Air pollution and hospital admissions for the elderly in Birmingham, Alabama

Several studies have reported associations between airborne particles and/or ozone and hospital admissions for respiratory disease. This study examined whether such an association could be seen in Birmingham, Alabama, one of the few cities in the United States with daily monitoring of inhalable particles. Daily counts of hospital admissions were computed by date of admission from Medicare records for pneumonia and chronic obstructive pulmonary disease for the years 1986-1989. Classification was by discharge diagnosis. The daily average of ozone and particulate matter with an aerodiameter of < or = 10 microns (PM10) from all monitoring stations in Birmingham was computed. Approximately six admissions for pneumonia and two for chronic obstructive pulmonary disease were observed each day. In Poisson regression analysis controlling for time trends, seasonal fluctuations, and weather, inhalable particles were a risk factor for admission for pneumonia (for an increase of 100 micrograms/m3 in daily concentration, relative risk (RR) = 1.19, 95% confidence interval (CI) 1.07-1.32) and chronic obstructive pulmonary disease (RR = 1.27, 95% CI 1.08-1.50). The results were not sensitive to alternative methods for controlling for seasonal patterns and weather, nor to the exclusion of very hot or cold days. Ozone was more weakly associated with admissions for pneumonia, with a 2-day lag (RR = 1.14, 95% CI 0.94-1.38), and for chronic obstructive pulmonary disease, with a 1-day lag (RR = 1.17, 95% CI 0.86-1.60). The risks are for an increase in ozone exposure of 50 parts per billion. Tests for nonlinearity in the relation between inhalable particles and admissions were not significant, and nonparametric smoothing found no evidence of a threshold in the relation.

Growth hormone induces a DNA binding factor related to the interferon-stimulated 91-kDa transcription factor

Signaling mechanisms leading to regulation of gene transcription by growth hormone (GH) and other molecules that signal via the cytokine receptor family have been elusive. Based upon recent findings that GH and interferons activate JAK family tyrosine kinases, we have identified a novel signaling pathway leading from the GH receptor to the nucleus. We report that in 3T3-F442A fibroblasts, GH stimulates tyrosyl phosphorylation of a protein recognized by antibody to p91, a component of DNA-binding complexes that are activated by tyrosyl phosphorylation in response to interferons alpha and gamma. In addition, a GH-inducible DNA binding factor (GHIF) is identified that binds to the c-sis-inducible element of the c-fos promoter. GHIF contains a protein antigenically related to p91 and is tyrosyl-phosphorylated. These findings indicate that in signaling between their receptors and the nucleus, GH and interferons utilize related or identical components, including JAK family tyrosine kinases and proteins in the p91 family. When combined with recent findings that many members of the cytokine receptor family activate JAK kinases, including some cytokines that activate p91-related proteins, these findings suggest that signaling pathways involving JAK kinases and p91 family members may be broadly distributed.

Total suspended particulate matter and daily mortality in Cincinnati, Ohio

Recent studies have associated particulate air pollution with daily mortality in a number of U.S. communities. This study sought to replicate those analyses in Cincinnati, Ohio, and to test the strength of the association to the deletion of days with extreme weather conditions and to sensitivity analyses in the analytical approach. This study demonstrates the use of graphical diagnostic procedures to assure adequate control for season and weather and to confirm that the risk is particularly elevated in the elderly and for deaths from pneumonia and cardiovascular disease. Daily total suspended particulate (TSP) concentrations were available in Cincinnati from 1977 to 1982. They were matched to daily counts of nonaccidental deaths, temperature, and dew point temperature. Poisson regression analysis controlled for seasonal and monthly variations and potentially nonlinear relationships to temperature and humidity. TSP was associated with increased risk of mortality. The relative risk for a 100 micrograms/m3 increase in TSP was 1.06 (95% CI = 1.03-1.10). The relative risk for the elderly was higher (1.09), as was the risk for pneumonia (1.18) and cardiovascular disease (1.08). The similarity to recently reported results in Philadelphia is striking. Given the consistent findings from multiple locations, the relationship should be considered causal.

Secretion of adrenocorticotrophin (ACTH) and ACTH precursors in ovine anterior pituitary cells: actions of corticotrophin-releasing hormone, arginine vasopressin and glucocorticoids

Although corticotrophin-releasing hormone (CRH) and arginine vasopressin (AVP) have been extensively characterized as stimulators, and glucocorticoids as inhibitors of ACTH secretion, far less is known about the control of the secretion of ACTH precursors from the anterior pituitary or about the types of corticotrophs involved. The present study was designed to systematically evaluate the actions of stimulatory and inhibitory factors on the secretion of ACTH and ACTH precursors (pro-opiomelanocortin, M(r) 31,000; pro-ACTH, M(r) 22,000) from dissociated ovine anterior pituitary cells. The cells were stimulated for 3 h with CRH (10 nmol/l) and AVP (100 nmol/l), alone or in combination with the synthetic glucocorticoid dexamethasone. In designated wells, cells were treated with dexamethasone, (100 nmol/l), beginning 16-18 h before and continuing through the 3-h secretion experiments in the presence of CRH and AVP. Secretion of ACTH-like peptides from intact cultures was compared with that from cultures which had been pretreated with a cytotoxic CRH conjugate (cytotoxin) to eliminate CRH-target cells specifically. Immunoreactive (ir)-ACTH was measured by radioimmunoassay (RIA); ACTH(1-39) and ACTH precursors were specifically measured by two-site immunoradiometric assays that discriminate between the two. In intact populations of cells, dexamethasone had no effect on basal ACTH(1-39) secretion, but decreased the secretion of ACTH(1-39) in response to CRH or AVP. Pretreatment of cells in the same experiments with cytotoxin (for 18 h, beginning 3.5 days before secretion studies) also had no significant effect on basal ACTH(1-39) secretion, but eliminated the response to CRH and decreased the response to AVP.(ABSTRACT TRUNCATED AT 250 WORDS)

Bifunctional hybrids between the variable domains of an immunoglobulin and the maltose-binding protein of Escherichia coli: production, purification and antigen binding

Hybrids were constructed between the maltose-binding protein of Escherichia coli (MalE) and the variable domains (V-domains) of D1.3, a mouse antibody directed against hen lysozyme. Each V-domain was fused with the C- or N-terminus of MalE and expressed in E. coli, either alone or associated with the other V-domain, as a heterodimer (Fv) or as a single-chain fragment (scFv). The hybrids were exported into the bacterial periplasm, purified by affinity chromatography on cross-linked amylose and separated from incomplete products by ion-exchange chromatography. Hybrids between MalE and Fv bound the antigen specifically, with affinities increased up to 10-fold when compared to native D1.3. This strongly suggests that MalE contributed to the binding. The affinities and specificities of the different hybrids, as well as their levels of contamination by incomplete products, depended on their fusion pattern with MalE. Hybrids between MalE and either single V-domain also bound hen lysozyme specifically, which shows that each V-domain can recognize the antigen when fused with MalE. The high affinity of VH-MalE (KD = 3 nM) could be due to both participation of MalE in the binding and a conformational adaptation of the lone V-domain.

What are people dying of on high air pollution days?

The air pollution disasters in London in 1952, the Meuse valley in 1930, and in Donoroa, Pennsylvania, in 1948 made it clear that extremely high levels of particulate-based smog could produce large increases in the daily mortality rate. Recent studies of fluctuations in daily air pollution and daily mortality have reported associations at much lower concentrations in London during the 1960s and in Philadelphia, Steubenville, Santa Clara, St. Louis, Utah valley, Detroit, and eastern Tennessee in the 1970s and 1980s. Whether these associations are causal or not is a matter of considerable public health concern. If the detailed pattern of the deaths at these lower concentrations appeared similar to the pattern in London, this would strengthen the argument for causality. To examine this issue, the death certificates from Philadelphia were examined on the 5% of the days with the highest particulate air pollution and the 5% of the days with the lowest particulate air pollution during the years 1973-1980. There was little difference in weather between the high and low pollution days, but total suspended particulate matter concentrations averaged 141 micrograms/m3 on the high pollution days versus 47 micrograms/m3 on the low pollution days. The relative risk of dying on the high pollution days was 1.08 P < 0.0001. The relative increase was higher for COPD (1.25) and pneumonia (1.13). Deaths were also elevated for heart disease and stroke; however, there was a substantial increase in the reports of respiratory factors as contributing causes for those underlying causes of death. Dead-on-arrival deaths and deaths outside of hospitals and clinics were also disproportionately increased. This paralleled the pattern seen in London in 1952. The age pattern of the relative risk of death was also similar. This adds to the evidence that the association is causal.

A common pathway for the destruction of cancer-cells - experimental-evidence and clinical implications

Chemopreventatives derived from different classes of chemical inhibit the growth of various cancers. This review concentrates on the chemopreventative activities of carotenoids, retinoids, and tocopherols. In this review we outline a common pathway for the antitumor action of chemopreventative agents. To establish this pathway we reviewed previous in vivo and in vitro studies indicating that the underlying modes of actions for chemopreventative activities were oxidative-reduction changes that developed in the tumor cell. Some of these changes were selective and did not appear in normal cells. The oxidative redox characteristics of the agents interacted with the oxidative redox systems of the tumor cell. Many chemopreventative agents are highly hydrophobic and interact with thiol peptides, and/or metalloproteins, such as glutathione reductase, superoxide dismutases, or flavoproteins. These could then become linked to prenylated membrane associated protein complexes or oxidized proteins. Interactions of the chemopreventative agents with these proteins can result in changes in expression of transcription factors nuclear binding proteins, such as, heat shock proteins (hsps) and p53. Dramatic reductions in mutant p53 and increased expression of wild type (antioncogene) p53 protein product has been associated with some chemopreventative agent inhibition of oral carcinogenesis. Enhanced hsp 70 and 90 expression has also been observed. These changes in protein expression occurred early during the process of oral carcinogenesis. The tumor cells accumulated in GO/G1 of the cell cycle and the induction of some apoptotic like changes (programmed cell death) were noted. Cell to cell communication and differentiation has also been increased with carotenoid, retinoid, and tocopherol treatment of transformed cells. Enhanced cytotoxic responses by macrophages and T lymphocytes at developing tumor sites were found to produce the oxygen reactive cytokine, tumor necrosis factor. The experimental evidence and hypothesized common pathway of antitumor action for chemoprevention may point to possible biomarkers that could be utilized in clinical intervention trials.

Relationship between dietary vitamin C intake and pulmonary function in the First National Health and Nutrition Examination Survey (NHANES I)

We assessed the relationship between dietary vitamin C intake and the level of pulmonary function (forced expiratory volume in 1 s, FEV1) in 2526 adults seen as part of the first National Health and Nutrition Examination Survey (NHANES I) between 1971 and 1974. Multiple-linear-regression analysis was performed with in FEV1 as the dependent variable. After age, height, body mass index, race, sex, cigarette smoking, and employment status were controlled for, dietary vitamin C intake was positively and significantly associated with the level of FEV1 (beta = 0.00132, P = 0.01). Interaction terms for vitamin C intake and smoking and vitamin C intake and respiratory disease were not significant. These data are consistent with the hypothesis that vitamin C intake has a protective effect on pulmonary function.

Undergraduate health care informatics education: a needs analysis and proposed curriculum

This paper describes a needs analysis and resulting curriculum in Health Care Informatics. It is implemented as a track for the BS degree within the Department of Information Systems at the University of Maryland, Baltimore County. The track in Health Care Informatics is an interdisciplinary specialty within the broader field of Information Systems which is itself an interdisciplinary field. The needs analysis shows current thinking by practitioners and educators in the new field of Health Care Informatics. It also presents a survey of undergraduate students to monitor interest in and knowledge of this field. A curriculum design is presented that addresses these needs.

Air pollution and daily mortality: a review and meta analysis

The air pollution disaster in London in 1952 established that very high levels of particulate-based smog can cause dramatic increases in daily mortality. Recently, more than a dozen studies at much lower particle concentrations have reported evidence that exposure to lower levels of airborne particles results in smaller, but nonzero increases in daily mortality. These studies were examined in a meta-analysis. A primary focus of the meta-analysis was to examine effect size estimates across large differences in both the levels of potential confounding factors and in their correlation with airborne particle concentration. In the primary meta-analysis, airborne particle concentration was a significant risk factor for elevated mortality (RR = 1.06, 95% CI = 1.05-1.07). The relative risk is for a 100 micrograms/m3 increase in TSP concentration. While mortality peaked in the cold months in all locations, in the majority of the studies airborne particle concentrations were highest in the warm months, indicating that seasonal patterns were not responsible for the observed associations. The relative risk was 1.06 (95% CI = 1.05-1.07) when the analysis was restricted to cities with summer peaking pollution. The relative risk was identical in cities with above average annual temperatures and cities with colder climates. It was also identical in drier and more humid climates, and similar across a wide range of correlations between temperature and airborne particle concentrations. These results suggest that inadequate weather control was not responsible for the association. A detailed examination of data from Philadelphia showed that control for season and weather was adequate for removing all long-term seasonal and subseasonal patterns from the mortality data, and that using a very flexible nonlinear fit to the weather factors did not disturb the association with TSP. The most reasonable interpretation of this pattern of results is that the association is causal. This is supported by other studies which have reported that particulate air pollution was associated with lung function deficits, increased symptoms, and increased hospitalization.

Vitamin C enhances the development of carcinomas in the hamster buccal pouch experimental model

Forty young adult male Syrian hamsters (Mesocricetus auratus) were divided into four groups of 10 animals. The animals in group 1 (tumor control) had the right buccal pouches painted three times a week with a 0.5% solution of 7,12 dimethylbenz(a)anthracene in heavy mineral oil USP with the use of a number 4 sable brush. The animals in group 2 (experimental group) had the right buccal pouches painted with the same solution as group 1. In addition, they received 1 mg ascorbic acid in 0.5 ml mineral oil three times a week on days alternating with the other application. The ascorbic acid was administered by mouth with the use of a pipette. The animals in group 3 received 1 mg ascorbic acid in 0.5 ml mineral oil three times weekly, and the animals in group 4 were untreated controls. The animals were killed after 14 weeks. Tumors were counted and measured. Both right and left (control) pouches were photographed, excised, fixed in formalin, sectioned in paraffin, and studied histologically. The animals that received the ascorbic acid (vitamin C) had significantly larger tumors in the right buccal pouch, although actual numbers of gross tumors were only slightly increased. The figures for tumor burden in the animals in groups 1 and 2 were 364 versus 648 mm3. Histologic study revealed that the animals in group 2 had more anaplastic tumors and a significantly greater number of areas of dysplastic leukoplakia than the animals in group 1.

Healthcare for the homeless. A public health agency, a business, and a Catholic provider open a clinic

In some communities, hospital emergency departments are the only places that provide healthcare services to homeless persons. In Dayton, OH, homeless persons have another option--the Samaritan: A Healthcare Clinic for the Homeless. The clinic is a collaborative venture involving the area's public health department, a Fortune 500 business, and a Catholic hospital. In 1991 Dayton's public health department, the Combined Health District (CHD) of Montgomery County, received an anonymous $50,000 donation to provide primary healthcare services to homeless persons. With the goal of generating a number of stakeholders to invest in the community (which would translate into additional volunteers and donations), CHD asked Good Samaritan Hospital, Dayton, if it would become a partner in launching the clinic. Good Samaritan agreed, seeing this as an opportunity to provide a much-needed community service and to fulfill its mission of providing care to the area's needy citizens. In addition, the project was consistent with the hospital's increased focus on primary care. Sponsors of the Samaritan: A Healthcare Clinic for the Homeless anticipate three outcomes resulting from this collaborative effort. First, the cost of healthcare for Dayton's citizens should decrease. Second, providing healthcare services to the homeless enhances the possibility of breaking the cycle of homelessness. Finally, it is critical that healthcare for the homeless become a community focus.

Air pollution and daily mortality in Erfurt, east Germany, 1980-1989

In Erfurt, Germany, unfavorable geography and emissions from coal burning lead to very high ambient pollution (up to about 4000 micrograms/m3 SO2 in 1980-89). To assess possible health effects of these exposures, total daily mortality was obtained for this same period. A multivariate model was fitted, including corrections for long-term fluctuations, influenza epidemics, and meterology, before analyzing the effect of pollution. The best fit for pollution was obtained for log (SO2 daily mean) with a lag of 2 days. Daily mortality increased by 10% for an increase in SO2 from 23 to 929 micrograms/m3 (5% quantile to 95% quantile). A harvesting effect (fewer people die on a given day if more deaths occurred in the last 15 days) may modify this by +/- 2%. The effect for particulates (SP, 1988-89 only) was stronger than the effect of SO2. Log SP (daily mean) increasing from 15 micrograms/m3 to 331 micrograms/m3 (5% quantile to 95% quantile) was associated with a 22% increase in mortality. Depending on harvesting, the observable effect may lie between 14% and 27%. There is no indication of a threshold or synergism. The effects of air pollution are smaller than the effects of influenza epidemics and are of the same size as meterologic effects. The results for the lower end of the dose range are in agreement with linear models fitted in studies of moderate air pollution and episode studies.

Technique of ultrasound examination during laparoscopic cholecystectomy

Intracorporeal ultrasonography was used as a new method to examine the bile ducts during laparoscopic cholecystectomy. A prototype rigid 7.5-MHz ultrasound probe, 10 mm in diameter and 50 cm in length, was introduced during 25 laparoscopic cholecystectomies. A dual scanning technique was developed for complete examination of the bile duct. This entailed transverse scanning via the subxyphoid trocar and longitudinal scanning via the umbilical trocar. The intrahepatic ducts were also visualized by placing the probe on the liver surface. Color Doppler imaging was useful to quickly distinguish the duct from vascular structures. Laparoscopic ultrasonography clearly delineated the bile ducts in all operations except one. The time required for imaging was significantly shorter for ultrasonography than for cholangiography. Our preliminary experience demonstrates that a complete examination of the bile ducts can be performed with intracorporeal ultrasonography in a relatively short period of time.

Prediction of respiratory symptoms by peripheral blood neutrophils and eosinophils in the First National Nutrition Examination Survey (NHANES I)

To examine specific cellular markers of inflammation in peripheral blood (neutrophils and eosinophils) and their relationship to respiratory symptoms, we used data from the First National Health and Nutrition Examination Survey (NHANES I). Cross-sectional data were available on a random sample of 6,913 adults aged 30 to 74 years who had American Thoracic Society-National Heart, Lung, and Blood Institute questionnaire information on respiratory symptoms and illnesses, including asthma, chronic bronchitis, dyspnea (grade 3), chronic cough, and chronic phlegm. Information was available on age, race, smoking status, peripheral blood leukocyte count, and differential cell count. These data were analyzed using logistic regression controlling for age, race, sex, and cigarette smoking. Physician-diagnosed asthma was significantly associated only with the eosinophil count (p = 0.001). Physician-diagnosed bronchitis was significantly associated with the neutrophil count (p = 0.012) and marginally associated with the eosinophil count (p = 0.072). Chronic phlegm was also significantly associated with both the eosinophil count (p = 0.049) and the neutrophil count (p = 0.041). Grade 3 dyspnea (p = 0.049) was only significantly associated with the neutrophil count. These data suggest that both peripheral blood neutrophils and eosinophils are associated with a broad range of respiratory symptoms and that the eosinophil may play a role in nonasthmatic respiratory inflammation.

p53 in the anticancer mechanism of vitamin E

Immunohistochemical techniques were used to study the expression of "wild type" p53 and "mutant" p53 in experimental cancer inhibition by vitamin E. The cancer model used was the squamous cell carcinoma of hamster buccal pouch induced by the carcinogen 7,12 dimethylbenz(a)anthracene (DMBA). Cancer development was studied sequentially for 8-14 weeks and specimens prepared for histological and immunohistochemical interpretation. Primary antibodies used were monoclonal antibodies for "wild type" and "mutant" p53. Specificity of antibodies was confirmed by flow cytometry. Peroxidase-antiperoxidase staining was used on the tissue specimens. In those animals receiving vitamin E the buccal pouch tumour development was significantly inhibited and there was a notable expression of "wild type" p53. There was also a relative absence of "mutant" p53 in the buccal pouch lesions of animals receiving vitamin E. These observations suggest that vitamin E may inhibit cancer formation by stimulating the expression of a cancer suppressor gene.

Hyperparathyroidism associated with Raynaud's phenomenon--a case history

The authors describe a patient with hyperparathyroidism and Raynaud's phenomenon. This association was hitherto undescribed.

Patent ductus arteriosus involving three generations--a case history

The authors present a family with patent ductus arteriosus (PDA) involving three generations, in the absence of consanguinity.

A variant of Noonan's syndrome: a case history

The authors describe a variant of Noonan's syndrome hitherto undescribed. The special findings in this case were anomalous origin of the aortic arch vessels and focal glomerulonephritis.