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Berlin Brandenburg

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  • Wiley Online Library  (41)
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  • 1
    In: Journal of the Royal Statistical Society: Series A (Statistics in Society), October 2011, Vol.174(4), pp.975-989
    Description: Bacterium causes genital chlamydia infection. Yet little is known about the efficiency of transmission of this organism. Ethical constraint against exposing healthy subjects to infected partners precludes the possibility of quantifying the risk of transmission through controlled experiments. This research proposes an alternative strategy that relies on observational data. Specifically, we present a stochastic model that treats longitudinally observed states of infection in a group of young women as a Markov process. The model proposed explicitly accommodates the parameters of transmission, including per‐encounter sexually transmitted infection acquisition risks, with and without condom protection, and the probability of antibiotic treatment failure. The male‐to‐female transmission probability of is then estimated by combining the per‐encounter disease acquisition risk and the organism's prevalence in the male partner population. The model proposed is fitted in a Bayesian computational framework.
    Keywords: Bacterial Infection ; Binary Outcome ; Longitudinal Study ; Markov Chain Monte Carlo Methods ; Markov Model ; Observational Data ; Transmission Probability
    ISSN: 0964-1998
    E-ISSN: 1467-985X
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  • 2
    In: Perspectives on Sexual and Reproductive Health, March 2010, Vol.42(1), pp.43-48
    Description: CONTEXT: Adolescent pregnancy prevention is difficult because adolescent sex is intermittent. Understanding why sexually experienced adolescents have sex after a period of abstinence will help clinicians to tailor counseling. METHODS: For up to 4.5 years between 1999 and 2006, a sample of 354 adolescent women recruited at urban primary care clinics were interviewed and tested for STDs every three months, and were asked to complete three months of daily diaries twice a year. Survival analyses were used to estimate associations between intrapersonal, relationship and STD‐related characteristics and the risk of ending an abstinence period with sex. RESULTS: Participants reported 9,236 abstinence periods, which averaged 31 days. The risk that an abstinence period ended with sex increased steeply for periods of fewer than 17 days (short), rose less steeply for 17–39‐day (intermediate) periods and was fairly steady for longer periods. For short periods, the risk increased with age, sexual interest, positive mood, partner support, relationship quality and history of STD diagnosis more than three months ago (hazard ratios, 1.02–1.2); it decreased as negative mood increased (0.98) and was reduced among adolescents with a recent STD diagnosis (0.9). For intermediate periods, the association with a recent STD diagnosis became positive (1.4). For long periods, sex was associated only with age, sexual interest and relationship quality. CONCLUSIONS: To provide targeted and timely sexual health counseling, clinicians may want to ask adolescents not only whether they are sexually active but also when they last had sex.
    Keywords: Sexual Abstinence -- Research ; Teenage Sexual Behavior -- Research ; Sexual Intercourse -- Research;
    ISSN: 1538-6341
    E-ISSN: 1931-2393
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  • 3
    Language: English
    In: Arthritis & Rheumatism, November 2009, Vol.60(11), pp.3514-3515
    Keywords: Chondroitin Sulfates -- Therapeutic Use ; Glucosamine -- Therapeutic Use ; Osteoarthritis, Knee -- Drug Therapy;
    ISSN: 0004-3591
    E-ISSN: 1529-0131
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  • 4
    Language: English
    In: Arthritis & Rheumatism, May 2002, Vol.46(5), pp.1223-1227
    Description: OBJECTIVE: A suspected, but heretofore undemonstrated, limitation of the conventional weight-bearing anteroposterior (AP) knee radiograph, in which the joint is imaged in extension, for studies of progression of osteoarthritis (OA) is that changes in knee pain may affect extension, thereby altering the apparent thickness of the articular cartilage. The present study was undertaken to examine the effect of changes in knee pain of varying magnitudes on radiographic joint space width (JSW) in the weight-bearing extended and the semiflexed AP views, in which radioanatomic positioning of the knee was carefully standardized by fluoroscopy.METHODS: Fifteen patients with knee OA underwent a washout of their analgesic/nonsteroidal antiinflammatory drug (NSAID) agents (duration 5 half-lives), after which standing AP and semiflexed AP knee radiographs of both knees were obtained. Examinations were repeated 1-12 weeks later (median 4.5 weeks, mean 6.0 weeks), after resumption of analgesic/NSAID therapy. Knee pain was measured with the pain subscale of the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index (Likert scale). JSW was measured with a pair of calipers and a magnifying lens. Mixed model analyses of variance were used to test the significance of changes in pain and JSW within and between 2 groups of knees with mild-to-moderate radiographic severity of OA: (a) "flaring knees," in which the patient rated standing knee pain as severe or extreme after the washout and in which pain decreased to any degree after resumption of analgesics and/or NSAIDs (n = 12) and (b) "nonflaring knees," in which standing knee pain was absent, mild, or moderate after the washout or did not decrease after resumption of treatment (n = 15).RESULTS: After reinstitution of treatment, WOMAC pain scores decreased significantly in both flaring and nonflaring knees (-44%; P 〈 0.0001 and -18%; P 〈 0.01, respectively). After adjustment for the within-subject correlation between knees, mean JSW (+/-SEM) in the extended view of the flaring OA knee increased significantly from the first to second examination (0.20 +/- 0.06 mm; P = 0.005). In contrast, the change in adjusted mean JSW in the extended view of the nonflaring OA knee was negligible (-0.04 +/- 0.04 mm) and significantly smaller than that observed in flaring knees (P 〈 0.01). Mean JSW in the semiflexed AP view was unaffected by the severity or responsiveness of standing knee pain in flaring and nonflaring OA knees.CONCLUSION: JSW in weight-bearing extended-view radiographs of highly symptomatic OA knees can be altered significantly by changes in joint pain. In clinical trials and in epidemiologic studies of OA progression that use this radiographic technique, longitudinal variations in pain may confound changes in the apparent thickness of the articular cartilage.
    Keywords: Medicine;
    ISSN: 0004-3591
    E-ISSN: 1529-0131
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  • 5
    Language: English
    In: Arthritis & Rheumatism, October 2005, Vol.52(10), pp.3160-3167
    Description: To determine whether baseline or serial plasma concentrations of stromelysin (matrix metalloproteinase 3 [MMP-3]) protein might distinguish subjects with progressive radiographic knee osteoarthritis (OA) from those with stable disease. Subjects were 120 women with unilateral knee OA who participated in a 30-month randomized, placebo-controlled trial of structure modification with doxycycline. Anteroposterior views of both knees in a semiflexed position were obtained at baseline, 16 months, and 30 months. Subjects were selected to obtain comparisons of plasma MMP-3 levels between 60 progressors (21 taking doxycycline, 39 taking placebo) and 60 nonprogressors (30 taking doxycycline, 30 taking placebo) with respect to medial joint space narrowing (JSN) in the index knee. Each group consisted of 30 subjects who exhibited significant increases in knee pain. Blood samples were obtained semiannually for MMP-3 assay. Subjects in the placebo group whose MMP-3 concentration was in the upper tertile of the baseline distribution showed a 4-fold increase in the odds of progression of JSN as compared with the lower tertile (odds ratio 4.12, P = 0.037). Baseline MMP-3 levels were unrelated to knee pain. The within-subject mean of serial MMP-3 concentrations was associated with concurrent JSN in the placebo group over the 0-16-month interval (b = 0.18 mm/SD increase in the mean MMP-3, P 〈 0.01) and over the 16-30-month interval (b = 0.15, P 〈 0.05). Similar evidence of concurrent validity was found in the placebo group for the maximum of intercurrent MMP-3 values. The baseline MMP-3 level was a significant predictor of JSN in this pilot study. Moreover, serial plasma MMP-3 levels reflected concurrent JSN in the placebo group over the 30-month period of observation.
    Keywords: Knee Joint -- Pathology ; Matrix Metalloproteinase 3 -- Blood ; Osteoarthritis, Knee -- Blood;
    ISSN: 0004-3591
    E-ISSN: 1529-0131
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  • 6
    Language: English
    In: Arthritis & Rheumatism, December 1989, Vol.32(12), pp.1577-1583
    Description: After we assessed the functional status of 439 patients with osteoarthritis, we randomly assigned them to 1 of 3 intervention groups or to a control group. The interventions consisted of providing information, and differed only in the method of delivery: by phone, in person at the clinic, or both. Physical health improved ( = 0.02), pain was reduced ( = 0.02), and psychological health improved marginally ( = 0.10) in patients contacted by phone compared with those not contacted by phone. In those contacted only at the clinic, physical health worsened ( = 0.02), but neither pain ( = 0.80) nor psychological health ( = 0.90) differed from the values in patients not contacted at the clinic. We conclude that telephone contact is a useful intervention that can enhance the functional status of patients with osteoarthritis.
    Keywords: Medical Social Work -- Evaluation ; Osteoarthritis -- Care And Treatment ; Patients ; Information Services;
    ISSN: 0004-3591
    E-ISSN: 1529-0131
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  • 7
    Language: English
    In: Arthritis & Rheumatism, January 2002, Vol.46(1), pp.109-113
    ISSN: 0004-3591
    E-ISSN: 1529-0131
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  • 8
    Language: English
    In: Arthritis & Rheumatism, January 2002, Vol.46(1), pp.100-108
    Description: OBJECTIVETo evaluate the effectiveness of tidal irrigation (TI) in comparison with a well-matched sham irrigation (SI) procedure as a treatment for knee osteoarthritis (OA). METHODSOne hundred eighty subjects with knee OA were randomized to receive TI or SI, with clinical followup over the ensuing 12 months. The primary outcomes of interest were change in pain and function, as measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Subjects and the nurse assessor were blinded, and success of blinding was assessed. RESULTSAlthough the study groups were otherwise comparable, the baseline WOMAC pain and physical functioning scores were higher (worse) in the SI group. After adjustment for baseline, there were no differences between the effects of
    Keywords: Aged–Administration & Dosage ; Anti-Inflammatory Agents, Non-Steroidal–Adverse Effects ; Debridement–Methods ; Double-Blind Method–Diagnosis ; Female–Therapy ; Follow-Up Studies–Adverse Effects ; Gout–Methods ; Humans–Methods ; Male–Methods ; Middle Aged–Methods ; Osteoarthritis, Knee–Methods ; Pain Measurement–Methods ; Therapeutic Irrigation–Methods ; Treatment Failure–Methods ; Abridged ; Anti-Inflammatory Agents, Non-Steroidal;
    ISSN: 0004-3591
    E-ISSN: 1529-0131
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  • 9
    Language: English
    In: Arthritis & Rheumatism, August 2001, Vol.44(8), pp.1786-1794
    Description: OBJECTIVEPrevious studies of knee osteoarthritis (OA) have yielded variable estimates of the rate of joint space narrowing (JSN) in the standing anteroposterior (AP) radiograph, due largely to longitudinal changes in the alignment of the medial tibial plateau (MTP) and x-ray beam. To characterize this bias, we examined serial radiographs of subjects with knee OA in population-based and clinical OA cohorts from 3 locations in the United States and the United Kingdom. METHODSRadiographic features of knee OA (e.g., osteophytosis, JSN) and MTP alignment in 428 OA knees were evaluated by consensus of 2 readers. Alignment was considered satisfactory if the anterior and posterior margins of the MTP were superimposed within 1 mm. Readers were blinded to subject identity, and films were read in random order. The minimum medial joint space width was also measured manually (standard error of repeated measurements 0.20 mm) in serial knee images. RESULTSOnly 14% of serial radiographs exhibited alignment of the MTP in both images. In OA knees with satisfactory alignment in both images, the mean rate of JSN over 2-3 years (0.26 mm/year) was significantly larger (P = 0.004) than that in OA knees with misalignment in 1 or both radiographs and was 86% more rapid than the mean JSN in all OA knees. Moreover, the within-group standard deviation of JSN was significantly smaller among knees with reproduced alignment of the MTP than in knees in which misalignment occurred in 1 or both images (P = 0.006). CONCLUSIONPoor standardization of knee positioning in serial standing AP radiographs in previous studies of OA progression has obscured the rate and variability of articular cartilage loss in subjects with knee OA. True JSN (i.e., JSN that is not attributable to longitudinal changes in the alignment of the MTP with the x-ray beam in serial radiographic examinations) may occur more rapidly, and with less between-subject variability, than that previously thought to be characteristic of knee OA.
    Keywords: Aged–Diagnostic Imaging ; Cohort Studies–Diagnostic Imaging ; Diagnostic Errors–Pathology ; Disease Progression–Methods ; Female–Methods ; Humans–Methods ; Male–Methods ; Menisci, Tibial–Methods ; Osteoarthritis, Knee–Methods ; Radiography–Methods ; Abridged;
    ISSN: 0004-3591
    E-ISSN: 1529-0131
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  • 10
    In: Annals of the New York Academy of Sciences, December 1993, Vol.703(1), pp.86-95
    ISSN: 0077-8923
    E-ISSN: 1749-6632
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