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Long-term body weight fluctuation in an overweight population.

Weight loss programs report such low percentages of overweight subjects who lose weight and maintain the loss that the concern arises whether these results represent anything more than baseline population weight fluctuations. In this study, weights recorded for medical purposes at two clinic visits separated by intervals of 1 to 5 years were analysed for 332 adult patients who were initially at least 20 percent over their ideal body weight. Weight change calculations for this general patient population revealed that 219 (66 percent) had increased in weight by a mean of 5.7 kg, and that 113 (34 percent) had decreased in weight by a mean of 5.3 kg. The 59 patients measured over a 5-year interval showed an 'apparent body weight loss' for 31 percent of this sub-group with a mean decrease of 7.3 kg. Weight loss studies and programs must demonstrate a rate of weight loss maintenance beyond that of a control group before attributing 'weight loss' in a population to any factor other than normal weight fluctuation.

Adult

The implications for information system design of how health care costs are determined.

As the costs of health care assume increasing importance in national health policy, information systems will be required to supply better information about how costs are generated and how resources are distributed. Costs, as determined by accounting systems, often are inadequate for policy analysis because they represent resources consumed (expenditures) to produce given outputs but do not measure forgone alternative uses of the resources (opportunity costs). To accommodate cost studies at the program level and the system level, relational information systems must be developed that allow costs to be summed across individuals to determine an organization's costs, across providers to determine an individual patient's costs, and across both to determine system and population costs. Program level studies require that cost variables be grouped into variable costs that are tied to changes in volume of output and fixed costs that are allocated rationally. Data sources for program-level analyses are organizational financial statements, cost center accounting records, Medicare cost reports, American Hospital Association surveys, and the Department of Veterans Affairs (VA) cost distribution files. System-level studies are performed to predict future costs and to compare costs of alternative modes of treatment. System-level analyses aggregate all costs associated with individuals to produce population-based costs. Data sources for system-level analyses include insurance claims;n Medicare files; hospital billing records; and VA inpatient, outpatient, and management databases. Future cost studies will require the assessment of costs from all providers, regardless of organizational membership status, for all individuals in defined populations.

Accounting

Dynamics of dog and cat populations in a community.

OBJECTIVE: To describe dynamics of the pet dog and cat populations in a single community in terms of reproductive patterns and turnover. DESIGN: Cross-sectional, random-digit dial telephone survey. SAMPLE POPULATION: Information gathered from 1,272 households in St Joseph County, Ind that owned a dog or cat between Dec 1, 1993 and Nov 30, 1994 was compared with data on 9,571 dogs and cats received by the Humane Society of St Joseph County during the same period. RESULTS: Prevalence of pet ownership was lower than expected, compared with consumer panel surveys. Eight hundred forty-three of 1,335 (63.1%) dogs were neutered, compared with 816 of 1,023 (79.8%) cats. Cost was cited as a reason that 35 of 441 (7.9%) dogs and 34 of 132 (25.8%) cats were not neutered. Only 33 of 968 (3.4%) dog-owning households reported that their dog had had a litter during the past year, whereas 52 of 662 (7.9%) cat-owning households reported their cat had had a litter of kittens. Most cat litters were unplanned, whereas two thirds of dog litters were planned. Annual turnover in owned pets was 191 of 1,354 (14.1%) dogs and 194 of 1,056 (18.4%) cats. Pet owners underreported relinquishing pets to a shelter in the telephone survey. CLINICAL IMPLICATIONS: A combination of animal shelter- and human population-based data are needed to describe pet population dynamics in a community. Information about species-specific reproductive patterns is essential in designing population control programs.

Animal Welfare

Screening and biochemical characterization of transthyretin variants in the Portuguese population.

The study of pathogenic and nonpathogenic transthyretin (TTR) variants is very important for the understanding of such TTR-related diseases as hereditary amyloidosis and also to establish a relationship between the structure and function of the molecule. Variants with clinical manifestations can be easily detected, but clinically silent variants can be detected only by population screening programs using specialized techniques. Hybrid isoelectric focusing (HIEF) in extremely flattened immobilized pH gradients (IPG) allows the detection of even neutral amino acid substitutions and has been used to analyze approximately 5,000 samples from the Portuguese population. Comparison with samples from carriers of three known TTR mutations (Met 30 associated with hereditary amyloidosis, Met 119, and Asn 90) was also made. In this study we detected: (1) 8 individuals carriers of TTR Met 30, (2) 35 carriers of TTR Met 119, (3) 12 carriers of TTR Asn 90, (4) 1 compound heterozygote for TTR Met 30/Met 119, and (5) 5 variants that presented a different pattern from the controls used. We also performed DNA sequencing analyses of two of the variants with the different band pattern in HIEF. The individuals were found to be carriers of TTR Ile 122 and TTR Thr 190, respectively. All the mutations detected, except for Asn 90, result from substitutions in CpG hot spots and thus can be rather frequent in the populations. Studies on the clinical evolution of the compound heterozygotes and on the physical-chemical properties of these hybrid TTRs will help to understand the pathogenicity associated with TTR.

Amyloidosis

A computer program for modeling the kinetics of gene expression.

Enzyme induction may be modeled on the basis of four, quantifiable processes that control the rates at which specific gene products accumulate and decay. These processes include synthesis of functional mRNA, translation and degradation of mRNA, and degradation of the protein product. We present a simple computer program that permits mathematical simulation of gene expression on the basis of experimentally determined rates of synthesis and degradation. The program was implemented as a spreadsheet using Microsoft Excel for Macintosh and MS-DOS operating systems and also was adapted for HyperCard on the Macintosh. It contains a formula to account for growth of tissue or cell populations. The program predicts amounts of individual mRNAs and proteins (or enzyme activities) in cells as a function of time after a stimulus alters their rates of synthesis or degradation.

Animals

Population and family planning in China.

As the most populous country of the world, China pursues an integrated programme for socio-economic development with family planning as a vital part of it. The aim is to ensure that population growth does not outpace the economic development, the availability of natural resources and environmental protection efforts. Current policy on family planning includes: the promotion of late marriage and deferred child bearing, advocating the practice of "one couple, one child", to encourage birth spacing for those who want a second child. Technical guidelines are: contraception as the priority; comprehensive use of various contraceptive methods in men and women; induced abortion allowed on request if no contraindications; state provided contraceptives, barrier devices and technical services. The birth rate of 33.34/1000, death rate of 7.6/1000 and natural increase rate of 25.83/1000 in 1970 was brought down to 21.04/1000, 6.7/1000 and 14.26/1000 respectively in 1985. A total fertility for 1950 of 5.87 was gradually brought down to 2.31 in 1990. 260 million births were averted between 1970-1991; the world's "5-billion population day" was postponed for 2 years and Asian "3-billion population day" was postponed for 3 years. The State Family Planning Commission under the State Council was set up in 1981. The China Family Planning Association, the China Population Association and non-governmental organisations promote family planning work in a coordinated way. The current family planning policy is now well accepted in the urban area, and gaining increasing momentum in the rural area. Persistant education is still important to break the millennia old tradition of having more children and more boys.

Aging

Plasma lipid distributions in selected North American populations: the Lipid Research Clinics Program Prevalence Study. The Lipid Research Clinics Program Epidemiology Committee.

Cross-sectional age- and sex-specific plasma lipid distributions (means, medians and selected percentiles) are given for 48,431 white participants in visit 1 of the Lipid Research Clinics (LRC) Prevalence Study. This study consisted of two visits in which 10 LRCs screened participants selected from well-defined North American target populations that included a broad range of sociodemographic subgroups. These data confirm findings from earlier studies in developed countries, showing age-related differences in plasma lipid levels. However, for overall distributions, the LRC data showed slightly lower cholesterol and markedly higher triglyceride values than those previously reported for North America. Some variation in plasma lipid values was evident among the clinic populations. The large number of participants within most subgroups permitted a variety of analytic and comparative studies. For example, data from the large pediatric population revealed a drop in plasma cholesterol levels in adolescent males and females. Males aged 20--50 years had higher cholesterol levels than females in the same age group, and higher triglyceride levels between ages 20--70 years. Numbers were also sufficient for meaningful comparisons between lipid distributions of females who were taking sex hormones and those who were not: In females taking sex hormones, cholesterol and triglyceride levels were higher for subjects younger than 45 years, but slightly lower after age 45, than lipid levels in females not taking hormones.

Adolescent

Infant feeding practices in Bombay slums.

A study was conducted in two slum areas in a Bombay suburb covering a total population of 4879. One hundred and fifty-three mothers having children below two years were interviewed. Ninety six per cent infants below the age of 4 months received breast milk, though exclusive breastfeeding was practised only in 37% infants. Timely complementary feeding rate was only 0.48. Twenty three per cent of mothers used bottle for administration of supplementary food or water. Only 15.7% of mothers used commercial milk formula and 8.5% used commercial weaning food.

Bottle Feeding

Estimation of potential carcinogenic effects related to waterborne environmental contaminants.

Described here is a computer program that provides estimates of theoretical cancer levels in a community following long-term exposure to contaminants found in domestic drinking water. The program employs one of three low-dose risk assessment models using dichotomous outcome data to derive a dose-response curve. Based on this curve, lifetime probabilities are determined, by dose, for acquiring selected types of cancer in a specified population. The program allows for sensitivity analyses of varying demographic, epidemiologic, and environmental factors, all of which could influence the occurrence of disease at the community level.

Carcinogens, Environmental

A model for planning local contraceptive services.

Data were collected on abortion referral rates, single young maternity rates and uptake of contraceptive services in order to identify specific areas of unmet need in the Nottingham Health District. Comparisons were made between boroughs and in the City of Nottingham between electoral wards. There was a direct relationship between abortion rate, single young maternity rate and social disadvantage. Analysis of contraceptive usage suggested a more ineffective service in the inner city, which has implications for the more efficient use of resources in the future. Targeting of consumer acceptable services to residents of the inner city and teenagers in general was recommended as a result of the study. For future planning a more useful routine data set was developed to record the activity at family planning clinics.

Adolescent

Inbreeding of Wistar-Kyoto rat strain with hyperactivity but without hypertension.

A genetic inbreeding program using Wistar-Kyoto rat strains as progenitors was used to combine the hyperactivity trait of the spontaneously hypertensive rat (SHR) with the normotensive trait of the WKY genetic control strain. From an SHR X WKY cross we produced a gene-assorting F2 population from which selected brother-sister matings were carried out through seven successive inbred populations. This program produced a new strain of hyperactive rats with normotensive mean systolic blood pressure levels, and we have designated the new strain as the Wistar-Kyoto hyperactive (WK/HA) rat. Another behavioral characteristic of the SHR rat, poor habituation in a nonreinforcing novel environment, did not appear as a characteristic trait of the new strain of WK/HA rats, suggesting a separate underlying genetic basis for the two traits that had been apparently fortuitously fixed in the SHR genotype as a result of intensive inbreeding of that strain. The new WK/HA strain, together with the WKY control strain, is considered as more suitable for subjects in studying hyperactivity in rats than the original SHR strain with its concomitant hypertension and poor habituation traits.

Animals

Effect of calcium on skeletal development, bone loss, and risk of fractures.

In assessing the role of calcium, it must be stressed that calcium is not the cause of bone health but simply a necessary condition for it. It is mechanical usage that is of primary importance for bone. In just the same way iron is essential for hemoglobin synthesis and protein is essential for muscle mass, but neither is sufficient by itself. What, then, ought we to expect from a high calcium intake? Can we prevent estrogen-withdrawal bone loss? No. Calcium is not a substitute for estrogen, anymore than it is a substitute for exercise. Will calcium slow the remodeling loss that occurs with aging? Yes, to some extent; as calcium slows remodeling, it will inevitably slow remodeling-related loss. But most importantly, a high calcium intake will prevent calcium-deficiency bone loss. The only question, therefore, is the extent to which calcium deficiency loss may contribute significantly to bone fragility in various populations. The bone loss and fracture data reviewed briefly here indicate that an important portion of the osteoporotic fracture burden is calcium-related. What that portion is will be a function of the fraction of the population with inadequate intakes in any given country. Better than half of all adult American women have calcium intakes less than 500 mg/day, whereas only a small fraction of Dutch or Danish women, for example, would be under that level. Hence, a population-wide program to increase calcium intake in the United States would be likely to yield a greater benefit than in either the Netherlands or Denmark. That does not mean, of course, that there could not be substantial benefit to individuals with low intakes in all countries. Calcium intakes of greater than or equal to 1,500 mg are both safe and natural. While not all bone loss and low trauma fractures are due to low calcium intake, some almost certainly are. Adaptation to low intakes does occur, but it is seldom sufficient to compensate for the low intake. We cannot easily distinguish those who need more calcium from those who need less, and for that reason it makes good sense to ensure an adequate calcium intake for the entire adult population. What should that intake be? During adolescence, 1,500 mg will come close to ensuring the achievement of genetically programmed levels of peak bone mass.(ABSTRACT TRUNCATED AT 250 WORDS)

Bone and Bones

[Ultrasonographic diagnosis of tumors and non-tumor diseases in mass preventive examination of the rural population].

Ultrasound diagnostical examinations were performed during mass prophylactic check-ups in cotton-growing collective farms of Kashkadar'inskaya Region. Out of 903 examinees cancer was detected in 1 patient (0.11%), benign tumors in 11 (1.2%), precancer in 25 (2.7%), nontumor diseases in 298 (33.0%). The lesions were predominantly localized in the gastrointestinal and urogenital tracts. It is advisable to organize paid mobile teams at regional consultative and diagnostic centers for broad-scale check-ups of rural population. Screening programs of such teams are to include diagnostic ultrasound.

Adolescent

Doxepin: a useful adjunct in the treatment of heroin addicts in a methadone program.

An uncontrolled trial of doxepin as an adjunct to treatment of heroin addicts in a methadone program was performed over a 14-month period. Approximately 10% (27) of the program's population utilized a mean of 73 mg of doxepin, usually briefly, and beneficial results were noted in 93% (25). One adverse reaction occurred. No instance of habituation or addiction was noted. A controlled study is warranted to confirm the impression that doxepin represents a useful adjunct in the treatment of heroin addicts in a methadone program.

Adult

Methodology of ECG interpretation in the Dalhousie program; NOVACODE ECG classification procedures for clinical trials and population health surveys.

The Dalhousie ECG Program was designed specifically for the needs of epidemiologic studies, health surveys, and clinical trials. The program logic is dynamic in that it can accommodate any combination of ECG leads, record length and sampling rate. The NOVACODE module of the program classifies ECGs according to the Minnesota Code, supplemented with new sets of logic criteria for conduction defects, acute myocardial infarction, and serial ECG changes. Improved statistical models are incorporated for enhanced detection of myocardial infarction using the Cardiac Infarction Injury Score, and for quantification of left ventricular mass estimation. It is anticipated that these program improvements will enhance its utility particularly in monitoring progression and regression of cardiac involvement in hypertensive and ischemic heart disease, and in the assessment of the effectiveness of intervention on cardiovascular disease risk factors.

Adolescent