Search

Background/Aims: Analysis of gene expression is dependent on normalization using housekeeping genes. However, many of these housekeeping genes (e.g. GAPDH, ß-actin) are upregulated in chronic pancreatitis and pancreatic cancer, and cannot be used for normalization. For this reason we tried to identify a housekeeping gene useful for expression analysis in pancreatic diseases. Methods: RNA isolated from various tissues and states of disease was subjected to reverse transcription and subsequently amplified by PCR using primers for GAPDH and for the ribosomal highly basic 23-kDa (rb 23kDa, RPL13A) protein. Results: As anticipated, expression of GAPDH varied markedly in the different tissues, whereas the expression of rb 23-kDa was constant in all samples investigated. Conclusion: We recommend the use of the ribosomal highly basic 23-kDa protein as a standard for normalization at least for the pancreas and the prostate.

Recent studies have identified a novel polymorphism (C825T) of the gene encoding the beta(3) subunit of heterotrimeric G proteins (G:beta(3)) which is associated with enhanced activation of G-proteins and appears to be more common in hypertensive patients and possibly contributes to decreased kidney allograft survival.

Measurements ofR, sphericity and thrust are presented for c.m. energies between 12 and 31.6 GeV. A possible contribution of at continuum can be ruled out for c.m. energies between 16 and 31 GeV.

This paper summarizes the measurements one+e- annihilation performed by the DASP Collaboration in the energy range between 3.1 and 5.2 GeV. The following topics are covered: total cross section, production and two body decays of the narrow resonances, radiative decays of theJ/? and ?' resonances and evidence for theX(2.82), ?' cascade decays, inclusive ? production and evidence for theF meson, semileptonic decays of charmed mesons and properties of the heavy lepton.

Recent studies have suggested an association between a deletion (D) variant of the angiotensin-converting-enzyme (ACE) gene and diabetic nephropathy. However, this finding has not been confirmed by all investigators. Furthermore, an M235T variant of the angiotensinogen (AGT) gene has been associated with hypertension, an important risk factor for the development and progression of diabetic nephropathy. The objective of our study was therefore to examine the relationship between these genetic variants of the renin-angiotensin system and diabetic nephropathy and hypertension, respectively, in a large (n = 661) group of Caucasian patients with insulin-dependent (n = 360) or non-insulin-dependent (n = 301) diabetes mellitus. The study had a power of 0.8 to detect a doubling of risk of nephropathy or hypertension in patients with the ACE-DD or AGT-235TT genotype, respectively. Allelic frequencies of the ACE-D and AGT-235T alleles were similar between patients with and without nephropathy in either type of diabetes, and accordingly, there was no significant association between diabetic nephropathy and the ACE or AGT genotype. Likewise, there was no significant association between the ACE or AGT genotype and hypertension. Thus, our data, in this large and ethnically homogeneous group of patients, do not support the hypothesis that these genetic variants of the renin-angiotensin system are strongly associated with either nephropathy or hypertension in patients with insulin-dependent or non-insulin-dependent diabetes mellitus. These genetic markers are therefore unlikely to serve as clinically useful predictors of either nephropathy or hypertension in Caucasian patients with diabetes. [Diabetologia (1997) 40: 193–199]Recent studies have suggested an association between a deletion (D) variant of the angiotensin-converting-enzyme (ACE) gene and diabetic nephropathy. However, this finding has not been confirmed by all investigators. Furthermore, an M235T variant of the angiotensinogen (AGT) gene has been associated with hypertension, an important risk factor for the development and progression of diabetic nephropathy. The objective of our study was therefore to examine the relationship between these genetic variants of the renin-angiotensin system and diabetic nephropathy and hypertension, respectively, in a large (n = 661) group of Caucasian patients with insulin-dependent (n = 360) or non-insulin-dependent (n = 301) diabetes mellitus. The study had a power of 0.8 to detect a doubling of risk of nephropathy or hypertension in patients with the ACE-DD or AGT-235TT genotype, respectively. Allelic frequencies of the ACE-D and AGT-235T alleles were similar between patients with and without nephropathy in either type of diabetes, and accordingly, there was no significant association between diabetic nephropathy and the ACE or AGT genotype. Likewise, there was no significant association between the ACE or AGT genotype and hypertension. Thus, our data, in this large and ethnically homogeneous group of patients, do not support the hypothesis that these genetic variants of the renin-angiotensin system are strongly associated with either nephropathy or hypertension in patients with insulin-dependent or non-insulin-dependent diabetes mellitus. These genetic markers are therefore unlikely to serve as clinically useful predictors of either nephropathy or hypertension in Caucasian patients with diabetes. [Diabetologia (1997) 40: 193–199]

Summary Hyperphenylalaninaemia due to tetrahydrobiopterin deficiency is a group of rare and severe diseases. Prenatal diagnosis of dihydropteridine reductase and pyruvoyltetrahydropterin synthetase deficiencies can be achieved by enzyme assay in cultured fluid cells and/or fetal blood. In contrast, prenatal diagnosis of GTP cyclohydrolase deficiency can only rely on the measurement of pterin metabolites in the amniotic fluid.

The authors discuss two health care programs under Veterans Affairs (VA) Health Care System which are being used at the Minneapolis VA Medical Center, Minnesota. They mention that one is Community Living Center (CLC) which is an onsite 74-bed, three-unit service that provides several services including geriatric care and palliative care. Home-Based Primary Care (HBPC) program is another program which aims at delivering services at a patient's home to prevent hospitalization.

Discusses the results of a study on the use of functional magnetic resonance imaging in aberrant response inhibition and task switching in attention-deficit hyperactivity disorder (ADHD). Identification of adolescents with ADHD as the most responsive group in the study; Speculation of the authors on the relation of increased activation in the left temporal lobe with the use of verbal mediations strategy; Indication of deficits in response and task switching due to the reduced activation in the left temporal lobe.

Reports on the results of a double-blind, placebo-controlled trial of dexmethylphenidate hydrochloride and d,l-threo-methylphenidate hydrochloride (d,l-MPH) in children with attention-deficit hyperactivity disorder. Percentage of significant improvements in parent ratings in the group taking d-methylphenidate (d-MPH); Safety efficacy of the drug; Evidences supporting the longer duration of d-MPH than d,l-MPH.

Reports on the results of a study on the specificity in the familial aggregation of overt and covert conduct disorder (CD) symptoms in a referred attention-deficit hyperactivity disorder (ADHD) sample. Categorization of the symptoms of conduct disorder; Use of multivariate regression model for familial aggregation models; Prediction of the overt and covert CD scores of children with ADHD in their first-degree relatives.

Health care in the United States is a flawed system characterized by high costs, access disparities, and complicated policies (LiPuma & Robichaud, 2020). As the United States searches for answers [...], Nearly one in four Medicare beneficiaries have been diagnosed with mental health or substance use disorders, and research indicates this population responds well to mental health treatment. However, Medicare policy omits licensed mental health counselors (LMHCs) and licensed marriage and family therapists (LMFTs) as approved providers, exacerbating an existing national provider shortage. Emerging research demonstrates that the provider omission, referred to as the Medicare mental health coverage gap (MMHCG), profoundly impacts excluded providers and the communities they serve. This paper represents a synthesis of the most current scholarship on Medicare research, policy, and advocacy. In particular, we explore three ways the MMHCG impacts providers and beneficiaries alike: limiting provider choices, thwarting continuity of care, and creating challenging decisions for beneficiaries and providers. Our aim is to help mental health counselors better understand and navigate the MMHCG and aid in advocacy efforts for legislation to include LMHCs and LMFTs as approved Medicare providers.

1 | INTRODUCTION Achieving optimal access to primary care is an important factor in population health. (1) Access to care is defined as 'the potential ease of having virtual or [...], Objective: To develop a model for identifying clinic performance at fulfilling next-day and walk-in requests after adjusting for patient demographics and risk. Data Source: Using Department of Veterans Affairs (VA) administrative data from 160 VA primary care clinics from 2014 to 2017. Study Design: Using a retrospective cohort design, we applied Bayesian hierarchical regression models to predict provision of timely care, with clinic-level random intercept and slope while adjusting for patient demographics and risk status. Timely care was defined as the provision of an appointment within 48 hours of any patient requesting the clinic's next available appointment or walking in to receive care. Data Collection/Extraction Methods: We extracted 1 841 210 timely care requests from 613 263 patients. Principal Findings: Across 160 primary care clinics, requests for timely care were fulfilled 86 percent of the time (range 83 percent-88 percent). Our model of timely care fit the data well, with a Bayesian [R.sup.2] of.8. Over the four years of observation, we identified 25 clinics (16 percent) that were either struggling or excelling at providing timely care. Conclusion: Statistical models of timely care allow for identification of clinics in need of improvement after adjusting for patient demographics and risk status. VA primary care clinics fulfilled 86 percent of timely care requests. KEYWORDS access/demand/utilization of services, administrative data uses, primary care

Since September 11, the world in which American military children grow up has changed dramatically due to unprecedented levels of deployment and the increased reliance on Reserve and National Guard [...]

Uninsurance in the United States is most highly concentrated in young adults. In 2009, the year prior to the passage of the Affordable Care Act, 29.3 percent of adults aged [...], Objective. To examine the robustness of findings regarding state-level adult dependent coverage expansions using detailed outcomes that specify coverage source. Data Sources. This study uses the 2001-2009 files of the Current Population Survey's Annual Social and Economic Supplement, covering calendar years 2000-2008, and considers young adults ages 19 through 29. Study Design. Difference-in-differences methods were used to estimate the effect of state-level dependent coverage expansions on finely detailed categories of coverage, and falsification tests were used to evaluate the models themselves. Principal Findings. Certain published results on state-level parental coverage expansions are flawed, with reported increases driven by changes in spousal coverage. Other published results appear to be in fact driven by parental coverage, but they are not robust to alternative model adjustments. Conclusions. This study shows evidence that one study's results on 'dependent' coverage are in fact driven by changes in rates of spousal coverage. Results from a second study, though not robust to use of a more conventional DD model, would seem to apply most strongly to individuals at ages at which one would typically have lost parental coverage before reform, consistent with a 'passive' effect rather than an 'active' effect that enrolls previously uninsured youths. Key Words. Health care reform, health insurance regulation, health policy, health economics, dependent coverage

Racial/ethnic disparities in mental health care remain large (AHRQ 2009) and persistent (Blanco et al. 2007; Cook, McGuire, and Miranda 2007; Auk-Brutus 2012). Blacks and Latinos access mental health care [...], Objective. To investigate disparities in mental health care episodes, aligning our analyses with decisions to start or drop treatment, and choices made during treatment. Study Design. We analyzed whites, blacks, and Latinos with probable mental illness from Panels 9-13 of the Medical Expenditure Panel Survey, assessing disparities at the beginning, middle, and end of episodes of care (initiation, adequate care, having an episode with only psychotropic drug fills, intensity of care, the mixture of primary care provider (PCP) and specialist visits, use of acute psychiatric care, and termination). Findings. Compared with whites, blacks and Latinos had less initiation and adequacy of care. Black and Latino episodes were shorter and had fewer psychotropic drug fills. Black episodes had a greater proportion of specialist visits and Latino episodes had a greater proportion of PCP visits. Blacks were more likely to have an episode with acute psychiatric care. Conclusions. Disparities in adequate care were driven by initiation disparities, reinforcing the need for policies that improve access. Many episodes were characterized only by psychotropic drug fills, suggesting inadequate medication guidance. Blacks' higher rate of specialist use contradicts previous studies and deserves future investigation. Blacks' greater acute mental health care use raises concerns over monitoring of their treatment. Key Words. Racial/ethnic disparities in mental health care, episodes of care, longitudinal data, panel data, psychotropic drug use

OBJECTIVE--Insulin resistance plays a part in diabetic nephropathy (DN). The association between the peroxisome proliferator-activated receptor γ Pro to Ala alteration at codon 12 (Pro 12Ala) polymorphism and the risk [...]

EXECUTIVE SUMMARY Government-operated trauma facilities fill an important role as safety nets in our health system, providing care to millions of individuals who lack health insurance. Because these hospitals are [...]

Modeling tools played an important role in the debate over health care reform legislation--quantifying the likely effects of changes and specifying the extent to which effects will vary by the [...], Background. Computer models played an important role in the health care reform debate, and they will continue to be used during implementation. However, current models are limited by inputs, including available data. Aim. We review microsimulation and cell-based models. For each type of model, we discuss data requirements and other factors that may affect its scope. We also discuss how to improve models by changing data collection and data access procedures. Materials and Methods. We review the modeling literature, documentation on existing models, and data resources available to modelers. Results. Even with limitations, models can be a useful resource. However, limitations must be clearly communicated. Modeling approaches could be improved by enhancing existing longitudinal data, improving access to linked data, and developing data focused on health care providers. Discussion. Longitudinal datasets could be improved by standardizing questions across surveys or by fielding supplemental panels. Funding could be provided to identify causal parameters and to clarify ranges of effects reported in the literature. Finally, a forum for routine communication between modelers and policy makers could be established. Conclusion. Modeling can provide useful information for health care policy makers. Thus, investing in tools to improve modeling capabilities should be a high priority. Key Words. Modeling, microsimulation, health care policy

From a public health perspective, alcohol marketing matters. While there is tremendous diversity in the kinds of alcohol available throughout the world, from communally-produced traditional beverages to globalized mass consumer [...], Alcohol marketing is a global phenomenon, in which an increasingly small number of companies spend considerable sums to establish and embed their brands in the lives and lifestyles of populations. Market research data offers insight into the size and extent of the global alcohol trade, and the magnitude of alcohol advertising expenditures. Recent examples of alcohol marketing in a variety of national contexts illustrate the techniques used by the global companies. The effects of this marketing on young people are described in reviews of recent research studies on youth exposure to alcohol marketing and the effects of that exposure, interpretive models to explain the effects of alcohol marketing on young people, whether alcohol advertising targets young people, and assessments of the effectiveness of regulatory restrictions on marketing and other countermeasures. Despite the failure of public health research to keep pace with newly developing marketing technologies, there is a growing body of evidence that alcohol marketing influences young people's drinking behavior. Measures to reduce that impact should be considered by national governments seeking to limit the public health burden caused by harmful use of alcohol. KEY WORDS: alcohol, advertising, youth, globalization, marketing.

OBJECTIVE--Oxidative stress is a major contributing factor in the development of diabetic nephropathy. Peroxisome proliferator-activated receptor y heterozygous mice and Pro12Ala polymorphism in PPARG exhibited increased resistance to oxidative stress. [...]

Since the early 1980s, microalbuminuria--defined as a urinary albumin excretion rate (AER) between 20 and 200 µg/min (or 30 and 300 mg/24 h) in overnight (or daily) urine collections--has been [...], OBJECTIVE--Cross-sectional studies found less microalbuminuria in type 2 diabetic patients with the Ala12 allele of the peroxisome proliferator-activated receptor-γ2 (PPAR-γ2) Pro12Ala polymorphism. We prospectively evaluated the association between Pro12Ala polymorphism (rs1801282) and new-onset microalbuminuria. RESEARCH DESIGN AND METHODS--Pro12Ala polymorphism was genotyped by TaqMan-based assay in genomic DNA of 1,119 consenting patients from BErgamo NEphrologic DIabetic Complications Trial (BENEDICT)--a prospective, randomized trial evaluating ACE inhibition effect on new-onset microalbuminuria (albuminuria 20-200 µg/min in at least two of three consecutive overnight urine collections in two consecutive visits) in hypertensive type 2 diabetes with albuminuria RESULTS--Baseline characteristics of Ala (Ala/Ala or Ala/ Pro) carriers and Pro/Pro homozygotes were similar, with a nonsignificant trend to lower albuminuria (P = 0.1107) in the 177 Ala carriers. Over a median (interquartile range) of 44.0 (17.1-51.9) months, 7 (4%) Ala carriers and 86 (9.1%) Pro/Pro homozygotes developed microalbuminuria (hazard ratio [HR] 0.45 [95% CI 0.21-0.97]; P = 0.042). Final alburainuria was significantly lower in Ala carriers than Pro/Pro homozygotes (7.3 ± 9.1 vs. 10.5 ± 24.9 µg/min, respectively), even after adjustment for baseline albuminuria (P = 0.048). Baseline and follow-up blood pressure and metabolic control were similar in both groups. Incidence of microalbuminuria was significantly decreased by ACE versus non-ACE inhibitor therapy in Pro/Pro homozygotes (6.3 vs. 11.9%, respectively, HR 0.46 [0.29-0.72]; P < 0.001). CONCLUSIONS--In type 2 diabetes, the Ala allele protects from worsening albuminuria and new-onset microalbuminuria, and ACE inhibition blunts the excess risk of microalbuminuria associated with the Pro/Pro genotype. Evaluating Pro12Ala polymorphism may help identifying patients at risk who may benefit the most from early renoprotective therapy.

A spending cap is an insurance design feature that changes out-of-pocket prices faced by the insured after she exceeds a spending limit. Often the cap is a coverage limit, so [...], Objective. To estimate the impact of a soft cap (a ceiling on utilization beyond which insured enrollees pay a higher copayment) on low-income elders' use of prescription drugs. Data Sources and Setting. Claims and enrollment files for the first year (June 2002 through May 2003) of the Illinois SeniorCare program, a state pharmacy assistance program, and Medicare claims and enrollment files, 2001 through 2003. SeniorCare enrolled non-Medicaid-eligible elders with income less than 200 percent of Federal Poverty Level. Minimal copays increased by 20 percent of prescription cost when enrollee expenditures reached $1,750. Research Design. Models were estimated for three dependent variables: enrollees' average monthly utilization (number of prescriptions), spending, and the proportion of drugs that were generic rather than brand. Observations included all program enrollees who exceeded the cap and covered two periods, before and after the cap was exceeded. Principle Findings. On average, enrollees exceeding the cap reduced the number of drugs they purchased by 14 percent, monthly expenditures decreased by 19 percent, and the proportion generic increased by 4 percent, all significant at p< .01. Impacts were greater for enrollees with greater initial spending, for enrollees without one of five chronic illness diagnoses in the previous calendar year, and for enrollees with lower income. Conclusions. Near-poor elders enrolled in plans with caps or coverage gaps, including Part D plans, may face sharp declines in utilization when they exceed these thresholds. Key Words. Prescription drugs, copayments, elasticity of demand, low-income elderly

When a pediatrician decides it is time to refer a child or adolescent to a mental health clinician, an invisible line has been crossed. The child officially needs 'mental health [...]

U.S. hospitals may be spending more than $25 billion annually to provide free health care (Acts of Charity: Charity Care Strategies for Hospitals in a Changing Landscape, PricewaterhouseCoopers Health Research [...]

The intent of parity laws is to improve equity in private insurance coverage for mental health care. Health insurers have covered mental health care at a significantly lower level than [...], Objective. To study the financial impact of state parity laws on families of children in need of mental health services. Data Source. Privately insured families in the 2000 State and Local Area Integrated Telephone Survey National Survey of Children with Special Health Care Needs (CSHCN) (N = 38,856). Study Design. We examine whether state parity laws reduce the financial burden on families of children with mental health conditions. We use instrumental variable estimation controlling for detailed information on a child's health and functional impairment. We compare those in parity and nonparity states and those needing mental health care with other CSHCN. Principle Findings. Multivariate regression results indicate that living in a parity state significantly reduced the financial burden on families of children with mental health care needs. Specifically, the likelihood of a child's annual out-of-pocket (OOP) health care spending exceeding $1,000 was significantly lower among families of children needing mental health care living in parity states compared with those in nonparity states. Families with children needing mental health care in parity states were also more likely to view OOP spending as reasonable compared with those in nonparity states. Likewise, living in a parity state significantly lowered the likelihood of a family reporting that a child's health needs caused financial problems. The likelihood of reports that additional income was needed to finance a child's care was also lower among families with mentally ill children living in parity states. However, we detect no significant difference among residents of parity and nonparity states in receipt of needed mental health care. Conclusion. These results indicate that state parity laws are providing important economic benefits to families of mentally ill children undetected in prior research. Key Words. Parity, mental health, CSHCN, economic burden

Executive function is a complex, high-level cognitive domain that describes the ability to plan and regulate a task or combinations of tasks. (1) Task switching is one aspect of executive [...], Background and Purpose Task switching is a cognitive skill that may be compromised after brain damage. The purposes of this study were to examine task-switching abilities in the subacute phase after stroke, to determine whether a switching task under endogenous or internal control is more difficult than a switching task under exogenous or cued control, and to determine whether deficits in switching attenuate in the first few months after stroke. Subjects The participants in this study were 46 adults with stroke and 38 adults without stroke. Methods Subjects performed 2 computer-based switching tasks, an alternating task that relied on endogenous control and a cued task that relied on exogenous control. Testing was done in subjects' homes at 1 and 3 months after stroke and at a 2-month interval for control subjects. Switch costs, or the difference between the no-switch condition and the switch condition, were calculated for accuracy and response time. Results Subjects in the stroke group had higher switch costs for accuracy than did subjects in the control group. The alternating task was more difficult than the cued task, with higher switch costs for accuracy and response time. The alternating task was particularly difficult for subjects in the stroke group, with high switch costs for accuracy. Both groups showed decreased response time switch costs at the second testing session. Discussion and Conclusion Task switching, particularly if under endogenous control, is impaired in adults in the subacute phase after stroke. Clinicians should be aware of performance deficits that may relate to task switching.

OBJECTIVE--To determine whether the peroxisome proliferator-activated receptor (PPAR)-γ Pro12ala polymorphism modulates susceptibility to diabetes in South Asians. RESEARCH DESIGN AND METHODS--South Asians (n = 697) and Caucasians (n = 457) [...]

Abstract This national study describes students, teachers, and principals in elementary day treatment and residential schools for students with emotional and behavioral disorders (EBD). A survey was mailed to a [...]

Diabetic nephropathy is the most serious long-term complication of diabetes, accounting for ~40% of new cases of end-stage renal disease (ESRD) in the U.S. (1). Two lines of evidence suggest [...], Several lines of evidence, including familial aggregation, suggest that allelic variation contributes to risk of diabetic nephropathy. To assess the evidence for specific susceptibility genes, we used the transmission/disequilibrium test (TDT) to analyze 115 candidate genes for linkage and association with diabetic nephropathy. A comprehensive survey of this sort has not been undertaken before. Single nucleotide polymorphisms and simple tandem repeat polymorphisms located within 10 kb of the candidate genes were genotyped in a total of 72 type 1 diabetic families of European descent. All families had at least one offspring with diabetes and end-stage renal disease or proteinuria. As a consequence of the large number of statistical tests and modest P values, findings for some genes may be false-positives. Furthermore, the small sample size resulted in limited power, so the effects of some tested genes may not be detectable, even if they contribute to susceptibility. Nevertheless, nominally significant TDT results (P < 0.05) were obtained with polymorphisms in 20 genes, including 12 that have not been studied previously: aquaporin 1; B-cell leukemia/lymphoma 2 (bcl-2) proto-oncogene; catalase; glutathione peroxidase 1; IGF1; laminin alpha 4; laminin, gamma 1; SMAD, mothers against DPP homolog 3; transforming growth factor, beta receptor II; transforming growth factor, beta receptor Ill; tissue inhibitor of metalloproteinase 3; and upstream transcription factor 1. In addition, our results provide modest support for a number of candidate genes previously studied by others.

Diabetic nephropathy is one of the most severe complications of type 1 and type 2 diabetes. Diabetic nephropathy has become the leading cause of end-stage renal failure in the western [...], The risk of diabetic nephropathy is partially genetically determined. Diabetic nephropathy is linked to a gene locus on chromosome 18q22.3-q23. We aimed to identify the causative gene on chromosome 18 and to study the mechanism by which the product of this gene could be involved in the development of diabetic nephropathy. DNA polymorphisms were determined in 135 case (diabetic nephropathy) and 107 control (diabetes without nephropathy) subjects. The effect of carnosine on the production of extracellular matrix components and transforming growth factor-β (TGF-β) after exposure to 5 and 25 mmol/l D-glucose was studied in cultured human podocytes and mesangial cells, respectively. A trinucleotide repeat in exon 2 of the CNDP1 gene, coding for a leucine repeat in the leader peptide of the carnosinase-1 precursor, was associated with nephropathy. The shortest allelic form (CNDP1 Mannheim) was more common in the absence of nephropathy (P = 0.0028, odds ratio 2.56 [95% CI 1.36-4.84]) and was associated with lower serum carnosinase levels. Carnosine inhibited the increased production of fibronectin and collagen type VI in podocytes and the increased production of TGF-β in mesangial cells induced by 25 mmol/l glucose. Diabetic patients with the CNDP1 Mannheim variant are less susceptible for nephropathy. Carnosine protects against the adverse effects of high glucose levels on renal cells.

OBJECTIVE--The insertion/deletion (I/D) polymorphism of the ACE gene has been reported to be associated with diabetic microvascular or macrovascular complications. The aim of the present study was to investigate the [...]

INTRODUCTION Mental health conditions, over the span of a lifetime, can be very disabling--the combined burden of mental health and substance use disease, measured in terms of disability-adjusted life years, [...], This study analyzed annual service use and payment data for children in racial/ ethnic subgroups in Medicaid Programs of four States, and compared service use of youth treated with mental health or substance abuse (MH/SA) conditions to youth without such conditions. In addition to geographic variation in rates (6.2 to 10.7 percent used MH/SA related care), results showed children who used MH/SA services to be disproportionately older, male, and white when compared with all Medicaid children. Examination of costs per claimant found costs for the MH/SA population of children to be three to six times greater than a comparison sample.

OBJECTIVE--The aim of this study was to investigate whether diabetic patients carrying the [Arg.sup.972] insulin receptor substrate-1 (IRS-1) variant are at increased risk for secondary failure to sulfonylurea. RESEARCH DESIGN [...]

There is considerable evidence that costs of care vary widely across medical conditions and general health status, and children with certain conditions generate higher medical costs than the average pediatric [...], Objective. To identify children and evaluate patterns of charges for pediatric medical care, by overall health status, severity of illness, and categories of medical service. Data Sources. Enrollment, claims, and charges data from a Washington State health plan. The study population includes all children ages 0 to 18 years during calendar year 1999. Study Design. Children were classified into clinically defined health status groups and severity levels using Clinical Risk Groups (CRGs). Health plan charges were analyzed according to core health stares group, severity level, and category of service. Data Collection. The three secondary data sources were obtained electronically from the health plan and cleaned for unique members and data quality before analysis. Principal Findings. Children classified as healthy (85.2 percent) had mean and median annual charges of $485 and $191. Children with one or more chronic conditions (9.5 percent) had mean and median charges increasing by status and severity group from $2,303 to $76,143 and from $1,151 to $19,456, and accounted for 45.2 percent of all charges. Distribution of charges varied across health status groups. Healthy children had 70.6 percent of their charges in outpatient and physician services. Children classified in the complex, catastrophic, and malignancy groups had 67 percent of their charges in inpatient encounters. Children with chronic conditions accounted for 31.8 percent of all physician, 41.8 percent of outpatient, 47.7 percent of pharmacy, 60.7 percent of inpatient, and 75.8 percent of all other charges. Conclusions. Children with chronic conditions account for a disproportionately high percentage of children's health expenditures. They account for different percentages of expenses for different medical services. These percentages vary according to health status and severity. This analysis can be used to identify and track groups of children for various purposes. Key Words. Children, chronic illnesses, administrative data, charges, special health care needs

The peroxisome proliferator-activated receptor γ2 (PPARγ2) Pro12Ala polymorphism has been associated with a decreased risk of type 2 diabetes and a lower albumin excretion rate (AER) in patients with established [...]

J Med Genet 2003;40:773-780 Peroxisome proliferator activated receptor-γ (PPAR-γ) is a transcription factor abundantly expressed in adipocytes, and plays a key role in the regulation of adipocyte differentiation, lipid storage, [...]

Tumor necrosis factor (TNF)-related apoptosis-inducing ligand (TRAIL) is expressed in different tissues and cells, including pancreas and lymphocytes, and can induce apoptosis in various tumor cells but not in most [...]

Peroxisome proliferator-activated receptor-γ2 (PPAR-γ2) is a transcription factor that is expressed predominantly in adipose tissues and is believed to have a critical role in adipogenesis and insulin action (1,2). A [...], Recent research suggests that the Pro12Ala variant in peroxisome proliferator-activated receptor-γ2 (PPAR-γ2) is associated with diabetes- and obesity-related traits, and that its effects may be modified by obesity status. We characterized this variant in a population-based sample of 1,441 middle-aged African-American individuals with respect to diabetes-, obesity-, and other cardiovascular-related traits, both cross-sectionally and prospectively. The overall frequency of Ala12 was 1.9% (95% CI 1.5-2.5%), significantly lower than in Caucasian populations. Consistent with previous findings in Caucasians, African Americans with type 2 diabetes tended to be less likely to have the Pro/Ala genotype than those without (odds ratio [OR] 0.64, 95% CI 0.34-1.20); however, this OR was not statistically significant. Among nonobese individuals, the Pro/Ala genotype was associated with significantly lower In(insulin) (P = 0.001), lower In(HOMA-IR) (homeostasis model assessment of insulin resistance) (P = 0.002), higher fasting glucose-to-insulin ratio (P = 0.005), and lower diastolic blood pressure (P = 0.02). Among overweight individuals (BMI 25-29.9 kg/[m.sup.2]), the Pro/Ala genotype was associated with greater BMI (P = 0.02), waist-to-hip ratio (P = 0.01), and waist circumference (P = 0.04). Among obese individuals, there was no association between any of the diabetes- or obesity-related traits and the Pro12Ala PPAR-γ2 variant. We conclude that among nonobese African Americans, the Pro/Ala genotype is associated with markers of greater insulin sensitivity.

Insulin resistance is an important risk factor for type 2 diabetes and cardiovascular disease (CVD) (1,2). The peroxisome proliferator-activated receptor (PPAR)-γ, which is a member of the nuclear hormone receptor [...], The peroxisome proliferator-activated receptor (PPAR)-γ2 gene polymorphism Pro12Ala has been associated with increased insulin sensitivity in some but not all studies. Little is known about its effect on the tracking of insulin resistance status over time. These aspects were examined in a community-based sample of 686 white young adults, aged 20-38 years, and 426 white children, aged 4-17 years, and a subsample of a cohort (n = 362) who participated both as children and adults, with an average follow-up period of 13.4 years. Insulin resistance was measured by the homeostasis model assessment of insulin resistance (HOMA-IR) using fasting insulin and glucose. The frequency of the variant Ala12 allele was 0.104 in whites vs. 0.017 in blacks. After adjusting for sex, age, and BMI, adult subjects with the genotype Pro/Pro, Pro/Ala, and Ala/Ala, respectively, showed significant decreasing trends in fasting insulin (11.7, 10.3, and 8.8 µU/ml; P = 0.002) and HOMA-IR (2.4, 2.1, and 1.7; P = 0.006). Similar but nonsignificant trends were noted in childhood. A significant genotype-BMI interaction effect on insulin (P = 0.020), glucose (P = 0.007), and HOMA-IR (P = 0.001) was found in adulthood, with carriers versus noncarriers showing attenuated association with BMI. The genotype-BMI interaction effect on these variables tended to be similar in childhood. With respect to tracking over time, of individuals in the top age- and sex-specific quartile of HOMA-IR in childhood, 48.7% (38/78) of noncarriers vs. 16.7% (2/12) of the carriers (P = 0.035) remained in the same quartile in adulthood. A similar trend was observed for insulin (2/13 vs. 35/77, P = 0.037). In conclusion, the Pro12Ala polymorphism of the PPAR-γ2 gene beneficially influences insulin resistance and its tracking from childhood to adulthood. Further, the Ala12 allele attenuates the adverse association between adiposity and insulin resistance measures.