Showing papers by "Centers for Disease Control and Prevention published in 1990"
TL;DR: The authors analyzed National Hospital Discharge Survey data for the years 1979-1984 to describe the epidemiology of appendicitis and appendectomy in the United States and found that for the elderly, the preventive value of an incidental procedure is considerably lower.
Abstract: Addlss, D. G. (CDC, Atlanta, GA 30333), N. Shaffer, B. S. Fowler, and R. V. Tauxe. The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol 1990;132:910-25. To describe the epidemiology of appendicitis and appendectomy in the United States, the authors analyzed National Hospital Discharge Survey data for the years 1979-1984. Approximately 250,000 cases of appendicitis occurred annually in the United States during this period, accounting for an estimated 1 million hospital days per year. The highest incidence of primary positive appendectomy (appendicitis) was found in persons aged 10-19 years (23.3 per 10,000 population per year); males had higher rates of appendicitis than females for all age groups (overall rate ratio, 1.4:1). Racial, geographic, and seasonal differences were also noted. Appendicitis rates were 1.5 times higher for whites than for nonwhites, highest (15.4 per 10,000 population per year) in the west north central region, and 11.3% higher in the summer than in the winter months. The highest rate of incidental appendectomy was found in women aged 35-44 years (43.8 per 10,000 population per year), 12.1 times higher than the rate for men of the same age. Between 1970 and 1984, the incidence of appendicitis decreased by 14.6%; reasons for this decline are unknown. A life table model suggests that the lifetime risk of appendicitis is 8.6% for males and 6.7% for females; the lifetime risk of appendectomy Is 12.0% for males and 23.1% for females. Overall, an estimated 36 incidental procedures are performed to prevent one case of appendicitis; for the elderly, the preventive value of an incidental procedure is considerably lower.
1,862 citations
TL;DR: A PCR typing method was devised in which each human serotype virus produced a characteristic segment size, readily identifiable in agarose gels, which provided a rapid and efficient means of obtaining large quantities of cDNA suitable for sequencing, cloning, and other genetic studies, precluding the need for cell culture and virus purification.
Abstract: The rotavirus gene segment coding for the major outer capsid glycoprotein vp7 was amplified directly from stool specimens by the polymerase chain reaction (PCR). Double-stranded RNA extracted from stool samples was used as the template for reverse transcription, which was followed immediately and in the same reaction mix with amplification, using the Taq polymerase. Various conditions were examined to optimize the yield of the amplified gene. The concentrations of MgCl2, dimethyl sulfoxide, and template RNA were critical. The choice of primer pairs allowed amplification of the entire segment or specific portions. By using type-specific primers derived from distinct regions on the gene, we devised a PCR typing method in which each human serotype virus produced a characteristic segment size, readily identifiable in agarose gels. The PCR typing method was applied to 10 rotavirus reference strains, including all 6 known human serotypes (serotypes 1, 2, 3, 4, 8, and 9), and to 34 stool specimens previously serotyped by an enzyme immunoassay with monoclonal antibodies. An absolute correlation was found between the molecular and serologic methods. In addition, 14 stool specimens nonserotypable by an enzyme immunoassay with monoclonal antibodies could be typed by the PCR method. Besides the application for rotavirus detection and typing directly from stools, the PCR method provides a rapid and efficient means of obtaining large quantities of cDNA suitable for sequencing, cloning, and other genetic studies, precluding the need for cell culture and virus purification.
1,524 citations
TL;DR: Kaposi's sarcoma in persons with AIDS may be caused by an as yet unidentified infectious agent, transmitted mainly by sexual contact.
1,051 citations
TL;DR: Depressed smokers were 40% less likely to have quit compared with nondepressed smokers and adjusted for amount smoked, sex, age, and educational attainment by means of a Cox proportional hazards model found that depression plays an important role in the dynamics of cigarette smoking in the United States.
Abstract: Data from multiple studies suggest that depression plays a role in cigarette smoking. To obtain a national perspective on the role of depression in the dynamics of smoking, we analyzed data from the first National Health and Nutrition Examination Survey and the National Health and Nutrition Examination Survey Epidemiologic Follow-up Study. We used the Center for Epidemiologic Studies Depression Scale to assess symptoms of depression and used the standard cutoff (score, ≥16) for defining persons as depressed. The cross-sectional analysis of the first National Health and Nutrition Examination Survey showed that the prevalence of current smokers increased as the Center for Epidemiologic Studies Depression Scale score increased, whereas the quit ratio (former smokers/ever smokers) decreased as the Center for Epidemiologic Studies Depression Scale score increased. Among the cohort of smokers in the National Health and Nutrition Examination Survey Epidemiologic Follow-up Study, the estimated incidence of quitting after 9 years of follow-up was 9.9% for depressed smokers and 17.7% for nondepressed smokers. When we adjusted for amount smoked, sex, age, and educational attainment by means of a Cox proportional hazards model, we found that depressed smokers were 40% less likely to have quit compared with nondepressed smokers (relative risk, 0.6). These findings suggest that depression plays an important role in the dynamics of cigarette smoking in the United States. ( JAMA . 1990;264:1541-1545)
896 citations
TL;DR: Et1.1 represents a portion of the genome of the principal viral agent, to be named hepatitis E virus, which is responsible for epidemic outbreaks of ET-NANBH, and specifically identified similar sequences in complementary DNA prepared from infected human fecal samples collected from five geographically distinct ET- NANH outbreaks.
Abstract: Major epidemic outbreaks of viral hepatitis in underdeveloped countries result from a type of non-A, non-B hepatitis distinct from the parenterally transmitted form. The viral agent responsible for this form of epidemic, or enterically transmitted non-A, non-B hepatitis (ET-NANBH), has been serially transmitted in cynomolgus macaques (cynos) and has resulted in typical elevation in liver enzymes and the detection of characteristic virus-like particles (VLPs) in both feces and bile. Infectious bile was used for the construction of recombinant complementary DNA libraries. One clone, ET1.1, was exogenous to uninfected human and cyno genomic liver DNA, as well as to genomic DNA from infected cyno liver. ET1.1 did however, hybridize to an approximately 7.6-kilobase RNA species present only in infected cyno liver. The translated nucleic acid sequence of a portion of ET1.1 had a consensus amino acid motif consistent with an RNA-directed RNA polymerase; this enzyme is present in all positive strand RNA viruses. Furthermore, ET1.1 specifically identified similar sequences in complementary DNA prepared from infected human fecal samples collected from five geographically distinct ET-NANBH outbreaks. Therefore, ET1.1 represents a portion of the genome of the principal viral agent, to be named hepatitis E virus, which is responsible for epidemic outbreaks of ET-NANBH.
789 citations
TL;DR: A prospective, laboratory-based surveillance project obtained accurate data on meningitis in a population of 34 million people during 1986, suggesting that improvements in early detection and antibiotic treatment may have occurred since that time.
Abstract: A prospective, laboratory-based surveillance project obtained accurate data on meningitis in a population of 34 million people during 1986. Haemophilus influenzae was the most common cause of bacterial meningitis (45%), followed by Streptococcus pneumoniae (18%), and Neisseria meningitidis (14%). Rates of H. influenzae meningitis varied significantly by region, from 1.9/100,000 in New Jersey to 4.0/100,000 in Washington state. The overall case fatality rates for meningitis were lower than those reported in several studies from the early 1970s, suggesting that improvements in early detection and antibiotic treatment may have occurred since that time. Concurrent surveillance was also performed for all invasive disease due to the five most common causes of bacterial meningitis. Serotypes of group B streptococcus other than type III caused more than half of neonatal group B streptococcal disease and mortality, suggesting that an optimal vaccine preparation must be multivalent. Of the organisms evaluated, group B streptococcus was the second most common cause of invasive disease in persons greater than 5 years old.
785 citations
TL;DR: Over the past 5 years Salmonella enteritidis infections in humans have increased on both sides of the Atlantic ocean, and investigations in individual countries suggest it is related to consumption of eggs and poultry which harbour the organism.
Abstract: Over the past 5 years Salmonella enteritidis infections in humans have increased on both sides of the Atlantic ocean The WHO salmonella surveillance data for 1979-87 were reviewed and show that S enteritidis appears to be increasing on at least the continents of North America, South America, and Europe, and may include Africa S enteritidis isolates increased in 24 (69%) of 35 countries between 1979 and 1987 In 1979, only 2 (10%) of 21 countries with reported data reported S enteritidis as their most common salmonella serotype; in 1987, 9 (43%) of 21 countries reported S enteritidis as their most common serotype; 8 (89%) of 9 were European countries Although the reason for the global increase is not yet clear, investigations in individual countries suggest it is related to consumption of eggs and poultry which harbour the organism
718 citations
TL;DR: Findings show that anti-C100-3-positive patients with chronic post-transfusion NANBH are likely to be viraemic; confirm that antibodies to C 100-3 are a marker for infectivity; and suggest that the prevalence of HCV infections may be underestimated from the frequency of antibodies to cDNA/polymerase chain reaction alone.
711 citations
TL;DR: Patients in whom Crohn's disease was diagnosed before age 30 with any colonic involvement at diagnosis had a higher relative risk than those diagnosed at older ages, and duration of follow-up did not affect risk.
682 citations
TL;DR: The Atlanta Birth Defects Case-Control Study evaluated the risks for malformations among babies born to residents of Metropolitan Atlanta between 1968 and 1980 and found no statistically significant differences among infants of mothers with gestational diabetes mellitus who did not require insulin during pregnancy.
Abstract: Although the excess risk for birth defects among children of mothers with diabetes mellitus is well documented, there are few data concerning the risk for specific malformations. In the Atlanta Birth Defects Case-Control Study, those risks for malformations were evaluated. The population-based study included 4929 live and stillborn babies with major malformations ascertained by the Metropolitan Atlanta Congenital Defects Program in the first year of life born to residents of Metropolitan Atlanta between 1968 and 1980. The study also included 3029 nonmalformed live babies who were frequency-matched to case babies by race, period of birth, and hospital of birth. The relative risk for major malformations among infants of mothers with insulin-dependent diabetes mellitus (n = 28) was 7.9 (95% confidence interval [CI]1.9, 33.5) compared with infants of nondiabetic mothers. The relative risks for major central nervous system and cardiovascular system defects were 15.5 (95% CI = 3.3, 73.8) and 18.0 (95% CI = 3.9, 82.5), respectively. The absolute risks for major, central nervous system, and cardiovascular system malformations among infants of diabetic mothers were 18.4, 5.3, and 8.5 per 100 live births, respectively. Infants of mothers with gestational diabetes mellitus who required insulin during the third trimester of pregnancy were 20.6 (95% CI = 2.5, 168.5) times more likely to have major cardiovascular system defects than infants of nondiabetic mothers. The absolute risk for infants of this group of diabetic mothers was 9.7%. No statistically significant differences were found among infants of mothers with gestational diabetes mellitus who did not require insulin during pregnancy.(ABSTRACT TRUNCATED AT 250 WORDS)
593 citations
TL;DR: Patients with no history of transfusions were just as likely to be positive for antibody to hepatitis C virus as patients with transfusion-associated hepatitis, indicating that hepatitis Cirus is the major causative agent of all non-A, non-B hepatitis in the United States.
Abstract: The Centers for Disease Control conducted intensive surveillance for acute non-A, non-B hepatitis in four sentinel counties over a 7-year period. Testing for antibody to hepatitis C virus was performed with the newly developed enzyme immunoassay. The incidence of non-A, non-B hepatitis remained relatively stable (average, 7.1 cases per 100 000), but there were significant changes in disease transmission patterns. The proportion of patients with a history of blood transfusion declined from 17% to 6%, but the proportion with a history of parenteral drug use increased from 21% to 42%. The proportion of patients with histories of sexual exposure (6%), household exposure (3%), occupational exposure to blood (2%), or hemodialysis (0.6%) did not change over time. Antibody to hepatitis C virus was found in 45% of patients within 6 weeks of onset of illness and in 68% of patients followed up for at least 6 months. Patients with no history of transfusions were just as likely to be positive for antibody to hepatitis C virus as patients with transfusion-associated hepatitis, indicating that hepatitis C virus is the major causative agent of all non-A, non-B hepatitis in the United States. ( JAMA . 1990;264:2231-2235)
TL;DR: The etiologic agents and food vehicles associated with the 7458 outbreaks of foodborne disease reported to the Centers for Disease Control between 1973 and 1987 were examined and bacterial pathogens accounted for 90% of deaths, with L. monocytogenes and Clostridium botulinum having the highest death-to-case ratios.
TL;DR: The study suggests that PRn titers less than or equal to 120 were not protective against measles disease and illness without rash due to measles may occur in persons with PRN titers above this level.
Abstract: A school blood drive before a measles outbreak permitted correlation of preexposure measles antibody titers with clinical protection using the plaque reduction neutralization (PRN) test and an EIA. Of 9 donors with detectable preexposure PRN titer less than or equal to 120, 8 met the clinical criteria for measles (7 seroconfirmed) compared with none of 71 with preexposure PRN titers greater than 120 (P less than .0001). Seven of 11 donors with preexposure PRN titers of 216-874 had a greater than or equal to 4-fold rise in antibody titer (mean, 43-fold) compared with none of 7 with a preexposure PRN titer greater than or equal to 1052 (P less than .02). Of 37 noncases with preexposure PRN titer less than 1052, 26 (70%) reported one or more symptoms compared with 11 (31%) of 35 donors with preexposure PRN titers greater than or equal to 1052 (P less than .002). By EIA, no case had detectable preexposure antibody; the preexposure geometric mean titer of asymptomatic donors (220) was not significantly higher than that of symptomatic donors who did not meet the clinical criteria for measles (153) (P = .10). The study suggests that PRN titers less than or equal to 120 were not protective against measles disease and illness without rash due to measles may occur in persons with PRN titers above this level.
TL;DR: The rate of fall injury events coming to acute medical attention increased exponentially with age for both elderly men and women (predominantly white), reaching a high for those aged 85 years or more of 138.5 per 1,000 for males and 158.8 for females.
Abstract: Falls are a leading cause of death from injury among older persons in the United States, and about one in three older persons falls each year. Yet, reliable estimates of the incidence of fall injury events in a population-based setting are not readily available. Therefore, the authors analyzed population-based surveillance data, between July 1985 and June 1987, from the Study to Assess Falls Among the Elderly, Miami Beach, Florida. The rate of fall injury events coming to acute medical attention increased exponentially with age for both elderly men and women (predominantly white), reaching a high for those aged 85 years or more of 138.5 per 1,000 for males and 158.8 per 1,000 for females. Compared with males, females had a higher incidence of fractures other than skull. Males were nearly twice as likely to die, however, following a fall injury event than were females. Of those fall injury events identified through the surveillance system, about 42% resulted in hospital admission. The mean length of hospital stay was 11.6 days overall and was 15.5 days for hip fracture, 9.8 days for skull fracture/intracranial injury, 11.2 days for all other fractures, and 9.1 days for all other injuries. About 50% of fall injury events that occurred at home and required hospital admission resulted in a person being discharged to a nursing home.
TL;DR: Maternal age less than 20 years old was the strongest risk factor for both preeclampsia and eClampsia, and data indicate a need for improved prenatal care among teenagers.
TL;DR: Neither changes in International Classification of Diseases coding nor improved recognition of asthma, as demonstrated by trends in autopsy rates or rates of in-hospital deaths, seems to explain the increasing mortality of the 1980s.
Abstract: Studies have suggested increases in hospitalization for asthma and in asthma mortality during the early 1980s. Using US Vital Records, we examined asthma mortality from 1968 through 1987 to describe the rates of change among children and young adults (aged 5 to 34 years) with time and in small geographic areas. During the 1970s, US asthma mortality declined by 7.8% per annum ( ± 1.0%), declining faster among women and nonwhites. During the 1980s, mortality increased by 6.2% per annum ( ± 1.2%), increasing faster among those aged 5 to 14 years than among those aged 15 to 34 years. Small-area geographic analysis revealed four areas with persistently high asthma mortality. Neither changes inInternational Classificationof Diseases coding nor improved recognition of asthma, as demonstrated by trends in autopsy rates or rates of in-hospital deaths, seems to explain the increasing mortality of the 1980s. (JAMA. 1990;264:1683-1687)
TL;DR: This article showed that B/Yamagata/16/88-like viruses were more closely related to epidemic viruses from 1983 (B/USSR/100/83) than to more recent reference strains such as B/Victoria/2/87.
19 Oct 1990
TL;DR: Injuries are not among the case definitions.
Abstract: Injuries are not among the case definitions. Available: http://www.cdc.gov/mmwr/preview/mmwrhtml/00025629.htm Language: en
TL;DR: It is concluded that obesity prevention should begin among adults in their early 20s and that special emphasis is needed for young women who are already overweight.
Abstract: • We estimated the 10-year incidence of major weight gain (a gain in body mass index of ≥5 kg/m2and overweight (a body mass index of ≥278 for men and ≥273 for women) in US adults using data from the First National Health and Nutrition Examination Survey Epidemiologic Follow-up Study Persons aged 25 to 74 years at baseline were reweighed a decade after their initial examination (men, 3727; women, 6135) The incidence of major weight gain was twice as high in women and was highest in persons aged 25 to 34 years (men, 39%; women, 84%) Initially overweight women aged 25 to 44 years had the highest incidence of major weight gain of any subgroup (142%) For persons not overweight at baseline (men, 2760; women, 4295), the incidence of becoming overweight was similar in both sexes and was highest in those aged 35 to 44 years (men, 163%; women, 135%) We conclude that obesity pervention should begin among adults in their early 20s and that special emphasis is needed for young women who are already overweight (Arch Intern Med 1990;150:665-672)
Journal Article•
TL;DR: The epidemiology of rotavirus--its seasonality in the cooler months, its universal spread in temperate and tropical zones in developed and less developed settings--more closely resembles that of childhood viruses that are spread by the respiratory route than that of common enteric pathogens that areSpread predominantly by the faecal-oral route.
Abstract: Data from 34 studies of the etiology of childhood diarrhoea were compiled in order to investigate the seasonal patterns of rotavirus gastroenteritis and consider their implications for transmission of the virus. Rotavirus was detected in 11-71% of children with diarrhoea, and the median rate of detection (33%) was independent of the level of economic development or geographical region of the study area, as well as of the method of detection used. While rotavirus infections have been called a winter disease in the temperate zones, we found that their incidence peaked in winter primarily in the Americas and that peaks in the autumn or spring are common in other parts of the world. In the tropics, the seasonality of such infections is less distinct and within 10 degrees latitude (north or south) of the equator, eight of the ten locations exhibited no seasonal trend. Throughout most of the world, rotavirus is present all the year round, which suggests that low-level transmission could maintain the chain of infection. The virus is spread by the faecal-oral route but airborne or droplet transmission has also been postulated. The epidemiology of rotavirus--its seasonality in the cooler months, its universal spread in temperate and tropical zones in developed and less developed settings--more closely resembles that of childhood viruses that are spread by the respiratory route (such as measles) than that of common enteric pathogens that are spread predominantly by the faecal-oral route.
TL;DR: The decline in the number of hepatitis B cases among homosexual men probably results from the modification of high-risk sexual behavior; the decline among health care workers is due mostly to hepatitis B immunization.
Abstract: To determine trends in the incidence and epidemiology of acute hepatitis B in the United States we conducted intensive surveillance for viral hepatitis in four sentinel counties from October 1, 1981, to September 30, 1988. The overall incidence of hepatitis B remained relatively constant throughout the study period (average, 13.2 cases per 100 000 population), but disease transmission patterns changed significantly. The proportions of hepatitis B cases accounted for by homosexual activity and health care employment decreased 62% and 75%, respectively; the proportions of cases accounted for by parenteral drug use and heterosexual exposure increased 80% and 38%, respectively. The percentage of patients for whom no risk factor was identified (30% to 40%) did not change over time. These patients tended to belong to minority populations, and their socioeconomic level was low. The decline in the number of hepatitis B cases among homosexual men probably results from the modification of high-risk sexual behavior; the decline among health care workers is due mostly to hepatitis B immunization. The current strategy for prevention of hepatitis B, which targets high-risk groups for immunization, has failed to have a significant impact on the incidence of disease. (JAMA. 1990;263:1218-1222)
TL;DR: Data obtained indicate that this agent, termed the hepatitis C virus (HCV), is the major cause of post-transfusion, community-acquired and cryptogenic, NANB and many asymptomatic but infectious blood donors can now be detected using this antibody assay.
Abstract: A 'blind' recombinant immunoscreening approach, of general application to studies of infectious diseases, was used to clone and identify the genome of the previously uncharacterized non-A, non-B hepatitis (NANB) virus. This agent is a positive-stranded RNA virus that appears to be distantly related to the flaviviridae family. A recombinant viral antigen (C100-3) was used to develop a capture assay for circulating antibody. Data obtained using this assay indicate that this agent, termed the hepatitis C virus (HCV), is the major cause of post-transfusion, community-acquired and cryptogenic, NANB. Anti-C100-3 antibody appears to be directed towards dominant, non-structural viral epitopes. It is a non-neutralising antibody that develops generally late in infection and is a particularly good marker of chronic, persistent viraemia. Many asymptomatic but infectious blood donors can now be detected using this antibody assay. HCV is associated with the development of hepatocellular carcinoma and possibly, other liver diseases.
TL;DR: To see whether changes in the epidemiology of group A streptococcal disease in the USA have been accompanied by a corresponding change in serotype distribution, epidemiological and M-typing and T-typed data for 5193 strains sent to the Centers for Disease Control, Atlanta, between 1972 and 1988 were analysed.
TL;DR: The proportion of extrapulmonary tuberculosis among all patients with tuberculosis by age was found to be largest in children and generally to decrease with increasing age, larger among black, Asian, and American Indian patients, bigger among female than among male patients, and larger among the foreign-born than among patients born in the United States.
Abstract: From 1963 to 1986, the number of reported cases of pulmonary tuberculosis in the United States declined an average of 5.0% annually, and the number of cases of extrapulmonary tuberculosis declined an average of 0.9% annually over the same period. In 1986, 17.5% of all cases of tuberculosis were extrapulmonary. Of pulmonary cases, 63.0% occurred among racial ethnic minorities and the foreign-born, whereas of extrapulmonary cases, the respective proportion was 71.2%. After adjustment for other variables, the proportion of extrapulmonary tuberculosis among all patients with tuberculosis by age was found to be largest in children and generally to decrease with increasing age, larger among black, Asian, and American Indian than among non-Hispanic white patients, larger among female than among male patients, and larger among the foreign-born than among patients born in the United States. The smaller decline in extrapulmonary tuberculosis over the years may be partially due to changes in the demographic characte...
Journal Article•
TL;DR: The purpose of this article is to provide guidance in interpretation of Western blot test results and their use in the diagnosis of HIV-1 infection in patients and evidence that the reaction observed against the gp120 on certain Western blots may have in part resulted from a reaction with a multimeric form of the gp41.
TL;DR: Overall, 63% of the patients died of tumor; large tumor size and high mitotic rate portended a poor prognosis, as did the need for resection by amputation, and an unexpected finding was the absence of a significant difference in survival rates between patients with and without VRN.
Abstract: Using strict clinical and pathologic criteria for the inclusion of cases, the authors have reviewed the clinicopathologic features of 43 malignant peripheral nerve sheath tumors of the buttock and extremity seen over a 35-year period. Twenty-three (53%) of the patients had neurofibromatosis (VRN), whereas 20 (47%) did not. Fifty-one percent of the patients were women. The mean age at presentation was 36 years for patients with VRN and 44 years for patients without VRN. A nerve of origin was identified for 72% of the cases and an associated neurofibroma for 44% (65% with VRN and 20% without VRN). The mean greatest dimension of the tumors was 12.3 cm, and this did not differ significantly between the two groups. The predominant histologic pattern in 86% of the tumors was that of tightly packed spindle cells in an interlacing and woven pattern; heterologous sarcomatous elements were noticed in 12% of the cases. Surgical resection was the main modality of treatment for all patients; 65% also received adjuvant therapy. Follow-up evaluation was done in every case. An unexpected finding was the absence of a significant difference in survival rates between patients with and without VRN. Overall, 63% of the patients died of tumor: 65% of the patients with VRN and 60% of the patients without VRN. Large tumor size and high mitotic rate (greater than 20 per 10 high-power fields) portended a poor prognosis, as did the need for resection by amputation. Adjuvant radiation therapy and chemotherapy did not affect survival rates.
TL;DR: The outbreak of the eosinophilia-myalgia syndrome in 1989 resulted from the ingestion of a chemical constituent that was associated with specific tryptophan-manufacturing conditions at one company.
Abstract: Background. The eosinophilia—myalgia syndrome is a newly recognized illness that has been associated with the consumption of tryptophan products. It is not known whether the cause is related to the tryptophan itself or to chemical constituents introduced by the manufacturing process. Methods. To describe the epidemiology of the eosinophilia—myalgia syndrome further and elucidate a possible association with the manufacturing process, we conducted surveillance for the syndrome in Minnesota, a community survey of tryptophan use in Minneapolis-St. Paul, and a case–control study to assess potential risk factors, including the use of tryptophan from different manufacturers. We performed high-performance liquid chromatography on tryptophan samples to identify other chemical constituents. Results. The prevalence of tryptophan use increased from 1980 to 1989 and was highest among women. Among the subjects for whom the source of the tryptophan was known, 29 of 30 case patients (97 percent) and 21 of 35 con...
TL;DR: Broader social and health system changes and research targeted at the causes of the mortality gap, coupled with increased efforts aimed at modifiable risk factors, may all be needed for egalitarian goals in health to be realized.
Abstract: We compared the mortality rate ratios, before and after adjustment for different risk factors, of black vs white adults in the National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study. For persons 35 to 54 years old, the rate ratio of mortality for blacks vs whites decreased from 2.3 (unadjusted) to 1.9 when adjusted simultaneously for six well-established risk factors (smoking, systolic blood pressure, cholesterol level, body-mass index, alcohol intake, and diabetes) and decreased from 1.9 to 1.4 when adjusted for the six risk factors plus family income. Thus, approximately 31% of the excess mortality can be accounted for by six well-established risk factors and a further 38% by family income. This leaves 31% unexplained. Broader social and health system changes and research targeted at the causes of the mortality gap, coupled with increased efforts aimed at modifiable risk factors, may all be needed for egalitarian goals in health to be realized.
TL;DR: The results suggest that this 6-month regimen is similar in effectiveness, toxicity, and acceptability to the 9- month regimen for treating pulmonary tuberculosis.
Abstract: STUDY OBJECTIVE To determine the effectiveness, toxicity, and acceptability of a 6-month antituberculous regimen compared with a 9-month regimen. DESIGN A nonblinded, unbalanced, randomized, multicenter clinical trial. SETTING Twenty-two tuberculosis clinics in public health departments and hospitals in the United States. PATIENTS Patients were eligible if Mycobacterium tuberculosis, isolated from sputum cultures, was susceptible to study drugs. Of 1451 patients enrolled, 75% (617 of 823) assigned to the 6-month regimen and 71% (445 of 628) assigned to the 9-month regimen were eligible. INTERVENTIONS Patients took self-administered isoniazid and rifampin daily for 24 weeks (6-month regimen) or 36 weeks (9-month regimen). In addition, patients assigned to the 6-month regimen took self-administered pyrazinamide daily during the first 8 weeks. RESULTS Patients on the 6-month regimen converted more rapidly than patients on the 9-month regimen (94.6% compared with 89.9% after 16 weeks of therapy, with a difference of 4.7% [95% CI, 0.7% to 8.7%]); had similar rates of adverse drug reactions (7.7% compared with 6.4%, with a difference of 1.3% [95% CI, 0.0% to 4.6%]); had lower noncompliance rates (16.8% compared with 29.2%, with a difference of 12.4% [95% CI, 6.8% to 18.0%]); and had similar relapse rates 96 weeks after completing therapy (3.5% compared with 2.8%, with a difference of 0.7% [95% CI, 0.0% to 3.9%]). A significantly greater proportion of patients assigned to the 6-month regimen successfully completed therapy (61.4% compared with 50.6%; chi 2 = 11.976). CONCLUSIONS Our results suggest that this 6-month regimen is similar in effectiveness, toxicity, and acceptability to the 9-month regimen for treating pulmonary tuberculosis.