Jonathan Berkowitz

Assessing information and decision preferences of men with prostate cancer and their partners

The purpose of this study was to identify and compare information and decision preferences of men with prostate cancer and their partners at the time of diagnosis. A convenience sample of 80 couples was recruited from The Prostate Centre in Vancouver, Canada. Participants used a computerized version of two previously used measures with this population: Control Preferences Scale and Information Survey Questionnaire. Results showed that men had a preference to play either an active or a collaborative role in decision making with their physician (92.5%) and partners (100%). The majority (55%) of partners wanted to play a collaborative role in treatment decision making. Couples identified prognosis, stage of disease, treatment options, and side effects as the top 4 information preferences. Men ranked information on sexuality more important than partners, and partners ranked information on home self-care higher than men. Men who had sons, a positive family history, and lower levels of education ranked heredity risk significantly higher. Profiles of information categories did not differ according to role preferences of either men or partners. The computer program has been shown to be a reliable and acceptable method of assessing information and decision preferences of these couples. An individualized approach is suggested, given the high reliability of individual’s profiles.

Biopsychosocial Multivariate Predictive Model of Occupational Low Back Disability

Study Design. To establish outcome, 253 workers with subacute and chronic low back conditions were assessed with a comprehensive multimethod biopsychosocial protocol at baseline, 3 days after the initial examination, and 3 months later. Objective. To validate empirically a biopsychosocial model for prediction of occupational low back disability. Summary of Background Data. Costs of low back occupational disability continue to spiral despite stabilization of low back injury rates. An empirically based model to predict occupational disability in workers with low back injuries is required. Methods. Workers with subacute low back injuries (4–6 weeks after injury, n = 192) and those with chronic back pain (6–12 months after injury, n = 61) were the study participants. The biopsychosocial protocol included five groups of variables: 1) sociodemographic, 2) medical, 3) psychosocial, 4) pain behavior, and 5) workplace-related factors. Predictive validity was investigated through a 3-month follow-up assessment, at which time the return to work outcome was determined. Stepwise logistic regression models were developed to predict work status. Results. The final integrated model consisted of variables from a wide biopsychosocial spectrum: vitality, health transition, feeling that job is threatened due to injury, expectations of recovery, guarding behavior, perception of severity of disability, time to complete walk, and right leg typical sciatica. Conclusions. The “winning” variables identified in the integrated model are dominated by cognitions, which are accompanied by disability behaviors. A cognitive–behavioral model with an adaptation-oriented rather than a pathology-oriented focus is favored for early intervention with high-risk workers since cognitions are amenable to change.

Predicting return to work after low back injury using the Psychosocial Risk for Occupational Disability Instrument: a validation study.

Introduction: This paper reports on the predictive validity of a Psychosocial Risk for Occupational Disability Scale in the workers’ compensation environment using a paper and pencil version of a previously validated multimethod instrument on a new, subacute sample of workers with low back pain. Methods: A cohort longitudinal study design with a randomly selected cohort off work for 4–6 weeks was applied. The questionnaire was completed by 111 eligible workers at 4–6 weeks following injury. Return to work status data at three months was obtained from 100 workers. Sixty-four workers had returned to work (RTW) and 36 had not (NRTW). Results: Stepwise backward elimination resulted in a model with these predictors: Expectations of Recovery, SF-36 Vitality, SF-36 Mental Health, and Waddell Symptoms. The correct classification of RTW/NRTW was 79%, with sensitivity (NRTW) of 61% and specificity (RTW) of 89%. The area under the ROC curve was 84%. Conclusions. New evidence for predictive validity for the Psychosocial Risk-for-Disability Instrument was provided. Implications: The instrument can be useful and practical for prediction of return to work outcomes in the subacute stage after low back injury in the workers’ compensation context.

Fertility intentions of women of reproductive age living with HIV in British Columbia, Canada.

Background:We undertook a study to examine the fertility intentions and reproductive health issues of women living with HIV in a broad-based sample in British Columbia, Canada. Methods:Between November 2003 and December 2004, we invited women with HIV at all HIV clinics and AIDS service organizations in the province of British Columbia, Canada, to complete the survey instrument ‘Contraceptive Decisions of HIV-positive Women’. Logistic regression analysis was conducted to calculate adjusted odds ratios to identify factors that may be significant predictors of the intention of women living with HIV to have children. Results:Of the 230 surveys completed, 182 women (79.1%) were of reproductive age (≤ 44 years), and 25.8% of women living with HIV indicated an intention to have children. In multivariate modeling, non-aboriginal ethnicity, younger age and having a regular partner were associated with an increased likelihood of reporting the intention to have children in the future. Discussion:In this study, we found that the predictors of fertility intention of women with HIV were age, ethnicity and marital status. Women who were HIV-positive described an intention to have children at levels approaching those among the general population and regardless of their clinical HIV status. Public policy planners and health practitioners need to consider and plan for the implications of increased numbers of women with HIV who may choose to have children.

Role of laparoscopic salpingostomy in the treatment of hydrosalpinx

OBJECTIVE To determine pregnancy rates after laparoscopic salpingostomy in occlusive distal tubal disease. To evaluate the relative impact of various historical, physical, and operative factors on pregnancy outcome using a multivariate statistical analysis. DESIGN Prospective cohort. SETTING University-affiliated tertiary care infertility clinic. PATIENT(S) One hundred thirty-nine infertile women with occlusive distal tube disease. INTERVENTION(S) Laparoscopic salpingostomy. MAIN OUTCOME MEASURE(S) The occurrence of intrauterine (IUP) and ectopic pregnancy (EP). RESULT(S) The overall IUP and EP rates were 24.5% and 16.5%, respectively. Analysis of historical variables, assessed independently, demonstrated a significantly higher IUP rate with a positive history of gonorrhea and a significantly higher EP rate with a positive history of pelvic inflammatory disease, lack of history of intrauterine device (IUD) usage, or the performance of a bilateral procedure. The logistic regression model to predict intrauterine pregnancy had an overall predictive value of 77.5% and included the following significant variables: secondary infertility, positive history of gonorrhea, and the operative finding of moderate periadnexal adhesions. The logistic regression model to predict ectopic pregnancy had an overall predictive value of 89.0% and included the following significant variables: previous ectopic pregnancy, negative history of IUD use, positive history of PID, a bilateral procedure, and perihepatic adhesions. CONCLUSION(S) Operative laparoscopy may be effective for the correction of hydrosalpinges in selected patients. The probability of achieving an intrauterine or an ectopic pregnancy can be predicted based on combinations of significant variables.

A Randomized Controlled Comparison of Epidural Analgesia and Combined Spinal-Epidural Analgesia in a Private Practice Setting: Pain Scores During First and Second Stages of Labor and at Delivery.

BACKGROUND:There has been no prospective evaluation of combined spinal-epidural (CSE) analgesia in a private practice setting and few studies have focused on pain relief during the second stage of labor and at delivery. In this randomized controlled trial, we compared verbal pain scores during the first and second stages of labor and at delivery in women receiving CSE or traditional epidural analgesia at a busy private maternity hospital. METHODS:Healthy, term parturients received epidural or CSE analgesia for labor pain upon request. Epidural analgesia was initiated with 0.125% bupivacaine plus 2 &mgr;g/mL fentanyl, 15 mL; CSE analgesia was initiated with intrathecal plain bupivacaine 3.125 mg plus 5 &mgr;g fentanyl. Thereafter, patient-controlled epidural analgesia with 0.125% bupivacaine plus 2 &mgr;g/mL fentanyl was used for maintenance analgesia in both groups. The primary outcome was an assessment of “typical” pain, using a verbal rating pain score from 0 to 10, made at the end of the first stage of labor and shortly after delivery. RESULTS:Data from 398 epidural and 402 CSE subjects were analyzed. The typical verbal rating pain score during the first stage was lower in the CSE group (mean: 1.4 vs 1.9; P < 0.001; 99.5% confidence interval [CI] for difference: −0.92, −0.14). Pain scores during the second stage of labor (1.7 vs 1.9; P = 0.17; 99.5% CI for difference: −0.82, 0.28) and at delivery (2.0 vs 2.0; P = 0.77; 99.5% CI for difference: −0.73, 0.59) were the same between groups. Fewer patients received an epidural top-up dose in the CSE group (16.4% vs 25.6%; P = 0.002; 99.5% CI for difference: −17.0%, −1.0%). Epidural catheters were replaced in 1.2% CSE vs 2% in the epidural group (P = 0.39; 99.5% CI for difference: −3.3%, 1.8%). CONCLUSIONS:Compared with traditional epidural labor analgesia, CSE analgesia provided better first-stage analgesia despite fewer epidural top-up injections by an anesthesiologist.

Use of psychometric measures and nonorganic signs testing in detecting nomogenic disorders in low back pain patients

The effect of financial compensation on responses to psychometric testing was studied in 231 chronic back pain patients. Item by item comparison of responses to two tests, read ministered within 4 hours, yielded Inconsistency scores. These inconsistency scores, along with scores on other psychometric measures and on Waddells nonorganic signs test, of a group of 97 patients anticipating or receiving financial compensation [AFC], and a group of 134– patients not receiving or anticipating financial compensation [non-AFC] were compared. The AFC group had significantly higher mean scores than did the non-AFC group on the inconsistency measures, on almost all psychometric tests and on nonorganic signs. Almost all non-AFC subjects scored NO“ on nonorganics, whereas 83% of AFC subjects scored ”2“ or higher. Prediction analysis revealed that the nonorganics score alone can predict AFC/non-AFC status; 90% of subjects were correctly classified, The Inconsistency scores correctly classified 78%, Together, they correctly classified 93%. It was concluded that nonorganic scores and inconsistency scores [as defined by the investigators] distinguish between, and can predict membership in AFC and non-AFC groups. The significantly higher inconsistency scores obtained by the AFC group suggest that these psychometric test results are unreliable and hence invalid for this group.

Natural killer (NK) cells in chronic progressive multiple sclerosis patients treated with lymphoblastoid interferon

Natural killer (NK) cell functional activity, as defined by the lysis of 51Cr-labelled K-562 cells, and number, defined phenotypically by anti-Leu-11, are significantly decreased in chronic progressive multiple sclerosis (MS) when compared to normal controls. When age- and sex-matched populations are compared, NK cell functional activity is again significantly reduced in MS compared to controls but not when compared to a control group of other medical disease (OMD). The MS group could be differentiated from the OMD group, however, when results of NK cell functional activity are combined with NK cell phenotype. With the administration of lymphoblastoid interferon daily for 6 months, NK cell activity increased significantly at 48 h and at 1 week. By 1 month, activity decreased to a level slightly above placebo treatment values. The results likely reflect interferons enhancement of mature NK cell activity combined with a variable effect on recruitment of pre-NK cells.

Tooth–Surface Progression and Reversal Changes in Fluoridated and No–Longer– Fluoridated Communities over a 3–Year Period

Objective: To compare permanent tooth surface–specific progression/reversal changes between fluoridation–ended (F–E) and still–fluoridated (S–F) communities in British Columbia, Canada, over a 3–year period. Methods: D1D2MFS examinations were contrasted for 2,964 schoolchildren in 1993/94 (grades 2, 3, 8 and 9) and 1996/97 (grades 5, 6, 11 and 12). Generalized Estimating Equation (GEE) models explored the relation between progression/reversal changes and fluoridation status, age, gender, socioeconomic status, and dietary/fluoride histories. Results: Within a scenario of low levels of caries overall, few children had multiple surfaces progressing. At least one smooth surface progressed in 31.4% of subjects; at least one pit–and–fissure (PF) surface progressed in 43.1% of subjects. At least one smooth surface reverted in 89% of subjects who had reversible stages; at least one PF surface reverted in 23.8% of subjects who had reversible stages. GEE (smooth) indicated that odds ratios of progression were twice as large in the F–E site compared to the S–F site, and slightly increased in older participants and in participants exposed to more fluoride technologies. GEE (PF) also indicated that progression was slightly more common in the F–E site; more frequent snacking and lower parental educational attainment had modest associations with increased progression in PF surfaces. For the two types of surfaces, GEE models demonstrated that unerupted surfaces were less likely to progress than sound surfaces. No associations were found between reversals and independent variables. Conclusion: Progressions were found to be weakly linked to socio–demographic factors; baseline surface statuses were better predictors of progression. Using the current definitions for disease transitions, F–E communities had more frequent progressions than a S–F community.

Factors Associated With a Successful External Cephalic Version in the Esarly ECV Trial

OBJECTIVES The objective of this research was to determine factors that were associated with a successful external cephalic version (ECV) procedure. METHODS We undertook a secondary analysis of data from a randomized controlled trial, The Early External Cephalic Version (Pilot) Trial. In this secondary analysis, we included data for the subset of 178 women who had an ECV as part of the pilot trial (123 nulliparous women with any breech presentation and 55 multiparous women with a frank breech presentation only). Using this dataset, we began with two separate univariate analyses, one of characteristics that could be determined before undertaking a procedure, and the other of factors associated with the ECV procedure itself. Variables that had a P value of < or = 0.1 in the univariate analyses were included in two separate logistic regression models, one for preprocedural and one for procedural factors, using a backward elimination approach. RESULTS Multiparity and a non-engaged presenting part were significant preprocedural predictors of ECV success. Procedural factors predictive of ECV success included lower reported maternal pain scores during the procedure, a single attempt at ECV, and a more mobile fetus. CONCLUSION Non-engagement of the presenting part was the only modifiable factor predicting ECV success that was identified in this analysis, and it supports the hypothesis that beginning the ECV procedure earlier in pregnancy, prior to engagement, may have merit. The Early ECV 2 Trial is in progress and will further test this hypothesis.