The relationships among accommodative ability, younger-onset diabetes, and other factors are examined in this report. The study population consists of younger-onset diabetic persons less than 45 years of age who participated in the Wisconsin Epidemiologic Study of Diabetic Retinopathy. In 656 of 859 such persons, near point of accommodation was measured twice for each eye using the best correction for distance visual acuity and a Prince rule. Mean amplitude of accommodation in the diabetic population decreased with age and was less than that of a nondiabetic group and of previously published reports. Other factors associated with decreased accommodation in the diabetic population in a multiple linear regression analysis include sex, with the female population being more susceptible; absence of myopia; a longer duration of diabetes; higher glycosylated hemoglobin level; higher blood glucose level; increasing severity of diabetic retinopathy; and higher systolic blood pressure.

Accommodation, Ocular↗

PubMed1987

Towards a new pluralism.

The thesis of this paper is that the future development of health services, cross-nationally, is likely to be influenced more by changes in organisational, managerial and information technologies than by ideological preferences. Such changes are likely to make the traditional ideological and conceptual distinction between the public and private sector redundant, as boundaries become blurred. The trend, it is argued, is towards forms of organisations based on networks rather than hierarchies and towards for-profit or co-operative health care enterprises complementing large-scale public organisations. Such forms of health care organisation, it is further argued, are likely to promote adaptability in the face of rapid change and satisfy producer demands for autonomy. The thesis is illustrated by the recent experience of Britain where more flexible organisational patterns are emerging which, however, do not comfortably fit into the traditional public/private conceptual antithesis despite the ideological bias of the Conservative Government towards market solutions. Finally, the paper concludes that American ideas and experience may be a poor guide for European countries, since change starts from a very different organisational and intellectual foundation.

Government↗

PubMed1987

Pathological gambling among high school students.

Eight hundred and ninety-two high school students from four New Jersey high schools were given a questionnaire concerning their gambling behavior. Ninety-one percent of the students had gambled at least once in their lifetime, 86% gambled in the last year and 32% gambled at least once a week. Using an index which was validated in other research (Lesieur, Blume, & Zoppa, 1986) 5.7% of the students showed clear signs of pathological gambling. The pathological gambling signs index was found to be correlated with sex, parental gambling problems, grade average, and the extent of gambling by the student.

Achievement↗

PubMed1987

Immunology of primary biliary cirrhosis.

(1) The serological diagnosis of PBC is possible in almost 100% of cases when appropriate methods and specific antigen preparations are used such as the purified ATPase fraction by ELISA for the detection of anti-M2, sonicated mitochondria by immunodiffusion for the demonstration of precipitating antibodies against M-A or M-B, and cell cultures by immunofluorescence for the detection of antibodies against nuclear dots. (2) The establishment of AMA profiles obtained by ELISA and CFT seems to be a sensitive approach to a better definition of the natural course of PBC. A distinction between a rather benign and a more progressive course seems especially possible in the presence of the AMA profiles A and B (anti-M9 and/or anti-M2-positive only by ELISA) versus D (anti-M2-, anti-M4-, anti-M8-positive in the CFT). (3) The analysis of cellular immune reactions in vitro and in vivo suggests an activation of cytotoxic T cells as well as a defect in the function of T suppressor cells. (4) Although the aetiology of PBC is unknown, the detection of MHC Class II antigens on bile duct epithelial cells in liver biopsies of patients with PBC but not of normal individuals may imply that an infectious agent being exposed in association with these MHC structures may trigger the disease. The inability of the immune system in controlling this infectious process would then lead to an ongoing inflammatory reaction which is responsible for the continuous destruction of bile ducts within portal triads.

Antibody Formation↗

PubMed1987

Optic disc cupping as clinically estimated from photographs.

Cup-to-disc ratios of 204 right eyes were evaluated by two clinicians and by a trained grader using a standardized grading scheme. Mean measurements by the grader were greater than estimates made by either clinician. The measurement scheme used by the trained grader has a high degree of reliability and validity. The standard protocol provides an objective assessment of optic disc cupping and could be easily adapted for office use.

Diabetic Retinopathy↗

PubMed1987

The Wisconsin Epidemiologic Study of Diabetic Retinopathy. VII. Diabetic nonproliferative retinal lesions.

The prevalences of hard exudates, soft exudates, intraretinal microvascular abnormalities (IRMAs), and venous beading and their relationships to demographic and other characteristics were examined in a population-based study in southern Wisconsin. For participants whose age at diagnosis was less than 30 years and who were taking insulin (N = 996), hard exudates were found in 24.2%, soft exudates in 15.3%, IRMAs in 16.5%, and venous beading in 7.0% of the population. For participants whose age at diagnosis was 30 years or older and who were taking insulin (N = 674), hard exudates were found in 28.3%, soft exudates in 15.5%, IRMAs in 8.8%, and venous beading in 3.2%. For older-onset persons not taking insulin (N = 696), hard exudates were found in 9.4%, soft exudates in 5.4%, IRMAs in 2.6%, and venous beading in 0.9% of the population. The severities of the lesions were found to be consistently associated with longer duration of diabetes in younger-onset persons and the presence of proteinuria in older-onset persons.

Cross-Sectional Studies↗

PubMed1987

The Wisconsin Epidemiologic Study of Diabetic Retinopathy. VI. Retinal photocoagulation.

The prevalence of focal and panretinal photocoagulation and its relationship to demographic and other characteristics were examined in a population-based study in southern Wisconsin. For participants whose age at diagnosis was less than 30 years and who were taking insulin (996 persons) the prevalence rate of panretinal photocoagulation (13.9%) was higher than that of focal photocoagulation (3.6%). For those whose age at diagnosis was 30 years or older (1370 persons), the prevalence rate for panretinal photocoagulation (3.6%) was slightly higher than that of focal photocoagulation (3.0%). Seventy-two percent of eyes of younger onset and 45% of eyes of older onset persons that had received panretinal photocoagulation treatment were found to have incomplete regression of retinal new vessels, and in approximately half of these eyes severe proliferative retinopathy (Diabetic Retinopathy Study High Risk Characteristics [DRS-HRC]) was present. Among eyes with DRS-HRC, 55% were found to be untreated.

Adult↗

PubMed1987

The association of iris color with eye disease in diabetes.

Iris (eye) color was examined for its effect on eye disease in a population-based study of diabetic retinopathy in Wisconsin. Eye color was determined by comparing the iris in a red reflex photograph with standard photographs. In younger-onset diabetic persons (N = 996), macular edema was more prevalent in persons with blue or grey eyes (12%) compared with intermediate (9%) or brown (6%) (P = 0.04). Cataracts were more prevalent in blue or grey eyes (32%) compared with intermediate (22%) or brown (20%) in the younger-onset group (P less than 0.001). In older-onset persons (N = 1370), intraocular pressure (IOP) was higher in persons with brown eyes (17.8 mmHg) compared with blue or grey (17.1 mmHg) or intermediate (16.6 mmHg) (P = 0.012). Eye color was not associated significantly with diabetic retinopathy in either the younger- or older-onset group or with age-related macular degeneration or glaucoma in the older-onset group.

Adult↗

PubMed1987

Glycosylated hemoglobin in a population-based study of diabetes.

Glycosylated hemoglobin was measured in persons who participated in a population-based study of diabetic retinopathy in southern Wisconsin. There were 996 persons who were diagnosed prior to 30 years of age and who were taking insulin (younger onset), and 1,370 persons who were diagnosed at 30 years of age or older (older onset) who were examined from 1980-1982. Glycosylated hemoglobin was measured using a microcolumn technique. Mean glycosylated hemoglobin was highest in younger onset persons (10.9%), and lowest in older onset persons not taking insulin (9.0%). Only a small percentage of values for the diabetic persons fell within the range of values found in a nondiabetic comparison group. Mean glycosylated hemoglobin was found to be associated with retinopathy status but not with proteinuria.

Adolescent↗

PubMed1987

The epidemiology of diabetic retinopathy: findings from the Wisconsin Epidemiologic Study of Diabetic Retinopathy.

Explore the source record for details and available documents.

Adult↗

PubMed1987

Adrenocortical function in acquired immunodeficiency syndrome.

Clinical features of adrenal steroid deficiency occur in patients with the acquired immunodeficiency syndrome (AIDS). To determine the frequency of aberrations in peripheral steroid levels in patients with AIDS and AIDS-related complex (ARC) we measured morning recumbent plasma cortisol, deoxycorticosterone, 18-hydroxydeoxycorticosterone (18-OHDOC), corticosterone, aldosterone, and 18-hydroxycorticosterone concentrations before and after administration of 0.25 mg ACTH (Cosyntropin) in 74 randomly selected hospitalized patients with AIDS and 19 patients with ARC. Basal (0800 h) cortisol levels in the AIDS patients were significantly higher (P less than 0.01) than those in normal subjects, while other ACTH-dependent steroids of the 17-deoxypathway, deoxycorticosterone, corticosterone, and 18-OHDOC, were normal. These latter steroids increased subnormally in response to ACTH in patients with either AIDS (P less than 0.001) or ARC (P less than 0.005), but in ARC patients plasma 18-OHDOC levels were significantly higher than in those with AIDS (P less than 0.001). Supraphysiological doses of ACTH were then administered for 3 consecutive days to 14 patients with AIDS and 9 with ARC, which confirmed and amplified the subnormal responses of these steroids in AIDS. The mean plasma cortisol response was reduced on the third day only in AIDS patients, whereas in the ARC patients the steroid responses were normal. Angiotensin III infusion and postural stimulation increased plasma aldosterone and 18-hydroxycorticosterone levels in AIDS and ARC patients. Defective stimulation of 18-OHDOC alone or in combination with defective stimulation of other 17-deoxysteroids can be a harbinger of subsequent impaired adrenal capacity in AIDS.

AIDS-Related Complex↗

PubMed1987

The regulation of nursing homes: a comparative perspective.

Britain and the United States alike face the question of how best to protect the growing and vulnerable population of nursing home residents through State regulation of private institutions. Despite marked differences in scale, organization, and financing between the two nations, there are striking similarities in the problems encountered and in styles of enforcement adopted in response. Analysis of the regulatory systems in practice shows a convergence in the regulatory process despite the dissimilarities between formal regulatory models. Both systems are responding--however imperfectly--to the social environment of nursing home care. Future regulatory policy will have to encompass formal and informal, legal and social control.

Aged↗