Freckles and solar lentigines have different risk factors in Caucasian women.

BACKGROUND: To date, few epidemiological data on the relationships between solar lentigines, freckles and behavioural and constitutional risk factors in Caucasian populations exist. OBJECTIVES: To investigate the potential impact of behavioural and phenotypic variables, as well as the MC1R genetic background, on the history of facial freckles and the severity of solar lentigines in Caucasian women. METHODS: The severity of solar lentigines was graded from facial digital images of 523 French middle-aged women by a dermatologist and summarized by a score afterwards. The history of facial freckles was assessed and the sun-exposure behaviour was characterized using a six-category typology. Risk factors including MC1R polymorphism were evaluated using logistic regression models. RESULTS: Two constitutive host factors were found to be independently associated with a history of facial freckles: frequent sunburns and the presence of diminished function variants of the MC1R gene. In addition to age, five factors were independently associated with solar lentigines: constitutive host factors (dark skin colour and tanning capacity), a history of freckles, sun-exposure behaviour and current intake of oral contraceptive or progestogen treatments. CONCLUSION: These results strengthen the hypothesis that solar lentigines are markers of photoaging, whereas freckles are mainly determined by genetic factors. The finding that hormonal treatment is associated with a higher risk for solar lentigines merits further investigations.

Artificial and natural ultraviolet radiation exposure: beliefs and behaviour of 7200 French adults.

BACKGROUND: Despite the increasing use of indoor tanning facilities, little is known regarding the behaviour of adults with respect to artificial and natural ultraviolet (UV) radiation exposure and the relationship between the two forms of exposure. OBJECTIVES: To describe the beliefs and behaviour of French middle-aged volunteers regarding artificial and natural UV exposure. METHODS: Cross-sectional study of a French national cohort using a self-completed questionnaire. RESULTS: Participants were identified as 'indoor UV tanners' (n= 1076) and as 'non-users' (n= 6124). Predictor factors associated with indoor tanning were gender, age, smoking, phototype, region of residence, sun exposure during hobbies, voluntary sun exposure in particular during the hottest hours of the day, nudism practice, facial sunscreen habits, sunglass use, importance for lying in the sun and the claim 'ever heard of melanoma'. LIMITATIONS: The quality of information may be limited by the data collection method. CONCLUSION: Whereas indoor tanning should be discouraged, it seems that indoor tanners are also regular sunbathers unconcerned about the risk of photoageing and skin cancer occurrence. Moreover, indoor tanners seem to have more behavioural risk factors for cancer, such as smoking.

[Phototype, vitamin D status and bone mineral density among women at risk of osteoporosis]. / Phototype, statut en vitamine D et densité minérale osseuse chez des femmes à risque d'ostéoporose.

PURPOSE: The aim of this study was to test the influence of phototype and vitamin D status feature on the bone mineral density (BMD) of the femoral neck in a group of middle-aged women considered at risk of osteoporosis (low levels of vitamin D [25(OH)D3<78 nmol/L] and hyperparathyroidism [parathormone level>36 pg/mL]). METHODS: This two-step study was conducted on 122 French women enrolled in the SUVIMAX (supplémentation en vitamines et minéraux antioxydants: antioxidant vitamin and mineral supplementation) cohort. The impact of various variables on BMD, including age, body mass index (BMI), vitamin D status, alcohol intake, sun exposure intensity and phototype was investigated using regression models. RESULTS: No statistical link was found between BMD and the variables documenting vitamin D status and parathormone levels, nor phototype. Nevertheless, fair phototypes tended to be associated with lower BMD values. However, BMD decreased with age and increased with BMI and physical activity level. CONCLUSIONS: Whatever their phototype, adult women concerned about precarious vitamin D status should undergo a vitamin D supplementation in combination with an adequate calcium intake all year long and a proper sun protection. Moreover, a physical activity maintenance should provide an additional benefit for prevention of osteoporosis.

The utility of peak flow, symptom scores, and beta-agonist use as outcome measures in asthma clinical research.

STUDY OBJECTIVES: Several methods of utilizing peak expiratory flow (PEF) and other markers of disease activity have been suggested as useful in the management of asthma. It remains unclear, however, as to which surrogate markers of disease status are discriminative indicators of treatment failure, suitable for use in clinical trials. DESIGN: We analyzed the operating characteristics of 66 surrogate markers of treatment failure using a receiver operating characteristic (ROC) curve analysis. PARTICIPANTS: Information regarding FEV(1), symptoms, beta(2)-agonist use, and PEF was available from 313 subjects previously enrolled in two Asthma Clinical Research Network trials, in which 71 treatment failures occurred (defined by a 20% fall in FEV(1) from baseline). INTERVENTIONS: None. MEASUREMENTS AND RESULTS: None of the measures had an acceptable ability to discriminate subjects with a > or % fall in FEV(1) from those without, regardless of the duration of the period of analysis or the criteria for test positivity employed. Areas under the ROC curves generated ranged from 0.51 to 0.79, but none were statistically superior. Sensitivity and specificity combinations were generally poor at all cutoff values; true-positive rates could not be raised without unacceptably elevating false-positive rates concurrently. CONCLUSIONS: Studies that seek to detect treatment failure defined by a significant fall in FEV(1) should not use such individual surrogate measures to estimate disease severity.

Hormone replacement therapy usage: a 10 year experience of a solo practitioner.

The objective of this study was to identify factors affecting hormone replacement therapy (HRT) usage among patients of a single physician. All active patients (n = 330) given a HRT prescription over the past 10 years (1985-1995) by the physician were sent a questionnaire on health knowledge, lifestyle patterns, general medical and reproductive histories, responses to HRT usage and decision-making about HRT use. A total of 214 useful questionnaires were returned giving a response rate of 65%. For this cohort, the length of HRT use for those still taking HRT was 60 months; and for those no longer taking HRT, it was 32 months; and 85% of those ever given an HRT prescription were still using HRT at the time of survey. The educational backgrounds, exercise patterns, health knowledge, medical and reproductive histories of this group were representative of those found among suburban postmenopausal women in central Pennsylvania. Among this cohort, the most important reason for them taking HRT was the physicians' recommendation.

Assessment of sun reactive skin type with multiple correspondence analysis, hierarchical and tree-structured classification methods.

The sun reactive skin type classification is based on sunburn susceptibility, tanning ability and phenotypic information. As subjects rarely match all features of a given skin type, the attribution to a class is partially subjective. The aims of the study, were to analyse the contribution of each characteristic to the classification made by the expert, and to establish a classification based on a statistical approach conducted on 212 women living in the Ile-de-France area. Multiple regression was used to construct a formula for each phototype. The coefficients obtained demonstrated that the importance of each characteristic was extremely variable from one phototype to another, suggesting that the phototype determination could be facilitated by adding a weight for every characteristic in the decision. Then, multiple correspondence analysis and clustering analysis methods showed that one phototype could be divided into two more homogenous classes.

Reference ranges of skin micro-relief according to age in French Caucasian and Japanese women.

BACKGROUND/PURPOSE: The variation of skin surface morphological indicators according to age has not been frequently studied. The aim of this work was to establish French Caucasian and Japanese reference ranges of these indicators according to age. METHODS: Two studies were performed simultaneously in Paris and Sendai on 356 Caucasian and 120 Japanese healthy women aged from 20 to 80 years. Skin replicas were obtained from the volar forearm and analysed by interferometry. This analysis yielded 16 morphological indicators. Reference ranges according to age were established using the statistical methodology defined by Royston. RESULTS/DISCUSSION: Reference ranges were found for 15 out of the 16 parameters for the French women as well as for the Japanese women. The models' truthfulness will have to be confirmed using new samples, larger if possible. Moreover, non-parametric methods will be used in order to compare the results provided by these approaches.

Self-reported skin sensitivity in a general adult population in France: data of the SU.VI.MAX cohort.

OBJECTIVE: This study aimed to examine the frequency of self-assessed facial skin sensitivity and its different patterns, and the relationship with gender and sun sensitivity in a general adult population. METHODS: A standardized 11-item questionnaire investigating reactions experienced during the past year was developed. The questions explored different patterns of skin sensitivity: pattern I (blushing related to vascular reactivity), pattern II (skin reactions to certain environmental conditions), pattern III (skin reactions after substance contact), and for women pattern IV ('breakout of spots' related to menstrual cycle). Additional items were addressed for women and men, including sun sensitivity. The questionnaire was administered to a large middle-aged population involved in the 'Supplément en Vitamines et Minéraux Antioxydants' (SU.VI.MAX) cohort. RESULTS: Sensitive facial skin was reported by 61% of the women (n = 5074) and 32% of the men (n = 3448), and the frequency decreased with age. The frequency of patterns I, II and III was greater for women (78, 72 and 58%, respectively) than for men (56, 48 and 28%) of comparable classes of age. The frequency of pattern IV was reported by 49% of premenopausal women, and skin reactions after shaving by 41% of the men. Sun sensitivity was found to be a major component of skin sensitivity. Factor analysis showed that individuals with fair phototype frequently evoked reactions associated with pattern I, and skin redness and burning sensations were related to certain environmental conditions (pattern II). CONCLUSION: Skin sensitivity is a common concern that declines with age and is relevant for men as well as for women.

Mitogenic stimulation of transcription by RNA polymerase III.

Regulation of protein synthesis is an important aspect of growth control. RNA polymerase (pol) III plays a key role in this process by catalysing production of tRNA and 5 S rRNA. Growth factors trigger a rapid increase in pol III activity and this is essential for cell proliferation. The transcription factor TFIIIB plays a key role in controlling pol III activity and is a target for regulation by a number of mechanisms. This review will focus on how TFIIIB is targeted by these proteins in response to mitogen stimulation.

Occupational radiation exposure to interventional radiologists: a prospective study.

This study investigates the occupational radiation dose to interventional radiologists and the operator-controlled factors that may affect dose. Thirty interventional radiologists wore radiation badges over and under lead aprons for 2 months and answered a questionnaire. The relationships between dose and caseload, case mix, experience, optional fluoroscopy features, lead apron type, and additional lead shielding were evaluated. Mean projected yearly dose (PYD) over lead was 49.1 mSv (1 mSv = 100 mrem) but was 66.6 mSv for persons performing 1,000 or more cases per year (P = .027). Mean PYD under lead was 0.9 mSv but was 1.3 mSv for persons with 0.5-mm lead coverage and 0.4 mSv for those with 1.0-mm lead coverage (P = .002). No other significant correlation was found. Conclusions are that caseload and apron thickness are the primary determinants of total body dose, that over-lead dose is high enough to warrant additional lead shielding for the head and neck, and that a double-thickness apron lowers under-lead dose by two-thirds. The large difference between under-lead and over-lead doses suggests that use of a collar badge alone for monitoring purposes is not predictive of total-body effective dose for this group of radiation workers.

Transient effects in the Cox proportional hazards regression model.

We consider a model for mortality rates that includes both the long and short term effects of switching from an initial to a second state, for example, when patients receive an initial treatment and then switch to a second treatment. We include transient effects associated with the switch in the model through the use of time-dependent covariates. One can choose the form of the time-dependent covariate to correspond with a variety of possible transition patterns. We use an exponential decay model to compare the survival experience of transplant versus dialysis treatment of end stage renal disease (ESRD) patients from the Michigan Kidney Registry (MKR). This model involves a hazard function that has an initial effect in mortality at the time of transplant, expected to be higher, followed by a smooth exponential decay to a long term effect, expected to be lower than the risk for those remaining on dialysis. Cox and Oakes used this model to analyse the Stanford Heart Transplant data. The model implicitly suggests there is a time at which the hazard curves (and survival curves) for the treatment groups cross. Those crossing times are useful in advising patients who have the option of receiving a transplant. We describe methods for obtaining estimates of the crossing times and their associated variances, and then apply them in analysing the MKR data.

Extension of the Carter-Yang polynomial growth curve model to allow unique times of measurement for subjects.

A PC program extending the procedure due to Carter and Yang (Commun Stat: Theory Methods, 8 (1986) 2507-2526) to allow unique times of measurement for subjects is described, illustrated and made available. Given longitudinal observations on each of N subjects comprising a single group, this program determines the lowest degree polynomial in time adequate to fit the average growth curve (AGC); estimates this curve and provides confidence bands for the AGC, and confidence intervals for the corresponding polynomial regression coefficients; and so-called prediction intervals which, with a given level of confidence, will contain the growth curve of a 'new' subject from the same population of which the N subjects constitute a random sample. Two kinds of missing data are accommodated. First, in the context of studies planned so that subjects will be measured at identical times and, second, in unstructured studies where subjects may present with their own, unique times of measurement.

Comparison of survival probabilities for dialysis patients vs cadaveric renal transplant recipients.

OBJECTIVE: To compare mortality risk among cadaveric renal transplant recipients vs transplant candidates on dialysis in the cyclosporine era. SETTING: Patient mortality risk was analyzed by treatment modality for a completed statewide patient population. PATIENTS: All Michigan residents younger than age 65 years who started endstage renal disease (ESRD) therapy between January 1, 1984, and December 31, 1989, were included. Patients were followed up from ESRD onset (n = 5020), to wait-listing for renal transplant (n = 1569), to receiving a cadaveric first transplant (n = 799), and to December 31, 1989. MAIN OUTCOME MEASURE: Mortality rates. RESULTS: Using a time-dependent variable based on the waiting time from date of wait-listing to transplantation and adjusting for age, sex, race, and primary cause of ESRD, the relative risk (RR) of dying was increased early after transplantation and then decreased to a beneficial long-term effect, given survival to 365 days after transplantation (RR, 0.36; P < .001). This lower long-term risk was most pronounced (RR, 0.25) among diabetic transplant recipients compared with diabetic wait-listed dialysis patients (P < .001) and not observed among patients with glomerulonephritis as cause of ESRD (P > .05). Overall, the estimated times from transplantation to equal mortality risk was 117 +/- 28 days and to equal cumulative mortality was 325 +/- 91 days. CONCLUSIONS: The overall mortality risk following renal transplantation was initially increased, but there was a long-term survival benefit compared with similar patients on dialysis. These analyses allow improved description of comparative mortality risks for dialysis and transplant patients and allow advising patients regarding comparative survival outcomes.

Hospitalization among United States dialysis patients: hemodialysis versus peritoneal dialysis.

Measurements of hospitalization in the dialysis population are important because they provide insight into the morbidity and the cost of treatment among dialysis patients. Prior comparisons of hospitalization for different dialysis modalities have had conflicting results. This study was designed to compare hospitalization for patients treated with peritoneal dialysis (PD) versus hemodialysis (HD) using the data from the U.S. Renal Data System 1993 Annual Data Report. The study population included all Medicare dialysis patients prevalent on January 1, 1988 through 1990. Patients were monitored to transplantation, death, or end of the calendar year for a total of 189,654 patient years. Hospital admission rates were computed from the total number of hospital admissions during the year divided by the total number of patient years at risk. Patients were classified by treatment modality (PD, HD), cause of ESRD (diabetes as a cause of ESRD versus all other causes), age (0 to 19, 20 to 44, 45 to 65, +65), and race (black, white). Rate ratios (RR:PD/HD) for hospital admissions per year at risk were estimated, while adjusting for the other factors with Poison regression. On average, hospital admission rates per patient year at risk for dialysis patients treated with PD were 14% higher than for those treated with HD (RR = 1.14; 95% confidence interval (Cl), 1.13 to 1.15) when adjusting for race, age, gender, and cause of ESRD. The excess in the overall adjusted admission rates in PD patients compared with HD patients was higher for black than for white patients (RR:PD/HD = 1.22 versus RR = 1.11; 95% Cl, 1.10 to 1.13).(ABSTRACT TRUNCATED AT 250 WORDS)

A comparison of mortality between patients treated with hemodialysis and peritoneal dialysis.

Patients with ESRD treated with dialysis have a high mortality rate. Controversy exists as to whether this high mortality rate is affected by modality choice. The purpose of this epidemiologic study was to compare mortality in prevalent hemodialysis-treated (HD) and peritoneal dialysis-treated (PD) patients in a large national sample, adjusting for demographic characteristics. Data were obtained from the U.S. Renal Data System for patients prevalent on January 1 of the years 1987, 1988, and 1989, each with 1 yr of follow-up. Patients were censored at transplantation. Death rates per 100 patient years were compared between HD and PD, adjusting for age, race, gender, cause of ESRD (diabetes versus nondiabetes) and < 1 yr or > 1 yr of prior ESRD, by the use of Poisson regression. There were 42,372 deaths occurring over 170,700 patient years at risk. On average, prevalent patients treated with PD had a 19% higher adjusted mortality risk (relative risk (RR) = 1.19; P < 0.001) than did those treated with HD. This risk was found to be insignificant (P > 0.05) and small for ages < 55 and increasingly large and significant for ages > 55 yr. It was accentuated in diabetics (RR = 1.38; P < 0.001) but was also present in nondiabetics (RR = 1.11; P < 0.001). Although present in both males and females, this risk was accentuated in females (RR = 1.30 versus 1.11; both P < 0.001). In this national study of prevalent U.S. dialysis patients, treatment assignment to PD was associated with a 19% higher all-cause mortality rate than HD.(ABSTRACT TRUNCATED AT 250 WORDS)

A comparison of cause of death between patients treated with hemodialysis and peritoneal dialysis.

Mortality rates associated with peritoneal dialysis (PD) have been found to be higher than those associated with hemodialysis (HD) among prevalent U.S. patients over the age of 55 in the preceding study. Given the substantial technical differences between PD and HD, causes of death might also be expected to differ between these dialytic modalities. In order to help elucidate the relative contributions of these technical differences and to further the understanding of the excess mortality observed among PD-treated dialysis patients, this epidemiologic study compared cause of death in prevalent HD- and PD-treated patients in a large national sample, adjusting for demographic characteristics. Data for patients prevalent on January 1 of the years 1987, 1988, and 1989, each with 1 yr of follow-up, were obtained from the U.S. Renal Data System. Patients were censored at transplantation. Death rates per 100 patient years for seven cause-of-death categories were compared between HD and PD, adjusting for age, race, gender, cause of ESRD (diabetes versus nondiabetes), and < 1 yr or > 1 yr of prior ESRD, by use of the Poisson regression. There were 42,372 deaths occurring over 170,700 patient years at risk. There was a significantly increased mortality risk for PD compared with HD for all cause-of-death categories, except malignancy, for which there was a higher mortality risk for HD. The excess all-cause mortality observed in PD-treated patients can be accounted for, in decreasing order, by infection (35%), acute myocardial infarction (24%), other cardiac causes (16%), cerebrovascular disease (8%), withdrawal (8%), and malignancy (-6%).(ABSTRACT TRUNCATED AT 250 WORDS)

Causes of death in dialysis patients: racial and gender differences.

The risk of death in the dialysis population is high and has previously been shown to be accentuated in male (versus female) and white (versus black) subgroups. To better understand the difference in mortality among these subgroups, the causes of death between males and females as well as between whites and blacks adjusting for age, cause of ESRD (diabetic versus nondiabetic), dialysis modality, and time on dialysis (< 1 yr versus > 1 yr) were compared, with national data obtained from the U.S. Renal Data System. A total of 42,372 deaths occurring over 170,700 patient years at risk were analyzed. Males had a 22% higher risk of death than females (P < 0.001), attributable to a higher risk of death due to acute myocardial infarction (relative death rate ratio (RR) = 1.48; P = 0.001), all other cardiac causes (RR = 1.3; P = 0.001), and malignancy (RR = 1.59; P < 0.001). Whites had a 29% higher risk of death than blacks (P < 0.001), accounted for by an increased risk of death due to acute myocardial infarction (RR = 1.34), all other cardiac causes (RR = 1.30), withdrawal from dialysis (RR = 2.72) (all P < 0.001), and infection (RR = 1.09; P = 0.005). This analysis expands the knowledge and understanding of the excess mortality seen in male and white subgroups, which is a necessary step in designing strategies to reduce the high mortality in dialysis patients.

Association of gender and access to cadaveric renal transplantation.

Previous studies have revealed that females are less likely than males to receive a renal transplant, the most successful form of treatment of end-stage renal disease (ESRD). The purpose of this study was to determine whether the barrier is to inclusion on the transplant waiting list or to transplantation after being placed on the transplant waiting list. An existing data set was used that included data from the Michigan Kidney Registry, supplemented with data received from the Organ Procurement Agency of Michigan. White and black patients less than 65 years of age and starting ESRD treatment between January 1, 1984, and December 31, 1989, were included. Cox proportional hazards models were used to determine the effect of gender on (1) time to transplantation among all ESRD patients, (2) time from diagnosis of ESRD to inclusion on the transplant waiting list among all ESRD patients, and (3) time from inclusion on the waiting list to transplantation among those patients on the waiting list. Patients were censored at the time of living-related transplantation or death, and were monitored until December 31, 1989. In all, 5,026 incident ESRD patients were included in the study (44.3% female). Of these, 1,626 patients were included on the waiting list (40.1% female); 823 of these received a transplant (37.7% female). Adjusting for age, race, and diagnosis, females were 25% less likely to receive a cadaveric transplant than males (female to male relative rate ratio [RR], 0.75; P < 0.001). Females with ESRD aged 46 to 55 years and 56 to 65 years were 33% (RR, 0.67; P < 0.001) and 29% (RR, 0.71; P < 0.05) less likely to be included on the transplant waiting list, respectively, than their male counterparts. There was no difference in the rate of wait list inclusion among ESRD patients younger than 46 years. Females with ESRD who were included on the transplant waiting list were 26% (RR, 0.74; P < 0.001) less likely to receive a transplant than males on the waiting list. These results indicate that females are both less likely to be on the transplant waiting list (ages over 45 years) and, once on the list, less likely to receive a transplant (all ages) than males. Further study is necessary to determine the factors contributing to these important barriers to transplantation among females with ESRD.

Dietary caffeine intake is not correlated with adolescent bone gain.

OBJECTIVE: This study was conducted to determine whether dietary caffeine consumed by American white females between ages 12 to 18 affects total body bone mineral gain during ages 12 to 18 or affects hip bone density measured at age 18. METHODS: The Penn State Young Women's Health Study is a longitudinal investigation of bone, endocrine and cardiovascular health in non-Hispanic, white, teenage women. Nutrient and food group intakes were obtained by averaging over 6 years of prospective diet records. The cohort, as of age 18, (n = 81) was separated into three subgroups according to mean daily caffeine intake averaged across ages 12 to 18. Group I (n = 37) consumed less than 25 mg caffeine per day; Group II (n = 33) consumed 25 to 50 mg caffeine per day; and Group III (n = 11) consumed greater than 50 mg caffeine per day. The group mean daily caffeine intakes (SD) were Group I = 14 (6) mg/day; Group II = 35 (7) mg/day; Group III = 77 (27) mg/day. Total body bone gain and hip bone density were determined by dual energy x-ray absorptiometry (DXA). RESULTS: There were no significant differences among the three caffeine intake groups for total body bone mineral gain during the ages 12 to 18 or of hip bone density at age 18. The low caffeine intake group consumed more milk (and therefore more calcium) and more fruit per day than did the other two groups. Group III, the highest caffeine intake group, consumed more sugar per day than did the other two groups. The observed differences in nutrient and food intakes among the three groups were not associated with any differences in anthropometric measurements or bone gain among the three groups. CONCLUSION: These findings indicate that dietary caffeine intake at levels presently consumed by American white, teenage women is not correlated with adolescent total bone mineral gain or hip bone density at age 18.

A comparison of knowledge and attitudes about diet and health among 35- to 75-year-old adults in the United States and Geneva, Switzerland.

OBJECTIVES: This study compared responses of US and Geneva residents to items on analogous questionnaires concerning knowledge and attitudes about diet and health. METHODS: Comparable data were available from 2 population-based sample surveys: the Cancer Control Supplement of the 1987 National Health Interview Survey and the 1994 Bus Santé 2000 in Geneva, Switzerland. Samples included 10,366 US respondents and 698 Geneva respondents, aged 35 to 74 years. The analysis involved descriptive statistics, contingency tables, and linear regression models. RESULTS: In both the United States and Geneva, health consciousness was greater among women and more highly educated persons than among other groups. Compared with Americans, Genevans assigned more importance to avoiding salt, sugar, and overweight (odds ratio = 1.6, 2.9, and 5.9, respectively) and less importance to lowering cholesterol (odds ratio = 0.6). Genevans were more likely to recognize the relatively high fiber content of lettuce, carrots, and apples. Recognition of low-fat foods was slightly better in the United States. CONCLUSIONS: Knowledge and attitudes differed despite high general diet and health awareness in both populations. Identifying why generally similar dietary guidance messages are embraced to different extents across cultures may facilitate global implementation.