The Hound of the Baskervilles effect: natural experiment on the influence of psychological stress on timing of death

Which Types of Stress Are Associated With Accelerated Biological Aging? Comparing Perceived Stress, Stressful Life Events, Childhood Adversity, and Posttraumatic Stress Disorder

OBJECTIVE

Stress and stressful events are associated with poorer health; however, there are multiple ways to conceptualize and measure stress and stress responses. One physiological mechanism through which stress could result in poorer health is accelerated biological aging. This study tested which types of stress were associated with accelerated biological aging in adulthood.

METHODS

Studying 955 participants from the Dunedin Longitudinal Study, we tested whether four types of stress assessed from ages 32 to 45 years-perceived stress, number of stressful life events, adverse childhood experiences, and posttraumatic stress disorder-were associated with accelerated biological aging.

RESULTS

Higher levels of all four measures of stress were significantly associated with accelerated aging in separate models. In a combined model, more perceived stress and more stressful life events remained associated with faster aging, and the stress measures explained 6.9% of the variance in aging. The magnitudes of the associations between the four measures of stress and biological aging were comparable to associations for smoking and low education, two established risk factors for accelerated aging. People with high levels of perceived stress, numerous adverse childhood experiences (4+), high stressful life event counts, or posttraumatic stress disorder were aging an additional estimated 2.4 months, 1.1 additional months, 1.4 months, and 1.4 months per year, respectively.

CONCLUSIONS

Assessing stress, particularly perceived stress, could help identify people at risk of accelerated aging. Intervening to treat stress or the health-relevant sequelae of stress could potentially slow the rate at which people are aging, improving their health as they age.

Limited English Proficiency and Screening for Cervical, Breast, and Colorectal Cancers among Asian American Adults

BACKGROUND

Literature shows that limited English proficiency (LEP) influences individual healthcare-seeking behaviors. The Asian population is the fastest-growing racial/ethnic group in the US, and approximately 50% of foreign-born Asians are estimated to live with LEP.

OBJECTIVE

To examine associations of LEP and patient-provider language concordance (PPLC) with evidence-based cancer screening utilization for cervical, breast, and colorectal cancers among Asian American adults.

METHODS

We obtained LEP, PPLC, and up-to-date status on the three types of cancer screening from a nationally representative sample of Asian Americans aged ≥ 18 years in the 2010-2016 and 2018 Medical Expenditure Panel Surveys. We used multivariable logistic regression models with recommended survey weighting to examine associations of LEP and PPLC with the cancer screening uptake based on USPSTF guidelines.

RESULTS

The study population comprised 8953 respondents, representing 8.17 million Asian American adults. Overall, 11.9% of respondents experienced LEP; of those with LEP, 20% were with PPLC. In multivariable models, compared to respondents without LEP, respondents with LEP and without PPLC were significantly less likely to report up-to-date status on breast (OR = 0.44; 95% CI: 0.26-0.76), cervical (OR = 0.44; 95% CI: 0.26-0.75), or colorectal cancer screening (OR = 0.46; 95% CI: 0.26-0.80). However, these differences were not detected in respondents with LEP and with PPLC.

CONCLUSION

LEP is associated with lower up-to-date status on cancer screening among Asian Americans, while PPLC seems to moderate this association. These findings suggest the enhancement for language-appropriate and culturally competent healthcare for Asian Americans with LEP, which helps accommodate their communication needs and promotes cancer screening.

Cardiovascular reactivity, stress, and personal emotional salience: Choose your tasks carefully

Both greater cardiovascular reactivity and lesser reactivity ("blunting") to laboratory stressors are linked to poor health outcomes, including among people who have a history of traumatic experiences. In a sample of recently separated and divorced adults (N = 96), this study examined whether differences in cardiovascular reactivity might be explained by differences in the personal emotional salience of the tasks and trauma history. Participants were assessed for trauma history, current distress related to their marital dissolution, and cardiovascular reactivity during two tasks, a serial subtraction math stressor task and a divorce-recall task. Participants with a greater trauma history evidenced less blood pressure reactivity to the serial subtraction task (a low personal emotional salience task) when compared to participants with less trauma history. In contrast, participants with a greater trauma history evidenced higher blood pressure reactivity to the divorce-recall task, but only if they also reported more divorce-related distress (high personal emotional salience). These associations were not significant for heart rate reactivity. Among people with a history of more traumatic experiences, a task with low personal salience was associated with a lower blood pressure response, whereas a task with higher personal emotional salience was associated with a higher blood pressure response. Future studies examining cardiovascular reactivity would benefit from determining the personal emotional salience of tasks, particularly for groups that have experienced stressful life events or trauma.

Stress and the baroreflex

The stress response to emotions elicits the release of glucocorticoids from the adrenal cortex, epinephrine from the adrenal medulla, and norepinephrine from the sympathetic nerves. The baroreflex adapts to buffer these responses to ensure that perfusion to the organs meets the demands while maintaining blood pressure within a within a narrow range. While stressor-evoked autonomic cardiovascular responses may be adaptive for the short-term, the recurrent exaggerated cardiovascular stress reactions can be maladaptive in the long-term. Prolonged stress or loss of the baroreflex's buffering capacity can predispose episodes of heightened sympathetic activity during stress leading to hypertension, tachycardia, and ventricular wall motion abnormalities. This review discusses 1) how the baroreflex responds to acute and chronic stressors, 2) how lesions in the neuronal pathways of the baroreflex alter the ability to respond or counteract the stress response, and 3) the techniques to assess baroreflex sensitivity and stress responses. Evidence suggests that loss of baroreflex sensitivity may predispose heightened autonomic responses to stress and at least in part explain the association between stress, mortality and cardiovascular diseases.

Linking stressful life events and chronic inflammation using suPAR (soluble urokinase plasminogen activator receptor)

Stressful life events have been linked to declining health, and inflammation has been proposed as a physiological mechanism that might explain this association. Using 828 participants from the Dunedin Longitudinal Study, we tested whether people who experienced more stressful life events during adulthood would show elevated systemic inflammation when followed up in midlife, at age 45. We studied three inflammatory biomarkers: C-reactive protein (CRP), interleukin-6 (IL-6), and a newer biomarker, soluble urokinase plasminogen activator receptor (suPAR), which is thought to index systemic chronic inflammation. Stressful life events were not associated with CRP or IL-6. However, people who experienced more stressful life events from age 38 to 44 had elevated suPAR at age 45, and had significantly greater increases in suPAR from baseline to follow-up across the same period. When examining stressful life events across the lifespan, both adverse childhood experiences (ACEs) and adult stressful life events were independently associated with suPAR at age 45. ACEs moderated the association of adult stressful life events and suPAR at age 45-children with more ACEs showed higher suPAR levels after experiencing stressful life events as adults. The results suggest systemic chronic inflammation is one physiological mechanism that could link stressful life events and health, and support the use of suPAR as a useful biomarker for such research.

Financial Stressors During the Great Recession and Subsequent Risk of Early Mortality

OBJECTIVE

The Great Recession in 2008 was a period of severe economic upheaval and myriad financial stressors. Financial stress is associated with poorer health, but for whom is this stress the most health-relevant? The current study examined the association between financial stressors and mortality, as well as whether this association varied based on people's financial status.

METHODS

Participants from the Midlife in the United States study (n = 2760) were assessed before (2004-2005) and after (2013-2014) the Great Recession (2008). Mortality status was then tracked from 2013 to 2017.

RESULTS

People who experienced more financial stressors during the Great Recession were at greater risk of early mortality over the 4-year follow-up (hazard ratio [HR] = 1.14 [1.00-1.29], p = .046). This association was moderated by the importance of financial security (B = 0.34 [0.08-0.59], p = .009). Financial stressors were more strongly associated with mortality among people who reported that financial security was important to their well-being (HR = 1.29 [1.08-1.54], p = .006) compared with people who reported it was not (HR = 1.02 [0.82-1.26], p = .89). Household income and subjective financial status did not moderate the association between financial stressors and mortality.

CONCLUSIONS

Experiencing financial stressors during the Great Recession was associated with increased mortality over the 4-year follow-up period, particularly for people who reported financial security was important to their well-being. Interventions designed to reduce financial stress to improve health may benefit from targeting people for whom such stressors are particularly important.

Happy birthday? An observational study

BACKGROUND

Previous studies show contradictory findings on the relationship between birthday and deathday, in particular whether people postpone death until after their birthday. We examine the phenomenon in eight groups of famous people.

METHODS

Birthday and deathday for the following groups were recorded: British prime ministers, US presidents, Academy Award best actor, best female actor, best director, Nobel Prize winners, Wimbledon men's and ladies' singles winners, all from when records began. For each group, the difference in days between the deathday and birthday was calculated. Under the hypothesis of no association, one can expect the difference to have a uniform distribution. This is assessed using goodness-of-fit tests on a circle.

RESULTS

All groups showed some departure from the uniform and it occurred around the birthday in all groups. British prime ministers, US presidents, Academy Award actors and directors, Nobel Prize winners and Wimbledon men show a 'dip' in deaths around the birthday. The length of the 'dip' varied between the groups and so they gave different p-values on different test statistics. For Academy Award female actors and Wimbledon ladies, there was rise in deaths before and after birthday. When Nobel Prize winners were subdivided into their categories, Science and Literature had a 'dip' around the birthday, but not other categories.

CONCLUSIONS

We conclude 'something' happens to deathday around the birthday. Some groups of famous people show a 'dip' in death rate around the birthday while for others, particularly women, the association is in the opposite direction.

The sociocultural effects on orthopedic surgeries in Taiwan

Various sociocultural factors affect healthcare-seeking behaviors. In Taiwanese society, superstitions and lunar festivals play important roles in people’s lives. We investigated the impact of “Ghost Month” (the 7^th lunar month) and Chinese New Year (the 12^th lunar month and the 1^st lunar month of the following year) on the number of elective surgeries and emergent surgeries in Taiwan. The number of total knee replacement (TKR) surgeries and proximal femur fracture (PFF) surgeries in each lunar month from 2000 to 2011 were extracted from the Taiwan National Health Insurance Database, a computerized and population-based database. Patients were then sorted by location of residence or gender. The average number of TKR surgeries performed was significantly lower during the 1^st, 7^th, and 12^th lunar months in urban areas, whereas in rural areas this trend was only evident in the 7^th and 12^th lunar months. There was however, no significant difference in the average number of PFF surgeries in each lunar month except for an increase seen in the 1^st lunar month in rural patients (p<0.05). When sorted by gender, the average number of TKR surgeries was significantly decreased in the 7^th and 12^th lunar months in male patients, and decreased in the 1^st, 7^th, and 12^th lunar months in female patients. In contrast, there was no difference in the average numbers of PFF surgeries in the 7^th and 12^th lunar months either in male or female patients. We proposed that the timing of elective surgeries such as TKR might be influenced by Ghost Month and Chinese New Year; however, emergent PFF surgeries were not significantly influenced by sociocultural beliefs and taboos in Taiwan.

Long-range fine particulate matter from the 2002 Quebec forest fires and daily mortality in Greater Boston and New York City

During July 2002, forest fires in Quebec, Canada, blanketed the US East Coast with a plume of wood smoke. This "natural experiment" exposed large populations in northeastern US cities to significantly elevated concentrations of fine particulate matter (PM2.5), providing a unique opportunity to test the association between daily mortality and ambient PM2.5 levels that are uncorrelated with societal activity rhythms. We obtained PM2.5 measurement data and mortality data for a 4-week period in July 2002 for the Greater Boston metropolitan area (which has a population of over 1.7 million people) and New York City (which has a population of over 8 million people). Daily average PM2.5 concentrations were markedly increased for 3 days over this period, reaching as high as 63 μg/m3 for Greater Boston and 86 μg/m3 for New York City from background ambient levels of 4-48 μg/m3 in the non-smoke days. We examined temporal patterns of natural-cause deaths and 24-h ambient PM2.5 concentrations in July 2002 and did not observe any discernible increase in daily mortality subsequent to the dramatic elevation in ambient PM2.5 levels. Comparison to mortality rates over the same time periods in 2001 and 2003 showed no evidence of impact. Results from Poisson regression analyses suggest that 24-h ambient PM2.5 concentrations were not associated with daily mortality. In conclusion, substantial short-term elevation in PM2.5 concentrations from forest fire smoke were not followed by increased daily mortality in Greater Boston or New York City.

Against the "placebo effect": a personal point of view

The author reviews 10 of his favorite studies which are said to be about the "placebo effect," but which, instead, show the significance of meaning in a medical context. "Placebos," he argues, are inert substances which can't do anything. Yet it's clear that after the administration of such drugs, things do happen. The one (and maybe only) clear thing here is that whatever happens is not due to the placebo (that is what "inert" means). But placebos can be of various colors and forms which can convey compelling meaning to patients. They often represent medical treatment in compelling ways; they can be metonymic representations of the entire medical experience (a metonym is a representation where a part of something comes to represent it all, as in "counting noses," where the nose represents the whole person, or a "White House statement" where the White House represents the Executive Branch of the US Government; here, the pill represents the whole medical experience). More precisely, they can be metonymic simulacra (a simulacrum is a sort of artificial object, like a statue rather than a man, or a placebo rather than an aspirin). Such objects are well known for their powerful abilities to contain and convey meaning; for example, a European cathedral ordinarily is constructed of thousands of metonymic simulacra, from the rose window to the altar. In this context, a placebo can repeatedly remind the patient of the medical encounter, its shadings and comforts. Placebos can convey the physicians innermost feelings about medication and treatment; and the clinician can by her simple presence enhance the effectiveness of a medical procedure (and a clinician is hardly a placebo, hardly inert). Inert placebos can help us see the human dimensions of medical treatment; but calling these things "placebo effects" dramatically distorts our understanding of such treatments, by focusing on the inert, and avoiding the meaningful. Think "meaning response," not "placebo effect."

Strategies for piloting a breast health promotion program in the Chinese-Australian population

In Australia, women from non-English-speaking backgrounds participate less frequently in breast cancer screening than English-speaking women, and Chinese immigrant women are 50% less likely to participate in breast examinations than Australian-born women. Chinese-born Australians comprise 10% of the overseas-born Australian population, and the immigrant Chinese population in Australia is rapidly increasing. We report on the strategies used in a pilot breast health promotion program, Living with Healthy Breasts, aimed at Cantonese-speaking adult immigrant women in Sydney, Australia. The program consisted of a 1-day education session and a 2-hour follow-up session. We used 5 types of strategies commonly used for cultural targeting (peripheral, evidential, sociocultural, linguistic, and constituent-involving) in a framework of traditional Chinese philosophies (Confucianism, Taoism, and Buddhism) to deliver breast health messages to Chinese-Australian immigrant women. Creating the program's content and materials required careful consideration of color (pink to indicate femininity and love), symbols (peach blossoms to imply longevity), word choice (avoidance of the word death), location and timing (held in a Chinese restaurant a few months after the Chinese New Year), communication patterns (the use of metaphors and cartoons for discussing health-related matters), and concern for modesty (emphasizing that all presenters and team members were female) to maximize cultural relevance. Using these strategies may be beneficial for designing and implementing breast cancer prevention programs in Cantonese-speaking Chinese immigrant communities.

The relationship between serious injury and blood alcohol concentration (BAC) in fatal motor vehicle accidents: BAC = 0.01% is associated with significantly more dangerous accidents than BAC = 0.00%

AIM

To analyze the severity of automotive injuries associated with blood alcohol concentration (BAC) in increments of 0.01%.

DESIGN/SETTING

Epidemiological study using the Fatality Analysis Reporting System.

PARTICIPANTS

All people in US fatal automotive accidents, 1994-2008 (n = 1 495 667).

MEASUREMENTS

The ratio of serious: non-serious injuries for drivers, by BAC.

FINDINGS

Accident severity increases significantly even when the driver is merely 'buzzed', a finding that persists after standardization for various confounding factors. Three mechanisms mediate between buzzed driving and high accident severity: compared to sober drivers, buzzed drivers are significantly more likely to speed, to be improperly seatbelted and to drive the striking vehicle. In addition, there is a strong 'dose-response' relationship for all three factors in relation to accident severity (e.g. the greater the BAC, the greater the average speed of the driver and the greater the severity of the accident).

CONCLUSIONS

The severity of life-threatening motor vehicle accidents increases significantly at blood alcohol concentrations (BACs) far lower than the current US limit of 0.08%. Lowering the legal limit could save lives, prevent serious injuries and reduce financial and social costs associated with motor vehicle accidents.

Alcohol as a risk factor for sudden infant death syndrome (SIDS)

AIM

To test whether alcohol is a risk factor for sudden infant death syndrome (SIDS).

DESIGN AND SETTING

US epidemiological study using computerized death certificates, linked birth and infant death dataset, and Fatality Analysis Reporting System.

PARTICIPANTS

All SIDS cases (n = 129,090) and other infant deaths (n = 295,151) from 1973-2006; all persons involved in late-night alcohol-related crashes (n = 135,946) from 1994-2008.

MEASUREMENTS

Three measures were used: the expected number of deaths on New Year versus the observed number (expected values were determined using a locally weighted scatterplot smoothing polynomial), the average number of weekend deaths versus the average number of weekday deaths, and the SIDS death rate for children of alcohol-consuming versus non-alcohol-consuming mothers.

FINDINGS

These measures indicate that the largest spikes in alcohol consumption and in SIDS (33%) occur on New Year, alcohol consumption and SIDS increase significantly on weekends, and children of alcohol-consuming mothers are much more likely to die from SIDS than are children of non-alcohol-consuming mothers.

CONCLUSIONS

Alcohol consumption appears to be a risk factor for sudden infant death syndrome, although it is unclear whether alcohol is an independent risk factor, a risk factor only in conjunction with other known risk factors (like co-sleeping), or a proxy for other risk factors associated with occasions when alcohol consumption increases (like smoking). Our findings suggest that caretakers and authorities should be informed that alcohol impairs parental capacity and might be a risk factor for sudden infant death syndrome; in addition, future research should further explore possible connections between sudden infant death syndrome and alcohol.

A July spike in fatal medication errors: a possible effect of new medical residents

BACKGROUND

Each July thousands begin medical residencies and acquire increased responsibility for patient care. Many have suggested that these new medical residents may produce errors and worsen patient outcomes-the so-called "July Effect;" however, we have found no U.S. evidence documenting this effect.

OBJECTIVE

Determine whether fatal medication errors spike in July.

DESIGN

We examined all U.S. death certificates, 1979-2006 (n = 62,338,584), focusing on medication errors (n = 244,388). We compared the observed number of deaths in July with the number expected, determined by least-squares regression techniques. We compared the July Effect inside versus outside medical institutions. We also compared the July Effect in counties with versus without teaching hospitals.

OUTCOME MEASURE

JR = Observed number of July deaths / Expected number of July deaths.

RESULTS

Inside medical institutions, in counties containing teaching hospitals, fatal medication errors spiked by 10% in July and in no other month [JR = 1.10 (1.06-1.14)]. In contrast, there was no July spike in counties without teaching hospitals. The greater the concentration of teaching hospitals in a region, the greater the July spike (r = .80; P = .005). These findings held only for medication errors, not for other causes of death.

CONCLUSIONS

We found a significant July spike in fatal medication errors inside medical institutions. After assessing competing explanations, we concluded that the July mortality spike results at least partly from changes associated with the arrival of new medical residents.

The value of superstitions

This paper estimates the value of superstitions by studying the auctions of vehicle license plates. We show that the value of superstitions is economically significant, which justifies their persistence in human civilization. We also document the changes of the value of superstitions across different types of plates, across different policy regimes, and across different macroeconomic environments. Interestingly, some of the changes are rather consistent with economic intuition.

Is there a scientific basis for pet therapy?

PURPOSE

Pet therapy is a non-pharmacological intervention, but its scientific value is still undefined.

METHODS

The first step to identify the papers of interest was the access to the MEDLINE library from 1960 until June 2007 and the Cochrane controlled trials registry.

RESULTS

At present there is consistent evidence of the protective effect against cardiovascular risk, mainly through the moderate exercise prompted by walking a dog. Indeed, walking a dog may contribute to a physically active lifestyle. Moreover, patients suffering from chronic illness are likely to benefit from pet companionship.

CONCLUSIONS

There is a contrast between physical effects (for which the evidence is fairly clear) and the psychological benefits (for which the evidence is controversial). Further randomised researches are necessary to convey scientific dignity to the human - animal relationship.

Belief in ghost month can help prevent drowning deaths: a natural experiment on the effects of cultural beliefs on risky behaviours

Studies have suggested that cultural beliefs, such as those underlying religious social occasions and superstitions, have both positive and negative effects on mortality rates. Many people in Southern China believe that there are wandering ghosts who were released from hell during the lunar month of July (ghost month: mostly August in the Gregorian calendar): people therefore avoid unnecessary risky activities during ghost month. The aim of this study was to examine whether unintentional drowning deaths decreased during ghost month, using a matched control design and mortality data of Taiwan between 1981 and 2005. Results show that overall days-adjusted monthly death rate in ghost month days in Gregorian August was 1.37 (per 1,000,000). This was significantly lower than those in non-ghost month days, which was 1.67. The mean number of deaths in ghost months was lower than that in the matched controls, which was -3.2 deaths (-2.6 to -3.5) during weekends and -4.5 deaths (-2.2 to -7.2) during weekdays. The differences were more prominent in men than in women. For other main causes of death, we did not find persistent significant differences throughout the four matched controls. In conclusion, our findings support the death-dip hypothesis. Possible mechanisms are that people who believe in the ghost month might either decrease their exposure to water-related activities or involve themselves less in risky behaviours during ghost month, as a kind of risk compensation, consequently resulting in a reduction in the number of drowning deaths. As such we conclude that cultural factors should be taken into consideration when designing injury prevention programs.

Possible influence of spiritual and religious beliefs on hypertension

Religious and spiritual beliefs are beneficial in stroke patients as coping strategies. This work has investigated the feeling of people about it by proposing to 174 volunteers aged 54.0 +/- 16.9 years the Royal Free Interview (RFI). Interviewed subjects considered the beliefs beneficial for health independently of their form. Ascertaining the pre-morbid understanding of life in subjects at risk of hypertension may be useful to verify self-confidence and coping possibilities against anger, fear, and stress, factors that may exert a negative effect.

A bio-psycho-socio-molecular approach to pain and stress management

Stress and trauma are interconnected with the experience of pain. This connection is due to a physiological coupling of underlying molecular autoregulatory mechanisms, as well as phenomenological similarities. Nonpharmaceutical therapeutic approaches such as the relaxation response, a process that supports physiological stress reduction and decreases the negative mental and physical effects of stress, also facilitate pain relief, again demonstrating physiological commonalities. These behavioral approaches have a critical impact on molecular patterns of autoregulation, leading to the assumption of a bio-psycho-socio-molecular model of autoregulation, including stress and pain. Thus, molecules and behavior may be seen as two sides of the same problem in pain and stress relief.

Emotional triggers of acute coronary syndromes: strength of evidence, biological processes, and clinical implications

Emotional triggers of acute coronary syndromes include population-level events such as earthquakes and terrorist attacks, and individual experiences of acute anger, stress and depression. The methodology of studying emotional triggers has developed markedly over recent years, though limitations remain. The biological processes underlying triggering include acute autonomic dysregulation, neuroendocrine activation, hemostatic and inflammatory responses which, when associated with plaque disruption, promote myocardial ischemia, cardiac dysrhythmia and thrombosis formation. Prevention and management strategies for ameliorating emotional triggering remain to be effectively developed.

Can faith protect from emotional distress after stroke?

BACKGROUND AND PURPOSE

Emotional distress is common in the aftermath of stroke and can impact negatively on the outcome. The study was aimed at evaluating whether religious beliefs can protect from emotional distress.

METHODS

Data were collected from 132 consecutive inpatients who were hospitalized for stroke rehabilitation and met the research requirements. At admission all study participants received a semi-structured interview on religious beliefs (Royal Free Interview for religious and spiritual beliefs) and were assessed on their mood with the Hospital Anxiety and Depression Scale. The relationship between religious beliefs and mood was explored, adjusting for possible confounders.

RESULTS

Subjects with over-threshold Hospital Anxiety and Depression Scale scores had significantly lower Royal Free Interview scores (odds ratio, 0.95; CI, 92 to 98). The direction and magnitude of the association did not change after adjusting for possible confounders (odds ratio, 0.95; CI, 91 to 98). The same pattern was observed when analyzing separately Hospital Anxiety and Depression Scale anxiety and depression subscales. The other significant variable was functional dependence.

CONCLUSIONS

The strength of religious beliefs influences the ability to cope after a stroke event, with stronger religious beliefs acting as a possible protective factor against emotional distress.

The five elements and Chinese-American mortality

D. P. Phillips, T. E. Ruth, and L. M. Wagner (1993) reported that 1969-1990 California mortality data show that Chinese Americans are particularly vulnerable to diseases that Chinese astrology and traditional Chinese medicine associate with their birth years. For example, because fire is associated with the heart, a Chinese person born in a fire year (such as 1937) is more likely to die of heart disease than is a Chinese person born in a nonfire year. However, many diseases were excluded from this study, some diseases that were included have ambiguous links to birth years, and the statistical tests were indirect. A more complete statistical analysis and independent California mortality data for the years 1960-1968 and 1991-2002 did not replicate the original results.

Reversible ventricular dysfunctiontakotsubocardiomyopathy

BACKGROUND

Recently, many cardiologists have recognized the existence of a rapidly reversible form of heart failure of unknown origin characterized by a takotsubo-shaped, dyskinetic left ventricle on left ventriculography.

AIM

To determine the detailed clinical features of takotsubo cardiomyopathy.

METHODS

Thirteen elderly patients (11 women and 2 men with a mean age of 75.3 years) who had normal coronary arteries and takotsubo-like left ventricular dysfunction were prospectively enrolled in this study.

RESULTS

Cardiac enzymes did not increase significantly, but the mean plasma norepinephrine level was very high on admission (0.98 microg/l). Coronary angiography revealed normal coronary arteries in all patients, but left ventriculography showed apical akinesis combined with basal hyperkinesis, i.e., a takotsubo (Japanese octopus fishing pot)-shaped ventricle. Left ventricular wall motion normalized within a mean of 16.9 hospital days in 12 patients, but 1 patient died of acute renal failure on hospital day 7. Cardiac events did not recur during a follow-up period of 0.5 to 5 years.

CONCLUSION

Takotsubo cardiomyopathy seems to be a new type of acute heart failure, which generally has a good prognosis and does not recur. Myocardial damage by catecholamine overload, adrenoceptor hypersensitivity, and changes of catecholamine dynamics due to stress may cause this condition.

A spike in fatal medication errors at the beginning of each month

At the beginning of each month, there is a spike in government payments to individuals, resulting in a beginning-of-the-month spike in purchases of prescription drugs and in increased pharmacy workloads. Studies suggest that pharmacy error rates increase with increased workloads. These facts raise an important and previously unanswered question: is there a spike in fatal medication errors at the beginning of each month? We examined all United States death certificates from 1979-2000 (> 47,000,000 deaths) and showed that medication error deaths for which the decedent was dead on arrival or died in the emergency room or as an outpatient spiked by 25% above normal at the beginning of each month. This beginning-of-the-month spike (25% +/- 4%) was larger than for any other major cause of death. The beginning-of-the-month spike did not vary by socioeconomic status and was not larger for substance abusers than for others. Five explanations for the findings were tested. Evidence suggested that the spike in medication error deaths cannot be solely attributed to a spike in the consumption of alcohol or drugs. An increase in pharmacy error rates might play a role.

Is four a deadly number for the Chinese?

BACKGROUND

The numbers 4, 14 and 24 are associated with death for Cantonese-speaking Chinese people, as the words for these numbers sound like the words for "death", "must die" and "easy to die", respectively. A previous study in the United States investigating psychological stress engendered by fear of the number 4 found more cardiac deaths in Chinese and Japanese people, compared with white Americans, on the 4th day of the month.

OBJECTIVE

To determine whether more cardiac deaths occur in Hong Kong Chinese people on the days of the month with "deathly connotations" (4, 14 and 24).

DESIGN

Analysis of mortality data (1995-2000) of the Chinese population of Hong Kong from the Census and Statistics Department of the Hong Kong Government for these three days of the month, compared with the remaining days, according to both the Gregorian and Lunar calendars.

RESULTS

There were 17 346 cardiac deaths registered under ICD-9 codes 410-414 in 1995-2000. The mean (+ 1 SD) of the cumulative number of cardiac deaths on each day of the month was 587 (+ 30) for the Gregorian calendar or 573 (+ 24) for the Lunar calendar. The mean number of deaths on the 4th, 14th and 24th day of the month was not significantly different from the mean number of deaths on the remaining days of the month.

CONCLUSION

Our study of Hong Kong Chinese people does not support the concept that more cardiac deaths occur in Cantonese people on the 4th, 14th and 24th day of the month.

Possible noncausal bases for correlations between low concentrations of ambient particulate matter and daily mortality

Numerous studies of populations living in areas with good air quality have reported correlations between daily average levels of ambient particulate matter (PM) and daily mortality rates. These associations persist at PM levels below current air quality standards and are difficult to reconcile with the toxicology of PM chemical constituents. The unusual level of lethality per unit PM mass predicted by these associations may result from confounding by unmeasured societal, behavioral, or stress factors. Daily average ambient PM levels may be expected to correlate with societal activity level, because a working population increases PM emissions through increased manufacture, power utilization, construction, demolition, farming, and travel. Also, people's perceived and actual health depend on societal and psychological factors. A stress such as anger strongly increases the risk of death due to heart attack. Societal factors modify mortality as shown by calendar-related changes in mortality that are unrelated to air quality. Cardiovascular and respiratory mortality are correlated to day of the week, end of the month, and to the first week of the year. There is likely a role of such nontoxicologic variables in the PM associations, and without vigorously testing if other variables correlate as well as PM, we may erroneously conclude that reducing already low levels of PM will yield real public health benefits.

A biocultural model of aging

Addresses how the life sciences have concentrated on the pathology of aging while ignoring the biocultural aspects of health in the process of growing older. Argues that growing older is a dynamic cognitive, biological and cultural coauthoring of health rather than a hopeless unfolding of progressive pathology. Proposes that this fragmented concept of aging precludes operationalizing and understanding the cultural markers that affect longevity. These cultural milestones, or biocultural portals include middle age markers, retirement markers, perceived wisdom, sexuality, status in the community, transcendental beliefs, sense of empowerment vs helplessness and any other biocultural phase in human development. Suggests that the biocultural portals define and trigger the phase transitions of life as well as influence how they are accommodated. For example, the markers for middle age established by a culture, strongly influence the cognitive and biological expectations for the second half of life.