The effects of athletic training and muscle contractile character on the pressor response to isometric exercise of the human triceps surae

In this study, the influence of athletic training status and the contractile character of the active muscle on the magnitude of the pressor response (PR) to voluntary and electrically evoked isometric plantar flexion was investigated. Subjects were 10 sprint-trained athletes (sprint) (100-m, 200-m and 400-m) [mean (SD) age, 21 (2) years], 14 endurance trained athletes (distance) [22 (2) years] and 8 untrained men (control) [23 (3) years]. Twitch time to peak tension (TPT) in the sprint group [108 (7) ms] was significantly less (P<0.001) than that of the distance group [124 (10) ms]. During voluntary contraction, the mean change in systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (fc) was not significantly different between groups. During electrically evoked contractions, mean changes in SBP, DBP and fc were not significantly different between the sprint, distance and control groups. However, division of the sprint group into 400-m (sprint I) and 100/200-m athletes (sprint II) showed that an increase in DBP of 1.6 kPa (12 mm Hg) in sprint I was significantly less (P<0.05) than the 2.5 kPa (19 mm Hg) increase observed for both the distance and control groups. Prediction of the DBP response from our previously published relationship between TPT and DBP showed close agreement in all subject groups except sprint I; in these subjects the observed DBP response was only 55% of that predicted. Attenuation of the PR in the involuntary experiment suggests that some aspect of sprint training, but not endurance training, modifies the muscle afferent input to the PR in man.

An epidemiological evaluation of the use of microbiological tools for identifying gonorrhoea infection networks

We aimed to assess the utility of various techniques for identifying gonorrhoea infection networks. All residents of a non-metropolitan North Carolina county visiting a sexually transmitted disease (STD) clinic during a 17-month period were screened for gonorrhoea. Infection networks were estimated by serovar type combined with antibiotic resistance, arbitrarily primed polymerase chain reaction (AP-PCR), or temporal clustering. The residential addresses of infected patients were geocoded and mapped. Among 2 serovar types, the presence of distinguishing characteristics of a network, based on questionnaire data, was assessed with prevalence ratios and 95% confidence intervals (CIs) relative to those not in the network. Twenty-five serovar types were identified among 759 gonorrhoea infections. In one serovar, the networks further delineated by temporal clusters correlated with particular AP-PCR types. In most instances, however, different typing techniques painted different network pictures. No refined serovar network stood out as having a particular set of characteristics that could be used to shape intervention. Teasing out an individual infection network with unique characteristics will require the development and use of other microbiological tools.

A medial linkage orthosis to assist ambulation after spinal cord injury

A "proof of concept" prototype of a new device to link bilateral knee-ankle-foot orthoses, the Mooring Medial Linkage Orthosis (Moorong MLO), is presented. The device consists of an arcuate sliding link centred on the hip joints with rolling element bearings to minimise friction. A single repeated-measures case study is reported in which a woman with an incomplete C6 tetraplegia ambulated over different surfaces and gradients using both the Moorong MLO and the Walkabout orthosis. Results demonstrated a slight increase in gait velocity in the Moorong MLO (between 0.36-1.02 m/min faster) and a consistently lower oxygen cost across all conditions (between 18-61% reduction) compared to the Walkabout orthosis. The reduction was most noticeable on sloping surfaces. These preliminary results suggest an improved efficiency of ambulation in this new device.

Psychological distress and infertility: forty years of research

A critical review is provided of the literature of psychosomatic infertility, including research on the relation of psychological distress and infertility, interventional studies in which efforts to treat underlying psychopathology are related to success or failure in conceiving, and proposed neurophysiological mechanisms that relate psychological status and fertility. Directions for future research to address the issue of psychological distress and infertility are also outlined.

The natural history of untreated lower urinary tract symptoms in middle-aged and elderly men over a period of five years

OBJECTIVES

To describe changes in untreated lower urinary tract symptoms (LUTS), levels of bothersomeness and interference in selected living activities arising from LUTS in a cohort of men followed up for a period of 5 years.

METHODS

1,994 men aged 40-79 years registered in four health centres in Scotland completed a urinary symptom questionnaire in the community. 1,177 (71% of original eligible participants) were followed up at 5 years.

RESULTS

The mean level of LUTS and the level of bothersomeness they caused increased universally between baseline and 5 years. The largest increases in mean symptom levels occurred for straining, hesitancy, incomplete emptying, weak stream and nocturia, and for mean levels of bothersomeness, i.e. dribbling, incomplete emptying, weak stream, frequency, nocturia and intermittency. The increase in mean interference level in selected living activities arising from LUTS was less marked. The progression of LUTS over time in individual men was very variable; however, the overall trend was one of continuing deterioration.

CONCLUSION

If left untreated, overall levels of middle-aged and elderly mens' LUTS, bothersomeness and interference in selected activities caused by these symptoms will increase over time.

The cost and outcomes of community-based care for the seriously mentally ill

OBJECTIVE

To examine the cost-effectiveness of community-based mental health care.

DATA SOURCES/STUDY SETTING

Administrative data from Medicaid and the Massachusetts Department of Mental Health; primary data from 144 psychiatrically disabled adult Medicaid beneficiaries who lived in Boston, central Massachusetts, and western Massachusetts.

STUDY DESIGN

A cross-sectional observational study compared the costs and outcomes of treatment in three different types of public mental health service systems.

DATA COLLECTION/EXTRACTION METHODS

Beneficiaries, randomly sampled from outpatient mental health programs, were interviewed about their mental health status. All their acute treatment and long-term continuing care for the preceding year were abstracted from Medicaid and Department of Mental Health files. Costs were extracted from Medicaid paid claims and from Department of Mental Health contracts and other financial documents.

PRINCIPAL FINDINGS

Clients in the region allocating a greater proportion of its Department of Mental Health budget to community support services used far fewer hospital days, resulting in lower per person treatment expenditures. Outcomes, however, were not significantly different from outcomes of clients in the other regions. For all regions, substance abuse comorbidity increased hospitalization and total treatment costs. An individual-level cost-effectiveness analysis identified western Massachusetts (community-based care) as significantly more cost effective than the other two regions.

CONCLUSIONS

Systems with stronger community-based orientation are more cost effective.

Interpersonal perception of the AIDS risk potential of persons of the opposite sex

Individuals engage in high rates of AIDS risk behavior, despite awareness that infection is preventable, and use biased decision rules for determining the AIDS risk potential of their own and others' behavior. In this laboratory study, 32 male and 32 female university students made judgments of the AIDS risk potential of persons of the opposite sex following exposure to explicit information regarding AIDS-related attitudes and behavior in a discussion group. A social relations analysis showed that judgments of AIDS risk potential were determined by perceiver-based assimilation that was stronger than target-based consensus for both men and women. Further, perceptions of others were related to self-perception. However, the consensus that was observed showed moderate accuracy. Implications for AIDS prevention are discussed.

Interpersonal perception of the AIDS risk potential of persons of the opposite sex

Individuals engage in high rates of AIDS risk behavior, despite awareness that infection is preventable, and use biased decision rules for determining the AIDS risk potential of their own and others' behavior. In this laboratory study, 32 male and 32 female university students made judgments of the AIDS risk potential of persons of the opposite sex following exposure to explicit information regarding AIDS-related attitudes and behavior in a discussion group. A social relations analysis showed that judgments of AIDS risk potential were determined by perceiver-based assimilation that was stronger than target-based consensus for both men and women. Further, perceptions of others were related to self-perception. However, the consensus that was observed showed moderate accuracy. Implications for AIDS prevention are discussed.

A relative-value-based system for calculating faculty productivity in teaching, research, administration, and patient care

PURPOSE

To design and test a simple, easily modifiable system for calculating faculty productivity in teaching, research, administration, and patient care in which all areas of endeavor would be recognized and high productivity in one area would produce results similar to high productivity in another at the Louisiana State University School of Medicine in New Orleans.

METHOD

A relative-value and time-based system was designed in 1996 so that similar efforts in the four areas would produce similar scores, and a profile reflecting the authors' estimates of high productivity ("super faculty") was developed for each area. The activity profiles of 17 faculty members were used to test the system.

RESULTS

"Super-faculty" scores in all areas were similar. The faculty members' mean scores were higher for teaching and research than for administration and patient care, and all four mean scores were substantially lower than the respective totals for the "super faculty". In each category the scores of those faculty members who scored above the mean in that category were used to calculate new mean scores. The mean scores for these faculty members were similar to those for the "super faculty" in teaching and research but were substantially lower for administration and patient care. When the mean total score of the eight faculty members predicted to have total scores below the group mean was compared with the mean total score of the nine faculty members predicted to have total scores above the group mean, the difference was significant (p < .0001). For the former, every score in each category was below the mean, with the exception of one faculty member's score in one category. Of the latter, eight had higher scores in teaching and four had higher scores in teaching and research combined.

CONCLUSION

This system provides a quantitative method for the equal recognition of faculty productivity in a number of areas, and it may be useful as a starting point for other academic units exploring similar issues.

Selective catheter ablation of the tachycardia focus in patients with nonreentrant junctional tachycardia

We describe a technique for ablation of junctional tachycardia focus by means of examining the earliest atrial activation sequence during tachycardia. The procedure was successful in 7 of 9 patients, and 1 developed complete atrioventricular block.

Managing the care of schizophrenia. Lessons from a 4-year Massachusetts Medicaid study

BACKGROUND

In 1992, Massachusetts launched a state-wide managed care plan for all Medicaid beneficiaries.

METHODS

This retrospective, multi-year, cross-sectional study used administrative data from the Massachusetts Division of Medical Assistance and Department of Mental Health, consisting of claims for 16,400 disabled adult patients insured by Medicaid in Massachusetts between July 1, 1990, and June 30, 1994. The main outcome measures include annual rates of hospitalization, emergency department utilization, and follow-up care 30 days after discharge; length of inpatient stay; and per-person inpatient and outpatient expenditures.

RESULTS

Between 1991 and 1994, the likelihood of an inpatient admission decreased from 29% to 24% and was accompanied by a slight reduction in length of stay (median number of bed-days per admission dropped by 3.3 days). There was a slight decrease in the number of patients who sought care in general hospital emergency department utilization. However, there was a small increase in the fraction of patients readmitted within 30 days of discharge. Medicaid and Department of Mental Health expenditures for mental health per treated beneficiary decreased slightly, from $11,060 to $10,640, during the 4-year study period.

CONCLUSION

Although per-person expenditures dropped and most patient patterns of care remained the same, longer-term study is recommended to asses whether the trends can be maintained.

Changing AIDS risk behavior: effects of an intervention emphasizing AIDS risk reduction information, motivation, and behavioral skills in a college student population

This research used the Information-Motivation-Behavioral Skills (IMB) model of AIDS risk behavior change (J. D. Fisher & Fisher, 1992a) to reduce AIDS risk behavior in a college student population. College students received an IMB model-based intervention that addressed AIDS risk reduction information, motivation, and behavioral skills deficits that had been empirically identified in this population, or were assigned to a no-treatment control condition. At a 1-month follow-up, results confirmed that the intervention resulted in increases in AIDS risk reduction information, motivation, and behavioral skills, as well as significant increases in condom accessibility, safer sex negotiations, and condom use during sexual intercourse. At a long-term follow-up, the intervention again resulted in significant increases in AIDS preventive behaviors.

Changing AIDS risk behavior: effects of an intervention emphasizing AIDS risk reduction information, motivation, and behavioral skills in a college student population

This research used the Information-Motivation-Behavioral Skills (IMB) model of AIDS risk behavior change (J. D. Fisher & Fisher, 1992a) to reduce AIDS risk behavior in a college student population. College students received an IMB model-based intervention that addressed AIDS risk reduction information, motivation, and behavioral skills deficits that had been empirically identified in this population, or were assigned to a no-treatment control condition. At a 1-month follow-up, results confirmed that the intervention resulted in increases in AIDS risk reduction information, motivation, and behavioral skills, as well as significant increases in condom accessibility, safer sex negotiations, and condom use during sexual intercourse. At a long-term follow-up, the intervention again resulted in significant increases in AIDS preventive behaviors.

Quantitative analysis of hyaluronan in human synovial fluid using capillary electrophoresis

The glycosaminoglycan, hyaluronan, can be detected in human synovial fluid by capillary electrophoresis (CE). Variations in peak shape make this technique unsuitable for quantitative analysis of hyaluronan in raw synovial fluid. Quantitative analysis was achieved by hydrolysis of the polymeric hyaluronan to the tetrasaccharide by the action of testicular hyaluronidase and separation of the product using CE. A UV detector operating at 200 nm was used. The X-ray contrast material, omnipaque, a propriety aqueous solution of iohexol was used as internal standard. A second peak in the electropherogram of synovial fluid was quantified. The variation in concentrations of these two components correlate with the arthritic disease state of a joint.

Benign prostatic hyperplasia in an unselected community-based population: a survey of urinary symptoms, bothersomeness and prostatic enlargement

OBJECTIVES

To determine the prevalence of (anatomical) benign prostatic hyperplasia/enlargement (BPH/BPE) in an unselected population and to assess the relationships between BPE, urinary flow rates (UFRs) and symptoms in men with BPH.

SUBJECTS AND METHODS

All men aged 40-79 years and living in three ex-mining villages in Scotland were invited to undergo a measurement of UFR, transrectal ultrasonography (TRUS) and to complete a symptom score and a previously validated lifestyle questionnaire.

RESULTS

Of 597 eligible men, 367 (61%) completed the urinary symptom questionnaire and 310 (52%) underwent TRUS and measurement of UFR. The response rate in the age group 50-69 was > 60%. Age-specific prevalence rates for BPE (prostate size > 20 g) per 1000 men were: 40-49 years, 615; 50-59 years, 776; 60-69 years, 892; and 70-79 years, 889, giving an overall rate for all ages of 765. There was no significant relationship between prostate size and symptoms, nor between size and peak UFR, nor any clear association between size and interference with activities of daily living. However, men with a UFR of > 20 mL/s were very unlikely to have prostates > 40 g. Relationships were found between some urinary symptoms and UFR. Age, weight and the level of prostate-specific antigen (PSA) were the only independent variables associated with prostate size.

CONCLUSION

Compared to published studies, BPE was substantially more prevalent than assumed previously. This study further reinforces the need for the subtle and detailed evaluation of patients who have a syndrome of BPH in assigning them to intervention, be it medical or surgical, or non-intervention/watchful waiting.

Dental hygienists' information seeking and computer application behavior

A questionnaire requesting information on information seeking, critical analysis, and computer applications was returned in 1992 by 136 of 197 (69 percent) currently licensed dental hygienists residing in Alaska, Delaware, and Idaho. The most common sources used for professional development and information retrieval were continuing education courses, discussions with colleagues, and journals. The respondents' own experience, credibility of the journal, and discussions with colleagues were the most frequent methods used to evaluate professional information. Many hygienists owned or had access to a computer, yet they rarely conducted online database searches to obtain professional information. The computer was primarily used to perform business functions rather than for clinical applications in these dental hygienists' employment settings. The majority of these hygienists were interested in attending related continuing education courses and indicated that computer skills should be part of dental hygiene curricula.

Cisplatin plus etoposide with and without ifosfamide in extensive small-cell lung cancer: a Hoosier Oncology Group study

PURPOSE

To determine whether the addition of ifosfamide to cisplatin plus etoposide improves the response rate, time to disease progression, or overall survival in previously untreated patients with extensive-stage small-cell carcinoma of the lung (SCLC).

PATIENTS AND METHODS

Patients with extensive SCLC with a Karnofsky performance score (KPS) > or = 50 and adequate renal function and bone marrow reserve were eligible. Patients with CNS metastases were eligible and received concurrent whole-brain radiotherapy. Patients were randomized to receive cisplatin (20 mg/m2) plus etoposide (100 mg/m2) (VP) both given intravenously (i.v.) on days 1 to 4 or cisplatin (20 mg/m2), ifosfamide (1.2 g/m2), and etoposide (75 mg/m2) (VIP) all given i.v. on days 1 to 4. Cycles were repeated every 3 weeks for four cycles.

RESULTS

From May 1989 through March 1993, 171 patients were randomized (84 to VP and 87 to VIP). The median follow-up duration is 26 months. All patients were assessable for survival; 163 were fully assessable for response and 162 for toxicity. Myelosuppression was greater with VIP. Objective responses were observed in 55 of 82 (67%) and 59 of 81 (73%) assessable patients treated with VP and VIP, respectively (difference not significant). The difference in the median time to progression was statistically different (P = .039). The median survival times on VP and VIP were 7.3 months and 9.0 months, respectively (P = .045 for survival curves by stratified log-rank test) with 2-year survival rates of 5% versus 13%, respectively.

CONCLUSION

VIP combination chemotherapy is associated with an improved time to progression and overall survival over VP therapy in patients with extensive SCLC.

Information-seeking practices of dental hygienists

This paper reports on a survey of the information-seeking, critical-analysis, and computer-application practices of dental hygienists. Questionnaires were mailed to a convenience sample of seventy-one dental hygiene practitioners. A 62% response rate was achieved. Results indicated that discussions with colleagues, continuing education courses, journals, and newsletters were the sources used most frequently for professional development and information retrieval. To evaluate professional information, these hygienists tended to rely on personal experience, credibility of the journal, and discussions with colleagues. Word processing was the most frequently used computer application; online database searching was rare in this group. Computer used within the employment setting was primarily for business rather than clinical applications. Many hygienists were interested in attending continuing education courses on use of computers to acquire professional information.

Understanding and promoting AIDS-preventive behavior: insights from the theory of reasoned action

Psychological determinants of AIDS-preventive behaviors were examined from the perspective of the theory of reasoned action in prospective studies of gay men, heterosexual university students, and heterosexual high school students. Across samples, preventive behaviors, and prospective intervals of 1 and 2 months' duration. AIDS-preventive behaviors were predicted by behavioral intentions; behavioral intentions were a function of attitudes and norms; and attitudes and norms were a function of their theorized basic underpinnings. Discussion focuses on the development of AIDS-prevention interventions that modify intentions, attitudes, and norms concerning performance of AIDS-preventive behaviors by targeting the empirically identified underpinnings of attitudes and norms related to specific preventive behaviors in specific populations of interest.

Phase III trial of thoracic irradiation with or without cisplatin for locally advanced unresectable non-small-cell lung cancer: a Hoosier Oncology Group protocol

PURPOSE

Here we report the results of a phase III study, to evaluate whether the addition of cisplatin to radiation therapy (XRT) would improve progression-free survival or overall survival for patients with locally advanced unresectable non-small-cell lung cancer (NSCLC).

PATIENTS AND METHODS

Two hundred forty patients with biopsy-proven unresectable NSCLC without distant metastases or lower-stage medically inoperable patients were randomized to one of two treatment arms. Arm A consisted of thoracic XRT alone, 60 to 65 Gy total tumor dose in daily fractions of 1.80 to 2.00 Gy; and arm B consisted of identical XRT with the addition of cisplatin 70 mg/m2 every 3 weeks for three cycles beginning on the first day of irradiation.

RESULTS

Two hundred fifteen patients were eligible and assessable. The overall response rate was 50% on the combination arm versus 38% on the XRT-alone arm (P = .076). The median progression-free survival time was 23 versus 22 weeks, respectively (P = .0537). The median survival time was 43 weeks on the combination arm versus 46 weeks on the XRT arm (Poverall = .3469). The 1-, 2-, and 5-year survival rates were 43%, 18%, and 5% on the combination arm versus 45% 13%, and 2% on the XRT arm, respectively.

CONCLUSION

Cisplatin, administered every 3 weeks, does not significantly improve response rate, progression-free survival, or overall survival when added to thoracic XRT for locally advanced unresectable NSCLC.