A local likelihood proportional hazards model for interval censored data.

We discuss the use of local likelihood methods to fit proportional hazards regression models to right and interval censored data. The assumed model allows for an arbitrary, smoothed baseline hazard on which a vector of covariates operates in a proportional manner, and thus produces an interpretable baseline hazard function along with estimates of global covariate effects. For estimation, we extend the modified EM algorithm suggested by Betensky, Lindsey, Ryan and Wand. We illustrate the method with data on times to deterioration of breast cosmeses and HIV-1 infection rates among haemophiliacs.     

Late results in 65 physeal ankle fractures

Fifty-nine Salter-Harris III and IV lesions of the medial malleolus, Tillaux fractures, and triplane fractures were examined after 9 (3-32) years to assess the frequency of late symptoms, deformity, joint incongruity, and secondary arthrosis. Six out of 18 Salter-Harris III and IV lesions of the medial malleolus were reduced open, none of which had any signs of growth disturbance, whereas 1 case, left with a 3-mm residual dislocation, had 5 degrees of anterior angulation. Of the 17 Tillaux fractures, ten were not reduced and two of these gave slight symptoms, whereas five openly reduced fractures were asymptomatic at follow-up. Out of 18 triplane fractures, not reduced, two gave slight ankle pain and another had 6 degrees of anterior angulation, whereas three of ten reduced fractures were symptomatic. The overall results were good and no case of arthrosis, defined as reduction of the joint space, was found in any of the fracture groups despite a follow-up of 12 or more years in one third of the cases.     

Meningococcal disease in Louisiana 1978–1985

Data were analyzed from 729 meningococcal cases reported to the Epidemiology Section, Office of Preventive and Public Health Services, Louisiana Department of Health and Human Resources from 1978 through 1985. A total of 122 deaths (16.8%) occurred from these cases, with the highest case fatality rate (23.7%) noted in 1981. The eight-year average incidence rate per 100,000 population was 2.1. For individual years, the incidence rate was highest (3.6) in 1978 and lowest (0.8) in 1985. Although incidence rates per 100,000 population were greater for males during all years except 1978 and 1985 and greater for nonwhites in 1978, 1980, 1981, 1983 and 1984, the eight-year average incidence rates by sex and race were almost the same. Incidence rates were found to be highest in the less than one, and one to four-year age groups. For all eight years, over half of the cases were in the four years and under age group; the same was true for deaths, except in 1982 (46.7%). February was found to be the month with the highest frequency of reported case onset and death. The mean difference between date of disease onset and death for all fatal cases was 2.716 days (S.D.=6.48). Ten of the 64 Louisiana parishes reported no meningococcal disease cases from 1978–1985. There were 25 parishes with an eight-year average incidence rate of greater than 2.1. The overall incidence rates in Louisiana were greater than rates in the United States for the time periods reviewed.John B. Vaughn, D.V.M., M.P.H. Chairman and Professor, Department of Applied Health Sciences, Tulane University School of Public Health and Tropical Medicine, Theresa J. Forti, B.S.N., M.S. Hyg., Dr. P.H. Associate Professor, Department of Applied Health Sciences, Tulane University School of Public Health and Tropical Medicine. James E. Banta, M.D., M.P.H. Dean and Professor Tulane University School of Public Health and Tropical Medicine, Louise McFarland, M.P.H., Dr. P.H. is Chief, Epidemiology Section State of Louisiana Department of Health and Human Resources, and Karen Y. Kelso, C.R.N., B.S. is Nurse Epidemiologist State of Louisiana Department of health and Human Resources.The authors extend thanks to Mrs. Audrey P. Collins, Biostatistician, Louisiana Department of Health and Human Resources, and Barbara H. Denton, Demographer, Louisiana Tech University for their assistance in providing population data. Gratitude is also expressed to Dr. Charles T. Caraway for help with review of data.     

Vasopressin receptor antagonism — a therapeutic option in heart failure and hypertension

The precise role of vasopressin in the pathophysiology of cardiovascular disease is controversial, but this peptide hormone is important for several reasons. Firstly, circulating concentrations of vasopressin are elevated in heart failure and some forms of hypertension. Secondly, there is evidence that vasopressin is synthesized not only in the hypophysial-pituitary axis but also in peripheral tissues including the heart where it acts as a paracrine hormone. Thirdly, vasopressin has vasoconstrictor, mitogenic, hyperplastic and renal fluid retaining properties which, by analogy with angiotensin II, may have deleterious effects when present in chronic excess. Finally, the availability of orally active non-peptide vasopressin receptor antagonists allows vasopressin receptor antagonism to be considered as a therapeutic option in cardiovascular disease.     

Red reflex examination in reproductive and child health clinics for early detection of paediatric cataract and ocular media disorders: cross-sectional diagnostic accuracy and feasibility studies from Kilimanjaro,Tanzania

Background/objectivesLate presentation of congenital cataract in the developing world has led to poor outcomes such that cataract is the leading cause of childhood blindness. Our hypothesis was that, sensitivity of red-reflex testing is greater than sensitivity of torchlight examination. We aimed to compare sensitivity of new red reflex screening tools and assess the feasibility of Arclight red reflex screening in the community.Subject/methodsWe compared the diagnostic accuracy of four different screening tools for cataract and retinoblastoma performed by ophthalmic nurses, using a clinic based enriched sample of 41 positives and 60 negatives. We then conducted a separate feasibility study, training non-specialist community nurses. Following the training, community nurses examined 2827 children <5 years with Arclight who were attending their clinics for growth monitoring and immunisation.FindingsDiagnostic accuracy study: estimated sensitivities were 97.6% for Catcam, 92.7% for Arclight, 90.2% for PEEK retina and 7.3% for torchlight. Estimated specificities were above 90% for Catcam, Arclight and torchlight and 87% for PEEK retina. Feasibility study: twenty-four out of 2728 children screened failed community screening, seven were true positive (six cataract, one retinoblastoma). Prevalence of bilateral cataract was 1.5/1000 (95% CI: 0.40–3.75 per 1000).ConclusionsArclight and CatCam have higher sensitivity than torchlight, are easy to learn and use by primary health care nurses. Red reflex testing should be recommended in the WHO guidelines instead of torchlight examination to help early detection of potential blinding causes including congenital cataract and retinoblastoma.Subject terms: Physical examination, Education