Chi Trend Research Articles

Declining tuberculosis prevalence in Saharia, a particularly vulnerable tribal community in Central India: evidences for action

BackgroundIn spite of an alarmingly high tuberculosis (TB) burden amongst the Saharia tribe of central India, there is hardly any study to investigate the impact of DOTS implementation on the magnitude of tuberculosis disease and the changes over time. This article present the findings of TB prevalence surveys conducted amongst this indigenous population in two different time periods to know the change in the prevalence of TB.MethodsA cross sectional survey was conducted among Saharia population in Shivpuri district, Madhya Pradesh during February 2013 to May 2013 and resurvey during March 2015 to July 2015. All individuals (≥15 years) were examined for chest symptoms suggestive of TB. Sputum samples were collected from all presumptive TB cases and were confirmed by laboratory examination by Ziehl-Neelsen smear microscopy and solid media culture methods. All detected cases were referred to health facility for anti-tuberculosis treatment as per RNTCP guidelines.ResultsThere was significant reduction (trend Chi square 19.97; OR = 1.521; p = 0.000) in the prevalence of TB at the endline (1995 per 100,000) as compared to baseline (3003 per 100,000). The reduction was significant among males as compared to females (OR 1.55; p = 0.000) and in the age group of 25–34 years (OR 2.0; p = 0.007) and 45–54 years (OR 4.39; p = 0.003). There was significant reduction in the prevalence in both smear (OR 1.29; p = 0.02) and culture positive (OR 1.57; p = 0.000) TB at the endline survey.ConclusionThe study findings highlight a reduction in the prevalence of TB among Saharia tribal population. Further studies are needed to identify the factors associated with reduction in prevalence among this population and also further surveys to monitor the prevalence trend over a period.

The 7th/8th American Joint Committee on Cancer and the Modified Union for International Cancer Control Staging System for Hepatocellular Carcinoma.

PurposeAlthough many staging systems have been proposed for hepatocellular carcinoma (HCC), there is no globally accepted system due to the extreme heterogeneity of the disease. We aimed to compare the results of the 7th/8th American Joint Committee on Cancer (AJCC) and the modified Union for International Cancer Control (mUICC) staging systems in patients with HCC.Materials and MethodsWe collected data from 792 patients who underwent hepatic resection at our center. The Kaplan-Meier method was used to determine disease-free survival and overall survival. To evaluate homogeneity, ‘-2 log likelihood’ was calculated using Cox proportional hazards regression. To measure discriminatory ability, the linear trend chi method and the Cochran-Armitage test for trend were used. The ability to accurately predict survival was verified by cross-validation analysis.ResultsKaplan-Meier curves for disease-free survival and overall survival showed mUICC to be superior to the 7th/8th AJCC. The homogeneity test indicated that mUICC was the best for both disease-free survival and overall survival. In the discriminatory ability test, the chi-square value of mUICC was the best for disease-free survival, while the 7th AJCC had the best value for overall survival. In the cross-validation analysis, all three staging systems had significant predictive power.ConclusionmUICC seemed to be superior to the 7th/8th AJCC after analyzing the data of our surgical patients, although the geographic heterogeneity of HCC might result in differences between the staging systems. We believe that, while the three staging systems allow for the clear stratification of patients into prognostic groups, mUICC may be more appropriate in HCC.

The correlation between newborns and pregnant women measles antibody level and the regularity of the change of newborns antibody with time

Objective To analyze the correlation between newborn and mother's measles antibody level and the regularity of the change of newborn antibody with time. Methods Prenatal venous blood and newborns′ umbilical cord blood of 127 pregnant women in the Eighth People's Hospital of Qingdao were collected, and venous blood of 3-month-old in 79 cases, 6-month-old in 72 cases and 9-month-old in 57 cases of newborns were followed up.The level of measles IgG antibody was detected by enzyme-linked immunosorbent assay. Results The geometric mean concentration of the maternal measles antibody was (639.56±3.15)mIU/mL, which was significantly lower than that of the neonatal blood antibody concentration [(1 102.46±2.86)mIU/mL](P<0.05). The geometric means of neonatal measles antibody in 3, 6, 9 months old newborns were (159.95±3.25)mIU/mL, (126.35±4.06)mIU/mL, (113.04±4.32)mIU/mL respectively, which were significantly lower than those of the newborn at birth(all P<0.05). With the increase of the age, the positive rate and protection rate of the newborn all decreased significantly(all P<0.05). Using trend Chi square test, it was found that the level of measles antibody increased with the increase of measles antibody level(χ2=9.46, P<0.05). Pearson correlation analysis showed that the logarithmic level of maternal blood antibody was closely correlated with the umbilical cord blood(r=0.78), 3-month-old(r=0.54), 6-month-old(r=0.47), 9-month-old(r=0.53) blood antibody logarithm level(all P<0.05). Univariate analysis showed that the geometric mean of neonatal measles antibody was significantly correlated with neonatal sex, delivery mode, gestational age, birth weight and maternal age(all P<0.01). Conclusion With the increase of time, the measles antibody gradually attenuates, and the level of antibody is closely correlated with the level of maternal antibody.Therefore, we should actively implement measles vaccination for women of childbearing age, and adopt a way to improve maternal antibody concentration to increase the concentration of neonatal measles antibody, so as to prevent or reduce measles in infants. Key words: Measles; Antibodies; Newborns; Mothers

The occurrence and determinants of anxiety and depression symptoms in women of six counties/ districts in China during pregnancy

Objective: To estimate the prevalence of anxiety and depression symptoms during pregnancy among women from six districts of China and to explore the determinants of anxiety and depression during pregnancy. Methods: A cross-sectional study of maternal health status was conducted using the probability proportionate to size sampling method among pregnant women from six counties/districts in six provinces of China (Hebei, Liaoning, Fujian, Hunan, Sichuan and Yunnan). A questionnaire was completed by each of the women included in the study from August to December 2014. Women were recruited from three medical and health institutions with the most obstetrics patients in each district. A total of 4 210 pregnant women were included in the investigation. The hospital anxiety and depression (HAD) scale was applied to measure the symptoms of anxiety and depression in the pregnant women. Trend chi square test was used to assess the differences of anxiety and depression symptom among three trimesters. The multivariate logistic regression model was used to investigate potential contributory factors. Results: The detection rates for anxiety symptoms and depression symptoms during pregnancy were 8.5% (357/4 210) and 12.5% (525/4 210), respectively. The prevalence of anxiety symptoms during the first, second and third trimesters were 7.9% (110/1 392), 8.8% (124/1 413) and 8.8% (123/1 405), respectively (χ2trend=0.89, P= 0.419). The prevalence of depression symptoms during the first, second and third trimesters were 14.0% (195/1 392), 12.6% (178/1 413) and 10.8% (152/1 405), respectively (χ2trend=6.52, P=0.011). Multivariate logistic regression analysis showed an increased risk of anxiety and depression in women with an educational background of middle school rather than a college degree (OR=1.94, 95% CI: 1.44-2.63; OR=3.80, 95% CI: 2.45- 5.91). Furthermore, compared with planned pregnancies, women with unplanned pregnancies had a higher risk of anxiety and depression (OR=1.33, 95% CI: 1.06- 1.66; OR=1.35, 95% CI: 1.07- 1.71). Pregnant women who felt they lived in crowded residential conditions were at an increased risk of anxiety compared with those living in spacious residential environments (OR=1.82, 95% CI: 1.15- 2.87). Pregnant women with a household income of less than 10 000 yuan were at a higher risk of depression than living in a household with an income of ≥100 000 yuan (OR=1.91, 95% CI: 1.05-3.49). Similarly, multiparous women (≥2) were at higher risk of depression compared with nulliparous women (OR=1.88, 95% CI: 1.04- 3.41). Conclusion: The prevalence of anxiety and depression symptoms during pregnancy appears to be associated with several demographic factors, along with a women's obstetrical history. Lower educational background, unplanned pregnancy, the feeling of living under crowded residential conditions were all found to be risk factors for anxiety during pregnancy. Similarly, lower educational background, unplanned pregnancy, a lower household income (<10 000) and a greater number of previous deliveries were all risk factors for depression during pregnancy.

A Simple Indian Diabetes Risk Score Could Help Identify Nondiabetic Individuals at High Risk of Non-Alcoholic Fatty Liver Disease (CURES-117)

We aim to determine whether a simple Indian diabetes risk score (IDRS) is associated with individuals with non-alcoholic fatty liver disease (NAFLD) among nondiabetic Asian Indians. Nondiabetic participants (n = 409) were selected from the Chennai Urban Rural Epidemiology Study. Mean age was 40 ± 11.9 years, mean body mass index was 23.2 ± 3.9 kg/m(2), and 224 (54.8%) were women. The IDRS was classified as high (≥60), medium (30-50), and low (<30) risk. Non-alcoholic fatty liver disease was assessed by high-resolution β mode ultrasonography. To determine the factors associated with NAFLD, a univariate analysis was first done and a stepwise logistic regression analysis was done based on the factors associated with NAFLD. Biochemical and anthropometric measurements were obtained using standardized procedures. The overall prevalence of NAFLD was 24.7% (101/409 participants), and it was significantly higher among those with a high (30.4%) and medium IDRS (21%) compared with the low IDRS group (15.8%; trend chi square; p = .022). In stepwise logistic regression, IDRS was associated with NAFLD with an adjusted odds ratio of 1.78 (95% confidence interval 1.04-3.06), even after adjusting for potential confounders. The IDRS can be used as the initial step to screen individuals at high risk of NAFLD in the community.

Clinical profile of diabetes in the young seen between 1992 and 2009 at a specialist diabetes centre in south India

Aim To describe the trends and clinical profile of young diabetic patients (YD) attending a tertiary diabetes centre in south India. Methods We reviewed medical records of 2630 YD patients (age at onset ≤25 years) registered between 1992 and 2009. Patients were classified as type 1 diabetes (T1DM), type 2 diabetes (T2DM) gestational diabetes mellitus (GDM) and other types. Retinopathy was assessed initially by direct and indirect ophthalmoscopy and later by retinal photography, nephropathy if urine protein excretion was >500 mg/day, neuropathy if vibration perception threshold on biothesiometry was ≥20 V. Results The percentage of YD patients rose from 0.55% in 1992 to 2.5% in 2009 (trend chi square, 15.1, p < 0.001). Of the 2630 YD subjects registered, 1135 (43.2%) had T1DM, 1262 (48.0%) had T2DM, 118 (4.5%) had GDM and 115 (4.4%) other types. T1DM patients were younger, had lower body mass index, waist circumference, systolic and diastolic blood pressures, and less family history of diabetes compared to T2DM ( p < 0.001 for each). Retinopathy was seen in 71.9% and 77.3% nephropathy in 22.1% and 12.1% and neuropathy in 34.5% and 21.4% of T2DM and T1DM respectively in those with ≥15 years duration of diabetes. Conclusions The percentage of YD in south India is increasing, predominantly due to early onset T2DM.

Reactivity of hydrogen abstraction in CH 2Cl 2 by CHX [rad]− (X = F, Cl, Br, I) from a theoretical viewpoint

The H-abstraction reactions of CHX − (X = halogen) with CH 2Cl 2 have been investigated in detail using ab initio theoretical method. Optimized geometries and frequencies of all stationary points on PES are obtained at the MP2/6-311++G(d, p)/RECP level of theory, and then the energy profiles are refined at the QCISD(T)/6-311++G(3df, 2p)/RECP by using the MP2/6-311++G(d, p)/RECP optimized geometries. Our calculated findings suggest that the reactivity of the title reactions presents an increasing trend CHI − + CH 2Cl 2 < CHBr − + CH 2Cl 2 < CHCl − + CH 2Cl 2 < CHF − + CH 2Cl 2. This result was further analyzed by the NBO charges, the Activation Strain model and the correlations of activation barrier with both PA and IE, respectively. As an additional study, it is found that the entropy has little effect on the reactivity of the H-abstraction reactions.

Evaluation of the prognostic powers of various tumor status grading scales in patients with hepatocellular carcinoma

Several tumor status grading scales are available for patients with hepatocellular carcinoma (HCC), which include several tumor-node-metastasis (TNM) systems and clinical staging systems, such as Cancer of the Liver Italian Program (CLIP) and Barcelona Clinic Liver Cancer (BCLC). This study was performed to analyze the prognostic powers of these tumor status grading systems in HCC. A retrospective cohort of 499 consecutive patients with HCC was included. The tumor statuses of all patients were classified according to several TNM systems (sixth version of the American Joint Committee on Cancer, fourth version of the Liver Cancer Study Group of Japan [LCSGJ], and the United Network for Organ Sharing UNOS system) and according to the tumor status grading scales of the BCLC (TBCLC) and CLIP (TCLIP) systems. Prognostic powers were quantified using a linear trend chi(2)-test, c-index, and the likelihood ratio (LHR) chi(2)-test, and correlated using Cox's regression model adjusted using the Akaike information criterion (AIC). Of the TNM systems, the fourth LCSGJ system had the highest prognostic power (LHR chi(2) = 7.20, AIC = 4803.02). However, when TBCLC and TCLIP were included in the analysis, TCLIP showed the best predictive power (LHR chi(2) = 29.52, AIC = 4799.82). TCLIP had best predictive power in HCC patients of the various tumor staging systems examined. To improve prognostic power, factors other than tumor burden, such as tumor behavior, should be included in the tumor status grading system for HCC.

Comparison of Seven Staging Systems in Cirrhotic Patients With Hepatocellular Carcinoma in a Cohort of Patients Who Underwent Radiofrequency Ablation With Complete Response

Many staging systems for hepatocellular carcinoma (HCC) have been proposed but the best tool for staging of HCC remains controversial. The aim of the present study was to identify the best staging system evaluating the predictive ability for outcome for each of the seven different staging systems applied in a homogeneous group of patients who underwent percutaneous radiofrequency ablation (RFA). We analyzed retrospectively 112 patients with HCC and cirrhosis treated with percutaneous RFA from January, 1998 to April, 2005. Response to treatment after 30 days and for long-term follow-up was evaluated with computed tomography (CT) or magnetic resonance imaging (MRI) and serum alpha-fetoprotein level (AFP). All of the 112 patients were grouped according to each one of the seven different staging systems: Okuda, TNM, BCLC, CLIP, GRETCH, CUPI, JIS. The mean follow-up time of the 112 patients submitted to RFA was 24 months (range 3-92 months) with survival rates at 1, 3, and 5 yr of 82%, 40%, and 18%, respectively. Univariate and multivariate analyses showed that factors related to survival were Child-Pugh score (P</= 0.01), serum AFP (P</= 0.01), and the response to treatment (P</= 0.01) with hazard ratios of 2.09 (95% CI 1.21-3.61), 2.79 (95% CI 1.59-4.90), and 2.76 (95% CI 1.25-6.09), respectively. The comparison of the results of the different staging systems in all of the 112 patients and in a subgroup of 96 patients with complete response to treatment showed that BCLC had the best discrimination ability, monotonicity of gradient (linear trend chi(2) 6.07, P= 0.01), and homogeneity ability (LR chi(2) test 10.00, P= 0.008). The BCLC staging system shows a superior discriminatory power in our cohort of HCC patients who underwent RFA; moreover, it can give important prognostic information after complete response to treatment. Our study confirms the validity of the BCLC staging system in patients with HCC in cirrhosis.

Perceptions of tuberculosis patients about their physical, mental and social well-being: a field report from south India

Tuberculosis (TB) often leaves its impact physically, socially and mentally on patients. The goal of current tuberculosis services is microbiological cure of tuberculosis. Understanding patients’ perceptions about TB will enable better design of a client-oriented comprehensive programme for tuberculosis. We interviewed patients registered for treatment during July–December 2000 in government health facilities of two tuberculosis units of south India. Data on perceptions of their illness before the onset of illness and during the treatment period were collected, using a modified SF36 questionnaire. Health status was measured for the following: physical functioning, social role limitations due to physical and emotional problems (stigma), mental health, energy vitality, pain and general health perceptions. Of 980 patients registered, 610 (206 females) cured or treatment completed patients were interviewed at two time points. The reaction of patients to the disclosure of the diagnosis was worry (50%) and suicidal thoughts (9%). ‘Good health status’ was perceived initially in less than 7% of patients, and compared to the status at the onset of illness, there was significant improvement after treatment (more than 78% trend chi square p < 0.05 ). Despite microbiological cure, 47% of patients continued to have respiratory symptoms; this was significantly higher among patients who had delayed taking action for more than 3 months. Only 54% of patients perceived ‘happy mental status’ at the end of treatment, and there was no change in social stigma in both men and women. Tuberculosis control programmes should address issues such as continued respiratory symptoms, persistence of stigma, and poor emotional quality of life of patients with tuberculosis, even after they are cured. As well, providing social support for the needy, timely counseling and health education of patients, which will alleviate mental and social sufferings of patients, should be considered.

Lung findings on thoracic high-resolution computed tomography in patients with ankylosing spondylitis. Correlations with disease duration, clinical findings and pulmonary function testing.

The aim of this study was to identify the spectrum of abnormalities revealed on high-resolution computerized tomography (HRCT) in patients with ankylosing spondylitis (AS), to compare findings with those of plain radiography and pulmonary function testing (PFT), and to look for correlations between lung involvement and AS severity. We prospectively studied 55 consecutive patients with a diagnosis of AS according to the modified New York criteria who attended our department over a period of 2 years. All patients had a detailed rheumatological examination and underwent plain chest radiography, chest HRCT and PFT. HRCT revealed abnormalities in 29 patients (52.7%), whereas plain chest radiography was abnormal in only 2. Abnormalities consisted of interstitial lung disease (ILD) ( n=4), apical fibrosis ( n=5), emphysema ( n=5), bronchiectasis ( n=4), ground glass attenuation ( n=2), and non-specific interstitial abnormalities ( n=26). Only apical fibrosis and bronchiectasis were statistically more frequent with increasing disease duration (significant trend chi(2)test, p=0.0029 and 0.028, respectively). PFT showed a restrictive process in 19 patients (34.5%). No correlation was noted between HRCT and PFT, nor with AS symptomatic and structural severity parameters. However, there was a statistically significant correlation between PFT and AS symptomatic and structural severity parameters. In conclusion,: this study confirms that the chest HRCT of patients with AS showed a great number of abnormalities undetectable by standard X-rays. The high incidence of lung abnormalities emphasizes the importance of excluding such a diagnosis in patients with AS even without respiratory symptoms.

An analysis of esophageal cancer incidence in Cixian county from 1974 to 1996.

To describe the incidence of esophageal cancer (EC) in Cixian, a county of Hebei province during 1974-1996. We analyzed the sex and age characteristics as well as the geographic distribution of EC, in order to determine the impact so that methods of preventing and controlling EC in Cixian can be put in place. Since the early 1970s, the cancer registry system has been established, which collects the cancer incidence in Cixian county. The malignant tumors were coded according to International Classification of Disease IX (ICD-9). All the data were checked and analyzed using EPIINFO. The trend of the incidence rate of EC from 1974 to 1996 had declined, (229.9/100 000 vs 178.5/100 000, Odds ratio=1.47, 95 % CI:1.32-1.63, chi(2)=52.89. trend chi(2)=26.54, P<0.001). The incidence rate of males declined significantly (281.81/100 000 vs 157.96/100 000, Odds ratio=1.61, 95 % CI: 1.41-1.84, chi(2)=47.85. Trend chi(2)=44.86, P<0.001), whereas, the females remained steady (157.96/100 000 vs 133.41/100 000, odds ratio=1.28, 95 % CI:1.17-1.49, chi(2)=9.26. trend chi(2)=2.69, P>0.05). Male average annual incidence rate was 142.80/100 000 and the female's was 95.18/100 000. The sex ratio (males to females) was 1.50:1. The incidence rate was increasing along with the age. As to the geographic distribution, the incidence rate in mountainous areas and hilly areas showed a significantly declining trend (mountainous areas, trend chi(2)=149.93, P<0.001; hilly areas, trend chi(2)=42.70, P<0.001). The incidence rate of EC in plain areas had increased (trend chi(2)=22.39, P<0.001). The incidence rate of EC in Cixian county shows a trend and has declined after two decades, especially in mountainous area. But compared to other regions in the world, Cixian county still had a high incidence rate of EC.

Prevalence and risk factors of occupational asthma among hairdressers in Turkey.

This study was designed to evaluate the questionnaire-based prevalence and possible risk factors of occupational asthma among hairdressers in Turkey. We investigated occupational history and respiratory, ocular, dermal, and nasal symptoms using a standardized questionnaire, evaluated worksite pulmonary function tests, and performed allergen skin testing. We then determined asthma risk factors using age- and gender-adjusted logistic regression models. The prevalence of occupational asthma in hairdressers was 14.6%. The odds ratio for hairdressers in a high work intensity group was 3.6 (95% confidence interval, 1.2 to 10.9) with a significant dose-response trend (chi 2 trend = 4.875; P = 0.027). The odds ratio for occupational asthma among workers with atopy was 4.5 (95% confidence interval, 1.2 to 17.2). We also observed an excess risk of occupational asthma with allergic rhinitis and conjunctivitis. Occupational asthma did not differ among subgroups of hairdressers. We observed an important risk of occupational asthma among hairdressers. The most prominent risk factors were work intensity and atopy.

EFFECTIVENESS OF A HEALTH EDUCATIONAL PACKAGE FOR AIDS PREVENTION AMONG ADOLESCENT SCHOOL CHILDREN

A randomised, controlled, community based intervention trial was undertaken to assess the effectiveness of a Health Education Programme (HEP) for HIV infection and AIDS among school children at Pune. Sample size was calculated on the basis of conventional Type I and Type II errors. School children studying in classes 9th to 12th in six different schools (n=1102) formed the study material. Baseline assessment for knowledge for AIDS/HIV was undertaken and used for formulating the Health education Programme Package. Randomisation was done so as to allocate five schools into trial group (n=803) and one school into control group (n=299). Blinding was also ensured to reduce bias. The study revealed that the HEP was very effective in improving the knowledge, the difference being highly significant as compared to control group. The effect was specially well marked for girls in school level (OR=4.76) followed by boys intermediate level (OR=3.11); there was clear evidence of statistical effect modification as regards this 'sex and educational class' differential (Woolfs'chi square=11.82, p < 0.0001). The study also revealed that the maximum aceceptability of programme was among girls studying in girls school (Stratum OR =2.25) followed by boys in boys school (OR=1.50) compared to students in co-educational system (linear trend chi square=9.35, p < 0.01). Certain recommendations for health education for HIV/AIDS among school children have been submitted.

A survey of sunscreen use and sun‐protection practices in Darwin

A study was conducted to determine the prevalence and determinants of sun-protection practices in a sample of the non-Aboriginal population at the outdoor weekend markets in subequatorial Darwin, Northern Territory, at a time of intense sun exposure, between 11 a.m. and 1 p.m. from August to October 1992. All non-Aboriginal market-attenders who were seated within defined areas adjacent to food stalls were eligible to participate. Of 106 eligible market attenders, 105 (99 per cent) agreed to participate. Overall, fewer than 20 per cent of persons in this setting of extreme sun exposure were wearing sunscreen and less than one-third were wearing a hat. Only 44 per cent of people with a past history of skin cancer sitting in the midday sun had applied sunscreen and 61 per cent were wearing a hat; however, this was significantly more than those not reporting skin cancer (P < 0.002). The longer people had lived in the Northern Territory (compared with visitors and short-term residents) the less likely they were to have applied sunscreen in preparation for the midday sun (trend chi 2 = 3.99, P = 0.046). No association was demonstrated between the use of sunscreen and age or sex of the respondent. These results suggest that the sun-protection practices of visitors to the Northern Territory are less than optimal, and that among the longer-term residents of the Northern Territory who are at greatest risk of developing skin cancer, precautions against sun exposure could be greatly improved.

The Relation of Sleep Complaints to Respiratory Symptoms in a General Population

Based on data obtained from the Tucson Epidemiologic Study of Chronic Lung Disease that included body weight, questionnaire responses, and spirometry, we found that among subjects with no respiratory symptoms, 28.0 percent reported insomnia (difficulty initiating or maintaining sleep) and 9.4 percent reported daytime sleepiness. Among subjects with respiratory symptoms, cough and/or wheeze, the rates of sleep complaints increased. With one symptom, 39.1 percent reported insomnia and 12.4 percent reported daytime sleepiness. With both symptoms, the rates were 52.8 percent and 22.8 percent, respectively. Overall, we found significant relationships between rates of respiratory symptoms and sleep complaints (trend chi 2 = 73.9, p < 0.001 for insomnia; trend chi 2 = 37.9, p < 0.001 for daytime sleepiness). In separate analyses, obesity, snoring, and a diagnosis of lung disease also influenced the rate of sleep complaints but, when we employed logistic regression, we found that obesity, respiratory symptoms, gender, and age were the only variables related to the risk of insomnia or daytime sleepiness.

The physician-delivered smoking intervention project: Can short-term interventions produce long-term effects for a general outpatient population?

Patterns of smoking cessation using 6- and 12-month follow-up data are reported for 1,261 primary care patients randomized to 3 physician-delivered smoking interventions: advice only (AO), counseling (CI), and counseling plus availability of nicotine-containing gum (CI + NCG). One-week-point-prevalence cessation rates at 12 months did not differ among the interventions: AO (15.2%), CI (12.9%) and CI + NCG (16.7%). However, maintained cessation rates (abstinent at both 6 and 12 months) increased with intervention intensity: AO (6.0%), CI (7.8%) and CI + NCG (10.0%): Test of trend chi 2 = 5.06, p = .02. CI + NCG was significantly higher than AO (p = .02). The findings support the following conclusions: Brief physician-delivered intervention with availability of nicotine-containing gum can have a beneficial long-term effect on smoking cessation, and cohort data as well as point-prevalence rates are important when assessing the long-term impact of lifestyle interventions.

Cigarette smoking and parity as risk factors for the development of symptomatic gall bladder disease in women: results of the Royal College of General Practitioners' oral contraception study.

The effects of cigarette smoking and parity on the development of symptomatic gall bladder disease remain controversial. These relations have been examined in a cohort of 46,000 women followed for up to 19 years during the Royal College of General Practitioners' (RCGP) oral contraception study. During follow up, 1087 women were recorded as experiencing their first ever episode of symptomatic cholelithiasis (International Classification of Diseases, 8th revision (ICD-8) 574) or cholecystitis (ICD-8 575). Smokers were more likely to develop symptomatic gall bladder disease than non-smokers (relative risk 1.19; 95% confidence intervals (95% CI) 1.06 to 1.34) and there was a significant trend with the number of cigarettes smoked daily (test for trend chi 2 = 7.58, p < 0.01). This relation was most apparent among never users of oral contraceptives, although similar trends were found among current and former users. A significant direct relation between symptomatic gall bladder disease and parity was also found (test for trend chi 2 = 21.89, p < 0.001). When all were examined together a trend of increasing risk with lower social class was also found (test for trend chi 2 = 5.72, p = 0.02). Current users of oral contraceptives had a moderately increased risk of symptomatic gall bladder disease (relative risk 1.15; 95% CI 0.99 to 1.34), unlike former users (relative risk 1.03; 95% CI 0.90 to 1.18). These results suggest that smoking and parity are important risk factors for the development of symptomatic gall bladder disease in women.

The impact of symptoms and comorbidity on prognosis in stage IB cervical cancer

Like other gynecologic malignancies, cervical cancer is classified by the anatomic location and extent of the tumor. Because clinical variables such as patients' symptoms, symptom severity, and comorbidity may indicate a cancer's biologic virulence and the host-tumor interaction, this study was performed to test the hypothesis that clinical variables will also affect survival of patients with stage IB cervical cancer. From medical records of 251 cases of invasive cervical cancer treated at Yale-New Haven Hospital between 1984 and 1988, information was extracted for patients' demographic characteristics, symptoms, symptom severity, comorbidity, physical findings, laboratory data, treatment, and subsequent course. In the 122 available cases of stage IB cervical cancer the overall 3-year survival rate was 79%. For a composite clinical predictive system on the basis of symptom status and comorbidity, the 3-year survival rates were as follows: symptomatic patients with comorbidity 58% (seven of 12), either symptomatic or comorbid but not both 77% (46/60), and asymptomatic patients without comorbidity 86% (43/50) (p = 0.02 for linear trend chi 2). When entered into a Cox proportional-hazard model along with other variables that might have an impact on prognosis, the composite symptom-comorbidity stage was the only variable that remained statistically significant. These findings demonstrate the importance of clinical variables in estimating prognosis in stage IB cervical cancer. Unless these variables are suitably analyzed, prognostic estimates based only on morphologic studies will be imprecise and therapeutic evaluations may be misleading.

Role of Transfusion-mediated Viral Infections on the Lymphocyte Subset Profile in Multi-transfused Children

A total of 74 multitransfused (MT) children of beta thalassaemia major were analysed for prevalent viral markers transmitted through transfusion. A higher incidence of serological markers for Hepatitis B virus (HBV), cytomegalovirus (CMV) could be observed in the group of MT children compared to control group. There was a significant trend (chi 2 = 33.4; P < 0.001) in the increase in prevalence of viral markers along with the increase in the number of transfusions. MT children receiving more than 50 transfusions were found to have evidence for at least one or multiple viral infections transmitted through blood. Children receiving more than 50 transfusions were characterized by marked alteration of T3, T8, and B cells while T4/T8 ratio was found to be significantly decreased (P < 0.001) only in the group of children receiving more than 100 transfusions. Relative assessment of the alteration of lymphocyte subsets in various groups of viral infection showed that cases with CMV IgM to have more marked influence on the alteration of T8 cells, T4/T8 ratio, and B cells compared to other groups of viral infections. Reassessment of the lymphocyte subset profile in MT children in the light of CMV IgM positive cases revealed that in children receiving more than 50 transfusions significant alterations of lymphocyte subjects were influenced by the presence of CMV IgM positive cases in these groups. Our study points out that the correlation between the alteration of lymphocyte subset profile and number of transfusion in MT children need to be reassessed in the light of acute CMV infection in the form of CMV IgM.