Showing papers by "Women's College, Kolkata published in 2008"

A susceptibility locus for lung cancer maps to nicotinic acetylcholine receptor subunit genes on 15q25

Abstract: Lung cancer is the most common cause of cancer death worldwide, with over one million cases annually. To identify genetic factors that modify disease risk, we conducted a genome-wide association study by analysing 317,139 single-nucleotide polymorphisms in 1,989 lung cancer cases and 2,625 controls from six central European countries. We identified a locus in chromosome region 15q25 that was strongly associated with lung cancer (P = 9 x 10(-10)). This locus was replicated in five separate lung cancer studies comprising an additional 2,513 lung cancer cases and 4,752 controls (P = 5 x 10(-20) overall), and it was found to account for 14% (attributable risk) of lung cancer cases. Statistically similar risks were observed irrespective of smoking status or propensity to smoke tobacco. The association region contains several genes, including three that encode nicotinic acetylcholine receptor subunits (CHRNA5, CHRNA3 and CHRNB4). Such subunits are expressed in neurons and other tissues, in particular alveolar epithelial cells, pulmonary neuroendocrine cells and lung cancer cell lines, and they bind to N'-nitrosonornicotine and potential lung carcinogens. A non-synonymous variant of CHRNA5 that induces an amino acid substitution (D398N) at a highly conserved site in the second intracellular loop of the protein is among the markers with the strongest disease associations. Our results provide compelling evidence of a locus at 15q25 predisposing to lung cancer, and reinforce interest in nicotinic acetylcholine receptors as potential disease candidates and chemopreventative targets.

Lung cancer susceptibility locus at 5p15.33

Abstract: We carried out a genome-wide association study of lung cancer (3,259 cases and 4,159 controls), followed by replication in 2,899 cases and 5,573 controls. Two uncorrelated disease markers at 5p15.33, rs402710 and rs2736100 were detected by the genome-wide data (P - 2 x 10(-7) and P = 4 x 10(-6)) and replicated by the independent study series (P = 7 x 10(-5) and P = 0.016). The susceptibility region contains two genes, TERT and CLPTM1L, suggesting that one or both may have a role in lung cancer etiology.

Inpatient Compared with Home-Based Rehabilitation Following Primary Unilateral Total Hip or Knee Replacement: A Randomized Controlled Trial

Abstract: Background: Home-based rehabilitation is increasingly utilized to reduce health-care costs; however, with a shorter hospital stay, the possibility arises for an increase in adverse clinical outcomes. We evaluated the effectiveness and cost of care of home-based compared with inpatient rehabilitation following primary total hip or knee joint replacement. Methods: We randomized 234 patients, using block randomization techniques, to either home-based or inpatient rehabilitation following total joint replacement. All patients followed standardized care pathways and were evaluated, with use of validated outcome measures (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC], Short Form-36, and patient satisfaction), prior to surgery and at three and twelve months following surgery. The primary outcome was the WOMAC function score at three months after surgery. Results: The mean length of stay (and standard deviation) in the acute care hospital was 6.3 ± 2.5 days for the group designated for inpatient rehabilitation prior to transfer to that facility compared with 7.0 ± 3.0 days for the home-based rehabilitation group prior to discharge home (p = 0.06). The mean length of stay in inpatient rehabilitation was 17.7 ± 8.6 days. The mean number of postoperative home-based rehabilitation visits was eight. The prevalence of postoperative complications up to twelve months postoperatively was similar in both groups, which each had a 2% rate of dislocation and a 3% rate of clinically important deep venous thrombosis. The prevalence of infection was 0% in the home-based group and 2% in the inpatient group. None of these differences was clinically important. Both groups showed substantial improvements at three and twelve months, with no significant differences between the groups with respect to WOMAC, Short Form-36, or patient satisfaction scores (p > 0.05). The total episode-of-care costs (in Canadian dollars) for the inpatient rehabilitation and home-based rehabilitation arms were $14,532 and $11,082, respectively (p < 0.01). Conclusions: Despite concerns about early hospital discharge, there was no difference in pain, functional outcomes, or patient satisfaction between the group that received home-based rehabilitation and the group that had inpatient rehabilitation. On the basis of our findings, we recommend the use of a home-based rehabilitation protocol following elective primary total hip or knee replacement as it is the more cost-effective strategy. Level of Evidence: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.

Similarity measure of soft sets

Abstract: Soft set, as a parametrized family of subsets of a crisp universal set, has more ability to handle uncertain information. In this paper, we propose two types of similarity measure between soft sets and made a comparative study of these two techniques. Also we have shown an application of this similarity measure of soft sets.

Predictors of Contralateral Prophylactic Mastectomy in Women With a BRCA1 or BRCA2 Mutation: The Hereditary Breast Cancer Clinical Study Group

Abstract: Purpose To evaluate the rate of prophylactic contralateral mastectomy in an international cohort of women with hereditary breast cancer and to evaluate the predictors of uptake of preventive surgery. Patients and Methods Women with a BRCA1 or BRCA2 mutation who had been diagnosed with unilateral breast cancer were followed prospectively for a minimum of 1.5 years. Information was collected on prophylactic surgery, tamoxifen use, and the occurrence of contralateral breast cancer. Results Nine hundred twenty-seven women were included in the study; of these, 253 women (27.3%) underwent a contralateral prophylactic mastectomy after the initial diagnosis of breast cancer. There were large differences in uptake of contralateral prophylactic mastectomy by country, ranging from 0% in Norway to 49.3% in the United States. Among women from North America, those who had a prophylactic contralateral mastectomy were significantly younger at breast cancer diagnosis (mean age, 39 years) than were those without preventive...

Can we define acne as a chronic disease? If so, how and when?

Abstract: There is widespread misunderstanding of acne amongst both the medical and lay community, who often perceive the condition to be a simple, self-limited affliction of adolescents. Because many think that the disease "will go away on its own," they do not feel an urgency to aggressively treat acne. However, very often the reality is that acne treatment can be quite difficult. Furthermore, acne can be a devastating disease for the patient, since it manifests on visible body parts and in children near puberty, who are vulnerable both socially and psychologically. Most typically, acne is not an acute disease but rather a condition that continuously changes in its distribution and severity. Usually, acne treatment is necessary for many months and sometimes years. Despite treatment, acne may cause scarring and associated negative psychological effects. It is important for both patients and physicians to be aware that very effective treatments are available. It is also important to realize that new studies have proven the benefit of maintenance therapy with topical retinoids; these agents can minimize the potential for relapse, which is part of the natural history of acne. This article reviews the evidence suggesting that acne is a chronic disease in at least a subset of individuals. The members of the Global Alliance to Improve Outcomes in Acne believe that acne should be recognized and investigated as a chronic disease. This will change expectations of clinical trial design and treatment and will highlight gaps in the knowledge of acne epidemiology. The result should be an improvement in patient outcomes.

Ectopic Notch Activation in Developing Podocytes Causes Glomerulosclerosis

Abstract: Genetic evidence supports an early role for Notch signaling in the fate of podocytes during glomerular development. Decreased expression of Notch transcriptional targets in developing podocytes after the determination of cell fate suggests that constitutive Notch signaling may oppose podocyte differentiation. This study determined the effects of constitutive Notch signaling on podocyte differentiation by ectopically expressing Notch's intracellular domain (NOTCH-IC), the biologically active, intracellular product of proteolytic cleavage of the Notch receptor, in developing podocytes of transgenic mice. Histologic and molecular analyses revealed normal glomerular morphology and expression of podocyte markers in newborn NOTCH-IC-expressing mice; however, mice developed severe proteinuria and showed evidence of progressive glomerulosclerosis at 2 wk after birth. Features of mature podocytes were lost: Foot processes were effaced; expression of Wt1, Nphs1, and Nphs2 was downregulated; cell-cycle re-entry was induced; and the expression of Pax2 was increased. In contrast, mice with podocyte-specific inactivation of Rbpsuh, which encodes a protein essential for canonical Notch signaling, seemed normal. In addition, the damaging effects of NOTCH-IC expression were prevented in transgenic mice after simultaneous conditional inactivation of Rbpsuh in murine podocytes. These results suggest that Notch signaling is dispensable during terminal differentiation of podocytes but that constitutive (or inappropriate) Notch signaling is deleterious, leading to glomerulosclerosis.

The employment of female nationals in the United Arab Emirates (UAE): An analysis of opportunities and barriers

Abstract: Purpose – The purpose of this paper is to evaluate the reasons why the employment of Emirati females in the United Arab Emirates (UAE) is not currently realizing its potential.Design/methodology/approach – A literature‐based study that employs a framework adapted to predict the incidence of the employment of female nationals in the UAE. This gives rise to an analysis of reasons why this employment is not achieving the predicted level.Findings – The study indicates that cultural factors are largely responsible for inhibiting the level of employment of Emirati females in the UAE.Research limitations/implications – This paper presents a focused literature study and does not contain the first‐hand accounts of Emirati females both employed and not employed. It does, however, provide the basis for obtaining such first‐hand accounts in future studies.Practical implications – The study indicates that in a rapidly developing economy such as that of the UAE, cultural mores may take some time to catch up with the sp...

Misreporting of dietary energy, protein, potassium and sodium in relation to body mass index in young Japanese women.

Abstract: Although under-reporting of dietary intake is more common in persons with a high body mass index (BMI), it is not well known whether or not misreporting is selective for different foods (and hence energy and nutrients), particularly in non-Western populations. We examined misreporting of dietary intake against biomarkers and its relation with BMI in young Japanese women. Cross-sectional study. A total of 353 female Japanese dietetic students aged 18–22 years (mean BMI: 21.4 kg/m2, mean fat intake: 29.8% of energy). Misreporting of dietary energy, protein, potassium and sodium (assessed by a self-administered diet history questionnaire) was examined against respective biomarkers (estimated energy expenditure and 24-h urinary excretion). Reporting accuracy was calculated as the ratio of reported intake to that estimated from corresponding biomarkers (complete accuracy: 1.00). Mean reporting accuracy of absolute intake (amount per day) varied considerably (0.86–1.14). Reporting accuracy of absolute intake decreased with increasing BMI (P for trend 0.15), indicating that BMI-dependent misreporting was canceled by energy adjustment. This was owing to positive correlation between the reporting accuracy of energy intake and that of absolute intake of the three nutrients (Pearson correlation coefficient: 0.49–0.67, P<0.0001). Although differential misreporting of absolute intake was associated with BMI, differential misreporting of energy-adjusted value was not. These findings support the use of energy-adjusted values in the investigation of diet–disease relationships among lean populations with a low-fat intake.

Soluble glypican 3 inhibits the growth of hepatocellular carcinoma

Abstract: 1516 Hepatocellular carcinoma (HCC) is the most common primary malignant tumor of the liver, and the third most common cause of cancer-related mortality. Currently, there are not effective treatments for HCCs that cannot be removed by surgery. Work from our laboratory and from other groups has demonstrated that glypican-3 (GPC3) is expressed by most HCCs (~ 75 %), while it is undetectable in hepatocytes from normal liver and benign liver disease. GPC3 is a member of the glypican family. Glypicans are heparan sulfate proteoglycans that are bound to the exocytoplasmic surface of the plasma membrane through a glycosyl-phosphatidylinositol anchor. Experimental evidence accumulated during the last few years indicates that glypicans regulate the activity of several signaling pathways, including those triggered by Wnts, Hedgehogs, BMPs and FGFs. This regulatory activity is based on the ability of glypicans to facilitate or inhibit the interaction of these ligands withtheir signaling receptors. Our laboratory has previously shown that GPC3 promotes the in vitro and in vivo growth of HCC cells by stimulating theWnt signaling pathway. Preliminary evidence suggests that GPC3 facilitates the interaction of Wnt with its receptor Frizzled. Because the growth stimulatory activity of GPC3 in HCC cells requires the attachment of GPC3 to the cell membrane, we havehypothesized that a mutated GPC3 lacking the GPI anchoring domain (soluble GPC3, sGPC3) will inhibit HCC growth. To investigate this hypothesis, Huh7, Li7 and Huh6 HCC cell lines were transduced with alentivirus containingsGPC3 or viruscontrol. We observed that sGPC3-expressing cells have a lower proliferation rate and form fewer colonies in agar than the controls. In addition, sGPC3 significantly inhibited the in vivo growth of HCC cells. Our results suggest that sGPC3 could be used as a therapeutic tool for HCC.

Transgenic induction of vascular endothelial growth factor-C is strongly angiogenic in mouse embryos but leads to persistent lymphatic hyperplasia in adult tissues.

Abstract: Vascular endothelial growth factor-C (VEGF-C) is the quintessential lymphangiogenic growth factor that is required for the development of the lymphatic system and is capable of stimulating lymphangiogenesis in adults by activating its receptor, VEGFR-3. Although VEGF-C is a major candidate molecule for the development of prolymphangiogenic therapy for defective lymphatic vessels in lymphedema, the stability of lymph vessels generated by exogenous VEGF-C administration is not currently known. We studied VEGF-C-stimulated lymphangiogenesis in inducible transgenic mouse models in which growth factor expression can be spatially and temporally controlled without side effects, such as inflammation. VEGF-C induction in adult mouse skin for 1 to 2 weeks caused robust lymphatic hyperplasia that persisted for at least 6 months. VEGF-C induced lymphangiogenesis in numerous tissues and organs when expressed in the vascular endothelium in either neonates or adult mice. Very few or no effects were observed in either blood vessels or collecting lymph vessels. Additionally, VEGF-C stimulated lymphangiogenesis in embryos after the onset of lymphatic vessel development. Strikingly, a strong angiogenic effect was observed after VEGF-C induction in vascular endothelium at any point before embryonic day 16.5. Our results indicate that blood vessels can undergo VEGF-C-induced angiogenesis even after down-regulation of VEGFR-3 in embryos; however, transient VEGF-C expression in adults can induce long-lasting lymphatic hyperplasia with no obvious side effects on the blood vasculature.

Impact of seasonal variation on HSP70 expression quantitated in stressed fish hepatocytes.

Abstract: Heat shock protein 70 (HSP70) is an effective molecular chaperone, playing a role in cell protection from damage in response to stress stimuli. Here, we report the impact of environmental stress on hepatocyte HSP70 expression in Mugil cephalus living in either a contaminated (Ennore) or uncontaminated (Kovalam) estuary over the course of two seasons. Oxidative and nitrative stress was determined along with quantification of HSP70 by enzyme-linked immunosorbent assay (ELISA) after electroelution from polyacrylamide gels. Fish from Ennore showed significantly higher levels of oxidative and nitrative stress and HSP70 expression than fish from Kovalam. Also, there was significant seasonal variation in all oxidative, nitrative stress marker levels and HSP70 expression which peaked during summer. These results provide direct evidence that HSP70 overexpression in fish hepatocytes under stress may aid cell survival by protecting against oxidative and nitrative stress-induced changes. In addition, seasonal variation may have a significant impact on HSP70 expression.

Verbal fluency, trail making, and Wisconsin Card Sorting Test performance following right frontal lobe tumor resection.

Abstract: Three commonly used clinical tests of frontal-executive function are verbal fluency, the Trail Making Test, and the Wisconsin Card Sorting Test, but few lesion studies of regional specificity within the frontal lobe (FL) exist for them. We examined 20 patients with right FL tumor resection, and mapped their damage to explore brain-behavior relations with greater precision. Across tests, the patients performed poorly and they also showed a deficit in switching but not clustering in verbal fluency. Within the right FL, however, we found none of the regional differences reported in studies of mixed-etiology FL patients, possibly due to the gradual neural reorganization that can occur with brain tumors. We discuss the importance of etiology in examining brain-behavior relations.

Individuals' experience of living with osteoarthritis of the knee and perceptions of total knee arthroplasty.

Abstract: This study investigated the physical and psychosocial consequences of living with osteoarthritis (OA) in daily life and peoples' views of total knee arthroplasty (TKA) and the role of physiotherapy. In-depth interview data were used from a prospective qualitative study conducted by the senior author (KY). Participants were 15 volunteers with knee OA who were awaiting TKA at a specialized orthopaedic tertiary care facility in Toronto. A modified grounded theory method approach was used to analyze the interview data. The findings showed that experiences for the participants with OA were conceptualized as a "breakpoint." The breakpoint was centred on the experiences/processes of living with unremitting pain, the limitations of mobility, leisure and social activities, and the resulting consequences to the participant's physical and psychological well-being. In addition to the above experiences, participants also discussed their perceptions of TKA surgery. The findings showed that expectations of TKA were linked to participants' knowledge of the procedure and its outcomes. The participants listed acquaintances, friends, family members, and doctors as the main sources of knowledge for TKA. On the basis of the above analysis, recommendations are made for developing a preoperative physiotherapy program that would focus on minimizing preoperative disability and maximizing postoperative recovery.

A new and stronger central sets theorem

Abstract: Furstenberg's original Central Sets Theorem applied to central subsets of N and finitely many specified sequences in Z. In this form it was already strong enough to derive some very strong combinatorial consequences, such as the fact that a central subset of N contains solutions to all partition regular systems of homogeneous equations. Subsequently the Central Sets Theorem was extended to apply to arbitrary semigroups and countably many specified sequences. In this paper we derive a new version of the Central Sets Theorem for arbitrary semigroups S which applies to all sequences in S at once. We show that the new version is strictly stronger than the original version applied to the semigroup (R,+). And we show that the noncommutative versions are strictly increasing in strength.

The 'Brain Drain' of physicians: historical antecedents to an ethical debate, c. 1960–79

Abstract: Many western industrialized countries are currently suffering from a crisis in health human resources, one that involves a debate over the recruitment and licensing of foreign-trained doctors and nurses. The intense public policy interest in foreign-trained medical personnel, however, is not new. During the 1960s, western countries revised their immigration policies to focus on highly-trained professionals. During the following decade, hundreds of thousands of health care practitioners migrated from poorer jurisdictions to western industrialized countries to solve what were then deemed to be national doctor and nursing 'shortages' in the developed world. Migration plummeted in the 1980s and 1990s only to re-emerge in the last decade as an important debate in global health care policy and ethics. This paper will examine the historical antecedents to this ethical debate. It will trace the early articulation of the idea of a 'brain drain', one that emerged from the loss of NHS doctors to other western jurisdictions in the 1950s and 1960s. Only over time did the discussion turn to the 'manpower' losses of 'third world countries', but the inability to track physician migration, amongst other variables, muted any concerted ethical debate. By contrast, the last decade's literature has witnessed a dramatically different ethical framework, informed by globalization, the rise of South Africa as a source donor country, and the ongoing catastrophe of the AIDS epidemic. Unlike the literature of the early 1970s, recent scholarship has focussed on a new framework of global ethics.

A Phase II trial evaluating the palliative benefit of second-line oral ibandronate in breast cancer patients with either a skeletal related event (SRE) or progressive bone metastases (BM) despite standard bisphosphonate (BP) therapy.

Abstract: Background Despite bisphosphonate treatment, most patients with metastatic breast cancer will have either progressive bone metastases or skeletal related events (SREs). We evaluated the impact of second-line ibandronate on pain control and markers of bone turnover in these patients.

Adenine Nucleotide Translocator Transports Haem Precursors into Mitochondria

Abstract: Haem is a prosthetic group for haem proteins, which play an essential role in oxygen transport, respiration, signal transduction, and detoxification. In haem biosynthesis, the haem precursor protoporphyrin IX (PP IX) must be accumulated into the mitochondrial matrix across the inner membrane, but its mechanism is largely unclear. Here we show that adenine nucleotide translocator (ANT), the inner membrane transporter, contributes to haem biosynthesis by facilitating mitochondrial accumulation of its precursors. We identified that haem and PP IX specifically bind to ANT. Mitochondrial uptake of PP IX was inhibited by ADP, a known substrate of ANT. Conversely, ADP uptake into mitochondria was competitively inhibited by haem and its precursors, suggesting that haem-related porphyrins are accumulated into mitochondria via ANT. Furthermore, disruption of the ANT genes in yeast resulted in a reduction of haem biosynthesis by blocking the translocation of haem precursors into the matrix. Our results represent a new model that ANT plays a crucial role in haem biosynthesis by facilitating accumulation of its precursors into the mitochondrial matrix.

Family history as a predictor of uptake of cancer preventive procedures by women with a BRCA1 or BRCA2 mutation.

Abstract: Women with a BRCA1 or BRCA2 mutation are at an elevated risk of developing breast and ovarian cancer; however, it is unclear to what extent family history influences the uptake of cancer prevention options. Women with a BRCA1/2 mutation completed a follow-up questionnaire that assessed uptake of cancer preventive options. The pedigree of each woman was reviewed, and information was recorded on cancers diagnosed in relatives. Five hundred and seventeen women were included in the study. Women with a sister with breast cancer were more likely to have a prophylactic mastectomy than those without a sister with breast cancer [odds ratios (OR) = 2.4, p = 0.003]. Uptake of prophylactic mastectomy was significantly lower in women with a mother with ovarian cancer compared with those whose mother did not have ovarian cancer (OR = 0.4, p = 0.01). Having a mother or sister with ovarian cancer significantly predicted the uptake of prophylactic oophorectomy (OR = 1.6, p = 0.04). Women with a BRCA2 mutation were less likely to have a prophylactic oophorectomy than those with a BRCA1 mutation (OR = 0.49, p = 0.0004). Among women with a BRCA1 or BRCA2 mutation, family history predicts the uptake of prophylactic mastectomy and prophylactic oophorectomy.

Prevalence of urinary incontinence in Korean women: results of a National Health Interview Survey.

Abstract: We determined the prevalence and types of urinary incontinence (UI) in Korean women and analyzed their attitude toward treatment. This national survey was conducted as part of the Korean National Health Interview Survey to evaluate the prevalence of UI in Korean women between April and June 2005. In 13,345 Korean households, 13,484 women aged 19 years or older were interviewed by census takers. The subjects were asked about the type of UI that they had experienced and their treatment. UI was classified as “stress,” “urge,” “mixed” (stress and urge), or “other.” The overall prevalence of UI in the subjects was 24.4%. Of those women, 48.8% reported stress UI only; 7.7%, urge UI only; 41.6%, mixed UI; and 1.9%, other type of UI. The prevalence of UI increased with age. Only 12.6% of the women with UI had sought medical care, and only 0.8% had undergone surgery for UI. Self-reported depression was higher in women with UI than in those without that disorder, and UI was more prevalent in women who were married, unemployed, and undereducated. According to national population data estimated by weighted UI numbers, about 4.2 million Korean women aged 19 years or older have experienced UI. The prevalence of UI among women aged 19 years or older in Korea was 24.4%, and stress UI was the most prevalent type. Many women with UI did not seek medical treatment for that condition.

Constitutional CHEK2 mutations are associated with a decreased risk of lung and laryngeal cancers

Abstract: Mutations in the CHEK2 gene have been associated with increased risks of breast, prostate and colon cancer. In contrast, a previous report suggests that individuals with the I157T missense variant of the CHEK2 gene might be at decreased risk of lung cancer and upper aero-digestive cancers. To confirm this hypothesis, we genotyped 895 cases of lung cancer, 430 cases of laryngeal cancer and 6391 controls from Poland for four founder alleles in the CHEK2 gene, each of which has been associated with an increased risk of cancer at several sites. The presence of a CHEK2 mutation was protective against both lung cancer [odds ratio (OR) = 0.3; 95% confidence interval (CI) 0.2-0.5; P = 3 x 10(-8)] and laryngeal cancer (OR = 0.6; 95% CI 0.3-0.99; P = 0.05). The basis of the protective effect is unknown, but may relate to the reduced viability of lung cancer cells with a CHEK2 mutation. Lung cancers frequently possess other defects in genes in the DNA damage response pathway (e.g. p53 mutations) and have a high level of genotoxic DNA damage induced by tobacco smoke. We speculate that lung cancer cells with impaired CHEK2 function undergo increased rates of cell death.

Early radiation exposures and BRCA1-associated breast cancer in young women from Poland.

Abstract: To study whether or not there is an adverse effect of early chest X-rays on breast cancer risk in breast cancer susceptibility gene 1 (BRCA1) carriers, we compared the histories of chest X-ray exposures before age 30 in 138 BRCA1 carriers with breast cancer with 158 age-matched women with breast cancer, but without a BRCA1 mutation. All cases were drawn from a national breast cancer research registry. Affected carriers reported more frequent chest X-ray use before age 20 than affected non-carriers (0.6 vs. 0.3; P = 0.01). Affected carriers had, on average, 1.8 chest X-rays before age 30 compared to an average of 1.0 for affected non-carriers (P = 0.002). The odds ratio for ever having had a chest X-ray below age 30, given a BRCA1 mutation, was 1.8 [95% confidence interval (CI) = 1.2-2.9; P = 0.01]. These observations support the hypothesis that early radiation exposure may be a risk factor for breast cancer in BRCA1 carriers.

Differences in the perceived impact of sleep deprivation among surgical and non-surgical residents.

Abstract: OBJECTIVE Resident work hour restrictions have been mandated in the USA largely out of concern that sleep deprivation compromises doctor performance and patient care. However, individuals ability to recognise the effects of sleep deprivation has not been studied in medical education. We examined the perceived impact of sleep deprivation among different groups of postgraduate medical trainees. METHODS A survey addressing work hours, sleepiness and daily functioning was mailed to all residents in the internal medicine, surgery and psychiatry programmes at the University of Toronto who were working at 6 different teaching hospitals. The mailing included the Epworth Sleepiness Scale (ESS), measuring acute sleepiness, and a new Sleep Deprivation Impact (SDI) scale, consisting of 12 items designed to measure the perceived impact of sleep deprivation on an individuals own performance. RESULTS Overall, 62.5% of surgery (95/152) and 59.5% of non-surgery residents (194/326) completed the survey. Surgery residents reported working longer hours per week (83.0 versus 62.5 hours; P < 0.01), and scored higher on the ESS (12.8 versus 9.2; P < 0.01) compared with other residents. Surgery residents scored significantly lower than others on the SDI scale (45.2 versus 51.5, P < 0.01), indicating less perceived impact of sleep deprivation on performance. CONCLUSIONS These results are consistent with the presence of an underlying culture within surgery in which individuals may be less willing to accept a natural limitation of individual performance. Whether these findings represent an actual resilience to sleep deprivation among surgery residents or a misperception within this group remains to be determined.