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PubMed2000

Chamber formation and morphogenesis in the developing mammalian heart.

In this study we challenge the generally accepted view that cardiac chambers form from an array of segmental primordia arranged along the anteroposterior axis of the linear and looping heart tube. We traced the spatial pattern of expression of genes encoding atrial natriuretic factor, sarcoplasmic reticulum calcium ATPase, Chisel, Irx5, Irx4, myosin light chain 2v, and beta-myosin heavy chain and related these to morphogenesis. Based on the patterns we propose a two-step model for chamber formation in the embryonic heart. First, a linear heart forms, which is composed of "primary" myocardium that nonetheless shows polarity in phenotype and gene expression along its anteroposterior and dorsoventral axes. Second, specialized ventricular chamber myocardium is specified at the ventral surface of the linear heart tube, while distinct left and right atrial myocardium forms more caudally on laterodorsal surfaces. The process of looping aligns these primordial chambers such that they face the outer curvature. Myocardium of the inner curvature, as well as that of inflow tract, atrioventricular canal, and outflow tract, retains the molecular signature originally found in linear heart tube myocardium. Evidence for distinct transcriptional programs which govern compartmentalization in the forming heart is seen in the patterns of expression of Hand1 for the dorsoventral axis, Irx4 and Tbx5 for the anteroposterior axis, and Irx5 for the distinction between primary and chamber myocardium.

Animals↗
PubMed2000

Cervical cancer outcomes analysis: impact of age, race, and comorbid illness on hospitalizations for invasive carcinoma of the cervix.

OBJECTIVE: The aim of this study was to evaluate the association of age, race, and comorbid illness with procedures and complications in hospitalized patients with invasive carcinoma of the cervix in a statewide population-based database over a 3-year period. METHODS: Hospitalizations were classified into homogeneous subgroups based on a diagnosis of invasive cervical cancer. Cancer-related complications and comorbid diseases were evaluated. chi(2) and t tests determined differences in means or proportions. Linear regression techniques were applied to build models for hospitalization charges and lengths of stay (LOS). RESULTS: There were 1009 admissions. The mean age was 49.5, with a median age of 46 (21-100, SD 15.4). Of the total, 606/1009 (60%) were white, 354/1009 (35%) were African-American (AA), and 5% were "other" races. AAs were more likely to have Medicaid or be uninsured (44% vs 23%, P = 0. 001) and were more likely to be admitted for an emergency (unadjusted odds ratio (OR) = 1.6; 1.2-2.2), to have a comorbid illness (P = 0.001), to be admitted for a cancer-related complication (P = 0.036), to be admitted for a transfusion (P = 0. 01), and to be admitted for radiation therapy rather than surgery (P = 0.001). The following were associated with LOS and higher hospital costs: emergency admissions for complications of cancer, comorbid illness, and older age. CONCLUSIONS: Racial differences exist in patterns of admission, type of therapy, and severity of illness; however, there were no differences in charges or LOS for similar procedures. The large percentage of African-Americans uninsured or insured by government-supported programs indicates the potential impact of public policy on the care of these patients. Socioeconomic status rather than phenotypic appearance may be a more important determinant of outcome.

Adult↗
PubMed2000

Winner of the 1999 best medical student paper in preventive medicine. Don't hold your breath: personal exposures to volatile organic compounds and other toxins in indoor air and what's (not) being done about it.

BACKGROUND: Since the inception of the environmental movement early in the 1970s, the majority of regulation, laws, and standards regarding pollutants have focused on the release of pollutants into our air and water rather than on the extent of exposure. As a consequence, the actual amounts of toxic pollutants to which humans are continually exposed have long been ignored. Moreover, regulation and assessment of pollution have focused primarily on ambient environmental levels. This fails to adequately examine the state of indoor air. This is of particular concern and deserving of more attention, considering that a majority of people spend the majority of their time at home, RESULTS: Studies on indoor air quality suggest that, within the home, people are exposed to high levels of numerous pollutants. Of particular concern are the levels of polycyclic aromatic hydrocarbons and volatile organic compounds because many of these are known carcinogens. While the need for further study is clear, what evidence there is already warrants the establishment of indoor air regulation and the implementation of preventive measures. For such measures to be effective, a great deal of education and outreach will be necessary. Also, health care providers must play an active role.

Air Pollution, Indoor↗
PubMed1986

Black adolescent pregnancy: prevention and management.

In New York State, today and every day, 180 teenagers become pregnant. However, pregnancy in adolescents is not just a technical or demographic issue. It has cultural and practical dimensions. Nationally, unmarried black teenagers are five times more likely to give birth than white teenagers. In other words, one in every five nonwhite babies has a teenager for a mother! This has long-term societal consequences incalculable dimensions; and black leaders are increasingly concerned. It is recognized that sex-role socialization is an important component of personality development. Yet, few researchers have examined the unique situation of black girls in a society which denigrates both the female and the black role. As pluralistic as our society may be, and no matter how relevant cultural and subcultural values may be, it is an incontrovertible fact that, by exceedingly early childbearing, poor teenagers who are black immeasurably increase their inherent disadvantages to pursue education and acquire marketable skills, not to mention attractive jobs. On the other hand, more women in upper socio-economic categories are characteristically delaying, childbearing, and even marriage, into their thirties. The immediate and long-range consequences of unplanned teenage pregnancies are many. These include poverty, stress, suboptimal environment, nutritional inadequacy, and frequently, late or no prenatal care. Negative outcomes include low birthweight, prematurity, child abuse and development disability. There are, in addition, many delayed effects. Therefore, physicians and other health professionals must ensure that wanted pregnancies yield a healthy child. Young women and young men must be convinced that early childbearing will foreclose chances of a better socio-economic future for themselves and their progeny.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2002

Current status of iodine deficiency disorders (IDD) and strategy for its control in India.

Iodine Deficiency Disorders (IDD) reflects the broad manifestations of iodine deficiency including the implications on reproductive functions and lowering of IQ levels in school aged children. Today, IDD is a public health problem in 130 countries and affects 13% of world's population. In India, no state is free from iodine deficiency and 200 million people are 'at risk' of IDD. Daily consumption of salt fortified with iodine is a proven effective strategy and is the measure stressed by the Government of India. The paper describes the major five phases of the IDD Control Programme in India. The paper describes the major five phases of the IDD Control Programme in India since 1962 and synthesizes the spectrum of activities that significantly attributed to the Universal salt Iodisation (USI) efforts launched in 1992. The sustainability of the USI programme is critical since IDD prevalence will rise if programme of salt iodisation weakens. A two pronged strategy needs to be institutionalized for ensuring continued demand for iodised salt, linked to ongoing health, nutrition and education programmes as well as for ensuring supply of quality iodised salt.

Deficiency Diseases↗
PubMedDate not supplied

Using government schools to monitor iodine content of salt at household level in Delhi.

The Government had banned the sale of un-iodized salt in Delhi in 1989 as a step towards elimination of iodine deficiency disorders. The present study was done to detect the presence of iodine in salt samples every month from households of the students of government middle schools in Delhi using spot testing kits. One section each, from the classes six to eight of the thirty selected middle schools was chosen randomly. The children were asked to bring salt from their homes on a prefixed day. The salt samples were examined for the presence of iodine by a spot testing kit. This was repeated every month during the study (August '94 to February '95) among the same students in each school. A total of 16,596 salt samples were collected. Of this 12,736 (76.7%) tested positive for iodine and the rest (23.3%) of the salt samples did not contain iodine. The proportion of children who brought the salt samples varied between 53% to 72% in different months. As the study progressed, the trend showed more samples being tested positive for iodine. The differences in districts were not significant. Un-iodized salt thus still continues to be available in the households of the government school children of the National Capital Territory of Delhi. The use of rapid testing kits in schools is a practical and feasible way to enhance the monitoring activities of the government.

Community Medicine↗
PubMedDate not supplied

Assessment of status of salt iodization in Delhi.

The National Capital Territory (NCT) of Delhi was identified as an iodine deficiency endemic area in 1980. The government of NCT of Delhi banned the sale of non-iodised salt since 1989. The present study was aimed to estimate the iodine content of salt consumed in the households of the state. Thirty clusters were selected using population proportionate to size cluster sampling procedure. In each identified cluster one primary school was randomly selected. In each school, 60 salt samples were collected from an equal number of school children. The iodine content of a total of 1854 salt samples collected was analyzed using the standard iodometric titration method. Forty one per cent of families consumed salt with an iodine content of less than 15 ppm. Salt with nil iodine content was consumed only by 1.4% of the beneficiaries which indicated successful implementation of universal salt iodization programme in the state.

Data Collection↗
PubMedDate not supplied

Completeness and accuracy of the drug treatment reporting system in Dublin, Ireland.

BACKGROUND: The National Drug Treatment Reporting System (NDTRS) is the Irish treated-drug misuse surveillance system. AIM: To measure completeness and accuracy of the NDTRS. METHODS: Cross-sectional survey of clinical records and matching NDTRS reporting forms of a random sample of 520 clients attending 4 Dublin treatment centres. Using clients' clinical records as the gold standard, system completeness (proportion of sample reported to the NDTRS) and accuracy of selected variables (proportion of reported clients' information on the NDTRS that matched clinical record information) were measured. RESULTS: 452/520 (87%) selected records were retrieved. The NDTRS was only 61.1% (95% CI 56.5-65-5) complete; completeness differed across treatment centres (21.8%-85.6%, p < 0.0001) and was greater for new and returning clients than for continuing clients (81.7% versus 53.9% respectively, p < 0.0001). Problems were identified with the accuracy of some key variables. CONCLUSIONS: Urgent actions have been taken to improve the completeness and accuracy of the reporting system.

Cross-Sectional Studies↗
PubMed2005

[Telematics in the health system and data protection].

In the health system, telematics are to be used for the benefit of patients and to make it possible for them to receive better medical care. Telematics must be employed in accordance with the guidelines of data protection and this means in particular that the patient must remain the master of his data. Therefore, he must be able to decide in which situation and to whom he wants to reveal his medical data. For this reason, the exact implementation of the introduction of the electronic medical smart card envisaged by the law requires detailed access authorisations and limitations, which must be reinforced by ample technical security measures. These measures must be transmitted to the patients through co-operation of doctors and health insurance companies in such a transparent way that they recognise the advantages of the new technology. The higher the acceptance is on the patients' side, the more they will be willing to participate voluntarily in telematic projects.

Computer Communication Networks↗
PubMed2005

[Political aspects and aims of telematics].

Germany has a health care system that uses sophisticated technologies. On the other hand, with respect to the most important human asset--good health--duplication of work, media discontinuity, and incompatible documentations persist. The sector-oriented service structures and pillars of our health-care system are also reflect ed in the area of informatics and communication technologies. In the German health care system every institution in itself is an isolated solution, partially in line with the latest scientific research, but singular. As a rule, the limits of information technology are reached where the economic and business capacities of one's own institution are exhausted. So the essential advantage of telematics, which is in particular the use of synergistic benefits, is given away. Therefore, both the infrastructural conditions for the use of telematics have to be improved and also important key applications such as the electronic prescription have to be encouraged. By introducing the new electronic health card, the nation wide use of health telematics in Germany can be promoted. The activities of the Federal Government and the legislation initiated within the scope of the Act on the Modernization of the Statutory Health Insurance serve to expedite these improvements. The extension of the current health insurance card to an electronic health card is the task of the central associations of self-administration. They are also obligated to fulfill the agreement on the infrastructure necessary for the electronic health card.

Computer Communication Networks↗
PubMed2005

[Health telematics projects in the perspective of the German federal states].

Starting in autumn 2005 with pilot projects, the new German electronic health card (EHC) and electronic health professional cards (HPC) will be implemented in the German health system. These cards are constituents of the full coverage networking of more than 120,000 doctor's practices, 22,000 pharmacies, 2,200 hospitals and 300 health insurance companies. The functions of the EHC, for example electronic prescriptions, the digital medication recording and the European emergency database, need both the interactions with the HPCs and with a complex network of IT systems and telecommunication services, i. e. with a comprehensive health telematics infrastructure. Model regions for the construction of a telematics infrastructure have been established in numerous federal states, e. g. Baden- Wurttemberg, Bavaria, Bremen, Lower Saxony, North Rhine-Westphalia, Rhineland-Palatinate, Saxony and Schleswig-Holstein, and also recently in Mecklenburg-Vorpommern and Brandenburg. These model regions are designed in a way that allows smooth integration of the specifications of the so-called solution architecture of the EHC and also of electronic HPCs as soon as these are available. The implementation of first pilot trials in the model regions, each with 10,000 insured, is planned for the second half of 2005. A project task force was founded by a group from the German federal states in December 2004. The objective of these implementations is to establish a fully networked health system providing patients various e-Health applications which can be used any place and any time.

Computer Communication Networks↗
PubMed2004

[Clinical research in the "acute and chronic leukemias"competence network ].

Goal of the network is the construction of an exemplary cooperative leukemia network for the improvement of medical care and of health related research in acute and chronic leukemias. This is achieved by improved mechanisms of cooperation among all major groups in Germany that deal with the leukemias in research and in patient care. In practice, cooperation between clinical groups and scientists in research institutes is mediated by various instruments that improve communication, flow of information and interdisciplinary cooperation and also increase information transfer from top research institutions to clinical translation. The network comprises more than 1400 participants in about 400 university centers, large community hospitals and specialty practices with functional communication structures, interdisciplinary cooperation and nation-wide logistics. The improved cooperation and the accelerated information transfer from the bench to the "bedside" results in an added value that ultimately results in improved survival results of patients and in superior competitiveness of involved research workers and clinicians. Sustainability is addressed by establishing a leukemia foundation to support long term financial coverage of the network and by negotiating a proposal for a European Network of Excellence against leukemia within the Sixth Framework Programme of the European Union.

Acute Disease↗
PubMed2004

[Malignant lymphoma competence network].

The competence network Malignant Lymphomas is one out of 3 oncological networks which have been funded by the German Federal Ministry of Education and Research since 1999. The network's activities are based on the work of the German lymphoma research groups, which have led to significant progress in the diagnosis and therapy of malignant lymphoma over the last few years. Based on this infrastructure, the network aims to establish a professional quality management for the diagnostics and treatment of malignant lymphomas. Key aspects of activity include: 1st the establishment of an IT-based information and communication platform, 2nd IT-based networking of study groups and collaborating centres of pathology and radiotherapy, 3rd epidemiological and health care-economical research, 4th research on improved and new therapeutical approaches, 5th evidence-based medicine. Further information is presented in http://www.lymphome.de.

Biomedical Research↗
PubMed2004

[Hepatitis (Hep-Net) competence network].

In Germany almost 1 million people are affected by chronic viral hepatitis. Despite of the improved therapy options for the treatment of hepatitis B and C, several questions regarding epidemiology, pathophysiology and therapy are still unclear. Vaccines against hepatitis C and D viruses are still not available. Additionally, many patients and their relatives need information about infectiosity, course of the disease and therapy options. By the integration of doctors' practices and patient advocacy groups, Hep-Net aims at the educational information on the infection and tries to give access to qualified therapy strategies for all patients with an indication for therapy. After 18 months the Hep-Net Homepage already shows more than 9000 hits per day. Consultation hours via telephone, email-services and numerous activities in cooperation with the Deutsche Leberhilfe e.V. are highly frequented. In the Hep-Net study-house high-standard clinical studies with first successful results are centrally organized. Further, basic questions in the fields of epidemiology, virology and immunology are processed in cooperative research projects within the network.

Biomedical Research↗
PubMed2004

[Competence network "community acquired pneumonia" (CAPNETZ). A first interim report].

Community acquired pneumonia (CAP) is a disease with high morbidity and mortality in Germany. However, no reliable data are available about spectrum and resistance of pathogens, course of the disease, evidence based guidelines for treatment, and pathogen-host interactions. The German Ministry of Education and Research recognized these deficits and therefore decided to fund CAPNETZ, a network of competence for community acquired pneumonia. CAPNETZ integrates components of health research as well as clinical and basic research (horizontal network) on one hand and supports cooperation among general practitioners, community hospitals and universities (vertical network). Since October 2002, 1547 patients with CAP have been recruited within the network. First results indicate, that new observations made in terms of symptoms, spectrum of pathogens involved, and treatment modalities will impact on the formulation of new guidelines for the management of community acquired pneumonia.

Biomedical Research↗
PubMed2004

[HIV/AIDS competence network research group presents first results].

Germany's clinical HIV research efforts are underrepresented on an international level. This deficit is primarily due to a lack of clinical studies involving patients from across the country and the fact that no national patient cohort system exists in Germany which could provide a basis for such clinical studies. The competence network HIV/AIDS is filling this shortcoming by serving as a comprehensive, nationwide research alliance. The establishment of a patient cohort is linked to 20 projects. The success of this new structure is becoming visible.

Acquired Immunodeficiency Syndrome↗
PubMed2004

[Chronic inflammatory bowel diseases competence network ].

Inflammatory bowel diseases (IBD) are intermittently appearing, often chronic diseases mostly affecting young people between 20-30 years of age influencing their quality of life and socioeconomic efficiency. The triggering factors for the development of IBD are not completely understood: besides environmental factors there is clear evidence for additional genetic factors influencing the risk of disease and the pattern of gut inflammation in Crohn's disease. Pathopysiological discoveries are leading to new therapeutic opportunities which are conducted in large clinical studies with main participation of the competence network IBD. The disseminated structure of the network comprising universitary and nonuniversitary hospitals and labs, the self-help-organization DCCV and its vertical cooperation with general practitioners nationwide gives opportunity to describe the diseases from the point of view of the scientist and the physician simultaneously. Therefore the competence network IBD yields the basis for the standardized integration of patient information, for the development of guidelines and the establishment of a quality management system thus leading to an improvement of scientific and clinical research.

Biomedical Research↗