Estimating hazard ratios in cohort data with missing disease information due to death

In clinical and epidemiological studies information on the primary outcome of interest, that is, the disease status, is usually collected at a limited number of follow‐up visits. The disease status can often only be retrieved retrospectively in individuals who are alive at follow‐up, but will be missing for those who died before. Right‐censoring the death cases at the last visit (ad‐hoc analysis) yields biased hazard ratio estimates of a potential risk factor, and the bias can be substantial and occur in either direction. In this work, we investigate three different approaches that use the same likelihood contributions derived from an illness‐death multistate model in order to more adequately estimate the hazard ratio by including the death cases into the analysis: a parametric approach, a penalized likelihood approach, and an imputation‐based approach. We investigate to which extent these approaches allow for an unbiased regression analysis by evaluating their performance in simulation studies and on a real data example. In doing so, we use the full cohort with complete illness‐death data as reference and artificially induce missing information due to death by setting discrete follow‐up visits. Compared to an ad‐hoc analysis, all considered approaches provide less biased or even unbiased results, depending on the situation studied. In the real data example, the parametric approach is seen to be too restrictive, whereas the imputation‐based approach could almost reconstruct the original event history information.     

Knowledge of prosthodontic treatment among denture-wearers and non-denture-wearers attending a dental institute in India: a survey report

Objective: Knowledge of subjects regarding prosthodontic treatment may play a role in their acceptance of the prostheses. The purpose of this survey was to assess the knowledge of prosthodontic treatment among the denture‐wearers and non‐denture‐wearers reporting to the Institute of Dental Sciences, Belgaum. Methods: A self‐designed closed‐ended questionnaire containing 14 questions was designed. Four‐hundred and nineteen subjects aged between 25 and 65 years were surveyed over a period of 2 months. Collected data were statistically analysed using chi‐squared test at a significance level of p < 0.05. Results: From the 419 subjects surveyed, 140 subjects (33.4%) were dentate and 279 subjects (66.6%) were edentulous either in the maxillary, mandibular or both arches. Among the 279 edentulous subjects, 143 (51.3%) did not use any kind of prosthesis. There was a statistically significant difference in knowledge regarding the replacement of teeth by artificial means, the number of visits required for the provision of a complete denture, problems with dentures among subjects using and not using them (p < 0.001) whereas no significant difference was found among the subjects regarding aesthetics with dentures and socializing with friends. Conclusion: Attempts should be made to raise the level of knowledge of both denture‐wearers and non‐denture‐wearers reporting to the Institute for any dental treatment.     

Prediction of recurrent disease by cytology and HPV testing after treatment of cervical intraepithelial neoplasia

Objective: To assess the role of human papillomavirus (HPV) testing and cytology as predictors of residual/recurrent disease after treatment of high‐grade cervical intraepithelial lesions. Methods: One hundred and thirty‐eight women with cervical intraepithelial neoplasia (CIN) grade 2/3 lesion on biopsy were included in a prospective follow‐up study in Belgium and Nicaragua. All women were treated with loop electrosurgical excision procedure (LEEP) and follow‐up visits took place at 6 weeks, 6 months, 1 year and 2 years. During these visits, a Papanicolaou (Pap) smear test was taken, colposcopy was performed and specimens were collected for HPV testing. Cytology, high‐risk (HR) HPV presence, persistent HR HPV infection and combinations of these tests at different time points during follow‐up were correlated with histologically confirmed residual/recurrent disease. Results: Thirteen patients (9%) developed residual/recurrent disease during follow‐up. Abnormal cytology at 6 weeks after treatment was significantly correlated with residual/recurrent disease. Nine of thirty‐seven patients with abnormal cytology at 6 weeks had recurrent disease versus three of seventy with a normal cytology [odds ratio (OR): 7.2; 95% confidence interval (CI): 1.8–28.5; P = 0.003). Sensitivity of this test was 75.0%, specificity 70.5%. Combining abnormal cytology and the presence of HR HPV within the first 6 months after treatment gave the best correlation with residual/recurrent disease: of the 54 women with abnormal cytology and/or HR HPV presence within the first 6 months, 11 developed residual/recurrent disease (OR 10.2; 95% CI: 2.2–48.3). Sensitivity of this combination was 84.6% and specificity 65.0%. Conclusion: Cytology remains the cornerstone in the early follow‐up after LEEP for CIN lesions of the cervix. HPV testing can add value as it increases the sensitivity of cytology in concomitant testing within the first 6 months.     

Popularity of less frequent follow up for breast cancer in randomised study: initial findings from the hotline study.

OBJECTIVE: To compare the experiences of patients with breast cancer who were conventionally monitored with those in whom routine follow up was restricted to the time of mammography. DESIGN: Randomisation to conventional schedule of clinic visits or to visits only after mammography. Both cohorts received identical mammography and were invited to telephone for immediate appointments if they detected symptoms. SETTING: Combined breast clinic, Chelsea and Westminster Hospital. SUBJECTS: 211 eligible outpatients with a history of breast cancer. MAIN OUTCOME MEASURES: Acceptability of randomisation, interim use of telephone and general practitioner, satisfaction with allocation to follow up. RESULTS: Of 211 eligible patients, 196 (93%) opted for randomisation in the study. Of these, 55 were under 50 years, 78 were diagnosed fewer than five years before, 90 had stage T2-4 tumours, and 71 had involved axillary nodes. Patients who did not participate were more likely to be under 50 years, to be two to five years after diagnosis, and to have had aggressive primary disease. Twice as many patients in both groups expressed a preference for reducing rather than increasing follow up. No increased use of local practitioner services or telephone triage was apparent in the cohort randomised to less frequent follow up by specialists. CONCLUSIONS: Reducing the frequency of routine follow up has so far proved popular among patients with breast cancer at standard risk in this cohort. A multicentre study is needed to determine the effectiveness and cost-effectiveness of routine follow up with respect to disease outcomes.     

Commentary: assessing the effects of environmental pollution when people know that they have been exposed.

OBJECTIVE: To examine the effectiveness of routine clinic review in detecting relapse after treatment for Hodgkin''s disease. DESIGN: Review of hospital records. SETTING: Regional centre for cancer treatment and research. SUBJECTS: 210 patients with Hodgkin''s disease recruited to a chemotherapy trial protocol between 1984 and the end of 1990 who had achieved a complete or partial remission after treatment. MAIN OUTCOME MEASURES: The number of clinic visits made by patients over the period of observation, the number of relapses occurring during that time, and the route by which relapse was detected. RESULTS: The 210 patients generated 2512 outpatient reviews, and 37 relapses were detected. Thirty relapses (81%) were diagnosed in patients who described symptoms, which in 15 cases had resulted in an earlier appointment being arranged. In only four cases (11%; 95% confidence interval 4% to 25%) was relapse detected as a result of routine physical examination on investigation of a patient who did not have symptoms. CONCLUSIONS: Relapse of Hodgkin''s disease after treatment is usually detected as a result of the investigation of symptoms rather than by routine screening of asymptomatic patients. It is therefore proposed that the frequency of routine follow up visits should be reduced and greater emphasis placed on patient education. This should underline the importance of symptoms and encourage patients to arrange an earlier appointment if these develop.     

Implant‐supported overdenture in an elderly patient with Huntington’s disease

doi:10.1111/j.1741‐2358.2009.00343.x
Implant‐supported overdenture in an elderly patient with Huntington’s disease Huntington’s disease is a hereditary, progressive, neuro‐degenerative disorder characterised by increasingly severe motor impairment, cognitive decline and behavioural manifestations leading to functional disability. Dyskinesia and hyperkinesia of the tongue and the peri‐oral musculature make it impossible for the patient to wear a conventional complete denture, despite an adequate alveolar ridge. The present paper reports on a patient with Huntington’s disease who was rehabilitated with a mandibular overdenture supported by two endosteal implants. One year follow‐up examination showed that the prosthesis was stable and there was considerable improvement in the patient’s masticatory function.     

Weight maintenance 2 years after participation in a weight loss program promoting low-energy density foods

Objective: Observational study designed to determine weight outcomes and associated dietary intake patterns for a sample of participants ≥1 year after completing the University of Alabama at Birmingham EatRight Weight Management Program. Research Methods and Procedures: Seventy‐four former participants (64% women) completed follow‐up visits ≥1 year after participating in EatRight, which promotes low‐energy density, high‐complex carbohydrate foods. Weight maintenance was defined as gaining <5% of body weight since completion of the EatRight program and staying below their program entry weight. Those who gained ≥5% of their body weight since completion were classified as gainers. Results: During EatRight, participants of the follow‐up study lost an average of 4.0 kg. After a mean follow‐up time of 2.2 years, the average weight change was +0.59 kg (mean BMI, 32.5 kg/m²). Seventy‐eight percent of participants gained <5% of their body weight; 46% had no weight regain or continued weight loss. Unadjusted mean intake for maintainers was 1608 kcal, whereas calorie intake for gainers was 1989 kcal. Despite eating slightly fewer calories (adjusted difference, 244; p = 0.058), maintainers ate a similar amount of food, resulting in a lower energy‐density pattern (p = 0.016) compared with those who regained ≥5% of body weight. Gainers also reported consuming larger portions of several food groups. Discussion: Our results indicate that low‐energy‐density eating habits are associated with long‐term weight maintenance. Those who maintain weight after the EatRight program consume a low‐energy‐density dietary pattern and smaller portions of food groups potentially high in energy density than those who regain weight.     

Responses of jawbone to pressure

Objective: To provide a literature review of bone resorption of edentulous jaws focusing on responses to pressure. Background: After the extraction of all teeth in a jaw there is a continuous reduction of the residual ridge. The individual variation of bone resorption is great, and the aetiology is complex and not yet well understood. Materials and methods: A search of the literature published up to May 2003 on bone resorption and pressure was performed using PubMed/Medline. Results: Animal studies have demonstrated that excessive and constant pressure induces bone resorption. Recent experimental research has indicated that bone resorption is a pressure‐regulated phenomenon with a lower threshold for continuous than for intermittent pressure. Clinical studies have suggested that residual ridge resorption is due more to the effects of denture wearing than to disuse atrophy. However, the results of leaving out dentures at night are not conclusive. Nor does the literature offer any strong evidence for the so‐called combination syndrome, which has been described as a result of unfavourable loading. Clinical studies using multivariate analyses indicate that female gender and systemic factors may be of greater importance than oral and denture factors. Implant‐supported prostheses have a bone preserving effect rather than the continuing resorption under complete dentures. Conclusions: The best way to reduce bone resorption is to avoid total extraction, preserve a few teeth and fabricate overdentures. In edentulous jaws, placement of implant‐supported prostheses will lead to less bone loss and may even promote bone growth. To increase our knowledge of residual ridge resorption extended experimental, clinical and statistical methods will be needed, preferably including collaboration between dental and medical researchers.     

Mutational reversions during adaptive protein evolution

Adaptation is often regarded as the sequential fixation of individually, intrinsically beneficial mutations. Contrary to this expectation, we find a surprisingly large number of evolutionary trajectories on which natural selection first favors a mutation, then favors its removal, and later still favors its ultimate restoration during the course of antibiotic resistance evolution. The existence of reversion trajectories implies that natural selection may not follow the most parsimonious path separating two alleles, even during adaptation. Altogether, this discovery highlights the unusual and potentially circuitous routes natural selection can follow during adaptation.     

Influence of body mass index on the choice of therapy for depression and follow‐up care

Objective: Overweight and obese patients commonly suffer from depression and choice of depression therapy may alter weight. We conducted a cohort study to investigate whether obesity is associated with treatment choices for depression; and whether obesity is associated with appropriate duration of depression treatment and receipt of follow‐up visits. Design and Methods: Adults with a diagnosis of depression between January 1, 2006 and March 31, 2010 who had 1+ new episodes of an antidepressant medication and/or psychotherapy were eligible. Medication use, encounters, diagnoses, height, and weight were collected from health plan databases. We modeled receipt of the different therapies (medication and psychotherapy) by BMI and BMI trajectory during the 9‐months prior to initiation of therapy using logistic regression models that accommodated correlation within provider and adjusted for covariates. We modeled BMI via a restricted cubic spline. Fluoxetine was the reference treatment option in the medication models. Results: Lower BMI was associated with greater use of mirtazapine, and a declining BMI prior to treatment was associated with greater odds of initiating mirtazapine and paroxetine. Higher BMI was associated with greater odds of initiating bupropion even after adjustment for smoking status. Obese patients were less likely to receive psychotherapy and less likely to receive appropriate duration (180‐days) of depression treatment compared to normal weight subjects. Conclusions: Our study provides evidence that BMI is considered when choosing therapy but associations were weak. Our results should prompt discussion about recommending and choosing depression treatment plans that optimize depression care and weight management concurrently. Differences in care and follow‐up by BMI warrant additional research.     

Outcome analysis of 4 years' follow-up of patients referred for colposcopy with one smear showing mild dyskaryosis

Objective: To assess the 4‐year outcome of patients after one smear showing mild dyskaryosis with respect to smear regression rate, prevalence of cervical intraepithelial neoplasia (CIN) and the effect of age. Methods: Retrospective analysis of patients diagnosed with initial mildly dyskaryotic smear during the year 2000 with a follow‐up period of 48 months. These women had not had any previous abnormal smears. Settings: Cytopathology Department and Colposcopy Unit, King’s College Hospital, London, UK. Results: We identified 524 patients of whom 375 patients with complete follow‐up data are included. The age range was 19–67 years with a median of 29 years. There were 207 patients aged 35 years or less (55%). At 6 months, 258 smears were performed and 47.8% of them were negative (95% CI: 41.6–54.0%). The total number of negative follow‐up smears in the first year was 198 out of a total of 397 smears performed (50%). This proportion has significantly increased between 1 and 4 years’ follow‐up to 67.5% (RR: 1.24; 95% CI: 1.14–1.35). Over the 4‐year period, 791 smears were performed and 477 were negative (60.3%; 95% CI: 56.9–63.7%). Of the 477 negative smears there were only 61 smears (12.8%; 95% CI: 10–16%), in 54 patients (14%; 95% CI: 11–18%) that reverted back to low‐grade cytological abnormality. In only one case the repeat smear showed high‐grade abnormality after initial negative follow‐up; however, on biopsy, histology showed CIN I. Out of the 375 patients, 70 required treatment with excisional biopsy (19%; 95% CI: 15.0–22.9%). Histology confirmed high‐grade CIN in only 41 cases giving a prevalence of 11% (95% CI: 8.1–14.5%). There were no cases of microinvasive or invasive cancer detected. Age (≤35 years versus >35 years) did not significantly affect either cytological or histological outcome. Conclusion: Sixty per cent of follow‐up smears after initial mild dyskaryosis subsequently became negative; of them 87.2% remained negative over the 4 year follow‐up. Treatment was only required in 19% of patients, with 11% prevalence of high‐grade CIN. Age did not affect the outcome. These results are reassuring and indicate that colposcopic referral may not be necessary after only one mildly dyskaryotic smear.     

A Prospective Study of the Effect of Childbearing on Weight Gain in African‐American Women

Objective: To prospectively assess the influence of bearing a first, second, or later child on weight gain among African‐American women in the context of other risk factors. Research Methods and Procedures: Data were obtained in a prospective follow‐up study of African‐American women from across the U.S. who are participants in the Black Women's Health Study. Postal questionnaires were used to collect baseline data in 1995 and follow‐up data in 1997 and 1999. Parous and nulliparous women (11, 196) (21 to 39 years old at baseline), of whom 1230 had a singleton birth during follow‐up, are the subjects of the present analyses. We assessed change in BMI (kilograms per meter squared) in relation to childbearing during 4 years of follow‐up, with use of multivariable linear regression to control for important risk factors. Results: During 4 years of follow‐up, the BMI of participants increased by an average of 1.6 kg/m², equivalent to a weight gain of ～4.4 kg. Women who had a child during follow‐up gained more weight than women who remained nulliparous, and those who had a first child gained more than those who had a second or later child. The weight gain associated with childbearing increased with increasing baseline BMI and was appreciable among heavier women. For example, among women with a baseline index of 36, the increase in BMI for women who bore a first child was 1.1 kg/m² more than that of nulliparous women, equivalent to a difference in weight gain of ～3.0 kg. Discussion: Childbearing is an important contributor to weight gain among African‐American women.     

Does Excess Pregnancy Weight Gain Constitute a Major Risk for Increasing Long‐term BMI?

Objective: The objective was to assess the relevance of the recommendations of the Institute of Medicine (IOM), regarding gestational weight gain (GWG) for long‐term BMI development. Research Methods and Procedures: The Stockholm Pregnancy and Women's Nutrition is a follow‐up study of 483 women who delivered children in 1984 to 1985. ANOVA was used to examine the change in body weight before pregnancy, at 6 months, and 1 year postpartum and 15 years after childbirth. Multiple linear regression was used to assess the predictors of BMI at 15‐year follow‐up. Results: The weight increase from baseline to 15‐year follow‐up was 6.2 kg for IOM‐insufficient, 6.7 kg for IOM‐recommended, and 10.0 kg for IOM‐excessive weight gain (p < 0.01). ANOVA showed a main effect of time, group and group by time interaction. The weight of the women who had excessive GWG was significantly greater at each time‐point of follow‐up than the weight of those who gained within or below recommendations. GWG was related to BMI at 15‐year follow‐up even after accounting for several confounders. Women who gained excessive weight during pregnancy had an increase of 0.72 kg/m² in long‐term BMI compared with women who gained within recommendations. Discussion: The findings support the adequateness of IOM guidelines, not only for the pregnancy‐related health matters, but also for preventing long‐term weight retention after delivery. Healthcare providers should give women appropriate advice for controlling GWG and motivate them to lose pregnancy‐related weight during postpartum to prevent future overweight.     

The role of abdominal CT scan as follow-up after complete remission with successful Helicobacter pylori eradication in patients with H. pylori-positive stage I(E1) gastric MALT lymphoma

Background: Eradication of Helicobacter pylori with antibiotics is the established initial treatment of patients with localized gastric mucosa‐associated lymphoid tissue (MALT) lymphoma. However, there are few reports on follow‐up modalities to identify sustained remission in patients who achieve complete remission (CR). We therefore investigated the role of abdominal computed tomography (CT) as follow‐up after CR with H. pylori eradication. Patients and Methods: We retrospectively analyzed 122 patients with H. pylori‐positive stage I_E1 gastric MALT lymphoma who achieved CR with successful H. pylori eradication. Results: The median follow‐up after CR was 35 months (range 3–140months). At a median of 17 months (range 12–21 months) after CR, 7 of 122 patients (5.7%) experienced lymphoma recurrence, all cases of which were confined to the gastric mucosa and were detectable only by endoscopy with multiple biopsies. At the time of recurrence, four of seven patients showed re‐infection by H. pylori. Eradication therapy was successful in these patients, resulting in both bacterial eradication and tumor regression. Three patients who experienced histologic recurrence without H. pylori re‐infection were observed by a watch and wait strategy and again achieved CR. Conclusions: None of the patients with H. pylori‐positive stage I_E1 gastric MALT lymphoma who experienced tumor recurrence after CR with successful H. pylori eradication showed recurrence at extragastric sites, including lymph nodes without gastric mucosal lesion. These findings indicate that endoscopic biopsies without abdominal CT scans are sufficient to detect recurrence in these patients.     

Investigation of factor affecting health‐related quality of life in head and neck cancer patients

doi: 10.1111/j.1741‐2358.2012.00662.x Investigation of factor affecting health‐related quality of life in head and neck cancer patients Objectives: Head and neck cancer (HNC) patients have profound illness of physical, social and psychological factors that affects quality of life (QOL). The purpose of this study is to investigate the factors affecting HRQL in patients with intra‐oral prostheses. Background: Some cross‐sectional studies have been performed to investigate HRQL in patients with HNC, but these studies did not report in detail how factors affect the HRQL of maxillectomy and mandibulectomy and/or glossectomy patients. Materials and Methods: The University of Washington Quality of Life version 4 questionnaires (Japanese version) was administered to 50 maxillectomy and 50 mandibulectomy and/or glossectomy patients with intra‐oral prostheses who were selected according to inclusion and exclusion criteria. Gathered data were statistically analyzed to investigate how a number of factors, namely, age, sex, pathologic diagnosis, neck dissection, resection size, radiotherapy and dental condition affect HRQL. Results: In the maxillectomy patients, there were no significant differences between malignant and benign tumor in pathological diagnosis or between dentate and edentulous in dental condition. Age, sex, neck dissection and radiotherapy affected HRQL. In the mandibulectomy and/or glossectomy patients, there was no significant difference between dentate and edentulous in dental condition. Age, sex, glossectomy, neck dissection and radiotherapy affected HRQL. Conclusions: The factors affecting HRQL in the maxillectomy patients were different from those in the mandibulectomy and/or glossectomy patients. Though they wore stable prostheses; we were still able to show that resection size, radiotherapy and neck dissection affected HRQL.     

Oral status and its association with obesity in Southern Brazilian older people

Background and objective: The loss of a functional dentition imposes eating difficulties and food avoidance, which may be detrimental in terms of nutritional status and health. The objective of this study was to investigate whether tooth loss and edentulism that were not rehabilitated with dental prostheses were associated with obesity among elderly in Southern Brazil. Materials and methods: A random sample of 872 independently living elderly was evaluated by means of a cross‐sectional study. Socio‐demographic, medical history and behaviour data were assessed using a standardised questionnaire. Two trained dentists assessed the number of teeth and use of prostheses in accordance with the WHO criteria. Height and weight were assessed and used to generate body mass index (BMI = weight (kilos)/height (cm)²) data. Participants were categorised into non‐obese (BMI ≤ 30) or obese (BMI > 30). Multivariate logistic regression was used to model the relationship between number of teeth and use of dental prostheses with obesity adjusting for confounders. Results: Multivariate logistic regression revealed that edentulous persons wearing only upper dentures (OR = 2.34, 95% CI 1.18–4.27) and dentate participants with one to eight teeth wearing 0‐to‐1 prosthesis (OR = 2.96, 95% CI 1.68–5.19) were more likely to be obese. Conclusion: The results show that a poorer oral status, represented by having fewer teeth that were not replaced by dental prostheses, was associated with obesity in Southern Brazil older people, suggesting a close relationship between poor oral status and systemic conditions that may have important clinical implications.     

Evaluation of satisfaction with masticatory efficiency of new conventional complete dentures in edentulous patients--a survey

doi: 10.1111/j.1741‐2358.2012.00634.x Evaluation of satisfaction with Masticatory efficiency of new conventional complete dentures in edentulous patients. A survey Background: Knowing how patients really feel after treatment is, very often, as relevant as the success rate of the conventional dentures and it can even be the measurement of masticatory function. Aim and objectives: This questionnaire survey aimed to analyse the satisfaction level and masticatory efficiency of patients treated with conventional complete dentures. Design and setting: Thirty edentulous patients were considered in the study. Satisfaction level and masticatory efficiency were analysed based on specific questionnaires for edentulous patients and by a likert rating scale from 0 to 5, at three moments: Prior to treatment (edentulous period), after the insertion of the new dentures and at 30–45 days follow‐up. Materials and methods: Thirty patients including 12 male and 18 female patients (mean age 65 years), who voluntarily came for the services. T‐test was applied at three different levels. Results: The rehabilitation with conventional complete dentures produced an improvement (p < 0.05) in satisfaction level and masticatory efficiency. Conclusion: Thus, those patients who were edentulous previously and dissatisfied with their masticatory ability showed improvement after receiving a new set of conventional complete dentures.     

Is the clinical course of HIV-1 changing? Cohort study.

OBJECTIVE: To assess whether the clinical course of HIV infection has changed from 1985 to 1995. DESIGN: Cohort Study. SETTING: Infectious disease clinic. SUBJECTS: 285 patients recruited from September 1985 to January 1995 with < or = 12 months between the dates of their last seronegative and first seropositive test result and with first follow up visit in the six months after seroconversion and at least 12 months'' follow up. Patients were grouped according to the date of seroconversion. MAIN OUTCOME MEASURES: Time to CD4 cell count of < 500, 400, and 200 x 10(6) cells/l, and clinical outcome defining AIDS; variation in cell count per day between consecutive visits, and ratio between this variation and time from estimated date of seroconversion at each visit. RESULTS: The groups were similar in age, number with acute primary HIV infection, CD4 cell count at intake, and cell count at the beginning of antiretroviral treatment; they differed in sex ratio, risk factors for HIV, probability of CD4 cell decline to < 500, 400, and 200 x 10(6) cells/l. and risk of developing AIDS. Acute infection, seroconversion after December 1989, and serum beta 2 microglobulin > 296 nmol/l were independent predictors of poor clinical course. The speed of CD4 cell decline, expressed as cell variation divided by the number of days between consecutive visits, increased with more recent seroconversion (P = 0.02). Ratio between the speed of CD4 cell decline and time from estimated date of seroconversion at each visit was also higher in the patients who seroconverted after December 1989. CONCLUSIONS: The faster disease progression and the higher speed of CD4 cell decline at early stages in the patients with recently acquired HIV infection suggest changes in the clinical course of HIV infection.     

Cognitive behavioral therapy and fluoxetine for binge eating disorder: two-year follow-up

Objective: This study assessed the long‐term effects of group behavioral treatment plus individual cognitive behavioral therapy (CBT) and/or fluoxetine in binge eating disorder (BED) patients. Research Methods and Procedures: A total of 116 individuals were randomized to an initial five‐month trial and were followed up over two years. Assessments, including binge frequency, weight, and self‐report measures, were administered at pre‐treatment, post‐treatment, and ～6, 12, 18, and 24 months after initial treatment. Results: Across treatment groups, there was overall improvement over 29 months in binge frequency and in binge abstinence. The odds of binge abstinence 2 years post‐treatment were 1.373 times the odds of binge abstinence immediately post‐treatment. There was no significant change in weight over the two‐year period. Subjects who received individual CBT evidenced lower binge frequency over the two‐year follow‐up period than patients who had not received individual CBT. Similarly, CBT was associated with increased rates of binge abstinence. There were no main effects of treatment assignment on weight over the two‐year follow‐up period. There was a significant advantage for fluoxetine assignment over the two‐year follow‐up period on depressive symptoms. Discussion: The major significance of the study rests in its examination of the long‐term effects of standardized interventions for BED. Our findings provide support for the ideas that short‐term treatment may confer long‐term benefit and that not all treatments are equivalent in the benefits they confer.     

Rehabilitation with ear prosthesis linked to osseointegrated implants

doi: 10.1111/j.1741‐2358.2011.00612.x Rehabilitation with ear prosthesis linked to osseointegrated implants Background: The absence of an ear, which can be the result of a congenital malformation, surgical tumour resection or traumatic injury, is a significant aesthetic problem. Attachment of ear prostheses with adhesives can cause local irritation for the wearer and affect the colour of the prostheses. Use of implants in craniofacial reconstruction can improve the retention and stability of prostheses giving to patient greater comfort and security relative to adhesive attachment. Objective: The aim of this report was to present a clinical case of a mutilated patient who was rehabilitated by means of installing an ear prosthesis fixed through osseointegrated implants. Materials and methods: The patient had two implants installed in the mastoid region that were linked by a bar, and a clip‐type system was used. The ear prosthesis was constructed from medical‐use silicone, pigmented to match the patient’s skin colour and linked to the retention system. Conclusion: The patient’s rehabilitation was satisfactory from both a functional and an aesthetic point of view, making it possible for the patient to return to a normal social life and regain lost self‐esteem.