The metamorphosis of health planning in the Netherlands and the USA

The United States and the Netherlands are the focus for this comparative analysis of the evolutionary interaction between health planning and the political system, seen in the context of change in social and economic ideologies. While health planning in the USA started in 1946, it was the comprehensive health planning program in 1966 that created the form to be followed by Health Systems Agency effort in 1974: local, voluntary planning, coordinated by state agencies, supported by federal funding. Health planning in the Netherlands has moved through four distinct periods: a hospital construction period, starting during the post-war recovery; a hospital regionalization period, from 1971 through the late 1970s; a transition period from the late 1970s to 1982, during which several planning approaches were considered; and, the current comprehensive health and social services planning period. Today, federal support for health planning in the US has been eliminated as part of the current de-regulatory, competitive health care strategy. Health planning in the US is now an institutional activity, with less focus on community needs. Advocated changes in the Dutch planning approach incorporate ideas similar to past approaches in the US; but, a failed approach in one nation may work in another, if the underlying cultural and organizational characteristics are sufficiently different.     

Adult outcomes of attention deficit hyperactivity disorder and conduct disorder: are the risks independent or additive?

METHODS: Data were obtained from a longitudinal study sample of 754 adoptees and categorized based on review of the available adoption agency, medical, and psychiatric records of the biological parents. Categorical data were analyzed using chi2 or Fisher's exact tests, as appropriate. Logistic regression analyses were used to assess the relative contribution of variables. RESULTS: There was not a statistically significant difference in the frequency or type of self-reported adult disruptive behavior, arrests, jail stays, felony arrests, or frequency of conduct disorder (CD) when inattentiveness, impulsivity, and hyperactivity were analyzed individually. The contributions of attention deficit hyperactivity disorder (ADHD) were independent and no additional increased risk for future illegal behavior was conferred by the combination of the disorders. While the effect of CD on illegal behavior was correlated with substance abuse and dependence, ADHD continued to be a significant contributor after controlling for substance abuse and dependence. CONCLUSIONS: Data indicated that ADHD and CD are related but different disorders conferring risk for adult illegal behavior or arrest. In this sample, inattention was the most common domain impaired among those with ADHD, followed closely by hyperactivity, with impulsivity reported least often among those endorsing symptoms of ADHD.     

An electron microscopic study of local anesthetic-induced skeletal muscle fiber degeneration and regeneration in the monkey

An electron microscopic study was done on abductor pollicis brevis muscles of 18 Rhesus monkeys after intramuscular injections of 0.75% bupivacaine, 2% mepivacaine, or 2% lidocaine + epinephrine. The muscles were examined for from 2 h to 28 days. Severe muscle fiber damage, consisting of breakdown of sarcolemma and myofibrils, was seen as early as 2 h. Phagocyte mediated fragmentation of the degenerating muscle fibers was at its peak during the third and fourth days. Myoblasts were abundant during the fourth day. Early myotubes appeared on the fifth and sixth days, and they matured during the second week. Satellite cells appeared alongside mature myotubes. Overall, the local anesthetic-induced breakdown and regeneration of skeletal muscle fibers in the monkey followed a course quite similar to that seen in the rat.     

Reduction of Mortality in the Stockholm Ischaemic Heart Disease Secondary Prevention Study by Combined Treatment with Clofibrate and Nicotinic Acid

Consecutive survivors of a myocardial infarction from the Southern Hospital, below 70 years of age, were randomized into a Control group (n=276) and a Treatment group (n=279). The latter was openly prescribed the combination of clofibrate and nicotinic acid for serum lipid lowering. Each patient should remain in the study for 5 years and be seen regularly every 4 months at a special IHD outpatient clinic within the hospital. The concentration of serum cholesterol and triglyceride was lowered by 13% and 19%, respectively, in the Treatment group compared to the Control group. Total mortality was 82 cases in the Control group and 61 in the Treatment group, a 26% reduction (p<0.05). For patients above 60 years of age in the Treatment group the reduction in mortality was 28% (p<0.05). IHD mortality was reduced by 36% (p<0.01)in the Treatment group compared to the Control group. The beneficial effect of the serum lipid lowering treatment was related to the serum triglyceride concentration in two ways. First, it only occurred in patients with a triglyceride level >1.5 mmol/l (n=216). Secondly, it was most pronounced in the 44% of the treated patients who had a lowering of the serum triglyceride concentration by 30% or more, and in this subgroup the reduction of IHD mortality was 60% (p<0.01). For serum cholesterol there were no such relations. The difference between serum triglycerides and cholesterol concerning these relations to the treatment outcome may be due to the fact that hypertriglyceridaemia was the most common hyperlipidaemia among our patients, occurring in 50%, while hypercholesterolaemia only occurred in 13 %. Caution should be exercised in the interpretation of the results as the trial was not blind. However, the fact that the decrease in IHD deaths was directly related to the degree of serum triglyceride lowering indicates that it was the drug effect on serum lipids that was reponsible for the beneficial effect of the treatment.     

Blood pressure related separately to parenchymal fibrosis and vasculopathy of the kidney.

The term nephrosclerosis is customarily used to designate a pathological entity that tends to characterize subjects with high blood pressure; it refers to a condition of diffuse fibrous replacement of renal substance secondary to ischemia from hypertension-related vascular injury. The features of parenchymal fibrosis can be distinguished from those of vasculopathies in tissue sections, parenchymal fibrosis being measured by assessing the degree of interstitial fibrosis and by counting obsolete glomeruli, while vasculopathies are measured by determining arterial intimal fibroplasia and by counting hyalinized arterioles. A series of 166 autopsies in subjects aged 25 to 92 years, selected because ample documentation of blood pressure was available, was assessed. One form of vasculopathy, arterial fibroplasia, is a better correlate of high blood pressure than is parenchymal fibrosis in this body of data. Cases with much vasculopathy and little parenchymal fibrosis occurred frequently, and these subjects were usually hypertensive. Cases with little vasculopathy and much parenchymal fibrosis were also encountered, but these subjects were usually not hypertensive. The suggested conclusion is that blood pressure relates less to the renoprival state of nephron loss than it does to renal ischemia in patients with nephrosclerosis.     

Examining Equivalence of Concepts and Measures in Diverse Samples

While there is growing awareness for the need to examine the etiology of problem behaviors across cultural, racial, socioeconomic, and gender groups, much research tends to assume that constructs are equivalent and that the measures developed within one group equally assess constructs across groups. The meaning of constructs, however, may differ across groups or, if similar in meaning, measures developed for a given construct in one particular group may not be assessing the same construct or may not be assessing the construct in the same manner in other groups. The aims of this paper were to demonstrate a process of testing several forms of equivalence including conceptual, functional, item, and scalar using different methods. Data were from the Cross-Cultural Families Project, a study examining factors that promote the healthy development and adjustment of children among immigrant Cambodian and Vietnamese families. The process described in this paper can be implemented in other prevention studies interested in diverse groups. Demonstrating equivalence of constructs and measures prior to group comparisons is necessary in order to lend support of our interpretation of issues such as ethnic group differences and similarities.     

Total reconstruction of the hypopharynx and cervical esophagus: a 20-year experience.

We have reviewed 145 patients who underwent 148 total reconstructions of the hypopharynx and cervical esophagus between 1970 and 1989. The types and numbers of reconstruction included 45 deltopectoral (DP) flaps, 35 musculocutaneous (MC) flaps, 19 colon interpositions, 23 gastric transpositions, and 26 free jejunal transfers. Median hospitalization was 51 days for DP flaps, 24 days for MC flaps, 28 days for colon, 30 days for gastric, and 14 days for jejunum. Median resumption of oral intake was 92 days for DP flaps, 19 days for MC flaps, 12 days for colon, 13 days for gastric, and 9 days for jejunum. Functional failure, defined as the inability to maintain adequate nutrition without tube feedings, was 40% for MC flaps, 42% for colon interposition, 17% for gastric transposition, and 20% for free jejunal transfer. Microvascular free jejunal transfer has become our method of choice for reconstruction of the hypopharynx and cervical esophagus. Gastric transposition is an alternative when resection of the thoracic esophagus is necessary.     

Central serous chorioretinopathy in U.S. Air Force aviators: a review

Idiopathic central serous chorioretinopathy (ICSC) is an uncommon disease with the potential to cause loss of visual acuity, decreased color vision, and decreased depth perception. These visual changes may become permanent and require removal of aviators from flight status. This study reviews 55 eyes of 47 USAF aviators with ICSC examined at the United States Air Force School of Aerospace Medicine (USAFSAM), Brooks AFB, TX. Clinical and aeromedical findings, both on initial and on follow-up ophthalmic examination were studied. Ninety-seven percent of aviators otherwise medically qualified were ultimately returned to flight status. Overall, 51% had recurrent episodes, 17% had bilateral disease, and 13% underwent laser photocoagulation. Visual acuity correlated with active disease, and there was a trend toward poor stereopsis and diminished color vision with worsening visual acuity. Eighty-six percent attained a final visual acuity of 20/20 or better. On final examination, 90% had normal stereopsis, 87% had normal color vision, and 49% had a normal central visual field. Eyes with recurrent disease tended to have degraded final visual acuity, stereopsis, color vision, and central visual field. The visual and aeromedical prognosis from a single attack of ICSC is generally favorable, but repeated attacks can lead to a significant decrease in visual functions that may jeopardize flying status.