Cost-effectiveness analysis of telemedicine to evaluate diabetic retinopathy in a prison population.

OBJECTIVE: A cost-effectiveness analysis was conducted to investigate the clinical and economic impact of teleophthalmology in evaluating diabetic retinopathy in prison inmates with type 2 diabetes. RESEARCH DESIGN AND METHODS: Based on a hypothetical teleophthalmology system to evaluate diabetic retinopathy patients with type 2 diabetes in a prison care setting, a Markov decision model was developed with probability and cost data derived primarily from published epidemiological and outcome studies. A 40-year-old African-American man with type 2 diabetes was used as a reference case subject. The number of quality-adjusted life-years (QALYs) gained was used as the clinical outcome, and the cost in U.S. dollars from the year 2003 was used as the economic outcome. Teleophthalmology and nonteleophthalmology strategies were compared using an expected QALYs calculation and two types of sensitivity analyses: probabilistic and traditional n-way sensitivity analyses. RESULTS: The teleophthalmology strategy dominates in the cost-effectiveness analysis for the reference case subject: 16,514/18.73 dollars QALYs for teleophthalmology and 17,590/18.58 dollars QALYs for nonteleophthalmology. Ninety percent of the Monte Carlo simulations showed cost effectiveness (annual cost/QALYs < or = 50,000 dollars) in the teleophthalmology strategy based on an assumed inmate population. Teleophthalmology is the better strategy if the number of diabetic inmates in the prison community is >500. CONCLUSIONS: Our cost-effectiveness analysis demonstrates that teleophthalmology holds great promise to reduce the cost of inmate care and reduce blindness caused by diabetic retinopathy in type 2 diabetic patients.

The Raymond Pearl memorial lecture, 1992: Ethnicity and disease-more than familiality.

It has long been recognized that the prevalence of many, possibly most diseases differs among different ethnic groups, and it is further known that cultural differences among people affect the acceptability of measures to prevent or ameliorate a given disease process. Major public health challenges of our time are the delineation and understanding of how these differences in prevalence arise, and the fashioning of acceptable and effective intervention strategies. The web of causation is undoubtedly complex and in the unraveling there will be a need to examine new paradigms, new models of how genes and environments interact in the evolution of disease. These models must recognize the levels within the disease process where interactions can occur. This will demand a holistic rather than the reductionist approach that has obtained in the past. However, there are promising developments at the molecular and cellular levels, and the methods of data analysis grow progressively more sophisticated. This presentation briefly describes the methods of and problems confronted by genetic epidemiology in the context of studies of ethnic differences in disease. © 1993 Wiley-Liss, Inc.

Precision of the one- versus two-handed method of skinfold measurement in the obese.

Skinfolds at five anatomic sites were measured on 47 subjects in a study of gallbladder disease in Starr County, Texas, by two methods, one and two handed. A comparison was made of the two methods as to bias and precision. There were statistically significant but biologically unimportant differences (on the order of 1-2 mm) at four of the five sites. At three of these, the two-handed method gave larger values (lower thigh, triceps, and subscapular), and at the other site (medial calf) this method produced smaller values on average. Measurement precision was improved using the two-handed method at three of the five sites, significantly so for the triceps skinfold. Measuring skinfolds with two hands improves the precision of measurement for some skinfold sites in obese individuals. It does not introduce important and systematic biases across skinfold sites. Adoption of this technique should be used when circumstances outweigh the cost of involving an extra observer in the measurement of skinfold thickness, such as when precision is very important and when subjects are obese. © 1995 Wiley-Liss, Inc.

Obesity and upper body fat distribution in Mexican American children from families with a diabetic proband.

Upper and centralized body fat distribution is associated with non-insulin dependent diabetes mellitus (NIDDM). Few studies have focused on anthropometric characteristics of preadults from families in which there is a diabetic (NIDDM) proband. This study explores the prevalence of upper and centralized body fatness in Mexican American children from the Diabetes Alert study (1981-1983) in Starr County, Texas. Anthropometric data on 165 males and 224 females 9-19 years include measures of adiposity such as skinfold thicknesses and the body mass index (BMI), a measure of overweight. They show rates of obesity two to three times that of White children of comparable age and sex from National Health Surveys. In comparison with U.S. White subjects, Mexican American adults are shorter, have more adiposity and arm muscle mass and have sitting heights and body breadths at the mean of these dimensions for the U.S. POPULATION: Children from Diabetes Alert families show only marginal excess of severe obesity (> 95th percentile of BMI) when compared to the general population of children surveyed in Starr County schools. Girls from these families, but not boys, have excess fatness in the BMI compared to Mexican American children from the Hispanic Health and Nutrition Examination Survey (HHANES); suprailiac skinfold thicknesses are also greater in children of the Diabetes Alert study than in HHANES children. From 1972 through 1982, Mexican American children in South Texas showed an increase in average stature, weight, and the BMI. These data together suggest that excessive obesity exists and may be increasing in children in populations at risk for NIDDM. The prevention of NIDDM in the Mexican American population may be more effective if educational and promotional interventions include the school aged population. © 1993 Wiley-Liss, Inc.

Environmental lithium exposure in the north of Chile--II. Natural food sources.

Lithium, generally, occurs in barely trace amounts in ground water with few major exceptions. One of these is the northern area of Chile where all potable water and many of the food stuffs contain high levels of lithium. Surface water can contain between 100 and 10,000 times more than most rivers in North America. Inevitably, food, both animal and vegetable, contains higher lithium levels than found elsewhere. In consequence, the local population has been exposed to high levels of lithium in their food and drinking water for as long as the region has been populated. The present report details lithium levels in a variety of food stuffs from several locations in Northern Chile and compares these with those found elsewhere. The implications for the local population have been discussed in our earlier paper.

The children of atomic bomb survivors: a synopsis.

When the atomic bombing of Hiroshima and Nagasaki occurred in the summer of 1945, most members of the public presumed that many of the children conceived by the survivors would be grossly deformed or seriously damaged in other ways as a consequence of radiation-induced mutations. Although the experimental data then available, largely limited to studies of Drosophila melanogaster, the common fruit fly, did not support this perception, the limitations of the data and the depth of public concern warranted a careful follow-up of the children born to the survivors. To this end a surveillance was begun in 1947 of all pregnancy outcomes after 20 weeks of gestation in these two cities. Over the half century subsequent to the initiation of this surveillance, some 80-odd thousand pregnancy outcomes have been studied and a variety of potential indicators of mutational damage measured. This report summarises the findings of these studies and offers an estimate of the genetic risk based on these findings.

Perspectives fulfilled: the work and thought of J. V. Neel (1915-2000).

James V. Neel was one of the leaders who developed human genetics into a predominant field of 20th-century science. Neel was originally trained in basic biology, and this fact was clearly reflected in the evolutionary, population perspective of his life's work. His interests were in the amount and burden of mutation in human populations. He studied this problem in clinical samples, survivors of the atomic bombings in Hiroshima and Nagasaki, and minimally acculturated indigenous populations in Amazonia. Because his perspective was populational, he cautioned that the most serious health problems faced by our species should not be approached as if they have a genetic solution.

Los aimarás del oeste de Bolivia: salud y enfermedad / The aymará of Western Bolivia: health and disease

Desde hace tiempo la comunidad médica mundial se ha interesado en las enfermedades y la incapacidad relacionadas con la altitud, entre los habitantes de las ciudades y poblaciones de los Andes. Sin embargo, con muy pocas excepciones, la información sobre este tema ha sido algo limitada. Para remediar esta situación, una serie de instituciones académicas y gubernamentales de Bolivia, Chile, Perú, Ecuador y los Estados Unidos, han aunado sus esfuerzos en un amplio proyecto de investigación, conocido como el Programa Multinacional Andino de Genética y Salud. Como parte de este programa, este artículo comunica los resultados del estudio de 429 personas que viven en dos comunidades de los Andes del oeste de Bolivia (AU)

Los aimarás del oeste de Bolivia: salud y enfermedad / The aymará of Western Bolivia: health and disease

Desde hace tiempo la comunidad médica mundial se ha interesado en las enfermedades y la incapacidad relacionadas con la altitud, entre los habitantes de las ciudades y poblaciones de los Andes. Sin embargo, con muy pocas excepciones, la información sobre este tema ha sido algo limitada. Para remediar esta situación, una serie de instituciones académicas y gubernamentales de Bolivia, Chile, Perú, Ecuador y los Estados Unidos, han aunado sus esfuerzos en un amplio proyecto de investigación, conocido como el Programa Multinacional Andino de Genética y Salud. Como parte de este programa, este artículo comunica los resultados del estudio de 429 personas que viven en dos comunidades de los Andes del oeste de Bolivia (AU)

Abortion and background radiation in Brazil

A radioatividade natural näo mostrou efeito detectável na ocorrência de abortos no Brasil