Ruta Bajorunaite

Long‐term survival and late relapse in 2‐year survivors of autologous haematopoietic cell transplantation for Hodgkin and non‐Hodgkin lymphoma

This study described long‐term outcomes of autologous haematopoietic‐cell transplantation (HCT) for advanced Hodgkin (HL) and non‐Hodgkin lymphoma (NHL). The study included recipients of autologous HCT for HL (N = 407) and NHL (N = 960) from 1990–98 who were in continuous complete remission for at least 2 years post‐HCT. Median follow‐up was 104 months for HL and 107 months for NHL. Overall survival at 10‐years was 77% (72–82%) for HL, 78% (73–82%) for diffuse large‐cell NHL, 77% (71–83%) for follicular NHL, 85% (75–93%) for lymphoblastic/Burkitt NHL, 52% (37–67%) for mantle‐cell NHL and 77% (67–85%) for other NHL. On multivariate analysis, mantle‐cell NHL had the highest relative‐risk for late mortality [2·87 (1·70–4·87)], while the risks of death for other histologies were comparable. Relapse was the most common cause of death. Relative mortality compared to age, race and gender adjusted normal population remained significantly elevated and was 14·8 (6·3–23·3) for HL and 5·9 (3·6–8·2) for NHL at 10‐years post‐HCT. Recipients of autologous HCT for HL and NHL who remain in remission for at least 2‐years have favourable subsequent long‐term survival but remain at risk for late relapse. Compared to the general population, mortality rates continue to remain elevated at 10‐years post‐transplantation.

Racial/Ethnic Disparities in the Acceptance of Medicaid Patients in Dental Practices

OBJECTIVES Medicaid enrollees disproportionately experience dental disease and difficulties accessing needed dental care. However, little has been documented on the factors associated with the acceptance of new Medicaid patients by dentists, and particularly whether minority dentists are more likely to accept new Medicaid patients. We therefore examined the factors associated with the acceptance of new Medicaid patients by dentists. METHODS We analyzed 2001 data from the Wisconsin Dentist Workforce Survey administered by the Wisconsin Division of Health Care Financing, Bureau of Health Information. We used descriptive statistics and logistic regression analysis to examine the factors associated with the outcome variable. RESULTS Ninety-four percent of Wisconsin licensed dentists (n = 4,301) responded to the 2001 survey. A significantly higher likelihood of accepting new Medicaid patients was found for racial/ethnic minority dentists (35 versus 19 percent of White dentists) and dentists practicing in large practices (31 versus 16 percent for those in smaller practices). In the multivariable analysis, minority dentists [odds ratio (OR) = 2.06, 95 percent confidence interval (CI) = 1.30, 3.25] and dentists in practices with >3 dentists (OR= 2.25, 95 percent CI = 1.69, 3.00) had significantly greater odds of accepting new Medicaid patients. CONCLUSIONS Racial/ethnic minority dentists are twice as likely as White dentists to accept new Medicaid patients. Dentists in larger practices also are significantly more likely than those in smaller practices to accept new Medicaid patients. These findings suggest that increasing dental workforce diversity to match the diversity of the general US population can potentially improve access to dental care for poor and minority Americans, and may serve as an important force in reducing disparities in dental care.

Comparison of Nanoindentation Measurements Between Osteogenesis Imperfecta Type III and Type IV and Between Different Anatomic Locations (Femur/Tibia versus Iliac Crest)

Nanoindentation was used to compare the intrinsic mechanical properties of bone tissue (iliac crest biopsy) from children with type III and type IV osteogenesis imperfecta (OI). Youngs modulus and hardness values were not significantly different between the two clinical severity groups on either cortical or trabecular measurement. In comparing the ratio of modulus over hardness (E/H) between OI type III and IV. The type III bone showed a marginally significant decrease for cortical bone and significant decrease for trabecular bone, which indicated that the OI type III bone was more brittle than OI type IV bone at the tissue level. In addition, nanoindentation measurements of the bone tissue harvested at femur/tibia from the same patients were compared with the results from the iliac crest biopsy. Youngs modulus and hardness values were not significantly different between the two anatomic locations in either cortical or trabecular measurements. The ratio of E/H was not significantly different between the two groups. Results indicate that intrinsic modulus, hardness, and indentation deformation pattern (E/H) of OI bone tissues are not significantly different at long bone (midshaft of femur/tibia) and iliac crest. We observed that age (1.9 to 13.2 years) did not influence OI bone tissue intrinsic mechanical properties.

Ankle strength and functional limitations in children and adolescents with type I osteogenesis imperfecta.

Purpose: To determine whether children with type I osteogenesis imperfecta (OI) exhibit ankle plantar flexor weakness and whether this correlates with physical function. Methods: Twenty children and adolescents with type I OI and 20 age-matched controls (age 6-18 years) participated in a single evaluation session. Data included strength assessment, Gillette Functional Assessment Questionnaire, Pediatric Outcome Data Collection Instrument (PODCI), and Faces Pain Scale—Revised. Results: Ankle plantar flexor weakness was evident in the OI group compared with the control group. Heel-rise strength correlated with ankle isometric plantar flexion strength. Limitations in PODCI subscales—sports and physical function and pain/comfort—are present in the OI group. Conclusion: Ankle plantar flexor weakness is present in children and adolescents with type I OI and correlates with function. Gillette Functional Assessment Questionnaire, PODCI, and strength assessment are valuable evaluation tools for children and adolescents with type I OI and can aid therapists in goal setting.

Two-sample tests of the equality of two cumulative incidence functions

Typically, differences in the effect of treatment on competing risks are compared by a weighted log-rank test. This test compares the cause-specific hazard rates between the groups. Often the test does not agree with impressions gained from plots of the cumulative incidence functions. Here, we discuss two-sample tests of the equality of two cumulative incidence functions. The first test, based on a suggestion of Lin [1997. Non-parametric inference for cumulative incidence functions in competing risks studies. Statist. Med. 16, 901-910], compares the maximum difference between the two cumulative incidence functions. A Monte Carlo method is used to find p-values for the test. The second test, based on a suggestion of Pepe [1991. Inference for events with dependent risks in multiple endpoint studies. J. Amer. Statist. Assoc. 86, 770-778], compares the integrated difference between the functions. A new variance estimator is proposed for this statistic. A small simulation study is used to compare the various tests. The methods are illustrated on a bone marrow transplant study.

High probability of long-term survival in 2-year survivors of autologous hematopoietic cell transplantation for AML in first or second CR.

We describe the long-term outcomes of autologous hematopoietic cell transplantation (HCT) for 315 AML patients in first or second complete remission (CR). All patients were in continuous CR for ⩾2 years after HCT. Patients were predominantly transplanted in CR1 (78%) and had good or intermediate cytogenetic risk disease (74%). Median follow-up of survivors was 106 (range, 24–192) months. Overall survival at 10 years after HCT was 94% (95% confidence intervals, 89–97%) and 80% (67–91%) for patients receiving HCT in CR1 and CR2, respectively. The cumulative incidence of relapse at 10 years after HCT was 6% (3–10%) and 10% (3–20%) and that of nonrelapse mortality was 5% (2–9%) and 11% (4–21%), respectively. On multivariate analysis, HCT in CR2 (vs CR1), older age at transplantation and poor cytogenetic risk disease were independent predictors of late mortality and adverse disease-free survival. The use of growth factors to promote engraftment after HCT was the only risk factor for relapse. Relative mortality of these 2-year survivors was comparable to that of age-, race- and gender-matched normal population. Patients who receive autologous HCT for AML in CR1 or CR2 and remain in remission for ⩾2 years have very favorable long-term survival. Their mortality rates are similar to that of the general population.

Gait characteristics and functional assessment of children with Type I Osteogenesis Imperfecta

The purpose of this study was to improve the evaluation process of children with type I Osteogenesis Imperfecta (OI) by providing a quantitative comparison of gait and selected functional assessments to age‐matched controls. A 14‐camera Vicon Motion Analysis System was used for gait analysis along with selected functional assessments (Pediatric Outcomes Data Collection Instrument [PODCI], Functional Assessment Questionnaire [FAQ], Faces Pain Scale‐Revised [FPS‐R]) conducted on 10 subjects with type I OI and 22 age‐matched healthy controls. The results of the OI group demonstrated abnormal gait parameters including increased double support, delayed foot off, reduced ankle range of motion and plantarflexion during third rocker, along with greater ankle power absorption during terminal stance and reduced ankle power generation during push off. The functional assessment scores of the OI group were similar to the control group for basic mobility and function, but were lower than their peers in the sports and physical function category. The evaluation of individuals with OI by means of gait analysis and selected functional assessments, along with an accurate biomechanical model of the lower extremities, is proposed to better understand and predict OI disability and improve quality of life.

Comparison of failure probabilities in the presence of competing risks

Typically, differences in the effect of treatment on competing risks are compared by a weighted log-rank test. This test compares the cause specific hazard rates between the groups. Often the test does not agree with the impressions gained from plots of the cumulative incidence functions. Here we discuss several K-sample tests allowing us to directly compare cumulative incidence functions. These include tests based on the weighted integrated difference between the subdistribution hazards or cumulative incidence functions, Kolmogorov-Smirnov type test, and Renyi type test. In addition to unadjusted comparison techniques, tests based on the regression modeling of the cumulative incidence functions are considered. A simulation study is used to compare the various tests and to assess their power against different alternatives. The methods are illustrated using real data examples.

Inference for Competing Risks

Publisher Summary This chapter discusses inference problems for competing risks and illustrates methods using a typical competing risk data set taken from an International Bone Marrow Transplant (BMT) Registry study of alternative donor bone marrow transplantation reported by Szydlo et al. As in many BMT studies, there are two competing risks of treatment failure: relapse or recurrence of the primary disease and death in complete remission, also known as treatment-related mortality. This study consisted of patients with acute lymphocytic leukemia, acute myeloid leukemia, or chronic myeloid leukemia. The chapter discusses how the basic competing risk quantities can be estimated based on a censored sample of competing risk data. It presents three tests that have been proposed to directly compare the cumulative incidence functions. The first test is due to Gray. This test can be used to compare the cumulative incidence functions for two or more groups. The other two tests are available to directly compare the two cumulative incidence functions of two groups. Three approaches to estimation of how covariates directly affect the cumulative incidence function have been presented in the chapter.

Factors Associated With Receipt of Preventive Dental Treatment Procedures Among Adult Patients at a Dental Training School in Wisconsin, 2001-2002

BACKGROUND Gender differences in oral health-related quality of life and the fear of dental pain in seeking and receiving preventive dental care have been recognized and documented. Preventive dental treatment procedures (PDTPs) are commonly accepted as the primary approach to prevent dental disease. OBJECTIVE We examined whether the likelihood of receiving PDTPs differed by gender in adult patients receiving dental care at a dental training institution in Milwaukee, Wisconsin. METHODS Data from the Marquette University School of Dentistry electronic patient management database for 2001 through 2002 were analyzed. Descriptive, bivariate, and multivariable analyses were performed. The preventive procedures used in the study were those coded in accordance with the American Dental Associations classification system: D1110 (adult prophylaxis: professional cleaning and polishing of the teeth), D1204 (adult topical application of fluoride), D1205 (adult topical application of fluoride plus prophylaxis), and D1330 (oral hygiene instruction). RESULTS Of the 1563 consecutive patient records (888 women, 675 men) reviewed for the years 2001-2002, 794 individuals (51%), aged 18 to 60 years, were identified as having received PDTPs. At the bivariate level, a significant gender difference in the receipt of PDTPs was identified (423 women [48%] vs 371 men [55%]; P = 0.004). In the multivariable analyses, age, race/ethnicity, marital status, poverty level, and health insurance type (public, private, none) were significantly associated with the receipt of PDTPs (all, P < 0.05), but gender was not. CONCLUSIONS Gender differences in receiving PDTPs were not found in this dental school patient population. Receipt of PDTPs was associated with other demographic factors such as age, race/ethnicity, marital status, income level, and health insurance.