Man the risk taker

Most approaches to preventing chronic disease involve changing personal behavior. Appeals to change are often made on the grounds that certain behavior incurs a risk to health, but evaluative studies of health education suggest that this may not be a persuasive argument. Humans have always lived with risks and do not necessarily equate risk with personal danger. Many forces, both social and psychological, underlie the willingness to tolerate risks, and altering familiar behaviors may seem to the individual to be more of a loss than a benefit. If we seek to change health behavior, we must acknowledge this and recognize that factual information on risks will not encourage change unless the change forms part of a broader reappraisal of the person's values. Individual appeals for change will have little impact as long as broader social forces continue to encourage health risk behavior.     

A case of dark urine,hyperpigmentation and hepatomegaly

We report a case of malignant melanoma in which the presenting feature was melanuria. Melanuria should be considered in the differential diagnosis of any patient presenting with dark urine.     

Body piercing: issues in adolescent health.

Ask the Expert provides research‐based answers to practice questions submitted by JSPN readers.     

Development of hamster tracheal epithelium: III. Illustration of statistical methods for proportional data in biology

The data in the two companion papers (McDowell et al., 1985a,b) are of a commonly occurring type in which the dependent variable takes on one of a small number of distinct values; we wish to compare the relative proportions in which these values occur. Student's test is inapplicable. We explain here in detail the linear logistic model that is appropriate, using our data as an example. Several reasonable models must first be fit. We did this by the maximum likelihood method, using a computer. We then used a chi 2 test to decide statistically between models. This process amounts to deciding directly which of the independent variables are important in determining the outcome, and thus it is the center of physiologic interest. The outcome depends on the initial choice of parametrization of the model. Generalizations are required in more complicated, but still commonly occurring, types of data.     

Chromosome 1 studies in Wilms' tumor

Ten newly diagnosed patients with Wilms' tumor had blood and tumor samples taken for cytogenetic analysis. DNA was also extracted from these samples, along with blood obtained from both parents and an age- and sex-matched control. Molecular biological techniques were employed to study changes present in these samples with respect to chromosome 1. Two DNA probes, PIB 174 and PFBl, mapping to 1q12-qter and 1p12-pter, respectively, were examined for the presence of restriction fragment length polymorphisms (RFLPs) and to detect copy numbers of sequences homologous to the probes. These were normalized with respect to themselves and with regard to a control probe P30. No RFLPs were found with the restriction enzymes used. However, seven patients showed a marked alteration in hybridization signal in tumor and/or blood samples compared to control samples and the control probe. This was apparent using probe PFBl, but just failed to reach statistical significance using nonparametric testing. This would suggest that submicroscopic chromosome 1 changes are present more often in Wilms' tumor than previously recognized, and they may play a leading role in the genesis of this tumor.     

Insomnia and heart disease: a review of epidemiologic studies

Since the discovery and successful treatment of sleep apnea, researchers seem to believe that the association between sleep disturbance and coronary heart disease (CHD) has been explained. To determine whether subjective nighttime sleep complaints (trouble sleeping, trouble falling asleep, trouble staying asleep), exclusive of apnea, predicted myocardial infarction and other coronary events, a MEDLINE search was conducted for articles published between January 1976 through August 1997. Ten studies with an explicit measure of association between an insomniac complaint and CHD were identified. Reported risk ratios for various sleep complaints and CHD events ranged from 1.0 for waking too early and CHD death in an elderly North Carolina community to 8.0 for the highest versus lowest quintile of a sleep scale in Finnish men. Higher quality studies showed risk ratios of 1.47-3.90 between trouble falling asleep and coronary events after adjusting for age and various coronary risk factors (combined effect=1.7, p<0.0001). While alternative explanations such as medication use still need to be ruled out, we theorize that a subjective insomniac complaint either may be part of a larger syndrome that includes poor health and depression, or it may be related to continual stressors, reduced slow-wave sleep, and autonomic dysfunction, which increase the risk of heart problems.     

Conformations of trypsin-bound amidine inhibitors of blood coagulant factor Xa by double REDOR NMR and MD simulations.

Double rotational-echo double resonance (double REDOR) has been used to investigate the bound conformations of (13)C,(15)N,(19)F-labeled factor Xa inhibitors to bovine trypsin. Carbon-fluorine dipolar couplings were measured by (13)C{(19)F} REDOR with natural-abundance background interferences removed by (13)C{(15)N} REDOR. The conformations of the bound inhibitors were characterized by molecular dynamics (MD) simulations of binding restrained by double REDOR-determined intramolecular C-F distances. A symmetrical bisamidine inhibitor and an asymmetrical monoamidine-monoamine inhibitor of the same general shape had distinctly different conformations in the bound state. According to the MD models, these differences arise from specific interactions of the amidine and amine groups with the active-site residues of trypsin and nearby water molecules.