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Autonomous differentiation of dorsal axial structures from an animal cap cleavage stage blastomere in Xenopus.

Dorsal or ventral blastomeres of the 16- and 32-cell stage animal hemisphere were labeled with a lineage dye and transplanted into the position of a ventral, vegetal midline blastomere. The donor blastomeres normally give rise to substantial amounts of head structures and central nervous system, whereas the blastomere which they replaced normally gives rise to trunk mesoderm and endoderm. The clones derived from the transplanted ventral blastomeres were found in tissues appropriate for their new position, whereas those derived from the transplanted dorsal blastomeres were found in tissues appropriate for their original position. The transplanted dorsal clones usually migrated into the host's primary axis (D1.1, 92%; D1.1.1, 69%; D1.1.2, 100%), and in many cases they also induced and populated a secondary axis (D1.1, 43%; D1.1.1, 67%; D1.1.2, 63%). Bilateral deletion of the dorsal blastomeres resulted in partial deficits of dorsal axial structures in the majority of cases, whereas deletions of ventral midline blastomeres did not. When the dorsal blastomeres were cultured as explants they elongated. Notochord and cement glands frequently differentiated in these explants. These studies show that the progeny of the dorsal, midline, animal blastomeres: (1) follow their normal lineage program to populate dorsal axial structures after the blastomere is transplanted to the opposite pole of the embryo; (2) induce and contribute to a secondary axis from their transplanted position in many embryos; (3) are important for the normal formation of the entire length of the dorsal axis; and (4) autonomously differentiate in the absence of exogenous growth factor signals. These data indicate that by the 16-cell stage, these blastomeres have received instructions regarding their fate, and they are intrinsically capable of carrying out some of their developmental program.

Animals↗

Prostate cancer screening and prevention: "realities and hope".

Case finding and population screening for early prostate cancer are extensively debated issues. The increasing incidence and mortality of prostate cancer, although largely in older patients, suggests that some type of preventive measures should be undertaken to reverse this trend. The basic requirements for initiation of a population screening program were established by Wilson and Jungner in 1968. Based on available data, the following requirements are considered to be realities in this article: the importance of the health problem, the effectiveness of available treatment, the availability of the facilities, the identification of latent stages of the disease, the existence of effective screening methodology, and the acceptability of screening by the population to be screened. For choice of treatment and the stage of the tumor at the time of diagnosis, the data analysis is positive but caution is advised. Errors of commission and omission do occur in daily practice. The answers to the remaining four requirements are less clear. There is hope--but no certainty--that we are able to predict the natural history of the disease, that early treatment does reduce mortality, that treatment strategies avoid overlap, and that the cost of population screening has been appropriately calculated. The lack of a positive answer to these questions leads us to advise against general screening but to support definitively a randomized screening trial to provide answers in the next decade.

Humans↗

DDD pacemakers maximize hemodynamic benefits and minimize complications for most patients.

A 44-month retrospective analysis was performed on 666 pacemakers implanted at Mt. Sinai Medical Center. Mapping techniques and endocardial waveform analyses were used during lead positioning to ensure the best electrical environment. The optimal pacing lead type was selected based on the clinical situation. Follow-up evaluations were rigorous. Patient population ranged in age from 28 to 103 with a mean of 78 years at time of implant. Seventy percent of the patients received DDD pacemakers with an 81% survival incidence at 44 months. Of the VVI population (30% of the implants), there was a 62% survival incidence. Most problems associated with the pacing systems were related to the atrial channel. Loss of atrial sensing occurred in 7.5% of the population and was corrected noninvasively in 5.8%. Due to chronic loss of atrial sensing, 1.7% of the population remained programmed to DVI/VVI. A total of 7.7% were chronically reprogrammed from DDD to VVI, 5.6% secondary to atrial fibrillation. Reoperations were necessary in 1.2% of the malfunctioning systems that could not be corrected by reprogramming. The following conclusions were reached: (1) maximizing hemodynamic benefits and minimizing pacemaker complications permitted a survival rate equal to or better than that of the general population, and (2) chronic problems related to the atrial lead and malfunctions of the pacing system were minimized by careful patient selection, appropriate pacemaker and lead selection, endocardial waveform analysis, and thorough follow-up.

Adult↗

Managed care and public health.

Both public health and managed care organizations share an interest in ensuring the health status of a defined population. We explore the existing and potential relationships between managed care organizations and public health in several major public health areas, specifically clinical preventive services, prevention-oriented social and political policies, and core public health functions. The latter include health information, health education, personal health services provision, work force and research, community partnerships, and evaluation of health care. We believe there is much potential to improve the population's health through the collaboration of these two sectors of the health care system.

Government Agencies↗

Determinants of geographic mobility among participants in a population-based HIV/AIDS drug treatment program.

This study was undertaken to determine the geographic distribution and patterns of migration of persons with HIV in British Columbia. Our analysis was restricted to all HIV-positive men and women aged 18 years and over who had completed a participant survey and were enrolled in the HIV/AIDS Drug Treatment Program between September 1992 and September 1997. Patterns of migration were determined by examining participants whose postal code changed between July 1995 and September 1997. Statistical analysis were carried out using both parametric and non-parametric methodologies. Stepwise logistic regression was used to determine baseline predictors of migration. The final multivariate model revealed that residing in a census subdivision with a population less than 100,000, being heterosexual, acquiring HIV through intravenous drug use, and the absence of AIDS at baseline were all independently associated with moving census subdivisions during the period of observation. In summary, our analyses demonstrate the need for the continued study of the evolving geography and migration patterns of persons with HIV.

Adult↗

Epidemiologists in the United States: an assessment of the current supply and the anticipated need.

We provide 1985 estimates of the work force of epidemiologists in the United States, the number of graduates from training programs in epidemiology, and a projection of the future need for these health professionals. Our methods included a search of mailing lists from professional organizations, mail contact with graduate training programs, telephone interviews with experts, and a review of job announcements in professional journals. The study indicates that the current work force of epidemiologists in the United States is estimated to include 4,600 persons, more than half of whom are physicians; most epidemiologists are located in either a state with a major federal public health agency or one with a large population; and programs in epidemiology graduate an average of 475 persons with one or two years of master's level education and approximately 80 with doctoral-level education each year. After considering the factors that influence the supply of epidemiologists, we project a substantial need for more epidemiologists in the future than current sources will provide.

Education, Medical, Graduate↗

Implementing women's cancer screening programs in American Indian and Alaska Native populations.

The National Breast and Cervical Cancer Early Detection Program provides funding to tribes and tribal organizations to implement comprehensive cancer screening programs using a program model developed for state health departments. We conducted a multiple-site case study using a participatory research process to describe how 5 tribal programs implemented screening services, and to identify strategies used to address challenges in delivering services to American Indian and Alaska Native women. We analyzed data from semistructured interviews with 141 key informants, 16 focus groups with 132 program-eligible women, and program documents. Several challenges regarding the delivery of services were revealed, including implementing screening programs in busy acute-care environments, access to mammography, providing culturally sensitive care, and providing diagnostic/treatment services in rural and remote locations. Strategies perceived as successful in meeting program challenges included identifying a "champion" or main supporter of the program in each clinical setting, using mobile mammography, using female providers, and increasing the capacity to provide diagnostic services at screening sites. The results should be of interest to an international audience, including those who work with health-related programs targeting indigenous women or groups that are marginalized because of culture, geographic isolation, and/or socioeconomic position.

Alaska↗

Comparative study on family life education, sex education and human sexuality.

Under UNESCO (UN Educational, Scientific and Cultural Organization) EPD auspices, a comparative study on family life education, sex education and human sexuality is being undertaken by EPD in collaboration with UNESCO Regional Offices covering four regions of the world--Asia and the Pacific, Africa, Latin America and Caribbean, and Arab States. Over the past 20 years, some 90 countries in the world have implemented population education programs. These programs follow different conceptual frames of reference based on predominant national problems and thrusts. Many of these have included family life education, sexuality and human reproductive issues. In the light of emerging issues and problems, it has been urged that key concepts and contents on family life education should be revised and updated accordingly, taking into account the specificity of sociocultural contexts. Before undertaking the revision and updating of contents, an analysis of the contents of existing national and regional training and teaching/learning materials in the four regions is currently being undertaken. The results of these analyses will serve as basis for the reconceptualization of population education/family life education within the new EPD philosophy, taking into account the emerging needs in the areas of information, training, and educational materials development. The studies which are currently under preparation look into the following: (i) the justifications for implementing family life education programs; (ii) content analysis of family life education and sex education programs in terms of rationale, objectives, concepts, themes and contents, teaching strategies and methodologies, etc.; (iii) changing scenes in the 90s; (iv) emerging key issues and concepts; (v) objectives, concepts and contents to be reinforced or revised for training and teaching purposes; (vi) recommendations for a reconceptualization/reorientation; and (vii) lessons learned and future needs and requirements.

Africa↗

The effects of specialized training in alcohol information for counseling students.

The alcoholism problem in the United States has reached proportions impossible to ignore. It follows that we need trained professionals in significant numbers to deal with the alcoholic population. Graduate programs, however, provide little or no course offerings in the area of specific training for dealing with alcoholics. In academia some attempts have been made to address this situation. However, budget restrictions, limited marketability of counselors with specialized training, and the superiority of the generalist training model are some of the main arguments that have compromised adequate chemical dependence training. The research literature, however, is replete with studies indicating the need for specialized training to prepare mental health professionals to work as competent alcohol counselors. The focus of this research was to examine the effect of specific training for counseling students in preparing them to work with alcoholic clients. The results of the analyses indicated that a training session specifically designed for working with alcoholic populations significantly increased the objective knowledge base of counseling students, although the single training session was not enough to significantly improve subjective judgment and response scores. This research emphasizes a need for specialized training in counseling programs for alcohol counselors. Further, it is implied that training programs should include at least one semester-long course on alcohol remediation for counseling students.

Alcohol Drinking↗

Evaluating the Robert Wood Johnson Foundation program on chronic mental illness.

Community-based services for mentally ill individuals have developed in a fragmented and uncoordinated manner over the last 30 years. In response, the RWJF initiated a five-year demonstration in nine cities: the Program on Chronic Mental Illness (CMI). The project's background is described, as are its accomplishments and limitations. One outcome of sponsorship by the RWJF and the U.S. Department of Housing and Urban Development was to assure the problem of CMI a place in the public policy agenda. Despite specific improvements in quality of life for individuals with CMI, however, there was no general improvement for this population. The program thus demonstrated that structural changes alone are insufficient; quality of care must be attended to as well. Despite its drawbacks, the project revealed that interventions can be implemented with positive results.

Chronic Disease↗

Ageing of population and health care expenditure: a red herring?

This paper studies the relationship between health care expenditure (HCE) and age, using longitudinal rather than cross-sectional data. The econometric analysis of HCE in the last eight quarters of life of individuals who died during the period 1983-1992 indicates that HCE depends on remaining lifetime but not on calendar age, at least beyond 65+. The positive relationship between age and HCE observed in cross-sectional data may be caused by the simple fact that at age 80, for example, there are many more individuals living in their last 2 years than at age 65. The limited impact of age on HCE suggests that population ageing may contribute much less to future growth of the health care sector than claimed by most observers.

Aged↗

SNP-VISTA: an interactive SNP visualization tool.

BACKGROUND: Recent advances in sequencing technologies promise to provide a better understanding of the genetics of human disease as well as the evolution of microbial populations. Single Nucleotide Polymorphisms (SNPs) are established genetic markers that aid in the identification of loci affecting quantitative traits and/or disease in a wide variety of eukaryotic species. With today's technological capabilities, it has become possible to re-sequence a large set of appropriate candidate genes in individuals with a given disease in an attempt to identify causative mutations. In addition, SNPs have been used extensively in efforts to study the evolution of microbial populations, and the recent application of random shotgun sequencing to environmental samples enables more extensive SNP analysis of co-occurring and co-evolving microbial populations. The program is available at http://genome.lbl.gov/vista/snpvista1. RESULTS: We have developed and present two modifications of an interactive visualization tool, SNP-VISTA, to aid in the analyses of the following types of data: A. Large-scale re-sequence data of disease-related genes for discovery of associated and/or causative alleles (GeneSNP-VISTA). B. Massive amounts of ecogenomics data for studying homologous recombination in microbial populations (EcoSNP-VISTA). The main features and capabilities of SNP-VISTA are: 1) mapping of SNPs to gene structure; 2) classification of SNPs, based on their location in the gene, frequency of occurrence in samples and allele composition; 3) clustering, based on user-defined subsets of SNPs, highlighting haplotypes as well as recombinant sequences; 4) integration of protein evolutionary conservation visualization; and 5) display of automatically calculated recombination points that are user-editable. CONCLUSION: The main strength of SNP-VISTA is its graphical interface and use of visual representations, which support interactive exploration and hence better understanding of large-scale SNP data by the user.

Algorithms↗

Surveillance of hospitalized farm injuries in Canada.

OBJECTIVE: To provide an overview of hospital admissions for the treatment of farm injuries. METHODS DESIGN: descriptive analysis of data from the Canadian Agricultural Injury Surveillance Program (CAISP). POPULATION: persons experiencing a farm injury requiring hospitalization, April 1991 to March 1995. Access to hospital separation data was negotiated within Canadian provinces. Individual cases were verified by medical records personnel and supplemental data describing injury circumstances were obtained. ANALYSIS: descriptive analyses characterizing farm injuries by: persons involved, mechanisms, primary diagnoses, and agents of injury. RESULTS: Data from 8/10 Canadian provinces representing 98% of the farm population were obtained. A total of 8,263 farm injuries were verified. Adults aged 60 years and older were over-represented in these injuries. Leading external causes of agricultural machinery injury included entanglements, being pinned/struck by machinery, falls, and runovers. Non-machinery causes included falls from heights, animal related trauma, and being struck/by against objects. Leading diagnoses varied by age group, but included: limb fractures/open wounds, intracranial injuries, skull fractures, and spinal/ truncal fractures. CONCLUSIONS: CAISP is a new agricultural injury surveillance program in Canada. Data from this system are actively used to inform prevention initiatives, and to indicate priorities for etiological and experimental research in the Canadian agricultural setting.

Adolescent↗

Using Health Utility Index (HUI) for measuring the impact on health-related quality of Life (HRQL) among individuals with chronic diseases.

Quality of life is an important indicator in assessing the burden of disease, especially for chronic conditions. The Health Utilities Index (HUI) is a recently developed system for measuring the overall health status and health-related quality of life (HRQL) of individuals, clinical groups, and general populations. Using the HUI (constructed based on eight attributes: vision, hearing, speech, mobility, dexterity, cognition, emotion, and pain/discomfort) to measure the HRQL for chronic disease patients and to detect possible associations between HUI system and various chronic conditions, this study provides information to improve the management of chronic diseases. This study is of interest to data analysts, policy makers, and public health practitioners involved in descriptive clinical studies, clinical trials, program evaluation, population health planning, and assessments. Based on the Canadian Community Health Survey (CCHS) for 2000-01, the HUI was used to measure the quality of life for individuals living with various chronic conditions (Alzheimer/other dementia, effects of stroke, urinary incontinence, arthritis/rheumatism, bowel disorder, cataracts, back problems, stomach/intestinal ulcers, emphysema/COPD, chronic bronchitis, epilepsy, heart disease, diabetes, migraine headaches, glaucoma, asthma, fibromyalgia, cancers, high blood pressure, multiple sclerosis, thyroid condition, and other remaining chronic diseases). Logistic Regression Model was employed to estimate the associations between the overall HUI scores and various chronic conditions. The HUI scores ranged from 0.00 (corresponding to a state close to death) to 1.00 (corresponding to perfect health); negative scores reflect health states considered worse than death. The mean HUI score by sex and age group indicated the typical quality of life for persons with various chronic conditions. Logistic Regression results showed a strong relationship between low HUI scores (< or = 0.5 and 0.06-1.0) and certain chronic conditions. Age- and sex-adjusted Odds Ratio (OR) and p values showed an effect among individuals diagnosed with each chronic disease on the overall HUI score. Results of this study showed that arthritis/rheumatism, heart disease, high blood pressure, cataracts, and diabetes had a severe impact on HRQL. Urinary incontinence, Alzheimer/other dementia, effects of stroke, cancers, thyroid condition, and back problems have a moderate impact. Food allergy, allergy other than food, asthma, migraine headaches, and other remaining chronic diseases have a relatively mild effect. It is concluded that major chronic diseases with significant health burden were associated with poor HRQL. The HUI scores facilitate the measurement and interpretation of results of health burden and the HRQL for individuals with chronic diseases and can be useful for development of strategies for the prevention and control of chronic diseases.

Adolescent↗

Predictive value of foot pressure assessment as part of a population-based diabetes disease management program.

OBJECTIVE: To evaluate the effectiveness of dynamic plantar pressure assessment to determine patients at high risk for neuropathic ulceration. In choosing the cut point, we looked for an optimum combination of sensitivity and specificity of plantar pressure to screen for neuropathic ulceration. RESEARCH DESIGN AND METHODS: A total of 1,666 consecutive individuals with diabetes (50.3% male) presenting to a large urban managed care-based outpatient clinic were enrolled in this longitudinal 2-year outcome study. Patients received a standardized medical and musculoskeletal assessment at the time of enrollment, including evaluation in an onsite gait laboratory. RESULTS: Of the entire population, 263 patients (15.8%) either presented with or developed an ulcer during the 24-month follow-up period. As expected, baseline peak plantar pressure was significantly higher in the ulcerated group than in the group who did not ulcerate (95.5 +/- 26.4 vs. 85.1 +/- 27.3 N/cm(2), P < 0.001). There was also a trend toward increased pressure with increasing numbers of foot deformities, as well as with increasing foot risk classification (P = 0.0001). Peak pressure was not a suitable diagnostic tool by itself to identify high-risk patients. After eliminating patients without loss of protective sensation, using receiver operating characteristic (ROC) analysis, the optimal cut point, as determined by a balance of sensitivity and specificity, was 87.5 N/cm(2), yielding a sensitivity of 63.5% and a specificity of 46.3%. CONCLUSIONS: The data from this evaluation continue to support the notion that elevated foot pressure is an important risk factor for foot complications. However, the ROC analysis suggests that foot pressure is a poor tool by itself to predict foot ulcers.

Aged↗

[Prevalence of thirty long term disorders for French health insurance members in 1994].

BACKGROUND: The French health insurance has carried out a survey to estimate the medical and social prevalence for the 30 long-lasting affections. This estimation was extended to the instantaneous morbidity prevalence for some of these diseases. METHODS: The random sampling represented 2% of the 3,337,795 patients who were affected by long-lasting affections (ALD 30). To codify the diagnoses, the "médecin conseil" proceeded by different ways: either by examining the patient, by consulting the practicing physician (69% of the patients), or by consulting the individual medical file. Morbidity prevalence estimates were limited to some diseases: those for which correcting coefficients were available or those for which the legislation on long-lasting affections were applied in patients not likely to come under "invalidity". RESULTS: In November 1994, among the patients who came under "ALD 30", 39% were affected with cardio-vascular diseases, about 15% were affected with psychiatric diseases, and a similar proportion presented cancer or diabetes. The estimation of the insulin-dependent diabetes morbidity prevalence was 4.1/1000, non insulin-dependent diabetes 18/1000, progressive rheumatoid polyarthritis 2.8/1000, Parkinson disease 2.0/1000, and multiple sclerosis 0.4/1000. This survey also estimated the prevalence of seven other affections. CONCLUSIONS: This survey provides morbidity prevalence rates estimated on the basis of a representative sample of a sub-population including 70% of the French population. Most results are close to those which have been already published, but some of them appear quite new.

Adolescent↗