OBJECTIVEThis meta-analysis reviews rates of progression of diabetic retinopathy to proliferative diabetic retinopathy (PDR) and/or severe visual loss (SVL) and temporal trends.RESEARCH DESIGN AND METHODSThis systematic literature review and meta-analysis of prospective studies assesses progression of retinopathy among diabetic patients without treatment for retinopathy at baseline. Studies published between 1975 to February 2008 were identified. Outcomes of interest were rates of progression to PDR and/or SVL. Pooled baseline characteristics and outcome measures were summarized using weighted averages of counts and means. Baseline characteristics and outcomes were compared between two periods: 1975–1985 and 1986–2008.RESULTSA total of 28 studies comprising 27,120 diabetic patients (mean age 49.8 years) were included. After 4 years, pooled incidence rates for PDR and SVL were 11.0 and 7.2%, respectively. Rates were lower among participants in 1986–2008 than in 1975–1985. After 10 years, similar patterns were observed. Participants in 1986–2008 studies had lower proportions of PDR and non-PDR at all time points than participants in 1975–1985 studies.CONCLUSIONSSince 1985, diabetic patients have lower rates of progression to PDR and SVL. These findings may reflect an increased awareness of retinopathy risk factors; earlier identification and initiation of care for patients with retinopathy; and improved medical management of glucose, blood pressure, and serum lipids. Differences in baseline characteristics, particularly in the prevalence and severity of retinopathy, could also have contributed to these temporal differences.

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Assessment of clinically meaningful change is useful for treatment planning, monitoring progress, and evaluating treatment response. Outcome studies often assess statistically significant change, which may not be clinically meaningful. Study objectives are to: (1) evaluate responsiveness of the BASIS-24 using three methods for determining clinically meaningful change: reliable change index (RCI), effect size (ES), and standard error of measurement (SEM); and (2) determine which method provides an estimate of clinically meaningful change most concordant with other change measures. BASIS-24 assessments were obtained at two time points for 1,397 inpatients and 850 outpatients. The proportion showing clinically meaningful change using each method was compared to the proportion showing change in global mental health, retrospectively reported change, and clinician-assessed change. BASIS-24 demonstrated responsiveness at both aggregate and individual levels. Regarding clinically meaningful improvement and decline, SEM was most concordant with all three outcome measures; regarding no change, RCI was most concordant with all three measures.

Increasing racial and ethnic diversity calls for mental health assessment instruments that are appropriate, reliable, and valid for the wide range of cultures that comprise the current US population. However, most assessment instruments have not been tested on diverse samples. This study assessed psychometric properties and sensitivity to change of the revised Behavior and Symptom Identification Scale (BASIS-24) among the three largest race/ethnicity groups in the USA: Whites, African-Americans, and Latinos. BASIS-24 assessments were obtained for 2436 inpatients and 2975 outpatients treated at one of 27 mental health and/or substance abuse programs. Confirmatory factor analysis and several psychometric tests supported the factor structure, reliability, concurrent validity, and sensitivity of the instrument within each race/ethnicity group, although discriminant validity may be weaker for African-Americans and Latinos than for Whites. Further research is needed to test and validate assessment instruments with other race/ethnicity groups.

Although the majority of participants were concordant for PTSD status, over 25% of EMR diagnoses differed from those obtained in the diagnostic interview, with varying proportions of false positives and false negatives. Overall, those individuals with the most and least severe symptom presentations in the diagnostic interview were more likely to be accurately classified.

Background BisGMA-based dental composites may release bisphenol A (BPA). Our purpose was to assess changes in urinary BPA concentrations over 6-months follow-up in children and adolescents receiving bisGMA-based restorations. Methods We collected urine and interviewed parents/guardians for BPA-related exposure information before and approximately one-day, 14-days, and 6-months post-treatment among 91 participants aged 3–17 years needing composite restorations. We used multivariable linear regression models to test associations between number of surface-restorations placed and changes in urinary BPA concentrations. Results Participants had on average 1.4 (sd=1.0) surfaces filled with composite at the first treatment visit and a cumulative 2.3 (sd=1.6) surfaces filled during the study. Mean change in BPA between pretreatment and next-day was 1.71 ng/mL (sd=9.94) overall and 0.87 (sd=5.98) after excluding one participant with 8 surfaces filled at the visit. Overall, a greater number of composite surface-restorations placed was associated with higher BPA in the next-day sample (posterior-occlusal eβ=1.47, 95% CI 1.18–1.83; P<0.001), but this was attenuated after restricting to the 88 participants with ≤4 fillings (eβ=1.19, 95% CI 0.86, 1.64), and no association was observed using 14-day (eβ=0.94, 95% CI 0.75–1.18) or 6- month (eβ=0.88, 95% CI 0.74–1.04) samples. Conclusions Placement of bisGMA-based restorations in children and adolescents may produce transient increases in urinary BPA concentration, which are no longer detectable approximately 14-days or 6-months post-treatment in urine samples. When few restorations are placed, increases in urinary BPA concentrations may not be detectable owing to high inter-individual variation in BPA exposure. Practical Implications These results suggest that leaching of BPA from newly placed composites ceases being detectable in urine within 2 weeks of restoration placement. The potential human health impact of such short-term exposure remains uncertain.

Background: Statins have demonstrated protection against aggressive/late-stage and/or lethal prostate cancer (PC), but prior studies are limited by small populations, short follow-up, and unequal health care access. Research has not demonstrated that non-statin lipid-lowering medications (NSLLM) provide a similar benefit, which would support a cholesterol-based mechanism. We sought to rigorously test the hypothesis that cholesterol-lowering drugs affect PC incidence and severity.

Disclosure: S.D.R., C.A.P., S.M.C., B.S., and G.R. are employees of United BioSource Corporation (UBC) performing contract work for Amgen. I.E.A. received financial compensation from UBC for statistical consulting and reviewing the manuscript. No potential conflicts of interest were reported by the planners, reviewers, or staff managers of this article. LEARNING OBJECTIVESAfter completing this course, the reader will be able to:1. Provide the current best estimates of hemoglobin response with erythropoiesis-stimulating proteins in anemia of MDS.2. Specify prognostic factors for response that are potentially useful.3. Describe the gaps in the existing evidence base regarding these agents in MDS.Access and take the CME test online and receive 1 AMA PRA Category 1 Credit ™ at CME.TheOncologist.com CME CME ABSTRACT Objective. The objective was to assess the efficacy and safety of erythropoiesis-stimulating proteins (ESPs) in anemia of myelodysplastic syndrome (MDS).Method. A systematic review and meta-analysis was conducted covering English-language studies published from 1980 to December 2005.Results. Fifty-nine studies qualified: five controlled trials (n ‫؍‬ 354), all epoetin versus control (EvC); 51 epoetin single-arm studies (n ‫؍‬ 1,650); and three darbepoetin single-arm studies (n ‫؍‬ 102). In the EvC studies, epoetin patients demonstrated a significant advantage over controls in terms of hemoglobin (Hb) response (odds ratio, 5.2; 95% confidence interval, 2.5-10.8). Hb response was 48.1% in single-arm darbepoetin studies, 32.1% in epoetin single-arm studies, and 27.3% in EvC studies. Major Hb response averaged 38.8% in darbepoetin studies, 24.5% in epoetin single-arm studies, and 11.4% in EvC studies. Stratified analyses suggest that lower baseline erythropoietin levels, longer treatment durations, and concurrent iron may be associated with greater Hb response to ESPs. None of the analyzable predictors of Hb response (gender, baseline Hb, ESP type, and ESP duration) were significant in meta-regression analyses. In the few studies with quality-of-life measures, ESP groups attained a pre-post change (Functional Assessment of Cancer Therapy -Fatigue) that exceeded minimum clinically important differences. Selected adverse event rates did not differ between the epoetin and darbepoetin groups.Conclusion. Published studies suggest that ESPs are efficacious in anemia of MDS. Hb response appears higher in darbepoetin patients than in epoetin patients, and safety appears comparable, but darbepoetin data are sparse, and there are as yet no direct comparison studies.