Adult leukemia and proximity-based surrogates for exposure to Pilgrim plant's nuclear emissions.

Possible associations between adult leukemia incidence and proximity-based surrogate measures of potential for exposure to radioactive emissions from the Pilgrim nuclear power plant in Plymouth, Massachusetts, were investigated. Included in this study were 105 nonchronic lymphocytic leukemia cases, diagnosed between 1978 and 1986 at age 13 y or older, that occurred in 22 towns near Pilgrim; population controls numbered 208. Residence within 4 mi (6.4 km) of Pilgrim during "high-emissions" years was related to case-control status (adjusted odds ratio [OR] = 3.88, 95% confidence interval [95% CI] = 0.81-10.64). A high "exposure" score (i.e., a value that accounted for downwind time) was also related to case-control status (OR = 3.46, 95% CI = 1.50-7.96). Some statistically significant dose-response trends were found. Cautious interpretation of associations is warranted in light of the low levels of reported emissions.

Transtracheal oxygen delivery and patients with chronic obstructive pulmonary disease.

A total of 43 severely ill COPD patients already on 24 h, or near 24 h, per day supplemental O2 were randomly assigned to transtracheal oxygen delivery (n = 22) or usual delivery of O2 by nasal cannula or face mask (n = 21). A few important changes were found in pulmonary function over time such as decreases of PEFR, FEF and MVV for both experimental and control groups, and FEV1% and FEV3% in experimental patients. At the same time, there was a significant decrease in both hematocrit and hemoglobin, and per cent shunting for the experimental group and a significant increase in per cent shunting in the control group. Physical, social and psychologic assessments showed significant improvement over time for experimental patients and declines for the control group. Lastly, medical costs were positively affected, as fewer days were spent in hospital post-study enrollment by experimental than control groups, and post-enrollment relative to pre-enrollment by experimental patients.

The epidemiology of disease expenses. The costs of caring for children with cancer.

We determined medical costs and family out-of-pocket expenses over time for 569 children with malignant neoplasms. All medical charges (inpatient and outpatient), family out-of-pocket expenses, and wages lost were collected and annualized. The mean cost of cancer care and treatment per patient-year was $29,708, with variation by diagnosis, prognosis, and year since diagnosis. The mean annual hospital inpatient cost was $15,455; mean ambulatory care cost, $3,806; and family out-of-pocket disease-related expenses, $9,787. Family out-of-pocket expenses added about 50% to the total cost of disease-related care and consumed 38% of gross annual family income; wages lost accounted for nearly half. About 95% of all medical costs was paid by private, public, or charitable payers. Out-of-pocket medical expenses for which the family was responsible were about $1,000 each year. However, all nonmedical, disease-related expenses were borne by the family.

Where have all the students gone? An epidemiologic study of US nationals applying for certification by the Educational Commission for Foreign Medical Graduates, 1969 through 1982.

Larger and larger numbers of US nationals are studying medicine abroad and they now comprise the foremost national group of foreign medical graduates (FMGs) seeking to enter the US health care system. The Educational Commission for Foreign Medical Graduates (ECFMG) is currently conducting a comprehensive study of 205,542 graduates of foreign medical schools who, during a 14-year study period, 1969 through 1982, have sought its certification, an established prerequisite for FMGs applying for training in an accredited hospital residency program and/or licensure within the United States. This report summarizes preliminary data on the 17,642 US citizens included in the study who attended 431 different medical schools in 79 foreign countries. Particular attention is given to their performance on the combined medical knowledge-English language competence examinations requisite to the awarding of ECFMG certification.