Site specific osteoarthritis and the index to ring finger length ratio.

OBJECTIVE: To quantify the relationship between the index to ring finger length ratio second digit:fourth digit(2D:4D) and radiographic osteoarthritis (OA) of the knee. METHODS: Data from the Clearwater Osteoarthritis Study (COS) were analyzed. We selected a random sample of 236 subjects with knee OA (Kellgren-Lawrence scores >or=2) and compared their finger length ratio pattern with a random sample of 242 controls. Finger length measurements were recorded from digitized hand radiographs. Subjects were classified into three groups: type 1 (index finger longer than ring finger), type 2 (fingers of equal length) and type 3 (index finger shorter than ring finger). Using a case-control design, we calculated odds ratios (OR). RESULTS: The type 3 finger pattern was significantly associated with knee OA (OR 2.59, 95% confidence interval (CI) 1.54-4.37). Women demonstrated a stronger association of visual type 3 finger pattern and knee OA (OR 4.40, 95% CI 2.62-7.38) compared to men (OR 2.59, 95% CI 1.34-5.00). CONCLUSIONS: The type 3 finger length pattern is associated, to a statistically significant degree, with OA of the knee. The type 3 finger length pattern (ring finger longer than index finger) appears to be an indicator of OA predisposition. Consideration of this pattern in clinical assessments may be an added aid as clinicians screen patients for OA risk.

Prevalence and mortality rate of congestive heart failure in the United States.

OBJECTIVES: The study was designed to determine the prevalence and mortality rate of congestive heart failure in noninstitutionalized men and women in the U.S. BACKGROUND: Congestive heart failure is a serious condition with significant morbidity and mortality. Earlier epidemiologic descriptions of congestive heart failure were constructed from small surveys, limited data, hospital records or death certificates. No nationally representative data from noninstitutionalized persons have been examined. METHODS: Data collected from the National Health and Nutrition Examination Survey (NHANES-I, 1971 to 1975) were used to determine the prevalence of heart failure on the basis of both self-reporting and a clinical definition. Mortality data were derived from the NHANES-I Epidemiologic Follow-up Study (1982 to 1986). RESULTS: The prevalence of self-reported congestive heart failure approximates 1.1% of the noninstitutionalized U.S. adult population; the prevalence of congestive heart failure based on clinical criteria is 2%. These estimates suggest that between 1 and 2 million adults are affected. Mortality at 10 and 15 years for those persons with congestive heart failure increases in graded fashion with advancing age, with men more likely to die than women. In the group greater than or equal to 55 years old, the 15-year total mortality rate was 39.1% for women and 71.8% for men. CONCLUSIONS: Congestive heart failure is a common problem in the U.S., with significant prevalence and mortality, both of which increase with advancing age. As the population of the U.S. becomes older, the health care impact of congestive heart failure will probably grow.

Blood pressure in childhood. The National Health Examination Survey.

Data were analyzed from the U.S. Health Examination Survey (Cycle II) to determine relationships between blood pressure and other characteristics. This survey examined a national probability sample of children aged 6-11 years. Significant relationships were found for blood pressure and the following variables: chronological and skeletal age, skinfold thickness (adiposity) and other anthropometric measurements, pulse rate, and systolic murmurs. These relationships may be interpreted as indicating important relationships between blood pressure and growth, adiposity, and hemodynamic manifestations of cardiac output. Data from this representative population portray blood pressure relationships in childhood.

Blood pressure in adolescence. The United States Health Examination survey.

A nationally representative sample of adolescents 12-17 years of age were examined in the U.S. Health Examination Survey and relationships between blood pressure and other variables were explored. During adolescence, blood pressure increases more rapidly in males than in females and only small racial differences are present. Weight has the strongest relationship to both systolic and diastolic pressure. Physiological maturation assessed by skeletal age and adiposity (skinfold thickness) are components of weight and each is also related to blood pressure. Although systolic murmurs are related to blood pressure at the time of examination, the murmurs are transitory and not predictive of future pressures. All factors were equally influential in each race-sex group. No significant relationships were found between geographic or demographic variables and blood pressure. These observations indicate the important relationships of physiological maturation and adiposity to adolescent blood pressure.

Progress in the battle against hypertension. Changes in blood pressure levels in the United States from 1960 to 1980.

Intensive efforts by practicing physicians and public health workers to identify and treat persons with hypertension have been underway for many years. In this report, changes in blood pressure levels in the United States are assessed based on nationally representative health (and nutrition) examination surveys conducted by the National Center for Health Statistics in 1960 to 1962, 1971 to 1974, and 1976 to 1980. Analysis of age-adjusted data for adults aged 18 to 74 years (including those on antihypertensive medication) indicates that between the first and third surveys for whites and blacks, respectively, mean systolic blood pressure declined 5 and 10 mm Hg; the proportion of persons with systolic blood pressure of 140 mm Hg or higher fell 18 and 31%; the proportion with undiagnosed hypertension decreased 17 and 59%; and the proportion taking antihypertensive medications rose 71 and 31%. These differences between the first and third surveys were all statistically significant (p less than 0.05 or better). Changes in diastolic blood pressure levels were generally not significant among race-sex groups. The proportion of persons with definite hypertension (i.e., systolic blood pressure greater than or equal to 160 mm Hg, and/or diastolic blood pressure greater than or equal to 95 mm Hg, and/or taking antihypertensive medication) declined among blacks but rose slightly among whites. Study results are consistent with the recent decline in cardiovascular disease mortality.

Physiologic determinants of serum urate levels in adolescence.

During adolescence, serum urate increases and adult levels are achieved. Physiologic factors related to serum urate were investigated in a nationally representative population of 6,768 youths aged 12 to 17 years (the US Health Examination Survey). Serum urate concentration increases markedly from ages 12 to 14 years in males, and levels were related to sexual and skeletal maturation. Although similar relationships were observed in females, the association is less striking, probably because of earlier pubescence, which was not captured in this study, and a pronounced androgenic response. In the later stages of adolescence (ages 15 to 17 years for males and 13 to 17 years for females), body composition (body mass index and skinfold thickness), blood pressure, and hematocrit have stronger relationships than sexual and somatic maturation. These latter relationships are similar to those in adults. This survey affords a portrayal of physiologic interrelationships with serum uric acid during adolescence.

Physical activity as a risk factor for osteoarthritis of the knee.

A case-control study was conducted to evaluate the association between knee osteoarthritis (OA) and physical activity (PA) among a community group aged 40 years and older. Case patients (85 males, 154 females) had radiologically confirmed knee OA with grade 2+ changes, according to Kellgren and Lawrence criteria. Control subjects (85 males, 154 females) had no radiologic evidence of knee OA. A statistically significant positive association between high PA level and knee OA was observed for women, with an age-adjusted odds ratio (OR) of 1.66 and 95% confidence interval (CI) of 1.01 to 2.72. In men no association was observed (OR = 0.95; 95% CI, 0.49 to 1.83). These associations persisted when controlling simultaneously for potential confounders including age, obesity, history of knee injury, and socioeconomic status, indicating that the OA-PA association is limited to women. One possible explanation is that risk factors for knee OA are influenced by hormones.

Identification of sentinel health events as indicators of environmental contamination.

The consensus process was applied to addressing a public health topic; this was a novel endeavor. The following question was addressed: What role, if any, should sentinel health events play in the decision-making process for identifying the effects of environmental exposure? The panel developed three levels of sentinel health events lists: those that are clearly identifiable, those that are potential signs, and those that are indicators of body burdens. Additionally, the panel developed several salient statements regarding the principles of environmental health surveillance and, especially, recommendations for future research.

Bronchodilator testing "confidence intervals" based on the level of bronchial responsiveness.

"Confidence intervals" based upon inhalation of placebo have been proposed as criteria for defining a significant response to an inhaled bronchodilator. The published intervals were derived from a clinically heterogeneous population. We calculated the difference (delta) between spirometric data before and after placebo in 109 consecutive patients referred for methacholine bronchoprovocation challenge testing. The mean delta, expressed both as a percent change and as actual volume change for both the FVC and FEV1, was not significantly different in patients with bronchial hyperresponsiveness, as compared to subjects with a negative methacholine challenge test; however, the variance of measurements in hyperresponsive subjects was significantly greater than that of the normal population. In addition, as the category of responsiveness increased from mild to moderate to severe hyperresponsiveness, so did the variance within these groups. A negative correlation between the measured PC20FEV1 and the volume and percent change was noted. We conclude that patients with hyperresponsive airways may display increased spirometric variation before and after placebo. This general approach for establishing normal limits for defining a significant response appears to be valid, but the actual values used may vary, depending on the composition of the population tested and the goals of the study. Also, the use of the term, "confidence intervals," in this context is inappropriate; and we propose, instead, the use of percentiles and the simpler terms, upper 90th or 95th percentiles.

Histopathology of lung cancers among smokers and nonsmokers in Florida.

A study was undertaken of the relationship between lung cancer cell type and age, race, sex and smoking characteristics. The study population consisted of 35 183 cases of microscopically confirmed carcinoma of the lung, first diagnosed between 1981 and 1985, among residents of the state of Florida. The data suggested that the histological types of lung cancer observed varied by age, sex and the use of cigarettes. The number of cigarettes smoked per day did not appear to influence the cell types observed. The study indicated that adenocarcinomas occurred more frequently in lung cancer cases diagnosed at earlier ages, among both men and women. Among women who smoked, there was an increased proportion of small cell carcinomas compared to nonsmoking women, while in male smokers, the increase appeared primarily in squamous cell carcinomas.

Trends in total mortality and mortality from heart disease in 26 countries from 1950 to 1978.

Death rates for total mortality and for non-rheumatic heart disease and hypertension ('heart disease') are described for men and women ages 45-64 in six time periods during 1950-78 for 26 countries. Rates for men in high-rate countries are three times those in low-rate countries. This variation is more striking for men than women. There were marked increases for heart disease in men in most countries, but in 13 countries there was a slowing or reversal of that trend in the 1960's or 1970's or acceleration of an already downward trend. In 22 countries long-term declines for heart disease occurred in women. There was a widening of the north/south gradient in Europe and of the male/female ratio of heart disease mortality. Countries with high heart disease death rates in men had high ratios of heart disease to total death. Other countries experienced a rise in proportionate mortality. In women, proportionate mortality for heart disease remained flat or declined in most countries. In spite of these changes in rates, each country seems to have a range for heart disease mortality that is characteristic of its population and environmental setting so that profound changes in rates do not substantially alter their relative ranking. Our intent is to stimulate the search for reasons why heart disease mortality recently declined in some countries but not in others (already begun in the WHO-sponsored MONICA programme). Our forthcoming monograph on international mortality trends for the major causes of death will be a next step in this process.

Use of household pesticides and the risk of aplastic anaemia in Thailand. The Aplastic Anemia Study Group.

BACKGROUND: Aplastic anaemia is a severe blood dyscrasia that is more common in Thailand than in Western countries. Its a etiology remains poorly understood. METHODS: A case-control study was conducted in Bangkok and two rural regions of Thailand. The effect of household pesticides was evaluated among 253 incident cases of aplastic anaemia and 1174 hospital controls. RESULTS: A total of 54% of the cases and 61% of the controls were exposed 1-6 months previously. For most individual household pesticides and for groups classified according to chemical type (organophosphates, pyrethrins, and organochlorines), the relative risk (RR) estimates approximated 1.0; upper 95% confidence limits were below 2.0 for many comparisons. A significant association was observed for exposure to combination products containing dichlorvos and propoxur, with an overall RR estimate of 1.7 (95% confidence interval [CI]: 1.1-2.6); the estimate for regular use was 1.6 (95% CI: 0.9-2.9). CONCLUSIONS: The absence of a higher risk for the regular use of dichlorvos/propoxur reduces the credibility of the apparent association, which could well have been an artefact of multiple comparisons. We conclude that most household pesticides used in Thailand do not appear to increase the risk of aplastic anaemia.

Agranulocytosis in Bangkok, Thailand: a predominantly drug-induced disease with an unusually low incidence. Aplastic Anemia Study Group.

Agranulocytosis, a syndrome characterized by a marked reduction in circulating granulocytes, is strongly associated with medical drug use in Europe and the United States. Unregulated use of common pharmaceutical agents in developing countries has been suspected of causing large numbers of cases of agranulocytosis and deaths, especially among children. To elucidate the incidence and etiology of agranulocytosis in Thailand, a population-based case-control study of symptomatic agranulocytosis that resulted in hospital admission was conducted in Bangkok from 1990 to 1994. An attempt was also made to study the disease in Khonkaen (in northeastern Thailand) and Songkla (in southern Thailand), but there were insufficient cases in the latter regions, and the analysis was confined to subjects from Bangkok. In that region, the overall incidence of agranulocytosis was 0.8 per million per year; there were no deaths. As expected, the incidence was higher in females (0.9 per million), and it increased with age (4.3 per million beyond age 60). Among 25 cases and 529 controls the relative risk estimate for a combined category of all suspect drugs was 9.2 (95% confidence interval = 3.9-21), and the proportion of cases that could be attributed to drug use was 68%. For individual drugs and drug classes the data were sparse; within these limitations, the strongest association appeared to be with antithyroid drugs. One case and three controls were exposed to dipyrone, a drug known to cause agranulocytosis; with such scanty data the risk could not be evaluated. Exposure to pesticides or solvents was not associated with an increased risk. This is the first formal epidemiologic study of agranulocytosis in a developing country. As in the West, most cases are attributable to medical drug use. However, the incidence of agranulocytosis in Bangkok, and apparently, in Thailand as a whole, is unusually low, and the disease does not pose a public health risk.

Short course training in epidemiology and biostatistics for graduate and undergraduate public health professionals.

The University of South Florida has developed short courses of 2 to 3 days in epidemiology and biostatistics geared to public health workers. A key focus is providing skills which will assist local and State public health units to assess their status and measure progress with respect to achieving their explicitly stated health objectives for the year 2000. The courses were developed after the identification of the training needs in health departments and other public health settings. The training objectives were (a) to enhance the biostatistics skills of professionals involved in the analysis of health data; (b) to reinforce basic knowledge of epidemiologic methods and its practical applications in public health settings, including measures of disease frequency and association, epidemic outbreak investigations, and the identification and use of surveillance data; and (c) to demonstrate the application of the risk factor approach to select the interventions needed to reach health objectives for year 2000 and how to evaluate such interventions. A total of 43 students have taken this course series. Professional staff in health departments cannot always enroll in formal training in epidemiology and biostatistics because of time limitations or a lack of a bachelor's degree. However, the need exists. An alternative to such training could be the short course program described in this paper.

Evaluation of the accuracy of on-site multi-analyte drug testing devices in the determination of the prevalence of illicit drugs in drivers.

A principal goal of this research was to conduct a field evaluation of "on-site" multi-analyte drug testing devices to determine the most accurate, efficient, and cost-effective device available for the purpose of rapidly detecting drivers under the influence of drugs. Four on-site kits were selected and evaluated for accuracy and efficiency for the detection of tetrahydrocannabinol (THC), the cocaine metabolites (COC), and opiates (OPI). From 16 December 1995 to 17 March 1996, 303 voluntary urine specimens were collected by law enforcement officers from persons arrested for driving-under-the-influence (DUI). These specimens were tested using the four selected kits and aliquots of the specimens were sent to a DHHS certified lab for "gold standard" comparison testing by immunoassay and Gas Chromatography/Mass Spectrometry. On-site kit sensitivity ranged from 82.9% to 100% for THC, 82.5% to 100% for COC, and all were at 100% for OPI. Specificity, and positive and negative predictive values were also determined. Accuracy ranged from 94.0% to 98.3% for THC, 97.4% to 98.0% for COC, and 99.7% to 100% for OPI. All four kits were in very close agreement on prevalence: 15.5% to 15.8% for THC, all were at 13.2% for COC, and all were at 0.7% for OPI. For law enforcement purposes, sensitivity may be the most important indicator in these kits.