Psychological questionnaire score, cigarette smoking, and myocardial infarction: a continuing enigma

The ability of a group of 94 psychological questions to discriminate between men in whom cigarette smoking was associated with increased risk of myocardial infarction and men in whom smoking was not so associated remains puzzling. Further analyses, controlling for reported alcohol consumption and for a questionnaire item that might reflect physical activity, failed to alter this finding. This interaction of the questionnaire responses with smoking was not found with two other major coronary risk factors, serum cholesterol and systolic blood pressure. Believing that these observations may provide (a) a clue to how cigarette smoking affects risk of myocardial infarction, or (b) some means of identifying greater or lesser susceptibility to the effects of smoking, we invite other investigators to join in the pursuit of this matter. A list of ten selected yes-or-no questions with strong interaction with smoking is provided to assist others in studying this phenomenon; these are similar to ten items on the Minnesota Multiphasic Personality Inventory.     

Regression modeling of consumption or exposure variables classified by type

Consumption or exposure variables, as potential risk factors, are commonly measured and related to health effects. The measurements may be continuous or discrete, may be grouped into categories and may, in addition, be classified by type. Data analyses utilizing regression methods for the assessment of these risk factors present many problems of modeling and interpretation. Various models are proposed and evaluated, and recommendations are made. Use of the models is illustrated with Cox regression analyses of coronary heart disease mortality after 24 years of follow-up of subjects in the Framingham Study, with the focus being on alcohol consumption among these subjects.     

A comparison of hospital outpatient departments and private practice.

This article addresses cost differences between primary care physicians in private practice and hospital outpatient departments (OPD's). The analysis utilizes ambulatory visit groups (AVG's), the outpatient equivalent of diagnosis-related groups (DRG's), to adjust for case mix. Major findings are that OPD's have higher per visit costs than physicians' private offices; internists are more expensive than general practitioners regardless of site; and ancillary service costs are actually slightly higher in private practice. Any prospective payment system for ambulatory care must consider these costs differences.     

A meta-analysis of disparities in childhood sexual abuse, parental physical abuse, and peer victimization among sexual minority and sexual nonminority individuals

Objectives. We compared the likelihood of childhood sexual abuse (under age 18), parental physical abuse, and peer victimization based on sexual orientation.Methods. We conducted a meta-analysis of adolescent school-based studies that compared the likelihood of childhood abuse among sexual minorities vs sexual nonminorities.Results. Sexual minority individuals were on average 3.8, 1.2, 1.7, and 2.4 times more likely to experience sexual abuse, parental physical abuse, or assault at school or to miss school through fear, respectively. Moderation analysis showed that disparities between sexual minority and sexual nonminority individuals were larger for (1) males than females for sexual abuse, (2) females than males for assault at school, and (3) bisexual than gay and lesbian for both parental physical abuse and missing school through fear. Disparities did not change between the 1990s and the 2000s.Conclusions. The higher rates of abuse experienced by sexual minority youths may be one of the driving mechanisms underlying higher rates of mental health problems, substance use, risky sexual behavior, and HIV reported by sexual minority adults.The number of substantiated annual cases of childhood (i.e., under age 18) physical abuse in the United States declined 52% between 1992 and 2007, and cases of childhood sexual abuse declined 53% during the same period.¹ Criminal victimization of students in school declined 60% between 1995 and 2005.² Although these represent public health success stories, the abuse of children and adolescents is still a major problem. Child welfare agencies confirmed 79 866 cases of physical abuse and 56 460 cases of sexual abuse in the United States during 2007.³ One nationally representative sample found that 17% of youths reported having been the victim of moderate or frequent bullying at school during the prior 2 months,⁴ and another found that 13% experienced being hit, kicked, pushed, shoved around or locked indoors during the same time period.⁵Children and adolescents who experience sexual abuse are more likely to experience depression and dysthymia, borderline personality disorder, somatization disorder, substance abuse disorder, posttraumatic stress disorder, dissociative identity disorder, or bulimia nervosa; to attempt suicide; to become pregnant earlier; to engage in HIV sexual risk behaviors; to perform poorly at school; to be arrested for sex crimes; or to commit other criminal offenses.^6–10 Children and adolescents who experience parental physical abuse are more likely to experience similar psychological, substance use, behavioral, and criminal problems.^11–15 Outcomes of peer victimization among children and adolescents include depressive, anxiety, and drug abuse disorders, suicidal ideation, social isolation, psychosomatic symptoms, poor school performance, and delinquency.^16–20 In addition, these types of abuse are associated with negative psychological, behavioral, and physical outcomes in adulthood.^21–23 Risk markers of childhood abuse include the characteristics of parents (e.g., substance abuse, history being victims of physical or sexual abuse, social isolation, low self-esteem), families (e.g., marital conflict, spousal abuse, financial stress), the individuals themselves (e.g., emotional, psychological, or physical disabilities; low self-esteem; an inability to defend oneself; lack of social skills), and environments (e.g., negative school atmosphere, low socioeconomic status).^24–26One risk factor for experiencing these types of abuse may be sexual orientation. Studies suggest that sexual minority youths (i.e., youths who experience same-sex attractions or self-label as gay, lesbian, or bisexual, or who engage in same-sex sexual activity), compared with sexual nonminority youths, are more likely to experience sexual abuse, parental physical abuse, and peer victimization during childhood.^27–42 However, these studies vary in effect sizes, measurement of abuse and sexual orientation, the group being compared with heterosexuals (e.g., gays, lesbians, and bisexuals combined vs comparing groups individually; combining males and females vs comparing gender individually), sampling and recruitment strategies, and the decade in which the studies were conducted. Thus, relying on any one study to determine whether sexual orientation is a risk factor for child abuse, as well as determining the robustness of the difference in child abuse rates, is problematic. However, if sexual minority youths suffer greater rates of violence victimization, this phenomenon could be one explanation for the existence of substantial health disparities that exist among sexual minority adult populations.⁴³This meta-analysis therefore addressed the following question: are sexual minority adolescents more likely than sexual nonminority adolescents to experience childhood sexual abuse, parental physical abuse, and peer victimization? Beyond examining disparities, we tested the possible moderating role of bisexuality status because data suggest that bisexual adolescents are at greater risk than are gay and lesbian adolescents for engaging in certain risk behaviors^44,45; the decade of survey administration because rates of violence perpetrated against sexual minority youths relative to heterosexuals may have decreased over recent decades⁴⁶; the dimension used to measure sexual orientation (i.e., behavior or identity) because disparities in abuse between sexual minority and sexual nonminority individuals may be greater when sexual minority status is based on self-identification as gay, lesbian, or bisexual than when it is based on same-sex or both-sex sexual activity⁴⁴; and gender because this variable has been shown to moderate the association between sexual orientation and both substance use⁴⁴ and suicide attempts⁴⁷ in sexual minority youths.     

Therapeutic levels of intravenous procainamide in neonates: a retrospective assessment

STUDY OBJECTIVES: To evaluate dosing and pharmacokinetic parameters of intravenous continuous-infusion procainamide in neonates, and to identify dosage regimens and factors leading to therapeutic procainamide levels and minimal adverse events. DESIGN: Retrospective, observational study. SETTING: Pediatric hospital. PATIENTS:. Twenty-one patients (seven preterm, 14 full term) younger than 30 days who received continuous-infusion procainamide therapy for more than 15 hours or had two consecutive therapeutic procainamide levels obtained while receiving therapy between June 1, 2002, and December 31, 2005. MEASUREMENTS AND MAIN RESULTS: Data on demographics, dosing, drug levels, and adverse effects were collected. Doses that achieved therapeutic levels were documented, and procainamide clearance was calculated and evaluated with regard to renal function and gestational age in patients who were at steady state. Mean clearance and mean N-acetylprocainamide (NAPA):procainamide ratios were compared between preterm and term neonates. No patients experienced hemodynamic instability or other adverse effects due to procainamide. Procainamide was given as a mean +/- SD 9.6 +/- 1.5-mg/kg bolus in 20 of 21 patients before continuous infusion. The mean +/- SD dose at which two therapeutic levels were achieved was 37.56 +/- 13.52 microg/kg/minute. Procainamide clearance was 6.36 +/- 8.85 ml/kg/minute and correlated with creatinine clearance (r=0.78, p<0.00001) and age at day of sampling (r=0.49, p<0.00001). The NAPA:procainamide ratio at steady state was 0.84 +/- 0.53; two patients were determined to be fast acetylators (ratio > 1). Preterm infants had lower mean clearance rates (p<0.001) but higher NAPA:procainamide ratios (p<0.01) than those of term infants. Five patients experienced seven supratherapeutic levels while receiving therapy; four of these patients were preterm, and all had creatinine clearances less than 30 ml/minute/1.73 m(2). Three patients had four pairs of levels obtained after discontinuation of procainamide, and elimination rate constant and half-life were calculated. CONCLUSION: Procainamide can be safely used in neonates, with no short-term adverse effects. The dosage regimen for intravenous procainamide required to achieve therapeutic levels in neonates is similar to that of older infants and children. Doses may need to be reduced in premature infants and in those with renal dysfunction.     

Distribution of phenolic compounds and antioxidative activities in parts of sweet potato (Ipomoea batata L.) plants and in home processed roots

We measured six phenolic compounds by HPLC, the total phenolic content by Folin-Ciocalteu, and antioxidative activities by three methods in the sweet potato plant and in home processed roots. Total phenolic content was highest in the leaves. Eight root varieties were partitioned and analyzed for phenolics. The stem end of the root had significantly more phenolics. In all samples the predominant chlorogenic acids were 5-caffeoylquinic acid (5-CQA) and 3,5-diCQA. 3,4-diCQA was present in significant amounts in the leaves and the flower, and 4,5-diCQA in the leaves. Six home-processing/cooking techniques reduced phenolic content from 7% (baking) to ∼40% (deep frying/boiling). High correlations were observed between phenolic compounds determined by HPLC and Folin-Ciocalteu, radical scavenging activity by 2,2-diphenyl-1-picrylhydrazyl (DPPH), and oxidative activity by ferric thiocyanate (FTC) and thiobarbituric acid (TBA) methods. The results show that there is a large variation in phenolics among sweet potato varieties and different parts of the plant and that high-phenolic sweet potato leaves, widely consumed in Asian countries as a vegetable, should be considered for diets of other countries.     

The potential for health risks from intrusion of contaminants into the distribution system from pressure transients

The potential for public health risks associated with intrusion of contaminants into water supply distribution systems resulting from transient low or negative pressures is assessed. It is shown that transient pressure events occur in distribution systems; that during these negative pressure events pipeline leaks provide a potential portal for entry of groundwater into treated drinking water; and that faecal indicators and culturable human viruses are present in the soil and water exterior to the distribution system. To date, all observed negative pressure events have been related to power outages or other pump shutdowns. Although there are insufficient data to indicate whether pressure transients are a substantial source of risk to water quality in the distribution system, mitigation techniques can be implemented, principally the maintenance of an effective disinfectant residual throughout the distribution system, leak control, redesign of air relief venting, and more rigorous application of existing engineering standards. Use of high-speed pressure data loggers and surge modelling may have some merit, but more research is needed.     

Psychological and behavioral factors associated with colorectal cancer screening among Ashkenazim.

BACKGROUND: Psychological and behavioral factors related to annual colorectal cancer (CRC) screening were examined in a sample of Ashkenazi Jewish individuals. Identification of factors related to regular CRC screening in this population is important because of the possibility of a heightened incidence of CRC. METHODS: Eligible participants were 171 Ashkenazi Jewish adults 40 years or older attending an educational program about breast cancer genetics. Compliance with recommended guidelines for digital rectal examination and fecal occult blood test in the past year were dependent measures. Demographic variables, family history of CRC, perceived risk, physician recommendation, and worry about cancer were independent measures. RESULTS: Digital rectal examinations and fecal occult blood tests had been obtained in the past year by 46 and 31% of the participants, respectively. A logistic regression showed that physician recommendation was related significantly to obtaining digital rectal examinations. Physician recommendation and education were related significantly to obtaining fecal occult blood tests. Although participants with family histories of CRC perceived themselves as being at increased risk of developing CRC, and were more worried about developing colon cancer, they were no more likely to adhere to CRC screening guidelines than those without such histories. CONCLUSIONS: Overall, compliance with recommended CRC screening was low even among high-risk individuals. Physicians play a key role in motivating people to comply with CRC screening. Physicians need to en courage all asymptomatic patients 50 years and older to be screened for CRC.     

The gene expression profiles of medulloblastoma cell lines resistant to preactivated cyclophosphamide

The total expression profiles of two medulloblastoma cell lines resistant to the preactivated form of cyclophosphamide (4-hydroperoxycyclophosphamide, 4-HC) were examined using the Affymetrix GeneChip U133A array. Our primary objective was to look for possible genes, other than the well-studied aldehyde dehydrogenases (ALDH) that may be involved in cyclophosphamide (CP) resistance in medulloblastomas. We present here the lists of the most highly upregulated [30 for D341 MED (4-HCR); 20 for D283 MED (4-HCR)] and downregulated [19 for D341 MED (4-HCR); 15 for D283 MED (4-HCR)] genes which may be involved in conferring CP-resistance to the two medullobalstoma cell lines. The lists of genes from the two sublines almost had no overlap, suggesting different mechanisms of CP-resistance. One of the most noteworthy upregulated gene is TAP1 [90-fold increase in D341 MED (4-HCR) relative to D341 MED]. TAP1, a protein belonging to the ABC transporter family is normally involved in major histocompatibility class I (MHC I) antigen processing. This suggests the possible role of multidrug resistance (MDR), albeit atypical (which means it does not involve the usual MDR1 and MRP glycoproteins), in medulloblastoma's CP-resistance. Apart from TAP1, a number of other genes involved in MHC1 processing were upregulated in D341 MED (4HCR). D341 MED (4-HCR) also had a 20-fold increase in the expression of the aldo-keto reductase gene, AKR1B10, which may deactivate the reactive cyclophosphamide metabolite, aldophosphamide. For D283 MED (4-HCR), the most notable increase in expression is that of ALDH1B1, a member of the aldehyde dehydrogenase (ALDH) family of proteins.