ESMO expert consensus statements on the screening and management of financial toxicity in patients with cancer

BACKGROUND

Financial toxicity, defined as both the objective financial burden and subjective financial distress from a cancer diagnosis and its treatment, is a topic of interest in the assessment of the quality of life of patients with cancer and their families. Current evidence implicates financial toxicity in psychosocial, economic and other harms, leading to suboptimal cancer outcomes along the entire trajectory of diagnosis, treatment, supportive care, survivorship and palliation. This paper presents the results of a virtual consensus, based on the evidence base to date, on the screening and management of financial toxicity in patients with and beyond cancer organized by the European Society for Medical Oncology (ESMO) in 2022.

METHODS

A Delphi panel of 19 experts from 11 countries was convened taking into account multidisciplinarity, diversity in health system contexts and research relevance. The international panel of experts was divided into four working groups (WGs) to address questions relating to distinct thematic areas: patients with cancer at risk of financial toxicity; management of financial toxicity during the initial phase of treatment at the hospital/ambulatory settings; financial toxicity during the continuing phase and at end of life; and financial risk protection for survivors of cancer, and in cancer recurrence. After comprehensively reviewing the literature, statements were developed by the WGs and then presented to the entire panel for further discussion and amendment, and voting.

RESULTS AND DISCUSSION

A total of 25 evidence-informed consensus statements were developed, which answer 13 questions on financial toxicity. They cover evidence summaries, practice recommendations/guiding statements and policy recommendations relevant across health systems. These consensus statements aim to provide a more comprehensive understanding of financial toxicity and guide clinicians globally in mitigating its impact, emphasizing the importance of further research, best practices and guidelines.

Determination of Sodium in Foods by Flame Atomic Absorption Spectrometry after Microwave Digestion: NMKL Interlaboratory Study

Nine laboratories participated in an interlaboratory method performance (collaborative) study of a method for the determination of sodium in foods by flame atomic absorption spectrometry after wet digestion, using a microwave oven technique. Before the study, the laboratories were able to practice on samples with defined sodium levels (pretrial test). The method was tested on a total of 6 foods (broccoli, carrot, bread, saithe fillet, pork, and cheese) with sodium concentrations of 1480–8260 mg/kg. The materials were presented to the participants in the study as blind duplicates, and the participants were asked to perform single determinations for each sample. The repeatability relative standard deviations (RSDr) for sodium ranged from 1.9 to 6.5%. The reproducibility relative standard deviations (RSDR) ranged from 4.2 to 6.9%. The HorRat values ranged from 0.9 to 1.6.

Effectiveness of screening for colorectal cancer with a faecal occult-blood test, in Finland

Background

Screening for colorectal cancer (CRC) with guaiac-based faecal occult-blood test (FOBT) has been reported to reduce CRC mortality in randomised trials in the 1990s, but not in routine screening, so far. In Finland, a large randomised study on biennial FOB screening for CRC was gradually nested as part of the routine health services from 2004. We evaluate the effectiveness of screening as a public health policy in the largest population so far reported.

Methods

We randomly allocated (1:1) men and women aged 60–69 years to those invited for screening and those not invited (controls), between 2004 and 2012. This resulted in 180 210 subjects in the screening arm and 180 282 in the control arm. In 2012, the programme covered 43% of the target age population in Finland.

Results

The median follow-up time was 4.5 years (maximum 8.3 years), with a total of 1.6 million person-years. The CRC incidence rate ratio between the screening and control arm was 1.11 (95% CI 1.01 to 1.23). The mortality rate ratio from CRC between the screening and control arm was 1.04 (0.84 to 1.28), respectively. The CRC mortality risk ratio was 0.88 (0.66 to 1.16) and 1.33 (0.94 to 1.87) in males and females, respectively.

Conclusions

We did not find any effect in a randomised health services study of FOBT screening on CRC mortality. The substantial effect difference between males and females is inconsistent with the evidence from randomised clinical trials and with the recommendations of several international organisations. Even if our findings are still inconclusive, they highlight the importance of randomised evaluation when new health policies are implemented.

Trial registration

002_2010_august.

The effect of dietary intervention on paraffin-stimulated saliva and dental health of children participating in a randomized controlled trial

OBJECTIVES

The aim was to study the impact of dietary intervention on the properties of paraffin-stimulated saliva, and on dental caries.

STUDY DESIGN

At 7 months of age 1062 infants (540 intervention; 522 controls) started in the prospective, randomized Special Turku Intervention Project (STRIP) aimed at restricting the child's saturated fat and cholesterol intake to prevent atherosclerosis of adult age (www.clinicaltrials.gov NCT 00223600). At 3 years of age, every fifth child was invited to an oral sub-study, and 148 (78 boys) children attended. At 6, 9, 12 and 16 years of age 135, 127, 114 and 88 children were restudied, respectively. Dietary intakes of carbohydrates, protein, saturated fat, calcium, phosphate, and fibre were regularly recorded using 4-day food records. Height and weight were regularly monitored. Paraffin-stimulated saliva samples were collected at 6, 9, 12 and 16 years of age, and analyzed for flow rate, buffer capacity, calcium, phosphate and proteins. Dental health was recorded and expressed as d3mft/D3MFT, and as time of caries onset.

RESULTS

Dietary intakes of calcium, phosphate and fibre, and salivary flow rate increased with time in both groups (p<0.001, GLM for repeated measures). Fibre intake and salivary flow rate were higher in the intervention than in the control group (p=0.042 and p=0.0394, respectively, GLM for repeated measures). There were no correlations between dietary intakes and salivary concentrations of calcium or phosphate. Children who did not have caries experience (d3mft/D3MFT=0) during the entire follow-up had higher salivary calcium than those who had caries already at 3 years of age. The association between salivary calcium and caries onset was significant up to 12 years of age. Toothbrushing frequency was statistically significantly associated with caries-onset at ages 6 (gamma statistic 0.457, p=0.046) and 12 years (gamma statistic 0.473, p=0.019).

CONCLUSIONS

The current long-term dietary intervention increased children's paraffin-stimulated salivary flow rate. The concentration of salivary calcium was directly correlated to dental health. Higher salivary flow rate in the intervention group is believed to be due to higher fibre intake in the intervention group.

Caries prevention with xylitol lozenges in children related to maternal anxiety. A demonstration project

AIM

This was to compare the effect of a prevention program between children of anxious and non-anxious mothers.

METHODS

Mothers (n=120) with high and low dental anxiety scores (DAS>15 and DAS <8, respectively), and with high levels of mutans streptococci (>10(5)cfu/mL) were recruited at a maternity clinic of Tartu, Estonia. Two groups: 30 highly anxious, and 30 non-anxious mothers used xylitol (6 g/day) for 33 months and a non-treatment group of 60 mothers, both highly and low anxious (30 in each sub-group), acted as controls. All mothers were interviewed for oral health habits and education, and their dental health was examined. Due to discontinued participation 75% of the children (n=90) were examined at 2 and at 3 years of age.

RESULTS

Anxious mothers brushed less frequently (p=0.014), had a longer time since their last dental visit (p<0.0001), and a lower level of education (p<0.0001) than their non-anxious counterparts. However, maternal anxiety had no effect on children's dental health, contrary to the caries prevention program which was effective both at 2 and at 3 years of age (p<0.01; OR 6.6, 1.8-25.0 and OR 3.9, CI 1.5-10.0, respectively).

CONCLUSION

Children benefited from the caries prevention program, irrespective of maternal anxiety.

Hearing aid compliance in the elderly

OBJECTIVES

A decreasing but still substantial proportion of elderly persons with hearing aids use them only occasionally. Because the prevalence of age-related hearing loss is increasing, it is important for the hearing rehabilitation process to be effective. The aim of this study was to use a mailed questionnaire to evaluate the rate of hearing aid use and the reasons for minimal use or nonuse.

METHODS

Questions about hearing aid use and associated problems were included in a survey of hearing mailed to 4,067 people in age cohorts of 70, 75, 80 and 85 years in an industrialized urban community in Finland.

RESULTS

In this sample of 249 hearing aid users, 55.4% used their hearing aid daily, and 27.3% used it > 6 hours a day. The percentage of subjects who never used their hearing aid was 10.7%. Use of hearing aids tended to decline with advancing age. The most common reasons for minimal use were disturbing background noise, acoustic feedback problems, battery cost, and a lack of motivation to use the hearing aid.

CONCLUSIONS

Compliance with hearing aid use by the elderly is increasing, but a significant proportion of hearing aids are still used only occasionally or never. We discuss methods to improve compliance in this patient group. Our results may be used to reexamine existing procedures for fitting hearing aids for counseling, which may increase patient compliance with hearing aids, leading to greater benefits from their use.

Thermal comfort and gender: a literature review

This review examines scientific literature on the effect of gender on indoor thermal comfort. Gender differences have been generally considered to be small and insignificant but this review shows that a growing number of studies have found significant differences in thermal comfort between the genders. Clearly more than half of the laboratory and field studies have found that females express more dissatisfaction than males in the same thermal environments. Very few studies have found males to be more dissatisfied than females. A meta-analysis shows that females are more likely than males to express thermal dissatisfaction (ratio: 1.74, 95% confidence interval: 1.61-1.89). However, most studies found no significant difference in neutral temperatures between the genders. Females are more sensitive than males to a deviation from an optimal temperature and express more dissatisfaction, especially in cooler conditions.

PRACTICAL IMPLICATIONS

We should no longer neglect the more rigorous requirements that females have for indoor thermal environments. Gender differences indicate that females have, on average, a greater need for individual temperature control and adaptive actions than males. The results of this review suggest that females should primarily be used as subjects when examining indoor thermal comfort requirements, as if females are satisfied it is highly probable that males are also satisfied.

Effect of infancy-onset dietary intervention on salivary cholesterol of children: a randomized controlled trial

This study investigated salivary cholesterol of children from 6 to 16 years of age in response to dietary intervention. One thousand sixty-two infants started in the prospective, randomized project. At 3 years of age, every fifth child was invited into the study (n=178). Of these, 148 enrolled, and 86 completed the oral sub-study at 16 years of age. The intervention aimed at restricting the child's saturated fat and cholesterol intake. Control children received no special recommendations. Every third year, paraffin-stimulated saliva samples (10.0 mL) were collected for cholesterol assays. Nutrient intakes and serum total cholesterol concentrations were regularly followed up by means of 4-day food records and blood samples. Intake of saturated fatty acids (SAFA) was lower in the intervention than in the control group (p<0.001). Salivary cholesterol concentration increased from 1.9 (±1.1) µmol/L at 6 years of age to 16.0 (±9.0) µmol/L at 16 years of age. The increase was smaller in the intervention than in the control group (p<0.001). The ratios of salivary to serum cholesterol concentrations tended to be higher in boys than in girls (p=0.07). Thus, dietary intervention was reflected in children's salivary cholesterol values more sensitively than in serum cholesterol values. (clinicaltrials.gov NCT00223600).

The effect of liquorice extract-containing starch gel on the amount and microbial composition of plaque

The aim of this study was to find out whether liquorice-containing starch gel could affect plaque accumulation and its microbial composition. Sixteen healthy volunteers (mean age: 30.4+/-6.9 years) used 6 g of either control [8% acid-hydrolyzed corn starch, 25% maltitol syrup, water (w/w)] or liquorice gel (control + 2.5% liquorice extract), three times a day for 2 weeks. The gels were used in a random order with a 2-week washout period in between. At the end of each fortnight, plaque was allowed to accumulate for 2 days and all available plaque from the right side of the mouth was collected, weighed, and transferred to transport medium. The plaque on the left side was dyed and photographed in a standardized manner. Mutans streptococci, total streptococci, and facultative bacteria were assessed from the plaque using plate culturing. Plaque index (0-5) of incisors and canines on the left side was evaluated from the photographs. The clinical study was preceded by an in vivo acid production test. The acid production from gels containing 2.5-10% liquorice extract was monitored with a microelectrode. The in vivo acid production potential of the maltitol-containing starch gel was about 50% compared to the sucrose control. Liquorice inhibited acid production from the gel. In the clinical study, the weight of plaque after consumption of the liquorice gel did not differ from that of the control gel. No differences were found in the microbial counts nor in the plaque index between the two gels. In addition, the liquorice gel had no effect on the stability of the predominant bacterial populations of the plaque samples of 16 individuals as detected by PCR-denaturing gradient gel electrophoresis. In conclusion, an addition of liquorice extract to starch-containing gel with a low acid production potential had no effect on the plaque formed during a 2-week gel consumption period.

1H MRS studies in the Finnish boron neutron capture therapy project: detection of 10B-carrier, L-p-boronophenylalanine-fructose

This article summarizes the current status of 1H MRS in detecting and quantifying a boron neutron capture therapy (BNCT) boron carrier, L-p-boronophenylalanine-fructose (BPA-F) in vivo in the Finnish BNCT project. The applicability of 1H MRS to detect BPA-F is evaluated and discussed in a typical situation with a blood containing resection cavity within the gross tumour volume (GTV). 1H MRS is not an ideal method to study BPA concentration in GTV with blood in recent resection cavity. For an optimal identification of BPA signals in the in vivo 1H MR spectrum, both pre- and post-infusion 1H MRS should be performed. The post-infusion spectroscopy studies should be scheduled either prior to or, less optimally, immediately after the BNCT. The pre-BNCT MRS is necessary in order to utilise the MRS results in the actual dose planning.

Sucrose intake since infancy and dental health in 10-year-old children

The dental health of children in western countries has improved without a concomitant decrease in the mean sucrose consumption. Our aim was to analyse the association of long-term sucrose consumption with dental health in children representing the highest (n = 33, 18 boys) and the lowest 5 percentiles (n = 33, 21 boys) of sucrose intake, in a study where food consumption was prospectively recorded from infancy to 10 years of age. The sum of decayed, missing and filled teeth in the primary (dmft) and permanent (DMFT) teeth was assessed. Children's sucrose intake in the high intake group was constantly higher than in their counterparts (p < 0.001), and already exceeded 10% of energy intake (E %) at 2 years of age. The mean +/- SD of the dmft + DMFT scores was higher in the high than in the low sucrose intake group (3.9 +/- 3.9 and 1.9 +/- 2.5, respectively; p = 0.032). We conclude that a persistently high sucrose intake increases the risk of dental caries in children.

Frequent exposure to invasive medical care in early childhood and operative dental treatment associated with dental apprehension of children at 9 years of age

AIM

This was to study prospectively a cohort of children as to whether behaviour at a 3-year examination, exposure to medical care and operative dental treatment are associated with each other, and with the level of dental apprehension at 9 years of age.

METHODS

Data were collected at three subsequent dental examinations of 126 children (67 boys, 59 girls). Cooperation, general health condition and operative dental treatment during the preceding 3 years were obtained at dental examinations with 3-year intervals, i.e. at 3, 6 and 9 years of age. Children's dental apprehension was assessed at the age of 9 years. The data were analysed using an ordinal logistic regression model.

RESULTS

Dental apprehension at 9 years of age was associated with frequent exposure to invasive medical care (p<0.001) and past experience of operative dental care (p<0.002), but not with cooperation at 3 years of age (p=0.124).

CONCLUSION

Frequent invasive medical care in early childhood and operative dental treatment, tooth extractions in particular, are associated with dental apprehension at 9 years of age.

Vestibular dysfunction in adult patients with osteogenesis imperfecta

Progressive hearing loss is a major symptom in osteogenesis imperfecta (OI), a genetic brittle bone disease. Vertigo is frequently associated with otosclerosis in which the hearing loss clinically resembles that in OI. Vertigo is also common in basilar impression (BI) found in up to 25% of adult OI patients. In order to evaluate the cause, frequency, and characteristics of vertigo in OI, 42 patients were studied by interview, clinical examination, and audiological examination supplemented with electronystagmography (ENG) and lateral skull radiography. Audiometry showed hearing loss in 25 patients (59.5%). Nine patients (21%) displayed abnormal skull base anatomy in the forms of basilar impression, basilar invagination, or both, all designated here as BI. Twenty-two patients (52.4%) reported vertigo, mostly of floating or rotational sensation of short duration. Patients with hearing loss tended to have more vertigo than patients with normal hearing. Vertigo was not correlated with type of hearing loss or auditory brain-stem response (ABR) pathology. ENG was abnormal in 14 patients (33.3%). No dependency was found between vertigo and deviant ENG results. Patients with BI tended to have more vertigo than patients with normal skull base but the difference was not statistically significant. Neither ENG pathology, nor the presence or type of hearing loss showed correlation with BI. In conclusion, vertigo is common in patients with OI. In most cases, it may be secondary to inner ear pathology, and in only some patients does BI explain it. Since some OI patients without BI or hearing loss also suffer from vertigo, further clinical and neurological studies are needed to define the pathogenesis of vertigo in OI.

A prospective study on sucrose consumption, visible plaque and caries in children from 3 to 6 years of age

OBJECTIVES

As data on the association of sugar consumption and dental caries in the industrialized countries give mixed results, we prospectively studied this association in 135 healthy Finnish children (71 boys, 64 girls).

METHODS

The dental health and oral hygiene of the children was first examined at the mean age (+/-SD) of 37.4 (+/-2.1) months and again at 73.7 (+/-2.6) months. On both occasions the parents were interviewed about the child's sweet intake and toothbrushing habits, and sucrose consumption was analyzed using 4-day food diaries.

RESULTS

The proportion of children with caries experience, enamel and dentin lesions combined, increased from 16% to 40%. Daily sucrose intake of children who developed caries by 6 years of age, whether expressed as absolute (g) or as relative (E%) amounts, was already higher at 3 years of age than that of children who stayed caries-free (P<0.05 and P<0.03, respectively). Furthermore, children who used sweets more than once a week at 3 years of age, consumed more sucrose 3 years later (P<0.01) than those who used sweets once a week or less. The proportion of children with a combination of a sweet intake more than once a week and visible plaque, increased (P<0.05) during the follow-up. The risk ratio of children with the combined risk habit at 3 years of age to develop carious lesions by 6 years of age was 1.7 compared to the rest of the children (95% confidence interval 0.9-3.0).

CONCLUSIONS

We conclude that the manifestation of dental caries at 6 years of age seemed to be associated with a higher daily sucrose intake that had started already at 3 years of age. Moreover, a combination of sweet intake more than once a week and visible plaque at 3 years of age may be predictive of dental health 3 years later.

Electronystagmographic findings in patients with acute cerebral vascular disease and vertigo

A neurootologist examined 233 successive cases of acute disabling vertigo from the Clinic of Neurology of Turku University Central Hospital. On magnetic resonance imaging (MRI), 24 patients had evidence of acute cerebral or cerebellar brain infarction. The examination scheme included a case history analysis, clinical neurootological examination and electronystagmography (ENG). The audiological examination included pure-tone thresholds and speech audiometry. The ENG analyses were done by two neurootologists who had no information about the aetiology of the diseases. A central disturbance in ENG was observed in 59% (10/17) of the patients with cerebral brain infarction and 71% (5/7) of the patients with cerebellar brain infarction. ENG is not valid as a screening method for the central aetiology of vertigo; imaging of the central nervous system is needed.

Transtympanic versus tympanic membrane electrocochleography in examining cochleovestibular disorders

The use of electrocochleography (EcoG) is considered to be of clinical value in otological diagnosis. Non-invasive ear canal (EC) and tympanic membrane (TM) EcoG recording techniques, and invasive transtympanic (TT) technique are the methods used for objective assessment of cochlear function. In this study, eight adults (16 ears) with suspected Meniere's disease were examined using a newly designed, disposable tympanic electrode and a traditional, thin transtympanic needle. The amplitudes of the TT electrode responses were 4-6-fold larger than those produced by the TM electrode. The morphology of the waveforms for the two recording techniques was nearly identical. The mean amplitudes of the action potential (AP) obtained with the TM electrode were 2.39-3.73 microV, and with the TT electrode 14.08-19.60 microV, depending on the stimulus intensity. For the summating potential (SP), the TM and TT electrodes had mean amplitudes of 0.82-1.60 microV and 3.53-5.81 microV respectively. The SP/AP ratios were larger with the TM electrode than with the TT electrode. They were inconsistent in four ears (25%) when measured with the TM and TT electrodes. All patients were more satisfied with the TT examination, since it was quite painless, unlike the TM examination. The authors recommend the use of the TT recording technique as a painless examination in which the electrode is close to the inner ear, allowing a good signal-to-noise ratio and large amplitudes. Diagnostic interpretations are easier and more reliable with the TT electrode than with the TM electrode.

The effect of hormone replacement therapy on salivary calcium concentrations in menopausal women

Hormone replacement therapy in menopausal women is known to affect the general calcium turnover of the body. No information is available about the effects of hormone therapy on salivary electrolytes and on calcium in particular. A group of 16 healthy peri- and postmenopausal women, all recommended to start hormone replacement therapy, were studied longitudinally for 5 months. Paraffin-stimulated whole saliva was collected at baseline, at 3 and at 5 months after the onset of therapy, and analysed for calcium, sodium and potassium concentrations. In response to hormone replacement therapy, calcium concentration decreased (p = 0.037), that of sodium increased (p = 0.019), while no change was observed in the potassium concentrations during the follow-up period.

The limited value of three pathogen species in predicting healing of periodontal pockets

Baseline level of Actinobacillus actinomycetemcomitans has been suggested as being predictive of periodontal treatment outcome. We analyzed the presence of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, and Prevotella intermedia in 55 deep periodontal pockets of 29 patients (18 men, 11 women, 37-75 years) before and after periodontal treatment. At baseline and after treatment, 62% and 33%, respectively, of the subjects presented with 1, 2, or a combination of all 3 pathogens. The mean pocket depth of 6.6 mm (0.4 mm) before treatment decreased to 2.2 mm (0.4 mm) in response to treatment (P<0.001). The treatment plan of non-surgical or surgical treatment was based on pocket depths and tooth morphology only. No antimicrobial medications were used during the treatment. Eighty-two percent of the deep pockets healed satisfactorily to < or = 4 mm. The presence of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, or Prevotella intermedia at baseline was not associated with the outcome of the periodontal therapy. In conclusion, we found that the presence of the 3 periodontopathogen species had little or no value in predicting healing of periodontal pockets.

Association between early weaning, non-nutritive sucking habits and occlusal anomalies in 3-year-old Finnish children

OBJECTIVES, DESIGN AND SUBJECTS: Earlier results on the effect of breastfeeding on the one hand, and non-nutritive sucking habits (pacifier and/or digit sucking) on the other, on the orofacial development of infants are inconclusive. Thus we studied the prevalence of malocclusions and their relationship to the duration of breastfeeding and to non-nutritive sucking habits in a group of randomly selected 3-year-old children (n = 148).

RESULTS

Posterior crossbite was detected in 13%, anterior open bite in 18% and large overjet (> 3 mm) in 26% of the children. The proportion of children with anterior vertical open bite was significantly larger among children with non-nutritive sucking habits than among the other children (P < 0.001). Neither posterior crossbite nor large overjet were associated with non-nutritive sucking habits. The duration of exclusive breastfeeding was 5.8 +/- 3.6 months while that of total breastfeeding was 7.3 +/- 3.8 months on average. The exclusive and total breastfeeding periods of children with posterior crossbite were both significantly shorter than those of the other children (P < 0.01 and P < 0.002, respectively). Children's height and weight were unrelated to the duration of breastfeeding or occlusal anomalies.

CONCLUSION

We suggest that an early introduction of bottlefeeding, indicating a pattern of low-impact muscular activity, may interfere with the normal development of alveolar ridges and hard palate, and hence lead to posterior crossbite.

Update of cancer incidence among workers at a copper/nickel smelter and nickel refinery

OBJECTIVES

To assess cancer risk among nickel-exposed workers.

METHODS

We updated cancer incidence among 1388 workers employed for at least 3 months at a copper/nickel smelter and nickel refinery in Harjavalta, Finland. There were 1155 workers exposed to nickel during the period 1960-1985 in the smelter (566 workers), repair shop (239 workers), or refinery (418 workers). Cancer incidence was followed through the files of the Finnish Cancer Registry up to 31 December 1995. For overall cancer and for a priori selected specific cancer types the ratio of observed to expected numbers of cases was computed as a standardized incidence ratio (SIR), controlled for age, gender, and calendar period and using the region-specific rates as a reference.

RESULTS

The overall cancer incidence among both nickel-exposed and unexposed subcohorts was at the expected level. A small increase in lung cancer incidence, which reached statistical significance among workers with a latency exceeding 20 years, was observed among the smelter workers exposed to insoluble nickel compounds. Among workers in the refinery, who were exposed primarily to nickel sulfate at levels below 0.5 mg/m3 as well as to low concentrations of other nickel compounds, there was an increased risk for nasal cancer (SIR 41.1, 95% CI 4.97-148), positively associated with latency and duration of employment, and an excess risk for stomach (SIR 4.98, 95% CI 1.62-11.6) and lung (SIR 2.61, 95% CI 0.96-5.67) cancers.

CONCLUSIONS

Since elevated nasal and lung cancer risks were confined to the refinery, where the primary exposure was to nickel sulfate, it is likely that nickel sulfate is mainly responsible for the elevated respiratory cancer risk. We cannot rule out whether the excess stomach cancer risk is a chance finding, or related to the working environment.

Prevalence and etiology of unilateral sensorineural hearing impairment in a Finnish childhood population

A retrospective study was undertaken on the prevalence and etiology of unilateral sensorineural hearing impairment (> 25 dB at 0.5-4 kHz, including mixed hearing impairments with bone conduction thresholds > or = 25 dB) among children born between 1972 and 1986 in a province of eastern Finland. Only patients who had been diagnosed before the age of 10 years were included. A total of 84 children with such an unilateral hearing loss were identified, with prevalence of 1.7 per 1000 live births. A significant decline from the prevalence of 2.2 per 1000 in the 1970s to the prevalence of 1.2 per 1000 in the 1980s was observed, which was mainly due to the disappearance of hearing losses caused by mumps and measles in the 1980s and the decrease in cases attributed to otitis media. In agreement with some previous studies, a considerable male predominance was present. Thirty-five percent of the hearing losses were profound (> 95 dB) and 15% were severe (71-95 dB). Etiology of the hearing impairment was estimated as genetic in 2%, congenital non-genetic in 12%, delayed-onset non-genetic in 35% and remained unknown in 51%.

Possible explanations for social class differences in cancer patient survival

Social class differences in cancer patient survival have been reported for most cancer types and for a number of countries. The etiology of these differences has been studied less thoroughly and less systematically than social class differences in cancer occurrence. Stage of disease at diagnosis appears to be the most important factor contributing to the social class differences in cancer patient survival. This has been observed most clearly for gastrointestinal and gynaecological cancers. Social class differences in survival are generally wider for patients diagnosed with cancer at local stages than for those diagnosed with cancer at advanced stages. The reasons why cancers are more frequently diagnosed at a local stage in high than in low social classes in not properly understood at the moment. Of other potential contributing factors, the role of treatment and psychosocial factors has scarcely been studied. Biological indicators of tumour aggressiveness have failed to explain the social class differences.

Congenital and early-onset bilateral hearing impairment in children: the delay in detection

A retrospective review of 168 consecutive children with congenital or early-onset bilateral hearing impairment (> 25 dB, 0.5-4 kHz, in the better hearing ear) was conducted. Only 39 per cent of the hearing-impaired children were diagnosed within the first two years of life. The age at diagnosis was related to the severity of hearing loss with profound (> 95 dB) hearing losses being detected earlier than the other degrees. However, 37 per cent of children with severe to profound (> 70 dB) hearing loss were still not diagnosed until after two years of age. Children with severe to profound hearing loss and with known risk factors were diagnosed earlier than children with the same hearing status but with no known risk factors. It was concluded that the behavioural hearing screening tests used in our well-baby clinics are insufficient and, therefore, more reliable methods, preferably evoked otoacoustic emissions, should be used for universal hearing screening of infants and young children in spite of the great cost.

Prevention of temporomandibular disorder-related signs and symptoms in orthodontically treated adolescents. A 3-year follow-up of a prospective randomized trial

Recommendations about the need for occlusal adjustment after malocclusion therapy are inconclusive. A total of 123 orthodontically treated healthy adolescents (88 girls, 35 boys; 14.8 +/- 1.7 years old) agreed to participate in the present study. The subjects were interviewed and examined for signs and symptoms related to temporomandibular disorder (TMD) and were randomly allocated to intervention (n = 63) and control (n = 60) groups. At base line, occlusal adjustment was carried out for the intervention group and repeated every 6 months thereafter as needed. Mock adjustments were performed for the control group. At the end of the 3rd year 118 subjects (96%) turned up for re-examination. The number of subjects with palpatory pain of the masticatory muscles, and with occlusal centric slides decreased significantly in the intervention group but not in the control group (P < 0.001). In conclusion, occlusal adjustment therapy may prevent the occurrence of TMD signs in orthodontically treated healthy adolescents.

Salivary cholesterol of healthy adults in relation to serum cholesterol concentration and oral health

Salivary lipids are mostly glandular in origin, but some are believed to diffuse directly from serum. This diffusion and the role of salivary lipids in oral health have scarcely been studied. Therefore, the serum and saliva cholesterol concentrations and oral health were analyzed in a group of healthy adults (n = 139; 64 men and 75 women; 34.2 +/- 5.2 yrs). Paraffin-stimulated whole saliva was collected, centrifuged (10,000 x g; 30 min, 4 degrees C), and lyophilized, and the cholesterol and other neutral lipids were extracted, separated by thin-layer chromatography, and quantified. The mean +/- SD (range) of saliva cholesterol concentration was 1.20 +/- 0.75 (0.02-5.46) mumol/L, and the saliva cholesterol level of men (1.36 +/- 0.85 mumol/L) was significantly higher than that of women (1.06 +/- 0.64 mumol/L; p < 0.05). Weak positive correlations between saliva and serum cholesterol concentrations and saliva cholesterol and serum non-high-density lipoprotein cholesterol concentrations were found (r = 0.22, p < 0.05; r = 0.28, p < 0.005, respectively). The saliva cholesterol assay detected subjects with high (> or = 6.5 mmol/L) serum cholesterol values, with sensitivity and specificity values of 100% and 29%, respectively. A positive correlation between the body mass index and the level of saliva cholesterol concentration was also found (r = 0.31 p < 0.01). Oral health, microbial counts, or saliva flow rate revealed no differences in subjects with low and high salivary cholesterol level. We conclude that, in healthy adults, saliva cholesterol concentration reflects serum concentration to some extent and can be used to select individuals with high serum cholesterol levels.

Prevalence and etiology of bilateral sensorineural hearing impairment in a Finnish childhood population

A retrospective study was performed on the prevalence and etiology of bilateral sensorineural hearing impairment (> 25 dB at 0.5-4 kHz in the better ear) among children born 1974-1987 in a province of eastern Finland. A total of 98 children with hearing impairment were identified, which gave a prevalence of 2.1 per 1000 live births. This prevalence was higher than reported form most of other developed countries but slightly lower than reported from Sweden. A slight decline from the prevalence of 2.3 per 1000 in the 1970s to the prevalence of 1.9 per 1000 in the 1980s was observed. Contrary to several earlier studies, no male predominance was noted, there were even slightly more females than males (52 vs. 46). Etiology of the hearing loss was estimated to be genetic in 41%, congenital nongenetic in 13%, delayed-onset nongenetic in 16% and remained unknown in 30%. On average, children with a congenital disorder had more severe hearing impairment than those with delayed-onset hearing loss, e.g. 31% of the former patients had profound (> 95 dB) hearing loss compared to 6% of the latter. A very gratifying finding was that no case of congenital hearing impairment caused by maternal rubella was identified after 1982, obviously due to general vaccinations. Also, a decline in cases of hearing loss attributed to perinatal and neonatal complications was observed.

Patient managed clinical trial

We describe a trial design of postmenopausal hormone therapy. Our goal was to design a trial that allows more patient management than usual, would include placebo effect in the therapy, would imitate the normal practices of health care as much as possible, and would be based on ordinary health services. We gave women a randomized recommendation to use or not use hormone therapy, invited them to two discussion groups, and sent them two questionnaires. They were asked to consult their own physician and to pay for the therapy themselves. The design worked well regarding recruitment, but compliance after 6 months was not satisfactory. The main problems were the women's aversion to randomization, the attitudes of the women's own physicians, and the difficulty in stopping the use of hormone therapy. The last-mentioned problem could be avoided by different inclusion criteria. Unless societal perception of research can be changed, most solutions to improve compliance would lead toward traditional trial designs.

Oral health of 3-year-old children and their parents after 29 months of child-focused antiatherosclerotic dietary intervention in a prospective randomized trial

A long-term prospective, randomized dietary intervention to prevent exposure of children to the known atherosclerosis risk factors (the STRIP baby project) was started when the age of the children was 7 months. The aim of this substudy was to analyze the oral effects of the dietary intervention in the children and their parents when the children had reached the age of 3 years. Every fifth family of the main study was invited to this substudy (n = 179). Those studied (n = 148) represented well the intervention and the control groups and both genders in terms of intake of saturated fatty acids, the dietary polyunsaturated fatty acid to saturated fatty acid (PUFA/SAFA) ration and serum cholesterol and HDL cholesterol concentrations. Though no difference was found in sucrose consumption between the intervention and the control groups, the intervention children received relatively (in E%) more energy from carbohydrates than the control children (p < 0.005), used absolutely (in g) and relatively (in E%) less fat (p < 0.05) and had a higher PUFA/SAFA ratio in their diet (p < 0.001). Of the 3-year-old children 93% were caries free, and dental decay was a prevalent in the intervention as in the control children. Control children brushed their teeth unassisted more often than the intervention children (p < 0.05). The intervention fathers also received more energy (in E%) from carbohydrates (p < 0.01), the intervention mothers used less fat (p < 0.05) and had a higher PUFA/SAFA ratio in the diet (p < 0.05) than the control fathers and mothers, respectively. Dental and periodontal health of the intervention and control parents (n = 250, 84% attending, mean +/- SD age: 34.2 +/- 54.5 years also showed no differences even though the control parents had more commonly last visited a dentist over 3 years before this examination (p < 0.05). We conclude that a 29-month period of a low-saturated-fat, low-cholesterol but high-carbohydrate diet as advocated in the STRIP baby trial does not seem to have harmful effects on the oral health of the children or their parents. Minor untoward differences had occurred in the dental health behavior of the control children and their parents.

Social class and cancer patient survival in Finland

The effect of social class on survival was assessed in a cohort of cancer patients identified from the nationwide population-based Finnish Cancer Registry. The cohort consisted of all reported cases of the 12 most common types of cancer occurring in Finland between 1971 and 1985 among persons born in 1906-1945 (n = 106,661). Social class information based on occupation was obtained individually for each patient from the population census of 1970. Both observed and corrected (i.e., cause of death-specific) 5-year survival rates were used in the analyses. A statistically significant linear effect of social class on age-adjusted relative risk of cancer death was observed in six of 12 cancer types among men and in nine of 12 among women; and the risk was highest for those in the lowest social class. The relative risk of death due to cancer for social class I (highest) relative to social class IV (lowest) was lowest in bladder cancer (relative risk (RR) = 0.46, 95% confidence interval (CI) 0.34-0.61) and kidney cancer (RR = 0.61, 95% CI 0.48-0.78) among men and in corpus uteri (RR = 0.51, 95% CI 0.36-0.72) and rectum cancer (RR = 0.56, 95% CI 0.42-0.74) among women. The differences between results obtained using corrected and observed survival rates were small. These findings indicate that social class is an important determinant of cancer patient survival. Additional research is required to clarify the etiology of the social class differences and to identify factors that could be used for developing strategies to diminish such inequalities.

Hearing loss at the age of 5 years of children born preterm--a matter of definition

The effect of three common hearing impairment criteria on the prevalence of hearing loss was evaluated in 58 prospectively followed-up 5-year-old children born preterm at < or = 32 weeks of gestation. Audiological assessment was done as part of an extensive neurodevelopmental evaluation at the age of 5 years. With the criterion based on the classification of the World Health Organization (average threshold hearing level > 25 dB at frequencies of 0.5, 1 and 2 kHz, classified according to the less impaired side) there were two preterm children with mild hearing impairment. With Clark's criterion (unilateral average threshold hearing level > 15 dB at frequencies of 0.5, 1 and 2 kHz) eight children had slight hearing impairment; seven of these had conductive hearing problems. With the criterion of a single frequency-specific deficit > 15 dB for 0.25-4 kHz the number of hearing-impaired children was 28 out of 54 (51.9%), most of whom had conductive or unspecified hearing deficits. Moreover, of the four multiply handicapped, retarded children whose pure tone thresholds were not assessed monaurally, three would belong to the hearing-impaired group according to Clark's criterion and four according to the frequency-specific criterion.

Bladder tumours following chemotherapy and radiotherapy for ovarian cancer: a case-control study

A collaborative group of cancer registries and hospitals carried out a case-control study of tumours of the bladder in women who had previously been treated for ovarian cancer. A total of 63 cases of bladder tumours were identified, and 188 controls were selected matching for age, year of ovarian cancer diagnosis and survival time. Full details of the treatment for ovarian cancer were sought for both cases and for controls. The risk of bladder tumours was increased for patients who had been treated by radiotherapy alone (1.9; 95% confidence interval, 0.77-4.9), by chemotherapy alone (3.2; 0.97-10), and by chemotherapy and radiotherapy (5.2; 1.6-16), when comparison was made with patients treated only by surgery. Patients treated by chemotherapy were separated into 2 groups according to whether they had received cyclophosphamide. Among those who had, there was a clear increase in risk (approximately 4-fold) regardless of whether or not they had also received radiotherapy. For those who received only other drugs, risk was increased substantially among patients who had also been treated by radiation, as compared with patients treated by surgery alone, and those who had received radiotherapy only. Both melphalan and thiotepa were implicated as potential bladder carcinogens on the basis of these results. The estimated risk of bladder tumours due to cyclophosphamide was more than twice the risk following radiation to the bladder, and it appeared substantially earlier. For both agents, the risk continued to increase more than 10 years after treatment began.

Usher's syndrome type 3 in Finland

Usher's syndrome, type 3 (USH3) is characterized by progressive hearing loss. Usher's syndrome, type 3 has been supposed to be rare, occurring in 2% to 4% of all patients with Usher's syndrome. In a nationwide study we collected data on 229 patients with Usher's syndrome in Finland. Definite cases of USH3 were found in 30 (13%) of the 229 patients. An additional 61 patients had clinical evidence of earlier progression of their hearing impairment. We suggest that 91 (40%) of the 229 patients with Usher's syndrome represent cases of USH3.

Improvement of metabolic control does not normalize auditory brainstem latencies in subjects with insulin-dependent diabetes mellitus

INTRODUCTION

In our previous study (Am J Otolaryngol 14:413-418, 1993), we reported that prolonged auditory brainstem response latencies are associated with microvascular complications and the duration of diabetes in patients with insulin-dependent diabetes mellitus (IDDM). To investigate whether short-term improvement in metabolic control also affects ABR-responses, we compared ABR-latencies in subjects with IDDM before and after intensified insulin and diet therapy.

MATERIALS AND METHODS

Auditory brainstem latencies were measured in 13 subjects with IDDM (mean age: 25 years) before and after intensified insulin and diet therapy. The acoustic stimulus was a half sine wave with a duration of 0.250 millisecond and a frequency of 2,000 Hz. The stimulus was presented monaurally with fixed polarity through shielded headphones TDH-39 at repetition rate of 10 Hz and at 90 dB hearing level. All subjects had normal hearing ability. Glycated hemoglobin A1C (GHbA1C), blood glucose immediately before ABR-measurements, and mean blood glucose during 24 hours before auditory studies were measured before and after intensified therapy.

RESULTS

During intensified insulin therapy, GHbA1C improved significantly (P < .05) in study subjects. However, no changes were observed in ABR-latencies. We also studied those 10 patients whose blood glucose improved during intensified insulin therapy. Although blood glucose was significantly lower (P < .01) after intensified insulin therapy compared with that at baseline, no changes were observed between ABR-latencies at baseline and follow-up.

CONCLUSION

ABR-latencies were not affected by improvement in metabolic control in patients with IDDM. Our finding suggests that delayed ABR-latencies found in patients with IDDM are not caused by poor metabolic control of diabetes but rather by other mechanisms, for example, microvascular complications.

Assignment of an Usher syndrome type III (USH3) gene to chromosome 3q

Usher syndrome (USH) refers to genetically and clinically heterogeneous autosomal recessive disorders with combined visual and hearing loss. Type I (USH1) is characterized by a congenital, severe to profound hearing loss and absent vestibular function; in type II (USH2) the hearing loss is congenital and moderate to severe, and the vestibular function is normal. Progressive pigmentary retinopathy (PPR) is present in both types. A third type (USH3) differing from USH2 by the progressive nature of its hearing loss has been suggested. USH3 has previously been estimated to comprise 2% of all USH. However, based on clinical criteria, in Finland 42% of USH patients have progressive hearing loss suggesting enrichment of an USH3 gene. We excluded the four previously mapped USH regions as the site of the USH3 disease locus. Systematic search for USH3 by genetic linkage analyses in 10 multiple affected families using polymorphic microsatellite markers revealed significant linkage with markers mapping to chromosome 3q. Pairwise lod scores at zero recombination distance were 7.87 for D3S1308, and 11.29 for D3S1299, incorporating the observed linkage disequilibrium. Conventional multipoint linkage analysis gave a maximum lod score of 9.88 at D3S1299 assigning USH3 to the 5 cM interval between markers D3S1555 and D3S1279 in 3q21-25.(ABSTRACT TRUNCATED AT 250 WORDS)

Caries development after substitution of supervised fluoride rinses and toothbrushings by unsupervised use of fluoride toothpaste

In a nonfluoridated community of Finland, where fortnightly fluoride rinsing with 0.2% sodium fluoride has been used for nearly two decades, a total of 313 children 7-8 yr old were recruited and randomly divided into two groups. 206 children completed the 3-yr trial. The control group (n = 94) participated in the rinsing program which included supervised toothbrushings, while the test group (n = 112) received a new fluoride toothpaste tube (0.15% F) for home use every second month. Annual dental recordings, treatment plannings and the treatment itself were all carried out by one clinician. At the end of the study the number of caries-free children of the toothpaste group was lower (P < 0.01) and the caries increment higher (P < 0.05) than that of the mouthrinse group. Out of the mean of four dental visits per child and year some 1.5 were prophylactic by nature. No differences were found between the number of treatment visits, time or prophylactic care of the two groups. Unsupervised use of fluoride toothpaste may not be a sufficient substitute for the school-based fortnightly fluoride rinses and supervised toothbrushings in caries prevention of children with erupting permanent teeth.

Hearing thresholds in insulin-dependent diabetic patients

Hearing thresholds were studied in 53 patients with insulin-dependent diabetes mellitus (IDDM) and 42 randomly selected non-diabetic control subjects, aged between 20 and 40 years. The hearing level tended to be worse in diabetic patients than in control subjects, but the differences were statistically significant only at frequencies of 6,000 and 8,000 Hz. Microvascular complications (retinopathy and nephropathy), and the duration of diabetes were associated with the elevated hearing thresholds. In contrast, poor metabolic control (high fasting blood glucose and glycated haemoglobin A1c) was not associated with increased hearing thresholds. The changes caused by diabetic neuropathy appeared simultaneously with microvascular complications and a long duration of the diabetes, and thus a causative role of diabetic neuropathy in the pathogenesis of elevated hearing thresholds remained unsolved. It was concluded that elevated sensorineural hearing thresholds at the frequencies of 6,000 and 8,000 Hz in patients with IDDM are probably caused by the long duration of diabetes and the microvascular complications associated with it.

Relationship of leukemia risk to radiation dose following cancer of the uterine corpus

BACKGROUND

Radiotherapy has been linked infrequently to secondary leukemia despite extensive exposure of the active bone marrow to ionizing radiation. Few studies include substantial numbers of elderly patients.

PURPOSE

We evaluated women with cancer of the uterine corpus, the majority of whom were treated at older ages, to gain additional information on cancer risk following partial-body radiotherapy and to examine differences in risk between external-beam therapy and brachytherapy.

METHODS

A cohort of 110,000 women with invasive cancer of the uterine corpus who survived at least 1 year following their initial cancer was assembled from nine population-based cancer registries. Cancer diagnoses occurred from 1935 through 1985, and most patients were diagnosed during the 1960s and 1970s. Radiation doses were computed to 17 sections of the active bone marrow for 218 women who developed leukemia and for 775 matched control subjects.

RESULTS

Radiotherapy did not increase the risk of chronic lymphocytic leukemia (CLL) (relative risk [RR] = 0.90; 95% confidence interval [CI] = 0.4-1.9). However, for all leukemias except CLL, a significant risk was identified (RR = 1.92; 95% CI = 1.3-2.9). Overall, the pattern of risk in relation to dose was erratic and was most consistent with a constant increased risk across the entire dose range. The risk following continuous exposures from brachytherapy at comparatively low doses and low dose rates (RR = 1.80; 95% CI = 1.1-2.8; mean dose = 1.72 Gy) was similar to that after fractionated exposures at much higher doses and higher dose rates from external-beam treatment (RR = 2.29; 95% CI = 1.4-3.7; mean dose = 9.88 Gy), indicating a large difference in the estimated risk per unit dose. Risk did not vary by age at first exposure; increased risks were apparent for irradiated patients aged 65 years or older (RR = 1.77; 95% CI = 0.9-3.5).

CONCLUSION

The leukemia risk associated with partial-body radiotherapy for uterine corpus cancer was small; about 14 excess leukemia cases were due to radiation per 10,000 women followed for 10 years. Women aged 65 years or older had a radiation risk comparable with that found in younger women. The relationship of leukemia risk to radiation dose was found to be complex due to the competing processes of cell killing, transformation, and repair. At very high doses delivered at high rates, destruction of cells likely dominates, and the risk per unit dose is low. In the low dose range, where dose was protracted and delivered at relatively low dose rates, the leukemia risk appears lower than that projected from risk estimates derived from the instantaneous whole-body exposures of atomic bomb survivors.

Drinking water mutagenicity and gastrointestinal and urinary tract cancers: an ecological study in Finland

OBJECTIVES

The purpose of this study was to investigate the relationship between exposure to mutagenic drinking water and cancers of the gastrointestinal and urinary tract.

METHODS

Past exposure to drinking water mutagenicity was assessed in 56 Finnish municipalities for the years 1955 and 1970. The cases of bladder, kidney, stomach, colon, and rectum cancers were derived from two periods (1967 to 1976 and 1977 to 1986). Age, sex, social class, urban living, and time period were taken into account in the Poisson regression analysis.

RESULTS

Statistically significant exposure-response association was observed between exposure and incidence of bladder, kidney, and stomach cancers. In an ordinary municipality using chlorinated surface water, this exposure would indicate a relative risk of 1.2 for bladder cancer and of 1.2 to 1.4 for kidney cancer compared with municipalities where nonmutagenic drinking water was consumed.

CONCLUSIONS

The acidic mutagenic compounds present in drinking water may play a role in the etiology of kidney and bladder cancers, but, because the results are based on aggregate data, they should be interpreted with caution.

Effect of drinking water fluoridation on hearing of patients with otosclerosis in a low fluoride area: a follow-up study

Fluorine content in bone samples taken from the middle ears of otosclerotic patients was determined. Otosclerotic stapes footplate was found to have a significantly higher content of fluorine than skeletal bone from the meatus. Fluorine contents in footplate and meatal wall samples of otosclerotic patients drinking fluoridated water were slightly higher than those of patients drinking low-fluoride water. In the clinical part of the study, hearing levels of 280 patients with otosclerosis living in an area with low-fluoride water were assessed. In 344 operated ears, the preoperative and long-term postoperative air conduction and bone conduction thresholds of patients drinking fluoridated water did not differ significantly from those of patients drinking low-fluoride water. After a mean follow-up period of 9.6 years, air conduction thresholds of non-operated ears in patients drinking fluoride-poor water were found to be significantly worse than those of patients drinking fluoridated tap water, likewise there were significant differences in bone conduction thresholds at 2 and 4 kHz. Thus, fluoridation of drinking water has a beneficial effect on non-operated otosclerotic ears but has no significant effect on hearing levels of operated ears.

Acoustic-reflex responses in patients with insulin-dependent diabetes mellitus

PURPOSE

Patients with insulin-dependent diabetes mellitus (IDDM) are especially susceptible to microangiopathic complications such as nephropathy, retinopathy, and neuropathy. Microangiopathic changes are also the most important findings in histopathologic studies of the inner ear and central nervous systems in diabetic subjects. No previous studies have measured acoustic-reflex latencies (ARL) or amplitudes (ARA) in patients with IDDM. ARL and ARA reflect the function of the acoustic-reflex arch. Furthermore, possible changes in the tympanic membrane, ossicular chain, and stapedius muscle may affect the shape of acoustic-reflex.

SUBJECTS AND METHODS

Acoustic-reflex thresholds, latencies, and amplitudes were studied in 53 patients with IDDM and 42 randomly selected nondiabetic control subjects, aged between 20 and 40 years, using the Madsen Model ZO 73 Impedance Bridge (Madsen Electronics, Copenhagen, Denmark). Subjects with an abnormal tympanic membrane, conductive hearing loss, and known cause for hearing impairment eg, noise damage, were excluded from the study.

RESULTS

There were no differences between control and diabetic subjects in the contralateral acoustic-reflex thresholds. In contrast, patients with IDDM had longer ARLs and decreased ARAs compared with those of control subjects. ARA amplitude had linear correlation with the amplitude of tympanogram, whereas ARL had no linear correlation with auditory brainstem latencies in the same study subjects. Acoustic-reflex responses in insulin-dependent diabetic patients were not associated with the duration of diabetes, metabolic control, microangiopathy, or neuropathy.

CONCLUSIONS

Prolonged ARLs and decreased ARAs in patients with insulin-dependent diabetes are probably caused more by the stiff middle ear system than disturbances in the brainstem.

Neurodevelopmental profile at five years of children born at < or = 32 weeks gestation

Sixty children born preterm (gestational age < or = 32 weeks) and 60 control children matched by sex, and socio-economic and educational status of the parents were followed prospectively to the age of five years. Neurodevelopmental problems were surveyed by a detailed neurological and neuropsychological test battery, and by ophthalmological and hearing examinations. All except one of the preterm children with major disability had motor, visual-spatial and visual problems. The most frequent neurodevelopmental abnormalities encountered among preterm children without major disability were motor problems--emerging as gross and fine motor and/or visual-motor difficulties--and visual-spatial problems. Language difficulties were not associated with hearing problems. Among those without major disability, visual-spatial difficulties and ophthalmological problems seldom emerged simultaneously.

Auditory brainstem latencies in type I (insulin-dependent) diabetic patients

INTRODUCTION

This study was undertaken to compare auditory brainstem response latencies in insulin-dependent diabetics, and to compare these findings with metabolic control, microangiopathy, neuropathy, and the duration of diabetes.

METHODS

Auditory brainstem latencies were studied in 53 type I diabetic patients and 42 randomly selected nondiabetic control subjects, aged between 20 and 40 years. Three different stimulus repetition rates (10, 30, and 50 Hz) were used. All subjects had normal hearing ability.

RESULTS

Wave V latencies were longer in diabetic patients when compared with those of control subjects at all repetition rates. At repetition rates of 10 and 50 Hz, diabetic patients had a prolonged I-V interwave latency, and at a repetition rate of 50 Hz, diabetics had a longer III-V interwave latency than control subjects. These findings indicate a central disturbance in the auditory pathway. Microvascular complications (retinopathy, nephropathy) and the duration of diabetes were associated with the prolongation of auditory brainstem latencies. In contrast, poor metabolic control (high fasting blood glucose and glycated hemoglobin A1c) at the time of the present study was only marginally associated with prolonged auditory brainstem latencies. The changes in auditory brainstem latencies associated with diabetic neuropathy (measured with five cardiac autonomic nervous function tests) appeared simultaneously with microvascular complications and in patients with diabetes of long duration, and thus a causative role of diabetic neuropathy in the pathogenesis of prolonged auditory brainstem latencies remains unsolved.

CONCLUSION

Delayed auditory brainstem latencies in type I diabetic patients are probably caused by the long duration of diabetes and the microvascular complications associated with it.

Posterior crus stapedectomy

The results of stapedectomy were compared between 162 otosclerotic ears operated on using the posterior crus technique and 182 otosclerotic ears undergoing Teflon piston stapedectomy. The large fenestra technique with fascia seal to the oval window was used in all cases. Mean follow-up period was 9.6 years. Neither short-nor long-term hearing results showed any significant differences between the two surgical technique groups. Complications of surgery were more common in patients undergoing Teflon piston stapedectomy. On the other hand, a re-operation for recurring conductive deafness was performed significantly more often in patients undergoing posterior crus stapedectomy.

Voluntary eye movement tests in patients with insulin-dependent diabetes mellitus

Eye movement tests (saccade tests: reaction time, peak velocities and accuracy, and the eye tracking test) were studied in 53 insulin-dependent diabetic (IDDM) patients and 42 randomly selected non-diabetic control subjects, aged between 20 and 40 years. All subjects had central visual acuity of at least 0.1 in one eye, and none had ophthalmoplegia. The reaction time was longer and the accuracy decreased in the saccade test in diabetic patients as compared to control subjects. Peak velocities tended to be slower in diabetic patients, but no significant differences between diabetic and non-diabetic subjects were observed. The maximum eye movement velocities were reduced at all target velocities in diabetic patients as compared to control subjects. These findings can be explained on the basis of many potential disturbances in the central nervous system. Only the duration of diabetes had a clear association with maximum smooth pursuit eye movement velocities in the eye tracking test. Microvascular complications (retinopathy, nephropathy), autonomic neuropathy or metabolic control (high fasting blood glucose and glycated hemoglobin A1c) had no clear association with the results of eye movement tests. In conclusion, insulin dependent diabetes mellitus deteriorates the visuomotor responses.

Hearing levels of patients with otosclerosis 10 years after stapedectomy

Hearing levels of 174 patients (213 ears operated on) with otosclerosis undergoing stapedectomy were analyzed. All patients had followup of 10 years or more, the mean follow-up period being 13.4 years. Eighty-seven ears (41%) underwent posterior crus stapedectomy, and in the remaining 126 ears (59%) a prosthesis was inserted. Large fenestra technique was used in all cases. In the long run, both air conduction and bone conduction thresholds of ears operated on showed remarkable deterioration from the best values obtained 6 to 12 months postoperatively. Ten years after surgery both air conduction and bone conduction thresholds of ears operated on were significantly worse than those of normal controls. At 10 years, 70 percent of the ears operated on had hearing levels (at 0.5 to 2.0 kHz) of 30 dB or better and 88 percent had 40 dB or better. At the last follow-up examination, in 90% of the patients the better hearing ear had a hearing level of 40 dB or better. In 90% of patients with bilateral otosclerosis who had operations in only one ear, the ear operated on had better hearing function than the opposite ear that had not been operated on.

Survival rates in lung cancer patients with and without bronchial asthma

Bronchial asthma itself or the treatment of asthma may modify the immunological response to cancer. The survival of lung cancer patients with a preceding diagnosis of bronchial asthma was compared with that of non-asthmatic lung cancer patients in Finland during 1970-1989. This was accomplished by linking two nation-wide data registers, the medication reimbursement register and the cancer registry. For 921 out of the 926 asthmatic patients with lung cancer diagnosed after the diagnosis of bronchial asthma, a non-asthmatic referent patient, matching with respect to sex, anatomical site, and histological type of tumour, as well as to age and year of lung cancer diagnosis, was successfully found in the files of the Cancer Registry. Another referent group was formed by using the stage of lung cancer at diagnosis as an extra matching criterion; this search was successful for 895 asthmatic lung cancer patients. The corrected 5-year survival rate of asthmatic lung cancer patients was 8.4% and that of the referent patients, not matched for stage, 9.6%. When stage was included as matching criterion the corresponding rates were 8.5% and 8.1% respectively. None of these differences were significant. The prognosis of asthmatic and non-asthmatic lung cancer patients thus seemed to be similar.