Osteoarthritic changes in the knees of recently retired male professional footballers: a pilot study.

Background: Knee osteoarthritis (OA) is common amongst retired male professional footballers. There is limited understanding with respect to the interplay between imaging findings, clinical presentation and patient-reported outcome measures (PROMs) in retired professional footballers with knee OA. Objectives: This pilot study aimed to evaluate the extent of radiological and clinical knee OA in a cohort of retired male professional footballers, and to explore the relationship between these findings and knee-related PROMs. Methods: Fifteen retired male professional footballers underwent knee radiographs and were surveyed on their history of clinical OA, severe knee injury and previous knee surgery. The Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS) and the Patient-Reported Outcomes Measurement Information System Global Health (PROMIS-GH) were used to assess health outcomes, such as level of function and pain. Results: Radiological knee OA was diagnosed in six out of 15 participants. Seven of the participants had a clinical diagnosis of knee OA. Evidence of clinical and radiological OA was present amongst four participants. Radiological knee OA and clinical OA was significantly associated with a history of severe knee injury and previous knee surgery. Low correlations (ρ<-0.40) were found between knee OA severity and knee-related PROMs. Moderate correlation (ρ=-0.65) was found between clinical knee OA and KOOS-SP. Conclusion: Clinical knee OA correlates with PROMs amongst retired professional footballers but radiological OA does not. Further studies are required to understand the relationship between imaging findings, clinical presentation and PROMs amongst retired professional footballers with knee OA.

Cytoprotection by electromagnetic field-induced hsp70: a model for clinical application.

A unique approach to clinical application of cytoprotection is offered by electromagnetic (EM) field induction of stress proteins. EM fields are noninvasive and easily applied, as compared with the current hyperthermia protocols. Fertilized dipteran eggs and cultured rodent cardiomyocytes (H9c2 cells) were used as models to test EM fields for their ability to induce increased hsp70 levels for effective cytoprotection. Eggs preconditioned with an 8 microT 60Hz EM field for 30 min had 114% increase in hsp70 levels, and an average 82% increase in survival, following a lethal temperature of 36.5 degrees C. Thermal preconditioning at 32 degrees C was not nearly as effective in dipteran eggs, inducing only a 44% increase in survival. Preconditioning of cultured murine cardiomyocytes (H9c2 cells) with an 8 microT 60 Hz field induced a 77% average increase in hsp70 levels.

Pretreatment blood pressure as a predictor of 21-year mortality.

Our objective was to evaluate pretreatment predictors of longevity, particularly blood pressure, in a large cohort of hypertensive men. During 1974 to 1976, 10,367 male hypertensive veterans (47% black) were identified at screening and subsequently characterized in 32 special Veterans Administration (VA) hypertension clinics. Their mean age was 52 years and mean blood pressure (BP) 154/100 mm Hg. During an average of 21 years of follow-up, 61% died. Risk ratios for all-cause mortality as functions of BP and other risk factors are presented for each variable alone; for each variable controlling for age, race, and BP; and for a multivariate model. We observed that when the entire cohort was divided into deciles by systolic blood pressure (SBP) and by diastolic blood pressure (DBP), the risk ratios for 21-year mortality increased from lowest to highest decile by 178% for SBP and 16% for DBP. When the deciles were computed separately by age group, increases from lowest to highest decile for those less than 40 years of age were 138% for SBP and 263% for DBP. For those over 60 years, the increases were 154% and -10%, respectively. Although blacks were younger and had more severe diastolic hypertension than whites, the risk ratios were similar within each race group. Risk patterns for mean arterial pressure and pulse pressure resembled those for SBP but had smaller gradients. Survival curves for BP groups suggested constant mortality rates during follow-up. Other significant observations included decreasing mortality with increasing body mass index and increased mortality in the Stroke Belt. We concluded that pretreatment SBP strongly predicted all-cause mortality during 21-year follow-up. For the young, both SBP and DBP were strong predictors; for the elderly, only SBP was predictive.

The Washington University-EPRI Veterans' Cohort Mortality Study: preliminary results.

This article presents the design of and some results from a new prospective mortality study of a national cohort of about 50,000 U.S. veterans who were diagnosed as hypertensive in the mid 1970s, based on approximately 21 yr of follow-up. This national cohort is male with an average age at recruitment of 51 +/- 12 yr; 35% were black and 81% had been smokers at one time. Because the subjects have been receiving care at various U.S. Veterans Administration (VA) hospitals, access to and quality of medical care are relatively homogeneous. The health endpoints available for analysis include all-cause mortality and specific diagnoses for morbidity during VA hospitalizations; only the mortality results are discussed here. Nonpollution predictor variables in the baseline model include race, smoking (ever or at recruitment), age, systolic and diastolic blood pressure (BP), and body mass index (BMI). Interactions of BP and BMI with age were also considered. Although this study essentially controls for socioeconomic status by design because of the homogeneity of the cohort, selected ecological variables were also considered at the ZIP code and county levels, some of which were found to be significant predictors. Pollutants were averaged by year and county for TSP, PM10, CO, O3, and NO2; SO2 and Pb were considered less thoroughly. Both mean and peak levels were considered for gases. SO(4)2- data from the AIRS database and PM2.5, coarse particles, PM15, and SO(4)2- from the U.S. EPA Inhalable Particulate (IP) Network were also considered. Four relevant exposure periods were defined: 1974 and earlier (back to 1953 for TSP), 1975-1981, 1982-1988, and 1989-1996. Deaths during each of the three most recent exposure periods were considered separately, yielding up to 12 combinations of exposure and mortality periods for each pollutant. Associations between concurrent air quality and mortality periods were considered to relate to acute responses; delayed associations with prior exposures were considered to be emblematic of initiation of chronic disease. Preexposure mortality associations were considered to be indirect (noncausal). The implied mortality risks of long-term exposure to air pollution were found to be sensitive to the details of the regression model, the time period of exposure, the locations included, and the inclusion of ecological as well as personal variables. Both positive and negative statistically significant mortality responses were found. Fine particles as measured in the 1979-1984 U.S. EPA Inhalable Particulate Network indicated no significant (positive) excess mortality risk for this cohort in any of the models considered. Among the positive responses, indications of concurrent mortality risks were seen for NO2 and peak O3, with a similar indication of delayed risks only for NO2. The mean levels of these excess risks were in the range of 5-9%. Peak O3 was dominant in two-pollutant models and there was some indication of a threshold in response. However, it is likely that standard errors of the regression coefficients may have been underestimated because of spatial autocorrelation among the model residuals. The significant variability of responses by period of death cohort suggests that aggregation over the entire period of follow-up obscures important aspects of the implied pollution-mortality relationships, such as early depletion of the available pool of those subjects who may be most susceptible to air pollution effects.

Antihypertensive efficacy of treatment regimens used in Veterans Administration hypertension clinics. Department of Veterans Affairs Cooperative Study Group on Antihypertensive Agents.

There is continuing uncertainty about whether morbidity and mortality of treated hypertensive patients depends on the drug(s) used to treat or only on the level of blood pressure achieved. This study was undertaken in a sample of special Veterans Administration hypertension clinics to determine which antihypertensive drugs were selected by the involved healthcare providers and how effective they were in achieving normotension. Hypertensive veterans (n = 6100) were followed in six VA Hypertension Screening and Treatment Program clinics for 46 months beginning in May 1989. Their average age was 60.7 years; 53% lived in the Stroke Belt; 46% had target organ damage, 36% were black, 23% smoked, and 10% had diabetes mellitus. Antihypertensive regimens were divided into 12 all-inclusive categories. Blood pressures were averaged at the last study visit for all patients on a regimen. The regimens of diuretic or diuretic plus beta-blocker gave the lowest average pressures (140.6/82.3 mm Hg) and calcium antagonist the highest (149.0/86.5 mm Hg). ANOVA indicated that differences between seven common regimens and also between the four single drug regimens were highly significant (P<.0001). This pattern of low treated pressure with the "old" agents and higher treated pressure with newer agents was reflected in the percentage of patients controlled below 140/90 mm Hg and the percentage uncontrolled above 159/94 mm Hg. Blacks and patients with target organ damage resembled the entire cohort in average treated diastolic blood pressure, but the former had lower and the latter had higher treated systolic blood pressure than the entire cohort.

Community volunteers as recruitment staff in a clinical trial: the systolic hypertension in the elderly program (SHEP) experience.

During the recruitment phase of a trial it is often found that recruitment is not proceeding as quickly as projected. Budget limitations require innovative methods, such as use of volunteers, to increase recruitment yields without increasing cost. In the Systolic Hypertension in the Elderly Program (SHEP), volunteer staff at 12 of the 16 clinical centers (CCs) performed a range of tasks such as mailings, telephoning, and clerical work. SHEP volunteers donated almost 40,000 hours, at an estimated cost savings to the program of more than $368,000. Staff volunteers appear to require more training and supervision than regular staff and may require flexible work schedules. These limitations can be obviated by careful planning. This paper describes the SHEP experience with staff volunteers and provides suggestions for their use in other trials.

Early predictors of 15-year end-stage renal disease in hypertensive patients.

There has been a continuing increase in the incidence of end-stage renal disease (ESRD) in the United States, including the fraction that has been attributed to hypertension. This study was done to seek relationships between ESRD and pretreatment clinical data and between ESRD and early treated blood pressure data in a population of hypertensive veterans. We identified a total of 5730 black and 6182 nonblack male veterans as hypertensive from 1974 through 1976 in 32 Veterans Administration Hypertension Screening and Treatment Program clinics. Their mean age was 52.5 +/- 10.2 years, and their mean pretreatment blood pressure was 154.3 +/- 19.0/100.8 +/- 9.8 mm Hg. During a minimum of 13.9 years of follow-up, 5337 (44.8%) of these patients died and 245 developed ESRD. For 1055 of these subjects, pretreatment systolic blood pressure (SBP) was greater than 180 mm Hg; 901 were diabetic; 1471 had a history of urinary tract problems; and 2358 of the 9644 who were treated had an early fall in SBP of more than 20 mm Hg. We used proportional hazards modeling to fit multivariate survival models to determine the effect of the available pretreatment data and early treated blood pressure levels on ESRD. This model demonstrated the independent increased risk of ESRD associated with being black or diabetic (risk ratio, 2.2 or 1.8), having a history of urinary tract problems (risk ratio, 2.2), or having high pretreatment SBP (for SBP 165 to 180 mm Hg, risk ratio was 2.8; for SBP > 180 mm Hg, risk ratio was 7.6).(ABSTRACT TRUNCATED AT 250 WORDS)

Regional differences in mortality during 15-year follow-up of 11,936 hypertensive veterans.

Several different investigators have reported increased stroke mortality in the southeastern United States, leading to the introduction of the term "Stroke Belt." The results presented here from the Veterans Administration Hypertension Screening and Treatment Program (HSTP) demonstrate an increased all-cause mortality among hypertensive patients seen in HSTP clinics in the southeastern United States when compared with similar patients from other HSTP clinics. Several different groupings of southeastern states were examined and compared with nine states west of the Mississippi River. A total of 11,936 male veterans, 5737 of whom were black, were identified as hypertensive during 1974-1976 in 32 HSTP clinics. Their mean age was 52.4 +/- 10.4 years, and their mean pretreatment blood pressure was 153.8 +/- 19.1/100.4 +/- 9.8 mm Hg. During a minimum of 13.9 years of follow-up, 5360 (44.9%) of these patients died. Proportional hazards modeling was used to fit a basic survival model with terms representing race, age, blood pressure, smoking, and obesity. Risk was increased with higher blood pressure, age, and smoking and with lower body mass index. For 6 HSTP clinics in an 11-state Stroke Belt (defined as states with stroke mortality > 10% above the United States average), the relative risk of death was 1.226 (95% confidence interval, 1.106-1.358) when compared with 9 states west of the Mississippi River. For two different groupings of southeastern states with 10 and 8 HSTP clinics the relative risk of death was 1.231 and 1.295.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of 'stroke-belt' residence, screening blood pressure and personal history risk factors on all-cause mortality among hypertensive veterans.

OBJECTIVES: To seek regional differences within the USA in the 'all-cause mortality' of hypertensive men during the 14 years following institution of antihypertensive treatment, and to determine how other pretreatment data can be related to that all-cause mortality. DESIGN: In the mid-1970s pretreatment clinical data were collected and computerized for 5698 hypertensive veterans. Deaths during the subsequent 14 years were obtained from the Veterans Administration Beneficiary Identification and Record Location System and the National Death Index. Relationships between pretreatment data and death were sought using chi 2- and z-tests for bivariate comparisons and logistic regression for multivariate analyses. PATIENTS: Half of the 5698 previously untreated male hypertensive military veterans were Black. Their mean age was 52.3 years and mean pretreatment blood pressure was 160/104 mmHg. Additional pretreatment data included body mass index, cigarette and alcohol usage, age and self-reported comorbidities. These patients began antihypertensive treatment during 1974-1975 in 28 special Veterans Administration outpatient clinics throughout the USA. RESULTS: During the 14 years after treatment began, 2283 of these patients (40%) died. Those from the southeastern USA, i.e. in the 'Stroke Belt', were 1.32-fold more likely to die than patients living elsewhere. Other pretreatment characteristics positively related to all-cause mortality included age, systolic blood pressure, cigarette and alcohol usage, and self-reported comorbidities. Race was unrelated to mortality. CONCLUSION: All-cause mortality was increased among hypertensive subjects from the southeastern USA. The reasons for this excess mortality remain unclear. Other pretreatment characteristics were also related to mortality, but race was not.

Childhood sexual abuse in anorexia nervosa and bulimia nervosa: a pilot study.

OBJECTIVES: The aims of this pilot study were to determine the feasibility and scientific merit of coordinating a large-scale investigation of childhood sexual abuse (CSA) in outpatient-eating disordered women and to evaluate the usefulness and potential adverse effects of a semistructured trauma interview. METHOD: The sample was randomly selected from subjects participating in a naturalistic longitudinal study of anorexia nervosa (AN) and bulimia nervosa (BN). The refusal rate was 26%. Twenty women with DSM-III-R AN/BN were assessed with the traumatic antecedents interview (TAI); a brief semistructured follow-up interview was administered over the telephone 3 to 8 weeks after the first interview. Subjects also completed the Dissociative Experiences Scale (DES). RESULTS: Thirteen subjects (65%) reported CSA, and those with more comorbidity reported CSA more frequently. Subjects with a history of CSA had significantly higher scores on the DES. Minimal adverse consequences to the TAI were noted. CONCLUSIONS: The high compliance rate, high prevalence of CSA, and high DES scores among our pilot sample support the merit of studying CSA in a larger sample.

Parental visitation in the post-anesthesia care unit: a means to lessen anxiety.

Programs that assist parents and children with coping during hospitalization may minimize the emotional trauma of hospitalization and improve both child and family well-being. The purpose of this study was to determine the effect of parental visitation in the Post-Anesthesia Care Unit (PACU) on pre- and postoperative anxiety levels of pediatric patients and parents. Sixty-eight patient-parent pairs were enrolled in the study: 20 before implementing parental visitation and 48 following implementation. Although no differences were found in children's anxiety levels pre- to postoperatively, the anxiety levels of parents who visited their children in the PACU were significantly lower postoperatively.