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Liver enzymes among microelectronics equipment maintenance technicians.

Equipment maintenance workers within the microelectronics industry have opportunities for occupational exposure to a variety of toxic agents. This pilot investigation compares liver enzymes in this population with that of other coworkers. Participants (n = 135) were randomly selected from a medical surveillance program at the manufacturing facility. Nine job categories were examined, including equipment maintenance workers and electronic technicians. Although abnormal liver enzymes were detected among equipment maintenance workers (odds ratio 16.4; P less than .008) and electronic technicians (odds ratio 27; P less than .0005), the numbers of participants were small (n = 8, 10). The data suggest that independent and/or interactive etiologic roles of occupation and alcohol should be further investigated. Early detection of subclinical occupational or recreational hepatotoxicity with appropriate employment of industrial hygiene control technology and/or the reduction of alcohol consumption may provide a means of preventing liver disease.

Adult↗

Segregation of coarse and fine glossopharyngeal axons in the visceral nucleus of the tractus solitarius of the cat.

The projections of coarse and fine axons of the glossopharyngeal (IX) nerve upon the caudal two thirds of the nucleus of the tractus solitarius (NTS) were studied in the cat. These afferents convey the chemo- and baroreceptor activities from the carotid receptors. We applied the Fink-Heimer method on brainstem sections, at different survival times, after a petrosal ganglionectomy. A segregation of fine and coarse fibered components was observed. Degeneration of coarse axons was mostly found in the lateral NTS, while fine fiber degeneration was predominant in regions of the medial and commissural NTS. The injection of WGA-HRP in the different NTS divisions demonstrated that the lateral NTS was mainly innervated by the set of largest neurons of the petrosal ganglion and that the medial and the commissural NTS were innervated by the set of smaller neurons of the ganglia. These results were discussed in relation to cytoarchitecture, myeloarchitecture, distribution of normal axons, and known central connectivity of the different NTS divisions. We concluded that coarse and fine visceral afferents of the IX nerve, which includes the afferents of the carotid body and the carotid sinus, represent different afferent populations that project to particular divisions of the NTS and connect to different central pathways.

Animals↗

Contraceptive self-efficacy: a primary prevention strategy.

This paper discusses the development, implementation, and qualitative evaluation of an intervention designed to improve contraceptive self-efficacy (CSE) in a population at high risk for pregnancy. In a previous study, a relationship was found between CSE and a measure of contraceptive use for sexually active young women attending a family planning clinic. Here, the concept of CSE is further developed to identify contraceptive and sexual issues for adolescent males, for adolescents who show little or no motivation to obtain or use contraceptives, and for those adolescents who would plan to carry a pregnancy to term if they were to become pregnant. Implications are drawn for developing primary prevention programs.

Adolescent↗

Expanding the National Electronic Injury Surveillance System to monitor all nonfatal injuries treated in US hospital emergency departments.

STUDY OBJECTIVE: Injury is a major cause of morbidity and mortality in the United States. Although the National Vital Statistics System provides data on injury-related deaths, a national surveillance system is needed for timely identification of emerging nonfatal injury problems and continuous monitoring of severe nonfatal injuries. This work assesses the feasibility of expanding the National Electronic Injury Surveillance System (NEISS) to monitor all types and causes of nonfatal injuries treated in US hospital emergency departments and reports national estimates generated by a pilot study of this system. METHODS: At a stratified sample of US hospital EDs, persons receiving first-time treatment for an injury were monitored from May 1 through July 31, 1997. National estimates of the annual number and rate of ED-treated injuries overall, by patient characteristics, injury diagnosis, and external cause of injury were generated, and the sensitivity of the system for detecting ED-treated injuries was assessed. RESULTS: An estimated 29. 1 million injuries were treated in US EDs in 1997 (rate of 108.6/1, 000 population). The leading causes of injury were falls, being struck by or striking against an object or person, cutting or piercing, and motor vehicle traffic. Of 593 cases of injury detected by investigators from the Centers for Disease Control and Prevention during visits to 6 of the 21 NEISS hospitals in the study, 490 were also detected by NEISS coders for an overall sensitivity of 82.6%. CONCLUSION: Expanding the NEISS is a feasible means of timely and continuous monitoring of all types and causes of nonfatal injuries treated in US hospital EDs.

Adolescent↗

Golgi analyses of dendritic organization among denervated olfactory bulb granule cells.

In the vertebrate olfactory bulb, the primary projection neurons, mitral and tufted cells, have reciprocal dendrodendritic synapses with respective subpopulations of anaxonic interneurons called granule cells. In the neurological murine mutant Purkinje Cell Degeneration (PCD), all mitral cells are lost during early adulthood. As a consequence, a subpopulation of granule cells is deprived of both afferent input and efferent targets. The effect of this event on the morphology and sublaminar distribution of granule cells was studied with light microscopic Golgi procedures in affected homozygous recessive PCD mutants and normal heterozygous littermate controls. In the control mice, a minimum of three subpopulations were identified predominantly on the basis of the topology of apical dendrites and their spinous processes within the external plexiform layer (EPL) of the olfactory bulb: type I had dendrites extending across the full width of the EPL and a homogeneous distribution of spines; type II had dendritic arbors confined to the deeper EPL; type III had apical dendrites that arborized extensively within the superficial EPL with no arbors or spines present in the deeper EPL. Prior studies suggest that type II cells form connections with mitral cells; type III cells form connections with tufted cells; and type I cells may integrate information from both populations of projection neurons. In the mutant PCD mice, the classification of subpopulations of granule cells proved difficult due to a compression of dendritic arbors within the EPL. Dendritic processes followed a more horizontal tangent relative to the radial orientation seen in control mice. The length of dendritic branches was reduced by approximately 20% with a corresponding decrease in the number of spines. The density of spines (#/1 micron of dendrite) was constant in both controls and mutants at approximately 0.21. Truncation of the dendrites in the PCD mutants appeared to occur at terminal portions because the number of dendritic bifurcations was equal in both groups of mice. The data are discussed in terms of subpopulations of granule cells in the mouse olfactory bulb, the sublaminar organization of olfactory bulb circuits, and the capacity for survival and plasticity in the reciprocal dendrodendritic circuits mediated by the granule cell spines.

Animals↗

Lung function parameters of Bangladeshi male subjects in different living conditions.

The "standard" values of pulmonary function tests obtained from Western populations do not agree with that of people of Bangladesh. The present survey was conducted with a view to determining the values of three lung functions parameters, viz., vital capacity, forced vital capacity, and forced expiratory volume in healthy Bangladeshi male population. 250 non-smoker male subjects of age 20-40 years were selected for the study. Of these 150 were university students and employees and 100 were low income group slum dwellers. All three values correlated positively with height and weight and negatively with age. There was a definite effect of aging on the lung function showing a declining trend from age 35 years onwards. The slum dwellers showed lower values (-12.5% in young adults) of lung functions than the university students and employees. The difference decreased with age. Prediction equations were set up using height, weight, and age as parameters. In general the lung function values were found to be 80% of the European Standards.

Adult↗

Specificity of the Heidelberg Retina Tomograph's diagnostic algorithms in a normal elderly population: the Bridlington Eye Assessment Project.

PURPOSE: To determine the specificity of the Moorfields regression analysis (MRA) and R. Burk (RB) and F. S. Mikelberg (FSM) linear discriminant functions (LDFs) in classifying the optic discs of normal elderly patients imaged with the Heidelberg Retina Tomograph. DESIGN: Cross-sectional study. PARTICIPANTS: Optic nerve head analysis of 459 eyes of 459 normal elderly patients was performed by 2 operators. All patients were consecutive in a cohort screened for eye disease. Normals were defined as having a normal visual field (VF) on automated suprathreshold screening, normal intraocular pressure, and normal visual acuity. MAIN OUTCOME MEASURES: Specificity of the optic nerve head classification by MRA and the RB and FSM LDFs. RESULTS: Subjects' mean age (262 female, 197 male) was 72.6 years. Males were found to have significantly larger cups than females. Eighty-three percent, 11.3%, and 5.7% of discs were classed as within normal limits, borderline, and outside normal limits by MRA. Percentages of optic discs classified as outside normal limits in the smallest and largest quartiles for disc size were 0.9% and 14.9%. The association of disc size with the classification of outside normal limits was significant in males only. Agreement in MRA classification between 2 investigators separately placing the optic disc contour was moderate (Cohen's kappa = 0.54, P<0.001). The RB and FSM LDFs classified 6.8% and 11.8% of discs as diseased. The RB LDF was significantly more likely to return a diagnosis of disease in larger discs, though only in males. The FSM LDF tended to the same drop in specificity, although not significantly. CONCLUSIONS: Using the MRA and RB/FSM LDFs, specificity fell dramatically with increasing disc size, particularly in males. This may reflect the finding of significantly larger cups in males than in females in the normal elderly population. This divergence was not predicted by these diagnostic functions, which were developed on samples of younger subjects.

Aged↗

The marginal cost of public funds with an aging population.

"As populations in the United States and other advanced economies grow older, the burden of social security and health care financing is expected to rise markedly. Payroll, income, and other taxes on working populations are projected to rise accordingly. The marginal welfare cost to workers of social security and other public expenditures is analyzed within the context of a two-period life cycle model. By relaxing separability assumptions that have become common in the literature, the theoretical structure properly incorporates the effect of these public expenditures on labor supply. Comparative statics results indicate that changing age structure is likely to raise the marginal welfare to workers of social security, education, and other public expenditures. Illustrative calculations for the United States confirm this result, suggesting that the cost to workers of incremental social security benefits may easily double by 2025-2050."

Age Distribution↗

General practice-based population screening for abdominal aortic aneurysms: a pilot study.

All 1195 male patients aged between 65 and 74 years on the Family Practitioner Committee register for the four group practices in Stroud, UK were invited for a health screening check. The examinations included abdominal ultrasonography to measure maximum aortic diameter, measurement of blood pressure and recording of smoking habits. An attendance rate of 76 per cent was achieved (906 patients). Seventy-one patients (7.8 per cent) were found to have aortic diameters greater than 2.5 cm and 14 (1.5 per cent) had aortic diameters greater than 4.0 cm. Aneurysms were more common in smokers and in hypertensive patients. However, restriction of screening to patients with these risk factors would have led to a number of aneurysms remaining undiscovered. We recommend therefore that ultrasound screening for abdominal aortic aneurysms should be offered to all men between the ages of 65 and 74 years.

Aged↗

The feasibility of routine mortality and morbidity register data linkage to study the occurrence of acute coronary heart disease events in Finland. The Finnish Cardiovascular Diseases Registers (CVDR) Project.

Validated population-based data on the occurrence of coronary heart disease in Finland have previously been obtained from myocardial infarction (MI) registers. Such registers cannot, however, cover large areas. Therefore, the Finnish Cardiovascular Diseases Registers (CVDR) Project was set up to obtain data for the whole of Finland. The CVDR Project is based on routine mortality and morbidity data linkage. We report here the overall approach used in the project, the results of the feasibility study and the first main results. In Finland, data on all hospitalizations are registered in the nationwide Hospital Discharge Register. Also, data on all deaths are collected in the nationwide Causes of Death Register. The unique personal identification number assigned to all persons residing in Finland was used for data linkage. Data have been validated using the FINMONICA MI registers. Sensitivity analyses showed that the data were robust and consistent between different geographical areas. Coronary heart disease (CHD) mortality as well as the incidence and event rates showed the same very clear geographical pattern, dividing Finland to a southwest area with a lower occurrence and a northeast area with nearly twice higher occurrence. Case fatality did not differ much between the areas and did not follow this Southwest-Northeast division. The differences between northeast and southwest Finland may be related to differences in risk factor levels but also to socioeconomic and genetic differences. The CVDR Project data will be instrumental in further research addressing these issues.

Acute Disease↗

Can calls to NHS Direct be used for syndromic surveillance?

This study assessed whether NHS Direct could be a useful source of surveillance data for communicable diseases, using influenza as a pilot condition. Data on the weekly total number of calls and the number from people reporting influenza-like symptoms to three pilot NHS Direct sites were collected between November 1999 and March 2000. NHS Direct data were compared with routinely available influenza surveillance data. The NHS Direct call rate peaked at 331 per 100,000 population in week 52 of 1999. The percentage of calls for 'influenza-like illness' (one site) peaked at 15% during week 51. Information about weekly call numbers to NHS Direct could be produced in a timely way. It was not clear whether the observed peak in calls reflected a true increase in influenza or whether it was the result of an increase in calls over the Christmas/Millennium holiday period due to more difficulty in accessing other services. The ability to assess the proportion of calls made directly by, or on behalf of, each age group will be of vital importance in interpreting seasonal respiratory disease.

Disease Outbreaks↗

Ultrasound screening in the management of abdominal aortic aneurysms.

Planned surgery for abdominal aortic aneurysms carries a low mortality (0-2%). Ultrasound examination of the abdomen can identify the aorta in 92% of patients. We have undertaken a study of the asymptomatic population based on a general practice (Family Doctor) register. The long term aims of this survey will be to identify a high risk group in which surgery is indicated, a low risk group were surgery can be avoided and a group of aneurysms in whom emergency surgery is contra-indicated. Arguments are put forward against improved treatment of aneurysms as emergencies as a way of improving overall survival and against the treatment of all cases detected by ultrasound as planned procedures. The current methods of selecting high risk cases are criticised and a possible method of selecting cases for planned surgery, based on screening and ultrasound follow-up is put forward. The advantages and disadvantages of an ultrasound screening programme are discussed.

Aged↗

Face-to-face training emerges as most effective. New Delhi.

Three training modalities used for upgrading the knowledge and skills of teachers in population education were compared in a study undertaken by S.V. Yadav of the National Population Education Project of the National Council of Educational Research and Training. The 3 training modalities compared included face-to-face training, self-learning individual mode and self-learning paired mode. The study employed pre-test and post-test designs using control groups consisting of 96 secondary school teachers teaching in rural schools in 1 district. The 3 modalities were compared according to their effectiveness in terms of gains in awareness, knowledge and attitude as well as cost effectiveness. The study showed that the face-to-face modality is still the most effective in terms of gains in knowledge and attitude. It is, however, costlier, the report points out. When cost per unit and outcomes were taken together, the study found out that the self-learning, paired mode proved to be the most effective. The self-learning paired mode is also found to be more effective than the individual self-instruction mode because in the paired mode modality, the opportunity to discuss and share learning with a colleague improves their understanding of the issues in an area in which attitude and values are important. The study recommends on this basis that policy makers consider the combination of face-to-face and self-learning paired modalities in designing their teacher-training program on population education.

Asia↗

Study of simplified measures for malaria surveillance in the late consolidation phase in China.

This paper presents the results of a study on simplified surveillance methods conducted in 23 pilot counties in 11 provinces and municipalities in China where reside 15 million people and malaria control has been in the late consolidation phase. Two simplified surveillance Schemes (A and B) taking treatment of clinical cases as the main measure were implemented in 1992-1994. The rate of annual blood examination for case detection was 1.0% in pilot Scheme A, while in areas of scheme B it was 0.3%. The implementation of both Scheme A and Scheme B, simplified or without treatment of infection foci and management of mobile populations, acquired satisfactory effects against malaria. Consequently, malaria incidence was declining steadily, only a few indigenous and introduced cases were detected. The parasite rate in residents and the IFA positive rate in children were very low. The results of pilot studies and cost-effectiveness analysis indicated that Scheme B is effective, rational and economic, and can be implemented to replace the routine surveillance measures in areas where malaria has been at the late consolidation phase in China.

Adult↗

The EDNAP mitochondrial DNA population database (EMPOP) collaborative exercises: organisation, results and perspectives.

This paper presents an overview of the organisation and the results of the collaborative exercises (CE) of the European DNA Profiling (EDNAP) Group's mitochondrial DNA population database project (EMPOP). The aim of the collaborative exercises was to determine whether uniformity of mtDNA sequencing results could be achieved among different laboratories. These were asked to sequence either the complete mtDNA control region or the two hypervariable regions HVI (16024-16365) and HVII (73-340) from DNA extracts, buccal swabs or bloodstains, proceeding in accordance with the protocol and strategies used in each individual laboratory. The results of the collaborative exercises were employed to identify possible sources of errors that could arise during the analysis and interpretation of mtDNA profiles. These findings were taken as a basis to tentatively make suitable arrangements for the construction of a high quality mtDNA database. One hundred fifty mtDNA profiles were submitted to the evaluating laboratory, and disaccording profiles were classified into four groups corresponding to the source of error: clerical errors, sample mix-ups, contaminations and discrepancies with respect to the mtDNA nomenclature. Overall, 14 disaccording haplotypes (16 individual errors) were observed. The errors included 10 clerical errors, 3 interpretation problems, 2 cases of sample mix-up and 1 case of point heteroplasmic mixture, where the 2 sequencing reactions brought inconsistent base calls. This corresponds to an error rate of 10.7% in a virtual mtDNA database consisting of the collaborative exercise results. However, this estimate is still conservative compared to conclusions drawn by authors of meanwhile numerous publications critically reviewing published mtDNA population databases. Our results and earlier published concerns strongly emphasize the need for appropriate safety regulations when mtDNA profiles are compiled for database purposes in order to accomplish the high standard required for mtDNA databases that are used in the forensic context.

Clinical Laboratory Techniques↗

The population of GnRH-containing neurons showing socially mediated size changes project to the pituitary in a teleost, Haplochromis burtoni.

Reproductive function in all vertebrates is controlled by the brain-pituitary-gonadal axis. In teleost fish, endocrine cells within the adenohypophysis are grouped together and each collection of cells is innervated by specific neuropeptide fibers. An important regulatory step in reproductive control is gonadotropin-releasing hormone (GnRH), whose delivery to the pituitary is responsible for its release of gonadotropins. The hormone GnRH has been shown to play a critical role in the social control of reproduction in a teleost fish, Haplochromis burtoni. However, there has been no direct evidence that the preoptic area GnRH neurons project to the pituitary. In this study, we used a retrograde tracer and immunohistochemistry to identify those GnRH containing neurons that project to the adenohypophysis. We compared reproductively active territorial males with quiescent non-territorial males to discover whether the connectivity of the preoptic area GnRH neurons depends on the reproductive status of the male. We found that, irrespective of reproductive status, most GnRH neurons in the preoptic area project to the pituitary and that all of these GnRH neurons show the soma size change that has been associated with reproductive status in Haplochromis burtoni. Based on these data, we propose that there is a single population of GnRH containing cells in the preoptic area that change size as a function of reproductive state and that this entire population projects to the pituitary. This is the first direct demonstration that this essential circuit, linking GnRH neurons in the preoptic area to the pituitary, exists.

Agonistic Behavior↗

Reforming health care for the elderly--the example of Vorarlberg.

Vorarlberg--Austria's most western province with a population of about 325,000--has always implemented forms of social policy in which the principles of subsidiarity and solidarity play an important role. This is reflected in the structure of the organizations traditionally providing social services as well as in the more recent programmes the government has developed for social policy. This paper discusses two cases in point: the private associations for home care (Krankenpflegerverbände)--which now exist in 65 Vorarlberg communities and cover 85% of the population in the province--offering nursing services at home to members or to persons who are willing to join the organization when they need care, and the new organizational model, called Gesunder Lebensraum Vorarlberg (GLV), which is successfully operating in a few pilot communities. GLV has spawned umbrella organizations, run by volunteers, and offering a variety of social services relevant to the elderly, for example visiting services or neighbourhood help in case of emergencies. The volunteers get organizational help from a profit-making firm financed by the government. The Vorarlberg models can be interpreted as a step towards demedicalization and deinstitutionalization of health care for the elderly. Nevertheless, they also show the problems that arise when professionals and volunteers must cooperate. The models may lead to savings for the governments involved, although details are still subject to future empirical investigations.

Aged↗

Projected mortality from lung cancer in South Korea, 1980-2004.

BACKGROUND: In recent years, mortality from lung cancer has increased rapidly in Korea, a South East Asian country with a high prevalence of smoking. The objectives of this study are to examine how age, period, and birth cohort effects contributed to trends in lung cancer mortality in Korea 1980-1994, and to predict lung cancer mortality rates for 1995-2004. METHODS: Age- and sex-specific lung cancer mortality rates were obtained from annual reports of the National Office of Statistics in Korea. Poisson regression models were used to estimate age, period and cohort effects. RESULTS: Among men, age-adjusted annual mortality rates from lung cancer (per 100000) increased from 3.7 in 1980 to 17.8 in 1994; corresponding rates for women were 1.4 and 7.0. As age increased, mortality rates from lung cancer increased more rapidly in men than in women. Within the same age group, the mortality of younger cohorts was higher than older cohorts. The average annual number of lung cancer deaths projected for the years 2000-2004 among men and women will be 15441 and 3572 respectively, while the average annual age-adjusted mortality rates from lung cancer (per 100000) will be 65.4 for men and 15.1 for women. These rates correspond to 17.7- and 10.7-fold increases over the 1980 mortality rates in men and women, respectively. CONCLUSION: These results, in conjunction with trends in tobacco consumption, indicate that mortality from lung cancer in both men and women will increase substantially through the early part of the 21st century in Korea.

Adult↗