Anthropometric Measurements and Epithelial Ovarian Cancer Risk in African–American and White women

Previous studies of anthropometric factors and ovarian cancer risk have been inconsistent and none have evaluated the association among African–American women. Data from a population-based, case–control study of 593 cases and 628 controls were used to evaluate ovarian cancer risk in relation to weight, height, body mass index (BMI) and waist-to-hip ratio (WHR). Odds ratios (ORs) and 95% confidence intervals (CIs) were computed and established risk factors were adjusted for using logistic regression models, stratified by race. Among all races, weight at age 18, WHR, weight and BMI one year prior to interview were associated with elevated ovarian cancer risk. When stratified by race, the association between WHR and ovarian was similar among Whites and among African Americans. However, African–American women in the fourth quartile of height had an elevated risk of ovarian cancer (OR = 3.2; 95% CI = 1.3–7.8), but this risk was not apparent in Whites (OR = 1.0; 95% CI␣ = 0.7–1.4). These findings support the hypothesis that obesity is an important risk factor of ovarian cancer among African–Americans and Whites and also suggest that height may be a risk factor specific to African–Americans.^★ This work was performed at the Duke University Comprehensive Cancer, Durham, NC, USA.     

The prevalence and correlates of urinary tract symptoms in Norwegian men: the HUNT study

OBJECTIVES

To estimate the prevalence of lower urinary tract symptoms (LUTS) by severity (using the International Prostate Symptom Score, IPSS) in a population‐based study of men aged ≥ 20 years, and to assess the association between putative risk factors and the presence of moderate to severe LUTS.

SUBJECTS AND METHODS

Between 1995 and 1997, LUTS data were collected from 21 694 male residents aged ≥ 20 years in Nord Trøndelag County in Norway, using the IPSS; from the IPSS (score 0–35) LUTS was defined as a score of ≥ 8, indicating moderate to severe symptoms. We estimated the prevalence of LUTS and used logistic regression analysis to study lifestyle and anthropometric factors, and comorbidity related to LUTS.

RESULTS

The overall prevalence of moderate to severe LUTS was 15.8% (13.2% moderate and 2.6% severe). The prevalence of LUTS increased strongly with age, from ≈ 5% among men aged < 40 years to > 30% when aged ≥ 70 years. Factors positively associated with an increased risk of moderate and severe LUTS were anthropometric (body mass index and waist hip ratio) and lifestyle factors (alcohol consumption and smoking), as well as comorbid conditions, including diabetes, history of stroke, muscle complaints and osteoarthritis.

CONCLUSION

The findings from this population‐based study suggest that the prevalence of LUTS among men aged ≥ 20 years may be lower than previously estimated. Although LUTS may be viewed as an inevitable consequence of ageing, it appears to be exacerbated by lifestyle factors and comorbid conditions.

     

Feeling cold at work increases the risk of symptoms from muscles, skin, and airways in seafood industry workers

BACKGROUND: Norwegian workers in seafood industry plants are exposed to a cold and often wet environment. METHODS: 1,767 seafood industry workers participated in a questionnaire study. Seventeen plants were visited for thermal measurements. RESULTS: 15.9% of industrial workers and 1.7% of administrative workers reported that they often felt cold at work. Mean finger temperatures after 1 hr work varied between 16 and 22 degrees C. Foot temperature dropped from morning measurement until lunch time in 85% of the measurements. Industrial workers who reported that they often felt cold, had significantly increased prevalence of symptoms from muscles, skin, and airways while working, compared to workers who reported that they never felt cold at work. CONCLUSIONS: Moderate cooling, caused by a cold indoor working environment, may increase muscle-, airway-, and skin symptoms. The prevalence of feeling cold may be a useful exposure estimate in moderate cold exposure situations.     

Mutations in the genes KCND2 and KCND3 encoding the ion channels Kv4.2 and Kv4.3, conducting the cardiac fast transient outward current (ITO,f), are not a frequent cause of long QT syndrome

BACKGROUND: Long QT syndrome (LQTS) is a hereditary cardiac arrhythmogenic disorder characterized by prolongation of the QT interval in the electrocardiogram, torsades de pointes arrhythmia, and syncopes and sudden death. LQTS is caused by mutations in ion channel genes. However, only in half of the families is it possible to identify mutations in one of the seven known LQTS genes, why further genetic heterogeneity is expected. The genes KCND2 and KCND3, encoding the alpha-subunits of the voltage-gated potassium channels Kv4.2 and Kv4.3 conducting the fast transient outward current (I(TO,f)) of the cardiac action potential (AP) in the myocardium, have been associated with prolongation of AP duration and QT prolongation in murine models. METHODS: KCND2 and KCND3 were examined for mutations using single-strand conformation polymorphism (SSCP) analysis in 43 unrelated LQTS patients, where mutations in the coding regions of known LQTS genes had been excluded. RESULTS: Seven single nucleotide polymorphismsm (SNPs) were found, two exonic SNPs in KCND2 and three exonic and two intronic in KCND3. None of the five exonic SNPs had coding effect. All seven SNPs are considered normal variants. CONCLUSION: The data suggest that mutations in KCND2 and KCND3 are not a frequent cause of long QT syndrome.     

Assessing cost-effectiveness in mental health: helping policy-makers prioritize and plan health services

OBJECTIVE: We assessed, from a health sector perspective, options for change that could improve the efficiency of Australia's current mental health services by directing available resources toward 'best practice' cost-effective services. METHOD: We summarize cost-effectiveness results of a range of interventions for depression, schizophrenia, attention deficit hyperactivity disorder and anxiety disorders that have been presented in previous papers in this journal. Recommendations for change are formulated after taking into account 'second-filter criteria' of equity, feasibility of implementing change, acceptability to stakeholders and the strength of the evidence. In addition, we estimate the impact on total expenditure if the recommended mental health interventions for depression and schizophrenia are to be implemented in Australia. RESULTS: There are cost-effective treatment options for mental disorders that are currently underutilized (e.g. cognitive-behavioural therapy (CBT) for depression and anxiety, bibliotherapy for depression, family interventions for schizophrenia and clozapine for the worst course of schizophrenia). There are also less cost-effective treatments in current practice (e.g. widespread use of olanzapine and risperidone in the treatment of established schizophrenia and, within those atypicals, a preference for olanzapine over risperidone). Feasibility of funding mechanisms and training of staff are the main second-filter issues for CBT and family interventions. Acceptability to various stakeholders is the main barrier to implementation of more cost-effective drug treatment regimens. More efficient drug intervention options identified for schizophrenia would cost 68 million Australian dollars less than current practice. These savings would more than cover the estimated 36M Australian dollars annual cost of delivering family interventions to the 51% of people with schizophrenia whom we estimated to be eligible and this would lead to an estimated 12% improvement in their health status. Implementing recommended strategies for depression would cost 121M Australian dollars annually for the 24% of people with depression who seek care currently, but do not receive an evidence-based treatment. CONCLUSIONS: Despite considerable methodological problems, a range of cost-effective and less cost-effective interventions for major mental disorders can be discerned. The biggest hurdle to implementation of more efficient mental health services is that this change would require reallocation of funds between interventions, between disorders and between service providers with different funding mechanisms.     

Assessment of determinants of optimum performance of the CAST-2000 ELISA procedure

The Cellular Antigen Stimulation Test (CAST), a recent innovation in the laboratory detection of allergen sensitivity, is a functional assay based on the release of sulphidoleukotrienes (LTs) from allergen-activated circulating basophils. The current study was undertaken to establish optimum determinants of this procedure. The results demonstrate that treatment of blood with preservative-free heparin in polypropylene containers, and removal of erythrocytes by selective lysis with 0.83% ammonium chloride are excellent alternatives to the use of CAST venepuncture tubes and dextran, respectively. Similarly, decreasing and increasing the leucocyte concentration by 0.5- and 4-fold, respectively, as well as omission of interleukin-3 (IL-3) were also without significant effect. However, treatment of leucocyte suspensions with bacterial endotoxin (>1 microg/ml) activated the release of sulphidoleukotrienes from basophils and/or other types of leucocytes. The findings of this study are clearly relevant, both with respect to cost and performance, when implementing the CAST in clinical immunology laboratories.     

Amyloid myopathy presenting with distal atrophic weakness

Amyloid myopathy is a rare complication of primary amyloidosis usually presenting with proximal muscle weakness. We report a woman with multiple myeloma in whom marked atrophy and weakness of finger flexor muscles were the first manifestations of systemic amyloidosis. Muscle biopsy revealed amyloid angiopathy with deposits of lambda light chains in vessel walls. The recognition of amyloid myopathy is important because clinical symptoms may respond to chemotherapy.