Age-incidence curves of nasopharyngeal carcinoma worldwide: bimodality in low-risk populations and aetiologic implications

The distinct geographic variation in the global incidence of nasopharyngeal carcinoma reflects a complex etiology involving viral, environmental, and genetic components. The high to intermediate rates observed in endemic areas contrast markedly with the uniformly low rates seen in much of the world. An interesting epidemiologic observation is the early peak in age-incidence curves observed in certain geographically disparate populations, suggestive of distinct causal entities and the possible exhaustion of susceptible individuals from the population at a certain age. The aim of this study was to systematically evaluate the age-incidence profiles of NPC worldwide on partitioning populations according to level of risk, in an effort to provide clues about the importance of early-in-life factors and genetic susceptibility. Using data from 23 high-quality population-based cancer registries for the period 1983-1997, a key finding was the consistent pattern of bimodality that emerged across low-risk populations, irrespective of geographic location. Continual increases in NPC risk by age up to a first peak in late adolescence/early adulthood (ages 15-24 years) were observed, followed by a second peak later in life (ages 65-79 years). No such early peak in NPC incidence by age group was evident among the high-risk populations studied. These findings are discussed according to existing lines of biological and epidemiologic evidence related to level of population risk, age at diagnosis, and histologic subtype. A modified model for NPC tumor development is proposed on the basis of these observations.     

Hospital in the home (HITH) care following autologous stem cell transplantation for lymphoma and multiple myeloma.

BACKGROUND: Advances in outpatient and supportive care and increased pressure on hospital bed usage has led to the investigation of hospital in the home (HITH) management following autologous haematologous stem cell transplantation (AutoHSCT) for patients with multiple myeloma or lymphoma. DESIGN: The Newcastle Mater Hospital Haematology Unit together with the Mater Acute Care Community Service (MACCS) developed a protocol for HITH care following AutoHSCT. OUTCOMES: Clinical outcomes of the protocol were audited: 40% (13) of patients were suitable candidates for HITH care post transplantation. Of these 84.6% (11) were readmitted to the haematology unit within seven days of discharge from hospital. CONCLUSION: Our preliminary experience suggests that with adequate infrastructure support and rigorous patient selection this model of care is both safe and feasible.     

Magnesium supplementation during pregnancy: a double-blind randomized controlled clinical trial

Four hundred young normotensive primigravid women between 13 and 24 weeks' gestation were randomly allocated to one of two study groups. One group received placebo tablets and the other group received 365 mg of elemental magnesium daily (as magnesium aspartate hydrochloride). Three hundred seventy-four patients completed the study, 189 in the placebo group and 185 in the treatment group. There were no significant differences between the two groups regarding serum calcium, uric acid, or electrolyte levels. However, the magnesium-supplemented group had significantly higher magnesium levels at delivery (1.68 +/- 0.03 mg/dl vs. 1.56 +/- 0.03 mg/dl, p less than 0.01). There were no significant differences in either systolic or diastolic blood pressures between both groups either at time of enrollment or at subsequent gestational ages later during pregnancy. Analysis of variance for repeated measurements and Fisher's least significant difference testing indicated a significant increase (p less than 0.01) in blood pressure from the level at the time of enrollment to the level achieved at or beyond 37 weeks' gestation in each group. There were no significant differences between the two groups regarding any of the following parameters: incidences of preeclampsia, fetal growth retardation, preterm labor, birth weight, gestational age at delivery, or number of infants admitted to the special care unit. Magnesium supplementation during pregnancy did not improve pregnancy outcome in our population.     

Transcranial Doppler ultrasonic examination in vertebro-basilar circulatory pathology

Vertebrobasilar ischemic disease cannot be adequately explored by echo-Doppler ultrasonic investigating procedures, since they do not permit the study of the intracranial arteries. The transcranial pulsed Doppler (2 MHZ) velocity detection method developed by R. Aaslid now offers such possibilities, although it has not yet been validated in this field. The authors relate their experience and methodological criteria (patient's position, deepness of access, flow direction, response to compression tests). They conducted 2 studies, one bearing on the detection of 14 cases of 75% stenosis of the superior segment, or of arteriographically-confirmed endocranial vertebral/basilar artery occlusion; the other one was concerned with assessing the basilar hemodynamic consequences of vertebral-subclavian steal syndromes. Out of 17 steal syndrome cases, of which 5 were symptomatic (4 pre-steal cases, 7 permanent, 6 intermittent), basilar flow determined spontaneously or following postischemic hyperemic test of the upper limb, was moderately changed in 30% of cases. Transcranial pulsed Doppler ultrasonic examination could be recommended in addition to the regular echo-Doppler velocity detection test, and thus contribute to exploring and monitoring transient or full-blown ischemic accidents of the vertebrobasilar circulation, in expectation of medical, surgical or angioplastic management.     

Family members' opinions about civil commitment

As part of a survey of 260 Oregon family members with mentally ill relatives, respondents were asked about their experiences with civil commitment and their opinions about proposed modifications in the commitment statutes. Family members typically described their mentally ill relative as a schizophrenic man in his thirties who had had six psychiatric hospitalizations and was currently being treated with medications at a community mental health center. Three-fourths of the relatives had been committed. A majority (57 percent) of the respondents were in favor of mandatory outpatient treatment and medication after involuntary hospitalization but were not enthusiastic about outpatient commitment without hospitalization. Family members also wanted more education about mental illness, more information about the commitment process, and assignment of a professional to help in the commitment process.     

Sustained attention in children with autism

Although many children with early infantile autism cannot maintain attention to externally imposed tasks, they may continue a repetitive behavior of their own choosing for long periods of time. This study examined the performance of autistic and mental age matched normal children on a Continuous Performance Test of sustained attention. Results suggest that autistic children's difficulties in sustaining attention on imposed tasks may be attributable partly to a developmental delay and partly to the motivational contingencies of task rather than to a primary impairment in the ability to sustain attention.This project was supported by an NIMH grant MH 28605 to L. Waterhouse and D. Fein. We appreciate the cooperation of the staff and students of League School, Newton, Massachusetts, and the Nazarene Child Care Center in Beverly, Massachusetts. We gratefully acknowledge the help of Hope Trefry, Dot Lucci, Kaye Cook, and Kathleen Sheber with data gathering and analysis. Ross Rizley, Anne Copeland, Jaqueline Liederman, and Leslie Brody of the Boston University Graduate Program in Psychology provided helpful comments at every stage of this project.