Surgical timing and complications, with body image, quality of life, sexual function and genital sensation in patients with congenital adrenal hyperplasia

INTRODUCTION

The aim of this project was to document the long-term outcomes relating to sexual function, genital sensation, body image and quality of life, in an Australian cohort of adolescent and adult women with congenital adrenal hyperplasia (CAH) who have undergone feminising genitoplasty in infancy, childhood or adolescence.

MATERIALS AND METHODS

Identification and follow-up of women with CAH aged 12-40 years who had their first feminising genitoplasty or ongoing management at a single tertiary referral center with multidisciplinary care (n = 80). Medical records were reviewed for Prader stage, and operative outcomes. The prospective component of the study included tracing indivudals aged 12-40 years (n = 69), of whom 34 were contactable. Twenty-one responded to the invitation to participate in the study, completing some or all of a series of validated standardized questionnaires and/or participation in examination of external genital with sensation testing. Results were compared to a control population of similar age distribution (n = 23).

RESULTS

The median Prader stage was 3, median age at surgery was four months, median hospital stay of three days with 80 % of surgery undertaken by one surgeon. There was one major and eight minor complications. Re-operation rates were low. There was no difference between participants and controls in terms of sexual function, quality of life, or body image outcomes including genital appearance. Participants had increased sensitivity to soft touch on genital sensation testing compared to controls. Most participants (71 %) reported that early timing of surgery was 'good', four (19 %) felt their surgery was too late, one felt their surgery was too early, and one was unsure. Most were happy with the outcome of their surgery.

DISCUSSION

Outcomes after feminising genitoplasty are mixed and influenced not only by the surgery itself, but also the ongoing management of the condition alongside each patient's own cultural and social context. At present there is no comparative data available on the sexual, mental, body image and quality of life outcomes of young females with CAH who have had their operation delayed until adulthood. Our study is limited by low participant response rate, and difficulty recruiting 1:1 control population for all participants, but nevertheless provides some insight into the outcomes of these patients for which limited data is available.

CONCLUSION

In the population studied feminising genitoplasty in infancy and childhood had overall positive outcomes. This occurred in a tertiary center with expert multidisciplinary individualised care.

Assessing the impact of a gynaecomastia assessment and treatment infographic in primary care in Greater Manchester

INTRODUCTION

Men with gynaecomastia are routinely referred to breast clinics, yet most do not require breast surgical intervention. The aim of this study was to assess the impact of a novel point-of-care gynaecomastia decision infographic in primary care on the assessment, management and referral practices to tertiary breast surgical services.

METHODS

A study was carried out of male patient referrals from primary care in Greater Manchester to a tertiary breast centre between January and March in 2018-2020. Referral patterns were compared before and after the infographic went live in general practices in Greater Manchester in January 2020. Data were collected for gynaecomastia referrals, including aetiology, investigation and management.

RESULTS

In total, 394 men were referred to a tertiary breast centre from 163 general practices, of which 271 (68.8%) had a diagnosis of gynaecomastia. Use of the decision infographic by primary healthcare providers was associated with a decrease in male breast referrals with gynaecomastia (79.6% to 62.0%). Fewer gynaecomastia patients were referred with a benign physiological or drug-related cause after implementation of the infographic (52.2% vs 41.8%). Only 10 (3.7%) patients with gynaecomastia underwent breast surgery during the study period.

CONCLUSION

Implementation of a gynaecomastia infographic in primary care in Manchester was associated with a reduction in gynaecomastia referrals to secondary care. We hypothesise that implementation of the infographic into primary care nationally may potentially translate to hundreds of patients receiving more specialty-appropriate referrals, improving overall management of gynaecomastia. Further study is warranted to test this hypothesis.

Abstract A018: Using qualitative methods to develop health messages aimed to reduce secondhand smoke exposure among African American breast cancer survivors in a rural state

Purpose. This study aimed to develop health messages that help African American breast cancer survivors reduce exposure to secondhand smoke in the home. African American women are disproportionately impacted by tobacco exposures and cancer mortality. Cigarette smoking decreases functional status (e.g., fatigue, pain) and increases complications related to breast reconstruction and the risk for secondary cancers. Understanding knowledge, attitudes, and beliefs related to tobacco and sociocultural and environmental influences may inform the development of messages that protect breast cancer survivors from the harm of smoke. Methods. We used a sequential design to conduct semi-structured interviews, photovoice interviews, and focus groups that informed message development related to secondhand smoke exposure. African American women breast cancer survivors aged 30-65 years, who smoked cigarettes or cigars in past 30 days or lived with a smoker, and were low income were invited to participate. Interviews assessed knowledge related to breast reconstruction and the prevention of secondary cancers; perceived susceptibility and severity related to the harms of tobacco; subjective norms; attitudes toward using tobacco and implementing smokefree home rules; perceived benefits and complexity of implementing smokefree home rules; and intentions to adopt smokefree home rules. Participants who completed the interviews (n=12) were invited to use photovoice to capture the socio-environmental context of survivorship and women’s motivations for making changes in tobacco exposure (n=9). Data from the interviews and photovoice were used to develop 16 messages related to secondhand smoke exposure. An iterative process was used to obtain feedback on each message (e.g., The smoke from cigarettes, pipes, and cigars of any kind is the same. Keep your home safe from secondhand smoke) from focus group participants (n=12). Results. Forty percent of African American women breast cancer survivors who completed the interviews reported current smoking and 54% had expired CO levels > 7 ppm. Most women felt that cigarettes cause some harm, but also stated that no one knows how each person is affected. Some women felt that occasional smoking was not harmful, that secondhand smoke was as bad as smoking, and that it is a gamble as to whether anything would happen if exposed to tobacco smoke. Some women expressed that smoking did not affect their breast reconstruction surgery while others felt that it slowed the healing process, or were unclear about its effects on surgery. Women who provided feedback on the messages during focus groups stated that people say secondhand smoke causes cancer, but they were unclear of its effects. Women felt that health messages needed to convey the type of cancers caused by secondhand smoke. Conclusions. Our study provided helpful information that informed the development of messages that can be used to increase awareness of the harms of secondhand smoke.

Citation Format: Nakita Lovelady, Pebbles Fagan, Camille Hart, Michael Preston, Tiffany Haynes, Ronda Henry-Tillman. Using qualitative methods to develop health messages aimed to reduce secondhand smoke exposure among African American breast cancer survivors in a rural state [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A018.

The Angel Wings Incision: A novel solution for mastectomy patients with increased lateral adiposity

Many techniques have been proposed to address the problem of increased lateral adiposity in patients undergoing mastectomy, however, there is no standard approach. This cosmetic deformity at the lateral end of the mastectomy scar, also known as a dog ear, is especially common in obese patients. This defect can be unsightly and uncomfortable. We describe a technique for creating a winged incision to eliminate the dog ear deformity. The Angel Wings Incision results in tissue flaps that create a smooth body contour upon closure in patients with increased lateral adiposity. The technique is reproducible, aesthetically pleasing, and improves patient satisfaction.

Improving the Leadership Development of Students Who Work Off-Campus

Using the cocurricular career connections (C3) leadership model, this chapter will focus on the potential for off-campus jobs to help a largely underserved group to develop leadership skills. In so doing, leadership educators and student employers can help students be more effective in their work, develop skills that can promote employability after college, and impact the perception of employers about how effectively colleges and universities are preparing students for the world of work.

A State-Level Examination of School Nurses' Perceptions of Condom Availability Accompanied by Sex Education

School nurses are often sources of health-care support for teens with sexually transmitted infections (STIs) and unintended pregnancies. However, providing prevention (e.g., condoms) and teaching technical skills (e.g., condom use) needed to reduce high-risk sexual behavior may require a change in perceptions and policies. This study used a cross-sectional study design to assess nurses' perceptions of condom availability accompanied by sex education programs among high school nurses (n = 87) in Kansas. Results showed that school nurses in this study supported condom availability, were comfortable providing condoms, and felt condom availability was within the scope of their job but were less likely to provide condoms because of external barriers. Common barriers include administration, parents, cost, community support, and policies. School nurses, by virtue of their access to the majority of Kansas' adolescents, have the potential to provide sex education and tools such as condoms, so young people can prevent STIs and unintended pregnancies.

Correlates and aetiological factors associated with hedonic well-being among an ageing population of US men and women: secondary data analysis of a national survey

OBJECTIVE

To understand the gender-specific factors that uniquely contribute to successful ageing in a US population of men and women, 57-85 years of age. This was achieved through the examination of the correlates of subjective well-being defined by health-related quality of life (HRQoL), across several biological and psychosocial determinants of health.

DESIGN

Cross-sectional study.

SETTING

The National Social Life, Health and Ageing Project (NSHAP), 2010-2011 a representative sample of the US population.

PARTICIPANTS

3377 adults aged 57-85 (1538 men, 1839 women) from the NSHAP.

MAIN OUTCOME MEASURES

The biopsychosocial factors of biological/physiological function, symptom status, functional status, general health perceptions and HRQoL happiness.

METHOD

HRQoL was measured using the NSHAP wave 2 multistage, stratified area probability sample of US households (n=3377). Variable selection was guided by the Wilson and Cleary model (WCM) that classifies health outcomes at five main levels and characteristics.

RESULTS

Our findings indicate differences in biopsychosocial factors comprised in the WCM and their relative importance and unique impact on HRQoL by gender. Women reported significantly lower HRQoL than men (t=3.5, df=3366). The most significant contributors to HRQoL in women were mental health (B=0.31; 0.22, 0.39), loneliness (B=-0.26; -0.35, -0.17), urinary incontinence (B=-0.22; -0.40, -0.05) and support from spouse/partner (B=0.27; 0.10, 0.43) and family B=0.12; 0.03, 0.20). Men indicated mental health (B=0.21; 0.14, 0.29), physical health (B=0.17; 0.10, 0.23), functional difficulties (B=0.38; 0.10, 0.65), loneliness (B=-0.20; -0.26, -0.12), depression (B=-0.36; -0.58, -0.15) and support from friends (B=0.06; 0.10, 0.11) as significant contributors. Those with greater social support had better HRQoL (F=4.22, df=4). Lack of companionship and reliance on spouse/partner were significant HRQoL contributors in both groups.

CONCLUSION

Our findings offer insight into ageing, gender and subjective well-being. The results provide an opportunity to identify biopsychosocial factors to inform interventions to support successful ageing.

Validation of a genetic risk score for Arkansas women of color

African American women in the state of Arkansas have high breast cancer mortality rates. Breast cancer risk assessment tools developed for African American underestimate breast cancer risk. Combining African American breast cancer associated single-nucleotide polymorphisms (SNPs) into breast cancer risk algorithms may improve individualized estimates of a woman's risk of developing breast cancer and enable improved recommendation of screening and chemoprevention for women at high risk. The goal of this study was to confirm with an independent dataset consisting of Arkansas women of color, whether a genetic risk score derived from common breast cancer susceptibility SNPs can be combined with a clinical risk estimate provided by the Breast Cancer Risk Assessment Tool (BCRAT) to produce a more accurate individualized breast cancer risk estimate. A population-based cohort of African American women representative of Arkansas consisted of 319 cases and 559 controls for this study. Five-year and lifetime risks from the BCRAT were measured and combined with a risk score based on 75 independent susceptibility SNPs in African American women. We used the odds ratio (OR) per adjusted standard deviation to evaluate the improvement in risk estimates produced by combining the polygenic risk score (PRS) with 5-year and lifetime risk scores estimated using BCRAT. For 5-year risk OR per standard deviation increased from 1.84 to 2.08 with the addition of the polygenic risk score and from 1.79 to 2.07 for the lifetime risk score. Reclassification analysis indicated that 13% of cases had their 5-year risk increased above the 1.66% guideline threshold (NRI = 0.020 (95% CI -0.040, 0.080)) and 6.3% of cases had their lifetime risk increased above the 20% guideline threshold by the addition of the polygenic risk score (NRI = 0.034 (95% CI 0.000, 0.070)). Our data confirmed that discriminatory accuracy of BCRAT is improved for African American women in Arkansas with the inclusion of specific SNP breast cancer risk alleles.

Carts Before Horses? Remembering the Primacy of the Student's Experience in Student Learning

This chapter makes a case for employing qualitative methodologies in the assessment of student leadership programs. Frameworks for reflective practice are discussed.

The importance of plant genotype and contemporary evolution for terrestrial ecosystem processes

Plant genetic variation and evolutionary dynamics are predicted to impact ecosystem processes but these effects are poorly understood. Here we test the hypothesis that plant genotype and contemporary evolution influence the flux of energy and nutrients through soil, which then feedback to affect seedling performance in subsequent generations. We conducted a multiyear field evolution experiment using the native biennial plant Oenothera biennis. This experiment was coupled with experimental assays to address our hypothesis and quantify the relative importance of evolutionary and ecological factors on multiple ecosystem processes. Plant genotype, contemporary evolution, spatial variation, and herbivory affected ecosystem processes (e.g., leaf decay, soil respiration, seedling performance, N cycling), but their relative importance varied between specific ecosystem variables. Insect herbivory and evolution also contributed to a feedback that affected seedling biomass of O. biennis in the next generation. Our results show that heritable variation among plant genotypes can be an important factor affecting local ecosystem processes, and while effects of contemporary evolution were detectable and sometimes strong, they were often contingent on other ecological, factors.

Vegetation feedbacks of nutrient addition lead to a weaker carbon sink in an ombrotrophic bog

To study vegetation feedbacks of nutrient addition on carbon sequestration capacity, we investigated vegetation and ecosystem CO2 exchange at Mer Bleue Bog, Canada in plots that had been fertilized with nitrogen (N) or with N plus phosphorus (P) and potassium (K) for 7-12 years. Gross photosynthesis, ecosystem respiration, and net CO2 exchange were measured weekly during May-September 2011 using climate-controlled chambers. A substrate-induced respiration technique was used to determine the functional ability of the microbial community. The highest N and NPK additions were associated with 40% less net CO2 uptake than the control. In the NPK additions, a diminished C sink potential was due to a 20-30% increase in ecosystem respiration, while gross photosynthesis rates did not change as greater vascular plant biomass compensated for the decrease in Sphagnum mosses. In the highest N-only treatment, small reductions in gross photosynthesis and no change in ecosystem respiration led to the reduced C sink. Substrate-induced microbial respiration was significantly higher in all levels of NPK additions compared with control. The temperature sensitivity of respiration in the plots was lower with increasing cumulative N load, suggesting more labile sources of respired CO2 . The weaker C sink potential could be explained by changes in nutrient availability, higher woody : foliar ratio, moss loss, and enhanced decomposition. Stronger responses to NPK fertilization than to N-only fertilization for both shrub biomass production and decomposition suggest that the bog ecosystem is N-P/K colimited rather than N-limited. Negative effects of further N-only deposition were indicated by delayed spring CO2 uptake. In contrast to forests, increased wood formation and surface litter accumulation in bogs seem to reduce the C sink potential owing to the loss of peat-forming Sphagnum.

Race is not a factor in overall survival in patients with triple negative breast cancer: a retrospective review

The purpose of this study was to determine if race is a factor on overall survival when stage at diagnosis is compared. In this study, a total of 93 women with triple negative breast cancer (TNBC) were evaluated for survival outcomes after diagnosis between the year 2000 through 2010. Thirty-five patients (38%) were African American (AA), and 58 patients (62%) were Caucasian. Overall survival rates were estimated using the Kaplan-Meier method and compared between groups using the log-rank test. Student's t-test was used to calculate differences in cancer recurrence and mortality rates by stage and race. Cox proportional hazards ratios were used to determine the association of patient and variables with clinical outcome. Of women diagnosed with stage 1 breast cancer, the overall survival rates for AAs was 100% compared to Caucasians at 94% (95% CI, 0.003 to 19; P = 0.5). For women with stage 2 breast cancer, overall survival for AA women was 85% and for Caucasian women was 86% (HR = 0.8; 95% CI, 0.3 to 2.6; P = 0.73). For advanced stages (stage 3 and 4), survival for AA women were 78% and 40% for Caucasian women (HR = 0.6; 95% CI 0.2 to 1.98; P = 0.43). Rates of recurrence and mortality were not significantly different between AA and Caucasian TNBC patients. After controlling for patient variables, race was not significantly associated with OS (HR = 1.24; 95% CI, 0.32 to 5.08; P = 0.74) when comparing AA to Caucasian patients. Our study suggests that race does not have an effect on overall survival in African American and Caucasian women diagnosed with TNBC in Arkansas.

Use of patient navigation to improve diagnostic and treatment delays among patients with abnormal mammography results from a mobile unit

73

Background: Screening mammography is frequently the initial step to breast cancer diagnosis. Upon detection of an abnormality on a mammogram, the patient must undergo follow-up procedures for diagnosis and treatment. The objective of this study was to examine the diagnostic and treatment delays after detection of an abnormality on a mammogram performed at a mobile unit.

Methods: During one-year beginning in February 2010, the mobile mammography unit of the University of Arkansas for Medical Sciences (UAMS) performed 1,547 mammograms in women who resided in counties that lacked a stationary mammography unit. Most of these counties are in rural areas with high poverty rates. The women were predominantly non-Hispanic white (62%) or African-American (36%) and 41% lacked health insurance. A patient navigator was available to assist patients through scheduling follow-up appointments, when needed. Diagnostic delay was defined as time from abnormal mammogram to biopsy that exceeded 60 days. Treatment delay was defined as time from abnormal mammogram to treatment initiation that exceeded 90 days.

Results: A total of 14 cancer cases were detected among the 1,547 women screened. The median age of these patients was 56 years of age and ranged from 46-79 years. The median time from screening mammography to biopsy was 31.5 days and ranged from 9-92 days, and diagnostic delay occurred in 2 (14%) patients. The median time from screening mammography to treatment was 78 days and ranged from 37-199 days, and treatment delay occurred in 5 (36%) patients. Three of these patients were managed outside the UAMS health care system, one patient required bilateral mastectomies and one patient refused the initial treatment recommendation.

Conclusions: Responsive health systems require vehicles to strengthen the continuum of breast care. With the use of a patient navigator, the proportion of patients with breast cancer who experienced diagnostic delays is comparable to that of other studies, but the proportion with treatment delays is higher than in other reports. Patient navigation provides a promising model to decrease diagnostic delays and improve access for the medically underserved.

Tissue inhibitor of metalloproteinase 1 regulates resistance to infection

Tissue inhibitor of metalloproteinase 1 (TIMP-1)-deficient mice are resistant to Pseudomonas aeruginosa corneal infections. Corneas healed completely in TIMP-1-deficient mice, and infections were cleared faster in TIMP-1-deficient mice than in wild-type littermates. Genetic suppression studies using matrix metalloproteinase (MMP)-deficient mice showed that MMP-9, MMP-3, and MMP-7 but not MMP-2 or MMP-12 are needed for resistance. Increased resistance was also seen during pulmonary infections. These results identify a novel pathway regulating infection resistance.

Human monoclonal antibodies to Pseudomonas aeruginosa alginate that protect against infection by both mucoid and nonmucoid strains

Two fully human mAbs specific for epitopes dependent on intact carboxylate groups on the C6 carbon of the mannuronic acid components of Pseudomonas aeruginosa alginate were found to promote phagocytic killing of both mucoid and nonmucoid strains as well as protection against both types of strains in a mouse model of acute pneumonia. The specificity of the mAbs for alginate was determined by ELISA and killing assays. Some strains of P. aeruginosa did not make detectable alginate in vitro, but in vivo protection against lethal pneumonia was obtained and shown to be due to rapid induction of expression of alginate in the murine lung. No protection against strains genetically unable to make alginate was achieved. These mAbs have potential to be passive therapeutic reagents for all strains of P. aeruginosa and the results document that alginate is a target for the proper type of protective Ab even when expressed at low levels on phenotypically nonmucoid strains.

Patterns of dying: palliative care for non-malignant disease

As awareness grows of the palliative care needs of those diagnosed with advanced life-threatening illness other than cancer, consideration needs to be given to how to address these needs. This paper focuses on palliative care for those with such diagnoses by describing variations in illness trajectory according to diagnosis, and exploring how this may affect provision of palliative care.

Types of conflicts and tensions between older parents and adult children

What are the most common themes of conflict between aging parents and their adult children? Six types emerged in a qualitative analysis of Longitudinal Study of Generations survey data: conflicts over (1) communication and interaction style; (2) habits and lifestyle choices; (3) child-rearing practices and values; (4) politics, religion, and ideology; (5) work habits and orientations; and (6) household standards or maintenance. There were generational differences: parents most often listed conflicts over habits and lifestyle choices, whereas children cited communication and interaction style. These results suggest a new agenda for gerontological research: intergenerational conflict in the context of solidarity within aging families.

Age, renal perfusion and function in island-dwelling indigenous Kuna Amerinds of Panama

BACKGROUND/AIMS

Among possible contributors to a progressive fall in renal perfusion and function with increasing age, some hypotheses have invoked the rise in blood pressure that occurs with age, and a high-protein diet typical of urban cultures. Kuna Amerinds residing in isolated islands off the Panamanian Coast have a very low protein intake and show no tendency for blood pressure to rise with age, thus providing an opportunity to test these hypotheses.

METHODS

We measured renal plasma flow and glomerular filtration rate (PAH and inulin clearance) in 16 Kuna Indians ranging in age from 18 to 86 years (51 +/- 6 years) who have resided on Ailigandi, an isolated Panamanian island for all of their lives. Inulin and PAH were infused with a battery-driven pump for 60 min, and a metabolic clearance rate used to calculate inulin and PAH clearance. For comparison, we employed identical techniques in 29 residents of Boston, ranging in age from 19 to 79 years (52 +/- 4 years), all normotensive and free of disease or medication use. Twenty-four were Caucasian.

RESULTS

The Bostonian controls showed the anticipated fall in PAH clearance with age (y = 806 - 4.9 x; r = -0.82; f = 38.0; p < 0.0001). Our hypothesis was that the absence of a blood pressure rise with age and the low protein intake would flatten the slope relating renal perfusion to Kuna age. Our finding was a numerically steeper slope relating age and renal plasma flow in the Kuna (y = 936 - 6.48x; r = -0.81; p < 0.001). Filtration fraction rose with age in both populations, and again the rise was steeper in the Kuna. GFR in the Kuna, on the other hand, was very much higher at any age (139 +/- 4 ml/min/1.73 m2) than in Bostonians (112 +/- 3 ml/min/1.73 m2; p < 0.001).

CONCLUSION

The findings are not in accord with the hypothesis that age-related changes in renal perfusion and glomerular filtration rate reflect an important contribution from blood pressure rise and a high protein intake, typical of modern, urban life.

Cystic fibrosis transmembrane conductance regulator-mediated corneal epithelial cell ingestion of Pseudomonas aeruginosa is a key component in the pathogenesis of experimental murine keratitis

Previous findings indicate that the cystic fibrosis transmembrane conductance regulator (CFTR) is a ligand for Pseudomonas aeruginosa ingestion into respiratory epithelial cells. In experimental murine keratitis, P. aeruginosa enters corneal epithelial cells. We determined the importance of CFTR-mediated uptake of P. aeruginosa by corneal cells in experimental eye infections. Entry of noncytotoxic (exoU) P. aeruginosa into human and rabbit corneal cell cultures was inhibited with monoclonal antibodies and peptides specific to CFTR amino acids 108 to 117. Immunofluorescence microscopy and flow cytometry demonstrated CFTR in the intact murine corneal epithelium, and electron microscopy showed that CFTR binds to P. aeruginosa following corneal cell ingestion. In experimental murine eye infections, multiple additions of 5 nM CFTR peptide 103-117 to inocula of either cytotoxic (exoU+) or noncytotoxic P. aeruginosa resulted in large reductions in bacteria in the eye and markedly lessened eye pathology. Compared with wild-type C57BL/6 mice, heterozygous DeltaF508 Cftr mice infected with P. aeruginosa had an approximately 10-fold reduction in bacterial levels in the eye and consequent reductions in eye pathology. Homozygous DeltaF508 Cftr mice were nearly completely resistant to P. aeruginosa corneal infection. CFTR-mediated internalization of P. aeruginosa by buried corneal epithelial cells is critical to the pathogenesis of experimental eye infection, while in the lung, P. aeruginosa uptake by surface epithelial cells enhances P. aeruginosa clearance from this tissue.

A community outbreak of Salmonella berta associated with a soft cheese product

In September 1994, a complaint was registered at a public health unit concerning a cheese product. In addition, public health laboratories in Ontario reported an increase in the number of isolates of Salmonella berta from patients with diarrhoeal illness. A clinical, environmental and laboratory investigation was initiated to determine the nature of this outbreak. Isolates of Salmonella berta were compared using large fragment genomic fingerprinting by pulsed-field gel electrophoresis (PFGE). By late October, 82 clinical cases had been identified including 35 confirmed, 44 suspected and 3 secondary. The investigation linked illness to consumption of an unpasteurized soft cheese product produced on a farm and sold at farmers' markets. Subtyping results of patient, cheese and chicken isolates were indistinguishable, suggesting that the cheese was contaminated by chicken carcasses during production. The outbreak illustrates the potential role of uninspected home-based food producers and of cross-contamination in the transmission of foodborne bacterial pathogens.

Aging, acculturation, salt intake, and hypertension in the Kuna of Panama

The indigenous Kuna who live on islands in the Panamanian Caribbean were among the first communities described with little age-related rise in blood pressure or hypertension. Our goals in this study were to ascertain whether isolated island-dwelling Kuna continue to show this pattern, whether migration to Panama City and its environs changed the patterns, and whether the island-dwelling Kuna have maintained their normal blood pressure levels despite partial acculturation, reflected in an increased salt intake. We enrolled 316 Kuna participants who ranged in age from 18 to 82 years. In 50, homogeneity was confirmed by documentation of an O+ blood group. In 92 island dwellers, diastolic hypertension was not identified and blood pressure levels were as low in volunteers over 60 years of age as in those between 20 and 30 years of age. In Panama City, conversely, hypertension prevalence was 10.7% and exceeded 45% in those over 60 years of age (P < .01), blood pressure levels were higher in the elderly, and there was a statistically significant positive relationship between age and blood pressure (P < .01). In Kuna Nega, a Panama City suburb designed to maintain a traditional Kuna lifestyle but with access to the city, all findings were intermediate. Sodium intake and excretion assessed in 50 island-dwelling Kuna averaged 135 +/- 15 mEq/g creatinine per 24 hours, exceeding substantially other communities free of hypertension and an age-related rise in blood pressure. Despite partial acculturation, the island-dwelling Kuna Indians are protected from hypertension and thus provide an attractive population for examining alternative mechanisms.

Radiology/pathology conference from Robert Wood Johnson Medical School

Inflammatory pseudotumor of the heart is a benign tumor-like lesion consisting of reparitive granulation tissue with fibroblasts, myofibroblasts, and plasma cells predominating. This lesion is commonly seen in the lungs. The authors present this case report to stimulate discussion.

Inflammatory cytology, infection and intraepithelial neoplasia

The prognostic implications of minor grades of abnormality on cervical cytology are unclear. Women attending genitourinary medicine clinics who had cytology showing inflammatory changes with or without koilocytosis or borderline dyskaryosis have a high incidence of cervical intraepithelial neoplasia and genital infection. Of 119 patients who had a colposcopically directed cervical biopsy after one smear showing these changes, 46 (38%) had cervical intraepithelial neoplasia. Seventy-eight (57%) of 138 women had genital infection of whom 26 (33%) had a sexually transmitted disease. We recommend vigilant follow-up of borderline cytology including colposcopy if adequate facilities exist.

In vivo and in vitro toxicity of phospholipase C from Pseudomonas aeruginosa

Pseudomonas aeruginosa produces phospholipase C (PLC), a heat-labile hemolysin. Histopathological analysis of PLC-treated mice revealed that the primary target organs involved in PLC-induced toxicity were the liver and kidney. Mice treated i.v. with PLC demonstrated significant tubular epithelial necrosis of the kidney with hematuria, while when given i.p. they exhibited hepatonecrosis with cellular infiltration. Splenomegaly was also a consistent finding. Results from in vitro studies indicate that PLC is toxic for mouse peritoneal cells and human leukocytes.

Relationships between IQ and neuropsychological measures in neuropsychiatric populations: within-laboratory and cross-cultural replications using WAIS and WAIS-R

Several studies have reported positive correlations between measures of intelligence (a quasi-subject variable) and level of performance on neuropsychological tests; few, however, have presented test results by IQ grouping, which could be useful for comparative purposes. The present study examined the relationships of WAIS and WAIS-R Full Scale IQ to performance on a neuropsychological battery consisting of the Halstead-Reitan Battery (HRB), the Wide Range Achievement Test (WRAT), and the Wechsler Memory Scale (WMS). Four mixed neuropsychiatric samples provided cross-cultural and within-laboratory replications, two tested with WAIS and two with WAIS-R. Means and standard deviations for each measure were presented by five IQ levels within each sample. IQ was strongly related to scores on problem-solving tasks, auditory and linguistic measures, memory tasks, academic achievement levels, and tactual imperceptions, while motor functioning and sensory suppressions were less strongly related to IQ. IQ level was related to educational level in all samples. Correlations of years of education with dependent variables in the two WAIS-R samples were strong and replicable for WRAT scores, verbal memory measures, linguistic errors on the Aphasia Screening Test, and finger-tapping speeds but not for other HRB measures. Finally, IQ-HRB relationships were compared to those reported for other populations.

Age group differences on neuropsychological battery performance in a neuropsychiatric population: an international descriptive study with replications

The relationship of age to performance on the Halstead-Reitan Neuropsychological Battery was examined in three samples drawn from neuropsychiatric populations: an initial sample of 217 subjects, a within-laboratory replication of 307 subjects, and a cross-national replication sample of 101 subjects. The results showed significant relationships of age to subtests of the Halstead-Reitan Battery involving problem-solving abilities and motor strength, which were replicated across the three samples. Verbal and perceptual subtests were not consistently related to age across samples. For those problem-solving and motor tests showing replicated correlations with age. mean scores are provided for three age groups (16-34, 35-54, and 55 and above), and group differences were tested with analysis of variance. These results help clarify for which measures age group differences are consistent in neuropsychiatric populations. Implications of these results for treatment program planning are discussed

Multiple roles and women's mental and physical health: what have we learned?

Research on the effects of multiple roles on women's health has in the past been conducted within the context of two competing hypotheses: the scarcity hypothesis and the expansion hypothesis. Empirical evidence is more supportive of the expansion than the scarcity hypothesis, i.e., women who occupy several roles are healthier than those with few. However, this generalization obscures important health differentials related to types of roles occupied and attributes of those roles. Research on multiple roles is now shifting from examining numbers of roles to analyzing the effects of specific role combinations, patterns, and characteristics. Further research is needed to identify ways in which rewards and stresses within each role interact to produce health outcomes.