NIOSH selection of chemicals and study publications: setting priorities for reproductive research.

The National Institute for Occupational Safety and Health (NIOSH) prioritizes topics for reproductive research in order to allocate limited resources to the most important issues. In the past, we have relied on an informal network including our own project officers, toxicologists, and the public to nominate chemicals to study. Setting priorities has consisted of the evaluation of research ideas by criteria such as the chemical's probable toxicity and the extent of exposure to the chemical in the workplace. NIOSH researchers are developing a system for evaluating large databases of toxicologic and occupational exposure information to identify potential reproductive toxins. When this system is operational it will provide a systematic way to nominate chemicals for study.

Methods of monitoring menstrual function in field studies: attitudes of working women.

This study was designed to determine the attitudes and compliance of working women toward methods being evaluated for use in the assessment of the effects of toxicants on reproductive potential. Women such as the highly motivated fertility patients and nurses, who are typically familiar with the methods and procedures of fertility assessment and the value of medical research, have been used to validate such methods in a clinical setting. However, the attitudes of a general working female population toward these methods are unknown. Nine participants were selected on the bases, in part, of not seeking fertility assistance, working full-time but not in the medical field, and having less than one year of college education. Attitudes were also evaluated for 193 non-participating women to whom the procedures had been verbally described. Participants measured basal body temperature and salivary and vaginal mucous electrical resistance, evaluated cervical mucus manually (CME), and collected the first morning urine for two menstrual cycles. Blood, saliva, and transvaginal ultrasonograms (US) were obtained at a fertility clinic 6 to 9 days per cycle. Participants brought urine to the laboratory every 3 days. All participants performed all methods. Participants were paid $400; nonparticipants were not compensated. Only 3% of the respondents objected to the proposed methods: principally to CME, US, and giving blood samples. No respondent perceived the study as unimportant.(ABSTRACT TRUNCATED AT 250 WORDS)

The estimated predictive value of screening for illicit drugs in the workplace.

This paper estimates the predictive values of screening tests for six illicit drugs of common concern in the workplace (amphetamines, barbiturates, cocaine, hallucinogens, marijuana, and opiates) using published information on test sensitivity and specificity and survey data on prevalence. Estimated predictive values (negative) were generally high, whereas the estimated predictive value of a positive test ranged from 1 per cent for amphetamines to 100 per cent for hallucinogens and was only 38 per cent for marijuana, the most prevalent drug.

Risk factors for depression in adolescence.

Public health concern regarding depression has recently increased as a result of the rise in the rate of adolescent suicide, with a probable concomitant rise in the rate of depression in this age group. The rise appears to be both a period effect, in that increased rates are now observed across age categories, and a cohort effect, in that being born after 1960 also contributes to the increase. The clinical phenomena and epidemiology of depression in adolescence are reviewed. Diagnostic criteria for depressive mood and depressive syndrome are similar to those in adults. However, the predictive value of a depressive episode in adolescence, and whether the occurrence of depression in adolescence is a transient developmental experience or whether it predicts a particular subtype of future depression, are at present unknown. The familial, social and personal risk factors for adolescent depression are reviewed, The major factors are: parental history of affective illness, childhood experience of parental loss, and female gender. Other factors, such as birth order and sibling factors, socio-economic status, race, religion, geography, concomitant medical illness, intelligence, career aspirations, substance abuse and life events, are reviewed, although their relative contributions as risk factors are less clear-cut. It is proposed that cross-sectional, retrospective and longitudinal studies are required to clarify important areas of uncertainty.

A systematic review of the mortality of depression.

OBJECTIVE: The literature on the mortality of depression was assessed with respect to five issues: 1) strength of evidence for increased mortality, 2) controlling for mediating factors, 3) the contribution of suicide, 4) variation across sample types, and 5) possible mechanisms. METHOD: All relevant English language databases from 1966 to 1996 were searched for reviews and studies that included 1) a formal assessment of depressive symptoms or disorders, 2) death rates or risks, and 3) an appropriate comparison group. RESULTS: There were 57 studies found; 29 (51%) were positive, 13 (23%) negative, and 15 (26%) mixed. Twenty-one studies (37%) ranked among the better studies on the strength of evidence scale used in this study, but there are too few comparable, well-controlled studies to provide a sound estimate of the mortality risk associated with depression. Only six studies controlled for more than one of the four major mediating factors. Suicide accounted for less than 20% of the deaths in psychiatric samples, and less than 1% in medical and community samples. Depression seems to increase the risk of death by cardiovascular disease, especially in men, but depression does not seem to increase the risk of death by cancer. Variability in methods prevents a more rigorous meta-analysis of risk. CONCLUSION: The studies linking depression to early death are poorly controlled, but they suggest that depression substantially increases the risk of death, especially death by unnatural causes and cardiovascular disease. Future well-controlled studies of high risk groups may guide efforts to develop treatments that reduce the mortality risk of depression.

Clonazepam treatment of panic disorder in patients with recurrent chest pain and normal coronary arteries.

OBJECTIVE: To examine the efficacy of clonazepam in chest pain patients with panic disorder and normal coronary arteries. METHOD: We conducted a placebo controlled, double blind, flexible dose (1-4 mg/d), six-week trial of clonazepam. All subjects (N = 27) had current panic disorder and a negative coronary angiogram or thallium exercise tolerance test within the previous year. RESULTS: Analyses show modest improvements in the clonazepam and placebo groups over the first four weeks in both primary outcome measures. Eight of twelve (67%) clonazepam treated patients responded with reduction of panic attacks by week four to zero per week or half of initial frequency, while seven of fifteen (47%) placebo treated patients responded (not significant). When response was measured by 50 percent reduction in Hamilton Anxiety total score, however, seven of twelve (58%) clonazepam treated patients responded, while two of fifteen (14%) placebo treated patients responded, (p = .038) by Fisher's exact test. Within-subject improvements over the first four weeks were not significantly greater for the clonazepam group than for the placebo group on either outcome measure. CONCLUSIONS: These results show a generally good outcome in chest pain patients with panic disorder, and they provide suggestive evidence for the efficacy of clonazepam compared to placebo. This study points to the need for larger, well-funded treatment studies of chest pain patients with panic disorder.

The shocking lung mass: a case report.

Two years after implantation of an ICD with epicardial patch leads, a patient presented with hemoptysis. The posterior left ventricular patch was found to have eroded into lingular segmental bronchus. During thoracotomy, the hardware was removed and the bronchus successfully repaired.