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In this article, as part of an evaluation of the future of medical education In California, we characterize the distribution of disease and injury in California; identify major factors that affect the epidemiology of disease and injury in California, and project the burden of disease and injury for California's population to the year 2007. Our goal is to elucidate the major causes of Illness and disability at present and in the near future in order to focus state resources on the interventions likely to have the greatest impact. Data from various governmental agencies were utilized; the base year, 1993, is the most recent year with sufficient information available when this report v0s prepared. Several major risk factors have decreased, including smoking (30% decline from 1984 to 1993) and drinking and driving. However, hypertension prevalence has not changed, and overweight has increased dramatically. Poverty continues to burden about 15% of Californians, with poverty highest among children. During 1993, 220,271 Californians died, with 3 major causes accounting for 61% of these deaths: coronary heart disease (31%), cancer (23%), and stroke (7%). In terms of potential years of life lost (years lost before age 65), the most important causes of death in 1993 were unintentional injury (756 years lost/100,000 population), cancer (632 years), and the acquired immunodeficiency syndrome (AIDS; 491 years). Mortality rates were highest among blacks and lowest among Asians. Overall mortality in California has been declining for decades; in just 1 decade, from 1980 to 1991, mortality declined from 780 to 680 deaths per 100,000 population. Several major causes of death have declined, including coronary heart disease, stroke, unintentional injury, cirrhosis, and suicide, while others have increased, for example, chronic obstructive lung disease and diabetes mellitus. Death from AIDS increased dramatically in the past decade, but is leveling off, and death from cancer is beginning to decline. Rates for overall mortality and morbidity, and for most specific conditions, should continue to decline. A projected 28% population increase by 2007 will yield a corresponding increase in the absolute level of disease cases and death; a disproportionate increase in younger and older groups will yield increased conditions affecting young (unintentional injury, AIDS) and older (heart disease, cancer, stroke, diabetes mellitus) people. Californians should experience overall improved health in coming years, reaping benefits of reduced environmental and behavioral risk factors as well as improved medical treatment and rehabilitation. Coordinated strategies for health promotion, disease prevention, delivery of medical treatment, and rehabilitation are needed to maintain and improve present levels of health across the life span. (Ragland DR, Buffler PA, Reingold AL, Syme SL, Buffler ML. Disease and injury in California with projections to the year 2007--Implications for medical education. West J Med 1998; 168:378-399), This study was conducted at the request of the Office of the President of the University of California as part of an effort to evaluate the future of medical education [...]

Interventions designed to encourage people to change high-risk behavior have not been very successful. This is an important challenge because the number of older people in the population will double within the next 20 to 30 years. The increase will put enormous strain on an already overburdened medical care system. We therefore will need to put more emphasis on disease prevention programs. Helping people change high-risk behavior will be the key to prevention. To develop more effective prevention programs, we will have to train a new generation of experts who can not only provide people with risk information but also work with them as partners in achieving mutually agreed upon goals.

Self-rated health (SRH) is an independent predictor of mortality; studies have investigated correlates of SRH to explain this predictive capability. However, the interplay of a broad array of factors that influence health status may not be adequately captured with parametric multivariate regression. This study investigated associations between several health determinants and SRH using recursive partitioning methods. This non-parametric analytic approach aimed to reflect the social-ecological model of health, emphasizing relationships between multiple health determinants, including biological, behavioral, and from social/physical environments. The study sample of 3648 men and women was drawn from the year 15 (2000–2001) data collection of the CARDIA Study, USA, in order to study a young adult sample. Classification tree analysis identified 15 distinct, mutually exclusive, subgroups (eight with a larger proportion of individuals with higher SRH, and seven with a larger proportion of lower SRH), and multi-domain risk and protective factors associated with subgroup membership. Health determinant profiles were not uniform between subgroups, even for those with similar health status. The subgroup with the largest proportion of higher SRH was characterized by several protective factors, whilst that with the largest proportion of lower SRH, with several negative risk factors; certain factors were associated with both higher and lower SRH subgroups. In the full sample, physical activity, education and income were highest ranked by variable importance (random forests analysis) in association with SRH. This exploratory study demonstrates the utility of recursive partitioning methods in studying the joint impact of multiple health determinants. The findings indicate that factors do not affect SRH in the same way across the whole sample. Multiple factors from different domains, and with varying relative importance, are associated with SRH in different subgroups. This has implications for developing and prioritizing appropriate interventions to target conditions and factors that improve self-rated health status.

Alternative dispute resolution (ADR) refers to extrajudicial methods of settling legal disputes. In the construction industry where contractual disputes are prevalent, ADR is an attractive alternative to costly litigation. There are also other methods for avoiding disputes but the paramount concern underlying all of them is the avoidance or prevention of any dispute from arising in the first place. It would also be ideal if a project manager learns how to recognize potential problems so they can be corrected in their early stages.

The article discusses the court case, Downtown Soup Kitchen v. Municipality of Anchorage, wherein nonprofit religious organization Hope Center sued for injunctive relief in federal court for the argument that its rejection to housing a transgender homeless woman at its shelter Downtown Soup Kitchen was not covered by the non-discrimination provisions of Anchorage's anti-discrimination ordinance, and the ruling by U.S. District Judge Sharon L. Gleason on the case.

Emotional writing almost guarantees that the reader will not react emotionally. Being excited is not being exciting. A writer with the power to excite emotions coldly examines his own passions [...]

Vacations enable people to help one another, spend time together in pleasant contexts, and renew relational resources. Reasoning that these shared activities spread social and psychological benefits through social networks, we hypothesized that increase in the number of vacationing workers engenders nonlinear decline in psychological distress at the population level. We applied time-series methods to aggregate data on monthly dispensation of antidepressants to the Swedish population for the 147 months starting January 1993. We obtained the data from the pharmacy corporation allied with the national health care system and from governmental sources. Dispensation of antidepressants declined logarithmically with increase in the number of vacationing workers, for men and women alike. The associations held among people beyond retirement age as well as people of working age, further evidence that vacation benefits spread beyond vacationing workers. The results bear on the social regulation of time for restoration as a general determinant of population health.

Tightened budgets and a fiercely competitive real estate market have placed additional strain on owners and their representatives to complete new building projects on schedule and within budget. Now more [...]

Social risk factors are often less vigorously pursued in clinical assessments of infant risk than are biologic risk factors. We examined the relative importance of early social and biologic risk factors in predicting poor health and educational outcomes in children.

Purpose. To investigate relationships between adolescents' current alcohol, tobacco, and marijuana use; perceptions of neighborhood disorder; and sense of hope.Design. Questionnaires were administered to a nonrandom sample of middle school students during the spring of 1999.Subjects. The ethnically and geographically diverse sample (n = 369), from a range of low socioeconomic status backgrounds, was considered to be at high risk for alcohol, tobacco, and other drug use because of previous enrollment in low socioeconomic status elementary schools.Measures. Alcohol, tobacco, and marijuana use were dichotomized into current and never/no use. Six variables described neighborhood social disorder. Sense of hope was assessed using the Children's Hope Scale.Results. Statistically significant relationships were found between perceived neighborhood disorder and current alcohol (p = .01), tobacco (p = .001), and marijuana (p < .001) use. A statistically significant and independent relationship was found between sense of hope and current alcohol (p = .02), tobacco (p = .02), and marijuana (p = .06) use. Results indicated linear trends in participants' increased use of alcohol, tobacco, and marijuana and (1) perception of higher neighborhood disorder and (2) lower sense of hope.Conclusion. Substance use prevention programs for youth might usefully be directed not only to agdolescents but also to the neighborhoods in which they live. Additionally, it would be important to emphasize creating safer neighborhood environments that support the development of a stronger sense of hope for the future.

Utilization of frontal balloon sinuplasty in pediatric complicated acute rhinosinusitis (ARS) is demonstrated to be a safe and expedient alternative to other procedures such as trephination or functional endoscopic sinus surgery (FESS) in this case series. We performed a retrospective review of six pediatric cases of frontal balloon sinuplasty for ARS with intracranial complications at a tertiary academic center. Patients underwent unilateral (n = 5) or bilateral dilation (n = 1) in addition to functional endoscopic sinus surgery (FESS) including anterior ethmoidectomy (n = 5) and maxillary antrostomy (n = 6). This technique effectively addressed frontal sinus obstruction and served as an alternative to procedures such as trephination or functional endoscopic sinus surgery. No immediate or short-term complications of balloon dilation were observed in these cases. A larger cohort and extended follow-up are necessary to determine the use and long-term impact of this technique.

A major theme in virtually all of Bertil Gardell's work is that the social and work environment affects health and well-being. This concern with the social environment has been a major influence in the development of a new area of research referred to as social epidemiology. In this area of work, difficulties are increasingly being recognized in identifying specific social factors in the environment toward which intervention programs can be directed. An approach to this complex problem is to focus attention on the “mini-environment” of the workplace. Research here has yielded several interesting hypotheses that may have important implications for studies of the larger environment. These hypotheses involve the concepts of control and participation, concepts that are central to all of Garden's work.

Fiveyear prospective cohort study of 1449 transit operators.

Chronic nicotine administration in animal models evokes a dose-dependent increase in brain nicotinic receptor numbers. Genetically determined variability in nicotinic receptor number in different mouse strains has also been reported, which is thought to affect sensitivity to nicotine, as well as the development of tolerance. Humans self-administer nicotine principally in the form of cigarettes and other tobacco products. The present study compared [3H]nicotine binding in human postmortem brain from thalamus and hippocampus of nonsmoking subjects, subjects who had variable life-long smoking histories and subjects who had quit smoking. A significant increase was seen in [3H]nicotine binding in both hippocampus and thalamus of subjects with life-long smoking histories. In the hippocampus, this change resulted from a change in total receptor number (Bmax), with no change in receptor affinity (Kd). There was also a positive correlation between the degree of smoking, as measured by the average reported packs smoked per day, and the number of nicotine binding sites found in both the hippocampus and thalamus, showing that humans exhibit a dose-dependent increase in brain nicotinic receptor binding. Receptor levels in these brain regions after smoking cessation were at or below those found in the control population, which indicated that smoking-induced changes are reversible after cessation of nicotine treatment. These results suggest that increases in nicotinic receptor levels in the human brain may underlie nicotine tolerance and addiction in smokers.

The article focuses on the cameo glass of John Northwood I. The lost art of making cased glass and carving it was reportedly reinvented in England in the 1870s with Northwood carving a replica of the famous Portland Vase in the British Museum in London. It is stated that he also carved a Milton Vase inspired by "Paradise Lost" and tazzas with profile busts of William Shakespeare and Sir Isaac Newton. The disappearance of cameo glass about 1890 due to high production costs is also noted.

A precision research instrument for the measurement of stress-strain-time properties of tex tile materials, which was constructed in the research laboratory of the American Viscose Corpo ration, is described. Classification of this instrument as a research tool rather than as a routine testing instrument allows more flexibility in operating conditions. It is of the constant-rate-of- extension type, for use on all textile materials from single filaments to fabrics. The instrument consists essentially of a constant speed drive, a Statham gage, and a Brown recording potentiometer.

A stress-strain study has been made of various fibers to determine their entropy force behavior at room temperature. The relative importance of the entropy and internal energy forces is shown with some illustrations of the use of these quantities in under standing the fine structure of polymers. Details are presented to show the effects of extension and godet stretch on some samples.

Approximately half of all causes of mortality in the United States are linked to behavioral factors such as smoking, diet, alcohol use, sedentary lifestyle and accidents (McGinnis & Foege, 1993). One very promising strategy for promoting health and preventing disease, therefore, is to help people change behaviors that increase disease risk—but helping people do this has proven to be a very difficult and challenging problem. One would think that if we informed people of their risks they would rush home and, in the interests of good health, change behaviors that caused the risk. Some people do, but most do not (Smedley & Syme, 2000).

High gestational weight gain (GWG) in overweight/obese pregnant women increases maternal-fetal complications. We conducted a 6-week GWG intervention based on an energy balance model that includes theories of planned behavior (TPB) and self-regulation constructs to promote exercise and healthy eating motivation and behaviors. The purposes of this proof-of-concept feasibility study were to examine: (1) the energy balance model constructs over the intervention, and (2) pre-post intervention, weekly, and dose-response changes in study constructs. Methods. Overweight/obese pregnant women (N=17) were randomized to 1 of 6 conditions, increasing in intensity, and included varied combinations of components (exercise sessions, healthy eating demonstrations, etc.). Exercise and healthy eating TPB (attitude, subjective norm, perceived behavioral control, intention), and self-regulation (prospective, retrospective) constructs were collected weekly. Exercise behavior, energy intake, and GWG were collected daily. Results. We observed: (a) significant increases in exercise TPB constructs, healthy eating attitude (limit unhealthy foods), exercise/healthy eating retrospective self-regulation; (b) significant decrease in healthy eating subjective norm (limit unhealthy foods); (c) trending increases for healthy eating perceived behavioral control (limit unhealthy foods), healthy eating prospective self-regulation, and energy intake; (d) significantly higher active time, steps, and energy expenditure at W3 relative to other weeks; (e) no significant increase in GWG; and, (f) a dose response effect such that women in more intensive dosages had greater gains in exercise and healthy eating perceived behavioral control (eat healthy/limit unhealthy foods). Conclusion. Brief exposure to a theoretically-driven, GWG intervention resulted in changes to exercise and healthy eating TPB and self-regulation motivational determinants, no significant increase in GWG, and suggests intervention intensity can strengthen perceived ability to engage in exercise/healthy eating behaviors; offering initial proof-of-concept for the intervention to regulate GWG in overweight/obese pregnant women. Future research will test this intervention over the course of pregnancy to understand long-term impact on maternal-fetal health outcomes.

Several letters to the editor are presented in response to articles in previous issues including “Rabbis Unite!" in the November 28, 2014 issue, "A Safe Haven" on the topic of anti-Semitism in the December 5, 2014 issue and “Your Say" by Morris N. Saks in the November 21, 2014 issue.

TO THE EDITOR:— In the editorial in The Journal of March 26, page 1126, on obesity, attention was wisely drawn to the importance of psychological or psychopathological factors in determining overeating and resulting obesity and a recent work was quoted on the real value of psychotherapy in suitable cases. However, the endocrine glands were dismissed with a single sentence stating that "the older theories that attributed obesity to an endocrine disturbance have been shown to be erroneous." This dogmatic statement appears to ignore the important influence of several hormones on appetite and on determining the relative protein-fat constitution of the body, as well as some challenging clinicopathological facts. Even so, I would not venture to comment, by letter, on an American editorial if it were not for the fact that the statement ignores fundamental work carried out in the United States, particularly the demonstration by Kendall of the Mayo Clinic