In spite of advances made in our understanding of the biology of the hepatitis C virus (HCV), the epidemiology and natural history of HCV infection, and the treatment of chronic hepatitis C, the development and worldwide implementation of a comprehensive prevention and control strategy remains necessary. A World Health Organization informal consultation with the Viral Hepatitis Prevention Board was convened and met in Geneva, Switzerland, 13-14 May 2002, to review epidemiological and public health aspects of HCV infection, and the various prevention and control strategies that are currently in place. Based on the presentations and discussions, a number of specific recommendations were made, which should be considered in conjunction with previously published recommendations.

Mycobacterium tuberculosis is an important human pathogen in virtually every part of the world. Here we investigate whether distinct strains of M. tuberculosis infect different human populations and whether associations between host and pathogen populations are stable despite global traffic and the convergence of diverse strains of the pathogen in cosmopolitan urban centers. The recent global movement and transmission history of 100 M. tuberculosis isolates was inferred from a molecular epidemiologic study of tuberculosis that spans 12 years. Genetic relationships among these isolates were deduced from the distribution of large genomic deletions, which were identified by DNA microarray and confirmed by PCR and sequence analysis. Phylogenetic analysis of these deletions indicates that they are unique event polymorphisms and that horizontal gene transfer is extremely rare in M. tuberculosis. In conjunction with the epidemiological data, phylogenies reveal three large phylogeographic regions. A host's region of origin is predictive of the strain of tuberculosis he or she carries, and this association remains strong even when transmission takes place in a cosmopolitan urban center outside of the region of origin. Approximate dating of the time since divergence of East Asian and Philippine clades of M. tuberculosis suggests that these lineages diverged centuries ago. Thus, associations between host and pathogen populations appear to be highly stable.

Helicobacter pylori (HP) infection can cause hypochlorhydria, a positive risk factor for Mycobacterium tuberculosis (MTB) infection. This study examined the association between HP and MTB infections among persons attending the Policlinico Peruano Japones Gastrointestinal Clinic in Lima, Peru. From 23 June 2000 to 18 August 2000, consenting 18-55 year olds who attended the clinic for gastric biopsy gave blood for HP serologic testing, underwent tuberculin skin testing (TST) and completed a social and medical history. Of 128 participating patients, 78 (61%) were TST positive for MTB, and 107 (84%) were infected with HP by serology. Of the patients who were HP positive, 67 (63%) developed positive TST reactions compared to 11 (52%) of 21 HP-seronegative subjects (OR 1.29; 95% CI 0.54-3.11; P = 0.6). There was no association after adjusting for covariates of H. pylori infection (OR 0.78; 95% CI 0.23-2.71; P = 0.7). However, study power was limited by high prevalence of the two infections.

OBJECTIVE: This study examines the risk, predictors of relapse and the effects of successfully sustained remission on the drinking behavior, functioning, life context, coping and help seeking of older adults who were problem drinkers earlier in life.

METHOD: Older former problem drinkers (n = 447) were prospectively followed for 10 years and compared to lifetime nonproblem drinkers.

RESULTS: Of former problem drinkers, 31% (n = 141) died over the 10-year interval, a rate 1.6 times higher than that of lifetime nonproblem drinkers. Among surviving former problem drinkers, although relapse was relatively uncommon (11%), a less severe drinking history, heavier baseline alcohol consumption, and lower baseline income were associated with relapse. The majority (63%) of former problem drinkers who successfully achieved sustained remission continued to drink alcohol, though at levels below those consumed by older lifetime nonproblem drinkers (n = 339). Stably remitted problem drinkers who were abstinent (SRAs) generally reported more severe drinking histories, greater functioning and life context deficits and more help seeking than did stably remitted problem drinkers who were nonabstinent (SRNs). Although SRAs and SRNs both experienced improvements in functioning over the 10-year interval, they continued to experience financial, health-related and life context deficits relative to older lifetime nonproblem drinkers.

CONCLUSIONS: Results suggest there are long-term costs associated with earlier drinking problems, even when remission is maintained. Both current drinking behavior and drinking history are worth considering when making recommendations regarding older adults' alcohol consumption

The world of Eli Ginzberg can readily be thought of as a triptych-a career in three parts. In his early years, Ginzberg's work was dedicated to understanding the history of economics, from Adam Smith to C. Wesley Mitchell, and placing that understanding in what might well be considered economic ethnography. His studies took him on travels from Wales in the United Kingdom to California in the United States. For example, the poignant account of Welsh miners in an era of economic depression and technological change remains a landmark work. His report of a cross country trip taken in the first year of the New Deal provides insight and evaluation that can scarcely be captured in present-day writings.

The second period of his career corresponds to Ginzberg's increasing involvement in the practice of economics. He deals with issues related to manpower allocation, employment shifts, and gender and racial changes in the workforce. His writing reflects a growing concern for child welfare and education. In this period, his work increasingly focuses on federal, state and city governments, and how the public sector impacts all basic social issues. His work was sufficiently transcendent of political ideology that seven presidents sought and received his advice and participation.

After receiving all due encomiums and congratulations for intellectual work and policy research well done, Ginzberg then went on to spend the next thirty years of his life carving out a place as a preeminent economist of health, welfare services, and hospital administration. It is this portion of his life that is the subject of Eli Ginzberg: The Economist as a Public Intellectual. What is apparent in Ginzberg's work of this period is his sense of the growing interaction of all the social sciences-pure and applied-to develop a sense of the whole. The contributors to this festschrift, join together to provide a portrait of a figure whose life and work have spanned the twentieth century, and yet pointed the way to changes in the twenty-first century. Eli Ginzberg from the start possessed a strong sense of social justice and economic equality grounded in a Judaic-Christian tradition. All of these aspects come together in the writings of a person who transcends all parochialism and gives substantive content to the often-cloudy phrase, public intellectual.

Sexual dysfunction is highly prevalent in both sexes and adversely affects patients' quality of life and well being. Given the frequent association between sexual dysfunction and cardiovascular disease, in addition to the potential cardiac risk of sexual activity itself, a consensus panel was convened to develop recommendations for clinical management of sexual dysfunction in patients with cardiovascular disease. Based upon a review of the research and presentations by invited experts, a classification system was developed for stratification of patients into high, low, and intermediate categories of cardiac risk. The large majority of patients are in the low-risk category, which includes patients with (1) controlled hypertension; (2) mild, stable angina; (3) successful coronary revascularization; (4) a history of uncomplicated myocardial infarction (MI); (5) mild valvular disease; and (6) no symptoms and 3 cardiovascular risk factors. These patients can be safely encouraged to initiate or resume sexual activity or to receive treatment for sexual dysfunction. An important exception is the use of sildenafil in patients taking nitrates in any form. Patients in the intermediate-risk category include those with (1) moderate angina; (2) a recent MI (6 weeks); (3) left ventricular dysfunction and/or class II congestive heart failure; (4) nonsustained low-risk arrhythmias; and (5) >/=3 risk factors for coronary artery disease. These patients should receive further cardiologic evaluation before restratification into the low- or high-risk category. Finally, patients in the high-risk category include those with (1) unstable or refractory angina; (2) uncontrolled hypertension; (3) congestive heart failure (class III or IV); (4) very recent MI (2 weeks); (5) high-risk arrhythmias; (6) obstructive cardiomyopathies; and (7) moderate-to-severe valvular disease. These patients should be stabilized by specific treatment for their cardiac condition before resuming sexual activity or being treated for sexual dysfunction. A simple algorithm is provided for guiding physicians in the management of sexual dysfunction in patients with varying degrees of cardiac risk.

Few large institutions have changed as fully and dramatically as the U.S. healthcare system since World War II. Compared to the 1930s, healthcare now incorporates a variety of new technologies, service-delivery arrangements, financing mechanisms, and underlying sets of organizing principles.

This book examines the transformations that have occurred in medical care systems in the San Francisco Bay area since 1945. The authors describe these changes in detail and relate them to both the sociodemographic trends in the Bay Area and to shifts in regulatory systems and policy environments at local, state, and national levels. But this is more than a social history; the authors employ a variety of theoretical perspectives - including strategic management, population ecology, and institutional theory - to examine five types of healthcare organizations through quantitative data analysis and illustrative case studies.

Providing a thorough account of changes for one of the nation's leading metropolitan areas in health service innovation, this book is a landmark in the theory of organizations and in the history of healthcare systems.

This book received the Max Weber Award from the American Sociological Association, Section on Organizations, Occupations and Work for best scholarly book in 2001

To assess the benefits of intervention programs against Helicobacter pylori infection, we estimated the baseline curves of its incidence and prevalence. We developed a mathematical (compartmental) model of the intrinsic dynamics of H. pylori, which represents the natural history of infection and disease progression. Our model divided the population according to age, infection status, and clinical state. Case-patients were followed from birth to death. A proportion of the population acquired H. pylori infection and became ill with gastritis, duodenal ulcer, chronic atrophic gastritis, or gastric cancer. We simulated the change in transmissibility consistent with the incidence of gastric cancer and duodenal ulcer over time, as well as current H. pylori prevalence. In the United States, transmissibility of H. pylori has decreased to values so low that, should this trend continue, the organism will disappear from the population without targeted intervention; this process, however, will take more than a century.