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Deals with a study which discussed the scan test which has been applied to retrospective data to detect carbon monoxide poisoning clusters. Methods used in the study; Results and conclusion.

This study was designed to assess the effects of the North Carolina Improved Pregnancy Outcome (IPO) Project on use of prenatal care and incidence of low birthweight among its primarily Black registrants. Weighted least squares and stratified analysis procedures were used to scrutinize vital statistics data for subpopulation effects. IPO services were received by 51.7 per cent of Black women in the counties served by the project. For all Black registrants, the risk of receiving less than adequate prenatal care was 55.1 per cent of that of the comparison group. For Black teenage registrants, the risk was even less: 37.2 per cent of that of the comparison group. Nevertheless, no corresponding effects on the incidence of low birthweight could be detected. The evaluation methods used in this study can be applied to programs for mothers and infants in other locales to generate useful and practical information for state-level decion-making. [ABSTRACT FROM AUTHOR]

The purpose of the present investigation was to examine the impact of blood transfusion on resource utilisation, morbidity and mortality in patients undergoing coronary artery bypass graft (CABG) surgery at a major university hospital. The resources we examined are time to extubation, intensive care unit length of stay (ICULOS) and postoperative length of stay (PLOS). We further examined the impact of number of units of packed red blood cells (PRBCs) transfused during PLOS. This is a retrospective observational study and includes 1746 consecutive male and female patients undergoing primary CABG (on- and off-pump) at our institution. Of these, 1067 patients received blood transfusions, while 677 did not. The data regarding the demography, blood transfusion, resource utilisation, morbidity and mortality were collected from the records of patients undergoing CABG over a period of three years. The mean time to extubation following surgery was 8.0 h for the transfused group and 4.3 h for the nontransfused group (P = 0.001). The mean ICULOS for the transfused group was 1.6 d and 1.2 d for the nontransfused group (P < 0.001). The PLOS was 7.2 d for the transfused group and 4.3 d for no-transfused cohorts (P = 0.001). In all patients and in patients with no preoperative morbidity, partial correlation coefficients were used to examine the effects of transfusion on mortality, time to extubation, ICULOS and PLOS. Linear regression model was used to assess the effect of number of PRBC units transfused on PLOS. We noted that PLOS increased with the number of PRBCs units transfused. Transfusion is significantly correlated with the increased time to extubation, ICULOS, PLOS and mortality. The transfused patients had significantly more postoperative complications than their nontransfused counterparts (P = 0.001). The 30-day hospital mortality was 3.1% for the transfused group with no deaths in the nontransfused group (P = 0.001). We conclude that the CABG patients receiving blood transfusion have significantly longer time for tracheal extubation, ICULOS, PLOS and higher morbidity and 30-day hospital mortality. Blood transfusion was an independent predictor of increased resource utilisation, postoperative morbidity and mortality. [ABSTRACT FROM AUTHOR]

Background: The availability of several effective screening options for colorectal cancer (CRC) screening calls for involving patients in decision making about CRC screening. The current study examined (1) participant characteristics associated with their preferences for participation in CRC screening decision making, (2) correspondence between participant preferences for decision making and their usual participation in decision making, and (3) associations between participant decision-making preferences and CRC screening practices and attitudes. Methods: Data were obtained using a random, population-based telephone survey, conducted during August 2001 and April 2002, of 2119 community-living adults aged 50 to 75 years (56% female) residing in Long Island, NY. Results: Overall, 77% reported that preferences for CRC screening decision making matched how screening decisions were usually made (simple kappa coefficient=0.67 [0.64–0.69]). Fifteen percent preferred to make screening decisions themselves, while 25% preferred to make decisions after considering their physician’s opinion; nearly 50% preferred to share decision making, and 16% preferred that their physician make all screening decisions. Less education was associated with preferring that the physician make all screening decisions. Preferring physician involvement in screening decision making was associated with greater odds of citing no physician recommendation as a barrier to CRC screening, when compared to those who preferred no physician involvement. Preferring no physician involvement in decision making was associated with lower odds of reporting a recent CRC screening exam, as well as lower odds of endorsing positive attitudes and greater odds of endorsing negative attitudes toward CRC screening, when compared to participants who preferred physician involvement in decision making. Their attitudes also reflected intentions not to screen for CRC if they were asymptomatic, as well as the perception that they were not at personal risk for CRC. Conclusions: Several factors were identified as significantly associated with preferences for decision making and deserve further exploration for their application to clinical practice. [Copyright &y& Elsevier]

The effect on women's breast cancer screening utilization of a barrier-specific telephone counseling ( BSTC ) intervention, with and without a concurrent continuing medical education ( CME) activity for their physicians, was evaluated. All participants (50-80 years of age) were not regular mammography users at baseline. A 4-arm quasi-experimental design was employed. Women were randomized to the BSTC or no BSTC group and assigned (with their physicians) to the CME or no CME group based on place of residence. Pre- and postintervention data were obtained for 1,601 women using telephone interviews conducted during 1995 and 1998, respectively. Among women who had ever used mammography at baseline, those who received BSTC were more likely than the control group to become regular mammography users at follow-up (OR = 1.4, p = .033). Greater reductions in perceived barriers to mammography, from baseline to follow-up, were significantly associated with receiving BSTC compared with the control group (p = .001), among women with previous mammography experience. Findings suggest that CME may have potential for initiating mammography use among women who never had a previous mammogram. However, because of the small sample available for analyses of the CME intervention and differential attrition among women who never had a previous mammogram, further study is needed to confirm this hypothesis. [ABSTRACT FROM AUTHOR]

The objective of this study was to determine the accuracy of self-reports of mammography use by low-income women. Mammography van records were used to verify self-report of mammography use in the past year by women aged 50 through 75 years who had visited five community health centers (n = 237). Van records verified mammography use for 99% of these women (82% within the previous year and 98% within the past 2 years). Forty percent of those with van records who reported both the month and year of the mammogram were accurate. Inaccurately reported dates were more frequently after (74%) rather than before (26%) the actual date. These findings indicate that self-reports of mammography use by low-income women are generally reliable. [ABSTRACT FROM AUTHOR]

Background Long-term treatment with a high-strength hydroquinone (HQ) cream (usually 4% HQ) is the mainstay therapy for hyperpigmentation disorders. Instability and high potential for irritancy hinders patient compliance. A new 4% HQ preparation has been designed with an innovative antioxidant for stability and a biomimetic of an herbal extract for skin calming. Aims To investigate the activity, stability, and irritancy of a new HQ cream. Methods To evaluate the new HQ cream in comparison with commercial 4% HQ creams for stability by temperature stress test, for irritancy by repeated-insult patch test on human subjects, and for lightening effect using the MelanoDerm™ B skin equivalent model. Results The new HQ is more resistant to browning and shows less irritancy than three commercially available 4% HQ products. It has comparable bleaching effect with faster onset than a 4% HQ product containing 0.05% tretinoin and 0.01% fluocinolone acetonide. Conclusion Based on its improved stability, lower irritancy, and activity in skin lightening, the new approach to the formulation of 4% HQ may improve therapeutic outcomes by improving patient compliance to dosing. [ABSTRACT FROM AUTHOR]

BACKGROUND AND AIMS: Although studies suggest a positive association between alcohol consumption and risk for colorectal neoplasia, the impact on screening has not been fully examined. It is also unclear whether all types of alcohol are associated with an increased risk. We performed a cross-sectional study to examine the impact of regular alcohol consumption on the detection of significant colorectal neoplasia in a screening population. METHODS: Data collected for 2,291 patients presenting for screening colonoscopy: known risk factors for colorectal neoplasia and alcohol drinking pattern. Our outcome was the endoscopic detection of significant colorectal neoplasia, which included adenocarcinoma, high-grade dysplasia, villous tissue, adenomas 1 cm or greater and multiple (>2) adenomas of any size. RESULTS: When compared to abstainers, we found an increased risk for significant neoplasia in those patients who consumed more than eight drinks of spirits alcohol (26.3%; OR = 2.53; 95% CI = 1.10–4.28; p < 0.01) and those who drank more than eight servings of beer per week (21.7%; OR = 2.43; 95% CI = 1.11–5.32; p= 0.02). Consuming one to eight glasses of wine per week was associated with a decreased risk for significant neoplasia (OR = 0.55; 95% CI = 0.34–0.87; p < 0.01). CONCLUSIONS: While there was a more than twofold increased risk of significant colorectal neoplasia in people who drink spirits and beer, people who drank wine had a lower risk. In our sample, people who drank more than eight servings of beer or spirits per week had at least a one in five chance of having significant colorectal neoplasia detected by screening colonoscopy. (Am J Gastroenterol 2005;100:1–7) [ABSTRACT FROM AUTHOR]

BACKGROUND: Previous colorectal cancer screening studies have observed that some patients may have advanced proximal neoplasia without distal findings. Since these studies have included only gender, age, and family history as risk factors, they are limited in their ability to identify predictors of isolated proximal neoplasia.METHODS: Data were collected from the charts of 1,988 patients who presented for colonoscopy. Information gathered included endoscopic findings, histology, known risk factors for colorectal neoplasia, and smoking pattern. Our main outcome was the presence of proximal adenomatous neoplasia in patients who had no distal adenomas. We defined significant neoplasia as adenocarcinoma, high-grade dysplasia, villous polyps, adenomas 1 cm or greater or more than two adenomas of any size.RESULTS: Fifty-five patients had isolated significant proximal neoplasia that would have been missed on a flexible sigmoidoscopy. While patients older than 60 yr had a greater risk for this neoplasia (odds ratio= 3.01: 95% CI= 1.66–4.23;p<0.001), those who took a daily aspirin had a reduced risk (OR= 0.60; 95% CI= 0.30–0.88;p<0.05). A family history of colorectal cancer increased the patient's risk of having any adenomas (OR= 2.01; 95% CI= 1.33–3.40;p<0.01) or villous tissue (OR= 2.03; 95% CI= 1.27–3.51;p<0.05) in the proximal colon without distal findings. Smoking was associated with an increased risk of large (>1 cm) isolated proximal tubular polyps (OR= 2.71; 95% CI= 1.64–4.46; p<0.01) as well as isolated significant proximal neoplasia (OR= 2.30; 95% CI= 1.59–3.31;p<0.01).CONCLUSIONS: Age greater than 60 yr, a history of at least 10 pack-years of smoking, and a family history of colorectal cancer increased the risk of finding significant proximal polyps in patients without distal pathology. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Smoking has been linked with colorectal neoplasia. Previous colonoscopy screening studies have omitted smoking and have examined only gender, age, and family history. Our aim was to use a screening population to measure the prevalence of neoplasia in smokers, the anatomic location of these lesions, and the strength of this association relative to other risk factors. METHODS: Data collected from the charts of 1988 screening colonoscopy patients included colonic findings, histology, risk factors for colorectal neoplasia, and smoking pattern. Current smokers were defined as those who had smoked more than 10 pack-years and were currently smoking or who had quit within the past 10 yr. Our outcomes were any adenomatous lesion and significant colonic neoplasia, which included adenocarcinoma, high grade dysplasia, villous tis- sue, large (>1 cm) adenomas, and multiple (more than two) adenomas. RESULTS: Multivariate analysis revealed that current smokers were more likely to have any adenomatous lesion (odds ratio [OR] = 1.89; 95% CI = 1.42-2.51; p < 0.001) as well as significant neoplasia (OR = 2.26; 95% CI = 1.56-3.27; p < 0.00 1) than those who had never smoked. The increased risk for smokers was predominantly for left-sided neoplasia. The risk for significant neoplasia was greater for smokers than for patients with a family history of colorectal cancer (OR = 1.20; 95% CI = 0.75-1.92; p > 0.05). CONCLUSIONS: Smoking is a significant risk factor for colorectal neoplasia in a screening population, especially for significant left-sided lesions. In our sample population, smoking posed a greater risk than family history of colorectal cancer. [ABSTRACT FROM AUTHOR]

The Electromagnetic Fields and Breast Cancer on Long Island Study (EBCLIS) is a large population-based case-control study investigating possible associations between magnetic fields and breast cancer, and includes a comprehensive set of in-home measurements. We investigated the reproducibility of wire codes, their relation to 24-h measurements of residential magnetic fields, and potential influences, such as housing characteristics, in homes of the 1161 EBCLIS participants. Replicate wire coding was performed in homes originally categorized as having very high current configurations (VHCC) in the Wertheimer-Leeper (W-L) wire coding scheme, and a random sample of other homes (235 residences). Reproducibility was very high, with a ? statistic of 0.83 (95% confidence interval (CI)=0.77-0.89) for the five-category W-L wire codes and 0.91 (95% CI=0.86-0.95) for the three-category Kaune-Savitz (K-S) codes. As levels of W-L and K-S wire codes increased, the mean and median 24-h levels of broadband and harmonic fields in the residences also increased, indicating an association between wire codes and magnetic fields measurements. Regions of Long Island with the highest percentage of homes built before 1950 had the highest percentage of higher current configuration homes, as well as the highest average 24-h broadband and harmonic measurements. Adjustment for age of the home and region did not affect the relation between wire codes and measured magnetic fields. Our results indicate that: (a) a high reproducibility in wire coding was achieved, (b) wire codes were correlated with magnetic fields, and (c) wire code levels were related to the age of the home. The high level of reproducibility suggests that, in our case-control analyses, there will be minimal bias due to misclassification of wire code categories. Results also suggest that wire codes are a proxy measure, to some degree, for current in-home magnetic field measurements in this study.Journal of Exposure Analysis and Environmental Epidemiology (2003) 13, 283-293. doi:10.1038/sj.jea.7500280 [ABSTRACT FROM AUTHOR]

We tested the hypothesis that cross-reactivity between the outer surface protein A (OspA) of Borellia burgdorferi and human leukocyte function antigen (LFA) type 1 mediates chronic autoimmune sequelae of Lyme disease. T cell response was studied in subjects with Lyme disease presenting with erythema migrans alone (n = 36), erythema migrans with neurological disease (n = 12), and chronic Lyme disease syndrome (n = 20), as well as healthy control subjects from Lyme-endemic (n = 50) and -nonendemic (n = 18) regions. Antigens included recombinant OspA and OspC (all strain B31) and human LFA-1 peptide (IYVIEGTSKQDLTSF). Proliferation to OspA was detected in 11 (28%) of 39 of subjects presenting with erythema migrans, which increased to 50% at 4 weeks of follow-up. Reactivity to OspA and LFA-1 was significantly correlated (P < .001) and was observed in 18 (78%) of 23 of OspA-responsive subjects. However, there was no correlation between T cell response to human LFA-1 peptide and clinical status. [ABSTRACT FROM AUTHOR]

Abstract: To guide the planning of a multifacetted hypertension control program in Edgecombe County, North Carolina. a baseline survey of a stratified (by township) random sample of 1,000 households wan conducted. All adults (>/= 18 years) were interviewed and had their blood pressures (BP) measured Five hundred thirty-nine individuals. 27 per cent of the survey population, had diastolic BP >/= 90 mm Hg or were receiving anti-hypertensive drug therapy. The 539 hypertensives were divided into seven subgroups reflecting successive stages in the control of hypertension based on the awareness, treatment, and control of their hypertension. Unaware hypertensives were further subdivided into three groups according to the recency of their last BP check, and those aware but untreated were subdivided by whether they had previously received treatment. The seven subgroups of hypertensives were compared, separately for women and men. with respect to sociodemographic characteristics, health behaviors, and health status, in general, the progression from undetected hypertension 10 treatment and control appeared to be associated with being older, female, and White. This progression was further associated with greater educational levels and higher family incomes among women and increasing self-reported morbidity among men. The implications tot intervention of these and other described associations are discussed. (Am J Public Health 1984: 74:237-242.) [ABSTRACT FROM AUTHOR]

To investigate the significance and measurement of depressive symptoms in young adolescents, 624 junior high school students were asked to complete the Center for Epidemiologic Studies Depression Scale (CES-D) during home interviews. In 384 usable symptom scales, item-scale correlations (most were above .50), inter-item correlations, coefficient alpha (.85), and patterns of reported symptoms were reasonable. Persistent symptoms were reported more often by Blacks, especially Black males. Prevalence of persistent symptoms in Whites was quite close to reported figures for adults, ranging from 1 per cent to 15 per cent in adolescent males and 2 per cent to 13 per cent in adolescent females. Adolescents reported persistent vegetative symptoms less often and psychosocial symptoms more often. Reports of symptoms without regard to duration were much more frequent in the adolescents, ranging from 18 per cent to 76 per cent in White males, 34 per cent to 76 per cent in White and Black females, and 41 per cent to 85 per cent in Black males. The results support the feasibility of using a self-report symptom scale to measure depressive symptoms in young adolescents. Transient symptoms reported by adolescents probably reflect their stage of development, but persistent symptoms are likely to have social psychiatric importance. [ABSTRACT FROM AUTHOR]