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PubMed1995

Unclaimed Children revisited: the status of state children's mental health service systems.

In 1982, Jane Knitzer's Unclaimed Children described continued nationwide failure to provide services for children and adolescents with serious emotional disturbances. Since 1982, there has been considerable change in the philosophy, administration, and operation of services for this population. The current study compared state child and adolescent (C/A) mental health systems to those described in Unclaimed Children. Present findings are based on surveys of State Mental Health Representatives for Children and Youth in 1988/89 and 1993. Results indicated a marked increase in the number of state administrative offices and staff for C/A mental health. Much pertinent legislation had been passed. States developed a target population definition and largely officially embraced the Child and Adolescent Services System Program (CASSP) principles of an ideal system of care. Out-of-state placements were high, and placements on adult wards still existed. Counts of these placements were often unavailable to mental health officials.

Adolescent↗
PubMed2005

Obesity, shame, and depression in school-aged children: a population-based study.

OBJECTIVES: To investigate whether there is an association between adolescent obesity and depression in a nonclinical population and whether psychosocial and economic status and subjective experiences of shame (defined as experiences of being degraded or ridiculed by others) may account for such an association. METHOD: We examined associations between self-reported body mass index (BMI) and depression, controlling for gender, shame, parental employment, parental separation, and economy. The study was performed on a sample of 4703 adolescents (71% of the target population of 15- and 17-year-old students in 1 Swedish County) who answered the Survey of Adolescent Life in Vestmanland 2004. RESULTS: Obesity was significantly related to depression and depressive symptoms among 15- and 17-year-olds. Obesity was also significantly related to experiences of shame. All significant association between BMI grouping and depression according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition disappeared when shaming experiences, parental employment, and parental separation were controlled for. Adolescents who reported many experiences of shame had an increased risk (odds ratio: 11.3; confidence interval: 8.3-14.9) for being depressed. CONCLUSIONS: There is a significant statistical association between adolescent obesity and depression. Effects of experiences of shame, parental separation, and parental employment explain this association. These results suggest that clinical treatment of obesity may sometimes not just be a matter of diet and exercise but also of dealing with issues of shame and social isolation.

Adolescent↗
PubMed2002

Male reproductive ageing: human fertility, androgens and hormone dependent disease.

The waning of male virility with age, in all its ambiguities, has always intrigued humans, prompting innumerable approaches to staving it off. In modern terms, advancing age impacts on all aspects of male reproductive health sexuality, fertility and androgenization with differing extents and tempo. With ageing, male sexual function declines predominantly due to vasculogenic defects in cavernosal haemodynamics, whereas libido and ejaculation are less affected. This raises the potential for prevention and treatment of erectile dysfunction as an early clinical manifestation of atherosclerosis. After maturity, male fertility persists throughout life but decreases modestly with age presumably due to concomitant decline in sexual activity rather than in sperm output or function, although systematic population studies of the latter are difficult. Male ageing is associated with a progressive, partial and variable degree of androgen deficiency, but the clinical and public health significance remain to be established. Available evidence suggests that androgen supplementation is unlikely to prolong life expectancy but might improve quality of life through prevention of apparently age-related declines in androgen-sensitive tissues. The appropriate target population, treatment modality and objectives remain to be established by further controlled clinical studies.

Aging↗
PubMed1998

[Malaria situation in the People's Republic of China in 1997].

According to the case reporting system, the number of malaria cases in China numbered 34,645 (Taiwan Province and Hong Kong not included) in 1997, with a mean incidence of 2.91 per a hundred thousand and lethal cases of 46. However, the estimated number of actual malaria cases based on investigations at provincial level was 220,000-250,000, showing a slight diminution as compared with that in 1996. Yunnan and Hainan were continued to be the major provinces endemic for malaria, where the number of malaria cases amounted to 46% of the total in the whole country. In Yunnan Province, an increase of outbreak spots and resurgence of malaria incidence in border region were reported, while the incidence was stable or slightly declined in most other provinces, but was fluctuated in provinces distributed with Anopheles anthropophagus. Blood examination on febrile patients for 9,209,102 man/time in 1,294 counties of 18 provinces/municipalities/autonomous regions (P/M/A) with a population of 569,703,000 detected 26,816 cases positive for malaria parasite, showing a mean positive rate of 0.29%; of which the number of falciparum malaria cases were 4,114 (including mixed infections with vivax malaria, the same below), accounting for 15.3% of the total parasite positives; of the three quartan malaria cases detected, one was infected via blood transfusion. Totally 568,783 target-population and migratory people were surveyed, 2,861 were positive for malaria parasite, with a mean parasite rate of 0.50%; and 586 falciparum malaria cases were among the positives. As a whole, the endemicity of falciparum malaria was still confined to 44 counties of Hainan and Yunnan Provinces. Imported falciparum cases were reported in 74 counties located in 17 P/M/A, however, no introduced falciparum malaria cases were recorded.

China↗
PubMed1999

Lifestyle factors and continence status: comparison of self-report data from a postal survey in England.

OBJECTIVE: To compare health and lifestyle factors of people with and without urinary incontinence (UI). DESIGN: A postal survey was undertaken that represents the first of a 3-stage project designed to evaluate the health interventions of primary health care teams and continence advisory services on patient outcomes related to UI. SETTING AND SUBJECTS: Two random samples of adult populations (N = 12,529) were included, generated from the family physician patient registers within 2 health authorities in England. INSTRUMENTS: Data were collected using a structured questionnaire that queried demography, perceived health status, activities of daily living, self-care, and use of local health and social services. Information was also collected on past and present continence status. METHODS: Structured questionnaires and a cover letter were mailed to the target population. Two reminders were sent to nonresponders to maximize the response rate. MAIN OUTCOME MEASURES: The main measures relate to factors associated with UI: mobility, sleep, childbirth, smoking, diet, body mass index, and accommodation. RESULTS: Significantly more women than men had UI (P < .0001). Respondents with UI were older than those who were continent (P < .0001). Women with UI were significantly more likely to have a greater number of pregnancies (P < .0001), were more likely to have given birth to a baby weighing more than 9 lb (P < .01), and to have had more than 4 children (P = .01) compared with women who were continent. People with UI were less likely to be single and more likely to be widowed than those who were continent (P < .0001). People who lived alone and who had UI were also significantly less likely to have a relative or friend that they could depend on for help than those who were continent (P < .001). UI was also found to be significantly associated with impaired mobility (P < .0001) and sleeping difficulties (P < .0001). No meaningful differences were found between diet and UI, although significantly more people with UI had higher mean body mass index, were obese, or reported that they felt too heavy for their height when compared with people who were continent (P < .0001). No association was found in the present study with smoking or ethnicity and UI. CONCLUSIONS: Key health and lifestyle factors associated with UI included age, gender, childbirth, mobility, sleep patterns, obesity, living alone, and access to help. These factors should be assessed when planning and implementing health care for persons with UI. Attention to these associated factors may prove useful in identifying new cases or people at risk of developing UI when screening people as part of routine health checks. This, in turn, could assist with targeting effective and efficient health care but may also contribute to prevention for some people.

Activities of Daily Living↗
PubMed1990

The costs of smoking and the cost effectiveness of smoking-cessation programs.

The impact of cigarette smoking on morbidity and mortality in this country is enormous. It is the cause of one out of every six deaths in the U.S., and is linked to conditions ranging from cardiovascular disease to cancer to low-birth weight. Economic analyses indicate that cessation of cigarette smoking will probably not lead to reduced health care expenditures in the general population because of increased health care utilization during those years of life saved as a result of cessation. However, when indirect costs (economic productivity) are taken into account, cessation of cigarette smoking appears to be cost saving. In addition, for particular subgroups (such as pregnant women and post-myocardial infarction patients), there may be health-care cost savings. Cost-effectiveness analyses of smoking cessation methods are reviewed. A relatively narrow range of smoking cessation methods has been evaluated for cost effectiveness. There is some evidence that cost-effective smoking cessation programs are tailored to the target population and consist of multiple interventions with reinforcement of the cessation techniques or messages. Equity considerations demand that smoking cessation programs not be chosen simply on the basis of their cost effectiveness because it is likely that certain groups (such as minorities or heavy smokers) will not be targeted. Some potentially efficacious smoking cessation methods such as bans on smoking in public places and excise taxes are not easily assessable using cost-effectiveness methodology.

Cost-Benefit Analysis↗
PubMed1999

Population-based recruitment for quit-smoking programs: an analytic review of communication variables.

BACKGROUND: Attempts to reduce the prevalence of smoking through quit-smoking programs have been unsuccessful because they have not attracted large numbers of smokers to participate in them. METHOD: An analytic review of the literature was conducted to identify potential communication variables that might enhance recruitment for community-based quit-smoking programs. Recruitment was defined as the number of smokers who enroll in a quit-smoking program divided by the estimated number of smokers in the target population. RESULTS: Thirty-three publications reporting the results of 40 recruitment campaigns were located. The median recruitment rate was 2.0%. Logistic regression was used to examine the effect of six variables on recruitment rate: the type of program sponsor, the type of program, program costs, use of participation incentives, whether messages were segmented by stage of change, and the type of channel used to send messages. The only significant predictor of recruitment rate was channel type (i.e., the method used to deliver a message). Studies that used interactive recruitment channels (telephone, interpersonal communication) were 66.5 times more effective than those using passive recruitment strategies (mass media, direct mail). Results examining the segmentation of messages by stage of change on recruitment were inconclusive. CONCLUSIONS: Results suggest that researchers and practitioners interested in population-based smoking cessation programs should pay more attention to recruitment methods. The use of interpersonal channels has been underused and appears to be particularly promising for improving the population impact of quit-smoking programs.

Adolescent↗
PubMed1998

Novel method for in vitro depletion of T cells by monoclonal antibody-targeted photosensitization.

An immunotargeting method (called photo-immunotargeting) has been developed for selective in vitro cell destruction. The procedure combines the photosensitizing (toxic) effect of light-induced dye-molecules, e.g., hematoporphyrin (HP) and the selective binding ability of monoclonal antibodies (mAb) to cell surface molecules. The photosensitizer HP molecules were covalently attached to monoclonal antibodies (a-Thy-1) recognizing an antigen on the surface of T lymphocytes, and used for T cell destruction. To increase the selectivity of the conventional targeting methods, a physical activation step (local light irradiation) as a second degree of specificity was employed. The HP in conjugated form was sufficient to induce T cell (thymocytes, EL-4 cell line) death after irradiation at 400 nm, at tenfold lower concentration compared to the photosensitizing effect of unbound HP. The selective killing of T lymphocytes (bearing the Thy-1 antigen) in a mixed cell population was demonstrated after a treatment with the phototoxic conjugate and light irradiation. This method can be useful for selective destruction of one population (target cell) in an in vitro heterogeneous cell mixture, e.g., in bone marrow transplants for T cell depletion to avoid graft vs. host reaction.

Animals↗
PubMedDate not supplied

The Pediatric Quality Appraisal Questionnaire: an instrument for evaluation of the pediatric health economics literature.

OBJECTIVES: Currently there is no tool available to adequately appraise the quality of the pediatric health economics literature. A comprehensive pediatric-specific instrument would be valuable in informing allocation decisions related to pediatric interventions and services. The goal of this study was to develop the Pediatric Quality Appraisal Questionnaire (PQAQ). METHODS: A draft instrument was constructed from published checklists and questionnaires. New questions pertaining to the pediatric population were incorporated. An expert panel reviewed the draft instrument and the proposed scoring scheme for face and content validity. A revised version was pilot tested by three independent appraisers. After addressing discrepancies in scores, a final version was created and subjected to interrater and test-retest reliability assessment. RESULTS: The 57 items in the final PQAQ were mapped onto 14 domains: economic evaluation, comparators, target population, time horizon, perspective, costs and resource use, outcomes, quality of life, analysis, discounting, incremental analysis, sensitivity analysis, conflict of interest, and conclusions. Among the 57 items, 46 have response options that are scored from 0 to 1. Interrater reliability was 0.75 (95% confidence interval [CI] 0.66-0.81) and test-retest reliability was 0.92 (95% CI 0.71-0.98). CONCLUSIONS: The PQAQ is a comprehensive instrument demonstrating face and content validity and strong interrater and test-retest reliability in the appraisal of pediatric economic evaluations. This tool will be valuable to health economists, methods researchers, and policy decision makers involved in allocation decisions for pediatric health care.

Bibliometrics↗
PubMed2006

The cost of prostate cancer chemoprevention: a decision analysis model.

BACKGROUND: The Prostate Cancer Prevention Trial found reduced prostate cancer prevalence for men treated with finasteride. The public health cost of wide-scale chemoprevention is unclear. We developed a model to help clarify the cost effectiveness of public use of prostate cancer-preventive agents. METHODS: A Markov decision analysis model was designed to determine the lifetime prostate health-related costs, beginning at the age of 50 years, for men treated with finasteride compared with placebo. Model assumptions were based on data from the Prostate Cancer Prevention Trial, a literature review of survival and progression rates for patients treated with radical prostatectomy, and costs associated with prostate cancer disease states. RESULTS: Chemoprevention with finasteride resulted in a gain of 8.7 [corrected] life years per 1,000 men at a cost of $1.107 million [corrected] per life year saved (LYS). However, if finasteride is assumed to not increase the incidence of high-grade tumors, it renders a gain of 16.9 [corrected] life years per 1,000 men at a cost of $578,400 [corrected] per LYS; finasteride must cost $160 per year [corrected] to reach $100,000 [corrected] per LYS. When applied to a population at higher risk (lifetime prevalence >or=40%) [corrected]for developing prostate cancer, the cost of finasteride must be reduced from its current cost ($62/month) to <$15/month [corrected]for the cost effectiveness to fall below $50,000 [corrected] per LYS. CONCLUSIONS: Given the natural history of treated prostate cancer, implementation of chemoprevention would require an inexpensive medication with substantial cancer risk reduction to be cost effective. Targeting populations at higher risk for developing prostate cancer, however, allows for considerable flexibility in the medication cost to make prostate cancer chemoprevention a more attainable goal.

Aged↗
PubMed2005

Prevalence and incidence of human papillomavirus infection in women in the USA: a systematic review.

A systematic review of studies published in the last decade was conducted to summarize data on the epidemiology of human papillomavirus (HPV) in the USA. A structured protocol was used to screen studies for review. Studies had to meet the following criteria: (1) the study was conducted in the USA, (2) the study population was predominantly adolescent women, (3) the description of the study's methodological and statistical methods is provided, and (4) the prevalence and/or incidence of HPV were clearly stated. The prevalence of HPV reported in the assessed studies ranged from 14% to more than 90%. The highest prevalence of HPV was identified among women attending sexually transmitted diseases (STD) clinics and college students, identifying them as target populations for prevention interventions. Conversely, the lowest HPV prevalence was among women in the general population. The review also revealed that HPV prevalence in African Americans is understudied, and the results of a few studies in this area are inconclusive.

Female↗
PubMed1998

Cost effectiveness of screening for subclinical hypothyroidism in the elderly. A decision-analytical model.

OBJECTIVE: The value of early detection of subclinical hypothyroidism is the object of a long lasting debate. In this study, we assessed the cost effectiveness of a policy based upon screening for this condition through thyroid-stimulating hormone (TSH), triiodothyronine (T3) and thyroxine (T4) serum level measurements in the elderly. DESIGN: A Markov model was developed where hypothetical elderly patients (i.e. > or = 60 years of age), who attend general practitioner (GP) clinics for periodic health examinations in a primary-care setting in Italy, made transitions between health states at annual interval for 15 years, thus allowing an estimation of the average cost and of the expected average number of quality-adjusted life-years (QALY). In this model, patients were assumed to be seen at annual intervals by GPs for clinical examination and serum cholesterol level measurement, to which a TSH, T3 and T4 serum measurement was added. In the base-case analysis, TSH was measured every 5 years and, if abnormal, T3 and T4 serum levels were also determined. Costs were analysed from the perspective of the Italian National Health Service (NHS) and reflected 1996 values. MAIN OUTCOME MEASURES AND RESULTS: In the base-case analysis, the additional benefit estimated from testing a female population for subclinical hypothyroidism every 5 years was 0.36 QALY, with a cost per QALY gained of 668,298 lire (L). The expected gain in QALY for men was 0.20 and the cost per QALY gained was L270,322. In general, the best cost-effectiveness profile was seen with testing every 3 years. Results were sensitive to variations in the prevalence of disease among the target population, both in men and women. CONCLUSIONS: Our study indicates that a screening policy for subclinical hypothyroidism in the elderly population could be worthwhile. However, as the costs could be significant when applied at the population level, this policy deserves further assessment through well-designed primary research.

Aged↗
PubMed2003

[Prostate cancer screening].

Prostate cancer has become the most frequent cancer and the second cause of cancer mortality in men. This public health problem is becoming increasingly important due to the increasing life expectancy. At the present time, prostate cancer will be discovered in one in every eight men during their lifetime. Prostate cancer represents 25% of all new cases of male cancers. Prostate cancer screening is designed to detect early stage, asymptomatic prostate cancer, as the patient's chances of cure are higher when the cancer is diagnosed at an early stage. The conclusions of the ANAES evaluation in 1998 did not recommend mass screening for prostate cancer. Several international prospective randomized studies based on serum PSA assay, sometimes associated with digital rectal examination, are currently underway. France is participating in the European ERSPC study (European Randomized Study of Screening for Cancer Prostate) and is organizing a national study on high-risk populations. While waiting for the final results of these studies, a recommendation needs to be proposed to inform general practitioners and specialists about optimal use of the currently available tests. Based on the conclusions of its oncology committee (composed of urologists, medical oncologists, radiotherapists, pathologists and radiologists), the Association Française d'Urologie proposes a recommendation concerning prostate cancer screening and defines its modalities, especially concerning the target population, screening tests and the information given to men before screening. The Association Française d'Urologie recommends prostate cancer screening by PSA assay (prostate specific antigen) and digital rectal examination annually between the ages of 50 and 75 years, and from the age of 45 years in men with a family or ethnic risk. If total PSA is above the normal value of the test or if digital rectal examination is abnormal, referral to a urologist is recommended. Information concerning the limits, benefits and risks of screening and the available treatment options must be given before performing these examinations.

Humans↗
PubMedDate not supplied

Implementation of a hypertension control program in the county of North Karelia, Finland.

A hypertension control program was established as part of the more comprehensive North Karelia Project. This project was started in 1972 in response to a petition from the population of North Karelia, a county in Finland, asking for national assistance to reduce the exceptionally high cardiovascular disease mortality and morbidity in the area. The North Karelia Project was carried out from 1972 to 1977.The hypertension control program was implemented mainly in local health centers by physicians and public health nurses, who followed guidelines issued by the project staff and worked under its supervision.Although the target population for the North Karelia Project was the entire population of North Karelia, the project focused on middle-aged men. The hypertension subprogram was introduced in steps. Its objectives included the training of health personnel, establishment of an information system in the county to educate people about hypertension, and organization of the detection, treatment, and followup of hypertensives. A hypertension dispensary was established in each of the 12 health centers in the county. Continuous training of the local public health nurses and physicians faciliated integration of the hypertension program into the operations of the health centers.A central hypertension register and the hypertension control clinics at the health centers were the essential tools in the systematic followup of hypertensives. Some 17,000 hypertensives were on the register by the end of the 5-year project.The main aim in providing health education about hypertension, as well as in treating hypertension itself, was to prevent severe cardiovascular diseases as a whole. Therefore the hypertension control program was integrated into the comprehensive cardiovascular disease control program, and hypertensives received advice concerning smoking and dietary changes as well as about high blood pressure.A survey of health care personnel in North Karelia and in a reference area showed that the care of hypertensives was more systematic in North Karelia and that its health care personnel were more satisfied with the cardiovascular disease care that was provided.

Adult↗
PubMed2003

New insights into diabetic polyneuropathy.

Patients with complaints of numbness, tingling, and dysesthesias in the toes and feet are frequently referred to neurologists. Often, the only objective evidence for peripheral nerve dysfunction in these patients is limited to small-caliber sensory nerve fibers. On examination these patients may have reduced distal pinprick sensation, and distal leg skin biopsies show loss of small-caliber nerve fibers. Studies focusing on small-caliber nerve fibers have led to a growing impression that neuropathy can be associated with early diabetes or impaired glucose tolerance (IGT). Often, neuropathy can be the presenting symptom of either diabetes or IGT. Furthermore, the oral glucose tolerance test appears to be a more sensitive measure of glucose dysmetabolism in these patients than levels of fasting blood glucose or glycated hemoglobin. Patients with IGT-associated neuropathy may represent an attractive target population for future regenerative studies given that their neuropathy is less severe and presumably more easily reversed than neuropathy occurring in patients with diabetes.Historically, small-caliber fibers have not been extensively evaluated due to a lack of objective measures. Several measures to evaluate these fibers are emerging, including skin biopsy with visualization of epidermal nerve fibers. The accessibility of epidermal nerve fibers makes them an attractive target for nerve injury models, which have potential for development as novel outcome measures. Such approaches may address some of the challenges of past diabetic polyneuropathy trials.

Biopsy↗
PubMed1999

[Quality of care of patients with diabetes mellitus living in a rural area of Germany].

PATIENTS AND METHOD: In a population based study the quality of diabetes care of insulin-treated diabetic patients aged 16 to 60 years and living in a rural area was studied. The parameters of metabolic control as well as the incidence of acute complications (severe hypoglycemia with the need of glucose or glucagon injection, ketoacidosis with hospital admission) were assessed by examination and with a standardized questionnaire in 81% of the target population (type-1/type-2-diabetic patients: n = 25/33). Also, in all the patients diabetic long-term complications (retinopathy, nephropathy, amputations of the lower extremities) were examined. 76% of the patients with type-1-diabetes and 91% of the patients with type-2-diabetes mellitus completed standardized questionnaires to assess quality of life and treatment satisfaction. RESULTS: In type-1-diabetic patients HbA1c was 9.38 +/- 1.6%. In type-2-diabetic patients it was 9.53 +/- 1.91%. None of the patients examined was regularly treated by a specialized physician/diabetologist. The goal of metabolic control, a HbA1c value below 7.2%, was reached only by 4% of the patients with type-1-and 12% of the patients with type-2-diabetes mellitus. In multivariate analysis the most important factor associated with HbA1c was in type-1-diabetic patients female sex (R-squared = 0.17, c = 0.38, p = 0.059); in patients with type-2-diabetes mellitus it was the number of insulin injections per day (R-squared = 0.37, c = 0.19, p = 0.0096). All other factors investigated in the model (diabetes duration, insulin dosage/kg body weight, frequency of blood- or urine-glucose self-monitoring/week, body mass index, educational level) showed no significant associations. Quality of life and treatment satisfaction of the patients were good and comparable to other trials. CONCLUSION: Out of other studies there is evidence for better metabolic control in patients regularly treated by specialized physicians/diabetologists and in patients who participated in structured treatment and teaching programs. These features must be the main goals of treatment for all patients with diabetes mellitus.

Adolescent↗
PubMed1985

Cytostatic activity of in vitro generated macrophages: evidence for a prostaglandin-independent reversible cytostatic mechanism.

Culture of spleen cells for 5 days has previously been shown to result in the generation of strongly adherent cells from nonadherent precursors. In the current report it is shown that the majority (85-95%) of adherent cells are Mac-1+, FcR+, Thy 1.2- macrophages. Expression of effector activity by these macrophages requires exposure to activating signals. Coculture of the macrophages with Con A-stimulated spleen cells results in the expression of cytostatic activity against lymphocytic and monocytic tumor cell lines. Significant cytostatic activity is apparent within 6 hr after addition of the activating cells. Culture supernates of Con A-stimulated spleen cells (CAS-CM) are not effective in inducing cytostatic activity in the adherent macrophage population either alone or in the presence of additional Con A. However, stimulation of the culture generated macrophages with LPS in the presence of CAS-CM does induce cytostatic activity. The effector cell must be metabolically active in order to effect cytostasis insofar as heat fixation of the culture generated macrophage population eliminates effector activity. Proliferation of the tumor cells is significantly reduced after a 4-hr incubation period with the activated macrophages and is reduced two- to threefold after an 8- to 12-hr incubation period. The cytostatic effect is rapidly reversible. Proliferative activity of the tumor cells returned to control level within 12-24 hr after removal from activated macrophages. Cell cycle analysis indicated that the target cells were not arrested in a single stage of cell cycle, although an increase in frequency of cells in G1-phase was observed. Fluorescence analysis of bromodeoxyuridine (BrdU) incorporation rate demonstrated that the rate of DNA synthesis was reduced in all of the cells in the target population and that the mean rate of BrdU incorporation of the inhibited cells was three- to fivefold lower than control cells. RNA and protein synthesis were not affected to the same degree as DNA synthesis. The cytostatic effect was not mediated by prostaglandins or thymidine insofar as addition of indomethacin and 2-deoxycytidine did not prevent the cytostatic activity of the macrophages. The supernates of activated macrophages contained little inhibitory activity especially when indomethacin was included in the culture medium (19% inhibition of tumor cell proliferation by 1:1 dilution of supernate). The activity that was present could be eliminated by dialysis against fresh culture medium using Spectropor membranes with a 1000-Da molecular cutoff.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMedDate not supplied

Improvement in quality of diabetes control and concentrations of AGE-products in patients with type 1 and insulin-treated type 2 diabetes mellitus studied over a period of 10 years (JEVIN).

Advanced glycation end (AGE)-products, a complex and heterogeneous group of compounds, have been implicated in diabetes-related long-term complications. Up to the present, only few data exist about serum levels of the AGE-proteins N- epsilon -carboxymethyllysine (CML) and pentosidine in selection-free populations of patients with type 1 and insulin-treated type 2 diabetes mellitus. In the present 10-year, population-based trial of patients with insulin-treated diabetes mellitus, serum CML and pentosidine levels were examined in correlation to the patients' quality of diabetes control and the prevalence of diabetes-related long-term complications. Jena's St. Vincent Trial (JEVIN) was started in 1989/1990. At this time, a centralised diabetes care system existed. After the baseline examination of 190 patients (83% of the target population) with insulin-treated diabetes mellitus, follow-up examinations were performed in 1994/1995 and 1999/2000. In 1994/1995, the CML concentration in patients with type 1/type 2 diabetes mellitus was 1096.47+/-405.50/1136.43+/-405.24 ng/ml. In 1999/2000, it was significantly lower (727.49+/-342.91 ng/ml, P=.033/743.76+/-312.47 ng/ml, P<.0001). The same tendency showed the AGE-protein pentosidine (type 1: 1994/1995 203.18+/-118.88 vs. 1999/2000 156.59+/-104.84 pmol/ml [P=.029], type 2: 1994/1995 189.72+/-67.66 vs. 1999/2000 151.54+/-127.73 pmol/ml [P=.020]). Parallel to the decrease in the mean concentration of the AGE-products CML and pentosidine mean HbA1c improved and the prevalence of diabetic long-term complications (retino-, neuro-, and nephropathy) remained comparable 1999/2000-1989/1990. Comparing the data of 1999/2000 with those from 1994/1995, there was not only a substantial improvement in patients' quality of diabetes control but also a decrease in the concentration of AGE-products. In patients with diabetes mellitus, the AGE-products seem to be mainly influenced by the quality of diabetes control. However, the most important parameter reflecting the risk for development and progression of diabetes-related long-term complications seems not to be the AGE-products, but patients' HbA1c.

Adult↗