Changing demographic characteristics of women veterans: results from a national sample

Women veterans are a small but growing percentage of the U.S. veteran population. There are some indications that, along with this increase, the characteristics and military experiences of younger women veterans differ considerably from those of older colleagues. Many of these characteristics are not well defined, but they could have implications for women's health care needs and health policy initiatives. Using the first sample drawn from the Department of Veterans Affairs' new National Registry of Women Veterans, we designed and administered a telephone survey to a representative sample of women veterans across several major age groups. Groups approximated primary eras of military and wartime service based on the assumption that different eras might be associated with differing military experiences. We found a number of age-related similarities and differences in women veterans' demographic characteristics, military experiences, physical health symptoms, and functional outcomes. Women veterans in general also differed from female civilian counterparts on exposure to sexual trauma. Trends in the population of women veterans are likely to have implications for the variety of health care systems that treat women veterans.

Effects of L-dopa treatment on methylation in mouse brain: implications for the side effects of L-dopa

The effects of L-dopa on methylation process in the mouse brain were investigated. The study is based on recent findings that methylation may play an important role in Parkinson's disease (PD) and in the actions of L-dopa. The methyl donor, S-adenosylmethionine (SAM) and a product of SAM, methyl beta-carboline, were shown to cause PD-like symptoms, when injected into the brain of animals. Furthermore, large amounts of 3-O-methyl dopa, the methyl product of L-dopa, are produced in PD patients receiving L-dopa treatment, and L-dopa induces methionine adenosyl transferase, the enzyme that produces SAM. The results show that, at 0.5 hr, L-dopa (100 mg/kg) decreased the methyl donor, S-adenosylmethionine (SAM) by 36%, increased its metabolite S-adenosylhomocysteine (SAH) by 89% and increased methylation (SAH/SAM) by about 200%. All parameters returned to control values within 4 hr. But 2, 3 and 4 consecutive injections of L-dopa, given at 45 min intervals, depleted SAM by 60, 64 and 76% and increased SAM/SAH to 818, 896, and 1524%. L-dopa (50, 100 and 200 mg/kg) dose-dependently depleted SAM from 24.9 +/- 1.7 nmol/g to 13.0 +/- 0.8, 14.7 +/- 0.8 and 7.7 +/- 0.7 nmol/g, and increased SAH from 1.88 +/- 0.14 to 3.43 +/- 0.26, 4.22 +/- 0.32 and 6.21 +/- 0.40 nmol/g. Brain L-dopa was increased to 326, 335 and 779%, dopamine to 138, 116 and 217% and SAH/SAM to 354, 392 and 1101%. The data show that L-dopa depletes SAM, and increases methylation 4-5 times more than dopamine, therefore, methylation may play a role in the actions of L-dopa. This and other studies suggest that the high level of utilization of methyl group by L-dopa leads to the induction of enzymes to replenish SAM and to increase the methylation of L-dopa as well as DA. These changes may be involved in the side effects of L-dopa.

Idiopathic calcinosis of the tongue

Idiopathic calcinosis of the tongue is very rare. We report a case of idiopathic calcinosis of the tongue in a 19-year-old female.

Visualism in community nursing: implications for telephone work with service users

This article explores the potential effects of visualism (a prejudice in favor of the seen) on the perceived legitimacy of telephone work in community nursing. It discusses data from an exploratory study on telephone work, which used guided interviews with a purposive sample of 14 community nurses. Interviewees expressed both positive and negative ideas about telephone work and had particular concerns about the assessment of people, context, problems, and comprehension by telephone. These issues are discussed with reference to publications on visualism, metaphor, communication, and nursing work. The authors conclude that an awareness of the possible effects of visualism on ideas and practice could lead to improvements in both communication and assessment, whether carried out by telephone or face to face.

Risk of acquiring Creutzfeldt-Jakob disease from blood transfusions: systematic review of case-control studies

OBJECTIVE

To determine the strength of association between history of blood transfusion and development of Creutzfeldt-Jakob disease.

DATA SOURCES

English and non-English language articles published from January 1966 to January 1999 were retrieved using a keyword search of Medline and Embase. These were supplemented by handsearching key journals and searching bibliographies of reviews.

STUDY SELECTION

Two independent reviewers selected the relevant abstracts and articles. Articles were chosen that reported the results of case-control studies trying to identify rates of prior blood transfusion in patients with Creutzfeldt-Jakob disease and in controls.

DATA EXTRACTION

Odds ratios and information on study quality were extracted from the selected articles by two independent reviewers.

DATA SYNTHESIS

Five studies containing data on 2479 patients were included. Three of the five studies used medical or neurological patients as controls, the other two used population controls. Odds ratios for developing Creutzfeldt-Jakob disease from blood transfusion ranged from 0.54 to 0.89. Four of the five studies had confidence intervals that crossed 1.0. The combined odds ratio was 0.70 (95% confidence interval 0.54 to 0.89).

CONCLUSIONS

Case-control studies do not suggest a risk of developing Creutzfeldt-Jakob disease from blood transfusion. Rather, a trend seems to exist towards a lower frequency of previous blood transfusion in patients with Creutzfeldt-Jakob disease than in controls. However, it is important to be aware of these studies' methodological limitations-primarily the choice of control population and reliability of recall of transfusion status.

Gender, poverty and location: how much difference do they make in the geography of health inequalities?

It is often said that women live longer than men, but suffer more illnesses throughout their lives. It has also been demonstrated in various studies of women's health that measures of health and health behaviour vary over different geographic scales. Added into this mix is the fact that historically more women than men in relative terms are found on the lower rungs of the socio-economic ladder. What has not been so well-developed is our understanding of the connections among health, gender, poverty and especially location. In 1998, Statistics Canada released the second wave of the National Population Health Survey (NPHS-2). Included with the NPHS-2 public use microdata file are measures of health status, gender, income and location which can be analyzed in the form of logistic regression models. Results are reported which provide a better understanding of the relative roles that gender, poverty and location play in the geography of inequalities.

The complete sequence of the mitochondrial genome of the crustacean Penaeus monodon: are malacostracan crustaceans more closely related to insects than to branchiopods?

The complete sequence of the mitochondrial genome of the giant tiger prawn, Penaeus monodon (Arthropoda, Crustacea, Malacostraca), is presented. The gene content and gene order are identical to those observed in Drosophila yakuba. The overall AT composition is lower than that observed in the known insect mitochondrial genomes, but higher than that observed in the other two crustaceans for which complete mitochondrial sequence is available. Analysis of the effect of nucleotide bias on codon composition across the Arthropoda reveals a trend with the crustaceans represented showing the lowest proportion of AT-rich codons in mitochondrial protein genes. Phylogenetic analysis among arthropods using concatenated protein-coding sequences provides further support for the possibility that Crustacea are paraphyletic. Furthermore, in contrast to data from the nuclear gene EF1alpha, the first complete sequence of a malacostracan mitochondrial genome supports the possibility that Malacostraca are more closely related to Insecta than to Branchiopoda.

Identifying male college students' perceived health needs, barriers to seeking help, and recommendations to help men adopt healthier lifestyles

Seven focus groups at a university campus were formed to identify college men's health concerns, barriers to seeking help, and recommendations to help college men adopt healthier lifestyles. Content analysis was used to identify and organize primary patterns in the focus-group data. Results of the study revealed that the college men were aware that they had important health needs but took little action to address them. The participants identified both physical and emotional health concerns. Alcohol and substance abuse were rated as the most important issues for men. The greatest barrier to seeking services was the men's socialization to be independent and conceal vulnerability. The most frequently mentioned suggestions for helping men adopt healthier lifestyles were offering health classes, providing health information call-in service, and developing a men's center. Implications of the results are discussed.

Depression and the dying older patient

Depression remains a source of considerable suffering among dying older adults. Unfortunately, clinical depression commonly is overlooked in this vulnerable population and often goes untreated. An overview of diagnosing depression in older patients is presented. Various risk factors for depression in the palliative care setting are examined. The somatic therapies that are available for treatment consideration in older, depressed adults nearing death are reviewed.

Health care, federalism and the new Social Union

The Social Union framework agreement and the Health Accord provide examples of the close relationship that exists between federalism and the delivery of health care. These recent agreements represent a move from a federal-unilateral style of federalism to a more collaborative model. This shift will potentially affect federal funding for health care, interpretation of the Canada Health Act and the development of new health care initiatives. The primary advantage of the new collaborative model is protection of jurisdictional autonomy. Its primary disadvantages are blurring of accountability and potential for exclusion of the public from decision-making.

Effect of smoking cessation on mortality after myocardial infarction: meta-analysis of cohort studies

OBJECTIVE

To determine the effect of smoking cessation on mortality after myocardial infarction.

DATA SOURCES

English- and non-English-language articles published from 1966 through 1996 retrieved using keyword searches of MEDLINE and EMBASE supplemented by letters to authors and searching bibliographies of reviews.

STUDY SELECTION

Selection of relevant abstracts and articles was performed by 2 independent reviewers. Articles were chosen that reported the results of cohort studies examining mortality in patients who quit vs continued smoking after myocardial infarction.

DATA EXTRACTION

Mortality data were extracted from the selected articles by 2 independent reviewers.

DATA SYNTHESIS

Twelve studies were included containing data on 5878 patients. The studies took place in 6 countries between 1949 and 1988. Duration of follow-up ranged from 2 to 10 years. All studies showed a mortality benefit associated with smoking cessation. The combined odds ratio based on a random effects model for death after myocardial infarction in those who quit smoking was 0.54 (95% confidence interval, 0.46-0.62). Relative risk reductions across studies ranged from 15% to 61%. The number needed to quit smoking to save 1 life is 13 assuming a mortality rate of 20% in continuing smokers. The mortality benefit was consistent regardless of sex, duration of follow-up, study site, and time period.

CONCLUSION

Results of several cohort studies suggest that smoking cessation after myocardial infarction is associated with a significant decrease in mortality.

Diagnostic evaluation of patients with blunt abdominal trauma: a decision analysis

OBJECTIVES

Using decision analysis, to compare the expected utility (EU) of diagnostic peritoneal lavage (DPL), computed tomography (CT), and ultrasonography (US) to determine the optimal modality for the evaluation of blunt abdominal trauma (BAT) in hemodynamically stable adults.

METHODS

Data points for the decision analysis were obtained from three sources: 1) prevalence of BAT and the sensitivity and specificity of each diagnostic modality were determined through a criteria-based review of the literature; 2) rate of BAT necessitating immediate intervention, perioperative complication rate, and operative mortality rate were calculated using data from the authors' institution's trauma registry; and 3) outcome utilities were determined by telephone survey of adults in a random sample of households in the region. The decision tree was constructed and evaluated in standard fashion. For each diagnostic modality, the authors calculated the EU using the minimum, mean, and maximum sensitivity and specificity across a range of prevalence. Mean outcome utilities were used for each branch of the tree when calculating the EU.

RESULTS

The EU of CT was consistently lower than the EUs of DPL and US at all levels of prevalence. However, the rank order of the EUs of US and DPL varied with the prevalence of BAT. When the prevalence was <30%, the EU of US was higher than that for DPL. When the prevalence was 30-40%, the EUs were similar. When the prevalence was >40%, the EU of US was less than that of DPL.

CONCLUSIONS

Among institutions operating under constraints similar to those used in this model, the optimal diagnostic modality for the evaluation of BAT can be determined based on the sensitivity and specificity of the modality at their institution and the prevalence of BAT in their patient population.

Restructuring public health in Ontario: implications for heart health promotion

Community-based heart health promotion is viewed as an effective means of reducing cardiovascular disease risk. Although public health agencies have a central role in the implementation and dissemination of heart health programmes, their effectiveness is being challenged by major structural changes to Provincial public health systems across Canada, although the impacts of the changes have received relatively little attention in the research literature. As part of the Canadian Heart Health Initiative--Ontario Project (CHHIOP), this study used a qualitative approach to address the perceived implications of these changes to Ontario's public health system for heart health promotion. Interviews (n = 38) were conducted in eight public health units with staff most familiar with managing and/or delivering heart health activities. The results are mixed; that is, while many see the future of heart health promotion programming in Ontario as being at risk, others see recent changes as a step forward toward their institutionalization, particularly in light of recent funding decisions made by the Ministry of Health's Health Promotion Branch.

Restructuring public health in Ontario: implications for heart health promotion

Community-based heart health promotion is viewed as an effective means of reducing cardiovascular disease risk. Although public health agencies have a central role in the implementation and dissemination of heart health programmes, their effectiveness is being challenged by major structural changes to Provincial public health systems across Canada, although the impacts of the changes have received relatively little attention in the research literature. As part of the Canadian Heart Health Initiative--Ontario Project (CHHIOP), this study used a qualitative approach to address the perceived implications of these changes to Ontario's public health system for heart health promotion. Interviews (n = 38) were conducted in eight public health units with staff most familiar with managing and/or delivering heart health activities. The results are mixed; that is, while many see the future of heart health promotion programming in Ontario as being at risk, others see recent changes as a step forward toward their institutionalization, particularly in light of recent funding decisions made by the Ministry of Health's Health Promotion Branch.

Employment satisfaction of individuals with spinal cord injury

OBJECTIVES

Community reentry after a spinal cord injury is a long-term integrative process, because individuals must adjust to an extraordinary new set of circumstances. In this study, quality-of-life and work satisfaction variables associated with employed or unemployed individuals with spinal cord injury were examined.

METHODS

Quality-of-life and work satisfaction variables associated with 109 employed or unemployed individuals with spinal cord injury were examined by using an employment satisfaction survey.

RESULTS

Most of those employed indicated that they would either change jobs or some employment variable such as duties, supervisor, or hours worked. Participants who were not working attributed unemployment to an array of factors including ongoing health problems, lack of transportation, and impact of and/or lost disability benefits. Both groups offered feedback related to information provided to them by medical professionals about return-to-work resources.

CONCLUSIONS

The following three themes emerged from this analysis: (1) more comprehensive provider training about spinal cord injury is needed; (2) increased communication between consumer and family would be beneficial; and (3) an increase in the flexibility and availability of services would help to ensure access to essential care.

Discovery of novel antifungal (1,3)-beta-D-glucan synthase inhibitors

The increasing incidence of life-threatening fungal infections has driven the search for new, broad-spectrum fungicidal agents that can be used for treatment and prophylaxis in immunocompromised patients. Natural-product inhibitors of cell wall (1,3)-beta-D-glucan synthase such as lipopeptide pneumocandins and echinocandins as well as the glycolipid papulacandins have been evaluated as potential therapeutics for the last two decades. As a result, MK-0991 (caspofungin acetate; Cancidas), a semisynthetic analogue of pneumocandin B(o), is being developed as a broad-spectrum parenteral agent for the treatment of aspergillosis and candidiasis. This and other lipopeptide antifungal agents have limited oral bioavailability. Thus, we have sought new chemical structures with the mode of action of lipopeptide antifungal agents but with the potential for oral absorption. Results of natural-product screening by a series of newly developed methods has led to the identification of four acidic terpenoid (1,3)-beta-D-glucan synthase inhibitors. Of the four compounds, the in vitro antifungal activity of one, enfumafungin, is comparable to that of L-733560, a close analogue of MK-0991. Like the lipopeptides, enfumafungin specifically inhibits glucan synthesis in whole cells and in (1,3)-beta-D-glucan synthase assays, alters the morphologies of yeasts and molds, and produces a unique response in Saccharomyces cerevisiae strains with point mutations in FKS1, the gene which encodes the large subunit of glucan synthase.

Distribution and origin of secretoneurin-immunoreactive nerves in the female rat uterus

Secretoneurin is a 33-amino acid peptide derived from secretogranin II. Secretoneurin immunoreactivity has been localized in the peripheral nervous system where it exerts potent chemotactic activity for monocytes and may play a role in inflammation. Secretoneurin could play a role in this process, although the presence and distribution of secretoneurin-immunoreactive neurons in the female reproductive system has not been documented. Thus, this study was undertaken to examine secretoneurin immunoreactivity in nerves of the rat uterus and uterine cervix. A moderate plexus of secretoneurin-immunoreactive nerve fibers was present in the myometrium and endometrium of the uterus as well as in the smooth muscle and endocervix of the cervix. Many of these fibers were associated with the vasculature as well as the myometrium. Secretoneurin immunoreactivity was present in small- to medium-sized neurons of dorsal root and nodose ganglia. Retrograde tracing with FluoroGold indicated that some of these sensory neurons project axons to the cervix and uterine horns. Secretoneurin-immunoreactive terminal-like structures were associated with neurons in the sacral parasympathetic nucleus of the lumbosacral spinal cord. In addition, some secretoneurin terminals were apposed to pelvic parasympathetic neurons in the paracervical ganglia that projected axons to the uterus and cervix. Double-immunostaining indicated co-existence of calcitonin gene-related peptide or substance P with secretoneurin in some sensory neurons, in some terminals of the pelvic ganglia, as well as nerve fibers in the uterine horn and cervix. Finally, fibers in the uterus and cervix were depleted of secretoneurin by capsaicin treatment. This study indicates that secretoneurin is present in the uterus in C-afferent nerve fibers whose cell bodies are located in sensory ganglia. Some of these fibers contain both secretoneurin and calcitonin gene-related peptide or substance P. These substances have functions in inflammatory reactions. Further, secretoneurin could influence postganglionic parasympathetic "uterine-related" neurons in the pelvic ganglia and preganglionic parasympathetic neurons in the lumbosacral spinal cord.

The teaching and learning principles of metropolitan Aborigines with diabetes

This study was undertaken at a leading Aboriginal health agency in Adelaide called Nunkuwarrin Yunti (King & Wilson 1998). One of the aims not previously reported involved identifying the way that metropolitan Aborigines prefer to learn about their diabetes management. An ethnographic approach was used to interview ten Aboriginal health professionals and four clients (n = 14) about this topic. The results indicated the worldview held by metropolitan Aborigines about diabetes health care, the Aboriginal learner, beliefs about teaching and learning, the characteristics of an effective teacher and a suggested teaching plan.

A simple, inexpensive method for teaching how membrane potentials are generated

We have developed a simple laboratory exercise that uses an inexpensive dialysis membrane (molecular weight cutoff = 100) to illustrate the generation of membrane potentials (Vm) across plasma membranes of animal cells. A piece of membrane approximately 2.0 cm2 is mounted in an Ussing-like chamber. One chamber half is designated cytosol and the other half external. Chamber sidedness helps students relate their findings to those of real cells. As in real cells, outward directed K+ concentration gradients [high cytosolic K+ concentration ([K+]c) and low extracellular K+ concentration] generate cytosol electrically negative Vm with a slope of approximately -45 mV/decade change in [K+]c. The polarity of Vm reflects the outward flow of potassium ions because flow of the larger counterion, H2PO4-, is restricted to the pores in the membrane. A slope less than Nernstian (<59 mV/decade) suggests that the membrane is slightly permeable to H2PO4-. Importantly, this facilitates teaching the use of the Nernst equation to quantify the relationship between ion concentration ratios across membranes and magnitude of Vm. For example, students use their data and calculate a permeability ratio PK/PH2PO4 that corresponds to a slope of approximately 24% less than Nernstian. This calculation shows that Nernstian slopes are achieved only when permeability to the counterion is zero. Finally, students use the concept of membrane capacitance to calculate the number of ions that cross the membrane. They learn where these ions are located and why the bulk solutions conform to the principle of electroneutrality.