负性生活事件与老年抑郁症发病率的关系

目的探讨负性生活事件和老年抑郁症发病率的关系。方法以GMS-AGECAT与MDS量表为调查工具,对基线调查时确定的非抑郁老年人进行队列研究。采用χ2检验、Spearman相关分析和多元Logistic回归分析来分析数据。结果随着负性生活事件发生数增加,老年抑郁症发病率增高,两者有密切相关(r=0.96,P<0.01)。χ2检验表明,健康恶化、经济困难、难过事情、亲友冲突、恐怖经历发生与否与老年抑郁症发病率关系达显著性水平(P<0.01)。多元Logistic回归分析表明,经济困难(RR=1.82)、亲友冲突(RR=5.18)对老年抑郁症发病率有显著性影响(P<0.01)。结论负性生活事件与老年抑郁症发病率密切相关,经济困难、亲友冲突是老年抑郁症的危险因素。     

二氯苯醚菊酯浸泡蚊帐防制大劣按蚊及疟疾的现场研究

１９８９年４月～１９９２年３月在海南万宁县北大乡进行了二氯苯醚菊酯浸泡蚊帐防疟试验。在现场选择１０个自然村６１２６人为实验区。浸帐前一年进行了流行病学基本数据调查，１９９０年４～５月和１９９１年４月分别用二氯苯醚菊酯５００ｍｇａｉ／ｍ２剂量浸泡蚊帐，浸帐率９８．２％，两次药帐人口覆盖率分别为７３．６％和７３．５％。实验区浸帐前（１９８９年６～１２月）平均月发病率９．９６‰，浸帐后分别降为３．４５‰（１９９０）和２．０７‰（１９９１），比浸帐前同期分别下降６５．４％和７９．２％。其中恶性疟下降尤其迅速而明显。三年试验结果表明，二氯苯醚菊酯浸泡蚊帐对大劣按蚊自然种群密度及疟疾传播均有明显的防制效果。     

A pilot model of vaccination against hepatitis B virus suitable for mass vaccination campaigns in hyperendemic areas.

A hepatitis B vaccination campaign was carried out in a town of 60,000 inhabitants, Afragola, Campania, Italy, a hyperendemic area for hepatitis B where HBsAg prevalence was 13.4% and anti-HBc prevalence was 64.7%. This experimental pilot project aimed to reduce the incidence of both acute and asymptomatic viral hepatitis B and of related chronic liver complications. From 1983-1989, 8,400 subjects were vaccinated: 6,900 children up to 10 years of age and 1,500 subjects from 11-60 years of age. High seroconversion rates were observed: 99.0% in all children under one year of age, 96.0% in the older children, and 86.7% in adults. The rate of infection in Afragola has diminished from 63/100,000 in 1983 to 10/100,000 in 1989. Carriers of HBsAg decreased in the general population (7.3% compared to 13.4%), especially in children up to 10 years of age (1.0% compared to 9.0%). In babies who received hepatitis B vaccine at the same time as compulsory vaccinations compliance was 98% while it was 80% in babies who were vaccinated separately. In June 1991 the Italian Parliament promulgated a decree which imposes hepatitis B vaccination for all newborn babies at 3, 5, and 11 months of age, at the same times as the mandatory childhood vaccinations (diphtheria, tetanus, and polio) according to a new protocol (Piazza scheme) which has been in use since January 1987 in our pilot vaccination campaign in Afragola.     

High incidence rate and absent family histories in one quarter of patients newly diagnosed with Huntington disease in British Columbia

The advent of the direct mutation test for Huntington disease (HD) has made it possible to identify a previously unrecognized symptomatic population of HD, including those with an atypical presentation or patients without a family history of HD. The present study investigated the uptake of this test in the province of British Columbia (BC), Canada and assessed the incidence rate and rate of identification of new mutations for HD. All symptomatic individuals residing in BC who were referred for the genetic test for HD between 1993 and 2000 (n=205) were analyzed for CAG expansion, baseline demographics and clinical data, and a family history of HD. A total of 141 (or 68.8%) had a CAG expansion > or =36. Of these, almost one-quarter (24.1%) did not have a family history of HD. An extensive chart review revealed that 11 patients (or 7.8%) had reliable information on both parents (who lived well into old age) and therefore possibly could represent new mutations for HD. This indicates a three to four times higher new mutation rate than previously reported. Our findings also show that the yearly incidence rate for HD was 6.9 per million, which is two times higher than previous incidence studies performed prior to the identification of the HD mutation. We also identified five persons with a clinical presentation of HD but without CAG expansion (genocopies) (2.4%).     

Increasing incidence but decreasing in-hospital mortality of adult Staphylococcus aureus bacteraemia between 1981 and 2000

Staphylococcus aureus is a leading cause of bacteraemia. This study analysed temporal trends from 18,702 adult cases of S. aureus bacteraemia in Denmark between 1981 and 2000. After stratification for mode of acquisition, 57% of cases were hospital-acquired (HA), 28% were community-acquired (CA) and 15% were of undetermined acquisition (UA). Incidence rates increased from 18.2 to 30.5 cases/100,000 population. Annual rates increased by 6.4% for CA, by 2.2% for HA and by 3.6% for UA cases, respectively. Case-mortality associated with HA bacteraemia decreased from 36.2% to 20.7% (43% rate reduction, p 0.0001), compared with a decrease from 34.5% to 26.5% (23% rate reduction, p 0.0001) for CA bacteraemia. Following multivariate analysis, age, pneumonia, endocarditis and chronic illness were associated with increased mortality, regardless of the mode of acquisition. Overall, mortality associated with S. aureus bacteraemia declined significantly between 1981 and 2000, but incidence rates doubled, so that the total number of deaths increased. These data emphasise the public health importance of S. aureus bacteraemia and the need for further preventive measures and improved care in order to reduce incidence rates and improve outcomes.     

Heterogeneity for mutations in medium chain acyl-CoA dehydrogenase deficiency in the UK population

MCAD is the commonest inherited disorder of fatty acid oxidation. We have sought for and studied 21 affected children from 18 families within the UK. In 14 families the children are homozygous for the G985 mutation. In three families the children are compound heterozygotes for G985 and thus carry another and unknown mutation. In one family the child does not carry the G985 mutation on either allele. The carrier incidence of the G985 mutation is 1 in 68, which suggests that the natural history of MCAD deficiency deserves further study.     

Risk Factors for De Novo Malignancy Following Lung Transplantation

Risk factors for non–skin cancer de novo malignancy (DNM) after lung transplantation have yet to be identified. We queried the United Network for Organ Sharing database for all adult lung transplant patients between 1989 and 2012. Standardized incidence ratios (SIRs) were computed by comparing the data to Surveillance, Epidemiology, and End Results Program data after excluding skin squamous/basal cell carcinomas. We identified 18 093 adult lung transplant patients; median follow‐up time was 1086 days (interquartile range 436–2070). DNMs occurred in 1306 patients, with incidences of 1.4%, 4.6%, and 7.9% at 1, 3, and 5 years, respectively. The overall cancer incidence was elevated compared with that of the general US population (SIR 3.26, 95% confidence interval [CI]: 2.95–3.60). The most common cancer types were lung cancer (26.2% of all malignancies, SIR 6.49, 95% CI: 5.04–8.45) and lymphoproliferative disease (20.0%, SIR 14.14, 95% CI: 9.45–22.04). Predictors of DNM following lung transplantation were age (hazard ratio [HR] 1.03, 95% CI: 1.02–1.05, p < 0.001), male gender (HR 1.20, 95% CI: 1.02–1.42, p = 0.03), disease etiology (not cystic fibrosis, idiopathic pulmonary fibrosis or interstitial lung disease, HR 0.59, 95% CI 0.37–0.97, p = 0.04) and single‐lung transplantation (HR 1.64, 95% CI: 1.34–2.01, p < 0.001). Significant interactions between donor or recipient smoking and single‐lung transplantation were noted. On multivariable survival analysis, DNMs were associated with an increased risk of mortality (HR 1.44, 95% CI: 1.10–1.88, p = 0.009).     

Breast Cancer and Transplantation

Breast cancer is an important cancer among solid organ transplant recipients. While the incidence of breast cancer in solid organ transplant recipients is comparable to the age‐matched general population, the outcomes are generally poor. Interventions such as cancer screening that preclude the development of late‐stage disease through early detection are not well studied, and clinical practice guidelines for cancer screening rely solely on recommendations from the general population. Among patients with a prior breast cancer history, disease recurrence after transplantation is a rare but fearful event. Once disease recurs, the risk of death is high. The focus of this review is to present the epidemiology of breast cancer in solid organ transplant recipients, screening and preventive strategies for those who may be at risk, novel genomic profiling for determining tumor progression, and the newer targeted interventions for recipients who have developed breast cancers after solid organ transplantation.     

An Analysis of Reported Cases of Fracture of the Universal Exeter Femoral Stem Prosthesis

Background

Between 1991 and 2008, approximately 80 cases of fracture (neck or stem) have been reported. This study aimed at determining factors predisposing to implant fracture.