A 1.5-megabase physical map encompassing the multiple endocrine neoplasia type-1 (MEN1) locus on chromosome 11q13

Linkage analysis and loss of heterozygosity studies have shown that the gene responsible for the multiple endocrine neoplasia type-1 (MEN1) syndrome localizes to a small interval between D11S427 and D11S460 on chromosome 11q13. As an initial step to clone this tumor suppressor gene, our group is the first to map the MEN1 region physically using yeast artificial chromosome, bacterial artificial chromosome (BAC), and cosmid contigs. The 1.5-Mb high-resolution, contiguous map extends from PYGM to 300 kb telomeric of D11S460. Of this, the 1.2-Mb interval between PYGM and D11S460 is isolated in cosmids and BACs and will be useful for the development of genomic sequences and transcription maps of this important region. Nine new sequence-tagged sites (STS) are also characterized from this region. The physical map and the STSs will be valuable tools for the cloning of the MEN1 gene.

The amygdala and intractable temporal lobe epilepsy: a quantitative magnetic resonance imaging study

OBJECTIVE

To establish a quantitative MRI technique using T2 relaxation time mapping to study systematically the amygdala in patients with intractable temporal lobe epilepsy (TLE).

BACKGROUND

Identification of a focal abnormality on MRI in patients with intractable TLE is important, because outcome from surgery depends largely on the removal of the underlying pathology. Hippocampal sclerosis (HS) is the most common cause of intractable TLE, but epileptogenic lesions can be confined to the amygdala.

METHODS

Twenty control subjects and 82 patients with intractable TLE were studied. Patients who had foreign tissue lesions visible on routine MRI were excluded. All subjects had a hippocampal T2 map and volumetry and an amygdala T2 (AT2) map.

RESULTS

Forty-four of the 82 patients (54%) had an abnormal AT2, which was bilateral in 18. Forty-four patients (54%) had unilateral HS on MRI, 25 (57%) of whom had an abnormal AT2. Seven patients (8%) had bilateral HS, four of whom had an abnormal AT2. Thirty-one patients (38%) had normal quantitative hippocampal measures, 15 of whom had an abnormal AT2, which was bilateral in seven. Fluid attenuated inversion recovery (FLAIR) imaging, where appropriate, confirmed that the increased AT2 signal was due to parenchymal changes. Neuropathologic correlates of an increased AT2 included microdysgenesis in one and gliosis in three patients. Patients with an isolated AT2 abnormality were significantly older at the onset of habitual epilepsy and rarely had a history of febrile convulsions, in comparison with patients who had HS. An isolated AT2 abnormality correlated well with interictal EEG findings.

CONCLUSIONS

The combination of AT2 mapping and FLAIR is a sensitive method to detect lesions that are not seen on routine MRI in the amygdalae of patients with intractable TLE. Further correlational studies will be required to define the role of this technique in the presurgical evaluation of patients with intractable TLE.

Regaining self-esteem: strategies and interventions for the infertile woman

Infertility can cause women to lose their sense of power and control, thus diminishing their self-esteem. Terminology, technology, and testing may contribute to this sense of failure. Nurses can intervene by recognizing this negative consequence of infertility and using strategies within the nursing model.

Multimodal management of diffuse neonatal hemangiomatosis

Diffuse neonatal hemangiomatosis is a rare, frequently fatal disorder. We describe the case of a neonate with numerous cutaneous and ocular hemangiomas. Hepatic hemangiomas were noted at 4 weeks of age, associated with congestive heart failure resulting from hepatic arteriovenous shunting. This condition was controlled by treatment with prednisone, interferon alfa-2b and hepatic embolization. Treatment of cutaneous hemangiomas with the tunable dye laser prevented hemorrhage, facilitated routine skin care, and allowed uninhibited intravenous access during hospitalization.

The use of ondansetron in the treatment of nausea and vomiting associated with acetaminophen poisoning

BACKGROUND

Nausea and vomiting associated with poisoning can complicate treatment and in some cases delay potential antidote administration. Side effect such as lowering the seizure threshold may at times discourage the use of traditional phenothiazine and butyrophenone antiemetics.

METHODS

We performed a prospective, single arm, observational study examining the effectiveness of the 5HT3 receptor antagonist ondansetron in the management if nausea and vomiting associated with acetaminophen poisoning. Patients with a history or laboratory evidence of acetaminophen poisoning were eligible for inclusion in the study. Exclusion criteria included age less than 18 or greater than 65, use of other antiemetic therapy within the previous 12 hours, history of preexisting hepatic or hematologic disease, pregnancy, or significant ingestion of other substances. Upon meeting entry criteria, patients were administered 8 mg of intravenous ondansetron. Nausea was graded on a 100 mm scale with number of emetic episodes recorded before and after treatment.

RESULTS

Six patients were entered in the study. All patients had nausea and at least one emetic episode prior to ondansetron and prior to administration of N-acetylcysteine. All patients reported relief of nausea after ondansetron. The degree of nausea decreased by an average of 52% at 30 min and 88% at 60 min following ondansetron administration. No significant vital sign changes were recorded in any patient, and there were no complications related to therapy. Three patients were administered N-acetylcysteine, and all tolerated this therapy without vomiting after ondansetron.

CONCLUSIONS

Ondansetron appears to be a potentially useful adjunct in the management of nausea and vomiting associated with acetaminophen poisoning.

Proton magnetic resonance spectroscopy in children with temporal lobe epilepsy

We performed proton magnetic resonance spectroscopy of the mesial temporal regions in 20 children with intractable temporal lobe epilepsy and compared results with those from 13 normal subjects. Abnormalities of the ratio of N-acetylaspartate to choline plus creatine (NAA/[Cho+Cr]) were seen in 15 patients (75%). The ratio NAA/(Cho+Cr) was correctly lateralizing in 55% and incorrectly lateralizing in none. Bilateral abnormalities were seen in 45%. Overall there was a unilateral decrease in N-acetylaspartate on the side ipsilateral to the seizure focus (mean 19% decrease vs normals, with 5% decrease on the contralateral side), suggesting neuronal loss or dysfunction. There was also a bilateral increase in creatine and choline (mean 18%), consistent with reactive astrocytosis. We conclude that proton magnetic resonance spectroscopy can contribute to lateralization of the seizure focus, and by detection of bilateral abnormalities, can contribute to the understanding of the underlying pathophysiology in temporal lobe epilepsy.

Total energy intake of the US population: the third National Health and Nutrition Examination Survey, 1988-1991

The third National Health and Nutrition Examination Survey (NHANES III) was conducted to assess the health and nutritional status of the US population. As part of the nutritional status assessment, reliable 24-h dietary recalls were collected for 14,801 examined persons. Mean (+/- SEM) energy intakes are reported for persons aged > or = 2 mo by age, sex, and race-ethnicity. Males had higher mean energy intakes than did females. Energy intakes peaked during late adolescence and young adulthood and declined thereafter. Energy intake patterns were similar among non-Hispanic whites, non-Hispanic blacks, and Mexican Americans. Underreporting was addressed by computing a ratio of energy intake (EI) to estimated basal metabolic rate (BMRest). This ratio (EI:BMRest) was 1.47 for adult males and 1.26 for nonpregnant adult females. Overweight adults had a lower mean EI:BMRest (1.09 in females and 1.28 in males). Underreporting in food consumption surveys remains problematic among females and overweight persons.

Overweight prevalence and trends for children and adolescents. The National Health and Nutrition Examination Surveys, 1963 to 1991

OBJECTIVE

To examine prevalence of overweight and trends in overweight for children and adolescents in the US population.

DESIGN

Nationally representative cross-sectional surveys with an in-person interview and a medical examination, including measurement of height and weight.

PARTICIPANTS

Between 3000 and 14,000 youths aged 6 through 17 years examined in each of five separate national surveys during 1963 to 1965, 1966 to 1970, 1971 to 1974, 1976 to 1980, and 1988 to 1991 (Cycles II and III of the National Health Examination Survey, and the first, second, and third National Health and Nutrition Examination Surveys, respectively).

MAIN OUTCOME MEASURES

Prevalence of overweight based on body mass index and 85th or 95th percentile cutoff points from Cycles II and III of the National Health Examination Survey.

RESULTS

From 1988 to 1991, the prevalence of overweight was 10.9% based on the 95th percentile and 22% based on the 85th percentile. Overweight prevalence increased during the period examined among all sex and age groups. The increase was greatest since 1976 to 1980, similar to findings previously reported for adults in the United States.

CONCLUSIONS

Increasing overweight among youths implies a need to focus on primary prevention. Attempts to increase physical activity may provide a means to address this important public health problem.

Methods to assess iron status in various NHANES surveys

This paper summarizes iron status measurements included in the three cross-sectional National Health and Nutrition Examination Surveys (NHANES) completed to date, as well as a special study of Hispanics, known as the Hispanic Health and Nutrition Examination Survey (HHANES). Approaches for defining iron status in the population based on these measurements are also described as well as issues in comparing iron status data between surveys, using NHANES II and III data as an example.

Outcome from critical care in the "oldest old" trauma patients

This study evaluated the "oldest old" Intensive Care Unit (ICU) trauma patients, defined as patients of age 75 and over, to determine the relationships between age, injury magnitude, physiologic severity of illness, and outcome in this group, compared with younger trauma patients. Of 1,039 consecutive Surgical ICU (SICU) patients with complete data, 45 were in the Oldest group, 54 were in the Elderly group (ages 65 to 74), and 940 were in the Younger group (age < 65). Age, sex, and type of trauma (penetrating versus blunt) did not predict outcome. The Injury Severity Score (ISS) was significantly higher in the Oldest group than in the other groups (p = 0.0005), but the Trauma Score was the same for all groups. The proportion of Oldest group patients with ISS > or = 20 was significantly higher than for Elderly and Younger group patients (p = 0.0002 and p < 0.00005, respectively). The Simplified Acute Physiology Score (SAPS) on the first SICU day was the best outcome predictor for all age groups, along with maximum SAPS during the SICU stay (p < 0.00005 for both). When patients were stratified by ISS, there was a statistically significant difference in day 1 SAPS among age groups for most ISS categories, with higher SAPS associated with advancing age. The oldest old fare worse with trauma because their injury is more severe (higher ISS) and because their physiologic response to a given level of injury is exaggerated (higher SAPS). However, once the oldest old are stratified by SAPS, their outcome parallels that of their younger trauma cohorts.(ABSTRACT TRUNCATED AT 250 WORDS)

Amino acid replacement of Asp369 in the sheep alpha 1 isoform eliminates ATP and phosphate stimulation of [3H]ouabain binding to the Na+, K(+)-ATPase without altering the cation binding properties of the enzyme

Modification of aspartic acid 369 in the sheep alpha 1 Na+,K(+)-ATPase to asparagine results in a membrane-associated form of Na+,K(+)-ATPase that can bind [3H]ouabain with high affinity in the presence of Mg2+ alone (KD = 20.4 +/- 2.6 nM). Ouabain binding to the D369N mutant is not stimulated by inorganic phosphate, confirming that Asp369 is both the catalytic phosphorylation site and the only Pi interaction site which stimulates ouabain binding. Cation inhibition of Mg(2+)-stimulated ouabain binding to the D369N mutant demonstrated that three Na+ and two K+ ions inhibit [3H]ouabain binding and suggests that this inhibition must occur via a cation-sensitive conformational change which does not directly involve dephosphorylation of the enzyme. In the presence of 10 mM Mg2+, ATP stimulates ouabain binding to the wild type protein, (AC50 = 21.4 +/- 2.7 microM) but inhibits the binding to the D369N mutant (IC50 = 2.52 +/- 0.17 microM) indicating that the mutation does not destroy the high affinity site for MgATP but does change the nature of the protein conformation normally induced by a nucleotide-Na+,K(+)-ATPase interaction. Increasing the Mg2+ from 1 to 10 mM did not alter the AC50 or IC50 values for ATP and reveals that the Mg2+ interaction which stimulates ouabain binding in the absence of nucleotide involves a distinct divalent cation site not associated with the binding of the magnesium-nucleotide complex. Thus, altering the catalytic phosphorylation site of Na+,K(+)-ATPase does not affect the expression of the ouabain-sensitive protein in the membrane fraction of NIH 3T3 cells and does not disrupt the binding of Na+, K+, Mg2+, ouabain, or ATP to the enzyme. However, the D369N substitution does inhibit the formation of a nucleotide-protein complex with high affinity for ouabain.

Glutamic acid 327 in the sheep alpha 1 isoform of Na+,K(+)-ATPase is a pivotal residue for cation-induced conformational changes

The cation binding characteristics of the mutant E327A formed in the sheep alpha 1 isoform of the Na+,K(+)-ATPase were examined using [3H]ouabain binding as a function of monovalent cation concentrations. Equilibrium competition binding assays in the presence of Mg2+, inorganic phosphate and various amounts of unlabelled ouabain indicated that both wild-type sheep alpha 1 protein and the E327A mutant expressed in 3T3 cells had similar affinities for ouabain (KD = 1.53 and 1.31 nM respectively). Sodium inhibition of ouabain binding appeared competitive in both enzymes. However, binding of three Na+ ions was required to explain the steep character of the Na+ inhibition curve for the wild-type Na+,K(+)-ATPase (Ki = 12.8 +/- 1.6 mM), whereas the binding of two Na+ ions was detected for the mutant E327A (Ki = 19.2 +/- 2.5 mM). Potassium binding of [3H]ouabain binding displayed a partially competitive nature with Hill coefficients of 2 for both wild-type sheep alpha 1 (Ki = 0.743 +/- 0.044 mM) and E327A (Ki = 0.875 +/- 0.067 mM). At concentrations of K+ above 10 mM, the sheep alpha 1 competition curve levelled off whereas the inhibition curve for E327A displayed a stimulation in ouabain binding. This stimulation in [3H]ouabain binding also occurred with Rb+, Cs+ and Li+, but was never observed with choline or Na+, suggesting that this effect was not due to ionic strength. From these [3H]ouabain-binding studies, it is obvious that the mutant enzyme E327A in the presence of Mg2+, Pi and ouabain, interacts with monovalent cations in a unique fashion. One interpretation of these data is that the glutamic acid residue at position 327 is involved in a conformational transition induced by the binding of monovalent cations to the Na+,K+-ATPase and that this transition is inhibited by the mutation of E327A.

Macronutrient intakes among adult Hispanics: a comparison of Mexican Americans, Cuban Americans, and mainland Puerto Ricans

OBJECTIVES

The purpose of this study was to compare energy and macronutrient intakes between adult Mexican Americans, Cuban Americans, mainland Puerto Ricans, and non-Hispanics.

METHODS

Age-specific mean intakes were estimated based on 24-hour recalls from the Hispanic Health and Nutrition Examination Survey (HHANES) (1982 to 1984) and the Second National Health and Nutrition Examination Survey (NHANES II) (1976 to 1980) and were compared with the use of t tests.

RESULTS

Mexican Americans had higher total fat, saturated fat, and monounsaturated fat intakes than did Puerto Ricans and older Cuban Americans. Cuban Americans and Puerto Ricans had similar intakes, except for younger Cuban Americans, who had higher total and saturated fat and lower carbohydrate intakes. Cholesterol intakes among Mexican American men and 60- to 74-year-old women were higher than those among other Hispanic groups. Carbohydrate and protein intakes were higher among Hispanic groups compared with those among non-Hispanics while total fat intakes were generally lower.

CONCLUSIONS

Since macronutrient intakes differ between Hispanic groups, dietary research, recommendations, and interventions should be targeted to each group individually. Older Puerto Rican and Cuban American adults met population guidelines for reducing chronic disease risk for more macronutrients than any other group.

Verbal memory impairment after right temporal lobe surgery: role of contralateral damage as revealed by 1H magnetic resonance spectroscopy and T2 relaxometry

We assessed performance on selected tests of verbal memory in 48 patients who had undergone either anterior temporal lobectomy or selective amygdalo-hippocampectomy for the relief of pharmacologically intractable epilepsy. We related performance both to the side of surgical excision and to the presence or absence of abnormalities in the contralateral, unoperated, temporal lobe, as revealed by proton magnetic resonance spectroscopy (1H MRS) or T2 relaxometry. There were abnormalities on the unoperated side detected by 1H MRS in 50% of the 34 patients who successfully underwent spectroscopy, and by T2 relaxometry in 33% of the complete series of 48 patients. There was no systematic relationship between seizure outcome and the presence or absence of abnormalities on the unoperated side. Verbal memory deficits were present in patients with left-sided excision, regardless of whether there were abnormalities on the unoperated side. The patients with right-sided excision also had verbal memory deficits, but only in the group with magnetic resonance abnormalities on the contralateral (ie, left) side and only on delayed recall. The study extends previous findings on the role of the temporal lobes in memory and highlights the role of these new magnetic resonance techniques in relating cognitive processes to brain structures.

Comparison of the effects of potassium on ouabain binding to native and site-directed mutants of Na,K-ATPase

We examined the effect of K+ on Mg(2+)- and P(i)-supported [3H]ouabain binding to Na,K-ATPases, including partially purified enzyme from sheep kidney and wild-type and mutant sheep alpha 1 isoforms (C104A, Y108A, E116Q, P118K, Y124F, R880P, R880L, and N122D) expressed in NIH3T3 cells. In the presence of increasing concentrations of K+, [3H]ouabain binding to these enzymes decreases but never reaches nonspecific binding levels, consistent with the concept that ouabain is still able to bind to the K(+)-complexed enzyme but with reduced affinity. A partially competitive model for K+ inhibition of ouabain binding is proposed which satisfactorily fits the binding data. The model is consistent with the sequential binding of two K+ ions to the enzyme. Ki values (approximately 1.0 mM) for K+ obtained from this model are comparable to the apparent K+ affinities of the rat alpha isoforms determined by measuring the K+ dependence of Na,K-ATPase activity [E. A. Jewell and J. B. Lingrel (1991) J. Biol. Chem. 266, 16925-16930]. This is consistent with the concept that K+ inhibition of Mg2+ plus P(i) supported ouabain binding is mediated by K+ binding to the same high-affinity binding sites present in the native enzyme under physiological conditions. While the mutants exhibit binding constants for ouabain which vary more than 30-fold from that of the wild-type enzyme, their affinities for K+ differ less than twofold from that of the native enzyme. Our results suggest that the ouabain and K+ binding sites are not the same and are differentially affected by mutations of the enzyme. The system described here should prove useful in the analysis of cation binding to other mutants of the Na,K-ATPase, especially those carrying amino acid replacements which result in an inactive enzyme.

Glutamic acid 327 in the sheep alpha 1 isoform of Na+,K(+)-ATPase stabilizes a K(+)-induced conformational change

By combining the tools of site-directed mutagenesis and [3H]ouabain binding, the functional role of glutamic acid 327 in the fourth transmembrane domain of the sheep alpha 1 isoform of Na+,K(+)-ATPase was examined with respect to its interactions with ouabain, Na+,K+,Mg2+, and inorganic phosphate. Using site-directed mutagenesis, this glutamic acid was substituted with alanine, aspartic acid, glutamine, and leucine. The mutant proteins were constructed in a sheep alpha 1 protein background such that [3H]ouabain binding could be utilized as a highly specific probe of the exogenous protein expressed in NIH 3T3 cells. Na+ competition of [3H]ouabain binding to the mutant forms of Na+,K(+)-ATPase revealed only slight alterations in their affinities for Na+ and in their abilities to undergo Na(+)-induced conformational changes which inhibit ouabain binding. In contrast, K+ competition of [3H]ouabain binding to all four mutant forms of Na+,K(+)-ATPase displayed severely altered interactions between these proteins and K+. Interestingly, [3H]ouabain binding to the mutant E327Q was not inhibited by the presence of K+. This mutant was previously reported to be functionally able to support cation transport with a 5-fold reduced K0.5 for K(+)-dependent ATPase activity (Jewell-Motz, E. A., and Lingrel, J.B. (1993) Biochemistry 32, 13523-13530; Vilsen, B. (1993) Biochemistry 32, 13340-13349). Thus, it appears that this glutamic acid in the fourth transmembrane domain may be important for stabilizing a K(+)-induced conformation within the catalytic cycle of Na+,K(+)-ATPase that is not rate-limiting in the overall ATPase cycle but that displays a greatly reduced affinity for ouabain.

Dietary intake of vitamins, minerals, and fiber of persons ages 2 months and over in the United States: Third National Health and Nutrition Examination Survey, Phase 1, 1988-91

Intervention strategies aimed at reducing the prevalence of nutrition-related diseases, including designing nutrition policies and nutrition education and assistance programs, require effective monitoring of what Americans are eating. Nutrient reference data from the third National Health and Nutrition Examination Survey provide essential information to achieve these goals. Mean and median iron intakes were adequate in males of all race-ethnic groups but were generally low in females and young children. Mean and median calcium intakes were also higher in males than in females and were lower than recommendations in adolescents and in women of all ages. Mean sodium intakes for all age, sex, and race-ethnic groups exceeded the minimum requirements of healthy persons and were higher in non-Hispanic black children and adolescents than in non-Hispanic white and Mexican American children and adolescents. Mean fiber intakes also did not meet recommendations in most subgroups and were higher in Mexican American adults followed by non-Hispanic white adults and non-Hispanic black adults. Further research is planned to compare the food sources of energy and nutrients consumed by different population groups in NHANES III to similar results from earlier nation surveys. NHANES III, Phase 2 (1991-94) recalls were collected using the same dietary method as those collected in Phase 1 (1988-91), and other analyses will compare findings from both phases of NHANES III.

Trauma in the elderly: an analysis of outcomes based on age

This study evaluated the comparative outcomes of elderly trauma patients admitted to a tertiary Surgical Intensive Care Unit (SICU) over a 5-year period (4/1/87-3/31/92). A total of 289 trauma patients 65 or older (mean age 76.3 +/- 0.4 years) were compared with 1,877 trauma patients under age 65 (mean age 31.4 +/- 0.3). The Simplified Acute Physiology Score (SAPS) severity of illness on admission for elderly trauma patients was 12.2 +/- 0.3, significantly higher than the SAPS of the younger patient group, 7.9 +/- 0.1 (P < 0.0005). Elderly survivors had higher than the SAPS of admission than their younger cohorts, 11.0 +/- 0.3 versus 7.3 +/- 0.1 (P < 0.0005), but there was no significant difference in SAPS for non-survivors. The Injury Severity Score (ISS) of elderly patients, 14.2 +/- 1.0, was not significantly higher than the ISS of younger patients, 12.3 +/- 0.3 (P = 0.06). Thirty-three elderly trauma patients (11.4%) died in the SICU, compared with 90 (4.8%) deaths in younger patients (P < 0.00005). However, when patients were stratified by admission SAPS, SICU mortality was nearly equivalent between the older and younger patient groups. An additional 14 elderly patients (4.8%) died in the hospital after SICU discharge, compared with 9 additional deaths (0.5%) in the younger patient group (P < 0.00005).(ABSTRACT TRUNCATED AT 250 WORDS)

Measurement of apolipoproteins A-I and B during the National Health and Nutrition Examination Survey (NHANES) III

We measured apolipoproteins (apo) A-I and B by rate immunonephelometry (rate INA) during Phase 1 of the National Health and Nutrition Examination Survey (NHANES) III. We also made the measurements by radial immunodiffusion (RID) in a 20% subset of the samples. Aliquots of this subset were also analyzed in the Northwest Lipid Research Laboratories by fixed-time INA calibrated to the World Health Organization (WHO)-International Federation of Clinical Chemistry (IFCC) First International Reference Materials for Apolipoproteins A-I and B. The CVs for the rate INA and RID measurements were: apoA-I, 4.5-7.7% and 2.5-7.6%, respectively; apoB, 2.3-5.3% and 2.3-6.4%, respectively. In NHANES III, rate INA values (x) can be transformed to WHO-IFCC Reference Material-based values (y) as follows: for apoA-I, y = 0.87x + 251.8 mg/L (r = 0.93, SEslope = 0.13, SEintercept = 17, n = 708); for apoB (mg/L), y = 1.068x + 112.8 mg/L (r = 0.98, SEslope = 0.08, SEintercept = 7, n = 646).

Measurement of apolipoproteins A-I and B during the National Health and Nutrition Examination Survey (NHANES) III

We measured apolipoproteins (apo) A-I and B by rate immunonephelometry (rate INA) during Phase 1 of the National Health and Nutrition Examination Survey (NHANES) III. We also made the measurements by radial immunodiffusion (RID) in a 20% subset of the samples. Aliquots of this subset were also analyzed in the Northwest Lipid Research Laboratories by fixed-time INA calibrated to the World Health Organization (WHO)-International Federation of Clinical Chemistry (IFCC) First International Reference Materials for Apolipoproteins A-I and B. The CVs for the rate INA and RID measurements were: apoA-I, 4.5-7.7% and 2.5-7.6%, respectively; apoB, 2.3-5.3% and 2.3-6.4%, respectively. In NHANES III, rate INA values (x) can be transformed to WHO-IFCC Reference Material-based values (y) as follows: for apoA-I, y = 0.87x + 251.8 mg/L (r = 0.93, SEslope = 0.13, SEintercept = 17, n = 708); for apoB (mg/L), y = 1.068x + 112.8 mg/L (r = 0.98, SEslope = 0.08, SEintercept = 7, n = 646).

Field evaluation of the NOVA Celltrak 12 hematology analyzer

An evaluation of the NOVA Celltrak 12 was performed over a 6-week period. Precision, linearity, carryover, and reproducibility of values compared favorably to manufacturers' claims. The correlation was performed using the Coulter S Plus VI as the reference instrument and yielded coefficients of correlation for measured parameters of greater than .98 with the exception of RDW at r = .84, MCV at r = 0.96, and MPV at r = .92. Three-part differential information and an expanded flagging system affords increased clinical information and trouble-shooting guides. The three-part differential information compared favorably with that of the Coulter S Plus VI with lymphocyte percentage r = .96, granulocyte percentage r = .94, and monocyte percentage r = .50. We conclude that this instrument performed well in a clinical setting.

Increasing prevalence of overweight among US adults. The National Health and Nutrition Examination Surveys, 1960 to 1991

OBJECTIVE

To examine trends in overweight prevalence and body mass index of the US adult population.

DESIGN

Nationally representative cross-sectional surveys with an in-person interview and a medical examination, including measurement of height and weight.

SETTING/PARTICIPANTS

Between 6000 and 13,000 adults aged 20 through 74 years examined in each of four separate national surveys during 1960 to 1962 (the first National Health Examination Survey [NHES I]), 1971 to 1974 (the first National Health and Nutrition Examination Survey [NHANES I]), 1976 to 1980 (NHANES II), and 1988 to 1991 (NHANES III phase 1).

RESULTS

In the period 1988 to 1991, 33.4% of US adults 20 years of age or older were estimated to be overweight. Comparisons of the 1988 to 1991 overweight prevalence estimates with data from earlier surveys indicate dramatic increases in all race/sex groups. Overweight prevalence increased 8% between the 1976 to 1980 and 1988 to 1991 surveys. During this period, for adult men and women aged 20 through 74 years, mean body mass index increased from 25.3 to 26.3; mean body weight increased 3.6 kg.

CONCLUSIONS

These nationally representative data document a substantial increase in overweight among US adults and support the findings of other investigations that show notable increases in overweight during the past decade. These observations suggest that the Healthy People 2000 objective of reducing the prevalence of overweight US adults to no more than 20% may not be met by the year 2000. Understanding the reasons underlying the increase in the prevalence of overweight in the United States and elucidating the potential consequences in terms of morbidity and mortality present a challenge to our understanding of the etiology, treatment, and prevention of overweight.

Increasing prevalence of overweight among US adults. The National Health and Nutrition Examination Surveys, 1960 to 1991

OBJECTIVE

To examine trends in overweight prevalence and body mass index of the US adult population.

DESIGN

Nationally representative cross-sectional surveys with an in-person interview and a medical examination, including measurement of height and weight.

SETTING/PARTICIPANTS

Between 6000 and 13,000 adults aged 20 through 74 years examined in each of four separate national surveys during 1960 to 1962 (the first National Health Examination Survey [NHES I]), 1971 to 1974 (the first National Health and Nutrition Examination Survey [NHANES I]), 1976 to 1980 (NHANES II), and 1988 to 1991 (NHANES III phase 1).

RESULTS

In the period 1988 to 1991, 33.4% of US adults 20 years of age or older were estimated to be overweight. Comparisons of the 1988 to 1991 overweight prevalence estimates with data from earlier surveys indicate dramatic increases in all race/sex groups. Overweight prevalence increased 8% between the 1976 to 1980 and 1988 to 1991 surveys. During this period, for adult men and women aged 20 through 74 years, mean body mass index increased from 25.3 to 26.3; mean body weight increased 3.6 kg.

CONCLUSIONS

These nationally representative data document a substantial increase in overweight among US adults and support the findings of other investigations that show notable increases in overweight during the past decade. These observations suggest that the Healthy People 2000 objective of reducing the prevalence of overweight US adults to no more than 20% may not be met by the year 2000. Understanding the reasons underlying the increase in the prevalence of overweight in the United States and elucidating the potential consequences in terms of morbidity and mortality present a challenge to our understanding of the etiology, treatment, and prevention of overweight.

Sustaining community living of the very old: medical and service issues

The unprecedented prolongation of life in the United States has been accompanied by increased numbers of disabled people in their 80s and 90s, who have high needs for health care and social services. The paper reports longitudinal findings on 150 individuals, 85 years and older. Over three years, their functioning on activities of daily living significantly declined at the same time that they continued to described their health as good and to report contentment about their life. Families were active in sustaining community living of the oldest old, but those most at risk of institutionalization were the childless. Over time, 48% of the survivors stayed functionally fit, while 28% became increasingly disabled and dependent and 24% remained stable at a high level of disability. The means by which the oldest old coped with their disabilities include practical steps in simplifying their environment and narrowing their social world. They also used cognitive regulation by modifying their health beliefs and delimiting those areas over which they could exert a sense of control.