Hispanic and black US children's paths to high adolescent obesity prevalence.

OBJECTIVE: The study aims to identify the ages contributing most to the development of higher obesity prevalence in the 8th grade (approximately age 14) among Hispanic and black children than among non-Hispanic white children in the United States. METHODS: Using the nationally representative Early Childhood Longitudinal Study (ECLS-K), a sample of 17,420 children in kindergarten in 1999, followed in 1st, 3rd, 5th and 8th grades through 2007, was analysed. First, 'normal', 'overweight' and 'obese' weight-status categories in each grade were assigned from US Centers for Disease Control body mass index percentiles. Second, probabilities of being in each of the three weight-status categories in kindergarten and of transitioning between categories after kindergarten were estimated by logistic regression. These probabilities were then used as parameters of a weight-status trajectory simulation model from which a decomposition analysis was performed. RESULTS: Obesity prevalence in the 8th grade was equally high among Hispanic (25.0%, 95% confidence interval [CI]: 22.3, 27.8%) and black children (25.1%; 95% CI: 20.9, 29.6%) compared to white children (17.4%; 95% CI: 15.9, 19.0%). As much as 73% of the Hispanic-white 8th grade obesity disparity was generated by 3rd grade and 44% by kindergarten. In contrast, only 15% of the black-white obesity 8th grade disparity was generated by kindergarten, whereas 75% was generated between the 3rd and 8th grades and 53% between the 5th and 8th grades. CONCLUSIONS: Although adolescent obesity is equally prevalent among Hispanic and black children, obesity emerges and is sustained earlier in Hispanic children. Diagnosis and prevention strategies should be designed accordingly.

Metabolic control of recombinant protein N-glycan processing in NS0 and CHO cells.

Chinese hamster ovary and murine myeloma NS0 cells are currently favored host cell types for the production of therapeutic recombinant proteins. In this study, we compared N-glycan processing in GS-NS0 and GS-CHO cells producing the same model recombinant glycoprotein, tissue inhibitor of metalloproteinases 1. By manipulation of intracellular nucleotide-sugar content, we examined the feasibility of implementing metabolic control strategies aimed at reducing the occurrence of murine-specific glycan motifs on NS0-derived recombinant proteins, such as Galalpha1,3Galbeta1,4GlcNAc. Although both CHO and NS0-derived oligosaccharides were predominantly of the standard complex type with variable sialylation, 30% of N-glycan antennae associated with NS0-derived TIMP-1 terminated in alpha1,3-linked galactose residues. Furthermore, NS0 cells conferred a greater proportion of terminal N-glycolylneuraminic (sialic) acid residues as compared with the N-acetylneuraminic acid variant. Inclusion of the nucleotide-sugar precursors, glucosamine (10 mM, plus 2 mM uridine) and N-acetylmannosamine (20 mM), in culture media were shown to significantly increase the intracellular pools of UDP-N-acetylhexosamine and CMP-sialic acid, respectively, in both NS0 and CHO cells. The elevated UDP-N-acetylhexosamine content induced by the glucosamine/uridine treatment was associated with an increase in the antennarity of N-glycans associated with TIMP-1 produced in CHO cells but not N-glycans associated with TIMP-1 from NS0 cells. In addition, elevated UDP-N-acetylhexosamine content was associated with a slight decrease in sialylation in both cell lines. The elevated CMP-sialic acid content induced by N-acetylmannosamine had no effect on the overall level of sialylation of TIMP-1 produced by both CHO and NS0 cells, although the ratio of N-glycolylneuraminic acid:N-acetylneuraminic acid associated with NS0-derived TIMP-1 changed from 1:1 to 1:2. These data suggest that manipulation of nucleotide-sugar metabolism can promote changes in N-glycan processing that are either conserved between NS0 and CHO cells or specific to either NS0 cells or CHO cells.

Factors associated with noncompliance with psychiatric outpatient visits.

Adherence to recommended services is essential for long-term effectiveness of ambulatory treatment programs, but factors associated with such adherence are not securely established. We evaluated attendance at 896 scheduled psychiatric clinic visits for 62 patients at a major psychiatric teaching hospital. Visit adherence was found to be significantly higher among patients in an acute stage of illness, those with a personality disorder, those with a post-high-school education, and those living alone. Adherence was also higher when visits were routinely scheduled, when the intervisit interval was shorter, and when the visit entailed psychotherapy rather than pharmacotherapy.

Combining registration-system and survey data to estimate birth probabilities.

With the widespread availability of event-history data, demographers have increasingly eschewed registration-system data in favor of survey data. We propose instead using survey and registration-system data in combination, via a constrained maximum-likelihood framework for demographic hazard modeling. As an application, we combine panel survey data and birth registration data to estimate annual birth probabilities by parity. The general fertility rate obtained from registration-system data constrains the weighted sum of parity-specific birth probabilities. The variances about the parity-specific birth probabilities are halved when registration-system data are used to constrain the estimates. Other demographic applications are discussed.

Psychosocial treatments in schizophrenia: a review of the past 20 years.

Pharmacotherapy can improve some of the symptoms of schizophrenia but has limited effect on the social impairments that characterize the disorder and limit functioning and quality of life. Through computerized literature searches and bibliographies of published reports we identified peer reviewed studies of group, family, and individual therapy with schizophrenia and schizoaffective disorder patients. We identified 70 studies: 26 on group therapy, 18 on family therapy, and 11 on individual therapy. Additionally, treatment models were compared in 4 studies and combined in 11 others. Controls were included in 61 and all studies included medication. Benefits in symptoms as well as social and vocational functioning were associated with psychosocial treatments. Family therapy demonstrated the most promising findings and traditional social skills treatment yielded the least robust results. Adjunctive psychosocial treatments augment the benefits of pharmacotherapy and enhance functioning in psychotic disorders. Although these positive results have led to increased enthusiasm about psychosocial treatments for schizophrenia, questions remain about comparative benefits of specific treatment methods and additional benefits of multiple treatments.

Entry or exit? A transition-probability approach to explaining the high prevalence of single motherhood among black women.

I analyze the prevalence of single motherhood among black and non-Hispanic white women in terms of differences in entry and exit. Higher initial entry rates among black women, especially through unpartnered childbearing, account for slightly more than half the difference between blacks and whites in the prevalence of single motherhood. The remainder of the difference is due to black single mothers' much lower rates of exit through union formation and to their very high rates of reentry through dissolution of these later unions. Entry and exit rates through the 1990s imply a widening racial gap.

Incomplete reporting of men's fertility in the United States and Britain: a research note.

We evaluate men's retrospective fertility histories from the British Household Panel Survey and the U.S. Panel Study of Income Dynamics (PSID). Further, we analyze the PSID men's panel-updated fertility histories for their possible superiority over retrospective collection. One third to one half of men's nonmarital births and births within previous marriages are missed in estimates from retrospective histories. Differential survey underrepresentation of previously married men compared with previously married women accounts for a substantial proportion of the deficits in previous-marriage fertility. More recent retrospective histories and panel-updated fertility histories improve reporting completeness, primarily by reducing the proportion of marital births from unions that are no longer intact at the survey date.

Monitoring recombinant human interferon-gamma N-glycosylation during perfused fluidized-bed and stirred-tank batch culture of CHO cells.

Chinese hamster ovary cells producing recombinant human interferon-gamma were cultivated for 500 h attached to macroporous microcarriers in a perfused, fluidized-bed bioreactor, reaching a maximum cell density in excess of 3 x 10(7) cells (mL microcarrier)-1 at a specific growth rate (mu) of 0.010 h-1. During establishment of the culture, the N-glycosylation of secreted recombinant IFN-gamma was monitored by capillary electrophoresis of intact IFN-gamma proteins and by HPLC analysis of released N-glycans. Rapid analysis of IFN-gamma by micellar electrokinetic capillary chromatography resolved the three glycosylation site occupancy variants of recombinant IFN-gamma (two Asn sites occupied, one Asn site occupied and nonglycosylated) in under 10 min per sample; the relative proportions of these variants remained constant during culture. Analysis of IFN-gamma by capillary isoelectric focusing resolved at least 11 differently sialylated glycoforms over a pI range of 3.4 to 6.4, enabling rapid quantitation of this important source of microheterogeneity. During perfusion culture the relative proportion of acidic IFN-gamma proteins increased after 210 h of culture, indicative of an increase in N-glycan sialylation. This was confirmed by cation-exchange HPLC analysis of released, fluorophore-labeled N-glycans, which showed an increase in the proportion of tri- and tetrasialylated N-glycans associated with IFN-gamma during culture, with a concomitant decrease in the proportion of monosialylated and neutral N-glycans. Comparative analyses of IFN-gamma produced by CHO cells in stirred-tank culture showed that N-glycan sialylation was stable until late in culture, when a decline in sialylation coincided with the onset of cell death and lysis. This study demonstrates that different modes of capillary electrophoresis can be employed to rapidly and quantitatively monitor the main sources of glycoprotein variation, and that the culture system and operation may influence the glycosylation of a recombinant glycoprotein.

Aggregating poor and near-poor elderly under different resource definitions.

The large number of near-poor relative to poor elderly persons in the United States may be recharacterized as a high-prevalence, low-intensity type of poverty. The present study investigates how this characterization is affected by accounting for assets and non-cash transfers in addition to cash income in resources available for current-year consumption. The Foster, Greer, Thorbecke (FGT) poverty index is used to separately and jointly analyze prevalence and intensity of poverty. Estimation is from 1984 Survey of Income and Program Participation data. Adding the annuity value of assets removes many elderly persons from the ranks of the poor and near-poor, while adding non-cash transfers moves many elderly persons from poverty into near-poverty. Their combined effect reinforces a high-prevalence, low-intensity characterization of poverty. Large total poverty reduction effects are missed by income-only resource definition, and large poverty-intensity reduction effects are missed by prevalence-only aggregation.

Elderly poverty alleviation through living with family.

"We estimate here the extent of United States elderly poverty alleviation through living with family. These estimates are motivated by public-policy concern about the well-being of the elderly, and by the relevance of the process for fertility under the old-age-security hypothesis. An inter-temporal poverty-measurement model is estimated with 1984 Survey of Income and Program Participation income and wealth data. Without extended-family co-residence, and assuming no bequests, poverty rates would increase 42% over observed rates. Female elderly account for almost all the alleviated poverty. As a population, their impoverishment with age is effectively prevented by co-residence. Proportionately more black than white elderly are beneficiaries of poverty alleviation through living with family, but white elderly are more likely to be beneficiaries if at risk."

Cohort trends in the lifetime distribution of female family headship in the United States, 1968-1985.

We use the PSID Relationship File to estimate cohort trends in the lifetime incidence and duration of female family headship. Hazard (event-history) techniques are used to estimate movements into and out of headship, accounting for duration dependence and left-censored spells. The mean number of years spent in headship between ages 14 and 59 rose dramatically over the period. The increase arose from an increased number of headship spells, including an increase in the number of women ever experiencing headship, but not all from an increase in durations of headship spells; those decreased slightly.

Prioritising waiting lists.

The 'top 22' patient conditions on the general surgical waiting list at Guy's Hospital were rated independently by five general surgeons. Each surgeon estimated the peri-operative mortality rates associated with each treatment; the proportion of patients who failed to benefit; the effect of successful treatment on life expectancy and on the patients' quality of life. the mean values were used to estimate the expected net benefits (in terms of quality-adjusted life-years) from treatment one year earlier than might otherwise have been the case. These benefits were then related to the operating times and length of stay associated with each treatment; this identified which treatments offered the greatest benefit per unit of each constrained resource. Of all conditions examined anal fissures where shown to be the least resource intensive in relation to the benefits generated, whilst varicose veins and epigastric hernias proved otherwise. For the full potential of this approach to be realised it needs to be repeated in other places and in other specialties. It nevertheless offers a more rational basis for interpreting waiting list data than presently exists and by using the short-cut methods is a relatively cheap way of generating much useful data.

Ischemic jejunal stenosis and blind loop syndrome after blunt abdominal trauma.

One month after suffering blunt abdominal trauma a patient developed severe steatorrhea and profound weight loss in association with an ischemic distal jejunal stricture and blind loop syndrome. Evidence for a partial mesenteric tear was found at resection of the stricture, which resulted in complete cure.

Colonoscopy: a survey of its value in a teaching hospital surgical unit.

A survey has been undertaken of the diagnostic, therapeutic and economic value of colonoscopy in a teaching hospital surgical unit. Provided it is undertaken in conjunction with a good clinical history and double contrast barium enema, colonoscopy provides a high yield of information bearing upon the patient's subsequent management. Therapeutic polypectomy was undertaken in 21% of examinations. Its value in acute colonic disease is discussed, and the importance of training colonoscopists for the future is emphasized.

Controversy: pomr-the case in favour.

The subject of medical records is not popular with clinicians these days. Having to see patients in the clinic without their notes is too common an experience, and one which raises the blood pressure of both doctor and patient. Paradoxically though, it does force us reluctantly to concede that these maligned documents do have a purpose. It might even persuade us that it is illogical to attach so much importance to them when they are missing, and to treat them with such indifference when they are not.

The effect of problem-oriented medical records on clinical management controlled for patient risks.

This study examines the change in clinical management by 28 medical and surgical firms in three London teaching hospitals following the introduction of Problem-Oriented Medical Records (POMR) in one of the hospitals. Comparison is made between firms using and not using POMR. The data are analyzed using a regression model. Analysis is based on the coefficient of change in each firm between the two study years when modified by the physiological and demographic patient variables significantly associated with the management of each disease. Although not conclusive, the results in four of the seven diseases studied encourage the speculation that POMR may have improved the thoroughness of patient management. The significant patient variables in each diagnosis suggest that patient risk on admission can affect management scores. Were this to be found elsewhere, the influences of patient mix might be considered in using explicit criteria to make comparisons between hospitals that serve different kinds of populations.