Young adults' preferred options for receiving chlamydia screening test results: a cross-sectional survey of 6085 young adults.

We investigated how young adults aged 18-29 years would like to be notified of chlamydia screening test results, and, when they test positive, their willingness and preferred mechanism for informing their partners. We conducted a cross-sectional survey of 6085 young adults and found that a call to their mobile phone was their preferred way of receiving positive test results (selected by 50%), followed by email. Text messages (short message service [SMS]) and calls to landline phones were unpopular options, selected by between 5 and 10%. Over 75% of respondents stated they would inform their current partner of a positive chlamydia diagnosis, and 50% would inform their previous partners. Most were willing to receive yearly reminders to go for a chlamydia test. Young adults preference for being informed of chlamydia test results by mobile phone call, rather than by email or SMS text, especially if they test positive, suggests they place high value on the security of the communication mechanism. Offering a range of mechanisms for receipt of test results may increase the acceptability and coverage of sexually transmitted infection (STI) control strategies.

Signal pathway profiling of epithelial and stromal compartments of colonic carcinoma reveals epithelial-mesenchymal transition.

Molecular crosstalk, including reciprocal stimulation, is theorized to take place between epithelial cancer cells and surrounding non-neoplastic stromal cells. This is the rationale for stromal therapy, which could eliminate support of a cancer by its genetically stable stroma. Epithelial-stromal crosstalk is so far poorly documented in vivo, and cell cultures and animal experiments may not provide accurate models. The current study details stromal-epithelial signalling pathways in 35 human colon cancers, and compares them with matched normal tissues using quantitative proteomic microarrays. Lysates prepared from separately microdissected epithelium and stroma were analysed using antibodies against 61 cell signalling proteins, most of which recognize activated phospho-isoforms. Analyses using unsupervised and supervised statistical methods suggest that cell signalling pathway profiles in stroma and epithelium appear more similar to each other in tumours than in normal colon. This supports the concept that coordinated crosstalk occurs between epithelium and stroma in cancer and suggests epithelial-mesenchymal transition. Furthermore, the data herein suggest that it is driven by cell proliferation pathways and that, specifically, several key molecules within the mitogen-activated protein kinase pathway may play an important role. Given recent findings of epithelial-mesenchymal transition in therapy-resistant tumour epithelium, these findings could have therapeutic implications for colon cancer.

Increase in observed mental health difficulties one year after acute coronary syndrome: general practitioner survey.

BACKGROUND: General practitioners (GPs) are often the first to assess mental health difficulties after acute coronary syndrome (ACS). AIMS: To determine whether GPs observed an increase in mental health difficulties one-year post-hospitalisation for ACS. METHODS: Postal survey. RESULTS: GPs rated patients (n = 442) as having probable (GP assessed 10%) or definite (formally assessed 7%) mental health difficulties pre-hospitalisation. Post-hospitalisation the prevalence of probable cases increased significantly to 19% (OR = 4.3, 95% CI 2.1-10.2, P < 0.001). In multivariate analysis, only smoking at index hospitalisation was associated with being assessed as a new case of probable/formal mental health difficulties (RR = 2.1, 95% CI 1.3-3.4, P = 0.003). Forty-seven percent of cases were prescribed some medication for this problem. CONCLUSIONS: GPs recorded a significant increase in mental health difficulties in ACS patients 12 months after hospitalisation, with smoking used as an indicator of new cases.

The relation between maternal work, ambulatory blood pressure, and pregnancy hypertension.

STUDY OBJECTIVE: The purpose of the study was to determine the relations between maternal work, ambulatory blood pressure in mid-pregnancy, and subsequent pregnancy outcome. DESIGN: Data were studied on 933 healthy normotensive primigravidas who had been enrolled into a study on the predictive value of ambulatory blood pressure measurement performed between 18 and 24 weeks gestation. They were classified into three groups depending on whether they were at work (working group, n=245), not working (not working group, n=289), or normally employed but chose not to work (ENK group, n=399), on the day monitoring was performed. SETTING: The Rotunda Hospital (a large maternity hospital), Dublin, Ireland. MAIN RESULTS: Adjusted for age, body mass index, smoking, drinking, and marital status, women at work had higher mean daytime systolic (p<0.01) and diastolic (p<0.01) and 24 hour systolic pressures (p=0.03) compared with those not working. The rate of subsequent development of pre-eclampsia was significantly higher (odds ratio 4.1, 95% CI 1.1 to 15.2, p=0.03) among those at work compared with those not working. The association between pre-eclampsia and maternal work remained significant (odds ratio 5.5, 95% CI 1.1 to 27.8, p=0.04) even after allowing for the confounding factors of age, smoking, body mass index, and marital status. When daytime systolic and diastolic blood pressure were added to the regression analysis the risk ratios for pre-eclampsia remained high but did not quite reach statistical significance (odds ratio 4.7, 0.90 to 24.8, p=0.066). Birth weight and placental weight were not predicted by work status or blood pressure. CONCLUSIONS: A significant independent relation was found between maternal work and ambulatory blood pressure levels in mid-pregnancy. In addition, it was found that maternal work was significantly associated with the subsequent development of pre-eclampsia

Three-year outcome of endovascular treatment of superficial femoral artery occlusion.

HYPOTHESIS: Patency after primary percutaneous transluminal angioplasty (PTA) and stenting of superficial femoral artery (SFA) occlusions is better than historical experience with PTA alone. DESIGN: Consecutive case series of primary PTA with stenting, and follow-up with duplex imaging every 6 months (mean +/- SD follow-up, 32 +/- 15 months). SETTING: Veterans Affairs medical center. PATIENTS AND METHODS: Patients were 57 previously untreated men with 71 limbs having chronic atherosclerotic SFA occlusion with suprageniculate reconstitution and patent tibial runoff. Critical ischemia (Society for Vascular Surgery [SVS] category, 4-6) was present in 7 (10%), the remainder had intermittent claudication only (SVS, 1-3). INTERVENTIONS: Guidewire recanalization followed by PTA, Wallstent deployment, and adjunctive thrombolysis as necessary; 19 limbs (27%) required thrombolysis to manage periprocedural thrombosis. MAIN OUTCOME MEASURES: Cumulative patency, limb salvage, and complications. RESULTS: Length (mean +/- SD) of occlusion was 14.4 +/- 9.9 cm. Length of stented artery was 24.3 +/- 11.1 cm. Ankle brachial index increased from 0.59 +/- 0.14 to 0.86 +/- 0.16 (P<.001) after stenting. One- and 3-year patencies were as follows: primary, 54.6% +/- 6.3% and 29.9% +/- 6.6%; assisted primary, 72.3% +/- 5.6% and 59.0% +/- 6.8%; and secondary, 81.6% +/- 4.8% and 68.3% +/- 6.5%. Three-year secondary patency when periprocedural thrombolysis was required was 35.7% +/- 12.5% compared with 70.6% +/- 7.4% for limbs not requiring periprocedural thrombolysis (P=.02); the differences in occlusion length and severity of ischemia were not significant between these 2 groups. Limbs undergoing adjunctive PTA during angiography 6 to 12 months after initial stenting had 63.0% +/- 13.3% patency at 3 years compared with 100% patency in limbs not requiring PTA at 6 to 12 months angiography (P=.046). Periprocedural mortality and morbidity were 2.8% and 15.5%, respectively. Three of the 7 limbs with critical ischemia underwent amputation during follow-up compared with 2 (3%) of 64 limbs with functional ischemia (chi(2) test, P<.006). A mean of 1.8 endovascular interventions per limb were performed. CONCLUSIONS: Percutaneous transluminal angioplasty and stenting yielded higher patency rates than historical controls undergoing PTA alone. When periprocedural thrombolysis is required, subsequent patency appears to be significantly worse. Poor results after PTA and stenting of limbs with critical ischemia and the need for additional endovascular therapy limit the technique's utility.

Angioplasty and stent placement in chronic occlusion of the superficial femoral artery: technique and results.

PURPOSE: To improve the patency rate for angioplasty in chronic occlusion of the superficial femoral artery by deploying stents after angioplasty. MATERIALS AND METHODS: Angioplasty and stent placement were performed in 61 arteries in 48 male patients. The mean occlusion length was 13.5 cm and the mean stent length was 30 cm. Patency rates were analyzed at 6 months and at 1, 2, 3, and 4 years. The predictors of restenosis were analyzed by univariate and multiple logistic regression. RESULTS: Patency rates were 87% at 6 months, consisting of 74% primary, 6% primary assisted, and 7% secondary; 79% at 1 year, consisting of 47% primary, 19% primary assisted, and 13% secondary; 72% at 2 years, consisting of 36% primary, 26% primary assisted, and 10% secondary; 70% at 3 years, consisting of 26% primary, 22% primary assisted, and 22% secondary; and 63% at 4 years, consisting of 25% primary, 0% primary assisted, and 38% secondary. There was a 15% morbidity rate and one mortality as a result of retroperitoneal bleeding. Better patency rates were noted at all time intervals in diabetic limbs, 7-mm-diameter versus 10-mm-diameter stents, shorter obstructions and shorter stents, nonsmokers, in limbs in which urokinase was not necessary after stent deployment, and in limbs with an International Society of Cardiovascular Surgery (ISCVS) classification under 3. Patency rates were not affected by age, race, number of trifurcation vessels patent, experience in performing the procedures, and procedures requiring less time. By multivariate logistic analysis, the independent predictors of patency at 6 months were postprocedure ankle/brachial index (ABI) and shorter stent length; at 1 year, preprocedure ABI, shorter stent length, and the presence of diabetes; at 2 years, preprocedure ABI and the presence of diabetes; and at 3 years, the preprocedure ABI. CONCLUSIONS: The techniques used to reestablish antegrade flow in these superficial femoral arteries yielded a high success rate. In addition, the use of angioplasty with stents may improve patency rates over angioplasty without stents.

The relationship between cyclooxygenase-2 expression and colorectal cancer.

CONTEXT: Epidemiological studies have implicated the inducible form of cyclooxygenase (COX-2) in the pathogenesis of colorectal cancer; however, its role is not fully understood. OBJECTIVE: To examine the relationship between the expression of COX-2 in human colorectal cancer and patient survival. DESIGN: Patients diagnosed as having colorectal cancer were evaluated and followed up for up to 9.4 years (median follow-up, 2.7 years). Tumor sections were stained for COX-2 using a rabbit polyclonal antibody raised against human COX-2. The extent of COX-2 staining was graded by 2 observers blinded to outcome. Preabsorption of the anti-COX-2 antibody with a COX-2 peptide abolished the staining, demonstrating the specificity of the assay. SETTING: Gastrointestinal unit of a large general teaching hospital in Dublin, Ireland. PARTICIPANTS: Seventy-six patients (median age, 66.5 years) with colorectal cancer (Dukes tumor stage A, n = 9; Dukes B, n = 30; Dukes C, n = 25; Dukes D, n = 12) whose diagnosis was made between 1988 and 1991. Fourteen normal colon biopsies were stained for COX-2 as controls. MAIN OUTCOME MEASURES: Survival in years following diagnosis compared by extent of COX-2 epithelial staining (grade 1, <1%; grade 2, 1%-19%; grade 3, 20%-49%; grade 4, > or = 50%), Dukes stage, tumor size, and lymph mode metastasis. RESULTS: COX-2 was found in tumor epithelial cells, inflammatory cells, vascular endothelium, and/or fibroblasts. The extent of epithelial staining was heterogeneous, varying markedly among different tumors. Normal tissue adjacent to the tumors also stained weakly for COX-2. No COX-2 was detected in control tissue samples. The Kaplan-Meier survival estimate was 68% in patients who had grade 1 tumor epithelial staining compared with 35% in those with higher grades combined (log-rank chi2 = 5.7; P = .02). Greater expression of COX-2 correlated with more advanced Dukes stage (Kendall tau-b, 0.22; P = .03) and larger tumor size (Kendall tau-b, 0.21; P = .02) and was particularly evident in tumors with lymph node involvement (Kendall tau-b, 0.26; P = .02). CONCLUSIONS: Our data indicate that COX-2 expression in colorectal cancer may be related to survival. These data add to the growing epidemiological and experimental evidence that COX-2 may play a role in colorectal tumorigenesis.

Refractory hypoxemia due to intrapulmonary shunting associated with bronchioloalveolar carcinoma.

Bronchioloalveolar carcinoma caused severe refractory hypoxemia due to intrapulmonary shunting in a patient. Preoperative evaluation by occlusion of the pulmonary lobar artery supplying the tumor showed normalization of the arterial oxygen saturation. Resection of the involved lobe corrected the intrapulmonary shunting, and the patient required no further supplemental oxygen. However, with recurrence of the tumor over the next 6 months the patient became progressively more hypoxemic and died.

Solar disinfection of drinking water and diarrhoea in Maasai children: a controlled field trial.

BACKGROUND: Solar radiation reduces the bacterial content of water, and may therefore offer a method for disinfection of drinking water that requires few resources and no expertise. METHODS: We distributed plastic water bottles to 206 Maasai children aged 5-16 years whose drinking water was contaminated with faecal coliform bacteria. Children were instructed to fill the bottle with water and leave it in full sunlight on the roof of the hut (solar group), or to keep their filled bottles indoors in the shade (control group). A Maasai-speaking fieldworker who lived in the community interviewed the mother of each child once every 2 weeks for 12 weeks. Occurrence and severity of diarrhoea was recorded at each follow-up visit. FINDINGS: Among the 108 children in households allocated solar treatment, diarrhoea was reported in 439 of the 2-week reporting periods during the 12-week trial (average 4.1 [SD 1.2] per child). By comparison, the 98 children in the control households reported diarrhoea during 444 2-week reporting periods (average 4.5 [1.2] per child). Diarrhoea severe enough to prevent performance of duties occurred during 186 reporting periods in the solar group and during 222 periods in the control group (average 1.7 [1.2] vs 2.3 [1.4]). After adjustment for age, solar treatment of drinking water was associated with a reduction in all diarrhoea episodes (odds ratio 0.66 [0.50-0.87]) and in episodes of severe diarrhoea (0.65 [0.50-0.86]). INTERPRETATION: Our findings suggest that solar disinfection of water may significantly reduce morbidity in communities with no other means of disinfection of drinking water, because of lack of resources or in the event of a disaster.

PIP: During December 1995-March 1996 in Kajiado Province, Kenya, 206 Maasai children, 5-16 years old, whose drinking water was contaminated with fecal coliform bacteria, were assigned 1.5 liter plastic bottles in which to store their drinking water. These bottles were re-used commercial table water bottles. The families of the children had only community sources for drinking water: 2 open water-holes and 1 tank fed from a piped supply. These water sources were not suited to chlorination. Scarce fuel and indoor air pollution precluded boiling water inside the hut. In the presence of their mothers, 108 children (the solar group) were told to fill the bottles with water at dawn, leave them in full sunlight on the roofs of their homes, and wait until midday before drinking from the bottles. The remaining 98 children (the control group) were told to leave the bottles in their homes. The purpose of the study was to evaluate the effect of solar disinfection on diarrheal disease in these Maasai children. Over a 12-week period, children in the solar group suffered fewer diarrhea episodes than those in the control group (4.1 vs. 4.5; adjusted odds ratio [AOR] = 0.66). They also were less likely to have diarrhea episodes severe enough to prevent them from doing their chores (1.7 vs. 2.3; AOR = 0.65). These findings suggest that solar disinfection of water may reduce diarrhea in communities with no access to other means of disinfection.

Determinants of patency after percutaneous angioplasty and atherectomy of occluded superficial femoral arteries.

BACKGROUND: Patients undergoing percutaneous recanalization of chronically occluded superficial femoral arteries were studied to determine which factors correlated with 1-year patency. Immediate change in ankle:brachial index (ABI), length of occlusion, tibial run-off, and the performance of supplemental catheter atherectomy were evaluated. METHODS: Eligible patients had at least one patient tibial run-off vessel and the absence of limb-threatening ischemia. Recanalization was performed via passage of a guidewire followed by balloon angioplasty. Tibial run-off was scored based on a modification of the angiogram scoring system of the Society for Vascular Surgery and the International Society for Cardiovascular Surgery. Supplemental transcutaneous extraction catheter atherectomy was randomly assigned to a sub-group of patients after initial experience with the recanalization technique. Clinical follow-up was employed to determine patency. RESULTS: Forty-two of 57 attempts (74%) at recanalization were immediately successful. Overall 1-year patency was 40% in 40 limbs that could be followed. In limbs with balloon angioplasty alone (n = 23), patency was 43% compared with 35% in those having supplemental atherectomy. Tibial run-off did not vary significantly between patent and occluded groups. When ABI increased by 0.3 or more, patency was 56% compared with 26% when the ABI increase was less than or equal to 0.1 (P = 0.13). Occlusion length averaged 18.1 +/- 10.6 cm for all limbs and did not vary significantly between early successes and failures. Limbs with short occlusions (less than or equal to 5 cm, n = 8) had 63% patency compared with 38% patency for limbs with long occlusions (greater than 25 cm, n = 16), but the difference was not significant by analysis of variance. CONCLUSIONS: An initial change in ABI was most predictive for patency, whereas no correlation with tibial run-off was demonstrated. Atherectomy did not increase patency. Short occlusions were more likely to remain patent than long ones, but overall patency was lower than described in other series.

The 15-year prognosis of a first acute coronary episode in women.

We report on the 15-year prognosis of 720 male and 246 female 28-day survivors of a first myocardial infarction or episode of unstable angina who were aged under 60 years at the time of admission to the study. Women were on average 1.9 years older than men, had higher cholesterol levels, a higher prevalence of hypertension and angina prior to admission and a higher proportion were lifetime non-smokers. Women were more likely to be admitted with unstable angina rather than infarction. When adjusted for age, smoking status, angina, hypertension and the difference in prevalence of infarction, women had a relative risk of death of 1.054 in a 15-year life table mortality analysis. Prognostic differences between the sexes reported may be the result of failure to allow for differences in other prognostic factors.

When does the risk of acute coronary heart disease in ex-smokers fall to that in non-smokers? A retrospective study of patients admitted to hospital with a first episode of myocardial infarction or unstable angina.

Nine hundred and seventy eight patients admitted with a first myocardial infarction or episode of unstable angina were studied to determine for how long after they gave up smoking did the risk in ex-smokers continue to resemble those of current smokers. Logistic regression was used to calculate a score, based on a combination of age, cholesterol, and hypertension, that separated current smokers from lifetime non-smokers. When this function was applied to ex-smokers, only those who had given up at least 15 years before the attack had a risk factor profile similar to that of non-smokers. Those who had given up less than five years before the ischaemic attack had a significantly higher level of other risk factors than current smokers; those who had stopped for between five and 15 years had levels similar to those of current smokers. Ex-smokers are at higher risk of acute coronary disease for at least 15 years after stopping, but some immediate reduction in risk is possible.

Smoking and acute coronary heart disease: a comparative study.

Nine hundred and seventy eight patients with a first documented myocardial infarction were studied to detect smoking related differences in clinical profile and in-hospital outcome. The distribution of infarct sites differed significantly between smokers and non-smokers. Smokers had higher peak cardiac enzyme concentrations. In spite of this, smokers had a better prognosis than non-smokers. There are important differences between smokers and non-smokers, both in clinical profile and in-hospital outcome, which may reflect a difference in the nature of the underlying coronary disease.

Relation of infarct site to 15 year prognosis in patients who survived for 28 days after a first myocardial infarction.

Six hundred and eighty four patients (629 men), all aged under 60 years, who had survived for 28 days after a first acute myocardial infarction were studied to determine the influence of the site of infarction on long term prognosis. The infarct site was not significantly related to age nor to extent of infarct at the time of the acute episode. Mechanical complications were more common in patients with anteroseptal infarctions, while atrioventricular conduction disturbances were more commonly found in those with inferior infarction. The site of infarction was not related to smoking habits or angina before the infarction or at 2 year follow up. Life table methods did not show any relation between infarction site and morbidity or mortality either two years or 15 years after the initial infarction.

Risk factors and in-hospital course of first myocardial infarction in the elderly.

We studied 980 patients with a first episode of unstable angina or myocardial infarction (MI), to examine age-related differences in risk factors and in-hospital complications and mortality. Of the total group, 52.9% were over 60 years of age and 24.3% over 70 years. The proportion of females rose with increasing age, as did the proportion of ex-smokers, while the proportion of current smokers fell. Age correlated negatively with total cholesterol levels, and positively with high-density lipoprotein cholesterol levels. The proportion of hypertensives rose with age, as did in-hospital systolic, but not diastolic, blood pressure. Older patients were more likely to have diabetes, and to have had chronic angina. There was no relation between age and either size or site of infarction. the proportion admitted with unstable angina fell with age, and, among infarctions, the proportion developing complications rose. Mortality rose from 3.1% in the under 60 subjects to 20.0% in those over 70. Cardiogenic shock tended to become more lethal with advancing age, but the outcome of ventricular fibrillation was not influenced by age. With the current aging coronary care population, management and secondary prevention methods derived from studies confined to younger subjects may be inappropriate.

Aetiological and prognostic correlates of site of myocardial infarction.

This is a study of the relationship between the site of infarction and both risk factors and in-hospital outcome in 745 consecutive patients admitted with a first myocardial infarction. Patients with anterior infarctions were significantly more likely never to have smoked than patients with inferior infarctions. They had a higher prevalence of hypertension and a higher mean cholesterol level. In-hospital prognosis was worse in anterior infarctions, with significantly higher rates of death and complications. Atrioventricular blocks were more common in inferior infarctions. Non-Q-wave infarctions had a lower incidence of complications than Q-wave infarctions. There was no difference in risk factor levels between Q-wave and non-Q-wave infarctions. Anterior and inferior infarctions were of similar size. Non-Q-wave infarctions were significantly smaller. A logistic regression showed a negative relationship between in-hospital mortality and smoking, and a positive one with peak cardiac enzyme levels. Any effect of site of infarction on mortality was eliminated when corrected for these factors. Our data indicate that the adverse prognosis associated with anterior myocardial infarction is related to differences in aetiology rather than to infarction size.

Risk factors and in-hospital course of first episode of myocardial infarction or acute coronary insufficiency in women.

This study examines the risk factor profile, in-hospital course and outcome of 337 women and 643 men admitted with a first episode of acute coronary insufficiency or myocardial infarction. The women were older than the men and had a risk factor profile dominated by hypertension and hypercholesterolemia rather than smoking. Women had a higher rate of unstable angina than did men after adjustment for age distribution. Women with acute infarction showed a higher rate of complications, which was associated with their greater age. They had a higher in-hospital mortality rate (12.6%) than did men (6.6%, p = 0.002). A logistic regression was used to adjust mortality and complication rates for differences in age between the sexes. When this was done, women and men had similar in-hospital prognoses. It is concluded that differences in risk factor profile may result in differences between the sexes in the expression of acute coronary heart disease, but that gender as such does not exert an independent influence on short-term prognosis in this disease.

Physician-dependent prognostic variables in the management of testicular cancer.

A study of 246 cases of germ cell testicular cancer in Ireland between 1980 and 1985 confirmed that the personnel and the manner of management can significantly influence the outcome. Inadequate staging by omitting marker assays or CT scan reduced prognosis. Failure to use standard chemotherapy (PVB, BEP, POMBACE, VAB) or a reduced dosage diminished survival. Regular investigations are necessary during treatment, including marker assays, chest X-ray and CT scan. Frequent monitoring is important in later follow-up. Management by a urologist improved survival, especially if he was involved from the outset. The results also favoured the concept of combined management by a urologist and an oncologist.

An evaluation of predisposing factors for testis cancer in Ireland.

All testis cancer in Ireland (1980-1985) was analysed (n = 240). Incidence was highest in young adults (5.8/10(5)/year in those aged 25-34 years) with a moderate level in the elderly (1.8/10(5)/year in those over 75 years). Associations elsewhere with maldescent and social class were confirmed but cryptorchidism (12%) was more common than expected. Significant infertility was not identified. Associations with urban domicile (77%, p = 0.001), mental handicap (2.8%, p less than 0.05), recent vasectomy (1.2%, p = 0.009) and certain occupations were observed.

Psychological response to an acute coronary event and its effect on subsequent rehabilitation and lifestyle change.

We assessed anxiety, depression, body image, motivation, and coping ability in 264 patients admitted with a first myocardial infarction. They were followed over 1 year to determine the relationship between psychological factors and subsequent return to work, smoking cessation, weight reduction, and adoption of a leisure exercise program. Females showed a poorer reaction to illness than did males. The better-educated, and patients in white-collar occupations showed less depression and expressed greater motivation. Anxiety and poor body image, however, tended to be least common in the intermediate educational and occupational group. All psychological factors predicted leisure exercise change, and all but anxiety predicted smoking cessation. Poor body image was linked with failure to reduce weight. Low expressed motivation was the only factor predicting delayed return to work.