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PubMedDate not supplied

Body composition and blood pressure in children based on age, race, and sex.

We evaluated 675 nine- and twelve-year-old children for body composition and circulatory differences based on age, race, and sex. The specific variables measured included height, weight, triceps and subscapula skinfolds, body mass index, percentage fat, fat-free weight, and systolic, diastolic, and mean arterial blood pressures. A 2 x 2 x 2 factorial multiple analysis of variance (MANOVA) test of significance showed body composition and blood pressure differences (P < .01) for race, age, and sex. The univariate test of the specific variables within the factors showed that black children had higher fat-free weights and lower fat levels but higher blood pressure values (P < .05) than white children. Boys had lower fat levels than girls, and the older children had higher values on the body composition variables but not on blood pressure. Zero order correlations between body composition and blood pressure ranged from 0.14 to 0.55; systolic blood pressure and body weight shared the highest correlation. These data show that, although black children have less body fat than white children, they are heavier and have higher blood pressure. We hypothesize that some aspect of fat-free body weight may contribute to hypertension in black individuals.

Age Factors↗
PubMed1996

The challenge of managing laboratory information in a managed care environment.

This article considers some of the major changes that are occurring in pathology and pathology informatics in response to the shift to managed care in the United States. To better understand the relationship between information management in clinical laboratories and managed care, a typology of integrated delivery systems is presented. Following this is a discussion of the evolutionary trajectory for the computer networks that serve these large consolidated healthcare delivery organizations. The most complex of these computer networks is a community health information network. Participation in the planning and deployment of community health information networks will be important for pathologists because information management within pathology will be inexorably integrated into the larger effort by integrated delivery systems to share clinical, financial, and administrative data on a regional basis. Finally, four laboratory information management challenges under managed care are discussed, accompanied by possible approaches to each of them. The challenges presented are (1) organizational integration of departmental information systems such as the laboratory information system; (2) weakening of the best-of-breed approach to laboratory information system selection; (3) the shift away from the centralized laboratory paradigm; and (4) the development of rule-based systems to monitor and control laboratory utilization.

Community Networks↗
PubMed1996

Fucosylated glycoconjugates of the human spermatozoon. Comparison of the domains of these glycoconjugates with the alpha-fucosyl binding sites, and with lactosaminic glycoconjugates and beta-D-galactosyl binding site domains.

Fucosylated glycoconjugates play an important role in fertilization as the recognition signal of the zona pellucida. In this work, using "critical" concentrations of either, FITC Lotus tetragonolobus lectin or FITC alpha-L-fucosyl-BSA neoglycoprotein as molecular probes, population densities of fucosylated glycoconjugates and of their "complementary" molecules (carrying fucosyl receptors), were found all over the sperm surface with higher population densities in post acrosomal sheath, neck and midpiece. These results were compared with previously reported data on the population densities of lactosaminic compounds and their "complementary" molecules, obtained on same samples of spermatozoa. Statistical data demonstrate that fucosylated glycoconjugates share the same domains with biantennary N-acetyllactosaminic oligosaccharides carrying outer galactose and bisected N-acetylglucosamine residues. These domains highly differ with those of the lactosaminic glycoproteins carrying tri and tetraantennary N-acetyllactosaminic oligosaccharides. These studies also show that the domains of fucosylated glycoconjugates and their "complementary" molecules (carrying fucosyl receptors) locate in different zones of the spermatozoon than those of the compounds carrying beta-galactosyl receptors. Besides, the results suggest structural differences between fucosylated glycoconjugates of the acrosome, equatorial zone and post acrosomal sheath. This may be relevant to the different biological behavior of these compounds and zones, in fertilization.

Amino Sugars↗
PubMedDate not supplied

Blood from a turnip. Financial models in case management.

The Baptist Health System has saved more than $5.4 million in a 3-year period as a result of its comprehensive case management program. The key to its success has been the pairing of financial cost data with key clinical information. Sharing this information with physicians and employing clinical experts as case managers has dramatically affected patient care across the continuum at the Baptist Health System. With more than 8 years of case management experience, the Baptist Health System's financial model has evolved into a concise method of measuring cost at the patient/day level. This cost information is analyzed by team members and used to improve patient care. At the core of this process is the case manager. By providing the case manager with the resources necessary, any healthcare institution can achieve significant financial savings and clinical process improvement.

Case Management↗
PubMed1997

Involvement of peripheral blood cells in multiple myeloma: chromosome changes are the rule within circulating plasma cells but not within B lymphocytes.

The mononuclear cells in the peripheral blood are implicated in the myeloma process especially with the presence of peripheral blood plasma cells (PBPC) and clonal B lymphocytes found using phenotypic or gene rearrangement techniques. The purpose of this study was to look for aneuploidy in the two main B cell components of the peripheral blood: PBPC and CD20-positive B lymphocytes. Conventional cytogenetics (CC) or DNA content analysis and fluorescence in situ hybridization (FISH) with centromeric probes were performed on bone marrow plasma cells (BMPC) of 21 patients with multiple myeloma and peripheral blood cells were studied as follows: immunostaining to look for PBPC and to assess their number, image analysis cytometry for the determination of their DNA content, and FISH chromosomes analysis. FISH was performed using probes against the chromsomes that were lost or gained in BMPC and was coupled with immunostaining of the relevant light chain or CD20 antigen to study PBPC or B lymphocytes, respectively. Monotypic PBPC were found in 16 patients. Their DNA content was the same or nearly the same as for BMPC and they exhibited the same monosomies or trisomies as those found within their BM counterpart. By contrast, DNA content of mononuclear cells other than PBPC was within normal ranges, and in 13 of 15 patients CD20-positive B lymphocytes failed to show chromosomal changes by FISH analysis. In two patients however, a few CD20+ cells with lymphoid morphology exhibited chromosome changes, hypothesizing that a few cytogenetically abnormal B cells without plasmocytic morphology may circulate. From these data, we conclude that PBPC share the same genetic abnormalities as BMPC and thus belong to the malignant clone, whereas most peripheral blood B lymphocytes are unrelated to the tumor clone.

Aged↗
PubMed2001

Oral antibiotic prescription in ambulatory care in 1999--a contribution to the development of methods for drug consumption and prescription surveillance monitoring.

The aim of the study was to estimate the consumption of antibiotic in ambulatory care. Oral antibiotic consumption in 1999 was analyzed in four pharmacies in the Zagreb area. The use of oral antibiotics in comparison with total drug consumption, the share of individual subclasses of oral antibiotics and the respective shares of individual products were also analyzed. The results obtained were expressed in terms of both the defined daily doses (DDD) and US$, and were compared with available national and international data. The study demonstrated a high share of oral antibiotics in the overall drug consumption, especially of newer and more expensive agents within individual subclasses of antibiotics. Further research is required to assess the rationale of such prescribing practices, especially in view of the current financial pressure on the Croatian health care system.

Administration, Oral↗
PubMed2005

Digital literacy in a landscape of data: a plea for a broader definition for citizens and patients.

The term 'digital literacy' is taking on a broader definition and greater urgency, as ubiquitous computing becomes a reality, and individuals and communities find their bodies and actions creating an exuberant wellspring of rich, complex data. These biological and sociological data can be ignored, used alone or shared with others for various reasons - for personal or social good or ill. Although strategies to protect our data from commercial, criminal, and governmental access are already being debated daily in the media, this paper is a brief plea for why we need to expand our concerns beyond the current financial and medical record security issues.

Biomedical Technology↗
PubMed2002

[Spermiologic parameters in Czech men from 1950 to 1984 (analysis of data from the archives of the Sexology Institute of the First Medical School of Charles University and the General Medical School Hospital in Prague].

Reports maintaining that sperm concentration in male ejaculates had decreased markedly over the past decades captured mind-share all over the world. However, literary data diverge about such a lasting trend. Our objective has been to contribute to the ongoing debate by presenting results of our own research. We have studied semen analyses of 5,363 men who had been tested at an outpatient care unit of the Prague Institute of Sexology between 1950 and 1984. These semen analyses measured volume of the ejaculate, sperm concentration, sperm motility, and a share of sperms with morphological abnormalities. None of these values showed statistically significant deterioration among seven groups of patients, each spanning five years. Therefore, our data did not confirm the above-mentioned lasting trend in semen analysis values. Research teams from all over the world have recently attracted a lot of attention by reporting a no-table decrease over the past decades in sperm concentration in the male ejaculates. However, literary data diverge about such a lasting trend. Our objective has been to contribute to the ongoing debate by presenting results of our own research. We have analysed semen tests filed in the archives of the Institute of Sexology at the 1st Faculty of Medicine of Charles University. We have studied a set of 5,363 men who had undergone their first sperm analysis between 1950 and 1984. We have gathered our data from medical records, using a uniform pattern of investigation. The set was divided into seven five-year groups based on the year of the first analysis. Volume of the ejaculate: The groups showed the following average volume of the ejaculate: 3.9-3.8-3.8-3.8-3.8-3.7-3.7 (ml). Neither the distribution nor the mean value of this variable has changed much over time. Sperm concentration: The groups showed the following mean sperm concentration: 32.9-42.3-56.2-57.9-72.2-70.8-72.3 (million per ml). It is obvious from these results that the mean sperm concentration increased over time in our set. Sperm motility: The groups showed the following mean sperm motility: 34.7-46.4-53.3-57.7-59.6-58.5-58.2 (per cent). Sperm morphology: The share of ejaculates with a high percentage of morphologically abnormal sperm cells has not grown much. Our data did not confirm the hypothesis that sperm analysis results have been gradually worsening. We have not found deteriorating trends in any of the sperm quality measures in the five-year intervals between 1950 and 1984. Although our results cannot close the debate about purported deterioration of sperm analysis results, they seem to indicate that we should take reports of universal decrease in sperm concentration in the seminal fluid with a grain of salt.

Adolescent↗
PubMed1988

Immunological studies in recurrent spontaneous abortion: effects of immunization of women with paternal mononuclear cells on lymphocytotoxic and mixed lymphocyte reaction blocking antibodies and correlation with sharing of HLA and pregnancy outcome.

The occurrence of maternal antipaternal lymphocytotoxic antibody (LCTA), mixed lymphocyte reaction blocking factors (MLRBF) and human leukocyte antigen (HLA) antigen sharing was studied in 115 couples with unexplained repeated spontaneous abortions (RSA). Comparisons were made to the same studies done on 41 couples with explained repeated miscarriages. We found no significant difference between the patient and control group with respect to the percent of couples sharing none, one, or two or more HLA-A,-B, or -DR antigens. Examination of the occurrence of LCTA and MLRBF likewise did not reveal differences between the groups, nor did the occurrence of these antibodies on initial testing correlate with HLA disparity between couples. Women with three or more spontaneous abortions were immunized with paternal mononuclear cells (MNC) if they met at least two of the following three criteria: they shared two or more HLA antigens; their serum was negative for paternal MNC-directed LCTA; their serum did not contain maternal versus paternal MLR blocking factors. Complete HLA, LCTA and MLRBF data pre- and post-treatment are available on 60 women. Sixty-three percent of women converted to LCTA positive 6 +/- 1 weeks after immunization, and 35% of women converted from negative to positive for MLR blocking after immunization. Fifty-eight women who had all three tests done prior to immunization became pregnant after immunization. Only 50% of this selected group have experienced successful pregnancy as judged by delivery of a live-born infant. In the patients presented, successful pregnancy outcome did not correlate with HLA antigen disparity, but successful patients were more likely than aborters to have either LCTA or MLRBF prior to pregnancy (28 vs. 7%). Post-immunization conversion to LCTA positive was more prevalent in the women who aborted after immunization (74%) compared to those who had successful pregnancy (48%) while MLR blocking antibody conversion from negative to positive was the same in both groups. The data indicate that neither HLA antigen sharing nor conversion to LCTA or MLR blocking positive after paternal WBC immunization are predictors for successful pregnancy outcome. Results so far suggest that conversion to LCTA positive after immunization may have a negative influence on pregnancy outcome.

Abortion, Habitual↗
PubMedDate not supplied

Prevalence of selected employer health insurance purchasing strategies in 1997.

This paper provides information about the nationwide prevalence of selected employer health insurance purchasing strategies. These strategies include raising the share of medical costs borne by employees; the use of quality information in choosing which plans to offer; and direct contracting with provider systems. The data are primarily from the 1997 Robert Wood Johnson Foundation Employer Health Insurance Survey.

Cost Sharing↗
PubMed2001

Linkage of prostate cancer susceptibility loci to chromosome 1.

Three prostate cancer susceptibility genes have been reported to be linked to different regions on chromosome 1: HPC1 at 1q24-25, PCAP at 1q42-43, and CAPB at 1p36. Replication studies analyzing each of these regions have yielded inconsistent results. To evaluate linkage across this chromosome systematically, we performed multipoint linkage analyses with 50 microsatellite markers spanning chromosome 1 in 159 hereditary prostate cancer families (HPC), including 79 families analyzed in the original report describing HPC1 linkage. The highest lod scores for the complete dataset of 159 families were observed at 1q24-25 at which the parametric lod score assuming heterogeneity (hlod) was 2.54 (P=0.0006) with an allele sharing lod of 2.34 (P=0.001) at marker D1S413, although only weak evidence was observed in the 80 families not previously analyzed for this region (hlod=0.44, P=0.14, and allele sharing lod=0.67, P=0.08). In the complete data set, the evidence for linkage across this region was very broad, with allele sharing lod scores greater than 0.5 extending approximately 100 cM from 1p13 to 1q32, possibly indicating the presence of multiple susceptibility genes. Elsewhere on chromosome 1, some evidence of linkage was observed at 1q42-43, with a peak allele sharing lod of 0.56 (P=0.11) and hlod of 0.24 (P=0.25) at D1S235. For analysis of the CAPB locus at 1p36, we focused on six HPC families in our collection with a history of primary brain cancer; four of these families had positive linkage results at 1p36, with a peak allele sharing lod of 0.61 (P=0.09) and hlod of 0.39 (P=0.16) at D1S407 in all six families. These results are consistent with the heterogeneous nature of hereditary prostate cancer, and the existence of multiple loci on chromosome 1 for this disease.

Chromosome Mapping↗
PubMed2006

Towards a virtual laboratory for FMRI data management and analysis.

Functional Magnetic Resonance Imaging (fMRI) is a popular tool used in neuroscience research to study brain activation due to motor or cognitive stimulation. In fMRI studies, large amounts of data are acquired, processed, compared, annotated, shared by many users and archived for future reference. As such, fMRI studies have characteristics of applications that can benefit from grid computation approaches, in which users associated with virtual organizations can share high performance and large capacity computational resources. In the Virtual Laboratory for e-Science (VL-e) Project, initial steps have been taken to build a grid-enabled infrastructure to facilitate data management and analysis for fMRI. This article presents our current efforts for the construction of this infrastructure. We start with a brief overview of fMRI, and proceed with an analysis of the existing problems from a data management perspective. A description of the proposed infrastructure is presented, and the current status of the implementation is described with a few preliminary conclusions.

Databases as Topic↗
PubMed1982

Does joint custody work? A first look at outcome data of relitigation.

Joint custody, with both divorced parents sharing childrearing functions, is a recent and controversial phenomenon. To the authors' knowledge there have been no published quantitative outcome studies establishing its efficacy. The authors present data on 414 consecutive custody cases in a Los Angeles court over a 2-year period, comparing relitigation rates (indicative of postdivorce parental conflict) of exclusive and joint custody. In those cases which were returns to court, the proportion of relitigation for joint custody families was one-half that of exclusive custody families, suggesting that joint custody is a more beneficial arrangement in terms of reduced parental conflict.

California↗
PubMed1997

The effect of HMOs on fee-for-service health care expenditures: evidence from Medicare.

This paper examines the relationship between HMO market share and fee-for-service health care expenditures using 1986-1990 county- and metropolitan statistical area-level data on Medicare expenditures and HMO market share. Fixed-effects estimates imply that fee-for-service expenditures are concave and decreasing in market share. Increases in market share from 20% to 30% are associated with 3-7% expenditure reductions. Instrumental variable estimates that exploit cross-sectional variation in HMO activity also indicate a concave relationship, with expenditures declining in market share for market shares above 15-18%, but imply larger expenditure responses to market share changes.

Catchment Area, Health↗
PubMed1982

The American Hospital Association's National Data Network and hospital data bases.

The growth and increasing complexity of the hospital industry has created an urgent need for hospital data. However, existing data bases have not been used as extensively or as intensively as they could be. This paper describes the major data bases of the American Hospital Association--the Annual Survey of Hospitals, the National Hospital Panel Survey, and the Special Surveys--and then discusses the American Hospital Association National Data Network, a remote-access, computer-time-sharing system that provides on-line entry into the AHA's data bases. The speed, economy, and ease with which Network data can be retrieved and manipulated means that national hospital data can now be disseminated more widely throughout the health care industry and can be regularly used for decision making even at the institutional level.

American Hospital Association↗
PubMed1988

The hazard of infection from the shared communion cup.

Interest and concern that the shared communion cup may act as a vehicle for indirectly transmitting infectious disease was reawakened when the human immunodeficiency virus (HIV) was detected in the saliva of infected persons. Bacteriological experiments have shown that the occasional transmission of micro-organisms is unaffected by the alcoholic content of the wine, the constituent material of the cup or the practice of partially rotating it, but is appreciably reduced when a cloth is used to wipe the lip of the cup between communicants. Nevertheless, transmission does not necessarily imply inoculation or infection. Consideration of the epidemiology of micro-organisms that may be transmitted via saliva, particularly the herpes group of viruses, suggests that indirect transmission of infection is rare and in most instances a much greater opportunity exists for direct transmission by other means. There is substantial evidence that neither infection with hepatitis B virus nor HIV can be transmitted directly via saliva so that indirect transmission via inanimate objects is even less likely. No episode of disease attributable to the shared communion cup has ever been reported. Currently available data do not provide any support for suggesting that the practice of sharing a common communion cup should be abandoned because it might spread infection.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Stereology, morphometry, and mapping: the whole is greater than the sum of its parts.

The latest developments in computer-based stereology build upon the similarities of classical stereology and computer microscopy to provide refined and effective spatial analyses that also permit mapping of anatomical regions. Classical stereology and computer microscopy have developed along independent pathways as methodologies to provide a quantitative understanding of the structure of the brain. They approach brain morphology and brain morphometry from different points of view. On one hand, stereology has concentrated upon the unbiased numerical estimation of parameters, such as length, area, volume, and population size that characterize entire regions of the brain, e.g. hippocampus, as well as individual elements within them, e.g. cell volume. On the other hand, computer microscopy has concentrated upon providing accurate three-dimensional maps of the morphology of entire regions of the brain as well as of individual elements within them, e.g. neuronal dendrite and axon systems. The differences in point of view are not so extensive as to keep the two methodologies separate. They share, after all, a similar manner of controlling microscope data input and analyzing the images the microscope provides. The incorporation of data archiving permits easier access to previous studies, as well as the sharing of stereological findings and their related maps throughout the scientific community. Some of the stereological systems now integrate spatial mapping with stereological analyses to provide more comprehensive methods to analyze brain tissue.

Animals↗
PubMed2000

The direct and indirect effects of cost-sharing on the use of preventive services.

OBJECTIVE: To test empirically a model for estimating the direct and indirect effects of different forms of cost-sharing on the utilization of recommended clinical preventive services. DATA SOURCES/SETTINGS: Stratified random sample of 10,872 employees, 18-64 years, who had belonged to their plan for at least one year, from seven large companies that were members of the Pacific Business Group on Health (PBGH) in 1994. DATA COLLECTION: The 1994 PBGH Health Plan Value Check Survey. 1994 PBGH data on requirements for employee out-of-pocket patient cost-sharing for 52 different health plans. DESIGN: Five equations were derived to estimate the direct and indirect effects of two forms of cost-sharing (copayments and coinsurance/deductibles) in two forms of managed care (HMOs and PPO/indemnity plans) on four clinical preventive services: mammography screening, cervical cancer screening, blood pressure screening, and preventive counseling. Probit models were used to estimate elasticities for the indirect and direct effects. PRINCIPAL FINDINGS: Both forms of cost-sharing in both plan types had negative and significant indirect effects on preventive counseling (from -1 percent to -7 percent). The direct effect of cost-sharing was negative for preventive counseling (-5 percent to -9 percent) and Pap smears (from -3 percent to -9 percent) in both HMOs and PPOs, and for mammography only in PPOs (-3 percent to -9 percent). The results of the effects on blood pressure screening are inconclusive. CONCLUSIONS: Both the direct and indirect effects of cost-sharing negatively affected the receipt of preventive counseling in HMOs and PPOs. As predicted, the direct negative effect of cost-sharing was greater than the indirect effect for Pap smears and mammography. Eliminating cost-sharing for these services may be important to increasing their utilization to recommended levels.

Adolescent↗