Circadian variation in incidence of cardioembolism

Cardioembolism is most likely to occur after waking in the morning. The identification of periods of high risk for cardioembolism may have important therapeutic implications, such as matching drug effects with vulnerability.     

Population health in programs of medical ecological screening

Effects of cAMP and cGMP dibutyryl derivatives (dbt), calcium ionophore A23187 and the protein kinase C activator PMA phorbol ester on mobility of human blood neutrophils were studied using the Magiskan 2A system of image processing. These drugs were added at concentrations, which allowed to produce similar inhibition of the cells mobility using a pattern of the middle velocity measurement in the cell population: dbt cAMP 5.10(-5)M, A23187 10(-6)M, PMA 10(-5)M; dbt cGMP 5.10(-6)M stimulated the neutrophil mobility. Differences in the patterns of mobility inhibition were detected by means of spectral characteristics related to alteration in the area of individual neutrophils. The drugs with inhibitory action (cAMP, A23187 and PMA) caused a decrease in the spectrum capacity of the area alteration as compared with normal state, while they affected dissimilarly the spectrum frequency characteristics. Dbt cAMP did not alter the frequency characteristics, A23187 shifted the spectrum towards a high frequency region and PMA--towards a low frequency range. Dbt cGMP did not alter the spectrum capacity but shifted it slightly to low frequency region. These alterations in the spectrum frequency characteristics are discussed considering the effect of secondary messengers on three types of the neutrophil movement which exhibit inherent frequencies.     

Age-specific incidence of cancer in Kingston and St. Andrew, Jamaica, 1988-1992

During the period 1988-1992, a total of 4,030 malignant neoplasms were recorded in Kingston and St. Andrew, Jamaica. These comprised 1,829 in males and 2,201 in females. Histological confirmation was obtained in 83.4%. The crude incidence rate for males was 128.5, and 136.2 for females. The age-standardized rates (ASR) were 179.9 for males and 166.1 for females. Age-specific rates by site, sex and age are tabulated. Attention is drawn to increased incidence for cancers of prostate, larynx, bronchus and non-Hodgkin's lymphoma in males. There was also an increase in female breast cancer (crude rate 36.0; ASR 47.1). Invasive cervix cancer has shown no significant change in incidence. Neoplasms of the body of the uterus have increased (crude rate 7.6; ASR 9.5). The rise in cancer of breast and body of uterus suggests that the influence of exogenous oestrogens should be considered.     

The geographic variation of cancer incidence in Ontario

OBJECTIVES: Our objectives were (1) to describe an analysis of the spatial pattern of cancer incidence in Ontario and (2) to discuss the quality of data in the Ontario Cancer Registry with respect to the accuracy of local cancer rates. METHODS: Cancer incidence rates were calculated for 22 cancer sites in 49 counties of Ontario during 1976 to 1986. Capture-recapture methods were used to estimate completeness of case registration, and completeness of residence information was also assessed. Spatial autocorrelation was used in measuring the geographic pattern of incidence rates. Comparisons were also made between sexes and with earlier data from 1966 to 1975. RESULTS: The quality of the geographic data in the registry appeared good, and corrections for incomplete or inaccurate registration had little impact. About one third of the sex-site combinations showed some evidence of spatial patterning in the cancer rate. Particularly strong regional variation was noted for cancers of the stomach, lung, uterus, and prostate. CONCLUSIONS: The analysis revealed a number of cancers with significant spatial patterning of risk. Further work is needed to relate the cancer data to other information on potential life-style and environmental factors.     

Seasonal variation in the incidence of Hodgkin's disease

Earlier literature suggested there may be a seasonal rhythm of onset of Hodgkin's disease. This issue has been re-examined using population-based prospectively-collected data with high ascertainment levels. The Data Collection Study (DCS) of the Leukaemia Research Fund (LRF) Centre for Clinical Epidemiology (University of Leeds) generated the information used, which was based on a population of 13.5 million--about one quarter of England and Wales--over 10 years. The RYE histopathological classification was employed. The findings show that in patients with nodular sclerosing histopathology there was a highly significant circannual rhythm with a low amplitude (extent of seasonal variation) and a peak in March. A significant, but different, rhythm with a high amplitude and a peak in August was found in lymphocyte predominant Hodgkin's disease. However, this finding is less certain, due to smaller numbers and a lower significance level. The main conclusion is that there is a highly significant seasonality in nodular sclerosing Hodgkin's disease. The findings provide further evidence that nodular sclerosing and lymphocyte predominant may be two different diseases. The differing seasonality rhythms may provide aetiological clues.     

New reliable biochemical marker for screening 21 alpha-hydroxylase deficiency without index person among hirsute women in agreement with HLA-haplotyping

Late onset congenital adrenal hyperplasia due to 21 alpha-hydroxylase deficiency (LO21OH def), as many other diseases, is the cause of hirsutism, menstrual disorders, infertility (PCO-like symptoms). We evaluated the reliability of a new biochemical marker for screening LO-21OH def in 47 women with PCO-like symptoms and 11 men, members of their families, comparing the results of separation using this new marker with those of HLA-haplotyping in 21 members of the patient population. All subjects were stimulated with 0.25 mg synthetic ACTH iv. Serum progesterone (P), 17-hydroxyprogesterone (17-OHP) and cortisol (F) at 0, 15, 30, 45 and 60 min following ACTH administration were determined and the new marker, namely the difference between 60min and 0min of the ratio F/17-OHP [delta F/17-OHP (60 min -0 min)] was calculated. According to the established biochemical criteria for the detection of LO-21OH def cases, (Gutai 30 min > or = 12 ng/dl/min and 17-OHP 60 min > or = 12 ng/ml for severe 21-OH def and Gutai 30 min < 6.5 ng/dl/min and 17-OHP 60 min < 5 ng/ml for "healthy" individuals regarding 21-OH def) two groups, A and B respectively, were separated from the patient population. In group A (n = 8), with LO-21OH def, the new marker showed negative values in all cases, while in group B (n = 9), without LO-21OH def, this marker was positive. The remaining subjects, depending on the results of the new marker were separated in 2 subgroups, Cneg (n = 28), with negative values, composed, consequently, of members with 21-OH def and Cpos (n = 13), with positive values, composed, consequently, of subjects with absence of LO-21OH def. HLA-typing was in agreement with the results of screening by the new marker, in 20 out of 21 cases, while there was only one false negative result. In conclusion, the proposed biochemical marker delta F/17-OHP (60 min-0 min) seems to be a reliable parameter for the LO-21OH def detection among young women with PCO-like symptoms as well as males suspected for congenital adrenal hyperplasia.     

Urban-rural variation in cancer incidence in Denmark 1943-1987

Urban and rural cancer incidence in Denmark in 1943-1987 was analysed. A consistent urban excess was found for all sites combined for individuals of each sex, irrespective of age at diagnosis. The capital:rural incidence ratio was 1.42 for men and 1.25 for women, and these ratios were not affected to any great extent using another definition of urban areas. Urban:rural ratios were highest for cancers of the respiratory, urinary and upper digestive tracts. The differences cannot be explained by tobacco and alcohol consumption alone. Other risk factors linked to urbanisation may contribute importantly to the "urban factor", and analytical studies of data at an individual level are required to establish their relative importance. Our findings contradict the generally accepted view that there is no urban-rural difference in cancer incidence in the relatively small, homogeneous population of Denmark.     

Synthesis and biochemical screening of phenylselenium-substituted steroid hormones

The syntheses of phenylselenium-substituted progesterone [21- (1) and 17 alpha-(phenylseleno)progesterone (2)] and testosterone [16 beta- (3) and 16 alpha-(phenylseleno)testosterone (4)] derivatives are described, along with data which help to establish the stereochemistry of the substituents in the testosterone molecules. Except for 21-(phenylseleno)-progesterone, the molecules exhibit greatly reduced receptor-binding capabilities.     

Rhegmatogenous retinal detachments. Seasonal variation and incidence

Seasonal variations in the relative incidence of rhegmatogenous retinal detachment were reported as a trend in several studies on the database of relatively limited cohort sizes. PATIENTS AND METHODS: An analysis on this topic was performed with a long-term database. A total of 3073 files of patients with rhegmatogenous retinal detachment, covering 11 years of observation, were reviewed for this study. Patients with signs of long-standing detachment or other predisposing diseases were excluded, so that a basic study population of 2314 patients remained for the analysis. RESULTS: The averaged seasonal incidence of rhegmatogenous detachments revealed a significant (P < 0.005) mid-summer peak (n in July = 228) and a winter trough (mean of December-January = 161; difference = 36%). Phase and curve fitting of the seasonal variations in the number of retina detachment cases was similar to the seasonal variation of the astronomic duration of the day (P < 0.001). The relation was closer compared to the average duration of light exposure per day calculated from behavioural data and the astronomic length of light phase (P < 0.0002). CONCLUSION: This long-time study revealed a close correlation of the relative seasonal incidence of retinal detachment and the seasonal variation of light hours per day. So far, this observations cannot be explained pathogenetically. Two basic hypotheses ought to be investigated further: (1) The influence of light on the generation of toxic oxygen radicals and the subsequent destruction of the vitreous and (2) possible light-induced changes in vitreoretinal adhesion.     

Mass screening programs for breast cancer in France. Comparative evaluation

OBJECTIVE: The purpose of this work was to comparatively assess the results of mass screening programs for breast cancer implemented in six French departments in 1986, within the scope of the National Fund for Health Prevention, Education and Information of the National Health Insurance Office of Salaried Workers. MATERIAL AND METHODS: The data collected by the screening centres were analyzed by ten assessment teams that were independent from the program promotion staff, all using the same evaluation form. A complementary population study performed in eight French districts then, allowed assessing the frequency of self-referred screening (mammography performed out of program). RESULTS: The rate of participation in screening programs, in relation to the invited population, ranged from 21 to 48%, according to the district (36% in average). This low participation was probably related to the extent of self-referred screening. In fact, 19 to 40% of women, according to the district, had previously had a screening mammographic coverage: rate was around 68% in women aged 50 to 69 years. Positive findings with mammography ranged from 4.5 to 15.8% (10.1% in average), while intervention rates ranged from 0.7 to 1.6% and detection rates from 3.8 to 6.2%. The ratio between benign tumors and cancers ranged from 0.7 to 2.1 according to the district. In order to enlighten the judgement on French results, we propose a comparison with the international standards in force. CONCLUSION: The various experiences with breast cancer screening in France show that this screening is technically feasible on the basis of existing medical structures. However, some criteria are still below the expected values, especially if compared with international standards. This result is probably accounted for by the high rate self-referred screening before age 40 in France. In these conditions, the question is whether extending breast cancer screening programs in France is an appropriate course of action.     

Variation in biochemical screening for Down''s syndrome in the United Kingdom

OBJECTIVE: To document the spontaneous resolution of retinal detachment developing after macular hole surgery. METHODS: We identified all patients who developed a postoperative retinal detachment after undergoing macular hole surgery at Washington University School of Medicine, St Louis, Mo; the surgery was performed by one of us (L.V.D.P. or H.J.K.) between 1991 and 1996. RESULTS: Six of 73 eyes developed a postoperative retinal detachment; the retinal detachment was inferior in all cases. Two eyes that had inferior retinal breaks underwent further surgery to repair the retinal detachment. Retinal breaks could not be identified in the other 4 eyes; the retinal detachment resolved without further surgery in all 4 of these eyes. CONCLUSION: The recognition that retinal detachment occurring after macular hole surgery can resolve without additional surgery may result in the avoidance of further surgical intervention in some eyes.     

Endoscopic screening for dysplasia and mucosal aneuploidy in adolescents and young adults with childhood onset colitis

OBJECTIVES: In adults, the premalignant nature of ulcerative colitis (UC) has long been accepted. Currently there is increasing concern that Crohn's disease (CD) may be equally premalignant. As a consequence, most adults with long-standing UC and many with chronic CD are enrolled in ongoing endoscopic cancer surveillance programs. In contrast, the risk of colonic cancer in adolescents and young adults with either form of colitis is less well recognized, and the need for dysplasia and cancer screening in this population has not been systematically evaluated. We therefore report the prospective results of colonoscopic cancer screening in such a young population. METHODS: Thirty-five adolescents and young adults with long-standing colitis (18 UC, 17 CD; 21 +/- 3 yr old, 11 +/- 3 yr colitis duration) underwent colonoscopic cancer screening. All had multiple biopsies for flow cytometry and light microscopy. RESULTS: Seven subjects had aneuploidy (3/18 UC, 4/17 CD). Of these seven, only two had dysplasia [one high grade (UC), one low grade (CD)]. One additional subject had indefinite dysplasia with normal flow cytometry. The remaining 27 subjects had both normal flow cytometry and light microscopy. Five of the seven aneuploid subjects underwent surgery within 1 yr of screening. Four, including both subjects with dysplasia, had no evidence of colon cancer at surgery. However, a 24-yr-old female with a 14-yr history of UC and no evidence of dysplasia or cancer at screening had a Dukes C adenocarcinoma. CONCLUSIONS: Adolescents and young adults with childhood onset UC or CD are at risk for aneuploidy, dysplasia, and colon cancer. Aneuploidy can be evident 10 yr after the onset of colitis and in patients as young as 16 yr of age. Therefore, the risk for colon cancer in patients with childhood onset colitis must be based on the duration of the illness, not on their chronological age. Incorporation of flow cytometry into an endoscopic screening protocol appears to enhance the ability to identify individuals at highest risk for colon cancer.     

Age-specific problems in rhythmic timing.

The authors investigated performance in 2 rhythm tasks in young (M?=?23.8 years) and older (M?=?71.4 years) amateur pianists to test whether slowing of a central clock can explain age-related changes in timing variability. Successive keystrokes in the rhythm tasks were separated by either identical (isochronous) time intervals or varying (anisochronous) intervals. Variability was comparable for young and older adults in the isochronous task; pronounced age effects were found for the anisochronous rhythm. Analyses of covariances between intervals rule out slowing of a central clock as an explanation of the findings, which instead support the distinction between target specification, timekeeper execution, and motor implementation proposed by the rhythm program hypothesis (D. Vorberg & A. M. Wing, 1996). Age stability was found at the level of motor implementation, but there were age-related deficits for processes related to target-duration specification. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hip fracture incidence among elderly Hispanics

OBJECTIVES: This study estimated hip fracture incidence for elderly Hispanics in the United States. METHODS: A cohort of Spanish-surnamed 1992 Medicare enrollees was followed for 2 years. Hip fractures were identified by inpatient diagnostic code. RESULTS: For Hispanic women, the national age-adjusted hip fracture rate was 7.3 per 1000 person-years; for men, the rate was 3.3. Rates varied markedly, with higher rates for the predominantly Mexican-American southwestern states than for Puerto Ricans. CONCLUSIONS: Nationally, the Hispanic population is at intermediate risk of hip fracture between Blacks and Whites, but geographic variation suggests that Mexican Americans are at higher risk than Puerto Ricans.     

Age-specific determinants of stunting in Filipino children

This study identifies age-specific factors related to new cases of stunting that develop in Filipino children from birth to 24 mo of age. Data come from nearly 3000 participants in the Cebu Longitudinal Health and Nutrition Survey, a community-based study conducted from 1983 to 1995. Length, morbidity, feeding and health-related data were collected bimonthly during home visits. Stunting (length >2 SD below the WHO age- and sex-specific medians) occurred in 69% of rural and 60% of urban children by 24 mo of age. We used a multivariate discrete time hazard model to estimate the likelihood of becoming stunted in each 2-mo interval. The likelihood of stunting was significantly increased by diarrhea, febrile respiratory infections, early supplemental feeding and low birth weight. The effect of birth weight was strongest in the first year. Breast-feeding, preventive health care and taller maternal stature significantly decreased the likelihood of stunting. Males were more likely to become stunted in the first year, whereas females were more likely to become stunted in the second year of life. Because stunting is strongly related to poor functional outcomes such as impaired intellectual development during childhood, and to short stature in adulthood, these results emphasize the need for prevention of growth retardation through promotion of prenatal care and breast-feeding, as well as control of infectious diseases.     

Determining worker preferences among employee benefit programs.

The paired comparison method was applied to measure the preferences of 1133 members of a trade union among a pay raise, a union shop proposal, a vacation plan, a shorter work week, hospital insurance, and a pension increase. Hospital insurance was most preferred while the shorter work week was least preferred. Differences in preference were markedly related to age and seniority, moderately related to physical-clerical job type, marital status, and number of dependent children. Preference for the pay raise was scarcely related to the demographic variables. The preference judgments were highly transitive and allow the 6 compensation options to be ranked in an ordinal scale. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Variation in incidence of indinavir-associated nephrolithiasis among HIV-positive patients

BACKGROUND: Nephrolithiasis may be an important consequence of indinavir therapy; however little has been published on the variation in incidence between different populations of patients or the possible mechanisms of calculus formation. OBJECTIVE: To examine variation in the incidence of indinavir-associated nephrolithiasis (IAN) in HIV-positive patients in relation to hemophilia and hepatitis C virus (HCV) infection. METHODS: Clinical data were abstracted retrospectively from the medical records of all adult patients treated with indinavir from September 1995 to September 1997. Occurrence of first IAN, defined as flank pain and hematuria after initiation of therapy, was analyzed in relation to hemophilia status and HCV infection. RESULTS: There were 17 episodes of IAN (22%) among 79 patients treated with indinavir. Of 10 patients with hemophilia, 50% developed IAN as compared with 17% of patients without hemophilia (P = 0.03). Median days to first IAN was 22 (range 7-110 days) for hemophiliacs and 156 (range 5-611 days) for those without hemophilia. Data for HCV status were available for 74 out of 79 patients: 10 out of 27 (37%) patients with HCV developed IAN compared with six out of 42 (14%) without HCV (P = 0.02). CONCLUSION: Overall incidence of IAN was higher than that previously reported and was significantly greater in hemophiliacs than in non-hemophiliacs. HCV may be a contributing factor.