Health Reporting from Different Data Sources: Does it Matter for Mental Health?

BACKGROUND

Bipolar disorder is among the top 10 causes of disability worldwide. The Short-Form Six-Dimension (SF-6D) is a frequently BACKGROUND: Mental disorders are typically stigmatized conditions associated with negative stereotypes, which may lead individuals to underreport them. Thus, survey data may be subject to biases. Although administrative data has some limitations, it is an alternative data source that may be considered more objective.

AIMS OF THE STUDY

This study aimed to identify the degree of agreement between survey and administrative health care data for mental health conditions, factors affecting underreporting, and whether underreporting also occurs for physical health conditions.

METHODS

We used Ontario data from the Canadian Community Health Survey linked to health records to examine the presence of mental health conditions (i.e., schizophrenia and mood disorders) and select physical health conditions (i.e., diabetes and cancer). Using administrative data as the reference standard, we created four categories for each health condition based on the level of agreement between the two data sources: consistent cases and non-cases (i.e. individuals with concordant data based on their reported health condition), and people who were found to underreport and overreport a condition (i.e. where the condition was present in the administrative data, but not in the survey data and vice-versa, respectively). The overall level of agreement was assessed using Cohen's kappa statistic. Probit regressions were estimated to determine the factors affecting underreporting.

RESULTS

The Kappa statistics for mood disorder was fair (k= 0.26) and moderate for schizophrenia (k = 0.49). Physical health conditions had higher kappa values (diabetes, k = 0.81; ever having cancer, k = 0.68), with the exception of currently having cancer (k = 0.24). Underreporting was highest for the most stigmatizing condition, schizophrenia (63%), followed by mood disorders (39%) and cancer (39%), and lowest for diabetes (25%). Older age, being born in Africa and Asia, and being employed all increased the probability of underreporting among individuals identified in the administrative data; the opposite held for social assistance.

DISCUSSION

We extended previous work on mental health reporting by combining survey data with administrative data to examine the level of agreement between respondents' self-reported mental health and administrative records. The data include some mental disorders not studied previously. We examined the entire adult population; this is important because prevalence of schizophrenia may be less common among older population groups due to higher mortality among this patient population. Additionally, there may be potential age-related differences in stigma and mental health conditions. The administrative health data captured only health services covered by the public provincial health insurance plan and thus did not capture medical care provided by psychologists, social workers, and nurses. While this would affect Kappa statistic values, it does not directly affect the underreporting analyses.

IMPLICATIONS FOR HEALTH CARE PROVISION AND USE

Our results suggest that disclosure of mental health conditions may differ by the level of stigma, which has implications for obtaining accurate estimates of mental health prevalence from self-reported data sources. IMPLICATIONS FOR HEALTH POLICIES AND IMPLICATIONS FOR FURTHER RESEARCH: It may be useful to use a combination of both survey and administrative data when estimating the prevalence of mental disorders. Future research should seek to examine overreporting and its determinants.

Provider caseload volume and short-term outcomes following colorectal surgeries in New Brunswick: a provincial-level cohort study

BACKGROUND

American studies have shown that higher provider and hospital volumes are associated with reduced risk of mortality following colorectal surgical interventions. Evidence from Canada is limited, and to our knowledge only a single study has considered outcomes other than death. We describe associations between provider surgical volume and all-cause mortality and postoperative complications following colorectal surgical interventions in New Brunswick.

METHODS

We used hospital discharge abstracts linked to vital statistics, the provincial cancer registry and patient registry data. We considered all admissions for colorectal surgeries from 2007 through 2013. We used logistic regression to identify odds of dying and odds of complications (from any of anastomosis leak, unplanned colostomy, intra-abdominal sepsis or pneumonia) within 30 days of discharge from hospital according to provider volume (i.e., total interventions performed over the preceding 2 years) adjusted for personal, contextual, provider and hospital characteristics.

RESULTS

Overall, 9170 interventions were performed by 125 providers across 18 hospitals. We found decreased odds of experiencing a complication following colorectal surgery per increment of 10 interventions performed per year (odds ratio 0.94, 95% confidence interval 0.91-0.96). We found no associations with mortality. Associations remained consistent across models restricted to cancer patients or to interventions performed by general surgeons and across models that also considered overall hospital volumes.

CONCLUSION

Our results suggest that increased caseloads are associated with reduced odds of complications, but not with all-cause mortality, following colorectal surgery in New Brunswick. We also found no evidence of volume having differential effects on outcomes from colon and rectal procedures.

Provider volume and maternal complications after Caesarean section: results from a population-based study

BACKGROUND

A large literature search suggests a relationship between hospital/surgeon caseload volume and surgical complications. In this study, we describe associations between post-operative maternal complications following Caesarean section and provider caseload volume, provider years since graduation, and provider specialization, while adjusting for hospital volumes and patient characteristics.

METHODS

Our analysis is based on population-based discharge abstract data for the period of April 2004 to March 2014, linked to patient and physician universal coverage registry data. We consider all hospital admissions (N = 20,914) in New Brunswick, Canada, where a Caesarean Section surgery was recorded, as identified by a Canadian Classification of Health Intervention code of 5.MD.60.XX. We ran logistic regression models to identify the odds of occurrence of post-surgical complications during the hospital stay.

RESULTS

Roughly 2.6% of admissions had at least one of the following groups of complications: disseminated intravascular coagulation, postpartum sepsis, postpartum hemorrhage, and postpartum infection. The likelihood of complication was negatively associated with provider volume and provider years of experience, and positively associated with having a specialization other than maternal-fetal medicine or obstetrics and gynecology.

CONCLUSIONS

Our results suggest that measures of physician training and experience are associated with the likelihood of Caesarean Section complications. In the context of a rural province deciding on the number of rural hospitals to keep open, this suggests a trade off between the benefits of increased volume versus the increased travel time for patients.

Associations between provider and hospital volumes and postoperative mortality following total hip arthroplasty in New Brunswick: results from a provincial-level cohort study

BACKGROUND

Several international studies have reported negative associations between hospital and/or provider volume and risk of postoperative death following total hip arthroplasty (THA). The only Canadian studies to report on this have been based in Ontario and have found no such association. We describe associations between postoperative deaths following THA and provider caseload volume, also adjusted for hospital volume, in a population-based cohort in New Brunswick.

METHODS

Our analyses are based on hospital discharge abstract data linked to vital statistics and to patient registry data. We considered all first known admissions for THA in New Brunswick between Jan. 1, 2007, and Dec. 31, 2013. Provider volume was defined as total THAs performed over the preceding 2 years. We fit logistic regression models to identify odds of dying within 30 and 90 days according to provider caseload volume adjusted for selected personal and contextual characteristics.

RESULTS

About 7095 patients were admitted for THA in New Brunswick over the 7-year study period and 170 died within 30 days. We found no associations with provider volume and postoperative mortality in any of our models. Adjustment for contextual characteristics or hospital volume had no effects on this association.

CONCLUSION

Our results suggest that patients admitted for hip replacements in New Brunswick can expect to have similar risk of death regardless of whether they are admitted to see a provider with high or low THA volumes and of whether they are admitted to the province's larger or smaller hospitals.

Associations between provider and hospital volumes and postoperative mortality following total hip arthroplasty in New Brunswick: results from a provincial-level cohort study

BACKGROUND

Several international studies have reported negative associations between hospital and/or provider volume and risk of postoperative death following total hip arthroplasty (THA). The only Canadian studies to report on this have been based in Ontario and have found no such association. We describe associations between postoperative deaths following THA and provider caseload volume, also adjusted for hospital volume, in a population-based cohort in New Brunswick.

METHODS

Our analyses are based on hospital discharge abstract data linked to vital statistics and to patient registry data. We considered all first known admissions for THA in New Brunswick between Jan. 1, 2007, and Dec. 31, 2013. Provider volume was defined as total THAs performed over the preceding 2 years. We fit logistic regression models to identify odds of dying within 30 and 90 days according to provider caseload volume adjusted for selected personal and contextual characteristics.

RESULTS

About 7095 patients were admitted for THA in New Brunswick over the 7-year study period and 170 died within 30 days. We found no associations with provider volume and postoperative mortality in any of our models. Adjustment for contextual characteristics or hospital volume had no effects on this association.

CONCLUSION

Our results suggest that patients admitted for hip replacements in New Brunswick can expect to have similar risk of death regardless of whether they are admitted to see a provider with high or low THA volumes and of whether they are admitted to the province's larger or smaller hospitals.

Incidence of cutaneous malignant melanoma by socioeconomic status in Canada: 1992-2006

BACKGROUND

There are no nationwide studies documenting changes in cutaneous malignant melanoma incidence or association of incidence with socioeconomic status (SES) in Canada. We sought to determine whether melanoma incidence increased from 1992 to 2006 and if there was an association between SES and melanoma incidence. Additionally, we studied whether there was a correlation between province of residence and melanoma incidence.

METHODS

Cases from the Canadian Cancer Registry were reviewed. Demographic and socioeconomic information were extracted from the Canadian Census of Population data. Cases were linked to income quintiles by postal code. A negative binomial regression was performed to identify relationships among these variables.

RESULTS

Overall incidence of melanoma in Canada increased by 67 % from 1992 to 2006 (p < 0.0001). The increase in incidence was greater for melanoma in situ compared with invasive melanoma (136 % versus 52 % [p < 0.0001]). Incidence was positively correlated with higher income quintiles; the incidence rates among patients in the lowest income quintiles were 67 % of that for the highest income quintiles (p < 0.0001).

DISCUSSION

A wide variety of explanations have been postulated for an increased incidence in melanoma among persons of higher SES, including access to and awareness of screening, more access to vacations in sunny climates, and increased leisure time. Variations in incidence of melanoma by urban vs. rural location and province may indicate differences in access to dermatologists across Canada.

CONCLUSIONS

Melanoma incidence is increasing in Canada and is higher among people in high SES groups. This rise is likely due to a combination of factors including a true rise in incidence due to increases in sun exposure, and also an increased detection rate, particularly in those who are more aware of the disease and have access to resources for detection.

Early tumor development captured through nondestructive, high resolution differential phase contrast X-ray imaging

Although a considerable amount is known about molecular dysregulations in later stages of tumor progression, much less is known about the regulated processes supporting initial tumor growth. Insight into such processes can provide a fuller understanding of carcinogenesis, with implications for cancer treatment and risk assessment. Work from our laboratory suggests that organized substructure emerges during tumor formation. The goal here was to examine the feasibility of using state-of-the-art differential phase contrast X-ray imaging to investigate density differentials that evolve during early tumor development. To this end the beamline for TOmographic Microscopy and Coherent rAdiology experimenTs (TOMCAT) at the Swiss Light Source was used to examine the time-dependent assembly of substructure in developing tumors. Differential phase contrast (DPC) imaging based on grating interferometry as implemented with TOMCAT, offers sensitivity to density differentials within soft tissues and a unique combination of high resolution coupled with a large field of view that permits the accommodation of larger tissue sizes (1 cm in diameter), difficult with other imaging modalities.

Cancer prevalence and education by cancer site: logistic regression analysis

BACKGROUND

Previously, using the American National Health Interview Survey (NHIS) and a logistic regression analysis, we found that upper aerodigestive tract (UADT) cancer is correlated with low socioeconomic status (SES). The objective of this study was to determine if this correlation between low SES and cancer prevalence exists for other cancers.

METHODS

We again used the NHIS and employed education level as our main measure of SES. We controlled for potentially confounding factors, including smoking status and alcohol consumption.

RESULTS

We found that only two cancer subsites shared the pattern of increased prevalence with low education level and decreased prevalence with high education level: UADT cancer and cervical cancer.

CONCLUSIONS

UADT cancer and cervical cancer were the only two cancers identified that had a link between prevalence and lower education level. This raises the possibility that an associated risk factor for the two cancers is causing the relationship between lower education level and prevalence.

Socio-economic factors and stage at presentation of head and neck cancer patients in Ottawa, Canada: a logistic regression analysis

To determine if socio-economic status (SES) affects the stage at presentation of head and neck cancer (HNC) patients in Ottawa, Canada. To determine if the method of diagnosis affects the stage at presentation in these patients. We obtained data on SES, method of diagnosis, and stage at presentation for patients presenting to the head and neck cancer clinic at The Ottawa Hospital Regional Cancer Centre (TORCC). We performed a logistic regression analysis using stage at presentation as the dependent variable. We found no statistically significant association between average family income (by postal code) and stage at presentation. We found that oral cancers presented at a later stage compared with other HNCs but that who made the diagnosis was an important factor. Oral cancers diagnosed by a dentist had 3.44 times the odds of being at a later stage than other HNCs (CI 1.01-11.96), but oral cancers diagnosed by other means had 11.42 times the odds of being at a later stage than other HNCs. We found that male patients presented at a later stage than female patients (OR 2.62, CI 1.03-6.63). Finally, former smokers had about 1/3 the odds of presenting at a later stage than current smokers (OR 0.33, CI 0.13-0.84) although nonsmokers were not significantly less likely than current smokers to present later (OR 0.47, CI 0.17-1.32). We found no evidence that in Ottawa, Canada patients of a lower SES with HNC presented at an different stage than patients with higher SES. We found that patients presenting with oral cancers presented at an earlier stage if they were diagnosed by a dentist.

Comparative virulence of Infectious salmon anaemia virus isolates in Atlantic salmon, Salmo salar L

Infectious salmon anaemia virus (ISAV) surveillance in the Bay of Fundy has identified the existence of a large number of genetically distinct ISAV isolates which appear to be of variable virulence. Genetically distinct isolates are currently being designated based on sequencing of the hyper polymorphic region (HPR) of genomic segment 6, which encodes the haemagglutinin-esterase protein, but it has been difficult to elucidate a clear association between these molecular variations and variations in virulence. This has hampered the establishment of proactive management decisions regarding infected fish, and ISAV infections, regardless of type, must be treated as one. Field data of ISAV infections is difficult to collect and to compare between infections because of a wide range of confounding factors including time of year, fish stock, cage site location, mitigating factors and stressors. An important tool in determining the relationship between molecular differences and virulence comes from analysis of quarantine studies. The goal of this study was to compare the virulence, by co-habitation and intraperitoneal injection, of four regionally common and recent ISAV isolates in a controlled environment. We found significant differences in mortality between ISAV molecular isolates, and present data showing that survival of ISAV infection confers significant resistance to re-infection with a different ISAV isolate. These findings, if borne out in field studies, will significantly alter the way ISAV infections are managed in the Bay of Fundy and elsewhere.

An evaluation of the Kearny Fallout Meter (KFM), a radiation detector constructed from commonly available household materials

A radiation detector constructed of common household materials was developed at Oak Ridge National Laboratory (ORNL) by Cresson H. Kearny and has been referred to as the Kearny Fallout Meter (KFM). Developed during the height of the Cold War, the KFM was intended to place a radiation meter capable of measuring fallout from nuclear weapons in the hands of every U.S. citizen. Instructions for the construction of the meter, as well as information about radiation health effects, were developed in the form of multi-page newspaper insert. Subsequently, the sensitivity of the meter was refined by a high school teacher, Dr. Paul S. Lombardi, for use in demonstrations about radiation. The meter is currently being marketed for survivalists in light of potential radiation terrorist concerns. The KFM and Lombardi's variation of it are constructed and evaluated for this work. Calibrated tests of the response and variations in response are reported. A critique of the multi-page manual is made. In addition, the suitability of using such a detector, in terms of actual ease of construction and practical sensitivity, is discussed for its use in demonstrations and introductory classes on nuclear topics.

Muscle-derived neurotrophin-3 reduces injury-induced proprioceptive degeneration in neonatal mice

During perinatal development, proprioceptive muscle afferents are quite sensitive to nerve injury. Here, we have used transgenic mice that overexpress neurotrophin-3 (NT-3) in skeletal muscle (myo/NT-3 mice) to explore whether NT-3 plays a neuroprotective role for perinatal muscle afferents following nerve injury. Measurements of NT-3 mRNA using RT-PCR revealed that levels of endogenous NT-3 mRNA in wild-type muscles remained constant during the first postnatal week following nerve crush or nerve section on postnatal day (PN) 1. In comparison, myo/NT-3 mice had significantly elevated levels of NT-3 mRNA that were maintained or increased following injury. To assess whether muscle-derived NT-3 could prevent injury-induced neuronal death, neuron survival in the DRG was analyzed in mice 5 days after sciatic nerve crush on PN3. Retrograde prelabeling of muscle afferents and parvalbumin immunocytochemistry both revealed that overexpression of NT-3 in muscle significantly reduced neuronal loss following injury. Similar neuroprotective effects of NT-3 were observed in wild-type mice injected with exogenous NT-3 in the gastrocnemius muscles. To test whether NT-3 could prevent muscle spindle degeneration, spindle number and morphology were assessed 3 weeks after sciatic nerve crush or section on PN1. No spindles were present in either wildtype or myo/NT-3 muscles after nerve section, demonstrating that NT-3 overexpression cannot maintain spindles following complete denervation. Moreover, NT-3 overexpression could not prevent moderate spindle loss in muscle and did not stimulate new spindle formation following nerve crush. Our results demonstrate that in addition to its early actions on sensory neuron generation and naturally occurring cell death, NT-3 has important neuroprotective effects on muscle afferents during postnatal development.

Increased chemokine gene expression during aging in the murine brain

Normal aging results in changes in the brain that contribute to the decline of various functions, including learning and memory. Mechanisms causing this decline have not been clearly established. Activation of microglia is associated with the normal aging process in rodents and primates. Microglial activation is regulated by chemokine gene expression, and activated microglia produce substances that can be detrimental to surrounding cells. In this study we determined whether changes in chemokine expression occur during normal aging in the mouse brain. RNA samples taken from the cortex, midbrain, hippocampus, and cerebellum of 4-, 10-, 21- and 30-month-old C57BL6/DBA2 mice were analyzed for changes in gene expression. RNase protection assays were used to examine a panel of chemokines. Increased expression of macrophage inflammatory protein (MIP)-1alpha, MIP-1beta, and RANTES occurred in all four regions of the brains in the oldest mice. These increases were first detectable at 21 months of age. Increases in MIP-1alpha, MIP-1beta, and RANTES protein levels were also detected in the brains of old mice, as measured by ELISA. Increased microglial activation in the brains of 30-month-old mice, as detected by immunohistochemistry using F4/80 antibodies, correlated with increases in chemokine expression. The observed increases in chemokine gene expression that occur in conjunction with increased microglial activation suggest that chemokines may contribute to the decreased brain function that occurs during normal aging.

Consistency of multicenter measurements of heart rate variability in survivors of acute myocardial infarction

Heart rate variability (HRV) analysis from 24-hour ambulatory ECG has been widely used in risk stratification of patients after myocardial infarction (MI). The accuracy of HRV assessment is known to potentially vary when different commercial systems are used. However, the consistency of HRV measurements has never been fully investigated. Twenty-six post-MI patients (mean age 59 +/- 8 years, 22 men) were studied, of whom 13 succumbed to sudden cardiac death (SCD) within 1 year and 13 remained alive for at least 3 years (MI survivors). Each patient had a 24-hour Holter ECG recorded before hospital discharge. HRV analysis was performed four times from the same recordings using three different Holter tape analysis systems (Marquette, Reynolds, and CardioData) by four independent operators (CardioData system was used twice, once in the United Kingdom and once in the United States). Mean normal-to-normal RR intervals (mNN) and 3 HRV parameters (SDNN, RMSSD, and HRV triangular index [HRVi]) were derived from each recording. The consistency of mNN and HRV measurements was evaluated by coefficient of variance (CV) and by the Bland-Altman method. The results demonstrated that (1) all indices measured by different systems were statistically similar (P = NS) except the measurement of RMSSD (P = 0.01), (2) the measurements of mNN were highly reproducible with a maximum mean difference of 1.8 +/- 13.8 ms and maximum limits of agreement from -14.6 to +15.6 ms. The maximum mean differences were--1.8 +/- 1.4 unit and 4.4 +/- 9.6 ms for HRVi and SDNN, respectively, and RMSSD was less reproducible with a maximum mean difference of--11.1 +/- 11.5 ms, and limits of agreement from -16.2 to +9.6 ms; and (3) the consistency of mNN (CV 0.9% +/- 0.9%) was significantly higher than that of HRVi, SDNN, and RMSSD (P < 0.0001). The consistency of HRVi was similar to that of SDNN (4.8% +/- 2.1% vs 5.7% +/- 4.8%, P = 0.4), and the consistency of RMSSD (26.6% +/- 13.3%) was significantly lower than that of the other measurements (P < 0.00001). In conclusion, the measurements of mNN by different analytical systems are the most consistent among the parameters studied. The global 24-hour measurements of HRV (SDNN and HRVi) are highly reproducible, whereas the measurement of short-term HRV components (RMSSD) is significantly less reproducible.

Induction of PYK-2 phosphorylation during LFA-1/ICAM-1-dependent homotypic adhesion of fresh human B-cells

Stimulation with the combination of PDB plus ionomycin induced LFA-1/ICAM-1-dependent homotypic adhesion of tonsil B cells. Adhesion of tonsil B cells in our system induced tyrosine phosphorylation of Pyk-2. Disruption of homotypic adhesion and concomitant inhibition of induction of protein tyrosine phosphorylation was achieved by physical separation of the cells and by treatment with methyl-2.5-dihydroxycinnamate (MDHC), an inhibitor of protein tyrosine phosphorylation. These results suggest that protein tyrosine phosphorylation that is associated with homotypic adhesion is mediated by LFA-1/ICAM-1 interactions.

Evaluation of vitamin A toxicity

Toxicity has been associated with abuse of vitamin A supplements and with diets extremely high in preformed vitamin A. Consumption of 25,000-50,000 IU/d for periods of several months or more can produce multiple adverse effects. The lowest reported intakes causing toxicity have occurred in persons with liver function compromised by drugs, viral hepatitis, or protein-energy malnutrition. Certain drugs or other chemicals may markedly potentiate vitamin A toxicity in animals. Especially vulnerable groups include children, with adverse effects occurring with intakes as low as 1,500 IU.kg-1.d-1, and pregnant women, with birth defects being associated with maternal intakes as low as approximately 25,000 IU/d. The maternal dose threshold for birth defects cannot be identified from present data. An identifiable fraction of the population surveyed consumes vitamin A supplements at 25,000 IU/d and a few individuals consume much more. beta-Carotene is much less toxic than vitamin A.

Vitamin/mineral supplement use: a telephone survey of adults in the United States

Vitamin/mineral supplement use in the United States was assessed through a national telephone interview survey of an age-stratified random sample of 2,991 adults 16 years old and older. A vitamin/mineral supplement was defined as any product containing one or more of 33 specific vitamins, minerals, or "miscellaneous dietary components." Excluding pregnant/lactating women, 39.9% of the population consumed one or more supplements. Of those users, 52.4% consumed one supplement only; 10.9% consumed five or more (up to a maximum of 14 separate products). Confirming other research, above-average consumption of supplements occurred in the western United States. The most widely consumed product type was the single vitamin/miscellaneous dietary component (45.2% of supplement users). Vitamin C, either alone or in combination with other nutrients, was the most widely consumed nutrient (90.6% of supplement users). Use of supplements was more prevalent among women than among men in each of the three age groups examined: 16 to 24 years, 25 to 64 years, and 65 years and older. Although consumption of the B vitamins was more widespread among women than among men, more men than women consumed zinc, iodine, copper, magnesium, and manganese. There was a wide range of intake of both vitamins and minerals, which extended to 10 to 50 times the RDAs for individual nutrients.

Effect of dichloromethylene diphosphonate on fluoride balance in healthy men

Healthy men with a daily intake of 0.37 mg fluoride were given dichloromethylene diphosphonate (Cl2MDP) or a placebo during a period of ambulation followed by bed rest. In both groups, serum ionic fluoride was unchanged, and fluoride balances were negative, but Cl2MDP significantly reduced loss of fluoride in the treated groups.

Fluoride balance studies in healthy men during bed rest with and without a fluoride supplement

In a program of studies of disuse osteoporosis, fluoride balances were determined in healthy men during ambulation and then during bed rest for 6 to 17 wk. Control subjects ingested basal diets containing 0.4 mg fluoride per day, whereas experimental subjects received 10-mg fluoride supplements in divided doses with meals. Fluoride and calcium were measured in diets, urine, and feces. Serum analyses included calcium and ionic fluoride. Fluoride balances during both phases were uniformly negative in control subjects (mean -0.46 mg/day) but uniformly positive in supplement subjects (mean +2.58 mg/day). Calcium balances were markedly negative during bed rest in both groups. Serum fluoride concentrations increased proportionally to fluoride intake, averaging 0.016 ppm in the controls and 0.045 ppm in the supplement subjects. The supplement of 10 mg fluoride daily did not protect against bed rest-induced calcium loss, or cause any clinical or laboratory abnormality in any subject.

Fluoride balance studies in ambulatory healthy men with and without fluoride supplements

Fluoride balances were determined in healthy adult males under metabolic ward conditions. This is the first fluoride study to use the diffusion method in exploring the balances of subjects ingesting basal (i.e., everyday) diets with deionized water for cooking and drinking. Certain groups were given daily supplements of 5 or 10 mg. fluoride as sodium fluoride in divided doses with meals. Fluoride was measured in the diets, sodium fluoride tablets, urine, feces, and serum. Approximately 90% of the fluoride excreted was found in the urine and the remainder in the feces in all groups. In the control subjects, fluoride balances were uniformly negative (mean of -0.40 mg/day); in contrast, balances were uniformly positive (mean of +1.38 and +2.88 mg/day, respectively) in subjects receiving 5 or 10 mg F supplements daily. Serum ionic fluoride concentration increased proportionally to fluoride intake and averaged 0.016, 0.029, and 0.040 ppm in the control, 5-mg and 10-mg groups, respectively. These fluoride supplements did not cause any clinical or laboratory abnormality in any subjects.

Wine versus ethanol in human nutrition. IV. Zinc balance

Six healthy young men participated in a metabolic balance study to assess the effects of wine versus ethanol on absorption of various elements. Zinc data are reported here. During each of four 18-day experimental periods, the subjects were fed a controlled diet plus 1 liter/day of one of the following test beverages, administered in random order: Zinfandel wine, dealcoholized Zinfandel wine, an aqueous ethanol solution, or deionized water. Urinary zinc was significantly greater during wine and ethanol administration than during administration of the nonalcoholic beverages, suggesting that alcohol may affect the metabolism or renal conservation mechanism for zinc. The possibility of muscle catabolism due to alcohol ingestion is discussed. There was increased absorption and, perhaps, also, decreased endogenous secretion of zinc during the wine and dealcoholized wine periods, as compared with ethanol and deionized water. That presumably was due to the nonalcoholic constiuents of wine. Analysis of zinc in whole sweat after strenous exercise revealed that a considerable amount of this ion can be lost under conditions of excessive sweating.

Wine versus ethanol in human nutrition. III. Calcium, phosphorous, and magnesium balance

A metabolic balance study was performed to determine the effects of wine vs ethanol on absorption of various elements. Calcium, phosphorus, and magnesium data are reported here. The study was divided into four 18-day experimental periods during which six healthy males were given, in random order, 1 liter/day of one of the following test beverages: Zinfandel wine (9.3% w/v alcohol); delacholized Zinfandel wine; pure ethanol (9.3% w/v aqueous solution); or deionized water. The test beverages were administered along with a controlled isocaloric diet in four equal feedings over a 12-hr period. Each man served as his own control. Urinary calcium and magnesium did not change appreciably during the course of the study. Urinary phosphorous, however, was significantly greater during wine and ethanol administration, suggesting that alcohol may affect the metabolism or renal tubular reabsorption of this element. Despite considerable individual variation, the data showed that wine and dealcoholized wine enhanced absorption of calcium, phosphorus, and magnesium. This apparently was due to an effect of one or more of the many congeners present in wine and absent in a calorically equivalent amount of pure ethanol. The natural acidity of wine also may have played a role in creating a more favorable intraluminal environment for absorption. There was no significant difference between experimental periods in serum calcium, phosphorus, and magnesium.

Wine versus ethanol in human nutrition. II. Fluid, sodium, and potassium balance

Six healthy males were studied under metabolic unit conditions to determine the effects of wine vs ethanol on the absorption of various elements. Fluid, sodium, and potassium data are reported here. The following test beverages in the amount of 1 liter/day were administered in random order to each of the subjects during four 18-day experimental periods: Zinfandel wine (9.3% w/v alcohol); dealcoholized Zinfandel wine; pure ethanol (9.3% w/v aqueous alcohol solution); and deionized water. A strictly controlled isocaloric formula diet was given with the test beverage in four equal feedings over a 12-hr period. No diuretic effect of alcohol was detected in any of the subjects. Urinary sodium was significantly less during the dealcoholized wine period than during the ethanol and water periods. Urinary potassium was significantly greater during ethanol administration as compared with the other test beverages. Fecal and serum sodium and potassium were essentially unchanged throughout the study.

Wine versus ethanol in human nutrition. I. Nitrogen and calorie balance

There are implications in the literature that wine is different from other alcoholic beverages and that it may even have a beneficial effect on the nutritional process. A metabolic study was undertaken in an attempt to document the effects of wine versus ethanol on absorption of various nutrients. Nitrogen and caloric data are presented here. During each of four 18-day experimental periods, six healthy, young men were given, in random order, a liter per day of the following test beverages: Zinfandel wine (9.3% w/v alcohol); dealcoholized Zinfandel wine; pure ethanol (9.3% w/v aqueous alcohol solution); and deionized water. These beverages were divided into four equal feedings and administered with a carefully controlled isocaloric diet over a 12-hr period. The subjects tended to lose weight on alcohol-containing regimens, suggesting that calories from alcohol may not be as efficient as those from fat and carbohydrate. Urinary excretion of nitrogen was significantly greater during wine and ethanol administration than during feeding of the other test beverages. This was reflected in an increase in uric acid and urea nitrogen output, primarily, the latter, suggesting that alcohol may directly affect protein catabolism. There was no significant difference in fecal nitrogen excretion between experimental periods.