Abstention in the General Population of the U.S.A.

Data on abstention from a 1979 general population survey in the U.S.A. were analyzed and compared to data from a similar 1964 survey. Trend comparisons for the 15 year interval revealed few changes in abstention rates among various demographic categories. There was no evidence that the difference between male and female abstention rates has narrowed, that a more abstemious older generation is being replaced by a less abstemious younger generation, that there has been a regional convergence of abstention rates, or that the influence of religion on abstention has declined. A cluster analysis of reasons for abstaining (among lifelong abstainers) identified four sets of reasons: moral objection to drinking, dislike of the consequences of drinking, ‘inconsequential’ reasons, and abstinent family background. Compared to drinkers, abstainers consistently and significantly tended to disapprove of drinking by others in a variety of situational contexts. Militancy on these issues was stronger among abstainers from dry regions and among abstainers who were fundamentalist Protestants. Militancy was not, however, related to age or education. Lifelong abstainers who cited moral reasons for abstaining were more militant than those who did not.     

Microalbuminuria and markers of the atherosclerotic process: the D.E. S.I.R. study

The relationship between microalbuminuria and tissue-type plasminogen activator antigen (tPA-ag) and fibrinogen was evaluated in non-diabetic subjects. Subjects were participants of the D.E.S.I. R. (Data from an Epidemiological Study on the Insulin Resistance syndrome) Study. Analyses were carried out on 2248 women and 2402 men for fibrinogen and on 272 women and 284 men for tPA-ag. Microalbuminuria was defined as urinary albumin concentration greater than 20 mg/l. Men with microalbuminuria had a 6% higher fibrinogen concentration than those without (3.07 g/l (95% confidence interval: 2.99,3.15) vs. 2.89 g/l (2.87,2.91), adjusted for age and smoking). This relationship existed in hypertensive as well as non-hypertensive subjects. The association between microalbuminuria and tPA-ag existed only in hypertensive men, those with microalbuminuria having a 21% higher tPA-ag than those without (4.39 ng/ml (3.70,5.08) vs. 3.63 ng/ml (3.32,3.94), adjusted for age and smoking). Adjustment for other risk markers for cardiovascular disease did not change the results. There was no relationship between microalbuminuria and these haemostatic factors in women. The results of this study suggest that in non-diabetic men, microalbuminuria is associated with fibrinogen, but with tPA-ag only when concomitant with hypertension.     

The nutritional status of the aged in the U.S.A.

An attempt was made to evaluate the nutritional status of the aged based on three large-scale federally sponsored surveys and several smaller studies. The evaluation is confounded by economic, socio-cultural, and genetic differences of the elderly as well as lack of agreement in methodology used and interpretation of the data obtained. Some general conclusions, however, can be reached. Calories, calcium, iron, thiamin, riboflavin, niacin, vitamin A and ascorbic acid were consumed in amounts less than two-thirds of the RDA by substantial percentages of the elderly (approaching 50% for many nutrients). Protein intake tended to be adequate. Hemoglobin values were low for approximately 1 out of 10 elderly whites and 1 out of 4 elderly blacks. Biochemical indices of vitamin status were much less likely to be inadequate, i.e., 1% to 17% of the populations surveyed. Obesity, apparently related to physical inactivity rather than caloric excess, was a major finding. Inadequate nutrient intakes of the aged tended to be associated with inadequate income, being female and/or being black. This paper as a part o f the mini-symposium on nutrition and aging organized by Charles Ho Barrows, Jr., and presented on Thursday, September 29, 1977 as part of the 7th Annual Meeting of the American Aging Association in New York City.     

E. Kondoleon: the man behind the procedure.

Historical events and their in-depth analysis have much to teach us about medicine today. Moreover, the lives of those who have made their mark in medical history can be a source of inspiration to future generations of medical scientists. A case in point is the career of E. Kondoleon, originator of the surgical procedure that bears his name. METHODS: Retrieval in the archives of the "Areteion" and "Hippocration" hospitals, where E. Kondoleon had worked and passed away, together with information obtained from the Chair of History of Medicine of the University of Athens, as well as information taken from the Hellenic Surgical Society relative to his life and the motives which led him to the Kondoleon surgical procedure namely: Wide excision of the fascia and concomitant partial excision of the hypertrophic tissue in the treatment of lymphoedema. RESULTS: The Kondoleon operative procedure was not a simple applicable idea of a surgical technique but the result of a long-term systematical study of the anatomy and pathophysiology of the lymphovascular system as well as the continuation of their experimental application. Thus in the beginning of our century, Kondoleon took the lead of carrying out his own technique on the human which for more than 50 years was the object of discussion and application in the treatment of lymphoedema. CONCLUSIONS: Although "the microworld" of the electronic microscope and the conventional microscope of surgery have illuminated many sections of pathophysiology and has led to newer evolutionary tactics (vascular anastomoses, transplantation of lymph-vessels) in the management of lymphoedema, the Kondoleon operative procedure has given the necessary stimuli for these developments. As with other prominent, celebrated men in the history of investigation, Kondoleon had a dramatic end.     

Successful outcomes with the h.e.a.l. program

The successful treatment of acute and chronic wounds can be daunting. In an effort to improve client outcomes and manage spiraling nursing and dressing supply costs, the Community Care Access Centre of Wellington-Dufferin (Canada) implemented the Healing Excellence with Advanced Learning (h.e.a.l.) program in March 2003 as a standardized, evidence-based means of providing wound care to home care clients. While implementation challenges remain and education is ongoing, indepth wound management education and standardization of care have reduced the percentage of patients receiving nonevidence-based wound care and resultant frequent dressing changes. This has enabled the Centre to reallocate 1.5 million dollars from dressing change costs to new nursing initiatives beyond wound care. The initial goals of the program were met. Continuing documentation of its outcomes will help underscore the importance of evidence-based protocols and provider education to the wound healing process.     

Periarthritis of the shoulder. II. Radiological features.

A group of 113 women and 73 men with periarthritis of the shoulder have been studied in detail. Electromyography showed 4 patients with neuralgic amyotrophy who had been referred for the shoulder study but were excluded on this basis. Nerve conduction studies showed little difference between the periarthritic group and a control group, apart from some reduction in amplitude and potential, and in women a suggestion of an increased latency. Duration of the action potential was equal. 6 patients had an undoubtedly long latency compatible with median nerve compression. Degenerative changes were found in the glenohumeral joints in 6-9%. Degenerative changes were found at the acromioclavicular joints in 31% of the men and 44% of the women. Calcification was found around 11 of the shoulder joints. There was frequently a previous history of 'rheumatism' before the episode of periarthritis. In one-third of the women 'nonspecific rheumatism' had occurred. Cervicobrachial pain and a previous episode of shoulder pain had occurred more often in the women. Arthrography was performed in 7 patients and there was a reduction in volume of material that could be injected in only one patient. There was obliteration of the axillary fold in that patient, and a torn capsule in a patient who had previously been manipulated. Lateral cervical spine x-rays were compared with films from an epidemiological survey. The disc space/vertebral body height ratio was taken, overcoming the magnification effects shown by technical alterations in the method of taking films. Good intra- and interobserver correlation was found for this ratio, but not for the width of the canal. There was no difference in the disc/body ratio between the periarthritic and control group in the upper cervical region. In the C5/6 and C6/7 intervertebral discs there was evidence of more disc degeneration in the periarthritic group. The differences from the control group were not great because of the high incidence of disc space narrowing and osteophytosis after the age of 45 years in the general population.     

On the within-population relationship between nutrition and serum lipids: the B.I.R.N.H. study

A randomized study was performed in Belgium concerning the relationshipbetween diet and serum lipids in 5485 men and 4856 women witha mean age of 49 years. In men 17.3% of total energy was providedby saturated fat, 15.2% by monounsaturated fat and 7.5% by polyunsaturatedfat. The fat intake in women was very similar. The P/S ratiowas 0.51 in men and 0.52 in women. The alcohol intake was significantlyhigher in men (5.2% of total energy) than in women (2% of totalenergy). In men and women total serum cholesterol increasedwith saturated fat intake (p <0.001) and decreased with polyunsaturatedfat intake (p <0.01). Saturated fat intake raised the HDL-cholesterollevel in men and women (p <0.001) and monounsaturated fatraised it in men only (p <0.01). Dietary cholesterol increasedthe HDL-cholesterol level in women only (p <0.01). HDL-cholesterolincreased with alcohol consumption (p <0.001) and decreasedwith cigarette smoking (p <<0.001). All these changeswere adjusted for differences in age, height and weight. Thestudy confirms the existence, within a population, of a significantrelationship between fat intake and serum lipid levels.