Acute and chronic disability among U.S. farmers and pesticide applicators: the National Health Interview Survey (NHIS).

The National Health Interview Survey (NHIS) is a multipurpose household survey of the U.S. civilian non-institutionalized population conducted annually since 1957. From 1986 to 1994, over 450,000 U.S. workers, age 18 years and older, participated in a probability sampling of the entire non-institutionalized U.S. population; variables collected included a range of measures of acute and chronic disability. The objective of the present study was to assess predictors of health status, and acute and chronic disability for farmers and pesticide applicators (pesticide-exposed workers) compared to all other U.S. workers using the 1986-1994 NHIS. After adjustment for sample weights and design effects using SUDAAN, several measures of acute and chronic disability and health status were modeled with multiple logistic regression. Farmers (n = 9576) were significantly older compared to all other U.S. workers (n = 453,219) and pesticide applicators (n = 180). Farmers and pesticide applicators had a higher proportion of males, whites, and Hispanics and were less educated. After adjusting for age, gender, race-ethnicity, and education, compared to all other workers, farmers were significantly less likely to report acute and chronic disability and health conditions, while pesticide applicators were more likely to report chronic disability, health conditions, and poor health. Given the cross-sectional nature of the data and the significant job demands of farming, both leading to a relative healthy worker effect, the present results indicate that at any point in time, farmers report less acute and chronic disability, compared to other U.S. workers, whereas pesticide applicators report similar or poorer health.

Design and analysis of multiple choice feeding preference data.

Traditional analyses of feeding experiments that test consumer preference for an array of foods suffer from several defects. We have modified the experimental design to incorporate into a multivariate analysis the variance due to autogenic change in control replicates. Our design allows the multiple foods to be physically paired with their control counterparts. This physical proximity of the multiple food choices in control/experimental pairs ensures that the variance attributable to external environmental factors jointly affects all combinations within each replicate. Our variance term, therefore, is not a contrived estimate as is the case for the random pairing strategy proposed by previous studies. The statistical analysis then proceeds using standard multivariate statistical tests. We conducted a multiple choice feeding experiment using our experimental design and utilized a Monte Carlo analysis to compare our results with those obtained from an experimental design that employed the random pairing strategy. Our experimental design allowed detection of moderate differences among feeding means when the random design did not.

The effect of knee and foot position on the electromyographical activity of the superficial quadriceps.

Isometric quadriceps exercises are used early in knee rehabilitation. Varying knee or foot position is hypothesized to selectively activate specific quadriceps muscles. This study examined the activities of the vastus medialis oblique, vastus lateralis, and rectus femoris during isometric contractions at 90 degrees, 150 degrees, and 175 degrees knee angles with internally rotated, neutral, and externally rotated foot positions. Subjects performed three perceived maximal isometric contractions at each knee angle/foot position while electromyographic activity (EMG) was collected. Statistical analysis consisted of a three-way repeated measures multiple analysis of variance, with post hoc analysis as was appropriate. Although no significant differences were detected among foot positions for the rectus femoris at 90 degrees, this knee angle produced significantly greater EMG activity for the neutral position compared with 150 degrees or 175 degrees. The 90 degrees angle was also superior to 175 degrees for the externally rotated position. The results for both the vastus medialis and vastus lateralis were similar, with the 90 degrees angle producing greater EMG activity than 175 degrees in the externally rotated position. In addition, the neutral position produced significantly more activity than the internally rotated position at 90 degrees. At 150 degrees, the neutral position was superior to the externally rotated position. Finally, at the 175 degrees knee angle, the highest level of EMG activity was with the foot internally rotated. Considering the combination of effects for EMG activity across all muscles tested, the 90 degrees knee angle with a neutral foot position may provide the most effective condition for rehabilitation of all muscles tested.(ABSTRACT TRUNCATED AT 250 WORDS)

Group A beta-hemolytic streptococcal bacteremia in a patient with sickle cell anemia on penicillin prophylaxis.

Serious invasive bacterial infections, particularly those due to Streptococcus pneumoniae and Hemophilus influenzae, are a well-known complication in patients with sickle cell disease. Early penicillin prophylaxis has been shown to prevent these infections and also to improve survival. This article describes a child with sickle cell anemia who, while on penicillin prophylaxis, developed a group A streptococcal bacteremia, a pathogen not commonly associated with bacteremia in sickle cell disease.

Puncture technique and portals of entry for diagnostic and operative arthroscopy of the temporomandibular joint.

Cadaveric research, expansion of successful arthrography techniques, and improved understanding of normal anatomy, pathology, and open surgery have led to the development of safe, repeatable, and effective puncture techniques and portals of entry in the temporomandibular joint. Single and multiple punctures are described. Two-year outcomes of operative procedures with favorable results are presented for 145 joints in 95 patients. Complications are discussed.

Nucleus reticularis lateralis involvement in the pressor component of the cerebral ischemic response.

Lesions of the ventromedial portion of the nucleus reticularis lateralis (NRL) of the medulla oblongata in the rabbit significantly and markedly reduced the pressor component of the cerebral ischemic response (CIR) without altering vasomotor tone. Use of horseradish peroxidase as an anterograde and retrograde tracer indicated that the ventromedial NRL projects to the intermediolateral cell column (IML) of the upper thoracic spinal cord. Injections of glutamate into ventromedial NRL elevated blood pressure (BP), indicating that neuronal cell bodies in this area are capable of eliciting BP elevations when stimulated. These findings suggest that cell bodies in the ventromedial NRL are capable of eliciting pressor responses during the CIR via direct projections to sympathetic preganglionic cell bodies.

Posttraumatic meningitis due to Hemophilus influenzae type A.

Posttraumatic meningitis is uncommon in children. This case report describes a 4-year-old child with this complication caused by an unusual type of Hemophilus influenzae. The efficacy of routine use of antibiotics in preventing posttraumatic meningitis remains uncertain. However, this report suggests that in the presence of prolonged fever and clinical evidence of a dural tear, antibiotic treatment is warranted.

Ten years of experience with falls from a height in children.

Falls from a height are a major cause of accidental death in urban children. The medical and social data on 61 children admitted over the last decade for falls of one or more stories were reviewed. Seventy-seven percent of the children survived. Of the children who fell three stories or less, all survived (100%). Fifty percent mortality occurred between the fifth and sixth floors. Seventy-seven percent of the falls were accidental and 23% of the children jumped or were pushed. The 96% decrease in accidental falls from windows since 1979 demonstrates that the "Children Can't Fly" program in New York City has almost eliminated accidental falls from windows in our hospital population.

Cardiovascular responses elicited by hypothalamic stimulation in rabbits reveal a mediolateral organization.

Heart rate and blood pressure response patterns were elicited by relatively low intensity (approximately 0.2 mA) stimulation (10 s trains; 100 pulses/s; 0.25 ms pulse duration) in different regions of the hypothalamus in anesthetized rabbits. A bradycardia/depressor pattern was elicited from both anterior and posterior stimulating electrode sites in the far lateral hypothalamus. Medial sites including the ventromedial hypothalamus elicited a tachycardia/pressor pattern. A bradycardia/pressor pattern was elicited from both the anterior and posterior hypothalamus at sites between the lateral hypothalamic (bradycardia/depressor) and the medial hypothalamic (tachycardia/pressor) zones. Paralysis by injection of decamethonium in conjunction with artificial ventilation did not reveal systematic differences in cardiovascular response threshold, form, or magnitude between the paralyzed and non-paralyzed state, indicating that the cardiovascular response patterns were not secondary to changes in respiration. Bilateral vagotomy abolished the bradycardia responses evoked by hypothalamic stimulation indicating that the cardiodeceleration was mediated by the vagus nerves; vagotomy attenuated tachycardia responses indicating that the responses in part reflected a decrease in vagal restraint. Bradycardia responses to ipsilateral but not contralateral hypothalamic stimulation were attenuated or abolished when examined 10-14 days after unilateral destruction of the central nucleus of the amygdala. This indicates that the bradycardia responses elicited by hypothalamic stimulation are in part mediated by fibers of passage. Stimulation of lateral hypothalamic sites eliciting a bradycardia/depressor pattern in anesthetized rabbits, evoked mild orienting in the same animals when conscious, whereas medial hypothalamic sites producing the tachycardia/pressor response pattern in anesthetized animals elicited intense excitement with autonomic concomitants in the nonanesthetized state. The results indicate that the rabbit hypothalamus has a mediolateral organization in terms of at least some cardiovascular and behavioral responses to intracranial stimulation.