Socioeconomic differences in health: how much do health behaviors and health insurance coverage account for?

As evidence accumulates that both unhealthy behaviors and inadequate access to health care are responsible in part for poor health, there is a tendency to attribute the differences in health status between the poor and the affluent to the higher prevalence of unhealthy behaviors and inadequate access to health care among people of low socioeconomic status (SES). The purpose of this study is to determine quantitatively how much health behaviors and health insurance coverage account for the SES disparity in health. The study employed secondary analysis of data collected through the Kentucky Behavioral Risk Factor Surveillance System for 2000. After adjusting for health behaviors and health insurance coverage, the differences in health among different levels of SES (measured by education and income) remained strong and significant. Health behaviors and health insurance coverage accounted for 10-16% of the socioeconomic differences in health.     

Walking the talk: Fit WIC wellness programs improve self-efficacy in pediatric obesity prevention counseling

Six sites of the California Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participated in a staff wellness pilot intervention designed to improve staff self-efficacy in counseling WIC clients about childhood overweight. A pre-post test design with intervention and control groups was used; outcome measures included staff perceptions of the intervention's effects on the workplace environment, their personal habits and health beliefs, and their counseling self-efficacy. Intervention site staff were more likely to report that the workplace environment supported their efforts to make healthy food choices (P <.001), be physically active (P <.01), make positive changes in counseling parents about their children's weight (P <.01), and feel more comfortable in encouraging WIC clients to do physical activities with their children (P <.05).     

Differences in the role and administrative relationships of medical directors in community and migrant health centers

This study examined differences in medical directors of Community and Migrant Health Centers (C/MHCs) in the United States based on the size of the center, including demographics, job characteristics, roles, and their relationship with C/MHC administrators and governing boards. Data for this analysis came from a 1996 cross-sectional survey of Community and Migrant Health Centers medical directors. A total of 411 centers (68.3% surveyed) responded to the survey including 240 rural centers (67.4%) and 171 urban (68.7%) centers. Small centers were categorized as those with three or fewer physicians (n = 136), medium centers had more than three but less than eight ETE physicians (n = 14), and large centers had eight or more ETE physicians (n = 109). Several differences were found regarding the medical directors' roles and relationships with the administrator and governing boards on the size of the center. Large C/MHC medical directors had more autonomy than did small and medium C/MHC medical directors including in the areas of managing clinical staff, the budget, and strategic planning activities. They spent more time cultivating community resources than small and medium center counterparts and were more likely to possess the management skills needed in their role than do those in small and medium centers. They also reported a stronger working relationship with the C/MHC administrator and had more input with the C/MHC board than small or medium medical directors.     

The Effects of Priming on a Public Health Campaign Targeting Cardiovascular Risks

Public health interventions are cost-effective methods to reduce heart disease. The present study investigated the impact of a low-cost priming technique on a public health campaign targeting cardiovascular risk. Participants were 415 individuals (66% female) ages 18 and older recruited through clinics and churches. The study consisted of three phases. In Phase I, participants completed a brief survey to assess knowledge of the cardiovascular health indicators. The survey served as the prime (intervention) for the study. At Phase II, participants were provided with access to a public health campaign consisting of an education brochure on cardiovascular health. Following the educational campaign, all participants completed a post-campaign survey in Phase III of the study. Participants who completed the surveys in both Phase I and III were placed in the intervention condition (26%) and those who only completed the Phase III survey were placed in the control condition (74%). Participants who were primed reported greater awareness of the public health campaign. Additionally, more intervention participants reported they had knowledge of their own and the normal ranges for cholesterol, glucose, and body mass index. For participants who were aware of the health promotion campaign, more participants in the primed group indicated they had knowledge of their own cholesterol and glucose levels and had made positive lifestyle changes as a result of the campaign. Results suggest the presence of a priming effect. Public health campaigns may benefit from the inclusion of a low-cost prime prior to intervention.     

The dorsomedial hypothalamus and the response to stress: part renaissance, part revolution

Emotional stress provokes a stereotyped pattern of autonomic and endocrine changes that is highly conserved across diverse mammalian species. Nearly 50 years ago, a specific region of the hypothalamus, the hypothalamic defense area, was defined by the discovery that electrical stimulation in this area evoked changes that replicated this pattern. Attention later shifted to the hypothalamic paraventricular nucleus (PVN) owing to (1) elucidation of its role as the final common pathway mediating activation of the hypothalamic-pituitary-adrenal (HPA) axis, a defining feature of the stress response and (2) the finding that the PVN was the principal location of hypothalamic neurons that project directly to spinal autonomic regions. Consequently, a primary role for the PVN as the hypothalamic center integrating the autonomic and endocrine response to stress was inferred. However, our findings indicate that neurons in the nearby dorsomedial hypothalamus (DMH)--a region originally included in the hypothalamic defense area--and not in the PVN play a key role in the cardiovascular changes associated with emotional or exteroceptive stress. Indeed, excitation of neurons in the parvocellular PVN and consequent recruitment of the HPA axis that occurs in exteroceptive stress is also signaled from the DMH. Thus, the DMH may represent a higher order hypothalamic center responsible for integrating autonomic, endocrine and even behavioral responses to emotional stress.     

Serum dioxin concentrations and age at menopause

2,3,7,8-Tetrachlorobenzo-p-dioxin (TCDD), a halogenated compound that binds the aryl hydrocarbon receptor, is a by-product of numerous industrial processes including waste incineration. Studies in rats and monkeys suggest that TCDD may affect ovarian function. We examined the relationship of TCDD and age at menopause in a population of women residing near Seveso, Italy, in 1976, at the time of a chemical plant explosion. We included 616 of the women who participated 20 years later in the Seveso Women's Health Study. All women were premenopausal at the time of the explosion, had TCDD levels measured in serum collected soon after the explosion, and were > or = 35 years of age at interview. Using proportional hazards modeling, we found a 6% nonsignificant increase in risk of early menopause with a 10-fold increase in serum TCDD. When TCDD levels were categorized, compared with women in the lowest quintile (< 20.4 ppt), women in quintile 2 (20.4-34.2 ppt) had a hazard ratio (HR) of 1.1 (p = 0.77), quintile 3 (34.3-54.1 ppt) had an HR of 1.4 (p = 0.14), quintile 4 (54.2-118 ppt) had an HR of 1.6 (p = 0.10), and quintile 5 (> 118 ppt) had an HR of 1.1 (p = 0.82) for risk of earlier menopause. The trend toward earlier menopause across the first four quintiles is statistically significant (p = 0.04). These results suggest a nonmonotonic dose-related association with increasing risk of earlier menopause up to about 100 ppt TCDD, but not above.     

Phase II studies of bryostatin-1 in patients with advanced sarcoma and advanced head and neck cancer

Background. Bryostatin 1 is a marinederived macrolactone with antineoplasticactivity modulated through protein kinaseC, and with good activity in in vitro and in vivomodels. There are fewdrugs that offer palliation for metastaticsoft-tissue sarcoma and head and neckcancer, and drugs with new mechanisms ofaction warrant detailed disease specificstudy. Patients and methods. Twophase II studies for patients withincurable soft tissue sarcoma (12), or headand neck cancer (12) were conducted. Patients were treated with bryostatin,120 mg/m²/72 hours every 2 weeks for 3cycles prior to re-evaluation. Mostpatients had received priorchemotherapy. Results. No patientshad objective responses to therapy. Sixpatients had brief periods of diseasestabilization. Toxicity was generallymild, with myalgia being prominent (n=8). Hyponatremia, not previously described,occurred in 5 patients. The mechanism ofthis toxicity was unclear. Conclusions. Bryosytatin 1given as a single agent for advanced adult soft tissuesarcoma and head and neck cancer isinactive. Myalgia and hyponatremia werethe predominant toxicities.     

Assessment of need for multicompetent allied health practitioners in the midlands of South Carolina

Recent attention has focused on integration of Multicompetent Allied Health Practitioners (MCAHPs) into the health care labor force to offset future imbalances in supply and demand for allied health practitioners, and to maximize use of existing allied health practitioners. Several recent studies have focused on multicompetency issues. However, there is little that shows the impact of MCAHPs on health care costs. This study was conducted to determine the current usage of MCAHPs, projected future need for them, needs-skill combinations, entry-level salary comparison between MCAHPs and single-skilled practitioners, projected yearly savings in personnel costs to health care organizations employing MCAHPs, and community support for a college-based MCAHP program. Results indicated a large market for MCAHPs, increased entry-level salaries for MCAHPs compared to single-skilled practitioners, and projected savings to health care institutions due to decreased personnel costs.     

Chemotherapy inhibits skeletal muscle ubiquitin-proteasome-dependent proteolysis

Chemotherapy has cachectic effects, but it is unknown whether cytostatic agents alter skeletal muscle proteolysis. We hypothesized that chemotherapy-induced alterations in protein synthesis should result in the increased incidence of abnormal proteins, which in turn should stimulate ubiquitin-proteasome-dependent proteolysis. The effects of the nitrosourea cystemustine were investigated in skeletal muscles from both healthy and colon 26 adenocarcinoma-bearing mice, an appropriate model for testing the impact of cytostatic agents. Muscle wasting was seen in both groups of mice 4 days after a single cystemustine injection, and the drug further increased the loss of muscle proteins already apparent in tumor-bearing animals. Cystemustine cured the tumor-bearing mice with 100% efficacy. Surprisingly, within 11 days of treatment, rates of muscle proteolysis progressively decreased below basal levels observed in healthy control mice and contributed to the cessation of muscle wasting. Proteasome-dependent proteolysis was inhibited by mechanisms that include reduced mRNA levels for 20S and 26S proteasome subunits, decreased protein levels of 20S proteasome subunits and the S14 non-ATPase subunit of the 26S proteasome, and impaired chymotrypsin- and trypsin-like activities of the enzyme. A combination of cisplatin and ifosfamide, two drugs that are widely used in the treatment of cancer patients, also depressed the expression of proteasomal subunits in muscles from rats bearing the MatB adenocarcinoma below basal levels. Thus, a down-regulation of ubiquitin-proteasome-dependent proteolysis is observed with various cytostatic agents and contributes to reverse the chemotherapy-induced muscle wasting.