IDDM2 and the Polymorphism of the Human Tyrosine Hydroxylase: MATERIALS AND METHODS

All type-1 diabetes cases were African-American, randomly selected from a Washington, DC population-based type-1 diabetes registry. The patients included in this registry were collected between from 1990 to 1999 as part of the World Health Organization’s multinational Project for Childhood Diabetes (Diamond project). The age range of disease onset was 0.5-17 years and the male/female ratio was 0.733. The World Health Organization (WHO) definition of type-1 diabetes was employed for this study. The criteria include history of ketoacidosis and daily insulin injection before the 17th birthday. All patients were residents of the Washington, DC metropolitan area at the time of the first insulin administration.

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IDDM2 and the Polymorphism of the Human Tyrosine Hydroxylase

INTRODUCTION

Polymorphisms in the tyrosine hydroxylase-insulin-insulin like growth factor 2 gene-regions (TH-INS-IGF2) on chromosome 11 were shown to have an association with type-1 diabetes. It is not yet clear whether TH gene carries susceptibility for type-1 diabetes. In the human, hTH molecules are encoded by at least three distinct messenger RNAs. The expression of these mRNAs varies in different parts of the nervous system. The calculated relative molecular mass of the deduced protein sequence is 55,473. Tyrosine hydroxylase is the first enzyme in the pathway of catecholamine synthesis. It catalyzes the formation of 3,4-dihydrox-yphenylalanine (DOPA) from tyrosine. hTH plays a central role in the neuronal transmission and hormonal action of catecholamines. Expression of the hTH gene is regulated in a tissue-specific fashionand is modulated by a variety of factors, such as cyclic AMP, glucorticoids, and trans-synaptic stimuli. The pathogenesis of some disorders of cate-cholaminergic neurons, such as schizophrenia, may be related to changes in hTH. The role of hTH in the pathogenesis of type-1 diabetes is not known, but many investigators are examining target organs, such as islet cell nerve and retina, for possible functional roles of hTH polymorphism. The hTH gene is located on chromosome llpl5.5 is composed of 14 exons interrupted by 13 introns, and spans ~8.5 kb.

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Workplace Tobacco Policies and Smoking Cessation Practices of Physicians: DISCUSSION

The findings are encouraging in that physicians in Nigeria demonstrated an awareness of smoking among their patients, routinely assessed smoking status, and believed that counseling patients about smoking would help them quit. Physician estimates of smoking among adults in Nigeria (31% for males, 7% for females) were somewhat higher than published prevalence data (15% for adult males, 2% for adult females), indicating that they either have inflated perceptions of smoking or smokers are disproportionately represented in their patient population. Also encouraging is that the majority of physicians made an effort to identify patients who are smokers and believed it was important for these patients to quit. Additionally, physicians in Nigeria thought that counseling smokers would help them quit, suggesting their belief in the importance of physician-assisted smoking cessation interventions.

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Workplace Tobacco Policies and Smoking Cessation Practices of Physicians: RESULTS

Of the 619 physicians surveyed, 373 completed the survey (60% response rate). Of the final sample, 187 physicians were from Hospital A, and 186 were from Hospital B. Characteristics of the sample are presented in Table 1.

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Workplace Tobacco Policies and Smoking Cessation Practices of Physicians: METHODS

Participants and Study Setting

Participants were physicians at two teaching hospitals, University of Ilorin, Ilorin, Kwara State and University College Hospital, Ibadan, Oyo State, both located in the southwestern region of Nigeria. Hospitals were comprised of a main campus made up of multiple hospital buildings. The physicians participating in this study worked in different buildings throughout the hospital campus. The workplace smoking policy was determined by the hospital; however, enforcement of the policy was the responsibility of the department(s) occupying each building (K.S. Okuyemi, personal communication, January 21,2004).

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Workplace Tobacco Policies and Smoking Cessation Practices of Physicians

BACKGROUND

Approximately 80% of the world’s smokers live in developing countries. While the prevalence of cigarette smoking has declined over the past two decades in developed countries, smoking prevalence continues to rise in the majority of developing countries. Tobacco is fast becoming the single leading cause of death worldwide and is estimated to kill nearly 10 million people per year by 2030. If current trends continue, an estimated one billion people worldwide will die from tobacco use in the 21st century. Approximately 70% of these tobacco-related deaths will occur among smokers in developing countries.

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Comparison of the Prevalence of First-Degree: DISCUSSION

An urban hospital setting, the prevalence of first-degree AV block is slightly less in African-American patients compared with Caucasian patients. The greatest contrast of the prevalence of first-degree AV block between the two ethnic groups occurs in the 10th decade of life when the prevalence of first-degree AV block rises to a level of 23.3% (n=10 of 43) in African-American patients compared with only 12.2% (n=22 of 181) in Caucasian patients in the same age group; p=0.06. The cause of the reduced prevalence of first-degree AV block in Caucasian patients in the 10th decade of life is not known. Although the sample size is relatively small for analysis, and the statistical relationship approaches—but does not achieve—traditional criteria of significance, one can speculate that the presence of various disease states involving the AV node could lead to complete AV block, death, or the implantation of an electronic pacemaker. Such a series of events would result in a decreased prevalence of first-degree AV block in Caucasian patients in the 10th decade of life. A similar observation was reported in an earlier study of intraventricular block in which there was a dramatic reduction in the prevalence of left ventricular conduction block in both ethnic groups in the 10th decade of life. This suggested failure of left ventricular conduction with advancing age due to increasing sclerosis of the left ventricular conduction system.

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