rely heavily on Christian symbolism as they were based on tales circulating among the monks and were written by an abbot, about an abbot. However, if you ignore the miraculous hyperbole, Book II can be read as a description of early British medicine. Columba seems to have been a widely respected GP with some knowledge of public health medicine. He investigated two epidemics, once by identifying a point source infection from a well ( anyone who drank from …