Racial/Ethnic Disparities Across Indicators of Cigarette Smoking in the Era of Increased Tobacco Control, 1992-2019.

INTRODUCTION: This study compared tobacco use and cessation for African Americans (AA), Asians/Pacific Islanders (API), Hispanics/Latinos (H/L), American Indian/Alaskan Natives (AI/AN), and non-Hispanic Whites (NHW) in the United States to California (CA), the state with the longest continually funded tobacco control program. The purpose of this study was to identify tobacco use disparities across racial/ethnic groups across time. METHODS: Cigarette use prevalence (uptake and current use), consumption (mean number of cigarettes smoked per day [CPD]), and quit ratios were calculated across survey years, and trends were examined within each race/ethnic group and comparing between CA and the United States, utilizing the 1992-2019 Tobacco Use Supplements to the Current Population Survey. RESULTS: Prevalence decreased for all race/ethnic groups. Current use among CA NHW showed significant decline compared with US counterparts, whereas US H/L showed greater decline than CA counterparts. CPD decreased by approximately 30% across race/ethnic groups, with CA groups having lower numbers. The greatest decrease occurred among AA in CA (average 10.3 CPD [95% confidence interval (CI): 10.3, 12.6] in 1992/1993 to 3 CPD [95% CI: 2.4, 3.7] in 2018/2019). Quit ratios increased from 1992/1993 to 2018/2019 for CA H/L 52.4% (95% CI: 49.8, 53.0) to 59.3 (95% CI: 55.8, 62.5) and CA NHWs 61.5% (95% CI: 60.7, 61.9) to 63.8% (95% CI: 63.9, 66.9). CONCLUSIONS: Although overall prevalence decreased over time for each racial/ethnic group, declines in CA outpaced the United States only for NHWs. Reductions in CPD were encouraging but the quit ratio points to the need to increase tobacco control efforts toward cessation. IMPLICATIONS: The successes in reduced cigarette use uptake and prevalence across time for both California and the rest of the United States were observed largely among non-Hispanic White populations. Although reductions in the number of cigarettes smoked per day are a notable success, particularly among the Californian African Americans, efforts to support quitting across racial/ethnic groups, especially marginalized groups, need to be prioritized.

Technical note: Evaluation of a commercial on-farm milk leukocyte differential tester to identify subclinical mastitis cases in dairy cows.

The objective of this study was to validate the precision and accuracy of a milk leukocyte differential tester to identify subclinical mastitis cases in dairy cows. Milk samples from individual quarters (n = 320) of 80 Holstein cows were aseptically collected and analyzed in this study. Each sample was divided into 2 replicate samples after mixing. One replicate was analyzed for somatic cell count (SCC) using the current gold standard of flow cytometry immediately after milking. The second sample was evaluated using the on-farm milk leukocyte differential tester directly after milking, where total leukocyte count (TLC; cells/mL) was obtained. The SCC and TLC were used to calculate somatic cell score (SCS) and TLC score [TLS = log2 (TLC/100,000) + 3]. Two subclinical mastitis thresholds were set: >200,000 (low) and >400,000 (high) cells/mL. First, precision was determined between the 2 methods. Total leukocyte count and calculated TLS from the milk leukocyte differential device were compared with the gold standard using correlation and regression coefficient of determination analyses. Correlation coefficients (r) were 0.97 for TLC and SCC and 0.90 for TLS and SCS. The coefficient of determination for regression (R2) was 0.94 for TLC and SCC and 0.80 for TLS and SCS. Slopes of regression for scores and measures were 0.36 [95% confidence interval (CI): 0.35-0.37] and 0.69 (CI: 0.65-0.73), respectively; both were significantly different from 1. Sensitivity, specificity, and diagnostic accuracy were calculated for correct diagnosis of the 2 SCC thresholds using the gold standard as reference. The sensitivity of the on-farm test was 58% (95% CI: 44 to 71%) and 73% (95% CI: 56 to 86%) for the low and high thresholds, respectively. The specificities for the on-farm test were 100% (95% CI: 99 to 100%) and 100% (95% CI: 98 to 100%) for the low and high thresholds, respectively. Subclinical diagnosis accuracies were 93% (95% CI: 89 to 95%) and 96% (95% CI: 92 to 98%) for the low and high thresholds, respectively. The on-farm milk leukocyte differential tester was precise but not overall accurate for total cell counts; it had high specificity and accuracy for diagnosis compared with a standard diagnostic tool. These results suggest that the tested system is a promising technology to detect subclinical mastitis on-farm.

Widening disparities in cigarette smoking by race/ethnicity across education level in the United States.

Reducing tobacco use is an important public health objective. It is the largest preventable cause of death and disease, yet inequalities remain. This study examines combined educational and racial/ethnic disparities in the United States related to cigarette smoking for the three largest racial/ethnic groups (African Americans, Hispanics/Latinos, and non-Hispanic Whites). Data included nine Tobacco Use Supplements to the Current Population Surveys (TUS-CPS) conducted in the United States from 1992/1993-2018 for four smoking metrics: ever smoking rates, current smoking rates, consumption (cigarettes per day), and quit ratios. Across all TUS-CPS samples, there were 9.5% African Americans, 8.8% Hispanics/Latinos, and 81.8% non-Hispanic Whites who completed surveys. Findings revealed that lower educational attainment was associated with increased ever and current smoking prevalence over time across all racial/ethnic groups, and education-level disparities within each race/ethnicity widened over time. Disparities in ever and current smoking rates between the lowest and highest categories of educational attainment (less than a high school education vs. completion of college) were larger for African Americans and non-Hispanic Whites than Hispanics/Latinos. Non-Hispanic Whites had the highest cigarette consumption across all education levels over time. College graduates had the highest quit ratios for all racial/ethnic groups from 1992 to 2018, with quit ratios significantly increasing for Hispanics/Latinos and non-Hispanic Whites, but not African Americans. In conclusion, educational disparities in smoking have worsened over time, especially among African Americans and Hispanics/Latinos. Targeted tobacco control efforts could help reduce these disparities to meet public health objectives, although racial/ethnic disparities may persist regardless of educational attainment.

Predictors of acceptance of offered care management intervention services in a quality improvement trial for dementia.

OBJECTIVE: Care management approaches have been proven to improve outcomes for patients with dementia and their family caregivers (dyads). However, acceptance of services in these programs is incomplete, impacting effectiveness. Acceptance may be related to dyad as well as healthcare system characteristics, but knowledge about factors associated with program acceptance is lacking. This study investigates patient, caregiver, and healthcare system characteristics associated with acceptance of offered care management services. METHODS: This study analyzed data from the intervention arm of a cluster randomized controlled trial of a comprehensive dementia care management intervention. There were 408 patient-caregiver dyads enrolled in the study, of which 238 dyads were randomized to the intervention. Caregiver, patient, and health system factors associated with participation in offered care management services were assessed through bivariate and multivariate regression analyses. RESULTS: Out of the 238 dyads, 9 were ineligible for this analysis, leaving data of 229 dyads in this sample. Of these, 185 dyads accepted offered care management services, and 44 dyads did not. Multivariate analyses showed that higher likelihood of acceptance of care management services was uniquely associated with cohabitation of caregiver and patient (p < 0.001), lesser severity of dementia (p = 0.03), and higher patient comorbidity (p = 0.03); it also varied across healthcare organization sites. CONCLUSIONS: Understanding factors that influence care management participation could result in increased adoption of successful programs to improve quality of care. Using these factors to revise both program design as well as program promotion may also benefit external validity of future quality improvement research trials.

Application of laser spectroscopy for measurement of exhaled ethane in patients with lung cancer.

There is increasing interest in ethane (C(2)H(6)) in exhaled breath as a non-invasive marker of oxidative stress (OS) and thereby a potential indicator of disease. However, the lack of real-time measurement techniques has limited progress in the field. Here we report on a novel Tunable Diode Laser Spectrometer (TDLS) applied to the analysis of exhaled ethane in patients with lung cancer. The patient group (n=52) comprised randomly selected patients presenting at a respiratory clinic. Of these, a sub-group (n=12) was subsequently diagnosed with lung cancer. An age-matched group (n=12) corresponding to the lung cancer group was taken from a larger control group of healthy adults (n=58). The concentration of ethane in a single exhaled breath sample collected from all subjects was later measured using the TDLS. This technique is capable of real-time analysis of samples with accuracy 0.1 parts per billion (ppb), over 10 times less than typical ambient levels in the northern hemisphere. After correcting for ambient background, ethane in the control group (26% smokers) ranged from 0 to 10.54 ppb (median of 1.9 ppb) while ethane in the lung cancer patients (42% smokers) ranged from 0 to 7.6 ppb (median of 0.7 ppb). Ethane among the non-lung cancer patients presenting for investigation of respiratory disease ranged from 0 to 25 ppb (median 1.45 ppb). We conclude that, while the TDLS proved effective for accurate and rapid sample analysis, there was no significant difference in exhaled ethane among any of the subject groups. Comments are made on the suitability of the technique for monitoring applications.

Clinical and extraneural histologic diagnosis of neuronal ceroidlipofuscinosis.

Neuronal ceroid-lipofuscinosis is manifested by visual and intellectual deterioration and seizures. Autofluorescent lipopigments are found in neural and many nonneural tissues, with characteristic staining and ultrastructural properties. Presumptive diagnosis can usually be made on the basis of history, physical examination, and electrodiagnostic tests, but in the absence of a specific biochemical defect, histologic confirmation is essential. A 6-year-old boy with the clinical appearance of the juvenile form of the disease had sea-blue histiocytes in the bone marrow, and curvilinear profiles in ultrastructural inclusions in skin biopsy tissue, cultured skin fibroblasts, and bone marrow cells.

The pattern evoked electroretinogram: its variability in normals and its relationship to amblyopia.

Electroretinograms evoked by pattern stimuli (contrast reversing gratings) were measured under steady state conditions in the normal and amblyopic eyes of 14 amblyopic individuals having Snellen acuities in the range 20/100 to 20/600. These ERGs were measured as a function of spatial frequency, and compared with the psychophysical threshold losses to the same stimuli. In all cases the authors compared the normal and fellow amblyopic eye's response while taking into account the variability of right-left eye comparisons of normal individuals for these psychophysical and electrophysiological tests. When factors such as optical focus, fixation alignment, and fixation stability have been individually optimized, no pattern ERG deficit was observed in a spatial frequency range where there were obvious psychophysical deficits to the same stimuli. Our results do not substantiate previous claims of a pattern ERG anomaly in many severely amblyopic eyes.

Aniridia and Wilms' tumor in a child constitutionally mosaic for 11p-;12q+: a new chromosomal change also present in Wilms' tumor cells of the blastema type.

A child with congenital aniridia was assessed closely, by repeated abdominal ultrasound examinations, beginning at birth. The Wilms' tumor subsequently discovered and removed was analyzed karyotypically and found to have some cells with a terminal deletion of chromosome 11; in other cells this deletion was associated with a duplication in the long arm of chromosome 12. These findings were identical to those observed in the patient's peripheral blood mononuclear cells. This case further substantiates the association between changes in chromosome 11 and Wilms' tumor and demonstrates how chromosomal abnormalities in early infancy may lead to the development of Wilms' tumor.

Paradoxic pupillary phenomena. A review of patients with pupillary constriction to darkness.

The presence of pupillary constriction to darkness is said to be a useful indicator of retinal disease. However, it is also associated with optic nerve disease. The phenomenon has been reported in patients with congenital stationary nightblindness, congenital achromatopsia, bilateral optic neuritis, and dominant optic atrophy. We have observed this response in additional disorders, including anomalies of the optic nerve development, congenital nystagmus, and a variety of diseases affecting the retina. Notably, four of our patients with strabismus and amblyopia, but without apparent retinal or optic nerve disease, have also demonstrated this paradoxic pupil response. While the mechanism for pupillary constriction to darkness remains unclear, the finding of this response in patients without retinal or optic nerve abnormalities questions its value as a localizing sign.

Steroids and the prostate.

Interelationships between steroid and growth factor regulation of cell proliferation has been examined in two androgen sensitive prostatic cell lines, grown in defined medium. The cell lines used were derived from normal (CAPE) and neoplastic (LNCaP) tissues. The growth of both cell lines was elevated by challenge with serum, androgens and epidermal growth factor (EGF) used as single agents. The effects of androgen in CAPE were small, but significant while the profound effects of these agents on the growth of LNCaP were confirmatory of other studies. Androgens upregulated EGF receptor expression in LNCaP measured by both ligand binding capacity and mRNA analysis. This was not observed in the CAPE cells. Addition of serum (whole or charcoal stripped) suppressed the observed androgenic stimulation of EGF receptor expression in LNCaP. This apparent anomaly is discussed in relation to the growth enhancing properties of serum in these cell lines and in the wider context of normal and neoplastic growth control in the prostate.

The ocular features of Down's syndrome.

A combined prospective and retrospective study of patients with Down's syndrome showed that these patients have narrowed and slanted palpebral fissures but that the fissures are of normal height. Patients with Down's syndrome also had increased prevalences (compared with control subjects) of blepharitis (23 of 53 patients or 46%), strabismus (23 of 53 patients or 43%), nystagmus (five of 53 patients or 9%), light-colored and spotted irides (46 of 53 patients or 87% and 43 of 53 patients or 81%, respectively), keratoconus (eight of 53 patients or 15%), cataracts (seven of 53 patients or 13%), severe myopia (13 of 48 patients or 27%), and astigmatism of more than 3 diopters (12 of 48 patients or 25%).

Electrophysiological responses in hydranencephaly.

We recorded electrophysiological responses, both electroretinograms (ERGs) and visual evoked responses (VER), at 4 and 21 months of age in a child with hydranencephaly. As expected, the ERG was normal. Despite the apparent absence of most of the cerebral cortex, a VER was present at both visits. The child's visual performance definitely improved both subjectively and electrophysiologically. The VER contained multiple early components in contrast to previous reports, where only a slow, monophasic response was detected.

Silicone intubation for obstruction of the nasolacrimal duct in children.

We performed 63 intubations with silicone tubing for nasolacrimal duct obstruction in children in whom nasolacrimal duct probings had failed. Fifty-nine (93.7%) obstructions were congenital and four (6.3%) were acquired. The average length of intubation was 4.3 months. The final results for both congenital and acquired obstructions combined were good in 52 cases (82.5%), fair in three (4.8%), and poor in eight (12.7%). Complications, with the exception of some with infection, were easily treated or minimal and did not affect the outcome significantly. We recommend silicone intubation as the procedure of choice for congenital or acquired nasolacrimal duct obstructions in children after failure of medical therapy and nasolacrimal duct probings.

Growth factor receptors and oncogene expression in prostate cells.

Specimens of benign prostatic hypertrophy (BPH) and prostate carcinoma and prostate cells in culture were assessed for their capacity to bind androgens, radioiodinated EGF, and IGF-I, and to express certain cellular protooncogenes. Prostate cell lines contained receptors for both EGF and IGF-I. Similarly, clinical samples of human diseased prostate contained receptors for both of these factors. Prostate carcinoma contained higher concentrations of EGF receptors based on DNA than did BPH, although it is accepted that BPH may not be the appropriate comparison for carcinoma. Increased EGF receptors were associated circumstantially with a decline in androgen receptors with deteriorating differentiation status and with an increase in expression of c-myc. Androgen receptor concentration correlated with increased expression of c-fos. Deteriorating differentiation status was associated with the appearance or increase in secondary sites with lower affinity for IGF-I. Whereas c-myc expression was increased in all grades of carcinoma compared to BPH, expression of c-H-ras accompanied loss of differentiation. Although those alterations are hindered by tissue heterogeneity and correlations are essentially circumstantial, they may provide clues to the progression of prostate cancer that can be validated in prostate cell lines with similar growth response capabilities.

Optical penalization can improve vision after occlusion treatment.

BACKGROUND: Optical penalization (OP) has previously been shown to successfully maintain vision in amblyopic eyes of older children when patching compliance is poor and when vision decreases once patching is discontinued. This study shows that the final vision in optically penalized eyes is often better than the vision obtained after patching alone. SUBJECTS AND METHODS: During the 5-year period from January 1992 to February 1997, 28 children aged between 3.7 and 8.2 years (average age, 6.5+/-1.1 years) were optically penalized for an average of 1.5+/-0.75 years. The maximum length of penalization was 3.3 years, whereas the minimum time was 6 months. There were 21 children with strabismic amblyopia and 7 children with anisometropic amblyopia. All 28 children had worn a patch to achieve their best visual levels and then had shown a loss of best vision when occlusion was stopped. Patching was usually resumed and continued until the previous best vision was obtained; at this point OP was started to "maintain" vision. Eighteen of the 28 children have discontinued penalization and have been followed up an average of 1(1/2) years. RESULTS: Twenty-six (93%) of the 28 patients showed an increase in best vision from that found at the conclusion of patching, and 2 patients maintained their vision at the initial level. The average visual acuity at the start of penalization was 20/50 (0.42+/-0.11 logarithm of the minimum angle of resolution [log MAR]). Final average visual acuity was 20/27 (0.15+/-0.12 log MAR). The average increase in vision was nearly 3 lines or 0.27+/-0.12 log MAR. CONCLUSION: OP alone (without the use of pharmacologic agents such as atropine) not only maintains vision after patching therapy, but also appears to improve the final visual outcome.

Geographic lip: a variant of geopgraphic tongue.

The following aspects of the classic geographic tongue are discussed: clinical polymorphism with the appearance of annulus migrans, histological appearacne of the spongiform pustule, frequent association with pustular psoriasis and related diseases, and its relationship to psoriasis buccalis. Two cases of geographic lip are described in which annulus migrans was present. In one case, the geographic lip was associated with a plicated lip, a labial form of plicated tongue.

Can my child see? The evaluation of visual function in children.

Careful evaluation of all parameters of ocular function are required to delineate the cause of lack of visual responses in children. Any visual fixation, no matter how fleeting, is a sign of intact visual pathways. If no sign of ocular pathology can be found on the routine exam of the visually inattentive child, electrophysiologic testing may be necessary to confirm the presence of abnormality of the visual pathways. In the child with a generalized CNS disorder, the lack of visual response may be due to his inability to respond to visual information (perceptual blindness) rather than to organic pathology in the occipital cortex (cortical blindness).

The association of strabismus and aphakia in children.

Strabismus was present in 40% of patients with cataracts/dislocated lenses at the time of initial diagnosis and continued to present an obstacle to complete rehabilitation with 86% of the congenital patients and 61% of the acquired patients found to have strabismus at their latest post therapy visits. The type of horizontal deviation found at the initial examinations was distributed equally between esotropia and exotropia in the unilateral congenital cataracts patients. However, all of our patients with strabismus and bilateral congenital cataracts were esotropic. The acquired group was heavily weighted toward the exodeviations at the time of the initial examination and during treatment showed an even greater percentage of exotropia. Visual acuity results in the various groups followed perhaps the expected trends with the poorest results in the unilateral congenital cataract patients. Those patients in the acquired groups have better visual results with 56% of the traumatic and 83% of the non-traumatic eyes achieving vision of 20/70 or better. Despite the high incidence of strabismus present in these patients, we feel this should in no way be a deterent to the decision to initiate therapy as it does not seem to relate to visual acuity results. The overall good visual results in these patients justifies the approach of early surgery, adequate correction, and vigorous occlusion.

VECP evidence for binocular function in infantile esotropia.

Since commonly used clinical methods of measuring binocular function require subjective responses, this testing has been limited to more cooperative children, usually older than 2 years of age. Recently, we have begun using a clinically practical, visually evoked cortical potential (VECP) method to detect the presence of binocular neurons in infants and young children. We studied 14 children, ages 4 to 44 months, with infantile esotropia. Nine had surgical correction for esotropia by the age of 2 years. Twenty-five normal infants ages 6 weeks to 22 months served as controls. Most normal infants showed the development of the "beat" by 2 months of age. The "sum" VECP was not consistently present until age 6 months. Four of the five esotropic infants less than 1 year of age, demonstrated neither a "sum" nor "beat" response. All nine patients with corrective surgery performed before 2 years of age developed a significant sum response and three developed a beat. Five patients had not had surgery until after 2 years of age. Two developed a sum and one a beat, but none had both beat and sum responses. The results suggest that there is a loss of nonlinear binocular response in esotropic children not corrected before the age of 2 years and that these responses can be restored after early treatment even if not present at the time of surgery.