Overview: Health and the planning of health care systems

Implicit functions of a health care system which are often omitted or improperly emphasized are the study and promotion of individual health. This situation stems from the fact that health care systems are primarily based on the concept of disease, while the attributes of health (positive health) have not been investigated and objectively defined. However, an operational definition of the elusive concept of health appears possible today and is discussed in this paper. If the hypotheses that health can be improved and deterioration due to age can be retarded are accepted, then the consequences of these possibilities must be analyzed in relation to the planning of health care systems and to the planning of national health care programs. Thus, any attempt to describe the natural history of the health process must include the effects of interventions aimed at the promotion of health in the absence of disease. These effects must be defined so that quantitative criteria, which would serve as the basis for predictive medicine, can be established. Quantitative predictive medicine is necessary in order to evaluate the effectiveness of preventive measures. While it is widely recognized that the prevention of disease is one of the major goals of a health care delivery system, the methods presently used to evaluate alternative courses of action are notoriously limited.     

Preventive cardiology in practice: a device for risk estimation and counseling in coronary disease

A method for the rapid estimation and display of coronary risk is used in counseling and for following progress in the practice of preventive cardiology. The estimator is a slide rule which computes risk of a future coronary event based on current age, smoking habit, serum cholesterol, and blood pressure levels. The device also displays estimated change in risk based on change in risk factors. The estimates are explained to clients as gross approximations. The slide rule is helpful in personalizing the need and the potential of preventive efforts.     

Efficacy of cervical cytologic screening in the control of cervical cancer

Cervical cancer mortality in the U.S. has been declining, and this has been attributed to cervical cytologic screening. This report reviews data on the incidence and mortality of cervical cancer in order to evaluate the effect of cytologic screening. U.S. cervical cancer mortality has been declining consistently since 1946, with little change in the mortality trend after widespread cytologic screening. Incidence of invasive cervical cancer in specific geographic areas has also declined. However, the rate of diagnosis of carcinoma in situ has increased sharply and parallels increasing cytologic screening rates. A causal association of cytologic screening with the decreasing mortality and incidence of invasive cervical cancer cannot be established using current data, especially considering declining mortality prior to widespread screening and increasing removal of women from the population at risk by hysterectomy.     

A systematic review and meta-analysis of the effect of curcuminoids on adiponectin levels

IntroductionCurcuminoids are known anti-inflammatory molecules with multiple mechanisms of action while adiponectin is an anti-inflammatory molecule secreted by the adipocytes. Curcuminoids may upregulate the expression of adiponectin and thus modulate their levels in serum. A meta-analysis was performed to identify randomized controlled trials evaluating the effect of curcuminoids on adiponectin concentrations.Materials and MethodsThe search included PubMed-Medline, Scopus, ISI Web of Science and Google Scholar databases (from inception to October 20, 2018) and the quality of studies was assessed according to Cochrane criteria. Quantitative data synthesis was conducted using a random-effects model and sensitivity analysis by the leave-one out method. Additional analysis was performed to assess the impact of potential confounders on adiponectin levels.ResultsThe meta-analysis of five randomized clinical trials (n = 686) showed a significant elevation of plasma adiponectin concentrations following supplementation with curcuminoids (WMD: 6.47 ng/mL, 95% CI: 1.85, 11.10, p = 0.010; I² = 94.85%). The effect size was robust in the leave-one-out sensitivity analysis and the effect size was not driven by a single study in the meta-analysis.ConclusionThis meta-analysis showed a significant increase in plasma levels of adiponectin following curcuminoids therapy, which may be one of the mechanisms of anti-inflammatory activity of curcumin.     

Jejunal absorption rates of glucose and glycine in post-infective tropical malabsorption

In a prospective study jejunal absorption rates of glucose (from a 200 mmol 1^?1 solution) and glycine (from a 100 mmol 1^?1 solution) were measured, using a perfusion technique, in nine patients with clinical evidence of post-infective tropical malabsorption (TM group) and in 10 others with trivial symptoms who had also visited the tropics (control group); all were of northern European origin. Seven and one in the two groups, respectively, had Giardia lamblia infections. Mean glucose absorption rate was significantly impaired by TM (P < 0·01); mean rate for glycine was also depressed but not significantly. Presence of G. lamblia did not affect the severity of malabsorption although numbers studied were small.     

Evaluation of the cost-effectiveness of an automated multiphasic health testing system

We present an evaluation of the cost-effectiveness of an automated multiphasic health testing system (AMHTS) compared with a manual system for providing comprehensive health examinations of large populations. The automated technology was found to be more economical (50–75% less/examinee) than the traditional system in performing each phase of the comprehensive screening and overall battery at a certain examinee load per month. Direct costs had a larger effect on cost per examinee than indirect costs and equipment depreciation. Highly automated phases (tests) were relatively more cost-effective than phases requiring more time and participation of physicians or trained personnel. This study demonstrates that an AMHTS can be utilized (within its parent medical care delivery organization) as an efficient, economical, and convenient method for conducting large-scale multiphasic screening.     

Assessment of attitudes toward mass screening for colorectal cancer and polyps

At the University of New Mexico outpatient clinics, 202 consecutive patients were asked by a bilingual medical student to complete a questionnaire and to indicate interest in volunteering for a Hemoccult colorectal cancer screening program. Only 70 (34%) agreed to undergo screening. Hispanics were less likely to volunteer than Anglos. Nonvolunteers were significantly more likely to object to specific aspects of the screening protocol and to deny that they could have cancer. Use of only 5 of the 15 items in the questionnaire gave maximal discrimination between volunteers and nonvolunteers.     

Type A behaviour in two ethnic rural communities of males in Israel with and without coronary heart disease

In an all male case-control study, 40 coronary heart disease patients were compared with 80 controls without coronary disease in terms of selected behavioural variables. The coronary patients were drawn from several rural villages receiving medical care from the Shimshon Medical Centre in Israel. The controls were selected at random from the computerized medical records of the Centre. The major behavioural assessment was the Jenkins Activity Survey (JAS) designed to measure the coronary-prone behaviour pattern (Type A). Coronary patients were found to score significantly more in the Type A direction than those men free of coronary disease. These results replicate earlier findings reported for several U.S.A. and European samples of retrospective coronary cases and controls. The Israeli sample was also compared in terms of other demographic variables and found to be similar to the prevalence samples studied in the U.S.A. This study is one of the first to provide evidence linking the Type A coronary-prone behaviour pattern, as measured by the JAS, to coronary disease in a rural population outside the United States. In addition, cases scored consistently higher than controls for both ethnic groups studied.     

A survey of respiratory disease among New York City postal and transit workers. IV. Racial differences in the FEV 1

In Negro male cigarette smokers the decline of the FEV₁ with age is significantly less than in whites. After correction for the original higher lung volumes in whites, the superiority of the Negro one-pack-per-day smoker relative to the White is estimated at +0.34 liters at age 60 (an amount equal to the difference between white nonsmokers and cigarette smokers at that age). Corrections were made for racial differences in amount smoked, age began, and inhaling.Negro and White nonsmokers do not differ in the rate of decline of the FEV₁ with age, suggesting that there is no intrinsic racial difference in the decline of the FEV₁ with age, but rather a difference in response to smoking.Prediction equations for the FEV₁ based on 2827 Negro males aged 30–59 are given for several smoking categories. For the total population the FEV₁ (in liters) = ?.022 age + .0285 standing height (centimeters) ?1.01.     

Psychosocial factors and blood pressure

The evidence linking psychosocial factors to sustained blood pressure elevation is highly suggestive and comes from a variety of sources. Hypertensives show increased responsiveness to emotional and mental stimuli. The hemodynamic characteristics of unstimulated hypertensives are similar to those of normotensives under emotional stress. It is likely that the sympathoadrenomedullary system partly mediates these responses, but the evidence in humans is mixed. Stranger evidence comes from studies of mice showing that symbolic stimuli in the form of disordered social relations lead to hypertension and increased heart size. In humans, the evidence linking psychological traits to hypertension is inconsistent. The prevalence of hypertension varies by social class and ethnic group and increases with acculturation from rural, traditional to modernized societies. One possible explanation for this is the attendant psychosocial changes. A variety of stress-management techniques have been shown to lower blood pressure, adding weight to a stress hypothesis.     

Kala-azar in Zambia: first report of two cases

Two autochthonous cases of kala-azar, the first such report of the disease from Central and Southern Africa, are described. Both patients presented with generalized macules, papules and nodules without ulceration and both also had tuberculosis. Amastigotes were cultured from blood and identified in skin, bone marrow, liver and spleen.     

Asbestos-exposed populations: prevention, care, and compensation

In Israel, the prevention and care of asbestos-associated diseases with latency periods of one to four decades (asbestosis, mesothelioma, increased frequency of cancer of the lung and other sites) are not satisfactory, and new national policies are required. Such policies have three major goals: (a) elimination or reduction of exposure to asbestos dust; (b) measures to promote cessation or drastic reduction of cigarette smoking among those currently or formerly exposed; and (c) equitable compensation for the consequences of past exposures. The practical elements of a program to achieve these three goals include (a) exposure standards and control technology; (b) identification of sources, routes, and levels of exposure and groups at risk; (c) compensation and job security; (d) medical monitoring and follow-up; (e) smoking cessation; (f) selective substitution of other substances for asbestos; and (g) establishment of a panel for policy supervision and the overseeing of compensation programs. Delay in implementation risks higher death rates for asbestosis and cancer among previously exposed workers, greater exposure among current workers, loss of experienced workers from the work force, and unnecessary hardship for families not adequately compensated.     

Risk factors for coronary heart disease among Jerusalem schoolchildren: Preliminary findings

The presence of risk factors for cardiovascular diseases was investigated in 7- and 11-year-old schoolchildren (808 subjects). Data analysis was performed according to sex, age, and country of origin of the father. The following variables were investigated: weight, height, total plasma cholesterol (TCH), high density lipoprotein cholesterol (HDL), plasma triglycerides, and systolic and diastolic blood pressure. Significant differences were found between sex, age, and origin groups for most variables. The prevalence of hypercholesterolemia (>180 mg/dl) varied between 9.6 and 14.1%, in the different sex and age groups, and that of low HDL cholesterol (<40 mg/dl), 6.8–12.1%. Elevated systolic blood pressure (>130 mm Hg) was found in 4.4–6.7% of the 7-year-old children, and in 13.4–18.6% of the 11-year-olds. Elevated diastolic blood pressure (>85 mm Hg) was found predominantly in the 11-year-old children, 6.2–9.1%. These findings demonstrate the necessity to initiate health programs related to prevention of cardiovascular diseases in childhood.     

Mortality during heat waves in New York City July, 1972 and August and September, 1973.

Twelve phthalic acid esters, including those commonly used as plasticizers for biomedical devices, were subjected to various biological tests for acute, short-term, and chronic toxicity. Certain aspects of subtle toxicity were investigated as well as overt toxic manifestations. The acute ip LD₅₀ for these compounds in mice ranged from 3.22 to more than 100 g/kg. A comparison of acute LD₅₀ to chronic LD₅₀ reveals that most of these phthalates are 2–4 times more toxic chronically. However, the chronic toxicity of di-n-octyl phthalate was 21.74 times greater than its acute toxicity, while for di-2-ethylhexyl phthalate the chronic toxicity was 27.99 times greater. Most of these compounds produced a prolongation of pentobarbital sleeping time in mice pretreated with a phthalate ester.     

Strategies for prevention using allied health professionals.

Preventive services which are directed at groups and individuals who are at high risk of some unfavorable outcome should be incorporated into the fabric of medical care practice. Allied health professionals have the required skills to provide preventive services with a greater sense of job satisfaction than do physicians. Experiences to date attest to the usefulness of allied health professionals in meeting the gaps in health care which are largely preventive in nature.     

Potential mechanisms for the augmentation of atherosclerosis and atherosclerotic disease by cigarette smoking.

Cigarette smoking is clearly associated with increased risk of atherosclerotic disease, but the mechanisms underlying the association are not known. In the direction of increasing the risk of atherosclerotic disease, smokers have more extensive advanced atherosclerosis, slightly higher serum concentrations of total cholesterol and LDL cholesterol, slightly lower concentrations of HDL cholesterol, higher erythrocyte counts and hemoglobin concentrations, and higher fasting blood-glucose concentrations than do nonsmokers. In the direction of decreasing risk, smokers are leaner and have lower blood pressures than nonsmokers. Observed effects which also may augment atherosclerosis in smokers as compared to nonsmokers include leucocytosis and increased hepatic mixed function oxygenase activity. This review of available evidence indicates that cigarette smoking probably contributes to atherosclerotic disease by a variety of mechanisms.     

Polycyclic aromatic hydrocarbons in mineral oil,tar, and pitch,excluding petroleum pitch

Polycyclic aromatic hydrocarbons (PAH) occur naturally in coal and petroleum and, in smaller amounts, in some fossilized woods, peat and lignite. Pitch, tar, and soot also contain PAH, and may induce skin tumours in those exposed to them in the course of their occupations. Soot was the first substance to be indicted as an occupational carcinogen, but is relatively unimportant nowadays compared with pitch and tar and mineral oil. Exposure to mineral oil has been shown to be the cause of most cases of scrotal cancer in the Birmingham (U.K.) region. In addition, there is a statistically significant excess of second primary tumours of the bronchus in men with a first primary tumour of the scrotum which appears to be related to their exposure to mineral oil. Benzo(a)pyrene is the most important carcinogen in soot; the carcinogenicity of crude oils seems to reside in the additive effects of a number of weak carcinogens, 4 or 5-ringed PAH. New products may be generated by cracking. The carcinogenicity of mineral oils can be modified by solvent extraction and industrialists are recommended to use oils so treated in order to reduce the risk to their employees.     

Bioaccumulation of lead and cadmium in the Louisiana heron (Hydranassa tricolor) and the cattle egret (Bubulcus ibis)

Lead and cadmium concentrations in the tissues and stomach contents of several age classes of Louisiana herons (Hydranassa tricolor) and cattle egrets (Bubulcus ibis) from the Galveston Bay region of Texas were measured, and levels of exposure and the rates of accumulation by these species were compared. Statistical analyses showed no differences in the rates and patterns of accumulation of these metals between these species; however, tissue and age class were both significant variables. Lead concentrations were highest in the bone of adult birds, while cadmium was highest in the adult kidney. Although these birds feed in different habitats, analyses of metal content in their food items showed similar rates of exposure. We note an important distinction between biomagnification and ontogenetic accumulation in studies which seek to estimate the importance of trophic position on risk of exposure to heavy metals.