AMA policy statement on cardiovascular screening of student athletes.
Explore the source record for details and available documents.
American Medical Association↗
Biomedical subjects
N H Nielsen
Publications and source records attributed to N H Nielsen.
Cardiovascular screening of student athletes.
Each year, a number of children and adolescents die suddenly from cardiac problems that are associated with a small subgroup of disorders and high-risk behaviors. While sudden cardiac death in any child or adolescent is distressing, it can be particularly devastating when it occurs in a seemingly healthy young athlete. Although uncommon in competitive sports, sudden death is a catastrophe that physicians who care for athletes should attempt to prevent. To prevent the occurrence of sudden death or cardiovascular disease progression in young athletes, the American Academy of Family Physicians, American Academy of Pediatrics, American College of Cardiology, American College of Sports Medicine, American Heart Association, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine and American Osteopathic Academy of Sports Medicine have developed or endorsed recommendations for cardiovascular screening of student athletes as part of a comprehensive sports preparticipation physical evaluation (PPE). Knowledge and understanding of these recommendations can help physicians make informed decisions about the eligibility of an athlete to participate in a particular sport and encourage development of a more uniform PPE screening process.
Adolescent↗
Nickel-induced cytokine production from mononuclear cells in nickel-sensitive individuals and controls. Cytokine profiles in nickel-sensitive individuals with nickel allergy-related hand eczema before and after nickel challenge.
Exposure to nickel is a major cause of allergic contact dermatitis which is considered to be an inflammatory response induced by antigen-specific T cells. Here we describe the in vitro analysis of the nickel-specific T-cell-derived cytokine response of peripheral blood mononuclear cells from 35 nickel-allergic and 30 non-nickel-allergic individuals. Peripheral blood mononuclear cells were stimulated with 10(-4) and 10(-5) mol/l NiSO4 for 6 days and then additionally with ionomycin and phorbol myristate acetate for 24 h. Culture supernatants were analysed for interleukin-4 (IL-4), IL-5, interferon-gamma (IFN-gamma) and tumour necrosis factor-alpha (TNF-alpha) by quantitative ELISA. The analysis showed that the synthesis of IL-4 and IL-5 but not of IFN-gamma or TNF-alpha was significantly higher in the nickel-allergic individuals. The finding of preferential synthesis of Th2 cytokines was somewhat of a surprise, since previous studies have suggested a Th1 response in nickel-mediated allergic contact dermatitis. Subsequently, the nickel-allergic individuals were randomized to experimental exposure to nickel or vehicle in a double-blind design. A daily 10-min exposure of one finger to 10 ppm nickel solution for 1 week followed by 100 ppm for an additional week evoked a clinical response of hand eczema in the nickel-exposed group. Blood samples were drawn on days 7 and 14 after the start of this exposure to occupationally relevant concentrations of nickel. No statistically significant differences were observed in the nickel-induced in vitro cytokine response during the exposure period. Our results indicate the possibility that IL-4 and IL-5 are involved in the pathogenesis of nickel-mediated contact dermatitis.
Cytokines↗
The prevalence of skin-test-positive allergic rhinitis in Danish adults: two cross-sectional surveys 8 years apart. The Copenhagen Allergy Study.
BACKGROUND: It is disputed whether increases in self-reported respiratory allergy represent a true increase or merely increased recognition. We aimed to investigate whether the prevalence of skin-prick-test (SPT)-positive allergic rhinitis had increased in an adult general population in Copenhagen, Denmark. METHODS: Two cross-sectional surveys were carried out in 1990 and 1998. A screening questionnaire on respiratory symptoms in random samples of 15-41-year-olds preceded both surveys. Among the responders, random samples were invited to a health examination including SPT. Totals of 312 (participation rate 74.6%) and 482 (participation rate 53.4%) subjects were examined in 1990 and 1998, respectively. Diagnoses of SPT-positive allergic rhinitis were based on a history of nasal symptoms on exposure to allergens and SPT positivity to allergens. RESULTS: The prevalence of a diagnosis of SPT-positive allergic rhinitis increased from 12.9% to 22.5% (adjusted odds ratio 1.94, 95% CI 1.30-2.90), whereas the prevalence of a positive SPT (allergen histamine wheal ratio > or = 0.5) to one or more of 10 allergens increased from 27.7% to 33.9% (adjusted odds ratio 1.47, 95% CI 1.05-2.05). CONCLUSIONS: The prevalence of SPT-positive allergic rhinitis has increased significantly. Our findings indicate that a true increase in respiratory allergy has occurred.
Adult↗
Increasing prevalence of specific IgE to aeroallergens in an adult population: two cross-sectional surveys 8 years apart: the Copenhagen Allergy Study.
BACKGROUND: There is evidence that the prevalence of respiratory allergy has increased in children in many countries. However, this evidence is largely based on questionnaire data, and little is known about similar trends in adults. OBJECTIVE: We investigated whether the prevalence of specific IgE to aeroallergens had increased in an adult general population over an 8-year period. METHODS: Two cross-sectional surveys were carried out in 1990 and 1998. A mailed screening questionnaire on respiratory symptoms sent to random samples of 15- to 41-year-old subjects living in Copenhagen (Denmark) preceded both surveys. Random samples of responders were invited to a health examination, including assessment of specific IgE to 6 common aeroallergens. Totals of 312 (74.6% of the invited subjects) and 482 (53.4% of the invited subjects) subjects were examined in 1990 and 1998, respectively. Analyses of serum samples from both surveys were performed in 1999. RESULTS: The prevalence of specific IgE to at least one allergen increased significantly from 1990 to 1998 (26.5% vs 33.9%; odds ratio adjusted for sex, age, and season of examination, 1.63; 95% confidence interval, 1.15-2.32; P = .006). This increase remained unexplained after adjustment for changes in questionnaire variables on lifestyle and home environment. The clinical significance of this increase was underlined by a corresponding increase in the prevalence of allergic rhinitis symptoms associated with specific IgE positivity. CONCLUSION: We found that the prevalence of specific IgE positivity to aeroallergens increased in an adult Danish general population from 1990 and 1998.
Adolescent↗
Use of opioids to treat chronic, noncancer pain.
Explore the source record for details and available documents.
Chronic Disease↗
Nickel concentrations in serum and urine of patients with nickel eczema.
This study is a part of the Biological Risk Assessment of Human Metal Sensitisation (BRAHMS) project with the aim of elucidating clinical and physiological effects of repeated exposures to low concentrations of metal allergens. Nickel allergic individuals (n = 35) with hand eczema and healthy controls (n = 30) were included in the study. Both groups had similar levels of nickel in urine, while the level of nickel in serum was significantly lower in nickel allergic individuals compared to controls. Nickel allergic individuals had a significantly lower intake of nickel-rich food items (chocolate, nuts, beans, porridge oats). Serum nickel levels correlated with intake of these foods, suggesting that the difference in serum nickel levels was caused by differences in dietary nickel intake.
Adult↗
Cyclin E dependent kinase activity in human breast cancer in relation to cyclin E, p27 and p21 expression and retinoblastoma protein phosphorylation.
The cell cycle machinery is regulated by cyclin dependent kinases and sets of activating and inhibitory proteins. The G1-S control mechanism is often deregulated in tumours supposedly leading to increased kinase activity, phosphorylation of substrates and subsequent S phase entrance. Increased kinase activity has been proposed to be essential in cell cycle aberrations, but few studies have actually shown enhanced kinase activity related to specific cell cycle defects in primary tumours. In the present study we have determined the cyclin E dependent kinase activity (cyclin E(kinase)) in 59 primary breast cancers, using an H1-kinase assay, and related the activity to the expression of cyclin E, p27 and p21. In a subgroup of 48 tumours, we further characterized the association between cyclin E(kinase), in vivo phosphorylation of the retinoblastoma protein (pRb) and proliferation. The cyclin E(kinase) correlated significantly with cyclin E content and inversely with p27 and p21 expression. P27, but not p21, was associated with low cyclin E(kinase) in specimens with normal/low levels of cyclin E. At elevated cyclin E levels, suppression of cyclin E(kinase) seemed to require high levels of both p21 and p27. The cyclin E(kinase) correlated with the phosphorylation status of pRb as well as with proliferation. Surprisingly, pRb phosphorylation did not correlate with proliferation. Our results support that pRb is a substrate for cyclin E(kinase) in primary breast cancer and that deregulation of cyclin E and p27 act through increased CDK-kinase activity, but cyclin E associated events beside pRb phosphorylation might be rate-limiting for entrance into S phase.
Breast Neoplasms↗
G1-S transition defects occur in most breast cancers and predict outcome.
Cell cycle deregulation is frequently observed in tumors and has moreover been proposed to be a requirement for tumor development. By analyzing the expression of p27 by immunohistochemistry in 100 primary breast tumors and combining the analyses with our earlier characterization of cyclin E, D1, p16, and the retinoblastoma protein (pRB), we have been able to cover the majority of potential G1-S transition defects and observed that 90% of the tumors had alterations in one or several cell cycle regulatory proteins. Considerable variations in protein levels were found among tumors, with low p16 expression as the most common alteration followed by cyclin E or cyclin D1 overexpression, low p27 expression or pRB inactivation in decreasing prevalence. Tumors were grouped according to observed combinations of defects and the proliferative capacity was determined for each group by analyzing Ki-67 labeling index. Low proliferation was observed in tumors with: low p16; high cyclin D1 with normal or high p16 expression; and in tumors without cell cycle defects. Tumors with high cyclin E/low p27 or pRB defects showed higher proliferation. The survival differed noticeably for patients with various combinations of cell cycle defects, and four distinctive clusters were identified showing significantly different breast cancer specific survival (p<0.0001) for both node-positive (p = 0.0006) and node-negative patients (p<0.0001). In summary, we have shown that G1-S transition defects are nearly obligatory in breast tumors and that the specific type of cell cycle defect influences the clinical behavior of the tumor.
Breast Neoplasms↗
Increasing prevalence of allergic rhinitis symptoms in an adult Danish population.
There is evidence that the prevalence of respiratory allergy is increasing. This is mainly based on studies in children and young adults. The aim of the study was to compare the prevalences of self-reported symptoms of respiratory allergy among Danish adults in two surveys 8 years apart. Identical questionnaires were mailed to two random general population samples in 1989 and 1997. The response rates were 86.1% (n = 3603) and 86.4% (n = 817), respectively. The sampling frame and sampling method were identical in both surveys. The changes in the prevalences of symptoms were expressed by sex- and age-adjusted odds ratios comparing 1997 to 1989. We found a significant increase in the prevalence of seasonal rhinitis symptoms (OR=1.6, 95% CI 1.4-1.9), rhinitis symptoms on exposure to pollen (OR =1.6, 95% CI 1.4-1.9), rhinitis symptoms on exposure to furry animals (odds ratio 1.6, 95% CI 1.3-2.0), rhinitis symptoms on exposure to house dust (OR = 1.3, 95% CI 1.1-1.6), and breathlessness on exposure to pollen (OR = 1.5, 95% CI 1.0-2.0). The observed increases were independent of sex and age. The questionnaire was validated in relation to allergen skin test reactivity in a subgroup of the responders to the 1989 survey. When the estimated associations between symptoms and skin test reactivity were considered, the results suggested an increase in allergy to pollen and animal dander. In conclusion, we found evidence of increased prevalence of allergic rhinitis symptoms associated with skin test reactivity.
Adolescent↗
Effects of repeated skin exposure to low nickel concentrations: a model for allergic contact dermatitis to nickel on the hands.
We studied the effects of repeated daily exposure to low nickel concentrations on the hands of patients with hand eczema and nickel allergy. The concentrations used were chosen to represent the range of trace to moderate occupational nickel exposure. The study was double-blinded and placebo controlled. Patients immersed a finger for 10 min daily into a 10-p.p.m. nickel concentration in water for the first week, and during the second week into a 100-p.p.m. nickel concentration. This regimen significantly increased (P = 0.05) local vesicle formation and blood flow (P = 0.03) as compared with a group of patients who immersed a finger into water. The nickel concentrations used also provoked significant inflammatory skin changes on sodium lauryl sulphate (SLS)-treated forearm skin of the patients, whereas inflammatory skin changes were not observed in healthy volunteers without hand eczema and nickel allergy, either on normal or on SLS-treated forearm skin. The present study strongly suggests that the changes observed were specific to nickel exposure. Standardized methods to assess trace to moderate nickel exposure on the hands, and the associated effects in nickel-sensitized subjects, are needed.
Adult↗
Awareness, diagnosis, and treatment of depression.
OBJECTIVES: To review recent findings on the epidemiology, burden, diagnosis, comorbidity, and treatment of depression, particularly in general medical settings; to delineate barriers to the recognition, diagnosis, and optimal management of depression in general medical settings; and to summarize efforts under way to reduce some of these barriers. DESIGN: MEDLINE searches were conducted to identify scientific articles published during the previous 10 years addressing depression in general medical settings and epidemiology, co-occurring conditions, diagnosis, costs, outcomes, and treatment. Articles relevant to the objective were selected and summarized. CONCLUSIONS: Depression occurs commonly, causing suffering, functional impairment, increased risk of suicide, added health care costs, and productivity losses. Effective treatments are available both when depression occurs alone and when it co-occurs with general medical illnesses. Many cases of depression seen in general medical settings are suitable for treatment within those settings. About half of all cases of depression in primary care settings are recognized, although subsequent treatments often fall short of existing practice guidelines. When treatments of documented efficacy are used, short-term patient outcomes are generally good. Barriers to diagnosing and treating depression include stigma; patient somatization and denial; physician knowledge and skill deficits; limited time; lack of availability of providers and treatments; limitations of third-party coverage; and restrictions on specialist, drug, and psychotherapeutic care. Public and professional education efforts, destigmatization, and improvement in access to mental health care are all needed to reduce these barriers.
Antidepressive Agents↗
Irritant contact dermatitis caused by methyl iodide.
Explore the source record for details and available documents.
Dermatitis, Occupational↗
Colorectal cancer in the Faroe Islands--a setting for the study of the role of diet.
BACKGROUND: The Faroe Islands are a group of small islands in the north Atlantic. The population is well-defined and is therefore very suitable for epidemiological research, including dietary studies in relation to carcinogenesis. With the establishment of a cancer registry on January 1, 1994, with data from 1960, inspection of incidence rates and trends in cancer may give clues to areas for etiologic research. METHODS: We identified retrospectively all incident cases of colorectal cancer in the period 1979-1993, by reviewing all case reports and death certificates in the Faroe Islands. RESULTS: We found 242 cases of colorectal cancer: 166 colon cancers and 76 rectal cancer, of which 93% and 96% (respectively) were histologically confirmed. Colorectal cancer incidence was significantly lower than in Denmark, with standardised incidence ratios (SIRs) for colon cancer at 0.8 (95% CI = 0.7-1.0) in men and 0.7 (95% CI = 0.6-0.9) in women. For rectal cancer SIRs were 0.6 (95% CI = 0.5-0.9) in males and 0.6 (95% CI = 0.4-0.9) in females. CONCLUSIONS: This paper presents for the first time incidence rates of colorectal cancer in the Faroe Islands. For both cancer types the most recent standardised incidence rates, 1989-1993, were among the lowest in north western Europe and North America. This relatively low risk of colorectal cancer occurs in spite of a low intake of vegetables and a high intake of total fat. However, the Faroese diet is high in fish, calcium and vitamin D and the possibility therefore exist that the low rates are due to a protective effect of these nutrients and micronutrients.
Adult↗
Telomerase activity in relation to p53 status and clinico-pathological parameters in breast cancer.
Cell cycle deregulation can occur at different levels in cancer. In human breast cancer it includes overexpression of cyclins D1 and E, down-regulation of cyclin-dependent kinase inhibitors and inactivation of the retinoblastoma and p53 tumor suppressor proteins. Telomerase activity is strongly associated with an immortal phenotype and expression of telomerase is linked to the cell cycle. We have recently demonstrated a connection between specific cell cycle defects within the pRB pathway and levels of telomerase activity in breast cancer. In the present study, 106 tumors were investigated for p53 gene and protein status. By single strand conformation polymorphism (SSCP) analysis, 15% showed mutations within exons 5-8 and by immunohistochemistry (IHC), 29% were p53 positive. Tumors with a telomerase activity above median (i.e., telomerase(high)) were significantly associated with p53 protein accumulation (p = 0.004), but not with p53 gene mutations. The strongest telomerase expression was found in tumors with p53 protein accumulation. Morphologic grade, estrogen and progesterone receptor expression differed significantly between the telomerase(high) and telomerase(low) groups (p < 0.0001, p = 0.016 and p = 0.046, respectively), but no difference was observed for stage or nodal status. Telomerase(high) tumors were significantly associated with a poor prognosis for node-negative (N0) patients (p = 0.008), but not for node-positive (N+) patients, whereas the opposite was demonstrated for tumors with p53 accumulation. The survival data indicated that telomerase expression has biological importance particularly for N0 tumors, suggesting that telomerase(low) tumors constitute a group of "pre-immortalized" tumors with a good prognosis.
Breast Neoplasms↗
[Prevalence of hidradenitis suppurativa in Denmark].
The morbidity of hidradenitis suppurativa can be considerable, but little is known about its epidemiology. Our purpose was to describe the one-year and point prevalences of hidradenitis suppurative and its potential precursor lesions. We obtained the histories and examined an unselected sample (599 persons) of the general population (one-year prevalence), and we performed physical examination for a consecutive sample of 507 persons undergoing screening for sexually transmitted diseases (point prevalence). The point prevalence was 4.1% (95% confidence interval [CI] = 3.0-6.0) on the basis of objective findings. The one-year prevalence of hidradenitis was 1.0% (CI = 0.4-2.2) on the basis of subject recollection only. The patients in the sample on which the point prevalence is based were younger than those in the unselected sample of the general population (p < 0.001). Hidradenitis was significantly more common in women (p = 0.037), which may result from a female preponderance of genitofemoral lesions (odds ratio [OR] = 5.4; CI = 1.5-19.3). No sex difference was found in the prevalence of axillary lesions. Hidradenitis suppurativa is significantly more common than hitherto estimated. A female preponderance of patients is confirmed, except for patients with axillary lesions. Additional longitudinal studies are necessary to assess the importance of potential precursor lesions such as non-inflamed nodules or comedones.
Adult↗
Alcoholism and alcohol abuse among women: report of the Council on Scientific Affairs. American Medical Association.
We describe characteristics of women alcohol abusers, risk factors for alcoholism in women, barriers to treatment, and implications and strategies for physicians dealing with alcohol abuse in women patients, including risk assessments and intervention strategies. Alcohol abuse and alcoholism have a different physiologic effect on women than on men. Societal attitudes about women and alcohol and internal (self-perception) and external (environmental) factors can create barriers to the detection and treatment of female alcohol abusers. Physicians are in an excellent position to address the medical, psychologic, and social concomitants of alcoholism and alcohol abuse. The Council on Scientific Affairs recommends that physicians become more active in the prevention, diagnosis, and treatment of alcohol-related problems in women, including the diseases that may be associated with chronic alcohol abuse and the effect of alcohol on the developing fetus. Specific American Medical Association policy and recommendations for physician practice are included.
Alcoholism↗
Bullous erythema multiforme following herpes zoster and varicella-zoster virus infection.
Four cases of herpes zoster-induced bullous erythema multiforme (EM) are reported. Three patients presented with widespread skin lesions 10 to 14 days after an episode of thoracic herpes zoster. In these patients a high increase in varicella-zoster virus (VZV) antibody titer was detected, indicating secondary VZV infection. Histologic examinations of skin biopsy from a patient with widespread lesions (case 4) revealed a mixture of EM, toxic epidermal necrolysis and herpetic virus infection. VZV should be included in the list of infectious agents able to trigger EM and Stevens-Johnson syndrome.
Acyclovir↗