Association between endogenous sex steroid hormones and inflammatory biomarkers in US men.

Sex steroid hormones and inflammatory biomarkers are both associated with the development and progression of chronic diseases, but their interrelationship is relatively uncharacterized. We examined the association of sex hormones and sex hormone-binding globulin (SHBG) with biomarkers of inflammation, C-reactive protein (CRP) and white blood cell (WBC) count. The study included data from 809 adult men in the National Health and Nutrition Examination Survey 1999-2004. Geometric means and 95% confidence intervals were estimated separately for CRP and WBC concentrations by sex steroid hormones and SHBG using weighted linear regression models. Higher concentrations of total (slope per one quintile in concentration, -0.18; p-trend, 0.001) and calculated free (slope, -0.13; p-trend, 0.03) testosterone were statistically significantly associated with lower concentrations of CRP, but not with WBC count. Men in the bottom quintile of total testosterone (≤3.3 ng/mL), who might be considered to have clinically low testosterone, were more likely to have elevated CRP (≥3 mg/L) compared with men in the top four quintiles (OR, 1.61; 95% CI, 1.00-2.61). Total and calculated free estradiol (E2) were positively associated with both CRP (Total E2: slope, 0.14; p-trend, <0.001; Free E2: slope, 0.15; p-trend, <0.001) and WBC (Total E2: slope, 0.02; p-trend, 0.08; Free E2: slope, 0.02; p-trend, 0.02) concentrations. SHBG concentrations were inversely associated with WBC count (slope, -0.03; p-trend, 0.04), but not with CRP. These cross-sectional findings are consistent with the hypothesis that higher androgen and lower oestrogen concentrations may have an anti-inflammatory effect in men.

Brian MacMahon (1923-2007): founder of modern epidemiology.

Brian MacMahon was born in Sheffield, UK in 1923. He served as chair of the Department of Epidemiology at Harvard School of Public Health for more than 30 years. He was admired as a noble and generous man and respected for his shining intellect, scientific integrity, and broad culture. He set the pace for modern epidemiology and led the way for a whole school of epidemiologists who are now spread around the nation and the world. He made major scientific contributions, received several distinguished prizes and awards, and continued to publish insightful papers until the very end. Brian MacMahon was the first editor-in-chief of Cancer Causes and Control.

Mortality of men versus women in comparable high-level jobs: 15-year experience in the Federal Women's Study.

The authors investigated exposure to high-level occupations in relation to the well-known survival advantage of women compared with men of the same age. Women in the federal workforce in positions of General Schedule 14 and above in 1979--1993 (n = 4,727) were each matched with three men (n = 14,181) by age, General Schedule level, and supervisory role. Fifteen-year mortality rates were compared between men and women and against expected 15-year mortality from the US general population. Despite similar job demands, women experienced markedly lower 15-year mortality than did men. However, men in these positions had nearly 50% lower mortality compared with age-matched men in the general population; the comparable reduction for women was 38%. The simultaneous substantial, but unequal by gender, improvement in mortality resulted in a reduced male/female mortality ratio, from 1.67 in the general population to 1.40. The reduced male/female mortality ratio was especially prominent for cancer and was not evident for heart disease mortality. Survival was nominally higher in non-White than in White participants. In summary, high-level employment is associated with substantially reduced mortality in both men and women. The relative improvement in survival is greater in men despite a comparable reduction in risk of heart disease mortality by gender.

Implementing a nonlatex surgical glove study in the OR.

Sterile surgical gloves are used to protect patients and health care workers (HCWs) from infection during surgery and to shield HCWs from exposure to bloodborne pathogens. Based on increased reports of latex allergy, many HCWs now use nonlatex surgical gloves as a substitute for natural rubber gloves. Little is known, however, about the performance of nonlatex gloves in surgery. This article describes a study that currently is being performed to test the barrier performance of nonlatex surgical gloves after they have been used in surgery and to determine HCW satisfaction. To date, 12,703 latex and nonlatex gloves from all surgical services have been collected and tested for barrier quality. This article describes the project and challenges encountered by the collaborative team of perioperative staff members and nurse researchers as they collect data.

A comparison of serum total cholesterol levels and their determinants between the Federal Republic of Germany and the United States.

Mean serum total cholesterol levels appear to be higher in the Federal Republic of Germany (FRG) than in the United States (US) while coronary heart disease death rates are lower. The study examined possible factors for the difference including possible differences in laboratory methodology. Cross-sectional data from the first two waves of the German National Health Surveys (1984-1986 and 1987-1989; n = 9709) and from the Second National Health and Nutrition Examination Survey (1976-1980; n = 7832) were compared for men and women 25-69 years of age. The influence of age, body mass index, diet, cigarette smoking, education, income, use of oral contraceptives or antihypertensive agents, alcohol consumption and potential differences in laboratory measurement were explored using multiple regression techniques separately for men and women for ages 25-39, 40-59 and 60-69 years of age. Overall ages, unadjusted mean total cholesterol levels were higher in German than US men (6.02 vs. 5.64 mmol/l) and in German than US women (6.04 vs. 5.80 mmol/l) as were HDL cholesterol levels (men: 1.30 vs 1.14 mmol/l; women: 1.65 vs. 1.38 mmol/l). Adjusting for lifestyle factors explained, on the average, 40% of the differences in mean total cholesterol of which half or 20% was accounted for by adjusting for alcohol intake. Adjusting for possible laboratory differences explained, on the average, an additional 30% of the differences. Frequency of alcohol intake was the most important factor in explaining differences in mean HDL cholesterol levels. Adjustment for differences in alcohol intake had negligible effects on reducing the differences in mean non-HDL cholesterol.

Race, sex, poverty, and the medical treatment of acute myocardial infarction in the elderly.

BACKGROUND: Race, sex, and poverty are associated with the use of diagnostic cardiac catheterization and coronary revascularization during treatment of acute myocardial infarction (AMI). However, the association of sociodemographic characteristics with the use of less costly, more readily available medical therapies remains poorly characterized. METHODS AND RESULTS: We evaluated 169 079 Medicare beneficiaries >/=65 years of age treated for AMI between January 1994 and February 1996 to determine the association of patient race, sex, and poverty with the use of medical therapy. Multivariable regression models were constructed to evaluate the unadjusted and adjusted influence of sociodemographic characteristics on the use of 2 admission (aspirin, reperfusion) and 2 discharge therapies (aspirin, beta-blockers) indicated during the treatment of AMI. Therapy use varied by patient race, sex, and poverty status. Black patients were less likely to undergo reperfusion (RR 0.84, 95% CI 0. 78, 0.91) or receive aspirin on admission (RR 0.97, 95% CI 0.96, 0. 99) and beta-blockers (RR 0.94, 95% CI 0.88, 1.00) at discharge. Female patients were less likely to receive aspirin on admission (RR 0.98, 95% CI 0.97, 0.99) and discharge (RR 0.98, 95% CI 0.96, 0.99). Poor patients were less likely to receive aspirin (RR 0.97, 95% CI 0. 96, 0.98) or reperfusion (RR 0.97, 95% CI 0.93, 1.00) on admission and aspirin (RR 0.98, 95% CI 0.96, 1.00), or beta-blockers (RR 0.95, 95% CI 0.91, 0.99) on discharge. CONCLUSIONS: Medical therapies are currently underused in the treatment of black, female, and poor patients with AMI.

Findings from the American College of Epidemiology's survey on Ethics guidelines. The American College of Epidemiology Ethics and Standards of Practice Committee.

PURPOSE: A survey to establish both the need and subject areas for a possible new set of ethics guidelines for epidemiologists was conducted among a random sample of 300 North American (Canada, Mexico, and United States) members of three major United States-based professional epidemiology organizations. METHODS: An 88% response rate revealed wide agreement on topics to be included in any new set of guidelines, but uncertainty prevailed about the need for new guidelines; 41% agreed that there was a need to develop a new set, 43% had no opinion, and 16% disagreed. RESULTS: There was almost no difference in preferences between men and women for topics to be included in a new set of guidelines, or between those aware or unaware of extant ethics guidelines in epidemiology. Fifty-four percent were aware of such guidelines and only 29% of these said they could describe the content of the guidelines. CONCLUSION: More needs to be done to evaluate the utility of ethics codes in epidemiology.

Could salicylates in food have contributed to the decline in cardiovascular disease mortality? A new hypothesis.

OBJECTIVES: The prophylactic effect of aspirin (at 80 mg/day) for the prevention of cardiovascular disease mortality has long been recognized. This study examined whether other salicylates are present in comparable quantities in the US food supply. METHODS: To estimate the order of magnitude for salicylates in the food supply, annual production data for selected synthetic salicylates were analyzed. RESULTS: Production figures for 1960 indicate exposure to salicylates of 250 mg/day per person, or 95 mg/day per person excluding aspirin. Trend data indicate a rise in the production of salicylates over time, reaching 341 mg/day per person, or 126 mg/day per person excluding aspirin, in 1970. CONCLUSIONS: The US ingestion of salicylates with aspirinlike properties may have increased to the point that many susceptible individuals have received a beneficial effect that has contributed to the decline in cardiovascular disease mortality.

Dietary calcium, alcohol, and incidence of treated hypertension in the NHANES I epidemiologic follow-up study.

Evidence concerning the relation between dietary calcium intake and development of hypertension is inconsistent. Some of this inconsistency may be due to interaction of this relation with other factors. The current study was designed to test for an interaction between alcohol consumption and the relation of dietary calcium intake to 10-year incidence of hypertension in a sample of the US adult population: the Epidemiologic Follow-up Study (1982-1984) of the First National Health and Nutrition Examination Survey (NHANES I) (1971-1975). Interactive logistic regression models were estimated with incident hypertension defined as self-reported treatment with antihypertensive medication. After exclusion of participants with evidence of hypertension at baseline (resulting n = 6,634), odds ratios for hypertension were estimated for each 1-g/day increase in calcium intake. The relation between dietary calcium and incident hypertension showed significant interactions with frequency of alcohol use (odds ratio (OR) = 1.33 for daily drinkers, OR = 0.84 for others; p = 0.005 for difference), age (OR = 0.75 for < or = 40 years at baseline, OR = 1.00 for > 40 years; p = 0.004), and body mass index, defined as weight (kg) divided by height (m) squared (OR = 0.82 for < or = 26, OR = 1.01 for > 26; p = 0.018). Interactions with sex and race (black vs. white) were not significant (p > or = 0.4). These findings suggest that a protective effect of foods containing calcium on the risk of developing hypertension may vary across levels of alcohol consumption and other risk factors for hypertension.

Trends in heart disease in the United States.

The twentieth century in the United States has witnessed a "heart disease epidemic" with a dramatic increase in ischemic heart disease (IHD) among men, particularly, beginning shortly after World War I. The epidemic reached its peak mortality among men in the 1960s and among women about two decades earlier. Highest mortality rates were observed in the Northeast at mid-century, but by 1990 the highest rates occur in the Southeast. With improvements in survival during the past few decades, prevalence of IHD has been increasing in the population. Identification of risk factors for IHD through longitudinal epidemiologic studies has led to prevention programs that have improved the risk profile of the population.

Setting and monitoring health objectives for the nation.

Healthy People 2000 is a national effort to focus and coordinate a wide variety of efforts to improve the health and longevity of the American people. By establishing specific objectives, each with measurable targets for the year 2000, the success of programs to improve health and prevent disease can be assessed. The cancer objectives concentrate on the leading sites that account for more than half of all cancer deaths. They include risk reduction objectives to modify individuals' behaviors towards more healthful practices, and services and protection objectives to enhance counselling and early detection efforts. National surveys conducted by the National Center for Health Statistics are in place to monitor the progress towards accomplishment of these objectives and to guide policies for effective actions.

Mortality surveillance system: models from the second year.

This is the second report presenting statistical charts and text from the Mortality Surveillance System (MSS). The first report presented the statistical charts and text from the first year of the MSS as published in the Monthly Vital Statistics Report (MVSR) volume 38, numbers 2-volume 39, number 1, and briefly described the methodology that was used. This report presents the statistical charts and text from the second year of the MSS as published in the MVSR volume 39, number 2-volume 40, number 1. Also presented are the monthly data used in fitting the models depicted in the published charts and the model statistics for the fitted curves. According to the Dictionary of Epdenriology edited by John Last (2) surveillance is "Ongoing scrutiny, generally using methods distinguished by their practicability, uniformity, and frequently their rapidity, rather than by complete accuracy. Its main purpose is to detect changes in trend or distribution in order to initiate investigative or control measures." Conceptually, then, the purpose of the MSS is to detect changes in trend or distribution to initiate further investigative and control measures in a practical and timely manner.