The changing faces of diabetes, hypertension and arthritis in a Caribbean population.

BACKGROUND: Globally, chronic illnesses are the leading cause of mortality, and this is no different in developing countries, particularly in the Caribbean. Little information emerged in the literature on the changing faces of particular self-reported chronic diseases. AIMS: This study examines the transitions in the demographic characteristics of those with diabetes, hypertension and arthritis, as we hypothesized that there are changing faces of those with these illnesses. MATERIALS AND METHODS: A sample of 592 respondents from the 2002 and 2007 Jamaica Survey of Living Conditions. Only respondents who indicated that they were diagnosed with these particular chronic conditions were used for the analysis. RESULTS: The prevalence of particular chronic diseases increased from 8 per 1,000 in 2002 to 56 per 1,000 in 2007. The average annual increase in particular chronic diseases was 17.2%. Diabetes mellitus showed an exponential average annual increase of 185% compared to hypertension (+ 12.7%) and arthritis (- 3.8%). Almost 5 percent of diabetics were less than 30 years of age (2.4% less than 15 years), and 41% less than 59 years. Three percent of hypertensive respondents were 30 years and under as well as 2% of arthritics. CONCLUSION: The demographic transition in particular chronic conditions now demands that data collection on those illnesses be lowered to < 15 years. This research highlights the urgent need for a diabetes campaign that extends beyond parents to include vendors, confectionary manufacturers and government, in order to address the tsunami of chronic diseases facing the nation.

Assessing Population Level Genetic Instability via Moving Average.

Tumoral tissues tend to generally exhibit aberrations in DNA copy number that are associated with the development and progression of cancer. Genotyping methods such as array-based comparative genomic hybridization (aCGH) provide means to identify copy number variation across the entire genome. To address some of the shortfalls of existing methods of DNA copy number data analysis, including strong model assumptions, lack of accounting for sampling variability of estimators, and the assumption that clones are independent, we propose a simple graphical approach to assess population-level genetic alterations over the entire genome based on moving average. Furthermore, existing methods primarily focus on segmentation and do not examine the association of covariates with genetic instability. In our methods, covariates are incorporated through a possibly mis-specified working model and sampling variabilities of estimators are approximated using a resampling method that is based on perturbing observed processes. Our proposal, which is applicable to partial, entire or multiple chromosomes, is illustrated through application to aCGH studies of two brain tumor types, meningioma and glioma.

Use of complementary and alternative medicine among children diagnosed with autism spectrum disorder.

This study examined the prevalence of the use of different types of conventional, complementary and alternative therapies by children diagnosed with an autism spectrum disorder (ASD). Of 112 families surveyed, 74% were using complementary and alternative medicine (CAM) for their child with ASD. CAM use was most strongly associated with parent report of child's diagnosis. Most CAM was reported by families to be either helpful or without effect, but not harmful. The main reasons for choosing CAM were related to concerns with the safety and side effects of prescribed medications. Conventional health care providers should be aware of the high prevalence of use among children with ASD and be prepared to discuss the use of CAM with families.

A novel pattern of transaminase elevation associated with autologous transplant for neuroblastoma.

To determine the pattern and degree of hepatic transaminitis experienced by children undergoing autologous transplantation for neuroblastoma. Sixty-four children with high-risk neuroblastoma received an autologous transplant with cyclophosphamide, etoposide, and carboplatin conditioning. Forty-eight went on to receive a second transplant with M and TBI conditioning. Charts were reviewed for evidence of hepatic regimen-related toxicity. A high rate of transaminitis was observed after both regimens. In each transplant, there was an early period of transaminitis during conditioning, from which patients recovered, followed by a second period of transaminase elevation. The degree of elevation was not associated with age, whether the administered dose was calculated based on a per kg or per M(2) basis or the presence of regimen-related severe mucositis. Elevated transaminases at admission were not associated with maximal hepatotoxicity during the first transplant although there was an association in the second transplant. However, the magnitude of transaminase elevation was less in the second transplant. VOD occurred in one and three patients in transplants 1 and 2, respectively. Both conditioning regimens were associated with an early and late elevation of transaminases without significant cholestasis. This biphasic pattern of transaminitis has not been reported previously. The high prevalence of transaminase elevation at time of both transplants was not associated with an increased incidence of VOD. We conclude that elevated transaminases should not preclude proceeding to a first or second autologous transplant with these regimens.

The effects of exposure to environmental tobacco smoke on pulmonary function in children undergoing anesthesia for minor surgery.

BACKGROUND: The objectives of this study were to assess whether children exposed to environmental tobacco smoke (ETS) present for surgery with poorer pulmonary function, and experience a more pronounced deterioration in pulmonary function following anesthesia and surgery, than non-ETS-exposed children. METHODS: Fifty-four children aged 5-15 years with a history of ETS exposure from one or both parents and 54 children with no such ETS history were included in the study. All participants were presenting for ambulatory surgery and were judged to conform to American Society of Anesthesiology class I or II. Spirometry was performed preoperatively, postoperatively in the recovery ward when the child met criteria for discharge (Aldrete score 8), and before discharge from the day ward. RESULTS: The ETS-exposed group had a significantly lower mean preoperative peak expiratory flow rate (PEFR) (9.5 points lower percent predicted, 95% confidence interval -18.1 to -1.0, P = 0.03). Although not statistically significant, they also had lower percent predicted baseline mean values of the other spirometric variables that were measured (forced expiratory volume in 1 s -4.5%, P = 0.07; forced vital capacity -4.1%, P = 0.10; forced expiratory flow between 25% and 75%-3.6%, P = 0.44). Pulmonary function tests (PFTs) performed in recovery were between 8% and 14% worse than preoperative values, but the results were similar in the two groups of children. PFTs performed before hospital discharge demonstrated an near-complete recovery to baseline values. Again the pattern was similar in exposed and nonexposed children. CONCLUSIONS: Environmental tobacco smoke exposure is associated with lower preoperative PEFR values, but does not impact on recovery from anesthesia for healthy children undergoing ambulatory anesthesia.

Financial disclosures of scientific papers presented at the 2003 RSNA Annual Meeting: association with reporting of non-Food and Drug Administration-approved uses of industry products.

PURPOSE: To retrospectively characterize the extent and nature of financial relationships with industry that are disclosed in the abstracts of scientific papers presented at the 2003 Radiological Society of North America (RSNA) Annual Meeting and to retrospectively assess whether the presence of relationships between researchers and industry was associated with a discussion on the use of products or devices that are not yet approved by the U.S. Food and Drug Administration (FDA). MATERIALS AND METHODS: Printed abstracts of scientific papers published in the 2003 Radiological Society of North America Scientific Assembly and Annual Meeting Program were classified according to the number and type of financial relationships disclosed. Also recorded was whether the abstracts discussed non-FDA-approved use of a product. Abstracts with and those without disclosures were then compared by using the Fisher exact test with respect to the percentage of abstracts that reported non-FDA-approved use. RESULTS: Of the 1549 published abstracts, 271 (17%) disclosed at least one author with financial ties to a company whose products or services were reported. The most common disclosures were for authors who were employees (39%), corporate grant recipients (34%), corporate consultants (23%), or shareholders (18%) of the corporation whose product was studied. A total of 87 (32%) of 271 abstracts with disclosed corporate relationships discussed non-FDA-approved use of a commercial product compared with 197 (15%) of 1278 abstracts with no disclosed tie to industry (P<.001). CONCLUSION: RSNA abstracts in which authors disclosed corporate financial relationships were twice as likely as those without such disclosures to discuss non-FDA-approved use of a commercial product. This raises the possibility that corporate relationships may influence radiology research.