Characteristics, detection methods and treatment of questionable occlusal carious lesions: findings from the national dental practice-based research network.

Questionable occlusal carious lesions (QOC) can be defined as an occlusal tooth surface with no cavitation and no radiographic radiolucencies, but caries is suspected due to roughness, surface opacities or staining. An earlier analysis of data from this study indicates 1/3 of patients have a QOC. The objective of this report has been to quantify the characteristics of these common lesions, the diagnostic aids used and the treatment of QOC. A total of 82 dentist and hygienist practitioner-investigators from the USA and Denmark in the National Dental Practice-Based Research Network participated. When consenting patients presented with a QOC, information was recorded about the patient, tooth, lesion and treatments. A total of 2,603 QOC from 1,732 patients were analyzed. The lesions were usually associated with a fissure, on molars, and varied from yellow to black in color. Half presented with a chalky luster and had a rough surface when examined with an explorer. There was an association between color and luster: 10% were chalky-light, 47% were shiny-dark and 42% were mixtures. A higher proportion of chalky than of shiny lesions were light (22 vs. 9%; p < 0.001). Lesions light in color were less common in adults than in pediatric patients (9 vs. 32%; p < 0.001). Lesions that were chalky and light were more common among pediatric than among adult patients (22 vs. 6%; p < 0.001). This is the first study to investigate characteristics of QOC in routine clinical practice. Clinicians commonly face this diagnostic uncertainty. Determining the characteristics of these lesions is relevant when making diagnostic and treatment decisions.

Incidence and prevalence of epilepsy among older U.S. Medicare beneficiaries.

OBJECTIVE: To determine the prevalence and incidence of epilepsy among U.S. Medicare beneficiaries aged 65 years old and over, and to compare rates across demographic groups. METHODS: We performed a retrospective analysis of Medicare administrative claims for 2001-2005, defining prevalent cases as persons with ≥1 claim with diagnosis code 345.xx (epilepsy) or 2 or more with diagnosis code 780.3x (convulsion) ≥1 month apart, and incident cases as prevalent cases with 2 years immediately before diagnosis without such claims. Prevalence and incidence rates were calculated for the years 2003-2005 using denominators estimated from a 5% random sample of Medicare beneficiaries. Results were correlated with gender, age, and race. RESULTS: We identified 282,661 per year on average during 2001-2005 (a total of 704,243 unique cases overall), and 62,182 incident cases per year on average during 2003-2005. Average annual prevalence and incidence rates were 10.8/1,000 and 2.4/1,000. Overall, rates were higher for black beneficiaries (prevalence 18.7/1,000, incidence 4.1/1,000), and lower for Asians (5.5/1,000, 1.6/1,000) and Native Americans (7.7/1,000, 1.1/1,000) than for white beneficiaries (10.2/1,000, 2.3/1,000). Incidence rates were slightly higher for women than for men, and increased with age for all gender and race groups. CONCLUSIONS: Epilepsy is a significant public health problem among Medicare beneficiaries. Efforts are necessary to target groups at higher risk, such as minorities or the very old, and to provide the care necessary to reduce the negative effects of epilepsy on quality of life.

Socio-demographic determinants of aflatoxin B1-lysine adduct levels among pregnant women in Kumasi, Ghana.

OBJECTIVES: Aflatoxins are fungal metabolites that contaminate staple food crops in many developing countries. Although studies have linked these toxins to adverse birth outcomes and poor infant development, no study has investigated the socio-demographic and economic determinants of aflatoxin levels among pregnant women living in sub-Saharan Africa. DESIGN: A cross-sectional study was conducted among 785 pregnant women in Kumasi. Aflatoxin B1 lysine adduct levels (AF-ALB) were determined by High Performance Liquid Chromatography. Analysis of variance was used to determine mean log AF-ALB levels and significance of differences in these levels according to socio-demographic variables. Logistic regression was used to identify independent associations of socio-demographics with having AF-ALB levels (≥ 11.34 pg/mg; upper quartile). RESULTS: AF-ALB levels ranged from 0.44 pg/mg to 268.73 pg/mg albumin with a median level of 5.0 pg/mg. Bivariate analyses indicates that mean ln AF-ALB as well as the percent of women having high AF-ALB levels (≥ 11.34 pg/mg; upper quartile) were inversely associated with indices of higher socioeconomic status: higher education and income, being employed and having a flush toilet. Higher income, being employed, having one child (verses no children) and having a flush toilet (verses no toilet facilities) were each independently associated with a 30-40% reduced odds of high AF-ALB levels. CONCLUSIONS: Additional research is needed to investigate how socio-demographic and economic factors interact to influence aflatoxin ingestion by individuals in regions with high aflatoxin crop contamination. This knowledge can be used to formulate and implement policies that will reduce exposure of women and their unborn children to these toxins.

Simplified dispatch-assisted CPR instructions outperform standard protocol.

OBJECTIVE: Dispatch-assisted chest compressions only CPR (CC-CPR) has gained widespread acceptance, and recent research suggests that increasing the proportion of compression time during CPR may increase survival from out-of-hospital cardiac arrest. We created a simplified CC-CPR protocol to reduce time to start chest compressions and to increase the proportion of time spent delivering chest compressions. This simplified protocol was compared to a published protocol, Medical Priority Dispatch System (MPDS) Version 11.2, recommended by the National Academies of Emergency Dispatch. METHODS: Subjects were randomized to the MPDS v11.2 protocol or a simplified protocol. Data was recorded from a Laerdal Resusci Anne Skillreporter manikin. A simulated emergency medical dispatcher, contacted by cell phone, delivered standardized instructions for both protocols. Outcomes included chest compression rate, depth, hand position, full release, overall proportion of compressions without error, time to start of CPR and total hands-off chest time. Proportions were analyzed by Wilcoxon's Rank Sum tests and time variables with Welch ANOVA and Wilcoxon's Rank Sum test. All tests used a two-sided alpha-level of 0.05. RESULTS: One hundred and seventeen subjects were randomized prospectively, 58 to the standard protocol and 59 to the simplified protocol. The average age of subjects in both groups was 25 years old. For both groups, the compression rate was equivalent (104 simplified versus 94 MPDS, p = 0.13), as was the proportion with total release (1.0 simplified versus 1.0 MPDS, p = 0.09). The proportion to the correct depth was greater in the simplified protocol (0.31 versus 0.03, p < 0.01), as was the proportion of compressions done without error (0.05 versus 0.0, p = 0.16). Time to start of chest compressions and total hands-off chest time were better in the simplified protocol (start time 60.9s versus 78.6s, p < 0.0001; hands-off chest time 69 s versus 95 s, p < 0.0001). The proportion with correct hand position, however, was worse in the simplified protocol (0.35 versus 0.84, p < 0.01). CONCLUSIONS: The simplified protocol was as good as, or better than the MPDS v11.2 protocol in every aspect studied except hand position, and the simplified protocol resulted in significant time savings. The protocol may need modification to ensure correct hand position. Time savings and improved quality of CPR achieved by the new set of instructions could be important in strengthening critical links in the cardiac chain of survival.

Association between antecedent intravenous antimicrobial exposure and isolation of vancomycin-resistant enterococci.

Vancomycin-resistant enterococci (VRE) have become important causes of nosocomial infections. This study evaluated the association between a variety of intravenous antimicrobial exposures and the isolation of VRE using two control groups: (1) a vancomycin-susceptible enterococci (VSE) group, to assess factors associated with development of VRE, and (2) a nonenterococci control group, to assess factors associated with positive cultures for enterococci without regard to vancomycin resistance. After adjusting for the effect of other antimicrobials, time at risk, and patient morbidity, compared to vancomycin-susceptible enterococci controls, exposures to imipenem (OR = 4.9, 95% CI = 1.6-14.1) and ceftazidime (OR = 2.6, 95% CI = 1.1-6.1) were significant predictors of VRE. When compared to nonenterococci controls, exposures to ampicillin (OR = 20.1, 95% CI = 1.5-263.1) and imipenem (OR = 5.1, 95% CI = 1.5-17.1) were significantly associated with VRE. Neither piperacillin nor vancomycin was associated with VRE compared to either control group. This study offers further evidence that the replacement of broad-spectrum cephalosporins by extended-spectrum penicillins, specifically piperacillin, may be effective in reducing VRE.

Vancomycin-resistant enterococci: 15 years and counting.

We review the history of vancomycin-resistant enterococci (VRE) and propose a causal model illustrating the roles of exposure to VRE reservoirs, patient characteristics, antimicrobial exposure, and prevalence of VRE in the progression from potential VRE reservoirs to active disease in hospitalized patients. Differences in VRE colonization and VRE infection are discussed with respect to hospital surveillance methodology and implications for interventions. We further document clonal transmission of VRE in a large, urban, teaching hospital and demonstrate VRE susceptibility to a wide array of antimicrobial agents. This model can guide the identification of mutable factors that are focal points for intervention.

Patient-perceived barriers to antiretroviral adherence: associations with race.

New antiretroviral (ARV) regimens require strict adherence if optimal suppression of HIV is to be maintained. This study is a theory-based examination of racial differences in patient-perceived barriers and reported ARV adherence. Participants (N=149) completed the Patient Medication Adherence Questionnaire (PMAQ), measuring adherence and perceived barriers to adherence. Adherence was defined as a self-report of 100% adherence in the past four weeks. Odds ratios were calculated to determine the relation of reported barriers to adherence for race and gender groups, and for the sample overall. For every ten-point increase in barrier score, there was an 86% increased risk of being non-adherent (OR=1.86; 95% CI: 1.19, 2.91). Adherence was not different between racial and gender groups, nor was total barrier score. However, individual barriers were differentially endorsed across groups. Rather than relying on demographic predictors, which may be only an indirect marker of adherence, evaluations of adherence should examine the psychological and social barriers to positive adherence outcomes in individual patients. Our findings support the use of theory-based behavioural interventions that address perceived barriers to adherence and other health promotion activities.

Oral contraceptive use and mammographic patterns.

High-risk mammographic patterns represent an increased risk of contracting breast cancer and may be used as a surrogate endpoint for the disease. We examined the relationship between oral contraceptive (OC) use and mammographic patterns among 3218 Norwegian women, aged 40-56 years. Information on ever OC use, duration, and age of first OC use and other epidemiological data were obtained through questionnaires. The mammograms were categorized into five groups. Patterns I-III were combined into a low-risk group and patterns IV and V into a high-risk group. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using logistic regression and adjusted for age, menopausal status, parity, age at first birth, and body mass index. Women who reported ever having used OCs were 20% more likely (OR 1.27, 95% CI 1.0-1.6) to have high-risk mammographic patterns compared with those reporting never having used OCs. There was no dose response between different measures of OC use and high-risk patterns. Among nulliparous women, ever OC users were four times more likely (OR 4.65, 95% CI 2.1-10.3) to have high-risk patterns compared with never users. Our findings suggest that, especially among nulliparous women, ever OC use may exert its effect on breast cancer risk through changes in breast tissue, which can be observed on a mammogram.

Longitudinal study of elbow and shoulder pain in youth baseball pitchers.

PURPOSE: Previous studies among young pitchers have focused on the frequency and description of elbow injuries. The purpose of this study was to evaluate the frequency of elbow and shoulder complaints in young pitchers and to identify the associations between pitch types, pitch volume, and other risk factors for these conditions. METHODS: A prospective cohort study of 298 youth pitchers was conducted over two seasons. Each participant was contacted via telephone after each game pitched to identify arm complaints. Generalized estimating equations were used to assess associations between arm complaints and independent variables. RESULTS: The frequency of elbow pain was 26%; that of shoulder pain, 32%. Risk factors for elbow pain were increased age, increased weight, decreased height, lifting weights during the season, playing baseball outside the league, decreased self-satisfaction, arm fatigue during the game pitched, and throwing fewer than 300 or more than 600 pitches during the season. Risk factors for shoulder pain included decreased satisfaction, arm fatigue during the game pitched, throwing more than 75 pitches in a game, and throwing fewer than 300 pitches during the season. CONCLUSION: Arm complaints are common, with nearly half of the subjects reporting pain. The factors associated with elbow and shoulder pain were different, suggesting differing etiologies. Developmental factors may be important in both. To lower the risk of pain at both locations, young pitchers probably should not throw more than 75 pitches in a game. Other recommendations are to remove pitchers from a game if they demonstrate arm fatigue and limit pitching in nonleague games.

Urine specific gravity and water hardness in relation to urolithiasis in persons with spinal cord injury.

STUDY DESIGN: A matched case-control study. OBJECTIVES: To clarify the influence of urine specific gravity and drinking water quality on the formation of urinary stones in persons with spinal cord injury (SCI). SETTING: A rehabilitation center within a university hospital. METHODS: Between 1992 and 1998, 63 stone cases (31 kidney, 27 bladder, and five both) and 289 age-duration-matched controls were recruited from a cohort of SCI patients enrolled in an on-going longitudinal study. Data on urine specific gravity and other characteristics of study participants were retrieved from the database and medical charts. Community water supply information was provided by the Alabama Department of Environmental Management. Multivariable conditional logistic regression analysis was performed to evaluate the association with stone formation. RESULTS: SCI individuals who had urinary stones were more likely than control subjects to use indwelling catheters and have decreased renal function. The occurrence of stones was not significantly related to gender, race, severity of injury, urinary tract infection, nor urine pH. After controlling for the potential confounding from other factors, a continuously increasing stone occurrence with increasing specific gravity was observed (P=0.05); this association was stronger for kidney (odds Ratio [OR]=1.8 per 0.010 g/cm(3)) versus bladder stones (OR=1.2) and for recurrent (OR=2.0) versus first stones (OR=1.5). Increased water hardness was not significantly associated with a decreased stone occurrence. CONCLUSIONS: Study results suggest that maintaining urine specific gravity below a certain level might reduce the occurrence of urinary stones. This could be easily achieved by using a dipstick for self-feedback along with appropriate fluid intake. For persons with SCI who are at an increased risk of a devastating stone disease, this prophylactic approach could be very cost-effective; however, this requires further confirmation.

Adolescent pregnancy, infant mortality, and source of payment for birth: Alabama residential live births, 1991-1994.

PURPOSE: To assess potential impact of programs to prevent adolescent pregnancy on infant mortality. METHODS: Infants (n = 247,503) born alive to Alabama residents from 1991 to 1994 were identified from birth cohort files and linked to infant death records. Deliveries funded by Medicaid, private insurance, and self-payers were studied separately. Relative risks (RR) and population attributable risks were calculated. The latter provided estimated percentages by which infant (<1 year) death risks would have decreased if adolescent (< or =19 years) pregnancies had been prevented. RESULTS: Infants of mothers <16 years of age were at higher risk of death than were infants of mothers aged 20 to 34 years (adults): the RRs were 4.1, 3.4, and 1.4 for self-payers, private insurance, and Medicaid groups, respectively. In the self-payer and private insurance groups, but not the Medicaid group, infants of mothers aged 17 to 19 years were more likely to die than were infants of adults. Infants from repeat adolescent pregnancies comprised nearly one-third of all infants born to adolescents, and in each payer-group were more likely to die than were infants of adults: The RRs were 4.9, 2.5, and 1.3 for self-payers, private-insurance, and Medicaid groups, respectively. Theoretically, preventing all adolescent pregnancies and preventing only repeat adolescent pregnancies would have reduced infant mortality in the total population by 8% and 4%, respectively. CONCLUSIONS: Programs to prevent first and subsequent adolescent pregnancies probably have little effect on infant mortality. Efforts to prevent adolescent pregnancies should not have a short-term goal of notably reducing infant mortality.

Pars planitis: a comparison of childhood onset and adult onset disease.

PURPOSE: To compare the symptoms, visual acuities and complications found in childhood onset pars planitis, with those seen in adult onset disease. METHOD: The records of 26 patients (52 eyes) with idiopathic pars planitis seen at a tertiary care clinic were reviewed. The study design allowed comparison of follow-up visual acuities for the adult onset and childhood onset groups at 2 years and 5 years from the time of initial diagnosis. RESULTS: The visual acuity at the time of initial diagnosis, at 2 years' follow up and at 5 years' follow up was worse for children than for adults, but this difference only reached statistical significance at 2 years' follow up (6/10 vs 6/7; P = 0.026). When looking at correlation coefficients between age and acuity, the same trend was observed at all time intervals, only reaching statistical significance with initial visual acuities (r = 0.32; P = 0.019). Adults had a tendency to complain more at presentation of blurred vision and floaters than children. Complication rates were similar for both groups. CONCLUSION: The study presents data supporting the idea that patients presenting with idiopathic pars planitis in childhood have a worse visual acuity both at initial diagnosis and at follow up than those presenting in adulthood. This is a long-suspected finding that has not previously been demonstrated.

Alternative strategies for selecting population controls: comparison of random digit dialing and targeted telephone calls.

PURPOSE: This project was carried out to identify a valid framework for selecting controls to be used in a population-based case-control study of breast cancer, and to compare participation rates and characteristics between women contacted using a standard random digit dialing (RDD) strategy and those who were sent a letter of presentation prior to telephone contact (targeted telephone calls, TTC). METHODS: Twelve hundred women, ages 20-74, were sampled from the Department of Motor Vehicles (DMV) and Health Care Financing Administration (HCFA) records. Women for whom telephone numbers were obtained (N = 771) were randomly assigned to RDD or TTC. The respondents participated in a brief telephone interview. Odd ratios (OR) and their 95% confidence intervals (CI) were used to estimate differences in characteristics of the respondents between the two contact strategies. RESULTS: Telephone numbers were obtained for 79% of women aged > or = 55 years and for only 38% of women aged < 55 years. Interviews were obtained for 48% of women for whom we obtained telephone numbers, and for 77% of women for whom eligibility was confirmed via telephone contact. Participation of target women appeared to be higher for the TTC than the RDD group (42% vs. 35%, p = 0.054). Among respondents who were > or = 55 years old, those in the TTC group were 80% more likely (OR = 1.8, 95% CI: 0.9-3.4) to report a serious medical condition than women in the RDD group, 60% less likely (OR = 0.4, 95% CI: 0.2-1.0) to report having used oral contraceptives, and 80% less likely (OR = 0.2, 95% CI: 0.1-0.5) to report having had breast surgery. CONCLUSIONS: Characteristics of respondents differed according to method of contact. These differences, along with the sampling frame used, should be considered when interpreting findings of case-control studies.

Prevention of mother-to-child transmission of HIV in Thailand: physicians' attitudes on zidovudine use, pregnancy termination, and willingness to provide care.

We administered a survey to Thai physicians, using regular mail, on their attitudes and practices regarding zidovudine (ZDV) use and pregnancy termination in HIV-infected pregnant women. We surveyed their willingness to care for these patients as well. In 1997, 79.5% of 480 respondents reported that they did not routinely use perinatal ZDV prophylaxis. Predictors of failure to use ZDV found to be significant in our logistic regression model included practice outside of Bangkok (odds ratio [OR] = 2.0), belief that ZDV is not cost effective (OR = 2.5), unfamiliarity with AIDS Clinical Trials Group (ACTG) 076 results (OR = 2.5), and failure to screen for HIV routinely (OR = 4.9). Elective abortion for HIV-infected women was advocated by 45.3% of respondents. Factors associated in multivariable analysis with this preference included specialty training in obstetrics/gynecology (OR = 1.8), practice inside Bangkok (OR = 2.0), male gender (OR = 1.9), and treatment of < or =2 HIV-infected patients yearly (OR = 1.8). A significant proportion of respondents described themselves as unwilling to perform pelvic examinations (19.2%), vaginal deliveries (30.7%), or cesarean deliveries (39.5%) on women who were known to be infected with HIV. We conclude that many Thai obstetric providers are reluctant to care for HIV-infected women, do not routinely use perinatal ZDV prophylaxis, and prefer to terminate pregnancies among HIV-infected patients. Physician education concerning the value of HIV screening and antiretroviral therapy in HIV-infected pregnant women is needed urgently in Thailand.

Compliance with mammography guidelines: physician recommendation and patient adherence.

BACKGROUND: Guidelines recommend that women ages 50-75 years receive screening mammography every 1-2 years. We related receipt of physician recommendations for mammography and patient adherence to such recommendations to several patient characteristics. METHODS: We retrospectively reviewed medical records of 1,111 women ages 50-75 attending three clinics in an urban university medical center. We ascertained overall compliance with mammography guidelines and two components of compliance: receipt of a physician recommendation and adherence to a recommendation. Outcome measures were the proportion of patients demonstrating each type of compliance and adjusted odds ratios, according to several patient-related characteristics. RESULTS: Overall, 66% of women received a recommendation. Of women receiving a documented recommendation, 75% adhered. Factors showing significant positive associations with receiving a recommendation included being a patient in the general internal medicine clinic, having private insurance, visiting the clinic more often, and having a recent Pap smear. Patient adherence was positively associated with private insurance and Pap smear history, negatively associated with internal medicine, and not associated with visit frequency. CONCLUSIONS: Patient factors influencing physician mammography recommendations may be different from those associated with patient adherence, except for having private health insurance, which was a predictor of both.

Moderate physical activity in relation to mammographic patterns.

High-risk mammographic patterns may be used as a surrogate end point for breast cancer in etiologic research as well as in prevention studies. Physical activity may be one of the few modifiable risk factors for breast cancer. We examined the relationship between physical activity and mammographic patterns among 2720 Norwegian women, ages 40-56 years, who participated in both the Second and Third Tromsø studies. Epidemiologic data were obtained through questionnaires. Two questions from the Second Tromsø study and five questions from the Third elicited information on physical activity. The mammograms were categorized into five groups based on anatomical-mammographic correlations. For analysis, patterns I through III were combined into a low-risk group and patterns IV and V into a high-risk group. Odds ratios that were adjusted for age, education, menopausal status, body mass index, parity, age at menarche, oral contraceptive use, and alcohol intake, with 95% confidence intervals, were estimated using logistic regression. Women who reported moderate physical activity, i.e., more than 2 h/week, were 20% less likely (odds ratio, 0.8; 95% confidence interval, 0.6-1.1) to have high-risk mammographic patterns compared with those who reported being inactive. This relationship remains consistent when stratified by menopausal status, parity, and tertiles of body mass index. However, all of the associations between various measures of physical activity and high-risk patterns found in this study are weak with confidence intervals that include 1.0. Thus, chance is a reasonable explanation for the weak associations found. The relationship between physical activity and high-risk patterns should be examined further as a means to explore the biologic mechanisms relating physical activity to breast cancer risk.

Chronic disease as a barrier to breast and cervical cancer screening.

OBJECTIVE: To assess whether chronic disease is a barrier to screening for breast and cervical cancer. DESIGN: Structured medical record review of a retrospectively defined cohort. SETTING: Two primary care clinics of one academic medical center. PATIENTS: All eligible women at least 43 years of age seen during a 6-month period in each of the two study clinics (n = 1,764). MEASUREMENTS AND MAIN RESULTS: Study outcomes were whether women had been screened: for mammogram, every 2 years for ages 50-74; for clinical breast examinations (CBEs), every year for all ages; and for Pap smears, every 3 years for ages under 65. An index of comorbidity, adapted from Charlson (0 for no disease, maximum index of 8 among our patients), and specific chronic diseases were the main independent variables. Demographics, clinic use, insurance, and clinical data were covariates. In the appropriate age groups for each test, 58% of women had a mammogram, 43% had a CBE, and 66% had a Pap smear. As comorbidity increased, screening rates decreased (p < .05 for linear trend). After adjustment, each unit increase in the comorbidity index corresponded to a 17% decrease in the likelihood of mammography (p = .005), 13% decrease in CBE (p = .006), and 20% decrease in Pap smears (p = .002). The rate of mammography in women with stable angina was only two fifths of that in women without. CONCLUSIONS: Among women who sought outpatient care, screening rates decreased as comorbidity increased. Whether clinicians and patients are making appropriate decisions about screening is not known.

Relations of hyperuricemia with the various components of the insulin resistance syndrome in young black and white adults: the CARDIA study. Coronary Artery Risk Development in Young Adults.

PURPOSE: To assess the association of hyperuricemia with the various components of the Insulin Resistance Syndrome (IRS) in a biracial cohort of young adults. METHODS: Cross-sectional study in 4053 young black and white adults aged 18-30 years from the Coronary Artery Risk Development in Young Adults (CARDIA) study. RESULTS: Body mass index (BMI), fasting insulin, and triglycerides were significantly higher, and high density lipoprotein (HDL)-cholesterol lower in subjects with hyperuricemia (uric acid > or = 7.0 mg/dl in males; > or = 6.0 mg/dl in females) (all p < 0.001). BMI showed the strongest positive correlation with uric acid among the IRS components. Significant associations of hyperuricemia with these risk factors were observed in all sex-race groups, which persisted after controlling for possible confounders including age, education, physical activity, smoking, alcohol intake, oral contraceptive use, and creatinine. Further adjustment for BMI and/or waist-to-hip ratio caused a large decrease in the strength of the associations. Adjustment for insulin also lead to decreases; however, the influence of fasting insulin appeared weaker than obesity. Even after controlling for obesity, insulin, and the other components of the IRS, male subjects in both races in the upper tertile of triglycerides were still more likely to have hyperuricemia. CONCLUSIONS: The association of hyperuricemia with most aspects of the IRS may result predominantly from their covariation with adiposity and secondarily with insulin level. Elevated triglyceride level seems to have an independent relationship with hyperuricemia in males. The relationship between hyperuricemia and cardiovascular disease observed in previous studies may be secondary to its association with the IRS.

Anthropometric indices in relation to mammographic patterns among peri-menopausal women.

The relationship between body height, weight and body mass index and mammographic patterns was examined among 3,208 Norwegian women, aged 40-56 years, participating in the Third Tromsø study. Standardized measurements of height and weight were recorded. Epidemiologic data were obtained through questionnaires. Mammograms were categorized into 5 groups based on anatomic-mammographic correlations. For analysis, patterns I-III were combined into a low-risk group and patterns IV and V into a high-risk group. Odd ratios (ORs), adjusted for menopausal status, age, parity, age at first birth, age at menarche and anthropometric measures, with 95% confidence intervals (CIs), were calculated. Body height was associated positively with high-risk patterns, while weight and body mass index were associated inversely with high-risk patterns. Women in the highest tertile of height were twice as likely (OR = 2.0, 95% CI 1.6-2.6) to have high-risk patterns compared with those in the lowest tertile, and women in the highest tertile of weight were 70% less likely (OR = 0.3, 95% CI 0.2-0.4) to have high-risk patterns compared with those in the lowest tertile. Associations with body mass index were similar to those with weight. All associations were present when stratified by menopausal status. Among post-menopausal women, the inverse associations between body weight and body mass index and high-risk patterns decreased with increasing number of years since menopause. Our results indicate that body height and weight are independently associated with the mammographic pattern among peri-menopausal women. We suggest that body height and weight are related to mammographic patterns through different mechanisms.

The Tabár classification of mammographic parenchymal patterns.

The purpose of this study was to describe one method of classification, based on anatomic-mammographic correlations, developed by Tabár. We also wanted to examine how the mammograms categorized as low- and high-risk according to Tabár and Wolfe criteria related to each other and to three selected risk factors for breast cancer. The study materials are based on questionnaires and mammograms from 3,640 Norwegian women, aged 40-56 years, participating in the third Tromsö study. The mammograms were categorized into five groups. Line drawings and their pathologic correlates of the five patterns are described in detail. The Tabár classification is based on anatomic-mammographic correlations, following three-dimensional (thick slice technique) histopathologic-mammographic comparisons, rather than simple pattern reading (Wolfe classification). For analysis patterns I-III (Tabár) and N1 and P1 (Wolfe) were grouped into low-risk groups and patterns IV and V (Tabár) and P2 and DY Wolfe) into high-risk groups. The overall agreement on high-risk versus low risk for the two classifications was 54% with a kappa-value of 0.22. The study displays that the strength of association between high-risk mammographic patterns and the three selected risk factors parity, number of children and age at first birth is of greater magnitude when the Tabár instead of the Wolfe classification is applied. More patients are needed to compare the classification directly with the risk of cancer. This study indicates that further development of the classification of mammograms may increase the usefulness of mammographic patterns in research and clinical practice.