The New England journal of medicine
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Epidemiologic studies suggest that low carotene intake and low levels of serum retinol may be associated with an increased risk of cancer. Likewise, in some animal studies vitamin E has been associated with a reduced rate of induced cancers. Therefore, we measured retinol, retinol-binding protein, vitamin E (alpha-tocopherol), and total carotenoids in serum collected in 1973 from 111 participants in the Hypertension Detection and Follow-up Program who were free of cancer at the time but were diagnosed as having cancer during the subsequent five years. ⋯ The mean base-line retinol level in the 18 subjects with subsequent lung cancer was higher than that in their matched controls (79.0 vs. 71.4 micrograms per deciliter, -4.9 to 19.7). Serum vitamin E levels were somewhat lower in subjects who later had cancer than in controls (1.16 and 1.26 mg per deciliter, -0.22 to 0.02), in part because of the confounding effect of serum cholesterol levels (when adjusted for lipid levels, the case-control difference was -0.05 mg per deciliter; -0.17 to 0.07). These data do not support hypotheses relating intake or serum levels of antioxidant vitamins to a reduced cancer risk.
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Clinical Trial
Prehospital defibrillation performed by emergency medical technicians in rural communities.
Survival after out-of-hospital cardiac arrest is poor in communities served only by basic ambulance services, but conventional advanced prehospital care is not an option for most rural communities. Ambulance technicians in 18 small communities (average population, 10,400) were trained to recognize and defibrillate ventricular fibrillation. Neither endotracheal intubation nor medication was used. ⋯ In the communities where early defibrillation was available, 12 of 64 patients (19 per cent) who were found in ventricular fibrillation were resuscitated and discharged alive from the hospital; this was true of only 1 of 31 such patients (3 per cent) in the control communities, where only basic life support was available (P less than 0.05). Ten (83 per cent) of the long-term survivors received electrical shocks administered solely by the technicians. Early defibrillation by minimally trained ambulance technicians is an effective approach to emergency cardiac care in rural communities.
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Physicians trained in foreign medical schools, including U. S. citizens, are once again playing a larger part in the provision of medical are in this country. After a decrease in the numbers of such physicians from 1977 through 1980, the number of foreign nationals entering the National Resident Matching Program increased by 312 per cent, and the number of U. ⋯ Since the number of residency positions will probably not expand to meet applicant demand, an increase in the pool of physicians with neither residency training nor licenses to practice medicine is likely. Alien foreign medical-school graduates and U. S. students who go abroad to study medicine can no longer take for granted residency training and practice in the United Stages.