Comparison of the clock test and a questionnaire-based test for screening for cognitive impairment in Nigerians

BACKGROUND

Since it is projected that by 2020 seventy percent of the elderly will reside in developing countries, a reliable screening method for dementia and cognitive impairment in general in populations with diverse languages, culture, education and literacy will be needed. We sought to determine if the Clock Test, a screening test for dementia, was suitable for use in a Nigerian population.

STUDY DESIGN

Cross-sectional survey of 54 men and 12 women from Northern Nigeria. Researchers administered two dementia screening tools: a questionnaire-based test adapted for use in a Nigerian population and the Clock Test.

RESULTS

Overall, 53.0% of the subjects had an abnormal Clock Test whereas 10.6% of the subjects had an abnormal questionnaire score. Only 9.1% of the subjects had abnormal scores on both tests. Subjects with more schooling had a greater probability of having a positive clock concept (understanding that a circle represented a clock). Of those with more than 6 years of schooling, 91.0% had a positive clock concept. Subjects with a negative clock concept were more likely to have an abnormal Clock Test (93.3%) than a questionnaire (26.6%).

CONCLUSIONS

The main finding of our study was the discrepancy between the results of the Clock Test and the questionnaire. Performance on the Clock Test appeared to have been heavily influenced by education level, indicating the test is not universally applicable across cultures. The questionnaire-based test appears to reduce the effects of illiteracy on assessing dementia in a Nigerian population. Larger studies should be done to control for how education affects the assessment of dementia.

Intracardiac expression of neutral endopeptidase

Neutral endopeptidase (NEP), a proteolytic enzyme, is known to degrade several peptides which control cardiovascular homeostasis. This is a preliminary study of the pattern of the intracardiac regional expression of the NEP gene in the normal heart, and the age-related changes in this expression in the cardiac regions. The relative abundance of NEP mRNA was determined by RT-PCR in the right atrium (RA), right ventricle (RV), left atrium (LA), left ventricle (LV) and interventricular septum (IVS) in 2-month-old (young) and 12-month-old (advanced-age adult) Wistar Kyoto (WKY) rats. The NEP gene was expressed in all 5 cardiac regions in both age groups. In young rats, the NEP expression level was lowest in the RA; this level was significantly lower than in the septum (p < 0.05). In the advanced-age adult rats, the level was lowest in the LA; this level also was significantly lower than in the septum (p < 0.05). The level in the RA in advanced-age rats was higher than that in the young rats (p < 0.01), but the levels in other regions were not significantly different between the young rats and advanced-age adult rats. Our study showed that the NEP gene was expressed in all cardiac regions of both young rats and advanced-age adult rats. However, the regional distribution of the gene was different in each age group. The region-specific expression of the NEP gene and the age-related regional changes in the expression may be due to the structural and functional characteristics of the various regions.

Prevalence of psychiatric disorders among persons convicted of driving while impaired

BACKGROUND

Large numbers of convicted drunk drivers are entering alcohol treatment programs, yet little information is available about their need for psychiatric treatment. This study of convicted drunk drivers estimates lifetime and 12-month prevalence of DSM-III-R psychiatric disorders (alcohol and drug abuse and dependence, major depressive disorder, dysthymic disorder, generalized anxiety disorder, posttraumatic stress disorder, and antisocial personality disorder) and compares rates with estimates from a US population-based survey.

METHODS

Six hundred twelve women and 493 men, aged 23 to 54 years, convicted of driving while impaired, who had been referred to a screening program in Bernalillo County, New Mexico, were located and interviewed using the Diagnostic Interview Schedule between January 25, 1994, and June 30, 1997. Psychiatric diagnoses were compared with findings from the National Comorbidity Survey for the western region of the United States, conducted between September 14, 1990, and February 6, 1992.

RESULTS

Eighty-five percent of female and 91% of male offenders reported a lifetime alcohol-use disorder, compared with 22% and 44%, respectively, in the National Comorbidity Survey sample. Thirty-two percent of female and 38% of male offenders had a drug-use disorder, compared with 16% and 21%, respectively, in the National Comorbidity Survey sample. For offenders with alcohol-use disorders, 50% of women and 33% of men had at least 1 additional psychiatric disorder other than drug abuse or dependence, mainly posttraumatic stress disorder or major depression.

CONCLUSION

Drunk-driving offenders need assessment and treatment services not only for alcohol problems but also for drug use and the other psychiatric disorders that commonly accompany alcohol-related problems.

Victim impact panels: do they impact drunk drivers? A follow-up of female and male, first-time and repeat offenders

OBJECTIVE

To examine gender differences and re-arrest rates of first-time and repeat offenders following referral to Victim Impact Panels (VIPs).

METHOD

Study participants (N = 6,702; 79% men) were first-time and repeat driving-while-impaired offenders who were referred to and completed a screening program in Bernalillo County, New Mexico, from 1989 to 1994. Whether subjects were mandated to attend a VIP was self-reported in a personal interview. Multivariate Cox proportional hazards analysis was used to test the effects of VIP referral and other predictors of recidivism. Separate models were developed for female and male first-time and repeat offenders.

RESULTS

After controlling for multiple risk factors, VIP referral was not statistically associated with recidivism for female or male first offenders. However, female repeat offenders referred to VIPs were significantly more likely to be re-arrested compared with those not referred, with an odds of rearrest more than twice that of females not referred.

CONCLUSIONS

Although many factors influence recidivism, this study raises the possibility that VIPs may have a negative impact on female repeat offenders.

Do risk factors for re-arrest differ for female and male drunk-driving offenders?

BACKGROUND

The present study investigated gender differences in factors affecting recidivism among 628 female and 659 male drunk-driving offenders. The study population included residents from New Mexico who completed a screening program for offenders and who were still residents when contacted 5 years later.

METHOD

Risk factors for re-arrest in the 5-year period after screening referral were examined using multiple logistic regression models. Predictor variables included gender, age, ethnicity, education, marital status, blood alcohol concentration at arrest, parental alcohol problems, spousal alcohol problems, lifetime use of cannabis, cocaine, or amphetamines, abusive behavior toward spouse, and scores on two standardized assessments.

RESULTS

Risk factors for re-arrest were similar for males and females except that young age predicted higher recidivism among males but not females. The overall 5-year re-arrest rate was 26%-20% for women, 38% for males age 30 and under, and 24% for males age 31 and older.

CONCLUSIONS

Young age predicts re-arrest for males but not for females. Neither the type of risk factors nor the number of risk factors fully explained female offenders' disproportionately lower recidivism rates, compared with young males.

Victim impact panels: who is sentenced to attend? Does attendance affect recidivism of first-time DWI offenders?

BACKGROUND

Victim Impact Panels (VIPs) have been implemented widely in the United States by judges as a deterrent to drinking and driving, but there is little evidence of their utility in preventing recidivism.

OBJECTIVES

The objectives of this study were to examine judges' referral patterns to the VIPs among a multiethnic population of convicted first-time driving while impaired (DWI) offenders and to compare 5-year recidivism rates of those mandated and not mandated to attend the VIP.

METHODS

Study participants included 5,238 convicted first-time DWI offenders who were referred to a screening program in Bernalillo County, New Mexico, and who completed a personal interview with a master's-level counselor between April 1989 and October 1995. Logistic regression analysis was used to evaluate judges' preferences in mandating offenders to attend a VIP. The percent of subjects reoffending in the 5 years following their referral for screening was calculated by standard life-table analyses. Cox proportional hazards analysis was used to test the effects of known independent predictors for recidivism. Separate models were developed for the entire population, non-Hispanic offenders, and Hispanic/Mexican national subgroups.

RESULTS

Female judges who regularly adjudicated DWI offenders were more likely to refer offenders to a VIP. Judges were less likely to refer men and offenders with less than 12 years of education and an unknown arrest blood alcohol concentration (BAC), and of Hispanic/Mexican national or other race/ ethnicity. Judges were more likely to refer unmarried offenders to a VIP. After controlling for multiple risk factors, referral to VIP was not a strong predictor of recidivism in Hispanic and non-Hispanic ethnic groups, with 95% confidence limits ranging from 0.8 to 1.0, compared to those not referred.

CONCLUSIONS

Female judges were more likely than male judges to refer offenders to a VIP, and referral patterns varied by offender characteristics. The VIP referral did not increase rearrest rates but lowered them marginally to not at all. This study should be followed up with a randomized design to control for referral patterns and to further define the impact of mandating offenders to the VIP.

The influence of ethnicity on use of herbal remedies in elderly Hispanics and non-Hispanic whites

OBJECTIVE

To compare the use of herbal remedies between elderly, self-identified Hispanics and non-Hispanic whites (NHW).

DESIGN

Cross-sectional, interviewer-administered survey.

PATIENTS/SETTING

186 patients, 65 years and older, at a university-based, ambulatory, senior health center.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Differences in herbal use patterns between Hispanic and NHW participants. Main outcome measures were participants' use of herbal remedies, types of remedies used, medical reason for use, age, sex, Hispanic or NHW ethnicity, income, and education.

RESULTS

Overall, 61% of patients had used an herbal remedy at some time in their lives. A larger proportion of Hispanic subjects used herbal remedies than did NHW subjects (77% versus 47%, respectively). Hispanic subjects preferred to use the raw herb in a tea, whereas NHW subjects preferred processed herbs in a capsule or tablet form. Significantly more Hispanic subjects grew or gathered their own herbs and received their information about herbs from a family member than did NHW subjects. Few subjects in either ethnic group received their information about herbal remedies from an allopathic provider. For both groups, the herbs most often used were yerba buena, manzanilla, poleo, osha, and alhucema. The top perceived medical problems that herbs were used for were health care maintenance, dyspepsia, upper respiratory infection, skin problems, and anxiety/nerves/insomnia.

CONCLUSION

Ethnicity was related to the frequency of herbal use, the choice and preferred form of herb, and the source of knowledge of herbal remedies. Hispanic culture may account for the observed differences.

Assessing food selection in a health promotion program: validation of a brief instrument for American Indian children in the southwest United States

OBJECTIVE

Brief dietary assessment instruments are needed to evaluate behavior changes of participants in dietary intervention programs. The purpose of this project was to design and validate an instrument for children participating in Pathways to Health, a culturally appropriate, cancer prevention curriculum.

DESIGN

Validation of a brief food selection instrument, Yesterday's Food Choices (YFC), which contained 33 questions about foods eaten the previous day with response choices of yes, no, or not sure. Reference data for validation were 24-hour dietary recalls administered individually to 120 students selected randomly.

SUBJECTS

The YFC and 24-hour dietary recalls were administered to American Indian children in fifth- and seventh-grade classes in the Southwest United States.

STATISTICAL ANALYSES PERFORMED

Dietary recalls were coded for food items in the YFC and results were compared for each item using percentage agreement and the kappa statistic.

RESULTS

Percentage agreement for all items was greater than 60%; for most items it was greater than 70%, and for several items it was greater than 80%. The amount of agreement beyond that explained by chance (kappa statistic) was generally small. Three items showed substantial agreement beyond chance (kappa > or = 0.6); 2 items showed moderate agreement (kappa = 0.40 to 0.59) most items showed fair agreement (kappa = 0.20 to 0.39). The food items showing substantial agreement were hot or cold cereal, low-fat milk, and mutton or chile stew. Fried or scrambled eggs and deep-fried foods showed moderate agreement beyond chances.

CONCLUSIONS

Previous development and validation of brief food selection instruments for children participating in health promotion programs has had limited success. In this study, instrument-related factors that apparently contributed to poor agreement between data from the YFC and 24-hour dietary recall were inclusion of categories of foods vs specific foods; food knowledge, preparation, and vocabulary, item length, and overreporting of attractive foods. Collecting and scoring the 24-hour recall data may also have contributed to poor agreement. Further development of brief instruments for evaluating changes in children's behavior in dietary programs is necessary. Factors related to the YFC that need further development may be issues that are also important in the development of effective, brief dietary assessments for children as individual clients or patients.

Use of AUDIT for alcohol screening among emergency room patients in Thailand. Alcohol Use Disorders Identification Test

This study evaluated the Alcohol Use Disorders Identification Test (AUDIT) against blood alcohol levels and medical diagnoses. The population under study included 695 current drinkers admitted to emergency rooms of four regional Thailand hospitals. The AUDIT positivity rate was 61% among 343 patients who drank prior to admission and 32% among 352 patients who did not drink alcohol before admission. Breath alcohol levels were positively associated with AUDIT scores. The sensitivity against a previous or current alcohol-related medical diagnosis was 89%. We concluded that the AUDIT is a satisfactory instrument for alcohol screening in this population.

Shortening deactivation of cardiac muscle: physiological mechanisms and clinical implications

PHYSIOLOGICAL MECHANISM: A rapid change of length applied during isometric contraction of skeletal or cardiac muscle may result in redeveloped tension less than appropriate for the new length because of "deactivation" of the contractile system. The amount of shortening deactivation is directly related to both the time during the contraction when the length change occurs and to the extent of muscle shortening. If the muscle is permitted to shorten early in the contraction, the redeveloped tension will be appropriate to the new length as predicted from the classic Frank-Starling relationship. However, the same length change, which is imposed later in the contraction, results in a redeveloped tension that is less than predicted. Furthermore, a greater change in length results in less tension being redeveloped than if a smaller length decrement is applied at the same time during the contraction. It has been demonstrated that the reduced tension during active muscle shortening is associated with reduced affinity of troponin C for Ca2+. The free Ca2+ is then picked up by the SR, with less Ca2+ available for tension development until the subsequent contraction.

CLINICAL SIGNIFICANCE

Although the clinical significance of shortening deactivation remains speculative, it seems likely that in the intact heart deactivation would affect myocardial O2 consumption. The decreased efficiency with which the heart maintains a given stroke work against a high afterload might be related to the lesser degree of fiber shortening and, therefore, less shortening deactivation. Conversely, it is well-known that the same level of stroke work accomplished by an increase in end-diastolic volume requires much less O2. This may be related, at least in part, to the greater degree of shortening with an accompanying increase in deactivation under the latter conditions. For example, in congestive heart failure where ejection fraction and fiber shortening are minimal, the maintenance of the longer fiber lengths could significantly increase the MVO2. Ford has suggested that the deactivating effect of shortening produced by afterload reduction would limit energy expenditure, therefore, exerting a favorable effect on the failing myocardium. It would also seem that an inotropic agent that increased shortening deactivation might compensate for the increased MVO2 caused by the inotrope and have a favorable effect on cardiac work. From most of the studies we have reviewed, it appears likely that shortening deactivation acts as a physiological "feedback" mechanism that affects afterload and in turn, myocardial oxygen consumption. Pathological situations such as acidosis and ischemia have been associated with reduced myofilament Ca2+ sensitivity or affinity and depressed cardiac contractility. Is it then possible that interventions that increase Ca2+ sensitivity might favorably alter ventricular pressure-volume relations during ejection and improve myocardial function by reducing the magnitude of shortening deactivation? Whatever the mechanism and clinical significance, future investigations will help to define the role of shortening deactivation in modifying ventricular function.

Drive-up liquor windows and convicted drunk drivers: a comparative analysis of place of purchase

This study examined alcohol purchase locations of convicted drunk drivers to determine the characteristics and arrest circumstances of offenders who bought alcohol at a drive-up liquor window compared with those who obtained alcohol elsewhere. Logistic regression analyses were used to assess the relationship between purchase location and the characteristics of 2,544 drunk drivers convicted in Santa Fe, NM, from 1986 to 1995. Analyses were performed to determine whether the place of purchase was related to arrest circumstances. The results revealed that drive-up windows were the preferred place of purchase of package liquor by offenders who bought the alcohol that they drank prior to arrest. The odds of being Hispanic (p < 0.0001), a high-risk problem drinker (p < 0.01), and drinking in the vehicle prior to arrest (p < 0.01) were significantly higher for drive-up window users than for offenders who purchased package liquor elsewhere. Based on these analyses, this study concludes that a statistically significant relationship exists between the use of drive-up windows and certain high-risk drinking behaviors. This increased use among vulnerable populations suggests that drive-up windows may facilitate alcohol misuse in these populations and thereby contribute to drunk driving.

Prevalence of alcohol problems among emergency room patients in Thailand

AIMS

To determine prevalence rates of alcohol problems among emergency room patients.

DESIGN

This was a cross-sectional survey including patient interviews and record reviews. The questionnaire included the Alcohol Use Disorders Identification Test to screen for hazardous or harmful alcohol use (alcohol problems). It also contained questions regarding the chief complaint and factors precipitating the admission.

SETTING

Emergency rooms of three regional hospitals in Thailand.

PARTICIPANTS

Consecutive emergency room admissions aged 14 and older, admitted from 18.00-02.00 h.

FINDINGS

Risk factors for alcohol problems included male gender, age 20-49, higher monthly income, less than university graduate education status and admission to the northeast regional ER. Among non-trauma patients, those with alcohol-related diagnoses and certain gastrointestinal disorders had the highest rates of alcohol problems. Patients with transportation injuries were twice as likely, and those with assault-, fall-, or burn-related injuries were at least three times more likely to screen positive compared to the non-injured comparison group. The estimated overall prevalence rate of alcohol problems for this population, adjusted for age and diagnostic classification, was 0.39 for males and 0.08 for females.

CONCLUSION

Especially among patients with specified diagnoses, the emergency room is an ideal setting for implementing alcohol screening and intervention programmes in Thailand.

Breastfeeding reduces risk of respiratory illness in infants

Breastfeeding has long been believed to protect against infection in infants, but protection against respiratory illnesses has not been consistently demonstrated in studies in developed countries. Between 1988 and 1992, the authors assessed the effect of breastfeeding on incidence and duration of respiratory illnesses during the first 6 months of life in a prospective study that actively tracked breastfeeding and respiratory illnesses. A cohort of 1,202 healthy infants, born in Albuquerque, New Mexico, between January 1, 1988 and June 30, 1990, from homes without smokers was enrolled. The daily occurrences of respiratory symptoms and breastfeeding status were reported by the mothers every 2 weeks. Illnesses were classified as lower respiratory illness (LRI) if wheezing or wet cough was reported; the remaining illnesses were classified as upper respiratory. The annualized incidence rates for LRI were 2.8, 2.6, and 2.1 during follow-up time with no, partial, or full breastfeeding, respectively, but the incidence rates for upper respiratory illness and lower respiratory illness combined were similar in the three categories. After adjustment for potential confounding factors, full breastfeeding was associated with a reduction in lower respiratory illness risk (odds ratio=0.81, 95% confidence interval 0.68-0.96). Median duration of all respiratory illnesses was 5 days for the fully breastfed infants during the first 6 months of life compared with a median of 6 days for not breastfed and partially breastfed infants. Multivariate analysis confirmed that breastfeeding significantly reduced the duration of respiratory illness. This pattern of reduced incidence of LRI and shorter duration of all respiratory illnesses suggests that breastfeeding reduces the severity of infant respiratory illnesses during the first 6 months of life.

Attitudes of physicians practicing in New Mexico toward gay men and lesbians in the profession

PURPOSE

To examine the attitudes of physicians practicing in New Mexico toward gay and lesbian medical students, house officers, and physician colleagues.

METHOD

In May 1996, the authors mailed a questionnaire with demographic and attitude questions to 1,949 non-federally employed physicians practicing in New Mexico. The questionnaire consisted of questions dealing with medical school admission, residency training, and referrals to colleagues. The response rate was 53.6%.

RESULTS

Of all the responding physicians, 4.3% would refuse medical school admission to applicants known to be gay or lesbian. Respondents were most opposed to gay and lesbian physicians' seeking residency training in obstetrics and gynecology (10.1%), and least opposed to their seeking residency training in radiology (4.3%). Disclosure of homosexual orientation would also threaten referrals to gay and lesbian obstetrician-gynecologists (11.4%) more than to gay or lesbian physicians in other specialties.

CONCLUSION

Physicians' attitudes toward gay and lesbian medical students, house officers, and physician colleagues seem to have improved considerably from those reported previously in the literature. However, gay men and lesbians in medicine continue to face opposition in their medical training and in their pursuit of specialty practice.

Factors related to miles driven between drinking and arrest locations among convicted drunk drivers

The objectives of the study were to estimate the distance driven between drinking and arrest locations among 3,107 offenders convicted of driving while impaired and to determined whether the drinking location, the driver's appearance (factors such as race, age, gender), or age of the vehicle account for any differences in the estimated distance driven. Statistical models were used to determine odds ratios for being arrested in the immediate vicinity of the drinking location, and for miles driven impaired. The independent sociodemographic and arrest variables included: age, gender, ethnicity/race, vehicle age, drinking location, whether the arrest followed a crash, time of arrest, blood alcohol concentration, and drinking in areas with varying levels of arrest intensity. The variables associated with arrest in the immediate vicinity of the drinking location (less than one half mile) were drinking in high or medium-high arrest intensity areas, Hispanic/Mexican ethnicity/nationality, Native American race, and drinking at home. Among those who were not arrested in the immediate vicinity, the number of miles driven ranged from 0.5 to 18.2, with a mean of 3.4 miles (median = 2.6). Analysis of covariance demonstrated that among those arrested outside the immediate vicinity of their drinking locations, persons who drank in a high or medium-high arrest intensity area, those with blood alcohol concentrations of > or = 200 mg/l, and those drinking at bars, restaurants, or private parties, drove fewer miles compared to other offenders. Our findings are mixed regarding ethnicity/race. Traits such as age, gender, and vehicle age are unrelated to how far drunk drivers travel before their arrests.

Use of computerized prenatal interviews for assessing high-risk behaviors among American Indians

The objectives of this study were to determine the prevalence of risk factors for adverse pregnancy outcomes among American Indians and to compare self-reported information collected under two computer interview conditions: an "anonymous" (N = 183) versus a "confidential" (N = 210) format. Results indicated that under 10% in both groups reported either use of cigarettes or other drugs of abuse, 16% reported risky drinking, 39% reported psychological distress, and 8% reported physical abuse during the current pregnancy. We concluded that confidential computer interviews were appropriate vehicles for obtaining risk information in this population.

A prospective study of the utility of standardized instruments in predicting recidivism among first DWI offenders

OBJECTIVE

The present study investigated the utility of four instruments--the MacAndrews scale of the MMPI-2 (MAC), four scales of the Alcohol Use Inventory (AUI), the Michigan Alcoholism Screening Test (MAST) and the Skinner's Trauma Scale (STS)--in assessing risk for rearrest among first driving while impaired (DWI) offenders.

METHOD

Subjects were clients (N = 1,384, 80% male) convicted of a DWI offense who were referred to the Lovelace Comprehensive Screening Program for evaluation and who completed a court-mandated screening program. Stratified life table analysis was used to determine rearrest rates in the period following the screening referral.

RESULTS

After 4 years of follow-up the overall rearrest rate was 21.0%. The best predictors of recidivism were a MAC score of 23 or above, elevated scores on AUI scales, young male status (age 30 or under) and arrest blood alcohol concentration (BAC) of .200% or above. The best schematic for classifying first offenders into risk groups was determined using the risk factors above and defined groups with recidivism rates ranging from 13.0% to 38.8%.

CONCLUSIONS

We were able to identify cohorts of first offenders at relatively low and high risk for recidivism using a stratified analysis with six strata defined from four variables. The MAC was the best, single variable for classifying offenders' future recidivism risk, indicating that, in addition to evaluating for the presence and severity of alcohol and drug use, screening programs for DWI offenders should carefully evaluate personality factors in making referral and sentencing recommendations.

Ascertaining hypoglycorrhachia in an acute patient

A study was undertaken in an urgent clinical setting to determine whether the use of a cerebrospinal fluid (CSF) to blood glucose ratio is appropriate for describing the relationships between CSF glucose and blood glucose in patients who had not fasted. Blood glucose levels were obtained before a lumbar puncture in 79 adults who had normal CSF findings. Regression analysis of CSF glucose and blood glucose levels of these patients who had not fasted, as well as data from four published studies of normal blood and CSF glucose levels, indicated that a ratio was not a valid measure of the normal relationship between CSF and blood. Only when the blood glucose level was between 89 and 115 mg/dL was the relationship within the expected "ratio" of 0.60 to 0.70. In hyperglycemic states, the normal relationship may be substantially lower than 0.50. a nomogram is presented which is useful in determining hypoglycorrhachia when the patient is hyperglycemic.

Use of computer interview data to test associations between risk factors and pregnancy outcomes

Computer interviews have been used in a variety of settings as a means of gathering data and providing health education information. The objective of this study was to determine whether data gathered from a computer interview have predictive validity in determining pregnancy outcomes. Pregnant women (N = 190) completed a computer-assisted interview to provide risk factor information. Medical records were reviewed to obtain prenatal and birth outcome information. Twenty-nine percent experienced prenatal complications and nearly half experienced problems related to labor and delivery. After known risk factors were controlled for, self-reported psychosocial problems, low social support, and substance abuse by the father were associated with pregnancy complications. An unbalanced diet and low social support were associated with lower infant birth weight. Findings suggest that data collected via computer interviews can provide useful risk factor screening information.

Health and lifestyle issues as risk factors for homelessness

BACKGROUND

The objective of this study was to test the hypothesis that there are health and lifestyle issues among homeless persons that differentiate them from other segments of the population and that can be described as risk factors for homelessness.

METHODS

This case-control study investigated health and lifestyle issues in a panel of patients visiting a health care clinic for homeless persons. The same information was collected from a panel of county indigent patients and an equal number of privately insured patients enrolled in a nearby academic family practice center.

RESULTS

We found significant differences among these three groups. Differences in health problems were evident, as significantly more homeless persons reported mental health, drug and alcohol abuse, and smoking problems. There were no differences in the prevalence of other general medical conditions as listed by the patients. Homeless persons were younger than the control group respondents and more likely to be male, a member of a minority group, and unmarried. The childhood experiences of homeless persons were distinctive; they were more likely to have lived in a group home or some other nonfamily situation, considered themselves to have been delinquent, run away from home, been expelled from school, or been placed in reform school. The same held true for having been in jail as an adult. They had significantly less education, their job experiences were in manual and unskilled arenas, and they were more likely to have a gambling problem. A continuum of risk also appeared in that for the most part the characteristics and experiences of the indigent group members ranked in frequency between those of the homeless and insurance groups.

CONCLUSIONS

Causes of homelessness appear to be multifactorial. Issues related to mental health, alcohol, nicotine, and other drug and substance abuse could be responsible for their medical problems, whereas other lifestyle issues might be regarded as risk factors for homelessness.

Does a physician visual assessment change triage?

A prospective comparative trial was conducted to determine the effect of a physician's visual assessment of emergency patients on triage categorization and ability at triage to predict admission. The setting was a university, county, referral center and residency training site. Participants were a consecutive sample of emergency department patients presenting between the times of 0700 and 2300 hours for 5 weeks. All patients were assigned a triage category by an emergency nurse (RN) who saw the patient and by an emergency physician (EP) who had the option of performing a visual assessment. Triage categorization was compared for interobserver agreement (Kappa [kappa] statistic) and by ability to predict admission (MacNemar's test). A total of 3,949 patients was entered. The patients that physicians visually assessed were triaged by nurses as more ill (P < .001). For triage categories visualized by the EP compared with RN categorization, interobserver agreement was 59.8%, kappa = .21. For triage categories not visualized by EP compared with RN categorization, interobserver agreement was 67.9%, kappa = .45 (P < .001). Sensitivity of EPs to predict admission is as follows: all RN triage, 41.3; not seen by EP, 54.9; seen by EP, 69.3. Specificity is as follows: all RN triage, 93.7; not seen by EP, 88.5, seen by EP, 83.9. When physician visual assessment was done, agreement between physicians and nurses decreased by more than half. Physicians who included visual assessment in patient triage were less likely to agree with RN categorization. A visual assessment by the physician improved the sensitivity for predicting admission with an only small cost in specificity.

Food preferences, practices, and cancer-related food and nutrition knowledge of southwestern American Indian youth

BACKGROUND

Pathways to Health is a cancer prevention and health promotion curriculum for fifth- and seventh-grade Navajo and Pueblo students living in New Mexico.

METHODS

A diet and nutrition questionnaire was administered to 1007 fifth- and seventh-grade students before beginning the Pathways to Health intervention. Sections of the questionnaire included listing favorite foods, frequency of intake of selected foods (e.g., "How often do you eat vegetables?"), targeted food practices (e.g., "When you eat chicken, do you eat the skin?"), and applied dietary fat and fiber knowledge questions. Descriptive analyses were generated by grade, gender, and tribe.

RESULTS

Students' favorite foods were pizza, hamburgers, and tacos. Only 35.7% of students reported consuming the U.S. Dietary Guidelines recommendation of two or more daily servings of fruit, with only 19.3% reporting more than once-a-day intake of vegetables. The mean score (percent correct responses) to questions identifying common food sources of dietary fat and fiber, and other cancer-related nutrition knowledge questions, was 45.2% and 57.9% for fifth- and seventh-grade students, respectively.

CONCLUSIONS

These and related data support the need for nutrition education interventions in this population that target essential cancer prevention skills and motivational information required to make positive dietary choices.

Triage: limitations in predicting need for emergent care and hospital admission

STUDY OBJECTIVE

Little is known about the accuracy and reliability of current triage methods. We examined agreement among observers with regard to the need for ED care and the ability to predict at triage the need for admission to the hospital and compared these findings with admission rates after medical evaluation and management.

METHODS

We used a crossover design in which each subject was subjected to nurse or computer-guided triage first, the other type of triage second, and physician triage last. Our null hypothesis: Triage methods will yield the same results. Our patients were a consecutive sample of patients at the ED of a university-affiliated county referral center. Critically ill patients were excluded. Triage categorization was examined for interobserver agreement (kappa-statistic) and prediction of admission (sensitivity, specificity, and predictive values).

RESULTS

Of the 5,106 patients enrolled in the study, 289 (6.2%) were admitted. With regard to the agreement of triage categorizations, we found kappa-values of .452 and .185, respectively, for physician triage compared with nurse (SE +/- .012) and computer triage (SE +/- .012)(P = .001 for the difference between the kappa values). Sensitivity and specificity in predicting admission were 41.3 and 93.8, respectively, for nurses, 61.6 and 87.1, respectively, for physicians; and 68.2 and 73.6, respectively, for computer-aided triage.

CONCLUSION

We found great variability among physicians, nurses, and a computer program with regard to triage decisions. Comparison of the three groups' triage decisions with actual data after medical evaluation and management showed that none of the three performed well in predicting which patients required admission. Until triage methods are standardized and validated, triage decisions should not be used to determine the timeliness of access to emergency care.

Homelessness and substance use among alcohol abusers following participation in project H&ART

Project H&ART was a randomized intervention trial for homeless alcohol abusers in Albuquerque, N.M. Interventions were four months in duration and included: a high intensity program (case management plus peer-supervised housing), a medium intensity group (peer-supervised housing only); a housed, and a nonhoused control group. Clients were interviewed at baseline and re-interviewed ten months following program entry to determine substance use, housing stability and employment status. Program graduation rates were about 25% for the three housed groups. The outcome evaluation revealed significant within groups improvements in all of the outcomes, no between groups or racial outcome differences, and more favorable alcohol use and housing stability outcomes among program graduates than dropouts. On follow-up, women in the study had fewer days of alcohol use and had more days of stable housing, but were less likely to be employed, compared with men. We suggest that clients' personal motivation for recovery, rather than program-related factors, were most influential in determining outcomes.

Risk factors for homelessness: a study of families of origin

OBJECTIVE

This study's objective was to test the hypothesis that there are health issues and other factors in families of origin that have an association with, and may be risk factors for, homelessness.

METHODS

This case control study identified risk factors in a group of homeless patients at a health clinic for the homeless. Two comparison groups from an academic family practice center were included. One comparison group was county indigent patients, and the other was patients who had health insurance.

RESULTS

Significant differences in families of origin among these three groups were identified. On univariate analysis, homeless persons were found to have an increased prevalence of alcoholism in the family of origin, earlier departure from the home, minority status, a self-described negative childhood, experiences of abuse as a child, high birth order in large families, less parental education, less-skilled parental occupations, less feeling of love in the childhood family, less likelihood of the father being in the home, more risk of the father having been in jail, and less identification with a religious group. Multivariate analysis revealed that compared to the study groups, the following family of origin factors were associated with homelessness: ethnic group, alcoholism, feeling loved as a child, and having one's father in jail.

CONCLUSIONS

Homelessness is a multifactorial issue, but risk factors can be identified that may distinguish individuals at increased risk. Root causes may begin in childhood and be related to the family of origin.

Tobacco use: baseline results from pathways to health, a school-based project for southwestern American Indian youth

BACKGROUND

This paper describes a school-based cancer prevention project for fifth- and seventh-grade Navajo and Pueblo Indian children living in the Southwest. Baseline data are presented from 714 students who completed questionnaires on smoking and smokeless tobacco.

METHODS

Questionnaires were administered in the fifth- and seventh-grade classrooms prior to students receiving the Pathways to Health cancer prevention curriculum.

RESULTS

In our sample there were increases from fifth to seventh grade in self-reported current cigarette use and intention to use. Also, boys were more likely to use and intend to use cigarettes than girls. The use of smokeless tobacco also increased with increasing grade level, though this trend was less pronounced for girls. A significant gender difference was found in the use of smokeless tobacco with boys reporting higher use. However, reported use by girls was higher than is typically noted for non-Hispanic white girls.

CONCLUSIONS

There is evidence of experimentation and regular use of tobacco products by both Navajo and Pueblo boys and girls. Even more students indicate intention to use tobacco products in the future. These data confirm the need for primary prevention programs designed for this population of American Indians.

Alcohol abuse screening instruments: normative test data collected from a first DWI offender screening program

OBJECTIVE

A variety of instruments are used by Driving While Impaired (DWI) screening programs nationwide to assess offenders for alcohol- or drug-related problems. This study presents normative data from five standardized instruments administered by a DWI screening program: the MAC scale of the MMPI, the Alcohol Use Inventory (AUI), the Michigan Alcoholism Screening Test (MAST), the Drug Abuse Screening Test (DAST) and the Skinner's Trauma Scale (STS).

METHOD

The population under study were 2,317 first DWI offenders who completed screening evaluations in 1989-91. The sample included 24% women; the racial distribution was 46% Hispanic, 43% non-Hispanic white, 8% Native American and 3% other races. A statistical model was developed to determine associations among scores on the various instruments and age, gender, ethnicity, education, blood alcohol concentration (BAC) and validity measures on the MMPI-2 (L and K scale scores)

RESULTS

There were significant differences in test scores among the ethnic- and gender-specific client groups. Test scores were significantly higher among men than women for the MAST, the D1 and D2 scales of the AUI, the MAC, and the STS. Correlations among the instruments were generally low, and the percentage of persons who scored above instrument cut-points varied significantly. The MAST identified the highest percentage of persons as alcoholic. MMPI profile validity was the most significant independent variable associated with test scores. Persons with scores in the valid range had higher mean scores on each of the instruments.

CONCLUSIONS

The choice of instruments used in the DWI assessment can greatly influence the percentage of offenders assessed as having alcohol-related problems.

Nitrogen dioxide and respiratory illness in children. Part III: Quality assurance in an epidemiologic study

This report describes the quality assurance and quality control program developed for the previously reported epidemiologic study of nitrogen dioxide (NO2) and respiratory illness in children (Health Effects Institute Research Report 58, Parts I and II). The specific aims of the program were to make certain that data were sufficiently accurate, complete, verifiable, and retrievable. The quality assurance and quality control program consisted of: a written protocol, standard operating procedures, written records, a project management system, appropriate data processing, data verification, and data analysis planning, and was staffed by qualified and appropriately trained personnel. Within the activities of the overall program, two focused quality assurance studies were conducted. During the first of these focused studies, parents maintained a calendar-diary of their child's daily respiratory symptoms. Telephone interviews were conducted at intervals of two weeks, and parents used the calendars to report on symptom occurrence since the previous call. To assess the comparability of illness events based on symptom reports from the parents with usual clinical diagnostic methods, nurse practitioners examined children during illness, and office and clinic records of outpatient visits were reviewed. Using the parent reports, respiratory illnesses were defined as symptom episodes of at least two consecutive days; lower respiratory illnesses included at least one day of either wet cough or wheeze. Runny or stuffy nose was reported for 93% of illnesses; and wet cough for 33% and wheeze for 6% of illnesses. In comparison with the diagnoses made by a nurse practitioner, parent reports of wet cough or wheeze were sensitive (93.4%) for detecting lower respiratory illnesses, but nonspecific (with specificity of only 24.2%). The majority of the false-positive lower respiratory illnesses had the symptom of wet cough. The comparison of parent reports with outpatient records provided similar findings. These findings indicate that standardized reporting of respiratory illnesses can be achieved with regular telephone interviews, but the classification of specific illnesses from the observations of parents' information may differ from diagnoses made by clinicians. The second focused quality assurance study evaluated the measurement error associated with the parents' use of passive diffusion samplers for NO2. Midway through the study, technicians conducted home visits to assess compliance with stated procedures, and to make independent measurements of NO2. Based on criteria for placement and use of the samplers, conditions of noncompliance were observed on about 40% of visits.(ABSTRACT TRUNCATED AT 400 WORDS)

Risk factors for violent behavior in elementary school boys: have you hugged your child today?

Seventeen Hispanic elementary schoolboys with violent behavior problems were compared with 27 matched control students who were not overtly violent at school. Violent boys were significantly more likely to not live with their fathers, to have unmarried parents, to have more siblings, and to have fathers who never show them affection. Parents of violent boys were more likely than those of matched control students to use spanking for discipline and to admit that they rarely express affection for their sons.

Nitrogen dioxide and respiratory illnesses in infants

Nitrogen dioxide is an oxidant gas that contaminates outdoor air and indoor air in homes with unvented gas appliances. A prospective cohort study was carried out to test the hypothesis that residential exposure to NO2 increases incidence and severity of respiratory illnesses during the first 18 months of life. A cohort of 1,205 healthy infants from homes without smokers was enrolled. The daily occurrence of respiratory symptoms and illnesses was reported by the mothers every 2 wk. Illnesses with wheezing or wet cough were classified as lower respiratory tract. Indoor NO2 concentrations were serially measured with passive samplers place in the subjects' bedrooms. In stratified analyses, illness incidence rates did not consistently increase with exposure to NO2 or stove type. In multivariate analyses that adjusted for potential confounding factors, odds ratios were not significantly elevated for current or lagged NO2 exposures, or stove type. Illness duration, a measure of illness severity, was not associated with NO2 exposure. The findings can be extended to homes with gas stoves in regions of the United States where the outdoor air is not heavily polluted by NO2.

Tuberculous meningitis in the southwest United States: a community-based study

This community-based study analyzed 54 patients with definite or probable tuberculous meningitis (TBM) in New Mexico from 1970 through 1990. Patients ranged in age from 4 months to 86 years. The highest age-specific incidence occurred in the elderly, but 22% of patients were less than 10 years old. Native American patients were overrepresented. Patients were as likely to live in small towns as in large urban cities. Symptoms were present for a median of 13 days before admission. The majority of patients had fevers, headache, stiff neck, and mental changes, such as confusion or lethargy. No patient was admitted comatose. Focal neurologic signs were present in 33%. Laboratory testing found hyponatremia in 79%, pulmonary infiltrates on chest x-ray in 40%, ventricular dilatation on CT or MRI in 52%, and tuberculomas in 16%. PPD skin tests were positive in 64%. CSF cultures grew Mycobacterium tuberculosis in 50%, but colony counts were always lower than 10(2)/ml. As a consequence, acid-fast stains of CSF sediment were reported as positive in only 4%. Six patients were not diagnosed during the hospitalization and died of complications. Twenty-three percent of patients who were appropriately treated also died of complications during the initial hospitalization. Tuberculous meningitis continues to be an important disease in small communities, and affects all ages and ethnic and socioeconomic backgrounds.

Comparability of parent reports of respiratory illnesses with clinical diagnoses in infants

In a cohort study of respiratory illnesses from birth through age 18 months, the investigators assessed the occurrence of illness by telephone reports of respiratory symptoms. To assess the comparability of illness events based on symptom reports with usual clinical modalities, a nurse practitioner examined children during illnesses, and office and clinic records of outpatient visits were reviewed. Respiratory illnesses were defined as symptom episodes of at least 2 days; lower respiratory illnesses included at least 1 day of either wet cough or wheeze. This report is based on 10,771 illnesses in the 1,315 subjects enrolled. Runny or stuffy nose was reported for most (93%) illnesses, wet cough in 33%, and wheeze in 6%. In comparison with the diagnoses made by a nurse practitioner, parent report of wet cough or wheeze was sensitive (93.4%) for detecting lower respiratory illnesses, but nonspecific with specificity of only 24.2%. The majority of the false-positive lower respiratory illnesses had the symptom of wet cough. The comparison of parent reports with outpatient records provided similar findings. Standardized reporting of respiratory illnesses can be achieved with a telephone surveillance system but classification of specific illnesses from the surveillance information may differ from diagnoses made by clinicians.

Nitrogen dioxide and respiratory illness in children. Part II: Assessment of exposure to nitrogen dioxide

Repeated measurements of nitrogen dioxide were obtained from 1988 to 1991 in the homes of 1,205 infants living in Albuquerque, NM. Passive diffusion samplers were used to obtain a series of two-week integrated measurements from the home of each infant for use in a cohort study of the relation of residential exposure to nitrogen dioxide and respiratory illnesses. Information on stove use and time spent inside the residence was collected at two-week and two-month intervals, respectively. During the winter, in the bedrooms of homes with gas cooking stoves, mean nitrogen dioxide concentrations were 21 parts per billion (ppb); mean concentrations in the living room and kitchen were 29 ppb and 34 ppb, respectively. In homes with electric cooking stoves, the mean bedroom concentration was 7 ppb during the winter. Lower indoor concentrations were observed during the summer in homes with both gas and electric stoves. On average, infants spent approximately 12.3 hours per day in their bedrooms, 7.3 hours in the living rooms, 35 minutes in the kitchens, and 3.8 hours out of their homes. (As a condition of participation, none of the infants spent more than 20 hours per week in day care outside of their homes). The mean time infants spent in the kitchen during cooking was approximately nine minutes per day. We tested whether exposures of infants living in homes with gas stoves could be reasonably estimated by measurements in the bedroom in comparison with time-weighted average concentrations based on time-activity data and simultaneous nitrogen dioxide measurements in the kitchen, living room, and bedroom. In 1,937 two-week intervals from 587 infants, 90% of time-weighted exposure (on the three-level classification used in this study) estimates were in agreement with estimates based on bedroom concentrations alone. The agreement of the time-weighted nitrogen dioxide exposure estimates with the bedroom concentrations is attributed to limited amounts of cooking stove use (the mean was 29 minutes per day), small room-to-room differences in nitrogen dioxide concentrations (the mean kitchen-bedroom difference was 12 ppb), and the relatively large proportion of time that infants spent in their bedrooms.

Nitrogen dioxide and respiratory illness in children. Part I: Health outcomes

We have carried out a prospective cohort study to test the hypothesis that exposure to nitrogen dioxide increases the incidence and severity of respiratory infections during the first 18 months of life. Between January 1988 and June 1990, 1,315 infants were enrolled into the study at birth and followed with prospective surveillance for the occurrence of respiratory infections and monitoring of nitrogen dioxide concentrations in their homes. The subjects were healthy infants from homes without smokers; they were selected with stratification by type of cooking stove at a ratio of four to one for gas and electric stoves. Illness experience was monitored by a daily diary of symptoms completed by the mother and a telephone interview conducted every two weeks. Illnesses with wheezing or wet cough were classified as involving the lower respiratory tract; all other respiratory illnesses were designated as involving the upper respiratory tract. Exposure to nitrogen dioxide was estimated by two-week average concentrations measured in the subjects' bedrooms with passive samplers. This analysis is limited to the 1,205 subjects completing at least one month of observation; of these, 823 completed the full protocol, contributing 82.8% of the total number of days during which the subjects were under observation. Incidence rates for all respiratory illnesses, all upper respiratory illness, all lower respiratory illnesses, and lower respiratory illness further divided into those with any wheezing, or wet cough without wheezing, were examined within strata of nitrogen dioxide exposure at the time of the illness, nitrogen dioxide exposure during the prior month, and type of cooking stove. Consistent trends of increasing illness incidence rates with increasing exposure to nitrogen dioxide were not evident for either the lagged or unlagged exposure variables. The effect of nitrogen dioxide exposure on illness occurrence during at-risk intervals of two weeks' duration was examined using the generalized estimating equation approach. In these multivariate analyses, none of the odds ratios was significantly elevated for unlagged nitrogen dioxide exposures, lagged nitrogen dioxide exposures, or stove type. Duration of illness was assessed in relation to the same exposure variables; illness duration and nitrogen dioxide exposure were not associated. We have found that indoor exposure to nitrogen dioxide is associated with neither the incidence nor the duration of respiratory illnesses. The study was designed to have sufficient power to detect effects of nitrogen dioxide exposure of magnitudes previously reported and in a range relevant to public health concern; the lack of association cannot be attributed to potential bias from misclassification of outcome or exposure.(ABSTRACT TRUNCATED AT 400 WORDS)

On the probability that kidneys are different in autosomal dominant polycystic disease

We hypothesized that highly variable cyst fluid sodium concentrations are a characteristic of every kidney in autosomal dominant polycystic kidney disease (ADPKD). We added our data on sodium concentrations in 124 fluids from ten ADPKD kidneys to data published by others of concentrations in 32 fluids from five kidneys. The values ranged from 3 to 207 mEq/liter; none fell between 59 and 74 mEq/liter. Fluids were designated as low (< 60 mEq/liter; 50 fluids) or high (> 60 mEq/liter; 106 fluids) sodium fluids. Transmission electron microscopy identified differences in the depths of apical tight junctions between cells from cyst walls of 12 of the low and 10 of the high sodium fluids from two kidneys (mean +/- SE depths of 2039 +/- 74 A vs. 386 +/- 18 A respectively; P < 0.0001). When fluids were grouped by kidney of origin, six of the 15 kidneys had only high sodium fluids. The probability that chance had led to the sampling of only high sodium fluids in these organs, given that 32% of all fluids were low sodium fluids, was calculated at < 0.00015. The possibility must be considered that all kidneys are not alike in ADPKD.

Acculturation, education, and income as determinants of cigarette smoking in New Mexico Hispanics

Surveys of cigarette smoking among Hispanics in the Southwest have shown a pattern of smoking distinct from that of non-Hispanic whites, but determinants of smoking by Hispanics remain inadequately characterized. We have assessed household income, education, and language preference as predictors of cigarette smoking in 1072 Hispanic adults residing in a community in New Mexico. Cigarette smoking status (never, former, or current smoker) varied strongly with educational attainment, showing the anticipated gradient of increasing smoking as level of education declined. In contrast, cigarette smoking status did not vary in a consistent pattern with reported language preference. A composite measure of socioeconomic status, combining education and household income, predicted continued smoking among ever smokers, whereas language preference had no effect. In males, the age at which subjects started to smoke increased significantly with increasing education; a similar trend in females did not reach statistical significance. Determinants of numbers of cigarettes smoked daily were not identified. The findings suggest that, as in other U.S. populations, Hispanics in the Southwest with lower education and less income should be targeted for smoking prevention and cessation.

A study of respiratory illnesses in infants and nitrogen dioxide exposure

Toxicologic and epidemiologic studies have elevated concern that exposure to nitrogen dioxide (NO2) in outdoor and indoor air may increase the frequency and severity of respiratory infections. We have developed and implemented a prospective cohort study to test the hypothesis that exposure to NO2 increases the incidence and severity of respiratory infections during the first 18 mo of life. This study, which was based on extensive pilot research, was designed to address the potential limitations of misclassification, confounding, and inadequate power. Enrollment of 1,315 subjects has been completed. This paper reviews the methods used in the study, characteristics of the enrolled subjects, NO2 concentrations in the homes of study participants, and rates of illness occurrence.

Heritability of ventilatory function in smoking and nonsmoking New Mexico Hispanics

Familial aggregation of ventilatory function has been described in several populations, but the effects of age and cigarette smoking on the extent of aggregation have not been well characterized. We used data from a survey of a Hispanic population in New Mexico to obtain estimates of heritability for FVC and FEV1 as percentages of predicted value. Product-moment correlations for FVC of spouse pairs were 0.18 (n = 90 pairs) if neither smoked, 0.013 (n = 45 pairs) if only the wife smoked, 0.18 (n = 118 pairs) if only the husband smoked, and -0.04 (n = 83 pairs) if both smoked. Correlations for FEV1 of spouse pairs were similar. Because parent-child correlations did not vary with sex, we calculated product-moment correlations from the pooled data. The parent-child correlations for nonsmoking parents with nonsmoking children 6 to 17 yr of age and living in the same house were 0.16 (n = 335 pairs) and 0.17 for FVC and FEV1, respectively. For parents whose children were 25 yr of age or older, the parent-child correlations for those living in different houses were 0.37 (n = 63 pairs) for FVC and 0.40 for FEV1 if neither smoked, and 0.24 (n = 27 pairs) for FVC and 0.14 for FEV1 if both smoked. Heritability estimates, estimated by path analysis, were 0.43 for FVC and 0.42 for FEV1 if neither family member smoked and 0.65 for FVC and 0.44 for FEV1 if both family members smoked. We conclude that there is a moderate degree of heritability of FVC and FEV1 with no substantial change based on age or smoking status.

Effects of temperature and buffer composition on calcium sequestration by sarcoplasmic reticulum and plasma membrane of rabbit renal artery

45Ca electron microscopic autoradiography was used to examine the effects of buffer composition and temperature on the distribution of calcium in rabbit renal artery smooth muscle cells. The results show that the relative distribution of calcium is dependent on both the buffer used (Tris or Krebs) and the temperature of the bathing solution (25 degrees C or 34 degrees C). Krebs buffer at 34 degrees C gave the highest relative activity in the plasma membrane, sarcoplasmic reticulum, and mitochondria. Buffer and temperature had little effect on the relative activity of the nucleus or cytoplasm. Next, we identified the cellular sites of calcium accumulation after 5, 15, 30, or 60 min exposure to 45Ca in Krebs buffer at 34 degrees C. The results show that sarcoplasmic reticulum and plasma membrane are the primary sites of calcium accumulation during influx into these cells. Although the amount of 45Ca in the cell continues to increase with longer exposure, the relative distribution of calcium is essentially the same after 5 or 60 min. The data also indicate that the relative activity of plasma membrane + sarcoplasmic reticulum (a combination site that includes sarcoplasmic reticulum within a mean distance of 275 nm of the plasma membrane) is similar to the membrane alone and is lower than the sarcoplasmic reticulum alone.

Fetal hyperinsulinemia and protein turnover in fetal rat tissues

The effects of fetal hyperinsulinemia on protein turnover in various tissues of fetal rats were determined after transuteral injection of insulin to rat fetuses at day 19 of gestation. Tissue protein content was measured on the subsequent days of gestation (days 20-22), and protein synthesis was determined at day 20 of gestation in fetal tissues after intravenous injection of [3H]phenylalanine into the maternal circulation, followed by measurements of tissue free and protein-bound phenylalanine specific radioactivity in fetal diaphragm, brain, heart, and liver. Rates of protein degradation in these fetal tissues were calculated by subtracting protein accretion rates from rates of protein synthesis. The injection of insulin to rat fetuses at day 19 of gestation resulted in relative macrosomia versus saline-injected controls from the same litter (body wt at day 20 of gestation, 3.26 +/- 0.15 g for saline-injected fetuses and 3.60 +/- 0.25 g for insulin-injected fetuses, P less than 0.001) and increased protein and RNA content of brain, heart, and liver. Although fractional rates of protein synthesis were not significantly elevated in tissues from the hyperinsulinemic fetuses, absolute rates of protein synthesis were increased in brain, heart, and liver of hyperinsulinemic fetuses. Hyperinsulinemia did not reduce calculated rates of protein breakdown in fetal brain, heart, or liver but did in fetal diaphragm. We conclude that the major effect of fetal hyperinsulinemia on protein turnover in rats is to increase protein synthesis in selected tissues without simultaneously affecting protein breakdown.

Spirometric prediction equations for Hispanic children and adults in New Mexico

We conducted a population-based survey of respiratory diseases and lung function in a New Mexico Hispanic community, and developed spirometric prediction equations based on data from 576 children and adults. Spirometric test procedures were followed as recommended by the American Thoracic Society. For children 6 through 18 yr of age, we used a logarithmic model to predict spirometric parameters. We used simple linear regression for adults 25 through 80 yr of age. On the basis of exploratory analyses, we excluded adult subjects who were obese, defined as a body mass index of 30 kg/m2 or greater. This report describes these regressions. We did not perform regression analysis for those subjects between 19 and 24 yr of age because of small numbers and the inappropriateness of grouping these subjects with older adults for regression analysis. As an alternative to a regression equation for this age group specifically, we propose linear interpolation between values obtained using prediction equations developed for children and for adults. Finally, we compared the percent predicted values obtained from our internal prediction equations with equations from other populations of white children and adults. In general, the comparison equations underestimated the percent predicted values in our population.

Diabetes, gallbladder disease, obesity, and hypertension among Hispanics in New Mexico

Because Hispanics in the Southwest are genetically admixed with American Indians, the hypothesis has been advanced that the excess occurrence of diabetes mellitus, obesity, and gallbladder disease in this ethnic group may be genetic in origin and results from genes derived from American Indians. This report describes the prevalence of these diseases in 1,175 adult Hispanic participants in a survey of a New Mexico community conducted in 1984-1985. At nearly all ages, the majority of subjects had a body mass index of 25 kg/m2 or greater, and a substantial proportion exceeded 30 kg/m2. The prevalence of obesity was much greater in these Hispanics than is shown in nationwide data for US whites. Diabetes mellitus was also reported more often by Hispanic subjects in this survey than by US whites nationwide. A report of gallbladder trouble or of gallbladder removal was common in both males and females; the prevalence of gallbladder removal was as high in this population as in Mexican Americans previously studied in Starr County, Texas. In spite of the high prevalence of obesity, hypertension was less frequent among the New Mexico Hispanics than is shown in nationwide data for US whites. These findings complement those of previous surveys in Texas, which have shown a notably high proportion of adults to be obese, to have non-insulin-dependent diabetes mellitus, and to have gallbladder disease. The similar epidemiology of these diseases in the Hispanics of New Mexico and the Mexican Americans of Texas supports the hypothesis that American Indian admixture underlies the development of these conditions in Hispanics throughout the Southwest.

Natural history of frequent recurrences of herpes simplex labialis

We prospectively studied all herpes simplex labialis (HSL) episodes in a group of 84 (age, 6 to 71 years) persons who previously had frequent recurrences of HSL to determine whether their recurrences of HSL were different from those of the general population. The mean +/- standard error for number of HSL outbreaks for 6 months was 2.7 +/- 0.3. Age, gender, or season did not influence the recurrence rate. The mean time to vesicle healing of 214 outbreaks was 6.4 +/- 0.2 days. Again, age or gender did not influence healing time. An episode of HSL did not elicit a refractory period to the next attack of HSL. Furthermore, the severity of the previous HSL lesion did not influence the interval to next recurrence or the location of the next lesion. In 47%, the next recurrence of HSL crossed the midline of the face, and in 45%, it moved from one lip to the other. The high recurrence frequency and multiple facial locations of HSL lesions seen in these persons differed from the general population, who report infrequent lesions of HSL at the same facial location.

Histologic chorioamnionitis in pregnancies of various gestational ages. II: Implications in preterm labor

A retrospective review of placental materials (membranes, chorionic plate, umbilical cord) derived from preterm birth is reported. All those studied had intact membranes on admission and did not have spontaneous rupture. Those with preterm labor unresponsive to tocolysis, including those with brief and more prolonged labors, were compared with those delivered preterm because of maternal or fetal indications without labor. Those with labor had inflammatory changes in all three sites of greater frequency than those without labor. Those with longer labors had significantly higher rates of inflammation than those without labor. In this population, removing the influence of spontaneous rupture and labor over 6 hours long greatly diminished the likelihood of inferring that inflammation of the choriamniotic environment is a cause of preterm labor unresponsive to tocolysis.

Respiratory diseases and cigarette smoking in a Hispanic population in New Mexico

We have conducted a cross-sectional study of Hispanic residents of a community in New Mexico. A total of 2,111 subjects were recruited from 733 households; the overall participation rates were 68.1% for males and 78.9% for females. For all subjects, a standardized respiratory symptoms questionnaire was completed, spirometric testing was performed, and saliva and end-tidal breath samples were obtained. As in other populations, chronic respiratory symptoms were uncommon in children, and asthma was more prevalent in boys than in girls. In adults, physician-diagnosed chronic bronchitis and emphysema were less prevalent in this population than in a previously studied sample of non-Hispanic whites in New Mexico. Spirometric testing was confirmatory; less than 1% of the Hispanic males and females had chronic air-flow obstruction. The prevalence of cigarette usage in the Hispanics was comparable to data from non-Hispanic whites in New Mexico and from nationwide surveys. However, daily cigarette consumption by the Hispanics in this sample tended to be low, as found in previous studies in New Mexico and elsewhere.

Discrepancies between self-reported and validated cigarette smoking in a community survey of New Mexico Hispanics

In a population-based survey of respiratory disease in New Mexico Hispanics, we validated self-reports of cigarette use by 1,317 subjects against salivary cotinine level and end-tidal carbon monoxide concentration. For identifying likely deceivers about cigarette smoking among self-reported never smokers and former smokers, we used cutoff values of 20 ng/ml and 8 parts per million (ppm) for salivary cotinine and carbon monoxide, respectively. Among males and females, age-standardized prevalences of current smokers based upon questionnaire reports were 30.9 and 27.1%, respectively. After adjustment for cotinine alone, these percentages were 36.2 for males and 31.1 for females, and after adjustment for cotinine and carbon monoxide level, the corresponding percentages were 39.1 for males and 33.2 for females. We conclude that self-reports about smoking habits may lead to underestimation of the prevalence of current smokers and that questionnaire responses should be validated with biologic markers of tobacco smoke exposure.

Prophylactic knee braces and injury to the lower extremity

Five hundred and eighty high-school football players were studied over a period of two seasons to determine the effect of so-called prophylactic knee braces on the lower extremity. Two hundred and forty-seven athletes who wore single-hinged braces and eighty-three who wore double-hinged braces were paired for the same season of play with 250 athletes who were similar in height, weight, and playing position but who did not wear braces. The fifty-three injuries of the knee that occurred were significantly more frequent (p less than 0.001) in the group that wore single-hinged braces than in the matched, non-braced group. While there were more injuries of the knee in the participants who were double-hinged braces than in the matched controls, who did not wear braces, the increase in the number of injuries was not significant. There was also a dramatic increase (p less than 0.01) in the number of injuries of the ankle and foot in the athletes who wore braces. Our results question the efficacy of the braces that were studied and call attention to the potentially adverse effect of the braces on adjacent joints in the ipsilateral limb.