Community occupational structure, medical and economic resources, and coronary mortality among U.S. blacks and whites, 1980-1988

Through cooperation between the German Contact Dermatitis Research Group (DKG) and the Information Network of Departments of Dermatology (IVDK), results of standardized patch tests performed by the participating centres are centrally recorded in Germany. For this study, data from 24 departments of dermatology (19678 patients) were evaluated retrospectively and separately for 1995 and 1996. With decreasing frequency, nickel, fragrance mix, balsam of peru, and thimerosal yielded positive reactions most often; surprisingly high numbers of positive reactions were also seen with amerchol L-101 and palladium. Differentiated lists of allergens were compiled for 1995, referring to subgroups of patients (defined by gender, age, localization of eczema, geographical region, occupation, sensitization) and particular problems. In men, percentages of positive reactions were markedly lower for nickel, fragrance mix and balsam of peru than in women. Younger patients reacted more often to thimerosal and older ones to topical medical preparations. Medical allergens were also often positive in patients with leg eczema, whereas occupational allergens were found more frequently in patients with hand eczema. A comparison of positive reactions obtained in distinct geographical regions was problematic because of differences between test populations. The spectrum of allergens found in office workers was similar to that of the whole test population. Patients with positive reactions to nickel and fragrance mix had more positive reactions to unrelated allergens than the total test population. Sex- and age-adjusted frequencies of sensitization revealed a decrease in reactions to nickel and an increase in reactions to mercury allergens from 1995 to 1996. The clinical relevance of mercury reactions was often not apparent. Differentiated lists of allergens can be used to improve the quality of diagnostic and prophylactic procedures in allergic contact dermatitis.     

The trends in histological types of lung cancer during 1980-1988, Guangzhou, China

In human neutrophils, the choline-containing phosphoglycerides contain almost equal amounts of alkylacyl- and diacyl-linked subclasses. In contrast to phosphatidylinositol hydrolysis which yields diacylglycerol, hydrolysis of choline-containing phosphoglycerides by phospholipase D coupled with phosphohydrolase yields both alkylacyl- and diacylglycerol. While diacylglycerol activates protein kinase C, alkylacylglycerol does not, and its role is unclear. Yet previous studies have shown that exogenous alkylacyl- and diacylglycerols can prime for the release of radiolabeled arachidonic acid (AA) in intact neutrophils stimulated by formyl-methionyl-leucyl-phenylalanine. We have now examined the effects of both diacylglycerol (1-oleoyl-2-acetylglycerol; OAG) and alkylacylglycerol (1-O-hexadecyl-2-acetylglycerol; EAG) on the activation of mitogen-activated protein (MAP) kinase and the 85-kDa cytosolic phospholipase A2 (cPLA2) in human neutrophils. We observed that while OAG could effectively activate p42 and p44 MAP kinases along with cPLA2 in a time- and concentration-dependent manner, EAG could not. A novel p40 MAP kinase isoform is also present and activated in response to OAG treatment; the behavior of this MAP kinase isoform is discussed. The activation of cPLA2 and MAP kinase by 20 microM OAG could be inhibited by pretreatment with 1 microM GF-109203X, a selective inhibitor of protein kinase C. Although only OAG activated cPLA2, both OAG and EAG primed for the release of AA mass as determined by gas chromatography/mass spectrometry. The priming of AA release by OAG may be explained by the phosphorylation of cPLA2 through the activation of protein kinase C linked to MAP kinase. However, priming by EAG appears to involve a separate mechanism that is dependent on a different PLA2. Our results support a role for phospholipase D-derived products modulating the activation of cPLA2, further supporting the idea of cross-talk among various phospholipases.     

Socioeconomic correlates of infant mortality in Hong Kong, 1979-93

Contractions change the configuration of the lesser curvature of the stomach while they indent the greater curvature. We studied these lesser curvature changes by measuring the position and angle of the gastric incisura on still frames captured from videotapes of isolated cat stomachs suspended in physiologic solution. In response to filling with 100 mL Krebs' solution stomachs generated a tonic contraction of the fundus/body segment and gave rise to a peristaltic contraction that spread from the body and through the antrum to the pylorus. In preparations where we left the duodenal cannula open we found that the incisura moves toward the gastro-oesophageal (GO) junction and the angle of the incisura widens as the contraction passes through the stomach and empties its contents. Furthermore, the angle of the incisura is most acute when the full stomach starts contracting in its fundic segment and again when the contraction involves the gastric sinus (the wedge-shaped segment adjacent to the incisura which forms the transition between the body and the antrum of the stomach). In preparations where the duodenal cannula was kept closed, the angle of the incisura becomes most acute when the contraction involves the gastric body and when the luminal pressure peaks. We conclude that changes in the position and angulation of the incisura are part of the mechanical response of the stomach to filling and emptying; unlike the peristaltic contraction along the greater curvature the net movement of the incisura goes in the orad direction. Movements of the incisura profoundly affect the configuration of the stomach and hence the distribution of luminal contents between various gastric segments. The gastric sling muscles are responsible for the formation of the gastric incisura but their role in any movements of the incisura remains to be defined.     

Socioeconomic inequalities in coronary heart disease and stroke mortality among Australian men, 1979-1993

BACKGROUND: During the 1970s in Australia, mortality from coronary heart disease (CHD) and stroke was higher among lower socioeconomic groups and inequalities were widening. This analysis examines subsequent trends in socioeconomic inequalities, with reference to socioeconomic patterns in major cardiovascular risk factors. METHODS: Socioeconomic status was defined by occupation. Age-standardized mortality rates were calculated for men aged 25-64, using death registration data and labour force estimates for 1979-1993. Risk factor data were taken from three cross-sectional population surveys conducted in 1980, 1983 and 1989. RESULTS: Men in manual occupations were at least 35 percent more likely to die from CHD than men in professional occupations and 60 percent more likely to die from stroke. Their 5-year population risk of a coronary event was 30 percent higher. Since 1979, both groups experienced reductions in coronary risk and mortality. CONCLUSIONS: Socioeconomic inequalities in CHD mortality continued to widen during the early 1980s, stabilized thereafter and persisted into the 1990s. Decreases in blood pressure and smoking prevalence contributed most to declines in coronary risk and to socioeconomic differentials.     

Trends in relative mortality from cerebrovascular diseases in Brazilian state capitals, 1950-1988

This article seeks to describe trends in relative mortality from cerebrovascular diseases (CVDs) in Brazilian state capitals from 1950 through 1988. Absolute numbers of deaths from all causes; from CVDs; and from ill-defined signs, symptoms, and afflictions were obtained from official Brazilian mortality statistics. In calculating relative CVD mortality, deaths from ill-defined signs, symptoms, and afflictions were excluded. The collected data permitted calculation of relative CVD mortality in most state capitals for 1950, 1955, 1960, 1961-1965, 1966-1970, 1971-1975, 1977-1980, 1981-1985, and 1986-1988. During the study period CVD mortality was found to play an increasing role in overall mortality in all the state capitals. Regional grouping of data showed greater relative CVD mortality in the South and Southwest Regions toward the start of the study period. However, over the course of this period the part that CVD mortality played in overall mortality grew most rapidly in the less-developed North, Northeast, and Center-West Regions. In general, relative CVD mortality data in nearly all the state capitals demonstrate the attention that needs to be devoted to CVDs within the context of adult public health. In particular, there is a clear need to greatly strengthen and improve the marginal existing programs for detection and control of hypertension and diabetes in Brazil. This should be done by assessing international experience with programs of this type and adapting that experience to Brazilian conditions. Beyond that, it will be important to support health promotion and protection efforts that can deal with risk factors and secure prevention through lifestyle modification--something that can provide benefits in dealing not only with CVDs but also with diabetes, obesity, and certain neoplasias.     

Socioeconomic aspects of the changed mortality rate of coronary disease in Switzerland 1988-1993

Mortality from ischemic heart disease (ICD 410-414) is changing. Remarkable decreases have been observed in the age groups from 35-64 years, while overall mortality (all age groups) has remained approximately stable. In Switzerland this has meant a gain of some 4700 life years in the period 1988 to 1993 in the working population (35-64 years). The object of this study was to assess the associated change in indirect costs (productivity losses) due to premature death, using the human capital approach. The indirect costs were CHF 519 million (CHF 7.5 million per 100,000 population) in 1993. This represents approximately half of all indirect costs (and 25% of the total costs generated by the disease). Compared with the year 1988, a decrease in productivity losses due to premature death was observed amounting to CHF 46 million (-11%) in constant Swiss francs. Society benefits from this decrease in indirect costs, a desirable development hardly ever mentioned.     

The evolution of mortality in the first year of life in Spain (1975-1988)

In recent years, the rate of decline in infant mortality and the proportional mortality by some causes of death in the first year of life have had important changes. The objectives of this study are to describe such changes, and to suggest hypotheses about their meaning. Infant, early neonatal, late neonatal and postneonatal mortality rates from 1975 to 1988 were calculated with information from the death register. Also, several indicators of the trends of those rates and proportional mortality by "certain conditions originating in the perinatal period" have been calculated. The reduction in infant mortality was due, mainly, to early neonatal mortality, which had an annual average decline of 4.6% during the study period. The proportional mortality and the mortality rate by perinatal conditions in the postneonatal period increased between 1975 and 1988. The first increased from 1.3% to 5.2%, and the second from 0.07 to 0.15 per 1000 live births. Hypotheses about the meaning of these results are suggested, and some actions are proposed in order to monitor and conduct research on mortality during the first year of life.     

Childhood cancer incidence and trends in Minnesota, 1988-1994

Childhood cancer incidence patterns for Minnesota, obtained from the Minnesota Cancer Surveillance System, were compared with national rates as well as with historic data from eight Minnesota counties. In total, 1,140 neoplasms were diagnosed in children (ages 0 to 14) between 1988 and 1994. Leukemias were the most common diagnosis for boys (30.3%) and girls (29.6%), followed by central nervous system tumors. The average annual age-adjusted incidence rates for all cancer sites were 167.2 and 136.2 per million for boys and girls, respectively. These rates were somewhat higher than national rates. In particular, the incidence rate for astrocytoma in boys was significantly elevated. Childhood cancer incidence, particularly brain tumors, has increased in the eight-county region from 1969 to 1994. This analysis demonstrated the Minnesota's childhood cancer incidence patterns are similar to national patterns.     

Sir George Newman, infant diarrhoeal mortality and the paradox of urbanism

This article describes what happened with the participants and the group as a whole in an analytical group psychotherapy session. Our aim is to reveal how the particular session was run. We describe a period of resistance to change when the principal defences used were: somatization, acting-out, identification-with-the-aggressor, and, more specifically, language abuse leading to confusion. We discuss the value of interpretations that are focused on the group as a whole, where the group is considered to be an internal object. Although this article is not exclusively about an object-relations model, we attempt to analyze the influence of projective identification, which has an effect on the therapist's task of recognizing his "container" and interpreting functions.     

Preventability of infant mortality in a rural community

Preventability of infant mortality in a rural southern county was examined with a Delphi technique using case summaries of infant deaths during a selected four-year period. The first two rounds were aimed at developing a consensus of panelists' opinions about problems leading to the high infant mortality rate in the study area. From these opinions, an Infant Mortality Preventability Decision Tree and a Problem List was developed. Panelists used these in Rounds III and IV to evaluate the case summaries. There were significant differences in the preventability ratings between physicians and nurses, indicating the importance of assessing individuals' philosophies of preventability when working with an interdisciplinary team of health care providers.     

Jurisdictional trends in opioid overdose deaths, 1988-96

Management factors in 36 Pacific Northwest dairy herds were evaluated for their association with the prevalence of Shiga toxin-positive Escherichia coli O157 (E. coli O157) in dairy cattle. The within-herd prevalence of E. coli O157 was estimated by bacteriological culture of fecal pat samples, collected monthly for 6 months (approximately 60 per visit), from heifer cattle. During the first visit to each farm, a management questionnaire was administered that covered a broad range of animal husbandry practices. On each subsequent visit, a brief questionnaire was administered to detect changes in management practices. A significantly higher prevalence of E. coli O157 was noted in herds that fed corn silage to heifers compared to herds that did not feed corn silage. More tentative associations of E. coli O157 prevalence were observed for weaning method, protein level of calf starter, feeding of ionophores in heifer rations, feeding of grain screens to heifers, and feeding of animal by-products to cows.     

Widening social inequalities in mortality: the case of Barcelona, a southern European city

OBJECTIVE: To analyse trends in mortality inequalities in Barcelona between 1983 and 1994 by comparing rates in those electoral wards with a low socioeconomic level and rates in the remaining wards. DESIGN: Mortality trends study. SETTING: The city of Barcelona (Spain). SUBJECTS: The study included all deaths among residents of the two groups of city wards. Details were obtained from death certificates. MAIN OUTCOME MEASURES: Age standardised mortality rates, age standardised rates of years of potential life lost, and age specific mortality rates in relation to cause of death, sex, and year were computed as well as the comparative mortality figure and the ratio of standardised rates of years of potential life lost. RESULTS: Rates of premature mortality increased from 5691.2 years of potential life lost per 100,000 inhabitants aged 1 to 70 years in 1983 to 7606.2 in 1994 in the low socioeconomic level wards, and from 3731.2 to 4236.9 in the other wards, showing an increase in inequalities over the 12 years, mostly due to AIDS and drug overdose as causes of death. Conversely, cerebrovascular disease showed a reduction in inequality over the same period. Overall mortality in the 15-44 age group widened the gap between both groups of wards. CONCLUSION: AIDS and drug overdose are emerging as the causes of death that are contributing to a substantial increase in social inequality in terms of premature mortality, an unreported observation in European urban areas.     

The recent decline in mortality from coronary heart disease, 1980-1990. The effect of secular trends in risk factors and treatment

OBJECTIVE: To examine whether secular trends in risk factor levels and improvements in treatment can account for the observed decline in coronary heart disease mortality in the United States from 1980 to 1990 and to analyze the proportional contribution of these changes. DATA SOURCES: Literature review, US statistics, health surveys, and ongoing clinical trials. STUDY SELECTION: Data representative of the US situation nationwide reported in adequate detail. DATA EXTRACTION: A computer-simulation state-transition model of the US population between the ages of 35 and 84 years was developed to forecast coronary mortality. The input variables were estimated such that the combination of values led to an adequate agreement with reported coronary mortality figures. Subsequently, secular trends were modeled. DATA SYNTHESIS: Actual coronary mortality in 1990 was 34% (127,000 deaths) lower than would be predicted if risk factor levels, case-fatality rates, and event rates in those with and without coronary disease remained the same as in 1980. When secular changes in these factors were included in the model, predicted coronary mortality in 1990 was within 3% (10,000 deaths) of the observed mortality and explained 92% of the decline; only 25% of the decline was explained by primary prevention, while 29% was explained by secondary reduction in risk factors in patients with coronary disease and 43% by other improvements in treatment in patients with coronary disease. CONCLUSIONS: These results suggest that primary and secondary risk factor reductions explain about 50% of the striking decline in coronary mortality in the United States between 1980 and 1990 but that more than 70% of the overall decline in mortality has occurred among patients with coronary disease.     

Nosocomial Legionnaires' disease in England and Wales, 1980-92

Two hundred and eighteen nosocomial cases of Legionnaires' disease with 68 deaths were reported to the National Surveillance Scheme for Legionnaires Disease between 1980 and 1992, representing 15% of the reported infections acquired in England and Wales. Twenty-two nosocomial outbreaks accounted for 135 (62%) of these cases, the remainder occurring as single cases either in hospitals where other single cases or outbreaks had been reported in different years or as 'sporadic' cases in hospitals from which no other cases were reported. A clinical history prior to onset of Legionnaires' disease was available for 124 patients, 61 of whom had undergone recent transplant therapy or were immunosuppressed for other reasons. Sixty cases (27%) were diagnosed by culture of the organism and isolates from 56 patients were typed; 25 (42%) were non L. pneumophila serogroup 1 infections. Methods for prevention and control of nosocomial outbreaks are discussed, in particular the susceptibility to Legionnaires' disease of certain groups of hospital patients.