Urban poverty and infant-health disparities among African Americans and whites in Milwaukee

This study examined neighborhood and infant health disparities between African-American and white mothers in Milwaukee, Wisconsin. Census-block data were used for 1990 and Vital Statistics data were used for 1992 through 1994. African-American mothers lived in less desirable, more segregated neighborhoods than white mothers did in 1990. African-American infant and neonatal mortality rates were twice those of whites (2.3 and 2.0, respectively), while African-American postneonatal mortality rates were three times that of whites (3.0). African-American low and very low birth weight rates were more than twice those of whites (2.5 and 2.6, respectively). All African-American mothers were nearly eight times as likely as all white mothers to have inadequate prenatal care, whereas poor African-American mothers were three times as likely to have inadequate prenatal care as were poor white mothers. Public health experts and practitioners may want to consider the communities of minority patients to devise interventions suitable for addressing health disparities.     

Are medical oncologists biased in their treatment of the large woman with breast cancer?

Purpose. Obesity and breast cancer are common conditions that often coexist. Concerns of relative overdosing of chemotherapy in the large cancer patient have led clinicians to apply empiric dose reductions, cap the body surface area (BSA) at 2m², or use ideal rather than actual body weight to calculate BSA. There are no data supporting or refuting these practices and their prevalence is unknown. We sought to determine the distribution of body size and prevalence of obesity in the breast cancer population of our cancer centre, and to determine clinician chemotherapy dosing practices in the era of modern adjuvant chemotherapy. Patients and methods. Women with invasive breast cancer receiving systemic therapy at our institution between 1980 and 1998 were identified and their recorded height and weight were used to calculate BSA and body mass index (BMI). We reviewed the first cycle adjuvant chemotherapy dosing practices from 1990–1998. The ideal dose of chemotherapy was calculated based on calculated BSA, and then contrasted with the actual dose received at cycle one. Discrepancies were recorded and categorized, using the largest single drug reduction if more than one drug was reduced. Results. Mean BMI in the systemic therapy population was 26.4±5.3kg/m², 54% were overweight, 2% severely obese and 18% moderately so. Their mean BSA was 1.7±0.2m² and only 5% had a BSA2m². In the adjuvant chemotherapy subgroup, most patients received >85% of their ideal dose. The mean dose reduction was 5.3±11.3% versus 9.9±11.3% in the BSA <2 and >2m² groups, respectively (p=0.02), and 4.3±8.2% versus 6.7±13.1% in the BMI <25 and 25kg/m² groups, respectively (p=0.008). While only 24% of chemotherapy dose reductions of 15% were in the BSA 2m² group, 76% were in the BMI 25kg/m² group. Conclusions. Obesity is prevalent in this breast cancer population. BSA is not a sensitive index of large body size. We consistently detected more frequent empiric dose reductions at cycle one of adjuvant chemotherapy, with reductions of greater magnitude in the largest women (BSA 2m²) and those who were overweight (BMI 25kg/m²).     

Effects of central noradrenaline depletion by the selective neurotoxin DSP-4 on the behaviour of the isolated rat in the elevated plus maze and water maze

RATIONALE: Social isolation of the rat from weaning influences behaviour following central noradrenaline (NA) depletion by the selective neurotoxin N-(2-chloroethyl)-N-ethyl-2-bromobenzylamine (DSP-4). OBJECTIVES: The study characterised the effects of DSP-4 on the behaviour of isolates in the elevated plus maze and water maze. METHODS: Male Lister hooded rats were reared singly or in groups after weaning. Two weeks postweaning, the rats were injected with DSP-4 (25 mg/kg, i.p.) or saline. From week 4, rats were tested in the plus maze and in the water maze. RESULTS: DSP-4 significantly reduced cortical and hippocampal NA but had no effect on hypothalamic NA. Isolation rearing alone had no significant effects on behaviour in the elevated plus maze but enhanced retention of platform placement in the water maze as measured by increased entries to the platform annulus during the probe test. DSP-4 in group-reared rats increased activity in the open arms and increased general activity in the elevated plus maze with no effect on water maze performance. DSP-4-treated isolates spent less time in the open arms and were hypoactive in the plus maze compared to group-reared DSP-4-treated rats, and had impaired retention of spatial memory in the water maze compared to isolate controls. CONCLUSIONS: DSP-4 treatment had an 'anxiolytic' effect in group-reared rats in the elevated plus maze. In the water maze, isolation rearing enhanced retention of spatial information, an effect normalised by NA depletion. The results demonstrate the importance of noradrenergic function in the regulation of responsiveness to environmental cues.     

Clinical anatomy and physiology of the voice

The anatomy and physiology of voice include not only the larynx but also all body systems. The larynx consists of a skeleton, mucosa, intrinsic muscles, and extrinsic muscles. The vocal folds form the oscillator of the vocal tract, the subglottic vocal tract acts as a power source, and the supraglottic vocal tract functions as a resonator. Complex interactions are responsible for voice production.