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The Genes and Environment in Multiple Sclerosis project establishes a platform to investigate the events leading to multiple sclerosis (MS) in at-risk individuals. It has recruited 2,632 first-degree relatives from across the USA. Using an integrated genetic and environmental risk score, we identified subjects with twice the MS risk when compared to the average family member, and we report an initial incidence rate in these subjects that is 30 times greater than that of sporadic MS. We discuss the feasibility of large-scale studies of asymptomatic at-risk subjects that leverage modern tools of subject recruitment to execute collaborative projects., (© 2015 American Neurological Association.)

Field spinal immobilization using a backboard and cervical collar has been standard practice for patients with suspected spine injury since the 1960s. The backboard has been a component of field spinal immobilization despite lack of efficacy evidence. While the backboard is a useful spinal protection tool during extrication, use of backboards is not without risk, as they have been shown to cause respiratory compromise, pain, and pressure sores. Backboards also alter a patient's physical exam, resulting in unnecessary radiographs. Because backboards present known risks, and their value in protecting the spinal cord of an injured patient remains unsubstantiated, they should only be used judiciously. The following provides a discussion of the elements of the National Association of EMS Physicians (NAEMSP) and American College of Surgeons Committee on Trauma (ACS-COT) position statement on EMS spinal precautions and the use of the long backboard. This discussion includes items where there is supporting literature and items where additional science is needed.

Changes in the size and type of operation of residential facilities for persons with mental retardation in the United States over the past 2 decades were discussed and current (June 30, 1988) interstate variability in residential services along these same dimensions examined. Considerable progress was noted nationally in securing relatively small, community-based residential opportunities for persons with mental retardation. However, this progress has not been uniformly realized in all states or for all types of facilities. Standards for federal policy that would make the official national commitment to community-based services more consistent among all the states were considered.

Although there is still dispute about the "surplus" of physicians, federal policies have begun to constrain the number of new entrants. Black students have been especially affected by retrenchment of federal support to education and by eroding medical school commitments to equity. Such trends undercut the demonstrable preference of black students to practice in geographic and specialty areas of greatest need. Better preparation for entry into medical school, and support through the long educational process, are necessary to preserve and extend the gains in both equity and health begun in the mid-1960s.

Telephone interview data from aggregated state surveys showed that about 21 percent of the U.S. adult population expends greater than or equal to 3 kcal/kg-day in vigorous leisure-time exercise. Three kilocalories per kilogram-day is equivalent to the amount commonly recommended to maximally reduce the incidence of coronary heart disease. Approximately 36 percent of the U.S. population reported no vigorous leisure-time exercise. Men, younger persons, and the more highly educated were most likely to expend greater than or equal to 3 kcal/kg-day, but for no subgroup did the rate exceed 30 percent. People who did not smoke, were not obese, and who did wear seat belts are also more likely to expend energy in vigorous leisure-time exercise. The prevalence of alcohol misuse is similar for all exercise categories. The proportion of people who expend greater than or equal to 3 kcal/kg-day is unrelated to self-reported occupational physical effort. Given the established and presumed benefits of physical activity, a substantial portion of the U.S. population would probably benefit from regular, vigorous, leisure-time exercise.

A national census of all state-licensed residential facilities for mentally retarded persons was conducted in 1982. This census enumerated 243,669 mentally retarded residents living in 15,633 facilities on June 30, 1982. Information on characteristics of facilities (e.g., type, location, size, type of operator, reimbursement rates) is presented along with demographic/functional characteristics of residents (e.g., age, level of retardation, previous and subsequent placement). The census verified the existence of an extensive variety of residential living alternatives available to mentally retarded people.

For a single year, 1983, we compared the actual and estimated morbidity, mortality, and costs attributable to measles, mumps, and rubella with having or not having a childhood immunization program using the combined measles-mumps-rubella (MMR) vaccine. Without an immunization program, an estimated 3,325,000 cases of measles would occur as compared to 2,872 actual cases in 1983 with a program. Instead of an expected 1.5 million rubella cases annually, there were only 3,816 actual cases. Mumps cases were lowered from an expected 2.1 million to 32,850 actual cases. Comparable reductions in disease-associated complications, sequelae, and deaths are gained with an immunization program. Without a vaccination program, disease costs would have been almost $1.4 billion. Based on the actual incidence of disease in 1983, costs were estimated to be approximately +14.5 million. Expenditures for immunization, including vaccine administration costs and the costs associated with vaccine reactions, totaled $96 million. The resulting benefit-cost ratio for the MMR immunization program is approximately 14:1. The savings realized due to the use of combination rather than single antigen vaccine total nearly $60 million.

Eight national surveys conducted in the United States and Canada between 1972 and 1983 are reviewed for evidence of leisure-time physical activity patterns in the population. The authors' major conclusion is that it is difficult to make reliable generalizations when definitions of exercise used in the surveys vary so widely. Nevertheless, the young and persons of relatively high socioeconomic status are definitely more active than average in their leisure time; this is probably also true of westerners and suburbanites. Males and females are about equally likely to be involved in conditioning activities, but males are more likely to participate in vigorous exercise and sport. It appears likely that exercise prevalence has increased in recent years, and a maximum of 20 percent of the population exercises at a level frequently recommended for cardiovascular benefit. Major areas of uncertainty and ignorance remain, and the authors identify 15 such areas. Secondary analysis is recommended to help resolve several questions currently impeding a complete description of the exercise patterns of the population. For future surveys, five recommendations are offered on definitions and essential data items. Existing time series studies are generally inadequate. The authors recommend that detailed surveys of exercise patterns be conducted every 5 years to supplement the continual monitoring that is also essential to detect shifts in this important health behavior.