High prevalence of postprandial and orthostatic hypotension among geriatric patients admitted to Dutch hospitals.

BACKGROUND: Previous studies have indicated that postprandial hypotension (PPH) and orthostatic hypotension (OH) occur infrequently together. As data on geriatric patients in hospitals are scarce, we investigated the prevalence of PPH and OH and their combined occurrence. Our study sample included patients admitted to two geriatric departments in Dutch hospitals. METHODS: During 9 months, hemodynamic changes were measured with Spacelab 90207 after standing and after meals in all eligible patients. PPH is defined as a meal-related decline in systolic blood pressure (SBP) > or =20 mmHg, OH after standing up. RESULTS: Eighty-five patients (44 men), mean age 80 +/- 7 years (range 60-98 years), with 4 +/- 2 diseases and 6 +/- 3 prescriptions, were included. PPH was present in 57 patients (67%) with a significant postmeal SBP decrease of 34 +/- 4 mmHg. OH was present in 44 patients (52%) with a mean SBP decline of 44 +/- 4 mmHg after standing. Thirty-two patients (37%) had OH and PPH. Only 16 patients (19%) had neither OH nor PPH. Symptoms of PPH were present in 65% of patients, with syncope (in five patients) and sleepiness as the most common symptoms. OH was symptomatic in 61% of patients, with dizziness and risk for falls as the most common symptoms. CONCLUSIONS: PPH and OH are more common in geriatric patients than was previously appreciated, with a high statistical probability that OH and PPH occur simultaneously. There is little overlap in symptoms of OH (dizziness, fall risk) versus PPH (sleepiness, syncope), which can play an important role in diagnosis. Because of the high prevalence of symptomatic PPH and OH, blood pressure measurements for diagnosing hypotensive syndromes should be part of a comprehensive geriatric assessment.

Persistent organochlorine compounds and birth weight.

PURPOSE: To determine whether weight at birth is related to prenatal exposure to persistent organochlorine compounds. METHODS: Birth weight was obtained for 197 singleton infants drawn from the general population born in two cities in Ukraine in 1993 to 1994. Concentrations of seven organochlorine pesticides (p,p'-DDT, p,p'-DDE, beta-hexachlorocyclohexane, hexachlorobenzene, trans-nonachlor, oxychlordane, heptachlor epoxide) and 11 polychlorinated biphenyl congeners measured in maternal milk taken at four or five days after birth were used as an index of prenatal exposure. RESULTS: The greatest differences were seen for beta-hexachlorocyclohexane, with a pattern not suggestive of dose-response; infants in the lowest tertile were small, those in the central tertile were large, and those in the upper tertile were average. Adjustment for gestational age and other potential confounders had little effect on these patterns. Infants in the two upper tertiles for p,p'-DDE were larger than those in the lower tertile, with the effect being more striking after adjustment for gestational age. Adjustment for potential confounders made the pattern disappear. Other chemicals showed no convincing evidence of effects. CONCLUSIONS: Prenatal exposure to the chemicals studied, at concentrations currently seen in this population, does not impact weight at birth.

Breast cancer: occurrence, risk factors and hormone metabolism.

Breast cancer is by far the most frequent cancer among women worldwide. Its determinants include reproductive events, exogenous and endogenous hormone levels and metabolism, exposures, such as radiation and chemicals, and genetics. This paper will review available evidence from all of these areas, exploring the occurrence of cancer, risk factors for occurrence and the hormonal milieu that underlies it.

Mini-and microsatellite mutations in children from Chernobyl accident cleanup workers.

Knowledge about possible genotoxic effects of low-dose radiation on the human germline is limited and relies primarily on extrapolations from high-dose exposures. To test whether ionizing radiation can cause paternal genetic mutations that are transmitted to offspring, we enrolled families of 88 Chernobyl cleanup workers exposed to ionizing radiation. We analyzed DNA isolated from lymphocytes for mutations via DNA blotting with the multi-locus minisatellite probes 33.6 and 33.15 and via PCR in a panel of six tetranucleotide repeats. Children conceived before and children conceived after their father's exposure showed no statistically significant differences in mutation frequencies. We saw an increase in germline microsatellite mutations after radiation exposure that was not statistically significant. We found no dependence of mutation rate on increasing exposure. A novel finding was that the tetranucleotide marker D7S1482 demonstrated germline hypermutability. In conclusion, our results do not support an increased level of germline minisatellite mutations but suggest a modest increase in germline mutations in tetranucleotide repeats. Small sample size, however, limited statistical power.

Placental weight and its ratio to birthweight in a Ukrainian city.

BACKGROUND: Placental weight and its ratio to birthweight have recently been reported to predict later chronic disease. These fetal growth indicators have been measured in the west for over a century with consistent results when methods of preparation were comparable. We investigated whether recent difficult conditions in the former eastern bloc have altered placental weight or its relationship to other fetal size measures from what has historically been reported. METHODS: Placentas were obtained from 1621 singleton births of at least 28 weeks gestation in a Ukrainian city during 1993-1994, using a systematic protocol. Maternal characteristics were obtained from questionnaires. Pregnancy complications and birth size measures (infant weight, length, crown-rump length, and head circumference) were abstracted from medical records. We examined relationships of placental weight and ratio to these variables. RESULTS: Placental weight ranged from 100 to 1000 g, with a mean of 470 g. Mean placental ratio was 13.9%. Placental weights increased and ratios decreased with gestational age. Larger ratios were related to larger maternal BMI. Absolute measures of infant size and placental weight were mutually positively correlated. Placental ratio, infant length, and ponderal index (PI) were nearly uncorrelated. CONCLUSIONS: Absolute and relative weights of Ukrainian placentas were similar to historical reports, as were their relationships to other infant size indicators. Placental weight ratio (PWR), ponderal index, and infant length measured different birth size dimensions. Placental availability, consistency of placental measurements, and placental ratio's reflection of an independent facet of fetal growth make the placenta a useful research tool.

Effects of maternal drinking, smoking, size, and parity on parent-offspring birth weight correlations.

Parent-offspring birth weight correlations are presented by sex of parent and infant. They range from .14 to .16, except for the mother-daughter correlation, which is .32. This pattern of parent-offspring correlations varies when the parity of the infant, the size of the mother, and the mother's drinking and smoking status are considered. All parent-offspring correlations are higher when the infant is parity 2 or more. The mother-daughter correlations are significantly higher than mother-son correlations when the mother is above average in usual weight, height, or pregnancy weight gain. When the mother smoked before conception, all birth weight correlations except mother-daughter are essentially zero. The mother-son correlation is also very small if the mother was a regular drinker, independent of her smoking status. The complex relationships in this sample demonstrate that interactions with environmental variables must be taken into account in studies of familial aggregation of human birth weight.

Alcohol, breastfeeding, and development at 18 months.

OBJECTIVE: We aimed to replicate a previous study of 1-year-olds that reported a deficit in motor development associated with moderate alcohol use during lactation, using a different but comparable population. METHODOLOGY: The mental development of 915 18-month-old toddlers from a random sample of a longitudinal population-based study in the United Kingdom was measured using the Griffiths Developmental Scales. Frequent self-administered questionnaires during and after pregnancy provided maternal data. The dose of alcohol available to the lactating infant was obtained by multiplying the alcohol intake of the mother by the proportion of breast milk in the infant's diet. We compared this dose with the Griffiths Scales of Mental Development, taking into account potentially confounding variables. RESULT: Three of the Griffiths scales increased slightly but significantly with increasing infant alcohol exposure; there was no association in the remaining 2 or average of the scales. DISCUSSION: We were unable to replicate the earlier deficit in motor skills associated with lactation alcohol use. One reason may be that the dose of alcohol reaching the lactating infant is small, and tests of infants and toddlers have limited ability to pick up small effects. Studies of older children may resolve the question of the safety of drinking while nursing.

Smoking and its correlates among preadolescent children in France.

BACKGROUND: Smoking often begins in early adolescence, and addiction can occur rapidly. For effective smoking prevention efforts with younger children, knowledge of their early smoking experience is needed. The purpose of this paper was to report the smoking experience of French elementary school children and to describe their lifestyle habits and health knowledge. METHODS: A cross-sectional study of 913 children age 9-11 years in 31 randomly selected schools of the Loire administrative department in France was conducted, using anonymous previously validated questionnaires. Correlates of smoking initiation and intention to smoke in the future were assessed by unconditional logistic regression analysis. RESULTS: A total of 12.3% of the children had smoked at least one cigarette, 5.1% within the previous 30 days. Correlates of ever smoking were male sex, older age, engaging in physical activity, reporting not following safety-related recommendations, or drinking alcohol. Of the 112 children who reported ever smoking, 45.5% stated that they did not want to remain smokers in the future and an additional 26.8% were not sure. CONCLUSIONS: Information on the smoking experience of preadolescents should help in designing effective prevention programs, which are essential for reinforcing abstinence in nonsmokers and preventing others from progressing to addiction.