[Measurement of the inferior vena cava diameter for estimating fluid status in hemodialysis patients].

OBJECTIVE: To investigate the clinical application of inferior vena cava diameter (VCD) for estimating fluid status. METHODS: VCD were measured during the expiratory phase (VCD-E) in 64 patients before hemodialysis (hypervolemia) and 71 normovolemia cases by ultrasonography, meanwhile collapsibility index (CI) were calculated. RESULTS: (1) VCD-E was (10.69 +/- 2.18) mm, CI was (26.24 +/- 6.34)% in normovolemic group; and (13.78 +/- 2.95) mm, (19.28 +/- 6.24%) in hypervolemic group respectively. There were significant differences in both (P < 0.01). (2) Change of VCD-E between pre- and post-dialysis was related with the amount of ultrafiltration during hemodialysis (r = 0.38, P < 0.01). The ratio was (2.0 +/- 1.2) mm.kg-1. (3) By using VCD-E to estimate hypervolemia, receiver operating characteristic (ROC) curve showed if VCD-E > or = 13.0 mm, the sensitivity was 87.0% and the specificity was 87.5%. CONCLUSION: VCD-E in postdialysis patients would approach (10.7 +/- 2.2) mm, which could be interpreted as being close to the dry weight. Thus VCD appears to be a valuable tool in estimating fluid status.

[The relationship between bone mineral density and secondary hyperparathyroidism bone disease].

The bone mineral density (BMD) and Z score in distal 1/3 radius were measured with dual energy X-ray absorptiometry (DEXA) in 185 hemodialysis (HD) patients, meanwhile serum parathyroid hormone (PTH), alkaline phosphatase (ALP) and hand X-rays were detected. Results showed that BMD in HD patients was significantly lower than that in control group(P < 0.05), and decreased with dialysis duration increasing. BMD in HD patients was negatively related with PTH, ALP and rate of subperiosteal erosions. By using Z score to diagnose hyperparathyroidism bone disease, receiver operating characteristic (ROC) curve was worked out. If Z score < or = -2.02, the sensitivity was 79.41% and specificity was 78.15%. In conclusion the measurement of BMD is a useful tool for the detection of hyperparathyroid bone disease.

Differential perceptions, behaviors, and motivations among African Americans, Latinos, and whites suspected of heart attacks in two hospital populations.

To evaluate the hypothesis that socioeconomic status would exert greater influence on patients' care-seeking behavior than racial/ethnic group status, we undertook a sequential study of African-American, Latino, and white patients hospitalized for acute chest pain from August 1988 through July 1990 at two sites. The study took place in an urban public medical center and an urban private health maintenance organization medical center, which provide care to mixed racial/ethnic groups of lower and middle socioeconomic status, respectively, in Los Angeles. Three concurrent case series of African-American, Latino, and white patients hospitalized for acute chest pain were recruited. The racial/ethnic distribution of the total group was African Americans, 448; Latinos, 487; and whites, 499. The main outcome measure was the length of time patients spent in deciding to seek emergency medical care for acute chest pain and the associated perceptions, behaviors, and motivations involved in deciding to seek care. For the total group, public hospital site and lack of health insurance were the strongest significant predictors of a longer decision phase, whereas differential symptom perceptions, consultation with medical professionals, and use of paramedic transport were significant predictors of shorter duration. Multiple regression results were similar in separate analyses demonstrated significant differences in patients' perceptions of symptom intensity and incapacitation within racial/ethnic groups related to socioeconomic status, as well as in specific behavior and motivation in seeking care. The study concluded that socioeconomic status as determined by hospital site exerted a stronger influence on patients' care-seeking behavior for acute chest pain than racial/ethnic status. Specific care-seeking behaviors of minority and lower-socioeconomic-status patients in the use of medications and paramedics in the face of acute symptoms should be targeted in future educational programs.

Acute chest pain in African Americans: factors in the delay in seeking emergency care.

OBJECTIVES: African Americans have been shown to have longer delay times than the majority population in seeking care for acute cardiac problems. The purpose of this study was to determine whether socioeconomic factors affect delay times. METHODS: Structured interviews were administered to 254 African Americans admitted to a public hospital and 194 African Americans admitted to a private hospital for suspected acute myocardial infarction. RESULTS: Patient characteristics found by multiple regression analysis to affect decision-making and travel time for care-seeking were structural access to care, persistence of symptoms, degree of incapacitation, consultation with a layperson, consultation with medical professionals, and mode of transportation. CONCLUSIONS: Within-group differences were found to be related to socioeconomic status. Strategies to increase knowledge about heart attack symptoms, improve access to care, and improve the socioeconomic status of at-risk African Americans are indicated.

A case-control study of breast cancer in Tianjin, China.

In a population-based case-control study of breast cancer in Tianjin, China, involving 300 cases and 300 population controls interviewed during 1985-1986, a number of strong risk factors were identified. Although average age at menarche was late by Western standards in this developing country (14.4 years), it was clearly related to risk. Women with their first menstrual period at age 12 years or earlier had 80% greater risk than women who started at age 17 years or later. Age at first full-term pregnancy was also strongly related to risk, with women whose first birth after age 30 years having 3.2 times the risk of women whose first birth was under age 20 years. Other established breast cancer risk factors in Western populations (family history of breast cancer, a history of benign breast disease, and use of oral contraceptives late in reproductive life) were also risk factors in this population. Parity and duration of lactation were both strongly protective against breast cancer development in univariate analyses. These two variables were highly correlated with each other and with age at first full-term pregnancy. Although the effects of each variable dissipated somewhat in multivariate analysis, our data strongly suggest that both parity and lactation independently contribute to breast cancer risk.

Consumption of salted fish and other risk factors for nasopharyngeal carcinoma (NPC) in Tianjin, a low-risk region for NPC in the People's Republic of China.

The dietary habits, occupational exposures, use of tobacco and alcohol, and medical history were compared among 100 patients with histologically confirmed nasopharyngeal carcinoma (NPC) in Tianjin City, People's Republic of China, and 300 neighborhood controls who were individually matched to the patients with regard to age (within 5 yr), sex, and race (Han). Exposure to salted fish was significantly associated with an increased risk of NPC. Four characteristics of exposure to salted fish independently contributed to the increased risk: (a) earlier age at first exposure, (b) increasing duration of consumption, (c) increasing frequency of consumption, and (d) cooking the fish by steaming it rather than frying, grilling, or boiling it. In addition, significant associations were observed for consumption in childhood of salted shrimp paste (increased risk) and carrots (reduced risk), and the three dietary effects (i.e., those from consumption of salted fish, salted shrimp paste, and carrots) were independent of each other. None of the non-dietary factors studied were significantly associated with NPC risk.