How Do Physicians Define “Light,”“Moderate,” and “Heavy” Drinking?

Although widely used, terms associated with consumption of alcohol–such as "light,""moderate," and "heavy"—are unstandardized. Physicians conveying health messages using these terms therefore may impart confusing information to their patients or to other physicians. As an initial attempt to assess if informal standardization exists for these terms, the present study surveyed physicians for their definitions of such terms. Physicians operationally defined "light" drinking as 1.2 drinks/day, "moderate" drinking as 2.2 drinks/ day, and "heavy" drinking as 3.5 drinks/day. Abusive drinking was defined as 5.4 drinks/day. There was considerable agreement for these operational definitions, indicating there is indeed an informal consensus among physicians as to what they mean by these terms. Gender and age did not influence these definitions, but self-reported drinking on the part of physicians was a factor. We also asked physicians for their opinions regarding the effects of "light,""moderate," and "heavy" drinking on health in general and specifically on health-related implications for pregnant women, and whether they felt their patients shared these beliefs.     

Premature Aging in Male Alcoholics: “Accelerated Aging” or “Increased Vulnerability”?

This study involved an evaluation of two versions of the "premature aging" theory of chronic alcoholism: the accelerated aging and increased vumerabHty versions. The major dependent measures used were the tests included in Reitan's brain age quotient (BAO), a series of neuropsychological tests known to be sensitive to the effects of alcoholism and aging. Subjects were 40 chronic alcoholic inpatients and 40 matched controls, divided into age groups by; decade, ranging from the 30s to the 60s. It was proposed that an j interaction between age and presence or absence of alcoholism, with BAO test differences between alcoholics and controls widening as age increases, would support the increased vulnerability version, while the absence of such aw interaction would support the accel-] erated aging version. The results dearty favored the accelerated aging version, with merited BAO test differences between alcoholics, and controls appearing even in the 30-year-old groups. It was concluded that chronic ateohoftcs tend to perform at levels found for nonalconoiics 10 years their senior, but the discrepancy between, alcoholics and nonalcohoics does not increase with age.     

Cardiac resynchronization therapy: “Nonresponders” and “hyperresponders”

BACKGROUND: Cardiac resynchronization therapy (CRT) is a recognized treatment modality for patients with dilated cardiomyopathy (DCM), left bundle branch block, and severe cardiac failure. However, 30% of patients are "nonresponders." Intriguingly, the opposite case has not been reported until recently: Do some patients treated with CRT have a "complete" recovery and thus can be considered "hyperresponders"? OBJECTIVE: The purpose of this study was to investigate patients treated with CRT who have a "complete" functional recovery, with normalization of left ventricular function after therapy. METHODS: Eighty-four consecutive patients with DCM, sinus rhythm, and left bundle branch block in New York Heart Association functional class III and IV who were implanted with a CRT device were prospectively followed. Patients were considered to be "hyperresponders" if they concurrently fulfilled two criteria: functional recovery and left ventricular ejection fraction > or = 50%. RESULTS: Among the 84 patients with DCM, 11 (13%) were "hyperresponders" within 6 to 24 months after CRT (left ventricular ejection fraction increased from 25% +/- 8% to 60% +/- 6.5%, P = .001). Comparison of baseline parameters between "hyperresponders" and the remaining patients showed that only etiology of the DCM was statistically discriminative. All "hyperresponders" belonged to the group of patients with nonischemic DCM (18% vs 0%, P = .05). CONCLUSION: In a subset of patients successfully implanted with a CRT device, "complete" functional recovery associated with normalization of LV function was observed, giving rise to the concept of "hyperresponders." This finding is observed exclusively in the subgroup of patients with nonischemic DCM and suggests that left bundle branch block may be the causal factor of DCM in this subgroup of patients.     

Hon v. Stroh Brewery Company: What Do We Mean by “Moderate” and “Heavy” Drinking?

Although widely used, drinking terms such as "light,""moderate," and "heavy" are unstandardized and, as a result, public health messages using these terms may convey confusing information. As an initial attempt in providing such standardization, the present study surveyed public definitions for these terms. "Light" drinking was operationally defined as 1.4–2.4 drink/day; "moderate" drinking was defined as 2.5–3.6 drink/day; and "heavy" drinking was defined as 3.7 drinks/day and above. These ranges, however, were dependent on the respondent's gender, age, socioeconomic status, and especially the respondent's self-reported tolerance. Males had a higher threshold of consumption for "moderate" and "heavy" drinking than women. Older respondents likewise assigned a higher threshold for these terms than younger respondents. As respondent income increased, the threshold for "heavy" drinking decreased. The heaviest drinkers had a higher threshold for assigning the "heavy" label than did any other group. Ethnicity did not significantly affect these ranges, and religion only affected the threshold for "heavy" drinking.
Because researchers ultimately rely on terms such as "moderate" or "heavy" to communicate their findings to colleagues and the public, it would seem apposite for them to agree on operational definitions for such terms. It would also seem appropriate to consider the operational definitions the public uses when referring to these terms to promote credibility of research findings and appropriate changes in behavior.     

Respiratory syncytial virus is an “opportunistic” killer

Respiratory syncytial virus (RSV), responsible for more than three million yearly hospitalizations and up to 118 000 deaths in children under 5 years, is the leading pulmonary cause of death for this age group that lacks a licensed vaccine. Ninety‐nine percent of deaths due to the virus occur in developing countries. In‐hospital RSV fatalities affect previously healthy term infants in association with bacterial sepsis, clinically significant pneumothoraxes and, to a lesser extent, comorbid conditions. Community deaths affect low‐income children from socially vulnerable families and appear to be as frequent as inpatient fatalities. In industrialized countries, RSV deaths occur almost exclusively in children with premorbid conditions. In a sense, RSV is an “opportunistic” killer. It needs a synergistic premorbid, medical practice‐related, infectious, or social co‐factor to cause a fatal outcome. But while the complex problems associated with these co‐factors await solutions, candidate vaccines, long‐lived monoclonal antibodies and antivirals against RSV are under clinical evaluation. It seems reasonable to predict that the landscape of RSV infections will look different in the next decade.

     

Transplantation of “live” hearts

A “stabilized” form of heart-lung preparation is presented, which enabled the authors to transplant hearts experimentally in a fully perfused, beating stage, without the assistance of parabiosis or extracorporeal circulation. This method proved to be most effective in maintaining the donor heart viable and functioning in the extracorporeal phase, as well as during the process of transplantation.     

“I JUST ACCEPT IT!” RESEARCH REMINISCENCES ON AGED INCOME SECURITY

From its inception in 1909 the Australian Age Pension became well established as a social ‘right’ of citizenship over the following eight decades. Since 1988 and the Social Security Review, though, retirement incomes policy has become subject to political debate and policy turbulence. Ideally, abstract and applied policy should draw upon the lessons of history. So the perceptions of pensioner beneficiaries about the effects of pension provision on life chances are pertinent to present discussion. Such social policy story-telling suggests that for working class seniors of the present cohort, memories of the Great Depression ameliorate any sense of present hardship, creating appreciation and acceptance of extant pension provisions. In view of the contemporary exhortations that individuals should now take full financial responsibility for their own retirement income security, the lesson that ordinary working folk cannot save an adequate retirement nest egg seems salient Furthermore, politicians' past behaviour of ‘super swindle’ seems likely to be repeated. The baby boom generation, having funded aged care in its day, can itself only anticipate a bleak future in terms of the retreat of the State from the provision of aged income security.     

Validity of the Distinction Between “Substance-Induced” and “Independent” Depression and Anxiety Disorders

Diagnosis of comorbid psychiatric disorders in substance abuse patients is complicated by the fact that many abused substances induce transient symptoms that mimic independent disorders. The authors applied criteria designed to distinguish “independent” comorbid disorders from those that may have been “substance-induced,” to determine the impact on rates of diagnosis and on concurrent and predictive validity. Of those with symptoms sufficient to meet criteria for comorbid depression (12%) or anxiety diagnoses (26%), fewer than one-fourth were considered to have independent disorders, and these patients did not constitute a category of greater severity. Current guidelines for defining independent diagnoses were not supported. Further work is required to identify criteria that will provide a clinically meaningful distinction.     

“Bacteroides” bacteremia

Clinical and bacteriologic data relating to 250 patients with bacteremia due to anaerobic, nonsporulating, gram-negative bacilli, “bacteroides,” were analyzed. A total of 433 human blood culture specimens submitted included nine Bacteroides species and four species of Fusobacterium; twenty-nine were mixed with other microorganisms. The characteristic clinical syndrome consisted of hectic fever, rigors and diaphoresis. The gastrointestinal tract was the probable portal of entry for the majority of Bacteroides, the lung and oropharynx for Fusobacterium species. Prior surgery, malignant neoplasms, diabetes mellitus, and steroid, immunosuppressive or cytotoxic therapy were common associated factors. Emboli, thrombophlebitis, endocarditis and metastatic abscesses were common complications. The over-all mortality of the patients was 32 per cent. The mortality of patients with B. fragilis bacteremia, the most common organism involved, was 34 per cent. The death rate of patients with B. oralis and B. variabilis was approximately 70 per cent, but none of the patients with B. melaninogenicus bacteremia died. Patients treated with tetracyclines, sulfonamides, incision and drainage, or a combination of these, showed the highest survival rate.     

Identification of “substrate fibrillators” and “trigger fibrillators” by pacemaker diagnostics

BACKGROUND: The population of patients likely to respond to selected pacing algorithms for maintenance of sinus rhythm is unknown. OBJECTIVES: The purpose of this study was to identify patients with specific onset patterns of paroxysmal atrial fibrillation (AF). METHODS: Dual-chamber pacemakers with advanced diagnostic functions were implanted in 112 patients with conventional indications for antibradycardia pacing and a history of paroxysmal AF. Pacemaker diagnostic data were analyzed after 97.5 +/- 40.9 days. According to the frequency of premature atrial contractions (PACs) during the 5 minutes before AF onset, patients were assigned to one of three groups: group A (high PAC activity), group B (moderate PAC activity), or group C (low PAC activity). RESULTS: AF burden was lower in group A (4.6% +/- 2.4%) than group B (15.8% +/- 3.0%, P = .003) and group C (15.5% +/- 3.1%, P = .003). Fewer AF episodes occurred in group A (2.1 +/- 1.3 per day) than group B (3.8 +/- 1.2 per day, P = .006). Mean AF episode duration was shorter in group A (11.4 +/- 10.2 hours) than group C (41.4 +/- 27.5 hours, P = .03). CONCLUSION: The coincidence of low PAC activity before AF onset, high AF burden, and extended arrhythmia episode duration appears to be the consequence of a high atrial substrate factor. In these "substrate fibrillators," the efficacy of pacing algorithms for maintenance of sinus rhythm may be limited. In contrast, "trigger fibrillators" exhibiting low AF burden despite high PAC incidence may represent the target population for specific PAC-suppressing pacing algorithms.     

The “Bladder sign”—An important early marker of retroperitoneal hemorrhage

Retroperitoneal hemorrhage remains one of the major complications of cardiac and peripheral vascular catheterization. Its high associated morbidity and mortality require vigilance and early intervention. We report six cases of retroperitoneal hemorrhage featuring a “bladder sign.” The compression of the bladder described in this series can be visualized on the incidental cystogram that results from contrast given during catheterization. Its significance as a highly specific marker of retroperitoneal hemorrhage should be appreciated. © 2011 Wiley Periodicals, Inc     

The ballooning mitral valve in patients with the “precordial honk” or “whoop”

Eight patients with a “precordial honk” or “systolic whoop” were studied by complete right and left heart catheterization and left ventricular cineangiocardiography. The patients were divided into two groups on the basis of the absence (group 1) or presence (group 2) of significant heart disease. In all 5 patients in group 1 and in 1 in group 2, ballooning of the mitral valve into the left atrium during ventricular systole was demonstrated on the cineangiograms. The ballooning mitral valve was associated with late systolic mitral insufficiency in 4 of the 5 patients in Group 1.

The incidence of the ballooning mitral valve in this laboratory was determined from 200 consecutive left ventricular cineangiocardiograms obtained from patients with a variety of cardiac lesions. Twelve of these patients (6%) had a ballooning mitral valve, and 10 of these 12 had coexisting mitral insufficiency.

The electrocardiographic features of patients with a “precordial honk” or “whoop” were discussed, and possible mechanisms for the genesis of the sound were suggested. That the “precordial honk” is intracardiac in origin has been demonstrated by several investigators using intracardiac phonocardiography. This report presents anatomic evidence for these data i.e., ballooning of the mitral valve and late systolic mitral insufficiency.     

CRST syndrome and “neuropathic” arthropathy

A 48-year-old woman had features of the CRST variant of systemic sclerosis as well as a severe “neuropathic” arthropathy. No underlying neurologic disorder could be found with certainty. She denied the existence of joint pain, and it is suggested that hysterical indifference to joint pain aggravated the otherwise mild arthritis of systemic sclerosis.     

Early Treatment of Allergy—Does the Child “Outgrow” It?

According to Rapaport and associates,¹the incidence of major allergies in individuals under 14 years of age lies in the neighbourhood of 20%. The age of onset of asthma as reported by Broder and associates² is shown in Table 1.     

Iron Metabolism and “Sports Anemia”

Abstract Several reports have suggested that iron deficiency might explain “sports anemia” especially in long distance runners. The present study was made to further study the iron metabolism in runners as the proposed cause of “sports anemia” is abstruse considering the good iron nutrition in these athletes. Based on a screening of 43 elite male runners, using bone marrow hemosiderin, serum ferritin and transferrin saturation, two groups of subjects were selected for a very extensive study on iron metabolism. In group 1 (n=5) iron depletion was suggested in at least one of the screening studies. In group 2 (n=7) at least one test strongly indicated good iron repletion. This experimental design was chosen to obtain two groups with similar body composition and exercise load but different iron metabolism. The studies comprised determinations of red cell and plasma volumes, plasma iron turnover and red cell incorporation of radioiron, red cell indices, plasma iron and transferrin, red cell protoporphyrin, serum ferritin, serum haptoglobin, urinary iron losses, iron absorption, bone marrow hemosiderin, dietary intake of energy and nutrients and a Desferal test. Pooling the results together it was obvious that none of the subjects were truly iron-deficient. A few occasional findings suggesting low iron stores cannot be satisfactorily explained and indicate that further studies are needed