Factors related to the incidence of stomach cancer in the Pittsburgh Standard Metropolitan Statistical Area.

This report presents an analysis of several demographic discriminants of stomach cancer incidence for residents of the Pittsburgh Standard Metropolitan Statistical Area (SMSA) with the use of data collected as part of the Third National Cancer Survey, 1969-71. The Pittsburgh SMSA, one of nine areas included in the Third National Cancer Survey, was of particular interest in the study of stomach cancer, since area residents showed the highest age-adjusted incidence rate for cancer of this site while showing the fifth highest rate for all sites. To examine the data in greater detail, we used the variables of sex, race, nativity, and median income level to classify the cancer patients into homogeneous subgroups of census tracts of residence to allow comparisons of the average annual age-adjusted incidence rates among the groups. The data indicated that Pittsburgh SMSA residents showed stomach cancer incidence patterns that were generally consistent with earlier published reports; particularly when contrasted with appropriate population subgroups, higher rates appeared for males, for blacks, for lower income areas, and for areas with "large" proportions of foreign-born and foreign-stock residents. Furthermore, when one considered interactions among the factors, the relationship between ethnic composition and incidence appeared to supercede that of income among white males.

A population-based study of severe firearm injury among children and youth.

BACKGROUND: Firearm injuries are a major cause of pediatric mortality and morbidity in the United States. To date, population-based studies describe the epidemiology of firearm-related deaths; however, the patterns of severe, nonfatal pediatric firearm-related injuries are not as well defined. OBJECTIVES: To determine the epidemiology of severe firearm-related deaths and injuries among a statewide population of children and youth ages birth to 19 years. METHODS: Demographic, geographic, and cost data were analyzed from Connecticut death certificates for 1988 through 1992 and hospital discharge data for 1986 through 1990 for firearm-related unintentional, self-inflicted, and assaultive injury among children and youth ages birth to 19 years. RESULTS: There were 219 firearm deaths: 68% homicides, 25% suicides, 6% unintentional, and 1% of undetermined intent, resulting in an annual age-specific death rate of 6.6 per 100,000 persons. There were 533 hospitalizations for gunshot wounds (16 per 100,000); 41% were assaults, 1% suicide attempts, 39% unintentional gunshot wounds, 1% legal interventions, and 18% of undetermined intent. More than 80% of deaths from gunshot wounds and hospitalizations occurred among 15- to 19-year-old males, most occurring in Connecticut's five largest cities. Most firearm homicides occurred among urban residents; most firearm suicides occurred among nonurban residents; and unintentional shootings were evenly distributed between urban and nonurban residents. The total cost of firearm-related hospitalizations averaged $864,000 per year. CONCLUSIONS: Firearms are a major cause of mortality and morbidity of Connecticut children and youth, exceeded only by motor vehicles as a cause of death among those 1 to 19 years of age. Handguns were responsible for a disproportionate amount of trauma compared with other firearm types. The epidemiology of pediatric gunshot injuries requires a range of strategies for prevention. Physicians caring for families with children must include firearm injury prevention counseling as a routine part of anticipatory guidance.

Evaluation of the preterm infant for patent ductus arteriosus.

As a first step in a multicenter, collaborative project to study the role of indomethacin in the management of patent ductus arteriosus in premature infants, a diagnostic scheme was developed, on an a priori basis, by a consensus of the participating neonatologists and pediatric cardiologists. The scheme, which utilizes clinical and noninvasive findings, was designed to detect infants with a "hemodynamically significant" patent ductus arteriosus (PDA). Among 1,689 infants with birth weight less than 1,750 g who were monitored during the first year of the study, 342 (20.2%) met the criteria for PDA. Rates were higher for smaller infants (42% with birth weight less than 1,000 g) than for larger infants (7% with birth weight 1,500 to 1,750 g). Although study protocol did not require a direct procedure to confirm the diagnosis of PDA, a marked decrease in the presence of most criteria was noted following surgical ligation of the ductus. Although the echocardiographic criterion (ratio of left atrium to aorta [LA/Ao] greater than or equal to 1.15) proved to have a low specificity for PDA, the data suggest that the overall scheme led to a very low rate of false-positive diagnosis. Following the application of the scheme for 1 year at 13 clinical centers, it has been shown to be a highly acceptable means of detecting infants with PDA.

Potential mechanisms for failure to eradicate group A streptococci from the pharynx.

OBJECTIVE: To investigate the relative efficacy of orally administered cefadroxil and penicillin V in the treatment of group A streptococcal (GABHS) pharyngitis and the mechanism(s) responsible for failure of antimicrobial therapy to eradicate GABHS from the pharynx. STUDY DESIGN: A prospective, randomized clinical trial was conducted in four pediatric offices in which 462 patients with acute pharyngitis and positive culture for GABHS were randomly assigned to receive cefadroxil (n = 232) or penicillin V (n = 230). RESULTS: Bacteriologic treatment success rates for patients in cefadroxil and penicillin groups were 94% and 86%, respectively. However, among patients classified clinically as likely to have bona fide GABHS pharyngitis, there was no difference in bacteriologic treatment success rates in cefadroxil and penicillin groups (95% and 94%, respectively). Among patients classified clinically as likely to be streptococcal carriers, bacteriologic treatment success rates in cefadroxil and penicillin groups were 92% and 73%, respectively. The presence of beta-lactamase and/or bacteriocin-producing pharyngeal flora had no consistent effect on bacteriologic eradication rates among patients in either penicillin or cefadroxil treatment groups or among patients classified as having either GABHS pharyngitis or streptococcal carriage. CONCLUSIONS: Neither beta-lactamase nor bacteriocin produced by normal pharyngeal flora are related to bacteriologic treatment failures in GABHS pharyngitis. Cefadroxil seems to be more effective than penicillin V in eradicating GABHS from patients classified as more likely to be streptococcal carriers. However, among patients we classified as more likely to have bona fide GABHS pharyngitis, the effectiveness of cefadroxil and penicillin V seems to be comparable.

Differentiation of Enterobacteriaceae, Pseudomonas aeruginosa, and Bacteroides and Haemophilus species in gram-stained direct smears.

The accuracy of examination of the Gram-stained direct smear to classify presumptively Gram-negative rods into three morphotype groups, that is, (a) Enteric bacteria, (b) Pseudomonas, and (c) Bacteroides or Haemophilus, was evaluated. Randomly selected clinical strains (4-9) each of Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Ps. aeruginosa, B. fragilis, and H. influenzae were used to produce peritonitis or subcutaneous abscesses in mice. A Gram-stained direct smear was prepared from exudate collected from each animal. The direct smears were examined to classify bacteria observed into one of the three morphotype groups. The percent accuracy was 82, 56, and 95, respectively, and 76 overall. The assumption was made that classification was based primarily on differences in length and width of the organisms. To test this hypothesis, we prepared scanning electron photomicrographs from each specimen of exudate and measured the lengths and widths of bacteria. Examination of the Gram-stained direct smear was more accurate for classification of enteric bacteria, H. influenzae, or B. fragilis. Electron microscopy was more accurate for classification of Ps. aeruginosa. The higher length-width radio should be helpful in recognizing Ps. aeruginosa in direct smears.

Sources of information used in diagnosing childhood learning disabilities.

One hundred nineteen questionnaires in which board certified/eligible child neurologists were asked to rank the diagnostic importance of 8 sources of information commonly used in the assessment of children with learning disabilities were analyzed by the Wilcoxon matched-pairs signed ranks test. All pairwise comparisons of the 8 sources revealed significant differences (P less than or equal to .033) except for psychologic reports (mean rank +/- 1 S.D. = 2.09 +/- 1.14) and medical histories (2.26 +/- 1.45) which were rated equal (P = .397) and, compared to the other sources, diagnostically most useful (P less than .0001). Analysis of the 6 remaining sources demonstrated the following: teachers' reports (3.39 +/- 1.35) were deemed more helpful than the mental status examination (3.92 +/- 1.61; P = .033) and questionnaires distributed to parents and teachers (5.05 +/- 2.11) were more useful than findings on the remainder of the neurologic examination (5.81 +/- 1.46; P = .012). Social service reports (6.45 +/- 1.32) took precedence over soft signs (7.12 +/- 1.05; P = .001) which were considered the least diagnostically helpful. Analysis of variance revealed that this rank order was relatively independent of the responders' age, type of practice, years elapsed since completion of training and percentage of professional time spent examining pediatric patients. Information derived from outside sources (collective mean rank +/- 1 S.D. = 4.25 +/- 0.9) contributed significantly more to the diagnosis of learning disabilities than to information elicited directly by the examining neurologists (4.77 +/- .88; P = .002).(ABSTRACT TRUNCATED AT 250 WORDS)

Mental status examination of children with learning problems.

Questionnaires were submitted to 163 board-certified/eligible child neurologists to determine whether they employed a consistent approach to the mental status examination of children with learning problems and whether this approach appropriately emphasized the assessment of higher and related cortical functions. The responders' frequency of testing in 6 major categories of mental status function was independent of their age, sex, board-certified/eligible status, type of practice, and years elapsed since completion of training. The results of the entire study group and comparisons among demographic subgroups demonstrated a progressive decline in testing frequency with increasing complexity of mental status function. Child neurologists' approach to the mental status examination was remarkably uniform across a wide range of demographic variables. Higher and related cortical functions are tested significantly less often in children with learning problems than are other more elementary categories of mental status function; therefore, the importance of the mental status examination in this context must be questioned. It is likely that the diagnosis ascribed to a child with learning problems is based on findings other than those provided by the mental status examination.

Evaluating the impact of a street barrier on urban crime.

OBJECTIVES: Violence is a major urban public health problem in the United States. The impact of a physical barrier placed across a street in a public housing project to prevent street violence and drug activity was evaluated. METHODS: Hartford Police Department data on violent and drug related crime incidence within the housing project containing the barrier were analyzed by use of a computerized geographic information system. RESULTS: Violent crime decreased 33% on the intervention street during the 15 month period after erection of the barrier, compared with the 15 month period before erection of the barrier, but there was no change in drug related crime. On adjoining streets and surrounding blocks, violent crime decreased 30%-50% but drug related crimes roughly doubled. A non-adjacent area of the housing project and the entire city experienced 26% and 15% decreases in violent crimes, and 414% and 25% increases in drug crimes, respectively. CONCLUSIONS: The barrier decreased violent crime but displaced drug crimes to surrounding areas of the housing project. These results have important implications for other cities that have erected or are considering erecting similar barriers.

Increased risk for lymphoma and glomerulonephritis in a closed population of cats exposed to feline leukemia virus.

Feline leukemia virus (FeLV)-associated diseases were observed in a household in eastern Connecticut having 134 cats over a period of five and a half years. FeLV-positive cats had a much higher mortality rate (34.6 deaths per 1000 cat-months of follow-up) than did FeLV-negative cats (8.9 deaths per 1000 cat-months of follow-up). The leading cause of death was glomerulonephritis followed by lymphoma. The relative risk for virus-positive cats as compared to virus-negative cats for the two diseases was 9.9 and 9.6, respectively. The major risk factors for the development of lymphoma were virus positivity and low antibody titer to the feline oncornavirus-associated cell membrane antigen (FOCMA). No significant differences in cancer incidence were seen between the two major breeds (Abyssinian and Burmese) in the household. An older age at arrival in the house decreased death rates for all causes in the household, but it did not significantly affect death rates from lymphoma, although there was a positive trend.

Urinary tract symptoms: microbiologic evaluation in rural family practice.

In order to define the etiology of urinary symptoms in rural family practice, this study examines 106 patients (88 women, 18 men) who went to their family physicians in private practice or a resident-faculty practice with genitourinary symptoms. Evaluation of each patient included history, physical examination, urinalysis, and urine or cervical cultures for bacteria, Mycoplasma, and Chlamydia. Using agar plate culturing techniques, 37 patients (35 percent) were identified as having significant urine bacteria. Chlamydia was rarely associated with urinary tract symptoms. Mycoplasma hominis, however, was isolated and felt to be etiologic in 19 (22 percent) of the 88 symptomatic women (P = 0.0026). Older women (mean age 42 years, P less than 0.001) with greater than 5 white blood cells per high-power field (WBC/hpf) on microscopic urinalysis (P less than 0.001) were likely to have cystitis and significant bacteria on urine culture. Younger women (mean age 31 years, P less than 0.001) with less than 5 WBC/hpf (P less than 0.001) had negative urine cultures and were likely to have M. hominis as a pathogen. These results demonstrate that the etiology of genitourinary symptoms seen in rural family practice may vary substantially from those seen in other patient care settings.