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Stalking is relatively common yet little is known of the longer-term health effects of stalking. Using the National Violence Against Women survey, we estimated lifetime stalking victimization among women and men, ages 18 to 65, identified correlates of being stalked, and explored the association between being stalked and mental and physical health status. With a criterion of being stalked on more than one occasion and being at least "somewhat afraid," 14.2% of women and 4.3% of men were victims. Among those stalked, 41% of women and 28% of men were stalked by an intimate partner. Women were more than 13 times as likely to be "very afraid" of their stalker than men. Negative health consequences of being stalked were similar for men and women; those stalked were significantly more likely to report poor current health, depression, injury, and substance use. Implications for victims, service providers, and the criminal justice system were reviewed.
In 1995, the American Society of Tropical Medicine and Hygiene (ASTMH) adopted defined criteria for accreditation of clinical training programs in tropical diseases. The first data on the development, enrollment, and outcomes of such a program are presented. A nine-week Diploma course, the Gorgas Course in Clinical Tropical Medicine, given on-site in the tropics (Lima, Cusco, and Iquitos, Peru) has trained 157 individuals from 38 countries from 1996 through 2001. The average age of participants was 38.3 with 11.3 years since graduation. Graduates were 44.5% primary care physicians, 22.2% infectious diseases specialists, 12.7% emergency medicine specialists, 13.5% other specialists, and 7.1% nurses. Residents and fellows accounted for 32.8% and full-time academic faculty for 11.0%. Approximately half of all eligible Gorgas graduates have taken the ASTMH certification examination. In response to the enrollees' profiles and needs, adult learning theory has been extensively used in course design. Stable professional relationships between multiple educational partners are required for an endeavor of this scope.
BACKGROUND - Acute pulmonary embolism confers a high mortality rate despite advances in diagnosis and therapy. Thrombolysis is often effective but has a high frequency of major bleeding complications, especially intracranial hemorrhage. Therefore, we liberalized our criteria for acute pulmonary embolectomy and considered operating on patients with anatomically extensive pulmonary embolism and concomitant moderate to severe right ventricular dysfunction despite preserved systemic arterial pressure.
METHODS AND RESULTS - We report 29 (17 men and 12 women) consecutive patients who underwent embolectomy from October 1999 through October 2001. Twenty-six patients (89%) survived surgery and were alive more than 1 month postoperatively. Median follow-up is 10 months.
CONCLUSION - The high survival rate of 89% can be attributed to improved surgical technique, rapid diagnosis and triage, and careful patient selection. We hope that other tertiary centers will evaluate pulmonary embolism patients with an algorithm that includes surgical embolectomy as one of several therapeutic options. Our contemporary approach to pulmonary embolectomy no longer confines this operation to a treatment of last resort reserved for clinically desperate circumstances.
BACKGROUND - Small cell carcinoma of the esophagus is a rare disease with aggressive behavior and poor prognosis. Multidrug chemotherapy remains the treatment of choice given the systemic nature of the disease. Radiotherapy has been used concurrently with chemotherapy to enhance local control. The role of surgery in patients with limited disease is controversial. Limited data exist regarding the pathologic response of the tumor to chemoradiotherapy. The goal of the current study was to analyze the outcome of 8 patients treated at the M. D. Anderson Cancer Center, with particular focus on the histologic findings of the resected specimens.
METHODS - Patient records were reviewed for demographics, presenting symptoms, diagnostic modalities, disease stage, treatment, and outcome.
RESULTS - Two of eight patients had metastatic disease at the time of diagnosis and received combination chemotherapy. Six patients had limited stage disease. Four received combined modality treatment including esophagectomy, and two received radiotherapy only. All four patients who underwent esophagectomy had pure small cell carcinoma histology at diagnosis and received preoperative combination chemotherapy with or without radiotherapy. None of the four patients achieved a pathologic complete remission. Two patients had residual small cell carcinoma; one patient had squamous cell carcinoma and one adenocarcinoma. The median overall survival for the group of patients was 12.5 months (range, 5-57 months).
CONCLUSIONS - In selected patients with limited stage disease, surgery with curative intent should be considered as part of multimodality treatment.
Copyright 2000 American Cancer Society.
To investigate if decreased exposure to common childhood infections is associated with risk of childhood acute lymphoblastic leukaemia (ALL) we conducted a case-control study of 1842 newly diagnosed and immunophenotypically defined cases of ALL under age 15, and 1986 matched controls in the US. Data regarding day care, sibship size and common childhood infections were obtained through parental interviews. Data were analysed stratified by leukaemia lineage and separately for 'common' childhood ALL (age 2-5 years, CD19, CD10-positive). Neither attendance at day care nor time at day care was associated with risk of ALL overall or 'common' ALL. Ear infections during infancy were less common among cases, with odds ratios of 0.86, 0.83, 0.71 and 0.69 for 1, 2-4, 5+ episodes, and continuous infections respectively (trend P = 0.026). No effect of sibship size or birth interval was seen. With one exception (ear infections), these data do not support the hypothesis that a decrease in the occurrence of common childhood infection increases risk of ALL.
This is a multisite study examining the internal validity and comprehensiveness of the International Association for the Study of Pain (IASP) diagnostic criteria for Complex Regional Pain Syndrome (CRPS). A standardized sign/symptom checklist was used in patient evaluations to obtain data on CRPS-related signs and symptoms in a series of 123 patients meeting IASP criteria for CRPS. Principal components factor analysis (PCA) was used to detect statistical groupings of signs/symptoms (factors). CRPS signs and symptoms grouped together statistically in a manner somewhat different than in current IASP/CRPS criteria. As in current criteria, a separate pain/sensation criterion was supported. However, unlike in current criteria, PCA indicated that vasomotor symptoms form a factor distinct from a sudomotor/edema factor. Changes in range of motion, motor dysfunction, and trophic changes, which are not included in the IASP criteria, formed a distinct fourth factor. Scores on the pain/sensation factor correlated positively with pain duration (P<0. 001), but there was a negative correlation between the sudomotor/edema factor scores and pain duration (P<0.05). The motor/trophic factor predicted positive responses to sympathetic block (P<0.05). These results suggest that the internal validity of the IASP/CRPS criteria could be improved by separating vasomotor signs/symptoms (e.g. temperature and skin color asymmetry) from those reflecting sudomotor dysfunction (e.g. sweating changes) and edema. Results also indicate motor and trophic changes may be an important and distinct component of CRPS which is not currently incorporated in the IASP criteria. An experimental revision of CRPS diagnostic criteria for research purposes is proposed. Implications for diagnostic sensitivity and specificity are discussed.
The Bronx, a borough of New York City with 1.16 million people, has a distinctive pattern of prevalence and distribution of acquired immunodeficiency syndrome (AIDS), i.e., 62.2% of AIDS patients are intravenous drug users, 20.3% are female, 87.3% are black or Hispanic, and 4.5% are children under age 13 years. Local data on reported AIDS cases by risk factors, age, and sex are combined with local indices of the intravenous drug use population to estimate numbers of intravenous drug users. The Bronx is estimated to have 40,400 intravenous drug users (range, 28,080-52,800), 78% of whom fall into the age group 25-44 years. On the basis of local serosurveys, 45-55% are considered to be human immunodeficiency virus (HIV)-positive. With Bronx population census data as the denominator, minimum rates of HIV seroprevalence are calculated for all Bronx males and females aged 25-44 years, a group comprising 76% of the AIDS cases in the Bronx through February 1, 1987. These data produce a population seroprevalence range for those aged 25-44 years of 5.4-12.5% for all Bronx males and 1.4-3.3% for females. For the South Bronx, with 66% of all intravenous drug users and 38% of the population, these age-specific HIV prevalence estimates are 9.4-21.6% for males and 2.4-5.5% for females.