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PubMed1981

Regional hospital input price indexes.

This paper describes the development of regional hospital input price indexes that is consistent with the general methodology used for the National Hospital Input Price Index. The feasibility of developing regional indexes was investigated because individuals inquired whether different regions experienced different rates of increase in hospital input prices. The regional indexes incorporate variations in cost-share weights (the amount an expense category contributes to total spending) associated with hospital type and location, and variations in the rate of input price increases for various regions. We found that between 1972 and 1979 none of the regional price indexes increased at average annual rates significantly different from the national rate. For the more recent period 1977 through 1979, the increase in one Census Region was significantly below the national rate. Further analyses indicated that variations in cost-share weights for various types of hospitals produced no substantial variations in the regional price indexes relative to the national index. We consider these findings preliminary because of limitations in the availability of current, relevant, and reliable data, especially for local area wage rate increases.

Abstracting and Indexing↗
PubMed2000

The significance of the American Urological Association symptom index score in the evaluation of women with bladder outlet obstruction.

PURPOSE: The American Urological Association (AUA) symptom index was originally designed to assess the severity of lower urinary tract symptoms in men with benign prostatic hyperplasia. Data concerning the clinical application of the AUA symptom index to women are sparse. We evaluated the significance of the AUA symptom index in women with urodynamically defined bladder outlet obstruction. MATERIALS AND METHODS: From a urodynamic database of 587 consecutive women 38 (6.5%) were identified with bladder outlet obstruction, defined as a maximum flow rate of less than 12 ml. per second on repeat noninvasive uroflowmetry studies with a detrusor pressure at a maximum flow of greater than 20 cm. water on pressure flow study. All patients underwent a complete clinical and urodynamic evaluation, and completed the AUA symptom index questionnaire. Results in women with urodynamic obstruction were compared with those in 2 control groups, including women without obstruction but with sphincteric incontinence and asymptomatic healthy women. RESULTS: Mean symptom score was significantly higher in women with obstruction than in those with sphincteric incontinence or no symptoms (15.8+/-8.4 versus 10.3+/-6.4 and 2.1+/-2.7, respectively). Likewise, scores were classified as severe in 34% of women with obstruction compared with only 7% of those with sphincteric incontinence. However, no correlation was noted between symptom index scores and objective urodynamic parameters, which is similar to data already reported in male populations. CONCLUSIONS: The AUA symptom index score may be useful as a bothersomeness index in women with bladder outlet obstruction. However, subjective symptoms associated with bladder outlet obstruction are nonspecific and a complete urodynamic evaluation is essential for making the diagnosis.

Female↗
PubMedDate not supplied

[Cerebrovascular reactivity by means of the breath holding index (voluntary apnea): the reliability of early repetition].

INTRODUCTION: The Breath Holding Index (BHI) is a non-invasive method for evaluation of cerebrovascular reactivity, the results of which correlate with those obtained by using intravenous acetazolomide and CO2 inhalation, so that it can be used as an alternative method to these in cooperative patients. However, the technique is not completely defined. Therefore Markus et al make a second measurement of the BHI 2-3 minutes later and take the arithmetical mean of the two readings as the final result. OBJECTIVES: To assess the intra-observer concordance between two BHI obtained with less than two minutes difference, and therefore whether the second index obtained may be used as an indicator of cerebrovascular reactivity. PATIENTS AND METHODS: Our study included 18 patients (7 men and 11 women; average age: 28.8 years; limits 17-50 years) with primary headache and no known cerebrovascular disease, diabetes mellitus or arterial hypertension. Using transcranial Doppler 28 measurements of the BHI (BHI1) were made in the middle cerebral arteries (right and/or left) in a similar way to that described by Markus. Once the average arterial velocity returned to basal levels the procedure was repeated in the first two minutes (BHI2) after the first index. Statistical analysis was done using the Student's t test and the kappa index between the two BHI after taking 0.8 as the cut-off point. RESULTS: The BHI2 (average +/- DT: 0.79 +/- 0.34) was significantly lower than that of BHI1 (average +/- DT: 1.04 +/- 0.44) (p < 0.005, t = 3.683). The kappa index between the two indices was very low: 0.058 +/- 0.158. CONCLUSION: The BHI2 is not a reliable index of cerebrovascular reactivity since it under-estimates it in relation to the previous index, even when the average arterial velocity has returned to basal levels.

Adolescent↗
PubMed1999

[Importance of determining the propidium-iodide index of plasmacytes in multiple myeloma. II. Relation to disease extent and activity].

The authors evaluated in a group of 50 patients with multiple myeloma (MM), examined when the diagnosis was established before onset of treatment, and in a group of 85 patients examined in different stages of MM the relationship of proliferative characteristics of myeloma plasmocytes assessed by means of the propidium-iodide index PI/CD38, PI/"UHKT" and PI/B-B4(CD138) with the progression, "performance status" and the activity of the disease. With the exception of a different value of the PI/CD38 index between stages 1 and 3 evaluated according to Durie-Salmon, in the whole group of patients no relationship was found with the progress of the disease. When evaluating the whole group the authors observed a difference between sub-stages A and B (i.e. between patients without and with a serious impairment of renal function) when using indexes PI/CD38 and PI/B-B4(CD138). Only in the whole group of 85 patients the authors found a significant relationship of all proliferation indexes (PI/CD38PI/"UHKT" and PI/B-B4) with the "performance status" according to ECOG score to or > or = 3 vs. < 3. In both groups there was a very close statistically significant relationship without the activity of the disease whichever of the three proliferation indexes was used. It was revealed that patients with the active but stable form of the disease have different PI/CD38 and PI/B-B4(CD138) indexes within the framework of the same stage of MM (stages 1 + 2 vs. 3). From the investigation ensues that examination of the PI proliferation index, in particular PI/B-B4(CD138) or possibly PI/CD38 using multiparametric flow cytometry is a valuable method extending hitherto used examination procedures in MM, and that it replaces adequately former autoradiographic and microscopic immunofluorescent techniques.

Adult↗
PubMed2001

Nutritional status and well being. Is there a relationship between body mass index and the well-being of older people?

Poor nutritional status may impair well being indirectly as a consequence of increased morbidity and decline in functional status. The aim of this study was to examine the independent effect of body mass index on the well being of older people. Thirty one hospital-based patients over 65 years of age were studied. Well being was assessed using the Philadelphia Geriatric Center Morale Scale (PGCMS)--anglicised version. Body mass index and well being were assessed on admission to hospital and at three months. At follow-up, a significant correlation was observed between body mass index and PGCMS values. Further analysis showed that this relationship was linear, with poor nutritional status being associated with low levels of well being and good nutritional status being associated with the highest levels of well being. High or low body mass index was able to predict the PGCMS score with a poor sensitivity of 44% and specificity of 96%. When the contribution of potential confounding variables was analysed, body mass was found to have no significant independent effect on well being. Instead, the presence of depression was the most powerful predictor of levels of well being. In conclusion, this study has demonstrated that nutritional status, as indicated by body mass index, has no detectable independent effect on well being. However, measurement of nutritional status may still have a role in the assessment of well being, in that, while the finding of a low body mass index cannot be taken as indicative of low levels of well being, the finding of a high body mass index is likely to indicate adequate well being. Further studies, however, are required in this area that would involve larger numbers of subjects and alternative measures of nutritional status and well being.

Activities of Daily Living↗
PubMedDate not supplied

Does body mass index (BMI) influence morbidity and long-term survival in gastric cancer patients after gastrectomy?

BACKGROUND/AIMS: The long-term survival of patients with gastric cancer is governed by various factors, such as the clinical stage of the cancer, the patient's nutritional state, and the treatment and may be governed by the volume of intraperitoneal adipose tissue. The aim of this study is to clarify the relationship between the degree of the patients' body mass index and their long-term survival. METHODOLOGY: Gastric cancer patients who had undergone a gastrectomy with D2-lymphadenectomy and with resection A and B according to the criteria of the Japanese Research Society for Gastric Cancer Rules were subgrouped into those patients with a body mass index < 0.185 (the lower body mass index group) and those patients with a body mass index > 0.210 (the higher body mass index group). The patient's morbidity and long-term survival rate was retrospectively compared between the 2 groups. RESULTS: A significantly longer mean survival rate was observed for the lower body mass index group in stage 2 (1667 vs. 1322 days, P = 0.0240). Also, a significantly longer mean survival rate was observed for the higher BMI group in stage 3a (1431 vs. 943, P = 0.0071). CONCLUSIONS: The body mass index is one of the prognostic factors of stage 2 and stage 3a gastric cancer. However, it does not appear to be useful for determining the prognosis of stage 1a, 1b, 3b, and 4a gastric cancers.

Adult↗
PubMed2003

[The correlation of Child-Pugh score, PGA index and MELD score in the patient with liver cirrhosis and hepatocellular carcinoma according to the cause of alcohol and hepatitis B virus].

BACKGROUND/AIMS: To determine the treatment modalities and the prognosis of a patient with liver cirrhosis, quantitative estimation of liver function is important. We assessed the Child-Pugh score (CPS), the common method as a severity index for the cirrhosis, the Prothrombin, gammaGT, and Apolipoprotein A1 (PGA) index and model for end-stage liver disease (MELD) score. The purpose of this study was to evaluate the correlation between these indices in the patients with cirrhosis only and hepatocellular carcinoma (PHC), according to underlying causes (HBV and alcohol). METHODS: We reviewed medical records of 339 cirrhotic patients with/without hepatocellular carcinoma and divided patient groups by disease and underlying cause: cirrhosis caused by alcohol; LC-Al, cirrhosis caused by HBV; LC-B, hepatocellular carcinoma with cirrhosis caused by alcohol; HCC-Al, hepatocellular carcinoma with cirrhosis caused by HBV; HCC-B. We assessed the CPS, PGA index and MELD score and calculated the correlation coefficient between these scores. RESULTS: Among the total of 339 patients, 201 patients were diagnosed on the liver cirrhosis only, and 138 patients on the hepatocellular carcinoma with cirrhosis. In each groups, mean score values were not significantly different in CPS, PGA index and MELD score. The correlation of CPS, PGA index and MELD score in all groups, except for the correlation of PGA index and MELD score in HCC-Al group, was significantly positive (p<0.05). Compared to correlation coefficients between three indices, the patients with cirrhosis only had higher tendencies than the patients with hepatocellular carcinoma. The patients by HBV had higher tendencies than by alcohol. CONCLUSIONS: The correlations between CPS, PGA index and MELD score showed significantly positive correlations in the patients with liver cirrhosis only and hepatocellular carcinoma with cirrhosis (except in HCC-Al group). The patients with cirrhosis only had higher correlation coefficients than the patients with PHC and the patients by HBV had higher than by alcohol.

Adult↗
PubMed1992

Refinement of the Modified Navy Plaque Index to increase plaque scoring efficiency in gumline and interproximal tooth areas.

To improve the assessment of plaque present on teeth, a new index, based on the original Modified Navy Plaque Index, has been developed. The primary modifications to the original Modified Navy Plaque Index were: (1) extending areas F (distal) and D (mesial) into the region just below the interproximal contact point, and (2) extending areas C and A so as to increase the gumline (or marginal gingiva) region. The new index assesses the amount of plaque in the tooth area bounded by the tooth contact, the free gingival margin, and mesial or distal line angles. The use of this new index enables the examiner to evaluate and record both the gumline (or marginal areas) and interproximal areas of the tooth, thus giving these an anatomical areas an increased importance. A pilot clinical assessment study was conducted to utilize this new index in evaluating the plaque removal efficacy of five manual toothbrushes. The results from this pilot study indicated that, when the new plaque scoring index was used, significant differences between pre-toothbrushing and post-toothbrushing plaque scores (as well as among toothbrush groups) could be demonstrated. Further, these differences (plaque removal efficacy) were demonstrated on an interproximal (mesial and distal) basis and a gumline (or gingival margin) basis, as well as on a whole mouth basis.

Adolescent↗
PubMed2005

Australian sweet lupin flour addition reduces the glycaemic index of a white bread breakfast without affecting palatability in healthy human volunteers.

The addition of some legume ingredients to bread has been associated with effects on glycaemic, insulinaemic and satiety responses that may be beneficial in controlling type 2 diabetes, cardiovascular disease and obesity. However, the effect of Australian sweet lupin (Lupinus angustifolius) flour (ASLF) is unknown. This investigation examined the effect of adding ASLF to standard white bread on post-meal glycaemic, insulinaemic and satiety responses and palatability in healthy subjects. Using a randomised, single-blind, cross-over design, 11 subjects consumed one breakfast of ASLF bread and two of standard white bread > or =7 days apart after fasting overnight. Each breakfast also included margarine, jam, and tea with milk and contained 50 g available carbohydrate. On each test day, blood samples were taken after fasting, then several times over 2 hours post-prandially, and analysed for plasma glucose and serum insulin. Subjects rated breakfast palatability and perception of satiety, in the fasting state and over 3 hours post-prandially, after which food intake from an ad libitum buffet and for the rest of the day was recorded. Incremental areas under the curves for glucose, insulin and satiety, glycaemic index, insulinaemic index and satiety index were calculated. ASLF addition to the breakfast reduced its glycaemic index (mean +/-SEM; ASLF bread breakfast = 74.0 +/-9.6. Standard white bread breakfast = 100, P=0.022), raised its insulinaemic index (ASLF bread breakfast = 127.7 +/-12.0. Standard white bread breakfast = 100, P=0.046), but did not affect palatability, satiety or food intake. ASLF addition resulted in a palatable breakfast; however, the potential benefits of the lowered glycaemic index may be eclipsed by the increased insulinaemic index.

Adult↗
PubMed2005

Cocaine addicts prone to cocaine-induced psychosis have lower body mass index than cocaine addicts resistant to cocaine-induced psychosis--Implications for the cocaine model of psychosis proneness.

BACKGROUND: The specific pathogenesis of increased vulnerability to cocaine-induced paranoia/psychosis is unknown. Weight loss has been long observed in patients abusing stimulants (including cocaine and the amphetamines). In the current study, we compared Body Mass Index (calculated as weight in kilograms divided by the square of height in meters) in Cocaine-Induced Psychosis cases, referred to as "Cocaine-Induced Psychosis-prone" (n=40) and non-Cocaine-Induced Psychosis cases, referred to as "Cocaine-Induced Psychosis-resistant" (n=29) consecutively admitted to a research substance abuse unit to determine whether Body Mass Index is associated with Cocaine-Induced Psychosis. Height and weight were measured and Body Mass Index calculated by a licensed nutritionist using a standardized protocol. Cocaine-induced psychosis and cocaine use patterns were assessed using the Cocaine Experience Questionnaire. RESULTS: Body Mass Index in the Cocaine-Induced Psychosis-prone patients was significantly lower than in the Cocaine-Induced Psychosis-resistant patients (i.e., 23.1 kg/m2 +/-2.5 vs. 25.4 kg/m2 +/-3.5 (P=.003), respectively). Percentage of Ideal Body Weight also differed significantly between the two groups. CONCLUSIONS: The data suggest that lower Body Mass Index may be associated with increasing proneness to developing psychotic symptoms in the context of crack cocaine use or that higher Body Mass Index might be associated with some protection against Cocaine-Induced Psychosis in the context of similar use patterns. In the Discussion the authors speculate as to why Cocaine-Induced Psychosis is more commonly observed in the patient population with lower Body Mass Index and lower percentage of Ideal Body Weight. They evoke possible involvement of cocaine's influence on the anorexigenic cytokine Tumor Necrosis Factor, Cocaine-and-Amphetamine-Regulated Transcript, or suppression of the appetite stimulating Neuropeptide Y, or cocaine-induced deficits in nicotinic cholinergic neural-transmission, all of which have not only been linked to weight and appetite, but also to idiopathic psychosis. It could be speculated that one or more of these systems might be differentially affected by cocaine addiction in the psychosis prone Cocaine-Induced Psychosis group vs. the psychosis resistant non-Cocaine-Induced Psychosis group. Further exploration of these possible associations seem warranted. Such findings would have implications for the cocaine model of psychosis proneness and perhaps for the stimulant model of psychoses in general.

Adult↗
PubMed1989

CINAHL and MEDLINE: a comparison of indexing practices.

A random sample of fifty nursing articles indexed in both MEDLINE and CINAHL (NURSING & ALLIED HEALTH) during 1986 was used for comparing indexing practices. Indexing was analyzed by counting the number of major descriptors, the number of major and minor descriptors, the number of indexing access points, the number of common indexing access points, and the number and type of unique indexing access points. The study results indicate: there are few differences in the number of major descriptors used, MEDLINE uses almost twice as many descriptors, MEDLINE has almost twice as many indexing access points, and MEDLINE and CINAHL provide few common access points.

Abstracting and Indexing↗
PubMedDate not supplied

[Factor impact and indexing in bibliographic databases: comparison of these quality criteria for the assessment of pharmaceutical journals].

In spite of limits, the impact factor (IF) of Journal Citation Reports (JCR) of Science Citation Index (SCI) edited by the Institute for Scientific Information (ISI) is the most currently used bibliometric factor by scientists. Otherwise, bibliographic systems select and index scientific journals with their own quality criterion. In order to bring scientists and information professionals some new journal evaluation developments, we studied and compared pharmaceutical journal IF and the number of bibliographic systems in which they were indexed. We firstly have given our definition of pharmaceutical journal and then evaluated these journals by giving one point each time they were indexed in one of the five following bibliographic systems: Index Medicus/Medline, Excerpta Medica/Embase, International Pharmaceutical Abstracts, Chemical Abstracts, Current Contents. We then compared their results with IF. We selected 292 journals: 14.4% scored 5 points, 22.3% scored 4 points, 27.7% scored 3 points, 18.8% scored 2 points, 16.8% scored 1 point. We also showed that the more journals scored highly, the more they had chances of being taken by JCR. We studied the first hundred journals indexed by JCR and having the highly IF: 31, 40, 21, 6 and 2 journals were respectively indexed by 5, 4, 3, 2 and 1 bibliographic systems. We showed that there was a significant difference between the two classifications. So, we can say that people who take IF as the one and only journal quality criterion have in fact a very partial representation of the edition of scientific papers.

Abstracting and Indexing↗
PubMed2003

The outpatient bleeding risk index: validation of a tool for predicting bleeding rates in patients treated for deep venous thrombosis and pulmonary embolism.

BACKGROUND: Long-term anticoagulation prevents recurrent thrombosis in patients with idiopathic deep venous thrombosis or pulmonary embolism, but with a risk of clinically important so-called major bleeding. Physician- and patient-based decisions on the optimal duration of therapy are sensitive to the bleeding risk. The Outpatient Bleeding Risk Index potentially provides a means of calculating the potential risk of bleeding using easily elicited clinical findings, but, to our knowledge, the authors of the index have provided the only published validation of it. We sought to determine the accuracy of the index in our population of patients. METHODS: We prospectively applied the Outpatient Bleeding Risk Index to consecutive patients in our clinic who had been objectively diagnosed as having pulmonary embolism or deep venous thrombosis and who were about to undergo standard therapy. Standard therapy consisted of a minimum of 5 days of low-molecular-weight heparin therapy overlapped with warfarin sodium therapy, and continuation of warfarin therapy for at least 3 months, with a target international normalized ratio of 2.5. Patients were placed in 3 risk groups (low, moderate, or high), as defined by the index. The survival curves of the groups, using major hemorrhages as the events, were then compared by the log-rank test. RESULTS: Bleeding rates were lower than expected, but the index did discriminate between low- and moderate-risk groups (P =.03, log-rank test). The rate of major hemorrhage per 100 person-years was 0% (95% confidence interval, 0%-2.8%) in the low-risk group and 4.3% (95% confidence interval, 1.1%-11.1%) in the moderate-risk group. The rate in the high-risk group could not be defined because only 2 patients were at high risk. CONCLUSION: The Outpatient Bleeding Risk Index discriminates between low- and moderate-risk patients, and could be used to guide decisions on the optimal duration of anticoagulant therapy.

Aged↗
PubMed2000

Rater agreement and the generalized Rudas-Clogg-Lindsay index of fit.

Rudas, Clogg and Lindsay proposed a new index of fit for contingency table analysis. Using the two-component mixture, where the first component with weight (1-w) represents the model to be tested and the second component with weight w is unstructured, the RCL index of lack of fit was defined to be the smallest mixing weight w(*) being compatible with the two-component mixture to be saturated. This index of fit, which is not sensitive to sample size, is applied to the problem of assessing agreement between two raters whereby three hypotheses (pure agreement, quasi-independence, independence) are considered. As quasi-independence comprises the two other hypotheses, a natural generalization of the RCL index of fit results from assuming the model itself to be composed of two submodels (pure agreement, independence) while the third component remains unstructured. Two examples demonstrate the application of this generalized RCL index of fit, with the first 3x3 contingency table having no empty cells, and the second 4x4 table having five of them. In both cases estimating the parameters and determining w(*) was possible without problems within the linear logistic framework for latent class analysis. A further analysis of the 4x4 table assumes the model to be the two-class latent class model that certainly does not belong to the family of standard models for contingency table analysis. Thus, in contrast to the recommendations given originally, the following conclusions seem to be justified: (i) the number of components representing the model may exceed one (generalized RCL index); (ii) the application of the original RCL index of fit may be extended to more complex models; and (iii) empty cells bear no problems so that this approach may be recommended in the case of both large and small sample sizes.

Dermatitis, Atopic↗
PubMed1988

Multiple myeloma: relationship between light chain isotype suppression, labelling index of plasma cells, and CD38 expression on peripheral blood lymphocytes.

In this study we have investigated the relationship between the labelling index of plasma cells, the expression of CD38 positive lymphocytes in the peripheral blood, and light chain isotype suppression. This study confirms the relationship between plateau-phase disease and light chain isotype suppression (LCIS) and documents an inverse relationship between LCIS and CD38 positive lymphocytes (.001 less than P less than .01), which is similar to the relationship we have described with the expression of CD10 positive lymphocytes. PCA-1 is rarely expressed in the peripheral blood of patients with myeloma and does not fulfill a role as a marker of active vs. stable disease. There is no relationship between the labelling index of plasma cells and LCIS, because many patients can enter a stage of progressive disease and yet have a labelling index of less than 1% at that time, although a labelling index less than 1% is present in the majority of patients with LCIS. beta-2-microglobulin (beta 2M) also fails to differentiate these two phases of disease in myeloma and does not have a relationship with LCIS, CD38 expression, or CD10 expression. These data suggest that myeloma, like chronic granulocytic leukemia (CGL), can be considered as having two phases of disease: a stable or chronic phase disease, as identified by the presence of LCIS, the absence of CD10 and CD38 positive lymphocytes in the peripheral blood, and a low labelling index, and progressive disease, which is associated with the loss of LCIS and of, CD10 and CD38 positive lymphocytes in the peripheral blood and a high labelling index, although in many cases of progressive disease, the labelling index may also be low. beta 2M does not differentiate between these states.

ADP-ribosyl Cyclase↗
PubMed2006

High ponderal index at birth predicts high estradiol levels in adult women.

Inter-individual variation in levels of sex hormones results from differences in genetic, developmental, and environmental factors. We tested a hypothesis that programming of the fetal neuroendocrine axis may predispose some women to produce higher levels of steroid hormones during their menstrual cycles as adults. One hundred forty-five regularly menstruating 24- to 36- year-old women collected daily saliva samples for one menstrual cycle. Data on women's birth weights and birth lengths were obtained from medical records. A positive relationship was observed between ponderal index at birth (an indicator of nutritional status, calculated as birth weight/(birth length)(3)) and levels of estradiol (E2) in menstrual cycles, after controlling for potential confounding factors. Mean E2 was 16.4 pmol/l in the low ponderal index tertile, 17.3 pmol/l in the moderate ponderal index tertile, and 19.6 pmol/l in the high ponderal index tertile (the high ponderal index group had significantly higher E2 than both low and moderate ponderal index groups, P=0.0001). This study shows a positive association between ponderal index recorded for women at birth and levels of E2 measured during their menstrual cycles as adults. This suggests that conditions during fetal life influence adult production of reproductive hormones and may contribute to inter-individual variation in reproductive function. In addition, because large size at birth is one of the factors linked with an increased risk of breast cancer, our findings provide a physiological link for the observed positive relationship between indicators of energetic conditions during fetal growth and breast cancer in women.

Adult↗
PubMed2002

The hypersensitivity pneumonitis diagnostic index: use of non-invasive testing to diagnose hypersensitivity pneumonitis in metalworkers.

BACKGROUND: Since 1993, several outbreaks of hypersensitivity pneumonitis (HP) have been reported in metalworkers. We report the largest outbreak of HP in metalworkers yet known. It occurred in a Connecticut factory that produces precision parts for the aerospace industry. The workers typically presented with systemic and respiratory problems ("sick fatigue," myalgias, cough, dyspnea, wheezing, and chest tightness). They had variable findings on clinical tests, which complicated diagnosis. An HP diagnostic index was developed to help reduce the uncertainties in case identification. METHODS: Data from 16 biopsy-confirmed cases and 14 non-HP patients were compared, and the HP diagnostic index was derived using variables that best discriminated between the two groups. The index is based on (a) work-related symptoms, (b) dry crackles on auscultation, (c) restrictive spirometry, (d) decreased diffusion capacity and/or increased A-a oxygen gradient, (e) elevated erythrocyte sedimentation rate, (f) abnormal radiographic images, and (g) abnormal gallium scans. We then applied the HP diagnostic index and, for comparison, the "Kenosha epidemiological case criteria" (developed during a recent HP outbreak in an automobile factory) to our data set. RESULTS: The HP diagnostic index and the Kenosha criteria confirmed HP in overlapping sets of 36 and 34 patients, respectively, that were both in good agreement with the clinical diagnoses. CONCLUSIONS: The HP diagnostic index relies less heavily on symptoms, subjective evaluations, and invasive tests than the Kenosha criteria, but both identified similar subsets of the 61 patients as having HP. The HP diagnostic index could provide a useful tool in future HP outbreaks, which are increasingly being recognized in metalworking facilities.

Alveolitis, Extrinsic Allergic↗
PubMed1989

Relationship between body mass index, cigarette smoking, and plasma sex steroids in normal male twins.

Smoking has been observed to affect plasma sex hormones and body mass index. The relationship between smoking, body mass index, and plasma concentration of sex hormones was studied in normal adult male twins. The analyses were performed for between 150 and 159 twin pairs for whom hormonal data were available on both twins. With bivariate analysis, neither body mass index nor smoking affected estrone, luteinizing hormone, follicle-stimulating hormone, ratio of testosterone to estradiol, or ratio of testosterone to dihydrotestosterone. Body mass index significantly (P less than 0.05) affected sex hormone binding globulin, whereas smoking had no effect. The plasma contents of testosterone and dihydrotestosterone and the luteinizing hormone/testosterone ratio were affected by both body mass index and smoking, although, after allowing for body mass, smoking was less significant (0.05 less than P less than 0.10). A path model was formulated to examine the relationship of body mass and sex steroid levels. Our results suggest that body mass index affects sex steroids, since common environmental factors do not account for the strength of the relationship. The bivariate analysis suggests that the smoking effect on sex hormones (except perhaps for dihydrotestosterone) is secondary to an effect on body mass index.

Adult↗