HICN244 News Part 2/2 
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 HICN244 News Part 2/2

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coprevalence is  consistently  higher  than  predicted  by  their  independent
distributions.  The  explanation  may  be  apparent  for  two  of these pairs:
coronary heart disease and hypertension (a  known  risk  factor  for  coronary
heart  disease)  and  hypertension and diabetes,  which share overweight as an
underlying risk factor.  For the  other  six  pairs  of  conditions,  however,
increased  rates  of  coprevalence  were  not anticipated.  Although these are
modest  increases,  their  impact  may  be  substantial.   For  example,   the
independent  distributions  of  hypertension  and  arthritis  predict that 7.6
million persons aged greater than or equal to 60 years have  both  conditions.
However,  the  SOA  data  indicate  that  this  pair of conditions occurred in
approximately 9 million persons--1.4 million more than expected.
    At least  three  factors  may  contribute  to  the  increase  in  observed
coprevalence  for  conditions  not  generally  recognized as being associated.
First,  those persons with one condition  may  have  more  contacts  with  the
medical-care system and, therefore, greater likelihood of any second condition
being  diagnosed.  Second,  persons  who report having one disease may be more
likely to report having other  diseases.  Third,  in  some  persons,  genetic,
environmental,  and  behavi{*filter*}factors may increase general susceptibility to
disease,  resulting in the occurrence of multiple diseases in the later  years
of life.
    The  SOA data also suggest an association between the number of conditions
present and the proportion of persons with disability (as assessed by  ability
to  perform  activities  of  daily living).  This association was present even
though the conditions  were  not  weighted  for  severity;  in  addition,  the
potential  impact of these conditions on disability varied considerably (e.g.,
stroke has a greater potential impact  than  varicose  veins).  Despite  these
important limitations, the number of conditions present may represent a useful
measure of the burden of illness on older persons,  as reflected by associated
disability.  Because functional limitations increase with age  and  number  of
chronic  conditions,  comprehensive  public  health  strategies should include
disability prevention as well as health promotion and disease prevention.


1.  Rice  DP,  LaPlante  MP.   Chronic  illness,  disability,  and  increasing
longevity.  In:  Sullivan S, Lewin ME, eds.  The economics and ethics of long-
term care and disability.  Washington,  DC:  American Enterprise Institute for
Public Policy Research, 1988:9-55.

2.  NCHS,  Fitti  JE,  Kovar MG.  The supplement on aging to the 1984 National
Health Interview Survey.  Hyattsville,  Maryland:  US Department of Health and
Human  Services,  Public  Health Service,  1987:DHHS publication no.  87-1323.
(Vital and health statistics; series 1, no. 21).

Health InfoCom Network News                                             Page 10
Volume  2, Number 44                                      November 29, 1989

                    Progress in Chronic Disease Prevention
     Chronic Disease Reports: Deaths from Chronic Liver Disease -- United
                                 States, 1986

    In 1986, 26,151 persons died with an underlying diagnosis of chronic liver
disease and cirrhosis (chronic liver disease,  International Classification of
Diseases,  Ninth Revision (ICD-9), code 571) (Table 1).  Chronic liver disease
was a contributing cause in an additional 13,475 deaths (1).  Among deaths for
which chronic liver disease was the underlying cause,  42% were diagnostically
associated with {*filter*} (e.g.,  {*filter*}ic cirrhosis of the liver and {*filter*}ic
liver  damage,  unspecified) (ICD-9 571.0-571.3);  3%,  with chronic hepatitis
(ICD-9 571.4);  1%,  with biliary  cirrhosis  (ICD-9  571.6),  and  53%,  with
unspecified conditions and no mention of {*filter*} (ICD-9 571.5,  571.8,  571.9)
    Forty-eight percent of deaths  from  chronic  liver  disease  occurred  in
persons aged less than 60 years (2); chronic liver disease accounted for 2% of
years of potential life lost before age 65 (3). Rates of chronic liver disease
mortality  were highest among persons aged 65-74 years (51.9 per 100,000 males
and 25.8 per 100,000 females).  When adjusted for age,  mortality from chronic
liver  disease  was  2.3  times  higher in males than in females and 1.7 times
higher in blacks than in whites (4).
    The highest rates of chronic liver disease mortality in 1986 (age-adjusted
to  the  1986  U.S.   population)  occurred  in  southwestern  states  and  in
California,   Delaware,   the   District  of  Columbia,   Florida,   Illinois,
Massachusetts,  Michigan,  New Jersey,  and New  York  (Table  2,  Figure  1).
Arkansas  had  the lowest rate (5.9 per 100,000) and the District of Columbia,
the highest (30.9 per 100,000).

Reported by:  Div of  Surveillance  and  Epidemiologic  Studies,  Epidemiology
Program  Office;  Hepatitis  Br,  Div of Vial Diseases,  Center for Infectious
Diseases, CDC.

Editorial Note:  Risk factors for  chronic  liver  disease  include  drug  and
occupational  exposures;   infection  with  hepatitis  B  virus;  parenterally
transmitted  non-A,   non-B  hepatitis  virus;   and  other  diseases   (5,6).
Consumption  of  {*filter*}ic  beverages  is  a  well-established risk factor for
cirrhosis (7);  risk of cirrhosis  mortality  increases  with  the  amount  of
{*filter*}  consumed  and  the  duration  of  elevated  consumption  (8).   Other
environmental or genetic factors can also play a role in  the  development  of
cirrhosis (9).
    Average  daily  consumption  of greater than or equal to 1 oz.  of ethanol
(approximately two drinks of wine,  beer,  or spirits) is regarded  as  "heavy
drinking"  (7).  Based  on  recent  rates  of heavy drinking (4) and a risk of
cirrhosis mortality seven times higher in  heavy  drinkers  than  in  nonheavy
drinkers  (recalculated from (10)),  at least 15% of cirrhosis mortality among
females and 46% of cirrhosis mortality among males is  attributable  to  heavy
drinking.  Thus,  the  reduction  of  heavy  {*filter*}  consumption  remains  an
important means for the control of cirrhosis mortality.


 1.  NCHS.  Vital statistics mortality data,  multiple cause of death  detail,
1986  (machine-readable  public-use  data  tape).  Hyattsville,  Maryland:  US
Department of Health and Human Services, Public Health Service, 1988.

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Volume  2, Number 44                                      November 29, 1989

 2. NCHS. Vital statistics of the United States, 1986.  Vol II--Mortality, pt.
A.  Hyattsville, Maryland:  US Department of Health and Human Services, Public
Health Service, 1988; DHHS publication no.  (PHS)88-1122.

 3. CDC. Years of potential life lost before age 65--United States, 1987. MMWR

 4. CDC. Health, United States, 1988.  Hyattsville, Maryland: US Department of
Health and Human Services,  Public Health Service, 1989;  DHHS publication no.

 5.  Sherlock S.  Diseases of the liver and biliary system.  7th  ed.  Boston:
Blackwell Scientific Publications, 1985.

 6.  Alter HJ.  The chronic consequences of non-A, non-B hepatitis.  In: Seeff
LB,  Lewis JH,  eds.  Current perspectives in  hepatology.  New  York:  Plenum
Medical Book, 1989:83-97.

 7.  National  Institute on {*filter*} Abuse and {*filter*}ism.  {*filter*} and health.
Rockville, Maryland: US Department of Health and Human Services, Public Health
Service, 1989; DHHS publication no. (ADM)87-1519.

 8.  Lelbach WK.  Cirrhosis in the {*filter*}ic and its relation to the volume of
{*filter*} abuse. Ann N Y Acad Sci 1975;252:85-105.

 9.  Grant BF, Dufour MC, Harford TG. Epidemiology of {*filter*}ic liver disease.
Semin Liver Dis 1988;8:12-25.

10.  Klatsky AL, Friedman GD, Siegelaub AB.  {*filter*} and mortality: a ten-year
Kaiser-Permanente experience. Ann Intern Med 1981;95:139-45.

Health InfoCom Network News                                             Page 12
Volume  2, Number 44                                      November 29, 1989

      Apparent Per Capita Ethanol Consumption -- United States, 1977-1986

    Trend  data on apparent ethanol consumption by beverage type reflect long-
term {*filter*} consumption patterns. In 1986, 5.8 billion gallons of beer, 585.3
million gallons of wine, and 394.7 million gallons of spirits were sold in the
United States.* For each person aged greater than  or  equal  to  14  years,**
these amounts represent 29.8 gallons (approximately 318 12-oz.  cans) of beer,
3.0 gallons (77 5-oz.  glasses) of wine, and 2.1 gallons (179 1.5-oz.  drinks)
of  spirits.  When volumes of beer,  wine,  and spirits are converted into per
capita ethanol volume,*** apparent per capita ethanol consumption in 1986 was:
1.34 gallons of ethanol for beer,  0.39 gallons of ethanol for wine,  and 0.85
gallons of ethanol for spirits.
    Apparent  per  capita  consumption  of ethanol from all beverages combined
increased annually from 1977 to 1980, leveled in 1980 and 1981,  then declined
to  2.58 gallons in 1986--a 2.3% decrease from the 1977 level (Figure 1).  Per
capita consumption of spirits decreased over this period from a peak  of  1.07
gallons  in  1978  to  0.85  gallons  in 1986.  In contrast,  wine consumption
increased 0.1 gallons between  1977  and  1986,  and  beer  consumption,  0.05
    Data  for  specific  states  differ  from  national patterns and trends in
beverage preference and consumption (Figures 2 and 3).  Because nondrinkers as
well  as  drinkers  are  included  in  the denominator from which apparent per
capita consumption rates are calculated, these rates underestimate the average
consumption among  persons  who  drink  {*filter*}ic  beverages.  To  adjust  for
abstention  in  per  capita  consumption,   estimates  of  the  percentage  of
abstainers in the population are necessary--ideally,  from the same geographic
units  measured  over  the  same  time  for  which  data on beverage sales are
available.  Behavi{*filter*}Risk Factor Surveillance  System  data  for  individual
states  provided estimates of the percentage of abstainers in 26 states (Table
1).  Excluding abstainers substantially  alters  the  per  capita  consumption
ranking of these states.

Reported  by:   MC  Dufour,  MD,  National  Institute  on  {*filter*}  Abuse  and
{*filter*}ism, {*filter*}, Drug Abuse, and Mental Health Administration. FS Stinson,
PhD, RA Steffens,  CG Freel,  D Clem,  {*filter*} Epidemiology Data System,  CSR,
Inc, District of Columbia.

Editorial  Note:  In 1986,  the decline in consumption of distilled spirits in
the United States was greater than for any year since 1956,  in terms of  both
actual  cases  sold  and  percentage  decrease (2).  Per capita consumption of
spirits in 1986 was at its lowest level since 1959 (1).
    The decline in spirits consumption may represent changes in  the  drinking
patterns  and preferences in the drinking-aged population.  These changes were
reflected by greater interest in beverages with reduced {*filter*} content (e.g.,
"light" beers and  wine  coolers),  as  well  as  increased  public  awareness
regarding physical fitness, nutrition, and {*filter*} abuse (3-5).  In 1985, wine
coolers accounted for 17% of the wine market (3) and, in 1986, nearly 25% (2).
The increased popularity of wine coolers through 1986 may  have  accounted  in
part for the increases in wine consumption (5).
    Although  two  thirds  of  the {*filter*} population drink {*filter*}ic beverages,
{*filter*}  consumption  is  unevenly   distributed   throughout   the   drinking
population: 10% of drinkers (6.5% of the {*filter*} population) account for half of
all  {*filter*}  consumed  in  the  United  States (6).  In some southern states,
historically low levels of apparent per capita consumption may have reflected,
in part, the high percentage of abstainers in those states.

Health InfoCom Network News                                             Page 13
Volume  2, Number 44                                      November 29, 1989


1. Doernberg D, Stinson F. US {*filter*} epidemiologic data reference manual. Vol
1.  US apparent consumption of  {*filter*}ic  beverages  based  on  state  sales,
taxation,  or receipt data.  Rockville, Maryland:  US Department of Health and
Human Services, Public Health Service, {*filter*}, Drug Abuse,  and Mental Health
Administration, 1985.

2.  Jobson  Publishing.  Jobson's  liquor  handbook  1987.  New  York:  Jobson
Publishing, 1987.

3.  Hecht D, ed.  Jobson's liquor handbook 1985.  New York: Jobson Publishing,

4.  Jobson Publishing. Jobson's wine marketing handbook 1987. New York: Jobson
Publishing, 1987.

5.  Steffens RA,  Stinson FS,  Freel CG,  Clem D.  Apparent per capita {*filter*}
consumption:  national,  state,  and  regional trends,  1977-1986.  Rockville,
Maryland:  US Department of Health and Human Services,  Public Health Service,
{*filter*},  Drug Abuse,  and Mental Health Administration,  1988.  (Surveillance
report no. 10).

6. National Institute on {*filter*} Abuse and {*filter*}ism. Sixth special report to
the US Congress on {*filter*} and health from the Secretary of Health  and  Human
Services.  Rockville,  Maryland:  US  Department of Health and Human Services,
Public Health Service, {*filter*}, Drug Abuse,  and Mental Health Administration,

*Based  on  1986  beverage  sales  or  tax receipt data from 33 states and the
District of Columbia  and  on  production  and  shipment  data  from  beverage
industry  sources  in  17 states that do not furnish data on beverage sales or
tax receipts.

**Results from the 1983 {*filter*} and Health  Practices  Survey  indicated  that
6.8%  of  the U.S.  drinking population aged greater than or equal to 18 years
started drinking at less than or equal to 14 years of age  (NCHS,  unpublished
data, 1986).

***Coefficients used to convert beer,  wine, and spirits to ethanol were 0.045
for beer, 0.129 for wine, and 0.414 for spirits (1).

Health InfoCom Network News                                             Page 14
Volume  2, Number 44                                      November 29, 1989


                             Anatomy of Elbow Pain
                            by Sandra Conner, P.T.
        "Second Wind", St. Joseph's Hospital Center For Sports Medicine

The term ``tennis elbow'' has been used to describe a pained elbow, regardless
of whether the sufferer has ever picked up  a  tennis  racquets  or  not.  The
injury,  medically  termed  lateral  epicondylitis,  involves the outside of a
person's elbow.  In this same vein, in,  ``golfer's elbow'' is the common name
which  defines medial epicondylitis or involvement of the inside aspect of the


Lateral  epicondylitis  is  a  condition  of  inflammation,   irritation   and
microtrauma  of  the muscle tendon where it attaches to the bony prominence on
the outside of the elbow.  The muscle which extends and supinates  (turns  the
palm  up) the wrist is called the extensor carpi radialis brevia.  This muscle
tendon tends to be the most vulnerable to stress.

So why do some people and not  others,  suffer  from  aching  elbows?  Certain
factors  such  as age,  level of ability,  equipment,  increased playing time,
improper  techniques,  decreased  flexibility  and  strength,  and  continuous
repetition  can  all  contribute to this condition.  Repeated use of the wrist
for gripping,  typing or reaching can also cause pain,  as the muscle  becomes
fatigued and further stressed.

The  repetitive  movement,  for  example  in  a  golf swing,  can cause medial
epcondylitis,  as can any sport that pronates (turns the palm down) or  flexes
the  wrist.  This may involve one or several of the tendons that attach to the
medial (inside) elbow.

The elbow area is susceptible to injury due to the small area of attachment of
the muscle tendon.  It creates a greater force load when the muscle contracts.
Studies have shown it to be more common in persons over 4O, which could be the
result  of a degenerative or accumulative process.  Typical symptoms of tennis
elbow are point tenderness over the outside or inside of the  elbow,  pain  or
weakness with active or resisted wrist movement,  including grip or repetitive


Consult a physician as soon as possible,  to avoid further microtrauma.  Icing
the  muscle may be recommended by using an ice bag for 15-20 minutes or an ice
cup (applied in a massage fashion) for 7-10  minutes  Also,  as  common  sense
would dictate, try to prevent further irritation by avoiding the movement that
is causing the pain.

There  are  several  types  of  elbow supports/braces that can be worn to help
disperse the force of the movement to a broader area in the forearm.  To avoid
deconditioning, cycling, swimming, running or aerobics should be continued. As

Health InfoCom Network News                                             Page 15
Volume  2, Number 44                                      November 29, 1989

with  all sports,  stretching should be started immediately and continued on a
regular basis as activity increases.

Extra efforts should be taken to stretch  the  wrist  extensors  and  flexors.
Progressive  resistive  exercises  can  be started for the wrist extensors and
flexors when they can be performed in a pain free manner.  This includes  both
concentric  and  eccentric  training  of  the  muscles.   High  volt  electric
stimulation,  ultrasound,  hydrotherapy,  ice and  manual  resistive/range  of
motion  therapy  are  other recommended modalities used in the clinic for this
condition.  Non-steriodal anti-inflammatories may be prescribed,  and in  more
severe  cases  an injection may be necessary.  Surgery is performed in a small
percentage of cases if conservative treatment fails.

Shoulder girdle strength provides stability for a constantly moving elbow  and
hand, and is very important in rehabilitation.


Once  you've  experienced  the  pain  of  tennis  or  golfer's elbow,  you can
appreciate the importance of preventive measures to avoid a reoccurrence. Make
the effort to analyze the cause of your problem and  work  on  modifying  your
habits accordingly.  if tennis or golf is actually the cause,  then you should
have  your  playing  techniques  evaluated.   This  may  involve  lessons  and
racquets/club evaluation.  If the problem is not specifically sports oriented,
an  evaluation  of  worksite  conditions  may be discussed with your doctor or
therapist in addition to implementing a flexibility program during your day.


A nagging ache in the elbow can lead to  a  chronic  problem  if  not  treated
immediately.  A regular flexibility and strengthening program is a good start.
If you have any problems or questions call the St.  Joseph's Center for Sports
Medicine at 1-602-285-3770

Health InfoCom Network News                                             Page 16

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