Body image treatment for a community sample of obligatory and nonobligatory exercisers.

OBJECTIVE: Cognitive-behavioral therapy (CBT) was used to treat body dissatisfaction in obligatory and nonobligatory exercisers within a community sample of normal weight women. METHOD: Ninety-four women (36% obligatory exercisers, 64% nonobligatory exercisers) were assigned randomly to CBT or the waiting-list (WL) control group. RESULTS: The hypotheses that obligatory exercisers would show poorer pretreatment body image and greater compulsiveness than nonobligatory exercisers were supported partially. The prediction that obligatory exercisers would respond less favorably to treatment was not supported. Overall, CBT participants evidenced significantly better body image outcomes than the WL at posttreatment, but many effects were lost by the follow-up. DISCUSSION: Treatment response is considered in light of the unique characteristics of this ethnically diverse, older community sample when compared with the young students in earlier body image intervention studies. The high rate of physical activity among even the nonobligatory exercisers is highlighted for its mood-regulation properties and its treatment implications.

Testing the HMO competitive strategy: an analysis of its impact on medical resources.

Competitive approaches to health care reform, including managed competition, are hypothesized to reduce health care expenditures and the resources devoted to medical care. Empirical evidence has been limited. The short- and long-run effects of an experiment closely resembling managed competition are analyzed. We examine effects on hospitals, technology diffusion, physicians, and health insurance premiums. The strategy reduces capital in hospitals, has minor effects on physicians and technology, and has only initial effects on average premiums.

Insulin-like growth factor-I regulates transcription of the elastin gene.

Neonatal rat aortic smooth muscle cell cultures were used to investigate the mechanisms by which insulin-like growth factor-I (IGF-I) up-regulates aortic elastogenesis. The addition of IGF-I (50 ng/ml) to quiescent smooth muscle cell cultures resulted in a 5-fold increase in the steady-state levels of tropoelastin mRNA beginning between 2 and 4 h and reaching maximal levels at 8 h. Addition of cycloheximide blocked the effect of IGF-I. Nuclear run-on transcription analyses of nuclei isolated from IGF-I-treated cells showed increased synthesis of new tropoelastin transcripts indicating that transcriptional activation is a major component of IGF-I up-regulation. Transient transfections with deletion constructs containing different portions of the elastin 5'-upstream region localized the IGF-I-responsive area to sequences between -195 and -136 base pairs and further showed that this region contains a negative element. Gel retardation assays using nuclear proteins extracted from control and IGF-I-treated cells demonstrated that IGF-I treatment results in the loss of binding complexes. Footprint analyses of specific binding complexes affected by IGF-I show the deprotection of two closely positioned sequences spanning positions -165 to -137 base pairs. These results suggest that IGF-I up-regulation of elastogenesis involves the abrogation of a negative element functionality.

Medicaid, welfare dependency, and work: is there a causal link?

Medicaid exerts a strong "pull" on potential welfare recipients, increasing the probability that a number of single mothers will apply for and stay on welfare in order to be covered by Medicaid. However, the availability of private health insurance coverage exerts a strong positive influence on women's decisions to work and a strong negative effect on welfare participation rates. If private insurance coverage were as comprehensive as Medicaid and readily available at all jobs, its impact on promoting work would be substantially greater than is the impact of Medicaid in promoting the use of welfare.

Long-term maintenance following attainment of goal weight: a preliminary investigation.

The present study sought to determine whether the high relapse rates observed among subjects in fixed length behavioral-based weight loss programs would be lowered if subjects were allowed to continue in treatment until they had reached their desired weights. Five hundred seventeen (517) clients at a commercial weight-loss program were surveyed approximately 1 year posttreatment regarding their current weight status. Of the 267 subjects who responded to the mailed survey, it was found that 82% remained within 10% of their posttreatment weights at the time of the follow-up. Of particular interest was the fact that weight trends during the intervening year suggested subjects were actively and effectively calibrating their weight. It was concluded that the high relapse rates typical for this mode of treatment may be an artifact of premature treatment cessation and further investigation is indeed merited.

Alterations of tropoelastin biosynthesis by elastase damage to smooth muscle cell matrices.

The effect of porcine pancreatic elastase (PPE)-induced proteolysis of the extracellular matrix on elastin biosynthesis in neonatal rat aortic smooth muscle cell cultures (NRSMC) was examined. The quantity of insoluble elastin remaining in the damaged cultures decreased with increasing amounts of enzyme used, however no significant cell damage was demonstrated. The accumulation of soluble elastin (tropoelastin) was examined in enzyme injured and control cultures by radiolabelling with [3H]-valine for 4 hours. The tropoelastin content of both the cell layer and media were less in injured cultures on the day of injury and up to one week later when compared to control cultures. In addition, experiments in which cultures were radiolabelled for 15 minutes demonstrated that the biosynthesis of tropoelastin was decreased in the enzyme treated cultures. Moreover, the incorporation of radiolabelled elastin into the insoluble matrix also decreased. Steady-state levels of elastin mRNA showed no differences between injured and control cultures, which suggested that elastin synthesis is affected at a translational or post-translational level.

Physician responses to fee-for-service and capitation payment.

The ability to achieve reductions in health care costs is determined in part by physician payment mechanisms. This study observes the response to a change in the reimbursement mechanism by a group of physicians who participated in a fee-for-service plan and then formed an IPA using capitation payment for primary care physicians and a reduced fee schedule for specialists. Patient benefits were similar under the two plans. Analyses of data for a group of continuous enrollees show that the change in the physician payment mechanism was associated with a reduction in hospitalizations but increases in length of hospital stay and number of ambulatory visits. These increases may have occurred because capitation for primary care physicians and a reduced fee schedule for specialists led to a greater number of referrals with no incentive in place for reductions in length of stay for specialty admissions.

The synthesis economic fertility model: a latent variable investigation of some critical attributes.

"This study uses Nicaraguan data to estimate a latent variable system of reduced-form demands for births, infant mortality, contraception, nutrition and breastfeeding. The estimates support some of the synthesis extensions to the standard fertility model, such as the concurrent increase of contraception, health, nutrition and fertility and decline in breastfeeding with income increases from initial low levels.... The initial stages of development may experience an increase in family size despite an increase in contraceptive use...as well as a profertility impact of reduced breastfeeding." Data are from a survey of women aged 15-45 that was conducted in Nicaragua from 1977 to 1978.

Trends in the prevalence of work disability from 1962 to 1984, and their correlates.

Self-reported disability has increased in recent decades among working-age persons, while age-specified mortality rates conversely have fallen. Current Population Survey data permit defining a statistical measure of disability based on the presence of work limitations and/or receipt of disability transfers tied to health-constrained employment. The proportions of people meeting the definition graphically trace a hump-shaped pattern, rising from the 1960s to peaks in the mid to late 1970s, at which time downturns occur. Changes in impairment/pathology alone are unlikely to account for the observed pattern; more plausibly, the changes are due to individuals' propensity to report health problems as the reason for constrained work or to receive disability transfers.

Elastin mRNA levels and insoluble elastin accumulation in neonatal rat smooth muscle cell cultures.

Insoluble elastin accumulation, elastin mRNA translational efficiencies, and elastin mRNA levels were evaluated in cultures of neonatal rat aortic smooth muscle cells grown for several days in consecutive passages. When the products of in vitro translation were immunoprecipitated with an anti-alpha-elastin antibody, a single 79,000-Da protein was obtained. Northern blot analysis also indicated an elastin mRNA species corresponding to approximately 4.2 kilobases. Insoluble elastin accumulation increased in cells cultured for 7-21 days in first through fourth passages, while with one exception, relative levels and translational activity of elastin mRNA decreased with time in culture. The data indicated that a simple relationship between elastin accumulation and elastin mRNA levels was not evident.

Diagnosis related groups (DRGs): efficiency and/or quality producing? Some evidence from surgical patients.

Hospital charges and length of stay for inguinal hernia and acute appendicitis patients were examined in a university hospital to determine the degree of variation with DRGs. Evidence presented here suggests that DRGs may lead to a reduction in medical care costs without a reduction in patient outcomes. Mode/year DRGs to take account of source of admission and maintaining outliers payments may be desirable to avoid patient selectivity and incentives for lowering quality of care of the most severely ill patients.

Women's schooling and children's health. Are the effects robust with adult sibling control for the women's childhood background?

Women's schooling is thought to have an important positive impact on children's health and nutrition in developing countries. A special adult sister sample from Nicaragua is used to explore this relation. Standard individual reduced-form estimates suggest a strong positive impact. With control for the unobserved common childhood family background characteristics shared by the sisters, the impact of women's schooling on nutrition is quite robust, but on the health outcomes declines substantially or evaporates. Thus, contrary to the standard estimates, mother's schooling does not appear to improve substantially their children's health outcomes, though it does seem to increase their nutrient intakes.

Elastase effect on the extracellular matrix of rat aortic smooth muscle cells in culture.

The effect of elastase on the extracellular matrix of neonatal rat aortic smooth muscle cell cultures was monitored both chemically and ultrastructurally. Porcine pancreatic elastase was shown to decrease the elastin content in these cultures. Although chemically no distinction could be made between the elastin remaining in the culture matrix after elastase when compared to that in the nontreated cultures, the elastin was dramatically altered morphologically. The elastin assumed a "mottled" appearance after elastase treatment similar to that seen in vivo in emphysema models. A highly sensitive immunogold staining technique was used to detect elastin at the earliest stages of accumulation. Pulse experiments demonstrated an increase in protein synthesis by the cells 20 hr after elastase exposure. The culture system described here provides a model for probing in vivo elastase effects on elastin-containing tissues.

Health status and medical expenditures: is there a link?

Until now, cross-national studies have not demonstrated a positive relationship between health care expenditures and improved health status, as measured by such indicators as age-adjusted mortality rates. It has therefore been argued that cutting expenditures will not have a negative effect upon health status. Using health and life-style data from the OECD for Germany, the United Kingdom, The Netherlands, France, Sweden and the United States, this study finds that when one holds constant those changes in life style that have an impact upon health (e.g. smoking, drinking, traffic accidents, dangers on the job) and adjusts for inflation and population size, health care expenditures do bear a positive relationship to health status. This suggests that reductions in health care expenditures may well have some cost in terms of overall health.

Aging effects on the elastin composition in the extracellular matrix of cultured rat aortic smooth muscle cells.

Elastin accumulation in the extracellular matrix of cultured rat aortic smooth muscle cells was monitored as a function of age. The effect of the animal donor age and time in culture in single or consecutive passages on the cells' ability to accumulate total protein as well as elastin was evaluated. Smooth muscle cells were obtained from animals ranging in age from 2 d to 36 mo. Protein accumulation by the cells based on DNA content was similar regardless of which of the above aging parameters was examined. Although there were significant amounts of elastin present in the extracellular matrix of those cells originating from the younger animals (2 d and 6 wk old), little or none was detected in cell cultures derived from the oldest animals. A soluble elastin-like fraction which was isolated from the cultures of the 2-d-old rats seemed to be lacking in the cultures of cells from the 36-mo-old animals. This observation may, in part, explain the absence of insoluble elastin in the matrix of some cultures obtained from older animals. The data strongly suggest that the age of the donor animal from which the cells originate has the greatest influence on in vitro elastin accumulation.

The influence of health on school outcomes. A multivariate approach.

This study investigates the relationship between chronic poor health and school outcomes among children. A simultaneous three-stage least squares model is estimated in which achievement and attendance are endogenous variables. The hypothesis that particular health characteristics are associated with differences in individual school outcomes is confirmed. For example, attendance is affected most by illnesses likely to interfere with school or peer interactions or difficulty doing only strenuous activity. Achievement is lowered by moderate to severe psychologic problems. Including attendance as an endogenous variable increases its significance. Other socioeconomic and school variables, such as mother working, marital status and special schooling, are included in the model. Policy implications are suggested.

The economics of surgical signatures.

Identification and analysis of practice patterns for a group of surgeons within the same institution show a significant variation in total hospital charges, length of stay, and ancillary charges for simple uncomplicated hernia repairs and appendectomies. When presented to surgeons, these data can be of immense value in terms of altering practice patterns in order to deliver cost-effective, high-quality health care.