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PubMed1988

Axon arbors of X and Y retinal ganglion cells are differentially affected by prenatal disruption of binocular inputs.

In the mammalian visual system, the terminal arbors of retinal ganglion cell axons from the two eyes are restricted to mutually exclusive territories within their thalamic target, the lateral geniculate nucleus (LGN). Here we have investigated some of the factors that determine the adult morphology of terminal arbors in the cat's retinogeniculate system. Removal of one eye during prenatal life at a time when retinogeniculate axons from the two eyes are extensively intermixed within the LGN perturbs the subsequent morphological development of some but not all axons from the remaining eye. The presence of terminal arbors qualitatively normal in size, shape, and location within the LGN suggests that for some retinal axons, ongoing binocular interactions throughout prenatal life are not needed for the development of normal arbor morphology. However, many of the axons form arbors of abnormal size or location, suggesting that such features of axon morphology are not intrinsically determined for these axons but may be susceptible to external influences. Electrophysiological studies reveal that the abnormal arbors all belong to the functionally distinct Y class of retinal ganglion cells, whereas the normal arbors all belong to X cells. The different responses of X and Y axons to prenatal enucleation demonstrate that during development subsets of a single neuronal population projecting to the same target in the central nervous system can be under different developmental controls for axon arbor differentiation.

Animals↗
PubMed1996

The development and use of demographic models.

In this review, we first examine two classical demographic models - conventional life tables and stable populations - and a modern generalization of stable population theory; we then discuss mathematical models of conception and birth. These models involve purely mathematical relations in formal demography as opposed to empirical regularities. Next we consider model age schedules of mortality, nuptialitiy, marital fertility, fertility, and migration that are explicitly based on such empirical patterns. We close this empirical section with a discussion of model stable populations, which are based on model life tables. We next examine the use of demographic models in forecasting future mortality, nuptiality, and fertility and in population projection. Following a discussion of microsimulation models, which gives us the opportunity to mention model age schedules of post partum amenorrhoea and of sterility, we close with observations about the purposes and uses of demographic models.

Demography↗
PubMed2000

Beyond affirmative action: one school's experiences with a race-neutral admission process.

The authors first review the national debate about affirmative action programs, examine the results of these programs in higher education, and present data from 1995 through 1999 for minority enrollment in U.S., California, and Texas medical schools. Population projections for the state of Texas indicate a national trend that minority groups will outnumber the current majority early in the new millennium. A brief review of studies of the practice patterns of minority physicians concludes that minority physicians serve patients of their own races and/or ethnicities, poor patients, and Medicaid patients in disproportion to their numbers. This rationale, as well as the humanitarian need to develop all persons to their highest potential, led the Texas A&M University Health Science Center College of Medicine to develop a race-neutral process for admission. Changes in the admission process are described and preliminary results are presented. This article is written to stimulate other medical colleges to engage in an ongoing dialog about admission criteria and processes that can effectively select applicants who fit the mission of each medical college and who, as physicians, will care for patients who are members of this country's burgeoning minority groups.

Education, Medical, Undergraduate↗
PubMed2001

The importance of gender on outcome after major trauma: functional and psychologic outcomes in women versus men.

BACKGROUND: Outcome after major trauma is an increasingly important focus of injury research. The effect of gender on functional and psychological outcomes has not been examined. The Trauma Recovery Project is a large, prospective, epidemiologic study designed to examine multiple outcomes after major trauma, including quality of life, functional outcome, and psychological sequelae such as depression and early symptoms of acute stress reaction. The specific objectives of the present report are to examine gender differences in short- and long-term functional and psychological outcomes in the Trauma Recovery Project population. METHODS: Between December 1, 1993, and September 1, 1996, 1,048 eligible trauma patients triaged to four participating trauma center hospitals in the San Diego Regionalized Trauma System were enrolled in the study. The enrollment criteria for the study included age 18 years and older, admission Glasgow Coma Scale score of 12 or greater, and length of stay greater than 24 hours. Quality of life was measured after injury using the Quality of Well-being scale, a sensitive index to the well end of the functioning continuum (range, 0 = death to 1.000 = optimum functioning). Depression was assessed using the Center for Epidemiologic Studies Depression scale and early symptoms of acute stress reaction were assessed using the Impact of Events scale. Patient outcomes were assessed at discharge and at 6, 12, and 18 months after discharge. RESULTS: Functional outcome was significantly worse at each follow-up time point in women (n = 313) versus men (n = 735). Quality of Well-being scale scores were markedly and significantly lower at 6-month follow-up in women compared with those in men (0.606 vs. 0.646, p < 0.0001). This association persisted at 12-month (0.637 vs. 0.6685, p < 0.0001) and 18-month (0.646 vs. 0.6696, p < 0.0001) follow-up. Women were also significantly more likely to be depressed at all follow-up time points (discharge odds ratio [OR] = 1.4, p < 0.05; 6-month follow-up OR = 2.2, p < 0.01; 12-month follow-up OR = 2.0, p < 0.01; 18-month follow-up OR = 2.2, p < 0.01) and to have early symptoms of acute stress reaction at discharge (OR = 1.4, p < 0.05). These differences remained significant and independent after adjusting for injury severity, mechanism, age, and sociodemographic factors. CONCLUSION: Women are at risk for markedly worse functional and psychological outcomes after major trauma than men, independent of injury severity and mechanism. Gender differences in short- and long-term trauma outcomes have important implications for future studies of recovery from trauma.

Adult↗
PubMed2001

Perceived threat to life predicts posttraumatic stress disorder after major trauma: risk factors and functional outcome.

BACKGROUND: The importance of psychological morbidity after major trauma, such as posttraumatic stress disorder (PTSD), is continuing to gain attention in trauma outcomes research. The Trauma Recovery Project is a large prospective epidemiologic study designed to examine multiple outcomes after major trauma, including quality of life (QoL) and PTSD. The specific objectives of the present report are to examine risk factors for PTSD and to assess the impact on QoL at the 6-, 12-, and 18-month follow-up time points in the Trauma Recovery Project population. METHODS: Between December 1, 1993, and September 1, 1996, 1,048 eligible trauma patients triaged to four participating trauma center hospitals in the San Diego Regionalized Trauma System were enrolled in the study. The enrollment criteria for the study included age 18 years and older, admission Glasgow Coma Scale score of 12 or greater, and length of stay > 24 hours. QoL was measured after injury using the Quality of Well-being scale, a sensitive index to the well end of the functioning continuum (range, 0 = death to 1.000 = optimum functioning). Early symptoms of acute stress reaction (SASR) at discharge were assessed using the Impact of Events Scale (score > 30 = SASR). PTSD at 6-month follow-up was diagnosed using standardized Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, criteria. Patient outcomes were assessed at discharge and at 6, 12, and 18 months after discharge. RESULTS: PTSD was diagnosed in 32% (261 of 824) patients at 6-month follow-up. Perceived threat to life predicted PTSD onset (odds ratio [OR], 1.6; p < 0.01) and early SASR (OR, 2.2; p < 0.001). PTSD was more frequent in women (39%) than in men (29%) and in younger low-income patients. Other major risk factors were penetrating trauma (OR, 2.3; p < 0.001) and assaults (OR, 1.5; p < 0.05). PTSD had a major impact on QoL at 6-, 12-, and 18-month follow-up (Quality of Well-being scale score: 6 months, 0.576 vs. 0.658; 12 months, 0.620 vs. 0.691; 18 months, 0.620 vs. 0.700; p < 0.0001). CONCLUSION: These results provide new and provocative evidence that perceived threat to life and mechanism predict PTSD after major traumatic injury. PTSD had a prolonged and profound impact on short- and long-term outcome and QoL.

Adolescent↗
PubMed2002

Gender differences in long-term posttraumatic stress disorder outcomes after major trauma: women are at higher risk of adverse outcomes than men.

BACKGROUND: The importance of psychological morbidity after major trauma, such as posttraumatic stress disorder (PTSD), is continuing to gain attention in trauma outcomes research. The Trauma Recovery Project is a large prospective epidemiologic study designed to examine multiple outcomes after major trauma, including quality of life (QoL) and PTSD. Patient outcomes were assessed at discharge and at 6, 12, and 18 months after discharge. The specific objectives of the present report are to examine gender differences in prolonged PTSD (L-PTSD) and to assess the impact of PTSD by gender on QoL at the 6-, 12-, and 18-month follow-up time points in the Trauma Recovery Project population. METHODS: Between December 1, 1993, and September 1, 1996, 1,048 eligible trauma patients triaged to four participating trauma center hospitals in the San Diego Regionalized Trauma System were enrolled in the study. The enrollment criteria for the study included the following: age 18 years and older; admission Glasgow Coma Scale score of 12 or greater; and length of stay greater than 24 hours. QoL was measured after injury using the Quality of Well-being (QWB) scale, a sensitive index to the well end of the functioning continuum (range: 0 = death to 1.000 = optimum functioning). Early symptoms of acute stress reaction (SASR) at discharge were assessed using the Impact of Events Scale (score > 30 = SASR). PTSD at 6-, 12-, and 18-month follow-up was diagnosed using standardized Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. PTSD (L-PTSD) was diagnosed if full or partial (F + P) or full (F) PTSD Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria were present at all follow-up time points. RESULTS: PTSD (L-PTSD) (F + P) was diagnosed in 35% (221 of 627) of patients at follow-up. PTSD (L-PTSD) (F) was present in 32% (153 of 627). Women were at significantly higher risk of PTSD (F + P) (odds ratio = 2.4, p = 0.001) and PTSD (F) (odds ratio = 2.8, p = 0.001) than men. The association of gender with PTSD was independent of mechanism and injury event-related factors such as perceived threat to life. In multivariate logistic regression, female gender, perceived threat to life, and SASR were strongly and independently associated with PTSD risk. Women were also at risk for worse QWB outcomes; beginning at discharge through the 18-month follow-up, women had significantly lower QWB scores at each follow-up time than men, regardless of prolonged PTSD status. CONCLUSION: These results provide important new evidence that high rates of PTSD persist in the long-term aftermath of major trauma. The association of gender with PTSD was independent of mechanism and injury event-related factors such as perceived threat to life. Within categories of specific mechanism of injury and injury event-related factors, women were at significantly higher risk of prolonged PTSD onset. Prolonged PTSD was associated with significantly reduced quality of life in both men and women, with markedly worse QWB outcomes in women regardless of prolonged PTSD status.

Chi-Square Distribution↗
PubMed1999

Lung cancer epidemiology and genetics.

Lung cancer is the number one cause of cancer death for all citizens of the United States regardless of gender, race, or ethnic background. Surgery, the only curative treatment available, is feasible in only 35% of all patients with lung cancer. But even in this group of patients, most will die of recurrent disease. Treatment advances have been modest at best, and the 5-year survival rate of approximately 15% has not changed appreciably in the past two decades. Population projections indicate a continuation of the lung cancer epidemic among men and a rise among women, in whom rates of smoking have remained relatively high. It is estimated that 90% of all lung cancers are smoking related, and gender, race, and family history are important risk modifiers. Several promising markers of lung cancer susceptibility have recently been identified. However, the relative contribution of individual intrinsic factors (genetic markers, family history, race, gender) on lung cancer susceptibility in the context of complex extrinsic factors (behavior, environmental exposure, socioeconomic status) is unknown and requires further study for more informed screening and primary prevention.

Female↗
PubMed1997

The effect of universal coverage on health expenditures for the uninsured.

OBJECTIVES: Universal coverage will trigger an increase in health-care spending, because the uninsured will use more services after they are insured. The effect of insurance status on expenditures is estimated here from a multivariate statistical model. METHODS: The model is estimated with data from the 1987 National Medical Expenditure Survey, aged to 1994 using population projections from the US Bureau of the Census and expenditure projections from the Health Care Financing Administration. RESULTS: Expenditures for the full-year uninsured increase by approximately $700 per person in 1994 as a result of universal coverage. Nearly half of the increase is because of a substantial increase in the likelihood of hospitalization. CONCLUSIONS: If the uninsured are enrolled in plans similar to those offered by employers currently, personal health-care spending increases by approximately $20 billion in 1994. There are other costs associated with universal coverage that are not included in this figure.

Adolescent↗
PubMed2006

Gonochorism vs. hermaphroditism: relationship between life history and fitness in three species of Ophryotrocha (Polychaeta: Dorvilleidae) with different forms of sexuality.

1. The relationships between life history, fitness and sexuality, together with their ecological and evolutionary significance, has been analysed comparing the main life-history traits and demography in three closely related species belonging to the genus Ophryotrocha. The species are: the gonochoristic O. labronica, the simultaneous hermaphrodite O. diadema and the protandrous hermaphrodite O. puerilis. 2. Survivorship and reproductive data were collected weekly and were used to construct life tables and population projection matrices for each species and compare life-history characteristics. Elasticity, life-table response and decomposition analyses were performed to examine the relative contribution of fecundity and survivorship to differences in lamda between species. 3. The gonochoristic and hermaphroditic species differ in all the main life-history parameters and also in demographic characteristics. In particular the value of lamda, used commonly to express fitness, is markedly higher in the gonochoristic species while in terms of fitness simultaneous and sequential hermaphroditism are very similar. In the genus Ophryotrocha gonochorism currently represents the most widespread condition, being characteristic of the majority of the known species in the genus. 4. Given the demographic advantage ensured by gonochorism, it remains be understood why some species have retained simultaneous hermaphroditism and one has evolved a sequential type hermaphroditism; the most probable hypothesis is correlated with the density of the species in natural habitats.

Age Factors↗
PubMed1996

The likely increase in maternal mortality rates in the United Kingdom and in France until 2005.

In the UK, the decline in maternal mortality rates has stopped. In France, where they are higher than in most European countries, maternal mortality rates have been increasing since 1990. Based on the population projections published by Eurostat, maternal mortality predictions have been made for 1995, 2000, 2005 and 2010. A rise in the level of maternal mortality rates of more than 0.5 per 100000 livebirths is expected between now and 2005, in both countries. In the present context of near stability, this rise could be viewed as an important increase. Maternal mortality rises with maternal age and the proportion of births to women over thirty is growing and will continue to rise until 2000-2005. This structural and demographic evolution explains the expected rise of maternal mortality rates and shows how the change in the maternal age distribution of births will affect these rates.

Adolescent↗
PubMed1994

Dental status, diet and cardiovascular risk factors in middle-aged people in northern Sweden.

The aim of the present study was to compare the dietary intake and the levels of traditional cardiovascular (CVD) risk factors in edentulous middle-aged individuals and individuals of the same age and sex who still had natural teeth. The study was performed within the framework of the MONICA-project. Population registers were used to sample randomly 1287 men and 1330 women aged 25-64 yr. Data were collected from a mailed questionnaire, blood analyses, registrations of blood pressure and anthropometric measures. The estimated daily energy intake did not differ between the two groups, but edentulous men and women ate more sweet snacks compared to those who still had teeth. Edentulous men also ate less fruits, vegetables and fibre and edentulous women ate more fat than dentates. Edentulous men and women were more obese and had lower serum HDL-cholesterol concentrations than those with remaining teeth. Edentulous women also had significantly higher concentrations of total cholesterol and triglycerides in serum than dentate women. Edentulous men and women were more often regular smokers, but not snuff users, than dentates of the same age and sex. Thus, the presence of two or more cardiovascular risk factors was more common in edentulous individuals than in those who still had natural teeth. In summary, these results support the hypothesis that edentulous middle-aged individuals have a more unfavourable risk factor profile for CVD. Counselling on balanced dietary habits and non-smoking given by dental personnel to orally diseased patients--recommendations given to improve resistance to dental caries or periodontitis--might therefore improve general health and possibly also improve risk factors for CVD.

Adult↗
PubMed1983

Suicide among older people: projections for the future.

Guided by recent demographic analyses of birth cohort effects, the authors demonstrate the relationship between cohort size and longitudinal suicide rates, with reference to four particular cohorts which have entered adulthood at various periods throughout the present century. Combining this perspective with a look at projected population increases among older age groups, estimates are made of the scope of the problem of suicide among older people which is likely to be encountered during the early decades of the next century.

Adolescent↗
PubMed2006

The number of people with glaucoma worldwide in 2010 and 2020.

AIM: To estimate the number of people with open angle (OAG) and angle closure glaucoma (ACG) in 2010 and 2020. METHODS: A review of published data with use of prevalence models. Data from population based studies of age specific prevalence of OAG and ACG that satisfied standard definitions were used to construct prevalence models for OAG and ACG by age, sex, and ethnicity, weighting data proportional to sample size of each study. Models were combined with UN world population projections for 2010 and 2020 to derive the estimated number with glaucoma. RESULTS: There will be 60.5 million people with OAG and ACG in 2010, increasing to 79.6 million by 2020, and of these, 74% will have OAG. Women will comprise 55% of OAG, 70% of ACG, and 59% of all glaucoma in 2010. Asians will represent 47% of those with glaucoma and 87% of those with ACG. Bilateral blindness will be present in 4.5 million people with OAG and 3.9 million people with ACG in 2010, rising to 5.9 and 5.3 million people in 2020, respectively. CONCLUSIONS: Glaucoma is the second leading cause of blindness worldwide, disproportionately affecting women and Asians.

Adult↗
PubMed1983

North Hammersmith stroke prevention project.

The North Hammersmith stroke prevention project was designed to reduce the number of deaths from stroke in this health district by improving the detection of hypertensive patients and thereafter reducing the default rate from treatment. Starting in May 1979 general practitioners in the district were asked to register hypertensive patients over the age of 40 so that the proportion of such patients in each practice was known and could be compared with the average for all practices. This confidential information was fed back every year to the individual general practitioners so that they could assess their performance. Forty of 44 eligible general practitioners agreed to participate and 29 proceeded to register patients. Over a three year period 1006 patients were registered, representing 4.3% of the project population over the age of 40. Individual practice registration rates ranged from 1.1% to 9.1%. Sixty five per cent of the registered patients were women, 34% of all registrations were in the age group 60-69, 31% in the group 50-59, 12% in the group 40-49, and 23% in the group over 70. The average blood pressure before treatment was 190/111 mm Hg. After one and two years the patients were contacted or their notes examined to ensure that they still receiving treatment. Persistant default from treatment occurred in under 12% over the three year period.

Adult↗
PubMed1997

An estimate of chronic disease burden and some economic consequences among the elderly Hong Kong population.

OBJECTIVES: To estimate the burden of chronic disease for an elderly Chinese population aged 70 years and over, and to illustrate the use of this information in estimating the economic consequences of disease burden using stroke as an example. PARTICIPANTS: A total of 1902 subjects recruited by random sampling of the old age and disability allowance schemes, which cover over 90% of the Hong Kong elderly population, stratified by sex and five year age groups from age 70 years onwards. METHOD: Information was collected on 10 medical conditions at baseline: arthritis, hypertension, cardiac disease, stroke, chronic obstructive airways disease, peptic ulcer, diabetes mellitus, osteoporotic fracture, malignancy, and dementia. A follow up survey was carried out after 18 months to determine the occurrence of new disease and the number with disease who had died. Disease burden is calculated as the number with disease at baseline plus the number developing new disease minus the number who had died. RESULTS: Disease burden figures were highest for arthritis, hypertension, cardiac disease, and peptic ulcer, and were higher in the 70-79 age group than the 80+ age group for some diseases. For stroke, the economic cost based on a population projection for 2001 was estimated to be around HK$1,900,000,000, or US$250 million. CONCLUSION: Information on the burden of chronic disease is important. It enables the economic consequences to be estimated so that strategies can be developed to prevent diseases with high costs and known effective preventive methods.

Age Distribution↗
PubMed1990

Striatal afferents in the newt Triturus cristatus.

In order to investigate the neuronal populations projecting to the corpus striatum in the brain of a urodele, Triturus cristatus, horseradish peroxidase (HRP) retrograde labeling was used in parallel with anterograde degeneration, glyoxylic acid histofluorescence and behavioral testing. Striatal injections of HRP revealed that the main striatal afferent systems originate within the diencephalon, specifically in the dorsal thalamus and paraventricular organ of the hypothalamus. Several small groups of neurons in other diencephalic areas also participate in striatal innervation: proeminentia ventralis, amygdala, contralateral corpus striatum, preoptic area, posterior tuberal nucleus, locus coeruleus and raphe nuclei. Degeneration experiments after mechanical lesion of the paraventricular organ established the existence of a hypothalamostriatal projection. Degenerating axonal profiles were also found in many of the structures already identified as projecting to the striatum, suggesting that the paraventricular organ might influence the striatum not only directly but also indirectly through these other afferent systems. In the paraventricular organ, glyoxylic acid fluorescence histochemistry showed numerous monoamine neurons that corresponded in distribution and morphology to the retrogradely HRP-labeled neurons. Paraventricular-organ-lesioned males displayed a severe impairment of courtship behavior in the form of decreased tail beating and head stepping by the females. This suggests that the regulation of stereotyped hypermotricity might involve the monoamine component of the hypothalamo-striatal projection.

Afferent Pathways↗
PubMed1991

Epidemiological evidence and clinical trials of dietary calcium's effect on blood pressure.

The intervention trials intended to assess prospectively the efficacy of increasing calcium intake to lower blood pressure have in general been inconclusive in their results. If, however, they are evaluated in terms of what had been suggested by the epidemiological surveys as to the conditions that would have to be met, then a more consistent pattern emerges. When one requires a combination of either an adequate sample size with frequent enough blood pressure determinations carried out in a population projected to be sensitive to this life-style (diet) intervention, then the results are remarkably consistent. Excluding the trials of short duration and/or limited blood pressure determinations plus those carried out in young females, a consistent benefit from increasing calcium intake for reducing arterial pressure is apparent in both normotensive and hypertensive males and females.

Adult↗