Mental and physical distress and high-risk behaviors among reproductive-age women

OBJECTIVE: To examine the prevalence of mental and physical distress indicators among women of reproductive age and the association of these indicators with cigarette smoking and alcohol use, by pregnancy status. METHODS: The Behavioral Risk Factor Surveillance System data for several years were aggregated across states and weighted for this analysis. Seven measures of self-reported mental and physical distress and general health were examined along with demographic variables. RESULTS: Overall, 6.7% (95% confidence interval [CI] 6.5-6.9) of women reported frequent physical distress, 12.3% (95% CI 12.0-12.6) reported frequent mental distress, 9.9% (95% CI 9.4-10.4) reported frequent depression, 18.4% (95% CI 17.8-19.1) reported feeling anxious, and 34.3% (95% CI 33.5-35.1) reported that they frequently did not get enough rest. At the time of the survey 4.6% of the women were pregnant. Pregnant women were less likely than nonpregnant women to report frequent mental distress. Although there was attenuation of cigarette smoking and alcohol use during pregnancy, those with mental and physical distress were more likely to consume cigarettes and alcohol than were those without such experiences. CONCLUSION: High proportions of reproductive-age women report frequent mental and physical distress. Women experiencing mental and physical distress were more likely to report consuming cigarettes and alcohol than women without such experiences.     

Inter- and intra-individual variation in tests of cell-mediated immunity in young and old women

Exploring means to maintain or improve immunity in older persons has been receiving attention. To establish relationships between immune function and variables of interest, it is important to determine these variables accurately and precisely. Precision relates to the degree of variation in the laboratory test. The nature and magnitude of variability in tests of immune function has not been described extensively. We examined inter- and intra-individual variation in tests of cell-mediated immunity (CMI) in generally healthy and well-nourished young (20-40 years; n=15) and old (60-80 years; n=15) women. Subjects provided blood samples on 2 days within a week to determine leukocyte subsets, T-cell proliferation response to phytohemagglutinin A and concanavalin A, and interleukin (IL)-1beta, IL-2 and IL-6 production by stimulated mononuclear cells. Intra-individual variation was partitioned into day-to-day biological and analytical variation. Inter-individual variation was greater than intra-individual variability for most tests of CMI for both age groups. Furthermore, all CMI tests exhibited large day-to-day intra-individual variation (CV approximately 15% or greater) which was primarily due to biological rather than analytical sources, for both age groups. In conclusion, both age groups showed large between-person and considerable within-person variation in CMI tests. Therefore, assessment of CMI based on a single blood draw may not provide a reliable estimate of immune function.     

CLO vs histology: optimal numbers and site of gastric biopsies to diagnose Helicobacter pylori

OBJECTIVE: To determine the optimal numbers and sites of biopsies required for diagnosis of Helicobacter pylori by using the CLOtest and comparing the results with those of a routine histological assessment in a district general hospital (DGH) setting. METHODS: A prospective study comparing the sensitivity of the CLOtest containing one antral (CLO 1), two antral (CLO 2) and two antral and one body biopsy (CLO 3), and with histological examination for H. pylori. Consecutive patients undergoing upper gastrointestinal endoscopy (UGIE) at Stepping Hill Hospital, Stockport, UK, who had evidence of gastritis, gastric ulcer, duodenitis or duodenal ulcer were included in the study. RESULTS: Ninety-six patients were biopsied. Forty were positive on at least one of the CLOtests; of these, nine were negative on histological assessment. Of these nine, two were positive on all CLOtests and seven were positive only on CLO 3. One was positive on histology but negative on all CLOtests. This study showed that CLO 3 was more sensitive than CLO 1 (P = 0.004), CLO 2 (P = 0.016) and histology (P = 0.022). There was no significant difference between CLO 1 and CLO 2 (P = 0.500), CLO 1 and histology (P = 1.000), CLO 2 and histology (P = 1.00). CONCLUSION: We feel that in a busy clinical setting, taking two antral and one body biopsy in a single CLOtest is superior to routine histological assessment for the detection of H. pylori, with resulting cost saving.     

Prognostic scoring for critically ill hospitalized patients

The objective of the study was to validate and refine the APACHE II (acute physiology and chronic health evaluation II) prognostic system in the Indian context. We prospectively collected data on 79 patients admitted in the medical intensive care unit. We have studied APACHE II and 11 other physiological variables and sought to improve the risk prediction by developing a new score to be governed by the rule of thumb at the bed side. The new score included the following five variables: pH and serum albumin at admission and heart rate, bilirubin and Glasgow coma scale at 48 hours. A score below 3.5 was independently associated with a statistically significant increase in the risk of hospital death. This model resulted in a pseudo r2 of 0.43 in comparison to pseudo r2 of 0.02 and 0.12 for APACHE II scores on the day of admission and after 48 hours, respectively.