Trends in cigarette smoking in 36 populations from the early 1980s to the mid-1990s: findings from the WHO MONICA Project

OBJECTIVES: This report analyzes cigarette smoking over 10 years in populations in the World Health Organization (WHO) MONICA Project (to monitor trends and determinants of cardiovascular disease). METHODS: Over 300,000 randomly selected subjects aged 25 to 64 years participated in surveys conducted in geographically defined populations. RESULTS: For men, smoking prevalence decreased by more than 5% in 16 of the 36 study populations, remained static in most others, but increased in Beijing. Where prevalence decreased, this was largely due to higher proportions of never smokers in the younger age groups rather than to smokers quitting. Among women, smoking prevalence increased by more than 5% in 6 populations and decreased by more than 5% in 9 populations. For women, smoking tended to increase in populations with low prevalence and decrease in populations with higher prevalence; for men, the reverse pattern was observed. CONCLUSIONS: These data illustrate the evolution of the smoking epidemic in populations and provide the basis for targeted public health interventions to support the WHO priority for tobacco control.     

The Recovery of the Testis over 8 Weeks after Short-Term Dosing with Ethylene Glycol Monomethyl Ether: Histology, Cell-Specific Enzymes, and Rete Testis Fluid Protein

The Recovery of the Testis over 8 Weeks after Short-Term Dosingwith Ethylene Glycol Monomethyl Ether Histology, Cell-SpecificEnzymes, and Rete Testis Fluid Protein. CHAPIN, R. E., DUTTON,S. L., ROSS, M. D., SWAISGOOD, R. R., AND LAMB, J. C, IV (1985)Fundam. Appl. Toxicol. 5, 515–525. Ethylene glycol monomethylether (EGME) has been found to affect meiotic spermatocytes,spermatids, other stages of spermatocytes, and spermatogonia,depending on the dose used. These studies, which examine testicularrecovery from EGME treatment, analyzed tissues from rats treatedfor 5 days with 0, 50, 100, or 200 mg EGME/kg/day and sacrificedat eight subsequent weekly intervals; some epididymal spermparameters of these animals have been described. Histologically,the testes of the low-dose group showed very mild changes, whilethe 100- and 200-mg/kg groups showed widespread damage and celldeath which recovered somewhat during the course of the study.There was no treatment-related effect on seminal vesicle orprostate weights. Rete testis fluid protein levels were changedonly in the high-dose group, when protein levels rose to a maximumof sixfold the control values at Week 4; by Week 6, there wasno difference between groups. Changes in cell-specific enzymeactivities were dose dependent and generally mirrored changesin the number of germ cells in the testis     

An investigation of the attitudes of medical students to physically disabled people

A study was carried out to investigate the change in attitudes towards physically disabled people of a group of fifty-eight medical students during the first 3 years of their course. The students attended a newly established medical school which has developed a curriculum without the traditional division into preclinical and clinical years and where contact with patients occurs from the first year. Results demonstrated that, as expected, at the start of the course the attitudes of females towards disabled people were more positive than those of males. Also, a significant change in attitudes was found after 3 years, both males and females demonstrating more positive attitudes toward physical disability. The differences between males and females were maintained. The relationship between these students' attitudes and their behaviour was discussed and proposals for further research to investigate this are outlined.     

The effect of temperature on systolic blood pressure

OBJECTIVES: To quantify the association between systolic blood pressure and season, indoor and outdoor temperature and short-term trends in outdoor temperature. METHODS: The study used data from the WHO MONICA Project risk factors surveys from 25 populations in 16 countries. Random samples of men and women aged 35-64 years were invited to participate. Systolic blood pressure measurements were available for 115 434 participants. Hierarchical models were used to quantify the association between blood pressure and temperature, and account for differences in the associations between populations. RESULTS: Populations closer to the equator showed larger seasonal changes in blood pressure. A 1 degrees C increase in indoor temperature reduced systolic blood pressure by an average of 0.31 mmHg (95% posterior interval: -0.44, -0.19). A 1 degrees C increase in outdoor temperature reduced blood pressure by the smaller average of 0.19 mmHg (95% posterior interval: -0.26, -0.11). Increased outdoor, but not indoor, temperatures had a stronger effect in women than in men. The effect of outdoor temperature remained after controlling for indoor temperature. Short-term trends in temperature did not have a statistically signicant effect. CONCLUSIONS: Indoor and outdoor temperature have independent effects on systolic blood pressure, and both should be controlled for in studies that measure blood pressure. Improved protection against cold temperatures could lead to a reduction in the winter excess of cardiovascular mortality.     

7α-Methyl-Nortestosterone (MENT): The Optimal Androgen for Male Contraception

Many methods of contraception involve the use of drugs that affect the secretion of hormones essential for reproduction. Oestrogens and progestins have been used for contraception in women as inhibitors of gonadotropin secretion and ovulation. Similarly, androgens must be used in methods of fertility control for men that block gonadotrophin secretion. Androgen supplementation currently involves large, frequent doses of testosterone esters that are associated with wide fluctuations of plasma testosterone levels. Hence, there is a need for an androgen preparation that provides appropriate, continuous replacement doses over long periods. To achieve this goal, 7α-methyl-19-nortestosterone (MENT), a synthetic androgen that is considerably more potent than testosterone, is suitable. As a consequence, it is feasible to administer this androgen as a substitute for testosterone for 1 year by subdermal implants. Another important feature of MENT is that it does not undergo 5α-reduction in prostate as does testosterone. As a consequence, a dose of MENT sufficient to maintain normal muscle mass and gonadotrophin secretion will not hyperstimulate the prostate because its action in this organ is not amplified as is that of testosterone. Thus, MENT can be administered to men with the assurance that it will be less prone to cause diseases of the prostate than testosterone. Conclusions: (i) MENT is the first androgen that has a health benefit compared to testosterone; (ii) MENT will be promoted as one component of a two-implant system for male contraception, the other component being an implant that will release an LHRH analogue; (iii) MENT has potential uses in patients with a variety of disorders, including hypogonadism, prostatic hyperplasia and muscle wasting.     

Integrating Hazard Analysis and Critical Control Point (HACCP) and Sanitation for Verifiable Food Safety

Reliable, verifiable food safety requires the application of technologically correct methods in a systematic way. This requires making a distinction between sanitation and Hazard Analysis and Critical Control Point (HACCP) and integrating these two systems into one food safety system. Although sanitation and HACCP share the same goal of producing safe food products, the focus of sanitation is on the environment surrounding the food to prevent contamination, whereas the focus of HACCP is on controlling hazards intrinsic to food materials. Together they provide the organizational base for applying the correct methods and procedures to ensure and verify that food served is safe for foodservice clients. These approaches also provide records that demonstrate that food safety measures have been planned and completed as planned. One way to demonstrate a responsible approach to food safety is to understand the differences between sanitation and HACCP and to build approaches to food safety that use both of these systems. The resulting integrated system has a better chance of controlling all the hazards than either system by itself. J Am Diet Assoc. 1997; 97: 889–891.     

Anesthesia for major general surgery in neonates with complex cardiac defects

Centers with large cardiac workloads may be presented with neonates who need major general surgery before correction or palliation of a serious cardiac defect. This is still a rare situation with only three short case reports available in the medical literature ( 1–3 ). We have reviewed the anesthetic and analgesic regimens of 18 such neonates who presented to the Birmingham Children's Hospital in the 4-year period 2004–2007. These children require meticulous preoperative evaluation and although it might be anticipated that they would pose a serious challenge to anesthetists, in reality with thorough investigation, preparation, and careful management, they tolerate general anesthesia well. These children may be transferred to centers of specialist pediatric cardiac anesthesia to be benefited from experience obtained there.