The correlation between occupation type and fibromyalgia severity

BACKGROUND

Fibromyalgia (FM) is a chronic pain disorder associated with financial burden, decreased work productivity and absenteeism. Occupational stressors and specific employment factors may contribute to the severity of FM.

AIMS

To determine if occupation type or employment status correlates with FM diagnostic and severity parameters, as assessed via validated instruments including tender points (TP), Widespread Pain Index (WPI), Symptom Severity (SS) and pain regions.

METHODS

We performed a cross-sectional study of 200 adult patients diagnosed with FM at a single-centre FM clinic. Demographic and clinical data were extracted from the electronic medical records. Occupations were manually grouped in an iterative modified-Delphi approach and participants were grouped by employment status (Working, Not Working/Disabled or Retired) for analysis.

RESULTS

In our cohort, 61% were employed and 24% were not working/disabled, while the remainder were students, homemakers or retired. SS score was significantly higher (P < 0.001) in not working/disabled patients compared to those employed. Business owners had the lowest TP count (median = 14) and the lowest median SS score (median = 7). WPI was highest for Others (Arts/Entertainment, Driver/Delivery and Housekeeper/Custodian workers; median=16) and the lowest for Retail/Sales/Wait Staff (median = 11).

CONCLUSIONS

Work-related factors, occupation type and employment status correlate with diagnostic and severity parameters of FM. Employed participants had significantly lower SS scores suggesting that work loss correlates with SS. Participants employed in entry-level jobs or jobs with higher physical or financial stressors may experience greater FM symptoms. Further studies are required to explore work-related factors and their impact on the diagnostic and severity parameters of FM.

A systematic surveillance programme for infectious salmon anaemia virus supports its absence in the Pacific Northwest of the United States

In response to reported findings of infectious salmon anaemia virus (ISAV) in British Columbia (BC), Canada, in 2011, U.S. national, state and tribal fisheries managers and fish health specialists developed and implemented a collaborative ISAV surveillance plan for the Pacific Northwest region of the United States. Accordingly, over a 3-1/2-year period, 4,962 salmonids were sampled and successfully tested by real-time reverse-transcription PCR. The sample set included multiple tissues from free-ranging Pacific salmonids from coastal regions of Alaska and Washington and farmed Atlantic salmon (Salmo salar L.) from Washington, all representing fish exposed to marine environments. The survey design targeted physiologically compromised or moribund animals more vulnerable to infection as well as species considered susceptible to ISAV. Samples were handled with a documented chain of custody and testing protocols, and criteria for interpretation of test results were defined in advance. All 4,962 completed tests were negative for ISAV RNA. Results of this surveillance effort provide sound evidence to support the absence of ISAV in represented populations of free-ranging and marine-farmed salmonids on the northwest coast of the United States.

Initiation of prandial insulin therapy with AIR inhaled insulin or insulin lispro in patients with type 2 diabetes: A randomized noninferiority trial

BACKGROUND

Insulin initiation in patients with type 2 diabetes is often delayed because of concerns about injections. Our objective was to compare the effects of AIR inhaled insulin (Eli Lilly and Co., Indianapolis, IN) (AIR is a registered trademark of Alkermes, Inc., Cambridge, MA) with those of injectable insulin on glycemic control and safety.

METHODS

This was planned as a 24-month, open-label, randomized study in adults with diabetes inadequately controlled by one or more oral antihyperglycemic medications (OAMs). Following a 2-week baseline period, patients continued OAMs and were randomized to AIR insulin (n = 208) or insulin lispro (n = 203) before meals. The primary end point was hemoglobin A1C (A1C) change from baseline to 6 months. Noninferiority was established if the upper limit of the 95% confidence interval of the difference in A1C change was < or =0.4%.

RESULTS

Early termination of the study diminished the number of patients for the 12- and 24-month analyses, but not for the primary 6-month end point analyses. AIR insulin and injectable insulin groups had comparable baseline A1C values (8.18% vs. 8.21%, respectively). Change in A1C from baseline to 6-month end point was similar (least squares mean, -0.81 +/- 0.09% and -0.87 +/- 0.09%; 95% confidence interval for the difference -0.117, 0.234; P = 0.51) and so were final A1C values of 7.36% and 7.31% for AIR insulin and injectable insulin, respectively. At 6 months, no differences were observed in eight-point profiles, overall and nocturnal hypoglycemia, and weight gain. Greater decreases in spirometry were observed in the AIR insulin group at 12 months. Cough was the most frequently reported adverse event (20% [AIR insulin] vs. 10% [insulin lispro]; P = 0.002).

CONCLUSIONS

Treatment with AIR insulin resulted in similar improvement in glycemic control compared with insulin lispro. More frequent cough and greater decrease in spirometry were observed with AIR insulin.

Two-year efficacy and safety of AIR inhaled insulin in patients with type 1 diabetes: An open-label randomized controlled trial

BACKGROUND

Patients with type 1 diabetes require intensive insulin therapy for optimal glycemic control. AIR((R)) inhaled insulin (system from Eli Lilly and Company, Indianapolis, IN) (AIR is a registered trademark of Alkermes, Inc., Cambridge, MA) may be an efficacious and safe alternative to subcutaneously injected (SC) mealtime insulin.

METHODS

This was a Phase 3, 2-year, randomized, open-label, active-comparator, parallel-group study in 385 patients with type 1 diabetes who were randomly assigned to receive AIR insulin or SC insulin (regular human insulin or insulin lispro) at mealtimes. Both groups received insulin glargine once daily. Efficacy measures included mean change in hemoglobin A1C (A1C) from baseline to end point, eight-point self-monitored blood glucose profiles, and insulin dosage. Safety assessments included hypoglycemic events, pulmonary function tests, adverse events, and insulin antibody levels.

RESULTS

In both treatment groups, only 20% of subjects reached the target of A1C <7.0%. A significant A1C difference of 0.44% was seen favoring SC insulin, with no difference between the groups in insulin doses or hypoglycemic events at end point. Patients in both treatment groups experienced progressive decreases in lung function, but larger (reversible) decrements in diffusing capacity of the lung for carbon monoxide (DL(CO)) were associated with AIR insulin treatment. Greater weight gain was seen with SC insulin treatment.

CONCLUSIONS

The AIR inhaled insulin program was terminated by the sponsor prior to availability of any Phase 3 data for reasons unrelated to safety or efficacy. Despite early termination, this trial provides evidence that AIR insulin was less efficacious in lowering A1C and was associated with a greater decrease in DL(CO) and increased incidence of cough than SC insulin in patients with type 1 diabetes.

Safety and efficacy of AIR inhaled insulin compared with subcutaneous insulin in patients having diabetes and asthma: A 12-month, randomized, noninferiority trial

BACKGROUND

Long-term safety and efficacy of AIR((R)) inhaled insulin (Eli Lilly and Co., Indianapolis, IN) (AIR is a registered trademark of Alkermes, Inc., Cambridge, MA) in patients with diabetes and concomitant lung disease remain to be established.

METHODS

This 1-year, randomized, open-label, active comparator, two-arm, parallel study compared the safety and efficacy of AIR insulin to subcutaneous (SC) insulin in patients having type 1 or type 2 diabetes and asthma. Patients with type 2 diabetes continued taking their prestudy oral antihyperglycemic medication.

RESULTS

Change in hemoglobin A1C from baseline to end point was similar for the AIR insulin and SC insulin groups (-0.063 +/- 0.128% and -0.315 +/- 0.128% respectively, P = 0.105), but noninferiority failed to be achieved (the upper limit of the 95% confidence interval [-0.053, 0.555] was >0.4%). The total daily prandial dose increased more in the AIR insulin group than in the SC insulin group (0.150 U/kg and 0.044 U/kg, respectively, P = 0.002). Safety profiles were generally comparable between treatments. At end point, forced expiratory volume in 1 s (FEV(1))/forced vital capacity (FVC) postbronchodilator (-0.016 +/- 0.005 vs. 0.002 +/- 0.005, P = 0.006) and diffusing capacity of the lung for carbon monoxide (-1.214 +/- 0.325 mL/min/torr vs. -0.383 +/- 0.311 mL/min/torr, P = 0.028) both decreased more in the AIR insulin group than in the SC insulin group, but the differences were not present at follow-up. FEV(1) and FVC were similar between treatment groups at end point. Incidences of hypoglycemia were comparable between groups. Insulin antibody binding increased more in the AIR insulin group. Cough was the most common adverse event; however, there was no difference in incidence between the AIR insulin (15.3%) and SC insulin (12.4%) treatment groups (P = 0.572).

CONCLUSIONS

In patients who have diabetes and asthma, AIR insulin demonstrated glycemic efficacy similar to SC insulin. Additionally, the safety profile of AIR insulin in patients with and without asthma is consistent.

Epizootiology of tropical canine pancytopenia

Tropical canine pancytopenia (TCP) is a newly recognized infectious disease of dogs in diverse tropical and subtropical areas. The disease is characterized by hemorrhage, pancytopenia, severe emaciation and persistent infection. Dogs with TCP are often presented with epistaxis, which is the most dramatic sign of the disease; however, a large number of affected dogs develop severe pancytopenia and die without manifesting clinical signs of hemorrhage. The disease has been reported most frequently in the German Shepherd. Pathological findings consist of petechial and ecchymotic hemorrhages on serosal and mucosal surfaces of numerous organs. The most prominent histological finding is a perivascular plasma cell infiltrate in most organs. Disease, indistinguishable from the natural disease, has been produced in laboratory dogs inoculated with whole blood from affected dogs. Ehrlichia canis has been consistently recovered from all experimentally infected dogs. Attempts to transmit the disease to other laboratory animals and to propagate the agent in cell cultures and embryonating eggs have been unsuccessful. The tick is the probable vector of the disease.

Hyponatremia and syndrome of inappropriate anti-diuretic hormone reported with the use of Vincristine: an over-representation of Asians?

PURPOSE

This retrospective study used a pharmaceutical company's global safety database to determine the reporting rate of hyponatremia and/or syndrome of inappropriate secretion of anti-diuretic hormone (SIADH) among vincristine-treated patients and to explore the possibility of at-risk population subgroups.

METHOD

We searched the Eli Lilly and Company's computerized adverse event database for all reported cases of hyponatremia and/or SIADH as of 1 November 1999 that had been reported during the use of vincristine.

RESULTS

A total of 76 cases of hyponatremia and/or SIADH associated with vincristine use were identified. The overall reporting rate was estimated to be 1.3/100,000 treated patients. The average age of patients was 35.6 +/- 28.3 years, and 62% were males. Approximately 75% of the patients were receiving treatment for leukemia or lymphoma. Among the 39 reports that included information on race, the racial distribution was: 1 Black, 3 Caucasian, and 35 Asian.

CONCLUSION

Our data suggest that Asian patients may be at increased risk of hyponatremia and/or SIADH associated with vincristine use. Although the overall reported rate of SIADH associated with vincristine is very low, physicians caring for Asian oncology patients should be aware of this potential serious but reversible adverse event.

Open-label randomized trial of torsemide compared with furosemide therapy for patients with heart failure

PURPOSE

Because the bioavailability of oral furosemide is erratic and often incomplete, we tested the hypothesis that patients with heart failure who were treated with torsemide, a predictably absorbed diuretic, would have more favorable clinical outcomes than would those treated with furosemide.

PATIENTS AND METHODS

We conducted an open-label trial of 234 patients with chronic heart failure (mean [+/- SD] age, 64 +/- 11 years) from an urban public health care system. Patients received oral torsemide (n = 113) or furosemide (n = 121) for 1 year. The primary endpoint was readmission to the hospital for heart failure. Secondary endpoints included readmission for all cardiovascular causes and for all causes, numbers of hospital days, and health-related quality of life.

RESULTS

Compared with furosemide-treated patients, torsemide-treated patients were less likely to need readmission for heart failure (39 [32%] vs. 19 [17%], P <0.01) or for all cardiovascular causes (71 [59%] vs. 50 [44%], P = 0.03). There was no difference in the rate of admissions for all causes (92 [76%] vs. 80 [71%], P = 0.36). Patients treated with torsemide had significantly fewer hospital days for heart failure (106 vs. 296 days, P = 0.02). Improvements in dyspnea and fatigue scores from baseline were greater among patients treated with torsemide, but the differences were statistically significant only for fatigue scores at months 2, 8, and 12.

CONCLUSIONS

Compared with furosemide-treated patients, torsemide-treated patients were less likely to be readmitted for heart failure and for all cardiovascular causes, and were less fatigued. If our results are confirmed by blinded trials, torsemide may be the preferred loop diuretic for patients with chronic heart failure.

A fiber-optic lactate sensor based on bacterial cytoplasmic membranes

A new type of fiber-optic biosensor based on bacterial cytoplasmic membranes (CPM) as the biological recognition element and an oxygen sensitive dye layer as the transducer is described for the detection of lactate. CPMs from bacteria with an induced lactate oxidase system are adsorbed onto a cellulose disk. The disk is fixed mechanically over an oxygen sensitive siloxane layer on the distal end of an optical fiber. This system detects lactate with no interference from glucose, fructose or glutamic acid.

High-density fiber-optic DNA random microsphere array

A high-density fiber-optic DNA microarray sensor was developed to monitor multiple DNA sequences in parallel. Microarrays were prepared by randomly distributing DNA probe-functionalized 3.1-microm-diameter microspheres in an array of wells etched in a 500-microm-diameter optical imaging fiber. Registration of the microspheres was performed using an optical encoding scheme and a custom-built imaging system. Hybridization was visualized using fluorescent-labeled DNA targets with a detection limit of 10 fM. Hybridization times of seconds are required for nanomolar target concentrations, and analysis is performed in minutes.

Transcription initiation-defective forms of sigma(54) that differ in ability To function with a heteroduplex DNA template

Transcription by sigma(54)-RNA polymerase holoenzyme requires an activator that catalyzes isomerization of the closed promoter complex to an open complex. We examined mutant forms of Salmonella enterica serovar Typhimurium sigma(54) that were defective in transcription initiation but retained core RNA polymerase- and promoter-binding activities. Four of the mutant proteins allowed activator-independent transcription from a heteroduplex DNA template. One of these mutant proteins, L124P V148A, had substitutions in a sequence that had not been shown previously to participate in the prevention of activator-independent transcription. The remaining mutants did not allow efficient activator-independent transcription from the heteroduplex DNA template and had substitutions within a conserved 20-amino-acid segment (Leu-179 to Leu-199), suggesting a role for this sequence in transcription initiation.

Incidence of stroke and season of the year: evidence of an association

Evidence of seasonal variation in the incidence of stroke is inconsistent. This may be a likely consequence of one or more methodological shortcomings of the studies investigating this issue, including inappropriate analytic models, insufficient length of time, small sample size, and a regional (vs. national) focus. The authors' objective was to ascertain whether an association exists between season of the year and the incidence of stroke by using a methodological approach designed to overcome these limitations. The authors used a longitudinal study design involving 72,779 veterans hospitalized for stroke at any Veterans Affairs hospital nationally during the years 1986-1995. These data were analyzed by using time series methods. There was clear evidence of a seasonal occurrence for stroke in general. This seasonal effect was found for ischemic stroke, but not for hemorrhagic stroke. The peak occurrence was in mid-May. Neither the region (i.e., climate) nor the race of the patient substantially modified the seasonal trend. An explanation for this pattern remains to be determined.

Screening unlabeled DNA targets with randomly ordered fiber-optic gene arrays

We have developed a randomly ordered fiber-optic gene array for rapid, parallel detection of unlabeled DNA targets with surface immobilized molecular beacons (MB) that undergo a conformational change accompanied by a fluorescence change in the presence of a complementary DNA target. Microarrays are prepared by randomly distributing MB-functionalized 3-microm diameter microspheres in an array of wells etched in a 500-microm diameter optical imaging fiber. Using several MBs, each designed to recognize a different target, we demonstrate the selective detection of genomic cystic fibrosis related targets. Positional registration and fluorescence response monitoring of the microspheres was performed using an optical encoding scheme and an imaging fluorescence microscope system.

Racial disparity in cardiac decision making: results from patient focus groups

BACKGROUND

While numerous studies suggest that African Americans receive fewer invasive cardiac procedures than whites, the basis for these treatment differences is not understood.

METHODS

We conducted focus group sessions with patients who had received treatment in the hospital or the emergency department within the preceding 3 months for ischemic heart disease at 2 urban, university-affiliated hospitals.

RESULTS

Discussions with patients identified the following factors that influenced their decision making: clarity, simplicity, and consistency of treatment recommendations; advice from friends and family about whether to accept recommendations; availability to speak with others who accepted similar recommendations; and having honest and caring physicians. African American patients identified the following additional factors that influenced their decision making: perceptions of health care discrimination; perceptions of undesirable physician behavior; faith in God to control one's destiny; and patient-physician camaraderie.

CONCLUSIONS

Participants identified common issues influencing health care decision making, regardless of race. However, additional factors were expressed only by African American participants. These factors conveyed racial differences in perceptions of the health care system that may, in part, contribute to differences in health care decision making and treatment.

Racial differences in cardiac catheterization use and appropriateness

The authors sought to investigate the role of medical appropriateness as a potential explanatory factor in previously observed interracial cardiac procedure rate differences. A retrospective cohort study using RAND appropriateness criteria was conducted at a Veterans Affairs medical center among a sample of patients who were evaluated for cardiovascular disease during 1993 (n=200). All participants were men and 50% were black (mean age=61.8 years). Blacks were less likely than whites to undergo cardiac catheterizations (CC) (odds ratio [OR]=0.23, P < 0.01). When RAND criteria were applied, blacks were found to have fewer indications that made them appropriate candidates for CC and more indications making them inappropriate candidates for CC (chi-square test, P < 0.05). No CC procedure underuse was found among blacks, whereas 10% of CC overuse was found among whites. Interracial CC procedure use differences were not due to procedure underuse among blacks but were in part due to overuse among whites.

Can raters consistently evaluate the content of focus groups?

Focus groups are increasingly being used to provide insights to researchers and policy makers. These data complement quantitative approaches to understanding the world. Unfortunately, quantitative and qualitative methodologies have often been viewed as antithetical, rather than complementary, strategies. While focus groups can clearly generate rich information that is unobtainable through other quantitative methods, it is important to determine the degree to which different raters can consistently extract information from transcripts. Thus, our goal was to quantify agreement in the interpretation of transcripts from patient and physician focus groups, using decision-making in ischemic heart disease as a model. We used data from focus groups with both patients and physicians that sought to identify factors affecting diagnostic and treatment decisions in ischemic heart disease. Three raters independently reviewed transcribed audiotapes from focus groups of patients with ischemic heart disease, as well as focus groups of physicians who care for these patients. We found that raters could not distinguish between major and minor factors reliably. More troubling, however, is that consistency regarding the apparently straightforward judgment as to the mere presence or absence of a factor was difficult to achieve. In particular, the three raters of each transcript failed to agree on between one third and one half of the factors. This reasonably high level of disagreement occurred despite the raters: (1) having generated the individual factors themselves based upon their reading a random sample of actual transcripts and (2) being trained in the use of rating forms (including standard definitions of themes). These data suggest that if a single rater evaluates focus group transcripts, as is commonly done, judgments may not be reproducible by other raters. Moreover, a single rater may not extract all important information contained in the transcripts.

Case management programs in primary care

To review the impact of case management programs on health care resource use; their impact on patient satisfaction, quality of life, and functional status (patient-centered outcomes); and their cost-effectiveness, we reviewed the English language literature utilizing the following MEDLINE and HealthSTAR headings: case management, patient care planning, patient-centered care, disease management, care management, and managed care programs. Bibliographies of relevant articles were also reviewed. Only randomized controlled trials were included. Data were extracted manually from relevant publications and are presented descriptively because formal, quantitative methods were not applicable. Nine studies met our inclusion criteria. Of the seven studies examining case management's impact on health resource use, only two found a positive effect. Both successful programs targeted patients with specified disease conditions and care was supervised by a medical subspecialist. None of the programs targeting general disease conditions or supervised by generalists reported a positive effect. All six studies examining patient-centered outcomes reported a positive impact. These effects were unrelated to the patient's conditions or the study personnel. Both studies examining clinical parameters found a positive impact. Only three studies examined costs; all reported nonsignificant cost savings. While case management programs offer theoretical benefits, few examples of successful programs were found. Positive effect was related to disease condition and specialty training of study personnel. Patient-centered outcomes were often improved upon but at unknown cost. Further multisite clinical trials are needed to define case management's role in our future health care system.

Examination of racial differences in management of cardiovascular disease

OBJECTIVES

We sought to identify the clinical characteristics associated with, and to investigate the impact of cohort selection criteria on, interracial use of invasive cardiac procedures and to determine survival.

BACKGROUND

Although interracial differences in the use of invasive cardiac procedures have been previously reported, the underlying reasons are not known.

METHODS

A retrospective cohort study was conducted at a Veterans Affairs Medical Center. Study patients were evaluated for cardiovascular disease between January 1 and December 31, 1993.

RESULTS

The study included 1,406 male patients (85% white, 58% married), with a mean age of 63.4 years. African Americans were less likely than whites to undergo procedures (cardiac catheterization: odds ratio [OR] 0.37, 95% confidence interval [CI] 0.24 to 0.58; coronary angioplasty: OR 0.60, 95% CI 0.25 to 1.49; coronary bypass surgery: OR 0.22, 95% CI 0.08 to 0.63; any procedure: OR 0.32, 95% CI 0.21 to 0.50). On bivariate analysis, patients who underwent cardiac procedures were more likely to be younger, married and reside nonlocally and less likely to have severe comorbid disease; however, African Americans were less likely to be married and to reside nonlocally and more likely to have severe comorbid disease. Cohorts adjusting for referral status and specified cardiac diagnoses reduced or reversed interracial treatment differences. Thirty-day and 1-year survival rates (96% and 87.6%, respectively) were equivalent.

CONCLUSIONS

Racial disparity in invasive cardiac procedure use may be partially explained by clinical differences and cohort selection bias. Despite treatment differences, survival rates were equivalent in African Americans and whites.

Role of duration of diuretic effect in preventing sodium retention

OBJECTIVE

To determine whether the duration of diuretic effect at the active nephron site enhances ability to excrete an exogenous salt load.

METHODS

We conducted a study that involved eight patients with New York Heart Association class II to III congestive heart failure. In a randomized, crossover manner, each patient received 3.25 mg intravenous bumetanide at 0 hours and again at 6 hours or a loading dose of 0.5 mg bumetanide at 0 hours followed by a continuous infusion of 0.5 mg/hr for 6 hours. Response was followed for 12 hours; a total of 6.5 mg of bumetanide was administered in each arm of the study. Eight hours after dosing began, we administered approximately 80 mEq sodium intravenously and examined its excretion over 4 hours.

RESULTS

The percentage of the load excreted was 86% +/- 15% versus 29% +/- 30% for the infusion and bolus regimens, respectively (p = 0.0005). More bumetanide was excreted during the infusion (667 +/- 133 micrograms versus 240 +/- 121 micrograms; p = 0.0002). During the infusion, however, more sodium was excreted relative to amounts of bumetanide, indicating that the efficiency of response was greater during the infusion, 0.10 +/- 0.02 mEq sodium per microgram bumetanide versus 0.07 +/- 0.05 mEq for the bolus (p = 0.0145).

CONCLUSIONS

These data support the notions that a long-acting loop diuretic maintains its efficacy and that a longer duration of action facilitates excretion of a sodium load, such as that which might occur during dietary indiscretion.

A fiber-optic DNA biosensor microarray for the analysis of gene expression

A fiber-optic biosensor array is described for the simultaneous analysis of multiple DNA sequences. A bundle of optical fibers was assembled with each fiber carrying a different oligonucleotide probe immobilized on its distal end. Hybridization of fluorescently labeled complementary oligonucleotides to the array was monitored by observing the increase in fluorescence that accompanied binding. The approach enables fast (< 10 min) and sensitive (10 nM) detection to multiple DNA sequences simultaneously, with the potential for quantitative hybridization analysis.

Risk factors for delirium tremens development

OBJECTIVE

To identify clinical characteristics associated with inpatient development of delirium tremens so that future treatment efforts can focus on patients most likely to benefit from aggressive therapy.

DESIGN

Retrospective cohort study among patients discharged with diagnoses related to alcohol abuse.

SETTING

University-affiliated inner-city hospital.

PATIENTS/PARTICIPANTS

Two hundred consecutive patients discharged between June 1991 and August 1992 who underwent evaluation and treatment for alcohol withdrawal or detoxification.

MEASUREMENTS AND MAIN RESULTS

Mean age was 41.9 years, 85% were male, 57% were white and 84% were unmarried. Forty-eight (24%) of the patients developed delirium tremens during hospitalization. Bivariate analysis indicated that those who developed delirium tremens were more likely to be African-American, unemployed, and homeless, and were more likely to have gone more days since their last drink, and to have concurrent acute medical illness, high admission blood urea nitrogen level and respiratory rate, and low admission albumin level and systolic blood pressure. In multiple logistic regression analyses, patients who developed delirium tremens were more likely to have gone more days since their last drink (odds ratio [OR] 1.3; 95% confidence interval [CI] 1.09, 1.61) and to have concurrent acute medical illness (OR 5.1; 95% CI 2.07, 12.55). These risk factors were combined for assessment of their ability to predict the occurrence of delirium tremens. If no factors were present, 9% developed delirium tremens; if one factor was present, 25% developed delirium tremens; and if two factors were present, 54% developed delirium tremens.

CONCLUSIONS

Inpatient development of delirium tremens was common among patients treated for alcohol detoxification or withdrawal and correlated with several readily available clinical variables.

Effect of bovine herpesvirus-1 on expression of interleukin-2 receptors and effect of interleukin-12 on lymphocyte proliferation

Expression of the interleukin-2 receptor alpha chain (IL-2R alpha) by peripheral blood mononuclear cells (PBMC) from Holstein calves, both experimentally-infected with bovine herpesvirus-l (BHV-l) and controls, was measured by flow cytometry. Expression of IL-2R alpha was 35 percent and 23 percent higher in infected calves than controls, on days 2 and 3 postinfection (PI), respectively. Concurrent with this increase in IL-2R alpha expression, a significant decrease (P < 0.001) was observed in the PHA-induced proliferative responses of PBMC from infected compared with control calves. In vitro treatment with recombinant human (rhu) IL-12 enhanced PHA-induced proliferative responses of PBMC from both infected and control calves. This rhuIL-12 enhancement of mitogen-induced proliferative responses was significant (P < 0.001) in infected calves on day 2 PI and was sufficient to abrogate the decrease observed due to BHV-1 infection. Since the expression of the beta and gamma chains of IL-2R was not measured it is difficult to speculate as to the status of high affinity receptor expression during BHV-1 infection. However results of the present study suggest that the decrease in proliferative responses observed during infection may not be due to a decrease in IL-2R alpha expression but may possibly be due to a selective down-regulation of signal transduction through IL-2R and/or by modulation of the expression of other cytokines involved in lymphocyte activation and proliferation.

Demographic and epidemiological aspects of plastic surgery: profile of a supradistrict specialty

The workload of plastic surgery is often poorly understood by the public and those responsible for financing health care. The authors have used linked statistical data to analyse demographic and epidemiological profiles of workload in plastic surgery in Oxfordshire. The analyses were constructed for residents of the district and for patients treated from other districts. The former provides a profile of workload generated for plastic surgery from a geographically-defined population. The latter complements this by adding information about 'imported' workload. Admission rates for plastic surgery were higher for children and elderly people than for other age groups; higher for males than females; and they increased during the 11 years of the study. Most of the increase represented an increase in people treated by the service, rather than an increase in readmissions, although there was a modest increase in the latter too. Lengths of stay per admission and total time spent in hospital per person declined considerably. The bulk of the workload in plastic surgery is concerned with the treatment of trauma (including burns), cancer and congenital malformations. The main clinical conditions treated by the specialty are documented distinguishing, for each condition, the extent to which the patients came from outside the authority in which the provider unit is cited.

Pyrolysis of Aryl Azides. XIII. Conformational Effects on the Ability of Carbonyl as a Neighbouring Group

Our previous claim, that locking an ortho carbonyl group into a favourable conformation causes very large increases in the rate of thermolysis of aryl azides , has been reexamined. In 8-azido-5-methoxy-1-tetralone the rate advantage over an azide with a rotatable ortho acetyl group is estimated to be only 18-fold. Nevertheless, this factor is large enough to invalidate attempts to explain relative neighbouring group abilities on simple electronic effects alone. The very large rate increases we reported previously for 1-azidoacridin-g(10H)-one and 1-azidoanthracene-9,10-dione are partly due to favourable retention of conjugation in the transition state.

Effect of stress on interleukin-2 receptor expression by bovine mononuclear leukocytes

Holstein calves given three consecutive i.m. injections of dexamethasone (DEX) (0.04 mg kg-1) showed lymphopenia and neutrophilia with increased numbers of mature neutrophils on post-injection Days 1 and 2, but these values returned to normal levels by post-injection Day 3. Interleukin-2 receptor (IL-2R) expression by peripheral blood mononuclear cells (PBMC) was evaluated by flow cytometry using a monoclonal antibody specific for bovine IL-2R alpha. Treatment with DEX significantly decreased expression of IL-2R alpha in Concanavalin A (Con A)-activated PBMC on Day 1 (P < 0.02) and on Day 2 (P < 0.1). On Day 3, expression of IL-2R alpha by PBMC was similar in control and DEX-treated calves. This decrease in IL-2R alpha expression correlated with decreased proliferative responses of PBMC to the T-cell mitogens, phytohemagglutinin (PHA) and Con A. Following in vitro treatment with recombinant human (rhu) interleukin-12 (IL-12) Con A-induced proliferative responses of PBMC tended to be higher in both groups. However, the rhu IL-12 induced increase of Con A activated proliferative responses were significantly greater in DEX-treated calves than in control calves. IL-2R alpha expression by PBMC was found to be less in calves transported 800 km in a truck as compared to that in PBMC from controls. These data suggest that stress-induced immunosuppression in calves may involve decreased IL-2R alpha expression and decreased IL-12 production. Serum chemistry results indicated a trend toward higher creatine kinase (CK) levels in DEX-treated calves. This may be due to the lysis of corticosteroid sensitive lymphocytes.

Analgesia after thoracotomy: effects of epidural fentanyl concentration/infusion rate

After thoracotomy some patients have discomfort, primarily in the rostral portion of their incisions. In this prospective, randomized study in 66 patients after lateral thoracotomy we evaluated whether, for equal fentanyl dosage in micrograms per kilogram, epidural infusion (lumbar catheter) of fentanyl 5 micrograms/mL provided better segmental analgesia (including the rostral portion of the incision) than a 10-micrograms/mL concentration infused at a rate half that used in the 5-micrograms/mL group. Ketorolac was used as an analgesic adjunct for nonincisional pain. Postoperative epidural fentanyl infusion included a 1-microgram/kg initial dose and an initial infusion rate of 1 microgram.kg-1.h-1 in both the 5-micrograms/mL and 10-micrograms/mL groups. Patients were evaluated for comfort level and pain relief while resting, taking a deep breath, coughing, and ambulating at eight times over 3 days using two visual analog scales for overall comfort and a verbal rating score (VRS) for segmental analgesia. There were no significant differences in demographics, surgical procedure, intraoperative fentanyl dose, side effects, rates of epidural fentanyl infusion, or total epidural fentanyl doses at 12, 24, 36, 48, and 60 h postbolus. Analgesia was effective in both groups. Although overall comfort levels were lower (i.e., indicated greater comfort) in the 5-micrograms/mL group in 6 of 8 visual analog scores (VASs) for comfort level and 20 of 24 VRSs for comfort level scores, and mean VRSs for the rostral portion of the incision were lower (i.e., indicated greater comfort) in the 5-micrograms/mL group at 21 of 24 evaluation subsets (one statistically significant), statistical significance was achieved in only six evaluation subsets.(ABSTRACT TRUNCATED AT 250 WORDS)

In-patient workload in medical specialties: 1. Demographic profiles and time trends from linked statistics

Admission rates, multiple admissions per individual and time spent in hospital in general medical and geriatric care are described using data from the Oxford Record Linkage Study from 1968-86. For patients aged 15-39 years, age-specific admission rates did not vary appreciably with age and were a little higher in women than in men. For patients aged 40 years and over, admission rates rose steeply with age and were considerably higher in men than in women. Admission rates, measured as episodes, increased over time by 3.4% per year in women and 3.7% in men. Measured as individual people admitted per year, they increased by 2.2% per year people in women and 2.6% in men. Expressed as age-standardized rates, they increased by 1.5% per year in women and 1.8% in men. The greater rise in episodes than in people treated reflected an increase in repeat admissions per patient admitted. Mean length of stay per hospital episode and total time spent in hospital per patient admitted per year both showed a consistent decline over time. Increases in admission rates were seen in all of the common broad clinical groupings studied, except infectious diseases which, as a group, showed a mean annual decrease of just over 2% per year.

In-patient workload in medical specialties: 2. Profiles of individual diagnoses from linked statistics

We analysed hospital use for 58 common clinical conditions in the medical specialties, using data from the two districts covered by the Oxford record linkage study 1968-1986. Episode rates, person rates, and ratios of multiple admissions per person were computed. In young adults, poisoning was the most common reason for admission. In older adults, the most common clinical conditions included atherosclerotic diseases and smoking-related lung diseases. Comparing the first and last time periods studied, admission rates increased by 10% or more in 37 of the 58 conditions, including 7 of the 10 conditions with the highest overall hospitalization rates. Conditions in which admissions increased by 10% or more included myocardial infarction, other ischaemic heart disease, chronic obstructive lung disease, asthma, pneumonia, diabetes, poisoning, dementia, prostate cancer and breast cancer among others. Workload declined by 10% or more in 13 conditions, including stroke, subarachnoid haemorrhage, hypertension, thyrotoxicosis, acquired hypothyroidism, and tuberculosis. Secular trends in hospital use are generally attributable either to changes in disease frequency in the population or to changes in clinic- or hospital-based technology and practice.

Workload in trauma and orthopaedic surgery: use of linked statistics to profile a specialty

We have used linked hospital morbidity statistics to construct a basic profile of the demographic and epidemiological features of trauma and orthopaedic surgery in a defined population. This paper reports on this profile and illustrates trends in the specialty between 1976-86. During this period episode-based inpatient admission rates rose by about 20%. Multiple admissions per person varied with age but did not increase over time. Thus the increase in admission rates in this specialty represented an increase in numbers of people who received treatment. Average length of stay per episode of inpatient care and the total time spent in hospital per person declined over time. New outpatient attendance rates increased by 19% in the 11-year period. The ratio of follow-up outpatient appointments to new appointments fell from 2.68:1 to 2.24:1; the number of inpatient beds fell by about 13% and bed occupancy remained stable at about 80%. We describe some of the major components of clinical workload in the specialty, with emphasis on conditions for which admission rates changed over time, relating the data to numbers of people treated as well as to episodes of care.

Pyrolysis of Aryl Azides. XII. Mechanistic Implications of the Very Small Neighboring Group Effects Across the 2,3-Bond of 2-Azidonaphthalene

2-Azidonaphthalenes with nitro, acetyl, benzoyl and methoxycarbonyl substituents in the 3-position have been synthesized and then pyrolysed in nitrobenzene solution. At 120°, the rates (relative to 2-azidonaphthalene) are respectively 27.9, 24.8, 5.00 and 3.67. These very small neighbouring group effects are consistent with a transition state which has considerable quinonoid character. No evidence of cyclic products was obtained from the two azides with nitro and ester neighbouring groups. With the two azido ketones there was infrared spectroscopic evidence of clean cyclization in dilute solution, to form the corresponding naphth [2,3-c] isoxazole. Our attempts to isolate these two naphthisoxazoles led to decomposition, though 3-methylnaphth[2,3-c] isoxazole has been reported previously ( Friedrichsen and Kaschner 1977).

Esthesioneuroblastoma: the role of adjuvant radiation therapy

PURPOSE

We describe our experience with adjuvant radiation therapy in patients who underwent operation for esthesioneuroblastoma.

METHODS AND MATERIALS

Between January 1951 and December 1990, 49 patients with esthesioneuroblastoma received their initial treatment at the Mayo Clinic. There were 27 male and 22 female patients; their ages ranged from 3 to 79 years (median, 54 years). The tumors were Kadish Stage A in 4 patients, Stage B in 13, Stage C in 29, and modified Kadish Stage D in three (cervical nodal or distant metastasis). The tumors were graded according to Hyams' classification. Treatment included gross total resection alone in 22 patients and gross total resection and postoperative adjuvant radiation therapy in 16. The patients treated with adjuvant radiation had a greater proportion of advanced-stage and high-grade tumors.

RESULTS

The 5-year actuarial overall survival, disease-free survival, and local control rates were 69.1% + 7.0%, 54.8% + 7.6%, and 65.3% + 7.4%, respectively. The only significant predictor for overall survival, disease-free survival, and local control was Hyams' grade. Local control was improved in patients who received postoperative adjuvant radiation even though this group of patients had more advanced and higher-grade tumors (5-year rate of local control was 85.9% + 9.3%, compared with 72.7% + 9.5% for those who had operation alone, p = 0.26).

CONCLUSION

Adjuvant radiation therapy for esthesioneuroblastoma improves local tumor control, particularly for high-grade and high-stage tumors. We recommend additional treatment with radiation (55.5 Gy) after complete resection of esthesioneuroblastoma.

Computational prediction of the stability of lipid emulsions in total nutrient admixtures

The relationships between the stability of lipid emulsions in a number of parenteral total nutrient admixtures (TNAs) and their electrokinetic properties were examined. Previous studies have attempted to measure or calculate zeta potentials of lipid emulsions in nutrient admixtures to rationalize their stability behavior, but there has been no demonstration that zeta potentials do actually determine emulsion stability or that such computational approaches can be successful. The present study demonstrates that emulsion stability in a range of TNAs is dependent on the emulsion zeta potential and also that van der Waals forces, influenced by the presence of glucose, are important. By accounting for these factors we show that it is possible to calculate the stability of TNAs by Deryaguin-Landau-Verwey-Overbeck-based methods and obtain reasonable agreement with experimental stability data in most systems.

Profiles of workload in general surgery from linked hospital statistics

Data from the Oxford Record Linkage Study between 1976 and 1986 were used to analyse statistical profiles of hospital care, taking account of multiple admissions per patient. Admission rates were higher in the elderly than the young, they were higher for men than women, and they increased over time. Episode-based admission rates increased by 15.5 per cent and person-based rates by 11.6 per cent. Most of the increase therefore represented a real rise in the number of people treated rather than an increase in multiple admissions per person. In the latest year of the study there was a mean of 125 admissions per annum per 100 male patients admitted and of 118 admissions per annum per 100 female patients admitted. The mean length of stay per admission and the total time spent in hospital per person per annum declined substantially from 1976 to 1986. Admission rates for prostatectomy, colectomy and varicose vein surgery increased significantly and those for appendicectomy, cholecystectomy and peptic ulcer decreased significantly.

An epidemiological profile of in-patient workload in dermatology

Trends in admission rates, patterns of readmission, lengths of stay and clinical caseload for in-patient dermatology from 1976 to 1985 are described using data from the Oxford record-linkage study. Age-specific admission rates were considerably higher in people aged 50 years and over than in younger people. Admission rates declined over time in most age-sex groups below the age of 70 years, but increased over time for the over 70s. In dermatology, unlike most other specialties, the length of patients' stay did not decrease substantially over the 10 years. In-patient workload consisted predominantly of leg ulcers, psoriasis, and eczema. This did not change appreciably over time. New out-patients at dermatology clinics rose by 41% from 1976 to 1985, and all out-patient visits rose by 20% during the 10-year period. Because the profile of in-patient workload changed relatively little over time, we speculate that the impact of innovations in dermatological practice has been much greater in the ambulatory setting than in the management of those patients requiring prolonged in-patient care. Future routine measures of workload in dermatology should include demographic and clinical data on out-patients.

Pain following coronary artery bypass grafting: an exploration of contributing factors

Patients suffer pain and discomfort in ICU following coronary artery bypass grafting (CABG). While the surgical procedure causes pain, it is the psychological state of the individual which influences his perception of the pain. For the patient undergoing cardiac surgery, several stressors may influence his psychological state, including coronary heart disease (CHD) itself, impending surgery and the intensive care unit (ICU) environment. The types of pain caused by the surgical procedure are discussed. Each of these aspects are brought together in an attempt to gain a better understanding of the patient's perspective of cardiac surgery, and any pain experienced as a result. Given the major influence of the patient's mind in pain perception, there is a need for nurses to consider alternative methods of pain relief in addition to drug therapy.

Workload in oral and maxillofacial surgery: analysis of time trends from linked statistics in a defined population

Data from the Oxford Region were used to study trends in hospital admission rates and demographic profiles of hospital care in the National Health Service in oral and maxillofacial surgery. In a defined population of 1.9 million people, admission rates for inpatient care, day case care, and outpatient attendance rates all almost doubled between 1975-1985. Population-based age-specific admission rates were much higher in teenagers and young adults than in other age-groups. In these age-groups admission rates for females were about double those for males. Whilst perhaps not surprising to the oral and maxillofacial surgeon, these demographic profiles of workload are strikingly different from those found in most other hospital specialties.

Some epidemiological observations on medicinal and non-medicinal poisoning in preschool children

STUDY OBJECTIVE

The aim was to identify and compare rates of admission to hospital of preschool children for medicinal and non-medicinal poisoning in a defined population.

DESIGN

The study was an analysis of computerised abstracts of hospital inpatient records for poisoning.

SETTING

Six districts in southern England covered by the Oxford record linkage study.

SUBJECTS

The subjects were children under six years of age residing in the six districts from 1975 to 1986.

MEASUREMENTS AND MAIN RESULTS

6152 children, drawn from an average annual resident population of 164,000 children in 1975-1986, experienced 6562 hospital admissions for poisoning before six years; 3702 (56.4%) were attributed to medicinal and 2860 (43.6%) to non-medicinal agents. Of the latter, 646 (9.8% of the total) were recorded under the International classification of diseases code, described as "noxious food" (almost exclusively plant material). Average annual admission rates in children under six were 1.88 per 1000 for medicinal agents and 1.45 for non-medicinal substances. Analgesics accounted for 28.1% of the admissions for medicinal poisoning; berries and mushrooms for 97.4% of the plant materials; and corrosive aromatics, acids and alkalis for 22.0% of the other non-medicinals. Admission rates were higher in males than females in each category of poisoning. In children aged 1-4 years there was a significant decrease in admission rates between 1975 and 1986, averaging per annum 5.8% for medicinal poisoning, 6.9% for non-medicinal poisoning (excluding plant material), and 12.8% for plant material poisoning. Significant seasonal variation was found for each class of poisoning.

CONCLUSIONS

Admission rates for medicinal and non-medicinal poisoning in preschool children declined between 1975 and 1986. The decline could reflect a change in thresholds for admission although, if so, this would be against the general trend in paediatric medical admissions, which is upward. An alternative explanation is a decline in the incidence of poisoning.

Pyrolysis of Aryl Azides. XI. Enhanced Neighboring Group Effects of Carbonyl in a Locked Conformation

Rates of pyrolysis in nitrobenzene solution have been measured for 1-azido-9H-fluoren-9- one, 1-azido-9H-xanthen-9-one, 1-azidoacridin-9(10H)-one and 1-azidoanthracene-9,1O-dione; relative to azidobenzene at 120� these were respectively 5.68, 1750, 5090 and 18400. The lack of neighbouring group participation for the first azide is related to the large distance between carbonyl oxygen and the inner azido nitrogen atom, and the data argue against a published proposal that the transition state is stabilized by electrostatic attraction. In the remaining azides, the 'locked conformation' leads to much larger neighbouring group assistance than is observed for freely rotating ortho groups such as benzoyl (krel79). Only the last azide yields an isoxazole on pyrolysis , the second and third ones providing the first reported examples of neighbouring -group-assisted pyrolysis in which no cyclic product is obtained. These results are interpreted in terms of an electrocyclic mechanism in which the transition state is early and N---0 bond formation is less advanced than other changes in bonds. Much of the rate enhancement is attributed to an electron distribution which favours nitrogen loss. 1-Aminoanthracen-9(10H)-one, 1-amino-9H-fluoren-9-one and 1-amino-9H-xanthen-9-one do not yield the corresponding isoxazoles when oxidative cyclization is attempted.

Melatonin therapy of advanced human malignant melanoma

We undertook a study to investigate the therapeutic potential of orally administered melatonin in patients with advanced melanoma. Forty-two patients received melatonin in doses ranging from 5 mg/m2/day to 700 mg/m2/day in four divided doses. Two were excluded from analysis. After a median follow-up of 5 weeks, six patients had partial responses, six additional patients had stable disease. Sites of response included the central nervous system, subcutaneous tissue and lung. The median response duration was 33 weeks for the partial responders. There was a suggestion of a dose-response relationship. The toxicity encountered was minimal and consisted primarily of fatigue in 17 of 40 patients. Melatonin also appeared to reduce basal levels of follicle-stimulating hormone (FSH). No significant changes were encountered in serum levels of luteinizing hormone (LH) or thyroid stimulating hormone (TSH). We conclude that further study of melatonin as a potentially useful agent in metastatic melanoma is warranted.

Workload trends in otolaryngology: some statistical observations from medical record linkage

Trends in admission rates, lengths of stay, and clinical case mix (adjusted for multiple admissions per person) for Otolaryngology from 1975 to 1985 are described using the Oxford Record Linkage Study. Person-based admission rates increased generally, most strikingly amongst children and adolescents. Both length of stay per episode and total number of days an individual stayed in hospital each year decreased. Operations on tonsils and adenoids decreased averaging 2.2% per annum; admissions for diagnoses for otitis media with effusion increased averaging 8.2% per annum; for the operations of myringotomy and tympanostomy tube insertion increased averaging 9.2% per annum; for other diagnoses related to the ear increased averaging 5.7% per annum; and admissions for malignant neoplasms decreased averaging 2.0% per annum. Clearly more people are being treated for a changing case mix. The largest increases are occurring with children and adolescents.

Audit of workload in gynaecology: analysis of time trends from linked statistics

OBJECTIVE

To report on trends in workload patterns in gynaecology using linked statistical data.

DESIGN

Retrospective analysis of linked abstracts of hospital inpatient and day case records for patients treated in the National Health Service in gynaecology.

SETTING

Six health districts in the south of England covered by the Oxford record linkage study.

SUBJECTS

Records for hospital admissions to gynaecology (excluding obstetric admissions) from 1975 to 1985.

MEASUREMENT AND MAIN RESULTS

Inpatient episodes increased by 23.5% and day case episodes increased by 13.1%. More people treated contributed about 90% and increased readmissions contributed about 10% to the increase in workload. The workload was decreased by strike action in 1975 and 1981-2. Average length of stay decreased substantially and consistently over the 11 years. Emergency readmissions increased annually by an average of 2.7%. Admission rates in 11 groups of surgical procedures accounting for 85% of all gynaecological inpatients are reported, and increases occurred in 10 of the 11 groups. For example, average increases in annual admission rates were 1.0% for sterilization, 1.9% for legal abortion and 8.2% for biopsy of the cervix, the rate for dilatation and curettage decreased by 1.4%.

CONCLUSIONS

The increase in admission rates in gynaecology was almost entirely due to increases in numbers of people treated. The rise would have been even greater if the increase in private patients had been considered. The increase may reflect increased expectations on the part of patients and their doctors, advances in technology and increased bed availability due to declining lengths of stay.

Ophthalmology in the Oxford region: analysis of time trends from linked statistics

OBJECTIVES

to report on trends in ophthalmology workload using linked statistical data;

DESIGN

analysis of linked abstracts of hospital inpatient and day case records for ophthalmology;

SETTING

six districts in Southern England covered by the Oxford record linkage study;

SUBJECTS

records for hospital admissions to ophthalmology from 1975 to 1985;

MEASUREMENTS AND MAIN RESULTS

Over the period of study, the number of episodes of inpatient and day case care increased by 16.3%. Notable increases in age-specific admission rates were seen among the elderly. An increase in the number of individuals treated contributed about 67% and an increase in multiple admissions per individual contributed about 33% to the increase in admission rates. Both average length of stay per episode and total time in hospital per individual decreased consistently during the 11 years; and there was no increase in emergency readmissions over time. No significant changes over time were found in admission rates for retinal detachments and defects or for glaucoma. There was a statistically significant increase averaging 4.8% per annum in admission rates for cataract, and a significant decrease averaging 5.2% per annum in admission rates for strabismus and other disorders of binocular eye movement between 1975 and 1985.

CONCLUSIONS

Age-specific admission rates in ophthalmology are much higher in the very young and old than in other age groups. Patterns of work in the specialty are therefore particularly affected by variation in the age distribution of the population. The increase in cataract surgery reflected both the increase in numbers of old people in the population and an increase in age-specific operation rates for cataract. Attempts to alter attitudes and behaviour of the elderly regarding eye diseases, disability, and facilities for treatment may have had a positive impact on the use of services. The decrease in admissions for children probably reflects the impact made by child health surveillance programmes. As the child screening programme has expanded, the admission rates for strabismus have decreased.

Predictors of pesticide poisoning

The analysis of 1,026 reports of suspected pesticide poisonings to the regional Poison Control Centre at the Hospital for Sick Children, Toronto consisted of 597 (58.2%) cases less than six years of age. Age was the strongest predictor: there was a risk of 3.1 that young children would encounter rodenticide poisoning compared to that of insecticides; a ten-fold risk of having symptoms from pesticide poisoning if the victim was over five years of age; an increased risk of 5.9 of exposure to moderate or large amounts of pesticide, compared to small quantities, for those over five years of age; and there was less treatment referral for young children, and a 5.7 risk of being referred if the victim was over the age of five years. Other significant predictor variables include the type of person making the inquiry (lay or physician/nurse), the calendar season of the event, and the location (metropolitan or nonmetropolitan) of the event.

Suspected Pesticide Poisoning: Evaluating calls to a poison control center

Of 1125 calls to a regional poison control center about suspected pesticide poisonings, more than half concerned children younger than 6 years, most of whom had ingested small amounts and required no treatment other than drinking fluids. Adults represented a small proportion of victims, but were more likely to have consumed moderate or large quantities, to have symptoms, and to need referral.