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PubMedDate not supplied

Basic problems of diversely reported biological effects of radio frequency fields.

The large differences in RF safety standards are due to different philosophical approaches to public health standards development, different scientific approaches and interpretations of the scientific data, and different jurisdictions in various countries. In this paper, the origin of these differences is explored. The emphases are on the basic problems of why reported biological effects of RF fields are controversial, and how the general public can be misinformed. While there are differences in approaches and methods, science should converge and not diverge in finding the threshold level for exposure to EMF that is not adverse to human health. As the progress in technology continues and human beings are enjoying an increased quality of life, it is essential for scientists to ensure that safety is not compromised. More importantly, it is the responsibility and moral obligation of scientists and the media to bring "verified" information to the public. Scientists must conduct well-designed studies and to report the results in a clear and detailed manner, so other independent investigators can repeat the study or explore further. Mistakes must be minimized and stopped at the first level of scientific research.

Animals↗
PubMed2005

Microcalcifications of the breast: how does radiologic classification correlate with histology?

PURPOSE: To assess the correlation between the pre-biopsy classification of microcalcifications and the underlying histology. MATERIAL AND METHODS: Using the morphology and distribution patterns according to the Breast Imaging-Reporting and Data System (BI-RADS) lexicon, the microcalcifications of 199 lesions in 163 consecutive patients scheduled to undergo 11 G vacuum core biopsy were classified within the BI-RADS categories. The correlation between BI-RADS assessment categories 3, 4, and 5 and the final histological results was statistically evaluated with the chi2 test. The diagnostic indices were calculated. RESULTS: The prospectively classified BI-RADS 3/4/5 findings revealed a malignant histology in 5.9%/17.6%/90.9% of all lesions, respectively. The relationship between BIRADS categories 3, 4, and 5 and histology was statistically highly significant (P<0.0001). The sensitivity, specificity, positive and negative predictive values were 95.7%/21.2%,/37.8%/94.3%, respectively. CONCLUSION: The BI-RADS lexicon describes microcalcifications of the breast and provides diagnostic categories that lead to standardized biopsy recommendations. Nevertheless, how to link description to classification of microcalcifications is still a difficult diagnostic task. The evaluation of microcalcifications as proposed in this article may help to set standards in the clinical routine and in the comparability of scientific data.

Adult↗
PubMed1984

Antifibrillatory drugs: the case for bretylium tosylate.

The preferred treatment for ventricular fibrillation (VF) refractory to maximal electrical defibrillation remains controversial, as evidenced by recent changes in the American Heart Association's treatment algorithm. To date there have been no published studies conclusively proving one mode of therapy to be superior to another. There is, however, an abundance of animal and clinical data suggesting that bretylium tosylate (BT) is the drug of choice in this setting. In animal studies BT has been shown to lower the canine defibrillation threshold, to facilitate conversion of hypothermia-induced ventricular fibrillation, and to effect spontaneous defibrillation. In 15 years of clinical use as a drug of last resort, and more recently as a first-line drug, BT has developed an impressive track record. Most of the clinical reports are uncontrolled and/or retrospective, but they share a central theme: BT is effective in the treatment of VF refractory to standard therapy. Several small studies have reported successful conversion of VF to a stable rhythm with BT after failure of standard electrical and pharmacologic therapy. Recent studies suggest that earlier use of BT may be associated with improved outcome. Finally, as in animal studies, spontaneous defibrillation has been reported. It is important to note that no drug currently used in the treatment of countershock-refractory VF has been proven effective. The use of some of these drugs is based on tradition rather than scientific evidence. The bulk of currently available scientific data indicates that BT is superior to other commonly used antiarrhythmics in the treatment of VF resistant to countershock.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2001

Tooth preparations for complete crowns: an art form based on scientific principles.

STATEMENT OF THE PROBLEM: No recent literature has reviewed the current scientific knowledge on complete coverage tooth preparations. PURPOSE: This article traces the historic evolution of complete coverage tooth preparations and identifies guidelines for scientific tooth preparations. MATERIAL AND METHODS: Literature covering 250 years of clinical practice was reviewed with emphasis on scientific data acquired during the last 50 years. Both a MEDLINE search and an extensive manual search were used to locate relevant articles written in English in the last 50 years. RESULTS: Teeth should be prepared so that they exhibit the following characteristics: 10 to 20 degrees of total occlusal convergence, a minimal occlusocervical dimension of 4 mm for molars and 3 mm for other teeth, and an occlusocervical-to-faciolingual dimension ratio of 0.4 or greater. Facioproximal and linguoproximal line angles should be preserved whenever possible. When the above features are missing, the teeth should be modified with auxiliary resistance features such as axial grooves or boxes, preferably on proximal surfaces. Finish line selection should be based on the type of crown/retainer, esthetic requirements, ease of formation, and personal experience. Expectations of enhanced marginal fit with certain finish lines could not be validated by recent research. Esthetic requirements and tooth conditions determine finish line locations relative to the gingiva, with a supragingival location being more acceptable. Line angles should be rounded, and a reasonable degree of surface smoothness is desired. CONCLUSIONS: Nine scientific principles have been developed that ensure mechanical, biologic, and esthetic success for tooth preparation of complete coverage restorations.

Bicuspid↗
PubMed2006

Proceedings of the 2006 annual meeting of the Fetal Alcohol Spectrum Disorders Study Group.

This article describes the proceedings of the 2006 Annual Meeting of the Fetal Alcohol Spectrum Disorders Study Group (FASDSG), which was held in Baltimore, Maryland on June 24, 2006. The meeting was held in conjunction with the annual meeting of the Research Society on Alcoholism and was supported by a grant from the National Institute on Alcohol Abuse and Alcoholism. The 2005-2006 FASDSG officers, Daniel J. Bonthius (President), Heather Carmichael Olson (Vice-President), and Jennifer Thomas (Secretary-Treasurer), organized the meeting. Nationally prominent speakers delivered plenary lectures on topics of newborn screening, ethics, and neuroscience. Selected members of the FASDSG provided brief scientific data (FASt) reports, describing new research findings. Representatives from national agencies involved in fetal alcohol syndrome (FAS) research, treatment, and prevention provided updates regarding priorities, funding, and agency activities. Presentations were also made by the 2006 Student Merit Award recipient and by the 2006 Rosett Award recipient. The meeting served as a forum for clinicians, neuroscientists, psychologists, social scientists, and other professionals to discuss recent advances in FAS research and to identify the most important gaps in the understanding of alcohol-induced teratology.

Animals↗
PubMed2002

Effects of smoked marijuana in healthy and HIV + marijuana smokers.

This article presents data from two avenues of marijuana research. First, the author shows that daily marijuana smoking in healthy individuals produces dependence, as demonstrated by withdrawal symptoms such as increased irritability and depression and decreased food intake. In addition, two antidepressant medications were evaluated to assess their potential effectiveness in the treatment of marijuana withdrawal symptoms: (1) sustained-release bupropion (0, 300 mg/day) and (2) nefazodone (0, 450 mg/day). Research participants were regular marijuana smokers who lived in a residential laboratory in groups of two to four. While inpatients, participants smoked active marijuana (2.8%-3.1% THC) repeatedly for 4 days, followed by 8 to 12 days of placebo marijuana (0.0% THC). Results show that during marijuana abstinence, (1) bupropion increased ratings of irritability, depression, and stomach pain and decreased food intake and sleep quality compared to placebo maintenance, and (2) nefazodone decreased anxiety during marijuana withdrawal but did not alter ratings of irritability and misery. Thus, neither medication showed promise as potential treatments for symptoms of marijuana withdrawal. The second avenue of research focused on the effect of cannabinoids in individuals with muscle mass loss, an indicator of wasting in HIV illness. Given that there are little scientific data contributing to the debates concerning medical marijuana, this study directly compared the effects of oral delta9-THC (0, 10, 20, 30 mg PO) to smoked marijuana (0.0%, 1.8%, 2.8%, 3.9% THC) in HIV + marijuana smokers with muscle mass loss (< 90% body cell mass/height). Multiple dimensions of human behavior were measured, including food intake, mood, and cognitive performance. Drugs were administered using a within-subject, double-blind, staggered, double-dummy design. Participants were free to self-select from a variety of foods throughout most of the session. Preliminary data (n = 9) suggest that oral THC was more effective at increasing food intake, but the volunteers "liked" the effects of smoked marijuana more than the effects of oral THC.

Bupropion↗
PubMed2001

A treatment scale for axillary management in breast cancer.

BACKGROUND: We have investigated a method, the Kaufman axillary treatment scale (KATS), to help assign patients with a clinically negative axilla to one of three current options of axillary management: standard axillary dissection, sentinel node sampling followed by axillary dissection if the sentinel node is positive, or no axillary surgery at all. The KATS score uses preoperative data to guide the choice of axillary treatment. METHODS: The KATS score is calculated by adding the preoperative values of tumor size, patient age, and pathologic grade. Values range from 1 to 4 for size (1 to 9 mm, 10 to 14 mm, 15 to 19 mm, and 20 to 30 mm), 1 to 3 for age (70 years and over, 50 to 69 years, less than 50 years), and 1 to 2 for grade (low or not low) to calculate the score. The KATS score ranges from 3 to 9. We have applied this score against the SEER (Surveillance, Epidemiology, and End Results) tumor registry of 529 patients with invasive breast cancer with known pathologic data. We then validated it by applying it to our own set of 190 patients using preoperative data. The chi-square test and logistic regression analysis were used for P values (all two sided), univariate and multivariate analysis, odds ratio and confidence intervals utilizing SPSS statistics software. RESULTS: In the SEER database using American Joint Committee on Cancer pathologic size alone, no sizable group was identified with a positive node rate neither below 8% (T1a) nor above 48% (T2). KATS scores of 3 and 4 (68 patients, group 1) identify patients with an average node positive rate of 4.4% (P <0.02, group 1 versus 2). Those patients with KATS scores of 5, 6, and 7 (341 patients, group 2) carry an average node positive rate of 22% (P <0.001, group 2 versus 3). KATS scores of 8 and 9 (120 patients, group 3) identify patients with an average node positive rate of 50% (P <0.001, group 3 versus 1). Similar results were found on our own group of 190 patients using preoperative available data. KATS scores of 3 or 4 (11 patients, group 1) had no positive nodes. Group 2 (100 patients, KATS score 5, 6, and 7) had an average 30% node positive rate. Group 3 (79 patients, KATS score 8 and 9) had 61% node positive rate. The KATS score allows the clinician to separate patients into three axillary management groups. Group 1 are those patients who may need no axillary surgery at all. Group 2 are patients who would benefit from sentinel node mapping. Group 3 has a node positive rate (61%) similar to that of clinically palpable nodes (since not all clinically palpable nodes are positive). Group 3 patients may be considered for standard axillary dissection, similar to the palpable node patient. If group 3 patients have sentinel node mapping, more than half of these patients require axillary dissection and the impact of false negative sentinel node procedures may become clinically significant. CONCLUSIONS: An axillary treatment score has been developed to aid in the triage of patients toward reasonable axillary treatment choices for the benefit of the patient. The KATS score is a guideline and not a mandate. The KATS score attempts to use breakpoints that are both clinically practical and validated by scientific data. Like many other attempts to categorize patients, there is a continuum of data points along any variable. The treating physician utilizing the full array of available data on each patient makes the final clinical decision of axillary management.

Age Factors↗
PubMed1984

Intracoronary streptokinase in acute evolving myocardial infarction: you can, but should you?

Intracoronary streptokinase infusion is an exciting new technique, it is feasible and relatively safe, and it can restore antegrade coronary flow in 80% of the patients with an evolving myocardial infarction. Current data indicate that successful reperfusion apparently is associated with improved left ventricular function. The ultimate benefit, a significant decrease in mortality, has not yet been established. Furthermore many questions have not been answered: what is the optimal dosage of streptokinase? How should it be administered: systemic, intracoronary or super selective? Which thrombolytic agent should we use? How can we prevent reocclusion? What is the role of PTCA or acute surgery? A major shortcoming of this technique is the impact on equipment and personnel together with the rather low percentage (25%) of patients with evolving myocardial infarction, in whom this technique is applicable. Of course, although not within the scope of this article, this i.c. streptokinase treatment will have to be compared with other interventions which may reduce morbidity and mortality in patients with acute myocardial infarction. Thus, antegrade flow with i.c. streptokinase can be restored in patients with an evolving myocardial infarction. The main question is: should you do so? Until now, management of patients with an acute myocardial infarction has been conservative and is directed to treatment of pain, arrhythmias and heart failure. At the moment this approach can be considered respectable. For those who propose active management and believe in i.c. streptokinase treatment, until now, insufficient scientific data are available to back this up. For those who have doubts, but like to be active, the best is to put their patients in a well-conducted randomized trial. This will eventually resolve the question: you can, but should you? However, even if i.c. streptokinase is proven to be beneficial to the patient, this technique will not receive widespread application because of its great impact on limited health resources.

Arrhythmias, Cardiac↗
PubMedDate not supplied

[The toxicology and prevention of the risks of occupational exposure to aromatic polycyclic hydrocarbons. III. The effects: epidemiological evidence, early effects. Individual hypersusceptibility. Health surveillance].

Adverse effects following occupational exposure to polycyclic aromatic hydrocarbons (PAH) are mainly carcinogenic. The available epidemiological data suggest that some substances and industrial processes, in which PAH exposure is frequent, are classified as carcinogenic to humans: primary aluminium industry, cola gasification, coke production, iron and steel foundry, coal tar, pitch, creosote, untreated mineral oils, asphalt, soot. The target organs are mainly lung, bladder, skin. Other relevant effects are skin lesions such as folliculitis. The studies on early biological effects (chromosomal aberrations, sister chromatid exchanges, micronuclei) have shown contradictory results, mainly because of differences in exposure intensity. The metabolic polymorphism may account for a higher susceptibility to lung and bladder cancer following exposure to risk factors; the role of PAH occupational exposure is however to be examined, and the use of indicators of genetic susceptibility is currently limited to research programs. Health surveillance for PAH exposed workers is funded on the Italian laws (DPR 303/56 and D.Lgs. 626/94) and it is mainly dedicated to prevention of carcinogenic effects. Preventive examinations should consider PAH target organs (skin, lung, bladder, larynx) and look for early signs and symptoms. Particular attention will be paid to life habits such as tobacco smoking or diseases which could represent condition of susceptibility. Periodical examinations (every six months) will similarly evaluate PAH target organs. Health surveillance is also programmed for formerly exposed workers and the institution of exposure and cancer registries is mandatory. On the basis of the current scientific data, it is not advisable the use of tumor markers or cytogenetic tests at the individual level as well as the screening of asymptomatic PAH exposed workers for early diagnosis of lung or bladder cancer. Information and formation activities will be part of medical examinations and will be included in specific programs in cooperation with other company functions.

Carcinogens↗
PubMed2006

[Epidemiologic study on hearing impairment and ear diseases in old people].

OBJECTIVE: To investigate the prevalence of hearing impairment and ear diseases in old people and provide scientific data for drawing up the prevention and treatment strategies. METHODS: Using the probability proportion to size (PPS) method, 1261 people over 60 years were investigated in 40 clusters in Jiangsu Province with the WHO protocol. RESULTS: The prevalence of hearing impairment was 58.1% (the standardized rate: 59.5% in the whole country, 60.9% in Jiangsu province). Degrees of hearing impairment were mild (33.1%), moderate (17.8%), severe (5.9%) and profound (1.3%). The prevalence of hearing disability was 25.0% (the standardized rate: 26.6% in the whole country, 28.1% in Jiangsu province). There were significant difference of the prevalence between male and female, as well as urban and rural, and different ages. The prevalence of the ear diseases was auricle malformation (0.2%), wax (1.7%), otitis externa (0.1%), fungi (0.5%), serous otitis media (1.2%), chronic suppurative otitis media (1.6%), dry perforation of tympanic membrance (2.3%). The causes of hearing impairment were ear diseases (2.9%), non-infectious condition (92.6%), genetic condition (0.3%) and undetermined causes (4.2%). Of which, 31.1% of persons needed hearing aids while 2.3% of persons needed medicine treatment, but 0.9% of persons needed non-urgent surgery and 1.0% of persons needed other treatment. CONCLUSIONS: The prevalence of hearing impairment and disability in the old rised obviously than the last investigation in 1987. It was a heavy burden for social development in China. The government and the whole society should take more concern about the problem. The scientific strategies of prevention and treatment were urgently needed and implemented.

Aged↗
PubMed2004

The use of sodium lamps to brightly illuminate mouse houses during their dark phases.

The human and murine diurnal rhythms are out of phase. Consequently in conventionally-lit mouse houses the mice's deep sleep is often disrupted, the daily welfare monitoring of the mice is limited by their inactivity, and scientific data obtained from the mice model the sleeping rather than awake human. Sodium light is bichromatic, with both wavelengths being in the human visual field but at the margin of murine vision. We report here that sodium lamps can be used to light mouse houses to a level that is comfortable for humans, but still sufficiently dull to permit nocturnal behaviour in mice. The response of mice to sodium light was initially monitored by recording the locomotory activity of BALB/c mice. The movement of mice in their cages greatly increased at the start of the nocturnal phase. Alterations in the white light cycle caused an acute change in the onset of nocturnal behaviour. In contrast, sodium light did not suppress the onset of nocturnal locomotory behaviour, even though the lighting was sufficiently bright for humans to read without light adaptation. The sodium lighting was then used to observe the nocturnal behaviour of over 150 mice of various strains, for over 1.5 years. Mice were invariably awake and alert during the nocturnal/sodium light phase. All exhibited high locomotory activity, except for nursing mothers. Some tasks, such as cage cleaning and minor surgery, were more easily done under white than sodium lighting. We therefore adjusted the timing of the light cycles to provide white light in the morning and sodium light (nocturnal phase) in the afternoon. This provided for easy operation of the mouse house, while yielding both animal welfare and scientific advantages.

Animals↗
PubMed2001

Should celecoxib be contraindicated in patients who are allergic to sulfonamides? Revisiting the meaning of 'sulfa' allergy.

Celecoxib, a selective cyclo-oxygenase-2 inhibitor, is a diaryl-substituted pyrazole derivative containing a sulfonamide substituent. Because of this structural component, celecoxib is contraindicated for use in patients who have demonstrated allergic reactions to sulfonamides. However, there is a lack of data demonstrating cross-reactivity among sulfonamide medications. A sulfonamide is any compound with an SO2NH2 moiety. The major difference between sulfonamide antimicrobials and other sulfonamide-containing medications such as furosemide, thiazide diuretics and celecoxib, is that sulfonamide antimicrobials contain an aromatic amine group at the N4 position. This allows for division of the sulfonamides into 2 groups: aromatic amines (i.e., sulfonamide antimicrobials) and nonaromatic amines. In addition, sulfonamide antimicrobials contain a substituted ring at the N1-position; this group is not found with nonaromatic amine-containing sulfonamides. Adverse reactions to sulfonamide antimicrobials include type I, or immunoglobulin (Ig) E-mediated reactions, hypersensitivity syndrome reactions, and severe skin reactions such as toxic epidermal necrolysis. The aromatic amine portion of the sulfonamide antimicrobial is considered to be critical in the development of latter 2 reactions. In susceptible individuals, the hydroxylamine metabolite is unable to be detoxified leading to a cascade of cytotoxic and immunological events that eventually results in the adverse reaction. Since celecoxib does not contain the aromatic amine, adverse reactions such as hypersensitivity syndrome reactions and toxic epidermal necrolysis would not be expected to occur at the same frequency as they do with sulfonamide antimicrobials. Similarly, for IgE-mediated reactions, the N1-substituent and not the sulphonamide moiety is important in determining specificity to antibodies. Celecoxib and other nonaromatic amine-containing sulfonamide medications do not contain the N1-substituent. Cross-reactivity among the various sulfonamide-containing medications has also not been substantiated by published case reports. In fact, conflicting information exists in the literature. Reports showing lack of cross-reactivity balance the few case reports suggesting cross-reactivity. Cross-reactivity between sulfonamide medications should be based on scientific data, including chemistry, metabolism, immune responses and clinical data. Based on the current information, there is no documentation for cross-reactivity between sulfonamide antimicrobials and other sulfonamide medications, such as celecoxib.

Anti-Infective Agents↗
PubMed2001

[Analyses of preanalytical issues on samplings and samples].

To obtain "exact" laboratory data which show or reflect the pathophysiological conditions of patients, preanalytical, analytical and postanalytical processes should be checked. However, it is difficult to know the preanalytical situation or out of laboratories. We realize preanalytical issue is one of the weak points in current laboratory medicine. I reported the results of analyses on the issues concerning abnormal laboratory data produced by inadequate handling of samples and sample collection. Five issues are described as follows: 1) The effect of detergents on fecal occult blood test. Immunological methods were affected markedly to moderately by various sanitizers and detergents tested. In collecting feces for immunological fecal occult blood test, contact of feces with toilet flush water dissolving sanitizers should be inhibited. 2) Blood storage and potassium(K) release. Causes of slight elevation of K in serum are sometimes unknown. Addition of injection drugs in vitro showed that various drugs induced K release from erythrocytes. Cold storage of blood is well-known to bring elevation of K level, however, the detailed mechanism is still unknown. We developed a simple method to measure K flux activity of erythrocytes and the decreased activity was shown in patients with chronic renal insufficiency and the aged as well as the aged erythrocytes. 3) Thawed serum and concentration difference. Frozen serum samples were thawed without mixing and various layers contained different concentrations in 60 items tested. Comparing the concentration before freezing, the upper layer contained 1/2 and the bottom 2 times more. T3 and FT4 showed exceptionally smaller difference, significance of which is unknown. 4) Two syringe method in blood collection. Blood samples drawn in the first half and the latter half were comparatively measured for APTT, PT and TT. Blood amount of 1 ml or more showed no differences. TT showed elevation in the first half in 0.5 ml-sample. The effects of local treatment by warming, tapping and congestion were examined. In some cases, tissue factor level elevated by such physical pretreatment. However, in usual blood collection in human, two syringe method is not necessarily employed. 5) Heat-inactivation and cold storage of serum. Preheating sera at 56 degrees C for 30 min reduced markedly the levels of ALT, ALP, CK, ChE, ATIII and alpha 2-PI. In seroimmunology, some complement components are markedly affected and rheumatoid factor of IgM classes was also affected. In about a half of HCV-Ab positive sera, CH50 levels were decreased by the cold storage(cold activation). We reported previously the non-participation of C1q in this phenomenon. In such sera, temperature management is important. Scientific data on the storage and collection of samples should be informed not only to laboratory staffs but to nurses and doctors in order to provide "exact" data.

Blood Preservation↗
PubMedDate not supplied

[Factors associated with suicidal risk among consulting young people in a preventive health center].

UNLABELLED: The association between suicidal risk and various psychological or biographical factors in teenagers or young adults is already well documented. Yet, the role of stressful life events or contexts during childhood or of the recent past, as well as the respective weight of such determinants, has to be specified. METHODS: One thousand one hundred and thirty-nine individuals, aged 16 to 25, who consecutively consulted in a preventive health center supported by the National Health Insurance System, located in Seine-Saint-Denis (a French department characterized by an unfavourable socio-economic context) on the occasion of a free work up were invited to fill out several self-administered questionnaires, aimed at assessing especially the level of psychosocial distress (Golberg's GHQ-28) and the level of hopelessness (Beck's hopelessness scale). They were also invited to meet a psychologist for a semi-structured interview, when the day of their consultation coincided with one of the three days a week the psychologist was present in the center; the interview was aimed at collecting information upon the biographical context and ancient or recent life events and to determine the level of suicidal risk, on the basis of a scale of suicidal ideation [Ducher's Suicidal Risk Scale (ERSD)]. The concurrent validity of the later has already been previously tested and positive correlation coefficients were found with Beck Depression Inventory, Hamilton's Depression Rating Scale and Beck's Hopelessness Scale. RESULTS: One thousand and four records could be analysed, as regards self-administered questionnaires, and among those, 576 as regards the interview with the psychologist and data related to suicidal risk. The studied population included 61.3% of females and 59.3% of individuals aged 20 to 25: mean age was comparable in males and females. GHQ-28 global score and sub-scores (somatisation, anxiety, social dysfunction and depressive mood) were all higher in women (all the p<0.001). A high suicidal risk (ERSD score 4) was found in 24.1% of the studied population. Subjects presenting with a high suicidal risk were characterized by higher levels of GHQ-28 psychosocial distress and GHQ-28 sub-scores as well as hopelessness (all the p<0.001). Several biographical antecedents during childhood were significantly associated with suicidal risk: unknown father (p<0.001), death of parents (p<0.001), separation from parents (p<0.001), severe quarrel between parents (p<0.001), money problems within the family (p<0.007), disorders related with alcohol consumption in parents (p<0.016), drug addiction within the family (p<0.001). Other predictors were several recent stressful events or contexts: violence within the family (p<0.001), social isolation (p<0.001), lack of self-esteem of (p<0.002), school difficulties (p<0.001), educational failure (p<0.001); as well as the notion of a consumption of drugs (p=0,001) or medications: neuroleptics (p<0.015), antidepressants (p=0.001) and tranquilizers (p<0.001). A series of univariate regression analyses allowed to compute the Odds Ratios (OR) and the 95% Confidence Intervals (95% CI) of the sub-group characterized by a high suicidal risk for each socio-demographic, psychological and biographical independent variable, linked to suicidal risk at a threshold of p<0.10. A multiple regression analysis was then performed in 2 steps: in a first step, independent variables were pooled by blocks, according to their nature (psychological characteristics, relational deficiencies among biographical antecedents, other stressful conditions among antecedents, stressful conditions among recent biographical context, recent consumption of drugs or medications); in a second step, all the independent variables which still remained associated with suicidal risk within each block were included in a final multiple regression analysis. Five variables continued to independently predict a high suicidal risk: hopelessness at Beck's scale (OR=4.09), depressive mood at GHQ-28 (OR=3.75), the notion of an unknown father (OR=2.95), the notion of a recent destabilizing event other than a school problem or an aggression (OR=1.90) and the notion of an educational failure (OR=1.78). CONCLUSION: These results confirm previous scientific data on this topic and underline that childhood context, educational course, psychological vulnerability and the occurrence of recent stressful life events combine their effects, enhancing the risk of a suicidal attempt. They can be useful for better sensitising educational as well as social and health care circles, for settling more efficient screening and preventive programs.

Adolescent↗
PubMed2000

Pharmacotherapy of smoking cessation.

Tobacco use is the number one cause of preventable diseases in the United States. Smoking accounts for more than 400,000 deaths yearly and 30% of all cancer deaths. Primary care physicians have access to 70% of smokers, approximately 60% of whom are perceived to be in excellent health. Recent advances in the pharmacotherapy of nicotine addiction, including nicotine nasal spray, nicotine inhaler, bupropion hydrochloride, and over-the-counter transdermal nicotine patches, have increased the treatment options physicians can offer to smokers. Physicians, especially those in primary care specialties, should familiarize themselves with these products to improve efforts to help their patients stop smoking. This article reviews scientific data on the efficacy of approved medications, benefits, adverse effects, and appropriate use of these products. We also discuss nicotine addiction and treatment for special populations, including women, ethnic minorities, light smokers, and patients with cardiovascular and pulmonary diseases.

Administration, Cutaneous↗
PubMed2001

Sudden sensorineural hearing loss: does application of glucocorticoids make sense?

BACKGROUND: Treatment of sudden sensorineural hearing loss (SSNHL) consists of administration of blood flow-promoting drugs with or without the addition of glucocorticoids. General guidelines based on scientific data do not currently exist. OBJECTIVE: To investigate the effect of glucocorticoids on the treatment of SSNHL. SETTING: Academic medical center. PATIENTS AND METHODS: We retrospectively analyzed the audiograms of 603 patients with SSNHL: 301 patients (cared for between January 1, 1986, and December 31, 1991) received intravenous blood flow-promoting drugs without glucocorticoids and 302 patients (cared for between January 1, 1992, and December 31, 1998) received intravenous blood flow-promoting drugs with glucocorticoids (intravenous +/- oral application). The age distribution of patients with SSNHL in lower, middle, and higher frequencies was similar in both groups. RESULTS: Patients with SSNHL in lower and middle frequencies (250-2000 Hz) who received glucocorticoids (prednisolone-21-hydrogen-succinate) showed significantly better recovery of hearing levels compared with those who did not receive glucocorticoids (P<.05). There was no significant difference at higher frequencies between the 2 groups. Patients with SSNHL throughout all frequencies (pancochlear hearing loss) who received glucocorticoids also had significantly better recovery of hearing levels compared with those who received blood flow-promoting drugs alone (P<.05). Also, patients with elevated blood sedimentation rates had better improvement of their hearing levels after receiving glucocorticoids. CONCLUSIONS: Administration of glucocorticoids should be recommended for treatment of patients with SSNHL. In particular, patients with SSNHL in the lower and middle frequency range and pancochlear hearing loss have significantly better recovery of hearing levels.

Adult↗
PubMed1993

The rationale for lowering serum cholesterol levels in American children.

The pediatric approach to the primary prevention of coronary artery disease in adults remains controversial. Measurement and intervention to lower serum cholesterol levels have been advocated recently in a selected group of American children by the Expert Panel on Blood Cholesterol Levels in Children and Adolescents of the National Cholesterol Education Program. This article reviews the clinical and scientific data contributing to the controversy surrounding cholesterol in American children. Arguments in favor of and opposed to an aggressive approach to identifying American children with elevated serum cholesterol levels are presented. The rationale for a selective screening approach is demonstrated.

Adult↗
PubMed2002

The 2001 Bethesda System: terminology for reporting results of cervical cytology.

OBJECTIVES: The Bethesda 2001 Workshop was convened to evaluate and update the 1991 Bethesda System terminology for reporting the results of cervical cytology. A primary objective was to develop a new approach to broaden participation in the consensus process. PARTICIPANTS: Forum groups composed of 6 to 10 individuals were responsible for developing recommendations for discussion at the workshop. Each forum group included at least 1 cytopathologist, cytotechnologist, clinician, and international representative to ensure a broad range of views and interests. More than 400 cytopathologists, cytotechnologists, histopathologists, family practitioners, gynecologists, public health physicians, epidemiologists, patient advocates, and attorneys participated in the workshop, which was convened by the National Cancer Institute and cosponsored by 44 professional societies. More than 20 countries were represented. EVIDENCE: Literature review, expert opinion, and input from an Internet bulletin board were all considered in developing recommendations. The strength of evidence of the scientific data was considered of paramount importance. CONSENSUS PROCESS: Bethesda 2001 was a year-long iterative review process. An Internet bulletin board was used for discussion of issues and drafts of recommendations. More than 1000 comments were posted to the bulletin board over the course of 6 months. The Bethesda Workshop, held April 30-May 2, 2001, was open to the public. Postworkshop recommendations were posted on the bulletin board for a last round of critical review prior to finalizing the terminology. CONCLUSIONS: Bethesda 2001 was developed with broad participation in the consensus process. The 2001 Bethesda System terminology reflects important advances in biological understanding of cervical neoplasia and cervical screening technology.

Female↗