Change in quality of life of stage IA non-small cell lung cancer after surgery or radiation therapy.

Background: Few studies have examined the differential impact of stereotactic body radiotherapy (SBRT) and surgery for early-stage non-small cell lung cancer (NSCLC) on quality of life (QoL) during the first post-treatment year. Methods: A prospective cohort of stage IA NSCLC patients undergoing surgery or SBRT at Mount Sinai Health System had QoL measured before treatment, and 2, 6, and 12 months post-treatment using: 12-item Short Form Health Survey version 2 (SF-12v2) [physical component summary (PCS) and mental component summary (MCS)], Functional Assessment of Cancer Therapy-Lung Cancer Subscale (FACT-LCS), and the Patient Health Questionnaire-4 (PHQ-4) measuring depression and anxiety. Locally weighted scatterplot smoothing (LOWESS) was fitted to identify the best interval knot for the change in the QoL trends post-treatment, adjusted piecewise linear mixed effects model was developed to estimate differences in baseline, 2- and 12-month scores, and rates of change. Results: In total, 503 (88.6%) patients received surgery and 65 (11.4%) SBRT. LOWESS plots suggested QoL changed at 2 months post-surgery. Worsening in PCS was observed for both surgery and SBRT within 2 months after treatment but was only significant for surgical patients (-2.11, P<0.001). Two months later, improvements were observed for surgical but not SBRT patients (0.63 vs. -0.30, P<0.001). Surgical patients had significantly better PCS (P<0.001) and FACT-LCS (P<0.001) scores 1-year post-treatment compared to baseline, but not SBRT patients. Both surgical and SBRT patients reported significantly less anxiety 1-year post-treatment compared to baseline (P<0.001 and P=0.03). Decrease in depression from baseline to 1-year post-treatment was only significant for surgical patients (P<0.001). Conclusions: Post-treatment, surgical patients exhibited improvements in physical health and reductions in lung cancer symptoms following initial deterioration within the first two months; in contrast, SBRT patients showed persistent decline in these areas throughout the year. Nonetheless, improved mental health was noted across both patient categories post-treatment. Targeted interventions and continuous monitoring are recommended during the initial 2 months post-surgery and throughout the year post-SBRT to alleviate physical and mental distress in patients.

CT Predictors of Visceral Pleural Invasion in Patients with Non-Small Cell Lung Cancers 30 mm or Smaller.

Background CT-defined visceral pleural invasion (VPI) is an important indicator of prognosis for non-small cell lung cancer (NSCLC). However, there is a lack of studies focused on small subpleural NSCLCs (≤30 mm). Purpose To identify CT features predictive of VPI in patients with subpleural NSCLCs 30 mm or smaller. Materials and Methods This study is a retrospective review of patients enrolled in the Initiative for Early Lung Cancer Research on Treatment (IELCART) at Mount Sinai Hospital between July 2014 and February 2023. Subpleural nodules 30 mm or smaller were classified into two groups: a pleural-attached group and a pleural-tag group. Preoperative CT features suggestive of VPI were evaluated for each group separately. Multivariable logistic regression analysis adjusted for sex, age, nodule size, and smoking status was used to determine predictive factors for VPI. Model performance was analyzed with the area under the receiver operating characteristic curve (AUC), and models were compared using Akaike information criterion (AIC). Results Of 379 patients with NSCLC with subpleural nodules, 37 had subsolid nodules and 342 had solid nodules. Eighty-eight patients (22%) had documented VPI, all in solid nodules. Of the 342 solid nodules (46% in male patients, 54% in female patients; median age, 71 years; IQR: 66, 76), 226 were pleural-attached nodules and 116 were pleural-tag nodules. VPI was more frequent for pleural-attached nodules than for pleural-tag nodules (31% [69 of 226] vs 16% [19 of 116], P = .005). For pleural-attached nodules, jellyfish sign (odds ratio [OR], 21.60; P < .001), pleural thickening (OR, 6.57; P < .001), and contact surface area (OR, 1.05; P = .01) independently predicted VPI. The jellyfish sign led to a better VPI prediction (AUC, 0.84; 95% CI: 0.78, 0.90). For pleural-tag nodules, multiple tags to different pleura surfaces enabled independent prediction of VPI (OR, 9.30; P = .001). Conclusions For patients with solid NSCLC (≤30 mm), CT predictors of VPI were the jellyfish sign, pleural thickening, contact surface area (pleural-attached nodules), and multiple tags to different pleura surfaces (pleural-tag nodules). © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Nishino in this issue.

Radiologic Features of Nodules Attached to the Mediastinal or Diaphragmatic Pleura at Low-Dose CT for Lung Cancer Screening.

Background Pulmonary noncalcified nodules (NCNs) attached to the fissural or costal pleura with smooth margins and triangular or lentiform, oval, or semicircular (LOS) shapes at low-dose CT are recommended for annual follow-up instead of immediate workup. Purpose To determine whether management of mediastinal or diaphragmatic pleura-attached NCNs (M/DP-NCNs) with the same features as fissural or costal pleura-attached NCNs at low-dose CT can follow the same recommendations. Materials and Methods This retrospective study reviewed chest CT examinations in participants from two databases. Group A included 1451 participants who had lung cancer that was first present as a solid nodule with an average diameter of 3.0-30.0 mm. Group B included 345 consecutive participants from a lung cancer screening program who had at least one solid nodule with a diameter of 3.0-30.0 mm at baseline CT and underwent at least three follow-up CT examinations. Radiologists reviewed CT images to identify solid M/DP-NCNs, defined as nodules 0 mm in distance from the mediastinal or diaphragmatic pleura, and recorded average diameter, margin, and shape. General descriptive statistics were used. Results Among the 1451 participants with lung cancer in group A, 163 participants (median age, 68 years [IQR, 61.5-75.0 years]; 92 male participants) had 164 malignant M/DP-NCNs 3.0-30.0 mm in average diameter. None of the 164 malignant M/DP-NCNs had smooth margins and triangular or LOS shapes (upper limit of 95% CI of proportion, 0.02). Among the 345 consecutive screening participants in group B, 146 participants (median age, 65 years [IQR, 59-71 years]; 81 female participants) had 240 M/DP-NCNs with average diameter 3.0-30.0 mm. None of the M/DP-NCNs with smooth margins and triangular or LOS shapes were malignant after a median follow-up of 57.8 months (IQR, 46.3-68.1 months). Conclusion For solid M/DP-NCNs with smooth margins and triangular or LOS shapes at low-dose CT, the risk of lung cancer is extremely low, which supports the recommendation of Lung Imaging Reporting and Data System version 2022 for annual follow-up instead of immediate workup. © RSNA, 2024 See also the editorial by Goodman and Baruah in this issue.

Development of a new 17-item Asthenopia Survey Questionnaire using Rasch analysis.

AIM: To develop the 17-item Asthenopia Survey Questionnaire (ASQ)-17 by Rasch analysis, and to generate a predictiveness score. METHODS: Totally 739 participants were recruited and 680 were involved in the result analysis in this prospective, cross-sectional study. Three rounds of Rasch analysis were used to analyze the psychometric characteristics of items and options. RESULTS: Phase 1 assessed the original ASQ-19, adjusted the item scoring mode to a four-point Likert response rating scale and combined the 18th and 19th items into a new item. Phase 2 deleted the 11th item. Phases 3 and 4 assessed the new ASQ-17. All the evaluation indexes of ASQ-17 were acceptable. The Infit and Outfit MnSq values of items were 0.67-1.48, the variance explained by the principal component and the unexplained variance explained by the first contrast were 53.90%-59.40% and 1.50-1.80 in three dimensions. The curve peaks of scores in each dimension were separated and in the same order. The PSR and PSI values were 2.80 and 0.89, respectively. The mean scores of dimensions A (9.5±4.1 vs 3.5±3.2), B (7.3±3.3 vs 2.5±2.7), C (4.3±2.2 vs 1.4±2.0) and total (21.1±8.1 vs 7.4±7.0) in asthenopia participants were significantly higher than those without asthenopia (all P<0.001). The area under the curve in two groups was 0.899 (P<0.001). Youden's index was up to the maximum value of 0.784 when the cut-off value was 12.5. CONCLUSION: ASQ-17 has stronger option sorting and suitability than ASQ-19. It is an effective assessment tool for asthenopia with an optimal cut-off threshold value of 12.5, which is suitable for diagnosis and curative effect evaluation.

Predictors of pulmonary embolism in hospitalized patients with COVID-19.

BACKGROUND: High venous thromboembolism (VTE) rates have been described in critically ill patients with COVID-19. We hypothesized that specific clinical characteristics may help differentiate hypoxic COVID-19 patients with and without a diagnosed pulmonary embolism (PE). METHODS: We performed a retrospective observational case-control study of 158 consecutive patients hospitalized in one of four Mount Sinai Hospitals with COVID-19 between March 1 and May 8, 2020, who received a Chest CT Pulmonary Angiogram (CTA) to diagnose a PE. We analyzed demographic, clinical, laboratory, radiological, treatment characteristics, and outcomes in COVID-19 patients with and without PE. RESULTS: 92 patients were negative (CTA-), and 66 patients were positive for PE (CTA+). CTA + had a longer time from symptom onset to admission (7 days vs. 4 days, p = 0.05), higher admission biomarkers, notably D-dimer (6.87 vs. 1.59, p < 0.0001), troponin (0.015 vs. 0.01, p = 0.01), and peak D-dimer (9.26 vs. 3.8, p = 0.0008). Predictors of PE included time from symptom onset to admission (OR = 1.11, 95% CI 1.03-1.20, p = 0.008), and PESI score at the time of CTA (OR = 1.02, 95% CI 1.01-1.04, p = 0.008). Predictors of mortality included age (HR 1.13, 95% CI 1.04-1.22, p = 0.006), chronic anticoagulation (13.81, 95% CI 1.24-154, p = 0.03), and admission ferritin (1.001, 95% CI 1-1.001, p = 0.01). CONCLUSIONS: In 158 hospitalized COVID-19 patients with respiratory failure evaluated for suspected PE, 40.8% patients had a positive CTA. We identified clinical predictors of PE and mortality from PE, which may help with early identification and reduction of PE-related mortality in patients with COVID-19.

miR-4478 Accelerates Nucleus Pulposus Cells Apoptosis Induced by Oxidative Stress by Targeting MTH1.

OBJECTIVES: Low back pain is the leading cause of disability in the elderly population and is strongly associated with intervertebral disk degeneration (IVDD). However, the precise molecular mechanisms regulating IVDD remain elusive. This study aimed to investigate the role of differentially expressed miRNAs in the pathogenesis of IVDD. MATERIALS AND METHODS: We analyzed miRNA microarray datasets to identify differentially expressed miRNAs in IVDD progression and conducted quantitative real-time polymerase chain reaction and fluorescence in situ hybridization analysis to further confirm the differential expression of miR-4478 in nucleus pulposus (NP) tissues of patients diagnosed with IVDD. Using public databases of miRNA-mRNA interactions, we predicted the target genes of miR-4478, and subsequent flow cytometry and western blot analyses demonstrated the effect of MTH1 in H 2 O 2 -induced nucleus pulposus cells (NPCs) apoptosis. Finally, miR-4478 inhibitor was injected into NP tissues of the IVDD mouse model to explore the effect of miR-4478 in vivo. RESULTS: miR-4478 was upregulated in NP tissues from IVDD patients. Silencing of miR-4478 inhibits H 2 O 2 -induced NPCs apoptosis. MTH1 was identified as a target gene for miR-4478, and miR-4478 regulates H 2 O 2 -induced NPCs apoptosis by modulating MTH1. In addition, downregulation of miR-4478 alleviated IVDD in a mouse model. CONCLUSIONS: In summary, our study provides evidence that miR-4478 may aggravate IVDD through its target gene MTH1 by accelerating oxidative stress in NPCs and demonstrates that miR-4478 has therapeutic potential in IVDD treatment.

Treatment and outcome of a patient with low-energy 'Logsplitter' injury.

The low-energy 'Logsplitter' fracture, caused by a sprain or fall, is characterized by an intact or slightly separated inferior tibiofibular joint. Compared with the high-energy 'Logsplitter' fracture, this atypical subtype is rarely seen and is easily missed. Here, the case of a 33-year-old male patient with a fractured right ankle as a result of a sprain during walking is reported. The patient initially received routine surgical treatment comprising internal fixation of the fibular, medial and posterior malleoli. Unexpectedly, post-surgery imaging examinations revealed that the medial clear space of the right ankle had widened to 6 mm, due to incomplete reduction of the lateral malleolus, shortening and rotation of the fibula, and an unreduced avulsion fracture block of the anterior malleolus. A revision surgery was then performed to anatomically reduce and fix the lateral malleolus, as well as the anterior malleolus avulsion fracture. During 5 months following surgery, the patient achieved good fracture union and functional restoration of the right ankle. For this rare injury, the present case demonstrates that complete restoration of the fracture is required to achieve good clinical efficacy.

Spontaneous rupture of the right quadriceps tendon in a patient undergoing long-term hemodialysis: a case report.

Spontaneous unilateral quadriceps tendon rupture is an uncommon injury that is generally associated with chronic kidney disease and metabolic disorders. The current case involved a 50-year-old man with a painful right knee that he was unable to extend as a result of minor trauma sustained in an accident. Physical examination combined with radiographic and ultrasonographic investigations led to a diagnosis of quadriceps tendon rupture of the right knee. The patient had a 7-year history of hemodialysis for treatment of chronic kidney disease, leading to secondary hyperparathyroidism. He underwent successful tendon repair surgery, and his right knee was immobilized with splints for 6 weeks postoperatively. He gradually resumed full weight bearing and then normal walking.

Magnetic Properties of Nano-Maghemites with Different Crystal Shapes.

The differences between the macroscopic and microscopic magnetic properties of granular, rod, and tubular nano-maghemites were studied. The macroscopic magnetic properties of the different nano-maghemites were all ferrimagnetic by using a superconducting quantum interference device (SQUID). However, the coercive magnetic field and magnetization per unit volume were both in the orders of grain > tube > rod, which indicated that the crystal shape influenced macroscopic magnetic properties. A magnetic force microscope (MFM) was used to observe the microscopic magnetic structures; the samples were all magnetic in multiple domains, but the form and distribution of these domains were different. However, the domain information of nano-maghemites calculated from SQUID results suggested that all specimens were pseudo-single domains. The MFM results suggested that the crystal morphology had a significant effect on magnetic properties of these nano-maghemites owing to their different magnetic domain structures. Therefore, MFM can be used to detect minute magnetic-properties that are imperceptible to macroscopic measurements. Thus, it is a tool with potential development in earth science.

Effect of the degree of osteoporosis on the biomechanical anchoring strength of the sacral pedicle screws: an in vitro comparison between unaugmented bicortical screws and polymethylmethacrylate augmented unicortical screws.

STUDY DESIGN: An in vitro laboratory study. OBJECTIVE: (i) To evaluate the effect of osteoporotic degree in determining the strength of sacral screw fixation and (ii) to compare the strength of unaugmented bicortical pedicle screw and polymethylmethacrylate (PMMA) augmented unicortical pedicle screw in sacral fixation. SUMMARY OF BACKGROUND DATA: Screw loosening is a clinical problem in lumbosacral fusions, especially in osteoporotic patients. To improve the screw anchoring strength of sacrum, bicortical and PMMA augmented sacral pedicle screw fixation techniques are widely used in clinical practice. However, the biomechanical strength of the bicortical and PMMA augmented sacral screw fixations remains undetermined in different degrees of osteoporosis. METHODS: Twenty-five fresh osteoporotic cadavers were used in this study. According to the value of lumbar bone mineral density (BMD) assessed by DEXA, specimens were divided into 3 groups: group A (N=9): BMD=0.7 to 0.8 g/cm, group B (N=8): BMD=0.6 to 0.7 g/cm, and group C (N=8): BMD<0.6 g/cm. In each specimen, S1 pedicle screw was inserted bicortically on the left side, and S1 pedicle screw with PMMA augmentation was inserted unicortically on the right side of the sacrum. Following a dynamic cyclic loading from 30 to 250 N on the screw head for 2000 cycles, the subsidence displacement and axial pull-out strength of each screw were measured. RESULTS: No anchoring failure (defined as the subsidence displacement exceeding 2 mm within 2000 loading cycles) occurred in group A and B. However, in group C, 6 cases (75%) in bicortical fixation and 5 cases (63%) in PMMA augmented fixation failed during cyclic loading. In group A, no significant difference between the bicortical and PMMA augmented fixations was detected in terms of the subsidence and maximal pull-out strength. In group B, significantly less subsidence and higher maximal pull-out strength were demonstrated in the PMMA augmented technique than that in the bicortical fixation. Both techniques exhibited lower subsidence of the screw in group A than in group B. The bicortical technique exhibited higher maximum pull-out strength in group A than that in group B. However, statistical difference in terms of PMMA augmentation was not detected between group A and B. CONCLUSION: For BMD value more than 0.70 g/cm, bicortical sacral pedicle screw fixation could obtain sufficient anchoring strength comparable with the PMMA augmented technique. When BMD value is within 0.6 to 0.7 g/cm, the PMMA augmented technique would be more beneficial in improving the fixation strength than the bicortical fixation. For BMD values less than 0.6 g/cm, early screw loosening may occur in both bicortical and PMMA augmented fixations.

Biomechanical comparison of 4 fixation techniques of sacral pedicle screw in osteoporotic condition.

STUDY DESIGN: An in vitro biomechanical cadaver study. OBJECTIVES: To compare the subsidence displacement after cyclic loading among 4 sacral pedicle screw fixations of bicortical, tricortical, standard polymethylmethacrylate (PMMA) augmentation, and sub-endplate PMMA augmentation in osteoporotic condition. SUMMARY OF BACKGROUND DATA: Implant failure caused by screw loosening is a clinical problem for lumbosacral fusions, especially in osteoporotic patients. To improve sacral screw anchoring strength, the main fixation techniques need to be evaluated biomechanically. METHODS: For this study, 11 fresh osteoporotic cadaver sacra were harvested and bone mineral density was measured with dual-energy radiograph absorptiometry. A 7 mm diameter monoaxial pedicle screw (S1) was randomly assigned by side (left vs. right) and placed bicortically or tricortically. The 2 screws, followed 2000 cyclic compression loading of 30 to 250 N, were removed. The screw tracts were filled up with PMMA, then, screws 5 mm shorter than the bicortical or tricortical fixation were reinserted (defined as standard and sub-endplate PMMA augmented sacral screw fixations, respectively). The PMMA augmented screws were then retested as before. Screw subsidence displacement after 2000 cyclic loading was measured and compared. RESULTS: The average bone mineral density of 11 specimens was 0.71 g/cm, ranged from 0.65 to 0.78 g/cm. No significant difference of subsidence displacement was detected between tricortical and standard PMMA augmented screws (P>0.05), however, the 2 fixations exhibited markedly less subsidence than bicortical screw (P<0.05). Sub-endplate PMMA augmented screw showed the least subsidence among all the screws (P<0.05). CONCLUSIONS: PMMA augmentation can increase the bonding strength of sacral screw-bone interface and the sub-endplate PMMA augmented sacral screw could obtain the highest stability among the 4 fixation techniques in osteoporotic condition.

The effect of screw length and bone cement augmentation on the fixation strength of iliac screws: a biomechanical study.

STUDY DESIGN: Comparison of the biomechanical fixation strengths offered by 3 iliac screw fixation techniques: short screw, short screw augmented with cement, and long screw. OBJECTIVE: Evaluate the effect of screw length and bone cement augmentation on the fixation strength of iliac screw upon fatigue loading. SUMMARY OF BACKGROUND DATA: Iliac screws have been used in treating spinal disorders such as spinal deformity, spondylolisthesis, and sacral tumor. In clinical practices, both short screws and long screws are being used. It has been reported that short iliac screws have a higher rate of loosening. Therefore, short iliac screws are being used with bone cement augmentation to improve fixation. To date, no biomechanical study has compared the strengths of these 3 different iliac screw fixation techniques. METHOD: Fresh, frozen human cadaveric pelvis specimens (n = 18, 12 males, 6 females, average age 61 y) were used. Bone density was measured to characterize bone quality. The specimens were randomly divided into 2 groups. In group 1 (n = 8), short screws of 7.0-mm diameter and 70 + or - 4 mm length (as the length of exceeding over ischial notch) and long screw of 7.0-mm diameter and 120 + or - 4 mm length were placed on either side of the pelvis (left and right). In group 2 (n = 10), short iliac screws were placed after augmentation with polymethyl methacrylate bone cement on 1 side of the pelvis and long iliac screw were placed on the other side (left and right). Cyclic loading ranging from 20 to 200 N was applied to each screw at a frequency of 2 Hz up to 5000 cycles. Pullout tests were then conducted at the rate of 5 mm/min after the fatigue test, and the maximum pullout strength for each screw was recorded and analyzed. RESULTS: The maximum pullout strength of the long screw and short screw groups after fatigue conditioning were 2386 + or - 1470 and 833 + or - 681 N respectively. Significant difference was found between the 2 groups (P < 0.05). The short iliac screw had a higher loosening rate. The pullout force of the short screw fixation with augmentation and the long screw fixation after cyclic loading were 2436 + or - 915 and 2529 + or - 1055 N, respectively. No significant difference was found between the 2 groups (P > 0.05). CONCLUSIONS: Short iliac screws are susceptible to loosening after cyclic loading. Bone cement augmentation of short screws has demonstrated a significant increase in the fixation strength of short screws to an extent similar to that of long iliac screws. Thus, short iliac screw fixation after augmentation with bone cement will be a viable clinical option for spino-pelvic reconstruction.

Effect of iliac screw insertion depth on the stability and strength of lumbo-iliac fixation constructs: an anatomical and biomechanical study.

STUDY DESIGN: Comparison of feasibility and safety of the placement of short and long iliac screws by anatomic and biomechanical evaluations as they apply to lumbo-iliac fixation construct. OBJECTIVE: To compare the stability of the short and long iliac screw fixations for lumbo-iliac reconstruction by anatomic and biomechanical evaluations. SUMMARY OF BACKGROUND DATA: Spinopelvic reconstruction remains a challenge to spine surgeons. Despite the advent of many fixation methods, the use of iliac screws seems most favorable so far. Various lengths of iliac screws are applied in surgical treatments; however, no biomechanical comparison has been reported based on the screw length. METHODS: For anatomic observation, CT scan data of 60 Chinese adults were used to measure the details of the iliac spine structures. For biomechanical evaluation, 7 adult human cadavers (L3-pelvis) were observed. L4-S1 pedicle screw fixation was performed with posterior spinal fixation system. On the basis of the lengths of iliac screws, 2 groups were tested (short screw group using 70 mm screws and long screw group using 138 mm screws). In this study, short and long iliac screws were placed in the same specimen. Biomechanical testing was performed on a material testing machine under 800 N compression and 7 Nm torsion loading modes for stiffness evaluations. Finally, pullout testing was performed for all the iliac screws to measure the maximum pullout force. RESULTS: The length of the line between posterior superior iliac spine and anterior inferior iliac spine was 140.6 +/- 1.1 mm, and the distance between this line and the greater sciatic notch was 18.3 +/- 0.8 mm. The length of the line between posterior superior iliac spine and the second narrowest point was 67.1 +/- 0.62 mm in men and 70.1 +/- 1.4 mm in women. Insertion lengths of the short and long iliac screws were 70 +/- 2 mm and 138 +/- 4 mm, respectively. The lumbo-pelvic reconstruction using short and long iliac screws restored 53.3% +/- 13.6% and 57.6% +/- 16.2% of the initial stiffness in compression testing respectively. In torsion testing, the use of short and long iliac screws harvested 55.1% +/- 11.9% and 62.5% +/- 9.2% of the initial stiffness, respectively. No significant difference was detected between the 2 reconstructions in terms of compressive and torsional stiffness (P > 0.05). However, the maximum pullout strength of long iliac screw group was significantly higher than the short screw group (P < 0.05). CONCLUSION: The local stability is rather difficult to be restored to the original levels regardless the length of iliac screws. Obviously, long iliac screws resisted significantly greater axial pullout force. However, under physiologic, torsional, and compressive loading conditions, the mechanical stability of lumbo-pelvic fixation construct with short iliac screws was comparable with that of the long ones. Therefore, the use of short iliac screws, which are only about half the length of the long iliac screws, could reduce the implantation risk without significantly compromising on the stability of the construct.

Increased drinking in a metropolitan city in China: a study of alcohol consumption patterns and changes.

AIMS: To investigate alcohol drinking among urban Chinese and any changes between 2002 and 2005. DESIGN: Two identical face-to-face interviews were carried out with two random samples with 2327 and 2613 respondents, respectively. SETTING: Respondents were selected randomly from Wuhan City, Hubei province, China, between May and June 2002, and June and August 2005. PARTICIPANTS: Fifteen to 65-year-old urban Chinese adults. MEASUREMENTS: Prevalence of drinking, frequency of drinking, typical occasion quantity, volume of annual consumption and heavier drinking were the main measures. FINDINGS: Nearly three-quarters (90% for men and 55% for women) were current alcohol drinkers in 2005, and the prevalence of drinking alcohol had increased significantly since 2002 among both men and women; the largest increases occurred in the younger group (18-19 years) and among older women. There was no change in the frequency of drinking, the average quantities consumed by drinkers and the volume of absolute alcohol consumed by drinkers over this 3-year period. However, reflecting the increased prevalence of drinkers, the median volumes of absolute alcohol consumed in the sample as a whole had increased significantly. Older males were more likely to be categorized as larger-quantity drinkers: 30-65-year-old men accounted for 63%. There was also an increase over time in the proportion of larger-quantity drinkers: the proportion of male larger-quantity drinkers increased from 27% in 2002 to 35% in 2005. CONCLUSIONS: In the urban setting of Wuhan, over the time-period 2002-05, there was an increase in prevalence of drinkers, particularly among younger people and older women. The average frequency and quantities consumed by drinkers did not change over this period; among drinking men the volumes of alcohol consumed were comparable to those in much more saturated commercial alcohol markets. The results did, however, show an increase over time in the proportion of older men who were engaged in heavier drinking and, in 2005, the proportion exceeded that in more saturated markets. These data suggest that, given the relatively high levels of consumption among established drinking groups, increases in the prevalence of drinkers over time may result in increases in harm if effective policies are not implemented.

Relationship between alcohol drinking and alcohol-related health problems.

OBJECTIVE: To study the relationship between drinking environment, attitudes and situation and alcohol-related health problems. METHODS: A sample of 2327 respondents was randomly collected from Wuhan, Hubei Province in China by a face-to-face interview. The structural equation modeling analysis was performed for the data collected. RESULTS: Both parents' drinking behaviors and respondents' drinking situation strongly impacted the alcohol-related problems and diseases. Friends' or peers' drinking behaviors influenced the respondents' drinking attitudes and behaviors. Males experienced more alcohol-related problems and diseases than females. CONCLUSIONS: Comparatively, parents' drinking behaviors exert the most significant influence on drinkers. Therefore, it is beneficial to restrict parents' drinking behaviors for the offsprings and the whole society, and an intensive professional education in early motherhood is also necessary for Chinese women.

Cost savings from a sustained compulsory breath testing and media campaign in New Zealand.

This paper evaluates three approaches to compulsory breath testing (CBT) where all drivers stopped are tested: (1) intensive, moderate-profile CBT (plus zero alcohol tolerance for drivers under age 20, which was implemented simultaneously, remains in effect, and unavoidably is commingled with CBT in the effectiveness estimates); (2) CBT plus an enhanced media campaign; and (3) shifting to aggressively visible booze buses, which also streamlined drunk-driver processing, plus enhanced community campaigns against drunk-driving. Approaches 1 and 2 were implemented throughout New Zealand (NZ) in 1993 and 1995. Booze buses and community programs were added for about one-third of the country in late 1996. ARIMA time series models estimated the impact on serious and fatal injury crashes between 10 p.m. and 3 a.m., a proxy for alcohol-related crashes. A benefit-cost analysis assessed return on investment. Cost savings were analyzed from four perspectives: societal, governmental, drunk-drivers', and people other than drunk-drivers (external cost). CBT plus zero tolerance reduced expected night-time crashes by 22.1% and enhanced media by 13.9%. Booze buses yielded a further 27.4% reduction where implemented. The program and associated crash reduction persisted until at least 2001 (the most recent data available). Estimated societal benefit-cost ratios were 14 for CBT, 19 for CBT plus enhanced media, and 26 for the comprehensive package. Government saved more than it spent on the program, especially with booze buses. Aggressive CBT plus zero alcohol tolerance for youth, media blitzes, and booze buses proved dramatically effective. Together, these four interventions halved late night serious and fatal injury crashes. Sustained effort seems to be critical. Better outcomes may be achieved with staged, increasingly visible and inescapable checkpoints than with an "ideal" initial program. It appears CBT is best implemented in conjunction with broader community-centered efforts to reduce drunk-driving.