RESUMEN
Public health policy decisions in the United States have resulted in 62.4% of the population having access to fluoridated water. The purpose of this study was to examine the association between community water fluoridation and osteosarcoma. A secondary data analysis was performed with data collected from 2 separate but linked studies. Patients for phase 1 and phase 2 were selected from US hospitals via a matched case-control study design. For both phases, cases included patients diagnosed with osteosarcoma, and controls were patients diagnosed with other bone tumors or nonneoplastic conditions. In phase 1, cases (n = 209) and controls (n = 440) were patients of record in the participating orthopedic departments from 1989 to 1993. In phase 2, cases (n = 108) and controls (n = 296) were incident patients who were identified and treated by orthopedic physicians from 1994 to 2000. This analysis included all patients who met eligibility criteria on whom we had complete data on covariates, exposures, and outcome. Conditional logistic regression was used to estimate odds ratios (ORs) and 95% CIs for the association of community water fluoridation with osteosarcoma. A modestly significant interaction existed between fluoridation living status and bottled water use (P = 0.047). The adjusted OR for osteosarcoma and ever having lived in a fluoridated area for nonbottled water drinkers was 0.51 (95% CI, 0.31 to 0.84; P = 0.008). In the same comparison, the adjusted OR for bottled water drinkers was 1.86 (95% CI, 0.54 to 6.41; P = 0.326). Findings from this study demonstrated that community water fluoridation is not associated with an increased risk for osteosarcoma.
Asunto(s)
Neoplasias Óseas , Fluoruración , Osteosarcoma , Adolescente , Adulto , Neoplasias Óseas/epidemiología , Estudios de Casos y Controles , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Oportunidad Relativa , Osteosarcoma/epidemiología , Osteosarcoma/etiología , Estados Unidos/epidemiología , Abastecimiento de Agua , Adulto JovenRESUMEN
OBJECTIVE: To determine predictors of the occurrence of systemic lupus erythematosus (SLE) in patients with early (< or = 1 yr) undifferentiated connective tissue disease (CTD). METHODS: Analysis of a cohort of 213 patients with early undifferentiated CTD at entry, followed for 5 yrs at 11 tertiary centers. Baseline demographic, clinical, and laboratory data were compared using univariate and Cox multivariate regression analyses to identify possible predictive features for the subsequent occurrence of SLE. RESULTS: 143 of 213 patients had ascertainable clinical status at 5 yrs. By univariate analyses those who evolved to SLE (13%) were more likely to be younger, African-American, and to have alopecia, serositis, discoid lupus, positive Coombs' test, positive anti-dsDNA and anti-Sm antibodies, positive ANA (homogeneous pattern), and/or a false positive test for syphilis. Discoid lupus (relative risk = 15.8), serositis (4.1), ANA-homogeneous (4.8), and anti-Sm positivity (28.2) were retained as predictors of the occurrence of SLE in the Cox regression model. CONCLUSION: Some clinical and laboratory features in patients with early undifferentiated CTD can predict the subsequent occurrence of SLE.
Asunto(s)
Lupus Eritematoso Sistémico/diagnóstico , Lupus Eritematoso Sistémico/epidemiología , Adulto , Artritis/diagnóstico , Artritis/epidemiología , Estudios de Cohortes , Dermatomiositis/diagnóstico , Dermatomiositis/epidemiología , Progresión de la Enfermedad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Valor Predictivo de las Pruebas , Pronóstico , Enfermedad de Raynaud/diagnóstico , Enfermedad de Raynaud/epidemiología , Factores de Riesgo , Sarcoidosis/diagnóstico , Sarcoidosis/epidemiología , Esclerodermia Sistémica/diagnóstico , Esclerodermia Sistémica/epidemiologíaRESUMEN
OBJECTIVE: To identify different subsets of patients from a large tertiary care center who were presumptively referred for and/or diagnosed with systemic lupus erythematosus (SLE) (or followed up). METHODS: All patients who were referred, followed up, and/or diagnosed with SLE at our center, who had disease duration of < or = 5 years, and who resided in Alabama, were identified and their charts reviewed and abstracted. RESULTS: Abstracted data were reviewed by 3 rheumatologists, and patients were assigned to 1 of 3 categories: 1) SLE by the American College of Rheumatology (ACR; formerly, the American Rheumatism Association) criteria, 2) clinical SLE but not meeting 4 of the ACR criteria, or 3) fibromyalgia-like manifestations with antinuclear antibody (ANA) positivity. There were 90 patients in the first group (criteria), 22 in the second group (clinical), and 37 in the third group (fibromyalgia-like). Patients in all 3 groups were predominantly women. Only 5% of the fibromyalgia-like group were African-American, compared with 55-65% for the other 2 groups. Organ system involvement occurred with comparable frequency in the first 2 groups, but mucocutaneous and hematologic abnormalities were more frequent in the criteria group; in contrast, the patients with fibromyalgia-like symptoms primarily presented with arthralgias/myalgias, fatigue, depression, and sleep disturbances, as well as mucocutaneous manifestations. CONCLUSION: When the ACR criteria for SLE are used to determine eligibility for lupus studies, a group of patients with clinically unequivocal SLE are excluded. A group of patients with fibromyalgia-like manifestations, who test positive for ANA and differ clinically and sociodemographically from the patients in the other 2 groups, very likely do not belong within the spectrum of SLE.
Asunto(s)
Lupus Eritematoso Sistémico/clasificación , Adulto , Diagnóstico Diferencial , Femenino , Fibromialgia/complicaciones , Fibromialgia/diagnóstico , Estudios de Seguimiento , Humanos , Lupus Eritematoso Sistémico/complicaciones , Lupus Eritematoso Sistémico/diagnóstico , Masculino , Persona de Mediana Edad , Derivación y Consulta , Factores de TiempoRESUMEN
Features of fetal motor responsivity include both the magnitude of the startle response elicited by a single stimulus (i.e., basal reactivity) and the ease by which responding to successive stimuli is inhibited (i.e., habituation). We examined basal motor reactivity and habituation of the motor response in 56 normal human fetuses between 34 and 40 weeks of gestation. Testing consisted of 8 trials of a 1-sec vibroacoustic stimulus (VAS) with a 10-sec interstimulus interval. A score of 0-10 was assigned for each trial based on subjective assessment of intensity and duration of the fetal motor response. Measures of habituation included the ratio of responding after a fixed number of trials divided by the initial response, and the rate of change in the behavioral response over trials. No relationship was found between the rate of motor habituation and either basal reactivity, gestational age, or prestimulus fetal heart rate (FHR) variability. In contrast, more mature fetuses responded less intensely to the first stimulus than did their younger counterparts (r = -0.329, p = 0.005), and fetuses who were initially in a quiet state exhibited a more vigorous startle response as compared to fetuses who were initially in a more active state (r = -0.372, p = 0.001). The relationship between basal reactivity and prestimulus FHR variability was statistically significant even after controlling for gestational age (r = 0.295, p = 0.01). These findings may have important clinical implications regarding the appearance in early life of certain behavioral tendencies such as temperament.
Asunto(s)
Movimiento Fetal/fisiología , Feto/fisiología , Habituación Psicofisiológica/fisiología , Desempeño Psicomotor/fisiología , Cognición/fisiología , Femenino , Edad Gestacional , Frecuencia Cardíaca Fetal/fisiología , Humanos , Embarazo , Temperamento/fisiologíaRESUMEN
The purpose of this study was to determine if discriminant analysis could be used to categorize fetal heart rate (FHR) - fetal eye movement (FEM) patterns. Statistical characteristics from 27 normal human fetuses at term for behavioral states, transitions, and insertions were established by combining the digitized FHR-FEM data for subjectively identical epochs. The mean FHR, the variance about the mean, and the presence or absence of FEM were calculated for each 3-min block in a sliding moving window with a 1-min step size. For each fetus, discriminant analysis was then used to assign 3-min blocks to either a behavioral state, a transition, or an insertion by comparing the statistical properties of a 3-min block with that of the data base. We found no difference between discriminant analysis and visual assignment in the average time spent in behavioral states 1F, 2F, and 4F, or in the mean duration of the transition/insertion periods. There was a highly significant linear relationship between computer-generated and visually-determined durations for behavioral states 1F (r = 0.972, p < 0.0001) and 2F (r = 0.989, p < 0.0001) and for the transition/insertion periods (r = 0.863, p < 0.0001). We conclude that discriminant analysis is a reliable computer-based method for behavioral state identification.
Asunto(s)
Análisis Discriminante , Movimientos Oculares , Feto/fisiología , Frecuencia Cardíaca Fetal , Femenino , Humanos , EmbarazoRESUMEN
To determine the relative merits of primary percutaneous transluminal coronary angioplasty (PTCA) and intravenous thrombolytic therapy for acute myocardial infarction, 12 tertiary care hospitals entered patients who had > or = 30 minutes of chest pain and were admitted to a cardiac intensive care unit within 12 hours of symptom onset into a prospective registry. Of 1,170 such patients, 118 (10%) underwent primary PTCA and 230 (19%) received intravenous thrombolytic therapy within 6 hours of registry hospital admission (144 at the registry hospital and 86 prior to arrival at the registry hospital). Baseline demographic characteristics of PTCA and thrombolytic subgroups were remarkably similar. The interval from initial evaluation at the registry hospital to treatment was shorter with intravenous thrombolytic therapy than with primary PTCA (64 vs 104 minutes, p < 0.001), as was the interval from pain onset to treatment (184 vs 252 minutes, p < 0.001). Among the 230 thrombolytic patients, coronary arteriography and PTCA were performed within the first 24 hours in 44% and 18%, respectively, and during the entire hospitalization in 90% and 49%, respectively. During hospitalization, blood was transfused in 16% of the 230 thrombolytic patients versus 5.9% of the 118 PTCA patients (p < 0.001). Otherwise, adverse events during the initial hospitalization were similar in PTCA and thrombolytic groups. Survival at 1-year follow-up was 88% in the PTCA group and 91% in the thrombolytic group (p = NS), and survival free of reinfarction was 85% and 88%, respectively (p = NS).(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Angioplastia Coronaria con Balón , Infarto del Miocardio/tratamiento farmacológico , Infarto del Miocardio/terapia , Terapia Trombolítica , Adulto , Anciano , Anciano de 80 o más Años , Angioplastia Coronaria con Balón/métodos , Transfusión Sanguínea , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Estudios Prospectivos , Sistema de Registros , Estudios Retrospectivos , Factores de Riesgo , Estreptoquinasa/uso terapéutico , Tasa de Supervivencia , Terapia Trombolítica/métodos , Factores de Tiempo , Resultado del Tratamiento , Activador de Plasminógeno de Tipo Uroquinasa/uso terapéuticoRESUMEN
OBJECTIVE: To determine the frequency, the clinical and laboratory associations, and the impact on survival of anti-dsDNA, anti-Sm, anti-nRNP, anti-Ro, and anti-La in patients with systemic lupus erythematosus (SLE). METHODS: The clinical and laboratory features of 94 patients with SLE tested for anti-dsDNA, anti-nRNP, anti-Sm, anti-Ro and anti-La were studied. Survival analyses were performed by the Kaplan Meier method. RESULTS: Anti-Ro, anti-nRNP and anti-Sm were found with lower frequency in our patients compared to other reports. There was a higher frequency of anti-Sm (19.5 vs 10%, p = 0.0093) and anti-nRNP positivity (29.2 vs 7.5%, p = 0.006) among African American patients compared to Caucasian patients. No clinical or laboratory associations were found with any of the autoantibodies. Patients had a mean followup up 11.8 years. There were no protective or negative effects of the different autoantibodies on the probability of survival of the patients studied. CONCLUSION: Our study failed to demonstrate the impact of the autoantibodies studied in the survival of our patients.
Asunto(s)
Autoanticuerpos/sangre , Lupus Eritematoso Sistémico/inmunología , Ribonucleoproteínas Nucleares Pequeñas , Adulto , Anticuerpos Antinucleares/sangre , Autoantígenos , Femenino , Humanos , Lupus Eritematoso Sistémico/mortalidad , Masculino , Persona de Mediana Edad , Pronóstico , Análisis de Supervivencia , Proteínas Nucleares snRNPRESUMEN
OBJECTIVE: To determine the frequency and clinical and HLA associations of anticardiolipin (aCL) antibodies in patients with systemic lupus erythematosus (SLE), as well as their impact on survival. METHODS: We studied 139 patients with SLE seen at a university based practice. We tested for clinical, laboratory, and HLA associations with levels of aCL antibody isotypes either in sera available in the bank (distant past) or in 2 samples. Demographic, clinical, laboratory, and HLA data were subjected to univariate survival analysis; variables of importance were entered into Cox multivariate regression analyses. RESULTS: aCL antibodies (any isotype) were present in 57 (41.0%) of the 139 patients tested in the distant past sample, and in 23 (32.3%) as a persistent event in the 71 patient subgroup tested twice. IgG aCL were significantly associated with deep venous thrombosis (DVT) (p = 0.04). No other clinical or HLA association was found with aCL positivity. In the survival analyses, older age at diagnosis, presence of major infections, endstage renal disease, and IgM aCL antibody positivity in the distant past emerged as important independent factors adversely affecting survival. In the subgroup tested twice for aCL antibodies (n = 71), persistent IgM aCL antibody positivity (n = 10) emerged as an important independent factor. Among the subgroup of patients that had HLA data available (n = 88), HLA-DQw7 and thromboembolic events also adversely affected survival. CONCLUSION: We confirmed the association of IgG aCL antibody positivity with DVT, and the impact on survival of endstage renal disease, major infections, and older age at diagnosis. IgM aCL antibody positivity present either as an isolated event in the distant past or as a persistent finding, thromboembolic events, and HLA-DQw7 emerged as important prognostic factors.
Asunto(s)
Anticuerpos Anticardiolipina/análisis , Antígenos HLA/análisis , Lupus Eritematoso Sistémico/inmunología , Lupus Eritematoso Sistémico/mortalidad , Adulto , Causas de Muerte , Femenino , Antígenos HLA-DQ/análisis , Humanos , Lupus Eritematoso Sistémico/fisiopatología , Masculino , Persona de Mediana Edad , Análisis Multivariante , Índice de Severidad de la Enfermedad , Análisis de SupervivenciaRESUMEN
The purpose of this study was to compare two different methods for assessing fetal heart rate (FHR)--fetal eye movement (FEM) synchronization: (1) periods of high (HV) and low (LV) variability in the FHR and the presence (EM) and absence (NEM) of FEM were determined by visual inspection and the degree of association between FHR and FEM was assessed in terms of the fraction of study time for which no periods of LV-NEM and HV-EM could be identified; and (2) the maximum cross-correlation coefficient (rmax) and the lag at rmax (Lmax) were determined by direct computer analysis of FHR and FEM data for each fetus. Twenty normal human fetuses between 38 and 40 weeks of gestation were examined for a total of 2051 min (mean 103 min, range 72-150 min). In general, the state HV-EM was observed approximately twice as often as was the state LV-NEM; neither of these two states could be identified during 12.4% of the study time. The coefficient rmax was calculated assuming a sliding 3-min moving window, using either the average FHR (mean 0.53, range 0.31-0.85) or the variability in the FHR (mean 0.52, range 0.18-0.77). No relationship was found between rmax and Lmax calculated using the mean FHR and the fraction of time for which no state could be identified (P = 0.995). When the cross-correlation analysis was performed using FHR variability, a statistically significant relationship was found between the periods of no coincidence (of states LV-NEM and HV-EM) and rmax and Lmax (r2 = 0.32; P = 0.04).(ABSTRACT TRUNCATED AT 250 WORDS)