1996 outlook: systems, for-profit chains, medical groups, religious healthcare, managed care, post-acute care, finance, purchasing, info systems, labor, legal, construction

It's put-up-or-shut-up time for healthcare providers in 1996. Two years ago, everyone talked about fixing the healthcare system. Not much happened. Last year, providers and politicians concentrated on squeezing medical costs. According to some of Modern Healthcare's key beat reports, this year it's back to the basics of running a business.     

高血压患者血清锌、铜、钙、钴、镉、镁、镍、铬、钛的测定

本文应用直流等离子体原子发射光电直读光谱仪测定了60例正常人,45例高血压患者血清锌、铜、钙、钴、镉、镁、镍、铬、钛含量。结果表明,正常人血清锌19.70±3.75μmol/L(1.2876±0.2457μg/ml),铜17.23±3.48μmol/L(1.0945±0.2213μg/ml),钙2211.09±430.72μmol/L(104.6523±17.2634μg/ml),钴2.87±1.05μmol/L(0.3694±0.0616μg/ml),锅0.44±0.27μmol/L(0.0491±0.0300μg/ml),镁783.71±294.29μmol/L(19.0520±7.1543μg/ml),镍0.42±0.27μmol/L(0.0252±0.0156μg/ml),铬0.28±0.24μmol/L(0.0148±0.0123μg/ml),钛0.82±0.50μmol/L(0.0391±0.0243μg/ml),与文献报道值类似。高血压患者血清锌16.45±2.85μmol/L(1.0754±0.1863μg/ml),钙2308.32±276.29μmol/L(92.5175±11.0738μg/ml),钴2.23±0.62μmol/L(0.1316±0.0368μg/ml)和钛0.61±0.31μmol/L(0.0292±0.0147μg/ml),均低于正常对照组(分别为p<0.001,p<0.05)。镉0.85±0.40μmol/L(0.0951±0.0452μg/ml),镁1022.20±399.91μmol/L (24.8497±9.721 8μg/ml)和镉/锌比值高于正常对照组(P<0.001)。而铜17.58±3.11μmol/L(1.1169±0.1973μg/ml),镍0.39±0.01μmol/L(0.0231±0.0045μg/ml),铬0.31±0.12μmol/L(0.0163±0.0     

International standards and international reference preparations: amphotericin B, vancomycin, capreomycin, cefalotin, demethylchlortetracycline, gentamycin, gramicidin S, kanamycin and kanamycin B, lincomycin, lymecycline, methacycline, paromomycin, rifamycin SV, ristocetin and ristocetin B, spiramycin, and triacetyloleandomycin

Each of the preparations described here was obtained and evaluated at the request of a WHO Expert Committee on Biological Standardization. Unless otherwise stated, a standard procedure was used to distribute the material into individual ampoules. The procedure was as follows. Upon receipt by the National Institute for Medical Research (NIMR), London, materials were stored temporarily in the dark at a temperature of -10°C or lower, and protected from moisture. At a convenient time they were brought back to room temperature, mixed, and distributed into individual neutral glass ampoules so that each ampoule contained 50-100 mg of powder. If it was known that the material was light-sensitive non-actinic glass ampoules were used. After exhaustive drying in vacuum over phosphorus(V) oxide, the ampoules were either constricted (up to 1963) or fitted with capillary leak plugs, dried for a further period under the same conditions, filled with dry nitrogen, and sealed by fusion of the glass. The total drying period varied from 8 to 38 days according to the nature of the material. After they had been tested for leaks, the ampoules were stored in the dark at -20°C.     

健康成人血清铜、铁、锌、镉、铅、锰、铬、钙、镁、钾含量的调查研究

应用原子吸收光谱分析法,测定了在南京从事不同作业的360名健康成人血清中Cu、Fe、Zn、Cd、Pb、Mn、Cr、Ca、Mg、K 10种元素的含量,经分组统计处理,探讨了不同工种、性别、年龄及工龄与血清元素水平的关系。结果表明,不同工种间血清Cu、Fe、Zn、Cr、Mn、Pb、Ca、Mg、K含量均有显著性差异;不同年龄段血清Cu、Zn、Cd、Mn、Pb、Mg含量有显著差异;女性血清Cu、Zn、Ca、K含量高于男性,而血清Cd低于男性;不同工龄间血清Cu、Fe、Zn、Cd、Cr、Pb、Mg含量有显著性差异。     

Vitamin C—Sources,Physiological Role,Kinetics, Deficiency,Use, Toxicity,and Determination

Vitamin C (L-ascorbic acid) has been known as an antioxidant for most people. However, its physiological role is much larger and encompasses very different processes ranging from facilitation of iron absorption through involvement in hormones and carnitine synthesis for important roles in epigenetic processes. Contrarily, high doses act as a pro-oxidant than an anti-oxidant. This may also be the reason why plasma levels are meticulously regulated on the level of absorption and excretion in the kidney. Interestingly, most cells contain vitamin C in millimolar concentrations, which is much higher than its plasma concentrations, and compared to other vitamins. The role of vitamin C is well demonstrated by miscellaneous symptoms of its absence—scurvy. The only clinically well-documented indication for vitamin C is scurvy. The effects of vitamin C administration on cancer, cardiovascular diseases, and infections are rather minor or even debatable in the general population. Vitamin C is relatively safe, but caution should be given to the administration of high doses, which can cause overt side effects in some susceptible patients (e.g., oxalate renal stones). Lastly, analytical methods for its determination with advantages and pitfalls are also discussed in this review.     

Update: multistate outbreak of monkeypox--Illinois,Indiana, Kansas,Missouri, Ohio,and Wisconsin, 2003

CDC and state and local health departments continue to investigate cases of monkeypox among persons who had contact with wild or exotic mammalian pets or persons with monkeypox. This report updates epidemiologic, laboratory, and smallpox vaccine use data for U.S. cases, and summarizes the laboratory-based evidence implicating imported African rodents as the probable source of the outbreak.     

Nutrients, nuclear receptors, inflammation, immunity lipids, PPAR, and allergic asthma

The peroxisome proliferator-activated receptors (PPARs) belong to the larger superfamily of steroid/thyroid nuclear receptors. PPARgamma is expressed in a number of hematopoietic cells, including dendritic cells, eosinophils, macrophages, and T cells. A number of lipids and synthetic compounds interact with PPARgamma, that, depending on the cell type, results in the regulation of specific genes. There is now a large body of data indicating that allergic asthma is the result of a predominant type-2 helper T cell immune response including IL-4, -5 and -13, eosinophilic inflammation in the lungs, mucous production, and airway hyperresponsiveness (AHR). Targeting the production of these type-2 helper T cell mediated cytokines has been proposed as a way to regulate this disease. Because PPARgamma ligands can affect T cell cytokine production in vitro, we have examined whether these ligands affect symptoms of allergic asthma in a murine model of this disease. We discuss data showing that ciglitazone and GW1929, two agonistic ligands for PPARgamma, significantly inhibited airway inflammation during allergic asthma induction. Oral treatment with ciglitazone and GW1929 inhibited airway inflammation, with less of an effect on AHR. By contrast, intranasal exposure to GW1929 significantly reduced AHR following exposure to allergen, while GW9662, a PPARgamma antagonist, had no effect. In vitro, T cells from ciglitazone-treated mice secreted significantly less IL-4 and IFN-gamma in response to restimulation. These data suggest that PPARgamma agonists may be useful for the treatment of allergic asthma.     

Update: multistate outbreak of monkeypox--Illinois,Indiana, Kansas,Missouri, Ohio,and Wisconsin, 2003

CDC and state and local health departments continue to investigate cases of monkeypox among persons who had contact with wild or exotic mammalian pets or persons with monkeypox. This report updates epidemiologic, laboratory, and smallpox vaccine use data for U.S. cases.     

Lung clearance, translocation, and acute toxicity of arsenic, beryllium, cadmium, cobalt, lead, selenium, vanadium, and ytterbium oxides following deposition in rat lung

Young adult rats were exposed via inhalation or intratracheal instillation to oxides of arsenic, beryllium, cadmium, cobalt, lead, selenium, vanadium, and ytterbium. Serial necropsies were performed to assess the metal content in organs at times up to several weeks after exposure. The lung clearance varied widely for these compounds, and the times to remove 50% of the initial burden ranged from 18 min for vanadium to 400 days for beryllium. Arsenic, cadmium, lead, selenium, and vanadium were initially soluble in lung, but a small fraction (1-20%) remained there over the long term. Extrapulmonary tissues often accumulated substantial amounts of the soluble oxides, and whole-body retention was often greater for compounds that were more soluble in lung. Arsenic, selenium, and vanadium translocated to carcass and bone. Arsenic, cadmium, lead, and selenium accumulated in the liver, and the kidney retained cadmium and lead. Beryllium, cobalt and ytterbium did not deposit at any extrapulmonary site in significant amounts. In general, the aqueous solubility of these compounds was a poor predictor for behavior in vivo because of their interaction with metabolic processes. Of the metal oxides tested for acute lethality following pulmonary deposition, cadmium was most toxic, followed by selenium, vanadium, and arsenic.     

Update: multistate outbreak of monkeypox--Illinois,Indiana, Kansas,Missouri, Ohio,and Wisconsin, 2003

CDC and state and local health departments continue to investigate cases of monkeypox among persons who had close contact with wild or exotic mammalian pets or persons with monkeypox. This report updates epidemiologic, laboratory, and animal data for U.S. cases.     

Update: multistate outbreak of monkeypox--Illinois,Indiana, Kansas,Missouri, Ohio,and Wisconsin, 2003

CDC and state and local health departments continue to investigate cases of monkeypox among persons in the United States who had contact with wild or exotic mammalian pets or with persons with monkeypox. This report updates results of the epidemiologic investigation, provides information on the use of smallpox vaccine during the outbreak, and summarizes the animal tracing activities to identify the origin and subsequent distribution of infected animals.     

Nutritional status of vitamin A, E, C, B1, B2, B6, nicotinic acid, B12, folate, and beta-carotene in young women

To investigate the vitamin status of young Japanese women, dietary intakes of vitamin A, E, C, B1, B2, B6, B12, niacin, folate, and beta-carotene were assessed by a 3-d weighed food record in 150 female students aged 21-22. Whole blood levels of vitamin B1, B2, and nicotinic acid, and serum levels of retinol, alpha-tocopherol, vitamin B6, and beta-carotene were determined by HPLC. Vitamin B12 and folate in serum were measured by chemiluminescence immunoassay, and serum vitamin C was done by dinitrophenylhydrazine method. When the 6th revision RDAs for the Japanese (physical activity level 1) were applied, 46.7% of the females showed sufficient intake for vitamin A, 28.7% for E, 80.7%, for B1, 92.7% for B2, 54.7% for B6, 99.3% for niacin, 76.0% for B12, 34.0% for folate, and 54.0% for C. Fifty-nine percent of total vitamin A (microgRE) intakes were derived from beta-carotene. The mean+/- SD of energy intakes was low, 1.572+/-315 kcal. Significant correlations among intakes of energy and all these vitamins were found. Serum folate and ascorbic acid levels in the females with corresponding vitamin intakes above the RDA were significantly higher than in those with intakes below the RDA. There were significant correlations between blood vitamin levels and vitamin intakes in vitamin B12 (r=0.185), folate (r=0.255), vitamin C (r=0.272), and beta-carotene (r=0.319). Mean blood levels of folate, ascorbic acid, vitamin B2, B12, and beta-carotene were higher in the highest quartile of intake than in the lowest. The 95% confidence intervals of blood vitamin levels obtained from the females with sufficient vitamin intakes were nearly equal to those obtained from all subjects. Only a few females (0.7-4.7%) had their blood vitamin levels below the lower limits. Serum alpha-tocopherol levels were significantly correlated with serum levels of retinol, beta-carotene, and vitamin C. This data suggested that young women should increase suitable dietary food intakes in order to maintain good status of vitamin. Moreover, sufficient amount of physical activity would be expected for prevention of excessive energy intake.     

Spatial,Ecologic, and Clinical Epidemiology of Community-Onset,Ceftriaxone-Resistant Enterobacteriaceae,Cook County,Illinois, USA

We performed a spatial and mixed ecologic study of community-onset Enterobacteriaceae isolates collected from a public healthcare system in Cook County, Illinois, USA. Individual-level data were collected from the electronic medical record and census tract–level data from the US Census Bureau. Associations between individual- and population-level characteristics and presence of ceftriaxone resistance were determined by logistic regression analysis. Spatial analysis confirmed nonrandom distribution of ceftriaxone resistance across census tracts, which was associated with higher percentages of Hispanic, foreign-born, and uninsured residents. Individual-level analysis showed that ceftriaxone resistance was associated with male sex, an age range of 35–85 years, race or ethnicity other than non-Hispanic Black, inpatient encounter, and percentage of foreign-born residents in the census tract of isolate provenance. Our findings suggest that the likelihood of community-onset ceftriaxone resistance in Enterobacteriaceae is influenced by geographic and population-level variables. The development of effective mitigation strategies might depend on better accounting for these factors.     

Hormone replacement therapy, cancer, controversies, and women's health: historical, epidemiological, biological, clinical, and advocacy perspectives

Routine acceptance of use of hormone replacement therapy (HRT) was shattered in 2002 when results of the largest HRT randomised clinical trial, the women''s health initiative, indicated that long term use of oestrogen plus progestin HRT not only was associated with increased risk of cancer but, contrary to expectations, did not decrease, and may have increased, risk of cardiovascular disease. In June 2004 a group of historians, epidemiologists, biologists, clinicians, and women''s health advocates met to discuss the scientific and social context of and response to these findings. It was found that understanding the evolving and contending knowledge on hormones and health requires: (1) considering its societal context, including the impact of the pharmaceutical industry, the biomedical emphasis on individualised risk and preventive medicine, and the gendering of hormones; and (2) asking why, for four decades, since the mid-1960s, were millions of women prescribed powerful pharmacological agents already demonstrated, three decades earlier, to be carcinogenic? Answering this question requires engaging with core issues of accountability, complexity, fear of mortality, and the conduct of socially responsible science.     

Employment, unemployment, occupation, and smoking

This study analyzes the relationships of cigarette smoking and smoking histories to employment status and occupation. Data from a large, representative sample of U.S. adults in 1985 were analyzed separately for white men, white women, black men, and black women, with controls for age, education, and marital status included in all analyses. It has been hypothesized that women who adopt traditional male roles are more likely to become smokers. However, our data indicate that participation of women in the labor force or employment of women in male-dominated occupations have had little or no effect on women's smoking adoption or cessation. Unemployed men and women (those who were not employed but were seeking work) were substantially more likely than employed men and women to be smokers. Among employed whites, the percentage of smokers was high for industrial manual workers and service workers and low for professionals and farmers. Similar differences were observed in the proportion who had ever adopted smoking. These differences in smoking adoption had begun at young ages, before most people have adopted adult roles, which suggests that the differences in smoking adoption were not caused by unemployment or occupation. Rather, it appears that certain personal characteristics or early experiences influenced both smoking adoption and adult unemployment or occupation. In addition, unemployment may decrease smoking cessation, and employment in professional occupations may increase smoking cessation.     

The what,who, why,where, when,and how of primary prevention

This paper discusses primary prevention's basic tenets and generic principles. It describes its essential elements and explains how prevention's technology of education, social competency, community organization/systems intervention, and natural caregiving can be used to prevent dysfunctional behaviors while promoting healthy lifestyles.     

Occurrence,exposure, effects,recommended intake and possible dietary use of selected trace compounds (aluminium,bismuth, cobalt,gold, lithium,nickel, silver)

Background: Minerals, metals, clays and rocks were widely used by physicians in the past. However, it was and it is well known that some inorganic elements at high dosage may have curative effects but also serious toxicity. The effects at low or ultra-low concentrations, on the contrary, are less documented, but the idea that low dosage supplementation might be beneficial to human health is widespread even in the present period. Methods: The main information about aluminium, bismuth, cobalt, gold, lithium, nickel and silver was selected and evaluated from a vast body of medical literature. Results: In modern times, most elements are proposed for human use at levels comparable with normal dietary intake, probably for precautionary considerations. Conclusion: Some inorganic trace compounds might have unexpected effects at extremely low dosages, but scientific demonstrations of beneficial effects of supplementation are mostly not available in the medical literature.     

Arsenic,cadmium, cobalt,copper, lead,mercury, molybdenum,selenium and zinc concentrations in liver,kidney and muscle in Australian sheep

Matched muscle, liver and kidney samples from 152 sheep in different states of Australia were analysed for trace elements. Mean levels found in muscle, livers and kidneys were 0.010, 0.010 and 0.011 mg kg⁻¹ (fresh weight) for arsenic; 0.0035, 0.280 and 0.853 mg kg⁻¹ for cadmium; 0.006, 0.060 and 0.044 mg kg⁻¹ for cobalt; 0.74, 66.0 and 2.72 mg kg⁻¹ for copper; 0.007, 0.040 and 0.057 mg kg⁻¹ for lead; 0.0025, 0.0034 and 0.0061 mg kg⁻¹ for mercury; 0.014, 1.05 and 0.44 mg kg⁻¹ for molybdenum; 0.09, 0.31 and 0.95 mg kg⁻¹ for selenium; and 40.4, 37.2 and 20.8 mg kg⁻¹ for zinc. The lead, mercury and arsenic concentrations in meat and organs may be regarded as low, but the concentrations of cadmium in kidney and livers are sometimes relatively high. Apart from cadmium, lead and selenium, tissue trace element concentrations were not related to the age of the investigated animals. Differences in essential and non-essential trace element accumulation in sheep reared in different regions (states and territories) of Australia were also evaluated. Cadmium, lead and selenium were the only elements that appeared to show significant regional differences. Overall the results show that concentrations of the elements considered are within current acceptable ranges.     

Euphoria,ecstacy, inebriation,abuse, dependence,and addiction: a conceptual analysis

A conceptual analysis of basic notions of addictiology, i.e., Euphoria, Ecstasy, Inebriation, Abuse, Dependence, and Addiction was presented. Three different forms of dependence were distinguished: purely psychic, psycho-physiological, and purely somatic dependence. Two kinds of addiction were differentiated, i.e. appetitive and deprivative addiction. The conceptual requirements of addiction were discussed. Keeping these in mind some ethical problems of drug therapy and psychotherapy were explained. Criteria for the assessment of therapeutic approaches are suggested: effectiveness, side effects, economic, ethic, and esthetic valuation.