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PubMed2003

Socioeconomic status over the life course and stages of cigarette use: initiation, regular use, and cessation.

STUDY OBJECTIVE: To investigate the association between multiple indicators of socioeconomic status (SES) over the life course and three stages of cigarette use: initiation, regular use, and cessation. DESIGN: Prospective birth cohort study. SETTING: Providence, Rhode Island. PARTICIPANTS: Subjects (n=657) aged 30 to 39 were offspring of participants in the Brown University cohort of the United States National Collaborative Perinatal Project started in 1959. MAIN RESULTS: A significantly increased risk of smoking initiation was observed among people from lower socioeconomic backgrounds. Low SES in childhood also increased the risk for progression to regular smoking, and was associated with a reduced likelihood of smoking cessation. Progression to regular smoking and smoking persistence were also associated with lower adult SES. CONCLUSIONS: Socioeconomic conditions over the life course accumulate to produce increased rates of smoking uptake and reduced rates of cessation among lower SES people. Addressing SES gradients in smoking will require persistent and extended intervention over multiple life stages.

Adult↗

PubMed1992

Italian Longitudinal Study on Ageing: incidence study of dementia.

The Italian Longitudinal Study on Ageing (ILSA) is a population-based, multicentre study focusing on normal ageing and ageing pathology. Prevalence, incidence and risk factors for specific age-associated diseases, such as dementias will be investigated. A sample of 5,056 subjects 64 + resident in the field areas will be selected. The incidence rates will be estimated by using two subsequent prevalence surveys. In the first prevalence survey, each sampled subject will undergo the Mini-Mental-State examination as screening. Those who have been screened positive, will undergo an extensive diagnostic workup to identify dementia cases and to classify them as Alzheimer's disease, vascular dementia or other dementias, according to the DSM-IIIR, ICD-10R and NINCDS-ADRDA criteria. Subjects identified as non-cases will be re-assessed 3 years later by using the same procedure, instruments and criteria to estimate incident cases. Finally, genetic and environmental risk factors for Alzheimer's disease and vascular dementia will be assessed by means of case-control studies, one on prevalent and one on incident cases, and of the cohort study. The project started in January 1991.

Aged↗

PubMedDate not supplied

[The impact of cancer on the healing status of patients].

The peculiar characteristics of the Italian neoplastic patients, as far as their knowledge concerning the disease (information, prognosis, therapeutic options, etc) and the different cultural, environmental and health realities, place different problems on the routine application of the quality of life questionnaires which were constructed and edited in North European or North American Countries, even if correctly translated and validated in Italy. The QVonc (Quality of Life in Oncology) Project started five years ago from the common interest of medical oncologists who felt the need to make a careful study on some aspects regarding the evaluation of Italian patient's quality of life. A multidisciplinary working group, comprehensive of statisticians, epidemiologists, psychologists, nurses and methodologists, was then put together. During the last three years the Group produced a deep analysis of the different aspects and determinants of the italian patient's quality of life, mainly about their disease and medical environment perception. A prospective research was started in 1995 with the aims of identifying the contents of quality of life, using a sample of cancer patients as "experts" and of measuring the relevance of selected contents in different subgroups of patients. In the first study the quality of life dimensions were analysed as perceived from 248 neoplastic patients, uniformely and randomly distributed for pathology and place of residence in Italy, through an open questionnaire and interviews conducted by our psychologists. Some peculiar aspects of the quality of life perception in italian patients were evidenced: relationship with the family, with the medical team and health facilities, economic problems and occupational difficulties. The study confirmed that the information on the contents of quality of life can be derived only studying people suffering the specific disease and cast a doubt on the available QL instruments currently used. The second study evaluated the quality of life perception in 6939 consecutive cancer patients referred in the second week of July 1996 to 79 Italian medical oncology/radiotherapy institutions. Patients were asked to fill out a questionnaire concerning the importance of 46 domains of QL, each one scored on 4 levels (not at all, a little, much and very much). Domains were derived from a previous content analysis of 268 pts answers to 4 questions related to their own QL: "in your experience, what is QL?", "what is a bad QL?", "what is a good QL?", "Did the diagnosis and treatment received modify your QL?". 6939 patients entered the study; of these, 820 (11.8%) did not fill out the questionnaire due to various reasons. Among the 6,119 evaluable pts, the most frequent cancers were: breast (2,328), colo-rectal (968), lung (517), lymphoma (351), gastric (225). The most frequently chosen domains (much or very much) were related to health facilities or communication between patient-physician/nurse. Family relationship and general well being were also found important, while from the negative perspective the presence of the disease and the related anxiety were the most relevant problems. In conclusion, when choosing or constructing QL instruments, at least for Italian cancer pts, factors such as health facilities and pt--physician/nurse relationship should be more adequately considered. Most currently used QL questionnaires are probably lacking in this regard.

Attitude to Health↗

PubMed1999

Community postpartum care needs assessment and systems development for low income families.

Decreased lengths of stay for U.S. childbirth hospitalization, infant morbidities, repeat adolescent pregnancies, and high no-show rates for postpartum visits among disadvantaged populations suggest barriers to continuity of maternity care. Findings of a survey of maternity health professionals (N = 78) providing postpartum case management with an urban Healthy Start project indicated less tracking and follow-up for postpartum care as compared to prenatal care as well as maternal postpartum health education, social support, and environmental needs. Recommendations included: (a) earlier timing of postpartum visit, (b) community care sites and home visiting, (c) coordinated postpartum maternal and infant care, and (d) increased postpartum psychosocial and environmental services.

Case Management↗

PubMed2007

Engineering site-specific endonucleases.

Site-specific endonucleases are involved in many aspects of the biochemistry of nucleic acids. Restriction enzymes and their relatives have become paradigms for enzymes acting on DNA. Numerous efforts have been devoted to changing their specificity by rational protein design, with, by and large, little success, presumably because the recognition process is highly redundant and recognition and catalysis are tightly coupled. This chapter describes one of the few successful examples of a change in specificity--namely the conversion of the mismatch repair nuclease, MutH, which, when stimulated by MutS and MutL, nicks hemimethylated d(GATC) sites, into a variant that cleaves fully methylated DNA as well as hemimethylated and unmethylated DNA. This chapter will describe the various steps involved in this design project, starting from the analysis of the structure and the identification of candidate amino acid residues responsible for sensing the methylation status, to the generation and characterization of MutH variants with an altered specificity toward hemimethylated d(GATC) sites.

Amino Acid Sequence↗

PubMedDate not supplied

Regional variability in the epidemiology of childhood diabetes in Italy.

The incidence rates of IDDM in Italy show remarkable variability. Sardinia, a region with the second highest incidence rate in the world, co-exists with other regions with lower rates. We review and compare epidemiologic data on the incidence of childhood-onset IDDM in Italy. papers published from 1980 to 1996 reporting incidence data in Italian areas were found by search of Medline and non-indexed Italian journals. The incidence data found cover only 57% of the Italian population. The analysis of our results shows how difficult it is to make a careful study of epidemiology of IDDM in Italy. The RIDI (the Registry for Insulin-dependent Diabetes mellitus in Italy) project started in 1996 according to international guidelines. The aims is to coordinate local IDDM registries, to promote the start of new registries in uncovered areas, and to standardize registration and data collection.

Adolescent↗

PubMed2001

Genomics, complexity and drug discovery: insights from Boolean network models of cellular regulation.

The completion of the first draft of the human genome sequence has revived the old notion that there is no one-to-one mapping between genotype and phenotype. It is now becoming clear that to elucidate the fundamental principles that govern how genomic information translates into organismal complexity, we must overcome the current habit of ad hoc explanations and instead embrace novel, formal concepts that will involve computer modelling. Most modelling approaches aim at recreating a living system via computer simulation, by including as much details as possible. In contrast, the Boolean network model reviewed here represents an abstraction and a coarse-graining, such that it can serve as a simple, efficient tool for the extraction of the very basic design principles of molecular regulatory networks, without having to deal with all the biochemical details. We demonstrate here that such a discrete network model can help to examine how genome-wide molecular interactions generate the coherent, rule-like behaviour of a cell - the first level of integration in the multi-scale complexity of the living organism. Hereby the various cell fates, such as differentiation, proliferation and apoptosis, are treated as attractor states of the network. This modelling language allows us to integrate qualitative gene and protein interaction data to explain a series of hitherto non-intuitive cell behaviours. As the human genome project starts to reveal the limits of the current simplistic 'one gene - one function - one target' paradigm, the development of conceptual tools to increase our understanding of how the intricate interplay of genes gives rise to a global 'biological observable' will open a new perspective for post-genomic drug target discovery.

Animals↗

PubMed1993

Electron microscope observations on LH-induced oocyte maturation in Japanese quail (Coturnix coturnix japonica).

The aim of this study was to describe the temporal sequence of ultrastructural changes in the boundary between the preovulatory oocyte and its surrounding follicular wall during maturation induced by injection of LH. Female Japanese quail were injected with ovine LH (20 micrograms per bird) 10-12 h before the expected time of ovulation. The largest and second largest follicles were excised before or 1, 2, 4 or 6 h after injection. The oocyte and the surrounding follicular wall were processed for observations using light and electron microscopy. Before injection of LH, cytoplasmic projections of granulosa cells interdigitated with microvilli on the surface of the oocyte and formed spot desmosomes and gap junctions with the oolemma. Two hours after injection of LH, the germinal vesicles in the largest but not in the second largest follicles began to break down and membrane-bound vesicles increased in number and size in the surrounding germinal disc. The junctions between the oocyte surface and the granulosa cell projections started to dissociate and a perivitelline space began to develop, possibly as the result of an accumulation of fluids transported from the capillary sinus in the theca interna. The first maturation spindle was formed 4 h after injection of LH, whereas the first polar body and the second maturation spindle were formed 6 h after LH stimulation. These observations suggest that the dissociation of connections between the oocyte and granulosa cells 2 h after exposure to increased concentration of LH is the first process of oocyte maturation.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed2006

Relative efficacy of a multisession sexual risk-reduction intervention for young men released from prisons in 4 states.

OBJECTIVES: We compared the effects of an enhanced multisession intervention with a single-session intervention on the sexual risk behavior of young men released from prison. METHODS: Young men, aged 18 to 29 years, were recruited from US prisons in 4 states and systematically assigned to the prerelease single-session intervention or the pre- and postrelease enhanced intervention. Both interventions addressed HIV, hepatitis, and other sexually transmitted infections; the enhanced intervention also addressed community reentry needs (e.g., housing, employment). Assessment data were collected before intervention, and 1, 12, and 24 weeks after release. RESULTS: A total of 522 men were included in intent-to-treat analyses. Follow-up rates ranged from 76% to 87%. Unprotected vaginal or anal sex during the 90 days before incarceration was reported by 86% of men in the enhanced intervention and 89% in the single-session intervention (OR=0.78; 95% CI=0.46, 1.32). At 24 weeks, 68% of men assigned to the enhanced intervention reported unprotected vaginal or anal sex compared with 78% of those assigned to the single-session intervention (OR=0.40; 95% CI=0.18, 0.88). CONCLUSION: Project START demonstrated the efficacy of a sexual risk-reduction intervention that bridges incarceration and community reentry.

Adolescent↗

PubMedDate not supplied

Dissolved organic carbon and disinfection by-product precursor release from managed peat soils.

A wetland restoration demonstration project examined the effects of a permanently flooded wetland on subsidence of peat soils. The project, started in 1997, was done on Twitchell Island, in the Sacramento-San Joaquin Delta of California. Conversion of agricultural land to a wetland has changed many of the biogeochemical processes controlling dissolved organic carbon (DOC) release from the peat soils, relative to the previous land use. Dissolved organic C in delta waters is a concern because it reacts with chlorine, added as a disinfectant in municipal drinking waters, to form carcinogenic disinfection byproducts (DBPs), including trihalomethanes (THMs) and haloacetic acids (HAAs). This study explores the effects of peat soil biogeochemistry on DOC and DBP release under agricultural and wetland management. Results indicate that organic matter source, extent of soil organic matter decomposition, and decomposition pathways all are factors in THM formation. The results show that historical management practices dominate the release of DOC and THM precursors. However, within-site differences indicate that recent management decisions can contribute to changes in DOC quality and THM precursor formation. Not all aromatic forms of carbon are highly reactive and certain environmental conditions produce the specific carbon structures that form THMs. Both HAA and THM precursors are elevated in the DOC released under wetland conditions. The findings of this study emphasize the need to further investigate the roles of organic matter sources, microbial decomposition pathways, and decomposition status of soil organic matter in the release of DOC and DBP precursors from delta soils under varying land-use practices.

Agriculture↗

PubMed2006

Enhanced disease surveillance through private health care sector cooperation in Karachi, Pakistan: experience from a vaccine trial.

INTRODUCTION: In research projects such as vaccine trials, accurate and complete surveillance of all outcomes of interest is critical. In less developed countries where the private sector is the major health-care provider, the private sector must be included in surveillance systems in order to capture all disease of interest. This, however, poses enormous challenges in practice. The process and outcome of recruiting private practice clinics for surveillance in a vaccine trial are described. METHODS: The project started in January 2002 in two urban squatter settlements of Karachi, Pakistan. At the suggestion of private practitioners, a phlebotomy team was formed to provide support for disease surveillance. Children who had a reported history of fever for more than three days were enrolled for a diagnosis. RESULTS: Between May 2003 and April 2004, 5540 children younger than 16 years with fever for three days or more were enrolled in the study. Of the children, 1312 (24%) were seen first by private practitioners; the remainder presented directly to study centres. In total, 5329 blood samples were obtained for microbiology. The annual incidence of Salmonella typhi diagnosed by blood culture was 407 (95% confidence interval (95% CI), 368-448) per 100 000/year and for Salmonella paratyphi A was 198 (95% CI, 171-227) per 100 000/year. Without the contribution of private practitioners, the rates would have been 240 per 100 000/year (95% CI, 211-271) for S. typhi and 114 (95% CI, 94-136) per 100 000/year for S. paratyphi A. CONCLUSION: The private sector plays a major health-care role in Pakistan. Our experience from a surveillance and burden estimation study in Pakistan indicates that this objective is possible to achieve but requires considerable effort and confidence building. Nonetheless, it is essential to include private health care providers when attempting to accurately estimate the burden of disease in such settings.

Adolescent↗

PubMed2001

Communicable disease epidemiology training in Northern Europe.

The five Nordic countries (Denmark, Finland, Iceland, Norway and Sweden) have a long tradition of collaboration in communicable disease epidemiology and control. The state epidemiologists and the immunisation programme managers have met regularly to discuss common challenges and exchange experiences in surveillance and control of communicable diseases. After the three Baltic countries (Estonia, Latvia and Lithuania) regained independence in 1991 and the Soviet Union dissolved, contacts were made across the old iron curtain in several areas, such as culture, education, business, military and medicine. Each of the Nordic communicable disease surveillance institutes started projects with partners in Estonia, Latvia, Lithuania or the Russian Federation. The projects were in such diverse areas as HIV surveillance and prevention, vaccination programmes and antibiotic resistance.

Curriculum↗

PubMed2006

Vascular tissue engineering.

Reconstructive surgery using autologous vessels is the conventional approach for substitution of diseased vessels or for generation of bypass to improve blood supply downstream of stenosed vessels. In some circumstances the use of autologous material is not possible due to concomitant diseases or previous use, and artificial grafts must be used. Unfortunately, these grafts cannot substitute small-caliber arterial vessels because of thrombotic complications. The objective of tissue engineering at the vascular level is then to generate biological substitutes of arterial conduits with functional characteristics of native vessels, combining cellular components with biodegradable scaffolds. These research projects started in several laboratories, in the late 1990s, and have expanded in different directions using a number of experimental approaches. The objective of this review is to give an overview of the results so far obtained in this area of research, and to discuss the problems related to these investigations, at the experimental and clinical level. The article provides an overview of different biodegradable scaffolds used, experimental techniques for vessels maturation in vitro under mechanical stimulation, and of differentiated as well as precursors of vascular cells, which opens new opportunities for further development of this form of cell transplantation. Finally, the current available results in clinical research will be discussed.

Bioartificial Organs↗

PubMed2002

[Leprosy Control and Basic Health Services Project].

Many tropical and subtropical communicable diseases are prevalent in Myanmar still now. Leprosy also is not completely controlled in spite of making exertions by the Government of Myanmar and more than 10,000 new leprosy patients were detected every year. In response to the pressure of World Health Organization (WHO), the government of Myanmar declared to eliminate this disease by the end of 2003, and all vertical staff concerned with leprosy control program concentrate to reach the goal of elimination (Prevalence rate: less than 1.0 per 10,000 population). Leprosy Control and Basic Health Services Project will be carried out in the project sites for 5 years, that is, from April, 2000 to March, 2001. Project purpose that was mentioned in the PDM were to support the leprosy control programme in Myanmar through the strengthening of Basic Health Service system by conducting training activities and other diseases' control programmes such as TB and Measles, by fully utilizing the above training opportunities. The Project started to conduct the main activities from 2001 as follows, 1. BHS training 2. Training of microscopic diagnosis 3. Sewing training as one of social rehabilitations 4. Training of reconstructive surgery 5. Survey on disabilities of leprosy patients, etc.

Communicable Disease Control↗

PubMed2005

[Background of development and effectiveness of myanmar sandals (the activity of Leprosy Control and Basic Health Services Project in Myanmar)].

"Leprosy control and Basic health service Project" was terminated at March 2005 within the scope of the period. I was assigned to develop the Plantar protect footwear for neuropathic feet, which called "Myanmar Sandals" in common. These sandals are not made by new technologies but made by basic knowledge. I would like to report about this activity as which is a part of distinguished strategy of ODA (Official Development Assistance) for developing country, but not as the technical report of these sandals. There is only one National Leprosy Hospital in Myanmar. At the time this project started, there were only two footwear technicians for the people who had disabilities by after effect of Hansen's disease in this country. And, it would appear that the number of the people is over 50,000. Furthermore, the budget of national hospital is not enough to refill necessary consumable supplies and materials. Although, I should instruct new technique which like making in Japan in ordinary circumstances, I could not think that such technical transfer by using costly imported materials woud bring beneficial effect and be continued. We were bound to be anxious about such situations when we made the plan. As a result of examining a plan based on these situations, we reached the conclusion that development of the simplified ready-made footwear was pressing need.

Clinical Trials as Topic↗

PubMed1993

Classification system for work in occupational health services.

Even though the World Health Organization has repeatedly advocated research on occupational health services to increase knowledge of its priorities and efficiency, no empirical study on work in such services is registered in major data bases. A common classification system for work in occupational health services is not available, but would facilitate comparison between studies. This report presents a feasible, reliable, and relevant classification for this purpose. Central among the policy-relevant questions on occupational health services is whether or not they work in accordance with their aims. Therefore, the project started from the aims of such services (in Norway and in the convention proposed by the International Labour Office in 1985) to obtain congruence between the instrument's eight categories of work and the aims of occupational health services. The classification was constructed in cooperation with occupational physicians and proved to be easy to use.

Cost-Benefit Analysis↗

PubMed1995

ERISA and health plans.

This Issue Brief is designed to provide a basic understanding of the relationship of the Employee Retirement Income Security Act of 1974 (ERISA) to health plans. It is based, in part, on an Employee Benefit Research Institute-Education and Research Fund (EBRI-ERF) educational briefing held in March 1995. This report includes a section by Peter Schmidt of Arnold & Porter, a section about multiemployer plans written by Judy Mazo of The Segal Company; and a section about ERISA and state health reform written by Kala Ladenheim of the Intergovernmental Health Policy Project. Starting in the late 1980s, three trends converged to make ERISA a critical factor in state health reforms: increasingly comprehensive state health policy experimentation; changes in the makeup of the insurance market (including the rise in self-insurance and the growth of managed care); and increasingly expansive interpretations of ERISA by federal courts. The changing interpretations of ERISA's relationship to three categories of state health initiatives--insurance mandates, medical high risk pools, and uncompensated care pools--illustrate how these forces are playing out today. ERISA does have a very broad preemptive effect. Federal statutes do not need to say anything about preemption in order to preempt state law. For example, if there is a direct conflict, it would be quite clear under the Supremacy Clause [of the U.S. Constitution] that ERISA, or any federal statue, would preempt a directly conflicting state statute. States can indirectly regulate health care plans that provide benefits through insurance contracts by establishing the terms of the contract. And they also raise money by imposing premium taxes. But they cannot do the same with respect to self-funded plans. That is one of the factors that has caused a great rise in the number of self-funded plans. State regulation [of employee benefits] can create three kinds of problems: cost of taxes, fees, or other charges; cost of dealing with substantive, possibly inconsistent, benefit standards; and cost of identifying, understanding, and complying with the regulations themselves.

Employer Health Costs↗

PubMed1982

The clinical accountable team.

This paper examines an experiment in an unusual method of accounting and budgeting, and discusses its implications to clinicians. Clinical teams were made responsible for their own expenditure. They were supplied with a breakdown of their expenditure and a budget based on previous expenditure. Each team, at its own discretion, could use savings made from reducing expenditure in one sphere to provide unrelated services. Reduced expenditure was achieved and new projects started.

Accounting↗