Accuracy and economic evaluation of screening tests for undiagnosed COPD among hypertensive individuals in Brazil.

In Brazil, prevalence of diagnosed COPD among adults aged 40 years and over is 16% although over 70% of cases remain undiagnosed. Hypertension is common and well-recorded in primary care, and frequently co-exists with COPD because of common causes such as tobacco smoking, therefore we conducted a cross-sectional screening test accuracy study in nine Basic Health Units in Brazil, among hypertensive patients aged ≥40 years to identify the optimum screening test/combinations to detect undiagnosed COPD. We compared six index tests (four screening questionnaires, microspirometer and peak flow) against the reference test defined as those below the lower limit of normal (LLN-GLI) on quality diagnostic spirometry, with confirmed COPD at clinical review. Of 1162 participants, 6.8% (n = 79) had clinically confirmed COPD. Peak flow had a higher specificity but lower sensitivity than microspirometry (sensitivity 44.3% [95% CI 33.1, 55.9], specificity 95.5% [95% CI 94.1, 96.6]). SBQ performed well compared to the other questionnaires (sensitivity 75.9% [95% CI 65.0, 84.9], specificity 59.2% [95% CI 56.2, 62.1]). A strategy requiring both SBQ and peak flow to be positive yielded sensitivity of 39.2% (95% CI 28.4, 50.9) and specificity of 97.0% (95% CI 95.7, 97.9). The use of simple screening tests was feasible within the Brazilian primary care setting. The combination of SBQ and peak flow appeared most efficient, when considering performance of the test, cost and ease of use (costing £1690 (5554 R$) with 26.7 cases detected per 1,000 patients). However, the choice of screening tests depends on the clinical setting and availability of resources.ISRCTN registration number: 11377960.

Growth of four tropical tree species in petroleum-contaminated soil and effects of crude oil contamination.

Under greenhouse conditions, we evaluated establishment of four tree species and their capacity to degrade crude oil recently incorporated into the soil; the species were as follows: Cedrela odorata (tropical cedar), Haematoxylum campechianum (tinto bush), Swietenia macrophylla (mahogany), and Tabebuia rosea (macuilis). Three-month-old plants were planted in soil with three treatments of heavy petroleum and a control (C0 0 mg kg-1; C1 18,000 mg kg-1; C2 31,700 mg kg-1; C3 47,100 mg kg-1) with four repetitions per treatment and species; the experiment was carried out for 245 days. Height and biomass of all species significantly diminished as petroleum concentration increased, although plant survival was not affected. The quantity of colony-forming units (CFU) of rhizospheric bacteria varied among tree species and treatments; petroleum stimulated bacterial CFU for S. macrophylla. The number of fungi CFU for S. macrophylla and T. rosea was significantly greater in C0 than in soil with petroleum, but among species and among different concentrations, no significant differences were found. The greatest percentage of total petroleum hydrocarbon (TPH) degradation was found in C1 for soil without plants (45 %). Differences from the remaining treatments (petroleum concentrations in soil and plant species) were not significant (P < 0.05). Among all trees, H. campechianum had the greatest TPH degradation (32.5 % in C2). T. rosea (C1) and H. campechianum (C2) resulted in petroleum degradation at levels ranging from 20.5 to 32.5 %. On the basis of this experiment, the tree species used did not improve TPH degradation. However, all of them showed high rates of survival and vigor. So, as tree species provide goods and services, experiments with inoculation of hydrocarbonclastic microorganisms, addition of fertilizers, and mixture of tree and grasses are recommended.

Transcranial Doppler ultrasonography in adults with sickle cell disease.

BACKGROUND: Transcranial Doppler (TCD) is used to select children with sickle cell disease (SCD) for primary stroke prevention using regular blood transfusion. Whether it can also identify high stroke risk in adults with SCD is not known. METHODS: The authors examined 112 adult patients from two convenience population samples with SCD and 53 healthy control subjects to compare velocities in adults to those reported in children with SCD and to evaluate the influence of age and hematocrit on TCD. RESULTS: Adults with SCD had a higher mean time-averaged maximum mean velocity (110.9 +/- 25.7 cm/s) compared with healthy controls (71.1 +/- 12.0 cm/s), and the difference is approximately proportional to their anemia. No cases with velocities >/=200 cm/s (the threshold used in children for prophylactic treatment) were found in this sample. CONCLUSIONS: Transcranial Doppler velocities in adults with sickle cell disease (SCD) are lower than those in children with SCD. Velocity criteria used in children cannot be used to stratify risk of stroke in adults.

Early adolescent marijuana use: risks for the transition to young adulthood.

BACKGROUND: This study assessed the relationship of early adolescent marijuana use to performance of developmental tasks integral to the transition to young adulthood. The tasks concerned intimacy, education, and work and social conformity. METHODS: African American (N = 617) and Puerto Rican (N = 531) youths completed questionnaires in their classrooms. Five years later they were individually interviewed. Logistic regression analysis estimated the increased likelihood that early marijuana users would make an inadequate transition to young adult social roles. RESULTS: Analyses examining the association between early marijuana use and 20 outcome variables found significant relationships for 10 of them: (a) having lower educational and occupational expectations; (b) being suspended or expelled from school, fired from jobs, 'high' at school or work, collecting welfare; and (c) rebelliousness, not participating in productive activities, not attending church, and being an unmarried parent. Marijuana use was not related to any of the intimate relationship measures. These finding emerged with controls on gender, ethnicity, age and mother's education. CONCLUSIONS: Among African Americans and Puerto Ricans, early marijuana use predicts less adequate performance on some developmental tasks integral to becoming an independent young adult. Marijuana is not a benign drug and is associated with future risks for the individual and society at large.

Extensive exchange of fungal cultivars between sympatric species of fungus-growing ants.

Fungal cultivars of fungus-growing ants (Attini, Formicidae) are carried by dispersing queens from parent to offspring nest. This vertical cultivar transmission between generations is thought to result in long-term ant-fungus coevolution and selection for beneficial cultivar traits that maximize harvests and thus colony productivity. In contrast to this traditional view of vertical cultivar transmission, frequent horizontal cultivar transmission between ant species is implicated by a phylogenetic analysis of 72 cultivars propagated by two fungus-growing ant species coexisting sympatrically in central Panama. The two ant species are specialized on the same group of closely related cultivars, but in six of 12 cultivar clades identifiable within this group, cultivars from both ant species were united in the same clade. Five of these 'mixed' clades were supported by bootstrap values of about 90% or higher. In one instance, colonies from the two ant species cultivated the same, genetically identical, cultivar clone. These phylogenetic patterns indicate that: (i) cultivar exchanges between the two ant species occur routinely throughout ecological time; and that (ii) coevolutionary processes between ants and their fungi are more diffuse than previously assumed. Because the two ant species are specialized on a narrow group of closely related cultivars that they regularly exchange among each other, but not with other sympatric ant species, cultivar exchanges are constrained, most likely, by ant preferences for their own cultivar group or by stringent selection against transitions of ant lineages to distantly related cultivars.

Impact of chronic transfusion on incidence of pain and acute chest syndrome during the Stroke Prevention Trial (STOP) in sickle-cell anemia.

OBJECTIVE: The Stroke Prevention Trial (STOP) demonstrated that chronic transfusion is highly effective in reducing the risk of stroke in children with sickle-cell disease and an abnormal transcranial Doppler ultrasonography examination result. Our objective was to determine whether chronic transfusion therapy reduces the incidence of pain and acute chest syndrome. METHODS: During STOP, 130 children with sickle-cell anemia or sickle beta(0)-thalassemia and abnormal transcranial Doppler ultrasonography examination result were randomly assigned to chronic transfusion (n = 63) or observation (n = 67). In addition to monitoring for stroke, nonneurologic sickle-cell complications were identified and recorded. RESULTS: Mean age at STOP study entry was 8.3 +/- 3.3 years, and mean follow-up was 19.6 +/- 6.5 months. Hospitalization rates (based on intent-to-treat analysis) for acute chest syndrome were 4.8 and 15.3 per 100 patient-years (P =.0027) and for pain were 16.2 and 27.6 per 100 patient-years (P =.13) in the chronic transfusion and observed groups, respectively. If analyzed according to treatment actually received, the difference in pain rate becomes significant (9.7 vs 27.1 events per 100 patient-years, P =.014), and transfusion remains protective from acute chest syndrome (2.2 vs 15.7 events per 100 patient-years, P =.0001). CONCLUSIONS: Compliance with aggressive chronic transfusion reduces the frequency of acute chest syndrome and pain episodes.

Rallicola deckeri n. sp. (Phthiraptera: Philopteridae) from Ruddy Woodcreepers Dendrocincla homochroa (Passeriformes: Furnariidae) collected in Campeche, Mexico.

A new species of Rallicola Johnston and Harrison (Phthiraptera: Philopteridae) is described from lice collected from a series of Ruddy Woodcreepers Dendrocincla homochroa (Aves: Dendrocolaptinae) in Campeche, Mexico. Rallicola deckeri is easily recognized by the unique shape of the mesosome in the male and by the pattern of divided sternites on the female.

Risk of recurrent stroke in patients with sickle cell disease treated with erythrocyte transfusions.

OBJECTIVE: To determine the effect of a transfusion program on risk of stroke recurrence in children with sickle cell disease. DESIGN: The clinical course and experience with transfusion therapy at eight centers were reviewed for subjects whose initial stroke occurred after January 1988. RESULTS: Sixty subjects were observed for 191.7 patient-years. Eight had a single recurrent stroke (two intracranial hemorrhages and six infarctions) for a prevalence of 13.3%, or one recurrence for each 24 patient-years of observation. Thirteen subjects had 15 transient neurologic events; two of these had subsequent strokes, but the overall risk was similar for those who did and those did not have transient events. Hemoglobin S levels were greater than the desired maximum of 30% at the time of 7 of 16 transient events and five of six recurrent infarctions. The stroke recurrence rate was similar to those in previous reports of children receiving long-term transfusion therapy but significantly less than that reported for children who did not receive transfusions (p < 0.001). CONCLUSIONS: We conclude that maintenance of hemoglobin S at a level less than 30% appears to be effective in reducing the rate of recurrent infarction but does not prevent transient neurologic events. Transient neurologic events are common but do not appear to be related to recurrent stroke.

Family planning needs and behavior of Mexican American women: a study of health care professionals and their clientele.

"A random sample of Mexican American women and a sample of family planning health care professionals, both from two major southwestern cities in the United States, were compared in terms of their reports of birth control methods used, problems in obtaining family planning services, and values involved in making fertility-related decisions, within the Mexican American population.... While there were points of agreement between the two samples, discrepancies were found in reports of problems in obtaining family planning services, fertility-related values, and in the acceptability of female sterilization as a birth control method. It was concluded that family planning professionals in these service areas tend to stereotype Mexican American women, and may not yet realize that the family planning attitudes and behavior of these women are probably changing in significant ways." (SUMMARY IN SPA)

Effect of different incremental exercise protocols on the determination of lactate and ventilatory thresholds.

The aerobic threshold (AeT) determined from ventilatory curves occurs at the same oxygen uptake and is independent of the rate of increase of power output in an incremental exercise test. On the other hand, it has been proposed that the AeT determined from blood lactate curves and the anaerobic threshold (AnT) determined from ventilatory curves may vary depending on the exercise protocol. Seven healthy subjects performed two incremental exercise tests to evaluate the effect of the rate of power increment on the AeT and the AnT determined from the break points in both ventilatory and venous blood lactate curves. The protocols on the cycle ergometer consisted of increments of 15 W every min (slow) or every 0.25 min (fast). When the results were expressed as the corresponding oxygen uptake, neither the lactate AeT (slow = 2.662 +/- 0.395 1/min; fast = 2.577 +/- 0.392 1/min; P greater than 0.05) nor the ventilatory AeT (slow = 2.737 +/- 0.426 1/min; fast = 2.583 +/- 0.555 1/min; P greater than 0.05) was significantly affected by the protocols. The lactate AnT (slow = 3.675 +/- 0.610 1/min; fast = 3.683 +/- 0.610 1/min; P greater than 0.05) and the ventilatory AnT (slow = 3.635 +/- 0.665 1/min; fast = 3.823 +/- 0.645 1/min; P greater than 0.05) were also not significantly affected by the protocols. The oxygen uptake corresponding to a blood lactate concentration of 2 mM was significantly higher for the fast protocol (slow = 3.235 +/- 0.735 1/min; fast = 4.005 +/- 0.643 1/min; P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Economic dependency and fertility in Asia and Latin America, 1960-1980.

PIP: This paper assesses the likely value of the dependency hypothesis -- the view that the degree of economic dependency on capitalist core nations is a key factor in determining levels or trends in fertility among less developed countries. It reviews contemporary theoretical and empirical work on fertility transitions in Ekuropean countries along with some new perspectives on recent fertility trends in less developed nations. The paper also discusses theoretical justifications for expecting or not expecting dependency effects on fertility and examines comparative analyses that tests for spuriousness and the reliability of dependency effects between Asian and Latin American countries. The cross-national analyses failed to demonstrate convincing support for the hypothesis that 1980 fertility levels or 1960 to 1980 fertility trends among less developed countreis in Latin America or Asia were affected by any of 13 to 15 (depending on the region) measures of economic dependency. While a few significant zero-order correlations in the expected order were found, these associations were the result of the correlation of the dependency measure with family planning program effort and/or social development. Lacking evidence of direct effects of dependency on fertility, an effort to uncover indirect effects (through early dependency effects on latter social or economic development levels) was attempted among Latin American countries. Early economic dependency was related to later dependency but not to later social or economic development. These results differ from those of Hout (1980, 1981) for Latin American and for all regions (nolan and White, 1983). Hout found significant effects using the percentage of imports from the leading trading partner in pooled regression analyses. Both his articles report significant effects of dependency interacting with development. The study differs from Hout¿s in that pooled regression of fertility (starting with 19-15-19 crude birthrates and then 1945-49, 1965, and 1975 CBRs) in both his studies differs from the studies of these authors. He included Argentina and Uruguay, while these authors omitted these 2 more developed countries. These 2 outlander countries and the inclusion of data from earlier years may help explain the difference between the results of these authors and those of Hout. Nolan and White (1983) find significant effects on 1977 fertility of dummy variables representing non-core (semiperiphery or periphery) countries in all regions. Using a comparative and multi-measurement strategy to test for economic dependency effects within 2 separate regions, there were 30 tests for dependency effects in Latin countries and 26 tests among Asian countries. No direct effects were found of dependency on fertility levels or change in even 1 of these 56 tests. It is concluded that economic dependency effects, if they exist, are small. In contrast, the substantive effects of social development and family planning program effort are large.^ieng

Ophthalmic manifestations of the Hermansky-Pudlak syndrome (oculocutaneous albinism and hemorrhagic diathesis).

We report the association of oculocutaneous albinism and defective platelet function, the Hermansky-Pudlak syndrome, in two young Puerto Rican patients, a 17-year-old boy and a 9-year-old girl. Wide variation in pigmentation may obscure the diagnosis of albinism. Puerto Rican albinos are at increased risk of inheriting this autosomal recessive syndrome. Although usually mild, bleeding in affected patients can be life-threatening, especially after aspirin administration. Albino patients should be questioned about a history of bleeding and referred for hematologic consultation.

Niveles de carboxyhemoglobin en la poblacion de Puebla y sus implicaciones / Carboxyhemoglobin levels in the population of Puebla and its implications

Se determinaron niveles de carboxihemoglobina en diversos grupos de poblacion en la ciudad de Puebla, con objeto de conocer el grado de contaminacion por monoxido de carbono en zonas de la ciudad donde el trafico de vehiculos de combustion interna es intenso y existen cantidades elevadas de gases procedentes de dichos vehiculos.Se encontro que las personas que durante varias horas desempenan trabajos en zonas "contaminadas", tienen niveles de carboxihemoglobina (X=1.65) varias veces mayores que los de las personas que habitan en areas rurales no contaminadas (X=0.43). Se hallaron cifras aun mas elevadas en choferes que conducen vehiculos dedicados al transporte urbano (X=1.85). Todos estos valores se elevaron en forma importante en los mismos grupos de personas, cuando en ellas existia el habito de fumar. Se concluye que el grado de contaminacion ambiental por monoxido de carbono proveniente de vehiculos de combustion interna es considerable en ciertas zonas de la ciudad de Puebla y que determinadas ocupaciones exponen considerablemente a esa contaminacion. Estos efectos aumentan con el habito de fumar. Se comparan los resultados obtenidos con hallazgos similares en otras ciudades

Gene flow versus selection pressure and ancestral differentiation in the composition of species: analysis of population variation of Juniperus ashei Buch. using terpenoid data.

Twenty-four populations of Juniperus ashei were sampled throughout the range of this taxon and the terpenoids of the foliage were analyzed by gas/liquid chromatography. Population differentiation was investigated by analysis of variance and numerical taxonomy. Three south Texas and one Mexican population clustered together with the rest of the taxon appearing fairly uniform. No evidence was found of hybridization or introgression with other taxa. Disjunct populations in Oklahoma and the Ozarks, which have been genetically isolated from the central population for thousands of years, showed no signs of differentiation nor genetic drift. The present pattern of distribution probably dates from the Pleistocene. The south Texas and Mexican populations appear to be the primitive elements of the species. Populational differences have apparently been maintained in adjacent populations in spite of seemingly large gene flow and conversely, chemical uniformity is being maintained in many disjunct populations where there is little or no gene flow.