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Association of cutaneous malignant melanoma with intermittent exposure to ultraviolet radiation: results of a case-control study in Ontario, Canada.

BACKGROUND: Although solar radiation is well established as a risk factor for melanoma, it is less clear how the pattern and timing of exposure to ultraviolet (UV) radiation might be important. The particular objective of this study was to evaluate the association of melanoma risk with various measures of intermittent and chronic exposures to UV radiation, and to assess how these exposures interact with other risk factors such as skin type. METHODS: Data were analysed from a large case-control study (583 cases, 608 controls) of malignant melanoma, carried out in southern Ontario, Canada. RESULTS: Significant risk increases were identified with several measures of intermittent exposure, including beach vacations in adolescence and in the past 5 years, previous sunburn, and use of sunbeds and sunlamps. Chronic exposure, indicated by days of outdoor activity during adolescence and by occupation in recent adult life, was associated with significantly reduced risk. Subgroup analyses showed: no major risk differences by body site of melanoma; stronger association of lentigo maligna melanoma with intermittent exposure; more pronounced effects of beach vacations and sunburn in younger subjects; and consistently higher risks for intermittent exposures among subjects with skin more susceptible to burning. CONCLUSIONS: The data lend limited support to the hypothesis of increased risk associated with intermittent UV exposure. The findings suggest that future studies should take age at diagnosis, host susceptibility and histological subtype into account.

Adult↗

Functional demonstration of intrathymic binding sites and microvascular gates for prothymocytes in irradiated mice.

Quantitative intrathymic (i.t.) and i.v. adoptive transfer assays for prothymocytes show strict log dose saturation kinetics, consistent with a finite number of i.t. binding sites (microenvironmental niches). This inference is supported here by demonstration of competitive antagonism obeying one-on-one receptor occupancy kinetics during the establishment of thymic chimerism in irradiated adult mice. The results of primary and secondary transfer experiments suggested that hematogenous precursors (i) enter specific i.t. niches between 4 and 24 h after injection, (ii) compete reversibly with subsequently introduced precursors, (iii) establish insurmountable competition within 5-7 days, (iv) mature through the initial stages of thymocytopoiesis preceding proliferative expansion, and (v) vacate the niches between 7 and 14 days after entry. The results also suggested that, as in non-irradiated mice, prothymocyte importation in irradiated mice is a gated phenomenon. Gate closure was indicated by the inability of i.v.-, but not i.t.-, injected bone marrow (BM) cells to induce thymic chimerism when administered 7--14 days after a primary injection and gate opening by the ability of i.v.-injected BM cells to induce thymic chimerism in competition with circulating host prothymocytes. Gate closing was log dose-responsive and could be induced in individual thymic lobes by unilateral i.t. injection, whereas gate opening, which occurs bilaterally, was not initiated until most of the niches for prothymocytes had been vacated. We therefore posit the existence of a series of associated microvascular gates and microenvironmental niches that act in concert to regulate prothymocyte importation and early thymocyte differentiation.

Adoptive Transfer↗

Myocardial infarction and coronary death among women: psychosocial predictors from a 20-year follow-up of women in the Framingham Study.

This study investigates the relation of psychosocial variables to the 20-year incidence of myocardial infarction or coronary death among women in the Framingham Study. In 1965-1967, a psychosocial interview was given along with the collection of other coronary risk factor data. This study includes 749 women aged 45-64 years who were free of coronary disease at this baseline examination. Demographic variables, psychosocial scales (such as tension and reactions of anger), and individual interview items (such as attitudes toward children, money, and religion) were measured. When age, systolic blood pressure, the ratio of serum total cholesterol to high-density lipoprotein cholesterol, diabetes, cigarette smoking, and body mass index were controlled for in multivariate proportional hazards models, the predictors of the 20-year incidence of myocardial infarction or coronary death were as follows: among employed women, perceived financial status only; among homemakers, symptoms of tension and anxiety, being lonely during the day, difficulty falling asleep, infrequent vacations, housework affecting health, and believing one is prone to heart disease (p less than 0.05 for all variables); and among both groups of women combined, low educational level, tension, and lack of vacations. These results are discussed in relation to previous findings from the Framingham Study.

Analysis of Variance↗

Annual and weekly changes in the sleep-wake rhythm of school children.

Sleep-wake patterns in 10- and 14-year-old children were followed over a year using sleep diaries kept during 2-week periods every 5 weeks. The times of awakening and sleep duration closely followed the annual and weekly alternations of schooldays and holidays. During vacations, sleep duration increased considerably as compared to the school year. The clear decrease in sleep duration was observed in spring only for 14-year-olds. Weekly changes of sleep patterns during the school year disappeared during vacations. It was concluded that sleep duration in children is closely related to the school schedules and could be a result of sleep deprivation and recovery.

Adolescent↗

Use of free time in the third and fourth years of a flexible curriculum.

In 1988, the author surveyed senior students on their use of the six months of free time in the junior-senior biennial at the University of Minnesota Medical School-Minneapolis. The students were asked both to provide detailed reports on their free-time activities and to rank the three activities they considered to be most helpful to their professional development. Of 274 seniors, 191 (70%) responded. The students had used a majority of their free time for pursuits related to education and advancement of their careers. Approximately one-third of the time had been used for vacations. The activities the students viewed as most helpful included research, interviewing for residency positions, vacation, study elsewhere, and preparation for the National Board of Medical Examiners Part II examination. The author suggests that when free time is made available in a flexible curriculum, students use it to advantage in an educationally responsible manner.

Curriculum↗

Current status of chairpersons in physical medicine and rehabilitation.

There are currently 77 academic departments, divisions or units of physical medicine and rehabilitation (PM&R) in the United States. The authors conducted a survey to develop a profile of the current chairpersons of PM&R, as well as to assess the short- and long-term needs of the field. The survey addressed basic demographic information as well as the level of formal training and/or experience in various management, patient care and academic areas. The level of satisfaction with various aspects of the position such as workload, relationship with the university and role as a researcher were also measured. The chairpersons were asked when they plan to vacate their position and if they felt there were any members of their faculty who are qualified and ready to assume a chairperson position. Those that identified a qualified individual were then asked whether the person had formal training and/or experience in the various management, patient care and academic areas. The results indicate that, although the chairpersons have a high level of job satisfaction with respect to the challenge of the position and their administrative and supervisory roles, they are least satisfied with their role as a researcher. The field must be concerned with this finding, because academic PM&R units in the United States will experience a substantial change in leadership by the end of the 20th century. Approximately 39% of the current chairpersons who returned the questionnaire are planning to step down by 1999, with an additional 37% unsure when they will vacate the position.(ABSTRACT TRUNCATED AT 250 WORDS)

Administrative Personnel↗

Risk factors for presenting problems in child psychiatric emergencies.

OBJECTIVE: To determine demographic and school-related risk factors for psychiatric emergencies presented by children in a hospital emergency room serving the majority of an urban community. METHOD: 1,436 consecutive psychiatric emergency room visits for children younger than 16 years of age seen over a 10-year period were broadly classified by presenting problem as exhibiting either suicidal ideation, suicide attempt, oppositional-defiance, or aggression. The strength of association of these classes of presentation with demographic risk factors (age, sex, and minority status) and with the school day (weekday or weekend) and school season (school year or vacation) of presentation were modeled using logistic regression. The capacity of these presenting problems and risk factors to predict whether the child was hospitalized was also assessed. RESULTS: Risk factors additively associated with suicidality included increasing age, being female, and presenting on weekdays and during the school year. Similar risk factors discriminated suicide attempters from suicidal ideators, and racial minority membership contributed additional risk for presenting with a suicide attempt. Risk factors associated with aggressive and oppositional presentation included younger age and male sex. Aggressive children presented relatively more often on weekends, and oppositional children presented more during school vacations. Independent risk factors for hospitalization included a suicidal or aggressive presentation, increasing age, and presentation during the school year. Hospitalization of children at the time of their initial visit protected against suicidality in subsequent presentations of the subset of children who had repeated emergency room visits. CONCLUSIONS: These findings are consistent with previously reported risk factors for suicidal behaviors and externalizing disorders. The distinctive profiles of risk discerned for the different groups of emergency room psychiatric subjects also suggest some degree of specificity for the risk factors associated with each class of presenting problem. They also suggest the importance of home and school environments as being variably either risk or protective factors for these presenting problems. The findings also suggest a role for hospitalization in the prevention of future suicidality.

Adolescent↗

Graduate nurse overhires. A cost analysis.

Traditionally, the process for filling vacated nursing positions has contributed to a hiatus between the departure of one nurse and the arrival of another who is prepared to assume patient care responsibility. This is due at least partially to limited work force renewal strategies. Given the cost to temporarily fill vacated positions with agency nurses or to pay nurses overtime rates, current methods of replacing departing nurses may no longer be practical in all cases. The authors discuss the strategy of overhiring graduate nurses and compare these costs to more traditional temporary methods of replacing nurses who have resigned.

Cost-Benefit Analysis↗

Morphologic correlates for laryngeal reinnervation.

OBJECTIVE: To describe morphologic correlates for laryngeal reinnervation. STUDY DESIGN: Review of anatomic experiments dealing with laryngeal innervation performed over a 25-year period. METHODS: Description of results from experimental studies on the cat and human laryngeal muscles and nerve supply. RESULTS: Despite separation of abductor and adductor laryngeal motor neurons in the central nervous system, the mixture of abductor and adductor axons in the recurrent laryngeal nerve indicates that selective re-innervation of an individual laryngeal muscle must be accomplished at the neuromuscular junction (NMJ) of the muscle. The optimal time for a reinnervating neural source to re-occupy vacated NMJ is at the time of denervation. If the reinnervation procedure is attempted long (>1 mo) after denervation, extraneous end plates of other neural systems must be eliminated to provide vacant NMJ. The nerve muscle pedicle (NMP) concept is an effective model for reinnervation of a laryngeal muscle provided its activity pattern is similar to that of the denervated muscle and its insertion into vacated NMJ is timely. CONCLUSION: NMP offers a logical method for selective laryngeal muscle reinnervation. Critical to the success of NMP are the physiological input to the NMP and timing of NMP implantation.

Animals↗

Mucosal wound healing is impaired by examination stress.

OBJECTIVE: Impairment of wound healing is a well-recognized sequelae of conditions that alter immune function, including diabetes, jaundice, and advanced age. There is also growing evidence that psychological stress has adverse consequences for immune function. This study addressed the effects of a commonplace stressor on wound healing. METHOD: Two punch biopsy wounds were placed on the hard palate of 11 dental students. The first wound was timed during summer vacation, whereas the second was placed on the contralateral side 3 days before the first major examination of the term; thus, each student served as her or his own control. Two independent methods assessed healing (daily photographs and a foaming response to hydrogen peroxide). RESULTS: Students took an average of 3 days longer to completely heal the 3.5-mm wound during examinations, ie, 40% longer to heal a small, standardized wound. Production of interleukin 1beta (IL-1beta) messenger RNA (mRNA) declined by 68% during examinations, providing evidence of one possible immunological mechanism. These differences were quite reliable: No student healed as rapidly or produced as much IL-1beta mRNA during examinations as during vacation. CONCLUSIONS: These data suggest that even something as transient, predictable, and relatively benign as examination stress can have significant consequences for wound healing.

Adult↗

Substance use, medications for sexual facilitation, and sexual risk behavior among traveling men who have sex with men.

OBJECTIVES: The objective of the study was to examine correlates of sexual risk behavior among men who have sex with men (MSM) traveling for leisure. STUDY DESIGN: MSM (N = 304) visiting popular tourist areas completed a brief survey assessing sexual behavior and substances used while on vacation, including the use of erectile dysfunction medications (e.g., Viagra). RESULTS: Forty-seven percent of the respondents were sexually active during their vacation, with a mean of 1.33 unprotected anal sex acts during their brief stay (mean = 3.6 days). More than half of the sexually active men reported sex with a partner of unknown HIV status. Individuals reporting substance use or taking erectile dysfunction medications reported higher rates of sexual risk behaviors. CONCLUSION: Many MSM travelers report behaviors that may put their health at risk, including substance use and unprotected sexual activity. Interventions designed to reduce risk behaviors among MSM tourists are needed.

Adult↗

Age-dependent haematological disturbances in anaesthetic personnel chronically exposed to high occupational concentrations of halothane and nitrous oxide.

Anaesthetic staff chronically exposed to high occupational concentrations of halothane and nitrous oxide were tested for numerous haematological and cellular function parameters at the peak of the working season and after 3 weeks vacation. The analysis of data was performed to compare differences in subjects younger and older than the age of 40 years, respectively when compared with normal controls. The analysis revealed a higher recovery of erythrocyte count in the blood of older staff, and stronger disturbance of leucocyte formation in younger staff. In contrast, monocytes appeared to be more stable in the younger staff as were the T and B lymphocyte counts. After stimulation with PHA, Con A and PWM mitogens, lymphocytes from the older age group incorporated a significantly higher amount of tritiated thymidine, but stimulation indices did not differ. Natural killer cell numbers appeared equally affected; natural killer cell activity was unaffected, but there was an increase in activity in the younger staff after the vacation. Serum immunoglobulin concentrations tended to be more affected in older individuals at the peak of the working season.

Adult↗

Persistence of axonal transport in isolated axons of the mouse.

We have examined the hypothesis, for the case of mouse axons, that isolating an axon from its cell body will lead to a rapid failure of fast axonal transport as anterogradely moving organelles vacate the axon in a proximo-distal direction, and retrogradely moving organelles vacate it in the opposite direction. We used CD1 and BALB/c mice and the Wallerian degeneration-resistant mutant C57BL/Ola. Sciatic nerves were cut high in the thigh; at various times up to 8 days later nerves were removed from the animal and individual myelinated axons from the segment distal to the cut were examined by video light microscopy to detect rapid organelle transport. Bidirectional fast organelle transport did decrease in amount with time but not nearly as rapidly as predicted, and anterograde and retrograde organelle velocities remained normal through time. In the C57BL/Ola mouse some structurally preserved axons contained organelles that transported at normal velocities in the anterograde and retrograde directions for as long as 8 days after axotomy. To test one of the possible origins of transported organelles in long-surviving axons we examined organelle transport very close to narrow lesions in axons bathed in a medium compatible with intracellular function. No organelles crossed the lesion but bidirectional organelle transport took place proximal and distal to the lesion; the amounts were compatible with the interpretation that approximately 30% of organelles reversed transport direction on either side of the lesion. We propose that at least some of the organelles that undergo persistent transport in axons isolated from their cell bodies shuttle back and forth between the ends of the isolated segment.

Animals↗

Reinnervation of denervated parasympathetic neurones in cardiac ganglia from Rana pipiens.

1. The sequence of events during reinnervation of the cardiac ganglion in the frog following interruption of the vagosympathetic nerve supply was studied with both electrophysiological and morphological techniques. 2. When cardiac ganglia were denervated by crushing the vagosympathetic nerve supply to the heart all synaptic endings on parasympathetic ganglion cells degenerated. Vacated post-synaptic densities were detected on denervated neurones for periods of at least 7 weeks. 3. The earliest signs of reinnervation were subthreshold responses evoked by stimulating the regenerating vagosympathetic trunks 2 1/2-3 weeks after crushing the cardiac branches of the vagus nerves. Analysis of the reversal potentials of these responses indicated that these synapses were distant from the cell body. 4. At slightly longer times (4-5 weeks), regenerating synapses could be recognized on post-ganglionic axons; no synapses were detected on the neuronal perikarya at these times. 5. By 6-7 weeks following denervation, vagal synapses reinnervated neuronal perikarya as well as post-ganglionic axons. At the same time, vacated post-synaptic densities declined in number. Furthermore, vagal stimulation at this stage evoked large, suprathreshold post-synaptic potentials. 6. These studies indicate that post-ganglionic axons are the initial sites for reinnervation of parasympathetic neurones in the heart. Only some time later are neuronal perikarya reinnervated and ganglionic transmission completely restored.

Animals↗

Effect of penicillin on the succession, attachment, and morphology of segmented, filamentous microbes in the murine small bowel.

Indigenous segmented filamentous microbes attach to murine ileal epithelial cells. These microbes can be seen on the epithelial surface with a scanning electron microscope. They colonize preferentially the distal ileum in mice. Penicillin, placed in the animal's drinking water, eliminates the microbes from the mouse ileum, but recolinization of the ileum is observed 4 to 5 weeks after the penicillin treatment is stopped. Within 3 to 5 h after rats are given penicillin, the morphology of the microbes is changed. Their external surfaces are wrinkled or broken. Vacated and partially vacated attachment sites are observed. Almost all of the organisms disappear from murine ilea after the animals are exposed to penicillin for 10 h. These observations are discussed in relation to the microbe itself and in its interaction with ileal epithelial cells.

Animals↗

Antipyrine clearance during experimental and occupational exposure to toluene.

Exposure to toluene vapour enhances hepatic microsomal enzyme function in animals as assessed by the metabolism of the test drug antipyrine. Thirty six printing trade workers with long term occupational exposure to a mixture of organic solvents and 39 matched controls were randomly allocated into four groups. Eighteen printers and 21 controls were exposed to 100 ppm of toluene during 6.5 hours in an exposure chamber. The remaining 18 printers and 18 controls were exposed to 0 ppm of toluene under similar conditions. The salivary clearance of antipyrine was measured immediately after the stay in the exposure chamber to investigate a possible acute change in liver function and was repeated two weeks later, shortly before the summer vacation. Antipyrine clearance was measured again at the end of the summer vacation-four weeks after exposure. To study a possible effect of chronic exposure on antipyrine clearance 12 printing trade workers with 17 years (median) of occupational exposure to toluene vapour at concentrations of about 100 ppm were investigated before and four weeks after cessation of exposure. No difference in antipyrine clearance was found either within the groups or between the groups at any of the measurements.

Antipyrine↗

Reversal of diurnal cortisol rhythm and suppression of plasma testosterone in obstetric residents on call.

OBJECTIVE: The study was undertaken to quantify the psychologic and physiologic responses to the stresses of an obstetrics/gynecology residency program. METHODS: Six male residents were studied on four occasions: one day during the first 2 weeks of their residency, one day immediately following a vacation period, one day after a night on call in obstetrics, and one day while in the gynecology clinic. Stress was evaluated by validated psychologic instruments and by levels of plasma testosterone, luteinizing hormone (LH), cortisol, and prolactin in morning and afternoon blood samples. RESULTS: Self-reported stress was significantly elevated during the first 2 weeks of the residency after a night on call. Anxiety scores were significantly elevated after a night on call as were depression subscores for some residents. Plasma testosterone was highly significantly suppressed after the obstetrics night on call and during the first 2 weeks of the residency in comparison with the vacation period. Luteinizing hormone levels were also significantly lower after the obstetrics on-call experience. Plasma cortisol levels after a night on call were suppressed in the morning and normal or elevated in the afternoon. In comparison, the gynecology rotation was associated with normal levels of testosterone and lower levels of cortisol. CONCLUSION: In this small sample of residents, we observed an inverse relationship between self-reported stress levels and the concentrations of plasma testosterone and LH. The high levels of stress and anxiety expressed after a night on call also disrupted the normal pattern of plasma cortisol levels.

Anxiety↗

Inflammatory mediators in nasal lavage, induced sputum and serum of employees with rheumatic and respiratory disorders.

Exposure to microbes present in mould-damaged buildings has been linked to increased frequency of various inflammatory diseases. The current study examined differences in inflammatory mediators in nasal lavage (NAL), induced sputum (IS) and serum of occupants with rheumatic or respiratory disorders and their controls, all working in the same moisture-damaged building. Exhaled nitric oxide (NO) measurements, lung function tests, skin-prick tests and health data collection by questionnaire were performed. Concentrations of NO, interleukin (IL)-1, IL-4, IL-6 and tumour necrosis factor-alpha in NAL, IS and serum (excluding NO and IL-1) of the subjects were measured during an occupational exposure period and the vacation period without such exposure. The concentrations of IL-4 in NAL fluid were significantly higher among all occupants during the working period (geometric mean 8.5 microg x mL(-1), range 0-206.5 microg x mL(-1)), as compared to that during vacation (0.4 microng x mL(-1) range 0-3.7 pg x mL(-1)) (p = 0.008). Absence from the work environment also significantly diminished reporting of symptoms. IL-4 levels in the serum of case subjects were significantly higher than in controls. Moreover, employees with respiratory symptoms had markedly higher exhaled NO values than their controls (p = 0.028). In summary, these data suggest that mediators in nasal lavage samples reflect the occupational exposure to moulds, whereas possible indicators of existing disorders are detectable in serum.

Adult↗