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Social policy for the elderly requires an analysis of the older generation's living conditions in the Federal Republic of Germany. Personal competence has to be maintained in order to prevent the need for nursing care. The urgent problems resulting from demographic changes in the population structure are met by societal and political institutions.
The aspirations of scientists and patients for human embryonic stem cell (hESC) research in the U.S. motivate attention to the nitty-gritty of law and regulation and its confluence with such moral consensus as lies within our reach. Federal law and regulation form a tangle. Analysis yields several conclusions not widely appreciated. A legislative enactment is the rate-limiting step of federally funded research, the restriction of research imposed by the previous administration's policy as reprised in current proposals fails to achieve its objective of avoiding complicity in embryo sacrifice, the current administration's policy is another failed noncomplicity scheme under which research cannot be expanded without demolishing its putative justification, and the Food and Drug Administration has already effectively interdicted procreative cloning. While it is not plausible to deny complicity in embryo sacrifice when performing or funding hESC research, one can justify sacrifice of some embryos by an argument whose premises are consistent with a wide range of moral and religious views. This paper proposes a rule of public policy providing for the use of donated embryos barred from the womb. This rule would optimize research while manifesting its moral justification. The rule is suitable for implementation by any government that funds hESC research. The rule's justification provides a cogent argument for such incremental steps toward its implementation as become politically feasible from time to time.
The aims of this study were to investigate the signs and symptoms of recurrent headaches in children and to identify if there are any discrete groups of children whose headaches corresponded to the World Federation of Neurology (1969) definition of migraine. One-hundred and fifty children recruited from the neurology clinics at Royal Manchester, Booth Hall, and Birmingham Children's Hospitals were interviewed to complete a standardized questionnaire. The data were examined using cluster analysis followed by comparative analysis of the headache signs and symptoms in the different groups identified. No stable groups were identified (i.e., no group was reliably identified by different methods of cluster analysis) which corresponded to the World Federation of Neurology definition of migraine. This would suggest that this definition is not appropriate for the sample investigated. Three groups of children evolved after cluster analysis. None of these groups was in agreement with the International Headache Society classification of headaches. The groups were neither 'stable' clusters nor 'useful' in predicting prognosis. This outcome supports the continuum theory of headache syndromes.
Neurotoxic effects are a non-cancer endpoint for health risk, and neurobehavioral screening tests can serve as a first tier investigation of neurotoxicity [US EPA, Federal Register 63 (1998) 26926]. Analysis of neurobehavioral screening data such as those of the functional observational battery (FOB) traditionally relies on analysis of variance (ANOVA). ANOVA is designed to detect whether there are dose-effects, but does not model the underlying dose-response relationship and subsequent risk assessment fails to utilize the shape of the underlying dose-response. In contrast, dose-response modeling interpolates toxic effects between experimental points, and permits prediction of toxic effects within the experimental range. Additionally it is also a prerequisite for estimating a benchmark dose. This paper discusses dose-time-response modeling of longitudinal neurotoxicity data and illustrates the methods using three continuous FOB outcomes from an EPA study involving acute exposure to triethyltin (TET). Several mathematical functions are presented as candidate dose-time-response models. The use of random effects is discussed to characterize inter-subject variation. The results indicate that it is feasible to use simple mathematical functions to model empirical dose-time-response observed in existing longitudinal neurotoxicological data. Further research is needed on the types of design and data required to reliably approximate the true underlying dose-time-response.
OBJECTIVE: Infection with high-risk human papillomavirus (HPV) types such as HPV-16 is a major risk factor for the development of cervical cancer. HPV-16 capsid antibodies are detectable in approximately 50% of patients with HPV-16 DNA-positive cervical cancer. We investigated the prognostic significance of HPV capsid antibodies for survival in patients with cervical cancer in comparison with conventional clinicopathologic features such as staging, histologic grading, histology, age, and treatment modality. STUDY DESIGN: Serum samples from 68 patients with cervical cancer and 65 healthy female control subjects were analyzed by enzyme-linked immunosorbent assay for HPV-specific immunoglobulin G (IgG) antibodies to baculovirus expressed HPV-6, HPV-11, HPV-16, and HPV-18 L1 virus-like particles (VLPs). RESULTS: HPV-16 L1 IgG antibodies were detectable in 6 of 65 (9%) of the control subjects and in 19 of 68 (28%) of the patients with cervical cancer (P =.007). In the subgroup of patients with HPV-16 DNA-positive cervical cancer (comprising 50% of the investigated samples), HPV-16 L1 antibodies were detected in 40%. HPV-16 L1 seropositivity was in univariate and multivariate analysis in addition to International Federation of Gynecology and Obstetrics stage, the only independent positive prognostic factor for overall survival (P =.01). CONCLUSION: Antibodies to HPV-16 L1 were found to be an independent prognostic factor for overall survival in patients with cervical cancer. Thus, HPV-16 infection may be involved not only in oncogenesis but also in tumor development and behavior.
This article provides a description and an analysis of how the U.S. federal courts have interpreted the least restrictive environment (LRE) clause in the Individuals with Disabilities Education Act (IDEA) since passage of the act by Congress in 1975. It begins with a brief highlighting of critical events in the evolution of the LRE concept in the political environment, particularly the impact of the clause on the educational placement of deaf children. The central roles within the IDEA of due process and parental involvement in educational decision making are then described. The article then charts the early (i.e., during the eighties and early nineties) evolution of judicial interpretation of LRE, before moving on to a review of cases involving the educational placement of deaf children where LRE has been a central issue. The first set of cases reviewed was all decided at the federal appeals court level, the second set at federal district court level. The article concludes with a comment regarding the prospects for a more balanced approach to educational placement for deaf youngsters.
The use of interventions claiming to prevent, retard, or reverse aging is proliferating. Some of these interventions can seriously harm older persons and aging baby boomers who consume them. Others that are merely ineffective may divert patients from participating in beneficial regimens and also cause them economic harm. "Free market regulation" does not seem to weed out risky, ineffective, and fraudulent anti-aging treatments and products. Public health messages, apparently, are having little effect. What more can be done to achieve better protection for older consumers? An analysis of the potential for federal and state action reveals many barriers to effective governmental regulation of anti-aging interventions. In view of dim prospects for stronger public regulation, physicians and other professionals--especially geriatricians and gerontologists--will need to be more aggressive in protecting older consumers. In particular, The Gerontological Society of America and the American Geriatrics Society should undertake a sustained program of specific educational efforts, directed at health professionals and the general public, in which they sort out as best they can the helpful, the harmful, the fraudulent, and the harmless anti-aging practices and products.
An analysis of reported state and federal adjudication from 1950 through 1989 was undertaken to identify trends in litigation involving medical students and undergraduate medical education. Of the 110 decisions cited, 51 (46%) involved disputes over general educational issues. A majority of the decisions affecting general education involved admissions and dismissal processes. Recently courts have begun scrutinizing readmission, course repetition, and cheating. Medical schools have accommodated to judicial scrutiny of general educational issues and have prevailed more often than claimants in litigation during this period, but litigation has not decreased as precedent and procedure have become clearer. Instead, litigation has continued unabated in alternative areas and at different levels of the educational process.
An analysis of reported state and federal adjudication from 1950 through 1989 was undertaken to identify issues and trends in litigation involving residents and their training. Of the 174 decisions cited, 38 (22%) involved disputes over general programmatic issues. The great majority of these addressed academic administration, especially issues arising from dismissals of residents. During more recent periods, residency programs have accommodated to judicial scrutiny of dismissals and have prevailed more often than claimants in litigation. Successful accommodation by residency programs has apparently not operated as a disincentive to further litigation, however.
OBJECTIVE: To compare risks for falls and their consequences among four major race/ethnic groups in California. METHODS: Cases are 104,902 hospital discharges of California residents with a same level fall injury as the principal external cause of injury. Included are all discharges for a first hospitalization for a given injury in any California non-federal hospital from 1995-97. Analysis includes crude and age standardized rates to describe risks, diagnoses, and consequences. RESULTS: Rates per 100 000 for same level hospitalized fall injuries for whites (161) are distinctively higher than for blacks (64), Hispanics (43), and Asian/Pacific Islanders (35). Whites are more likely to have a fracture diagnosis and to be discharged to long term care rather than home, suggesting a poorer outcome or greater severity. Same level falls absorb a large proportion of hospital resources directed to the treatment of injuries. CONCLUSIONS: In a four way comparison among race/ethnic groups, whites are distinguished by their high incidence, rates of fracture, and unfavorable discharge status. Prevention, particularly aimed at whites, has potential to improve health and save treatment resources.
Children, as consumers of health resources, have special developmental, psychological, and medical needs different from those of adults. Thus, cost containment efforts can affect children differently. Data related to insurance benefits changes, intensified market forces, and reductions in federal funding are cited. Their analysis focuses on the importance of accountability in applying cost constraints to services that can have a significant effect upon the health and well-being of one quarter of the next generation.
This article reviews the history of DNA-based human identification from its inception in 1985. Since the development of the technology, experts called for setting of standards and use of proficiency tests for quality assurance measures. The response of the National Institute of Standards and Technology to DNA forensic standards needs was catalyzed by the Technical Working Group on DNA Analysis Methods, sponsored by the Federal Bureau of Investigation with funding provided by the National Institute of Justice. Standard reference materials were developed for the original technologies used in DNA identification and for the newer polymerase chain reaction-based technologies. Adoption of recommended standards developed through the Federal Bureau of Investigation-commissioned DNA Advisory Board show the acceptance of National Institute of Standards and Technology standards for calibration of laboratory protocols. New technologies will require a process of validation and continued testing through the use of proficiency tests, such as those provided through the College of American Pathologists. Robotics and parallel processing of samples will lead to increased efficiency in DNA testing. The use of DNA data banks of convicted felons will increase dramatically with the the Federal Bureau of Investigation's national implementation of a computerized identification system known as the Combined DNA Index System. This system that will make major use of short, tandem, repeat genetic systems and will be the major driver of technology for the next 5 to 10 years. Finally, sample collection and training are of major concern for those who look at the long-term impact of DNA testing in forensic laboratories.
The subtyping of 350 isolates of HIV-1, isolated on the territories of 38 subjects of the Russian Federation, was carried out. The analysis was made by the method of the comparative heteroduplex mobility assay, as well as by the determination of the sequence of genes env [correction of ens] (gp 120) and gag (p17-p24). The study revealed that more than 50% of all cases of HIV-1 infection were caused by closely related variants of subtype A virus. The number of cases of HIV-1 infection caused by recombinant virus A/B was not less than 25%. The total number of cases caused by viruses of subtypes C, D, E, F and H was not more than 5%.
This paper presents the application of endo- and egzogenic evoked potentials (EP) in the most frequent neurological syndromes in children and adolescents on the basis of the author's own experiences. The advantages of the method are: objectiveness, noninvasive and the possibility of numerous repetitions. The principles of EPs application and interpretation are established by the recommendations of the International Federation of Clinical Neurophysiology. The analysis of the results contains morphology of recording, latencies and amplitudes of potentials. EPs constitute the important research method in child neurology. They are useful in diagnostics of demyelinating, degenerative and metabolic diseases, tumours of the nervous system, phacomatoses, infections and cerebrovascular disorders, CNS traumas and in cases of psychomotor retardation. The importance of this method consists in 1. diagnosis of symptomatic and asymptomatic pathological processes, 2. localization of the lesion, 3. confirmation of clinical diagnosis, 4. aid in differentiation, 5. monitoring of the treatment, 6. observation of the disease dynamics, 7. evaluation of the prognosis. Endogenic potentials enable neurophysiological evaluation of cognitive processes. Especially P 300 is analyzed in the range of its latency, amplitude and topography. P 300 is evaluated in relation to syndromes and diseases of developmental age, mostly in epilepsy, headaches, tumours, CVS traumas and minimal brain dysfunction.
The aim of this study was to evaluate secular trends by means of orthodontic measurements on lateral cephalograms. We use roentgenograms from three populations: 22 Bronze Age skulls from a cemetery near Hainburg/Austria, 140 soldiers who served in the Hapsburg Imperial Army in the late 19th century, and 154 contemporary recruits of the Austrian Federal Army. Using conventional morphometric analysis, no statistically significant differences could be established. But applying geometric morphometrics to the 2D-coordinates of the pentagon composed of the landmarks Sella, Nasion, Articulare, Gonion and Menton, some biologically interpretable differences were detected, the size allometry between the 19th- and 20th-century populations being the only notable one. We conclude that landmarks should be digitized directly (and many more of them) and that conventional methods used in clinical orthodontics are inappropriate for addressing the scientific questions approached here.
Physicians are moving into organized settings where their autonomy is more constrained and where management has more responsibility for physician satisfaction. The relationship of management practices to physician autonomy and satisfaction was explored in a survey of 185 psychiatrists in the State of Hessen in the Federal Republic of Germany (FRG). Analysis revealed that controlling for physician and institutional characteristics, management practices in relationship to participative activities, supportive communication, and peer review activities were the most important predictors both of perceived clinical autonomy and of work satisfaction. Gender was also a factor in that male physicians experienced greater perceived autonomy. Perceived clinical autonomy was an important factor in explaining satisfaction, whereas a few other physician and institutional characteristics were significant in predicting satisfaction. Unexpectedly, there was more perceived clinical autonomy among psychiatrists in larger, less well funded, more managerially constrained, state institutions than in smaller, community general hospitals and private organizations. Implications for further research are discussed.
Since 1993, the Centers for Disease Control and Prevention (CDC) has required state and local health departments to engage in a community planning process and to develop HIV prevention plans to spend federal HIV prevention funds. This analysis reviews the HIV prevention plans from 29 states, 5 local governments, and 6 Pacific Island jurisdictions (61.5% percent response rate). The plans from these 40 jurisdictions reflect the uneven implementation of HIV prevention community planning efforts and the uneven progress is achieving CDC's core objectives for HIV prevention community planning. Specifically, Asians and Pacific Islanders (APIs) often are not represented in state and local HIV prevention community planning groups. There also are significant gaps in the manner in which HIV and AIDS surveillance data are collected and reported for APIs. Finally, API populations are rarely included in HIV prevention priorities.
The article presents the chronological analysis of formation of the system for providing the medicament quality control in the medical service of Russian Federation Armed Forces. The role of Centers of medicament quality control and certification in the State system for providing medicament quality is demonstrated. The aims of these Centers are to prevent the getting of poor and falsified medicaments into the troops. The practical work of the Centers during 4 years was analyzed. As the result 35 types of falsified and 97 types of poor medicaments were revealed. The proposals for improving medicament quality control in the medical service of RF Armed Forces are given.