A preliminary study of dietary aluminium intake and risk of Alzheimer's disease.

BACKGROUND: epidemiological studies of Alzheimer's disease and aluminium intake have focused on aluminium in drinking water. There have been no studies investigating the relation between the disease and the consumption of foods containing large amounts of aluminium additives. OBJECTIVES: to conduct a pilot study to determine whether dietary intake of aluminium additives differs in individuals with and without Alzheimer's disease. DESIGN: matched case-control study. Controls were matched to cases on age, gender and date of admission to the centre. SETTING: Syracuse, New York, USA. SUBJECTS: 46 participants comprising 23 matched sets. METHODS: residents of the Loretto Geriatric Center with and without newly-diagnosed Alzheimer's disease were selected. Next-of-kin were asked to complete information on the resident's medical history, lifestyle behaviour and dietary intake before admission to the centre. An expanded form of the Health Habits and History Questionnaire was used to determine dietary intake. Consumption of foods containing elevated levels of aluminium additives was compared between cases and controls. RESULTS: the crude odds ratio for daily intake of foods containing high levels of aluminium was 2.0 and, when adjusted for covariates, was 8.6 (P=0.19). Intake of pancakes, waffles, biscuits, muffins, cornbread and/or corn tortillas differed significantly (P=0.025) between cases and controls. Adjusted odds ratios were also elevated for grain product desserts, American cheese, chocolate pudding or beverages, salt and chewing gum. However, the odds ratio was not elevated for tea consumption. CONCLUSION: past consumption of foods containing large amounts of aluminium additives differed between people with Alzheimer's disease and controls, suggesting that dietary intake of aluminium may affect the risk of developing this disease. Larger studies are warranted to corroborate or refute these preliminary findings.

Preoperative smoking habits and postoperative pulmonary complications.

OBJECTIVE: To examine the effect of preoperative smoking behavior on postoperative pulmonary complications. DESIGN: Prospective cohort study. SETTING: The Veterans Administration Medical Center, Syracuse, NY. PARTICIPANTS: Patients scheduled for noncardiac elective surgery (n=410). MEASUREMENTS AND RESULTS: Smoking status was determined by self-report. Postoperative pulmonary complications were determined by systematic extraction of medical record data. Postoperative pulmonary complications occurred in 31 of 141 (22.0%) current smokers, 24 of 187 (12.8%) past smokers, and 4 of 82 (4.9%) never smokers. The odds ratio (OR) for developing a postoperative pulmonary complication for current smokers vs never smokers was 5.5 (95% confidence interval [CI], 1.9 to 16.2) and 4.2 (95% CI, 1.2 to 14.8) after adjustment for type of surgery, type of anesthesia, abnormal chest radiograph, chronic cough, history of pulmonary disease, history of cardiac disease, history of COPD, education level, pulmonary function, body mass index, and age. Current smokers who reported reducing cigarette consumption prior to surgery were more likely to develop a complication compared with those who did not (adjusted OR=6.7, 95% CI, 2.6 to 17.1). CONCLUSIONS: Current smoking was associated with a nearly sixfold increase in risk for a postoperative pulmonary complication. Reduction in smoking within 1 month of surgery was not associated with a decreased risk of postoperative pulmonary complications.

Lead poisoning in telephone cable strippers: a new setting for an old problem.

Lead poisoning among workers processing lead sheathed telephone cable was identified at five worksites. High blood lead levels (BLLs) were identified during the medical evaluation of symptomatic workers following employer mandated air monitoring and through employer mandated blood lead levels. Once high BLLs were identified, governmental agencies became involved at every site, either as a result of worker complaints to OSHA or as a registry reporting mechanism. Workplace evaluation revealed significant overexposure to lead, particularly among workers mechanically stripping the lead sheaths. After intervention by a government agency, four of the workplaces chose to stop lead cable processing. Because the ongoing replacement of lead sheathed telephone cable with fiber optics may be continuing in many areas of the country, there is concern that the clusters we have identified represents a widespread and little recognized setting for lead overexposure. Recommendations for preventing overexposure to lead in this setting are given.

Indicators of poor dietary habits in a high risk population.

OBJECTIVE: This study was conducted to determine whether individuals attending an urban outpatient clinic met the National Health Promotion and Disease Prevention nutritional objectives and to assess factors associated with poor dietary habits. METHODS: Individuals who attended the general medicine outpatient clinic at the State University of New York Health Science Center in Syracuse were interviewed using an expanded version of the Health Habits and History Questionnaire. Usual dietary intake, medical history, occupation, stress, physical activity, tobacco use and other life-style factors were recorded. Of particular interest were the percentage of calories from fat in the diet and whether individuals consumed the daily requirements of the base-foods in the USDA Pyramid (grains, vegetables and fruits). Unconditional logistic regression was used to determine odds ratios (OR) and 95% confidence intervals for variables associated with high fat consumption and low consumption of vegetables, fruit and high-fiber grains. RESULTS: None of the patients met the minimal recommended daily servings for the three base-food categories combined (grains, vegetables and fruits) and 84% of subjects had fat intakes which constituted over 30% of daily energy intake. Individuals with less education, who were disabled or unemployed, and who participated in little physical activity were twice as likely to have poor dietary habits (i.e. low consumption of vegetables, fruit, and/or high-fiber grains) as other subjects (p < 0.05). Younger patients (20-49 years of age), especially those who were nonsmokers and who reported little physical activity were more likely to consume fat and less likely to consume fruit than older patients (> or = 50 years of age). Nonwhite subjects were less likely to consume high-fiber grains and whole-wheat breads than white patients (p = 0.04). CONCLUSIONS: Nutritional screening should be considered for all patients attending similar inner-city general medicine clinics, regardless of the primary diagnosis in order to provide early dietary intervention. In particular, young adults, the unemployed, and the disabled should not be overlooked.

A survey of alcohol use in an inner-city ambulatory care setting.

OBJECTIVE: To measure the prevalence of current drinking and potential problem drinking in an inner-city ambulatory care setting, using the CAGE questionnaire. DESIGN: Survey of patients attending ambulatory care clinics, using structured personal interviews. SETTING: Three ambulatory care clinics serving an indigent, predominantly black population of metropolitan Atlanta: a general medical appointment clinic, a walk-in clinic, and a neighborhood primary care clinic. PATIENTS/PARTICIPANTS: Patients over the age of 18 who attended one of the above clinics on a day when interviewers were available and who were estimated to have more than a 45-minute wait prior to seeing their health provider. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: 15.3% of subjects had CAGE scores greater than or equal to 2 (95% CI 12.2, 19.0). A CAGE score of greater than or equal to 2 was almost three times more common in men than in women, 26.7% vs. 9.5%. Only 8.6% (95% CI 6.3, 11.7) of subjects reported drinking greater than or equal to 2 drinks per day. These findings suggest that problem drinking may affect as many as one in six people seeking care in inner-city ambulatory care clinics and provide support for the use of screening instruments such as the CAGE questionnaire for improved sensitivity in detecting alcoholism in these practice settings.

A cost-effectiveness analysis of cyclosporine in cadaveric kidney transplantation.

Expected costs and health outcomes associated with cadaveric kidney transplantation using cyclosporine (CsA) plus steroids, azathioprine (Aza) plus steroids, and "dialysis only" were estimated from both a societal perspective and a Medicare perspective. Published data on patient and graft survival and treatment costs were incorporated into a Markov model to predict the ten-year experience of hypothetical cohorts of 1,000 35-year-old persons with end-stage renal disease (ESRD) exposed to each treatment option. In the base-case analysis conducted from the societal perspective, ten-year cumulative costs for the "dialysis only," CsA, and Aza cohorts were $181, $147, and $138 million, respectively. Transplantation using CsA rather than Aza would cost an estimated $19,800 per additional life-year and $9,700 per additional graft-year; whereas from Medicare's perspective, CsA would be less costly than Aza. This analysis suggests that under present regulations, widespread use of CsA instead of Aza for cadaveric graft recipients would result in significant cost shifting from Medicare to the private sector; but from a societal perspective, this would result in no, or at worst, relatively inconsequential, additional health expenditures. A policy whereby dollar savings achieved by Medicare from improved graft survival were used to help underwrite the cost of CsA for cadaveric kidney transplants would promote access to this drug and have little impact on the overall cost of care for individuals with ESRD.

Cost-effectiveness of computerized tomography and magnetic resonance imaging in dementia.

The benefits and costs of routinely using computerized tomography (CT) to diagnose surgically treatable causes of dementia compared to a more selective strategy were assessed, using a decision-analytic model, for hypothetical cohorts at 60, 70, and 80 years of age. The model was also used to project what the impact would be if magnetic resonance imaging (MRI) were to replace CT, assuming that MRI is a perfect test. Given plausible assumptions, routine CT could be expected to detect between 1 425 and 14 930 additional surgically treatable cases at an extra cost of between $0 and $49 million per 100 000 persons scanned. Replacing CT with MRI might yield an additional 70 to 150 cases of surgically treatable dementia, at an additional cost of $20-$30 million. Given current treatment limitations in dementia, it appears that, as a clinical tool, MRI will have little immediate health impact on this problem.

Occurrence of erythema chronicum migrans and Lyme disease among children in two noncontiguous Connecticut counties.

In May-November 1977 erythema chronicum migrans of Lyme arthritis occurred in at least 12 children in New London County, Connecticut, east of the original 3-town epidemic focus. The attack rate (0.15 cases per 1,000 persons under 18) was considerably lower than within the focus itself but similar to the rate in towns west of the focus. No cases were identified in Litchfield County in northwest Connecticut. Observed rates of Lyme disease varied markedly within Connecticut in 1977.

Reiter's syndrome following epidemic shigellosis.

To define the epidemiology of post-dysenteric Reiter's syndrome (RS), 1,162 persons were questioned about compatible symptoms soon after 3 separate outbreaks of shigellosis. We diagnosed RS for 3 women of 204 persons ill during an outbreak of Shigella flexneri 1b, for 3 women of 206 ill during an outbreak of S. flexneri 2a, and for none of 85 ill during an outbreak of S. sonnei. We found no RS among 667 persons without diarrhea. Prospective controlled investigations in defined populations documented that RS follows S. flexneri 1b as well as 2a infections in about 1.5% of white adults with dysentery and indicated that women develop post-dysenteric RS as often as men.

Pemphigus in Hartford County, Connecticut, from 1972 to 1977.

An investigation of a possible cluster of pemphigus cases that were diagnosed in Hartford County, Connecticut, in 1977 provided data for estimating the incidence of this disease in a defined population for the years 1972 to 1977. The average annual incidence (new cases per population per year) estimated for the overall adult population (over the age of 20 years) was 0.42 cases per 100,000 people, whereas that for Jewish adults was 3.2 cases per 100,000. Thus, the results of this report both support the hypothesis that Jewish people are at higher risk than others for the development of pemphigus and provide a basis for comparison with the results of other studies of this disease.