Biomedical subjects
Publications and source records attributed to P Camp.
Preventing caries and reducing out-of-pocket costs for dental services are two strategies proposed by the authors to lower the rate of tooth extractions. Efforts also must be made to change public values about the importance of restoring rather than extracting carious teeth.
To determine whether health outcomes in a health maintenance organisation (HMO) differed from those in the fee-for-service (FFS) system, 1673 individuals ages 14 to 61 were randomly assigned to one HMO or to an FFS insurance plan in Seattle, Washington for 3 or 5 years. For non-poor individuals assigned to the HMO who were initially in good health there were no adverse effects. Health outcomes in the two systems of care differed for high and low income individuals who began the experiment with health problems. For the high income initially sick group, the HMO produced significant improvements in cholesterol levels and in general health ratings by comparison with free FFS care. The low income initially sick group assigned to the HMO reported significantly more bed-days per year due to poor health and more serious symptoms than those assigned free FFS care, and a greater risk of dying by comparison with pay FFS plans.
The purpose of these studies was to determine the temporal requirements and time of day required for progesterone (P4) to amplify versus extinguish LH surges. The experimental animal model used in these studies was the 7-day ovariectomized rat (day 0) treated continuously with estradiol (E2) for 2-4 days (days 2, 3 or 4). In these studies we also examined the changes which occur in estrogen nuclear (ERn) and progestin cytosol (PRc) receptor concentrations in the preoptic area (POA), medial basal hypothalamus (MBH), corticomedial amygdala (CMA) and pituitary gland (PIT) associated with these physiological responses. When two P4 capsules (50 mg/ml) were placed subcutaneously at 09.00 h on day 2 and removed 3 h later (12.00 h), LH surges were amplified that afternoon. 24 and 48 h later (days 3, 4) phasic LH release reoccurred albeit in reduced concentrations compared to the LH values obtained in E2-treated rats on day 2. In contrast, if P4 capsules remained in situ for greater than 24 h, LH surges did not reappear on day 3. In a separate group of E2-treated rats, P4 capsules were placed subcutaneously at 15.00 h and removed at 21.00 h on day 2. Only minor increases in LH occurred on day 3 compared to E2-treated controls. Thus, both the duration of time and hour of day that the hypothalamo-pituitary unit is exposed to P4 seem important in determining which component of the biphasic LH response (amplification vs. inhibition) will occur.(ABSTRACT TRUNCATED AT 250 WORDS)
Explore the source record for details and available documents.
The relations among sociodemographic factors, health status, and use of prescribed sleeping pills and tranquilizers are examined. The data are from the Rand Health Insurance Experiment, which has a random sample of the nonaged, noninstitutionalized, civilian population in six U.S. sites. Information on sociodemographic factors, health status, and the use of prescribed psychotropic drugs during the previous 3 months was obtained from self-report questionnaires collected at enrollment. Mental and physical health status have large independent and significant effects on the probability of use of both prescribed tranquilizers (P less than 0.0001) and sleeping pills (P less than 0.0001), whether or not we remove the effects of sociodemographic factors. For the probability of tranquilizer use, there is no significant interaction between gender and mental health or between mental health and physical health. Age and gender have large and significant effects on the use of prescribed psychotropic drugs even after controlling for differences in health status and other demographic factors. The effects of site and socioeconomic status are modest compared with the effects of health, age, and gender.
The present studies were designed to answer three questions: (1) how will a progressive increase in serum estradiol (E2) in ovariectomized (OVX) rats affect progesterone (P4)-induced luteinizing hormone (LH) surge concentrations? (2) Can steroid-induced LH surges be correlated with estrogen nuclear receptor (E2Rn) and progestin cytosol receptor (PRc) levels in brain regions known to regulate LH secretion, and (3) do differences in pituitary responsiveness to LHRH in E2- or E2P4-treated OVX rats parallel changes in E2Rn and PRc concentrations in this gland? 1 week after ovariectomy of adult cyclic rats (day 0), Silastic E2 capsules were placed subcutaneously at 09.00 h and produced serum E2 levels of 6-8 (low), 12-19 (medium) and 27-37 (high) pg/ml, respectively. 2 days later (day 2), some rats also received Silastic P4 capsules subcutaneously which elevated serum P4 concentrations to 10-12 ng/ml. In rats with low serum E2, P4 treatment induced peak serum LH levels of 913 ng/ml. When serum E2 was increased to the medium or relatively high physiologic range, P4 treatment resulted in LH surge levels of 4,686 and 5,030 ng/ml. OVX controls and E2-treated OVX rats were sacrificed at 10.00 h on day 2 and E2Rn and PRc were measured concurrently in the preoptic area (POA), mediobasal hypothalamus (MBH), corticomedial amygdala (CMA) and pituitary gland (PIT). Raising serum E2 from OVX levels to the low range significantly increased both E2Rn and PRc in MBH and PIT, but not in the POA or CMA.(ABSTRACT TRUNCATED AT 250 WORDS)
In these studies we examined the temporal parameters of estradiol (E2) priming required before progesterone (P4) amplifies the surge release of luteinizing hormone (LH) in short-term ovariectomized (OVX) rats. Thereafter, we correlated the time of appearance and concentrations of estrogen nuclear (E2Rn) and progestin cytosol (PRc) receptors in brain regions known to be involved in the surge release of LHRH. Steroid receptor concentrations were also measured in the pituitary gland. 1 week after OVX (day 0), Silastic capsules containing E2 (150 micrograms/ml in oil s.c.) were placed at 09.00 h. The serum E2 concentrations produced by these capsules peaked (41 +/- 2.1 pg/ml) at 10.00 h on day 0 and declined thereafter to values which ranged between 19 and 10 pg/ml on days 1 through 4. Some of these E2-treated rats also received 2 P4-containing Silastic capsules (50 mg/ml s.c. in oil) at 09.00 h on either days 0, 1, 2, 3 or 4. Serum P4 concentrations produced by such capsules were 9.3 +/- 0.5 ng/ml. Blood was collected sequentially at 09.00 h and at hourly intervals from 12.00-18.00 h on the day that the animals received the P4 capsules and 10.00 and 15.00 h samples also were taken from each group the next day. LH surges occurred in these E2-treated rats in the afternoons of days 2-4, but not on days 0 and 1. P4 treatment on day 1 elicited an LH surge and on days 2-4 it amplified plasma LH surge concentrations and advanced by 1 h the time of release of this gonadotropin.(ABSTRACT TRUNCATED AT 250 WORDS)
Do children whose families bear a percentage of their health care costs reduce their use of ambulatory care compared with those families who receive free care? If so, does the reduction affect their health? To answer these questions, 1,844 children aged 0 to 13 years were randomly assigned (for a period of 3 or 5 years) to one of 14 insurance plans. The plans differed in the percentage of their medical bills that families paid. One plan provided free care. The others required up to 95% coinsurance subject to a +1,000 maximum. Children whose families paid a percentage of costs reduced use by up to one third. For the typical child in the study, this reduction caused no significant difference in either parental perceptions of their child's health or in physiologic measures of health. Confidence intervals are sufficiently narrow for most measures to rule out the possibility that large true differences went undetected. Nor were statistically significant differences observed for children at risk of disease. Wider confidence intervals for these comparisons, however, mean that clinically meaningful differences, if present, could have been undetected in certain subgroups.
Seven patients with a total of 12 roots were treated with overdentures (maxillary, mandibular, or both) and recalled at 6-month intervals for a period of 4 years. A periodontist evaluated the periodontal health status of the abutment roots after complete periodontal therapy, immediately prior to placement of the overdentures, and at all recall visits. The gingival tissues around all the abutments were slightly erythematous and edematous and bled on probing. There were no statistically significant changes in pocket depth or in apparent width of attached gingiva on an intra-arch basis. However, statistically significant changes were found on comparison between the maxillary and mandibular arches. Over the 4-year period 50% of the roots remained immobile, 25% of the roots that were initially mobile exhibited no mobility, and 25% of the roots decreased in mobility. Five of 14 roots in eight patients (35.7% of the abutment roots) developed dental caries. Periodic recalls to reinforce plaque control measures, to provide adjunctive periodontal therapy, and to correct and adjust the prostheses of patients treated with overdentures are important factors in the longterm success of this treatment modality. Biomechanically, treatment of patients with overdentures is a valid practical alternative to complete dentures.
This study determined whether the biochemical characteristics of the estradiol (E2) nuclear receptor located in three different brain areas and the pituitary gland (PIT) change in aging rats undergoing declining reproductive function. To measure maximal E2 nuclear receptor concentrations, groups of young (3-4 months old), middle-aged (8-11 months old), and old (16-18 months old) cycling rats were injected iv with E2 to translocate maximally cytosolic receptors into the nucleus. One hour later they were killed and nuclear extracts were prepared. Maximal E2 nuclear receptor concentrations and dissociation constants were assessed in the preoptic area (POA), medial basal hypothalamus (MBH), amygdala (AMYG), and PIT using an in vitro exchange assay and covariance analyses of double reciprocal plots (Lineweaver-Burk). Middle-aged cycling rats exhibited decreased E2 nuclear receptor concentrations in the POA, but no change in the MBH, AMYG, or PIT. Old rats exhibited decreased E2 nuclear receptor concentrations in the POA, MBH, and PIT and an unexpected increase in the AMYG. There was no change in the affinity of the receptor with age, although an apparent decrease in the pituitary E2 nuclear receptor of middle-aged rats was observed. This difference was not detected when saturation analyses were performed using varying dilutions of the pituitary nuclear extract. These results demonstrate that changes occur in maximal numbers of E2 nuclear receptors in the POA of middle-aged rats. As animals age further, the changes encompass a larger brain area and include the PIT. The data suggest that changes in E2 nuclear receptor concentrations may contribute to the age-related decline in reproductive function.
Explore the source record for details and available documents.
The present methods used to measure estrogen nuclear (E2Rn) and progestin cytosol (PRc) receptors in the hypothalamus and pituitary gland require that separate assays be performed to determine the concentrations of each receptor. In the present studies we describe a method which simultaneously measures both E2Rn and PRc in hypothalamic and pituitary tissue. Tissue samples were homogenized in tris-EDTA-glycerol-dithiothreitol buffer and centrifuged at 1500 X g for 5 min. The supernatant was purified for the PRc assay while the nuclear pellet was extracted for the E2Rn exchange assay. For the PRc assay, the supernatant was centrifuged at 106,500 X g for 30 min and aliquots from the resultant supernatant then were incubated with 3H-R5020. For the E2Rn exchange assay, the original pellet was purified further by successively resuspending and centrifuging it through several sucrose solutions. Estrogen-receptor complexes were extracted from the chromatin pellet with a 0.4M KC1 solution and aliquots of the final supernatant were incubated with 3H-estradiol. In both assays, the samples were placed onto Sephadex LH20 columns and the receptor bound 3H-steroid was eluted directly into scintillation vials. Scatchard analyses revealed that these assays measure a single class of binding sites for E2Rn and PRc with dissociation constants (KD) and maximal number of binding sites (Bmax) similar to those previously reported using a separate assay for each receptor.
Explore the source record for details and available documents.
OBJECTIVE: To study whether the extent and type of treatment for comorbid anxiety disorders varies for patients with depression, hypertension, diabetes, and heart disease treated by general medical clinicians. METHODS: Data are from 2189 general medical patients with and without comorbid anxiety disorders in the Medical Outcomes Study. Treatment data were based on clinician reports of counseling provided during a visit and patient reports of recent medication use. RESULTS: Patients with comorbid anxiety disorders were more likely to receive treatments for anxiety disorders than those without anxiety disorders. Among those with anxiety disorders, the use of psychosocial counseling and psychotropic medication was greater for patients with depression than for patients without depression who had chronic medical conditions. Minor tranquilizers were used more commonly than antidepressants, regardless of the type of comorbid condition. Among patients with anxiety disorders, those visiting medical subspecialists were more likely to use minor tranquilizers than those visiting family practitioners or internists. Patients of family physicians with chronic medical conditions (but not with depression) were less likely than similar patients of internists to use minor tranquilizers whether or not anxiety disorders were present. CONCLUSIONS: Anxiety disorders co-occurring with another disease (medical illness or depression) increases the likelihood of counseling and the use of psychotropic medication in the general medical sector. Patients with a chronic medical illness with or without comorbid anxiety disorders visiting family physicians are less likely to use minor tranquilizers than those visiting subspecialists or internists.