The effect of biliary enteroenterostomy on the pharmacokinetics of enterally administered cyclosporine in rats.

A major factor in poor bioavailability of cyclosporine in children undergoing orthotopic liver transplantation appears to be poor absorption of the drug. Our hypothesis is that the Roux-en-Y choledochojejunostomy used for biliary drainage in these children causes cyclosporine malabsorption by reducing the length of bowel available for absorption and by distally displacing the entry of bile into the intestine. In these experiments, we determined the effect of biliary enteroenterostomy on the pharmacokinetics of enterally administered cyclosporine in Sprague-Dawley rats. Experimental rats (n = 24) were prepared for study by constructing self-emptying jejunal blind loops. Sham rats (n = 9) had jejunal transection and reanastomosis. Control rats (n = 26) had no operation. Two to 4 weeks later, chronic biliary-enteric fistulae were formed in all animals. In experiments, [3H]cyclosporine was delivered into the duodenum while the site of bile delivery varied. Hourly and cumulative [3H]cyclosporine excretion into bile was quantitated, which our preliminary data show to be a valid estimate of absorption. In control rats, bile was delivered into the duodenum or was replaced with saline and sucrose solution. In experimental rats, bile was infused either into the duodenum, which tested bowel shortening only, or into the proximal end of the blind loop, which tested the combined effects of bowel shortening and distal displacement of bile entry. In sham rats, bile was infused into the duodenum, which controlled for previous abdominal surgery, or into the midjejunum, which tested for distal bile entry only. Two effects of biliary enteroenterostomy on cyclosporine absorption were observed.(ABSTRACT TRUNCATED AT 250 WORDS)

The research program and priorities of the Robert Wood Johnson Foundation.

Since its establishment as a national philanthropy in 1972, The Robert Wood Johnson Foundation has appropriated almost $560 million in grants directed toward improvement of health in the United States. Grants are made primarily to develop innovative methods of providing health services, for research and evaluation, and for education and training of health professionals. Since 1972, more than $100 million has been appropriated for research and evaluation projects. The research supported by the Foundation is applied rather than basic, and, like all of the Foundation's programs, must be responsive to the institution's mission. In the 1980s, this mission comprises three objectives: improving access to health care for the most vulnerable underserved population groups, containing increases in health care costs, and improving functional outcomes for patients. In this article, we provide details on the Foundation's research program and priorities, including evolution of the mission, the role of research in the Foundation's overall programs, the purposes for which the Foundation supports research and evaluation activities, and the types of grants available for health services researchers.

Changes in primary medical care delivery, 1975-1979: findings from the physician capacity utilization surveys.

Data from two national telephone surveys of office-based primary care physicians are used to examine changes in patterns of care delivery between 1975 and 1979 in metropolitan and nonmetropolitan areas. Aspects of care delivery considered include physician availability, average physician workload, qualitative attributes of the care delivered, physicians' policies toward acceptance of new patients and fees. Physician availability relative to population increased in metropolitan areas but was unchanged in nonmetropolitan areas. The average number of office visits provided per week declined for physicians in all areas, offsetting to some extent the increase in physician availability; average weekly office visit rates declined most in nonmetropolitan areas. Most of the indicators of the qualitative attributes of care examined suggest that access to primary care physicians increased in both metropolitan and nonmetropolitan areas, though not substantially. Fees increased in real terms in all areas. Relatively fewer physicians were refusing to accept new patients in 1979 than in 1975. The possibility that specialists are providing more primary care in nonmetropolitan areas is considered as a possible explanation for the improvement in qualitative attributes of care delivered by primary care physicians in nonmetropolitan areas despite the decline in per capita office visits provided by primary care physicians in those areas.

An evaluation of criteria to designate urban health manpower shortage areas.

In the United States, federally designated health manpower shortage areas (HMSAs) have been eligible for a variety of programs intended to improve access to health services. Before 1978, HMSAs were predominantly rural. The Health Professions Educational Assistance Act of 1976 (P.L. 94-484) mandated that the criteria for designating HMSAs be revised to facilitate designation of urban areas. The most recent version of the HMSA criteria was published in 1980. This study applied the 1980 criteria to two Canadian urban areas. In general, the criteria did not succeed in distinguishing areas with relatively poorer access from those with relatively better access.

[Phenylhydrargyrum boricum in glycerin (Glycero-Merfen) in young children: undesirable mercury resorption in mouth mucosa even when free of lesions]. / Phenylmercuriborat in Glycerin (Glycero-Merfen) im Kleinkindesalter: unerwünschte Quecksilberresorption auch bei intakter Mundschleimhaut.

The formulation of phenylhydrargyrum boricum in glycerine (Glycero-Merfen) being frequently used in infants and young children, attention is drawn to the potentially symptomatic mercury absorption associated with its topical administration in that age group. This finding applies to both inflamed and normal oral mucosa. The use of this drug formulation in pediatric patients should be avoided.

Impact of income maintenance on low birth weight: evidence from the Gary Experiment.

Birth weight is a useful index of infant health. Low birth weight (5.5 pounds or less) is associated with high rates of infant mortality and morbidity. Low birth weight is also associated with low socioeconomic status. The question arises, therefore, whether income transfers can affect the incidence of low birth weight among the poor. The impact of an expanded income support plan on low birth weight was analyzed using data on 404 infants born to participants in the Gary Income Maintenance Experiment. A significant health response was observed for children of women who face high-risk pregnancies.

Factors affecting the incomes of men and women physicians: an exploratory analysis.

Income differences between men and women physicians are analyzed using data from the Americal Medical Association's 1973 Eighth Periodic Survey of Physicians. While women tend to possess less favorable professional characteristics in terms of income-earning potential, the returns to many characteristics associated with higher incomes are greater for women than for men. Additional evidence on differences in weekly hours worked is presented in an effort to explain the lower incomes of women doctors.

Malpractice and employment of allied health personnel.

Increased costs of malpractice insurance and physician fear of involvement in malpractice suits have been suggested as inhibiting greater employment and utilization of allied health personnel in physicians' offices, since physicians are liable for acts of negligence by their employees. However, data obtained from a survey conducted by the American Medical Association in 1971 suggest that malpractice insurance expenses vary within only a relatively narrow range with the number of allied health personnel employed by physicians. Thus, malpractice insurance expense per se is probably not a significant factor in influencing physicians' decisions to hire aides. On the other hand, nonpecuniary aspects of the malpractice situation may still be an important deterrent to greater employment of allied health personnel.