Ages at different reproductive events, numbers of menstrual cycles in between and breast cancer risk

One hundred and seventy-five pathologically confirmed new cases of female breast cancer in National Taiwan University Hospital were selected as the case group. Four hundred and fifty-seven inpatient controls were individually matched for each case by age and date of admission. Information of reproductive factors and potential confounders were collected from questionnaire interview and medical records. Menstrual cycles before and after first fuIl-term pregnancy were estimated from the questionnaire. Conditional logistic regression was used to estimate the effects of reproductive risk factors and numbers of menstrual cycles before and after first full-term pregnancy. After adjusting for educational level, body mass index, family history of breast cancer and oral contraceptive use, age at menarche and menopause only showed borderline significance. Age at first full-term birth predicted breast cancer risk better. Parity was the most important protective factor. Number of menstrual cycles before first full-term pregnancy was also positively associated with breast cancer risk with linear trends.     

Increasing nosocomial infections of methicillin-resistant Staphylococcus aureus at a teaching hospital in Taiwan

Methicillin-resistant Staphylococcus aureus (MRSA) is a worldwide important pathogen in nosocomial infections. To investigate the extent of the problem in Taiwan, analysis for the period of 1981-1994 was carried out of prospective surveillance data from the National Taiwan University Hospital, a major university teaching hospital in Taiwan. The number of nosocomial MRSA infections increased from five in 1981 to 133 in 1994, and the incidence increased from 0.2 episodes/1000 discharges in 1981 to 2.9 episodes/1000 discharges in 1994. The most common infection site was surgical wounds, which accounted for 26.3% of total 577 episodes of nosocomial MRSA infections during the study period. However, bacteraemia has become more and more common during the past 14 years. MRSA infections occured more frequently in patients stayed in the burn unit and other intensive care units than in the general wards. Other than oxacillin, the resistance rate to many other antibiotics also increased in S. aureus strains causing nosocomial infections in this hospital. Vancomycin remained active to all these S. aureus strains, even until 1994.     

Proteoglycan depletion alone is not sufficient to stimulate proteoglycan synthesis in cultured bovine cartilage explants

Articular cartilage comprises a small number of cells embedded within a matrix primarily composed of collagen and proteoglycan (PG). The functional integrity of the tissue is highly dependent on the maintenance of matrix structure, which, in turn, is controlled by the chondrocytes. In normal tissue there is a slow but steady turnover of matrix components such that their levels remain constant. In certain diseased states the equilibrium is upset, resulting in a net loss of matrix components. The object of the present study was to artificially upset the synthetic/loss equilibrium by enzymic depletion and assess the ability of chondrocytes to respond by increasing PG synthesis. Cultured bovine articular cartilage explants were depleted using enzymes as follows; 10 U/ml Streptomyces hyaluronidase (induced a 30% loss of PG), 2000 U/ml testicular hyaluronidase (70% loss of PG) and 100 U/ml collagenase (35% loss of PG) and control (6% loss of PG). Collagenase also induced a 50% loss of collagen. Collagenase treatment induced a 50% stimulation of PG synthesis above control levels. Elevated synthesis levels were maintained for 9 days. Testicular hyaluronidase induced a brief elevation in PG synthesis on day 3 of culture. Streptomyces hyaluronidase treatment did not cause an alteration in the rate of PG synthesis above control levels. Histological examination indicated that collagenase-treated explants formed outgrowths consisting of rounded chondrocytes within a fine fibrous matrix which stained intensely with safranin-O, indicating a high concentration of PG. The production of repair-like outgrowths may explain the elevated PG synthesis rates measured. It appears, therefore, that collagen and matrix organization is more important than PG levels in the control of PG synthesis in articular cartilage explant cultures.     

The healthcare volunteer

Every year, volunteers contribute billions of dollars worth of time to the healthcare industry. Despite their contributions, however, little is known about who these volunteers are, what they do, why they volunteer, as well as the costs and benefits they bring to institutions. This article examines these and other characteristics of the healthcare volunteer.     

Improving vaccination coverage in urban areas through a health communication campaign: the 1990 Philippine experience.

From March to September 1990 the Philippine Department of Health, with the assistance of the HEALTHCOM Project, carried out a national mass-media communication campaign to support routine vaccination services. The essential elements of the campaign strategy were as follows: focusing on measles as a way to get mothers to bring their children to the health centre; emphasizing logistic knowledge in the mass-media messages, in particular popularizing a single day of the week as "vaccination day" and giving clear information about the age for measles vaccination; and focusing on urban areas, which had lower vaccination rates than rural areas. Evaluation of the effects of the campaign indicates an increase in vaccination coverage and a substantial increase in the timeliness of vaccination that can be attributed to improvement in carers'' knowledge about vaccination. Furthermore, most of the observed increase in knowledge was related to exposure to the mass-media campaign. There was no evidence of any programmatic change that could account for the increase in vaccination or evidence that increased health education efforts at health centres could account for the change in knowledge. These results indicate that when countries meet certain conditions--a high level of access to the media, sufficient expertise and funds available to develop and produce high-quality radio and television advertisements, and a routine system that is able to serve the increased demand--a mass communication campaign can significantly improve vaccination coverage.     

An audit of occupational medicine consultation records

There is a need to develop and test methods of audit of theconsultation process in occupational medicine and to draw conclusionsfrom the findings. An external audit was carried out on 313randomly selected consultation records from the occupationalhealth services of three health boards over a 26-month period.Additionally, nine months after the date of the first externallyaudited sample, a prospective internal audit was commenced withinone board. In 58 of the consultations selected (19 per cent),audit was not possible mainly because records could not be found.In an appreciable proportion of the rest, there were shortcomingsin the referral record or in the consultation record. The consultationrecords of ‘career’ occupational physicians werebetter than those of ‘non-career’ physicians, especiallyin recording specific diagnoses (91 per cent vs. 67 per cent;P<0.0001) and in conclusions regarding occupational implications(86 per cent vs. 74 per cent; P<0.0001). Multivariate regressionsshowed a highly significant improvement associated with prospectiveinternal audit in one item, namely the record of occupationalimplications. However, the magnitude of this difference beforeand after audit was smaller than the independent differencearising from the career status of the physicians. The valueof medical audit in improving quality of care and educationin occupational medicine is discussed.     

N-CAM promotes recovery in injured nerves

The neural cell adhesion molecule, N-CAM, makes critical contributions to the development of the nervous system. It mediates the stability of homophilic adhesion in embryonic neurons and participates in morphologic differentiation. The goal of these studies was to determine N-CAM contributions to nerve regeneration and recovery of function in two species with an excised segment of sciatic nerve. N-CAM was isolated from embryonic brains, affinity purified and admixed in collagen gel for administration. Recovery was compared 30 days after surgery for two types of N-CAM delivery: entubulization versus direct application. For control nerves, tubes contained gel only. In preliminary chicken studies, latency of nerve responses was measured to demonstrate N-CAM's ability to improve upon spontaneous recovery. In subsequent studies of rodent nerves, the direct application of N-CAM significantly improved recovery in evoked nerve response amplitude, number of regenerated axons and behavioral activity. Results demonstrate N-CAM's ability to augment nerve regeneration and suggest a potential for therapeutic use.