Racial and ethnic disparities in infant mortality: risk in social context

This article presents the multifaceted efforts of Syracuse Healthy Start, a federally funded initiative of the Onondaga County Health Department and over 20 partnering agencies to reduce racial and ethnic disparities in infant mortality. The analyses presented in this article demonstrate that many women--Caucasian, African American, and Hispanic--have serious risks for low birth weight and infant death. In many cases, multiple, simultaneous risks complicate a pregnant woman's situation and in other cases the longitudinal cumulative risks impact health across generations. Infant mortality decreased overall, and for both Caucasian and African American infants during the first 3 years of the project.

Molecular characterization and mitochondrial sequence variation in two sympatric species of Proechimys (Rodentia: Echimyidae) in French Guiana

Variations in mitochondrial DNA characters were used to characterize two morphologically similar and sympatric species of Neotropical terrestrial rodents of the genus Proechimys (Mammalia: Echimyidae). We sequenced both cytochrome b (1140pb) and part of the control region (445pb) from four individuals of P. cuvieri and five of P. cayennensis from French Guiana, which allowed us to depict intra- and inter-specific patterns of variation. The phylogenetic relationships between the nine sequences evidence the monophyly of each species, and illustrate that more polymorphism might exist within P. cuvieri than within P. cayennensis. By developing species-specific primers to amplify a fragment of the cytochrome b gene, we were able to identify 50 individuals of Proechimys spp. caught in two localities of French Guiana. In both sites of primary rainforests, we showed that the two species live in syntopy, and this observation emphasizes the need to document ecological differences which should exist in order to diminish inter-specific competition.

Stromelysin-3 expression in noninvasive and invasive neoplasms of the urinary bladder

Stromelysin-3 (ST-3) is a protease frequently expressed by fibroblasts surrounding invasive carcinomas. Based on its expression in some cases of breast carcinoma-in-situ, it has been thought to indicate a higher likelihood for subsequent invasion in preinvasive lesions. Carcinoma-in-situ (pTis) and noninvasive papillary tumor (pTa) of the urinary bladder are preinvasive lesions with an uncertain potential to become invasive. We studied the expression of ST-3 in pTis, pTa, and invasive bladder tumors to see whether it had an association with any established histopathologic variables and whether its expression might be an indicator of incipient invasion in the preinvasive lesions. Twenty-seven pTis, 27 pTa tumors, and 56 invasive bladder carcinomas were studied for ST-3 expression with immunohistochemistry and, in selected cases, with in situ hybridization. Staining for ST-3 was evaluated semiquantitatively. None of 27 pTis lesions, 4 of 27 pTa tumors, and 41 of 56 (73.2%) invasive carcinomas were positive for ST-3. Statistically significant associations were found in the invasive carcinomas between ST-3 expression and lymphatic vessel invasion, an infiltrative invasive pattern, and invasion into at least the muscle layer (pT2,3,4 v pT1). The expression of ST-3 in frankly invasive tumors was associated with a more aggressive tumor phenotype. Its expression in a small subgroup of pTa lesions may be indirect evidence that some tumors diagnosed as pTa have invasive potential.

Tracking the State Children's Health Insurance Program with hospital data: national baselines, state variations, and some cautions

State and federal agencies are concerned with the impact of the State Children's Health Insurance Program (CHIP) on the health care of enrolled children. As part of a broad program evaluation, and at relatively low cost, analysts can track data on hospital admissions for ambulatory care sensitive (ACS) conditions. This article uses hospital data for 19 states to calculate baseline ACS rates and to discuss trends and cross-state variations just prior to the start of the CHIPs. A few cautions and limitations are discussed. An unexpected result in the exploration was a substantial increase in the rate of ACS admissions for self-pay and Medicaid-enrolled children during the period of 1990-1995. During that same period, the admission rate for other insured children fell by more than a third. The comparisons across states are meant to be illustrative; they do reveal a relationship between the rate of asthma admissions and the proportion of self-pay plus Medicaid-enrolled cases.

Pht2;1 encodes a low-affinity phosphate transporter from Arabidopsis

An Arabidopsis genomic sequence was recently shown to share similarity with bacterial and eukaryotic phosphate (Pi) transporters. We have cloned the corresponding cDNA, which we named Pht2;1, and subsequently performed gene expression studies and functional analysis of the protein product. The cDNA encodes a 61-kD protein with a putative topology of 12 transmembrane (TM) domains interrupted by a large hydrophilic loop between TM8 and TM9. Two boxes of eight and nine amino acids, located in the N- and C-terminal domains, respectively, are highly conserved among species across all kingdoms (eubacteria, archea, fungi, plants, and animals). The Pht2;1 gene is predominantly expressed in green tissue, the amount of transcript staying constant in leaves irrespective of the Pi status of the shoot; in roots, however, there is a marginal increase in mRNA amounts in response to Pi deprivation. Although the protein is highly similar to eukaryotic sodium-dependent Pi transporters, functional analysis of the Pht2;1 protein in mutant yeast cells indicates that it is a proton/Pi symporter dependent on the electrochemical gradient across the plasma membrane. Its fairly high apparent K(m) for Pi (0.4 mM) and high mRNA content in the shoot, especially in leaves, suggest a role for shoot organs in Pi loading. Pht2;1 thus differs from members of the recently described plant Pi transporter family in primary structure, affinity for Pi, and presumed function.

Pht2;1 encodes a low-affinity phosphate transporter from Arabidopsis

An Arabidopsis genomic sequence was recently shown to share similarity with bacterial and eukaryotic phosphate (Pi) transporters. We have cloned the corresponding cDNA, which we named Pht2;1, and subsequently performed gene expression studies and functional analysis of the protein product. The cDNA encodes a 61-kD protein with a putative topology of 12 transmembrane (TM) domains interrupted by a large hydrophilic loop between TM8 and TM9. Two boxes of eight and nine amino acids, located in the N- and C-terminal domains, respectively, are highly conserved among species across all kingdoms (eubacteria, archea, fungi, plants, and animals). The Pht2;1 gene is predominantly expressed in green tissue, the amount of transcript staying constant in leaves irrespective of the Pi status of the shoot; in roots, however, there is a marginal increase in mRNA amounts in response to Pi deprivation. Although the protein is highly similar to eukaryotic sodium-dependent Pi transporters, functional analysis of the Pht2;1 protein in mutant yeast cells indicates that it is a proton/Pi symporter dependent on the electrochemical gradient across the plasma membrane. Its fairly high apparent K(m) for Pi (0.4 mM) and high mRNA content in the shoot, especially in leaves, suggest a role for shoot organs in Pi loading. Pht2;1 thus differs from members of the recently described plant Pi transporter family in primary structure, affinity for Pi, and presumed function.

[Efficacy of ultrasound screening in pregnancy]

OBJECTIVE

The purpose of this study was to examine the effectiveness of ultrasound screening in pregnancy.

MATERIAL AND METHODS

Therefore, it was registered whether fetal malformations in a study population of 11,172 deliveries were already diagnosed before birth.

RESULTS

341 defects were found in 297 children from mothers who had had prenatal care. Most anomalies were seen in the urogenital tract (n = 98; 28.7%), the heart (n = 67; 19.6%), the connective tissue (n = 39; 11.4%), the gastrointestinal tract (n = 32; 9.4%), and in the central nervous system (n = 33; 9.7%). Chromosomal anomalies (n = 22; 6.5%) and orofacial defects (n = 21; 6.2%) were more rare. 8.8% of all defects were lethal, 37% severe. 237 (69.5%) were classified as "diagnosable by ultrasound prenatally". 125 of them (53%) were identified prenatally, with high rates of 71% in central nervous system, 65.5% in intestinal and 54% in urogenital tract, while the detection rate was only 13.6% in chromosomal and 3.3% in cardiac defects. Only 14.3% were found before 24 weeks of gestation.

CONCLUSIONS

Thus, the effectiveness of ultrasound screening has to be improved by adequate measures.

Readability of skin cancer prevention brochures targeting parents of young children

Long-term exposure to UV radiation and severe sunburns increase one's risk of experiencing malignant melanoma later in life, so parents need to be informed about how to protect children from overexposure to the sun. We attempted to determine readability of skin cancer brochures targeted toward parents of young children. SMOG and FOG readability formulas were applied to 8 brochures published by the American Cancer Society, Skin Cancer Foundation, American Academy of Dermatology, and the Anti-Cancer Council. Readability levels of the brochures ranged between the 8th and 12th grade levels. To reduce the incidence of skin cancer, sun-safe knowledge and behavior should start in childhood. Pediatricians need access to brochures written at readability levels for the average parent. Skin cancer brochures written at the eighth or ninth grade comprehension levels may allow pediatricians to educate more parents about the importance of skin cancer prevention in childhood.

Communicating about youth's sun exposure risk to soccer coaches and parents: a pilot study in Georgia

Efforts to increase the sun-protective behaviors of children were extended to outdoor recreational sports and youth soccer settings in this study. The pretest results of a pilot survey of coaches (n = 12), parents (n = 50), and youths (n = 61) on eight soccer teams in south Georgia were used to guide the development of a health education program for coaches. In the pilot programs, half the coaches were trained to be involved in soccer-playing youths' sun protection by acting as positive role models and promoting sun protection to youths and their parents. The pilot demonstrated coaches' willingness to participate in sun protection promotion to youth: Youths indicated that coaches and parents were more likely to tell youths to wear sunscreen after the training than before, and coaches perceived getting youths to wear sunscreen to be less difficult than before.

Does managed care affect the supply and use of ICU services?

This paper analyzes use of hospital intensive care units (ICUs) by adult patients who are under age 65 and not covered by Medicaid; it allows for variation in indicators of the patient's condition, severity of illness, type of admission, emergency status, and degree of constraint on the total hospital ICU supply. We use data for Massachusetts and Florida in 1992. In neither state is there a significant difference in ICU admission rates between managed care patients and other privately insured patients. In Massachusetts, we find that the length of stay in the ICU is somewhat less for managed care and uninsured patients than for other privately insured patients. In both states, a hospital's ratio of total annual supply of ICU services to expected demand has a strong effect. In Massachusetts, the differences across payer groups in length of stay disappear for hospitals where the total ICU supply is relatively constrained.

Georgia's harvesting healthy habits: a formative evaluation

Occupational safety and health researchers seek to conduct effective cancer awareness campaigns to increase agricultural workers' skin cancer prevention and detection behaviors. Georgia undertook such a project using a social cognitive theory (Bandura, 1986) conceptual model, with its objectives focusing on personal determinants of and environmental influences on farmers' behavior. One underused strategy to increase the success of health campaigns, formative evaluation, was undertaken during year one of the demonstration project, with four goals. These included an assessment of: (1) the availability of societal resources to support farmers' practices, (2) the affordability for farmers to follow through with behaviors being promoted, (3) the social support for behaving in ways that reduce farmers' skin cancer risk, and (4) farmers' current knowledge, outcome expectations, and self-efficacy in this regard. Formative evaluation revealed an absence of information, products, services, and social support for farmers' skin cancer prevention and detection. As a result, the Georgia project's plan was refined to include specific activities aimed at increasing the environmental support for health promotion activities relating to farmers' skin cancer prevention and detection. These include a seminar for rural primary care physicians and public health nurses to increase knowledge and skills relating to conducting clinical skin exams; programs for agricultural extension agents, cotton scouts, and 4-H groups to provide opportunities to learn more about and practice sun safety; and a feed and seed store campaign.

Ebola virus outbreak among wild chimpanzees living in a rain forest of Côte d'Ivoire

An outbreak of Ebola in nature is described for the first time. During a few weeks in November 1994, approximately 25% of 43 members of a wild chimpanzee community disappeared or were found dead in the Taï National Park, Côte d'Ivoire. A retrospective cohort study was done on the chimpanzee community. Laboratory procedures included histology, immunohistochemistry, bacteriology, and serology. Ebola-specific immunohistochemical staining was positive for autopsy tissue sections from 1 chimpanzee. Demographic, epidemiologic, and ecologic investigations were compatible with a point-source epidemic. Contact activities associated with a case (e.g., touching dead bodies or grooming) did not constitute significant risk factors, whereas consumption of meat did. The relative risk of meat consumption was 5.2 (95% confidence interval, 1.3-21.1). A similar outbreak occurred in November 1992 among the same community. A high mortality rate among apes tends to indicate that they are not the reservoir for the disease causing the illness. These points will have to be investigated by additional studies.

Migrant farm workers' access to pesticide protection and information: Cultivando Buenos Habitos campaign development

Formative evaluation of south Georgian migrant farm workers' access to information and products to promote pesticide protection and understanding of cancer risk associated with pesticide exposure was conducted using field observation, in-depth interviews of Georgia's Migrant Health Program's outreach workers, and structured face-to-face surveys of migrant farm workers. The data indicated that fewer than one-third of the pesticide products reviewed contained messages about pesticide use and exposure risk for humans. Risk information on products appeared in English only. Few protective devices were available for purchase. Migrant farm workers were aware in a very general sense of health risks posed by pesticides, but they were specifically unaware of the reach of pesticides sprayed, as illustrated by their field behaviors. Findings also demonstrated the need to educate outreach workers about migrant farm workers' cancer risk, so that they may act as migrant farm workers' health advocates to reduce the adverse effects associated with pesticide exposure.

Comorbidity measures for use with administrative data

OBJECTIVES

This study attempts to develop a comprehensive set of comorbidity measures for use with large administrative inpatient datasets.

METHODS

The study involved clinical and empirical review of comorbidity measures, development of a framework that attempts to segregate comorbidities from other aspects of the patient's condition, development of a comorbidity algorithm, and testing on heterogeneous and homogeneous patient groups. Data were drawn from all adult, nonmaternal inpatients from 438 acute care hospitals in California in 1992 (n = 1,779,167). Outcome measures were those commonly available in administrative data: length of stay, hospital charges, and in-hospital death.

RESULTS

A comprehensive set of 30 comorbidity measures was developed. The comorbidities were associated with substantial increases in length of stay, hospital charges, and mortality both for heterogeneous and homogeneous disease groups. Several comorbidities are described that are important predictors of outcomes, yet commonly are not measured. These include mental disorders, drug and alcohol abuse, obesity, coagulopathy, weight loss, and fluid and electrolyte disorders.

CONCLUSIONS

The comorbidities had independent effects on outcomes and probably should not be simplified as an index because they affect outcomes differently among different patient groups. The present method addresses some of the limitations of previous measures. It is based on a comprehensive approach to identifying comorbidities and separates them from the primary reason for hospitalization, resulting in an expanded set of comorbidities that easily is applied without further refinement to administrative data for a wide range of diseases.

Morphogenesis of the antenna of the male silkmoth, Antheraea polyphemus. VI. Experimental disturbance of antennal branch formation

In the male silkmoth Antheraea polyphemus, the formation of the side branches of the quadripectinate antennal flagellum was disturbed by an experimental manipulation. Normally the side branches develop in the pupa via deep incisions which proceed from the periphery towards the centerline of the leaf-shaped antennal anlage. Local removal of the uppermost, pigmented cuticular layers of the pupal antennal pocket ('cuticular window') led to a local standstill of branch formation in the manipulated region of the pocket, most probably caused by increased evaporation of water through the remaining layers of meso- and endocuticle. These parts of the antenna retained an unbranched, plate-like shape. This early morphogenetic stage was conserved by the secretion of antennal cuticle. Besides cuticle formation, development of sensilla is not impeded by the manipulation. In the plate-shaped regions, the initial pattern formed by the sensilla in the antennal epidermis is preserved, because they maturate at their birth places. In the individual segments, the pattern of sensilla shows a mirror-like symmetry with respect to the segmental midline. From the edge to the midline, we found large s. trichodea, followed by small s. trichodea, s. basiconica, and s. coeloconica on the dorsal side whereas on the ventral side, there are only large s. trichodea and s. campaniformia. We conclude that the development of the featherlike antennal shape on the one hand and the development of sensilla and cuticle on the other hand are independent processes.

Acute rejection of vascular heart allografts by perforin-deficient mice

To study the role of perforin in cell-mediated graft rejection, vascularized hearts were grafted to perforin-deficient C57BL/6 and control C57BL/6 recipient mice. Fully allogeneic heart grafts (BALB/c) were acutely rejected by both recipients within 6 days. Peritoneal exudate lymphocytes from control mice but not from perforin-deficient mice exhibit a strong alloreactive cytotoxic activity in vitro. Histological analysis of the rejected tissues demonstrated extensive mononuclear cell infiltrates in both recipients. Flow cytometry analysis and immunohistology of graft-infiltrating cells showed similar proportions of lymphocyte subsets (CD8 >> CD4). Collectively, these data indicate that perforin is not essential in the cell-mediated acute rejection of a fully mismatched heart allograft. However, perforin-dependent effector mechanisms appeared to be limiting in the T cell-mediated rejection of heart allografts differing only at a single major histocompatibility complex class I antigen (bm1), because these grafts survived longer (mean 87.8 days) in perforin-deficient than in control mice (mean 31.5 days).

Factors influencing nuclear receptors in transcriptional repression

Members of the steroid receptor superfamily, like other transcription factors, can function as transcriptional inducers as well as repressors of transcription. The mechanisms by which repression is achieved seem to be specific for the factors and regulatory sequences involved. Silencing activity is conferred by the DNA bound v-ERBA, which is able to repress the activity of a complete or of a minimal promoter. Removal of the T3 or RA ligands converts the activated form of TR or RAR into a silencing conformation. Ligand-free TR, RAR or v-ERBA synergize with the DNA-bound negative protein 1 (NeP1) in a specific silencer sequence. In contrast to silencing, competitive repression is seen for specific negative hormone response elements. These elements are characterized by the presence of binding sites for other transcription factors.

The immunosuppressant rapamycin blocks in vitro responses to hematopoietic cytokines and inhibits recovering but not steady-state hematopoiesis in vivo

The immunosuppressive drug rapamycin suppresses T-cell activation by impairing the T-cell response to lymphokines such as interleukin-2 (IL-2) and interleukin-4 (IL-4). In addition, rapamycin blocks the proliferative response of cell lines to a variety of hematopoietic growth factors, including interleukin-3 (IL-3), interleukin-6 (IL-6), granulocyte-colony stimulating factor (G-CSF), granulocyte macrophage-colony stimulating factor (GM-CSF), and kit ligand (KL), suggesting that it should be a strong inhibitor of hematopoiesis. In this report, we studied the effects of rapamycin on different hematopoietic cell populations in vitro and in vivo. In vitro, rapamycin inhibited the proliferation of primary bone marrow cells induced by IL-3, GM-CSF, KL, or a complex mixture of factors present in cell-conditioned media. Rapamycin also inhibited the multiplication of colony-forming cells in suspension cultures containing IL-3 plus interleukin-1 (IL-1) or interleukin-11 (IL-11) plus KL. In vivo, treatment for 10 to 28 days with high doses of rapamycin (50 mg/kg/d, orally) had no effect on myelopoiesis in normal mice, as measured by bone marrow cellularity, proliferative capacity, and number of colony-forming progenitors. In contrast, the same treatment strongly suppressed the hematopoietic recovery normally seen 10 days after an injection of 5-fluorouracil (5-FU; 150 mg/kg, intravenously [i.v.]). Thus, rapamycin may be detrimental in myelocompromised individuals. In addition, the results suggest that the rapamycin-sensitive cytokine-driven pathways are essential for hematopoietic recovery after myelodepression, but not for steady-state hematopoiesis.

A thyroid hormone receptor-dependent glucocorticoid induction

Glucocorticoid and thyroid hormones exert their effects in many body tissues by binding to their respective receptors. The search for possible cross-talking mechanisms in overlapping target cells led to the discovery of synergism between a thyroid hormone receptor-binding site and a cryptic glucocorticoid-responsive element. Glucocorticoid responsiveness could only be detected in the presence of thyroid hormone and its receptor. This synergism requires the glucocorticoid receptor (GR) DNA-binding domain and is mediated by the transactivation domains. We found that synergism also occurs when the thyroid hormone receptor is replaced by the retinoic acid receptor or the GR is replaced by the progesterone receptor. Synergism is qualitatively independent of the type of thyroid hormone receptor-binding site and promoter. In several combinations of promoter and response elements, including a retinoic acid response element, T3 induction was only seen in the presence of the cryptic glucocorticoid-responsive element, GR, and glucocorticoids.

Fast chemiluminescent measurement of RNA polymerase activity based on photon counting technology

A fast and simple assay for T7 RNA polymerase based upon chemiluminescent detection of the synthesized, digoxigenin-labeled RNA on a nylon membrane with anti-digoxigenin coupled alkaline phosphatase and CSPD as substrate is described. Activity of RNA polymerase is determined with high sensitivity by quantifying the emitted light of the microplate-formatted dot-blot membrane with a photon counting microplate luminometer and a specially designed filter adapter. The described method is one example for the application of this new adapter to measure luminescent membrane filters.

Tennis elbow: a biomechanical and therapeutic approach

Lateral epicondylitis, one of the most common lesions of the arm, affects some 50% of tennis players. This condition poses a problem in clinical management because treatment is dependent not only on proper medical therapy but also on correction of the improper on-court biomechanics. The most common flaw is a late contact on the backhand groundstroke, forcing the player to extend the wrist with the extensor muscles. This action predisposes to trauma of the tendon fibers at the lateral epicondyle. Understanding the biomechanics will better prepare the physician to advise the patient and to communicate with a tennis teaching professional to facilitate long-term relief.

Antihypertensive and metabolic effects of single and combined atenolol regimens

The antihypertensive and metabolic effects of placebo (PL), a fixed combination of hydrochlorothiazide (25 mg) and triamterene (50 mg) (HCTZ/TRI), atenolol (25 mg) (Atc-25), atenolol (50 mg) (Ate-50) and their combination with HCTZ/TRI given once daily, were tested on 256 patients with mild-to-moderate essential-hypertension. After 3 weeks of PL monotherapy, 43 patients were randomized to PL (group 1), 41 patients to HCTZ/TRI (group 2), 44 patients to Ate-25 (group 3), 42 patients to Ate-50 (group 4), 43 patients to Ate-25/HCTZ/TRI (group 5), and 43 patients to Ate-50/HCTZ/TRI (group 6) in a double-blind parallel design study and were followed for 4 weeks. At the end of week 7, those patients who were randomized to groups 5 and 6 were allowed to continue for an additional 12 weeks, if their arterial pressure was satisfactorily controlled. Complete blood counts, blood chemistries, urinalyses, and electrocardiograms were done initially and during the study. Monotherapy with HCTZ/TRI, Ate-25, and Ate-50 had significant and equal antihypertensive effects compared with placebo. (P less than .01). However, the combination of Ate-25/HCTZ/TRI and Ate-50/HCTZ/TRI resulted in further reduction of arterial pressure with the effect being greatest with Ate-50/HCTZ/TRI (P less than .001). Patient groups 3 through 6 had also slower heart rates compared with groups 1 and 2 (P less than .01). Mild, but statistically significant, increases in BUN, glucose, triglycerides, and uric acid were noted in groups 2, 5, and 6 (P less than .05).(ABSTRACT TRUNCATED AT 250 WORDS)