A population-based survey of prostate cancer testing in New Mexico.

Prostate cancer screening has increased dramatically in the past decade, but few studies have looked at population-based testing rates and the factors that influence testing. The objectives of our study were to estimate prostate cancer testing rates for New Mexican men 50 years or older and to identify patient factors associated with testing. We surveyed men using random-digit dialing. Subjects completed a 32-item questionnaire asking about prostate cancer testing; demographics; cancer knowledge, attitudes, and beliefs; health behaviors; and risks for prostate cancer. Associations between patient factors and testing were analyzed with multivariate logistic regression. Two hundred thirty-nine subjects (36% response rate) completed the survey; 95% had heard of prostate cancer and nearly 90% felt that testing was important. Forty-eight percent had been tested, most within the past year. Significant predictors for testing included receiving regular health care (odds ratio = 2.15, 95% CI = 1.07-4.33), being retired (OR = 2.49, 95 CI = 1.18-5.28), and having been diagnosed with prostatic hyperplasia (OR = 3.14, 95% CI = 1.30-7.59). Prostate cancer testing occurred frequently among New Mexican men. The study variables that were the most significant predictors of testing were all markers for access to health care.

Variation in recommendations for cancer screening among primary care physicians in New Mexico.

The acceptance of age-appropriate cancer screening as an integral part of primary care has grown among physicians over the past decade. We conducted a mailed survey of all primary care physicians in New Mexico in order to better understand their current cancer screening practices. We found a high rate of self-reported screening, particularly for prostate and colorectal cancer. The screening rates were influenced only slightly by the introduction of evidence-based guidelines, with younger physicians and those with university affiliations more likely to follow recommendations. Female physicians and obstetrician-gynecologists endorsed breast and cervical cancer screening among all age groups and were less likely to follow recommendations for less frequent screening in women as they age. Since a physician's practice beliefs influence his/her attitude toward testing, tailoring education by physician specialty may be more effective than using generic messages in encouraging compliance with the most recent evidence-based guidelines.

An outbreak of salmonellosis among children attending a reptile exhibit at a zoo.

OBJECTIVE: In January 1996, an outbreak of diarrhea caused by Salmonella Enteritidis occurred in children attending a Komodo dragon exhibit at a metropolitan zoo. We sought to determine the extent of the outbreak and mode of transmission. STUDY DESIGN: A case-control study was conducted. Controls were randomly selected from zoo membership lists and matched to patients by age group and date of exhibit visit. RESULTS: Of 65 patients identified, 39 had confirmed and 26 had suspected cases. The median age was 7 years (range, 3 months to 48 years); 55% were enrolled in the case-control study. No patients and two (4%) controls reported touching a dragon; however, 83% of patients but only 52% of controls touched the wooden barrier that surrounded the dragon pen (odds ratio = 4.0, 95% CI 1.2 to 13.9). Washing hands at the zoo after visiting the dragons was highly protective (OR = 0.14, 95% CI 0.03 to 0.7). Cultures from the patients, one dragon, and the exhibit barriers yielded Salmonella Enteritidis, phage type 8. On the basis of an attack rate of 4.3% among exhibit attendees under 13 years old on whom data were collected, we estimate that 315 additional cases of salmonellosis occurred among visitors in this age group. CONCLUSION: This large outbreak demonstrates the importance of environmental contamination in the transmission of Salmonella from reptiles, and the protective value of hand washing. Recommendations regarding reptile exhibits and reptilian pets should emphasize this indirect route.

An active focus of high prevalence of fogo selvagem on an Amerindian reservation in Brazil. Cooperative Group on Fogo Selvagem Research.

Fogo Selvagem (FS) is an autoimmune disease characterized by subcorneal vesicles and antidesmoglein-1 autoantibodies. Previous epidemiologic data have linked the onset of FS to exposure to an environmental antigen(s). This investigation describes a unique human settlement with an extraordinarily high prevalence of FS. This community is made up of Amerindians belonging to the Terena tribe, which has settled on the Limao Verde reservation in the state of Mato Grosso do Sul in Brazil. Twenty-six well-characterized FS cases have been identified within a total population of 998, yielding a prevalence of 2.6%. Seventeen of the patients (65 %) were males, and over 50% were older than 30 y of age. The incidence of the disease shows temporal periodicity, i.e., years with several cases of FS alternating with years with no cases. Over one-half of the cases occurred in genetically related family members. Another Terena reservation, the Ipegue/Taunay, located 90 km west of the Limao Verde reservation, was also evaluated as a control group. This reservation, with a population of 2203, had no recorded cases of FS. Thus, the Limao Verde reservation represents a new focus of FS in which the disease exhibits temporal, geographic, and familial clustering. These results suggest that the environmental antigen or antigens precipitating FS are endemic to the Limao Verde reservation. This reservation appears to be an ideal population for carrying out sero-epidemiologic, genetic, and environmental studies aimed at disclosing the etiology of FS.

Rapid rise and subsequent decline in prostate cancer incidence rates for New Mexico, 1989-1993.

Beginning in the late 1980s, a large increase in incidence rates for prostate cancer occurred in association with increased prostate-specific antigen (PSA) screening. In New Mexico, the increased screening was associated with earlier detection of cancers and decreased prostate cancer mortality, suggesting that PSA screening may be effective. PSA screening has become a controversial topic of public debate, and anecdotal reports from physicians indicated that prostate cancer screening practice patterns were changing in New Mexico. To assess whether PSA-associated trends in prostate cancer incidence were continuing, we examined incidence rates from 1989 to 1993 among men in New Mexico. From 1989 to 1992, age-adjusted rates increased substantially for non-Hispanic whites (77%), Hispanics (50%), and American Indians (27%). Although rates increased for all stages combined, incidence rates decreased for distant-stage disease, especially for non-Hispanic whites, indicating a continuing trend toward earlier detection. In 1993, incidence rates unexpectedly decreased from 203 to 158/100,000 in non-Hispanic whites, largely as a result of changes in rates in men over age 65 years. Although incidence rates decreased, the trend toward earlier detection was maintained for non-Hispanic whites. In contrast, among Hispanic and American Indians, rates did not change substantially between 1992 and 1993. Because the epidemic in prostate cancer was associated with increased PSA screening, it is likely that the trends for non-Hispanic whites are also related to PSA screening. We suggest that the decrease in rates and the continued stage shift are consistent with repeated screening of men in the population at risk.

The importance of screening edentulous patients for oral cancer.

A study of the dental status of 947 patients with oral cancer was conducted to determine how dentists might gain better access to patients in whom this disease develops. This access could lead to earlier diagnosis and thereby improve the prognosis. Dental profiles revealed that 68% of the patients were partially or totally edentulous, 14% had neglected teeth, and the remaining 18% had intact dentitions. The mean age of patients was 61.7 years. Efforts should be made to promote the recall of edentulous patients. This may facilitate an earlier discovery of many oral cancers.

Relationship between nutrition, weight change, and fluid compartments in preterm infants during the first week of life.

This study was conducted to investigate the redistribution of fluid compartments and to examine the factors contributing to the variability of early weight loss in premature infants. Fourteen preterm infants (mean +/- SD: birth weight, 1473 +/- 342 gm; gestational age, 30.7 +/- 2.4 weeks) were studied at 1 and 7 days of age. Total body water was measured by deuterium oxide dilution, extracellular volume by bromide dilution, and intracellular volume by the difference between total body water and extracellular volume. There were significant changes in body fluid distribution per concurrent weight from birth to age 1 week. Extracellular volume decreased by 11%, and intracellular volume increased by 8.5% with no change in total body water. Infants were then grouped according to postnatal weight loss (group 1 (n = 7) > 10% and group 2 (n = 7) < 5% of birth weight). In group 1 there was a significant loss of both weight (mean +/- SD: 15.6% +/- 3.7%) and extracellular volume (15.9% +/- 9% of birth weight), with no change in intracellular volume. In group 2 there was no significant weight loss (1.4% +/- 1.8%), but a significant loss of extracellular volume (13.0% +/- 5.4% of birth weight) and a significant increase in intracellular volume. Other differences between the groups were a lower energy intake in group 1 than in group 2 (mean +/- SD: 177 +/- 46 vs 269 +/- 45 kilojoules/kg per day; p < 0.005) and a higher physiologic stability index in group 1 (p < 0.05). We conclude that significant postnatal weight loss as a result of the contraction of the extracellular compartment occurs only in less stable infants whose energy intake is inadequate. With adequate energy intake, weight loss is minimal because of the expansion of the intracellular compartment, which may be related to the onset of growth.

Left posterior hemiblock related to an interventricular septum tumour. First case in the literature.

A 22-year-old man who engaged in intense and regular physical exercise complained of atypical chest pain. The only remarkable abnormality found in the routine clinical work-up was a left posterior hemiblock. The echocardiogram and the magnetic resonance imaging (MRI) study showed a tumour in the posterior and superior aspect of the interventricular septum where the posterior fascicle of the left bundle is located. It was interpreted that the left posterior hemiblock was produced by the tumour.

Induction of cytotoxic T lymphocyte development from murine thymocytes by IL-1 and IL-6.

Cytotoxic T lymphocytes (CTL) are believed to play an important role in the regression of advanced malignancies in response to adoptive immunotherapy with interleukin-2 (IL-2) and lymphokine-activated killer cells or tumor-infiltrating lymphocytes. Because the current limitations to the use of adoptive immunotherapy are the IL-2 dose-dependent toxicities and the difficulty in expanding the effector cell population, recent investigations have focused on the development of newer methods for generating CTL in vitro. IL-1 and IL-6 have been shown to synergistically promote thymocyte proliferation; however, their effect on CTL development has not been studied. We investigated the ability of these two cytokines to induce CTL development from immature thymocytes. Thymocytes from 5-week-old BALB/c mice were cultured for 72 hours in the presence of Con A and recombinant IL-1, IL-6, or IL-1 plus IL-6. Cytotoxicity against 51Cr-labeled P815 target cells was then measured in the presence of submitogenic doses of PHA. Neither IL-1 nor IL-6 induced a significant number of CTL from immature thymocytes. However, these two cytokines synergistically induced maximal CTL development. The monoclonal antibody to IL-4 completely abrogated CTL development induced by IL-1 and IL-6, but antibody to the IL-2 receptor had no effect. The data suggest that IL-1 and IL-6 can provide an additional method for in vitro CTL generation in adoptive immunotherapy of advanced tumors.

Characterization of wound cytokines in the sponge matrix model.

Although different populations of inflammatory cells infiltrate the healing wound, the mechanisms by which they influence the healing process in vivo are poorly defined. In vitro studies suggest that these cells may mediate wound healing by releasing various cytokines within the wound. We measured the levels of interleukin (IL) 1, IL-2, IL-3, IL-4, IL-6, tumor necrosis factor, and macrophage colony-stimulating factor within a subcutaneously implanted polyurethane sponge on various days after injury. Significantly higher levels of IL-1, IL-6, tumor necrosis factor, and macrophage colony-stimulating factor were detected in the wound fluid compared with basal serum levels in nonwounded mice. Tumor necrosis factor, macrophage colony-stimulating factor, and IL-6 peaked earlier than IL-1; however, the levels of these cytokines had fallen by the 13th day after wounding. Interleukin 2, IL-3, and IL-4 could not be detected in the wound fluid, and the wound fluid inhibited the proliferation of the IL-2-dependent cell lines CTLL-2 and HT-2 in response to recombinant IL-2. We hypothesize that tumor necrosis factor, macrophage colony-stimulating factor, IL-1, and IL-6, which are secreted at the site of injury, interact to promote tissue remodeling. The decrease in the levels of these cytokines by the 13th day after wounding may be the result of a regulatory process by the healed wound.

46XY siblings with inadequate virilization and CNS deficiency.

Familial expression of inadequate virilization of 46XY siblings is often reported as an isolated anomaly. We recently evaluated two families with 2 siblings who had a 46XY karyotype, ambiguous genitalia or micropenis, facial anomalies and mental retardation. There is no evidence of gonadotropin deficiency, defects of steroidogenesis, or androgen insensitivity. While there was a testosterone response to human chorionic gonadotropin stimulation in all 3 tested, gonadotropin levels were elevated in 2 of the infants suggestive of faulty seminiferous tubules, 1 of whom later had elevated luteinizing hormone levels. These kindreds may represent a new syndrome with either an X-linked recessive or sex-limited autosomal dominant form of inheritance, with partial testicular failure, multiple congenital anomalies, and mental retardation.

Risk factors for victimization during the 1980 riot at the Penitentiary of New Mexico.

The New Mexico Penitentiary riot of February 2, 1980, resulted in death for 33 inmates at the hands of their fellow prisoners, and the hospitalization of 62 inmates for treatment of drug overdose or trauma. A case-control study of dead and hospitalized inmates was conducted to determine risk factors for victimization. Twelve (12.5%) of the 96 inmates housed in the protective custody unit were killed, compared with an overall penitentiary death rate of 2.9% (p = 0.0003). These 12 individuals were similar to the general inmate population with respect to age, race, years of education, crimes, time served, and prison rule infractions committed. In contrast, the 21 homicide victims housed in other areas were younger and had committed significantly greater numbers of rule infractions during incarceration. Prisoners hospitalized for drug overdose, but not those hospitalized for traumatic injuries, could be differentiated from the remaining prison population by increased convictions for homicide and higher prison infraction rates. Inmates in protective custody were targeted selectively for death; other subgroups of victims of violence appear to share characteristics often associated with perpetrators of violence.

Assessment of immunoglobulin use for hepatitis A control in New Mexico.

Community control of hepatitis A (HA) requires improvement of sanitation and timely use of immune globulin (IG) for selected contacts of ill persons. A marked increase in reported HA cases in New Mexico in late 1978 and early 1979 prompted aggressive evaluation of morbidity trends and of control efforts. This evaluation provided an opportunity to study the practices in disease reporting and IG administration in the State. In the 6-months study period January-June 1979, 596 cases of HA were reported in New Mexico (an annualized incidence rate of 95.9 cases per 100,000 population). Nearly three-fourths of the cases were reported within 14 days of onset of illness. IG was administered to the household contacts of 89 percent of the index patients; it was not indicated for the household contacts of 9 percent. Reasons for the failure to administer IG to the household contact of the other 2 percent of the index patients were not ascertained. Overall, 93 percent of the eligible household contacts received IG, and 80 percent of these contacts received it within 14 days of the onset of illness in the index patient. Differences in the relationship of physicians and health offices in the only metropolitan area in the State and in the rest of the State in respect to case reporting and IG administration were observed. The benefits from health department surveillance and control exceeded the costs by approximately fivefold. The reporting practices and the IG use of the physicians who reported HA cases were good; to improve further HA surveillance and control in the State, the focus needs to be on physicians who fail to report HA cases.

Increased incidence and prevalence of multiple sclerosis in Los Alamos County, New Mexico.

The incidence and prevalence of multiple sclerosis (MS) in Los Alamos County, New Mexico, were investigated because the number of reported cases appeared to have increased. The point prevalence on November 1, 1979, was 75.7 per 100,000, and average annual incidence rates for the period 1960-1969 and 1970-1979 were 3.4 and 3.7 per 100,000, respectively. The rates of MS in Los Alamos County were greater than expected from previous epidemiologic surveys of North America. The unusual ethnic composition and high socioeconomic level of the population probably contributed to the increases.

The advent of human diploid cell rabies vaccine: impact on vaccine utilization in New Mexico.

Three months' experience with the newly licensed human diploid cell rabies vaccine in the New Mexico comprehensive consultation-biologics system was reviewed. Comparison with the same period in 1978 and 1979 showed no increase in vaccine utilization despite the advent of this simpler-to-use, safer rabies vaccine. Anti-rabies treatments appear to be minimally influenced by new vaccine technology when a comprehensive consultation system is available to support and guide the private physician.