The dynamic nature of the socioeconomic determinants of cardiovascular health: A narrative review

Despite decades of social epidemiologic research, health inequities remain pervasive and ubiquitous in Canada and elsewhere. One reason may be our use of socioeconomic measurement, which have often relied on single point-in-time exposures. To explore the extent to which researchers have incorporated dynamic socioeconomic measurement into cardiovascular health outcome evaluations, we performed a narrative review. We estimated the prevalence of socioeconomic longitudinal cardiovascular research studies that identified socioeconomic exposures at two or more points in time between the years of 2019 and 2023. We defined cardiovascular outcome studies as those that examined coronary artery disease, myocardial infarction, acute coronary syndrome, stroke, heart failure, cardiac arrythmias, cardiac death, cardiometabolic factors, transient ischemic attacks, peripheral artery disease, or hypertension. Socioeconomic exposures included individual income, neighborhood income, intergenerational social mobility, education, occupation, insurance status, and economic security. 7% of socioeconomic cardiovascular outcome studies have measured socioeconomic status at two or more points in time throughout the follow-up period. Hypothesized mechanisms by which dynamic socioeconomic measures impacted outcome focused on social mobility, accumulation, and critical period theories. Insights, implications, and future directions are discussed, in which we highlight ways in which postal code data, can be better utilized methodologically as a dynamic socioeconomic measure. Future research must incorporate dynamic socioeconomic measurement to better inform root-causes, interventions, and health system designs if health equity is to be improved.

Review of Qualitative Research Methods in Health Information System Studies

OBJECTIVES

The aim of this study was to review hospital-based health information system (HIS) studies that used qualitative research methods and evaluate their methodological contexts and implications. In addition, we propose practical guidelines for HIS researchers who plan to use qualitative research methods.

METHODS

We collected papers published from 2012 to 2022 by searching the PubMed and CINAHL databases. As search keywords, we used specific system terms related to HISs, such as "electronic medical records" and "clinical decision support systems," linked with their operational terms, such as "implementation" and "adaptation," and qualitative methodological terms such as "observation" and "in-depth interview." We finally selected 74 studies that met this review's inclusion criteria and conducted an analytical review of the selected studies.

RESULTS

We analyzed the selected articles according to the following four points: the general characteristics of the selected articles; research design; participant sampling, identification, and recruitment; and data collection, processing, and analysis. This review found methodologically problematic issues regarding researchers' reflections, participant sampling methods and research accessibility, and data management.

CONCLUSIONS

Reports on the qualitative research process should include descriptions of researchers' reflections and ethical considerations, which are meaningful for strengthening the rigor and credibility of qualitative research. Based on these discussions, we suggest guidance for conducting ethical, feasible, and reliable qualitative research on HISs in hospital settings.

How well did the consensus methods apply in the guideline development of traditional Chinese medicine: a web-based survey in China

BACKGROUND AND OBJECTIVE

Consensus methods are crucial in developing clinical guidelines. Different methods, such as the Delphi and nominal group techniques, are commonly used, but there is a lack of detailed instructions on how to implement them effectively. The survey aims to explore the opinions and attitudes of the chair, panel and working group on the critical elements of the consensus methods during guideline development.

METHODS

We used a cross-sectional design to conduct this study and sent a structured questionnaire to stakeholders, including the chair, panel members, and working group participants, through the popular mobile phone application WeChat.We selected participants using a combination of purposive and snowball sampling. The questionnaire gathered information on demographics, experiences, opinions, and concerns regarding consensus methods and guideline development.

RESULTS

The sample comprised 290 participants representing 31 provinces or municipalities. Among them, the most significant number of respondents (n = 107, 36.9%) were from Beijing. Most participants, specifically 211 (72.76%), held senior professional titles, while 186 (64.14%) adhered to ongoing guidelines. The Delphi method was the most commonly used consensus method (n = 132, 42.31%), but the respondents had only a preliminary understanding of it (n = 147, 47.12%). The consensus process also revealed the insufficiency of involving pharmacoeconomists, patients, and nurses.

CONCLUSIONS

Consensus methods have to be standardised and used consistently in the guideline development process. The findings of this study offer insights into diverse roles and more effective ways to apply the consensus process during guideline development.

A Retrospective Analysis of Serious Adverse Events and Deaths in US-Based Lifestyle Clinical Trials for Cognitive Health

This retrospective analysis assessed the serious adverse events and deaths reported in lifestyle clinical trials designed to enhance cognitive health in older adults living in the United States. Data was collected from studies conducted between January 1, 2000, and July 19, 2023, using the ClinicalTrials.gov application programming interface. Our query revealed that 76% of these studies did not report trial results. The remaining studies with reported results were categorized under one of four intervention types: Cognitive/Behavioral, Exercise/Movement, Diet/Supplement, and Multi-modal. When all trial types are considered together, the results indicate that lifestyle clinical trials are safe, with no significant increase in relative risk of experiencing an SAE in an intervention group over a control group. And although the increase in relative risk of death in an intervention group over a control group was significant at 28% (X2 (1, N = 36), p < 0.00688), the probability of death was not higher than the U.S. mortality rates by age. When assessing the data using intervention type, Diet/Supplement trials and Multi-modal trials both had an increase in relative risk of experiencing an SAE in the intervention over the control group, with Diet/Supplement trials at 16% (X2 (1, N = 2), p < 0.0263) and Multi-modal trials at 365% (X2 (1, N = 5), p < 0.000213). The Diet/Supplement trials also had an increased risk of death at 67% (X2 (1, N = 2), p < 0.000197). These results should be taken with careful consideration. Due to such a low reporting rate, the 36 studies included in this analysis do not accurately represent the majority of lifestyle clinical trials conducted in the U.S. This study is valuable in that it highlights the importance of reporting clinical trial results, which will improve transparency in trial results and allow for more accurate assessments of safety in the growing field of cognitive aging and lifestyle interventions for older adults.

Reproducibility of prediction models in health services research

The field of health services research studies the health care system by examining outcomes relevant to patients and clinicians but also health economists and policy makers. Such outcomes often include health care spending, and utilization of care services. Building accurate prediction models using reproducible research practices for health services research is important for evidence-based decision making. Several systematic reviews have summarized prediction models for outcomes relevant to health services research, but these systematic reviews do not present a thorough assessment of reproducibility and research quality of the prediction modelling studies. In the present commentary, we discuss how recent advances in prediction modelling in other medical fields can be applied to health services research. We also describe the current status of prediction modelling in health services research, and we summarize available methodological guidance for the development, update, external validation and systematic appraisal of prediction models.

"Only 50% of randomized trials have high level of confidence in arthroscopy and sports medicine"-a spin-based assessment

PURPOSE

Pioneering works on the quality appraisal of RCTs have recognized and addressed most of the issues that affect the RCT quality but some issues such as "Writers' bias" or "Spin" are yet to be sorted out. Spin, particularly in the abstracts, is a potential source of deception to the readers. The purpose of this study is to grade the RCTs of arthroscopy and sports medicine based on a spin in their abstracts, analyze the prevalence of spin, and explore methods to remove spin.

METHODS

250 recent RCTs from the top 5 arthroscopy and sports medicine journals were selected. Baseline data of the articles were collected. Consort Adherence Score (CAS) was calculated. The abstracts of the RCTs were graded using the Level Of Confidence (LOC) grading tool developed by the Orthopaedic Research Group. The association of the spin grade with other characteristics of the articles was analyzed.

RESULTS

The median CAS for the included studies was 9 (IQR 8-10). It was found that only 49.6% (n = 124) articles had high LOC with no or one non-critical spin in the abstract. 20.8% (n = 52) had Moderate LOC with more than one non-critical spin. 19.6% (n = 49) had at least one critical spin and 10% (n = 25) had more than one critical flaw making their results have Low and Critically Low LOC, respectively. Of the ten variables analyzed in multivariate regression analysis, it was found that CAS was the only significant factor that determines the level of confidence in the abstract of RCTs CONCLUSION: Spin is prevalent in abstracts of sports medicine and arthroscopy journals with 50.4% having some form of spin. Grading the LOC of the RCTs based on spin is the necessity of the day for the readers. Only 49.6% of the RCTs had high LOC. Objective structuring of the abstracts would help eliminate spin in the future.

LEVEL OF EVIDENCE

Level 1.

Using citation tracking for systematic literature searching - study protocol for a scoping review of methodological studies and an expert survey

Background: Up-to-date guidance on comprehensive study identification for systematic reviews is crucial. According to current recommendations, systematic searching should combine electronic database searching with supplementary search methods. One such supplementary search method is citation tracking. It aims at collecting directly and/or indirectly cited and citing references from "seed references". Tailored and evidence-guided recommendations concerning the use of citation tracking are strongly needed. Objective: We intend to develop recommendations for the use of citation tracking in health-related systematic literature searching. Our study will be guided by the following research questions: What are the benefits of citation tracking for health-related systematic literature searching? Which perspectives and experiences do experts in the field of literature retrieval methods have with regard to citation tracking in health-related systematic literature searching? Methods: Our study will have two parts: a scoping review and an expert survey. The scoping review aims at identifying methodological studies on benefits or problems of citation tracking in health-related systematic literature searching with no restrictions on study design, language, and publication date. We will perform database searching in MEDLINE, The Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science Core Collection, two information science databases, and free web searching. Two reviewers will independently assess full texts of selected abstracts. We will conduct direct backward and forward citation tracking on included articles. The results of the scoping review will inform our expert survey through which we aim to learn about experts΄ perspectives and experiences. We will narratively synthesize the results and derive recommendations for performing health-related systematic reviews.

Using citation tracking for systematic literature searching - study protocol for a scoping review of methodological studies and a Delphi study

Background: Up-to-date guidance on comprehensive study identification for systematic reviews is crucial. According to current recommendations, systematic searching should combine electronic database searching with supplementary search methods. One such supplementary search method is citation tracking. It aims at collecting directly and/or indirectly cited and citing references from "seed references". Tailored and evidence-guided recommendations concerning the use of citation tracking are strongly needed. Objective: We intend to develop recommendations for the use of citation tracking in systematic literature searching for health-related topics. Our study will be guided by the following research questions: What is the benefit of citation tracking for systematic literature searching for health-related topics? Which methods, citation indexes, and other tools are used for citation tracking? What terminology is used for citation tracking methods? Methods: Our study will have two parts: a scoping review and a Delphi study. The scoping review aims at identifying methodological studies on the benefit and use of citation tracking in systematic literature searching for health-related topics with no restrictions on study design, language, and publication date. We will perform database searching in MEDLINE (Ovid), CINAHL (EBSCOhost), Web of Science Core Collection, two information science databases, web searching, and contact experts in the field. Two reviewers will independently perform study selection. We will conduct direct backward and forward citation tracking on included articles. Data from included studies will be extracted using a prespecified extraction sheet and presented in both tabular and narrative form. The results of the scoping review will inform the subsequent Delphi study through which we aim to derive consensus recommendations for the future practice and research of citation tracking.

Using citation tracking for systematic literature searching - study protocol for a scoping review of methodological studies and a Delphi study

Background: Up-to-date guidance on comprehensive study identification for systematic reviews is crucial. According to current recommendations, systematic searching should combine electronic database searching with supplementary search methods. One such supplementary search method is citation tracking. It aims at collecting directly and/or indirectly cited and citing references from "seed references". Tailored and evidence-guided recommendations concerning the use of citation tracking are strongly needed. Objective: We intend to develop recommendations for the use of citation tracking in systematic literature searching for health-related topics. Our study will be guided by the following research questions: What is the benefit of citation tracking for systematic literature searching for health-related topics? Which methods, citation indexes, and other tools are used for citation tracking? What terminology is used for citation tracking methods? Methods: Our study will have two parts: a scoping review and a Delphi study. The scoping review aims at identifying methodological studies on the benefit and use of citation tracking in systematic literature searching for health-related topics with no restrictions on study design, language, and publication date. We will perform database searching in MEDLINE (Ovid), CINAHL (EBSCOhost), Web of Science Core Collection, two information science databases, web searching, and contact experts in the field. Two reviewers will independently perform study selection. We will conduct direct backward and forward citation tracking on included articles. Data from included studies will be extracted using a prespecified extraction sheet and presented in both tabular and narrative form. The results of the scoping review will inform the subsequent Delphi study through which we aim to derive consensus recommendations for the future practice and research of citation tracking.

Fundamental Shifts in Research, Ethics and Peer Review in the Era of the COVID-19 Pandemic

The era of the coronavirus disease 2019 (COVID-19) pandemic has led to fundamental shifts in research, ethics, and peer review including reframing of the research design, adapting methodologies to the study type, transitioning of research mechanics, changing research methodologies, overcoming data collection and standardization constraints, upholding research standards and ethics, maintaining informativeness and social value, and providing guarded peer review flexibility. Indeed, the COVID-19 crisis, despite disrupting research worldwide to an unprecedented degree, has also become a catalyst to develop strategies of adaptation to this disruption. As the COVID-19 pandemic continuous to evolve, new, cost-effective, and highly flexible research models need to be developed. Planning is crucial for ensuring short-term and long-term contingency funds to support research logistics and personnel. A mental shift must accompany changes in methodologies to mentor and support researchers who are vital to the continuity of high-caliber research in the long term. A global research perspective through interinstitutional and interprofessional collaboration will sustain adherence to the highest standards of data collection and research reporting.

Five Phases of Dyadic Analysis: Stretching the Boundaries of Understanding of Family Relationships

In the last decade, an increasing number of qualitative studies sought to investigate the dynamics of various dyads by conducting in-depth, multiple family member interviews. The emphasis in the methodological literature dealing with this type of research is primarily on the data collection process, and much less on the development of methods suitable for the analysis of the data thus derived, especially with regard to dyads consisting of family members belonging to different systems: families of origin or nuclear families. The purpose of this paper is to propose a model for dyadic analysis based on examining the dynamics of the evolving relationships between key caregivers of a family member with brain injury. The model includes inductive and abductive phases of analysis, and it is based on an ecological-systemic perspective. The benefits of this model are highlighted, and its potential contribution is further discussed.

The work of the WHO Consultative Group on Poliomyelitis Vaccines

Synthetic peptides are one of the hepatitis C virus (HCV)-specific small molecules that have antiviral activity and represent a target for HCV vaccine. This study aims to determine the lowest concentration of adjuvanted and non-adjuvanted (multiple antigenic peptide [MAP]) form of three conserved HCV envelope peptides that can induce murine immunogenic responses and evaluate the neutralization capacities of the generated antibodies (Abs) against HCV in cultured Huh7.5 cells. In this study, three HCV synthetic peptides, E1 peptide (a.a 315-323) and E2 peptides (a.a 412-419 and a.a 516-531) were synthesized. Female Balb/c mice were immunized with different concentration of either adjuvanted linear peptides or nonadjuvanted MAP peptides to determine the lowest dose that generates Ab responses enough to confer viral neutralization in vitro. The humoral responses targeting these peptides in immunized mice sera were measured by enzyme-linked immunosorbent assay (ELISA). Viral neutralization capacities of the generated mice Abs were assessed using Huh7.5 cells infected with the HCVcc infectious system (J6/JFH-1). The results of this study showed that the MAPs induce higher Ab titers than adjuvanted linear peptides after 4 weeks of immunization (p = 0.003). The viral neutralization experiments showed that the immunized mice sera contain anti E1/E2 Abs that blocked HCVcc (J6/JFH-1) entry into Huh7.5 cells. In conclusion, the three HCV envelope MAP peptides are more immunogenic and produce higher neutralizing Abs than linear peptides; therefore, they can be essential components for HCV vaccine.

Development of the Chronic Pain Coding System (CPCS) for Characterizing Patient-Clinician Discussions About Chronic Pain and Opioids

OBJECTIVE

To describe the development and initial application of the Chronic Pain Coding System.

DESIGN

Secondary analysis of data from a randomized clinical trial.

SETTING

Six primary care clinics in northern California.

SUBJECTS

Forty-five primary care visits involving 33 clinicians and 45 patients on opioids for chronic noncancer pain.

METHODS

The authors developed a structured coding system to accurately and objectively characterize discussions about pain and opioids. Two coders applied the final system to visit transcripts. Intercoder agreement for major coding categories was moderate to substantial (kappa = 0.5-0.7). Mixed effects regression was used to test six hypotheses to assess preliminary construct validity.

RESULTS

Greater baseline pain interference was associated with longer pain discussions (P = 0.007) and more patient requests for clinician action (P = 0.02) but not more frequent negative patient evaluations of pain (P = 0.15). Greater clinician-reported visit difficulty was associated with more frequent disagreements with clinician recommendations (P = 0.003) and longer discussions of opioid risks (P = 0.049) but not more frequent requests for clinician action (P = 0.11). Rates of agreement versus disagreement with patient requests and clinician recommendations were similar for opioid-related and non-opioid-related utterances.

CONCLUSIONS

This coding system appears to be a reliable and valid tool for characterizing patient-clinician communication about opioids and chronic pain during clinic visits. Objective data on how patients and clinicians discuss chronic pain and opioids are necessary to identify communication patterns and strategies for improving the quality and productivity of discussions about chronic pain that may lead to more effective pain management and reduce inappropriate opioid prescribing.

The critical appraisal of the papers published in the "iranian journal of psychiatry and behavioral sciences", 2007-2010

OBJECTIVE

This study has been done in order to evaluate the papers published in the "Iranian Journal of Psychiatry and Behavioral Sciences" from 2007 to 2010.

METHODS

A questionnaire was developed according to the design, evidence level, and recommendations to write scientific papers. Validity was achieved by consulting experts. Reliability was tested by re-evaluation of 7 randomly selected papers, one month after the first evaluation by Pearson correlation coefficient (r = 0.8). Different parts of the paper, including title, abstract, introduction, materials and methods, results, discussion, and references, were evaluated by a total of 47 questions. Each required item was judged as: appropriate, partially appropriate, not appropriate, and not applicable. SPSS software was used for descriptive analysis.

RESULTS

From spring 2007 to summer 2010, 7 issues with 72 papers were published. The most frequent problem in the title was that one could not understand the design of the research by reading it. In the abstract part, in 90% of papers, time and setting of research were not mentioned. Statistical test was not mentioned in 70%, and reliability of the questionnaires was not mentioned in 70% of papers. The discussion part was the hardest part to judge and had few inappropriate issues, such as unnecessary repetition of introduction and/or results; in 20% of papers the conclusion was not appropriate based on the research design.

CONCLUSIONS

The evaluated papers had strong points, yet more effort is needed for them to approach excellence.

DECLARATION OF INTEREST

None.

The dexamethasone suppression test and long-term contraceptive treatment: measurement of ACTH or salivary cortisol does not improve the reliability of the test

Under the influence of high estrogen levels, the suppression of total serum cortisol in the dexamethasone test has often been found to be incomplete. Its measurement for the purpose of excluding Cushing's disease or adrenal tumors in women taking oral contraceptives is, therefore, considered unreliable. This study was designed to compare the reliability of measurements of total cortisol, unbound cortisol and ACTH suppression during chronic hyperestrogenaemia. An overnight suppression test with 2 mg of dexamethasone was performed in 19 women receiving long-term contraceptive treatment (group A) and in 12 controls (group C). Baseline and post-dexamethasone morning levels of ACTH, total serum cortisol and unbound salivary cortisol were determined by RIA. In addition, unbound serum cortisol was measured by equilibrium dialysis. Mean baseline levels of all four parameters were significantly higher in group A. This result points towards the possibility of a direct stimulatory effect of estrogens upon the corticotroph axis which is independent from CBG-mediated increase of total cortisol. Post-dexamethasone values of total and unbound cortisol showed no statistically significant differences, while ACTH suppression in group A was even slightly better than in group C. From these data it is concluded that there is no need for post-dexa routine measurement of ACTH or unbound cortisol under contraceptive treatment since neither one of these parameters provides any additional information in comparison to total cortisol.

Hormonal regulation of male reproduction (with reference to infertility in man)

In mammals, pituitary control of spermatogenesis varies with age. In the rat, before puberty FSH is highly active whereas LH is not; after puberty it seems that LH alone is able to support spermatogenesis. The mode of action of hormones is discussed. In the human, in case of infertility due to hypogonadotrophic hypogonadism, spermatogenesis can be restored by HCG or HMG. The best results are obtained after simultaneous treatment with both hormones, LH activity being predominant.

Drug utilization and morbidity statistics for the evaluation of drug safety in Sweden

For a continuous monitoring and evaluation of drug safety problems in Sweden, the Department of Drugs of the National Board of Health and Welfare has access to a number of computerised patient-, drug-, and disease-oriented registers. The usefulness and limitations of these registers are presented by examples. A recent increase in asthma deaths is presently being analysed by comparing information from death certificates and case records with drug sales and prescription data. A recent analysis of the cancer register showed no increased risk of malignant thyroid tumors after diagnostic or therapeutic doses of I 131. Similarly no increased risk of malformations after occupational exposure to hexachlorophene could be detected by analysing the malformation and medical birth-record registers in relation to hospital hexachlorophene use. The register of patient discharge diagnoses has been repeatedly used to analyse the incidence and pattern of drug induced blood dyscrasias and thromboembolism associated with oral contraceptives (OC). These analyses have resulted i.a. in the withdrawal of dipyrone and tenalidine and a decrease of the estrogen-content of OCs. At the same time about 1/3 of these serious adverse drug reactions (ADR) was found to have been reported to the ADR-register. By combining sales and prescription data with ADR-reports the risk of inducing lactic acidosis was found to be significantly higher for phenformin than for metformin. Also the incidence of tardive dyskinesia from longterm use of metoclopramide was found to be much higher than hitherto recognized. By use of these registers it is possible to obtain valuable information about the safety of drugs. The raw data must, however, be interpreted with care and often be supplemented with in depth studies of the various problems.

Experimental findings with spermantibodies: condom therapy (a case report)

A couple with no demonstrable cause for their infertility, except for a pronounced antisperm activity in the blood serum of the female partner, were instructed to use a condom while our laboratory monitored the wifes antibody titer. The antibody activity declined sufficiently and an artificial husband insemination were performed after seven months of therapy. A precise report of the spermantibody activity over an eleven month period are given by the authors.

Three cases of low chiasma frequency associated with infertility in man

Three new cases of low chiasma frequency in infertile men are described. In the first case, all cells showed abnormal diakineses; in the second, 20% of the diakineses were desynaptic, while the remaining 80% were normal; in the third, all diakineses were desynaptic and showed chromosome fragmentation. The possible mechanisms leading to asynapsis, desynapsis or precocious chiasma terminalization are discussed.

Determination of sperm-antibodies in sera of sterile women by affinity-chromatography (affinity-chromatography of sperm-antibodies)

The total amount of humoral sperm antibody protein is determined following its isolation by affinity-chromatography on spermatozoa. Serum proteins are eluted by Sorensen phosphate buffer. Antibodies attached to spermatozoa suspended in Sephadex G 75 columns resist elution by Sorensen buffer. They can be quantitatively washed out by 8 ml Tris HCl-buffer pH 8,9 and be determined as proteins by the Folin-Ciocalteu method.

Tobacco smoking and twinning

In a case-control study an association was found between mothers' smoking habits and the frequency of dizygotic twinning. As cases were included all twins born in Denmark in 1984 and 1985. A random sample of 1.5% of mothers to singletons, born in the same period were selected as controls. Only live-borns, conceived after no hormonal treatment, were included in the study. The finding may be due to the well-known anti-estrogen effect of smoking.

Effect of administration of a single dose of testosterone oenanthate on constituents of human seminal plasma and serum gonadotropins

Testosterone oenanthate was administered intramuscularly in six infertile men with oligozoospermia and its effects on serum gonadotropins and some constituents in the seminal plasma were studied. One week after injection the mean serum FSH level was decreased to about 50%. Serum LH levels did not change. The mean ornithine decarboxylase activity in human semen was increased by 100% after the testosterone administration. The androgen dependent nature of ODC, fructose and sialic acid have been demonstrated.

Vasectomy: a long-term study of its effects on testicular endocrine function in man

Plasma testosterone, luteinizing hormone (L.H.) and follicle stimulating (F.S.H.) were measured before operation in 39 males, aged 26 to 53 years with 2 to 5 children, seeking vasectomy for contraceptive purposes. These measurements were repeated at 3 and 12 months after vasectomy. Levels of L.H. at 12 months were significantly higher than pre-vasectomy levels, suggesting some degree of decreased Leydig cell function. However, testosterone and F.S.H. levels were similar at the three sampling times. Continuing yearly measurements for at least 5 years are planned.

Sterility induced in male rats by injection of chemical agents into the vas deferens

Changes in the histopathology of the testes with the epididymis were studied 3 months and 6 months after vasocclusion either with ethanol urea mixture or ethanol alone in male rats. A gradual decrease in the fertility of treated animals was observed. The epididymis showed tubules with sperm granuloma and the testis showed empty tubules with Leydig cell hyperplasia in the urea-ethanol treated animals.

Dietetic habits and quality of semen in Indian subjects

Dietetic habits revealed significant effect on seminal plasma vitamin B12 levels. The mean values for seminal plasma vitamin B12 activity in lactovegetarians from normozoospermic, oligozoospermic and azoospermic groups are significantly lower than the corresponding mean values observed in the nonvegetarian subjects. The mean vitamin B12 content of seminal plasma in azoospermic group was distinctly lower than the mean values in normozoospermic and oligozoospermic groups. However, seminal plasma vitamin B12 values showed no correlation with the sperm content of the corresponding semen in both normozoospermic and oligozoospermic subjects. Studies on sperm morphology and on biochemical parameters revealed no significant effect of the type of diet on sperm count, sperm motility, percentage abnormal sperms, seminal plasma total proteins, albumin, fructose, citric acid, acid and alkaline phosphatase activity in normozoospermic group.

On the morphology of the human Sertoli cells under normal conditions and in patients with impaired fertility

Sertoli cells in testicular biopsies from 7 patients with Sertoli-cell only syndrome, 8 patients who had been treated with cyclophosphamide for testicular neoplasia, 8 patients with oligozoospermia, 7 patients with cryptorchidism, and 8 patients with seminoma were examined under the electron microscope and compared with Sertoli cells of normal tissues. The investigations reveal that each of these conditions of impaired fertility is characterized of a special type of Sertoli cell. The cell pattern is either restricted to one or two of the normally occurring cell types, or modified cells predominate that might be typical of the underlying disturbances of spermatogenesis. It is suggested that the cell type which prevails in the Sertoli-cell only syndrome is capable of maintaining a basic production of a substance that inhibits FSH secretion.

The ultrastructural response of human Leydig cells to exogenous estrogens

The effect of long term treatment with estrogens alone or along with medroxyprogesterone acetate on the Leydig cell ultrastructure was studied in testes from males undergoing surgery for sexual reassignment. The testes were fixed for electron microscopy by a perfusion method to insure uniform preservation. The morphological features were not the same in all the treated testes. Therefore, the cells found in the intertubular region were classified into three groups: (A) Leydig cells very similar to controls; (B) Absence of typical Leydig cells, but with cells having increased microfilaments, abundant smooth endoplasmic reticulum and some lipid droplets; (C) Absence of any cell type possessing abundant smooth endoplasmic reticulum, but having varying amounts of microfilaments and pigmentation. It is suggested that some of the cell types found in the intertubular region are dedifferentiated Leydig cells. This study indicates that the human testis from transsexuals of reproductive age is an appropriate model to study the indirect and direct effects of estrogens on the ultrastructure of cell types found in the human testes.

The role of varicocele in male fertility

In summary, seventeen infertile men with varicocele in whom no other cause for infertility could be identified, were studied before and following varicocele repair. Morphologic alterations were the most common abnormality noted in the seminal fluid with all subjects demonstrating increased numbers of tapered or amorphous spermatozoa. Ligation of the varicocele resulted in improvement in one or more of the seminal fluid abnormalities in thirteen of the seventeen patients. Seven patients achieved a pregnancy. No single seminal fluid parameter was identified which was of predictive value in determining those subjects who would demonstrate improvement following varicocele repair.

Oral contraceptives, smoking and risk of myocardial infarction in young women. A longitudinal population study in eastern Finland

The use of oral contraceptives (OC) and smoking habits were studied by using a questionnaire in a random population sample of women from two counties of Eastern Finland in 1972. The participation rate was 95%. Data on use of OC and smoking were collected for 2,653 women aged 35-49 years. During the next seven years, 27 of them had developed an acute myocardial infarction (AMI). Smokers had a 2.6-fold (95% confidence interval (CI)=1.2-6.0) crude risk of developing AMI compared with non-smokers. Women taking OC had a 1.3-fold (95% CI = 0.4-6.9) risk of developing AMI compared with those who did not. Women who both smoked and used OC had a 7.2-fold (95% CI = 2.1-24.7) risk of AMI compared with non-smokers and non-users of OC. The results indicate that use of OC is associated with an excessive risk of AMI among female smokers.

Separation of X- and Y-bearing human spermatozoa with the sephadex gel-filtration method

By means of the Sephadex gel filtration method we were able to separate a fraction rich in X-bearing human spermatozoa, in contrast with the method of Ericsson et al. (1973), which allows to obtain a fraction rich in Y-bearing sperm. The method, which is simple and not time-consuming, may allow control of sex in cases of expressed sex desire in off-spring.

Effect of androgen on different biochemical constituents of human semen

Changes in the levels of fructose, sialic acid, ascorbic acid, cholesterol and acid and alkaline phosphatases in the semen were studied in eight azoospermic volunteers during administration of testosterone propionate over a four week period. In order of responsiveness, elevations were observed in the levels of acid phosphatase, fructose, sialic acid and alkaline phosphatase during androgen therapy. No changes were seen in the levels of cholesterol and ascorbic acid.

The effect of epididymal and testicular fluids on the fertilising capacity of testicular and epididymal spermatozoa

It is possible that the fertilising capacity of spermatozoa in the epididymis is influenced by the epididymal secretion. We have studied this problem by obtaining spermatozoa before entry into the epididymis and after passage through it, incubating both types of spermatozoa in fluids from the rete testis and cauda epididymidis and then checking their fertilising capacity. While spermatozoa from the rete testis were infertile, rete testis fluid did not decrease the fertilising capacity of epididymal sperm from the cauda epididymidis. Fluid from the cauda epididymidis did not promote the fertilising capacity of testicular spermatozoa. These results are discussed in the light of the current understanding of epididymal physiology.

QT-interval dispersion in malnourished children

BACKGROUND

Little is known about the electrocardiographic (ECG) QT interval and its variability in malnourished children.

HYPOTHESIS

The study of the QT interval and its dispersion in malnourished children was undertaken to determine whether the QT interval and its variability are increased in these children.

METHODS

In 40 children (20 malnourished and 20 controls) aged 12.2 +/- 14.4 months (23 male) a conventional ECG was performed for computing heart rate, heart rate variability, corrected QT interval, and QT-interval dispersion. A blood sample was obtained for measuring hemoglobin, hematocrit, plasma protein, and plasma electrolytic concentrations.

RESULTS

Corrected heart rate, heart rate variability, and QT Interval were similar in both groups. When compared with the control group, the malnourished children had greater corrected QT-interval dispersion, and that dispersion was more accentuated in the precordial leads. They also had repolarization abnormalities (flattened or inverted T waves and U waves). Hemoglobin, hematocrit, plasma protein, and plasma electrolytic concentrations were lower in the malnourished children. However, the ECG findings showed no statistically significant relationship with either the blood parameters, the severity or type of malnutrition, and the size or the weight of the children.

CONCLUSIONS

QT-interval dispersion is increased in malnourished children and the dispersion is more accentuated in the precordial leads.

Some influences on the ESR and the fibrinogen level in healthy subjects

In healthy subjects the ESR is higher in women than in men, and in both sexes a rise with age occurs. It is well established that pathological elevation of the ESR may be due to elevation of the fibrinogen level. The present study has shown that in normal subjects the ESR correlates not only inversely with the haemoglobin level but also directly with the fibrinogen level. These two factors together explain the difference in ESR between men and women, and the major part of the age-related increase in the ESR. Fibrinogen levels were found to be significantly higher in male smokers than male non-smokers, and in women were inversely correlated with alcohol consumption; despite this the ESR did not differ in smokers and non-smokers, nor was it related to alcohol intake. Oral contraceptive intake influenced neither the fibrinogen level nor the ESR. The correlation of ESR and fibrinogen concentration in healthy subjects suggests that physiological variation in the ESR is determined by the fibrinogen concentration as well as the haemoglobin level.

Reproductive health, population growth, economic development and environmental change

World population will increase by 1000 million, or by 20%, within 10 years. Ninety-five per cent of this increase will occur in the South, in areas that are already economically, environmentally and politically fragile. Morbidity and mortality associated with reproduction will be greater in the current decade than in any period in human history. Annually, 40-60 million pregnancies will be terminated and 5-10 million children will die within one year of birth. AIDS-related infections, e.g. tuberculosis, will undermine health care in Africa (and elsewhere) and in places AIDS-related deaths will decimate the work-force. The growth in population and associated morbidity will inhibit global economic development and spawn new problems. The key issues are migration, the spread of disease, the supply of water and the degradation of land, and fiscal policies with respect to family planning, pharmaceuticals and Third-World debt. Full education, particularly of women, and more effective family planning in the South have the power to unlock the problem. Failure will see the developed countries, with their 800 million population, swamped by the health, economic and environmental problems of the South, with its projected population of 5400 million people for the year 2000.

Backcalculation of flexible linear models of the human immunodeficiency virus infection curve

The authors present a regression approach to the backcalculation of flexible linear models of the HIV infection curve. They note that "because expected AIDS incidence can be expressed as a linear function of unknown parameters, regression methods may be used to obtain parameter and covariance estimates for a variety of interesting quantities, such as the expected number of people infected in previous time intervals and the projected AIDS incidence in future time intervals. We exploit these ideas to show that estimates based on maximum likelihood are, for practical purposes, equivalent to approximate estimates based on quasi-likelihood and on Poisson regression. These algorithms are readily implemented on a personal computer." These concepts are illustrated by projecting AIDS incidence in the United States up to 1993.