Girls prone to urinary infections followed into adulthood. Indices of renal disease

This study describes blood pressure and renal function, as well as indices of renal disease, in females with and without renal scarring followed from their first urinary tract infection (UTI) in childhood. Of the 111 patients with a median follow-up time of 15 years, 54 had renal scarring (reflux nephropathy) on urography, which was severe in 19 and moderate in 35. The glomerular filtration rate was lower in patients with severe renal scarring and correlated with renal area on urography. However, the filtration rate was decreased below the lower reference limit in only 7 patients, with a lowest value of 70 ml/min per 1.73 m². The diastolic blood pressure was higher in women with severe scarring. Hypertension of at least 140/90 mmHg was diagnosed in 3 of 54 (5.5%) females with renal scarring, 2 before and 1 at the follow-up examination. The excretion of albumin in urine was low and not correlated to filtration rate. Tubular enzymes in urine were similar in all groups. Thus the renal function was well preserved and the incidence of hypertension low. Within this range of renal function, the level of albumin in urine did not predict the degree of renal scarring.     

Is perceived nervousness and anxiety a predictor of premature mortality and severe morbidity? A longitudinal follow up of the Swedish survey of living conditions

STUDY OBJECTIVE: To find out if people perceiving nervousness, uneasiness, and anxiety have excess risks of premature death and severe morbidity. DESIGN, SETTING, PARTICIPANTS: Random samples of the Swedish population aged 16-74 years in 1980-81, 1988-89, and 1995-96 were followed up for 5 and 10 years with regard to deaths and hospital admissions for different causes. Relative risks were estimated by Poisson regression, comparing those who reported perceived nervousness, uneasiness, and anxiety with those who did not and adjustments were made for baseline characteristics as age, education, smoking, and longstanding illness. MAIN RESULTS: Perceived nervousness, uneasiness, and anxiety was strongly related to subsequent risks of suicide attempt and psychiatric disease. Those perceiving severe complaints of anxiety had a relative risk (fully adjusted) for suicide attempt of 9.2 (95% CI 3.0 to 28.8) for men and 3.1 (1.4 to 7.1) for women. Even for less severe complaints, there was a significant, but less pronounced excess risk. These negative feelings were also associated with later risks for all cause mortality, hospital care, and ischaemic heart disease, although to a lesser extent and more strongly among men. Unchanged relative risks over time shows no trend in response attitude and perceived anxiety seems to be a better predictor of a negative health outcome than self reported longstanding illness. CONCLUSIONS: Positive responses to self report survey questions about anxiety/nervousness are associated with adverse health outcomes, particularly hospital admission for deliberate self harm. This is an alarming signal bearing in mind the rapid increase in prevalence of perceived anxiety in the Swedish society.     

Violence against women

Violence against women is now well recognised as a public health problem and human rights violation of worldwide significance. It is an important risk factor for women's ill health, with far reaching consequences for both their physical and mental health. This glossary aims to describe various forms of interpersonal violence that are directed towards women and girls. Terms and basic concepts used in research and policy on this public health problem will be explained.     

Photopheresis for the treatment of refractory renal graft rejection

Acute rejection episodes still occur after kidney transplantation in spite of modern immunosuppressive protocols including combined tacrolimus, mycophenolate mofetil, and prednisolone. The authors present seven cases of biopsy-proven acute rejection after kidney transplantation refractory to conventional rejection therapy with repeated pulses of high-dose steroids followed by polyclonal or monoclonal antibodies that responded well to photopheresis treatment. Photopheresis is an atoxic immunomodulatory apheresis-based treatment with no generalized immunosuppressive action; rather, it is directed at suppressing donor-specific T-cell clones. At the last follow-up, 9 to 43 months after transplantation, all patients had functioning grafts, with serum creatinine levels ranging from 105 to 312 microM. The authors conclude that photopheresis treatment contributed to the favorable outcome. Therefore, the authors are presently designing a prospective, randomized trial to evaluate the effect of photopheresis as an adjuvant prophylactic treatment after renal transplantation.     

A short-form questionnaire identified genital organ prolapse

OBJECTIVE: We constructed a simple questionnaire that, with a minimum of questions, could accurately and reliably identify women with genital organ prolapse. STUDY DESIGN AND SETTING: Two hundred women with confirmed genital organ prolapse and 199 outpatients with various gynecologic symptoms but no objective prolapse answered 13 questions perceived to be valuable for the diagnosis. With stepwise backward logistic regression, the discriminatory ability of a successively abbreviated set of questions was assessed. The resulting short questionnaire was tested in a new population-based sample of 282 women participating in a screening survey. RESULTS: A final five-item questionnaire retained 94% of the predictive value of all 13 questions and had 92.5% sensitivity and 94.5% specificity in the first group of women. When the questionnaire was used in the subsequent population-based survey, the sensitivity and specificity values were 66.5% and 94.2%, respectively. Most missed cases had stage I prolapse. CONCLUSION: Although the sensitivity of the test was moderate, the specificity, and hence the ability to rule in cases, was satisfactory. The test is suitable for case finding in epidemiologic studies.     

Cerebellar dysfunction related to toluene sniffing

Only few cases with prolonged cerebellar symptoms after toluene sniffing have previously been reported. We describe here an 18-year-old female who inhaled pure toluene since the age of 12. She developed neurological symptoms with broad-based ataxic gait, incoordination of arms and legs, unsteadiness, dysarthria, downbeat nystagmus, bilateral positive Babinski sign, and poor concentration and abstracting ability. During her 5 weeks in hospital when she did not inhale toluene, her symptoms persisted but decreased and after 8 months had disappeared.     

Prenatal diagnosis of Gaucher disease Assay of the ß-glucosidase activity in amniotic fluid cells cultivated in two laboratories with different cultivation conditions

Sixteen pregnancies at risk for Gaucher disease - six with the Norrbottnian form, one with a juvenile form with a similar clinical course to the patients from Norrbotten and nine with the infantile form - have been monitored by the assay of β-glucosidase activity in cultivated amniotic fluid cells with natural labelled glycosylceramide as substrate. Two methods of cultivation were compared in respect of their effect on the activity of lysosomal enzymes. No significant difference was found between the two marker enzymes, β-galactosidase and N -acetyl-β-glucosaminidase, but the β-glucosidase activity was significantly higher in the cells cultivated with one of the methods. In four of the pregnancies at risk, the β-glucosidase activity in the cultivated amniotic fluid cells was less than 5 % of that in the two control materials. These fetuses were regarded as affected with Gaucher disease and were aborted. Differentiation between controls and Gaucher heterozygotes was not possible in cultivated amniotic fluid cells. The diagnosis of Gaucher disease in the amniotic fluid cells was confirmed in three of the four cases by the assay of the β-glucosidase activity in the liver and brain of the aborted fetuses. The glucosylceramide content of the liver from two aborted fetuses was not augmented. The β-glucosidase activity was examined in seven placentas from pregnancies at risk for Gaucher disease and found to be in agreement with that in the cultivated amniotic fluid cells.     

Acupuncture therapy for tennis elbow

Acupuncture therapy for patients suffering from tennis elbow has shown itself to be an excellent alternative to steroid injections. Twenty-one out of 34 patients who were treated with acupuncture became much better-completely free of pain. Many of them had previously been given one or more steroid injections without improvement. In a control group of 26 patients who received only steroid injections, 8 patients reported a corresponding improvement. The ancient Chinese technique adapted to Western conditions has, in the above cases, neither caused any side effects nor worsened the condition of any patient, and is well worth trying as therapy for this disabling complaint.     

Oral status, oral infections and some lifestyle factors as risk factors for oral and oropharyngeal squamous cell carcinoma. A population-based case-control study in southern Sweden

CONCLUSION: Our results show that average and poor oral hygiene and inadequate dental status are independent risk factors for oral and oropharyngeal squamous cell carcinoma (OOSCC), irrespective of tobacco and alcohol consumption. OBJECTIVE: To evaluate a possible relationship between oral cancer, oral hygiene, dental status, oral mucosal lesions and some lifestyle factors in a population-based case-control study. MATERIAL AND METHODS: Between September 2000 and January 2004, 132/165 (80%) of all incident cases of OOSCC and 320/396 (81%) of the intended eligible matched controls participated in the study. Cases and controls were subjected to an identical oral examination. A standardized protocol specially designed for the study was used. RESULTS: After adjusting for tobacco and alcohol consumption, average oral hygiene (OR 2.0; 95% CI 1.1-3.6) and poor oral hygiene (OR 5.3; 95% CI 2.5-11.3) emerged as significant risk factors for OOSCC. More than 20 lost teeth (OR 3.4; 95% CI 1.4-8.5), >5 defective teeth (OR 3.1; 95% CI 1.2-8.2) and poorly fitting or defective complete dentures (OR 3.8; 95% CI 1.3-11.4) were significant risk factors. Regular dental check-ups were associated with a decreased risk of OOSCC (OR 0.4; 95% CI 0.2-0.6).