BACKGROUND: Prospective studies have shown that doses equivalent to conjugated equine estrogens of 0.625 mg/d or higher are needed to produce a significant increase in bone mineral density of the lumbar spine. OBJECTIVES: To determine the effects of unopposed esterified estrogens on bone mineral density, lipid levels, and endometrial tissue structure, and to relate these effects to changes in plasma estradiol levels. METHODS: Four hundred six postmenopausal women were given calcium, 1000 mg/d, and randomly assigned to receive continuous esterified estrogens (0.3, 0.625, or 1.25 mg/d) or placebo for 24 months. Bone mineral density measurements and endometrial and laboratory assessments were conducted every 6 months; plasma estradiol concentrations were measured after 12, 18, and 24 months. RESULTS: All doses of esterified estrogens produced significant increases in bone mineral density of the lumbar spine compared with baseline and with placebo at 6, 12, 18, and 24 months. Mean plasma estradiol levels increased with esterified estrogens dose, and individual subject bone mineral density changes appeared related to plasma estradiol concentrations. Clinically relevant rates of endometrial hyperplasia were noted only in the groups receiving 0.625 and 1.25 mg of esterified estrogens daily. Lipid changes were dose related and apparent in all groups. CONCLUSIONS: Esterified estrogens at doses from 0.3 to 1.25 mg/d, administered unopposed by progestin, produce a continuum of positive changes on bone and lipids. Plasma estradiol concentrations increased with esterified estrogens dose and were related to positive bone mineral densities. The 0.3-mg dose resulted in positive bone and lipid changes without inducing endometrial hyperplasia.

Bone Density↗

PubMedDate not supplied

Non-A, non-B hepatitis: a prospective study of a hemodialysis outbreak with evaluation of a serologic marker in patients and staff.

An outbreak of non-A, non-B hepatitis (NANBH) in a hemodialysis unit was prospectively studied and the clinical, biochemical, and serologic events were correlated with an experimental immunodiffusion assay for serum antigen and antibody. One hundred sixteen subjects (76 dialysis patients and 40 staff members) were studied over an 8-month period. Hepatitis was defined as two consecutive SGPT levels greater than two times the upper limit of normal occurring in two separate samples drawn greater than 7 days apart in the absence of other likely causes of liver disease. Weekly serum specimens were obtained and tested for SGPT, SGOT, alkaline phosphatase, bilirubin HBsAg, anti-HBc, anti-HBs, total anti-HAV, and anti-HAV IgM by commercial reagents, and for antigen and antibody by agar gel diffusion using reference reagents previously obtained from well-documented posttransfusion NANBH patients. Clinical evaluations were performed three times per week. Thirty patients and none of the staff developed NANBH. The NANBH patients were asymptomatic, except for two patients with jaundice. Fifteen of the 30 patients were positive for antigen which was detectable in at least one serum collected during the acute phase. Six patients and 10 staff without clinical NANBH or abnormal serology had antigen. Antigenemia was also observed in three patients with acute hepatitis B, with chronic hepatitis B in one patient and with alcoholic hepatitis in one patient. Thus, an antigen was detected in a high proportion of patients during the acute phase of NANBH, and it was also found in exposed patients who had other liver diseases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMedDate not supplied

The use of an autoregressive model for the analysis of longitudinal data in epidemiologic studies.

Korn and Whittemore have presented methods for analyzing longitudinal data where the number of observations per individual is large relative to the number of variables considered for each subject. However, this is often not the case in epidemiologic studies, since one usually collects data at relatively few time points, and the quantity of data collected for each individual at each time point is typically extensive. We present here an autoregressive model for analyzing longitudinal data of this type for the case of a continuous outcome variable. Some of the important features of this model are that one can in the same analysis, consider both independent variables that are time-dependent and those that are fixed over time, partially use data for an individual where some examinations are missing, assess relationships between changes in outcome and exposure over short periods of time, use ordinary multiple regression methods. Anderson has considered this type of model, but, to our knowledge, the model has never been applied to biostatistical problems. We illustrate these methods with data from a longitudinal study that seeks to identify the role of personal cigarette smoking on changes in pulmonary function in children.

Adolescent↗

PubMedDate not supplied

Conference on menopause. Research recommendations.

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Adaptation, Psychological↗

PubMedDate not supplied

Nu-Trake cricothyrotomy instrument.

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Airway Obstruction↗

PubMedDate not supplied

Prospective analysis of splinting the first carpometacarpal joint: an objective, subjective, and radiographic assessment.

Predisposing factors contributing to the development of first carpometacarpal (CMC) osteoarthritis include an inherent laxity or incongruency of this joint, a shallow trapezium saddle, and heavy stresses placed on the joint with pinching and grasping. Splinting is a common mode of conservative treatment for CMC osteoarthritis. This study assessed the objective and subjective responses of patients with CMC osteoarthritis who wore short and long opponens splints, as well as radiographic changes associated with wearing of the splints. The study evaluated 26 hands. Each patient was assigned at random to wear the long or the short splint first. Patients wore the splints for one week. They then documented function in their splints (on 22 activities of daily living) and rated splint satisfaction and pain levels on visual analog scales. One week after application of the first splint, the second splint was applied and worn for one week, and all measures were repeated. On the final visit, tip pinches were evaluated and x-rays were taken to assess subluxation. One-way repeated-measure analysis and paired comparison were used to analyze the pinch, pain, radiographic, and splint-rating measures. Descriptive statistics were used to assess activity-of-daily-living function and splint preference. Both splints appear to reduce subluxation at the first CMC joint in patients with grades 1 and 2 osteoarthritis. The majority of the patients picked the short splint when asked at the end of the study which splint they preferred. The splints do not appear to increase pinch strength or affect pain levels associated with the performance of pinch strength measurements. This study supports anecdotal evidence that patients with CMC osteoarthritis get pain relief with splinting.

Activities of Daily Living↗