The prevalence of eHealth literacy and its relationship with perceived health status and psychological distress during Covid-19: a cross-sectional study of older adults in Blekinge, Sweden

BACKGROUND AND AIMS

eHealth literacy is important as it influences health-promoting behaviors and health. The ability to use eHealth resources is essential to maintaining health, especially during COVID-19 when both physical and psychological health were affected. This study aimed to assess the prevalence of eHealth literacy and its association with psychological distress and perceived health status among older adults in Blekinge, Sweden. Furthermore, this study aimed to assess if perceived health status influences the association between eHealth literacy and psychological distress.

METHODS

This cross-sectional study (October 2021-December 2021) included 678 older adults' as participants of the Swedish National Study on Aging and Care, Blekinge (SNAC-B). These participants were sent questionnaires about their use of Information and Communications Technology (ICT) during the COVID-19 pandemic. In this study, we conducted the statistical analysis using the Kruskal-Wallis one-way analysis of variance, Kendall's tau-b rank correlation, and multiple linear regression.

RESULTS

We found that 68.4% of the participants had moderate to high levels of eHealth literacy in the population. Being female, age [Formula: see text] years, and having a higher education are associated with high eHealth literacy ([Formula: see text]). eHealth literacy is significantly correlated ([Formula: see text]=0.12, p-value=0.002) and associated with perceived health status ([Formula: see text]=0.39, p-value=0.008). It is also significantly correlated ([Formula: see text]=-0.12, p-value=0.001) and associated with psychological distress ([Formula: see text]=-0.14, p-value=0.002). The interaction of eHealth literacy and good perceived health status reduced psychological distress ([Formula: see text]=-0.30, p-value=0.002).

CONCLUSIONS

In our cross-sectional study, we found that the point prevalence of eHealth literacy among older adults living in Blekinge, Sweden is moderate to high, which is a positive finding. However, there are still differences among older adults based on factors such as being female, younger than 75 years, highly educated, in good health, and without psychological distress. The results indicated that psychological distress could be mitigated during the pandemic by increasing eHealth literacy and maintaining good health status.

Five-factor model, technology enthusiasm and technology anxiety

Older adults need to participate in the digital society, as societal and personal changes and what they do with the remaining time that they have in their older years has an undeniable effect on motivation, cognition and emotion. Changes in personality traits were investigated in older adults over the period 2019-2021. Technology enthusiasm and technology anxiety are attitudes that affect the relationship to the technology used. The changes in the score of technology enthusiasm and technology anxiety were the dependent variables. They were investigated with personality traits, age, gender, education, whether someone lives alone, cognitive function, digital social participation (DSP) and health literacy as predictors of the outcome. The Edwards-Nunnally index and logistic regression were used. The results indicated that DSP, lower age, lower neuroticism and higher education were indicative of less technology anxiety. High DSP and high extraversion are indicative of technology enthusiasm. DSP and attitude towards technology seem to be key in getting older adults to stay active online.

Psychological Health and Digital Social Participation of the Older Adults during the COVID-19 Pandemic in Blekinge, Sweden-An Exploratory Study

COVID-19 has affected the psychological health of older adults directly and indirectly through recommendations of social distancing and isolation. Using the internet or digital tools to participate in society, one might mitigate the effects of COVID-19 on psychological health. This study explores the social participation of older adults through internet use as a social platform during COVID-19 and its relationship with various psychological health aspects. In this study, we used the survey as a research method, and we collected data through telephonic interviews; and online and paper-based questionnaires. The results showed an association of digital social participation with age and feeling lack of company. Furthermore, in addition, to the increase in internet use in older adults in Sweden during COVID-19, we conclude that digital social participation is essential to maintain psychological health in older adults.

'Double Whamm' and 'Triple Whamm' combinations in hospitalized surgical patients - real life data from a tertiary teaching hospital

The 'Triple-Whamm'-combination (TW) of renin-angiotensin-aldosteron-system-inhibitors (RAASI), diuretics and non-steroidal anti-inflammatory drugs (NSAID) can cause acute kidney injury (AKI), especially with additional risk factors like chronic kidney disease (CKD) or surgery. Thus, patients on 'Double-Whammy'-combination (DW) of RAASI and diuretics should receive postoperative NSAID only following risk-benefit-evaluation. Currently, there are no data how often surgical patients take DW/TW at admission and postoperatively. The objective of this study was to firstly assess the prevalence of DW/TW-patients, secondly, to evaluate postoperative NSAID use in DW-patients and possible effects on renal function (RF). In a seven-month retrospective study, the pre-hospital medication of patients admitted to surgical wards of a tertiary teaching hospital was screened for intake of TW-drugs and renal impairment (RI; eGFR <60 ml/min/1.73 m 2 ), respectively. For patients admitted with a DW-combination of RAASI and diuretic and undergoing surgery, postoperative NSAID use was recorded and checked against internal guidelines for postoperative pain management recommending as first line NSAID therapy ibuprofen in bone surgery and novaminsulfone in visceral surgery. If NSAID were taken, RF was followed for five days. Of 2007 patients, 343 (17.1%) presented with DW in pre-hospital medication and 28 (1.4%) with TW, which 19/28 (67.9%) took only on demand. Upon admission, RI was present in 113 (32.9%) DW-patients and 9 (33.3%) TW-patients. 227/343 (66.2%) DW-patients underwent surgery and 34/227 (15.0%) were prescribed postoperative NSAID. 24/227 (10.6%) actually received NSAID and 4/24 (16.7%) had a decrease of RF with one showing AKI. In our hospitalized surgical patients, TW-combination in pre-hospital medication was rare. The intake of DW-combination was common but only a small number actually received NSAID after surgery. When a TW-combination was given postoperatively, renal function decreased in every sixth patient. Thus, the absolute number of AKI following a TW-combination was small, however, the individual risk for TW-caused AKI should be considered when choosing postoperative pain management. Guidelines for postoperative NSAID use should consider the patient individual risk factors for AKI, thereby increasing drug safety.

[Current indications for plasma therapy in dermatology]

BACKGROUND

Plasma medicine is gaining increasing interest and provides a multitude of dermatological applications. Cold atmospheric pressure plasma (CAP) can be used in clinical applications without harming the treated tissue or in a tissue destructive manner. It consists of a complex mixture of biologically active agents, which can act synergistically on the treated material or tissue.

OBJECTIVES

A summary of the current research findings regarding dermatological applications of CAP is provided.

METHODS

Literature on CAP applications in dermatology has been screened and summarized.

RESULTS

CAP exerts antimicrobial, tissue-stimulating, blood-flow-stimulating but also pro-apoptotic effects. By exploiting these properties, CAP is successfully applied for disinfection and treatment of chronic ulcerations. Furthermore, positive effects of CAP have been shown for the treatment of tumors, actinic keratosis, scars, ichthyosis, atopic eczema as well as for alleviation of pain and itch.

CONCLUSIONS

While the use of CAP for disinfection and wound treatment has already moved into clinical practice, further applications such as cancer treatment are still exploratory.

Association of Maternal Vitamin D Deficiency with Early Childhood Caries

Alaska Native (AN) children experience one of the highest reported rates of severe early childhood caries (S-ECC). Serum vitamin D concentrations in AN childbearing women in the Yukon Kuskokwim Delta (YKD) region have decreased since the 1960s to currently low levels, related to a decrease in traditional marine diet. Recent studies suggest an association between prenatal vitamin D (25(OH)D) concentrations in mothers and S-ECC in their infants. We used independent t tests to analyze the influence of prenatal 25(OH)D levels in YKD AN mothers on S-ECC in their children using data collected in the Maternal Organics Monitoring Study (MOMS). Maternal 25(OH)D levels were assessed at prenatal visits and in cord blood. We queried electronic dental records to assess early childhood caries (ECC) status using highest decayed, missing, filled, primary teeth (dmft) scores at 12 to 59 mo of age. We examined prenatal and cord blood for 76 and 57 mother/infant pairs, respectively. Children 12 to 35 mo of age with "deficient" cord blood (25(OH)D <30 nmol/L) had a mean dmft score twice as high as children who were "nondeficient" at birth (9.3 vs. 4.7; P = 0.002). There was no significant difference in mean dmft scores for children aged 36 to 59 mo with deficient versus nondeficient cord blood 25(OH)D (10.9 vs. 8.7 P = 0.14). There was no significant difference in mean dmft scores for children aged 12 to 35 mo whose mothers had "sufficient" versus "insufficient" 25(OH)D during prenatal visits (9.0 vs. 7.4; P = 0.48). In this small sample, children with deficient vitamin D levels in cord blood had a dmft score at 12 to 35 mo 2-fold higher than children with nondeficient cord blood. Maternal 25(OH)D may influence the primary dentition, and improving vitamin D status in pregnant women might affect ECC rates in their infants.

Managing Uncertainty in Runoff Estimation with the U.S. Environmental Protection Agency National Stormwater Calculator

The U.S. Environmental Protection Agency National Stormwater Calculator (NSWC) simplifies the task of estimating runoff through a straightforward simulation process based on the EPA Stormwater Management Model. The NSWC accesses localized climate and soil hydrology data, and options to experiment with low-impact development (LID) features for parcels up to 5 ha in size. We discuss how the NSWC treats the urban hydrologic cycle and focus on the estimation uncertainty in soil hydrology and its impact on runoff simulation by comparing field-measured soil hydrologic data from 12 cities to corresponding NSWC estimates in three case studies. The default NSWC hydraulic conductivity is 10.1 mm/h, which underestimates conductivity measurements for New Orleans, Louisiana (95 ± 27 mm/h) and overestimates that for Omaha, Nebraska (3.0 ± 1.0 mm/h). Across all cities, the NSWC prediction, on average, underestimated hydraulic conductivity by 10.5 mm/h compared to corresponding measured values. In evaluating how LID interact with soil hydrology and runoff response, we found direct hydrologic interaction with pre-existing soil shows high sensitivity in runoff prediction, whereas LID isolated from soils show less impact. Simulations with LID on higher permeability soils indicate that nearly all of pre-LID runoff is treated; while features interacting with less-permeable soils treat only 50%. We highlight the NSWC as a screening-level tool for site runoff dynamics and its suitability in stormwater management.

Future directions for monitoring and human health research for the Arctic Monitoring and Assessment Programme

For the last two and a half decades, a network of human health experts under the Arctic Monitoring and Assessment Program (AMAP) has produced several human health assessment reports. These reports have provided a base of scientific knowledge regarding environmental contaminants and their impact on human health in the Arctic. These reports provide scientific information and policy-relevant recommendations to Arctic governments. They also support international agreements such as the Stockholm Convention on Persistent Organic Pollutants (POPs) and the Minamata Convention on Mercury. Key topics discussed in this paper regarding future human health research in the circumpolar Arctic are continued contaminant biomonitoring, health effects research and risk communication. The objective of this paper is to describe knowledge gaps and future priorities for these fields.

Molecular Characterization of Cellular Proteins from Colorectal Tumors

Aims and background

Recent evidence has suggested that progressive stages of colorectal tumorigenesis can be defined by a sequence of genetic events characterized by altered expression of certain genes and the appearance of cancer-specific proteins. Although the significance of these events is still not clear, expression of cancer-specific protein components may be directly involved in the neoplastic transformation. The purpose of the present study was to compare molecular characteristics of cellular proteins from human colorectal tumors and normal colonic mucosa.

Methods

Normal mucosa and colorectal tumors from 18 patients were fractionated by a differential centrifugation scheme into four cellular fractions, i.e., nuclear, mitochondrial (10P), microsomal (100P) and cytosolic (100S). The proteins of these fractions from normal and tumorigenic mucosa were analyzed by one-dimensional polyacrylamide gel electrophoresis followed by Coomassie brilliant blue R-250 and silver nitrate staining. Nuclear proteins from normal and neoplastic tissues which had revealed the most significant diversities were further characterized by two-dimensional gel electrophoresis. Electrophoretically cancer-specific nuclear proteins in the molecular mass zone 35-40 kDa were used as immunogen to produce rabbit polyclonal antibodies.

Results

Electrophoretic analysis by one-dimensional gel electrophoresis showed clear differences in molecular characteristics of cellular proteins between normal and tumorigenic mucosa, especially among nuclear fractions. The latter were also confirmed by their two-dimensional electrophoresis results. Rabbit antibodies raised against electrophoretically specific nuclear proteins characterized by molecular mass of 35-40 kDa cross-reacted with 36 kDa polypeptide in 15 of 18 (83.3%) studied nuclear fractions of colorectal tumors but not with any normal mucosa. In some cases, nuclear cancer-associated components of 38 and 40 kDa were also recognized by these antibodies.

Conclusions

During colorectal carcinogenesis, specific expression of several nuclear proteins takes place. One of them, the polypeptide of 36 kDa not found in normal colonic epithelium, was shared by over 83% of the studied carcinomas despite variations in detailed cancer properties. This particular nuclear protein may be considered as a potential marker for the colon malignancy.

Predictors in starting and stopping Internet use between 2002 and 2012 by Dutch adults 65 years and older

Research has indicated the need to consider the ageing process with technology adoption by older adults. This study examined psychological, health, social and demographic predictors with starting and stopping Internet use by older adults (2002–2012). Data were used from the Longitudinal Aging Study Amsterdam, and Cox regression analyses were done to test predictors over time with starting or stopping Internet use. The results indicated that older adults starting to use the Internet (11.6%) outnumbered those who stopped (3.1%). Psychological, health, social and demographic predictors separately predicted starting and stopping Internet use. Starting use was predicted by lower age, higher education, normal cognition and living alone. The predictors in stopping use were being younger, having a high sense of mastery and being higher educated. The results need to be interpreted as indicative due to the small number of stoppers. Suggestions are made on how to improve usability.

Case management for frail older adults through tablet computers and Skype

BACKGROUND

Frail older adults are high consumers of medical care due to their age and multiple chronic conditions. Regular contact with a case manager has been proven to increase well-being of frail older adults and reduce their number of health-care visits. Skype calls through tablet PCs can offer easier communication.

OBJECTIVE

This paper examines frail older adults' use of tablet computers and Skype, with their case managers.

METHOD

Interviews were conducted on 15 frail older adults. A content analysis was used to structure and analyze the data.

RESULTS

The results indicate that tablet computers were experienced in a positive way for most frail older adults. Conflicting feelings did emerge, however, as to whether the frail elderly would adopt this in the long run. Skype needs to be tested further as to whether this is a good solution for communication with their case managers. Strong technical support and well-functioning technology are important elements to facilitate use.

CONCLUSION

Using Skype and tablet PCs do have potential for frail older adults, but need to be tested further.

[Achilles tendinopathy]

Achilles tendinopathy (AT) is the most common cause of posterior heel pain. It is most often due to mechanical stress related to overload or overuse of muscle-tendon unit. It also may be associated in a minority of cases with inflammatory arthritis. Pain secondary to AT is generally located in the corporeal part of the tendon or its attachment to the bone and is worsened by exercise. Examination can reveal a painful swelling or thickening on palpation. Additional tests are not routinely recommended but may be useful. Treatment should be tailored to the stage of tendinopathy and to functional disability, and should include an assessment of predisposing factors, analgesia and physiotherapy. Other treatments (shock waves, ultrasound) are less well documented. The indications and effectiveness of infiltrations are controversial and are reserved for chronic AT. The risk benefit ratio should be well discussed with the patient.

[Best practice use of corticosteroids in rheumatoid arthritis]

Since the 50s oral glucocorticoids including prednisone are used in the management of rheumatoid arthritis due to their efficacy and the limited availability of the other treatments in the past. Thereafter numerous studies confirmed the usefulness of prednisone in controlling clinical inflammatory manifestations and the progression of radiographic damage. Sixty years later the position of prednisone in the treatment strategy of rheumatoid arthritis is still controversial, considering the presence of numerous side effects and the availability of other effective treatments. If prednisone can be reasonably used in some situations either as bridging therapy in combination with other treatments or in case of flare, its long-term use should be avoided.

Factors influencing Internet usage in older adults (65 years and above) living in rural and urban Sweden

Older adults living in rural and urban areas have shown to distinguish themselves in technology adoption; a clearer profile of their Internet use is important in order to provide better technological and health-care solutions. Older adults’ Internet use was investigated across large to midsize cities and rural Sweden. The sample consisted of 7181 older adults ranging from 59 to 100 years old. Internet use was investigated with age, education, gender, household economy, cognition, living alone/or with someone and rural/urban living. Logistic regression was used. Those living in rural areas used the Internet less than their urban counterparts. Being younger and higher educated influenced Internet use; for older urban adults, these factors as well as living with someone and having good cognitive functioning were influential. Solutions are needed to avoid the exclusion of some older adults by a society that is today being shaped by the Internet.

Hypoxic ventilatory response in Tac1-/- neonatal mice following exposure to opioids

Morphine is the dominating analgetic drug used in neonates, but opioid-induced respiratory depression limits its therapeutic use. In this study, we examined acute morphine effects on respiration during intermittent hypoxia in newborn Tac1 gene knockout mice (Tac1-/-) lacking substance P and neurokinin A. In vivo, plethysmography revealed a blunted hypoxic ventilatory response (HVR) in Tac1-/- mice. Morphine (10 mg/kg) depressed the HVR in wild-type animals through an effect on respiratory frequency, whereas it increased tidal volumes in Tac1-/- during hypoxia, resulting in increased minute ventilation. Apneas were reduced during the first hypoxic episode in both morphine-exposed groups, but were restored subsequently in Tac1-/- mice. Morphine did not affect ventilation or apnea prevalence during baseline conditions. In vitro, morphine (50 nM) had no impact on anoxic response of brain stem preparations of either strain. In contrast, it suppressed the inspiratory rhythm during normoxia and potentiated development of posthypoxic neuronal arrest, especially in Tac1-/-. Thus this phenotype has a higher sensitivity to the depressive effects of morphine on inspiratory rhythm generation, but morphine does not modify the reactivity to oxygen deprivation. In conclusion, although Tac1-/- mice are similar to wild-type animals during normoxia, they differed by displaying a reversed pattern with an improved HVR during intermittent hypoxia both in vivo and in vitro. These data suggest that opioids and the substance P-ergic system interact in the HVR, and that reducing the activity in the tachykinin system may alter the respiratory effects of opioid treatment in newborns.

Distribution of personality, individual characteristics and internet usage in Swedish older adults

OBJECTIVES

This article investigated factors associated with internet usage in the Swedish older adults ranging in age from 60 to 96. Personality traits and individual characteristics have been previously noted to influence internet usage, where older adults have not been the focus population. In this study, the relationships between personality, individual characteristics and internet usage were investigated.

METHODS

A descriptive analysis of the personality tests of a total of 1402 subjects included in the Swedish National Study on Aging and Care was conducted. Three variables were controlled for: sex, age and education. Descriptive statistics, Mann-Whitney and Kruskal-Wallis tests, chi-square tests and a logistic regression were used in order to detect the relationships with internet usage.

RESULTS

Men differ significantly from women in the personality traits analysis. Those with higher education were more open and neuroticism was lower in the oldest older adults. Internet usage declined significantly with age and those with middle to higher education were using the internet the most. No other associations with internet use were found.

CONCLUSION

Personality traits and individual characteristics do not seem to influence the Swedish older adult and their internet usage. What one needs to account for is the age and education of the person. The more educated and the youngest cohorts were using the internet more frequently.

Increased morphine analgesia and reduced side effects in mice lacking the tac1 gene

BACKGROUND AND PURPOSE

Although morphine is a very effective analgesic, its narrow therapeutic index and severe side effects limit its therapeutic use. Previous studies indicated that the pharmacological responses of opioids are modulated by genetic and pharmacological invalidation of tachykinin receptors. Here we address the role of substance P and neurokinin A, which are both encoded by the tachykinin 1 (tac1) gene, as modulators of opioid effects.

EXPERIMENTAL APPROACH

The analgesic and side effect potential of morphine was compared between wild-type and tac1 null mutant mice.

KEY RESULTS

Morphine was a more potent analgesic in tac1 null mutant mice, that is, in the absence of substance P/neurokinin A signalling. Interestingly, the most serious side effect of acute morphine, that is respiratory depression, was reduced in tac1(-/-) animals. Comparing the addictive potential of morphine in wild-type and knockout animals we found that morphine preference was similar between the genotypes. However, the aversive effect of withdrawal precipitated by naloxone in morphine-dependent animals was significantly reduced in tac1 knockout mice. Behavioural sensitization, the underlying mechanism of addiction, was also significantly lower in tac1(-/-) mice.

CONCLUSION AND IMPLICATIONS

The analgesic potential of morphine was increased in tac1 knockout mice. In contrast, both the ventilatory suppressing effect and the addictive potential of morphine were reduced. These results suggest that reducing activity of the tachykinin system may be a possible strategy to improve the pharmacological potential of morphine.

Impact of a quasi-stochastic cellular automaton backscatter scheme on the systematic error and seasonal prediction skill of a global climate model

The impact of a nonlinear dynamic cellular automaton (CA) model, as a representation of the partially stochastic aspects of unresolved scales in global climate models, is studied in the European Centre for Medium Range Weather Forecasts coupled ocean-atmosphere model. Two separate aspects are discussed: impact on the systematic error of the model, and impact on the skill of seasonal forecasts. Significant reductions of systematic error are found both in the tropics and in the extratropics. Such reductions can be understood in terms of the inherently nonlinear nature of climate, in particular how energy injected by the CA at the near-grid scale can backscatter nonlinearly to larger scales. In addition, significant improvements in the probabilistic skill of seasonal forecasts are found in terms of a number of different variables such as temperature, precipitation and sea-level pressure. Such increases in skill can be understood both in terms of the reduction of systematic error as mentioned above, and in terms of the impact on ensemble spread of the CA's representation of inherent model uncertainty.

Altered respiratory pattern and hypoxic response in transgenic newborn mice lacking the tachykinin-1 gene

Substance P is known to be involved in respiratory rhythm and central pattern-generating mechanisms, especially during early development. We therefore studied respiratory responses in transgenic newborn mice (Tac1(-/-)) lacking substance P and neurokinin A (NKA). In vivo, the effects of intermittent isocapnic hypoxia (IH) and hypercapnia were studied using whole body flow plethysmography at P2-3 and P8-10. In vitro, anoxic responses and the effects of hypocapnic and hypercapnic conditions were studied in brain stem-spinal cord preparations (C4 activity) at P2. Hypoxic challenge considerably modified the respiratory activity in transgenic mice displayed in vivo as an attenuated increase in tidal volume during IH. Transgenic mice also showed a more prominent posthypoxic frequency decline in vivo, and posthypoxic neuronal arrests appeared more often in vitro. We recognized two types of sigh activity: with or without a following pause. During IH, the amount of sighs with a pause decreased and those without increased, a redistribution that became stronger with age only in controls. Intermittent anoxia induced long-term facilitation effects in controls, but not in Tac1(-/-) animals, manifested as an increase in burst frequency in vitro and by an augmentation of ventilation during posthypoxic periods in vivo. Thus our data demonstrate that a functional substance P/NKA system is of great importance for the generation of an adequate respiratory response to hypoxic provocation in newborn mice and during early maturation. It also indicates that substance P (and/or NKA) is involved in the development of the plasticity of the respiratory system.

Circumpolar maternal blood contaminant survey, 1994-1997 organochlorine compounds

During the past 20 years a number of studies have found neurological and immunological effects in the developing fetus and infants exposed to background or only slightly elevated levels of persistent organic pollutants (POPs) such as polychlorinated biphenyls (PCBs). To address concerns arising from possible increased human exposure in the Arctic and possible effects of POPs, all circumpolar countries agreed in 1994 to monitoring of specific human tissues for contaminants in the Arctic under the Arctic Monitoring and Assessment Program (AMAP). Mothers in eight circumpolar countries contributed blood samples that were analysed at a single laboratory for 14 PCB congeners (IUPAC No. 28, 52, 99, 105, 118, 128, 138, 153, 156, 170, 180, 183, 187) and 13 organochlorine pesticides (aldrin, beta-hexachlorocyclohexane (beta-HCH), dichlordiphenyltrichloroethane (p,p'-DDT), diphenyldichloroethylene (p,p'-DDE), dieldrin, heptachlorepoxide, hexachlorobenzene (HCB), mirex, and the chlordane derivatives alpha-chlordane, gamma-chlordane, cis-nonachlor, oxychlordane and trans-nonachlor). Inuit mothers from Greenland and Canada have significantly higher levels of oxychlordane, transnonachlor and mirex than mothers from Norway, Sweden, Iceland and Russia. Inuit mothers from Greenland also have significantly higher levels of these contaminants than Inuit mothers from Canada and Alaska. These differences among Inuit groups may represent regional dietary preferences or different contaminant deposition patterns across the Arctic. Levels of PCBs are also elevated among some arctic populations due to their consumption of marine mammals and are in the range where subtle effects on learning and the immune system have been reported. The Russian mothers who consume mainly food imported from southern Russia have elevated levels of DDT, DDE, beta-HCH and a higher proportion of lower chlorinated PCB congeners. This study has allowed an assessment of the variation of contaminants such as PCBs and various organochlorine pesticides (DDT, chlordane, etc.) in human populations around the circumpolar north.

Patients with Paget disease of nipple and with palpable mass in breast have unfavorable prognosis

Recent data indicate that in breast cancer patients the presence of Paget disease of the nipple may be related to poor prognosis. Therefore, we decided to assess long-term results of the treatment of such patients, and to assess the relationship between the physical and pathological findings and prognosis. The files of 60 patients with Paget disease of the nipple who were treated between 1977 and 2000 were analyzed retrospectively with respect to the results of physical and pathologic examinations, disease recurrence and survival. In 38/60 patients, the cancer was invasive. In 26/60 patients, palpable masses in the breast were diagnosed. The 5-year overall survival probability was 0.68; the probability was 0.82 for patients without palpable masses, 0.51 for those with palpable masses, 0.91 for patients without invasive cancer and 0.58 for patients with associated invasive cancer. In conclusions, patients with Paget disease of the nipple and with palpable mass in the breast had unfavorable diagnosis. The nature of all nipple changes should be explained as early as possible in order to diagnose the disease when no mass is palpable in the breast.

Treatment of operable breast cancer in the elderly: a randomised clinical trial EORTC 10851 comparing tamoxifen alone with modified radical mastectomy

For treatment of early breast cancer in older women, little evidence is available from randomised trials. We conducted a randomised trial comparing modified radical mastectomy (MRM) with tamoxifen (TAM) as the sole initial therapy in 164 patients aged >/=70 years with operable breast cancer. 82 were treated by MRM and 82 with TAM. Survival curves were estimated using the Kaplan-Meier method: multivariate analyses were performed using the Cox's proportional hazards model. Endpoints included survival, time to first relapse or progression, loco-regional progression, time to distant progression and progression-free survival. After a median follow-up of approximately 10 years, there was a significantly decreased time to progression in the TAM only group (logrank P<0.0001) and significantly shorter time to local progression within the TAM group (logrank P<0.0001). Overall survival of the two groups was similar. The results indicate that tamoxifen alone leads to an unacceptably high rate of local progression or relapse.

Effects of hexachlorobenzene on embryonic mammalian cells

Hexachlorobenzene (HCB) is a persistent organic pollutant that has been found to be bioaccumulating in several Arctic regions of the world. The response of embryonic cells to HCB exposure has been evaluated for several different cytotoxic responses, including genotoxic effects. NIH 3T3 (mouse) and WS1 (human) embryonic cells were exposed to HCB at 1 and 10 times the average newborn cord blood concentrations of Alaska Arctic natives. Assays were then performed to determine the subsequent effects of HCB on overall cell number, viability, cell growth fraction and long-term survival, as well as specific biochemical and molecular responses. Exposure of both cell types to HCB results in cell membrane damage, a short-term decrease in cell number, increased DNA strand breaks, and a long-term decrease in colony survival. WS1 cells also undergo cell-cycle arrest and modulations in glutathione concentration after exposure to HCB. In addition, NIH 3T3 cells exhibit an increased number of transformed foci after repeated exposure to HCB. This study demonstrates that relevant environmental concentrations of HCB have significant effects on mammalian embryonic cells in culture.

Nuclear non-histone protein p36 associated with colorectal tumours

Rabbit serum raised against electrophoretically specific nuclear polypeptides with molecular weights of 35-40 kD from colon adenocarcinoma has been used to detect p36 antigen in 83.3% (40 of 48) of cases of large intestine tumours by means of Western blot technique. Immunological analysis revealed that this antiserum cross-reacted with antigen of the same molecular weight in 83.3% (10 of 12) and 85.7% (6 of 7) nuclear protein preparations from stomach and lung tumours, respectively, but not in any control tissue samples. No cross-reactivity within the region of 36 kD was observed among nuclear proteins isolated from mononuclear cells of B-cell chronic lymphocytic leukaemia patients as well as healthy donors.

Serum TNF-alpha level in the neoplasm patients qualified for surgical treatment

The aim of the study was to analyze serum tumor necrosis factor alpha (TNF-alpha) levels in patients with different neoplasm types qualified for surgical treatment and to evaluate their possible correlations with circulating immune complexes (CIC), IgG, IgM, and the complement (C) compounds: C1 inhibitor (C1i), C3c and C4 levels. Studies were performed in sera from 30 neoplasm patients before surgical treatment and in 10 persons from a control group (CG) with no malignancy. Serum TNF-alpha levels were measured with the Cytogen ELISA kit. Average TNF-alpha levels measured in neoplastic patient groups qualified for surgical treatment were not significantly different from the average TNF-alpha level in the CG group.

Pre-operative levels of serum immunoglobulins, circulating immune complexes and complement proteins in patients with different types of neoplasms

In the sera of 30 neoplasm patients without metastases, the average IgG level was higher than in the control group (CG) (18.16+/-5.10 vs. 12.62+/-2.14 g/l or 12.22+/-2.14 after excluding an outier). Average concentrations of circulating immune complexes (CIC), IgM, complement 1 inhibitor (Cli), C3c and C4 did not statistically differ between the groups. Dividing the patients' group into: breast or ovary cancer (BC), melanoma (M), digestive tract cancer (DT) and other neoplasms (ON) subgroups revealed that the IgG increase did not apply to the BC group. Relatively decreased CIC concentrations in the BC and DT group and an increased Cli in the DT group were found. Several diversities detected in the humoral immunity indices' distributions and correlations suggest activation of different mechanisms depending on the neoplasm types.

Effects of p,p'-DDE on immature cells in culture at concentrations relevant to the Alaskan environment

Arctic Alaskan Natives who maintain a traditional lifestyle have a disease profile that is significantly different from the general US population. There is concern that food sources containing environmental pollutants may contribute to this profile. In a preliminary study, umbilical cord blood was examined for the presence of several environmental contaminants. All cord blood samples analyzed thus far contain p,p'-DDE (1,1-dichloro-2,2-bis(p-chlorophenyl)ethylene) with an average concentration of 0.33 microg/l. This study was undertaken to ascertain if this concentration of p,p'-DDE had detectable effects on immature cells in culture. NIH 3T3 (embryonic mouse fibroblast) and WS1 (human fetal fibroblast) cultures were exposed to media containing either 1 or 10 times the average cord blood concentration of p,p'-DDE. Initial experiments indicated that exposure to p,p'-DDE resulted in a decrease in the cell number of both cell types. Subsequent analysis revealed that the decrease in cell number was due to cell death in NIH 3T3 cells and to cell-cycle arrest in WS1 cells. Furthermore, p,p'-DDE decreased the long-term survival of NIH 3T3 but not WS1 cells. This study has demonstrated that p,p'-DDE, at relevant environmental concentrations, has significant effects on two immature mammalian cell types in culture. In addition, these results highlight the necessity for further studies to address the specific effects of p,p'-DDE on developing fetal systems.

Surgical and combined treatment of gastric cancer--own experience

PURPOSE

In Poland, as well as all over the world, gastric cancer is still among the leading causes of mortality and morbidity from malignant diseases. Many attempts were made to improve the results of the treatment. In this paper we present our 25-year experience in this field.

MATERIAL AND METHODS

From 1977 to 2000 in the Clinical Department of Surgical Oncology, Medical University of Łódź, we treated 353 patients (males 63%; females 37%) with the diagnosis of gastric cancer, confirmed histologically. We analysed the age of patients, location of primary tumor, histologic type, stage of the disease, type of surgery, type of reconstruction of GI tract, type of adjuvant therapy and survival.

RESULTS

In patients with the disease in stage I and II according to UICC Fielding classification, the best results were achieved. Five year survival reached 76% which means that early recognised gastric cancer may be cured. However, patients from this group constituted only 6.7% of all the treated population. In patients with stage III disease, 5 year survival was 34.5%. In patients with IVA stage of the disease (72 cases), in whom only cytoreductive-palliative surgery was performed, 5-year survival was 16.7%. No patient with IVB stage of the disease (purely palliative procedures performed) survived 5 years. Significant improvement of distant results was, observed in patients receiving EAP as an adjuvant therapy (25.1% of 5-year survivors) in comparison to control group patients treated solely with surgery (18.2% of 5 year survivors). In 97 patients after total gastrectomy, significantly lower complication rate was observed in patients in whom intestinal pouch was created (Hunt-Lawrence) than in patients in whom the pouch was not created (Roux-Y, Engel-Graham).

CONCLUSION

In our opinion, we should consequently implement guidelines known as the "Polish Consensus of Gastric Cancer Treatment", like extensive radical stomach resection (whenever possible) with regional lymphadenectomy and adjuvant therapy.

Colorectal cancer-associated nuclear antigen

By using sodium dodecyl sulfate-polyacrylamide gel electrophoresis and immunoblotting assays in the presence of polyclonal antiserum raised against electrophoretically specific polypeptides of colorectal cancer nuclear polypeptides with M(r) of 35-40 kDa, we have identified p36 protein whose expression accompanies tumorigenesis of large intestine. Immunological analysis of 35 nuclear protein preparations has indicated expression of p36 antigen in nine of 11 right-sided (81.8%) and 21 of 24 (87.5%) left-sided colorectal tumor cases, but not in any control tissue samples. In this study, we have identified p36 antigen in two colon tumor cell lines, i.e., SW620 and HT29 as well. Fractionation experiments based on selective extraction of nuclei isolated from cancerous specimens, which enables their separation into chromatin, nuclear matrix and its subfraction, i.e., internal and peripheral matrix have revealed the concentration of this particular antigen in the internal matrix.

[Reconstruction methods for the continuous digestive tract using surgical stapling after gastrectomy with lymphadenectomy in patients undergoing surgery for stomach cancer. Personal evaluation]

From 1984 to 1994, 152 patients were operated for gastric cancer in Clinical Department of Surgical Oncology, Medical University of Lodz. Patients age ranged from 31 to 82 years (mean age-61.2). The purpose of this study was to evaluate the methods of reconstruction of gastrointestinal tract (GIT) continuity. Our material comprised patients who underwent total gastrectomy for gastric cancer. In 52 patients radical procedure--total gastrectomy--was performed, with reconstruction of gastrointestinal tract continuity. The latter part of surgery was accomplished using different methods: Roux-Y anastomosis-10 patients (19.2%); esophago-jejunal "end to side" anastomosis-8 patients (15.4%); Hunt-Lawrence-Rodino anastomosis-34(65%). During procedures staplers and VALTRAC rings were used, as well as ultrasound selector and argon coagulator for hepatic and pancreatic resections. Quality of life after gastrectomy was determined on the basis of interviews taken from patients, in whom GIT continuity was reconstructed with or without intestinal pouch creation. We also evaluated incidence and type of complications after such procedures. Perioperative mortality in our material was 7.7%. We concluded that the best results was achieved when continuity of gastrointestinal tract after total gastrectomy was reconstructed with intestinal (first loop of jejunum) pouch creation (Hunt-Lawrence procedure). This method warranted high quality of life and low incidence of complications. Staplers enables us to shorten time of procedure and to decrease the number of anastomosis leaks, so that our results of surgical treatment of patients with gastric cancer were better.

[1000 quadrantectomies--personal experience]

Analysis of 1000 quadrantectomies performed because of malignancy suspicion has been carried out to evaluate the long-term results of this method. Authors underline that only 5% of patients with breast cancer was able to be qualified to quadrantectomy.

[Histological and morphometric studies of femurs with stable hip joint replacement. An autopsy study with special reference to factors leading to late loosening]

To gain insight into the tissue reactions leading to non-infectious loosening 25 autopsy specimens of femurs with well-fixed cemented femoral components of hip prostheses were analysed histomorphologically and morphometrically. The implant duration ranged from one month to 15 years. With the exception of some focal bone-cement contacts bone and cement were separated by a fibrohistiocytic soft tissue membrane. This membrane contained wear particles predominantly of the bone cement mantle and--less abundant--of the polyethylene cups. The amount of wear particles as well as histiocytes and necroses within the membrane statistically significantly increased with advancing time in situ. The cancellous bone adjacent to the soft tissue membrane often revealed a mainly histiocytic infiltration too, accompanied by bone remodeling in this area. The histiocytic inflammatory reaction at the bone cement interface, which is mainly caused by the accumulation of wear particles is considered to be of major importance for the non infectious late loosening of cemented prostheses.

Pneumococcal vaccination in a remote population of high-risk Alaska Natives

In response to an increasing prevalence of serious pneumococcal disease among adult Alaska Natives of northwest Alaska, a 3-year program was begun in 1987 to identify residents of that remote region who were at high risk for developing invasive pneumococcal disease, to determine their pneumococcal vaccination status, and to deliver vaccine to at least 80 percent of those at risk. After reviewing public health nursing and Indian Health Service data bases, the authors identified 1,337 persons, 20 percent of the 6,692 residents of the region, at high risk for invasive pneumococcal infection, defined either by having a specific chronic disease or by age criteria. Cardiovascular disease and alcoholism were the two most common chronic diseases. Only 30 percent of those determined to be at high risk had received one or more doses of pneumococcal vaccine previously. Half of those persons had received their most recent vaccination 6 or more years earlier. The program used both customary and innovative methods to deliver 23-valent polysaccharide vaccine to 1,046 of those at high risk (78 percent), including 388 persons who were revaccinated. At the completion of the project, 1,123 persons, 84 percent of those at high risk, had received at least 1 dose. They included 1,088 persons, 81 percent of those at high risk, with vaccination within the previous 5 years as a result of the project, compared with a 15-percent rate prior to the vaccination phase of the project. The program demonstrated that high levels of vaccination against pneumococcal disease, exceeding Year 2000 objectives of 60 percent, are attainable in a remote rural Alaskan population.

Reduced primacy and related features in schizophrenia

Subtle memory disturbances are widely reported in schizophrenia. We investigated one such disturbance, reduced primacy in serial position recall among 20 schizophrenic patients, 20 depressed patients, and 20 normal controls. The main finding is that schizophrenic subjects show reduced primacy and middle position performance, but are able to match the recency recall of controls. We further demonstrate that primacy performance is associated with another memory anomaly frequently noted in schizophrenia, decreased context associated gain in recall. Among schizophrenic subjects, primacy performance is also related to increased repetition in speech, a feature associated with formal thought disorder in schizophrenia. These observations suggest that memory deviances and disordered speech may have a common pathogenesis.

Freebase cocaine and memory

Despite the seriousness of acute medical and psychological consequences of cocaine abuse, little knowledge exists about the chronic effects of the drug. Investigation of a sample of abstinent freebase (crack) abusers in the Bahamas provides the first research evidence that prolonged cocaine abuse may result in persistent short-term memory disturbances.