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PubMed2001

Longitudinal study of natural immune responses to the Plasmodium falciparum apical membrane antigen (AMA-1) in a holoendemic region of malaria in western Kenya: Asembo Bay Cohort Project VIII.

We investigated the development and maintenance of proliferative and antibody responses to apical membrane antigen-1 (AMA-1) epitopes in a holoendemic area of western Kenya. Young children (< 10 years), older children (10-17 years), and adults (> or = 18 years) were followed longitudinally for antibody and T-cell responses at 3 time points with an interval of 3-4 months. The proliferative responses against the AMA-1 T epitopes (PL171, PL172, PL173, PL186, PL191, and PL192) were not stable during follow-up; however, response to mycobacterial antigen PPD was highly stable. The responder frequencies were similar in all 3 time points except for epitope PL192. The younger and older children responded more frequently to T-cell epitopes, but the differences were not significant. A positive proliferative response to PL191 was associated with a significantly lower risk of parasitemia at subsequent follow-up (relative risk, 0.5; P = 0.03). The presence of antibody response to B epitopes PL169, PL170, PL173, PL187, and PL192 in one time point was associated with a subsequent response (P = 0.0001-0.008) suggesting a stable response. Younger (P = 0.046) and older children (P = 0.017) more frequently responded to epitope PL169 than did adults, and adults responded more frequently to PL187 than did younger children (P = 0.009). Responses to AMA-1 T-cell epitopes were short lived, and antibody responses were relatively stable.

Adolescent↗

PubMed1993

AMA's Todd pushes for reform--cautiously. Interview by Richard L. Clark.

James S. Todd, MD, executive vice president, American Medical Association (AMA), believes there are only two ways to make sure all Americans are covered by health insurance--raise taxes or decrease benefits. In an interview with Richard L. Clarke, FHFMA, president, Healthcare Financial Management Association, Todd discusses the AMA's national healthcare reform plan and the AMA's outlook on global budgets, managed competition, and physician-hospital relationships.

American Medical Association↗

PubMed2005

Implications of Amae for HIV risk in Japanese young adults.

Assertiveness, defined as perceived confidence to express true feelings in interpersonal relationships, has been reported to correlate with HIV risk avoidance. However, Japanese social structure encourages amae or self-repression. The present study investigated the implications of amae for HIV risk avoidance among Japanese university students. The results indicated that amae was antithetical to risk reduction.

Adult↗

PubMed1982

Discharge against medical advice (AMA) from an acute care private psychiatric hospital.

Discharge from psychiatric hospitals against medical advice (AMA) is noncompliance with a physician's treatment regimen. Forty-one patients (26 male, 15 female) discharged AMA from a 32-bed proprietary acute care psychiatric hospital were matched by sex to 41 regularly discharged patients. Data that pertained to account status, marital status, race, month of admission, day of week of admission, time of admission, day of week of discharge, time of discharge, length of stay, religion, diagnosis, employment status, presence of prior psychiatric treatment, attending physician, hospital census, and adolescent census at time of admission were analyzed by Student's t-test, Chi-square, and Pearson correlation coefficients. Significant differences were found for length of stay (p less than .01), time of discharge (p less than .002), presence of prior psychiatric treatment (p less than .0005), and attending physician (p less than .02). Age and length of stay for the regularly discharged group were correlated (r = .47; p less than .001). The failure of this study to support much prior research may be related to differences in hospital setting, client population, and therapist variables.

Adult↗

PubMed1983

Genetic control of drug resistance: assignment of ama-1 to Chinese hamster chromosome 7, confirmation of assignment of genes coding for TK, GALK, and ACP to chromosome 7, and tentative assignment of TPI to chromosome 8.

The gene which specifies a subunit of RNA polymerase II, ama-1, is assigned to chromosome 7 in the Chinese hamster. The assignment of genes coding for TK, GALK, and ACP to chromosome 7 is confirmed, with a provisional regional assignment of TK and GALK to 7q. On the basis of one clone with six subclones, a provisional assignment of TPI to Chinese hamster chromosome 8 is made. With the assignment of tk and ama-1 to chromosome 7 in the CHO cell line Ama1, this chromosome is shown to have two selectable markers.

Acid Phosphatase↗

PubMed2005

The AMA proposal to mandate nicotine reduction in cigarettes: a simulation of the population health impacts.

BACKGROUND: The American Medical Association (AMA) has advocated gradually reducing the nicotine content of cigarettes to decrease smoking prevalence. Some experts have voiced concerns that smokers may "compensate" by smoking more cigarettes or inhaling more deeply. Further, a black market may emerge, perpetuating cigarette availability. Thus, it is unclear whether a federal mandate would result in a net increase or decrease in population health. The purpose of this research is to estimate the long-term health gains or losses that are likely to accrue to the US population if the nicotine content of cigarettes is gradually reduced to trace levels over a 6-year period. METHODS: To estimate health impacts, we created the Tobacco Policy Model, a computer simulation model. The model simulates the US population as they age and change their smoking behavior over time. Secondary data for model parameters were obtained from publicly available sources. Population health impacts were measured as the change in cumulative quality-adjusted life-years (QALYs) in the US population over 50 years. RESULTS: Following a mandate to reduce nicotine, smoking prevalence is likely to decline from 23% to 5% of the population. Accordingly, a cumulative gain of 157 million QALYs is expected over 50 years. CONCLUSIONS: Despite any mortality increases due to compensatory smoking or the emergence of a black market, implementation of the AMA proposal would likely prevent the addiction of scores of new smokers and result in important gains to the nation's health. This research should prove useful to Congress as they contemplate giving the FDA the authority to regulate tobacco.

American Medical Association↗

PubMed2001

The AMA Residency Training in Adolescent Preventive Services Project: report of the working group. The American Medical Association.

PURPOSE: To improve resident education in provision of adolescent preventive health care. The American Medical Association (AMA) Residency Training in Adolescent Preventive Services Project Working Group convened to identify specific goals and objectives (G&Os) for pediatric and family medicine resident education in adolescent clinical preventive services and recommend strategies to achieve these G&Os. METHODS: Iterative review process involving members of the working group, nine experienced teaching faculty and 16 resident physicians from family medicine and pediatric training programs, and an advisory board. RESULTS: We achieved consensus on appropriate G&Os for pediatric and family medicine residency education in adolescent clinical preventive services. Faculty and residents expressed concerns about achieving G&Os because of challenges to implementing effective training and evaluation strategies. Suggestions for achieving G&Os included development of an adolescent clinical preventive services curriculum and evaluation program that could be adapted for use in a variety of training program structures. Faculty and residents anticipated the success of a training curriculum would be influenced by: (a) availability of adequate numbers of skilled teaching faculty; (b) availability of time and support for faculty development and teaching efforts; and (c) exposure of residents to adequate numbers of adolescent patients in settings where there are clear expectations for delivery of comprehensive preventive services. CONCLUSIONS: The AMA Residency Training in Adolescent Preventive Services Project Working Group presents G&Os for organizing training experiences in adolescent clinical preventive services in family medicine and pediatric residency training programs and recommends strategies to achieve these G&Os.

Adolescent↗

PubMed1999

AMA Clinical Quality Improvement Forum ties it all together: from guidelines to measurement to analysis and back to guidelines.

BACKGROUND: In Chicago October 15, 1998, the American Medical Association (AMA) Department of Clinical Quality Improvement introduced a broadened scope for its Practice Parameters Forum, now retitled the Clinical Quality Improvement Forum. The Forum will now focus on integrating all the components of what the AMA has identified as the quality continuum-clinical practice guidelines, performance measurement, and process and outcomes analysis. KEYNOTE ADDRESS: The address "The Quality Continuum" heralded the ushering in of a third stage known as "clinical integration," which will become medicine's "industrial revolution." Unexplained clinical variation remains the major roadblock to lowering costs, improving quality, and establishing accountability. But several tools, from guidelines to case management, will help us work through our industrial revolution and integrate clinically. PANEL I: GUIDELINES AND EVIDENCE-BASED REPORTS: The international Cochrane Collaboration, through its Collaborative Review Groups and systematic reviews, and the Agency for Health Care Policy and Research, through its Evidence-Based Practice Centers and other programs, are providing the evidence for other groups to use in developing their own guidelines, performance measures, and other tools. But measuring the effectiveness of implementing clinical preventive services remains a difficult challenge. PANEL II: CLINICAL PROCESS MEASUREMENT: Presentations on the relationship between guidelines and performance measures, translating guidelines into review criteria/process measures, reasons for non-compliance with guideline recommendations, patient-reported process measurement, and specific process measurement experiences together reflected federal, national medical specialty society, state medical society/peer review organization, and university/health plan perspectives. PANEL III: CLINICAL OUTCOMES MEASUREMENT: If outcomes can be associated with specific processes of care, clinical practice guidelines can be refined. However, outcomes are dependent on factors outside physicians' behavior and control, such as patient compliance, comorbidities, and other risk factors, and consequently consideration of these variables is essential to appropriately interpreting the data.

American Medical Association↗

PubMed2003

Impact of housing conditions on the health of the people at al-Ama'ri refugee camp in the West Bank of Palestine.

Al-Ama'ri camp is situated to the south of Ramallah city in the West Bank of Palestine. It is densely populated, with a total population of 4046, divided into 760 households, on a surface area of 93 dunums (93000 m(2)). In this research, the relationship between the housing conditions at Ama'ri camp and the prevalence and incidence rates of upper respiratory tract diseases has been studied. The diseases and symptoms most encountered in winter, and those include: common cold, cough, pharyngitis, influenza, ear infection, asthma and bronchitis have been studied. It was found that these are diseases directly related to poor housing conditions. Cold housing, presence of dampness and moulds, dust and smoke, burning of biomass fuel, crowding, poor ventilation and inadequate lighting problems are commonly found in the houses of this refugee camp.

Adolescent↗

PubMed1999

Self-reported physician specialties and the primary care content of medical practice: a study of the AMA physician masterfile. American Medical Association.

BACKGROUND: Many internal medicine physicians report both primary and secondary specialties in the American Medical Association (AMA) Physician Masterfile. Usually, those represent combinations of general internal medicine and medical subspecialty practice. Whether reported specialty combinations can be used to assess the contribution of specialists to primary care is unknown. OBJECTIVES: To examine whether internists' primary and secondary specialties reported in the Masterfile reflect the amount of primary care that they provide, and whether changes over time in internists' reported specialties reflect changes in primary care provision. DESIGN: The Masterfile was used to identify internists' reported specialties in 1992 and in 1996. A mail questionnaire was used to assess the primary care content of physicians' practices. The association between reported specialties and the amount of primary care provided was evaluated using analysis of variance. SUBJECTS: A stratified random sample of internists in active clinical practice. MEASURES: The percentage of visits which were for the general medical care of patients for whom the physicians maintained ongoing responsibility. In addition, how often the physicians initiated the provision of preventive care for their regular patients, provided general medical care to these patients, and organized and coordinated the care received by these patients from other providers. RESULTS: There was a strong association between the internists' primary and secondary specialties reported in the Masterfile and measures of the primary care content of physicians' practices (P < 0.0001). In contrast, changes over time in internists' reported specialties were not associated with physicians' assessments of changes in the primary care content of their practices. CONCLUSIONS: Aggregate estimates of the availability of primary care in the US could be adjusted by taking into account the primary and secondary specialties reported by internal medicine physicians in the AMA Physician Masterfile.

American Medical Association↗

PubMedDate not supplied

Blood vitamin levels of long-term adult home total parenteral nutrition patients: the efficacy of the AMA-FDA parenteral multivitamin formulation.

Although the AMA-FDA parenteral adult multivitamin formula is now widely used, there are no published data on the efficacy of this formulation in maintaining adequate vitamin nutriture in patients on long-term parenteral nutrition. Blood levels of its constituent nutrients were determined in 16 clinically stable home total parenteral nutrition patients with severe gastrointestinal dysfunction, the majority of whom had been on home total parenteral nutrition for 1 to 9 yr and most of whom were ingesting some food orally. The daily formula (MVI-12) was added to the basic total parenteral nutrition formula in 2-day batches; the vitamins were thus infused approximately 3 hr after preparation on day 1 and after 27 hr on day 2. The duration of infusions was from 8 to 16 hr. Blood was drawn approximately 36 hr after completion of the last vitamin infusion. Plasma, trichloroacetic acid-treated plasma, and whole blood were frozen until analyzed for the vitamins by microbiologic or chemical methods. All vitamin levels, except for vitamin D metabolites, were measured four times in each patient between the 4th and 36th wk while receiving daily MVI-12. Single determinations of 25-OH and 1:25 (OH)2 vitamin D were made in eight of the 16 patients between the 61st and 84th wk while on MVI-12. Repeat values during this extended period were also made on five of the patients for vitamins A and E. These values were compared with serum vitamin levels obtained on an earlier formulation (MVI concentrate, Berocca C, and folate each given twice weekly and B12 given once weekly). The AMA-FDA formula given daily maintained blood levels above the lower normal limits for most of its constituent vitamins and vitamin D metabolites for the great majority of stable home total parenteral nutrition adults with unexplained occasional exceptions. However, almost half of the vitamin A levels and some of the pantothenate and biotin values were above the normal range; these tended to be associated with the presence of renal disease. Ascorbic acid and thiamin levels tended to be clustered in the lower normal range. Because of evidence for loss of ascorbic acid standing in total parenteral nutrition solutions for 24 hr prior to infusion, it is recommended that the vitamin formulation be added to the total parenteral nutrition solution just prior to infusion.

Adult↗

PubMed1994

Aspects of immunity for the AMA-1 family of molecules in humans and non-human primates malarias.

The apical membrane antigen (AMA-1) family of malaria merozoite proteins is characterised by a high degree of inter-species conservation. Evidence that the protein (PK66/AMA-1) from the simian parasite Plasmodium knowlesi was protective in rhesus monkeys suggested that the 83kDa P. falciparum equivalent (PF83/AMA-1) should be investigated for protective effects in humans. Here we briefly review pertinent comparative data, and describe the use of an eukaryotic full length recombinant PF83/AMA-1 molecule to develop a sensitive ELISA for the determination of serological responses in endemic populations. The assay has revealed surprisingly high levels of humoral response to this quantitatively minor antigen. We also show that PK66/AMA-1 inhibitory mAb's are active against merozoites subsequent to release from schizont-infected red cells, further implicating AMA-1 molecules in red cell invasion.

Animals↗

PubMed1979

AMA withdraws from CME accrediting body.

The AMA House of Delegates voted to withdraw from the Liaison Committee on Continuing Medical Education and return to its own accrediting system. The move ends a situation that has irritated the state associations, but it opens the possibility of two CME accrediting bodies. The AMA also modified its stand on chiropractic in an attempt to stop its mounting legal problems.

Accreditation↗

PubMed1978

AMA postpones debate on cost containment report.

"Aggressive moderation" to combat government's excess was the position suggested by John H. Budd, M.D., in his presidential address to the AMA's House of Delegates. Topics under discussion at this interim meeting included cost containment, primary responsibility for hospitalized patients, medical staff representation on hospital governing boards, PSROs, and the AMA's national health insurance proposal.

American Medical Association↗

PubMed1978

AMA house backs voluntary controls, confronts government.

The AMA demanded more fiscal responsibility from government and strongly supported voluntary cost containment measures in actions at its annual convention. Of the 48 recommendations of the National Commission on the Cost of Medical Care, the house accepted those that were in agreement with AMA policy. Four commission recommendations that directly affect hospitals were passed: prospective rate setting, limitations on new hospital beds, decertification of existing health facilities, and strengthening physician price consciousness.

American Medical Association↗

PubMed1979

FTC allegations cause rift in AMA house.

The AMA attempted to close ranks on a number of potentially devisive issues at its interim meeting in December. Among the issues disputed were alleged AMA antitrust violations dealing with chiropractors and advertising policies and the association's position on national health insurance. Other medical staff issues put before the delegates included voluntary cost containment, due process, liability insurance requirements, and PSRO data confidentiality.

Advertising↗

PubMed1992

AMA fights back.

The vice chairman of the AMA Board fo trustees discusses the AMA's renewed campaign against family violence, including release of protocols for primary care physicians and formation of the Physicians Coalition Against Family Violence.

American Medical Association↗

PubMedDate not supplied

Neurological manifestations in Japanese Ama divers.

Repetitive breath-hold (BH) diving can lead to accumulation of nitrogen (N2) in blood and tissues, which may give rise to decompression illness (DCI). An unusual condition is "Taravana", the diving syndrome reported by Cross in the 1960s. That report generated wide discussion as to whether BH diving can cause DCI. Paulev was the first person to suggest the link between DCI and BH diving. He, a submarine medical officer developed symptoms of DCI after a series of BH dives, having proceeded the dives by spending time in a hyperbaric chamber at 20 meters for 8 minutes. Recently four professional Japanese BH divers (Ama) with histories of diving accidents were reported. Magnetic resonance imaging of these divers detected cerebral infarcts localized in the watershed areas of the brain. A survey conducted on their island revealed that many Ama divers had experienced stroke-like events. A clinical feature of DCI in BH diving is that the damage is limited to the brain. Although the mechanisms of brain damage in BH diving are unclear, N2 bubbles passing through the lungs or the heart so as to become arterialized are most likely to be the etiological factor.

Adult↗