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Transcription factor USF is a ubiquitously expressed member of the helix-loop-helix family of proteins. It binds with high affinity to E-box elements and, through interaction with coactivators, aids in the formation of transcription complexes. Previous work demonstrated that USF regulates genes during erythroid differentiation, including HoxB4 and beta-globin. Here, we show that the erythroid cell-specific expression of a dominant-negative mutant of USF, A-USF, in transgenic mice reduces the expression of all beta-type globin genes and leads to the diminished association of RNA polymerase II with locus control region element HS2 and with the beta-globin gene promoter. We further show that the expression of A-USF reduces the expression of several key erythroid cell-specific transcription factors, including EKLF and Tal-1. We provide evidence demonstrating that USF interacts with known regulatory DNA elements in the EKLF and Tal-1 gene loci in erythroid cells. Furthermore, A-USF-expressing transgenic mice exhibit a defect in the formation of CD71(+) progenitor and Ter-119(+) mature erythroid cells. In summary, the data demonstrate that USF regulates globin gene expression indirectly by enhancing the expression of erythroid transcription factors and directly by mediating the recruitment of transcription complexes to the globin gene locus.

Homozygous deficiency of the transcription factor Gata4 in mice causes lethality due to defects in ventral morphogenesis and heart tube formation. There is increasing evidence demonstrating that GATA4 function is also relevant for normal developed organ systems, including the heart and endocrinum. To analyze the implication of Gata4 beyond development, we generated transgenic mice expressing inducible small interfering RNA against Gata4. In longitudinal analysis, efficient suppression of Gata4 mRNA (down to 80% of wild-type levels) and protein expression in the heart was detected 38 days after induction of Gata4 short hairpin RNA. Decreased Gata4 expression was associated with reduction in the expression of known cardiac target genes, but the function of the heart remained unperturbed at 20-30% of normal Gata4 levels. Interestingly, Gata4 expression was almost abolished in the ovary and testis. This was accompanied in the testis by a significant reduction of GATA4 downstream target genes, such as the genes encoding Mullerian inhibiting substance (MIS) and steroidogenic acute regulatory (StAR) protein. By contrast, expression levels of Mis and Star were only slightly modified in the ovary, and concentrations of circulating FSH and LH were normal in female transgenic mice after induction of Gata4 short hairpin RNA. However, inhibition of Gata4 expression led to the formation of ovarian teratoma in 10% of females. Histology of the teratomas showed predominantly ectodermal and mesodermal structures. Our data demonstrate that Gata4 is critically involved in the function and integrity of the gonads in vivo.

The DNA double strand break repair gene Ku80 is thought to play a major role in the caretaking of the overall genome stability. It is very possible that defective in double strand break repair capacity can lead to human carcinogenesis. Thus, the polymorphic variants of Ku80 were firstly investigated regarding their association with oral cancer susceptibility. In this hospital-based case-control study, the association of Ku80 promoter G-1401T (rs828907), promoter C-319T (rs11685387), and intron19 (rs9288518) polymorphisms with oral cancer risk in a Taiwanese population was investigated. 600 patients with oral cancer and 600 age- and gender-matched healthy controls recruited were genotyped and analyzed by PCR-RFLP method. There were significant differences between oral cancer and control groups in the distributions of their genotypes (P=0.0038) and allelic frequencies (P=0.0044) in the Ku80 promoter G-1401T polymorphism. In the other two polymorphisms, there was no difference between both groups in the distribution of either genotype or allelic frequency. There is a synergistic gene-environmental interaction between Ku80 and areca chewing. Compared with G/G genotype in Ku80 promoter G-1401T, the G/T plus T/T significantly enhanced the risk only in the areca chewers (odds ratio=1.603; 95% confidence interval=1.053-2.011), not in the non-areca chewers. In conclusion, the Ku80 promoter G-1401T is correlated with oral cancer susceptibility and this polymorphism may be a useful marker for oral cancer prevention and early detection.

We report the first case of granulomatous amebic encephalitis caused by Acanthamoeba in a previously healthy farmer in Taiwan who fell into a ditch. The DNA amplicons of amebas identified by polymerase chain reaction in the cerebrospinal fluid specimen and the ditch water specimens were identical and shared strong homology with A. castellanii . He survived after treatment with amphotericin B, rifampin, and corticosteroids.

Background: Although modest improvements in colorectal cancer (CRC) screening utilization have occurred, rates remain low among Latinos. It is unclear whether acculturation plays a role in the utilization of CRC screening., Objective: This study aimed to examine the relationships between acculturation and CRC screening among older Mexican, Puerto-Rican and Cuban adults., Design: Cross-sectional observational study., Subjects: Latinos 50 years and older, never diagnosed with CRC, and who were surveyed in the 2000, 2003 and 2005 National Health Interview Survey (NHIS)., Measures: We measured acculturation with US nativity and language of interview, and examined three different CRC screening outcomes: fecal occult blood test (FOBT) in the past year, up-to-date endoscopy and any up-to-date CRC screening. Logistic regression models were adjusted for predisposing, enabling and health-care need factors consistent with the behavioral model of health-care utilization., Main Results: In adjusted analyses, US nativity was positively associated with up-to-date endoscopy among Mexicans (OR: 1.5; 95% CI: 1.1, 2.2), but negatively associated with FOBT in the past year among Puerto Ricans (OR: 0.3; 95% CI: 0.2, 0.7). In contrast to this latter finding among Puerto Ricans, English language interview was positively associated with FOBT in the past year (OR: 2.5; 95% CI: 1.1, 5.4)., Conclusion: Results underscore the importance of stratification by national origin in studies of acculturation and cancer screening and of targeting less acculturated adults to promote CRC screening. Clinicians, however, should consider the complexity of acculturation and treat US nativity and language preference as independent dimensions among their Latino patients.

Glaucoma is the leading cause of irreversible blindness in the world. Diagnosis and management of glaucoma is significantly associated with intraocular pressure, but contemporary office-based measurements are not sufficient to discover diurnal changes and spikes, nor do they demonstrate the effect of medication and compliance. Patient-directed self-tonometry can be taken throughout the day and is therefore the subject of much discussion and research. In this article we review the history of self-tonometry devices and present technologies for the future.

A novel one-step, closed-tube, loop-mediated isothermal amplification (LAMP) assay for detecting Entamoeba histolytica, one of the leading causes of morbidity in developing countries, was developed. The sensitivity of the LAMP assay is 1 parasite per reaction. A total of 130 clinical samples were analyzed, and the results compared with those of conventional nested PCR to validate the practicability of this assay. No DNA was amplified from other diarrheal pathogens, such as other Entamoeba species, bacteria, and viruses. These results indicate that LAMP is a rapid, simple, and valuable diagnostic tool for epidemiological studies of amebiasis.

Unlabelled: The aim of the present study was to evaluate the association between the polymorphisms of the Ku80 DNA repair gene, which plays an important role in maintaining genome stability, and the risk of bladder cancer in Central Taiwan., Materials and Methods: In this hospital-based case-control study, the association of Ku80 G-1401T rs828907, Ku80 C-319T rs11685387 and Ku80 intron 19 rs9288518 polymorphisms with bladder cancer risk in a central Taiwanese population was investigated. In total, 288 patients with bladder cancer and 288 age- and gender-matched healthy controls recruited from the China Medical Hospital in central Taiwan were genotyped., Results: A significantly different distribution was found in the frequency of the Ku80 G-1401T polymorphism genotypes, but not the Ku80 C-319T or intron 19 polymorphism genotypes, between the bladder cancer and control groups. The T allele of Ku80 G-1401T conferred a significant (p=0.0055) increased risk of bladder cancer. Gene-environment interactions with smoking, but not with alcohol consumption, were significant for the Ku80 G-1401T polymorphism. The Ku80 G-1401T GT and TT genotypes, in association with smoking, conferred an increased risk of 2.053-fold (95% confidence interval=1.232-3.419) for bladder cancer., Conclusion: The first evidence that the T allele of the Ku80 G-1401T may be associated with the development of bladder cancer and may be a novel useful marker for primary prevention and anticancer intervention is provided.

The ideal trabeculectomy bleb is diffuse, normally vascularized and characterized by microcystic change in the overlying conjunctiva. We compare and contrast the histopathology of a normally functioning mitomycin-C trabeculectomy site obtained from an eye enucleated for iris melanoma with abnormal blebs discussed in the literature. Representative sections of the normally functioning bleb were examined under the light microscope. The conjunctiva is composed of a uniform three-layered non-keratinizing stratified squamous epithelium overlying a single layer of oedematous basal cells. The conjunctival stroma consisted of loose connective tissue, traversed by capillaries and scattered small cystic spaces lined by endothelial cells. There were no goblet cells and few inflammatory cells and fibroblasts. The scleral trapdoor was evident as a cleft in the scleral wall in communication with the anterior chamber at the surgically created sclerostomy. Because the histopathological findings in our case correlate well with this clinical appearance, we conclude that whereas augmentation with anti-metabolites, such as mitomycin-C, can be associated with significantly altered conjunctival histopathology and consequent hypotony, but, if used carefully, normal architecture is conserved.

Aim: To evaluate the association between the polymorphisms of the Exo1 gene and the risk of lung cancer in central Taiwan., Patients and Methods: In this hospital-based study, the association of Exol A-1419G (rs3754093), C-908G (rs10802996), A238G (rs1776177), C498T (rs1635517), K589E (rs1047840), G670E (rs1776148), C723R (rs1635498), L757P (rs9350) and C3114T (rs851797) polymorphisms with lung cancer risk in a central Taiwanese population was investigated. In total, 358 patients with lung cancer and 358 age- and gender-matched healthy controls recruited from the China Medical Hospital in central Taiwan were genotyped., Results: A significantly different distribution was found in the frequency of the Exo1 K589E genotype, but not the other genotypes, between the lung cancer and control groups. The A allele Exo1 K589E conferred a significantly (p = 0.0097) increased risk of lung cancer. As for the rest of the polymorphisms, there was no difference in distribution between the lung cancer and control groups. Gene environment interactions with smoking were significant for Exo1 K589E polymorphism. The Exo1 K589E AG and AA genotype in association with smoking conferred an increased risk of 1.7208 (95% confidence interval = 1.2188-2.4295) for lung cancer., Conclusion: Our results provide the first evidence that the A allele of Exo1 K589E may be associated with the development of lung cancer and may be a novel useful marker for primary prevention and anticancer intervention.

The DNA repair gene Ku70, an important caretaker of the overall genome stability, is thought to play a major role in the DNA double strand break repair system. It is known that defects in double strand break repair capacity can lead to irreversible genomic instability. However, the polymorphic variants of Ku70 and their association with oral cancer susceptibility has never been reported on. In this hospital-based case-control study, the association of Ku70 promoter T-991C (rs5751129), promoter G-57C (rs2267437), promoter A-31G (rs132770), and intron3 (rs132774) polymorphisms with oral cancer risk in a Taiwanese population was investigated. In total, 318 patients with oral cancer and 318 age- and gender-matched healthy controls recruited from the China Medical Hospital in Taiwan were genotyped. The results showed that there were significant differences between the oral cancer and control groups in the distribution of their genotypes (P=0.0031) and allelic frequency (P=0.0009) in the Ku70 promoter T-991C polymorphism. Individuals who carried at least one C allele (T/C or C/C) had a 2.15-fold increased risk of developing oral cancer compared to those who carried the T/T wild-type genotype (95% CI: 1.37-3.36). In the other three polymorphisms, there was no difference between both groups in the distribution of either genotype or allelic frequency. In conclusion, the Ku70 promoter T-991C, but not the Ku70 promoter C-57G, promoter A-31G or intron3, is connected to oral cancer susceptibility. This polymorphism may be a novel useful marker for primary prevention and anticancer intervention.

Aim: Although research has suggested that medication adherence rates are lower than what is needed to achieve optimal pain control, the role of patient beliefs and attitudes in influencing opioid adherence has rarely been examined. Perceived self-efficacy is reported to be an important construct in predicting and enhancing adherence behaviour. The purpose of this study was to explore the relationship between opioid-taking self-efficacy, opioid beliefs, adherence behaviours, and pain experience amongst Taiwanese cancer outpatients., Method: The cross-sectional study included 92 oncology outpatients in two teaching hospitals in the Taipei area of Taiwan. The research instruments included the Opioid-Taking Self-Efficacy Scale-Cancer (OTSES-CA), the Pain Opioid Analgesic Beliefs Scale-Cancer (POABS-CA), opioid adherence, and the Brief Pain Inventory-Chinese (BPI-Chinese)., Results: Opioid-taking self-efficacy demonstrated a significant positive relationship with patients' opioid adherence (r=0.22, p<0.05) and pain relief (r=0.35, p<0.01), while also demonstrating a significant positive correlation with worst pain (r=0.25, p<0.05). In addition, the more negative beliefs regarding opioids the patient had, the worse their adherence to around the clock analgesic regimen (r=-0.30, p<0.01). Multivariate analysis identified opioid-taking self-efficacy continued to have a significant independent influence on opioid adherence and pain relief, after controlling for key demographic variables. Self-efficacy accounted for 4% (R(inc) (2)=0.04, p=0.043) of the variance and opioid beliefs accounted for 8% (R(inc) (2)=0.08, p=0.007) of the variance in opioid adherence. Multivariate analysis also identified that opioid-taking self-efficacy accounted for 11% (R(inc) (2)=0.11, p=0.001) of the variance in pain relief, but opioid beliefs did not continue to have an independent effect for this outcome., Conclusions: The study highlights the potential importance of a patient's self-efficacy beliefs in adherence to medication and key pain outcomes., ((c) 2008 John Wiley & Sons, Ltd.)

In the past decades, the incidence of cancer keeps its rapid increasing step all over the world and cancer is always an important threat to public health. It is believed that cancer is resulted from a series of genetic alterations leading to progressive disorder of the normal mechanisms controlling cell proliferation, differentiation, death, and/or genomic stability. The response of the cell to genetic injury and its ability to maintain genomic stability by means of a variety of DNA repair mechanisms are therefore essential in preventing tumor initiation and progression. From the same viewpoint, the relative role of DNA repair as a biomarker for prognosis, predicator of drug and therapy responses, or indeed as target for novel gene therapy is recently patented and very promising. In this review, we have summarized the studies investigating the association between XRCC4, one of the NHEJ genes, and the susceptibility to multiple cancers, and discussed its role in carcinogenesis and application in anticancer drug discovery.

Background: Acute renal insufficiency and dysfunction are common complications after clinical liver transplantation. This study examined whether augmentor of liver regeneration (ALR) played a significant role to ameliorate renal tubular epithelial cell injury after liver transplantation., Methods: Orthotopic liver transplantation was performed from Sprague-Dawley (SD) to SD rats. Twelve recipients were randomly divided into two groups: ALR group (with recombinated human ALR 100 microg/kg . d intramuscular injection postoperation) versus normal saline-treated group (with the same volume of normal saline injected intramuscularly postoperation). Rats were sacrificed at day 3 posttransplantation. Renal morphological changes in recipients were assessed with light microscopy. The expressions of tumor necrosis factor-alpha (TNF-alpha), proliferating cell nuclear antigen (PCNA) and caspase-3 protein and mRNA in the kidney were evaluated by real-time polymerase chain reaction and immunohistochemical staining., Results: Morphological changes in renal tubular epithelial cells were not significant in either group at day 3 posttransplantation. The intragraft expression of TNF-alpha and caspase-3 was strikingly promoted in the normal saline-treated group and PCNA attenuated compared to the ALR group., Conclusion: These data suggested that ALR may play a role to reduce renal damage in liver transplant recipients.

Objective: To observe clinical therapeutic effect of tendon-muscle picking therapy on myofascitis of back., Methods: One hundred and twelve cases were randomly divided into a tendon-muscle picking therapy group and an electroacupuncture (EA) group, 56 cases in each group. The tendon-muscle picking therapy group were treated by picking pain tendon-muscle tubercles on the back, and the EA group by EA at Dazhu (BI. 11), Feishu (BL 13), Xinshu (BL 15), Tianzong (SI 11) and Jiaji (EX-B 2). Their therapeutic effects were compared after treatment for 2 courses., Results: The total effective rate was 89.3% in the tendon-muscle picking therapy group and 78.6% in the EA group with a significant difference between the two groups (P<0.05)., Conclusion: Tendon-muscle picking therapy has a good therapeutic effect on myofascitis of back.

Aim: The aim of this study was to describe those tasks and behaviours that contribute to self-efficacy in the context of opioid-taking in Taiwanese outpatients with cancer and to explore those factors that influence a patient's self-efficacy with engaging in these behaviours., Background: Self-management with prescribed opioid regimen has become a necessary component of the cancer pain experience at home. Tailoring prescribed regimens is a complex and continuing effort for cancer pain control. Few studies, however, have explored the specific skills and behaviours required by patients to manage their opioid analgesics effectively., Design: A qualitative approach was used to explore those behaviours that contribute to patients' ability to self-manage medication for their cancer pain., Method: Ten Taiwanese cancer patients aged between 41-75 years attending two oncology outpatient departments, who were prescribed opioid analgesics, were interviewed. All interviews were tape-recorded and were transcribed verbatim. Qualitative content analysis was undertaken to identify categories., Results: Five main categories of behaviours were identified, which reflected patient's perceptions of the actions required for effective opioid-taking. These behavioural domains included communicating about pain and analgesic-taking, taking analgesics according to schedule, obtaining help, tailoring medication regimens and managing treatment-related concerns. In addition, patients described various situations in which performance of these behaviours was more or less difficult., Conclusions: Our results suggest that self-efficacy with opioid-taking includes not only beliefs about the ability to communicate, but also the ability to fulfil more complex tailoring of medication regimens and management of treatment-related concerns., Relevance to Clinical Practice: Health professionals need to incorporate strategies to assist cancer patients' ability to engage in these behaviours and to manage situational impediments that may influence this ability. More importantly, clinicians need to assist patients to enhance their beliefs in their ability in overcoming various situation impediments for opioid-taking.

The DNA repair gene X-ray cross-complementing group 4 (XRCC4), a member of the non-homologous end-joining (NHEJ) repair system, plays a major role in the repair of the double-strand breaks of the DNA sequence. This gene is critical to the maintenance of overall genome stability, and is also thought to play a key role in human carcinogenesis. In this case-control study, several novel polymorphic variants of XRCC4, including C-1622T (rs7727691), G-1394T (rs6869366), C-571T (rs2075686) and intron3 DIP (rs28360071), were investigated, and the correlation of these variants to prostate cancer susceptibility in a Taiwanese population was observed. A total of 134 prostate cancer patients were recruited along with 134 age-matched healthy controls, and the association of their selected genotypes with susceptibility to prostate cancer was determined. The G-1394T variant of XRCC4 proved, after analysis of the frequencies of each variant in the prostate cancer and control groups, to be a significant single nucleotide polymorphism (SNP) in prostate carcinogenesis. Our data clearly indicate that the heterogeneous G of G-1394T increases the risk of suceptibility to prostate cancer (P=0.0106), while no difference in distribution of XRCC4 C-1622T (rs7727691), C-571T (rs2075686) or intron3 DIP (rs28360071) between the prostate cancer and control groups was found. In conclusion, our findings suggest that the G allele of XRCC4 G-1394T may be responsible for prostate carcinogenesis, and could be useful in the early detection and prevention of the disease.

It is important to understand how knowledge of genomics can be translated from research into clinical practice and health policies. This review examines existing evidence on three key factors in the adoption of personalized medicine: utilization, preferences, and economic value, using two cancer examples: HER2/neu antigen testing and trastuzumab (Herceptin) treatment and genetic testing for Lynch syndrome. Our findings highlight areas in which additional research is required to build an evidence base addressing utilization of, preferences for, and the potential costs and benefits of personalized medicine. Major challenges include a lack of linked data, the need for relevant research frameworks and methodologies, and the clinical complexities of genomic-based diagnostics and treatment.

Background: The DNA repair gene XRCC4, an important caretaker of overall genome stability, is thought to play a major role in the development of human carcinogenesis. However, the association of the polymorphic variants of XRCC4 with oral cancer susceptibility has never been reported., Materials and Methods: In this hospital-based case-control study, the association of XRCC4 codon 247 (rs3734091), G-1394T (rs6869366), intron 7 (rs28360317) and intron 7 (rs1805377) polymorphisms with oral cancer risk in a Central Taiwanese population was investigated. In total, 318 patients with oral cancer and 318 age- and gender-matched healthy controls recruited from the China Medical Hospital in Central Taiwan were genotyped., Results: A significantly different distribution was found in the frequency of the XRCC4 codon 247 genotype, but not the XRCC4 G-1394T or intron 7 genotypes, between the oral cancer and control groups. A/C heterozygosity at XRCC4 codon 247 conferred a significant (2.04-fold) increased risk of oral cancer. As for XRCC4 G-1394T and intron 7 polymorphisms, there was no difference in distribution between the oral cancer and control groups. Gene-environment interactions with smoking, but not with betel quid chewing or alcohol consumption, were significant for XRCC4 codon 247 polymorphism. The XRCC4 codon 247 A/C genotype in association with smoking conferred an increased risk of 3.44 (95% confidence interval = 1.24-9.60) for oral cancer., Conclusion: Our results provide the first evidence that the heterozygous A allele of the XRCC4 codon 247 may be associated with the development of oral cancer and may be a novel useful marker for primary prevention and anticancer intervention.

Recent biochemical and genetic approaches have clearly defined the functional role of critical components in tyrosine phosphorylation-dependent signal transduction. These signaling modulators often exhibit evolutionarily conserved functions across various species. It has been proposed that if protein tyrosine kinases (PTKs), protein tyrosine phosphatases (PTPs), and thousands of their substrates could be identified and characterized, it would significantly advance our understanding of the underlying mechanisms that control animal development and physiological homeostasis. The fruit fly Drosophila melanogester has been used extensively as a model organism for investigating the developmental processes, but the state of its tyrosine phosphorylation is poorly characterized. In the current study, we used advanced mass spectrometry (MS)-based shotgun analyses to profile the tyrosine phosphoproteome of Drosophila S2 cells. Using immunoaffinity isolation of the phosphotyrosine (pTyr) subproteome from cells treated with pervanadate followed by enrichment of phosphopeptides, we identified 562 nonredundant pTyr sites in 245 proteins. Both this predefined pTyr proteome subset and the total cell lysates were then used as sample sources to identify potential substrates of dPTP61F, the smallest member in terms of amino acid number and molecular weight in the Drosophila PTP family and the ortholog of human PTP1B and T Cell-PTP, by substrate trapping. In total, 20 unique proteins were found to be specifically associated with the trapping mutant form of dPTP61F, eluted by vanadate (VO4(3-)), and identified by MS analyses. Among them, 16 potential substrates were confirmed as tyrosine phosphorylated proteins, including a receptor PTK PDGF/VEGF receptor, a cytosolic PTK Abl, and several components of SCAR/WAVE complex, which may work in coordination to control actin dynamics. Thus, our data suggest that dPTP61F plays a central role in counteracting PTK-mediated signaling pathways as well as in regulating actin reorganization and remodeling through tyrosine dephosphorylation of critical substrates in Drosophila cells.

A multilocus variable-number tandem-repeat (VNTR) analysis (MLVA) method was developed and evaluated for the subtyping of Shigella sonnei isolates. A total of 26 VNTR loci were identified by exploring the repeat sequence loci in the genomic sequences of S. sonnei strains Ss046 and 53G and by testing 536 isolates that had previously been characterized by pulsed-field gel electrophoresis (PFGE). The discriminatory power of MLVA (Simpson's index of diversity [D], 0.9524; 95% confidence interval [CI], 0.9373 to 0.9564) for the 536 isolates was significantly higher than that of PFGE (D, 0.8882; CI, 0.8667 to 0.9097). MLVA typing with the four and eight most variable loci had D values of 0.9468 and 0.9481, respectively, results approaching that of 26 loci. The usefulness of MLVA for outbreak investigation was evaluated using 151 isolates from 10 shigellosis outbreaks and 22 PFGE-indistinguishable isolates collected from nine epidemiologically unrelated events in five different countries. The evaluations indicated that MLVA was a powerful typing tool to distinguish isolates for outbreak investigation and that it exhibited a good discrimination of the 22 PFGE-indistinguishable isolates. Single-locus variants did occur during the outbreak; therefore, S. sonnei isolates with MLVA profiles differing at no more than a single locus should be considered part of the same outbreak. The present study suggests that MLVA has the potential to replace PFGE as a standard method of typing S. sonnei isolates for disease surveillance and outbreak investigation.

Introduction: Studies show that the recommendations of a primary care physician for colorectal cancer screening may be one important influence on an individual's use of screening. However, another possible influence, the effect of regional differences in physicians' beliefs and recommendations on screening use, has not been assessed., Methods: We linked data from the National Health Interview Survey on the use of colorectal cancer screening by respondents aged 50 years or older, by hospital-referral region, with data from the Survey of Colorectal Cancer Screening Practices on the colorectal cancer screening recommendations of primary care physicians, by region. Our principal independent variables were the proportion of physicians in a region who recommended screening at age 50 and continuing screening at the recommended frequency., Results: On average, 53.3% of physicians in a region correctly recommended initiating colorectal cancer screening, and 64.8% advised screening at the recommended frequency. Of adults who lived in regions where less than 30% of physicians correctly recommended initiating screening, 47.3% had been screened, in contrast to 54.8% in areas where 70% or more of physicians made correct recommendations. Seventy-one percent of respondents living in regions where less than 30% of physicians advised screening at the recommended frequency were current on screening, in contrast to 79.9% of respondents living in regions where 70% or more of physicians made this recommendation. These differences were statistically significant after adjustment for individual characteristics., Conclusion: Strategies to improve colorectal cancer screening recommendations of primary care physicians may improve the use of screening for millions of Americans.

Objectives: Personalized medicine using genetic information is increasing in cancer screening and treatment; however, little is known about perceived value of genetic testing for cancer risk in a general population. The objectives of this report are: to identify a general population's willingness to pay for genetic testing that provids colorectal cancer risk information; examine whether screening intentions (likelihood of testing and test choice) change based on risk; and identify providers' beliefs about patients' perceived value., Methods: A survey of US general (n = 1087) and physician (n = 100) populations using the willingness-to-pay method was carried out. Physicians responded from the perspective of a typical patient. χ 2 tests, t-tests and ordered logistic regression were used to examine factors associated with willingness to pay and intentions to be screened., Results: General population respondents' average willingness to pay for a genetic test for colorectal cancer risk was US$150. Higher willingness to pay was significantly associated with being male, having higher income and education, having private health insurance and reporting a greater likelihood of getting colorectal cancer screening when due. Physicians' beliefs about patients were different than general population responses: physicians believed patients would be willing to pay more (US$212; p < 0.001), fewer believed patients would not pay (1 vs 17%; p<0.001), and if a genetic test indicated higher than average risk, physicians believed patients would be more likely to get screened (65 vs 46%; p < 0.001) and would choose alternative screening tests (62 vs 22%; p < 0.001)., Conclusion: Respondents valued genetic tests to inform screening decisions and indicated that tests may influence screening choices. Additional studies are needed to examine the implications of physicians' beliefs about patients' choices for screening.

Infectious diseases remain a significant cause of morbidity and mortality in the growing number of adults over the age of 65 years in the United States. Declining immunity coupled with aging anatomy and physiology set the stage for increased vulnerability to infections and the development of atypical presentations in the elderly. Pneumonia, urinary tract infection, and skin and soft tissue infections are illnesses commonly encountered in the care of this unique population. This article explores the etiology, diagnosis, and constantly evolving treatment of these conditions in the context of the elderly patient.

Objective: To evaluate the costs of preventing AIDS transmission from mothers to children in a high-incidence area and to investigate relations between costs and effects, as well as to study the economical effects of this approach., Methods: According to the number of patients and each strategy on prevention of AIDS transmission, following aspects were calculated as: the cost of preventing each patient with HIV infection, to avoid the cost of one disability adjusted life year (DALY), to evaluate the cost of each patient with either HIV infection or HIV-infected thereafter,and to calculate the HIV-positive rates in mothers at the same levels between costs and effects., Results: The costs-effects for stopping pregnancy:it was 2264 Yuan for preventing one DALY, the costs of avoiding one case with HIV infection was 46 963 Yuan, but it was 211,000 Yuan from each patient after HIV infection, the ratio between effects and costs was 4.5:1. The costs-effects for comprehensive strategies showed that the cost was 60 853 Yuan for avoiding one case with HIV infection. It was 211,000 Yuan for each patient after HIV infection and the ratio between effects and costs was 3.5:1., Conclusion: The cost-effect of preventing HIV transmission from mothers to children was significant on the basis of economical level. It was more effective to evaluate the relation between costs and effects according to economical level in screening and preventing transmission from mothers to children under the situation that the HIV-positive rate in pregnant mothers was more than 0.03%.

Background: A major health priority is to increase colorectal cancer screening, and colonoscopy has become an increasingly important method of screening. The Medicare program began coverage for colonoscopy for average risk individuals in 2001., Objectives: We sought to examine whether overall colorectal cancer screening increased over time and whether these increases were a result of increased utilization of all methods or a result of greater use of colonoscopy but reduced use of other methods, whether the enactment of Medicare coverage was associated with an increase in colonoscopy among Medicare enrollees, and whether these trends equally affected subpopulations., Methods: We used nationally representative data from the 2000 and 2003 National Health Interview Surveys and analyzed data using used chi, difference-in-differences tests, and logistic regression analyses to examine whether screening rates differed between 2000 and 2003., Results: The percentage of individuals being screened for colorectal cancer using any method increased modestly from 2000 to 2003 (3%), with increases a result of increased use of colonoscopy and a reduction in the use of other methods. Increases in colonoscopy use were significant among all populations except the insured, non-Medicare population with low incomes. Among Medicare enrollees with high/middle incomes, colonoscopy use increased 14% from 2000 to 2003 compared with an increase of only 7% among low-income groups, which was a significant difference (P < 0.01). Similarly, among insured, non-Medicare enrollees with high/middle incomes, colonoscopy use increased 11% from 2000 to 2003 compared with an increase of only 4% among low-income groups, which also was a significant difference (P < 0.01)., Conclusions: Colorectal cancer screening utilization increased modestly from 2000 to 2003, with the increases that primarily were the result of increased colonoscopy use. Increases in colonoscopy use, however, were primarily among high/middle income groups. Although Medicare coverage may have indirectly facilitated the increase in colonoscopy, we could not determine that coverage directly increased screening rates. Screening rates remain modest and lower income individuals continue to be screened less. Topics for future research include approaches to facilitating screening among low-income individuals and evaluating the impact of policy coverage decisions.

Measuring the characteristics of managed care plans and of the health care markets in which the plans operate is a complex undertaking. Based on a previously developed framework of health plan factors, we review measures of managed care plans and the characteristics of the area in which an individual resides using two national surveys, the Medical Expenditure Panel Survey (MEPS) and the National Health Interview Survey (NHIS), and other data sources such as the Area Resources File and the United States census. We provide empirical applications of these measures and also discuss common analytical issues that should be considered. Despite the many analytical challenges presented by these complex surveys, the MEPS and NHIS are rich sources of data for examining the impact of health plans and the characteristics of markets or areas on health care expenditures and outcomes.

Introduction: Despite widespread recommendations for colorectal cancer screening, the U.S. screening rate is low. The objectives of this study were to describe the rates and predictors of colorectal cancer screening use by examining groups in two categories--1) those who have ever been screened and 2) those with up-to-date screening--and to assess whether trends and predictors change over time., Methods: We analyzed data from the 2000 and 2003 National Health Interview Surveys about the use of fecal occult blood tests, sigmoidoscopies, and colonoscopies for adults aged 50 years and older and without a history of colorectal cancer (N = 11,574 in 2000 and N = 11,779 in 2003)., Results: Rates in the 2000 study population of those who have ever been screened for colorectal cancer (53%) had increased in the 2003 study population (55%) as had the rates in the 2003 study population of those with up-to-date colorectal screening (53%) compared with the rates in the 2000 study population (38%). Among those who were ever screened, 76% were up-to-date with screening in 2003, compared with 68% in 2000. There was increased use of colonoscopies but decreased use of fecal occult blood tests and sigmoidoscopies. Individuals were more likely to be up-to-date with screening if they had higher income, higher education, insurance coverage, a usual source of care, and a dental visit in the last year than if these predictors were not evident. Since 2000, these predictors of colorectal cancer screening use have remained stable., Conclusion: Although there has been relatively limited success in increasing overall screening, it is encouraging that most people in the group of those who have ever been screened are up-to-date with colorectal cancer screening. Predictors for colorectal screening were stable over time despite changes in screening policies and rates. Further research is needed to uncover barriers to colorectal cancer screening.

Taiwan experienced a series of outbreaks of nosocomial severe acute respiratory syndrome (SARS) infections in 2003. Two months after the final outbreak, we recruited 658 employees from the hospital that suffered the first and most severe SARS infections to help us investigate epidemiological and genetic factors associated with the SARS coronavirus (SARS-CoV). SARS-CoV infections were detected by using enzyme immunoassays and confirmed by a combination of Western blot assays, neutralizing antibody tests, and commercial SARS tests. Risk factors were analyzed via questionnaire responses and sequence-specific oligonucleotide probes of human leukocyte antigen (HLA) alleles. Our results indicate that 3% (20/658) of the study participants were seropositive, with one female nurse identified as a subclinical case. Identified SARS-CoV infection risk factors include working in the same building as the hospital's emergency room and infection ward, providing direct care to SARS patients, and carrying a Cw*0801 HLA allele. The odds ratio for contracting a SARS-CoV infection among persons with either a homozygous or a heterozygous Cw*0801 genotype was 4.4 (95% confidence interval, 1.5 to 12.9; P = 0.007).

Alpha-D-galactosidase (alpha-Gal,E.C. 3.2.1.22) is an exo-glycosidase. The enzyme isolated from coffee beans has been well characterized. It has high activity in hydrolyzing the terminal alpha-D-galactoside residues from glycoconjugates on human blood group B erythrocytes, as well as in converting the blood group B into O. A different 1089 bp cDNA open reading frame(ORF) encoding Gal of Coffea liberica & C. canephora was cloned by homology-based RT-PCR. The cloned Gal most closely resembles the corresponding one from C. aribica (98.7% and 99.27% identity). Heterologous overexpression of the two 1.1 kb cDNA fragments was obtained by using one Pichia pastoris stain GS115 and two secret expression vectors, pPICZalphaA and pGAPZalphaA. The expressed protein from P. pastoris stain GS115 was concentrated by ammonium sulfate precipitation and SDS-PAGE assay showed a clear band in the gel. The highest activity of the recombinant enzyme was up to 48.22 U/mL.

Dispensing limits, which ration prescriptions to 30-day supplies when filled at community pharmacies, is a strategy commonly used to control prescription drug costs. Yet, little is known about drug dispensing patterns. Prescription dispensing patterns may have important influences on adherence, therapeutic and preventive health outcomes, and costs. This study examined dispensing patterns for five drug classes commonly prescribed for chronic conditions.

Oxygen therapy is administered to patients who require enhanced oxygenation of their arterial blood, patients with, for example, respiratory conditions which have resulted in impaired gaseous exchanges in the lungs, or many conditions that impair oxygen delivery to the tissues, such as myocardial infarction. Generally speaking, oxygen is an effective drug which is used very commonly in clinics. From internal medical problems, to emergency situations, even surgical problems, all of us care for patients receiving oxygen therapy sometimes. Regardless of the nurse's knowledge and skills in relation to oxygen therapy, the key nursing role is to support and reassure the patient and gain his or her confidence in order to maintain compliance with the treatment. This article discusses the pathophysiological changes associated with hypoxia, oxygen delivery devices, and guidelines for caring for patients requiring supplemental oxygen. We expect this article to contribute to improvements in the quality of clinical oxygen therapy.

Objective: To investigate the use of alternative therapies among different racial/ethnic groups in the USA. Specifically, we examined whether alternative medicine use differs for working aged whites, Asian Americans, African Americans, and Hispanics., Design: Using the 1996 Medical Expenditure Panel Survey, racial differences in utilization were investigated at two levels: (1) the bivariate level with no controls for other factors and (2) at the multivariate level with controls for age, sex, region, marital status, education, income, health status, satisfaction with conventional healthcare, and access measures., Results: Americans in this sample population used alternative and complementary therapies at a fairly low rate (6.5%). This 6.5%, however, was not consistent across all groups. African Americans and Hispanics were less likely than whites to utilize alternative therapies, whereas Asian Americans did not differ significantly from whites., Conclusions: The use of alternative and complementary therapies varied across racial/ ethnic groups. Evidence showed that individuals who were dissatisfied with the availability of conventional healthcare, who were in poor health, but very satisfied with their conventional provider were more likely to use complementary and alternative medicine (CAM) therapies. The addition of these variables to a logistic regression model did not change the findings for differential use by ethnicity, the relative ranking of groups, or the overall strength of the relationship.

Objective: Two potential barriers to use of oral contraceptives (OCPs) are out-of-pocket expenditures and the inconvenience of monthly pharmacy visits. This study used nationally representative data to examine the out-of-pocket costs of OCPs and whether women obtain more than 1 pack per purchase., Methods: We used data from the 1996 Medical Expenditure Panel Survey. Dependent variables were out-of-pocket expenditures per pack and the number of packs obtained per purchase. Chi2 tests were used to examine the bivariate relationships between the dependent variables and covariates. Regression analyses were used to examine the predictors of OCP expenditures and the number of packs obtained per purchase., Results: Women paid an average of 14 dollars per pack of OCPs, and 73% obtained only 1 pack per purchase. On average, privately insured women paid 60% of the total expenditures for OCPs. Women who had no prescription drug coverage, who were uninsured, or who were privately insured but not in managed care plans had higher out-of-pocket expenditures. Women who were without prescription drug coverage or who were in managed care plans were more likely to obtain only 1 pack per purchase., Conclusion: Out-of-pocket costs and dispensing restrictions may be barriers to consistent use of OCPs. Women's health care providers should consider options to overcome these barriers, such as the use of mail order prescription services.

Objective: Managed care may have widespread impacts on health care delivery for all patients in the areas where they operate. We examine the relationship between area managed care activity and screening for breast, cervical, and prostate cancer among patients enrolled in more managed care plans and patients who are enrolled in less managed plans., Data and Methods: Data on cancer screening from the 1996 Medical Expenditure Panel Survey (MEPS) were linked to data on health maintenance organization (HMO) and preferred provider organization (PPO) market share and HMO competition at the metropolitan statistical area (MSA) level. Logistic regression analysis was used to examine the relationship between area managed care prevalence and the use of mammography, clinical breast examination, Pap smear, and prostate cancer screening in the past two years, controlling for important covariates., Results: Among all patients, increases in area-level HMO market share are associated with increases in the appropriate use of mammography, clinical breast exam, and Pap smear (OR for high relative to low managed care areas are 1.75, p < .01, for mammography, 1.58, p < .05, for clinical breast exam, and 1.71, p < .01, for Pap smear). In analyses of subgroups, the relationship is significant only for individuals who are enrolled in the nonmanaged plans; there is no relationship for individuals in more managed plans. No relationship is observed between area HMO market share and prostate cancer screening in any analysis. Neither the level of competition between area HMOs nor area PPO market share is associated with screening rates., Conclusions: Area-level managed care activity can influence preventive care treatment patterns.

Objective: To assess whether the specialty of a patient's primary care physician or being part of a gatekeeper plan influence breast and cervical cancer screening., Methods: Cross-sectional study of women in a national sample. For mammography, we studied women aged 40 and above, and for Papanicolaou (Pap) smear, women aged 18-65 years. Screening mammography or Pap smear within the previous two years was measured by patient self-report. The key independent variables were primary care physician specialty and whether the patient had a gatekeeper., Results: Among women seen by a family practice physician, there was a higher probability of being screened if the patient was part of a gatekeeper plan than if the patient was not part of a gatekeeper plan: mammography (OR = 1.35; 95% CI = 1.20-1.52) and Pap smear (OR = 1.60; 95% CI = 1.34-1.91). Among women seen by an internal medicine physician, cancer screening did not vary significantly by gatekeeper status., Conclusions: The impact of gatekeeper plans upon cancer screening varies according to the primary care physician's specialty. Policy interventions designed to increase cancer screening should take into account different responses to gatekeeper requirements among different types of providers.

Background: Although the majority of studies examining racial/ethnic disparities in health care have focused on the characteristics of the individual, more recently there has been growing attention to the notion that an individual's health practices could be influenced by the characteristics of the place where they reside., Objective: The objective of this study was to examine whether access to care for individuals of different racial/ethnic groups varies by the prevalence of blacks and the prevalence of Latinos in their county of residence., Study Design: We conducted a cross-sectional cohort., Participants: Individuals from the 1996 Medical Expenditure Panel Survey, a nationally representative sample of U.S. households, who described their race/ethnicity as white, black, or Latino, and who resided in 1 of 677 counties (n = 14740) were studied., Measures: Counties were assigned to 6 groups based on the prevalence of blacks and Latinos who resided there (<6% referred to as "low prevalence," 6-39% referred to as "midprevalence," >or=40% referred to as "high prevalence" separately for both blacks and Latinos). Outcomes included whether during the past year any family members: 1). experienced difficulty obtaining any type of health care, delayed obtaining care, or did not receive health care they thought they needed (referred to as "difficulty obtaining care"); or (2). did not receive a doctor's care or a prescription medication because the family needed money to buy food, clothing, or pay for housing (referred to as "financial barriers")., Results: After controlling for other individual and area-level covariates, blacks reported lower rates of both outcome variables when they lived in a county with a high prevalence of blacks compared with blacks who lived in a county with a low prevalence of blacks (difficulty obtaining care: 4.3% vs. 18.8%, P <0.005; financial barriers: 1.6% vs. 10.5%, P <0.005). There was a similar association for Latinos by the prevalence of Latinos in the county for difficulty obtaining care (high: 5.0% vs. low: 13.4%, P <0.05), but not the financial barriers outcome (high: 2.2% vs. low: 2.4%, P = 0.90). Whites who lived in an area with a high prevalence of Latinos were more likely to report both outcomes compared with whites who lived in a county with a low prevalence of Latinos (difficulty obtaining care: 17.7% vs. 9.4%, P <0.05; financial barriers: 8.5% vs. 3.2%, P <0.005) ., Conclusions: Blacks and Latinos may perceive fewer barriers to care when they live in a county with a high prevalence of people of similar race/ethnicity. Conversely, whites may perceive more difficulty receiving care when they live in an area with a high prevalence of Latinos. Diminishing disparities in access to health care may require interventions that extend beyond the individual.

Objectives: To explore the characteristics of individuals who are dissatisfied with their health plan, assess what aspects of the medical care experience are associated with plan dissatisfaction, and examine how this association varies according to plan type., Study Design: Retrospective observational study using the 1996 Medical Expenditure Panel Survey., Methods: Unwillingness to recommend a health plan to others was used as a measure of overall plan dissatisfaction. Descriptive statistics were calculated to characterize the dissatisfied population. Logistic regressions and predicted probabilities controlling for personal characteristics were calculated to determine the association between plan or provider attribute and unwillingness to recommend a plan., Results: We found no personal characteristics that significantly differentiated individuals who reported their family was unwilling to recommend a health plan from those who were willing. The largest predictors of unwillingness to recommend a plan were dissatisfaction with choice of providers and preventive services coverage; in contrast, provider and personal characteristics were not significant predictors of dissatisfaction. We estimated the probability of being unwilling to recommend a health plan was 38% for individuals dissatisfied with the choice of providers and 34% for those dissatisfied with preventive services coverage. Although provider attributes were not found to be predictors of plan dissatisfaction for the entire sample, they were predictors of dissatisfaction for HMO and multiple plan members., Conclusions: Enrollee dissatisfaction with the choice of providers and preventive services coverage are major predictors of health plan dissatisfaction. Managers concerned about plan satisfaction may want to examine enrollee assessments of these measures.

Objectives: To develop a framework of factors to characterize health plans, to identify how plan characteristics were measured in a national survey, and to apply our findings to an analysis of the predictors of screening mammography., Data Source: The primary data were from the 1996 Medical Expenditure Panel Survey., Study Design: Women ages 40+, with private insurance, and no history of breast cancer were included in the study (N = 2,909). We used multivariate logistic regression to estimate mammography utilization in the past two years relative to health plan and demographic factors. Health plan measures included whether there is a defined provider network, whether coverage is restricted to a network, use of gatekeepers, level of cost containment, copayment and deductible amounts, coinsurance rate, and breadth of benefit coverage., Principal Findings: We found no significant difference in reported mammography utilization using a dichotomous comparison of individuals enrolled in managed care versus indemnity plans. However, women in health plans with a defined provider network were more likely to report having received a mammogram in the past two years than those without networks (adjusted OR= 1.21, 95 percent CI = 1.07-1.36), and women in gatekeeper plans were more likely to report receiving mammography than those without gatekeepers (adjusted OR = 1.18, 95 percent CI = 1.03-1.36). Restricted out-of-network coverage, use of cost containment, enrollee cost sharing, and breadth of benefit coverage did not appear to affect mammography use., Conclusions: It is important to examine the effect of individual health plan components on the utilization of health care, rather than use the traditional broader categorizations of managed versus nonmanaged care or simple health plan typologies.

Objectives: To examine whether there are differential impacts of patient cost sharing and health plan organizational characteristics on the use of a recommended cancer screening service (mammography) versus a controversial cancer screening service (prostate cancer screening [PCS])., Study Design: Observational cohort using the 1996 Medical Expenditure Panel Survey., Patients and Methods: A nationally representative sample of privately insured individuals was examined. Outcome measures were the receipt of mammography and PCS. Logistic regression was used to assess the impact of patient cost sharing and health plan organizational characteristics on the receipt of mammography and PCS, controlling for other covariates., Results: Patient cost sharing and gatekeeper requirements were strong predictors of PCS but were statistically insignificant predictors of mammography. Men in health plans with a copayment over dollar 10 (odds ratio [OR] = 0.38, 95% confidence interval [CI] = 0.19-0.78) or with deductibles over dollar 250 (OR = 0.38, 95% CI = 0.23-0.62) were significantly less likely to receive PCS than men in plans with no or lower copayments and deductibles. Men in gatekeeper plans were less likely to receive PCS than those without gatekeepers (OR = 0.48, 95% CI = 0.29-0.81)., Conclusions: We found the impact of cost sharing on utilization is different between mammography and PCS. Prostate cancer screening utilization appears to respond to financial incentives while mammography utilization does not. The use of copayments, deductibles, and gatekeepers may discourage controversial services but may not have an adverse effect on more recommended services. These findings have implications for the design of insurance benefits and plan organizational structure.

Objective: There is widespread debate over whether health plans should require enrollees to use "gatekeepers," which are primary care providers that coordinate care and control access to specialists. However, little is known about whether health plan gatekeeper requirements improve or reduce quality-of-care. Our objective was to examine whether gatekeeper requirements are associated with the utilization of cancer screening for breast, cervical, and prostate cancer., Data Sources: Three linked sources (N = 13,534): (1) 1996 Medical Expenditure Panel Survey (MEPS) Household Survey, a nationally representative, ongoing survey sponsored by the Agency for Healthcare Research and Quality; (2) 1996 MEPS Health Insurance Plan Abstraction, which codes data from health plan booklets obtained from privately insured respondents, and (3) 1995 National Health Interview Survey., Study Design/data Collection: Cross-sectional, multivariate logistic regression analysis using secondary data., Principal Findings: We found in multivariate analyses that women in gatekeeper plans were significantly more likely to obtain mammography screening (Odds Ratio [OR] = 1.22, 95 percent Confidence Interval [CI] 1.07-1.40), clinical breast examinations (OR = 1.39, 95 percent CI 1.23-1.57), and Pap smears (OR = 1.33, 95 percent CI 1.16-1.52) than women not in gatekeeper plans. In contrast, gatekeeper requirements were not associated with prostate cancer screening (OR = 1.11, 95 percent CI 0.93-1.33). We found no association between screening utilization and aggregate plan types (HMO, POS, PPO, FFS)., Conclusions: Gatekeeper requirements are associated with higher utilization of widely recommended cancer screening procedures, but not with utilization of a less uniformly recommended cancer screening procedure. Researchers should consider the analysis of specific plan characteristics rather than aggregate plan types in conducting future research, and insurers and policymakers should consider the potential benefits of gatekeepers with respect to preventive care when designing health plans and legislation.

Objectives: We examined the effect of race, socioeconomic status, and health insurance status on the prevalence of overweight among children and adolescents., Methods: We studied an observational cohort from the 1996 Medical Expenditure Panel Survey Household Component., Results: In the younger group, both Black and Latino children had a greater likelihood of being overweight compared with White children. Among the adolescent group, Latinos and Asian/Pacific Islanders were more likely to be overweight. Among adolescents, lacking health insurance and having public insurance were both positively associated with the prevalence of overweight. A relationship between insurance status and overweight was not observed for younger children., Conclusions: There are substantial racial differences in the prevalence of overweight for children and adolescents. Health insurance status is associated with the prevalence of overweight among adolescents.

Aim: In order to detect risk factors for esophageal cancer, a national research program was carried out during the Eighth Five-Year Plan (from 1991 to 1995)., Methods: Cixian County and Chichen County in Hebei Province were selected as the index and the control for the study fields with higher or lower incidence of esophagus cancer in China, respectively. In these areas, we investigated the pollution of three nitrogenous compounds in well water for drinking and the use of nitrogen fertilizer in farming., Results: In well water, nitrate nitrogen, nitrite nitrogen and ammonia nitrogen were 8.77 mg/L, 0.014 mg/L and 0.009 mg/L in Cixian County in 1993, respectively. They were significantly higher than their levels (3.84 mg/L, 0.004 mg/L and 0.004 mg/L) in Chichen County (P<0.01, t=6.281, t=3.784, t=3.775). There was a trend that the nitrogenous compounds in well water increased from 1993 to 1996. The amount of nitrogen fertilizer used in farming was 787.6 kg per hectare land in Cixian County in 1991, significantly higher than 186 kg per hectare in Chichen County (t=9.603, P<0.001)., Conclusion: These investigations indicate that the pollution of nitrogenous compounds in well water for drinking is closely related to the use of nitrogen fertilizer in farming, and there is a significantly positive correlation between the level of three nitrogenous compounds in well water and the mortality of esophageal cancer (correlation coefficient =0.5992). We suggest that improvement of well system for drinking water quality should be an effective measure for esophageal cancer prevention and control in rural areas.

Background: Ethnic disparities in access to health care is a persistent problem in the US. Despite the broad implementation of managed care, there is little information that specifically addresses how this type of coverage may affect ethnic disparities., Objectives: To examine the effect of managed care insurance on the use of preventive care for different ethnic groups., Research Design: Observational cohort using the 1996 Medical Expenditure Panel Survey., Subjects: Adults with health insurance who report their ethnicity as white, black, Hispanic, or Asian/Pacific Islander., Main Outcome Measures: (1) Mammography within the past 2 years for women between 50 and 75 years of age; (2) clinical breast exam within the past 2 years for women between 40 and 75 years; (3) Papanicolaou smear within the past 2 years for women between 18 and 65 years; and (4) cholesterol screening within the past 5 years for men and women older than the age of 20 years., Results: Hispanic people enrolled in a managed care plan report higher rates of mammography, breast exam, and Papanicolaou smear compared with Hispanic people with fee-for-service insurance. For example, the adjusted predicted probability of a mammogram for Hispanic women with managed care was 85.6% compared with 72.4% for Hispanic women with fee-for-service coverage (risk difference: 13.2%; 95% CI for the risk difference 0.7%-25.7%). White persons with managed care are also more likely than white persons with fee-for-service coverage to receive mammography and cholesterol screening. Managed care is not associated with less preventive care for any ethnic group., Conclusions: In this nationally representative household survey, it was found that managed care is associated with greater use of some preventive care for Hispanic persons and white persons than fee-for-service insurance. Despite a focus on prevention, the benefits of managed care are not apparent for black persons or Asian/Pacific Islanders.

Objective: To estimate the effect of financial incentives in medical groups--both at the level of individual physician and collectively--on individual physician productivity., Data Sources/study Setting: Secondary data from 1997 on individual physician and group characteristics from two surveys: Medical Group Management Association (MGMA) Physician Compensation and Production Survey and the Cost Survey Area Resource File data on market characteristics, and various sources of state regulatory data., Study Design: Cross-sectional estimation of individual physician production function models, using ordinary least squares and two-stage least squares regression., Data Collection: Data from respondents completing all items required for the two stages of production function estimation on both MGMA surveys (with RBRVS units as production measure: 102 groups, 2,237 physicians; and with charges as the production measure: 383 groups, 6,129 physicians). The 102 groups with complete data represent 1.8 percent of the 5,725 MGMA member groups., Principal Findings: Individual production-based physician compensation leads to increased productivity, as expected (elasticity = .07, p < .05). The productivity effects of compensation methods based on equal shares of group net income and incentive bonuses are significantly positive (p < .05) and smaller in magnitude. The group-level financial incentive does not appear to be significantly related to physician productivity., Conclusions: Individual physician incentives based on own production do increase physician productivity.

It has been suggested that the expansion of the leukemic cells in chronic lymphocytic leukemia (CLL) is due to dysregulation of pathways of programmed cell death (apoptosis) rather than cell proliferation, although differences may exist in early vs late and treated vs untreated patients. In the present study, we analyzed the expression of 11 proteins in CLL cells that are implicated in the control of apoptosis, proliferation, and differentiation, and correlated this expression profile with survival. Using a quantitative solid-phase radioimmunoassay (RIA), we measured the cellular protein levels of Bcl-2, cyclin D1, PCNA, ATM, Fas, Bax, retinoic acid receptor alpha (RARalpha), retinoic acid receptor beta (RXRbeta), Flt1, VEGF, and cellular beta2-microglobulin in 230 samples of CLL. Univariate analysis using the Cox proportional hazard model showed a correlation with survival of only the following proteins: Bcl-2 (P < 0.001), cyclin D1 (P = 0.027), Fas (P = 0.055), PCNA (P < 0.001), and ATM (P = 0.028). In a multivariate analysis using classification and regression tree analysis (CART), five groups of patients (nodes) could be generated with significant differences of survival expectation (P < 0.0001) based on levels of expression of the above proteins. Based on CART analysis, Bcl-2 levels emerge as the most important protein in predicting survival between all 11 proteins studied. Patients with marked elevation in Bcl-2 levels had the worst outcome while patients with intermediate levels, but with high levels of PCNA and cyclin D1 or abnormal ATM expression had intermediate survival. These data indicate that intracellular levels of proteins such as Bcl-2, ATM, cyclin D1, and PCNA can be used as markers to predict clinical behavior and survival in patients with CLL. The pathways in which these proteins are involved may also represent possible targets for future therapeutic trials in CLL.