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Biomedical subjects

E Wagner

Publications and source records attributed to E Wagner.

377 records · Page 21Linked to original sources
PubMedDate not supplied

Physician staffing ratios in staff-model HMOs: a cautionary tale.

Predictions of imminent large physician surpluses stem from two observations: rapid increases in the proportion of Americans in managed care plans, and the relatively lean physician staffing ratios reported for health maintenance organizations (HMOs). We use internal data from two large, mature staff-model HMOs to determine precise specialty-specific physician staffing ratios, to see whether these HMOs use fewer physicians than the fee-for-service sector uses. The two HMOs provided the equivalent of 180 physicians per 100,000 enrollees, which is near the national average and far above figures that typically are reported in the literature. Thus, caution regarding current workforce predictions is warranted.

Fee-for-Service Plans↗
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Fresh venous allografts as arterial substitutes in dogs: the importance of donor-recipient tissue compatibility.

Fresh venous allografts were investigated in dogs matched according to donor-recipient tissue compatibility, either originating from the same litter or chosen at random (pound dogs). Five centimeter long segments of femoral vein were interposed as carotid substitutes in an autografting and allografting manner between paired dogs. During a 5-month implantation period, donor-specific antibody development was measured in the recipient serum by a flow-cytometric assay using cultured donor vascular endothelial cells. Autografts and allografts were investigated in terms of patency, histopathology, and endothelial cell function. Fifteen of 16 autografts remained patent. Allografts between littermate dogs, whether compatible or incompatible, showed no donor-specific antibody development and were all patent at retrieval. Compatible and incompatible allografts in littermates did not show any difference in prostacyclin (PGI2)/thromboxane A2 (TXA2) ratios. In pound dogs, both compatible allografts were patent and one dog developed donor-specific antivascular endothelial cell antibodies. Among incompatible dogs, antibody formation was detected at 1 month in five of six recipients and graft patency was as follows: two partial thromboses, two stenoses, and two patent grafts. The PGI2/TXA2 ratio was significantly lower in incompatible allografts than in compatible ones (p = .028). These results show the importance of donor-recipient histocompatibility matching in improving the outcome of vein allografts.

Animals↗
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Putting population-based care into practice: real option or rhetoric?

BACKGROUND: Efforts to improve care have focused on population-based approaches, though little practical information exists about implementation. METHODS: This report reviews relevant literature on teamwork in the context of a time-series evaluation of a demonstration project to reorganize care of a single panel of patients in a managed care setting. The proportion of the study panel achieving recommended levels for breast and colon cancer screening, warfarin control, and diabetic eye care was compared with the surrounding practice panels and the managed care population as a whole. Using unconditional logistic regression, we compared changes within populations between March 1993 and March 1995, and the rate of change between populations during the same period. RESULTS: A model of team care was successfully implemented. Colon (occult blood in the stool) and breast (mammography) screening increased more rapidly in the study population than in the surrounding practices or plan as a whole (P < 0.05 for all comparisons). There was no significant improvement in warfarin control or diabetic eye examinations, though absolute increases occurred. CONCLUSION: This work shows that a team approach to population-based care is a real option. Such an approach, however, will not generalize to other settings or all conditions, and its implementation involves some major challenges.

Adult↗
PubMedDate not supplied

Assessing the validity of a survey of the restaurant health promotion environment.

Our primary question was whether a telephone survey of restaurant personnel could provide accurate community-level measures of the restaurant health promotion environment. An obvious concern was that restaurant personnel might exaggerate the extent to which their establishment had a positive health promotion environment. Comparison with the most obvious "gold standard"--direct observation--showed fairly accurate reporting about nonsmoking seating arrangements, but restaurant personnel exaggerated the extent to which menu items were designated as low in fat. We also compared the restaurant-survey measures of nonsmoking seating availability at the community level with measures of the restrictiveness of local no-smoking ordinances. We found a positive relationship, as expected, between measures of the restrictiveness of ordinances and the amount of nonsmoking seating indicated by the restaurant survey.

California↗
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Antitumor activity and induction of apoptosis by water-soluble derivatives of 7 beta-hydroxycholesterol in human colon carcinoma cell lines.

At present, cancer therapy of solid tumors, such as lung and colorectal cancer, is unsatisfactory. Recently, oxygenated sterols have shown selective cytotoxicity against tumor cells. In this study, the cytotoxicity of 7 beta-hydroxycholesterol (7 beta HC) and two water-soluble derivatives of 7 beta HC, i.e. 7 beta HC-bis-hemisuccinate [disodium salt] (7 beta HC-HS) and 7 beta HC-bis-hemisuccinate-diethanolaminoate (7 beta HC-EA), was determined in DLD-1, KM20L2, HCT-116, HT-29 and SW620 colon carcinoma cell lines using a cell count assay. IC50 values of the two water-soluble derivatives were, on the whole, comparable to 7 beta HC lying in the range of 3-10 microM. In addition, the water-soluble derivatives were able to induce apoptosis in the examined DLD-1 and KM20L2 colon carcinoma cell lines in contrast to the parent compound 7 beta HC, as shown by DNA fragmentation, by the cleavage of DNA repair enzyme poly(ADP) ribose polymerase (PARP), and by the proteolytic cleavage of caspase-3 (CPP32). Due to the improved water-solubility of 7 beta HC-HS and 7 beta HC-EA and their promising antitumor activity in vitro, animal studies in suitable tumor models are warranted.

Antineoplastic Agents↗
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Factors associated with regular aerobic exercise in an elderly population.

BACKGROUND: Little is known regarding the characteristics of elderly persons who do not regularly exercise. This lack of knowledge limits the design and marketing of exercise programs to persons who could benefit from regular exercise. METHODS: We compared characteristics of regular exercisers and nonexercisers among 561 randomly selected persons aged 65 years and older who were enrollees of a health maintenance organization. Baseline data were obtained on sociodemographics, health attitudes, and medical conditions. RESULTS: Of the 561 persons studied, 192 (34 percent) were regular exercisers. Exercisers were slightly younger than nonexercisers and reported more positive health perceptions. Nonexercisers tended to report lower incomes and lower educational levels than did exercisers. Exercisers were less likely to report hypertension, arthritis, or two or more of the following medical conditions: heart disease, hypertension, arthritis, and emphysema (odds ratio 0.49; confidence interval 0.28 to 0.86). Sex differences were present. In logistic regression analysis, higher reported income, better perception of current health, and fewer than two medical conditions were associated with regular exercise status. CONCLUSIONS: Specific characteristics are present in persons who regularly exercise compared with those who do not. These findings may prove useful in understanding the dynamics of exercise behavior in this age group and in designing exercise interventions for this population.

Age Factors↗
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Environmental indicators: a tool for evaluating community-based health-promotion programs.

We propose using a class of community-level measures--environmental indicators--as part of the evaluation of community-based health-promotion programs. Community-level measures of health-related behavior can be divided into three conceptual categories. The first two categories comprise statistical aggregates (e.g., means, sums, percentages) of measurements made on individuals, distinguished by whether individual-level covariates are also available. Individual-disaggregated measures include covariates, such as a comprehensive survey of health-risk behavior, including demographic information; individual-aggregated measures, such as sales data, do not. Our main focus is on the third category, environmental indicators, derived from observations of the community environment. Environmental indicators measures aspects of the physical, legal, social, and economic environment in a community that reflect, and likely influence, the attitudes and behavior of individual community members. They also measure an important intermediate step in community-based health-promotion interventions, namely environmental factors that programs target to modify individual attitudes and behavior. We present examples of environmental indicators for tobacco use and diet.

Attitude to Health↗
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The expression of EGF receptors, EGF-like factors and c-myc in ovarian and cervical carcinomas and their potential clinical significance.

The expression of the epidermal growth factor receptor (EGF-R) and the c-myc oncogene was investigated in different specimens of ovarian and cervical carcinomas. The EGF-Rs were analyzed by EGF binding assay, immunohistochemistry and Northern blotting. For analysis of c-myc expression, we used Northern blotting and immunohistochemistry. Furthermore, tissue concentrations of EGF-like factors (EGF-F) were measured in the same tumor and non-malignant specimens. The biochemical determination of EGF-R demonstrated that EGF specific binding sites were detected in 36% of ovarian (n = 140) and 81% of cervical carcinomas (n = 42). High amounts of EGF-R (greater than 10 fmol/mg specific binding) were found in 8% of the ovarian and 41% of the cervical carcinomas. Increased expression of EGF-R specific mRNA was detectable in 7/21 ovarian and in 5/7 cervical carcinomas. A positive correlation between the amounts of EGF-R mRNA, the EGF-R binding data and the staining index of EGF-R immunohistochemistry was found. The EGF-R immunohistochemistry demonstrates that only the tumor cells produce increased amounts of EGF-R, while the stromal cells are EGF-R negative. Low amounts of EGF-R specific mRNA were also detected in biochemically EGF-R negative tumors. The c-myc specific mRNA signal was found in all cases investigated. It is shown that the c-myc expression was increased in 10/21 ovarian and 5/7 cervical carcinomas. There was no positive correlation between the amounts of EGF-R and c-myc mRNAs. The product of myc, as detected by immunohistochemistry, is found in tumor as well as in stromal cells. The levels of EGF-F were measured in extracts of 63 ovarian and 12 cervical carcinomas and in 21 non-malignant tissues. About 30% of the tumor extracts contained higher EGF-F levels (4-15 ng/mg) than those found in the non-malignant specimens. Tumors with high EGF-F levels expressed high amounts of c-myc RNA. The EGF-R status (n = 111) and the EGF-F levels (n = 63) were related to the prognosis of survival for patients with ovarian carcinomas. EGF-R positive (EGF-R(+)) ovarian carcinomas had a significantly higher response rate to chemotherapy. The survival time of the EGF-R(+) group is reduced compared to the EGF-R negative (EGF-R(-)) group if only patients in remission are used to construct survival curves. Furthermore, a poor prognosis for survival was noticed for ovarian carcinoma patients with high EGF-F levels.

Biomarkers, Tumor↗
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Immunologic and genetic factors predisposing to allergy.

Allergy often begins with a subtle and/or transient T cell defect. This defect is first responsible for an IgA deficiency. The normal function of IgA is immune exclusion. In its absence, allergens can pass through the mucosa and stimulate the immunocompetent cells. The T cell defect may also be implied by the synthesis of IgE directed against the allergens which passed through. Clinical, biological and immunological findings (T cell defect in allergic disease, low range of IgA in the early life of atopics) are in agreement. The genetic factor for pollinosis and house dust allergy are segregated. In ragweed allergy there is an Ir gene coding for antigen-specific Ig of different classes and a group of non-linked major histocompatibility complex alleles coding for non antigen-specific IgE. There are some links with HLA. In house dust allergy the Ir gene is very common and almost everyone can produce an allergy under some conditions (T cell defect). Whatever the immunologic and genetic factors are, they need allergens and environmental factors to induce allergy. Allergy is a complex state in which several mechanisms, often associated and sometimes unclear, are involved. Some of them may be an abnormality of the autonomic nervous system, and/or an increase in the mucous membrane permeability, and/or a subtle immunodeficiency. All these mechanisms are regulated by genetic factors and modulated by environmental ones.

Environment↗
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Derivatives of 3.3-spiro-bi-5-methyl-5'-alkylaminomethyl-tetrahydrofuranone-2 as potential neurotropic agents. II.

Dilactone of gamma-bromo-beta-hydroxypropyl-beta-hydroxypropyl malonic acid 2 was prepared. By condensation with secondary or primary amines the tertiary amines 3--7. resp. the secondary amines 8--10 were obtained. The reaction of 2 with tertiary amines gave the corresponding ammonium salts 11--12. All the compounds are subjected to pharmacological examination.

Animals↗
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A community-based approach to preventing alcohol use among adolescents on an American Indian reservation.

This paper examines the effectiveness of a 5-year community-based health promotion program to reduce the rate of substance use, particularly alcohol, by adolescents on a Plains State American Indian reservation. The program was part of the Kaiser Family Foundation Community Health Promotion Grants Program. Since a reservation control group was not available, adolescents serving as control groups for other Community Health Promotion Grants Program communities, including a small sample of rural American Indians, were used as a basis for comparison. School-based surveys of 9th and 12th graders were carried out on the reservation and in five relevant California control communities--two suburban, three rural--in 1988, 1990, and 1992. The results showed that the use of both alcohol and marijuana declined substantially among American Indian adolescents living on the reservation. Binge drinking (five or more drinks on an occasion) declined from 46 percent to 30 percent, and marijuana use (in the past month) declined from 46 percent to 29 percent over the 4-year period. However, there were similar, if smaller, declines in alcohol use in the comparison groups. Since there was no evidence of a relative increase in exposure to alcohol and drug programs on the reservation, the authors are cautious in attributing the significant and heartening declines in substance use among adolescents on the reservation to the community-based program.

Adolescent↗
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Relationship between socioeconomic status, health status, and lifestyle practices of American Indians: evidence from a Plains reservation population.

This paper presents information on the prevalence of a variety of health behaviors and health conditions on an American Indian reservation in the Plains region of the western United States. In addition, data from two non-Indian comparison groups were used to examine the extent to which differences in health status and health behaviors between Indians and non-Indians could be explained by differences in socioeconomic status. The American Indian data were from a survey conducted in 1988 during an evaluation of a local community-based health promotion program, part of the Kaiser Family Foundation's Community Health Promotion Grants Program. The comparison groups were 12 communities in California surveyed in evaluating the Community Health Promotion Grants Program and three Plains States participating in the Behavioral Risk Factor Surveillance Survey. The results show that the higher prevalences of risk-taking behavior among Indians and their poorer self-reported health status remained after adjustment for socioeconomic status. Also, among Indians, higher levels of income and education were not associated with improved self-reported health status and lower prevalence of tobacco use, as was the case with the comparison groups. The higher prevalences of risk-taking behaviors and ill health among American Indians residing on one reservation, even among those with higher socioeconomic status, suggests a need for the investigation of other social and environmental influences.

Adolescent↗
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Conference report: community-based health promotion--state of the art and recommendations for the future.

The evaluators of the Henry J. Kaiser Family Foundation Community Health Promotion Grants Program in the West and the Foundation brought together 21 researchers, funders, and community organizers with a variety of perspectives on community-based health promotion to share what has been learned to date and how that knowledge should be applied in the future. The two-day conference was divided into three sessions, covering conceptual, implementation, and evaluation issues. Specific topics were selected by the organizers with input from participants. Two papers were presented in each session, followed by comments from discussants and a general discussion involving the entire group. The dominant theme of the conference was the relationship between communities and outside institutions, focusing on problems with the current state of relations and how they might be improved in the future. All viewed building partnerships between communities and institutions as a desirable goal; however, the challenges involved in building effective partnerships are considerable and require a substantial investment to make them work. Recommendations that emerged from the discussions included explicitly acknowledging the diverse interests of the parties in community-based programs at the earliest stages of program planning; making a concerted effort to bridge the cultural gaps that exist among the parties; structuring funding to allow enough lead time for partnerships to develop or using social reconnaissance to identify strong existing partnerships; and integrating the evaluation more closely into the process of program development.

Community Participation↗
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Gene expression and protein deposition of major basement membrane components and TGF-beta 1 in human breast cancer.

In the present study we used immunohistochemistry and in-situ hybridization for the localization of major basement membrane (BM) components and their mRNA, respectively, in order to determine the extent of BM production and deposition in normal mammary tissue as well as in invasive mamma carcinomas. While normal mammary tissue showed an intact epithelial BM, as evidenced by a continuous linear staining for collagen i.v., laminin, heparan sulfate proteoglycan (perlecan) and fibronectin, this staining was widely lost in the invasive carcinomas. Non-invasive intraductal areas of the carcinomas (carcinoma-in-situ) revealed focal fragmentation and duplication of the epithelial BM. Using in-situ hybridization, we observed only focally positive mRNA-expression for collagen i.v.-, perlecan- and fibronectin-mRNA in normal glands, while mRNA-signals were significantly enhanced in one case of fibroadenoma and particularly in invasive and non-invasive carcinomas, regardless of the degree of tumor cell differentiation. In these instances both tumor and stroma cells were positively labelled. In addition, we could demonstrate a significant increase in the level of TGF-beta 1-mRNA--as the most active cytokine for the induction of matrix component production--by carcinoma cells and to lesser extent by stroma cells. The discrepancy between significantly enhanced mRNA-synthesis and loss in protein deposition points either to an upregulated activity of matrix degrading proteinases (matrix-metalloproteinases) or a posttranslational block of protein synthesis or both.

Adult↗