Journal of the International Academy of Periodontology, 2007
The goal of this cross-sectional study was to assess the correlation between periodontal conditio... more The goal of this cross-sectional study was to assess the correlation between periodontal conditions of pregnant women and characteristics of the infant at birth. One hundred thirteen pregnant patients received a thorough dental and periodontal examination and questionnaire. Probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), and calculus index (CI) were recorded. Patients were classified as to whether they had periodontitis (presence of 2 or more teeth with 1 or more sites experiencing CAL > or = 3 mm and PD > or = 4 mm at the same site), gingivitis (> or = 25% of sites with BOP), or healthy periodontium. Patients were followed to ascertain information on pregnancy-related complications, gestational age, and birth weight. Miscarriages and infants born as single births at < 37 weeks or weighing < 5.5 pounds were classified as preterm low birth weight (PT/LBW) infants. The periodontal…
Adjuvant hormonal therapy may be beneficial in patients who are treated with RRP and found to hav... more Adjuvant hormonal therapy may be beneficial in patients who are treated with RRP and found to have adverse pathological findings. We assessed the natural history of detectable PSA in such patients with particular emphasis on the prognostic usefulness of PSADT. We identified 903 patients treated with RRP and adjuvant hormonal therapy (started less than 90 days postoperatively) for prostate cancer at our institution between 1990 and 1999. PSADT was calculated by log linear regression in men with 2 or more PSA measurements available at least 90 days apart. CSS and sRFS were estimated by the Kaplan-Meier method and analyzed using Cox proportional hazard models. At a median followup of 9.1 years PSA had become detectable in 369 of 771 patients (47.9%) who achieved an undetectable nadir. PSADT evaluable in 463 patients was less than 12 months in 68 (14.6%) and more than 10 years in 283 (61.1%). N stage and Gleason score were significantly associated with sRFS and CSS. PSADT was a significant predictor of sRFS and CSS in N+ and N0 cases with a cancer death HR of 0.55 (95% CI 0.43 to 0.71) and 0.50 (95% CI 0.31 to 0.79), respectively. The association between PSADT and survival persisted after multivariate adjustment for preoperative PSA, specimen Gleason score and seminal vesicle invasion. This study demonstrates that many patients have slow progression despite increasing PSA following RRP and adjuvant hormonal therapy. Nodal status, cancer grade and PSADT are predictive of sRFS and CSS, and may be a useful means of selecting patients for future adjuvant therapy trials.
To determine how well patient-reported cardiovascular disease (CVD) and CVD risk factor informati... more To determine how well patient-reported cardiovascular disease (CVD) and CVD risk factor information agrees with medical record information. Information from Patient/Family History (PFH) questionnaires completed between 1996 and 1999 by residents of Olmsted County, Minnesota, aged 20 years and older was compared with information available through the Mayo Clinic medical diagnostic index. Positive and negative agreement values were calculated by comparing agreement between the 2 data sources. Also, with the Mayo Medical Index serving as the criterion standard, sensitivity, specificity, and positive and negative predictive values of questionnaire information were calculated overall and by subgroups of sex, age, and years of education. Questionnaire responses were retrieved for 26,162 patients. Positive agreement values ranged from 31% for report of a medical problem or surgery related to arteries to the head, arms, or legs or the aorta to 78% for high blood pressure. Negative agreement...
The primary objective of this study was to evaluate the prevalence of pathogenic intestinal paras... more The primary objective of this study was to evaluate the prevalence of pathogenic intestinal parasitic infection in primary refugees to Minnesota (MN). Secondary objectives were to determine the association of intestinal parasitic infection with gender, age and continent of origin. A retrospective study was conducted on the first refugee screening visits done between January 1, 1996 and December 31, 2001 on data from the Minnesota Department of Health. Of the 10,358 refugees with screening results, 1969 (19%) had pathogenic intestinal parasites. Parasites were more common in men (OR=1.3; p&amp;amp;amp;amp;amp;amp;amp;amp;lt;0.0001) and were less prevalent with increasing 10 year age intervals (OR=0.79; p&amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). Asians had the highest proportion of refugees with intestinal parasitic infection (33.6%; p&amp;amp;amp;amp;amp;amp;amp;amp;lt;0.0001). The most common pathogenic intestinal parasites were Trichuris trichiura (7.1%), Giardia lamblia (5.7%), Ascaris lumbricoides (2.1%), and hookworm (2.0%). In this study almost 20% of newly arrived refugees to the state of MN had evidence of intestinal parasitic infection. With very little organized access to health care following arrival of refugees to a new country, risk of transmission of infection, and persistence of infection, the first health visit should be used as a critical opportunity for the screening and treatment of high-risk patients. Future public health work should focus on enhanced screening and surveillance strategies, follow-up for ensuring adequate treatment completion and eradication of parasitosis, as well as research on cost effectiveness of screening versus predeparture anti-helminthic treatment.
We compared the positive surgical margin rate of 2.5x and 4.3x optical loupe magnification with a... more We compared the positive surgical margin rate of 2.5x and 4.3x optical loupe magnification with associated technical improvement during open radical retropubic prostatectomy. From January 2, 2004 to September 16, 2005, 511 consecutive patients underwent open radical retropubic prostatectomy, as performed by 1 surgeon. Because 10 patients refused authorization for a retrospective chart review, 501 were evaluable. For the first 265 patients 2.5x power loupes were used and for the subsequent 236 we used 4.3x power loupes. We used the chi-square test for univariate analysis, followed by multivariate logistic regression analysis adjusted for commonly recognized predictors of positive surgical margins in the 2 successive cohorts. Focusing on the apex, which was the most commonly reported site of positive surgical margins, we include operative video segments mimicking 4.3x magnification to demonstrate the surgical precision possible at 4.3x for managing the periurethral fascial bands of Walsh and urethral transection at the prostato-urethral junction. Positive surgical margins were identified in 39 of 265 patients (14.7%) at 2.5x and in 12 of 236 (5.1%) at 4.3x. Apical positive surgical margins were identified in 25 of 265 patients (9.4%) at 2.5x and in 5 of 236 (2.1%) at 4.3x. On multivariate analysis 4.3x magnification was independently associated with a 75% decrease in the odds of a positive surgical margin overall and in the apex alone (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001 and 0.003, respectively). This exploratory retrospective study suggests that, compared with 2.5x magnification, the use of 4.3x magnification with technical refinements that are not possible or deemed safe at 2.5x resulted in a substantial decrease in the positive surgical margin rate.
Adjuvant hormonal therapy may be beneficial in patients who are treated with RRP and found to hav... more Adjuvant hormonal therapy may be beneficial in patients who are treated with RRP and found to have adverse pathological findings. We assessed the natural history of detectable PSA in such patients with particular emphasis on the prognostic usefulness of PSADT. We identified 903 patients treated with RRP and adjuvant hormonal therapy (started less than 90 days postoperatively) for prostate cancer at our institution between 1990 and 1999. PSADT was calculated by log linear regression in men with 2 or more PSA measurements available at least 90 days apart. CSS and sRFS were estimated by the Kaplan-Meier method and analyzed using Cox proportional hazard models. At a median followup of 9.1 years PSA had become detectable in 369 of 771 patients (47.9%) who achieved an undetectable nadir. PSADT evaluable in 463 patients was less than 12 months in 68 (14.6%) and more than 10 years in 283 (61.1%). N stage and Gleason score were significantly associated with sRFS and CSS. PSADT was a significant predictor of sRFS and CSS in N+ and N0 cases with a cancer death HR of 0.55 (95% CI 0.43 to 0.71) and 0.50 (95% CI 0.31 to 0.79), respectively. The association between PSADT and survival persisted after multivariate adjustment for preoperative PSA, specimen Gleason score and seminal vesicle invasion. This study demonstrates that many patients have slow progression despite increasing PSA following RRP and adjuvant hormonal therapy. Nodal status, cancer grade and PSADT are predictive of sRFS and CSS, and may be a useful means of selecting patients for future adjuvant therapy trials.
We assessed the impact of the timing of androgen deprivation on disease progression after radical... more We assessed the impact of the timing of androgen deprivation on disease progression after radical prostatectomy for patients with localized prostate cancer. We evaluated all patients who underwent radical prostatectomy between 1990 and 1999. Patients with pathological lymph node negative disease who received androgen deprivation therapy were then separated into 5 groups for analysis based on the time of hormone therapy initiation: 1--adjuvant androgen deprivation, 2--androgen deprivation therapy started at a postoperative prostate specific antigen of 0.4 ng/ml or greater, 3--at prostate specific antigen 1.0 or greater, 4--at prostate specific antigen 2.0 or greater and 5--at systemic progression. The first 4 groups were matched by clinical and pathological features to control groups who did not receive androgen deprivation after surgery using a nested, matched cohort design. Median followup for the entire cohort was 10 years. Clinical end points included systemic progression-free survival and cancer specific survival. After matching clinicopathological variables adjuvant androgen deprivation therapy was associated with improved 10-year systemic progression-free survival (95% vs 90%, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001) and 10-year cancer specific survival (98% vs 95%, p = 0.009), although overall survival for these patients remained unchanged (84% vs 83%, p = 0.427). In contrast, we found that men who started hormonal therapy at a postoperative prostate specific antigen of 0.4 or greater, 1.0 or 2.0 did not have improved systemic progression-free or cancer specific survival. Adjuvant hormonal therapy modestly improves cancer specific survival and systemic progression-free survival after prostatectomy. The benefit of hormone therapy is lost when androgen deprivation is delivered at the time of prostate specific antigen recurrence or systemic progression.
Minnesota (MN) is home to one of the highest number of refugees in the United States. The primary... more Minnesota (MN) is home to one of the highest number of refugees in the United States. The primary objective of this study was to evaluate the prevalence of latent and active tuberculosis (TB) infection in primary refugee arrivals to MN. Secondary objectives were to determine the association of TB infection with gender, age, and ethnicity of the refugees. A retrospective study of primary refugee arrivals to MN between January 1, 1997, and December 31, 2001, was conducted. Chi-square tests and logistic regression analyses were used to assess the association of TB infection with gender, age, and ethnicity. Of the 9,842 refugees who had Mantoux test results, 4,990 (50.7%) had a positive test. A positive test was more common in men [odds ratio (OR) = 1.6; p &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001], in Africans (OR = 1.6, p = &amp;amp;amp;amp;amp;amp;amp;amp;lt;0.0001), and increased with 10-year age intervals (OR = 1.4; p &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). A total of 116 (0.8%) refugees received treatment for active TB. Active TB was more common in men (OR = 1.7; p = 0.006), African ethnicity (OR = 4.3; p &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001), and increased with 10-year age intervals (OR = 1.1; p = 0.05). Screening and treatment for latent and active TB should be actively managed among refugees resettling in the United States, as this is common and can have significant public health implications.
Journal of the International Academy of Periodontology, 2007
The goal of this cross-sectional study was to assess the correlation between periodontal conditio... more The goal of this cross-sectional study was to assess the correlation between periodontal conditions of pregnant women and characteristics of the infant at birth. One hundred thirteen pregnant patients received a thorough dental and periodontal examination and questionnaire. Probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), and calculus index (CI) were recorded. Patients were classified as to whether they had periodontitis (presence of 2 or more teeth with 1 or more sites experiencing CAL > or = 3 mm and PD > or = 4 mm at the same site), gingivitis (> or = 25% of sites with BOP), or healthy periodontium. Patients were followed to ascertain information on pregnancy-related complications, gestational age, and birth weight. Miscarriages and infants born as single births at < 37 weeks or weighing < 5.5 pounds were classified as preterm low birth weight (PT/LBW) infants. The periodontal…
Adjuvant hormonal therapy may be beneficial in patients who are treated with RRP and found to hav... more Adjuvant hormonal therapy may be beneficial in patients who are treated with RRP and found to have adverse pathological findings. We assessed the natural history of detectable PSA in such patients with particular emphasis on the prognostic usefulness of PSADT. We identified 903 patients treated with RRP and adjuvant hormonal therapy (started less than 90 days postoperatively) for prostate cancer at our institution between 1990 and 1999. PSADT was calculated by log linear regression in men with 2 or more PSA measurements available at least 90 days apart. CSS and sRFS were estimated by the Kaplan-Meier method and analyzed using Cox proportional hazard models. At a median followup of 9.1 years PSA had become detectable in 369 of 771 patients (47.9%) who achieved an undetectable nadir. PSADT evaluable in 463 patients was less than 12 months in 68 (14.6%) and more than 10 years in 283 (61.1%). N stage and Gleason score were significantly associated with sRFS and CSS. PSADT was a significant predictor of sRFS and CSS in N+ and N0 cases with a cancer death HR of 0.55 (95% CI 0.43 to 0.71) and 0.50 (95% CI 0.31 to 0.79), respectively. The association between PSADT and survival persisted after multivariate adjustment for preoperative PSA, specimen Gleason score and seminal vesicle invasion. This study demonstrates that many patients have slow progression despite increasing PSA following RRP and adjuvant hormonal therapy. Nodal status, cancer grade and PSADT are predictive of sRFS and CSS, and may be a useful means of selecting patients for future adjuvant therapy trials.
To determine how well patient-reported cardiovascular disease (CVD) and CVD risk factor informati... more To determine how well patient-reported cardiovascular disease (CVD) and CVD risk factor information agrees with medical record information. Information from Patient/Family History (PFH) questionnaires completed between 1996 and 1999 by residents of Olmsted County, Minnesota, aged 20 years and older was compared with information available through the Mayo Clinic medical diagnostic index. Positive and negative agreement values were calculated by comparing agreement between the 2 data sources. Also, with the Mayo Medical Index serving as the criterion standard, sensitivity, specificity, and positive and negative predictive values of questionnaire information were calculated overall and by subgroups of sex, age, and years of education. Questionnaire responses were retrieved for 26,162 patients. Positive agreement values ranged from 31% for report of a medical problem or surgery related to arteries to the head, arms, or legs or the aorta to 78% for high blood pressure. Negative agreement...
The primary objective of this study was to evaluate the prevalence of pathogenic intestinal paras... more The primary objective of this study was to evaluate the prevalence of pathogenic intestinal parasitic infection in primary refugees to Minnesota (MN). Secondary objectives were to determine the association of intestinal parasitic infection with gender, age and continent of origin. A retrospective study was conducted on the first refugee screening visits done between January 1, 1996 and December 31, 2001 on data from the Minnesota Department of Health. Of the 10,358 refugees with screening results, 1969 (19%) had pathogenic intestinal parasites. Parasites were more common in men (OR=1.3; p&amp;amp;amp;amp;amp;amp;amp;amp;lt;0.0001) and were less prevalent with increasing 10 year age intervals (OR=0.79; p&amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). Asians had the highest proportion of refugees with intestinal parasitic infection (33.6%; p&amp;amp;amp;amp;amp;amp;amp;amp;lt;0.0001). The most common pathogenic intestinal parasites were Trichuris trichiura (7.1%), Giardia lamblia (5.7%), Ascaris lumbricoides (2.1%), and hookworm (2.0%). In this study almost 20% of newly arrived refugees to the state of MN had evidence of intestinal parasitic infection. With very little organized access to health care following arrival of refugees to a new country, risk of transmission of infection, and persistence of infection, the first health visit should be used as a critical opportunity for the screening and treatment of high-risk patients. Future public health work should focus on enhanced screening and surveillance strategies, follow-up for ensuring adequate treatment completion and eradication of parasitosis, as well as research on cost effectiveness of screening versus predeparture anti-helminthic treatment.
We compared the positive surgical margin rate of 2.5x and 4.3x optical loupe magnification with a... more We compared the positive surgical margin rate of 2.5x and 4.3x optical loupe magnification with associated technical improvement during open radical retropubic prostatectomy. From January 2, 2004 to September 16, 2005, 511 consecutive patients underwent open radical retropubic prostatectomy, as performed by 1 surgeon. Because 10 patients refused authorization for a retrospective chart review, 501 were evaluable. For the first 265 patients 2.5x power loupes were used and for the subsequent 236 we used 4.3x power loupes. We used the chi-square test for univariate analysis, followed by multivariate logistic regression analysis adjusted for commonly recognized predictors of positive surgical margins in the 2 successive cohorts. Focusing on the apex, which was the most commonly reported site of positive surgical margins, we include operative video segments mimicking 4.3x magnification to demonstrate the surgical precision possible at 4.3x for managing the periurethral fascial bands of Walsh and urethral transection at the prostato-urethral junction. Positive surgical margins were identified in 39 of 265 patients (14.7%) at 2.5x and in 12 of 236 (5.1%) at 4.3x. Apical positive surgical margins were identified in 25 of 265 patients (9.4%) at 2.5x and in 5 of 236 (2.1%) at 4.3x. On multivariate analysis 4.3x magnification was independently associated with a 75% decrease in the odds of a positive surgical margin overall and in the apex alone (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001 and 0.003, respectively). This exploratory retrospective study suggests that, compared with 2.5x magnification, the use of 4.3x magnification with technical refinements that are not possible or deemed safe at 2.5x resulted in a substantial decrease in the positive surgical margin rate.
Adjuvant hormonal therapy may be beneficial in patients who are treated with RRP and found to hav... more Adjuvant hormonal therapy may be beneficial in patients who are treated with RRP and found to have adverse pathological findings. We assessed the natural history of detectable PSA in such patients with particular emphasis on the prognostic usefulness of PSADT. We identified 903 patients treated with RRP and adjuvant hormonal therapy (started less than 90 days postoperatively) for prostate cancer at our institution between 1990 and 1999. PSADT was calculated by log linear regression in men with 2 or more PSA measurements available at least 90 days apart. CSS and sRFS were estimated by the Kaplan-Meier method and analyzed using Cox proportional hazard models. At a median followup of 9.1 years PSA had become detectable in 369 of 771 patients (47.9%) who achieved an undetectable nadir. PSADT evaluable in 463 patients was less than 12 months in 68 (14.6%) and more than 10 years in 283 (61.1%). N stage and Gleason score were significantly associated with sRFS and CSS. PSADT was a significant predictor of sRFS and CSS in N+ and N0 cases with a cancer death HR of 0.55 (95% CI 0.43 to 0.71) and 0.50 (95% CI 0.31 to 0.79), respectively. The association between PSADT and survival persisted after multivariate adjustment for preoperative PSA, specimen Gleason score and seminal vesicle invasion. This study demonstrates that many patients have slow progression despite increasing PSA following RRP and adjuvant hormonal therapy. Nodal status, cancer grade and PSADT are predictive of sRFS and CSS, and may be a useful means of selecting patients for future adjuvant therapy trials.
We assessed the impact of the timing of androgen deprivation on disease progression after radical... more We assessed the impact of the timing of androgen deprivation on disease progression after radical prostatectomy for patients with localized prostate cancer. We evaluated all patients who underwent radical prostatectomy between 1990 and 1999. Patients with pathological lymph node negative disease who received androgen deprivation therapy were then separated into 5 groups for analysis based on the time of hormone therapy initiation: 1--adjuvant androgen deprivation, 2--androgen deprivation therapy started at a postoperative prostate specific antigen of 0.4 ng/ml or greater, 3--at prostate specific antigen 1.0 or greater, 4--at prostate specific antigen 2.0 or greater and 5--at systemic progression. The first 4 groups were matched by clinical and pathological features to control groups who did not receive androgen deprivation after surgery using a nested, matched cohort design. Median followup for the entire cohort was 10 years. Clinical end points included systemic progression-free survival and cancer specific survival. After matching clinicopathological variables adjuvant androgen deprivation therapy was associated with improved 10-year systemic progression-free survival (95% vs 90%, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001) and 10-year cancer specific survival (98% vs 95%, p = 0.009), although overall survival for these patients remained unchanged (84% vs 83%, p = 0.427). In contrast, we found that men who started hormonal therapy at a postoperative prostate specific antigen of 0.4 or greater, 1.0 or 2.0 did not have improved systemic progression-free or cancer specific survival. Adjuvant hormonal therapy modestly improves cancer specific survival and systemic progression-free survival after prostatectomy. The benefit of hormone therapy is lost when androgen deprivation is delivered at the time of prostate specific antigen recurrence or systemic progression.
Minnesota (MN) is home to one of the highest number of refugees in the United States. The primary... more Minnesota (MN) is home to one of the highest number of refugees in the United States. The primary objective of this study was to evaluate the prevalence of latent and active tuberculosis (TB) infection in primary refugee arrivals to MN. Secondary objectives were to determine the association of TB infection with gender, age, and ethnicity of the refugees. A retrospective study of primary refugee arrivals to MN between January 1, 1997, and December 31, 2001, was conducted. Chi-square tests and logistic regression analyses were used to assess the association of TB infection with gender, age, and ethnicity. Of the 9,842 refugees who had Mantoux test results, 4,990 (50.7%) had a positive test. A positive test was more common in men [odds ratio (OR) = 1.6; p &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001], in Africans (OR = 1.6, p = &amp;amp;amp;amp;amp;amp;amp;amp;lt;0.0001), and increased with 10-year age intervals (OR = 1.4; p &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). A total of 116 (0.8%) refugees received treatment for active TB. Active TB was more common in men (OR = 1.7; p = 0.006), African ethnicity (OR = 4.3; p &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001), and increased with 10-year age intervals (OR = 1.1; p = 0.05). Screening and treatment for latent and active TB should be actively managed among refugees resettling in the United States, as this is common and can have significant public health implications.
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