ATW1H%ASUACAD.BITNET@oac.ucla.edu (Dr David Dodell) (08/15/89)
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applauds the suggested rule. The Health Care Financing Administration has
proposed similar regulations aimed at ensuring greater accuracy in laboratory
testing. AMERICAN MEDICAL NEWS June 16,1989.
The splitting of livers for transplants may provide one solution to the
shortage of organs, according to surgeons at the University of Chicago, who
have been employing the procedure with growing frequency and success. ``We're
potentially doubling the number of patients who could be treated with an
available donor,'' said Dr. Jean Emond, assistant professor of surgery.
CHICAGO TRIBUNE (AP) June 2,1989.
A bill that would permit the licensing of some foreign-born physicians after a
period of training in the state has been passed by the Florida House of
Representatives. The bill applies mainly to 400 or so immigrant M.D.s from
Nicaragua, who say they should be given the same treatment as the 6,000
immigrant Cuban M.D.s who were licensed from 1961 to 1968. AMERICAN MEDICAL
NEWS June 9,1989.
A fire on May 10 at the Jackson Laboratory in Bar Harbor, Maine, one of the
world's leading suppliers of research mice, has caused major disruptions in
experimental scientific work in the United States, Canada, and elsewhere. The
fire wiped out half the laboratory's production capacity and killed 500,000
mice, and it may take as long as two years to replenish the stock, company
officials say. THE NEW YORK TIMES June 15,1989.
A conservative estimate of the fatalities attributed to the heat last summer,
one of the hottest summers recorded in this century, was between 10,000 and
15,000 persons, about 70% of whom were older Americans, according to an
analysis by the Center for Environmental Physiology in Washington, D.C. Heat
stroke is the most dangerous heat-induced illness, and heat exhaustion the
most common. Those at greatest risk are older people living in the Northeast
or Midwest, where temperatures fluctuate widely and humidity gets very high.
AARP NEWS (American Association of Retired Persons press release) June
14,1989.
NEW COMPUTER-IMAGING PROGRAM MAY AID DIAGNOSIS
By using a simple, ``user-friendly'' graphic display on a computer screen,
physicians and medical technicians can now manipulate and alter body images to
analyze tumors and other parts of the body. Until now, doctors needing to
produce an image of a tumor, or opticians looking at a picture of the retina
of the eye, for example, had to enlist the help of image-processing and
computer-programmer specialists to enhance the images so relevant diagnostic
information could be obtained. The new system is called a visual programming
language (VPL). It was developed by British researchers at Canon's new
European research center in Guilford, England using Smalltalk, a programming
tool created by Xerox. VPL presents doctors with a screen display similar to
that of the Apple Macintosh; it uses picture symbols and display ``windows''
to represent different tasks and functions, respectively. Using the ``viewer''
function, doctors can look at an image they previously created. With the
``display'' function, they can select and display a particular part of an
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Volume 2, Number 29 July 17, 1989
image. They also can assign false colors to different areas of the image or
adjust brightness threshold values to make certain features easier to see. The
system is limited in its present form in that it can only select parts of an
image that are related visually, such as having the same brightness. It cannot
be used to highlight suspected tumors or other abnormalities. However,
according to David Lau-Kee, the research scientist who developed VPL, the
system could be adjusted to do this, provided an ``expert'' program containing
medical information were piggybacked onto the existing set up. A commercial
version of VPL is expected to be ready in about one year. NEW SCIENTIST June
24,1989; 122:39.
More than a million persons in the United States had facial plastic surgery in
1988, or a 17% increase since 1986, according to a study conducted by the
University of North Carolina for the American Academy of Facial Plastic and
Reconstructive Surgery (AAFPRS). Rhinoplasty (surgery of the nose) topped the
list of procedures performed by facial plastic surgeons last year, followed by
blepharoplasty (surgery of the eyelids), and facelifts. FACIAL PLASTIC
SURGERY (AAFPRS press release) June 18,1989.
Resembling a small tank with treads instead of wheels, a new wheelchair
developed by the Quest Technologies Corp. of Sunnyvale, Calif., can climb
curbs and stairs and negotiate rough terrains with ease. An automatic center-
of-gravity control tilts the seat of the Access Mobility System to keep the
rider level and a sonar-based inclinometer prevents a rider from attempting
too steep a climb. The $20,000 price tag on the 370-pound chair is said to be
offset by the fact that it eliminates the need to build ramps or install
elevators in the home. THE NEW YORK TIMES June 21,1989.
Victory has been claimed at last in the race to develop a vaccine against
malaria, the so-called killer scourge of the tropics for which no effective
preventive medicine has ever been found. If his success is established, the
laurels will go to Dr. Manuel E. Patarroyo, who has tested his vaccine on
hundreds of soldiers stationed in Colombia's Amazon lowlands, where malaria is
endemic. Until a report on the field testing is published, Dr. Patarroyo does
not want to divulge details of his work, but he did admit that the results
have been ``extremely positive.'' In Colombia, the number of reported cases of
malaria jumped to 101,000 last year, up from 55,000 in 1984. In Brazil, Latin
America's most populous country, it is estimated that 17,000 people died of
the disease in 1988. LOS ANGELES TIMES June 19,1989.
In a study of 1,273 stroke victims from hospitals in Baltimore, Boston,
Chicago, and New York, it was found that among 744 patients who had had
strokes while awake, the incidence was highest between 10 a.m. and noon, with
frequency progressively declining to a low point between 10 p.m. and midnight.
A smaller number, 331 patients, had awakened with stroke symptoms, suggesting
that the stroke had occurred during sleep. For the remaining patients, it was
not possible to determine the exact time at which they were stricken. The
findings reflect those of previous studies in Great Britain, Yugoslavia, and
France, which concluded that the peak time for strokes is in the morning and
early afternoon. THE WASHINGTON POST June 20,1989.
Researchers have found evidence of a class of cancer-promoting genes that
function by inactivating other genes that ordinarily prevent the cancer
process from starting, according to a report in the latest issue of ``Nature''
by Dr. Ronald M. Evans and colleagues from the Salk Institute for Biological
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Volume 2, Number 29 July 17, 1989
Studies in La Jolla, Calif. The research suggests that a newly discovered type
of oncogene, called the v-erbA gene, blocks the normal actions of thyroid
hormone in helping immature cells to differentiate. This blockage could then
lead to the production of large numbers of abnormally immature blood cells,
and possibly other cells as well, which could result in the proliferation of
cancerous tissue. THE NEW YORK TIMES June 22,1989.
Carbamazepine (Tegretol, Ciba-Geigy) has been added to the list of common
epilepsy drugs that appear to cause birth defects and retardation in the
children of women who take them during pregnancy. The findings could pose a
dilemma for pregnant epileptic women, because the seizures the drug is
intended to prevent can also harm the fetus. Ciba-Geigy criticized the study
on which the conclusions were based as having ``serious methodological
problems.'' The company noted that the researchers used women who were not
epileptics as a comparison group, and that the higher risk of birth defects
among the children of epileptic women might have resulted from the epilepsy
itself, and not from the medication. THE NEW YORK TIMES (AP) June 22,1989.
FIGHTING GUINEA WORM DISEASE
An estimated 20 million people globally are infected by guinea worm disease
each year, with another 140 million persons at risk of infection in 19 African
and 4 Asian countries, said Dr. Joseph Christmas, UNICEF's Chief-Designate of
the Water and Enviromental Section in New York.
Guinea worm is the common term for "drancunculiasis," a parasitic, water-borne
disease that affects the human body through the drinking of contaminated water
Caused by human ingestion of the guinea worm larvae, water fleas commonly know
as "cyclops," they are usually found in shallow pools, ponds and step-wells
used for drinking and washing in rural areas of developing countries.
When humans drink the contaminated water, the acidic gastric juice kills the
fleas and release the larvae, which then penetrate the stomach lining. About
12 months later, the nearly one-metre-long worm works itself out of a person's
skin, secreting a corrosive agent and causing painful ulcers. The disease is
particularly debilitating, because it incapacitates victims for a period of 1-
3 months, preventing children from going to school, or men and women from
working.
There is no suitable drug, vaccine or mass treatment available for its cure,
but guinea worm can be prevented by drinking safe water. Sanitation, health
and hygiene education are needed to help eradicate the disease, Dr. Christmas
said. Filtering and boiling the water, and digging bore-holes for wells that
provide clean water are preventive solutions.
In Nigeria, a study of a village with 1.6 million inhabitants showed that 20
million U.S. dollars were lost in rice production alone because of the problem
School children were unable to walk to school, and absenteeism was rampant due
to the disease, he said.
But UNICEF's experience in Nigeria and Benin, and India's successful
elimination of guinea worm in Tamil Nadu, demonstrate that by providing
communities with clean water and educating people about basic health and
hygiene, the disease is "eradicable." India, with an estimated 44,800 cases i
1983, reported 12,000 cases during 1988, and is well on its way to total
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Volume 2, Number 29 July 17, 1989
eradication by 1990, he said.
UNICEF, in collaboration with WHO, the Centers for Disease Control in Atlanta,
Georgia, the Carter Foundation's Global 2000 Project and other UN agencies hav
endorsed the elimination of "drancunculiasis" as a sub-goal of the
International Drinking Water Supply and Sanitation Decade, whose goals and
strategies have now been extended into the 1990s. "Funds for water supply and
sanitation should be redirected to endemic African countries where assessments
and surveys can determine the prevalence and severity of guinea worm disease,"
Dr. Christmas said. He told those attending the seminar that 1.5 million U.S.
dollars will go to these countries for assessments, training workshops and
other activities.
The lecture was part of UNICEF's series of lunch-time "Food for Thought"
seminars organised by its Staff Training Section.
Source: Division of Information
FEVER-LOWERING DRUGS MAY PROLONG SYMPTOMS OF VIRAL ILLNESS
Giving children with viral illnesses fever-lowering drugs such as aspirin and
acetaminophen may do more harm than good, by prolonging other symptoms, a team
of Baltimore researchers reports. Timothy F. Doran, MD, of the Department of
Pediatrics at Baltimore's Sinai Hospital and colleagues found not only that
acetaminophen (the active ingredient in Tylenol and in a number of other over-
the-counter headache and pain medicines) did not alleviate the symptoms of
chickenpox in children, it actually prolonged the symptoms. The researchers
say their findings ``support the American Academy of Pediatrics recommendation
that `consideration be given to the advisability of using any [fever lowering]
medications for [viral] illnesses.' '' Acetaminophen has been touted in recent
years as a ``safe'' alternative to aspirin, in light of indications that
giving aspirin to children infected with the influenza virus precipitated a
rare but life-threatening condition known as Reye syndrome, which usually
occurs in children under the age of 18 and is characterized by neurologic
changes that may lead to incoordination, mental deterioration, and coma. Dr.
Doran and his colleagues say their study is the first to examine the effect of
fever-lowering agents on the course of a childhood viral illness itself. They
examined 68 children aged one to 12 years who had chickenpox, an infection
caused by the varicella-zoster virus. All patients in the study were enrolled
within 36 hours of the first sign of the rash. Thirty-seven children were
assigned randomly to receive acetaminophen, and, for comparison, 31 randomly
received an inert pill as a placebo. Over the course of the study, the
children's parents were asked (based on photographs from the Centers for
Disease Control) to record the stage of progression of the rash until it
cleared, and to keep a ``temperature and symptom diary.'' Based on this
information, the researchers concluded that acetaminophen did not
significantly reduce fever, since fever greater than or equal to 38 degrees
Centigrade (100.4 degrees Fahrenheit) ``was equally distributed between [the
acetaminophen and the placebo] groups.'' They further found that, not only was
acetaminophen no better than placebo in alleviating symptoms such as itching
and loss of appetite, pustules on children treated with acetaminophen took
about one day longer to scab than did those in the placebo-treated group.
Since it is known that viral shedding ends when the vesicles have become dry
and encrusted, the researchers speculated (since viral cultures were not done)
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Volume 2, Number 29 July 17, 1989
that acetaminophen may have ``blunted'' the immune response to the varicella-
zoster virus infection, ``leading to a delayed clearance of the virus,''
indicating that it may prolong illness. THE JOURNAL OF PEDIATRICS June 1989;
114:1045-1048.
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Volume 2, Number 29 July 17, 1989
===============================================================================
Center for Disease Control Reports
===============================================================================
Morbidity and Mortality Weekly Report
Thursday July 6, 1989
Perspectives in Disease Prevention
and Health Promotion
Progress Toward Achieving the 1990 National Objectives
for Physical Fitness and Exercise
Eleven of the 1990 health objectives for the nation address physical
fitness and exercise. These 11 objectives target specific reductions in risk,
improvements in public and professional awareness, availability of services,
and surveillance systems. A status review in 1985 indicated that two
objectives had been achieved or were on track for achievement by 1990, and
seven were judged as unlikely to be achieved; data were unavailable to assess
progress toward two objectives (1). This article summarizes progress through
June 1988.
REDUCTION OF RISK
By 1990, the proportion of children and adolescents ages 10 to 17
participating regularly in appropriate physical activities, particularly
cardiorespiratory fitness programs which can be carried into adulthood, should
be greater than 90%.
This objective is unlikely to be met. The 1984 National Children and Youth
Fitness Study (NCYFS) (2) found that 66% of children ages 10-17 were
participating at the level recommended by the 1990 objective. The recommended
level is at least three or more times/week for at least 20 minutes/session in
an activity that is likely to be done as an adult, that involves large-muscle
groups in dynamic contractions, and that requires 60% or more of
cardiorespiratory capacity.By 1990, the proportion of children and adolescents
ages 10 to 17 participating in daily school physical education programs should
be greater than 60%.
This objective is unlikely to be met. In 1984, the NCYFS found that 36% of
children 10-17 years old in grades 5-12 had daily physical education classes.
In 1974-1975, an estimated 33% had daily classes. Achieving this 1990
objective will require different strategies for different grades. In 1984,
greater than 90% of children in grades 5-8 were enrolled in physical education
classes, but fewer than half had daily physical education classes. In
contrast, the proportion of children in grades 9-12 enrolled in physical
education classes ranged from 81% in grade 9 to 52% in grade 12; more than
half of those enrolled had daily physical education classes. Thus, to achieve
this objective by 1990, physical education classes need to be more frequent
for grades 5-8, and enrollment needs to be increased for grades 9-12.By 1990,
the proportion of adults 18 to 65 participating regularly in vigorous physical
exercise should be greater than 60%.
This objective is unlikely to be met. At the midcourse review in 1985, an
estimated 10%-20% of adults were participating at the level recommended in the
1990 objective. Data from the 1984-1987 Behavioral Risk Factor Surveillance
System (BRFSS) sur veys and the 1985 National Health Interview Survey (NHIS)
have shown that only about 8% of adults are participating regularly at the
level recommended in the 1990 objectives (3).By 1990, 50% of adults greater
Health InfoCom Network News Page 15
Volume 2, Number 29 July 17, 1989
than or equal to 65 years should be engaging in appropriate physical activity,
e.g., regular walking, swimming, or other aerobic activity.
This objective is unlikely to be met. In 1975, an estimated 35% of adults
greater than or equal to 65 years of age took regular walks. In the 1985 NHIS,
46% of this population reported walking for exercise. However, only 8% walked
or participated in other physical activities often enough or long enough to
meet the definition of appropriate physical activity recommended in the 1990
objectives (3).
PUBLIC/PROFESSIONAL AWARENESS
By 1990, the proportion of adults who can accurately identify the variety and
duration of exercise thought to promote most effectively cardiovascular
fitness should be greater than 70%.
This objective is unlikely to be met. In the 1985 NHIS, when adults
greater than 18 years of age were asked about the characteristics of exercise
needed to strengthen the heart and lungs, 39% reported that exercise should be
done 3-4 days/week; 23%, for 15-25 minutes/occasion; and 34%, so that the
heart rate and breathing are "a lot faster but talking is possible." All three
questions were correctly answered by 5%.By 1990, the proportion of primary-
care physicians who include a careful exercise history as part of their
initial examination of new patients should be greater than 50%.
On the basis of limited data, this objective may have been achieved. In
1981, 47% of primary-care physicians in Massachusetts and Maryland reported
that they "routinely" ask patients about exercise behavior.
SERVICES/PROTECTION
By 1990, the proportion of employees of companies and institutions with over
500 employees offering employer-sponsored fitness programs should be greater
than 25%.
This objective appears to have been met. In 1979, only 3% of such
companies had formally organized fitness programs. By 1985, 32% of the
worksites with 250-749 employees and 54% of the worksites with greater than or
equal to 750 employees reported offering employer-sponsored fitness programs
(4).
SURVEILLANCE/EVALUATION SYSTEMS
By 1990, a methodology for systematically assessing the physical fitness of
children should be established, with at least 70% of children and adolescents
ages 10 to 17 participating in such an assessment.
This objective has two targets: 1) the development of methods to assess
the fitness of children and 2) widespread participation by children in the
assessment. The first target has been achieved. At least three tests of youth
physical fitness, including national norms, are available (5-7). However,
reliable estimates of the number of children participating in such tests are
not available.By 1990, data should be available with which to evaluate the
short- and long-term health effects of participation in programs of
appropriate physical activity.
Progress toward this objective is difficult to evaluate. Since this
objective was formulated in 1978, knowledge has increased substantially
regarding the effects of physical activity on cardiovascular disease,
hypertension, osteoporosis, diabetes, colon cancer, weight management, and
depression. However, many questions about the health effects of physical
Health InfoCom Network News Page 16
Volume 2, Number 29 July 17, 1989
activity remain unanswered (Table 1).By 1990, data should be available to
evaluate the effects of participation in programs of physical fitness on job
performance and health-care costs.
Progress toward this objective is difficult to evaluate. Although several
studies have been conducted to assess the effects of physical fitness on job
performance and health-care costs, substantive concerns about study design
constrain firm conclusions. Other problems include the lack of standard
operational definitions for job performance and health-care costs and the lack
of comparability between measures.By 1990, data should be available for
regular monitoring of national trends and patterns of participation in
physical activity, including participation in public recreation programs in
community facilities.
The first part of this objective has been met. Surveys have been
implemented or are planned to monitor national trends and patterns of
participation in physical activity. These surveys include the 1985 health
promotion supplement to the NHIS, the BRFSS, and the National Health and
Nutrition Examination Survey III. No information is available about
participation in public recreation programs in community facilities, and no
surveys are planned.
Reported by: The President's Council on Physical Fitness and Sports. Office
of Disease Prevention and Health Promotion, Office of the Assistant Secretary
for Health, Public Health Service. Cardiovascular Health Br, Div of Chronic
Disease Control and Community Intervention, Center for Chronic Disease
Prevention and Health Promotion, CDC. Editorial Note: Documentation of the
health benefits of regular physical activity has increased, and methods to
systematically track and describe patterns of physical activity in the United
States have improved greatly. Evidence indicates that regular physical
activity reduces the incidence of and/or is otherwise beneficial to many
medical conditions--including coronary heart disease, colon cancer,
osteoporosis, hypertension, depression, diabetes mellitus, and obesity. Most
data about the relationship between physical activity and colon cancer have
appeared within the past decade (15) and suggest that regular physical
activity may reduce the risk of colon cancer as much as 50%. Because general
relationships between physical activity and specific medical conditions have
been established, research efforts can now be focused on more specific
questions (Table 1).
Although objectives for participation in regular physical activity will
not be fully met, systems to regularly assess the level of participation have
been implemented. In 1985, CDC's National Center for Health Statistics
included questions about physical activity in the NHIS. The same questions
will be used in the 1990 survey. In addition, CDC's Center for Chronic Disease
Prevention and Health Promotion has used the BRFSS to assist state health
departments in monitoring levels of participation in leisure-time physical
activity.
In the past decade, evidence has suggested that the benefits of regular
physical activity accrue at lower levels of intensity than those required to
meet the standard set in the 1990 objectives (16,17). For example, although
less than 10% of the adult population meet the definition for "appropriate
physical activity" suggested in the 1990 objectives, another 34% are regularly
active (i.e., at least three 20-minute sessions/week) but at levels of
intensity that are lower than the objectives recommend. Members of this latter
group also appear to be receiving some health benefits. The national health
objectives for the year 2000 will address the benefits from moderate-intensity
physical activity and encourage greater participation at both moderate and
Health InfoCom Network News Page 17
Volume 2, Number 29 July 17, 1989
vigorous levels.
References
1. Public Health Service. The 1990 health objectives for the nation: a
midcourse review. Washington, DC: US Department of Health and Human
Services, Public Health Service, 1986.
2. Ross JG, Dotson CO, Gilbert GG, Katz SJ. What are kids doing in school
physical education? J Physical Education, Recreation and Dance 1985;56:73-
6.
3. Caspersen CJ, Christenson GM, Pollard RA. Status of the 1990 physical
fitness and exercise objectives--evidence from NHIS 1985. Public Health
Rep 1986;101:587-92.
4. Office of Disease Prevention and Health Promotion. National Survey of
Worksite Health Promotion Activities: a summary. Washington, DC: US
Department of Health and Human Services, Public Health Service, Office of
the Assistant Secretary for Health, 1987.
5. President's Council on Physical Fitness and Sports. 1985 National School
Population Fitness Survey. Washington, DC: US Department of Health and
Human Services, Public Health Service, Office of the Assistant Secretary
for Health, 1986.
6. American Alliance for Health, Physical Education, Recreation and Dance.
AAHPERD health related fitness test manual. Reston, Virginia: American
Alliance for Health, Physical Education, Recreation and Dance, 1980.
7. Ross JG, Gilbert GG. The National Children and Youth Fitness Study: a
summary of findings. J Physical Education, Recreation and Dance
1985;56:45-50.
8. Powell KE, Thompson PD, Caspersen CJ, Kendrick JS. Physical activity and
the incidence of coronary heart disease. Annu Rev Public Health
1987;8:253-87.
9. Blair SN, Jacobs DR Jr, Powell KE. Relationships between exercise or
physical activity and other health behaviors. Public Health Rep
1985;100:172-80.
10. Blair SN, Goodyear NN, Gibbons LW, Cooper KH. Physical fitness and
incidence of hypertension in healthy normotensive men and women. JAMA
1984;252:487-90.
11. Cummings SR, Kelsey JL, Nevitt MC, O'Dowd KJ. Epidemiology of osteoporosis
and osteoporotic fractures. Epidemiol Rev 1985;7:178-208.
12. Taylor CB, Sallis JF, Needle R. The relation of physical activity and
exercise to mental health. Public Health Rep 1985;100:195-202.
13. Farmer ME, Locke BZ, Moscicki EK, Dannenberg AL, Larson DB, Radloff LS.
Physical activity and depressive symptoms: the NHANES I epidemiologic
follow-up study. Am J Epidemiol 1988;128:1340-51.
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14. Koplan JP, Siscovick DS, Goldbaum GM. The risks of exercise: a public
health view of injuries and hazards. Public Health Rep 1985;100:189-95.
15. Kohl HW, LaPorte RE, Blair SN. Physical activity and cancer: an
epidemiological perspective. Sports Med 1988;6:222-37.
16. Powell KE, Spain KG, Christenson GM, Mollenkamp MP. The status of the 1990
objectives for physical fitness and exercise. Public Health Rep
1986;101:15-21.
17. Leon AS, Connett J, Jacobs DR Jr, Rauramaa R. Leisure-time physical
activity levels and risk of coronary heart disease and death. JAMA
1987;258:2388-95.
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Volume 2, Number 29 July 17, 1989
Epidemiologic Notes and Reports
B Virus Infections in Humans -- Michigan
In June 1989, two men were admitted to a Kalamazoo, Michigan, hospital
with B virus (Herpesvirus simiae) infection. Both men worked at an animal
research facility with rhesus (Macaca mulatta) and cynomolgus (Macaca
fascicularis) monkeys.
Patient 1, a 23-year-old, had worked at the facility for 2 years. Since
April, he had sustained monkey bites to hands and arms, and one bite to the
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