Nephrectomy: changing indications, 1960-1990

OBJECTIVE: To review the indications for nephrectomy over the period 1960-1990. PATIENTS AND METHODS: A total of 1470 nephrectomies were performed (excluding transplant-related nephrectomies) over this period. Data were collected by means of a pathology report review and the indications were classified according to aetiology. RESULTS: The total number of nephrectomies performed has not significantly changed over this 31-year period. There was a significant decrease in the number of partial nephrectomies performed and an increase in the number of nephrectomies performed for tumour. This change was equally distributed between both renal adenocarcinomas and transitional cell tumours. The number of nephrectomies for chronic pyelonephritis decreased over this period. The change seen was not as great as might have been anticipated in view of the advent of modern antibiotics. Nephrectomies performed for tuberculosis decreased, although this change was not established until the 1980s. In the 1960s and early 1970s, most tuberculous nephrectomies were performed in patients from the native community. By the 1980s, most patients in this category were from the ethnic Asian immigrant community. Nephrectomy rates for polycystic kidney and trauma remained unchanged. CONCLUSIONS: Despite changes in the investigation and management of renal tract pathologies, which contributed to a change in the indications for nephrectomy, the overall number of nephrectomies performed has remained constant over a 31-year period.     

The rise of divorce and separation in the United States, 1880-1990

I use the Integrated Public Use Microdata Series to assess the potential effects of local labor-market conditions on long-term trends and race differences in marital instability. The rise of female labor-force participation and the increase in nonfarm employment are closely associated with the growth of divorce and separation. Moreover, higher female labor-force participation among black women and lower economic opportunities for black men may account for race differences in marital instability before 1940, and for most of such differences in subsequent years. However, unmeasured intervening cultural factors are probably responsible for at least part of these effects.     

The effect of changing excitation frequency on parallel conductance in different sized hearts

OBJECTIVE: An important component of the ventricular volume measured using the conductance catheter technique is due to parallel conductance (Vc), which results from the extension of the electric field beyond the ventricular blood pool. Parallel conductance volume is normally estimated using the saline dilution method (Vc(saline dilution)), in which the conductivity of blood in the ventricle is transiently increased by injection of hypertonic saline. A simpler alternative has been reported by Gawne et al. [12]. Vc(dual frequency) is estimated from the difference in total conductance measured at two exciting frequencies and the method is based on the assumption that parallel conductance is mainly capacitive and hence is negligible at low frequency. The objective of this study was to determine whether the dual frequency technique could be used to substitute the saline dilution method to estimate Vc in different sized hearts. METHODS: The accuracy and linearity of a custom-built conductance catheter (CC) system was initially assessed in vitro. Subsequently, a CC and micromanometer were inserted into the left ventricle of seven 5 kg pigs (group 1) and six 50 kg pigs (group 2). Cardiac output was determined using thermodilution (group 1) and an ultrasonic flow probe (group 2) from which the slope coefficient (alpha) was determined. Steady state measurements and Vc estimated using saline dilution were performed at frequencies in the range of 5-40 kHz. All measurements were made at end-expiration. Finally, Vc was estimated from the change in end-systolic conductance between 5 kHz and 40 kHz using the dual frequency technique of Gawne et al. [12]. RESULTS: There was no change in measured volume of a simple insulated cylindrical model when the stimulating frequency was varied from 5-40 kHz. Vc(saline dilution) varied significantly with frequency in group 1 (8.63 +/- 2.74 ml at 5 kHz; 11.51 +/- 2.65 ml at 40 kHz) (p = 0.01). Similar results were obtained in group 2 (69.43 +/- 27.76 ml at 5 kHz; 101.24 +/- 15.21 ml at 40 kHz) (p < 0.001). However, the data indicate that the resistive component of the parallel conductance is substantial (Vc at 0 Hz estimated as 8.01 ml in group 1 and 62.3 ml in group 2). There was an increase in alpha with frequency in both groups but this did not reach significance. The correspondence between Vc(dual frequency) and Vc(saline dilution) methods was poor (group 1 R2 = 0.69; group 2 R2 = 0.22). CONCLUSION: At a lower excitation frequency of 5 kHz a smaller percentage of the electric current extends beyond the blood pool so parallel conductance is reduced. While parallel conductance is frequency dependent, it has a substantial resistive component. The dual frequency method is based on the assumption that parallel conductance is negligible at low frequencies and this is clearly not the case. The results of this study confirm that the dual frequency technique cannot be used to substitute the saline dilution technique.     

The changing pattern of imported malaria in British visitors to Kenya 1987-1990

Following a sudden increase of imported malaria from Kenya in December 1989-January 1990, an investigation was set up to identify risk factors for travellers' malaria. A questionnaire asking for details of travel patterns and compliance with prophylaxis was sent to cases reported over the 6-month Kenyan winter period. Quarterly malaria attack rates between January 1987 and June 1991 were calculated and linked to meteorological conditions in Mombasa. The number of travellers to Kenya has doubled in the 4 years studied and the quarterly rates varied 4-fold over this period. There was no clear seasonal pattern of malaria in travellers, nor was there any clear relation of malaria to coastal rainfall. Compliance with chemoprophylaxis was poor, with only 16% of cases using currently advised regimens. While the annual malaria attack rate per 10,000 travellers decreased by 37% over the study period, the total numbers of malaria cases imported from Kenya rose by 61%, reflecting the increase in the numbers of travellers to the region. As the popularity of East Africa as a tourist destination continues to increase, Kenya will remain an important and significant source of malaria imported into the UK.     

Returns on investment in public health: effect of public health expenditures on infant health, 1983-1990

In this paper a number of methodological issues relating to research on the relationship between the menopause, mood and hormone replacement therapy (HRT) are discussed. These issues relate to problems of design and statistical analyses, problems which have prevented the reaching of definite conclusions regarding the relationship between menopause, mood and hormones. These problems are discussed under three main headings, namely, the assessment of menopausal status, statistical modelling and the design and analyses of clinical trials. Problems relating to concepts and measurement of dependent variables are the subject matter of the papers that follow. Within the three main headings more specific issues are detailed. The paper concludes with a list of recommendations on how research in this important area might be further advanced.     

The efficacy of using music in children of divorce groups: Impact on anxiety, depression, and irrational beliefs about divorce.

This study examined the efficacy of a children of divorce group using music as an intervention in comparison to a more traditional psychoeducational children of divorce group. It was predicted that children of divorce groups that utilized music would have a significantly greater impact on the children's levels of anxiety, depression, and irrational beliefs about divorce after the group ended and at a 3-month follow-up assessment. Both interventions significantly decreased cognitive and social anxiety and all irrational beliefs about divorce, except hope of reunification. Depression did not decrease for all participants but when the relationship between depression and irrational beliefs was examined, irrational beliefs were found to be mediators of depression for children of divorce. These results suggest that current interventions for children of divorce do decrease anxiety and irrational beliefs in general, but specifically addressing irrational beliefs may also decrease depressive symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A marked increase in the rate of diagnosed prostate cancer in the Netherlands during 1990-1996

OBJECTIVE: To study the variation of the number of histologically detected adenocarcinomas of the prostate in the Netherlands during the period 1990-1996. DESIGN: Retrospective. SETTING: National study. METHOD: Use was made of data from the National Automated Morbid-Anatomical Record Department (PALGA), Utrecht. The following data were established for each year of the study period: the total number of histological examinations of the prostate, the number of men involved (often several histological examinations of the prostate of the same man in the same year), how often adenocarcinoma was diagnosed by these examinations and how many men were involved, as well as the age of all carcinoma patients. These data were compared with those concerning variation and incidence of cancer of the prostate obtained from the Netherlands. Cancer Registration and the Central Statistics Office. RESULTS: In 7 years a total of 205,525 histological examinations of the prostate were performed in 179,298 men; the diagnosis 'adenocarcinoma of the prostate' was made 52,964 times in 44,182 men. The number of tissue examinations with the diagnosis 'carcinoma of the prostate' increased by 63% (from 5,596 to 9,146), the number of men in whom this diagnosis was made increased by 62% (from 4,710 to 7,614). The relative frequency of prostate carcinoma in relation to all examinations of the prostate increased in 6 years (1991-1996) from 22% to 28%. In that period, the (uncorrected) incidence increased by 50%, while mortality corrected for age remained the same. CONCLUSION: Of the marked increase of the number of detected cases of carcinoma of the prostate in the study period, only a small part could be attributed to demographic changes. Since autopsies have shown that there exists a large 'stock' of subclinical carcinomas, most of the growth can probably be explained by the more intensive diagnostics with prostate-specific antigen and transrectal ultrasonography.     

Congenital syphilis in Maryland, 1989-1991: the effect of changing the case definition and opportunities for prevention

BACKGROUND: The reported incidence of congenital syphilis in the United States rose dramatically during the 1980s. Although lack of prenatal care has been associated with congenital syphilis, little has been published regarding missed opportunities for prenatal intervention. GOAL OF THIS STUDY: To determine whether congenital syphilis increases in Maryland between 1989 and 1991 resulted from a true increase in congenital syphilis incidence or a change in the surveillance case definition, and to describe missed opportunities for prenatal intervention. STUDY DESIGN: This was a retrospective cohort study. RESULTS: When the revised case definition was used, a 473% increase in the number of cases was seen. Among infants who met the revised definition, 45% of mothers had received no prenatal care. Among those whose mothers had received prenatal care, opportunities to intervene were missed for 53%. CONCLUSIONS: Although a true increase in congenital syphilis incidence occurred before 1990, the increase reported in Maryland between 1989 and 1991 was primarily due to the change in case definition. Many cases of congenital syphilis could have been prevented with early and adequate prenatal care.     

The effect of changing sexual activity on HIV prevalence

In a one-sex preferred mixing model, reductions in the rate of partner change by those with low sexual activity increase the average probability of HIV infection in the remaining pool of available partners. This increases prevalence among people with high activity, and since high activity people disproportionately influence the spread of HIV, may increase long-run prevalence in the population as a whole. Calculations using the model and survey data on sexual activity indicate that in low prevalence populations, many people have low enough activity that reductions in their activity might increase the endemic steady-state prevalance. If these results prove robust in more realistic models, they would support the case for targeting public health messages urging reduced sexual activity to high activity people.     

Cancer incidence in The Netherlands in 1989 and 1990: first results of the nationwide Netherlands cancer registry. Coordinating Committee for Regional Cancer Registries

The first results are presented of the newly established Netherlands Cancer Registry, which covers the whole Dutch population (approximately 15 million people). The registry receives data on incident cancer cases from nine autonomous regional cancer registries. Notification occurs primarily through the national registry of all pathology and haematology departments, with additional reporting by medical records' departments of all hospitals. Data on cancer patients are abstracted directly from the medical records by trained registration clerks. In the years 1989-1990, the most common cancer sites among males were cancers of the lung, prostate and colon. For females, breast cancer ranked first, followed by cancer of the colon and lung. A comparison with age-adjusted (world standard population) incidence rates reported by other western cancer registries showed a relatively high incidence of lung cancer among males (72.9 per 100,000) and breast cancer among females (76.2 per 100,000). Through its near completeness and the high quality of the registered data, the Netherlands Cancer Registry offers excellent opportunities for epidemiological and clinical research.     

Children of divorce in the 1990s: An update of the Amato and Keith (1991) meta-analysis.

The present study updates the P. R. Amato and B. Keith (1991) meta-analysis of children and divorce with a new analysis of 67 studies published in the 1990s. Compared with children with continuously married parents, children with divorced parents continued to score significantly lower on measures of academic achievement, conduct, psychological adjustment, self-concept, and social relations. After controlling for study characteristics. curvilinear trends with respect to decade of publication were present for academic achievement, psychological well-being, self-concept, and social relations. For these outcomes, the gap between children with divorced and married parents decreased during the 1980s and increased again during the 1990s. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The study of natural disasters, 1977-1997: some reflection on a changing field of knowledge

As part of a series of papers to mark the 21st year of publication of Disasters, it is opportune to consider some of the changes that have occurred in the field it has covered so diligently for the last two decades. The paper begins with a brief review of the major natural disasters during this period and assesses their impact. It then considers the problem of how to define two key concepts: natural disaster and vulnerability, which remains an open question. The latter is one of the key determinants of the former. Next comes a review of what has occurred in the disasters field since the journal began publication, including some notes on the rise in vulnerability, the information technology revolution and the dilemmas of hazard mitigation. The following two sections assess, respectively, what hoped-for developments did not occur during the period studied and what assets were lost in the name of progress. For example, on the theoretical front, academic over-specialisation has predominated, while on the practical side there has been insufficient transfer of technology to where it is needed. The paper concludes that analyses of disaster need to become more sophisticated and multi-disciplinary and must take account of several forms of context within which developments take place.     

The development of anthropology and colonial policy in the Netherlands: 1800-1960

Although there have been studies of both Dutch colonial policy in the Indies and the development of anthropology in the Netherlands, there has been no systematic examination of the historical relations between them. This paper attempts this for a period of 160 years from the collapse of the Dutch East India Company to the birth of an independent Indonesian state. During this time, the need of successive governments for information on subject peoples was matched by the requirements of scholars for suitable conditions and locations for their work. As Dutch anthropology emerged in the nineteenth century and developed in the twentieth it was closely related to the prevailing political climate--state capitalism, liberal, and ethical policies. The analysis shows how there is a 'fit' between these and certain dominant anthropological styles and interests, principally in the form of empiricism, customy law studies, "Leiden" structuralism, and functionalism.