The unconscious, myth, and the rule of law: Reflections on the persistence of gender inequality.

Social order, to remain stable, needs the voluntary compliance of the majority of the population. Such consent requires normative justification. The rational foundation of the rule of law and the democratic state rests on the presumption of the equality of every citizen. Male domination of females nevertheless remains universal even in the most advanced democratic nation states because it is legitimized by the shared assumption that patriarchy reflects the will of God or is dictated by nature. Freud's diagnosis of patriarchy as a collective neurosis of the group mind negates every possible normative justification that can be made for gender hierarchy. Freud made extensive references to myth in developing his analysis of the neurotic foundations of social order. An analysis of the structure of myth suggests that ideological seduction rather than God, nature or biology determines male dominance.

Is the burden of overweight shifting to the poor across the globe? Time trends among women in 39 low- and middle-income countries (1991-2008).

BACKGROUND: Overweight prevalence has increased globally; however, current time trends of overweight prevalence by social class in lower income countries have not been fully explored. METHODS: We used repeated cross-sectional, nationally representative data from the Demographic and Health Surveys on women aged 18-49 years with young children (n=421,689) in 39 lower-income countries. We present overweight (body mass index ≥ 25 kg m⁻²) prevalence at each survey wave, prevalence difference and prevalence growth rate for each country over time, separately by wealth quintile and educational attainment. We present the correlation between nation wealth and differential overweight prevalence growth by wealth and education. RESULTS: In the majority of countries, the highest wealth and education groups still have the highest prevalence of overweight and obesity. However, in a substantial number of countries (14% when wealth is used as the indicator of socioeconomic status and 28% for education) the estimated increases in overweight prevalence over time have been greater in the lowest- compared with the highest-wealth and -education groups. Gross domestic product per capita was associated with a higher overweight prevalence growth rate for the lowest-wealth group compared with the highest (Pearson's correlation coefficient: 0.45). CONCLUSIONS: Higher (vs lower) wealth and education groups had higher overweight prevalence across most developing countries. However, some countries show a faster growth rate in overweight in the lowest- (vs highest-) wealth and -education groups, which is indicative of an increasing burden of overweight among lower wealth and education groups in the lower-income countries.

Emerging disparities in overweight by educational attainment in Chinese adults (1989-2006).

OBJECTIVE: To test whether a disparity in overweight by socioeconomic status (SES; represented by educational attainment) has emerged among men or women during a recent 17-year period in China. METHODS: Data from the China Health and Nutrition Survey (CHNS), a panel study including 7314 women and 6492 men, are used to longitudinally track the body mass index (BMI) and odds of overweight by educational attainment among Chinese adults (baseline age 18-50) from 1989 to 2006 to determine whether individuals of low (secondary school) educational attainment experienced a disproportionately faster increase in BMI or odds of overweight (BMI≥25) over time. The unadjusted mean BMI and prevalence of overweight by education are presented. Sex-stratified, random-effects models are used to estimate the associations, and interactions by birth cohort are included. FINDINGS: Overweight prevalence doubled for women and tripled for men. In 1989, among women, the odds of overweight were not different for those of high versus those of low educational attainment; however, by 2006, the odds of overweight were significantly lower for those with the highest education in both the younger (odds ratio (OR) 0.22 (CI 0.11, 0.42)) and the older (OR 0.27 (CI 0.10, 0.72)) birth cohorts. The reverse trend is seen for men, who also begin with no difference in odds of overweight by SES, but by 2006, the OR for the highest versus the lowest education group was 3.4 (CI 1.82, 6.18). CONCLUSIONS: Over 17 years, low SES has become associated with higher BMI and odds of overweight among Chinese women, whereas high SES remains a risk factor for overweight among Chinese men.

Laboratory assessment of the Sensodyne Mikro Aktiv extra soft toothbrush and the Oral-B indicator soft toothbrush.

OBJECTIVE: The objective of this laboratory study was to assess the Sensodyne Mikro Aktiv extra soft toothbrush, compared with the Oral-B Indicator soft toothbrush, for interproximal access efficacy (IAE). METHODS: Six toothbrushes of each product were tested four times, for a total of twenty-four tests on each toothbrush design. In the IAE assay, the tooth brushing technique involved independent evaluations of each toothbrush in a vertical or horizontal brushing motion, tooth shapes simulating anterior and posterior teeth, and a brushing weight of 250 g. The brushing apparatus was set to brush for 15 seconds at two strokes per second with a 50 mm stroke. All readings were measured with 3x magnification by a single investigator. RESULTS: The mean IAE value on anterior tooth shapes, with vertical and horizontal brushing, was significantly (p < 0.001) higher for the Sensodyne Mikro Aktiv toothbrush than for the Oral-B Indicator toothbrush. When the IAE values were combined to give an overall brushing average, the Sensodyne Mikro Aktiv toothbrush was significantly (p < 0.001) higher compared to the Oral-B Indicator toothbrush. CONCLUSION: The Sensodyne Mikro Aktiv toothbrush has demonstrated superiority to the Oral-B Indicator toothbrush for access into interproximal areas using this laboratory methodology.

Effects of T'ai Chi training on function and quality of life indicators in older adults with osteoarthritis.

OBJECTIVE: To determine the effects of T'ai Chi training on arthritis self-efficacy, quality of life indicators, and lower extremity functional mobility in older adults with osteoarthritis. DESIGN: A prospective, randomized, controlled clinical trial. Intervention length was 12 weeks, with outcomes measured before and after intervention using blinded testers. Group (T'ai Chi vs Control) x time (2 x 2) mixed factorial ANOVA. SETTING: Allied Health Sciences Center at Springfield College, Springfield, MA PARTICIPANTS: A total of 33 community-dwelling participants (mean age 68) diagnosed with lower extremity osteoarthritis and having no prior T'ai Chi training longer than 2 weeks. INTERVENTION: T'ai Chi training included two 1-hour T'ai Chi classes per week for 12 weeks. MEASUREMENTS: Arthritis self-efficacy (Arthritis Self-Efficacy Scale), quality of life indicators (Arthritis Impact Measurement Scale), functional outcomes (one-leg standing balance, 50-foot walking speed, time to rise from a chair). RESULTS: T'ai Chi participants experienced significant (P < .05) improvements in self-efficacy for arthritis symptoms, total arthritis self-efficacy, level of tension, and satisfaction with general health status. CONCLUSIONS: A moderate T'ai Chi intervention can enhance arthritis self-efficacy, quality of life, and functional mobility among older adults with osteoarthritis. T'ai Chi training is a safe and effective complementary therapy in the medical management of lower extremity osteoarthritis.

Excluded volume in the configurational distribution of a strongly-denatured protein.

The configurational distribution of phosphoglycerate kinase (PGK) strongly-denatured in 4 M guanidine hydrochloride solution is investigated using small-angle neutron scattering (SANS) and Monte Carlo computer simulation. It is shown that the experimental scattering profile can be represented by a random flexible chain of spheres of excess scattering density with excluded volume interactions, the best agreement being achieved when partial sphere intersection is allowed. The radius of gyration of the chain increases by a factor of 4 on denaturation, whereas the average length of segments approximately 5 residues long increases by only approximately 10%, consistent with a picture in which the large expansion on denaturation originates primarily from increased long-range flexibility of the polypeptide chain. The results provide a description of the chain statistics from which the construction of starting points for simulation studies of folding of the protein can be envisaged.

Naturally occurring muscle pain during exercise: assessment and experimental evidence.

The objectives were: (i) to present a method for assessing muscle pain during exercise, (ii) to provide reliability and validity data in support of the measurement tool, (iii) to test whether leg muscle pain threshold during exercise was related to a commonly used measure of pain threshold pain during test, (iv) to examine the relationship between pain and exertion ratings, (v) to test whether leg muscle pain is related to performance, and (vi) to test whether a large dose of aspirin would delay leg muscle pain threshold and/or reduce pain ratings during exercise. In study 1, seven females and seven males completed three 1-min cycling bouts at three different randomly ordered power outputs. Pain was assessed using a 10-point pain scale. High intraclass correlations (R from 0.88 to 0.98) indicated that pain intensity could be rated reliably using the scale. In study 2, 11 college-aged males (age 21.3 +/- 1.3 yr) performed a ramped (24 W.min-1) maximal cycle ergometry test. A button was depressed when leg muscle pain threshold was reached. Pain threshold occurred near 50% of maximal capacity: 50.3 (+/- 12.9% Wmax), 48.6 (+/- 14.8% VO2max), and 55.8 (+/- 12.9% RPEmax). Pain intensity ratings obtained following pain threshold were positively accelerating function of the relative exercise intensity. Volitional exhaustion was associated with pain ratings of 8.2 (+/- 2.5), a value most closely associated with the verbal anchor "very strong pain." In study 3, participants completed the same maximal exercise test as in study 2 as well as leg cycling at 60 rpm for 8 s at four randomly ordered power outputs (100, 150, 200, and 250 W) on a separate day. Pain and RPE ratings were significantly lower during the 8-s bouts compared to those obtained at the same power outputs during the maximal cycle test. The results suggest that noxious metabolites of muscle contraction play a role in leg muscle pain during exercise. In study 4, moderately active male subjects (N = 19) completed two ramped maximal cycle ergometry tests. Subjects drank a water and Kool-Aid mixture, that either was or was not (placebo) combined with a 20 mg.kg-1 dose of powdered aspirin 60 min before exercise. Paired t-tests revealed no differences between conditions for the measures of exercise intensity at pain threshold [aspirin vs placebo mean (+/- SD)]: power output: 150 (+/- 60.3 W) versus 153.5 (+/- 64.8 W); VO2: 21.3 (+/- 8.6 mL.kg-1.min-1) versus 22.1 (+/- 10.0 mL.kg-1.min-1); and RPE: 10.9 (+/- 3.1) versus 11.4 (+/- 2.9). Repeated measures ANOVA revealed no significant condition main effect or condition by trial interaction for pain responses during recovery or during exercise at 60, 70, 80, 90, and 100% of each condition's peak power output. It is concluded that the perception of leg muscle pain intensity during cycle ergometry: (i) is reliably and validly measured using the developed 10-point pain scale, (ii) covaries as a function of objective exercise stimuli such as power output, (iii) is distinct from RPE, (iv) is unrelated to performance of the type employed here, and (v) is not altered by the ingestion of 20 mg.kg-1 acetylsalicylic acid 1 h prior to the exercise bout.

Polio eradication in the World Health Organization South-East Asia Region by the year 2000: midway assessment of progress and future challenges.

In the South-East Asia Region (SEAR) of WHO, paralytic poliomyelitis has decreased from 25,711 cases in 1988 to 3304 cases in 1995, representing an 87% reduction. By 1995, in 6 of 10 member countries--India, Bangladesh, Myanmar, Nepal, Indonesia, and Democratic People's Republic of Korea--polio remained endemic. Two countries, Sri Lanka and Thailand, appear close to polio eradication, and 2, Bhutan and Maldives, reported no cases during 1989-1995. Although reported rates of acute flaccid paralysis and the percentage of cases virologically investigated are low in some countries, no isolates of wild poliovirus type 2 have been reported outside India since 1993. By the end of 1996, all 8 countries in which polio is endemic will have conducted national immunization days for polio eradication. The major challenge for polio eradication in SEAR will be strengthening surveillance, because national immunization days alone cannot eradicate polio.

The epidemiology of rotavirus diarrhea in the United States: surveillance and estimates of disease burden.

The decision to develop rotavirus vaccines was predicated on the extensive burden of rotavirus disease among children worldwide. US reports on nationwide hospitalizations (1979-1992) and deaths (1968-1991) due to diarrhea and weekly reports of rotavirus infection by 74 laboratories were reviewed to estimate the burden of rotavirus disease, identify epidemiologic trends, and consider methods for evaluating an immunization program when a vaccine becomes available. From 1968 to 1985, diarrhea-related deaths among US children <5 years old declined from 1100 to 300/year. This decline was associated with the disappearance of winter peaks for diarrhea-related deaths previously associated with rotavirus infection among children 4-23 months old. From 1979 to 1992, however, hospitalizations for diarrhea averaged 186,000/year and retained their winter peaks, which have been linked to rotavirus infections. Each year an estimated 54,000-55,000 US children are hospitalized for diarrhea, but <40 die with rotavirus. A rotavirus vaccine program will require improved surveillance, including the timely collection of data from sentinel hospitals, in which a diagnosis of rotavirus can be established or ruled out for all children hospitalized for diarrhea.

Cost-effectiveness analysis of a rotavirus immunization program for the United States.

OBJECTIVE: To estimate the economic consequences in the United States of routine childhood immunization of children younger than 1 year of age with a rotavirus (RV) vaccine. DESIGN: Cost-effectiveness analysis of a national RV immunization program from the perspective of the health care system and the perspective of society. Estimates of disease incidence, medical expenditures, productivity costs, vaccine efficacy, and vaccine coverage rates were derived from published literature and unpublished vaccine trial reports. The impact of changes in estimates of vaccine efficacy and medical costs was determined by sensitivity analysis. MAIN OUTCOME MEASURES: Incremental cost effectiveness, expressed as savings per case of RV diarrhea prevented. RESULTS: Given a vaccine efficacy rate of 50% and a vaccine cost of $30 per dose, an RV immunization program would prevent more than 1 million cases of RV diarrhea, 58,000 hospitalizations, and 82 deaths per year. A vaccine program would cost $243 million per year but would yield net savings of $79 million from the perspective of the health care system and $466 million from the perspective of society. The incremental cost effectiveness was a savings of $459 per case prevented from the societal perspective and $78 per case prevented from the health care system perspective. Sensitivity analyses substantiated net savings over a wide range of variables, and cost effectiveness increased with greater vaccine efficacy or decreased vaccine cost. CONCLUSIONS: Economic and disease reduction benefits would be realized from the use of an RV vaccine that is partially protective against severe RV diarrhea. These findings suggest that immunization with an RV vaccine would be cost effective and cost saving.

Technology assessment at the Institute for Clinical Systems Integration and HealthPartners.

The Technology Assessment Committee of the Institute for Clinical Systems Integration (ICSI) draws upon the resources of many different groups and in turn, keeps the groups informed about new medical treatments, devices, and procedures. This new Minneapolis-based technology assessment committee uses a collaborative effort to serve the information needs of many employer groups, patients, providers, and health care organizations in the area. This committee serves as the principal mechanism by which new medical and surgical procedures, devices, and treatments, as well as new applications of old but unproved or doubtful applications of existing technologies are reviewed for medical appropriateness at ICSI (a nonprofit quality improvement organization) and at HealthPartners (a combined staff and group model HMO in Minnesota).

A capitated payment system for involuntary mental health clients.

This DataWatch examines an outpatient capitated payment system, in the state of Oregon, designed to enhance community services for persons with chronic mental illness who had repeatedly been hospitalized involuntarily. Special state funds and Medicaid dollars were used to pay providers prospectively on a risk-adjusted basis for the delivery of outpatient mental health services. During the three-year study period clients were able to be discharged from the state hospital. Although the data are not straightforward, capitated clients' use of the state mental hospital seems to have declined somewhat more than that of comparison subjects. Outpatient service use was modest and appeared to have little relationship to a client's level of illness severity. Indeed, it was not possible to predict prospectively these clients' outpatient mental health services expenditures.

The mobile lithotriptor: an answer for the smaller centre.

The mobile lithotriptor is a new method of providing extracorporeal shock wave lithotripsy (ESWL) directly to the smaller urological centres. The unit, containing a Dornier HM4 lithotriptor, has treated 135 patients with a total of 168 treatments in 2 centres in the Oxford region. The overall success rate was 87% with no serious morbidity or mortality. The results compare well with the results from larger centres and the system is cost-effective. We suggest that it is one of the best methods of providing ESWL to the smaller urological centres.

[Prevalence of smoking among women in reproductive age in Puerto Rico]. / Prevalencia del hábito de fumar en mujeres de edad fértil de Puerto Rico.

The prevalence of smoking in Puerto Rican women was estimated on the basis of data from 3,157 women 15 to 49 years of age who had been surveyed in the 1982 Evaluation of Fertility and Family Planning in Puerto Rico. The weighted prevalence was 15.5%, with a 95% confidence interval of 13.8 to 17.1. The prevalence varied by age group, education, marital status, place of residence at age 15, and consumption of alcohol. The prevalence of smoking increased in successive birth cohorts while the mean age at initiation of the habit tended to decline. The data suggest that in Puerto Rico smoking is on the rise among younger women.