Management of otitis media in a high risk population

BACKGROUND: Rural and remote Aboriginal and Torres Strait Islander children have extremely high rates of otitis media and hearing loss. Despite considerable evidence, clinical practice continues to vary. This may be partly related to the failure of recent guidelines to be explicit about which factors should influence decision making. OBJECTIVE: To provide rural and remote GPs caring for young Aboriginal and Torres Strait Islander children with an evidence based guide to the principles that determine the clinical management of otitis media and hearing loss. DISCUSSION: While population health strategies are extremely important, the GP also needs to be able to advise families of affected children of the benefits and risks of the medical, surgical and audiological interventions available. The key to this process is the ability to distinguish between suppurative and non-suppurative disease, and a familiarity with the natural history and the likely hearing loss associated with different disease states in high risk populations.     

Determinants of plasma anti-oxidant vitamin levels in a population at high risk for stomach cancer

A high-performance liquid chromatographic method was developed for the determination of a new antiulcer agent, YJA-20379-2, in human plasma and urine. The sample preparation was simple: 2.5-volume of acetonitrile was added to the biological sample to deproteinize. A 50-microliter aliquot of the supernatant was injected onto a C18 reversed-phase column. The mobile phase employed was methanol-0.1M S?rensen phosphate buffer of pH 7.0-H2O (75:2:25, v/v/v), and was run at a flow-rate of 1.0 ml/min. The column effluent was monitored by ultraviolet detector at 295 nm. The retention time for YJA-20379-2 was approximately 7.0 min. The detection limits for YJA-20379-2 in human plasma and urine were both 100 ng/ml. The coefficients of variation of the assay (within-day and between-day) were generally low (below 9.16%) for both the human plasma and urine. No interference from endogenous substances was found.     

Dietary risk factors for colon cancer in a low-risk population

Spontaneous EEG was registered under different activity conditions in 26 volunteers. The EEG synchronisation parameters were compared with the geomagnetic and solar activity on the day of experiment. A positive correlation of the EEG data with the geomagnetic activity was revealed, being most obvious in the frontal and central areas. A negative correlation between some local EEG synchronisation parameters and different indices of the solar activity, was also revealed. The degree of synchronisation of the spontaneous EEG seems to reflect sensitivity of the human nervous system to the Earth's magnetic field. A stressor response to strong short-term disturbances in the geomagnetic field reveals itself in the form of enhancement of the EEG global synchronisation. A sedative effect of slow magnetic oscillations is locally revealed in the parameters of the EEG synchronisation within the left hemisphere as well as the interhemisphere synchronisation.     

An assay for selecting high risk population for gastric cancer by studying environmental factors

Gastric cancer mortality incidence data registered in two different areas of Eastern Transylvania (Roumania) were reported related to 325,000 inhabitants from the period of 1951-1972. The findings were compared to some geographical environmental factors deriving from an area of 13,300 km with 905,700 inhabitants. A 2-3.5 times larger incidence of gastric cancer (75-140 per 100,000/year) was found in some selected geographical areas of the intermontane depressions of Gheorgheni and Ciuc in comparison to hilly area of Transylvanian Tableland. The difference might be explained by some unknown environmental gastric cancer risk factors. Of the natural factors, the presence of magmatic substrata shows a significant degree of correlation. The main pedological factor seems to be badly drained pseudoglyied podzolic and peaty soils of low pH and high content of organic matter. Sofs drinking waters also may be involved as risk factor. High altitude, cold climate determining a restricted assortiment of cultivated plants, the successive production of vegetal and animal food on the same soil for livelong periods and several generations, especially in isolated rural areas, seem to represent gastric cancer risk factors. According to authors' opinion a survey of the high-risk population selected on the basis of the environmental factors, especially of the persons suffering from gastric disorders considered today possible precursors of gastric cancer, may offer some progress in detecting early gastric malignancy in the future.     

Prevalence of cardiovascular risk factors in the urban population of Soussa in Tunisia

BACKGROUND: With the epidemiological transition phenomenon, Tunisia is now facing the growing prevalence of chronic diseases. Environmental and behavioural changes such as the adoption of new dietary habits and a sedentary lifestyle, and the stress of urbanization and of working conditions all lead to the rise in cardiovascular disease (CVD) risk factors. METHODS: The aim of this study is to estimate the prevalence of the main CVD risk factors in an urban context. For this, we have undertaken a household epidemiological survey of a representative sample of the adult urban population of Soussa, Tunisia (n = 957). RESULTS: This study shows high prevalences of hypertension (blood pressure >160/95 mmHg) of 18.8 per cent with an adjusted rate of 15.6 per cent, history of diabetes of 10.2 per cent, and obesity (body mass index > 30) of 27.7 per cent [significantly higher in women (34.4 per cent)], android obesity 36 per cent, smoking habits 21.5 per cent [significantly higher in men (61.4 per cent)]. CONCLUSION: With this profile of CVD risk factors, Tunisia must implement a national strategy of primary prevention and heart health promotion in addition to the efforts recently made in secondary prevention of some chronic diseases such as hypertension and diabetes.     

The diagnosis of "pathological hyperglycaemia' in gestational diabetes in a high risk obstetric population

In order to define a level of "pathological hyperglycaemia', i.e. glucose intolerance that predicts perinatal morbidity among the obstetric population, 100 g glucose tolerance tests (GTTs) were performed in 660 patients attending for antenatal care at the University Hospital in Jeddah. The results were analysed in two ways: (1) patients were stratified according to the number of abnormal glucose values on the GTTs and (2) patients were placed into one of three groups according to the 100 g GTT diagnostic criteria, i.e. normal (non-GDM), abnormal with fasting blood glucose (FBG) > or = 5.8 mmol l-1 (GDM), and abnormal with FBG < 5.8 mmol l-1 (gestational induced hyperglycaemia, GIH). Although there was a stepwise association between fetal/maternal morbidity with increasing number of abnormal glucose values, no level of glucose intolerance could be defined as a threshold level for normal response. However, when stratified by FBG, GDM patients were significantly heavier (78.5 kg +/- SD 14.9), had a higher incidence of both macrosomia (27.5%) and operative delivery (25.3%) than the other two groups (14.7%, 14.3%, and 15.4%, 12.8% in the non-GDM and GIH, respectively). It is suggested that among patients with abnormal GTT results a FBG > or = 5.8 mmol l-1 identifies a threshold for true "pathological hyperglycaemia'.     

Cervical cancer

Several statistical methods are available for the analysis of responses with ordinal categories or continuous distributions for the respective visits in longitudinal studies. This paper discusses an alternative nonparametric strategy for studies with more than two groups through Mann-Whitney rank measures of association for all pairs of groups. The proposed method is based on U-statistic theory, and it applies a linear or linear logistic model to the Mann-Whitney estimators for the probabilities of better response for each group relative to each of the others. In addition, the ways of adjusting for covariables and managing stratification factors are explained. Analysis of parallel dose-response relationships for two treatments is illustrated for the proposed method with data from a multicenter study with repeated measurements. A nonparametric estimator for relative potency is provided from the method.     

Cervical cancer: a developmental perspective

Cervical cancer is a disease that affects women worldwide. In some countries it is the leading cause of death among women. Although the incidence of cervical cancer has decreased with the advent of the Papanicolaou smear, it remains a problem in adult women. Cervical dysplasia most often affects women in their 20s; carcinoma in situ affects women 30 to 39 years of age; and invasive carcinoma affects women older than 40 years. These age groups fall into the final three of Erickson's eight stages of ego development. However, taking a developmental approach in planning nursing interventions for women with cervical cancer has its drawbacks. Much of developmental theory research has been conducted on nonrepresentative samples, with women being underrepresented. A template for exploring patient problems from a life stage (developmental) perspective has been developed within the context of three different nursing diagnoses (sexual dysfunction, spiritual distress, and alteration in family processes).     

Tumor risk consultation for predisposed women from high risk cancer families

Germline mutations of the cancer susceptibility genes BRCA1 and BRCA2 seem to lead to a very high risk for breast and/or ovarian cancer. Therefore, genetic counselling and identification of high-risk families may be essential to offer the opportunity to participate in a specific early cancer detection program and to provide individualized psychological support. In a two year period (August 1994-August 1997) 304 consultees present for genetic counselling at the interdisciplinary cancer genetic clinic (Department of Obstetrics & Gynecology and Human Genetics, Heinrich-Heine-Universit?t, Düsseldorf). For genetic testing a BRCA1/2 mutation detection strategy including protein truncation test (PTT), single strand conformation polymorphism (SSCP), and direct DNA sequencing is used. 161 families fulfilled the inclusion criteria; at present, 72 families for whom complete analytical material is available are analyzed. Although genetic testing for BRCA1 and BRCA2 is technically challenging, women with a family history of multiple sporadic breast/ovarian cancers and those with a hereditary BRCA1 and BRCA2 gene defect may be distinguished. For the first group of consultees this may ease their concern, for the second group preventive measures including an early cancer detection or prevention program, psychological support or prophylactic surgery may be discussed.     

Genetic counseling for families at high cancer risk

About 5-10% of the most common cancers, such as breast, colon and melanoma, result from mutations in inherited predisposition genes. Recently some of these genes have been mapped or even cloned. These advances in cancer genetics have made more precise genetic counseling possible for cancer patients and their families. In our clinic for specific genetic counseling 180 families with a history of cancer were seen during a 10-month period. In counseling sessions, the family history was confirmed and interpreted, personal risk was estimated and the availability of molecular genetic testing was presented. Blood samples for DNA testing were drawn from those with certain criteria who wished to be tested. Instructions for early detection were also given, depending on the personal risk of cancer as compared to that of the general population.     

Asymptomatic gonorrhea: prevalence in a population of urban adolescents

During a 12-month period, 2,672 sexually active youths, 12 to 16 years of age, had genital bacteriologic cultures for Neisseria gonorrhoeae. Anterior urethral cultures were obtained from 2,098 males of whom 2,064 had no symptoms or signs of genitourinary disease. Forty cultures (1.9%) were positive for gonorrhea. Of 574 females, 374 were asymptomatic and 26 (7.0%) had positive gonorrhea cultures from the cervix. Since adolescent boys are more likely to be sexual adventurers, the 1.9% carrier rate represents an important reservoir of gonorrhea and equal in importance to that found in the asymptomatic adolescent girl.     

Reproductive characteristics of a population of urban Swiss women

OBJECTIVE: To describe the variability of reproductive life, from menarche to menopause, in the Geneva female population. DESIGN: Women's Health Survey, 1992-1993. SETTING: Mobile epidemiology unit of a University Hospital. SUBJECTS: One thousand and thirty-two women aged 30 to 74 years, resident in Geneva, Switzerland. MAIN OUTCOME MEASURE: Menstrual and reproductive history. RESULTS: A 'typical' woman of Geneva has her menarche at 13 years, regular 28 day cycles with 5 days of menstrual flow. She is 26 years old when she first gives birth and has her last baby (which is typically the second) at age 31. She has 37 years of potential fecundity and a natural menopause at age 50. In addition, 11% of the women have tried to be pregnant during two years without success, 67% have ever used oral contraceptives, 20% had a first birth at age 30 or more and 23% were nulliparous. Younger women reported earlier ages at menarche. Women with lower education tended to be a younger age at the birth of her first child. CONCLUSIONS: In this first study of the reproductive characteristics of women in Geneva, nulliparity and a late first birth appeared unusually frequent, especially when compared with American or Chinese women. The observed distributions of reproductive history are compatible with the very high incidence rate of breast cancer in the Geneva population.     

Use of trans-Sialidase inhibition assay in a population serologically negative for Trypanosoma cruzi but at a high risk of infection

The role of vasoactive mediators, such as endothelin-1, nitric oxide, prostacyclin, and thromboxane, in pulmonary hypertension remains undefined. This study investigated the circulating levels and transpulmonary gradients of these vasoactive mediators in patients with primary and secondary pulmonary hypertension to define whether there is increased production or decreased clearance of these substances in the lung vasculature.     

Sunscreen use in an urban Negev population

The use of sunscreen in the Negev population was assessed. The study population included 1458 subjects, mean age 35.5 +/- 14.2 years, half born in Israel and 25% in East Europe. Two-thirds were exposed to the sun 1-2 hours a day and 13% 4 hours a day or more. Only about 15% used sunscreen while shopping, 69% used it at the beach, and less than half applied it to children being sent to school. Sunscreen use was greater in women (p < 0.000001), especially those with sensitive skin (p < 0.0001) and red hair (p < 0.0001). No significant association was found with age, education or country of birth.     

Prevalence of cardiovascular risk factors in a French population

STUDY ON THE IDENTIFICATION OF CARDIOVASCULAR RISK FACTORS: Identification of cardiovascular risk factors and the estimation of their prevalence in different populations is an important aim of preventive medicine. We analysed the data from 58,803 volunteers who were subjected to systematic health examinations in the Centre d'Investigations Préventives et Cliniques in Paris during the period January 1991 to December 1993. In this report we present some results concerning the prevalence of the major cardiovascular risk factors and their associations with sex, age and the presence of hypertension. CONCLUSIONS: The present study clearly shows that before the age of 55 years, the prevalence of risk factors is higher in men than in women, whereas in postmenopausal women the risk-profile increases rapidly, reaching the level of men after the age of 65 years. The presence of multiple risk factors is much higher in hypertensive than in normotensive individuals. We also observed that more than two-thirds of the treated hypertensives had systolic/diastolic blood pressure levels of > 140/90 mmHg. These observations could contribute to the debate regarding the evaluation of global risk and therapeutic strategies in cardiovascular disease prevention.