Trends in rates of occupational fatal injuries in the United States (1983-92)

Recent advancements in laparoscopic surgery have made laparoscopic splenectomy possible. We retrospectively compared the outcomes of laparoscopic versus open splenectomy in patients with idiopathic thrombocytopenic purpura (ITP) or beta-thalassemia. From July 1993 to July 1997, 52 patients (ITP, 43 cases; beta-thalassemia, 9 cases) underwent either laparoscopic (30 patients, 9 men, 21 women; average age, 36.9 years) or conventional open splenectomy (22 patients, 5 men, 17 women; average age, 34.3 years). The two groups were similar in terms of sex, age, diagnosis, duration of disease, preoperative platelet count, and spleen size. The mean surgical time, estimated amount of blood loss, duration of postoperative recovery, analgesic usage, and complications were compared between the two groups. Laparoscopic splenectomy was successful in 29 (97%) of the 30 patients. The mean surgical time in the laparoscopy group was longer than in the open splenectomy group (190.6 vs 113.9 minutes, p < 0.01). The laparoscopy group had earlier postoperative oral intake (15.2 vs 52.6 hours, p < 0.01), less usage of analgesics (meperidine 50 mg/unit, 1.1 vs 2.8 units, p < 0.01) and a shorter postoperative hospital stay (4.1 vs 6.8 days, p < 0.01). The estimated blood loss, incidence of accessory spleen, surgical complication rate, and recurrence rate of thrombocytopenia were similar in the two groups. Our findings show that laparoscopic splenectomy in patients with ITP or beta-thalassemia is as safe as the open approach. While laparoscopy required a longer surgical time, the recovery period was shorter, analgesic use was less, and physical discomfort was less severe.     

Decreasing rates of cervical cancer among American Indians and Hispanics in New Mexico (United States)

Minority women in New Mexico (United States)--including American Indian and Hispanic women--have shown disproportionately high incidence rates of invasive cervical cancer during the 1960s and 1970s. Several public health programs in New Mexico were directed toward early detection of cervical cellular abnormalities, particularly targeting the state's minority women. To evaluate the effectiveness of these programs, we examined the New Mexico Surveillance, Epidemiology, and End Results (SEER) data collected from 1969-92, and calculated average annual, age-specific, and age-adjusted incidence rates by ethnic group (American Indian, Hispanic, and non-Hispanic White) for five-year time intervals. We also calculated age-adjusted mortality rates for cervical cancer in the same ethnic groups using state vital records. Age-adjusted incidence rates for invasive cervical cancer show substantial temporal decreases, especially for minority women in the state. The age-adjusted incidence rate decreased by 66 percent, from 30.3 to 10.3 per 100,000 for American Indian women, and by 61 percent, from 26.1 to 10.2 per 100,000 for Hispanic women. A stage shift to earlier stages of cervical neoplasia occurred over the study period, with a substantially higher proportion of in situ compared with invasive cancers diagnosed in the most recent cf the most remote time period. The ratio of incidence rates of in situ to invasive cancers changed dramatically for both American Indian and Hispanic women. Cervical cancer mortality rates decreased steadily among Hispanic women from 1958 to 1992; the decrease among American Indian women was less stable and fluctuated due to small numbers. Ongoing targeted screening programs should help to reduce cervical cancer incidence and mortality further in New Mexico.     

Revision rates after knee replacement in the United States

We present a force plate system which measures low-magnitude vertical reaction forces generated by small laboratory animals. The force plate mechanical design minimizes radiated transverse waves, acoustic reverberation, and standing waves caused by impacts on the force plate surface. A secondary force plate and PC-based software algorithm minimize floor vibrational artifact. The force plate was used to measure function of rats during two tests: forelimb/hindlimb hopping reaction and surface righting reaction. In control rats, forelimb hopping rate exceeded hindlimb hopping rate during 16 weeks of repeated testing. Subchronic intraperitoneal (i.p.) dosing of 10 mg/kg/day acrylamide produced a selective impairment of hindlimb hopping. In contrast, single doses of haloperidol (1-5 mg/kg, i.p.) slowed the righting reaction and produced a relatively selective impairment of forelimb hopping. The force plate system presents new opportunities for performing quantitative neurological assessments of small laboratory animals when previously such tests had been performed subjectively and qualitatively.     

Risk factors for male breast cancer (United States)

The significance of intersections in age-specific mortality rate distributions could be attributed to a fundamental statistical relationship between estimates of slope and intercept. A strong negative correlation between estimates of slope and intercept is often observed in simple linear regression problems. The net result is that the family of lines generated by repetitive estimates of slope and intercept in a static experimental situation will tend to intersect at a common point. This statistical relationship between slope and intercept, however, should be random with respect to the time-ordered sequence of slope and intercept estimates. Annual paired slope and intercept estimates derived using the method of longitudinal Gompertzian analysis of age-specific mortality rates for men and women in the United States from 1900 to 1988 were analyzed to determine if they varied randomly. The probability that the observed sequence in these annual paired slope-intercept estimates was random is less than 10(-50) for both men and women. This finding essentially excludes the possibility that intersections in age-specific mortality rate distributions reflect a fundamental statistical relationship between slope and intercept and further suggests biological relevance for the method of longitudinal Gompertzian analysis.     

Cesarean delivery rates in 1995 continue to decline in the United States

The anaesthesia management of a 10-year old girl with a fracture to her distal arm is presented, using inhalational anaesthesia with a laryngeal mask and a supplementary axillary plexus block. Due to light anaesthesia the patient vomited during the course of surgery resulting in a severe pulmonary aspiration necessitating four days of mechanical ventilation in the ICU. The safety of the laryngeal mask airway for emergency surgery is discussed.     

Trends in cesarean section rates for the United States, 1970--78

With National Hospital Discharge Survey data collected by the National Center for Health Statistics as a basis, rates of cesarean section deliveries were computed for the United States and its regions for 1970 through 1978. For each year and within each region, trends were examined according to variations in the mother's color, age, and marital status and in the hospital size (number of beds), the form of hospital ownership, and the length of the mother's hospital stay. Within each region and for each variable considered, cesarean section deliveries rose fairly uniformly. Nationally, C-sections comprised 5.5 percent of all deliveries in 1970, but rose steadily to comprise 15.2 percent of all deliveries in 1978. Overall, 1978 rates were highest in the Northeast, among whites, among women age 30 and over, among married women, in hospitals with 500 beds or more, and in proprietary hospitals. The mean length of the mother's hospital stay in 1978 was 6.7 days for cesarean section deliveries and 3.2 days for other deliveries, down from the mean hospital stay of 7.8 days for C-sections and 3.9 days for other deliveries observed in 1970.     

Survival rates for four forms of cancer in the United States and Ontario

OBJECTIVES: In this study, cancer survival rates for patients diagnosed in Ontario and selected areas within the United States were compared. METHODS: Relative survival rates were computed for patients aged 15 through 84 years diagnosed with any of four forms of cancer (breast, colon, lung, and Hodgkin's disease). The cohorts represented those diagnosed over the years 1978 through 1986 in the Canadian province of Ontario and in nine regions covered by the US National Cancer Institute's Surveillance Epidemiology and End Results program. Patients were followed through the end of 1990. RESULTS: The cumulative relative survival rates were similar for American and Canadian patients. The largest difference was observed for breast cancer, where patients in the United States enjoyed a survival advantage throughout the follow-up period. CONCLUSIONS: Patients in the United States and Ontario with the diseases studied, except for breast cancer, experience very similar survival. The greater use of mammographic screening in the United States could account for that country's higher breast cancer survival rate by promoting earlier and therefore more efficacious treatment, by introducing bias, or by a combination of both treatment and bias factors.     

Relationship of internal-external control and United States suicide rates, 1966-1973

The annual variations in scores obtained on the Rotter Internal-External (I-E) control scale by United States college students between the years 1966 and 1973 were related to the concomitant annual variations in suicide rates for the total United States population and for eight separate age groups. The I-E scores increased substantially during this time period and were correlated positively with the concomitantly increasing suicide rates among relatively young persons (in and below the 35-44 year age group). However, the suicide rates among older persons generally decreased during this time period and thus were correlated negatively with the I-E scores. These results suggest that perception of internal-external control did not change among older persons as they did among younger persons, perhaps because older persons might be less susceptible to the cultural influences that affect the perceived control of younger persons. Results of this and earlier research suggest that cultural characteristics that foster high perceptions of external control also foster suicidal behavior and suggest the value of attempts to convey perceptions of internal control to psychotherapy clients.     

Surgical operations in the United States. Then (1983) and now (1994)

OBJECTIVE: To study the hypothesis that numbers of surgical operations in the United States have increased from 1983 and 1994. DESIGN: Analysis of data from the National Center for Health Statics. SETTING: Short-stay general and specialty noninstitutional hospitals, and freestanding ambulatory surgical facilities, exclusive of federal, military, and Veterans Affairs hospitals. PATIENTS: Five-percent national sample. MAIN OUTCOME MEASURE: Ten most frequent surgical operations or classes of surgical procedures within neurosurgery, ophthalmology, otorhinolaryngology, cardiothoracic surgery, general surgery, urology, obstetrics and gynecology, and orthopedics. RESULTS: In 1994, the 10 most frequently performed surgical operations in the United States totaled 7,929,000 cases. This contrasted with 5,731,000 top 10 procedures in 1983, or an increase of 38%. The most common surgical operation in 1994 was cataract extraction, totaling 2,049,000 cases. Groin herniorrhaphy (689,000 procedures) remained the most common operation performed by a general surgeon. Cesarean section was the most frequently completed obstetrical-gynecological operation (858,000 procedures) and the country's second most common surgical procedure in 1994. Arthroscopy of the knee (632,000 procedures) demonstrated enormous growth (153%) and was the country's seventh most frequent operation in 1994. Transurethral prostatectomy (229,000 procedures) underwent the most precipitous decline (29%) of any No. 1-ranked specialty procedure. CONCLUSIONS: Numbers of top 10 surgical operations have increased in every surgical specialty except obstetrics-gynecology. Explanations may be the presence of new technologies, willingness of a preexisting reservoir of patients to undergo now less anxiety-provoking procedures, or less stringent indications.     

Mercury in alligators (Alligator mississippiensis) in the southeastern United States

Mercury methylation may be enhanced in wetlands and humic-rich, blackwater systems that crocodiles and alligators typically inhabit. Given their high trophic level and long life-spans, crocodilians could accumulate significant burdens of Hg. Our objectives were to survey Hg concentrations in alligators from several areas in the southeastern United States to test their utility as sentinels of Hg contamination, to examine relationships among Hg concentrations in various tissues and to look for any differences in tissue Hg concentrations among locations. We measured total Hg concentrations in alligators collected in the Florida Everglades (n = 18), the Okefenokee National Wildlife Refuge, Georgia (n = 9), the Savannah River Site (SRS), South Carolina (n = 49) and various locations in central Florida (n = 21), sampling tissues including blood, brain, liver, kidney, muscle, bone, fat, spleen, claws and dermal scutes. Alligators from the Everglades were mostly juvenile, but Hg concentrations in tissues were high (means: liver 41.0, kidney 36.4, muscle 5.6 mg Hg/kg dry wt.). Concentrations in alligators from other locations in Florida were lower (means: liver 14.6, kidney 12.6, muscle 1.8 mg Hg/kg dry wt.), although they tended to be larger adults. Alligators from the Okefenokee were smallest and had the lowest Hg concentrations (means: liver 4.3, kidney 4.8, muscle 0.8 mg Hg/kg dry wt.). SRS alligators had the greatest size range and intermediate Hg levels (means: liver 14.9, muscle 4.8 mg Hg/kg dry wt.). At some locations, alligator length was correlated with Hg concentrations in some internal organs. However, at three of the four locations, muscle Hg was not related to length. Tissue Hg concentrations were correlated at most locations however, claw or dermal scute Hg explained less than 74% of the variation of Hg in muscle or organs, suggesting readily-obtained tissues, such as scutes or claws, have limited value for non-destructive screening of Hg in alligator populations.     

Hip fracture rates in Hong Kong and the United States, 1988 through 1989

OBJECTIVES: Prior studies have suggested that hip fracture rates are substantially lower in Asian countries than in the United States. However, comparisons have been limited by unavailability of recent data, differences in case definition, lack of data from similar time periods, and small sample sizes. This study sought to examine trends by age and sex, with separate statistics for those aged 85 or older. METHODS: Hospital discharge data were used to obtain hip fracture incidence in Hong Kong and the United States from 1988 through 1989. RESULTS: Within each population, women had higher hip fracture rates than men. Fracture rates in the United States were significantly higher for both sexes than rates in Hong Kong. For persons over the age of 80, rates of hip fracture among White US males exceeded those for Hong Kong women. Inclusion of transferred cases in hip fracture rates minimized differences between the countries. CONCLUSIONS: Despite increasing hip fracture rates in Hong Kong, those rates are still substantially lower than the rates in the United States. Identifying factors responsible for this variation may prove useful in the search for preventive strategies.     

Incomplete pregnancies and risk of ovarian cancer (Washington, United States)

Because of the reduced risk of ovarian cancer related to prior full-term pregnancies, we sought to determine whether there was any association with a history of one or more incomplete pregnancies. White female residents of three counties in Washington State (United States) diagnosed with ovarian cancer during 1986-88 (n = 322), and a random sample of control women selected from these same counties (n = 426), were interviewed regarding their pregnancy and childbearing histories. Among women who had given birth to at least one child, an additional incomplete pregnancy was not associated with the risk of ovarian cancer (relative risk [RR] = 1.1, 95 percent confidence interval [CI] = 0.8-1.6, adjusting for age, oral contraceptive use, and number of births). For those who had never given birth, a somewhat smaller proportion of cases had a history of incomplete pregnancy than controls (RR = 0.8, CI = 0.4-1.7). In an analysis restricted to ever-pregnant women, a prior induced or spontaneous abortion was not found to be associated with the incidence of ovarian tumors (RR = 1.0, CI = 0.6-1.7, and RR = 1.3, CI = 0.8-1.9, respectively). Other studies of the possible relation between incomplete pregnancies and ovarian cancer generally have observed either a weak negative association or no association at all. It is possible that if incomplete pregnancies do affect the risk of ovarian cancer, their impact might be too small to be identified reliably through epidemiologic studies.     

Physical activity in usual occupation and risk of breast cancer (United States)

OBJECTIVE: To identify whether the cause, site of ductal obstruction, and characteristics of fluid aspirates are associated with the cryosurvival and fertility after thawing of sperm obtained during reconstruction of the excurrent ducts with microsurgical epididymal sperm aspiration, vasal sperm aspiration, or both. DESIGN: Prospective study. SETTING: Andrology center at a tertiary care institution. PATIENT(S): Men undergoing reconstruction of the excurrent duct and sperm aspiration (n = 42) or microsurgical epididymal sperm aspiration (n = 11). INTERVENTION(S): Sperm were tested for an association with the cause and site of obstruction. Fertilization and pregnancy rates after sperm aspiration and intracytoplasmic sperm injection (ICSI) were evaluated for fresh and frozen aspirates. MAIN OUTCOME MEASURE(S): Motile sperm count and percentage motility after thawing. RESULT(S): The motile sperm count before freezing was significantly higher in the caput epididymis than in the corpus. The motile sperm count before freezing was related inversely to the distance from the caput where the sperm were aspirated. Sperm from clear and opaque fluid aspirates had better percent motility than those from cloudy and creamy fluid aspirates. High fertilization and pregnancy rates were achieved using both fresh and frozen epididymal sperm. CONCLUSION(S): None of the factors studied was associated with cryosurvival of aspirated epididymal or vasal spermatozoa. Because motility is low after thawing, these specimens are best used with ICSI.     

The Wiskott-Aldrich syndrome in the United States and Canada (1892-1979)

Information was collected on 301 cases of the Wiskott-Aldrich syndrome in the United States and Canada Examination of available medical records, death certificates and published case reports on these patients showed that they came from a wide geographic area and many diverse ethnic and racial groups. No significant difference was found in the incidence of cases born between 1947 and 1976; the overall rate was 4.0 per million live male births in the United States. Median survival has increased with time from eight months for patients born before 1935 to 6.5 years for those born after 1964. Seventy-six of the 301 patients (25%) were still alive at last follow-up and ranged in age from 1 to 36 years with a median of 10 years. Causes of death were primarily limited to infections or bleeding, but malignancy represented a significant problem. Twelve percent of the group (36 of 301) developed malignancy, the predominant types being lymphorecticular tumors (23 of 36) and leukemia (7 of 36). The overall relative risk for malignancy was found to be greater than 100 times that of the general population and was found to increase with increasing age.     

Declining effect of latitude on melanoma mortality rates in the United States. A preliminary study

This article explores the complex barriers which may have prevented the formal integration of the spiritual dimension within programmes of nurse education in the UK. These barriers have been termed intrinsic (arising from within the educational institutions themselves) and extrinsic (reflecting society's and individuals' values, beliefs and cultural norms). It is argued that these barriers have slowed down curriculum innovation and change, preventing the spiritual dimension from receiving due recognition within programmes of nurse education.     

Family planning program activity and patient enrollment rates in the United States, 1969 and 1971

The effects of demographic characteristics, socioeconomic conditions, health care, and family planning program activity on patient enrollment rates are estimated for 1969 and 1971. Two program activity variables (agencies and clinic locations) have significant, positive net effects in both years. The effect of agencies changed little between 1969 and 1971, and it is the strongest effect in both years. The effect of clinic locations more than doubled between 1969 and 1971, partly due to increased demand. The direct effects of the demographic, socioeconomic, and health care variables are not large, but many of the demographic and socioeconomic variables have substantial indirect effects via health care program activity.     

Diet diversity, diet composition, and risk of colon cancer (United States)

In this study, we evaluate diet diversity, diet composition, and risk of colon cancer in an incident population-based study of 1,993 cases and 2,410 controls in the Kaiser Permanente Medical Care Program of Northern California, eight counties in Utah, and the Twin Cities area of Minnesota (United States). Ninety-one and one-half percent of the population were non-Hispanic White. Dietary intake was obtained using an adaptation of the CARDIA diet-history questionnaire. Diet diversity was defined as the number of unique food items reported; diversity also was explored within six major food groups. Composition of the diet was described by estimating the proportion of total number of food items contributed by major food groups. Younger individuals, higher educated individuals, and those who lived in larger households reported eating the most diverse diet. Total diet diversity was not associated with colon cancer. However, eating a diet with greater diversity of meats, poultry, fish, and eggs, was associated with a 50 percent increase in risk among all men (95 percent confidence interval [CI] = 1.1-2.0; P trend = 0.01), with slightly stronger associations for younger men and men with distal tumors. A diet with a greater number of refined grain products also was associated with increased risk among men (odds ratio [OR] = 1.7, CI = 1.3-2.3). Women who ate a diet with a more diverse pattern of vegetables were at approximately a 20 percent lower risk than women who had the least diverse diet in vegetables. Assessment of diet composition showed that men who consumed a large proportion of their food items from meat, fish, poultry, and eggs were at an increased risk, with the most marked association being for distal tumors (OR = 1.7, CI = 1.2-2.5). Women who consumed the largest percentage of their food items in the form of plant foods (fruits, vegetables, or whole grains) were at a reduced risk of developing colon cancer (OR = 0.7, CI = 0.5-1.0).