The Genetics of Drug Reactions

Genetically determined differences in metabolism are widespread and may be entirely innocuous for the individual unless a particular drug is prescribed. In this situation, however, the absence or deficiency of a particular enzyme or the abnormality of a receptor site may cause serious problems. Awareness of inherited variability in drug response is becoming more and more essential to the correct design of individual drug regimens.     

Interaction between a medical group and a school of public health: a case study of a productive affiliation

As schools of the health sciences come under increasing financial pressures and providers must cope with the increasing complexity of the health care system, mutually supportive arrangements may become more common and more important to both parties. Underlying such arrangements is the expectation that the schools of the health sciences may gain sources of support for professional education and access to training opportunities and that the providers may gain in operational capacity and access to specialized expertise. We have developed a collaborative relationship between a school of public health and a multispecialty group medical practice. Although in some respects an improbable combination, the relationship has yielded benefits and may be of interest to other institutions.     

Emigration of New Zealand and Australian physicians to the United States and the international flow of medical personnel

One in five physicians practising in the US received their initial medical qualifications in another country. Contrary to expectations, a large cadre come from developed nations such as New Zealand and Australia. In particular, these two countries provide a unique prism with which to view the international flow of medical talent. While they differ from developing nations that primarily export physicians without attracting others in return, they are distinguished from importing nations such as the US which rarely export. Our analysis is based on a unique dataset collected from three cross-sectional sources. We found that, compared to post-resident physicians remaining at home, New Zealand medical graduates (NZMGs) and Australian medical graduates (AMGs) in the US are typically older, more likely to be male, more likely to have received their initial medical qualifications from certain schools, less likely to be employed in a public hospital setting, more likely to work in a medical school and more likely to practice in a specialty than primary care. Additional findings show that NZMGs and AMGs in the US are more likely than other US physicians to have established themselves in areas with 50,000 or more people and are therefore more likely to serve a population with sociodemographic characteristics typical of the nation's urban centers. It appears then, that NZMGs and AMGs may be emigrating to the US for educational and professional opportunities that may be unavailable at home. In short, the emigration of NZMGs and AMGs may be an instance of what has come to be called the 'international equity problem' or 'brain drain'. However, losses resulting from the disproportionate migration of New Zealand and Australian physicians to the US may be compensated for by the importation of foreign trained physicians from other nations. Future analysis must be extended to take this facet of the international flow phenomena into account.     

Research technique for epidemiologic investigation of nutrition and cancer

When investigating cancer etiology, epidemiologists often correlate estimates of current dietary practices to cancer incidence. There is evidence that diets may be basically stable over time due to deep‐rooted habits; however, changes in eating behavior are often associated with life‐style or health‐status changes. By using a diet‐related life‐event schedule, dietary changes resulting from life events may be more easily recalled and a more accurate characterization of diet patterns during neoplasm initiation may be made.     

Effects of different remuneration methods on general medical practice: a comparison of capitation and fee-for-service payment.

There are severe methodological problems to be overcome in comparing the effects of different payment methods on general medical practice, not least because there are many factors which affect the pattern of service delivery. Also, the reliability and comparability of data may be poor. This article emphasises that the effects of capitation and fee-for-service payment methods on general medical practice should be carefully compared with factual information, especially numerical data. In so doing, it is shown that there are supporting data for the contention that a fee-for-service system encourages more consultations, more diagnostic tests, higher drug use, higher surgical rates and higher costs than a capitation system. On the other hand, a capitation system may lead doctors to hastier and less courteous care than a fee-for-service system. The geographical distribution of general practitioners (GPs) may be more even, and continuity of care may be better maintained, under a capitation system; but there may be excessive referrals from GPs to specialists under this system of payment. There is no evidence for the contention that a capitation system encourages preventive medicine, but the financial coverage for preventive procedures does encourage such procedures.     

婴幼儿早期抗生素应用与增加儿童肥胖的风险研究

肥胖是21世纪威胁人类健康的重要问题,而儿童肥胖是引起成人肥胖的重要危险因素之一。婴幼儿早期肠道菌群定植对机体以后的新陈代谢至关重要,早期抗生素的使用对肠道菌群有直接影响,可能引起儿童期体重增加,与以后疾病的发生发展有密切联系。能否在婴幼儿抗生素治疗后采取一些菌群复原策略,以平衡肠道菌群,促进机体的健康生长和发展,可能会成为预防早期肥胖的新的研究方向。本文综合了国内外的相关研究,对此做一综述。     

Facilities available for surveillance of the side effects of fertility regulating agents in the United States

A number of techniques utilizing currently available facilities may be employed to assess the extent of use and side effects of contraceptive agents. Interpretation of vital statistics and survey information describes trends in mortality from selected causes and choice of contraceptive agent. The use of adverse drug reaction surveillance and multiphasic screening programs may identify more specific relationships between drugs, devices and diseases. Such findings may stimulate the development of in-depth clinical evaluations or epidemiological studies of specific subjects such as thromboembolism and cancer. A number of representative studies are identified which may yield information not only describing elements of risk but also of demographic value. Full and coordinated use of these opportunities for information gathering will generate more accurate assessments of contraceptive status in large populations and form a more adequate baseline for future evaluations.     

Diagnosis of E.Coli Tricuspid Valve Endocarditis: A Case Report

Escherichia coli is a rare cause of bacterial endocarditis. We report a case of an elderly man with cirrhosis who developed bacterial endocarditis due to E.coli. We review the literature that summarizes a total of 41 cases, with a predominance of elderly women, diabetics, and patients with urinary tract infections and prosthetic heart valves. E.coli bacteremia may be mistakenly attributed to a more benign source such as urosepsis and overlooked as an indication of endocarditis. A delay in diagnosis may lead to higher mortality as the opportunity for early valve replacement in appropriate cases and more prolonged courses of antibiotics may not be considered.     

Parents' reactions to the diagnosis of cerebral palsy: associations between resolution, age and severity of disability

Background   For parents, receiving a diagnosis, typically in early childhood, that their child has cerebral palsy may conjure up high distress and anxiety. Resolution of these initial reactions may help parents to focus on the challenges and needs of their children. Aims of the study were to test whether parents of older children displayed resolution more often than parents of younger children, and whether parents of children with less severe cerebral palsy also showed more resolution.
Method   Resolution of reactions to diagnosis was assessed with the Reaction to Diagnosis Interview, in a clinic-based sample of 255 parents of children with cerebral palsy aged between 1.4 and 17.3 years. Physicians rated motor ability using the Gross Motor Function Classification System.
Results   Overall, the responses of 81.6% of the parents were predominantly indicative of resolution. Unresolved reactions were significantly more often found among parents of younger children and parents of children with more severe motor disabilities. Among parents of teenage children, resolution was more often apparent from a focus on action to better the lives of their children, whereas in parents of younger children, it was more apparent from their focus on constructive thoughts and information seeking.
Conclusions   Given time, the large majority of parents may resolve their reactions to the diagnosis that their child has cerebral palsy. Parents of the most severely affected children may need specific support which, given the age trends, might be aimed at different resolution processes for parents of younger and older children.     

Assessing spatio-temporal variability of risk surfaces using residential history data in a case control study of breast cancer

Background  

Most analyses of spatial clustering of disease have been based on either residence at the time of diagnosis or current residence. An underlying assumption in these analyses is that residence can be used as a proxy for environmental exposure. However, exposures earlier in life and not just those in the most recent period may be of significance. In breast cancer, there is accumulating evidence that early life exposures may contribute to risk. We explored spatio-temporal patterns of risk surfaces using data on lifetime residential history in a case control study of breast cancer, and identified elevated areas of risk and areas potentially having more exposure opportunities, defined as risk surfaces in this study. This approach may be more relevant in understanding the environmental etiology of breast cancer, since lifetime cumulative exposures or exposures at critical times may be more strongly associated with risk for breast cancer than exposures from the recent period.     

A tale of two limits

As they do with other potentially hazardous agents, occupational health and safety professionals in the United States take a two-pronged approach to controlling noise exposure. We assure compliance with OSHA's regulatory limits to satisfy lawyers and compliance officers while using TLVs to protect worker health. Unfortunately, using both the TLV and OSHA limits for noise exposure may involve considerably more work than for most chemical exposures. Using both limits for noise may require different measuring equipment or multiple measurements of exposure. Using the TLV also may require noise measurement at the abdomen, as well as the ear and consideration of concomitant chemical exposures. Finally, using the TLV requires the OHS professional to confront the fact that no exposure value can claim to protect all workers and that employee rotation may result in more hearing loss than would exposing a smaller group of workers to more noise. These facts make it clear why OHS professionals should never use exposure limits as just numbers. Rather, we strive to understand the basis for the limits we are using, to be sure we understand the limitations of those limits and how they might uniquely affect our workers in their work environments.     

Psychosocial aspects of disease duration and control in young adults with type I diabetes

Self-report questionnaires completed by young adults with Type I diabetes were examined to determine if individuals differing in recent metabolic control (Poor, Moderate or Very Good) or disease duration (Long, Short) also vary in either occurrence or type of life events during the past year or occurrence of recent emotional distress. Subjects in Poor control reported more positive and neutral life events during the past year, suggesting even those life changes individuals view benignly may be associated with metabolic control difficulties. Individuals in Poor control also reported more recent symptoms of depression, anxiety and hostility than did individuals in Moderate or Very Good control--symptomatology which may further impair their ability to adhere to a complex self-care regimen. Individuals with Long disease duration reported more positive and negative recent life experiences than did subjects with Short disease duration, but did not evidence concomitant disruptions in metabolic control. The role experience with a chronic disease may play in this finding was unclear, however. Although more research is required to clarify the exact relation of psychosocial variables and diabetic control, these findings suggest that clinically relevant subgroup parameters, subjects' perceptions of life change, and demographic variables may be important factors to assess.     

The effect of price on the consumers' perception of physicians

This attitudinal study indicates that consumers do not perceive a price-quality association for physician services. However, existing patients of physicians, if satisfied, are willing to pay more for their physician's services. Thus, physicians looking to attract new patients may find a high price strategy to be no more ineffective than a parity pricing strategy. But physicians with existing 'satisfied' patients may be able to increase their professional fees without having a major attrition of patients or suffering a loss in patient satisfaction.     

Age and gender dependent profile of food choice

Several studies have described remarkable differences in food choice between men and women. Consistently, women are reported to have higher intakes of fruit and vegetables, higher intakes of dietary fiber and lower intakes of fat. In accordance with such more healthy food choice, women usually attach greater importance to healthy eating. In addition, the motivation of weight control is more prominent in women and they are more likely to diet or restrain their eating behavior. Recently, studies found that health beliefs and weight control motivation may explain up to 50 percent of gender differences in food choice. In addition, less healthy food choice profiles of men may be related to their poorer nutritional knowledge. However, health beliefs, eating attitudes and dieting appear to be phenomena which vary throughout the life span. In growing older, changes in the chemosensory perceptual systems play an important role in food choice. The decline of gustatory and--perhaps even more pronounced--in olfactory function may lead to a decrease of the pleasantness of food, thus limiting the reinforcing properties of food intake which eventually results in a decrease of appetite, often reported in elderly people. In addition, there are some indications that sensory-specific satiety diminishes with age. Sensory-specific satiety is the reduction in the pleasantness of food as it is consumed. This decrease of pleasantness usually motivates the choice of other foods and therefore, a varied diet. Therefore, the decrease of sensory-specific satiety may in part explain the limited variety of the diet sometimes seen in elderly people. However, lifestyle, socio-economic situation and other variables may limit the influence of such physiological changes and help to maintain an adequate food intake despite these age-related processes.     

Effects of cyproterone acetate on sexual arousal patterns of pedophiles

The antiandrogen treatment of sexual offenders has been shown to reduce the recidivism rate. The mechanism of action has been assumed to be through asexualization with its secondary effects on sexual behavior. This study shows that the mechanism may be more complex and may involve a differential effect on sexual arousal patterns. Treatment responses may differ in high and low plasma testosterone groups.     

Role of dietary carbohydrate and frequent eating in body-weight control

Despite widespread interest in body-weight control, the prevalence of obesity continues to rise worldwide. Current public health advice for obesity prevention is clearly failing. The present paper examines the appropriateness of current public health advice for body-weight control, i.e. to reduce consumption of fatty foods, to reduce consumption of sugar and to avoid snacking between meals. An increase in carbohydrate: fat ratio should improve body-weight control, as high-carbohydrate low-fat diets are less likely to lead to overeating, and if overeating does occur, less of the excess energy is likely to be stored as fat. However, it is suggested that for the long-term prevention of weight gain, advice to increase consumption of carbohydrate-rich foods may be more effective than advice which focuses on reducing consumption of fatty food. Moreover, in view of the inverse relationship between fat and sugar intakes, sugar may have a positive role to play in body-weight control in facilitating an increase in carbohydrate: fat ratio. Snacking for most individuals appears not to adversely affect body-weight control, and for some it may improve control. This situation may exist because frequent eating helps appetite control, thus preventing overeating at meals, and as snacks overall tend to be higher in carbohydrate and lower in fat than meals, frequent eating may be a strategy for increasing carbohydrate: fat ratio. It is also suggested that eating 'little and often' may be a more compatible pattern of eating for a physically-active lifestyle than eating large meals. Perhaps the most appropriate advice on food intake that would work synergistically with concurrent advice to increase physical activity is to eat more carbohydrate, and to eat frequently.     

The Effect of Price on the Consumers' Perception of Physicians

This attudinal study indicates that consumers do not perceive a price-quality association for physician services. However, existing patients of physicians, is satisfied, are willing to pay more for their physician's services. Thus, physicians looking to attract new patients may find a high price strategy to be no more ineffective than a parity pricing strategy. But physicians with existing 'satisfied' patients may be able to increase their professional fees without having a major attrition of patients or suffering a loss in patient satisfaction.     

Gender differences in the presentation and symptoms of coronary artery disease

Chest pain is a typical feature of obstructive coronary disease, but unless carefully evaluated, may not be a reliable predictor in women. The use of standardized questionnaires and evaluation tools has been developed and validated in men, but only partially in women. If women over the age of 65 are evaluated, typical features of angina are much more reliable in representing coronary disease than in younger women, who may have risk factors, but are less likely to have significant coronary disease. Many studies have shown that chest pain is the most common presenting symptom for both men and women with unstable coronary syndromes or myocardial infarction. Other associated features, such as nausea, shortness of breath, and back pain, may be more common in women, while diaphoresis is more common in men. Since men and women at risk for coronary disease should be evaluated when any potential symptoms emerge, it is useful to employ a standardized assessment of the characteristics of the symptoms as well as a uniform approach to further evaluation.     

Estimation of risk factor associations when the response is influenced by medication use: an imputation approach

When the outcome of interest is a quantity whose value may be altered through the use of medications, estimation of associations with this outcome is a challenging statistical problem. For participants taking medication the treated value is observed, but the underlying 'untreated' value may be the measure that is truly of interest. Problematically, those with the highest untreated values may have some of the lowest observed measurements due to the effectiveness of medications. In this paper we propose an approach in which we parametrically estimate the underlying untreated variable of interest as a function of the observed treated value, and dose and type of medication. Multiple imputation is used to incorporate the variability induced by the estimation. We show that this approach yields more realistic parameter estimates than other more traditional approaches to the problem and that study conclusions may be altered in a meaningful way by using the imputed values.