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PubMed1989

Is there a gray peril? Retirement politics in Florida.

Using data from Florida, the most significant destination for Sunbelt retirees, three hypotheses concerning the political impact of retirement migration on the Sunbelt were tested. Surveys of local government officials and socioeconomic data about local government regarding 103 municipalities and 62 counties suggested that aging persons, although politically active, are seldom involved in organized advocacy or political opposition to local policies that are largely beneficial to other interests.

Aged↗
PubMedDate not supplied

Estimation of cancer incidences in Aichi prefecture: use of a model area with good quality registry data.

In Japan, local government is responsible for organization of population-based cancer registries and the quality of the registration remains modest, mainly due to dependence on voluntary-based operations without legal obligations. Aichi Prefecture cancer registry covers a large population, estimated at 7 million, and its quality has yet to reach the level required internationally. The derived cancer incidences for Aichi Prefecture therefore tend to be underestimated. In the present study we set up a model area, located in the central part of Aichi Prefecture, with a good quality of registry data, covering a reasonable population, including both urban and rural areas. Our model area has typical demographic features of Aichi Prefecture. The materials were data on cancer incidence and deaths during the period of 1996-2000 in this model area of Aichi prefecture, with a population of approximately one million, under the jurisdiction of three public health centers, covering nine municipalities. The percentage of death certificated notified (DCN) cases for all sites was around 14% and the incidence/death ratio was around 1.9. Estimated age-adjusted incidence rates were found to be 256.0 (per 100,000) for males and 177.6 for females, these values being 10-15 % higher than those generated using data for the whole prefecture, and quite close to incidence rates in Japan estimated from the highest quality of data available. It is suggested that the cancer incidence in the Aichi prefecture is indeed being underestimated and that the actual figures may be closer to the estimates provided here.

Adolescent↗
PubMed2001

Evaluation and comparison of multimedia mass balance models of chemical fate: application of EUSES and ChemCAN to 68 chemicals in Japan.

The European Union System for Evaluation of Substances (EUSES) and the ChemCAN chemical fate model are applied to describe the fate of 68 chemicals on two spatial scales in Japan. Emission information on the chemicals has been obtained from Japan's Pollutant Release and Transfer Registry and available monitoring data gathered from government reports. Environmental concentrations calculated by the two models for the four primary environmental media of air, water, soil and sediment agree within a factor of 3 for over 70% of the data, and within a factor of 10 for over 87% of the data. Reasons for certain large discrepancies are discussed. Concentrations calculated by the models are generally consistent with the lower range of concentrations that are observed in the environment. Agreement between modeled and observed concentrations is considerably improved by including an estimate of the advective input of chemicals in air from outside Japan. The agreement between the EUSES and ChemCAN models suggests that results of individual chemical assessments are not likely to be significantly affected by the choice of chemical fate model. Primary sources of discrepancy between modeled and observed concentrations are believed to be uncertainties in emission rates, degradation half-lives, and the lack of data on advective inflow of contaminants in air.

Biodegradation, Environmental↗
PubMed1981

Measuring children: one reference for all.

Growth standards developed in industrialised countries are appropriate for measuring child growth in developing countries. From data collected among privileged groups of children in developing countries, we have concluded that child growth is mainly influenced by socioeconomic status and not by race or by ethnicity. Height, weight, and age data were collected from 2366 children aged 6-59 months in Egypt, Togo, and Haiti. These children were chosen from private day-care centres, paediatricians' offices, and families of military and Government officials. These data were compared with the NCHS/CDC reference population, which is representative of healthy U.S. children. Distributions of weight-for-height and height-for-age values for the privileged group and the reference population were nearly identical. The 5th, 50th, and 95th centiles height-for-age of the privileged group did not differ greatly from the reference population. The privileged group, however, was heavier than the reference population at heights greater than 100 cm for the 50th and 95th centiles. Overweight appears to be a greater problem in those privileged groups than in the reference population. Since growth in privileged children in these developing countries and in the U.S. children is similar, we feel that use of the NCHS/CDC reference is justified for measuring nutrition status of preschool children in developing countries.

Anthropometry↗
PubMed1997

Nursing homes in 10 nations: a comparison between countries and settings.

AIM: to illustrate demographic differences and recent trends in the provision and structure of long-term care systems in the 10 countries participating in the Resident Assessment Instrument studies (Denmark, France, Iceland, Italy, Japan, The Netherlands, Sweden, Switzerland, the UK and the USA). METHOD: data were assembled from government documents, statistical yearbooks and articles from journals; supplemental data on long-term care and nursing homes were solicited from colleagues. RESULTS: All 10 countries are developed nations with high life-expectancies. Sweden has the oldest and Iceland the youngest population in this study, with Japan showing the highest ageing rates over the next three decades. Between 2 and 5% of elderly people reside in nursing homes. Interestingly, Iceland, as the 'youngest country' in this study, has the highest rate of institutionalization (living in residential or nursing homes), while the 'oldest country' (Sweden) has a low rate of institutionalization. In all countries the support ratio (number of elderly people per 100 younger adults) is high and increasing rapidly. CONCLUSIONS: no relation appears to exist between the ageing status of a country and the number of nursing home beds. Institutionalization rates among the nations studied differ even more, due at least in part to differences in the organization and financing of long-term care services, in the amount of responsibility assumed in the care for disabled elderly people by each sector and the availability of long-term care beds. Facing a rapid ageing of their population, many countries are in the process of health and social care reforms.

Aged↗
PubMed1997

Service provision among adult public dental service patients: baseline data from the Commonwealth Dental Health Program..

Patients using publicly funded dental care have been reported to have frequent emergency visits and extractions; however, reports have been based on data from a limited number of sites around Australia. The aims of this study were to provide baseline data at the beginning of the Commonwealth Dental Health Program to describe the service characteristics of patients receiving publicly funded dental care, and to analyse factors associated with extraction of teeth. In collaboration with state and territory government health departments, data were collected on patient characteristics, visit details and services received by a cross-sectional sample of adult patients receiving dental care in Queensland in October 1993, in New South Wales, Victoria, South Australia, Tasmania, the Australian Capital Territory and the Northern Territory from March to April 1994, and in Western Australia in October 1994. Data were available for 17,653 dental visits (89.4 per cent were dentate, 56.6 per cent were female, 69.1 per cent were from capital cities, and 38.0 per cent visited for an emergency). For dentate persons, logistic regression showed that factors associated with extractions were: age (< 30 years odds ratio (OR) = 1.28, reference 30+ years), sex (male OR = 1.37, reference (female), indigenous persons (indigenous OR = 2.56, reference nonindigenous), visit type (emergency OR = 4.70, reference nonemergency), and location (noncapital OR = 1.29, reference capital city). In publicly funded dental care, retention of teeth might be enhanced through changes in visit patterns, particularly for younger, male, indigenous and rural patients. Improved access for care is needed to achieve more desirable visit patterns, which would include: less emergency care and more planned care, shorter waiting times for nonemergency care, and fewer extractions.

Adolescent↗
PubMed1996

Genetic testing and early diagnosis and intervention: boon or burden?

The possibility of early diagnosis and intervention is radically changed by the advent of genetic testing. The recent report of the Nuffield Council on Bioethics is timely and helpful. I have suggested, that not only the severity of the disability indicated by genetic information, and the accuracy of the data, ought to govern the approach to the implementation of screening for genetic disorders. In addition, assessment of the value of the information to those involved should be considered. The efficacy of the available therapeutic measures, combined with the prognostic data are important indices of the value of the information. These measures fall into three categories and thus indicate that three different courses of intervention may be appropriate. Three approaches to diagnosis and intervention are then outlined, drawing on the experience of various clinical initiatives.

Adult↗
PubMed2002

Randomized trials of high-dose chemotherapy in breast cancer: fraud, the press and the data (or lessons learned in medical policy governing clinical research).

High dose therapy for breast cancer remains controversial. Of the 15 randomized trials of high dose therapy in breast cancer reported to date, two South African studies have been discredited leaving 13 remaining studies. Mortality was consistently low, in the 0 to 2.5% range, except for the BCNU containing American Intergroup study, which had a 7.4% toxic mortality rate. Seven of the remaining 13 studies randomized fewer than 200 patients. Three of these small studies have significant differences in disease free survival, and a fourth study has a trend in favor of high dose therapy. The other three small studies cannot exclude a survival difference of 20%. Of the 6 remaining moderately large trials of 219 to 885 randomized patients, 5 are adjuvant studies and one included patients with metastatic disease. Of the five adjuvant trials, four have significant differences in relapse rate favoring the high dose arm, and the remaining study has a trend (with a high dose sequential single agent design rather than combination therapy as in the other studies). A planned subset analysis of the first 284 patients in the largest study funded by the Dutch insurance industry showed a significant advantage for high dose therapy. Given the 2-year median time to relapse and an addition 2-year median to death after relapse, the follow up for survival of 3-5 years on these studies is still short. In the only moderately sized metastatic trial from the National Cancer Institute of Canada with a very short median follow-up of 19 months, a significant difference in disease free survival has emerged, with no difference in survival.

Antineoplastic Agents↗
PubMed2001

Database: relevant or not.

Progress in the field of ventricular assist devices requires a more rigorous and systematic method of collecting outcomes data. A worldwide registry of device implants and results is proposed. With widespread participation, data from this registry would improve the identification of risk factors and complications, and allow for the creation of predictive models that would enhance patient selection. Professional societies should lead the development of a registry in close partnership with government and industry. Data collection using the Web, with rigorous security measures to protect patient privacy, would offer numerous advantages in efficiency and immediacy of communication for all participants.

Databases, Factual↗
PubMed2026

Longitudinal Clinical, Physiological, and Molecular Profiling of Female Patients With Metastatic Cancer: Protocol and Feasibility of a Multicenter High-Definition Oncology Study.

PURPOSE: A substantial proportion of patients receiving genomically matched therapies do not achieve clinical benefit, underscoring the influence of nongenetic factors on cancer outcomes. High-Definition Oncology (HDO) proposes integrating longitudinal, multimodal patient data-spanning clinical, molecular, physiological, and behavioral domains-to enable truly individualized cancer care. This manuscript describes the HDO study design, framework, and feasibility results in women with metastatic cancer. METHODS: We initiated a prospective, multicenter observational study (HDO study; ClinicalTrials.gov identifier: NCT06590506) enrolling 300 female patients with newly diagnosed metastatic breast, lung, or colorectal cancer. Here, we report the study design, standardized workflows, prespecified feasibility criteria, and early internal pilot results. Eleven data modalities are collected longitudinally, including tumor and germline genomics, germline epigenomics, gut microbiome, blood and stool metabolomics and proteomics, exposome characterization, wearable-derived physiological monitoring, digital footprint assessment, medical imaging, and patient-reported outcomes. Standardized workflows govern clinical procedures, data acquisition, biospecimen processing, and quality control across all participating sites. RESULTS: Feasibility was evaluated in the first 30 participants (10% of planned accrual). Patients completed 100% of scheduled clinical visits, 97.4% of planned plasma collections, 80.7% of stool samples, and all tumor biopsies. Wearable devices captured activity, heart rate, sleep, and blood oxygen saturation data during 95.0%, 84.2%, 90.6%, and 70.7% of total patient-days, respectively. Biospecimens met predefined quality control metrics across all molecular modalities. Engagement with mobile applications for pain and emotion reporting exceeded 80%. CONCLUSION: The HDO study demonstrates the feasibility of comprehensive, longitudinal, multimodal data collection in women with metastatic cancer. This internal pilot establishes an integrated framework for future analyses aimed at characterizing disease trajectories, defining molecular and physiological determinants of outcomes, and developing patient-specific computational models.

Humans↗
PubMedDate not supplied

Development of a Dietary Exposure Potential Model for evaluating dietary exposure to chemical residues in food.

The Dietary Exposure Potential Model (DEPM) is a computer-based model developed for estimating dietary exposure to chemical residues in food. The DEPM is based on food consumption data from the 1987-1988 Nationwide Food Consumption Survey (NFCS) administered by the United States Department of Agriculture (USDA) and on residue data from government-sponsored monitoring programs. Foods reported in the NFCS were categorized into exposure core foods (ECFs). A computer program for DOS-based personal computers was developed to link consumption of the ECFs with residue values observed in the foods. The data files utilized by the DEPM were designed in dBASE IV with FoxPro for Windows applications programs for queries and reporting. The program calculates exposure estimates for categories of core foods, such as grain dishes, fruits, or vegetables; for individual core foods, such as wheat and apple combination dishes; and for individual foods, such as apples or carrots. The program, residue summary databases, and core food consumption database permit the analyst to evaluate potential exposure of several population groups to various chemicals via the diet. The DEPM is not intended for risk assessments, but is a suitable tool for identifying data gaps and establishing priorities for research, and for identifying potentially significant foods for human exposure monitoring.

Adult↗
PubMed2006

Advances in the analysis of dynamic protein complexes by proteomics and data processing.

Signal transduction governs virtually every cellular function of multicellular organisms, and its deregulation leads to a variety of diseases. This intricate network of molecular interactions is mediated by proteins that are assembled into complexes within individual signaling pathways, and their composition and function is often regulated by different post-translational modifications. Proteomic approaches are commonly used to analyze biological complexes and networks, but often lack the specificity to address the dynamic and hence transient nature of the interactions and the influence of the multiple post-translational modifications that govern these processes. Here we review recent developments in proteomic research to address these limitations, and discuss several technologies that have been developed for this purpose. The synergy between these proteomic and computational tools, when applied together with global methods to the analysis of individual proteins, complexes and pathways, may allow researchers to unravel the underlying mechanisms of signaling networks in greater detail than previously possible.

Computer Simulation↗
PubMed1991

Some indices pertaining to the leprosy control programme in Tamil Nadu, based on data from a random sample of fourteen government control units.

From a random sample of 14 Government Leprosy Control Units in Tamil Nadu, information on the profile of the newly-diagnosed leprosy patients and some important aspects of the control programme in 1978-81 was collected when monotherapy with dapsone was the practice. Among the new patients, 55 per cent were males, 24 per cent were children, 6 per cent had lepromatous leprosy and 9 per cent had a deformity. About 65 per cent were detected by active case-finding methods and 25 per cent were voluntary referrals. Of the total diagnosed patients, only 68 per cent started treatment; further, of these, about 40 per cent collected drugs for at least 6 months in the first year of treatment. The average attendance at the clinic was 34 per cent of the due attendance. Coverage in the annual examination of family contacts was 57 per cent. During the 4 yr period, about 70 per cent of the villages had population surveys with a coverage of 75 per cent or more. The introduction of multi-drug therapy has provided a new impetus to the programme and therefore a similar study is called for to provide valuable information about the extent of improvement in completion rates and overall impact.

Adolescent↗
PubMed2002

Utah youth suicide study, phase I: government agency contact before death.

OBJECTIVE: To delineate the probability of contact between government agencies and youths who complete suicide, to investigate the nature of those contacts, and to identify new risk factors for suicide. METHOD: A descriptive epidemiological analysis of data from multiple Utah government agencies on consecutive youth suicides (n = 151) between August 1, 1996, and June 6, 1999, aged 13-21 years. Data were collected from four government agencies: Office of the Medical Examiner, Juvenile Justice, Department of Human Services, and the Department of Education. RESULTS: Utah descriptive data were similar to national statistics, with the majority of completers being male (89%) and firearms the most common method of suicide (58%). The data demonstrated an association between youth suicide and contact with Juvenile Justice. Sixty-three percent of youths who completed suicide in Utah had contact with Juvenile Justice, and there was a direct correlation between number of referrals and increased suicide risk. Suicide completers had multiple minor offenses over many years. A significant minority of school-age subjects could not be located within the school system. Few suicide completers had evidence of active psychiatric treatment. CONCLUSIONS: Juvenile Justice is identified as a novel site for the screening and identification of youths at risk for suicide.

Adolescent↗
PubMed2001

Cost effectiveness of ramipril treatment for cardiovascular risk reduction.

OBJECTIVE: To assess the cost effectiveness of ramipril treatment in patients at low, medium, and high risk of cardiovascular death. DESIGN: Population based cost effectiveness analysis from the perspective of the health care provider in the UK. Effectiveness was modelled using data from the HOPE (heart outcome prevention evaluation) trial. The life table method was used to predict mortality in a medium risk cohort, as in the HOPE trial (2.44% annual mortality), and in low and high risk groups (1% and 4.5% annual mortality, respectively). SETTING: UK population using 1998 government actuary department data. MAIN OUTCOME MEASURE: Cost per life year gained at five years and lifetime treatment with ramipril. RESULTS: Cost effectiveness was pound36 600, pound13 600, and pound4000 per life year gained at five years and pound5300, pound1900, and pound100 per life year gained at 20 years (lifetime treatment) in low, medium, and high risk groups, respectively. Cost effectiveness at 20 years remained well below that of haemodialysis ( pound25 000 per life year gained) over a range of potential drug costs and savings. Treatment of the HOPE population would cost the UK National Health Service (NHS) an additional pound360 million but would prevent 12 000 deaths per annum. CONCLUSIONS: Ramipril is cost effective treatment for cardiovascular risk reduction in patients at medium, high, and low pretreatment risk, with a cost effectiveness comparable with the use of statins. Implementation of ramipril treatment in a medium risk population would result in a major reduction in cardiovascular deaths but would increase annual NHS spending by pound360 million.

Adult↗