Biomedical subjects
Publications and source records attributed to C C White.
The development of the ICF-MR program and the issue to which the ICF-MR program was intended to respond was briefly reviewed. National and state-by state statistics on changing patterns and interstate variations in use of ICF-MR services as of June 30, 1977, June 30, 1982, and June 30, 1986 were presented and ICF-MR problems and issues were discussed within the context of the evolving system of long-term care.
Although there is still dispute about the "surplus" of physicians, federal policies have begun to constrain the number of new entrants. Black students have been especially affected by retrenchment of federal support to education and by eroding medical school commitments to equity. Such trends undercut the demonstrable preference of black students to practice in geographic and specialty areas of greatest need. Better preparation for entry into medical school, and support through the long educational process, are necessary to preserve and extend the gains in both equity and health begun in the mid-1960s.
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For a single year, 1983, we compared the actual and estimated morbidity, mortality, and costs attributable to measles, mumps, and rubella with having or not having a childhood immunization program using the combined measles-mumps-rubella (MMR) vaccine. Without an immunization program, an estimated 3,325,000 cases of measles would occur as compared to 2,872 actual cases in 1983 with a program. Instead of an expected 1.5 million rubella cases annually, there were only 3,816 actual cases. Mumps cases were lowered from an expected 2.1 million to 32,850 actual cases. Comparable reductions in disease-associated complications, sequelae, and deaths are gained with an immunization program. Without a vaccination program, disease costs would have been almost $1.4 billion. Based on the actual incidence of disease in 1983, costs were estimated to be approximately +14.5 million. Expenditures for immunization, including vaccine administration costs and the costs associated with vaccine reactions, totaled $96 million. The resulting benefit-cost ratio for the MMR immunization program is approximately 14:1. The savings realized due to the use of combination rather than single antigen vaccine total nearly $60 million.
A national census of all state-licensed residential facilities for mentally retarded persons was conducted in 1982. This census enumerated 243,669 mentally retarded residents living in 15,633 facilities on June 30, 1982. Information on characteristics of facilities (e.g., type, location, size, type of operator, reimbursement rates) is presented along with demographic/functional characteristics of residents (e.g., age, level of retardation, previous and subsequent placement). The census verified the existence of an extensive variety of residential living alternatives available to mentally retarded people.
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Duroquinol (tetramethylhydroquinone) was found to function as an electron donor in chloroplasts. Non-cyclic electron transfer from duroquinol to electron acceptors such as oxygen proceeded at high rates, was insensitive to 3-(3,4-dichlorophenyl)-1,1-dimethylurea (DCMU) but was sensitive to the plastoquinone antagonist 2,5-dibromo-3-methyl-6-isopropyl-1,4-benzoquinone (DBMIB). The electron transport from duroquinol was coupled to the synthesis of ATP. Spectroscopic studies of chloroplast electron carriers in the dark indicated the high-potential "Rieske" iron-sulfur center, cytochrome f, plastocyanin and P-700 were all reduced by duroquinol. The dark reduction of the "Rieske" iron-sulfur center and cytochrome f were inhibited by DBMIB but not by DCMU. These results have been interpreted in terms of a linear sequence of electron carriers in the non-cyclic electron transport chain which includes plastoquinone, the "Rieske" iron-sulfur center, cytochrome f, plastocyanin and P-700.
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Glutathione (GSH), an antioxidant and conjugator of electrophilic toxicants, prevents toxicant-mediated destruction of ovarian follicles and oocytes. Ovarian GSH has previously been shown to change with estrous cycle stage in rats, suggesting that the gonadotropin hormones may regulate ovarian GSH synthesis. The present studies tested the hypotheses that [1] estrous cycle-related changes in ovarian GSH result from cyclic changes in protein and mRNA expression of the rate-limiting enzyme in GSH synthesis, glutamate cysteine ligase (GCL, also called gamma-glutamylcysteine synthetase), and [2] that these changes result from gonadotropin-mediated regulation of GCL subunit expression. In the first experiment, ovaries were harvested from cycling adult female rats on each stage of the estrous cycle. In the second experiment immature female rats were injected with pregnant mare's serum gonadotropin (PMSG) to stimulate follicular development or with vehicle and killed 8, 24, or 48 h later. In both experiments the ovaries were harvested for [1] total GSH assay, [2] Western analysis for GCL catalytic (GCLc) and regulatory (GCLm) subunit protein levels, or [3] Northern analysis for Gclc and Gclm mRNA levels. Ovarian GSH concentrations and Gclc and Gclm mRNA levels, but not GCL subunit protein levels, varied significantly with estrous cycle stage. PMSG administration significantly increased ovarian GSH concentrations 24 and 48 h later. GCLm protein levels increased significantly at 24 h and 48 h following PMSG. GCLc protein levels did not increase significantly following PMSG. Gcl subunit mRNA levels were not significantly increased at any time point by the planned ANOVA; however, an increase in Gelc at 48 h was identified by t-testing. These results support the hypothesis that gonadotropins regulate ovarian GSH synthesis by modulating GCL subunit expression.
We used a combination of decision analytic and modeling techniques in constructing a model for study of the management of an asymptomatic woman presenting to a sexually transmitted disease clinic as a contact of a man with gonorrhea. Total cost (physical, emotional, and economic) is expressed in units of dysutility. Initially the probabilities and "costs" of anogenital gonorrhea, incubating syphilis, carriage of the agents of nongonococcal urethritis, and coincident pharyngeal gonorrhea are considered; complications and sequelae are then accounted for. The best strategy is to culture for Neisseria gonorrhoeae, treat immediately with tetracycline, and follow up sexual partners if the culture is positive. Dysutility values calculated for the strategies of just treating with standard regimens of tetracycline, procaine penicillin, or amoxicillin are 288, 310, and 560, respectively. Sensitivity analyses show that the most important factors in determining optimal strategy are the probabilities and costs associated with the patient's carriage of the agents of nongonococcal urethritis. In order for this decision to change, the dysutility value for nongonococcal urethritis would have to decrease to 17% of our best estimate, or the overall prevalence of nongonococcal urethritis would have to be reduced to 16% of our best estimate.
An approach is presented using interactive microcomputers for the development of diagnostic decision aids applicable to some complaints encountered in ambulatory care. The central feature of the descriptive phase of the approach is the use of the underlying (and perhaps dynamic) state of patient health. The central feature of the prescriptive phase of the approach is quick, simple assessment which produces a set of nondominated diagnostic tests, the selection of which is biased by the subjectively determined disease(s) that the diagnostician wishes to rule out or confirm. We present an application of the approach to the complaint, "diarrhea of recent onset in adults," discuss the hardware/software implementation, and summarize preliminary evaluation results.
Telephone interview data from aggregated state surveys showed that about 21 percent of the U.S. adult population expends greater than or equal to 3 kcal/kg-day in vigorous leisure-time exercise. Three kilocalories per kilogram-day is equivalent to the amount commonly recommended to maximally reduce the incidence of coronary heart disease. Approximately 36 percent of the U.S. population reported no vigorous leisure-time exercise. Men, younger persons, and the more highly educated were most likely to expend greater than or equal to 3 kcal/kg-day, but for no subgroup did the rate exceed 30 percent. People who did not smoke, were not obese, and who did wear seat belts are also more likely to expend energy in vigorous leisure-time exercise. The prevalence of alcohol misuse is similar for all exercise categories. The proportion of people who expend greater than or equal to 3 kcal/kg-day is unrelated to self-reported occupational physical effort. Given the established and presumed benefits of physical activity, a substantial portion of the U.S. population would probably benefit from regular, vigorous, leisure-time exercise.
One of two commercial bovine serum albumin preparations caused decreases in rat liver and lung microsomal benzo(alpha)pyrene hydroxylase activities when measured by the fluorescence assay. The decreased activities were not due to a decreased recovery of a reaction product, 3-hydroxybenzo (alpha)pyrene, the presence of unmasked fatty acid binding sites or decreased content of cytochrome P450. The decreased enzyme activity may be due to a component present in the preparation. The results indicate that bovine serum albumin preparations should be carefully checked before use in the benzo(alpha)pyrene hydroxylase assay.
Eight national surveys conducted in the United States and Canada between 1972 and 1983 are reviewed for evidence of leisure-time physical activity patterns in the population. The authors' major conclusion is that it is difficult to make reliable generalizations when definitions of exercise used in the surveys vary so widely. Nevertheless, the young and persons of relatively high socioeconomic status are definitely more active than average in their leisure time; this is probably also true of westerners and suburbanites. Males and females are about equally likely to be involved in conditioning activities, but males are more likely to participate in vigorous exercise and sport. It appears likely that exercise prevalence has increased in recent years, and a maximum of 20 percent of the population exercises at a level frequently recommended for cardiovascular benefit. Major areas of uncertainty and ignorance remain, and the authors identify 15 such areas. Secondary analysis is recommended to help resolve several questions currently impeding a complete description of the exercise patterns of the population. For future surveys, five recommendations are offered on definitions and essential data items. Existing time series studies are generally inadequate. The authors recommend that detailed surveys of exercise patterns be conducted every 5 years to supplement the continual monitoring that is also essential to detect shifts in this important health behavior.