Renal cell cancer risk and occupational exposure to trichloroethylene: results of a consecutive case-control study in Arnsberg,Germany

BACKGROUND: German studies of high exposure prevalence have been debated on the renal carcinogenicity of trichloroethylene (TRI). METHODS: A consecutive hospital-based case-control study with 134 renal cell cancer (RCC) cases and 401 controls was conducted to reevaluate the risk of TRI in this region which were estimated in a previous study. Exposure was self-assessed to compare these studies. Additionally, the job history was analyzed, using expert-based exposure information. RESULTS: The logistic regression results, adjusted for age, gender, and smoking, confirmed a TRI-related RCC risk in this region. Using the database CAREX for a comparison of industries with and without TRI exposure, a significant excess risk was estimated for the longest held job in TRI-exposing industries (odds ratio (OR) 1.80, 95% confidence interval (CI) 1.01-3.20). Any exposure in "metal degreasing" was a RCC risk factor (OR 5.57, 95% CI 2.33-13.32). Self-reported narcotic symptoms, indicative of peak exposures, were associated with an excess risk (OR 3.71, 95% CI 1.80-7.54). CONCLUSIONS: The study supports the human nephrocarcinogenicity of trichloroethylene.     

Demographic and lifestyle characteristics of functional food consumers and dietary supplement users

Functional foods and/or supplements may be used in the context of a healthy lifestyle or as a means to compensate for an unhealthy lifestyle. Adverse long-term and/or cumulative effects of functional food or supplement intake are of public health concern; it is therefore important to identify functional food and supplement users. The present study compared Dutch functional food and supplement consumers with non-consumers with regard to demographic and lifestyle factors. The consumption of the most common functional foods and supplements in 2000 was studied (yoghurt with extra lactic acid bacteria, cholesterol-lowering margarine, lemonade and sweets with extra vitamins and minerals, milk and margarine with extra Ca, Ca tablets, multivitamin and mineral supplements, and Echinacea supplements). Data were obtained from self-administered questionnaires filled in by a consumer panel, aged 19-91 years (response rate 76 %, n 1183), representative of the Dutch population. The number of daily consumers of functional foods or supplements appeared to be relatively low (daily use of multivitamin and mineral supplements, 20 %; all other products, 3-9 %). Explanatory variables depended on the type of product; but gender, age, education, and vegetable intake were significant factors in the logistic regression model. Consumption of cholesterol-lowering margarines was more likely to be reported by individuals with a poorer subjective health (odds ratio 2.62 (95 % CI 1.15, 6.05)) and by smokers (odds ratio 2.93 (95 % CI 1.34, 6.40)). In conclusion, determinants of functional food or supplement use depended on the type of product, so generalisation of consumer characteristics over different foods is not legitimate. In addition to research on lifestyle factors, surveys about consumers' attitudes, norms and knowledge regarding functional foods in relation to actual dietary patterns and health risk profiles are necessary.     

Can mothers afford maternal health care costs? User costs of maternity services in rural Tanzania

Following the difficult economic situation various countries introduced health sector reforms, including user charges to finance the system. The assessment of user costs for maternity services in Tanzania was part of a larger study, which covered inputs, outputs and efficiency of services. The study was carried out from October 1997 to January 1998 in Mtwara urban and rural district in South Tanzania. One hundred and seven women attending a quarter of government health facilities were randomly selected and interviewed. Twenty one key informants were also interviewed and service procedures observed. Users of maternity services pay mainly for admission, drugs, other supplies and travel costs. Travel costs represent about half of these financial costs. The average total costs vary between US$11.60 for antenatal consultation and US$135.40 for caesarean section at the hospital. Unofficial payments are not included in the calculation. The amounts vary and payment is irregular. We therefore conclude that time costs are constantly higher than financial costs. High direct payments and the fear of unofficial costs are acute barriers to the use of maternity services. User costs can substantially be reduced by the re-organisation of service delivery especially at antenatal consultation.     

Prenatal diagnostic testing of the Noonan syndrome genes in fetuses with abnormal ultrasound findings

In recent studies on prenatal testing for Noonan syndrome (NS) in fetuses with an increased nuchal translucency (NT) and a normal karyotype, mutations have been reported in 9–16% of cases. In this study, DNA of 75 fetuses with a normal karyotype and abnormal ultrasound findings was tested in a diagnostic setting for mutations in (a subset of) the four most commonly mutated NS genes. A de novo mutation in either PTPN11, KRAS or RAF1 was detected in 13 fetuses (17.3%). Ultrasound findings were increased NT, distended jugular lymphatic sacs (JLS), hydrothorax, renal anomalies, polyhydramnios, cystic hygroma, cardiac anomalies, hydrops fetalis and ascites. A second group, consisting of anonymized DNA of 60 other fetuses with sonographic abnormalities, was tested for mutations in 10 NS genes. In this group, five possible pathogenic mutations have been identified (in PTPN11 (n=2), RAF1, BRAF and MAP2K1 (each n=1)). We recommend prenatal testing of PTPN11, KRAS and RAF1 in pregnancies with an increased NT and at least one of the following additional features: polyhydramnios, hydrops fetalis, renal anomalies, distended JLS, hydrothorax, cardiac anomalies, cystic hygroma and ascites. If possible, mutation analysis of BRAF and MAP2K1 should be considered.     

Effectiveness of Hypofractionated Radiotherapy in Painful Bone Metastases Two Prospective Studies with 1 × 4 Gy and 4 × 4 Gy

BACKGROUND: Although effectiveness of fractionated radiotherapy for painful bone metastases is well documented, there are unanswered questions regarding the adequacy of low-dose short radiation schedules for long-term pain control which give maximum benefit in patients with a short life expectancy. PATIENTS AND METHODS: Two consecutive non-randomized prospective follow-up studies were performed at a single institution to analyze pain response and duration of response in patients with a variety of primary tumors. Included were only patients with symptomatic nonvertebral bone metastases and without impending pathologic fracture. Forty-five patients received 1 x 4 Gy to 50 different sites (group I) while 86 patients received 4 x 4 Gy to 96 sites (group II). Pain relief to irradiation was evaluated according to patient interviews using a 4-point categorical scale. Follow-up was performed 7 and 90 days after radiotherapy. RESULTS: Pain relief after 4 x 4 Gy was significantly superior to 1 x 4 Gy with pain control rates being 86.5% vs 48% at day 7 (after end of treatment) and 80% vs 55% at day 90, respectively. A subgroup analysis of patients treated with 4 x 4 Gy demonstrated a more favorable outcome for breast cancer patients in comparison to patients with other primaries concerning pain relief (96% vs 81%), pain control after 90 days (93% vs 72%), median time to pain progression (9 vs 3 months), and median overall survival (14 vs 5.5 months). CONCLUSIONS: In this study 4 x 4 Gy proved to be clearly superior to 1 x 4 Gy in relieving pain from symptomatic nonvertebral bone metastases without impending pathologic fracture. Even if radiotherapy with 1 single fraction seems to be applicable in specific cases doses higher than 4 Gy should be chosen. In breast cancer patients pain control seems to be better compared to other primaries.     

PERC: A Nursing Syndrome for AIDS

PERC is an acronym and represents a proposed nursing syndrome for people with AIDS. It incorporates the NANDA human response patterns of perceiving, exchanging, relating and choosing. These patterns were identified through a review of literature on AIDS, especially that which addressed NANDA nursing diagnoses. The analysis showed that the most frequently used nursing diagnoses across various clinical areas were concentrated in the four human response patterns. Following an analysis of the concept, syndrome, PERC was seen as an appropriate way of consolidating those nursing diagnoses, signs and symptoms that the nurses will generally encounter in working with people with AIDS .