Factors affecting birthweights in Hindus, Moslems and Europeans

Summary. The birthweights of 664 Hindu and 132 Moslem babies were compared with those of 486 European babies born at the same hospital. The mean birthweight of the Europeans was 3362 g, compared with 3146 g for the Moslems and 2960 g for the Hindus. The Asian women were smaller than the European and tended to have a shorter length of gestation. Forty-four per cent of the Asians and 46% of the European mothers were of social classes I and II; 28% of the Europeans and 2% of the Asians smoked. There were no significant differences between Asians and Europeans in the effects of maternal size, parity, gestational age and fetal sex on birthweight. After adjustment for these variables and for cigarette smoking there was no significant difference in birthweight between the Moslems and the Europeans, but the mean birthweight of the Hindus was about 190 g lighter than that of the Europeans. Hindus from East Africa had lighter babies than those from India.     

Waste in the U.S. Health Care System: A Conceptual Framework

Context: Health care costs in the United States are much higher than those in industrial countries with similar or better health system performance. Wasteful spending has many undesirable consequences that could be alleviated through waste reduction. This article proposes a conceptual framework to guide researchers and policymakers in evaluating waste, implementing waste‐reduction strategies, and reducing the burden of unnecessary health care spending. Methods: This article divides health care waste into administrative, operational, and clinical waste and provides an overview of each. It explains how researchers have used both high‐level and sector‐ or procedure‐specific comparisons to quantify such waste, and it discusses examples and challenges in both waste measurement and waste reduction. Findings: Waste is caused by factors such as health insurance and medical uncertainties that encourage the production of inefficient and low‐value services. Various efforts to reduce such waste have encountered challenges, such as the high costs of initial investment, unintended administrative complexities, and trade‐offs among patients', payers', and providers' interests. While categorizing waste may help identify and measure general types and sources of waste, successful reduction strategies must integrate the administrative, operational, and clinical components of care, and proceed by identifying goals, changing systemic incentives, and making specific process improvements. Conclusions: Classifying, identifying, and measuring waste elucidate its causes, clarify systemic goals, and specify potential health care reforms that—by improving the market for health insurance and health care—will generate incentives for better efficiency and thus ultimately decrease waste in the U.S. health care system.     

Malignancy: Human T-Cell Lymphotropic Virus Type I and Adult T-Cell Leukaemia/Lymphoma

Adult T-cell leukaemia/lymphoma (ATLL) was first identified in Japan in 1977 [1,2]. The causative agent, the human T-lymphotropic virus type I (HTLV-I), was isolated 3 years later by Gallo's group from a patient initially diagnosed as having mycosis fungoides but subsequently reclassified as a case of ATLL [3]. Since this time, much has been discovered about the molecular pathogenesis of the disease. Despite this, treatment of ATLL remains disappointing and the prognosis of acute and lymphoma types poor. In the United Kingdom, cases of ATLL are mainly restricted to people of Afro-Caribbean descent but the disease is of general importance because ATLL has also been reported in non-endemic areas and may possibly spread into other populations via blood transfusion as blood donors in the UK are currently not screened for HTLV-I.     

Obtaining accurate patient‐specific perioperative anaesthetic costs in orthopaedic anaesthesia

□ The aim of the study was to obtain perioperative patient‐specific costs associated with orthopaedic anaesthesia □ A prospective observational study design was used to determine fixed, semi‐fixed, and variable costs □ The preliminary results of the first 60 patients reports a mean total perioperative anaesthetic cost of £291 (SD: £103.9, median: £278.09, IQR: £219.3–£369.5) □ Fixed and semi‐fixed costs are a major cost component of anaesthesia; variable costs account for only 12 per cent of total cost □ The results of this study will be used in an economic evaluation examining the use of different anaesthetic techniques in orthopaedics     

Current provision and recommendations for the management of psychosocial morbidity following disaster in England

Although disasters remain statistically rare events, the last decade has seen an increase in the number of major incidents affecting the UK. Concurrent with this increase has come clinical data, showing how psychosocial health may be adversely affected by disasters. There is good evidence that many victims of traumatic stress suffer from depression and suicidal behaviour; two of the English Department of Health’s stated objectives for reduction in their publication, Health of the Nation. The objectives of this paper were to give the Department of Health a survey of the current provision of psychosocial care after disasters at English regional health authority level and to make recommendations regarding good practice in the care of victims of trauma by healthcare professionals. The methodology used was varied. Letters were sent to all the regional public health departments asking for information about the psychological care element within their major incident plans. The findings showed that the provision for psychosocial care following a disaster in England is extremely variable and although there are undoubtedly regions with considerable expertise and interest, there are also regions where provision appears to be minimal or non-existent. The provision of specialist traumatic stress services at regional level is recommended.     

Multilineage mobilization of peripheral blood progenitor cells in humans following administration of PEG-rHuMGDF

The most important physiological regulator of megakaryocytopoiesis is the ligand for the c-mpl receptor (thrombopoietin/megakaryocyte growth and development factor, MGDF). We examined the effect of pegylated-recombinant human MGDF (PEG-rHuMGDF): patients received PEG-rHuMGDF at doses of 0.03, 0.1, 0.3 or 1.0 μg/kg/d or placebo for 10 d maximum in a double-blinded randomized study. There was a dose-dependent elevation in circulating platelet counts but no alteration in erythrocyte or total leucocyte counts. The number of bone marrow megakaryocytes was increased approximately 2-fold. The frequency of bone marrow progenitor cells was not altered. In contrast, both to the bone marrow results and to published pre-clinical data, there was a dose-dependent mobilization into the blood of progenitor cells of multiple cell lineages. Increased levels of Meg-CFC (maximum increase 30-fold), day 7 and day 14 GM-CFC and BFU-E were demonstrated at doses of 0.3 and 1.0 μg/kg/d PEG-rHuMGDF. At 0.1 μg/kg/d, mobilization of Meg-CFC alone occurred in two-thirds of patients. Maximum blood levels of progenitor cells occurred at day 12. Thus, administration of PEG-rHuMGDF to humans resulted in mobilization of progenitor cells of multiple lineages despite its 'lineage-specific' activity on mature cell development.     

Characteristics of Registered Clinic Patients Who Have Not Visited Their Family Physician for 3 Years

The objective of this study was to obtain and critically evaluatedata on the health characteristics and the need for medicalassistance in patients aged 40 years and over, from six urbanand rural medical practices in northern Israel, who have notconsulted their family physician for at least 3 years. A healthquestionnaire was completed by means of telephone calls andpersonal contacts, regarding 139 non-visitors (Out of 1847 patientsaged 40 and over). The health characteristics and prevalenceof medical and social problems were compared to regular clinicattenders. Questionnaires of 101 non-attenders were completedfor a response rate of 73% (101/139). The non-attendance ratewas 7.5% (139/1847) and there was a low rate of morbidity. Themajority (81%) were 40–59 years old and only 16% had hadprevious illnesses. Only 10% took medications regularly, mostof them medical personnel. Twenty-eight of the non-attenderswere employees of the regional health care system. Most of theseindividuals coped with chronic illnesses by consulting the regionalhospital's outpatient clinics. Non-attenders could be characterizedas less prone to health problems. Most of them seemed remarkablyfit and were not suffering unduly as a result of their lackof medical attention.