Variability and reliability of diastolic blood pressure during adolescence: The Philadelphia blood pressure project

This paper reports results of diastolic blood pressure studies done as part of the Philadelphia Blood Pressure Project (PBPP), a 3-year longitudinal study of black adolescents, initially ages 11–15, who were enrolled originally in the Philadelphia Collaborative Perinatal Project (CPP). Three samples were studied by the PBPP: a representative sample of over 500 black adolescents stratified by age and sex, a smaller sample of adolescents who had blood pressures elevated beyond one standard deviation of the CPP population mean at age 7, and a sample of adolescents born of toxemic pregnancies. We found, for the representative sample, consistent differences in the means of diastolic blood pressure phases IV and V and between diastolic blood pressures taken in supine and seated positions. Supine diastolic blood pressures were more variable at every age and were lower than the comparable seated diastolic blood pressures. In addition, we estimated on a random subsample from all three samples diastolic blood pressure reliability for supine readings taken sequentially by the same (N = 96) and different (N = 55) examiners. We also estimated measurement reliability simultaneously (N = 91 supine, N = 96 seated) using a double-listening stethoscope. We found that although diastolic phase IV blood pressure was more reproducible or less variable over short periods of time (5–15 min) when reliability measures were taken sequentially, two examiners simultaneously could not measure phase IV with significantly greater accuracy than phase V. We concluded that the fourth and fifth Korotkoff sounds should not be used interchangeably during adolescence and that postural position is an important contributor to diastolic blood pressure variance during adolescence. Also, since it has not yet been established which is more statistically predictive of adult blood pressure levels, whenever possible, both phase IV and V should be recorded for adolescents.     

Alcohol consumption and blood pressure: analysis of data from the Canada Health Survey

Recent epidemiologic studies report a significant association between alcohol consumption and elevations in both systolic (SBP) and diastolic (DBP) blood pressures. To test this hypothesis, we conducted a multivariate analysis of physical examination and other data on 721 men and 697 women aged 20 or more collected during the Canada Health Survey in 1978-1979. SBP and DBP were considered as separate dependent variables in multiple regression models with the following independent variables: age, alcohol consumption (measured as a 7-day recall history and as an average frequency of consumption), serum cholesterol, plasma glucose, physical activity, Quetelet index, parental history of hypertension, cigarette consumption, income, education, and exogenous hormonal use in women. In both weighted and unweighted multiple regression analyses, we could not demonstrate for either sex, a significant association between alcohol consumption (as recorded and following quadratic and logarithmic transformations) and either SBP or DBP. For both sexes, only age and Quetelet index were highly significantly (P less than 0.0001) and consistently associated with both SBP and DBP. No other independent variables were consistently associated, for either sex, with SBP and DBP. Further, the dose-response patterns noted by other investigators suggesting either a positive and linear relationship or a curvilinear relationship were not found in either our univariate or multivariate analyses. Rather, the alcohol-blood pressure curves showed no consistent patterns of any kind in either sex. These findings do not support recent claims that alcohol consumption is a determinant of elevations in either SBP or DBP.     

The primary prevention of high blood pressure: a population approach

This article presents our view of the evidence and strategies for the primary prevention of high blood pressure. We (a) attempt to indicate where the potential for prevention, along with relative safety, is sufficient for action, and (b) provide an outline of our ideas and experience in communicating these strategies. We believe that a unified preventive message and plan to control and prevent high blood pressure in whole communities is possible. Such a plan must emphasize the benefits that may accrue from a more healthful lifestyle. We believe that an eating and activity pattern that is attractive, palatable, and feasible can be proposed and modeled to fit different cultures and traditions. Finally, we present the idea that medical, preventive strategies and safe, feasible, and credible community-based programs are complementary modes of dissemination. In such programs, health professionals and medical services share roles with community leaders and organizations. This population strategy is indicated along with vigorous systematic hypertension detection and treatment as well as further research. A population strategy is, we believe, essential to the primary prevention of hypertension, i.e., to the prevention of elevated blood pressure in the first place.     

Multiple risk factor intervention trial (MRFIT).: VI. Intervention on blood pressure

The MRFIT blood pressure data derived from the Special Intervention (SI) group of men over the first 4 years are presented, and the results of the hypertension treatment program are reviewed. A therapeutic goal diastolic blood pressure (DBP) was established for each man determined to be hypertensive which included men with DBP ?90 mm Hg and men who were already taking antihypertensive drugs. A stepped care protocol was used to guide the drug treatment. At the fourth annual examination, 63.8% of the 5,790 SI men seen had been previously declared hypertensive. The mean baseline blood pressure (BP) for the hypertensive group was 140.3 mm Hg, systolic, and 94.5 mm Hg, diastolic, and at the 48-month visit, the mean BP was 120.7 mm Hg, systolic, and 82.5 mm Hg, diastolic. Of the hypertensive men seen at 48 months, 87.3% were taking antihypertensive drugs, 65.4% were at or below their goal pressure, and 83.5% had a DBP <90 mm Hg. Most men on antihypertensive drug therapy were at protocol Step 1 or Step 2, receiving a diuretic agent alone (32.9%), or in combination with an antiadrenergic drug (40.4%). Data for specific drug regimens are presented. Older men and men with higher BP levels at entry had a better response. The MRFIT BP results, achieved within a context of a multiple-risk-factor intervention program, compare favorably with the results from recently reported trials that focused solely on the treatment of mild hypertension.     

Intrauterine devices and menstrual blood loss. A comparative study of eight devices during the first six months of use

An experiment was conducted to determine changes in menstrual blood loss caused by IUDs. 78 volunteer women of similar age and parity were randomly selected from among those requesting IUDs from the outpatient department of the National Medical Center of the Mexican Institute of Social Security. Menstrual blood loss and hemoglobin were measured for 1-2 control cycles and for 6 postinsertion cycles. Of the 8 different types of IUDs used, the Lippes Loop and the copper-releasing devices caused a statistically significant increase in blood loss and a related decrease in hemoglobin. The steroid-releasing devices caused no significant increase in blood loss and no significant changes in hemoglobin concentration. The rigid copper devices caused the greatest increase in blood loss. The noted changes were clearly established by the 3rd postinsertion cycle.     

Physical health and depression: An epidemiologic survey

Levels of mental depression, physical health, and medical care utilization for physical health conditions were measured in Los Angeles County during 1979 in a multiethnic probability sample of 1,003 adults (66% participation). A strong association was observed between the rate of depression, based on the 20-item Center for Epidemiologic Studies-Depression (CES-D) scale, and measures of physical health status. Depressed persons reported more physical illnesses than the nondepressed (1.32 versus 0.89 per person), and they were more likely to contact a health professional for these conditions (1.49 versus 0.97 consultations per physical illness). Similar patterns were observed among the depressed and nondepressed for bed-disability days, hospital admissions, and hospital bed-days. While depression was more common in women than men, a parallel association with physical health status was observed in both sexes.     

Blood pressure determinants in progeny of parents taking or not taking antihypertensive drugs

Parent-child associations of blood pressure determinants were studied in 163 kindreds randomly recalled in the Princeton School Family Study, comparing 132 kindreds (337 children) with neither parents nor parental siblings on hypotensive agents (H-), and 31 kindreds (64 children) with at least one parent on hypotensives (H+). The following mean (SE) blood pressure determinants, covariance adjusted for age, race, and sex, differed in children from H+ and H- kindreds ($\text{1P ? 0.04, 7P < 0.01}$):

     

8.

A new view of the etiology of nasopharyngeal carcinoma   总被引：1，自引：0，他引：1  

T Hirayama  Y Ito 《Preventive medicine》1981,10(5):614-622

The epidemiological finding of high geographical similarity seen in the distribution of Croton tiglium, the parental plant for croton oil, as well as other related members of Euphorbiaceae family, and the nasopharyngeal carcinoma (NPC) in southern regions of China, led to the compilation of these data plus our recent laboratory observations on in vitro induction of Epstein-Barr virus (EBV) in human lymphoblastoid cell lines. The EBV genome-carrying P3HR-1 and Raji cells exerted a dramatic increase in EBV antigens when given a combined treatment with n-butyrate and croton oil, in nanogram concentrations. The Fusobacterium and other common microbial inhabitants of the mouth and nasopharynx of man efficiently produce, in laboratory culture fluids, n-butyric acid with EBV-inducer activity. Furthermore, the seeds and plant per se of C. tiglium and other Euphorbiaceae are currently being used as herbal drug in the southern parts of China. We hypothesize that NPC is initiated by persisting EBV as an essential and basic factor plus the combined action of the bacterial fatty acid and traditional intake of promoter substance of plant origin as cofactors, and that the EBV, induced and activated by such mechanisms, initiates the chain of events which ultimately lead to the emergence of the malignant disease.     

9.

Inhibition of implantation by intraluminal administration of concanavalin A in mice.     

J J Hicks  A M Guzmá-González 《Contraception》1979,20(2):129-136

Important characteristics of endometrial implantation sites are the changes of polarity and molecular composition of the cellular surface. For this reason the masking of surface carbohydrates could lead to an inhibition of the recognition by the blastocyst of the endometrial implantation site. Considering the impact of lectins on carbohydrates, we decided to utilize the intraluminal administration (5 microliter) of different concentrations of concanavalin A (15-60 microgram) in pregnant female mice in the preimplantation phase. An inhibition of 100% of implantation wqs obtained with concentrations of 30 and 60 microgram of the lectin administered on days 3 and 4 of the pregnancy (P less than 0.001). Less important effects were observed on administering 15 or 20 microgram of the lectin (73 and 87% of inhibition) and on utilizing the different doses on days 1 and 2 of the pregnancy. Thus, we conclude that the egg must recognize certain molecules of the endometrial surface (alpha-D-mannopyranose and alpha-D-glucopyranose) in order to implant and that the making of these sites potentially constitutes a new contraceptive approach.     

10.

Determinants of blood pressure in Jerusalem schoolchildren     

E Belmaker  L Gordon  H Palti  D Tamir  P Edelstein  S Cohen 《Preventive medicine》1984,13(5):528-534

In 1982, 113 first- and second-graders attending an elementary school in West Jerusalem had their blood pressure (BP), height, weight, and resting pulse measured. Three successive BP readings were taken. The mean of the second and third readings was used for data analysis. Mean systolic blood pressure (SBP) was 98.30 +/- 8.51 mm Hg and mean diastolic blood pressure (DBP) was 67.63 +/- 6.85 mm Hg. An analysis of covariance was performed in order to determine the contribution of each independent variable (height, weight-for-height, sex, age, and resting pulse) to the variance in BP, while adjusting for all other independent variables. Height, weight-for-height, and resting pulse were all found to be significantly associated with both SBP and DBP. Children in the upper quartile of weight-for-height had a mean adjusted SBP that was 10.2 mm Hg higher than those in the lower quartile and a mean adjusted DBP that was 7.9 mm Hg higher. Children in the upper quartile of height (for age) had mean adjusted SBP and DBP that were 6.1 and 4.7 mm Hg higher, respectively, than those of children in the lower quartile. Sex and age showed no significant association with SBP. The associations between DBP and both sex and age were not statistically significant (P less than 0.10), but there was a trend for girls and older children to have a slightly higher DBP. In a subsample of 93 children who had both resting pulse and recovery index measured (using the Modified Harvard Step Test for children).(ABSTRACT TRUNCATED AT 250 WORDS)     

11.

The multiple risk factor intervention trial (MRFIT): IV. Intervention on blood lipids     

Arlene W. Caggiula  George Christakis  Marilyn Farrand  Stephen B. Hulley  Ruth Johnson  Norman L. Lasser  Jeremiah Stamler  Graham Widdowson 《Preventive medicine》1981,10(4):443-475

The results are presented for the first 4 years of the Multiple Risk Factor Intervention Trial (MRFIT) nutrition intervention program. Study participants were at high risk (upper 10–15%) for Coronary Heart Disease (CHD). The Special Intervention (SI) group reached and sustained the goals of an eating pattern originally designed to limit cholesterol intake to less than 300 mg/day, with less than 10% of calories as saturated fat and not more than 10% as polyunsaturated fat. By the end of the first year, mean serum total cholesterol had fallen by 6.3% from the mean initial value of 254 mg/dl. The magnitude of the decrease became slightly greater in the ensuing years, reaching 7.4% by the fourth annual visit. Substantially larger decreases in mean serum cholesterol level were observed in the subgroups with the highest baseline level, greatest weight loss, in those who did not smoke, and in those who had normal blood pressure on entry. The changes in cholesterol level were accompanied by parallel changes in mean plasma LDL cholesterol, which also fell by 6.6% over the 4 years, but mean HDL cholesterol was not substantially altered. Comparison with earlier population data suggests that the overall responses to the MRFIT eating pattern were limited by the apparent fact that participants had already made self-initiated changes toward the fatcontrolled dietary pattern before they entered the study.     

12.

Preventing and treating periodontal disease with the keyes technique: A preliminary assessment     

Richard M. Scheffler  Sheldon Rovin 《Preventive medicine》1982,11(6):677-695

This article uses data from 190 patient records in 18 dental practices to conduct a shortterm assessment of the effectiveness and costs of the Keyes technique, a nonsurgical method for treating and preventing periodontal disease. The results of this study, based on nonexperimental data, suggest that controlled clinical trials are called for in assessing the long-term effectiveness of the Keyes technique. If clinical trials support the study's short-term results, then the Keyes technique would provide a cost-effective alternative to surgery for the prevention and treatment of periodontal disease.     

13.

Yields of selected toxic agents in the smoke of Canadian cigarettes, 1969 and 1978. A decade of change?     

William S. Rickert  Jack C. Robinson 《Preventive medicine》1981,10(3):353-363

Canadian sales-weighted averages of cigarette carbon monoxide (CO) and tar have been evaluated for the decade ending 1979. Virtually no change occurred up to 1976; between 1976 and 1979 the sales-weighted average CO dropped from 21 to 16 mg with a much smaller decrease in the corresponding values for tar (16.1 to 14.4 mg). Thus changes in CO deliveries did not take place at the same rate as changes in tar deliveries. If standardized smoking machine yields are related to the risk of smoking-related morbidity and mortality, the low correlation and the 8-year lag time in the curves describing the decrease in two of the major toxic constituents of cigarette smoke may be of importance in helping to explain a lower impact of less hazardous cigarettes on coronary heart disease (CHD) rates. Assuming that exposure to CO is a risk factor for CHD, the relatively recent reduction in sales-weighted CO yields might have the effect of decreasing CHD rates among smokers in the future. In addition to CO yields, HCN, acrolein, and total aldehyde yields of 25 brands of cigarettes manufactured in 1969 were compared with yields of the same cigarettes manufactured in 1978 in order to assess changes which may have occurred in other gas phase constituents. Significant decreases were noted in the yields of all constituents other than CO; the average decrease per brand was HCN, 69 μg; total aldehydes, 114 μg, and acrolein, 5.2 μg.     

14.

A study on cadmium-induced nephropathy in rats pretreated with puromycin aminonucleoside     

Y K Yamada  F Shimizu  K T Suzuki  M Yamamura  K Kubota 《Environmental research》1983,32(1):179-187

Nephrotoxicity of cadmium (Cd) was investigated using puromycin aminonucleoside (AN)-pretreated rats. AN pretreatment was performed by iv injection of 100 mg AN/kg body wt 11 days before the initial Cd injection. Since massive proteinuria and focal glomerular deposits were recognized, glomerular permeability is considered to be increased in AN-pretreated rats. AN-pretreated and intact rats were injected sc with 3 mg Cd/kg body wt, 4 times a week. In non-pretreated rats, slight tubular vacuolation was seen after 1-week Cd exposure and severe vacuolation and coagulative necrosis of the tubules was observed after 2-week Cd exposure. On the other hand, AN pretreatment delayed the onset of vacuolation and necrosis for 1 week and made the lesion milder. After 1-week Cd exposure, a larger amount of Cd was excreted into the urine of AN-pretreated rats than of non-pretreated ones, whereas Cd accumulation in the kidney and liver was lower in AN-pretreated rats than in non-pretreated ones. Thereafter, no difference in Cd concentration was recognized between two groups. From these findings, it is suggested that in early stage of Cd administration, Cd was filtered through the glomerular basement membrane modified by AN pretreatment and that this filterable Cd did not have nephrotoxic effects in AN-pretreated rats.     

15.

Seasonal patterns of asthma: A clue to etiology     

Inge F. Goldstein  Brian Currie 《Environmental research》1984,33(1):201-215

An extensive data set of daily hospital emergency room visits for asthma for two geographic areas (1953–1977 in New Orleans and 1969–1977 in New York City) was examined for seasonality. Previous studies using smaller data bases have reported an autumn increase (principally during October and November) in the number of emergency room visits for asthma in many locations in this country (including New Orleans and New York City). The results of this study indicated that for every hospital and every year of observation in New York City the number of asthma emergency room visits increased in September, reached a peak in October and November and declined in December. In contrast, in New Orleans an autumn increase in the number of asthma emergency room visits was not consistently observed, being absent or reduced during many years. The distribution of asthma epidemic days (days on which the number of asthma emergency room visits was greatly elevated) by month was also examined. In New York City, there was a tendency for these days to occur during September, October, and November while in New Orleans there was an equal likelihood of epidemic days occurring in April, May, and June as well as during September, October, and November. The observations tend to suggest different etiologies for asthma attacks in the two geographic areas.     

16.

Community participation in the control of trachoma in Gazankulu     

E.E. Sutter  R.C. Ballard 《Social science & medicine (1982)》1983,17(22):1813-1817

Groups of villagers, the care groups, are involved in prevention and treatment of trachoma within their own communities. The effect of the scheme on standards of hygiene and prevalence of trachoma has been evaluated by randomised cluster sampling methods. The number of households who were digging refuse pits, acquired individual face cloths and were aware of the role of good hygiene in the prevention of trachoma exceeded significantly those in (control) villages without a care group, in contrast the acquisition of pit latrines showed an insignificant increase. The prevalence and intensity of active trachoma was found to be significantly reduced as a result of the intervention of the care groups. This scheme has been totally integrated into the primary health care system of the area.     

17.

A randomized trial of aspirin and beta-carotene among U.S. physicians   总被引：2，自引：0，他引：2  

C H Hennekens  K Eberlein 《Preventive medicine》1985,14(2):165-168

The Physicians' Health Study is a randomized, placebo-controlled, double-blind clinical trial underway in the United States to assess the effects of aspirin (325 mg q.o.d.) on total cardiovascular mortality, and of beta-carotene (50 mg q.o.d.) on cancer incidence. The participants are 22,071 U.S. male physicians between the ages of 40-84 years. The design of the study is 2 x 2 factorial, which enables us to address two important research questions simultaneously. The trial is conducted entirely by mail, which involves sending calendar packs of drugs and questionnaires on health status and compliance, initially at six-month then at annual intervals. Compliance and follow-up rates to date are excellent. The large size of the trial, its simple design, and the use of highly motivated, dedicated, and health-conscious physicians should allow us to perform definitive tests of whether low-dose aspirin consumption reduces total cardiovascular mortality and beta-carotene decreases cancer incidence in a healthy population.     

18.

An epidemiologic study of the carpal tunnel syndrome in an adult female population   总被引：4，自引：0，他引：4  

G S Dieck  J L Kelsey 《Preventive medicine》1985,14(1):63-69

The relationships between certain reproductive, demographic, and medical variables and the carpal tunnel syndrome were examined using data from a hospital-based case-control study of women ages 45 to 74 years in the New Haven and Hartford, Connecticut, areas from 1977 to 1979. Characteristics of 40 carpal tunnel syndrome cases and 1,043 controls from hospital surgical services were compared. A history of diabetes was associated with an increased frequency of occurrence of the carpal tunnel syndrome, a finding consistent with clinical observation. Recent weight gain and use of estrogen replacement therapy were identified as possible risk factors; this provides some support for the theory that fluid retention in the soft tissues of the carpal tunnel is etiologically involved, although these results are preliminary and further research must be carried out to refute or support these findings. The negative association of the carpal tunnel syndrome with height and a history of varicose veins and the positive association with age at menopause cannot be explained and need verification.     

19.

Mental health professionals' knowledge in the field of caring for chronic mental disorders     

G E Barnes  J Toews 《Social science & medicine (1982)》1985,21(11):1229-1233

A national sample of 246 Canadian mental health professionals was given a knowledge test concerning principles of care for chronic mental patients. Results showed that: (1) mental health professionals were moderately knowledgeable on this topic (mean score 66%), (2) errors made were more commonly in the direction of over-enthusiastic support for the community approach and (3) there were no differences in knowledge scores by a demographic or professional status variables included in this study.     

20.

The role of patient education in the management of childhood asthma   总被引：2，自引：0，他引：2  

Sandra R. Wilson-Pessano Ph.D.  Wylie L. McNabb Ed.D. 《Preventive medicine》1985,14(6):670-687

Because patient behavior plays a major role in the prevention or precipitation of acute asthma attacks, patient education is an important adjunct to its medical management. A number of self-management education programs for patients with asthma recently have been developed and made available for widespread use. Many are aimed at children over the age of 6 years and their parents. They are designed for use with several types of patients in a variety of settings. Evidence of program effectiveness is of uneven quality, but what is available suggests that a number of the programs can be of significant value in reducing asthma morbidity. Self-management education programs for parents of preschool-age children and for adults with asthma are much less numerous and well developed than those for school-age children. Particular attention is given to the process by which the AIR POWER and AIR WISE programs for children were developed, since this systematic development process is generalizable to patient education programs for other age groups and health problems.     

	Weight (kg)	Quetelet (wt/ht2)	Hematocrit (%)	Bilirubin (mg/dl)
H+	53 ± 1.5	2.1 ± 0.04	44 ± 0.4	0.68 ± 0.04
H-	49 ± 0.71	1.9 ± 0.27	43 ± 0.27	0.52 ± 0.027

A new view of the etiology of nasopharyngeal carcinoma

The epidemiological finding of high geographical similarity seen in the distribution of Croton tiglium, the parental plant for croton oil, as well as other related members of Euphorbiaceae family, and the nasopharyngeal carcinoma (NPC) in southern regions of China, led to the compilation of these data plus our recent laboratory observations on in vitro induction of Epstein-Barr virus (EBV) in human lymphoblastoid cell lines. The EBV genome-carrying P3HR-1 and Raji cells exerted a dramatic increase in EBV antigens when given a combined treatment with n-butyrate and croton oil, in nanogram concentrations. The Fusobacterium and other common microbial inhabitants of the mouth and nasopharynx of man efficiently produce, in laboratory culture fluids, n-butyric acid with EBV-inducer activity. Furthermore, the seeds and plant per se of C. tiglium and other Euphorbiaceae are currently being used as herbal drug in the southern parts of China. We hypothesize that NPC is initiated by persisting EBV as an essential and basic factor plus the combined action of the bacterial fatty acid and traditional intake of promoter substance of plant origin as cofactors, and that the EBV, induced and activated by such mechanisms, initiates the chain of events which ultimately lead to the emergence of the malignant disease.     

Inhibition of implantation by intraluminal administration of concanavalin A in mice.

Important characteristics of endometrial implantation sites are the changes of polarity and molecular composition of the cellular surface. For this reason the masking of surface carbohydrates could lead to an inhibition of the recognition by the blastocyst of the endometrial implantation site. Considering the impact of lectins on carbohydrates, we decided to utilize the intraluminal administration (5 microliter) of different concentrations of concanavalin A (15-60 microgram) in pregnant female mice in the preimplantation phase. An inhibition of 100% of implantation wqs obtained with concentrations of 30 and 60 microgram of the lectin administered on days 3 and 4 of the pregnancy (P less than 0.001). Less important effects were observed on administering 15 or 20 microgram of the lectin (73 and 87% of inhibition) and on utilizing the different doses on days 1 and 2 of the pregnancy. Thus, we conclude that the egg must recognize certain molecules of the endometrial surface (alpha-D-mannopyranose and alpha-D-glucopyranose) in order to implant and that the making of these sites potentially constitutes a new contraceptive approach.     

Determinants of blood pressure in Jerusalem schoolchildren

In 1982, 113 first- and second-graders attending an elementary school in West Jerusalem had their blood pressure (BP), height, weight, and resting pulse measured. Three successive BP readings were taken. The mean of the second and third readings was used for data analysis. Mean systolic blood pressure (SBP) was 98.30 +/- 8.51 mm Hg and mean diastolic blood pressure (DBP) was 67.63 +/- 6.85 mm Hg. An analysis of covariance was performed in order to determine the contribution of each independent variable (height, weight-for-height, sex, age, and resting pulse) to the variance in BP, while adjusting for all other independent variables. Height, weight-for-height, and resting pulse were all found to be significantly associated with both SBP and DBP. Children in the upper quartile of weight-for-height had a mean adjusted SBP that was 10.2 mm Hg higher than those in the lower quartile and a mean adjusted DBP that was 7.9 mm Hg higher. Children in the upper quartile of height (for age) had mean adjusted SBP and DBP that were 6.1 and 4.7 mm Hg higher, respectively, than those of children in the lower quartile. Sex and age showed no significant association with SBP. The associations between DBP and both sex and age were not statistically significant (P less than 0.10), but there was a trend for girls and older children to have a slightly higher DBP. In a subsample of 93 children who had both resting pulse and recovery index measured (using the Modified Harvard Step Test for children).(ABSTRACT TRUNCATED AT 250 WORDS)     

The multiple risk factor intervention trial (MRFIT): IV. Intervention on blood lipids

The results are presented for the first 4 years of the Multiple Risk Factor Intervention Trial (MRFIT) nutrition intervention program. Study participants were at high risk (upper 10–15%) for Coronary Heart Disease (CHD). The Special Intervention (SI) group reached and sustained the goals of an eating pattern originally designed to limit cholesterol intake to less than 300 mg/day, with less than 10% of calories as saturated fat and not more than 10% as polyunsaturated fat. By the end of the first year, mean serum total cholesterol had fallen by 6.3% from the mean initial value of 254 mg/dl. The magnitude of the decrease became slightly greater in the ensuing years, reaching 7.4% by the fourth annual visit. Substantially larger decreases in mean serum cholesterol level were observed in the subgroups with the highest baseline level, greatest weight loss, in those who did not smoke, and in those who had normal blood pressure on entry. The changes in cholesterol level were accompanied by parallel changes in mean plasma LDL cholesterol, which also fell by 6.6% over the 4 years, but mean HDL cholesterol was not substantially altered. Comparison with earlier population data suggests that the overall responses to the MRFIT eating pattern were limited by the apparent fact that participants had already made self-initiated changes toward the fatcontrolled dietary pattern before they entered the study.     

Preventing and treating periodontal disease with the keyes technique: A preliminary assessment

This article uses data from 190 patient records in 18 dental practices to conduct a shortterm assessment of the effectiveness and costs of the Keyes technique, a nonsurgical method for treating and preventing periodontal disease. The results of this study, based on nonexperimental data, suggest that controlled clinical trials are called for in assessing the long-term effectiveness of the Keyes technique. If clinical trials support the study's short-term results, then the Keyes technique would provide a cost-effective alternative to surgery for the prevention and treatment of periodontal disease.     

Yields of selected toxic agents in the smoke of Canadian cigarettes, 1969 and 1978. A decade of change?

Canadian sales-weighted averages of cigarette carbon monoxide (CO) and tar have been evaluated for the decade ending 1979. Virtually no change occurred up to 1976; between 1976 and 1979 the sales-weighted average CO dropped from 21 to 16 mg with a much smaller decrease in the corresponding values for tar (16.1 to 14.4 mg). Thus changes in CO deliveries did not take place at the same rate as changes in tar deliveries. If standardized smoking machine yields are related to the risk of smoking-related morbidity and mortality, the low correlation and the 8-year lag time in the curves describing the decrease in two of the major toxic constituents of cigarette smoke may be of importance in helping to explain a lower impact of less hazardous cigarettes on coronary heart disease (CHD) rates. Assuming that exposure to CO is a risk factor for CHD, the relatively recent reduction in sales-weighted CO yields might have the effect of decreasing CHD rates among smokers in the future. In addition to CO yields, HCN, acrolein, and total aldehyde yields of 25 brands of cigarettes manufactured in 1969 were compared with yields of the same cigarettes manufactured in 1978 in order to assess changes which may have occurred in other gas phase constituents. Significant decreases were noted in the yields of all constituents other than CO; the average decrease per brand was HCN, 69 μg; total aldehydes, 114 μg, and acrolein, 5.2 μg.     

A study on cadmium-induced nephropathy in rats pretreated with puromycin aminonucleoside

Nephrotoxicity of cadmium (Cd) was investigated using puromycin aminonucleoside (AN)-pretreated rats. AN pretreatment was performed by iv injection of 100 mg AN/kg body wt 11 days before the initial Cd injection. Since massive proteinuria and focal glomerular deposits were recognized, glomerular permeability is considered to be increased in AN-pretreated rats. AN-pretreated and intact rats were injected sc with 3 mg Cd/kg body wt, 4 times a week. In non-pretreated rats, slight tubular vacuolation was seen after 1-week Cd exposure and severe vacuolation and coagulative necrosis of the tubules was observed after 2-week Cd exposure. On the other hand, AN pretreatment delayed the onset of vacuolation and necrosis for 1 week and made the lesion milder. After 1-week Cd exposure, a larger amount of Cd was excreted into the urine of AN-pretreated rats than of non-pretreated ones, whereas Cd accumulation in the kidney and liver was lower in AN-pretreated rats than in non-pretreated ones. Thereafter, no difference in Cd concentration was recognized between two groups. From these findings, it is suggested that in early stage of Cd administration, Cd was filtered through the glomerular basement membrane modified by AN pretreatment and that this filterable Cd did not have nephrotoxic effects in AN-pretreated rats.     

Seasonal patterns of asthma: A clue to etiology

An extensive data set of daily hospital emergency room visits for asthma for two geographic areas (1953–1977 in New Orleans and 1969–1977 in New York City) was examined for seasonality. Previous studies using smaller data bases have reported an autumn increase (principally during October and November) in the number of emergency room visits for asthma in many locations in this country (including New Orleans and New York City). The results of this study indicated that for every hospital and every year of observation in New York City the number of asthma emergency room visits increased in September, reached a peak in October and November and declined in December. In contrast, in New Orleans an autumn increase in the number of asthma emergency room visits was not consistently observed, being absent or reduced during many years. The distribution of asthma epidemic days (days on which the number of asthma emergency room visits was greatly elevated) by month was also examined. In New York City, there was a tendency for these days to occur during September, October, and November while in New Orleans there was an equal likelihood of epidemic days occurring in April, May, and June as well as during September, October, and November. The observations tend to suggest different etiologies for asthma attacks in the two geographic areas.     

Community participation in the control of trachoma in Gazankulu

Groups of villagers, the care groups, are involved in prevention and treatment of trachoma within their own communities. The effect of the scheme on standards of hygiene and prevalence of trachoma has been evaluated by randomised cluster sampling methods. The number of households who were digging refuse pits, acquired individual face cloths and were aware of the role of good hygiene in the prevention of trachoma exceeded significantly those in (control) villages without a care group, in contrast the acquisition of pit latrines showed an insignificant increase. The prevalence and intensity of active trachoma was found to be significantly reduced as a result of the intervention of the care groups. This scheme has been totally integrated into the primary health care system of the area.     

A randomized trial of aspirin and beta-carotene among U.S. physicians

The Physicians' Health Study is a randomized, placebo-controlled, double-blind clinical trial underway in the United States to assess the effects of aspirin (325 mg q.o.d.) on total cardiovascular mortality, and of beta-carotene (50 mg q.o.d.) on cancer incidence. The participants are 22,071 U.S. male physicians between the ages of 40-84 years. The design of the study is 2 x 2 factorial, which enables us to address two important research questions simultaneously. The trial is conducted entirely by mail, which involves sending calendar packs of drugs and questionnaires on health status and compliance, initially at six-month then at annual intervals. Compliance and follow-up rates to date are excellent. The large size of the trial, its simple design, and the use of highly motivated, dedicated, and health-conscious physicians should allow us to perform definitive tests of whether low-dose aspirin consumption reduces total cardiovascular mortality and beta-carotene decreases cancer incidence in a healthy population.     

An epidemiologic study of the carpal tunnel syndrome in an adult female population

The relationships between certain reproductive, demographic, and medical variables and the carpal tunnel syndrome were examined using data from a hospital-based case-control study of women ages 45 to 74 years in the New Haven and Hartford, Connecticut, areas from 1977 to 1979. Characteristics of 40 carpal tunnel syndrome cases and 1,043 controls from hospital surgical services were compared. A history of diabetes was associated with an increased frequency of occurrence of the carpal tunnel syndrome, a finding consistent with clinical observation. Recent weight gain and use of estrogen replacement therapy were identified as possible risk factors; this provides some support for the theory that fluid retention in the soft tissues of the carpal tunnel is etiologically involved, although these results are preliminary and further research must be carried out to refute or support these findings. The negative association of the carpal tunnel syndrome with height and a history of varicose veins and the positive association with age at menopause cannot be explained and need verification.     

Mental health professionals' knowledge in the field of caring for chronic mental disorders

A national sample of 246 Canadian mental health professionals was given a knowledge test concerning principles of care for chronic mental patients. Results showed that: (1) mental health professionals were moderately knowledgeable on this topic (mean score 66%), (2) errors made were more commonly in the direction of over-enthusiastic support for the community approach and (3) there were no differences in knowledge scores by a demographic or professional status variables included in this study.     

The role of patient education in the management of childhood asthma

Because patient behavior plays a major role in the prevention or precipitation of acute asthma attacks, patient education is an important adjunct to its medical management. A number of self-management education programs for patients with asthma recently have been developed and made available for widespread use. Many are aimed at children over the age of 6 years and their parents. They are designed for use with several types of patients in a variety of settings. Evidence of program effectiveness is of uneven quality, but what is available suggests that a number of the programs can be of significant value in reducing asthma morbidity. Self-management education programs for parents of preschool-age children and for adults with asthma are much less numerous and well developed than those for school-age children. Particular attention is given to the process by which the AIR POWER and AIR WISE programs for children were developed, since this systematic development process is generalizable to patient education programs for other age groups and health problems.