Development of a paperless, Y2K compliant exposure tracking database at Los Alamos National Laboratory.

The Industrial Hygiene and Safety Group at Los Alamos National Laboratory (LANL) developed a database application known as IH DataView, which manages industrial hygiene monitoring data. IH DataView replaces a LANL legacy system, IHSD, that restricted user access to a single point of data entry needed enhancements that support new operational requirements, and was not Year 2000 (Y2K) compliant. IH DataView features a comprehensive suite of data collection and tracking capabilities. Through the use of Oracle database management and application development tools, the system is Y2K compliant and Web enabled for easy deployment and user access via the Internet. System accessibility is particularly important because LANL operations are spread over 43 square miles, and industrial hygienists (IHs) located across the laboratory will use the system. IH DataView shows promise of being useful in the future because it eliminates these problems. It has a flexible architecture and sophisticated capability to collect, track, and analyze data in easy-to-use form.

NHMRC workshop on non-pharmacological methods of lowering blood pressure. Psychological methods of lowering blood pressure.

Brief descriptions are given of the main methods of psychological intervention for controlling blood pressure and comments are made on their usefulness as gathered from recent reviews of the subject. Over-all assessment suggests that they are of value in the treatment of some patients with hypertension, mainly as adjuncts to pharmacological therapy, with relaxation, meditation and biofeedback techniques in order of decreasing effectiveness. Although the reduction in blood pressure produced is generally small, it is comparable with that produced by drugs, and was associated with a 30% reduction in the incidence of morbid events in the Australian therapeutic trial in mild hypertension. Further research integrating the behavioural, biological, and pharmacological aspects of blood pressure control is needed.

State and trait anxiety correlates of illness behavior in survivors of myocardial infarction.

State and trait anxiety correlates of eight dimensions of illness behavior in response to myocardial infarction, were examined for 120 survivors of myocardial infarction. Six of eight illness behavior dimensions were found to be significantly associated with measures of state anxiety or trait anxiety or both. Trait anxiety was most predominently associated with illness behavior, inviting the conclusion that those persons who normally respond to crises with difficulty, will behave similarly in response to serious illness. It was suggested that recognition of this may be of use to clinicians faced with the care of survivors of myocardial infarction.

Life events and myocardial infarction revisited: the role of measures of individual impact.

This study was conducted to test the hypothesis that patients with MI are distinguished from persons with a less serious illness, more by subjective interpretations of the emotional impact of life events than by exposure to a surfeit of life events that purportedly representative samples of the population have judged to be inherently stressful. Life events data consisting of frequency of events in the year prior to illness onset, cumulative weights of life change and distress derived from magnitude estimation scales, and visual analogue scales assessing the individually interpreted impact of events were collected for 120 patients with unequivocal MI, and contrasted with the same data collected for 40 patients admitted to coronary care but rapidly discharged without a diagnosis of MI or other serious illness. Differences between the two groups were not evident for life event frequency, magnitude estimation scales of life change and distress, or individual impact scales of life change. Individual impact scales of emotional distress did, however, distinguish between the two groups at a statistically significant level, suggesting that patients with MI have interpreted their life event exposure in the year prior to illness onset as being particularly emotionally distressing. While there may be methodological criticism of the research strategy used in the study, it is suggested that due regard for the experiential uniqueness of life event data has strengthened the relationship between life events and MI, which would not have become apparent with the application of a more conservative research strategy.

A typology of responses to illness in survivors of myocardial infarction.

One hundred and eighteen survivors of myocardial infarction were assigned scores on eight dimensions of illness behaviour recently described as arising in response to myocardial infarction. These data were subjected to a cluster analysis to produce an optimal solution of four homogeneous clusters of patients. The first contained patients who, on clinical grounds, appeared to be claiming illness as a highly significant and consequential occurrence in their lives; the second accepted illness but experienced a marked affective response to it; the third appeared to adopt a realistic approach to illness and be coping adequately; and the fourth seemed to be denying (or at least minimizing) both the presence of serious illness and its possible consequences. These findings were discussed in terms of their bearing on prognosis, within the context of abnormal illness behaviour.

The relative importance of the major risk factors in atherosclerotic and other diseases.

Examination of results from the Framingham study shows considerable disparity between the various clinical conditions which are grouped together as atherosclerotic diseases in their relationship to systolic blood pressure, serum cholesterol level and cigarette smoking. The outstanding features are the dominance of blood pressure in cerebral conditions and the apparent unimportance of smoking in angina pectoris. Analysis of results from the National Co-operative Pooling Project shows that up to 70% of cardiac conditions in this category may be related to these three risk factors with each being of approximately equal importance. Further evidence suggesting that these factors are of greater importance than is commonly realised for non-cardiovascular deaths has been derived from results in the Chicago Peoples Gas Company Study. Though not conclusive, it is hoped that this analysis adds perspective to considerations of pathogenesis and prevention.

A perspective view of dieting to lower the blood cholesterol.

As a guide to physicians, patients, and potential patients concerned with the prospect and practicalities of changing the diet to lower the blood cholesterol in the hope of preventing disease, estimates have been made of the importance of various items of food which figure prominently in relation to this topic. The measure of importance adopted is the predicted average servings of these foods, the prediction being based on the content of fatty acids and cholesterol. The major contributors, each adding more than 10 mg/100 ml to the plasma level, include brains, double servings of meat, one egg per day, and butter. At the other extreme, polyunsaturated oils and margarines actively lower plasma cholesterol while oysters, skim milk, and nuts have practically no effect. The relative importance of items, includeing the newer polyunsaturated ruminant meats and other products, has been charted for easy reference. The culinary costs involved in a cholesterol-lowering diet, considered not in monetary terms but as debits and credits in the food statement, must be balances against the potential benefits to be gained from disease prevention.

Potential effect on coronary-heart-disease morbidity of lowering the blood-cholesterol.

As a practical aid to physicians and patients facing the decision whether or not to embark upon a life-long lipid-lowering regimen in the hope of preventing coronary heart-disease, estimates have been made of the potential benefits to be gained from lowering the plasma-cholesterol over a period of 20 years. The estimates have been derived from analyses of experiences in the Framingham population study. The results suggest that if 100 men who are non-smokers, with normal blood-pressure and electrocardiogram, lower their plasma-cholesterol from 310 to 260 mg. per 100 ml. starting at 35 years of age, 6 could potentially benefit by avoiding a coronary incident, 94 would be likely to follow the regimen without apparent benefit, and 8 of these would have an attack within 20 years despite adherence to the regimen. The potential benefit is less for women and for those who start the regimen at an older age. It is greater if cholesterol is lowered further and if other risk factors are present: for instance, 29 of 100 men starting at age 35 who are ciagrette smokers with moderate hypertension and left-ventricular hypertrophy and who reduce their plasma-cholesterol concentration from 310 to 210 mg. per 100 ml. would benefit.

Comprehensive one-day renal function testing in man.

A comprehensive one-day renal function test consisting of a single outpatient visit lasting nine hours, with a minimum of time off work or away from home, is described in detail. Although a large number of laboratory tests are performed in one day, patients usually appreciate thoroughness, and the cost is more than offset by the saving in occupancy of hospital beds and by the early and precise diagnosis of reversible aspects of renal disease. Some aspects of improved methodology, such as the sequential determination of minimum urinary pH, bicarbonate, titratable acid, ammonium, and total acid on a single sample using an automatic titrator, are given in detail. Clinical application of the comprehensive nine-hour renal function testing system is illustrated by the result sheet of a patient with analgesic nephropathy, who was shown in one day to have secondary severe renal failure (glomerular filtration rate 20% of normal for age and surface area), renal tubular acidosis of the distal gradient type (minimum urinary pH 6.20), increased urinary white cell excretion rate, hyaline casts, and absence of red cell casts, consistent with a diagnosis of analgesic nephropathy and urinary tract inflammation. Normal values with 95% range for this laboratory are also given. This testing system has been found to be very useful in investigating patients with analgesic nephropathy, renal tubular acidosis, and after renal transplantation.