Cohort mortality study of Philadelphia firefighters.

BACKGROUND: Fire fighters are exposed to a wide variety of toxic chemicals. Previous studies have reported excess risk of some cancers but have been limited by small numbers or little information on employment characteristics. METHODS: We conducted a retrospective cohort mortality study among 7,789 Philadelphia firefighters employed between 1925 and 1986. For each cause of death, the standardized mortality ratios (SMRs) and 95% confidence intervals were estimated. We also compared mortality among groups of firefighters defined by the estimated number of career runs and potential for diesel exposure. RESULTS: In comparison with U.S. white men, the firefighters had similar mortality from all causes of death combined (SMR = 0.96) and all cancers (SMR = 1.10). There were statistically significant deficits of deaths from nervous system diseases (SMR = 0.47), cerebrovascular diseases (SMR = 0.83), respiratory diseases (SMR = 0.67), genitourinary diseases (SMR = 0.54), all accidents (SMR = 0.72), and suicide (SMR = 0.66). Statistically significant excess risks were observed for colon cancer (SMR = 1.51) and ischemic heart disease (SMR = 1.09). The risks of mortality from colon cancer (SMR = 1.68), kidney cancer (SMR = 2.20), non-Hodgkin's lymphoma (SMR = 1.72), multiple myeloma (SMR = 2.31), and benign neoplasms (SMR = 2.54) were increased among firefighters with at least 20 years of service. CONCLUSIONS: Our study found no significant increase in overall mortality among Philadelphia firefighters. However, we observed increased mortality for cancers of the colon and kidney, non-Hodgkin's lymphoma and multiple myeloma. There was insufficient follow-up since the introduction of diesel equipment to adequately assess risk.

CD34+ immune suppressive cells in the peripheral blood of patients with head and neck cancer.

Patients with head and neck squamous cell carcinoma (HNSCC) have profound defects in their immune defenses. Using immunofluorescent staining and flow cytometric analysis, we found that most patients with HNSCC have increased levels of CD34+ cells within their peripheral blood. These circulating CD34+ cells contribute to the depressed functional competence of the peripheral blood T-lymphocytes. This was demonstrated by the increased level of proliferative responsiveness to interleukin-2 by the patients' peripheral blood T-cells after depletion of CD34+ cells. These results show the importance of CD34+ cells in contributing to the depression of T-lymphocyte function in patients with HNSCC and suggest that strategies designed to reduce the levels of circulating CD34+ cells may enhance the immune reactivity of the patients' circulating T-lymphocytes against the HNSCC.

Early polysomnographic findings and long-term subjective results in sleep apnea patients treated with laser-assisted uvulopalatoplasty.

OBJECTIVES/HYPOTHESIS: To examine the long-term results of laser-assisted uvulopalatoplasty (LAUP) for the treatment of patients with obstructive sleep apnea syndrome (OSAS). STUDY DESIGN: One hundred eighty-two OSAS patients treated with LAUP were followed for an average of 4 years. Of these patients, 131 have completed treatment. Complete polysomnographic data are available on 48 patients. Five patients were eliminated owing to nasal surgery performed during the period between the preoperative and postoperative sleep studies, thus 43 patients were included who had only LAUP treatment. Another three patients were eliminated because their postoperative polysomnograms were performed less than 6 weeks after the last procedure. Complete long-term subjective data are available on 31 patients. METHODS: Between July 1993 and July 1998, 1038 patients were evaluated for LAUP treatment for snoring and OSAS. Of the 1038 patients, 409 were treated with LAUP and the remaining 629 were treated with other surgical procedures, devices, or behavior modification. The 40 patients who underwent only LAUP treatment for OSAS and have complete polysomnographic data are the focus of this study. RESULTS: The significant objective polysomnographic findings include a decrease in the respiratory disturbance index (RDI) from 25.0 +/- 2.8 to 15.3 +/- 2.9 (P = < .0001), and a decrease in the apnea index (AI) from 14.6 +/- 2.6 to 9.0 +/- 2.4 (P = .00248). In addition, the percentage of time spent in rapid eye movement (REM) sleep significantly increased after LAUP, from 13.3% +/- 1.0 to 17.6% +/- 1.4 (P = .0149). The long-term subjective results indicate that the presenting complaints were improved after LAUP in 74.9% +/- 4.1 with a mean follow-up of 4.04 years +/- 72 days (median, 4.63 y). CONCLUSIONS: LAUP remains a safe and effective treatment for carefully selected patients suffering from OSAS. Five years after LAUP was introduced in the United States, objective polysomnographic data demonstrate reduction in the RDI and increased time spent in REM sleep after treatment. In addition, the long-term subjective results show that the presenting symptoms were no longer present in 75% of patients treated with LAUP.

Increased presence of CD34+ cells in the peripheral blood of head and neck cancer patients and their differentiation into dendritic cells.

Patients with head and neck squamous cell carcinoma (HNSCC) have profound immune deficiencies. In 65% of these patients, there is an increased intra-tumoral presence of immune-suppressive CD34+ progenitor cells. The goal of the present study was to determine whether CD34+ cell levels were also increased in the peripheral blood of HNSCC patients and if these immune-suppressive cells could be differentiated into dendritic cells. Our results showed that CD34+ cell levels are increased in the peripheral blood of HNSCC patients. To assess if these CD34+ cells could differentiate into dendritic cells, they were isolated from the blood of HNSCC patients and cultured for 12 days with various cytokine combinations. Culturing CD34+ cells with stem cell factor (c-kit ligand) plus granulocyte-macrophage colony-stimulating factor resulted in the appearance of a significant proportion of cells expressing phenotypic markers characteristic of dendritic cells. Also, including tumor necrosis factor-alpha yielded a significant proportion of cells resembling the bipotential precursor cells for dendritic cells and monocytes (CD14+CD1a+), in addition to the dendritic-like cells. When the differentiation inducer 1alpha,25-dihydroxyvitamin D3 [1,25(OH)2D3] was added along with the cytokine combinations, the yield of cells having characteristics of dendritic cells was further increased. Cells that were derived from CD34+ cell cultures containing 1,25(OH)2D3 had a more potent capacity to present the recall antigen tetanus toxoid to autologous peripheral blood leukocytes and to stimulate a mixed leukocyte response compared to cultures to which 1,25(OH)2D3 had not been added. Our results show that CD34+ cells, whose frequency is increased in HNSCC patients, can be differentiated into cells that phenotypically and functionally resemble dendritic cells and that 1,25(OH)2D3 accentuates this differentiation.

Prospective, randomized, controlled comparison of the effects of low-fat and low-fat plus high-fiber diets on serum lipid concentrations.

Previous studies examining the hypocholesterolemic effects of high-soluble-fiber diets have not been designed to control for dietary fat intake. Serum cholesterol reductions may therefore be accounted for by differences in consumption of fat. Moderately hypercholesterolemic, nonobese, Caucasian men and women, 30-50 y old were randomly assigned to low-fat, low-fat plus high-fiber, or usual-diet groups and followed for 12 mo. At 12 mo the high-fiber group consumed significantly more soluble fiber than both the low-fat and usual-diet groups (P = 0.0063 and P = 0.0001); the high-fiber group did not differ from the low-fat group in quantity of dietary fat consumed. The high-fiber group experienced a greater average reduction (13%) in serum cholesterol than did the low-fat (9%) and usual-diet (7%) groups. After adjustment for relevant covariates, the reduction in the high-fiber group was significantly greater than that in the low-fat group (P = 0.0482). Supplementation with soluble fiber reduces serum cholesterol beyond the reduction observed with low-fat diet alone.

Stress and tobacco addiction.

Primary care providers are confronted on a daily basis with persons who are addicted to tobacco. Research studies have demonstrated an association between substance use and stress and coping. This paper discusses macro- and micro-level perspectives of stress that need to be considered in the management of tobacco addition. Lazarus's stress and coping paradigm is emphasized as a useful framework for managing addicted clients.

The association between Type A behavior and change in coronary risk factors among young adults.

The association of Type A/B behavior pattern and changes in blood pressure, total serum cholesterol, serum triglyceride, body mass, and smoking was estimated in a cohort of 375 young Black and White men and women from a rural county in Central Kentucky between 1978-79 and 1985-88. Type A participants experienced significant increases in systolic (2.90 +/- 1.29 mmHg) and diastolic (3.80 +/- 1.17 mmHg) blood pressure and in cigarette smoking (3.26 +/- 0.89 cigarettes per day) over the eight-year follow-up period, but Type B participants experienced no change. Type A and B individuals showed similar changes in total serum cholesterol, serum triglyceride, or body mass. Differences between behavioral types in blood pressure were present for women but not men, and for Blacks but not for Whites. These findings suggest a possible significance of the Type A pattern for the development of cardiovascular risk of young adults.

Prevalence and correlates of depressive symptoms among older U.S. adults.

Using data from telephone interviews conducted during 1985, we investigated the prevalence and correlates of depressive symptoms in a national probability sample of 1,232 noninstitutionalized U.S. residents 65 years of age and older. The association between depressive symptoms and personal attributes, personal resources, illness behavior, life events, and self-reported health was examined through chi-square and logistic regression analyses. We measured depressive symptoms with the Center for Epidemiologic Studies--Depression (CES-D) scale using a score of 16 or greater as an indication of high depressive symptoms. Prevalence of high depressive symptoms was 9.9% in the total sample. For black males the prevalence of depressive symptoms was 7.4%, and for white males it was 6.8%. For black females the prevalence of depressive symptoms was 20.8%, while for white females it was 11.5%. In the regression analysis, female gender, single marital status, poor self-reported assessment of health, illness behavior, and a low number of club/organization memberships were significantly associated with high depressive symptoms. In comparison to respondents reporting good to excellent health, those reporting poor to fair health were almost four times more likely to report a high number of depressive symptoms (odds ratio = 3.97).

Components of self-rated health among adults: analysis of multiple data sources.

Four data sources were used to examine competing interpretations of self-rated health measures: whether they are best classified as summary indicators of both physical and psychological health status, or merely as surrogate measures of physical health. Multiple regression analysis revealed that, within each data source, measures of physical health and depression were each independently associated with general health status ratings after six sociodemographic indicators (sex, race, age, education, income, and residence) were held constant. These results were confirmed using both cross-sectional and longitudinal models, and using several different indicators of physical health. They suggest that researchers should be cautious in interpreting global health ratings, as they contain significant information regarding the psychological, as well as physical, health status of respondents.

The nature and efficacy of intervention studies in the National High Blood Pressure Education Research Program.

Results from seven research projects funded by the National Heart, Lung and Blood Institute are reviewed. These methodologically advanced studies employed a variety of intervention strategies intended to improve blood pressure control and patient adherence to therapeutic recommendations. The strategies are categorized as representing four themes. The 'active patient' theme emphasizes the need to increase patient responsibility for self-care. The 'social support' theme is represented in interventions in which another person provides various resources for meeting the illness challenge. The 'fear arousal' theme is seen in manoeuvres that attempt to heighten patient concern about the dire consequences of illness. Finally, the 'patient instruction' theme is expressed as transmittal of information about the nature of the illness or therapeutic regimen. Studies using the 'active patient' theme, especially contingency contracting, and those employing 'social support' approaches, especially those involving home visitation of patients by members of the health care team, were found to be most effective.

Health status as a mediating factor in the life change-academic performance relationship.

This study was designed to determine whether illness during the academic year, when gender and academic readiness are controlled, is the variable accounting for the demonstrated relationship between life change index and subsequent academic performance. A weak though significant inverse association was found between life change and grades; this association persisted even after statistical adjustment for gender, academic readiness, and illness experience. There was no evidence that illness experience mediated the life change-performance relationship. The association was not subject to a threshold effect according to level of life change.

Improved medical care for the elderly: intervening in medical education.

It is the premise of this paper that certain instructional interventions in the medical school behavioral science curriculum will eventually improve the health care received by elderly patients. Four content areas for such intervention are reviewed: patient adherence to medication regimens, risk and management of psychosocial stress, responses to chronic illness, and doctor-patient communication patterns. The final section describes research that supports the long-term efficacy of such curricular interventions.

The influence of a supportive, problem-solving, group intervention on the health status of students with great recent life change.

A small randomized trial was conducted with college students to test the efficacy of a supportive, problem-solving group intervention for reducing morbidity following accumulation of numerous life changes. The two intervention groups reported declines in number of illness episodes and number of disability days over the two semesters of study; one of the intervention groups also reported a decrease in number of days on which illness was experienced. The control group did significantly worse on these measures than the intervention groups.

Survey of knowledge among primary health care workers in diabetes.

The knowledge of diabetes mellitus held by allied health professionals in Kentucky and the short-term and long-term effectiveness of a symposium in altering this knowledge was studied. The groups investigated consisted of: 136 primary health workers (nurses, dieticians, health educators, and other health professionals) surveyed before and after the 12-hour symposium (group 1); 37 of these primary health professionals studied again one year after the first symposium (group 2); and 26 nurses who work at a university hospital, and who did not attend the symposium (group 3). Before training, all groups performed similarly on this survey. Group 1 scored 58.5 +/- 0.2% correct, group 2, 56.9 +/- 3.1% correct, and group 3, 52.7 +/- 5.0% correct. Performance did not correlate with educational level, job description, or geographic location within Kentucky. There was a negative correlation between performance and age for group 1 (r = -0.3494, P < .001). Follow-up studies immediately after the symposium showed that a significant improvement occurred in the performance of group 1 and group 2 on this knowledge survey (correct score +/- SEM = 82.5 +/- 0.3%, and 81.7 +/- 2.4% respectively, P < .005) compared to pretraining scores. A repeat survey of group 2 one year later showed a significant deterioration of knowledge (P < .05), but not to pretraining levels (mean correct score = 69.2 +/- 3.4% at one year versus 56.9 +/- 3.1% before training, P < .02). These results suggest that more emphasis on professional education in diabetes and study of effective methods for providing this education is required.