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Particulate Air Pollution and Mortality
This study examined the effects of five major air pollutants on daily mortality rates in 20 urban areas in the United States between 1987 and 1994. The pollutants were particulate matter that was less than 10 µm in aerodynamic diameter, ozone, carbon monoxide, sulfur dioxide, and nitrogen dioxide. The study found consistent evidence that increases in levels of particulate matter that was less than 10 µm in aerodynamic diameter were associated with increased rates of death from all causes and from cardiovascular and respiratory causes.
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Fludarabine versus Chlorambucil for Chronic Lymphocytic Leukemia
Chronic lymphocytic leukemia can present a daunting therapeutic challenge. The standard treatment is chlorambucil. Recently, interest has turned to fludarabine. In this randomized study of 509 patients with chronic lymphocytic leukemia, fludarabine was more effective than chlorambucil by several measures. Nevertheless, the newer agent was no better than chlorambucil in prolonging survival.
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Predictors of Venous Thromboembolism after Total Hip Arthroplasty
Venous thromboembolism is a common complication of total hip arthroplasty, and it may develop after discharge from the hospital. This study identified obesity, as reflected by a body-mass index of 25 or more, as an important risk factor for rehospitalization for symptomatic venous thromboembolism after hip replacement. The use of warfarin after discharge from the hospital may reduce the risk.
Familial Aggregation of Parkinson's Disease in Iceland
The role of genetic factors in Parkinson's disease is unclear. In this study, 772 patients in Iceland in whom Parkinson's disease had been diagnosed during the previous 50 years were identified, and the extent to which they were related to one another was determined. In the group as a whole, and in the subgroup of 560 patients with late-onset disease, the patients were more related to one another than were matched control subjects. There was no increase in risk among spouses.
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Regulation of Tobacco and Reduction in Mortality
In 1989, an aggressive tobacco-control program was implemented in the state of California, funded by a surtax on cigarettes.
A study by Fichtenberg and Glantz shows that between 1989 and 1992, when funds for the program were curtailed, there was a significant decrease in per capita cigarette consumption and a decline in mortality from heart disease. These beneficial changes were reduced beginning in 1992, when the program was cut back. The temporal relation between the changes in cigarette consumption and mortality was very close. The study provides evidence that state-supported antitobacco programs can lead to favorable trends in public health. But as two Sounding Board articles (Glantz and Annas, Myers) indicate, the question of who should regulate tobacco and how it should be done is not simple.
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