Simplified dispatch-assisted CPR instructions outperform standard protocol.

OBJECTIVE: Dispatch-assisted chest compressions only CPR (CC-CPR) has gained widespread acceptance, and recent research suggests that increasing the proportion of compression time during CPR may increase survival from out-of-hospital cardiac arrest. We created a simplified CC-CPR protocol to reduce time to start chest compressions and to increase the proportion of time spent delivering chest compressions. This simplified protocol was compared to a published protocol, Medical Priority Dispatch System (MPDS) Version 11.2, recommended by the National Academies of Emergency Dispatch. METHODS: Subjects were randomized to the MPDS v11.2 protocol or a simplified protocol. Data was recorded from a Laerdal Resusci Anne Skillreporter manikin. A simulated emergency medical dispatcher, contacted by cell phone, delivered standardized instructions for both protocols. Outcomes included chest compression rate, depth, hand position, full release, overall proportion of compressions without error, time to start of CPR and total hands-off chest time. Proportions were analyzed by Wilcoxon's Rank Sum tests and time variables with Welch ANOVA and Wilcoxon's Rank Sum test. All tests used a two-sided alpha-level of 0.05. RESULTS: One hundred and seventeen subjects were randomized prospectively, 58 to the standard protocol and 59 to the simplified protocol. The average age of subjects in both groups was 25 years old. For both groups, the compression rate was equivalent (104 simplified versus 94 MPDS, p = 0.13), as was the proportion with total release (1.0 simplified versus 1.0 MPDS, p = 0.09). The proportion to the correct depth was greater in the simplified protocol (0.31 versus 0.03, p < 0.01), as was the proportion of compressions done without error (0.05 versus 0.0, p = 0.16). Time to start of chest compressions and total hands-off chest time were better in the simplified protocol (start time 60.9s versus 78.6s, p < 0.0001; hands-off chest time 69 s versus 95 s, p < 0.0001). The proportion with correct hand position, however, was worse in the simplified protocol (0.35 versus 0.84, p < 0.01). CONCLUSIONS: The simplified protocol was as good as, or better than the MPDS v11.2 protocol in every aspect studied except hand position, and the simplified protocol resulted in significant time savings. The protocol may need modification to ensure correct hand position. Time savings and improved quality of CPR achieved by the new set of instructions could be important in strengthening critical links in the cardiac chain of survival.

Longitudinal study of elbow and shoulder pain in youth baseball pitchers.

PURPOSE: Previous studies among young pitchers have focused on the frequency and description of elbow injuries. The purpose of this study was to evaluate the frequency of elbow and shoulder complaints in young pitchers and to identify the associations between pitch types, pitch volume, and other risk factors for these conditions. METHODS: A prospective cohort study of 298 youth pitchers was conducted over two seasons. Each participant was contacted via telephone after each game pitched to identify arm complaints. Generalized estimating equations were used to assess associations between arm complaints and independent variables. RESULTS: The frequency of elbow pain was 26%; that of shoulder pain, 32%. Risk factors for elbow pain were increased age, increased weight, decreased height, lifting weights during the season, playing baseball outside the league, decreased self-satisfaction, arm fatigue during the game pitched, and throwing fewer than 300 or more than 600 pitches during the season. Risk factors for shoulder pain included decreased satisfaction, arm fatigue during the game pitched, throwing more than 75 pitches in a game, and throwing fewer than 300 pitches during the season. CONCLUSION: Arm complaints are common, with nearly half of the subjects reporting pain. The factors associated with elbow and shoulder pain were different, suggesting differing etiologies. Developmental factors may be important in both. To lower the risk of pain at both locations, young pitchers probably should not throw more than 75 pitches in a game. Other recommendations are to remove pitchers from a game if they demonstrate arm fatigue and limit pitching in nonleague games.

Reducing the cost of diagnosis of breast carcinoma: impact of ultrasound and imaging-guided biopsies on a clinical breast practice.

BACKGROUND: The objective of this study was to determine whether the use of ultrasound and percutaneous breast biopsies in patients with screen-detected nonpalpable abnormalities can reduce benign open surgical biopsies of the breast without increasing cost or sacrificing detection of potentially curable breast carcinomas. METHOD: Using a computerized mammography database and consecutive logs of needle localization procedures and fine- and large core needle biopsies of a single university-based breast imaging practice, the authors determined the breast carcinoma yield and cost of diagnosis over a 14-year period and the changes that occurred over time with the sequential introduction of ultrasound, ultrasound-guided biopsies, and stereotactic biopsies. RESULTS: The overall breast carcinoma yield for needle localization biopsies of nonpalpable lesions increased from 21% in 1984 to 68% in 1998 (P < 0.0001). The yield for nonpalpable masses increased from 21% to 87% (P < 0.0001) over the same period. The selective use of ultrasound alone and percutaneous fine- and large core needle biopsy resulted in a substantial reduction in benign open surgical biopsies. A cost analysis showed a 50% reduction in the average expense of discovering breast carcinoma. The breast carcinomas detected after introduction of these methods were prognostically favorable with 88% measuring 1.5 cm or less in size and 66% measuring less than 1 cm. CONCLUSIONS: Selective use of ultrasound and imaging-guided percutaneous biopsies can significantly reduce the number of benign open surgical biopsies generated by mammographic screening. This can result in substantial cost savings without decreasing the sensitivity for detecting small potentially curable lesions.

An interdisciplinary training program in nutrition sciences and cancer.

To address the shortage of health care professionals trained in the nutritional aspects of cancer prevention, the University of Alabama at Birmingham in 1988 initiated the Cancer Prevention and Control Training Program (CPCTP), with R25 grant support from the NIH/NCI. The CPCTP has enrolled 11 predoctoral and 12 postdoctoral trainees, of whom 18 have completed training and five remain in the program. The curriculum and other program elements are described, and the trainees' academic achievements and ultimate careers are reported. The CPCTP has become a significant resource for training cancer nutrition professionals.

Cancer Prevention and Control Training Program at the University of Alabama at Birmingham.

The pre- and postdoctoral Cancer Prevention and Control Training Program (CPCTP) at the University of Alabama at Birmingham (UAB) has attracted high-quality trainees from all over the United States. The trainees have pursued courses of study in epidemiology, nutrition sciences, health behavior, environmental health sciences, biostatistics, or public health nutrition; and research projects in cessation of tobacco use, cancer screening, cancer epidemiology, diet modification, nutrient-cancer relationships, statistical modeling of carcinogenesis, medical-nutrition education, and obesity, in precise alignment with NCI cancer control objectives. Both courses and research projects have been interdisciplinary, taking advantage of the strong interdepartmental collaborative atmosphere at UAB. Former trainees have been successfully placed in academic, administrative, and practice positions in which they can strategically apply their cancer prevention and control expertise.

Molecular epidemiology, pathogenesis and prevention of gastric cancer.

Cancer of the stomach is one of the most commonly diagnosed malignancies and remains an important cause of mortality world wide. This type of cancer is not uniformly distributed among populations but shows a marked variation in both incidence and mortality. Although gastric cancer is declining in many parts of the world, the reasons for this decline are not well understood and its etiology remains unclear. Several factors are suspected to play a role in gastric carcinogenesis, including the effects of diet, exogenous chemicals, intragastric synthesis of carcinogens, genetic factors, infectious agents and pathological conditions in the stomach (such as gastritis). A new look at the results of epidemiological and experimental studies is important for the establishment of strategies for control. Since cancer of the stomach has a very poor prognosis in its more advanced stages, such a control program must have its main focus on primary prevention. This review describes our knowledge about cancer of the stomach regarding epidemiology, pathogenesis and prevention.

Understanding meta-analysis in cancer epidemiology: dietary fat and breast cancer.

Meta-analyses of the relationship between dietary fat and breast cancer risk using different methodologies have reported conflicting results. This investigation compares methodologic aspects of meta-analyses of patient data (MAP) with meta-analyses of data from the literature (MAL), and computes relative risk (RR) estimates from a random effects model using 28 published studies of dietary fat and breast cancer. MAP and MAL results compare closely when homogeneity is verified. When statistical homogeneity is rejected, a random effects model adjusting for study design and location is appropriate. The highest RR was found for case-control studies of European women (RR: 1.46), followed by North American case-control studies (RR: 1.25), case-control studies of women on other continents (RR: 1.23), cohort studies in Europe (RR: 1.20), and cohort studies in North America (RR: 1.02). The overall risk estimate in a MAL with heterogeneous studies should be interpreted only in a conditional model.

Relationships between socioeconomic status and race-specific cervical cancer incidence in the United States, 1973-1992.

The association between low socioeconomic status (SES) in minority groups and higher incidence and mortality from cervical cancer was examined using two large U.S. databases. With cases from 1973 to 1992, all registries of the Surveillance, Epidemiology, and End Results (SEER) (except Hawaii) were used to calculate incidence rates of in situ and invasive cervical cancers by race group. SES indicators were derived from the Regional Economic Information System, Department of Commerce. Higher levels of SES indicators were related to decreased risk and lower incidence of invasive cancers in all race groups, but especially white and black populations, and to increased incidence of situ cancer in these populations. Results suggest that higher SES status is related to a decrease in invasive cervical cancer, but an increase in in situ cervical cancer in recent years. These findings may explain the racial differences in cervical cancer incidence and help target intervention programs.

Cancer incidence among predominantly black, rural-poor populations in southern states.

BACKGROUND: A seven-county, predominantly black, rural-poor population in Alabama is targeted for a program aimed at improving access to state-of-the-art cancer care. This paper presents combined age-adjusted cancer incidence rates for predominantly black, rural counties in North Carolina and Georgia similar to the Alabama counties and compares these rates with Surveillance, Epidemiology, and End Results (SEER) incidence rates. METHODS: Cancer incidence data from 1990 to 1993 were obtained from the Georgia Center for Cancer Statistics for 10 rural counties with predominantly black populations. Likewise, cancer incidence data from 1990 to 1993 were obtained for seven rural-poor counties in North Carolina from the North Carolina Central Cancer Registry. SEER incidence rates from 1990 to 1992 were obtained for nine SEER sites. RESULTS: The overall cancer incidence rate from North Carolina and Georgia is lower by 22% than the SEER rate. Cancer incidence rates for cancers of the breast, colon/rectum, lung, and prostate were at least 15% lower than the SEER rates, while the invasive cervical cancer rate was 1.78 times higher than the SEER rate. CONCLUSION: Blacks comprise about 50% of the population in these counties. In contrast, the SEER population is predominantly white, and the black population is primarily urban. Estimates of the number of cancer cases in black, rural-poor populations based on SEER incidence rates is not reflective of the cancer experience in these populations.

Distribution of astigmatism among Sioux Indians in South Dakota.

BACKGROUND: Previous studies have reported a greater prevalence of high astigmatism and vision disorders among Native Americans than occurs in the general U.S. population. The majority of these studies, however, have focused on Native American schoolchildren. This study assessed the distribution of astigmatism in a general clinic population at the Rosebud Indian Reservation in South Dakota. METHODS: From examination of 174 patients, demographic information, visual acuities, refractive error, binocular vision status, and eye health were recorded. RESULTS: The data showed more high astigmatism than would be expected in a general U.S. population. Three or more diopters of astigmatism were found in 9.2% of the right eyes and 10.8% of the left eyes in the study population. High astigmatism was noted less frequently among those ages 40 years and older (3.3% right eyes, 6.3% left eyes). Most of the astigmatism was with-the-rule, but a shift toward against-the-rule and oblique astigmatism was found in older individuals. No significant gender differences were noted. CONCLUSIONS: The results suggest an ethnic difference in astigmatism and emphasize thee need for continued and expanded vision services for Native American populations.

Elevated serum levels of p105(erbB-2) in patients with advanced-stage prostatic adenocarcinoma.

Expression of a truncated or extracellular form (p105erbB-2) of p185erbB-2 has been demonstrated in the sera of breast cancer patients. We examined the levels of p105erbB-2 in the sera of patients with various stages of prostatic adenocarcinoma, in patients with benign prostatic hyperplasia (BPH) and in a series of control male patients hospitalized for illnesses unrelated to the prostate. p105erbB-2 levels did not differ between the controls and BPH patients or between these groups and patients with stage A, B or C adenocarcinomas. In contrast, serum p105erbB-2 levels of patients with stage D adenocarcinomas were significantly elevated when compared with either control or BPH patients. There was no correlation between PSA and p105erbB-2 levels among controls, patients with BPH or patients with prostate cancer. Patients with poorly differentiated tumors (combined Gleason score >7) or moderately differentiated tumors (combined Gleason score 5-7) had higher p105erbB-2 levels as compared to patients with well-differentiated tumors (combined Gleason score <5), though this difference was not statistically significant. There was no correlation between serum p105erbB-2 levels and p185erbB-2 expression in malignant tissue, as determined by immunohistochemistry. However, patients with moderate to strong expression of p185erbB-2 within the adenocarcinomas were approximately 4 times more likely to demonstrate elevated serum p105erbB-2 levels as compared with patients with low expression of p185erbB-2.

The photic sneeze response: a descriptive report of a clinic population.

BACKGROUND: The prevalence of the photic sneeze response (PSR) as well as other characteristics have been studied in selected populations. However, the PSR has not been investigated in a general eye care patient population. This study was performed in an attempt to characterize the epidemiologic, descriptive, and demographic aspects of the photic sneeze response among patients attending for primary eye care. METHODS: A questionnaire on demographics, risk factors, and triggering stimuli was distributed to 500 consecutive patients presenting for a general eye examination at an academic health center optometry clinic. RESULTS: Three hundred and sixty-seven of 500 questionnaires were returned (73.4%). Among this sample 33% were self-recognized photic sneezers with the majority being females (67%) and Caucasian (94.3%). Statistically significant correlations were found between the presence of photic sneezing and the presence of a deviated nasal septum and a non-significant association was found with tobacco use. Uniform frequency of sneezing does not occur in response to light stimulus; only 12.3% of sneezers responded consistently to sunlight exposure. The majority of sneezers (90.7%) responded with three or fewer sneezes. The interval between successive sneezes was fewer than 19 seconds in 85% of respondents. Fewer than 27% of respondents were able to recall a parent who exhibited a sneeze response. CONCLUSIONS: The PSR is not an uncommon phenomenon. Systemic associations with the PSR are as diverse as deviated nasal septum and tobacco use. Results suggest that there may be a threshold level of light or frequency of light exposure which produces the response and that more patients may acquire the response than inherit it.

Breast cancer early detection: differences between African American and white women's health beliefs and detection practices.

PURPOSE/OBJECTIVES: To identify differences in African American and white women's health beliefs and practices regarding early detection of breast cancer. DESIGN AND SETTING: Descriptive survey of educators employed by one public school system in one southern state. SAMPLE: One hundred seventeen African American and 157 white female professional educators. METHODS: Subjects completed a survey questionnaire consisting of investigator-developed items and an adapted version of Champion's Health Belief Model Scales. MAIN OUTCOME MEASURES: Reported frequency of use of mammography, clinical breast examination (CBE), and breast self-examination (BSE); health beliefs about these procedures. FINDINGS: No significant difference in frequency of use of mammography and CBE was found between the two groups. The difference for BSE frequency approached significance (p = 0.058); African American women had performed BSE significantly more times (p = 0.028) than white women during the preceding 12 months. White women had a significantly higher mean score (p = 0.002) for barriers to mammography. The difference between the two groups for barriers to CBE and control with CBE reached the 0.05 level of significance; in both cases, white women had the higher mean score. No significant difference was found in mean scores for beliefs about BSE. CONCLUSIONS: The contribution of health beliefs about breast cancer, mammography, CBE, and BSE to frequency of use of these procedures by race remains unclear. IMPLICATIONS: Efforts to inform women of the need to adopt an early breast cancer detection program should continue. Additional studies are needed to validate present study findings and to expand the knowledge base for healthcare providers.

Prostate cancer screening (United States).

In 1995, there will be 244,000 new cases of prostate cancer, and 40,400 deaths from prostate cancer, among men in the United States. The American Cancer Society reports that the incidence rate of prostate cancer is increasing at an accelerated pace, and was 21 percent higher in 1994 than in 1993. The major reason for this steep rise is likely to be due to increased popularity of prostate cancer screening which, by identifying latent, asymptomatic cases, may convert them into clinical cases. Is screening--an important means of cancer control for many sites--a reasonable approach for prostate cancer control? The answer is not straightforward because prostate cancer is not one, but three diseases: a latent form which will cause no harm; a progressive form which will become symptomatic and can kill; and a rapidly progressive form so malignant that it is likely to kill, whether detected early or late. Screen-detection may be worthwhile only for the second form, as tumors of the first form need never be detected, and tumors of the third form progress so rapidly that timely screen-detection is nearly impossible and, if accomplished, may be valueless. As there is no way to differentiate among the three diseases when screening, the possible deleterious effects of screen-detection must be weighed against the benefits.

Comparison of suicide rates among industrial groups.

Suicide rates among industrial groups were examined systematically using death certificate data from 1984 through 1989 in Alabama. Poisson log-linear modelling was used to estimate the rate ratios (RR) of industries compared to a referent and to adjust for confounding. Marked differences in suicide rates were found among industrial groups. The rates ranged from 5.31 to 62.36 per 100,000 population per year. People employed in public administration had the lowest rate. In comparison with public administration, the construction industry had the highest risk (adjusted RR = 11.8, 95% confidence interval (CI): 9.6-14.6). Employees of the mining industry experienced a similarly high risk (adjusted RR = 11.5, 95% CI: 8.2-16.3). Persons employed in farming, agriculture services, forestry, and fisheries, manufacturing, and transportation, communications, and other public utilities industries had intermediate risks. Smaller elevations of suicide rates compared to public administration were observed in the wholesale trade, retail trade, finance, insurance, and real estate, and services industries. The differences of suicide rates may be related to sociodemographic differences, self-selection for occupation, ease of access to lethal agents, or job stress.

Concerned citizens collect cancer-incidence data.

A method for collecting cancer-incidence data in a rural town is described. A mail survey, prompted and conducted by concerned citizens, was utilized. When analyzed in light of local mortality data and national cancer incidence and mortality rates, the data collected in such a survey seem reasonably accurate and complete. The numbers of observed and expected incident cases, as well as the numbers of observed and expected deaths, correlated quite closely for most sites. Excesses of incident cases were observed for seven of 11 sex-specific sites, but only for melanoma and lymphoma among women were the excesses statistically significant. Provided that community support is substantial, which is necessary to maximize accuracy and completeness, this method of collecting cancer-incidence data may be useful in rural areas of states without a statewide registry.

Suicide in Alabama, 1980 to 1989.

Trends of US suicide rates show great variations among demographic groups over time. Although more attention has been directed to the increasing suicide rate among adolescents, persons aged 65 years and older continue to commit suicide at a higher rate than for any other age group. To examine the recent trend of suicide rates and compare the suicide pattern with that at the national level, we conducted a study using suicide data in Alabama from 1980 to 1989. For all age groups in Alabama in the 1980s, male suicide rates exceeded female rates. Of the four major race-sex groups, nonwhite females are an especially low-risk group, experiencing a rate of about 1.5/100,000 at all ages. There have been remarkable increases in suicide rates in the 1980s for males, especially for nonwhite males in Alabama. The results suggest that high-risk groups to be targeted for interventions are men over age 45 (especially white men over age 65), and divorced and widowed men and women.

Mammographic patterns and breast cancer risk factors among women having elective screening.

We assessed the association between Wolfe mammographic patterns and breast cancer risk factors among 239 women who attended the Breast Evaluation Unit screening program of the Comprehensive Cancer Center of Alabama, University of Alabama at Birmingham, from November 1984 through April 1986. Evaluation consisted of a breast cancer risk assessment based on a questionnaire concerning commonly accepted breast cancer risk factors, along with a physical breast examination and mammogram. Increased age, weight, and parity were associated with a low-risk pattern; late age at first birth, alcohol consumption, and oral contraceptive use were associated with a high-risk pattern. Our findings support those of previous studies, except for those concerning use of oral contraceptives. Further exploration is needed to ascertain whether the association of oral contraceptive use with high-risk patterns indicates a pathway through which estrogens may increase the risk of breast cancer.