Snoring in a Hispanic-American population. Risk factors and association with hypertension and other morbidity.

Snoring was investigated in a survey of respiratory disease in Hispanic-Americans of a New Mexico community. A population-based sample of 1222 adults was studied with questionnaires and measurements of height, weight, and blood pressure. The age-adjusted prevalence of regular loud snoring was 27.8% in men and 15.3% in women. Snoring prevalence increased with age and obesity in both men and women. Cigarette smoking was also associated with snoring, but chronic obstructive lung disease and alcohol consumption were not. Snorers more frequently had hypertension, ischemic heart disease, and excessive daytime sleepiness. In contrast to other studies, after adjustment for confounding factors, there was no effect of snoring on hypertension (odds ratio, 1.0; 95% confidence interval, 0.7 to 1.5), but an effect on myocardial infarction was still demonstrable (odds ratio, 1.8; 95% confidence interval, 0.9 to 3.6). The association of snoring with sleepiness suggests that respiratory disturbance of sleep related to upper airway obstruction, such as sleep apnea, occurs more frequently in snorers in this population.

Use of quantified and frequency indices of vitamin A intake in a case-control study of lung cancer.

Recent publications have examined the extent of food frequency data needed to estimate nutrient intakes in epidemiological studies. The need for amount (usual portion size) data to supplement information on average frequency of intake has been questioned. In a case-control study of risk factors for lung cancer, we have collected data on frequency, amount and past pattern of intake for common or rich sources of vitamin A. These data have been combined with standard content information to calculate three different types of indices: one based on frequency alone, a quantitative index that included both frequency and amount, and a past-weighted index that combined the frequency, amount and data on relative consumption in the past. Odds ratios by tercile of carotene, retinol and total vitamin A intake varied little between the frequency index and the quantified and past-weighted indices. Higher intakes of carotene and total vitamin A were associated with a lower risk for lung cancer regardless of index type. This consistency of results is explained by a stability of relative intakes regardless of index type. Spearman rank order correlation coefficients between the frequency and quantitative indices exceeded 0.90 for total vitamin A, carotene, and retinol. This stability is attributable to parallel trends of increased frequency of consumption and portion size at higher levels of nutrient intake. Because similar trends were observed in five main food groups included in these analyses, these findings may be generalizable to other nutrients.

History of residence and lung cancer risk in New Mexico.

Participants in a population-based case-control study of lung cancer in New Mexico between 1980 and 1982 were asked to identify all locations where they had resided for six months or more. These residential data were coded at the county and state levels and combined with county-level socioeconomic data from the 1910, 1930, 1950, and 1970 decennial censuses to generate indices of time lived in counties or metropolitan areas of different sizes, degrees of urbanization, or extents of employment in manufacturing industries. Urban residence was not associated with employment of male controls in jobs or industries considered to increase lung cancer risk. However, in the non-Hispanic white female controls, urban residence before age 30 years in a county of 500,000 or more residents was associated with a fourfold higher odds ratio for starting to smoke cigarettes. Male and female non-Hispanic controls who had ever lived in more populous counties smoked more cigarettes per day than did those who had not lived in such counties. Residential history patterns were the same in cases and controls; multiple logistic regression showed no consistent associations of the residence history variables with lung cancer risk.

Alternatives in the collection and analysis of food frequency interview data.

In addition to frequency of consumption, a food frequency questionnaire may assess amount consumed, often by using food models, and the stability of diet. A food frequency interview directed at preformed vitamin A and beta-carotene was administered to 130 cases and 309 controls in an ongoing population-based case-control study of lung cancer in New Mexico. The questionnaire measured frequency, amount, and stability of consumption for 55 food items. Different combinations of responses to these three types of questions were used to calculate indices of total vitamin A consumption. The index based on frequency alone had the lowest value and increased significantly when amount was combined with frequency. Consideration of past consumption had relatively little effect on absolute and relative estimates of intake. Spearman rank order correlations between index pairs were high. These results suggest that the use of frequency alone is appropriate when the objective of data collection is to establish subjects' relative intake of specific nutrients.

Phase II and pharmacokinetic study of high-dose methotrexate in the treatment of advanced gynecologic malignancy. A Southwest Oncology Group Trial.

Fifteen patients with advanced or recurrent gynecologic malignancy were treated with high-dose methotrexate (HDMTX) (1-8 g/M2) and citrovorum factor rescue (10-100 mg/M2). One complete response (13%) and two improved responses occurred in eight patients (25%) with squamous cell carcinoma and one of seven patients (14%) with nonsquamous nontrophoblastic carcinoma had stable disease for 7 months. The median duration of survival in the squamous group was 9 months and in the nonsquamous groups 6.5 months. Mean serum MTX concentrations were proportional to the doses administered and typical two compartment plasma disappearance curves were seen. Adverse toxic reactions were not observed at serum MTX levels less than 7.8 X 10(-7) M at 24 hr and 1 X 10(-7) M at 48 hr post-MTX. Hematopoietic toxicity occurred most frequently with leukopenia observed in 19.5% of courses. Hepatic, renal, gastrointestinal, and dermatologic toxicities were observed infrequently. Drug-induced nephrotoxicity occurred in one patient and possibly related leukoencephalopathy occurred in another patient. On the basis of the relatively low response rate observed in this trial and the high expense of HDMTX therapy, the value of such therapy may be limited in advanced nontrophoblastic gynecologic cancer.

Comparison of self- and surrogate-reported dietary information.

Studies of diet's role in the etiology of rapidly fatal diseases may utilize data taken from surrogate sources. To assess such sources, 46 subject-spouse pairs were interviewed with a food frequency questionnaire designed to provide an index of vitamin A consumption. Information concerning amount and past pattern of use was also obtained. The frequency and amount information was used to calculate two aggregate indices of vitamin A consumption: one based on frequency alone and the other based on frequency and amount. For single foods, the mean frequencies of consumption reported by subjects and by their spouses for them were similar; for both sexes combined, the average level of exact agreement was 66 per cent, with improvement to 93 per cent for agreement within one category. Similar agreement was found for amount. For the overall daily vitamin A intake of men, the means based on subject data were not significantly different from those calculated from their wives' responses. For women, husbands underreported their total intake. Agreement between subject- and surrogate-based overall vitamin A consumption was less satisfactory than for the individual foods.

Evaluation of educational methods in a comprehensive cost-containment project in ambulatory care.

The cost of medical care in the United States is a matter of great concern to many health policy makers and physicians as well as to the seekers of care. At the University of New Mexico, a comprehensive cost-containment education program was devised and put into effect with residents from three primary care disciplines. In addition to documenting the effectiveness of the educational package in reducing patients charges, we asked house staff to state which parts of the package were of most use. Wall posters displaying charges for commonly ordered tests, procedures, and prescription items and the distribution of sample bills for patients seen by the individual resident were rated most highly. A test of knowledge of charges to patients did not show resident improvement after education. Cost-containment education can be effective in reducing patient charges, even if physicians do not internalize the actual charge data. We recommend the inclusion of cost-containment education in all primary care training programs, as these physicians play such an important role in the generation of patient charges.

Professional review of laboratory utilization.

Overutilization of laboratory procedures is a significant problem, particularly in teaching institutions. The purpose of this study was to assess laboratory utilization patterns on the medical service of a university hospital, comparing data from implicit peer review by a pathologist with those from a group of practicing primary care physicians. Also, utilization of the most frequently ordered laboratory tests was compared with that of less common procedures. For charts reviewed both by the pathologist and by a panel of primary physicians, the pathologist found 26.5 per cent of tests unnecessary, while the primary physicians found 42.8 per cent unnecessary. The ten most frequently ordered tests had a significantly higher rate of overutilization than all other tests. Attempts to modify physicians' laboratory utilization should include concomitant peer review of the most commonly ordered procedures.

Maternal compliance in immunization of preschoolers as related to health locus of control, health value, and perceived vulnerability.

The health attitudes and behaviors of 94 mothers of preschool children were investigated by personal interview in this descriptive correlational study. Mothers were divided into two groups, depending on their compliance or noncompliance, with recommended immunizations for their children. Subjects were assessed for health locus of control, perceived vulnerability to six communicable diseases, and health as a value. Demographic variables of age, education, religion, ethnicity, income, and recall of earlier poliomyelitis epidemics were studied. Analysis of variance, chi-square and descriptive statistics were used in the data analysis. Results revealed no significant differences between compliant and noncompliant mothers to health locus of control measure, perceived vulnerability to six diseases under study, or recollection of earlier poliomyelitis epidemics. The majority of mothers were Hispanic, Catholic, in their late twenties, of low income and with a 12th grade education or less. Health as a value was selected first or second by the subjects in most cases, regardless of immunization compliance behavior. Compared with a normative sample, mothers in this study were predominantly more external than internal in their locus of control orientation.

A 45Ca autoradiographic and stereological study of freeze-dried smooth muscle of the guinea pig vas deferens.

In an effort to more clearly elucidate the role of cellular structures as calcium sinks and sources in smooth muscle cells, the intracellular distribution of radioactive calcium was evaluated by a new method based on freeze-drying. The guinea pig vas deferens was exposed to a physiological salt solution that contained 45Ca. The muscle was then freeze-dried and prepared for electron microscope autoradiography. The grain density over the plasma membrane, mitochondria, and sarcoplasmic reticulum (SR) was significantly greater than that of the matrix. These results suggest that the plasma membrane, mitochondria and SR have the capacity to accumulate calcium. Which of these structures serve as a source of calcium for contraction remains to be determined. A stereological comparison between freeze-dried and conventionally prepared smooth muscles revealed several differences. The cross-sectional area of freeze-dried cells was about twice that of conventionally prepared cells. Moreover, mitochondria and sub-surface vesicles occupied a significantly smaller percentage of the cell in the freeze-dried tissue than they did in the conventionally prepared tissue.

Suppression of rabbit peritoneal macrophage migration by heat-labile E. coli toxin.

Migration of rabbit peritoneal macrophages toward casein-serum was inhibited by preincubation of the cells with heat-labile toxin of Escherichia coli in direct relationship to the concentration of toxin in the incubation mixture. Cells preincubated with heated toxin or with toxin-antiserum migrated the same as those which had been incubated in toxin-free media. Toxin-preincubated cells had levels of cyclic AMP which were increased in direct relationship to the concentration of toxin in the preincubation mixture. Heated toxin failed to induce increased levels of cAMP in the cells at the highest concentration tested.

Antihistamines and alpha-adrenergic agents in treatment of otitis media.

Studies are not available to support the common use of alpha-adrenergic agents and/or antihistamines in the treatment of acute otitis media. A total of 378 patients with acute otitis were entered in a double-blind study comparing treatment results with antibiotics and either placebo, pseudoephedrine, triprolidine, or a combination of these; 196 patients returned. Age and return rate did not differ among groups. Cure rates and duration of fever were the same for each group. The cost and possible side effects of these agents, added to their lack of beneficial effect in otitis, should interdict their use.

Pneumonia in a Navajo community: a two-year experience.

This report describes surveillance of pneumonia in an entire community during a 2-year interval. The study, which was performed on the Navajo reservation, included those who sought care for defined clinical manifestations and who showed pulmonary infiltrate(s) on roentogenographic examination. Approximately 10 bouts of pneumonia per 1,000 persons required hospitalization, and an equal number were treated at home each year. Rates were highest at the extremes of age and were higher among males. Multiple attacks were observed in 14.5 per cent of infants and children and in 7.6 per cent of adults. Most illnesses were associated with pneumococci. The proportions of these illnesses, however, were smaller among hospitalized children than among adults. Pneumococcal bacteremia was uncommon in infants and children. Most pneumococcal serotypes isolated are included in currently proposed antipneumococcal vaccines. The 2-year case fatality rate was 2.2 per cent. None of those who dided had been previously well. Factors associated with multiple occurrences need further study. Efforts at prevention should be directed to life's extremes, especially to those already infirm.

Estimation of fetal or neonatal weight from the biperietal diameter.

This paper contains a table of predicted fetal or neonatal weight on the basis of the biparietal diameter. The tabulated values are derived under the assumption that the relationship between biparietal diameter and weight is nonlinear and that weight is best predicted by means of a third degree least square polynominal spline. We believe that our study overcomes the shortcomings inherent in a linear prediction formula, commonly employed in the literature.

Pulmonary dysfunction in systemic lupus erythematosus without pulmonary symptoms.

Pulmonary function was measured in a group of 28 patients with systemic lupus erythematosus (SLE) who were free of pulmonary involvement at the time of the study. When compared with age and sex matched controls, the SLE patients had a pattern of restriction with reduced lung volumes and vital capacity. Diffusing capacity was reduced in proportion to the reduction in lung volume. This is felt to be most compatible with inapparent pleural thickening resulting in impaired lung expansion. There was no evidence of airway obstruction on maximal expiratory flow-volume curves. The effect of cigarette smoking in the SLE patients was a reduction in flows at low lung volumes, which was indistinguishable from the effects in the control smokers. Both SLE and control smokers had a significant reduction in DL/VA when compared with control nonsmokers. Pulmonary function was not influenced by the presence of renal disease.