Biologically derived epicardial patch induces macrophage mediated pathophysiologic repair in chronically infarcted swine hearts

There are nearly 65 million people with chronic heart failure (CHF) globally, with no treatment directed at the pathologic cause of the disease, the loss of functioning cardiomyocytes. We have an allogeneic cardiac patch comprised of cardiomyocytes and human fibroblasts on a bioresorbable matrix. This patch increases blood flow to the damaged heart and improves left ventricular (LV) function in an immune competent rat model of ischemic CHF. After 6 months of treatment in an immune competent Yucatan mini swine ischemic CHF model, this patch restores LV contractility without constrictive physiology, partially reversing maladaptive LV and right ventricular remodeling, increases exercise tolerance, without inducing any cardiac arrhythmias or a change in myocardial oxygen consumption. Digital spatial profiling in mice with patch placement 3 weeks after a myocardial infarction shows that the patch induces a CD45pos immune cell response that results in an infiltration of dendritic cells and macrophages with high expression of macrophages polarization to the anti-inflammatory reparative M2 phenotype. Leveraging the host native immune system allows for the potential use of immunomodulatory therapies for treatment of chronic inflammatory diseases not limited to ischemic CHF.

Symptoms, Physical Activity, and Biomarkers in Children at the End of Leukemia Maintenance Therapy

Background: Symptoms in children with acute lymphocytic leukemia (ALL) change over the trajectory of treatment but little is known about their symptoms as treatment ends. Physical activity may help decrease symptom distress and is vital for ongoing development. The role of biomarkers in symptom science is emerging. The purpose of the study was to explore relationships between self-report of symptoms and physical activity, actigraphy measures, and cerebrospinal fluid (CSF) biomarkers. Methods: Participants were children who were ages 3 to 18 years at the time of ALL diagnosis and were now in the last 12-week cycle of ALL maintenance. Self-reports of fatigue, sleep disturbance, depressive symptoms, and physical activity were completed by participants and parents of younger children. Participants wore a wrist actigraph continuously for the 7 days before other measurements. F2-isoprostanes and interleukin-8 were evaluated in CSF samples. Results: Among the 15 participants, self-report of symptoms and physical activity indicated levels similar to healthy peers. F2-isoprostane had a strong positive correlation with fatigue levels and with depressive symptoms. Fatigue, sleep disturbance, and depressive symptoms positively correlated with each other. Actigraph measures showed children met the CDC guidelines for 60 min of daily moderate to vigorous activity; sleep time was slightly less than healthy norms. Discussion: During maintenance therapy, most children return to healthy norms in symptom burden and physical activity. F2-isoprostane in the CSF is a biomarker for fatigue and depressive symptoms. Children who had persistent symptoms experienced them as a cluster, which confirms previous symptom cluster research.

Biomarkers and Cognitive Function in Children and Adolescents During Maintenance Therapy for Leukemia

OBJECTIVES

To explore the relationship between biomarkers of oxidative stress and inflmmation in cerebrospinal fluid (CSF) and cognitive function in children receiving maintenance therapy for acute lymphocytic leukemia (ALL).

SAMPLE & SETTING

30 participants aged 4-17 years receiving ALL maintenance therapy at two pediatric cancer centers in the United States.

METHODS & VARIABLES

F2-isoprostane (F2-ISoP) and interleukin-8 (IL-8) were evaluated in CSF samples, and cognitive function measures were completed during the first and last cycles of ALL maintenance. The Flanker Inhibitory Control and Attention Test (Flanker) and Dimensional Change Card Sort were completed during the last cycle.

RESULTS

During maintenance therapy, IL-8 decreased, and parent reports of children's cognitive function improved. Higher IL-8 was associated with better parent reports of children's cognitive function at each timepoint. Higher F2-ISoP levels were associated with lower Flanker scores.

IMPLICATIONS FOR NURSING

F2-ISoP may be a useful biomarker in evaluating cognitive dysfunction in children with ALL and merits further investigation.

The Longitudinal Parallel Process Analysis of Biomarkers of Oxidative Stress, Symptom Clusters, and Cognitive Function in Children With Leukemia

Background: During treatment for acute lymphoblastic leukemia (ALL), children report co-occurring symptoms of fatigue, sleep disturbance, pain, nausea, and depression as a symptom cluster. Central nervous system-directed ALL therapies also put children at risk for cognitive impairments. Cancer therapies can cause an increase in oxidative stress, which may contribute to treatment-related symptoms. This study examined the longitudinal relationships between biomarkers of oxidative stress in the cerebrospinal fluid, the Childhood Cancer Symptom Cluster-Leukemia (CCSC-L), and cognition, in children over the first year of ALL treatment. Methods: Glutathione (GSH) biomarkers of oxidative stress were measured in cerebrospinal fluid collected during treatment lumbar punctures. GSH biomarkers, symptoms, and cognitive function of 132 children aged 3 to 18 years were evaluated at four time points during the first year of leukemia treatment. Participants, 7 years and older, completed self-report measures, and parents reported for younger children. Cognitive function measurements for all participants were completed by parents. A longitudinal parallel-process model was used to explore the influence of the initial measurement and the subsequent change over four time points of the GSH biomarkers on the CCSC-L and cognition. Results: GSH biomarkers increased over the four time points indicating decreasing oxidative stress. When GSH biomarkers were higher (less oxidative stress) at the initial measurement, the CCSC-L severity was lower, cognition was better, and cognition improved over the four measurements. Screening children for high levels of oxidative stress would be a foundation for future intervention studies to address symptom distress and cognitive impairments.

Influence of Inflammatory and Oxidative Stress Pathways on Longitudinal Symptom Experiences in Children With Leukemia

PURPOSE

The purpose of this study was to explore the influence of oxidative stress (F2-isoprostanes) and inflammatory (interleukin [IL]-8) biomarkers on symptom trajectories during the first 18 months of childhood leukemia treatment.

METHOD

A repeated-measures design was used to evaluate symptoms experienced by 218 children during treatment. A symptom cluster (fatigue, pain, and nausea) was explored over four time periods: initiation of post-induction therapy, 4 and 8 months into post-induction therapy, and the beginning of maintenance therapy (12 months postinduction). F2-isoprostanes and IL-8 were evaluated in cerebrospinal fluid (CSF) samples collected at baseline (diagnosis) and then at the four time periods. The longitudinal relationships of these biomarkers with the symptom cluster were examined using the longitudinal parallel process.

RESULTS

Pain and fatigue levels were highest during the post-induction phases of treatment and decreased slightly during maintenance therapy, while nausea scores were relatively stable. Even in the later phases of treatment, children continued to experience symptoms. CSF levels of the biomarkers increased during the post-induction phases of treatment. Early increases in the biomarkers were associated with more severe symptoms during the same period; patients who had increased biomarkers over time also experienced more severe symptoms over time.

CONCLUSIONS

Findings reveal that children experienced symptoms throughout the course of leukemia treatment and support hypothesized longitudinal relationships of oxidative stress and inflammatory biomarkers with symptom severity. Activation of the biomarker pathways during treatment may explain underlying mechanisms of symptom experiences and identify which children are at risk for severe symptoms.

A novel regimen for relapsed/refractory adult acute myeloid leukemia using a KMT2A partial tandem duplication targeted therapy: results of phase 1 study NCI 8485

KMT2A partial tandem duplication occurs in approximately 5–10% of patients with acute myeloid leukemia and is associated with adverse prognosis. KMT2A wild type is epigenetically silenced in KMT2A partial tandem duplication; re-expression can be induced with DNA methyltransferase and/or histone deacetylase inhibitors in vitro, sensitizing myeloid blasts to chemotherapy. We hypothesized that epigenetic silencing of KMT2A wildtype contributes to KMT2A partial tandem duplication-associated leukemogenesis and pharmacologic re-expression activates apoptotic mechanisms important for chemoresponse. We developed a regimen for this unique molecular subset, but due to relatively low frequency of KMT2A partial tandem duplication, this dose finding study was conducted in relapsed/refractory disease regardless of molecular subtype. Seventeen adults (< age 60) with relapsed/refractory acute myeloid leukemia were treated on study. Patients received decitabine 20 milligrams/meter² daily on days 1–10 and vorinostat 400 milligrams daily on days 5–10. Cytarabine was dose-escalated from 1.5 grams/meter² every 12 hours to 3 grams/meter² every 12 hours on days 12, 14 and 16. Two patients experienced dose limiting toxicities at dose level 1 due to prolonged myelosuppression. However, as both patients achieved complete remission after Day 42, the protocol was amended to adjust the definition of hematologic dose limiting toxicity. No further dose limiting toxicities were found. Six of 17 patients achieved complete remission including 2 of 4 patients with KMT2A partial tandem duplication. Combination therapy with decitabine, vorinostat and cytarabine was tolerated in younger relapsed/refractory acute myeloid leukemia and should be explored further focusing on the KMT2A partial tandem duplication subset. (clinicaltrials.gov identifier 01130506).

Abstract CT-06: The combination of bortezomib (BOR) and decitabine (DEC): A phase I trial in patients (pts) with acute myeloid leukemia (AML) targeting FLT3 expression

Most pts with AML are not cured with conventional chemotherapy regimens. Gain of function mutations & overexpression of tyrosine kinase (TK) receptors (ie KIT & FLT3) are associated with leukemogenesis and poor outcome & represent therapeutic targets. The use of TK inhibitors in AML has been disappointing. Recently we showed that BOR downregulates KIT in AML cells by upregulating miR-29b that disrupts a KIT transactivating complex comprising SP1 and NFκB (p65). In silico we found SP1 & p65 binding sites also in the FLT3 promoter region & speculated that FLT3 may be regulated similarly. Utilizing chromatin immunoprecipitation (CHIP) in MV4-11 cells expressing high FLT3 levels we showed enrichment of SP1 (1.6 fold) & p65 (3.1 fold) vs IgG control on the FLT3 promoter. Cotransfection of a luciferase reporter harboring the FLT3 promoter with SP1 or p65 vectors in 293T cells increased luciferase activity (3.1 & 3.0. fold); siRNA mediated knock-down of SP1 or p65 decreased activity (0.5 & 0.7 fold). In KG1 cells with low FLT3 levels, overexpression of SP1 or p65 increased FLT3 (1.7 & 1.6 fold); in MV4-11 cells siRNA-mediated knockdown of SP1 or p65 decreased FLT3 (0.05 & 0.3 fold) mRNA & protein. Since miR-29b can disrupt the SP1/p65 complex we overexpressed miR-29b in MV4-11 cells, which consequently downregulated FLT3 mRNA & protein level in MV4-11 cells to barely detectable levels. Both BOR & DEC can upregulate miR-29b; thus these drugs potentially decrease FLT3. Indeed BOR (60nM at 24h) or DEC (2.5µM at 48h) led to decreased FLT3 in MV4-11 cells (&lt;.001 & 0.5 fold) & in primary AML blasts (0.28 & 0.42 fold). We concluded that BOR & DEC target the expression of FLT3 via upregulation of miR-29b & disruption of the SP1/p65 complex. To validate these results, we assessed the expression of FLT3 in AML pts enrolled on a Phase I clinical trial (NCT00703300) that tested the BOR & DEC combination. Pts with relapsed/refractory AML or age &gt;60 years with previously untreated disease received DEC at 20mg/m2 IV daily on days 1-10. BOR was gradually dose escalated to 1.3 mg/m2 given on days 5, 8, 12 & 15. Cycles were repeated every 28 days. Pretreatment and day 26 expression levels of FLT3 and miR-29b were assessed. 19 patients were enrolled with a median age of 69 years (range: 32-83). Pts received a median of 2 cycles of therapy (range, 1-14 cycles). Febrile neutropenia & infectious complications were frequent. BOR & DEC at target doses were tolerable; neuropathy following repetitive cycles of BOR limited its administration. 7 pts achieved disease remission. Consistent with our preclinical results, miR-29b expression increased (median fold change: 3.9) and FLT3 expression levels decreased (median fold change: 0.4). As the FLT3 targeting results are encouraging a phase II study of BOR & DEC combination is being planned with modifications of BOR dosing to avoid neuropathy.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr CT-06. doi:1538-7445.AM2012-CT-06

Cellular uptake and intracellular levels of the bcl-2 antisense g3139 in cultured cells and treated patients with acute myeloid leukemia

PURPOSE

Down-regulation of Bcl-2 by the antisense G3139, currently under clinical evaluations, could restore chemosensitivity in otherwise resistant malignant cells. To date, the mechanism of intracellular accumulation of G3139 following in vivo administration remains to be elucidated. This study aimed to assess whether detectable intracellular concentrations of G3139 are achievable in vivo and how these relate to Bcl-2 down-regulation.

EXPERIMENTAL DESIGN

Cellular uptake of G3139 was studied in leukemia myeloid cell lines and blasts collected from treated patients using a newly developed, novel, and highly sensitive ELISA-based assay. Real-time reverse transcription-PCR was used to quantify Bcl-2 mRNA changes in treated cells.

RESULTS

The assay was fully validated and showed a limit of quantification of 50 pmol/L. When exposed to 0.33 to 10 mumol/L G3139, K562 cells exhibited intracellular concentrations in the range of 2.1 to 11.4 pmol/mg protein. When G3139 was delivered with cationic lipids, a 10- to 25-fold increase of the intracellular concentrations was observed. There was an accumulation of G3139 in the nuclei, and the ratio of nucleus to cytoplasm was increased 7-fold by cationic lipids. Intracellular concentrations of G3139 were correlated with Bcl-2 mRNA down-regulation. Robust intracellular concentrations of G3139 were achieved in vivo in bone marrow (range, 3.4-40.6 pmol/mg protein) and peripheral blood mononuclear cells (range, 0.47-19.4 pmol/mg protein) from acute myeloid leukemia patients treated with G3139.

CONCLUSIONS

This is the first evidence that measurable intracellular levels of G3139 are achievable in vivo in acute myeloid leukemia patients and that Bcl-2 down-regulation is likely to depend on the achievable intracellular concentrations rather than on plasma concentrations.

Durable hematologic complete response and suppression of HTLV-1 viral load following alemtuzumab in zidovudine/IFN-{alpha}-refractory adult T-cell leukemia

Adult T-cell leukemia (ATL) is a highly chemoresistant and usually fatal T-cell malignancy due to the human T-cell lymphotropic virus-1 (HTLV-1). After chemotherapy failure, antiretrovirals and interferon-alpha (IFN-alpha) produce brief responses followed by progression and death. More effective agents and new approaches to detect and treat minimal residual disease are needed. ATL cells express CD52, the target of the antibody alemtuzumab, which is active in a preclinical model of ATL and is cytotoxic for p53-deficient cells. A patient with refractory chronic ATL in transformation achieved longer than a 1-year complete hematologic response following 12 weeks of outpatient subcutaneous alemtuzumab. Persistent suppression of HTLV-1 viral load, even at recovery of T cells, after alemtuzumab and efficient in vitro complement-mediated cytotoxicity of primary ATL cells with mutated TP53 were observed. The unprecedented response and the profound suppression of HTLV-1 viral load observed in this patient suggest that further clinical investigation of alemtuzumab in ATL is warranted.

Evaluating Chicago's success in reaching the Healthy People 2000 goal of reducing health disparities

OBJECTIVE

This study was designed to assess Chicago's progress from 1980 to 1998 in addressing the Healthy People 2000 goal of reducing health disparities.

METHODS

Chicago vital statistics and surveillance data were used to calculate black:white rate ratios of mortality and morbidity for 1980-1998. Mortality and morbidity rate ratios were also used to compare people living in areas with the lowest median household income with those living in the highest for 1979-1981, 1991-1993, and 1996-1998. The health measures included mortality associated with leading causes of death; all-cause mortality, incidence rates for two communicable diseases; and two birth outcomes.

RESULTS

Both black:white and low-income:high-income rate ratios monotonically increased for virtually all measures of mortality and morbidity. Almost all of the rate ratios and linear trends were statistically significant. From 1980 to 1998, the black:white rate ratio for all-cause mortality increased by 57% to 2.03. From 1979-1981 to 1996-1998, the low-income:high-income rate ratio for all-cause mortality increased by 56% to 2.68.

CONCLUSIONS

These findings provide clear evidence that disparities in health did not decrease in Chicago. Instead, racial and economic disparities increased for almost all measures of mortality and morbidity used in this study. The fact that the Healthy People 2000 campaign to reduce and then eliminate health disparities was not effective must serve as a stimulus for improved strategies.

Evaluating Chicago's success in reaching the Healthy People 2000 goal of reducing health disparities

OBJECTIVE

This study was designed to assess Chicago's progress from 1980 to 1998 in addressing the Healthy People 2000 goal of reducing health disparities.

METHODS

Chicago vital statistics and surveillance data were used to calculate black:white rate ratios of mortality and morbidity for 1980-1998. Mortality and morbidity rate ratios were also used to compare people living in areas with the lowest median household income with those living in the highest for 1979-1981, 1991-1993, and 1996-1998. The health measures included mortality associated with leading causes of death; all-cause mortality, incidence rates for two communicable diseases; and two birth outcomes.

RESULTS

Both black:white and low-income:high-income rate ratios monotonically increased for virtually all measures of mortality and morbidity. Almost all of the rate ratios and linear trends were statistically significant. From 1980 to 1998, the black:white rate ratio for all-cause mortality increased by 57% to 2.03. From 1979-1981 to 1996-1998, the low-income:high-income rate ratio for all-cause mortality increased by 56% to 2.68.

CONCLUSIONS

These findings provide clear evidence that disparities in health did not decrease in Chicago. Instead, racial and economic disparities increased for almost all measures of mortality and morbidity used in this study. The fact that the Healthy People 2000 campaign to reduce and then eliminate health disparities was not effective must serve as a stimulus for improved strategies.

Marked declines in human immunodeficiency virus-related mortality in Chicago in women, African Americans, Hispanics, young adults, and injection drug users, from 1995 through 1997

BACKGROUND

Declines in human immunodeficiency virus (HIV)-related mortality between 1995 and 1996 were seen across the United States but were small to nonexistent among people in marginalized sectors who are most likely to contract HIV and die of its effects. No comprehensive analysis describing HIV-related mortality in 1997 was available.

OBJECTIVE

To describe Chicago's HIV-related mortality trends up to and including 1997, with specific attention focused on marginalized populations.

METHODS

An analysis of cross-sectional HIV-related mortality data with emphasis on the years 1995 through 1997 was conducted for Chicago, Ill. Numbers, proportions, and rates of declines in HIV-related deaths were examined for the city as a whole and also among those diagnosed at Cook County Hospital, as a proxy for people with very low socioeconomic status.

RESULTS

Between 1995 and 1996 there was an overall decline of 19% in HIV-related mortality in Chicago but small or no declines among women, African Americans, Hispanics, injection drug users, and people aged 20 to 29 years and more than 50 years. Between 1995 and 1997 there was an overall decline of 61%. At that time the declines were spread more evenly across diverse groups. There were almost no significant differences between the declines for these groups at Cook County Hospital and in the rest of Chicago.

CONCLUSIONS

The HIV-related mortality has fallen dramatically in Chicago since 1995, the year of its maximum. During 1997, declines were seen among all groups. Declines were also seen among the most disenfranchised of the city. Access to care and the new combination therapies are apparently sustaining life for many in Chicago.

Alternatively spliced products CC3 and TC3 have opposing effects on apoptosis

The human gene CC3 is a metastasis suppressor for small cell lung carcinoma (SCLC) in vivo. The ability of CC3 to impair the apoptotic resistance of tumor cells is likely to contribute to metastasis suppression. We describe here an alternatively spliced RNA of CC3, designated TC3, that encodes an unstable protein with antiapoptotic activity. TC3 and CC3 proteins share amino-terminal sequences, but TC3 has a unique short hydrophobic carboxyl terminus. Overexpression of CC3 results in massive death of rodent fibroblasts, but TC3 protects cells from CC3-induced death and from other death stimuli such as treatment with tumor necrosis factor or overexpression of Bax protein. The death-inducing activity of CC3 resides within its amino-terminal domain, which is conserved in TC3. The carboxyl terminus of TC3 is responsible for the antiapoptotic function of TC3; mutations in this domain abolish the ability of TC3 to protect cells from apoptosis. TC3 protein is short-lived due to its rapid degradation by proteasome, and it forms complexes with a regulatory subunit of proteasome known as s5alpha. The signal for the rapid degradation of TC3 resides within its carboxyl terminus, which is capable of conferring instability on a heterologous protein. The proapoptotic activity of CC3 in SCLC cells is induced by a wide variety of signals and involves disruption of the mitochondrial membrane potential (Deltapsim). The CC3 protein has sequence similarity to bacterial short-chain dehydrogenases/reductases and might represent a phylogenetically old effector of cell death similar to the recently identified apoptosis-inducing factor. CC3 and TC3 have opposing functions in apoptosis and represent a novel dual regulator of cell death.

Asthma hospitalizations and mortality in Chicago: an epidemiologic overview

STUDY OBJECTIVES

To characterize the patterns and correlates of asthma hospitalizations and mortality in Chicago.

DESIGN

Cross-sectional analysis of discharge data for 1996 and mortality time trend data for the period from 1990 to 1997.

SETTING

The city of Chicago, IL, with Cook County, IL, and US data employed for comparisons.

POPULATION STUDIED

People who were hospitalized with a primary diagnosis of asthma and people whose underlying cause of death was asthma.

INTERVENTIONS

None.

MEASUREMENTS AND RESULTS

The 1996 asthma hospitalization rate for Chicago was 42.8 per 10,000, more than twice as high as suburban Chicago or US rates. Medicaid patients were overrepresented. Length of stay was longer for older patients and Medicaid patients. Age-adjusted asthma mortality in Chicago was 4.7 times higher in non-Hispanic blacks than in non-Hispanic whites. The black/white asthma mortality ratio is 2.5:1 for the nation overall. Asthma mortality rates for Hispanics in Chicago were between those of non-Hispanic whites and blacks but have almost doubled during this decade.

CONCLUSIONS

The rising asthma mortality and high asthma hospitalization rates in Chicago constitute a significant public health problem. Comorbidities more common in urban environments, such as substance abuse, may play a unique role in determining the distribution of adverse outcomes within Chicago's population. Asthma hospitalizations and deaths may vary in their risk profiles, and this should be taken into account when developing research and intervention strategies.

The relation of gestation length to short-term heat stress

OBJECTIVES

This study examined the association between gestation length and heat exposure during the summer months of the Chicago heat wave of 1995.

METHODS

Birth data from Illinois vital records containing 11,792 singleton vaginal births were analyzed to calculate mean gestational ages.

RESULTS

No evidence was found to suggest an association between shortened gestation and increased maximum apparent temperature.

CONCLUSIONS

The data propose no special precautions for pregnant women exposed to short-term heat stress of the intensity evaluated in this study. However, the possible effects of chronic heat exposure on gestation cannot be ruled out.

The big cities health inventory, 1997

This manuscript reports on the publication of a unique document, The Big Cities Health Inventory, 1997: The Health of Urban U.S.A., which was released in July 1997 by the Chicago Department of Public Health (CDPH). The report presents data on 20 important health indicators such as AIDS, cancers, tuberculosis, sexually transmitted diseases, homicide, heart disease, infant mortality and low birthweight. Indicators of morbidity are gathered from participating local health departments and indicators of mortality and maternal and child health are obtained from vital records files provided by the National Center for Health Statistics (NCHS). The data are displayed and analyzed in two sections. The first consists of a series of tables presenting overall rates, gender and race/ethnicity-specific rates and city rankings according to these measures. These rankings provide meaningful comparisons between and within cities for specific demographic characteristics. The second component presents sample analyses which illustrate the possible uses of this information. The report represents an important tool for health professionals, researchers, policy makers and community advocates dedicated to promoting healthier cities. Such array of city-level data, to our knowledge not available from any other source, could indeed begin to lead to public health interventions that will impact the well-being of residents of large urban areas.

Redefining the growth of the heterosexual HIV/AIDS epidemic in Chicago

A dramatic shift in the relative distribution of the five categories of heterosexual transmission for AIDS cases diagnosed in Chicago since 1991 prompted a mode-of-transmission validation study of what had become the most frequently reported heterosexual exposure: heterosexual relations with a person with AIDS (PWA) or documented HIV infection whose risk is not specified.

METHODS

For 395 cases with originally reported heterosexual exposure, one or more of three supplemental data sources were employed: medical records were reviewed, medical providers were interviewed, and patients or proxies (i.e., spouse, significant other, or family member) were interviewed when possible. When reported HIV exposure could not be validated or reclassified, the transmission category employed was "no identifiable risk" (NIR).

RESULTS

Eighty-five percent (336 of 395 cases) were reclassified into different transmission categories. Most notably, 69% (272 of 395 cases) were reclassified into transmission categories that did not involve heterosexual contact, including NIR. The cumulative percentage of cases attributable to heterosexual contact declined from 8% to 5% as a result of reclassification. Additionally, reclassification resulted in a reduction of nearly 50% in the number of AIDS cases attributable to heterosexual contact diagnosed in 1993 and 1994.

CONCLUSIONS

In Chicago, an emerging problem in AIDS surveillance appears to be the use of an ambiguous heterosexual exposure category as a default when other information is not readily available. This study has found the growth in AIDS cases among persons exposed to HIV through heterosexual contact to be much slower than previously perceived. This finding may have important implications for the national debate over the extent to which heterosexual people are being infected and how funding and prevention strategies should be prioritized.

Mortality in Chicago attributed to the July 1995 heat wave

OBJECTIVES

This study assessed mortality associated with the mid-July 1995 heat wave in Chicago.

METHODS

Analyses focused on heat-related deaths, as designated by the medical examiner, and on the number of excess deaths.

RESULTS

In July 1995, there were 514 heat-related deaths and 696 excess deaths. People 65 years of age or older were overrepresented and Hispanic people underrepresented. During the most intense heat (July 14 through 20), there were 485 heat-related deaths and 739 excess deaths.

CONCLUSIONS

The methods used here provide insight into the great impact of the Chicago heat wave on selected populations, but the lack of methodological standards makes comparisons across geographical areas problematic.

Periodontal regeneration in naturally occurring Class II furcation defects in beagle dogs after guided tissue regeneration with bioabsorbable barriers

THE EFFICACY OF A BIOABSORBABLE polylactic acid based barrier was evaluated using naturally occurring buccal Class II furcation defects in beagle dogs. Sixteen furcation sites (8 control and 8 experimental) were treated in 6 adult animals. After full thickness flap reflection, exposed furcations and root surfaces were thoroughly root planed. In experimental sites a customized barrier was formed and fitted to cover the defect. Surgical flaps were replaced slightly coronal to the cemento-enamel junction. Animals were sacrificed at 6 months and specimens processed for histologic evaluation. Histologic and histometric analyses were done using 6 micrograms step serial sections in the buccal-lingual plane, corresponding to the buccal-lingual extent of the furcation. Results were: mean total defect experimental sites 1.92 mm; control sites 1.47 mm. Mean new cementum formation experimental sites 1.36 mm (71% of initial defect); control sites 0.25 mm (17% of initial defect). Mean new bone formation experimental sites 1.42 mm (74% of initial defect); control sites 0.20 mm (14% of initial defect). Mean junctional epithelium formation experimental sites 0.42 mm (22% of initial defect); control sites 1.21 mm (82% of initial defect). Statistical analysis demonstrated significant differences in all healing parameters favoring experimental (barrier-treated) sites. In this model, regeneration (new bone, cementum, and periodontal ligament) of 71% of the original defect in experimental sites and only 14% in control sites demonstrated a response that highly favored use of the barrier.

The epidemiology of homicide in Chicago

Public health agencies across the country are beginning to view violence as a problem that demands a public health response. However, before such a response can be mounted effectively, there must be a sound data-based understanding of this epidemic. With this in mind, the Chicago Department of Public Health implemented an epidemiological analysis of homicide in the city. Using vital records, police data, and census data, we found that the city's homicide rate in 1993 was 31 per 100,000 population. This rate placed Chicago 14th among other large cities in the United States and 4th out of the eight cities with a population > 1 million. The homicide rate in the city has been increasing over the past 30 years, but not steadily. For some intervals, the homicide rate has remained almost constant. African Americans, Hispanics, the young, and males are overrepresented in the epidemic. While guns accounted for almost 75% of all homicides in Chicago in 1993, gangs accounted for only 15%. Homicide cannot be viewed in isolation from the context of society. The literature suggests that poverty and racism are important risk factors for this epidemic. Although we cannot wait until these risk factors are remedied to develop violence prevention interventions, we also cannot proceed effectively without understanding this context.

Epidemiology of AIDS among Hispanics in Chicago

The purpose of this study was to describe the epidemiology of AIDS among Hispanics in Chicago. These data are needed to tailor prevention and treatment programs across diverse Hispanic ethnic subgroups. To pursue Hispanic origin for the 1,289 Hispanic persons diagnosed with AIDS in Chicago, death certificates for those cases contained in Chicago's AIDS Reporting System (ARS) file that were decreased were examined for information on national origin; the AIDS case reporting form was modified in January 1994 to collect data on Hispanic ethnic origin; care providers were contacted for further information; and medical records were investigated to determine Hispanic ethnic origin. Ethnic origins obtained from all sources are according to patient self-report. All reference to Hispanic ethnic subgroups in this study include U.S.-born and foreign-born Hispanics. Ethnic subgroup was identified for 989 Hispanic persons (77% of the 1,289 Hispanic cases) in the ARS. Data collected indicate that for all races and across Hispanic ethnic subgroups, Puerto Ricans have had the highest annual AIDS case rate since 1987. The mode of transmission for Puerto Rican males is predominantly through injection drug use (IDU), whereas for Mexican males the predominant mode of transmission is through males having sex with other males (MSM). For all Hispanic females, heterosexual contact was the predominant mode of transmission, with the largest proportion being sex partners of IDUs. The descriptive epidemiology of AIDS across Hispanic ethnic subgroups in Chicago highlights the need to target specific interventions among Puerto Ricans. In particular, culturally sensitive interventions tailored for Puerto Rican IDUs and their sex partners are needed, as are interventions for all Hispanic females who are at increased risk for heterosexual transmission.

A nurse-delivered intervention to reduce barriers to breast and cervical cancer screening in Chicago inner city clinics

An 18-month intervention was implemented to increase breast and cervical cancer screening among poor African-American women in Chicago. Breast and cervical cancer screening programs were set up in two public clinics, one community-based and the other hospital-based. Nurse clinicians and public health workers were used in these programs to recruit women in the clinics and in targeted community institutions to receive free breast and cervical cancer screening. The following barriers were specifically addressed by the intervention: accessibility of screening, knowledge about breast and cervical cancers, access to followup screening examinations, and access to treatment. A computerized followup system was specifically designed to track patients. During the 18 months of the intervention, 10,829 visits were made by 7,654 low-income women. A total of 84 cases of breast cancer and 9 cases of cervical cancer were detected. Awareness of the program, as measured by a survey after the completion of the intervention, increased in both clinics compared with baseline results. Knowledge about breast and cervical cancers also increased, as measured by scores on tests given before and after a class on breast and cervical cancers. Followup rates were 86 percent for women attending the programs. More than 90 percent of the women referred for evaluation of breast abnormalities kept an appointment. In summary, the intervention was successful in reducing barriers to breast and cervical cancer detection and in attracting a high-risk group of women.

Breast cancer screening in an urban public hospital. Five-year results

BACKGROUND

This report describes the first 5 years of the Breast Cancer Screening Program (BCSP) at Cook County Hospital (CCH), a hospital that serves a predominantly African-American and low-income population.

METHODS

A retrospective review of hospital cancer registry staging for breast cancers diagnosed between 1984 and 1988 was performed.

RESULTS

Between 1984 and 1988, 499 new breast cancers were diagnosed at CCH, of which 33% were diagnosed after referral from the BCSP. The percentage of early breast cancers, defined as Stages 0 or 1, was 25% in women referred from the BCSP, compared with 6% for women referred from other clinical areas (P < 0.001). During this same period of time, the proportion of women at CCH with localized breast cancer increased from 30% in 1980-1983 to 40% from 1984-1988 (P < 0.05), an increase that can be attributed to the BCSP. Only 21% of the breast cancers detected by the BCSP were found by mammography alone. Of these, 91% were localized.

CONCLUSIONS

The BCSP has had an impact on the proportion of early breast cancer diagnosed at CCH. Despite these efforts, the proportion of early breast cancer diagnosed at CCH (12%) is significantly less than that seen for all African-American women with breast cancer in Illinois (32%; P < 0.001).

Race, income, and survival from breast cancer at two public hospitals

BACKGROUND

Some studies have shown that adjustment for socioeconomic status reduces breast cancer survival differences between blacks and whites. The purpose of this study is to evaluate the effect of age, race, stage, treatment, and income status on breast cancer survival among women attending public hospitals in Chicago, Illinois.

METHODS

Hospital Cancer Registry data on 887 black women and 265 white women with breast cancer onset between 1973-1985 were analyzed using Cox regression and Kaplan-Meier techniques. The purpose was to examine the effect of age, race, stage, treatment, and income on breast cancer survival.

RESULTS

Black women with breast cancer were younger and poorer than white women with breast cancer. There were no significant differences between blacks and whites with regard to stage, estrogen receptor status, or type of treatment. Black women had lower 5-year breast cancer survival rates compared to white women (50.2% versus 60.2%; P = 0.05), and survival was lower when adjusted for stage and age. However, when adjusted for income in addition to stage and age, the effect of race on survival was reduced (from relative risk = 1.26; 95% confidence interval = 1.02, 1.57 to relative risk = 1.17%; 95% confidence interval = 0.95, 1.38).

CONCLUSIONS

Income influences breast cancer survival differences between blacks and whites in this population.

Referral adherence in an inner city breast and cervical cancer screening program

BACKGROUND

Early detection and immediate follow-up treatment for cancer of the breast and cervix can reduce morbidity and mortality. This report describes adherence to follow-up appointments for suspected breast and cervical malignancies in a population of low-income black women who participated in a community-based nurse-managed screening program.

METHODS

Components of the program that were part of the intervention included the following: a consistent referral mechanism augmented by a computerized tickler system; education of women about the importance of follow-up; and active nurse assistance in the follow-up process. Referral for follow-up of suspected malignancies or for other questionable findings was made to the public sector hospital clinics (86%) or to other providers of the women's choice (14%).

RESULTS

Follow-up rates for suspected malignancies of the breast were high (92%) in this population of women, sometimes described as less likely to adhere to recommendations for continued care. In contrast, adherence rates for gynecologic conditions were lower (70%).

CONCLUSIONS

This screening program and follow-up system has relevance to systems that serve similar groups of low-income women.

Do chart reviews and interviews provide the same information about breast and cervical cancer screening?

The National Cancer Institute of the United States has set a goal for the year 2000 that 80-90% of eligible women should have a Pap smear every 3 years and that 80% of women aged 50-70 should receive an annual breast examination and mammogram. Very few studies have examined how we might best measure our progress towards this goal. Specifically, should we employ interview data or data derived from medical records? To respond to this question, data were gathered at two different public health clinics in poor areas of Chicago using both techniques. The interviews estimated significantly higher proportions of women receiving Pap smears, breast examinations, and mammograms in the previous 12-month interval than were estimated from randomly selected medical records. A review of the literature suggests the same pattern exists when other studies using these two data gathering processes are compared. We are thus left with a serious problem, one that must be resolved before we will be able to fully assess our progress in increasing breast and cervical cancer screening.

Psychopathology in epilepsy. The role of psychology in altering paradigms of research, treatment, and prevention

This article offers a brief review of the literature examining epilepsy and abnormal behavior. The generally accepted concept of epilepsy as a high psychiatric risk disorder is reexamined in light of research that has investigated the influence of selection bias. A conceptual model that organizes the known or postulated risk variables (neurological, psychosocial, and medication) is presented, with emphasis on psychology's potential contribution.

Controlled examination of effects of progressive relaxation training on seizure reduction

We determined the efficacy of progressive muscle relaxation in reducing seizure frequency. Subjects were 24 people with epilepsy attending an urban neurology clinic. The experimental design consisted of an 8-week baseline period, a treatment period of six sessions of progressive relaxation training (PRT, n = 13) or quiet sitting (QS, n = 11) and an 8-week follow up. In the PRT group, 11 subjects reported a decrease in seizure frequency (p less than 0.01), and in the QS group, 7 reported a decrease (p greater than 0.05). The mean decrease in seizure frequency was 29% for the PRT group (p less than 0.01) but only 3% for the QS group (p greater than 0.05). This is the fifth recent report of a controlled study documenting the success of progressive relaxation therapy in seizure reduction. PRT is inexpensive and noninvasive and facilitates patient participation. Such a technique should be incorporated into clinical practice.

Psychopathology in epilepsy: The role of psychology in altering paradigms of research, treatment, and prevention

This article offers a brief review of the literature examining epilepsy and abnormal behavior. The generally accepted concept of epilepsy as a high psychiatric risk disorder is reexamined in light of research that has investigated the influence of selection bias. A conceptual model that organizes the known or postulated risk variables (neurological, psychosocial, and medication) is presented, with emphasis on psychology's potential contribution.

Patterns of breast and cervical cancer screening at three public health centers in an inner-city urban area

In an effort to examine breast and cervical cancer screening patterns among poor African-American urban women, medical records were abstracted at three public health centers located in the inner city of Chicago. The proportions of eligible women at these three centers who received Pap smears, breast examinations, and mammograms were computed. These proportions were notably low and differed significantly among the three centers. Because the literature is now suggesting that an appropriate sequence best defines adequate screening, sequences of screenings were also determined and were found to be lacking. All of these screening histories fall far below the screening objectives set by the National Cancer Institute for the year 2000. This information suggests that interventions are needed that will help health centers serving poor women to deliver more frequent cancer screening.

Psychosocial predictors of psychopathology in epilepsy

The 30-item version of the GHQ was administered to 102 adults with epilepsy, and four sets of variables (neurological, psychosocial, medication, demographic) were used to predict psychiatric distress. Psychopathology was found to be associated with increased perceived stigma, elevated number of stressful life events during the past year, poor adjustment to epilepsy, financial stress, vocational problems, external locus of control, and an earlier onset of epilepsy. Multiple regression procedures reduced this list to three independent predictors of psychopathology: an increased number of stressful life events in the past year, poor adjustment to epilepsy, and financial stress.

The architecture of research in the epilepsy/psychopathology field

In order to examine how research about the relationship between epilepsy and psychopathology has proceeded, the literature that has appeared since 1966 was reviewed and 78 relevant studies were located. The variables employed in these studies (510 in all) were tabulated to determine if they examined biological variables, social variables or medication variables as etiology of psychopathology in people with epilepsy. The results indicate an overwhelming tendency to omit social variables when searching for etiological factors. It is concluded that such an omission is of theoretical and practical significance and 3 hypotheses are put forward to account for the current distribution of research efforts. Finally, the implications of such a structure of investigation are considered.

An urban community-based cancer prevention screening and health education intervention in Chicago

Most types of cancer are disproportionately present in black populations. Among all ethnic and racial groups, black people have the highest incidence of all types of cancer combined, experiencing the highest mortality and the worst survival rate. A major intervention effort has begun in Chicago, targeting women living in 10 south side community areas whose populations are almost all black and among the poorest in the city. The purposes of the intervention are to develop and evaluate ways to reduce morbidity and mortality from breast and cervical cancer. Three outcome measures are being used, the proportion of women who receive Papanicolaou smears, breast examinations, and mammograms; the scores derived from a knowledge, attitudes, and practices survey; and the stage of diagnosed cancer. The results are being evaluated in three locations, the 10 target community areas, a Chicago Health Department clinic located in the community, and Fantus Clinic at Cook County Hospital. The intervention consists of reducing barriers to care at both public clinic sites and delivering education and information within the community. Public health outreach workers who are culturally sensitive to the population bring word of the program to places frequented by women, including local businesses (such as beauty shops, grocery stores, pharmacies, and currency exchanges), public housing developments (one being the largest in the country), and facilities belonging to city services programs. The intervention was developed to permit its ready adoption in similar environments should the evaluation results prove its usefulness.

The role of the EEG in epilepsy of long duration

Although the electroencephalogram's (EEG's) relevance in the initial work-up of individuals with epilepsy is well-defined, its role in epilepsy of long duration remains uncertain. A literature survey revealed eight studies that had evaluated epileptiform patterns (EPs) in series of patients but none of these were derived from outpatients presenting for regular follow-up. Such EEG results are crucial for determining disability benefits that are often denied to people with normal records. We therefore randomly surveyed 100 adult outpatients attending the seizure follow-up clinic at Cook County Hospital. An EP was detected in 33 patients, 36 had normal records, and 31 had non-EP abnormalities. The presence of an EP was significantly related to an etiology of head injury, duration of epilepsy, age of onset before age 20 years, and receiving more than one antiepileptic drug (AED). The presence of an EP did not correlate with seizure frequency, seizure type, or presence of a neurological deficit. A prior EEG increased the proportion with an EP only to 41%. The relatively low proportion of people who demonstrated an EP suggests that (a) the presence of an EP on an EEG should not be a factor in deciding about disability benefits for individuals with epilepsy, and (b) that use of an EP as an eligibility criterion for entry into a research series is likely to generate a select group of patients, thus making it difficult to generalize results.

Ideology and violence prevention

Interpersonal violence is a major problem in US society in terms of the death and destruction it causes, the fear it generates, and the attention it receives. A recent trend has been to regard the problem of violence as an epidemic and to shape ideas of violence prevention according to public-health formulations. This process does not take into account the ideological nature of the proposed violence-prevention measures. Problems arise because this ideology is relevant to the potential effectiveness of violence prevention.This paper delineates several ideological issues involved in violence prevention and discusses how they interact with frequently employed public-health prevention strategies. Based upon this discussion, a general perspective for violence prevention is proposed and guiding principles that emerge from this perspective are presented.

The neurological, psychosocial and demographic correlates of hypergraphia in patients with epilepsy

The multiaetiological determinants and correlates of interictal hypergraphia in patients with epilepsy were studied. A variety of neurological, psychosocial and demographic variables were examined in order to determine their relationship to experimental and clinically derived measures of hypergraphia in a sample of 50 patients with epilepsy. The results indicate that hypergraphia is of multifactorial origin in general, with especially strong relationships with measures of psychopathology. These results are related to the larger literature concerned with interictal behavioural change in patients with epilepsy.

Multietiological determinants of psychopathology and social competence in children with epilepsy

The purpose of this investigation was to inquire into the multietiological determinants of psychopathology and social competence in children with epilepsy. The relationship between behavioral functioning as assessed by the Child Behavior Checklist and a variety of biological, psychosocial, medication and demographic risk factors was investigated in a sample of 183 children with epilepsy aged 6-16. Several risk factors were found to be related to each behavioral measure. The results are discussed both in terms of their implications for models of psychopathology in epilepsy as well as their relationship to previous findings in the epilepsy/psychopathology field.

Stereomicroangiography in embryologic and teratologic investigation

Vascular dysmorphogenesis is usually investigated by invasive microdissection or time-consuming reconstruction of serial sections. Stereomicroangiography (SMA) was used for detection and analysis of vascular abnormalities in a murine trisomy 13 model demonstrating pulmonary atresia. Twenty-two litters from doubly heterozygous Robertsonian translocation Rb(6.13)3Rma/Rb(5.13)70Lub male matings to NMRI females were studied. Embryos (13-17 days gestation) were prepared by umbilical vein perfusion with buffered fixative and umbilical artery perfusion with 5% AgNO3. After immersion fixation specimens were infiltrated with paraffin, mounted on stubs, and stereoradiographed at multiple angles. Transverse serial sections were prepared of the thoracic area. Thoracic vascular morphology was satisfactorily imaged and trisomy 13 embryos were correctly distinguished from normals in 105 of 120 embryos (87.5%). When independent SMA and histologic interpretations were compared anomalous vasculature was correctly identified in all 27 trisomic embryos and one control, and falsely interpreted in one normal embryo. Normal vascular morphology was demonstrated in the remaining 76 normal embryos. Separate SEM evaluation of five microdissected hearts from nontrisomic embryos following this perfusion schedule showed normal distension of the ventricular cavity and metallic silver deposition on the surface and at junctions of endocardial cells. Light microscopy revealed silver staining at the endothelial surface and within the endocardial cushions. SMA accurately records embryonic vascular morphology for rapid screening of viable embryos.

Transfers to a public hospital. A prospective study of 467 patients

In recent years there has been a dramatic increase in the number of patients transferred to public hospitals in the United States. We prospectively studied 467 medical and surgical patients who were transferred from the emergency departments of other hospitals in the Chicago area to Cook County Hospital and subsequently admitted. Eighty-nine percent of the transferred patients were black or Hispanic, and 81 percent were unemployed. Most (87 percent) were transferred because they lacked adequate medical insurance. Only 6 percent of the patients had given written informed consent for transfer. Twenty-two percent required admission to an intensive care unit, usually within 24 hours of arrival. Twenty-four percent were in an unstable clinical condition at the transferring hospital. The proportion of transferred medical-service patients who died was 9.4 percent, which was significantly higher than the proportion of medical-service patients who were not transferred (3.8 percent, P less than 0.01). There was no significant difference in the proportion of deaths on the surgical service between patients who were transferred and those who were not (1.5 vs. 2.4 percent). We conclude that patients are transferred to public hospitals predominantly for economic reasons, in spite of the fact that many of them are in an unstable condition at the time of transfer.

Effects of progressive relaxation on epilepsy: analysis of a series of cases

It is well known that stress and other environmental factors often trigger seizures in people with epilepsy but reviews of the literature show no rigorous studies of behavioral approaches to minimize stress and improve seizure control. The purpose of this study was to overcome this deficiency by studying the effects of progressive relaxation therapy on the frequency of seizures in eight intellectually intact subjects with epilepsy. All 8 experienced at least six seizures in a 3-wk. baseline period. They were then randomly placed into either Group 1, who underwent relaxation therapy during the next 3-wk. interval, or Group 2, who underwent a 3-wk. sham treatment and then a 3-wk. relaxation therapy. All 8 subjects showed decreases from baseline to treatment, indicating a significant beneficial effect of relaxation therapy for reduction of seizures. All 8 gave subjective reports of improved feelings of well-being beyond decreases in the frequency of their seizures. The implications of these results are discussed and suggestions for research are presented.

Ideology and injury prevention

Data from a recently completed study of head injuries reveal that many of these injuries, and deaths from these injuries, result from interpersonal violence and automobile accidents. Such injuries are normally difficult to prevent. In this study it was found that much of the interpersonal violence involves family members and many of the vehicle accidents, especially those that result in death, happen to pedestrians. Prevention thus becomes even more difficult. Based upon these data and observations, five categories of prevention strategies are generated and evaluated. It is determined that the four strategies usually within the domain of traditional prevention (inaction, education, legislation, and design alterations) are not likely to prevent many head injuries or injuries in general. A fifth category is thus recommended. This category requires meaningful involvement of people into work that impacts on the social and political reality of their lives. The prevailing ideology of prevention offered by the health professions is considered and is found to be in opposition to our fifth prevention category. The implications of this opposition are examined and the search for improved health is considered in this context.

Validity of the Goldberg rules for classifying psychopathology in epilepsy

The purpose of the present investigation was to inquire into the validity of Rule 1 (Normal vs Abnormal) of Goldberg's MMPI sequential diagnostic system for patients with epilepsy. One hundred and five patients with epilepsy were classified according to their psychiatric status by a rater blind to MMPI scores. Consistent with Goldberg's predictions as well as with past research on other populations, Rule 1 was completely successful in discriminating among groups of patients with epilepsy classified according to psychiatric status but was substantially less accurate in making individual classifications. We conclude that Rule 1 of Goldberg's sequential diagnostic system is valid for epilepsy.

Epilepsy in prison: elevated prevalence and no relationship to violence

The epidemiologic, clinical, and social characteristics of epilepsy were investigated in men entering the Illinois prison system and compared with a matched control group of prisoners without epilepsy. The prevalence of epilepsy was 2.4%, four times higher than the prevalence among men aged 20 to 39 in Rochester, MN. Head trauma was the probable cause of epilepsy among 45% of the prisoners with epilepsy, a much higher percentage than that reported in studies of other populations. In comparison with an age- and race-matched group of prisoners without epilepsy, the epilepsy group was not convicted of more serious or more violent crimes.

Comparative head trauma experiences in two socioeconomically different Chicago-area communities: a population study

Although a few epidemiologic studies of head injuries have appeared recently, none have examined the incidence, causes and risk factors for an inner city environment. To overcome this deficiency, the authors visited 35 hospitals and the Office of the Medical Examiner and abstracted data from every chart that described a head injury that had been sustained during a 12-month interval by residents of either of two Chicago-area communities: one located in the inner city, comprised almost entirely of blacks; the other the city of Evanston, a Chicago suburb, about 21% black and 75% white. Denominators came from the 1980 Census. Age-adjusted incidence rates, per 100,000 population, were 403 for the inner city community, 394 for Evanston blacks and 196 for Evanston whites. In each race-community category, males were about 2.5 times more likely than females to sustain a head injury. Mortality rates from head trauma were 32 for the inner city community, 19 for Evanston blacks and 11 for Evanston whites. The leading cause of head trauma and death from head trauma was interpersonal attacks for the inner city residents and vehicle accidents for Evanston residents. Community differences, revealed in this study, and in a comparison of this study with previous reports, are discussed. Finally, methodological differences among these studies are examined in an effort to determine which differences in results reflect actual differences in head trauma experience.

Sequelae associated with head injuries in patients who were not hospitalized: a follow-up survey

Data about sequelae associated with head injuries in patients presenting at a suburban hospital but not hospitalized were collected from emergency department medical records and two follow-up telephone interviews. During the study period 669 patients with head injuries were discharged from the emergency department. Of these, 288 were asked to participate in the study, 275 (95%) agreed, and 262 (91%) were eventually contacted. Participants and nonparticipants were compared on six variables and differed significantly only on age--younger patients were more likely to be included. Forty-eight hours after trauma, 52% of the respondents suffered headaches, 14% complained of dizziness, and 13% complained of drowsiness. One week after trauma, the complaints were headaches in 27%, dizziness in 11%, and drowsiness in 9%. Twenty-seven per cent had not resumed normal activity at 48 hours after trauma, and 13% had not at 1 week. Sixty-six per cent of the patients followed the patient instructions regarding head injuries.