Zinc supplementation during pregnancy: effects on selected blood constituents and on progress and outcome of pregnancy in low-income women of Mexican descent.

The effects of zinc supplementation on levels of various blood constituents and the outcome of pregnancy in 213 Hispanic women attending a prenatal clinic in Los Angeles was assessed in this double-blind study. The women were randomized into either a control (C) or a zinc-supplemented (Z) group and received similar vitamin and mineral supplements except that 20 mg zinc was added to the Z group's capsules. At the final interview, women (C + Z) with low serum Zn levels (less than or equal to 53 micrograms/dl) had higher (p less than 0.01) mean ribonuclease activity and lower (p less than 0.01) mean delta-aminolevulinic acid dehydratase activity than women with acceptable serum zinc levels. The incidence of pregnancy-induced hypertension was higher (p less than 0.003) in the C than in the Z group, but pregnancy-induced hypertension was not associated with low serum zinc levels at either the initial or final interview. The expected increase in serum copper levels was greater (less than 0.001) in women with pregnancy-induced hypertension (C + Z) than in normotensives. Except for pregnancy-induced hypertension, there was a higher incidence of abnormal outcomes of pregnancy in the noncompliers than in the compliers (C + Z).

Zinc supplementation during pregnancy in low-income teenagers of Mexican descent: effects on selected blood constituents and on progress and outcome of pregnancy.

As a follow-up of our study of pregnant women, we report effects of zinc supplementation during pregnancy in another population of 138 Hispanic teenagers in Los Angeles. Teenagers were randomized (double-blind) to a control or zinc-supplemented group and received similar daily vitamin and mineral supplements except for 20 mg zinc added to the zinc-supplemented group's capsules. Initially, mean dietary zinc intakes of both groups were about 50% of the Recommended Dietary Allowance and their mean serum zinc levels did not differ significantly (69.8 +/- 11.2 micrograms/dl in control and 69.0 +/- 11.4 micrograms/dl in zinc-supplemented group). Zinc supplementation did not maintain mean serum zinc levels during pregnancy but, as in our earlier study, it reduced (p = 0.018) the number of low serum zinc values (less than or equal to 53 micrograms/dl) in late pregnancy. Zinc supplementation did not affect outcome of pregnancy but serum zinc levels were lower (p = 0.038) in teenagers with pregnancy-induced hypertension than in normotensives.

Risk factors and outcomes associated with identification of Aspergillus in respiratory specimens from persons with HIV disease. Pulmonary Complications of HIV Infection Study Group.

STUDY OBJECTIVES: To examine the significance of previously suggested risk factors and assess outcomes associated with Aspergillus identification in respiratory specimens from HIV-seropositive individuals. DESIGN: This was a nested case-control study. Patients who had Aspergillus species identified in respiratory specimens were matched at the time of study entry 1:2 with control subjects according to study center, age, gender, race, HIV transmission category, and CD4 count. SETTING: The multicenter Pulmonary Complications of HIV Infection Study. PARTICIPANTS: HIV-seropositive study participants. MEASUREMENTS AND RESULTS: Between November 1988 and March 1994, Aspergillus species were detected in respiratory specimens from 19 (1.6%) participants. The rate of Aspergillus identification among participants with CD4 counts <200 cells per cubic millimeter during years 2 through 5 after study entry ranged from 1.2 to 1.9%. Neutropenia, a CD4 count <30 cells per cubic millimeter, corticosteroid use, and Pneumocystis carinii infection were associated with subsequent identification of Aspergillus in respiratory specimens. Cigarette and marijuana use, previously suggested risk factors, were not associated with Aspergillus respiratory infection. A substantially greater proportion of patients with Aspergillus compared with control subjects died during the study (90% vs 21%). Excluding four cases first diagnosed at autopsy, 67% died within 60 days after Aspergillus was detected. CONCLUSIONS: Although Aspergillus is infrequently isolated from HIV-infected persons, the associated high mortality would support serious consideration of its clinical significance in those with advanced disease and risk factors.

Nonspecific airway hyperresponsiveness in HIV disease. Pulmonary Complications of HIV Infection Study Group.

OBJECTIVES: HIV disease is frequently complicated by episodic acute bronchitis, suggesting the presence of chronic bronchial inflammation. To further examine this concept, we investigated the possible association of nonspecific airway hyperresponsiveness (AHR) and HIV disease. DESIGN: Methacholine inhalation challenge studies were performed on 66 HIV-seropositive and 8 HIV-seronegative members of the Pulmonary Complications of HIV Infection Study Cohort. AHR was defined as 20% or more decline in FEV1 from the postdiluent value after inhalation of 125 or less cumulative breath units. The prevalence of AHR in HIV-seropositive cohort members was compared with that in matched control subjects who had undergone methacholine challenge testing for two unrelated studies. Demographic, behavioral, and clinical features in HIV cohort members with and without AHR were contrasted. The relationship between AHR and the occurrence of episodic airway disease or symptoms suggestive of airway disease was examined. RESULTS: AHR was not more prevalent in HIV-seropositive cohort members than control subjects (19.3% vs 12.9%; p > 0.1). Within the cohort, AHR was detected more frequently in members with than without a history of asthma (60% vs 16%; p < 0.05). A greater proportion with than without AHR had 1 or more episode of pneumonia within 2 years (46% vs 9%; p < 0.01), 1 or more asthma episode during the study period (39% vs 1.9%; p < 0.001), or wheeze noted during clinic visits (62% vs 17%; p < 0.01). The proportion that experienced acute bronchitis did not differ in the two groups. CONCLUSIONS: This study suggest that HIV-infected persons do not have increased prevalence of nonspecific AHR. In HIV disease, AHR is associated asthma, but not episodic acute bronchitis. Thus, the possibility that airway injury without demonstrable AHR might complicate HIV disease remains.

Identifying a limited number of foods important in supplying selected dietary nutrients.

Three methods were developed to identify a limited number of foods that are important dietary contributors of fat, dietary fiber, and vitamins A, C, and E. In the first method, foods were ranked by the amount of each nutrient supplied per person per day and the effect each food had on the relative ranking of individuals with respect to the intake of those nutrients. Foods scoring high on both scales for a given nutrient were selected as important dietary contributors of that nutrient. In the second method, foods were selected according to the mean nutrient contribution per consumer (nonconsumers of a food were eliminated from this estimation procedure). In the third method, foods were selected that contributed a relatively large percentage of the total dietary intake of a given nutrient. The three methods were applied to data from an extensive dietary questionnaire. The authors then compared the limited lists of foods identified by each method. Generally, the methods yielded similar food lists. Regression analysis was then employed to test the ability of the selected foods to predict the nutrient totals calculated from the original, more extensive dietary questionnaire. The results suggest that a limited number of foods may have strong predictive ability, but that has not been tested in any other population.

Health habits and risk factors among truck drivers visiting a health booth during a trucker trade show.

PURPOSE: The purpose of this report is to provide general information on the personal characteristics, health status, and health interests reported by long-haul truck drivers. DESIGN: A cross-sectional survey was conducted based on a convenience sample. Statistical independence between comparison groups for driver type, age, and gender were tested with the Pearson chi-square test. SETTING: The study population consisted of truck drivers who stopped at one of 65 truck stops participating in a trucker trade show. SUBJECTS: Subjects were 2,945 male self-identified truck drivers and 353 female self-identified truck drivers who visited health booths at the trade show. It was estimated that two thirds of visitors to the health booth participated. MEASURES: A self-administered, close-ended questionnaire recorded the participant's personal characteristics, health status, and health interests. Blood pressure was measured by trained volunteers. RESULTS: A large percentage of male truck drivers smoked cigarettes (54% vs. 30% of U.S. white males), did not exercise regularly (92%), were overweight (50% vs. 25% of U.S. white males), and/or were not aware they had high blood pressure (66% vs. 46% of U.S. population). Also, 23% of surveyed truck drivers tested positive on one measure of alcoholism. CONCLUSIONS: Although a scientific sample frame was not used, the health status and lifestyle observed in this study suggest truck drivers would clearly benefit from a health education and promotion program. The truck stops should be evaluated as a possible setting for such a program.

Cigarette smoking and lead levels in occupationally exposed lead workers.

One hundred eleven workers at a secondary Pb smelter were surveyed to determine smoking and personal hygiene habits. Fifty-three percent of the smokers had blood Pb levels in excess of 60 micrograms/dl, compared to 31% of nonsmokers (p = 0.02). Among smokers, 66% of "heavy" smokers (greater than or equal to 1 pack a day) had blood Pb levels over 60 micrograms/dl, compared to 39% of the "light" smokers (p = 0.05). Those who kept their cigarettes on their person had a higher proportion of blood Pb greater than 60 micrograms/dl than workers who kept their cigarettes elsewhere (63 versus 36%, respectively; p = 0.08). The difference in blood Pb levels between smokers and nonsmokers may be due in part to direct environmental contamination of cigarettes or impaired lung clearance mechanisms, and could be important in workers with already elevated blood Pb levels.

Subclinical effects of chronic increased lead absorption--a prospective study. I. Study design and analysis of symptoms.

Seventy workers exposed to lead for at least one year and 35 control workers have been enrolled in a prospective study of possible neurologic effects of chronic lead absorption at or below the current standard of 80 microgram per 100 ml whole blood. The study design is described in detail. Initial results of analysis of lead-related symptoms from baseline studies indicate few differences between the exposed and nonexposed workers. The majority of differences were for central nervous system (CNS) symptoms and muscle or joint pain. Little correlation was found between symptom reporting and indices of lead absorption. The evidence suggests that factors other than lead absorption itself may be important in symptom reporting.

Subclinical effects of chronic increased lead absorption--a prospective study. Part IV. Evaluation of heme synthesis effects.

The effects of lead exposure on heme synthesis in workers with subclinical responses and in controls were evaluated. delta-Aminolevulinic acid dehydratase (ALA-d) correlated significantly with blood lead levels in the control group but not with those in the exposed group. Free erythrocyte protoporphyrin correlated significantly with blood lead levels in the exposed group but not with those in the controls and was found to be a good indicator of blood lead history among exposed persons. Hemoglobin values determined at initial employment were not statistically different from those determined during the baseline test for a group of 12 workers with a maximum blood lead level of 86 micrograms/100 ml during their exposure history. The effect such heme inhibition may have on other body functions is uncertain.

Subclinical effects of chronic increased lead absorption--a prospective study. III. Neurologic findings at follow-up examination.

Neurologic examination, nerve conduction testing and electro-oculographic testing have been performed at a baseline examination and a follow-up examination in a group of lead workers with blood lead levels predominantly between 60 and 80 micrograms/dl and in a group of control workers. A statistically significant decreased saccade accuracy measurement in the lead workers compared to the controls was found at both examinations. No other simple test or pattern of findings differentiated between the lead workers and the controls, and the biological significance of the lower saccade accuracy is not clear. Nerve conduction measurements do not appear to be a satisfactory method of detecting subclinical neurologic effects of lead exposure.

Respiratory disease trends in the Pulmonary Complications of HIV Infection Study cohort. Pulmonary Complications of HIV Infection Study Group.

We examined trends in the incidence of specific respiratory disorders in a multicenter cohort with progressive human immunodeficiency virus (HIV) disease during a 5-yr period. Individuals with a wide range of HIV disease severity belonging to three transmission categories were evaluated at regular intervals and for episodic respiratory symptoms using standard diagnostic algorithms. Yearly incidence rates of respiratory diagnoses were assessed in the cohort as a whole and according to CD4 count or HIV transmission category. The most frequent respiratory disorders were upper respiratory tract infections, but the incidence of lower respiratory tract infections increased as CD4 counts declined. Specific lower respiratory infections followed distinctive patterns according to study-entry CD4 count and transmission category. Acute bronchitis was the predominant lower respiratory infection of cohort members with entry CD4 counts > or = 200 cells/mm3. In cohort members with entry CD4 counts of 200 to 499 cells/mm3, the incidence of bacterial and Pneumocystis carinii pneumonia each increased an average of 40% per year. In members with entry CD4 counts < 200 cells/mm3, acute bronchitis, bacterial pneumonia, and P. carinii pneumonia occurred at high rates without discernible time trends, despite chemoprophylaxis in more than 80% after Year 1, and the rate of other pulmonary opportunistic infections increased over time. Each year, injecting drug users had a higher incidence of bacterial pneumonia than did homosexual men. The yearly rate of tuberculosis was < 3 episodes/100 person-yr in each entry CD4 and HIV-transmission group. We conclude that the time trends of HIV-associated respiratory disorders are determined by HIV disease stage and influenced by transmission category. Whereas acute bronchitis is prevalent during all stages of HIV infection, incidence rates of bacterial pneumonia and P. carinii pneumonia rise continuously during progression to advanced disease. In advanced disease, the incidence of acute bronchitis, bacterial pneumonia and P. carinii pneumonia is high despite widespread chemoprophylaxis.

Subclinical effects of chronic increased lead absorption--a prospective study. II. Results of baseline neurologic testing.

This report summarizes the results of baseline neurologic testing in a group of apparently healthy workers from a secondary lead smelter and a group of controls from nearby aluminum processing plants. The test battery included a standard neurologic examination nerve conduction measurements, quantitative oculomotor function tests and detailed audiologic studies. Lead workers and controls were intermixed so that the examiners were unaware of the status of any individual being tested. Although the lead workers reported significantly more neurologic symptoms than the controls, relatively few differences were found on quantitative neurologic testing. Decreased deep tendon reflexes occured more frequently in the lead workers than in the controls (22% vs. 11%) but the difference was of borderline significance (p=0.06) and other signs of peripheral neuropathy occurred with equal frequency in both groups. The mean motor conduction velocity and sensory latency measurements were not significantly different in the lead workers and in the controls and, of the six oculomotor function measurements, only the mean accuracy of saccadic eye movements was significantly (p less than 0.01) different in the two groups. High frequency hearing loss occurred with equal frequency and severity in both groups, consistent with the level of noise exposure in the lead and control plants.