Sources of information on the health effects of environmental tobacco smoke among African-American children and adolescents

PURPOSE

To determine the common sources of information regarding the effects of smoking on health and their relationship to knowledge, attitudes, and preventative efforts regarding exposure to environmental tobacco smoke (ETS) among urban African-American children and adolescents.

METHODS

All students who were enrolled in Grades 5-12 in an urban public school district located in the greater metropolitan area of Detroit, Michigan were surveyed using a structured, written questionnaire that assessed sources of information on the health effects of smoking, as well as knowledge, attitudes, and preventive efforts with respect to exposure to ETS. The primary analytic procedures utilized in the study were correlation analysis and analysis of variance.

RESULTS

The African-American students surveyed in this study received information regarding the health effects of smoking from many sources, most notably television, family, and teachers. Second, students who received information on the effects of smoking on health from family and external sources (teacher, parent's friend, and religious leader) had higher overall knowledge, attitude, and preventive efforts scores than students who received information from other sources (friends, electronic media, and printed media). Finally, family influence was greater when parents were not smokers, and influenced elementary students more than middle school or high school students.

CONCLUSIONS

The active involvement of teachers, religious leaders, parents, and other influential adults should be elicited in tobacco education and prevention efforts to maximize their effectiveness.

Interpretation of the detection of Sarcocystis neurona antibodies in the serum of young horses

Horses that are exposed to Sarcocystis neurona, a causative agent of equine protozoal myeloencephalitis, produce antibodies that are detectable in serum by western blot (WB). A positive test is indicative of exposure to the organism. Positive tests in young horses can be complicated by the presence of maternal antibodies. Passive transfer of maternal antibodies to S. neurona from seropositive mares to their foals was evaluated. Foals were sampled at birth (presuckle), at 24h of age (postsuckle), and at monthly intervals. All foals sampled before suckling were seronegative. Thirty-three foals from 33 seropositive mares became seropositive with colostrum ingestion at 24h of age, confirming that passive transfer of S. neurona maternal antibodies occurs. Thirty-one of the 33 foals became seronegative by 9 months of age, with a mean seronegative conversion time of 4.2 months. These results indicate that evaluation of exposure to S. neurona by WB analysis of serum may be misleading in young horses.

Evaluating hypertension control in a managed care setting

BACKGROUND

We conducted a retrospective cohort study on a random sample of adult patients with hypertension in a large health maintenance organization to assess the feasibility of documenting blood pressure (BP) control and to compare different measures for defining BP control.

METHODS

Three criteria for BP control were assessed: systolic BP less than 140 mm Hg; diastolic BP less than 90 mm Hg; and combined BP control, with systolic BP less than 140 mm Hg and diastolic BP less than 90 mm Hg. Four methods of assessing hypertension control by the above criteria were examined: proportion of patients with BP under control at 75% and 50% or more of their office visits; the mean of all pressures during the study period; and the BP from the last visit during the study period.

RESULTS

The proportion of patients meeting each criterion for control was similar whether we used the mean BP for all visits, the last recorded BP, or control at 50% or more of visits. Control rates were substantially lower when the more stringent assessment, 75% of visits, was used. The proportion of patients with combined BP control at 75% or more of their visits was half that of the other methods.

CONCLUSIONS

In this health maintenance organization population, results with the use of the simplest approach, the last BP measurement recorded, were similar to results with the mean BP. Our findings indicate that evaluation of BP control in a large health maintenance organization will find substantial room for improvement, and clinicians should be encouraged to be more aggressive in their management of hypertension, especially with regard to the systolic BP, which until recent years has been underemphasized.

Mortality in the Survival With ORal D-sotalol (SWORD) trial: why did patients die?

The Survival With ORal D-sotalol (SWORD) trial tested the hypothesis that the prophylactic administration of oral d-sotalol would reduce total mortality in patients surviving myocardial infarction (MI) with a left ventricular ejection fraction (LVEF) of < or = 40%. Two index MI groups were included: recent (6 to 42 days) and remote (> 42 days) with clinical heart failure (n = 915 and 2,206, respectively). The trial was discontinued when the statistical boundary for harm was crossed (RR = 1.65; p = 0.006). All baseline variables known to be associated with mortality risk (e.g., LVEF, heart failure class, age) as well as variables related to torsades de pointes (e.g., time from beginning of therapy, QTc, gender, potassium, renal function, dose of d-sotalol) were assessed for interaction of each variable with treatment assignment, computing RR and 95% confidence interval (CI) from Cox regression models. The d-sotalol-associated mortality was greatest in the group with remote MI and LVEFs of 31% to 40% (RR = 7.9; 95% CI 2.4 to 26.2). Most variables known to be associated with torsades de pointes were not differentially predictive of d-sotalol-associated risk, except female gender (RR = 4.7; 95% CI 1.4 to 16.5). These findings suggest that (1) most of the d-sotalol-associated risk was in patients remote from MI with a LVEF of 31% to 40%; comparable placebo patients had a very low mortality (0.5%); and (2) very little objective data supports torsades de pointes or any specific proarrhythmic mechanism as an explanation for d-sotalol-associated mortality risk.

Hypertension-related morbidity and mortality in the southeastern United States

Stroke mortality is higher in the Southeast compared with other regions of the United States. The prevalence of hypertension is also higher (black men = 35%, black women = 37.7%, white men = 26.5%, white women = 21.5%), and the proportion of patients whose hypertension is being controlled is poor, especially in white and black men. The prevalence of hypertension-related complications other than stroke is also higher in the Southeast. The five states with the highest death rates for congestive heart failure are all in the southern region. Of the 15 states with the highest rates of end-stage renal disease, 10 are in the Southeast. Obesity is very prevalent (24% to 28%) in the Southeast. Although Michigan tops the ranking for all states, 6 of the top 15 states are in the Southeast, as are 7 of the 10 states with the highest reported prevalence regarding no leisure-time physical activity. Similar to other areas of the United States, dietary sodium and saturated fat intake are high in the Southeast; dietary potassium intake appears to be relatively low. Other factors that may be associated with the high prevalence, poor control, and excess morbidity and mortality of hypertension-related complications in the Southeast include misperceptions of the seriousness of the problem, the severity of the hypertension, lack of adequate follow-up, reduced access to health care, the cost of treatment, and possibly, low birth weights. The Consortium of Southeastern Hypertension Control (COSEHC) is a nonprofit organization created in 1992 in response to a compelling need to improve the disproportionate hypertension-related morbidity and mortality throughout this region. The purpose of this position paper is to summarize the data that document the problem, the consequences, and possible causative factors.

Cloning and characterization of tomato leaf senescence-related cDNAs

Senescence-related cDNA clones designated SENU1, 4, 5 (senescence up-regulated) and SEND32, 33, 34, 35 and 36 (senescence down-regulated) isolated from a tomato leaf cDNA library [9] were characterized. Southern analysis showed that SEND32 is encoded by a single-copy gene while SEND33, 34, 35, 36 and SENU1 and SENU5 are members of small gene families. DNA and protein database searches revealed that SEND32, SEND35, SENU1 and SENU5 are novel cDNAs of unknown function. SEND33 encodes ferredoxin, SEND34 encodes a photosystem II 10 kDa polypeptide and SEND36 encodes catalase. The SENU4 sequence is identical to the P6 tomato protein previously reported to be pathogenesis-related [46]. The mRNA levels of SENU1, 4 and 5 increased during leaf senescence and SENU1 and SENU5 were also expressed at high levels during leaf development and in other plant organs. The SENU4 mRNA was associated more specifically with leaf senescence, although low expression was also detected in green fruit. The mRNAs for all SEND clones decreased during tomato leaf development and senescence and all except SEND32 were expressed at low levels in other plant organs. The accumulation of mRNA homologous to SENU4 and the decrease in abundance of SEND32 provide good molecular markers for leaf senescence.

The validity of police assessment of driver intoxication in motor vehicle crashes leading to hospitalization

We evaluated the accuracy of the field sobriety assessment of police officers following a motor vehicle crash. Using linked data from a statewide traffic crash database and the trauma center registry, the results of a field sobriety evaluation for each driver were compared with a blood alcohol concentration (BAC) drawn in the emergency department. BAC values served as the "gold standard" in which drivers with values over 0.1 mg/dl were classified as intoxicated. The subjects were drivers over age 15 years who were admitted or died at Level I trauma center as a results of motor vehicle crash injuries during 1986-1993. A total of 1336 subjects had both a recorded BAC and a police sobriety assessment. Seventy percent of subjects were male and 79% under the age of 35 years. Overall, 40% of all subjects were judged by police to have been impaired, based on the scene sobriety assessment. Among all drivers, the field assessment had a sensitivity of 91%, a specificity of 90% and a predictive value positive of 85%. After excluding the 419 drivers which had breath testing as part of their assessment, the field assessment had a sensitivity of 74% and a specificity of 97%. The sensitivity of the field assessment did not vary appreciably by gender but was lower among older drivers, and higher among severely injured drivers and those involved in weekend and nighttime crashes. Police officers in this sample appear to recognize drunk driving with a high degree of accuracy when investigating crashes in which the driver is transported to a trauma center.

Differential expression of the 1-aminocyclopropane-1-carboxylate oxidase gene family of tomato

The tomato ACC oxidase gene family is comprised of three members designated AC01, AC02 and AC03. These are highly homologous throughout the protein coding regions but do show a degree of sequence divergence within the 3' untranslated regions. These regions have been cloned and used as gene-specific probes to analyse the differential expression of the tomato ACC oxidase gene family in various tissues at different stages of development. Results indicate that all three genes are transcriptionally active and display a high degree of inducibility in a number of organs at various stages of the life cycle. Both AC01 and Ac03 transcripts accumulate during the senescence of leaves, fruit and flowers. In addition, it appears that AC01 is wound-inducible in leaves. All three ACC oxidase genes are expressed during flower development, with each showing a temporally distinct pattern of accumulation. In addition, the ACC oxidase transcripts are also spatially regulated throughout flower development; AC01 is predominantly expressed in the petals and the stigma and style, AC02 expression is mainly restricted to tissues associated with the anther cone whereas AC03 transcripts accumulate in all of the floral organs examined apart from the sepals. ACC oxidase enzyme assays and Western blot analysis indicate that both enzyme activity and ACC oxidase protein increase with transcript abundance in several tissues. The physiological role of the differential expression of the ACC oxidase gene family, in relation to the regulation of ethylene synthesis, during these various developmental processes is discussed.

Physician practices regarding anticoagulation and cardioversion of atrial fibrillation

BACKGROUND

Stroke is one of the most significant potential complications in patients who are undergoing cardioversion for atrial fibrillation. To minimize the risk of stroke, the American College of Chest Physicians' (ACCP's) Third Consensus Conference on Antithrombotic Therapy developed specific recommendations regarding anticoagulation before and following elective cardioversion of patients with atrial fibrillation.

OBJECTIVE

To determine if patients undergoing cardioversion for atrial fibrillation are administered anticoagulants according to the ACCP's Third Consensus Conference on Antithrombotic Therapy recommendations.

DESIGN

A retrospective review of cases of atrial fibrillation at a tertiary care teaching hospital to determine if physicians are routinely following these recommendations.

METHODS

Data were collected for the year 1994 for all patients admitted to a tertiary care teaching hospital with a diagnosis of atrial fibrillation (n = 111). The ACCP's recommendations that were evaluated included the following: patients undergoing elective cardioversion for atrial fibrillation should receive anticoagulation for 3 weeks before and 4 weeks following cardioversion except in cases of new-onset atrial fibrillation, and warfarin and heparin should be administered jointly for several days before discontinuation of heparin therapy.

RESULTS

Of the 111 patients who presented with a diagnosis of atrial fibrillation, 51 underwent elective cardioversion. In 18 (35%) of 51 cases, physicians failed to follow at least one of ACCP's recommendations regarding anticoagulation. These included failing to (1) administer anticoagulants to patients for 3 weeks before elective cardioversion (n = 14); (2) administer anticoagulants to patients for 4 weeks following cardioversion (n = 6); and (3) overlap heparin and/or warfarin therapies for 72 hours (n = 4). Six cases failed to meet more than one of these recommendations.

CONCLUSION

Physicians are not routinely following the ACCP's Third Consensus Conference on Antithrombotic Therapy recommendations regarding anticoagulation in elective cardioversion of atrial fibrillation, thus increasing patients' risk of stroke.

Isolation and analysis of cDNAs encoding tomato cysteine proteases expressed during leaf senescence

Several cDNAs for mRNAs that change in abundance during tomato leaf senescence were isolated. In this paper we report molecular cloning and expression analysis of two cysteine proteases. SENU2 is identical to the cDNA C14 which encodes a cysteine protease previously shown to be expressed in response to extremes of temperature in tomato fruit [43]. SENU3 cDNA clone was 1.2 kb in length and hybridized to a transcript of 1.4 kb which suggested that the clone was not full-length. The missing 5' end was isolated using rapid amplification of cDNA ends (RACE). Southern blot analysis of tomato genomic DNA indicates that SENU3 is encoded by a single or low copy gene. SENU3 was also shown to have significant homology with known cysteine proteases. These two senescence-associated cysteine proteases are also expressed during other developmental processes, including seed germination, consistent with a role in protein turnover. SENU2 and SENU3 mRNAs were detectable in young fully expanded leaves and increased in abundance with leaf age, reaching a maximum during the later stages of visible leaf senescence. Such a pattern of expression suggests that the onset of leaf senescence is a gradual event. Analysis of senescence in transgenic plants deficient in ethylene biosynthesis, in which leaf senescence is delayed, indicated that enhanced accumulation of SENU2 and SENU3 mRNA was similarly delayed but not prevented.

The power of group purchasing

There are four issues facing provincial GPO's, independent GPO's, health care organizations and vendors: co-operation; commitment; compliance; and competition. Co-operation: Hospitals have traditionally competed with each other for scarce resources and, as a result, have managed their operations in isolation. However, group purchasing provides hospitals willing to work together with an opportunity to significantly increase their purchasing power with vendors, thereby substantially reducing costs. Commitment: The success of GPO's depends on the commitment to contracts by the members. The American experience indicates that commitment of smaller, more focused organizations is easier to control and maintain. Some provincial GPO's have difficulties ensuring commitment from members; therefore, they have not achieved their full potential. Compliance: Hospital compliance with committed volumes negotiated in the corporate contract is essential to ensuring the continued strength of the group's purchasing power. GPO's require mechanisms for ensuring compliance. Smaller GPO's with a common vision and a mutual understanding of the benefits to be realized from compliance will be more successful. Competition: Independent, national GPO's, like Medbuy, may be perceived to pose a threat to provincial GPO's. However, this competition should be viewed positively because it encourages all GPO's to work harder to provide higher quality services that will ultimately benefit the hospital membership. The group purchasing concept is valuable to provide reduced costs to groups through higher volume purchases. Canadian GPO's are evolving and now offer Canadians provincial, interprovincial and independent GPO alternatives. Health care organizations must study these options and decide which alternative would be most beneficial for their particular situation.(ABSTRACT TRUNCATED AT 250 WORDS)

Return of ovarian function following spontaneous abortion

Assays of first morning urine samples for oestrone-3-glucuronide, LH and pregnanediol-3-glucuronide, were used to study endocrine function and return to ovulation in 18 subjects following spontaneous miscarriage. On the basis of the endocrine data, ovulation occurred in all 18 women in the cycle prior to first menses at a mean of 29 days post-partum (range 13-103 days) with one subject conceiving in that cycle. Compared with the second cycle, the first cycle after spontaneous abortion had similar levels of follicular phase peak ovulatory oestrone excretion but lower levels during the late luteal phase (P less than 0.02), lower levels of peak LH (50.5 IU/g creatinine (C) cf. 68.8 IU/g C; P less than 0.04) and lower late secretory peak pregnanediol (4.6 mg/g C cf. 6.1 mg/g C; P less than 0.02). The mean luteal phase length of 12.9 days in the first cycle was shorter than the mean of 14.4 days in the second cycle (P less than 0.02). These data show that, although there is some disturbance of endocrine function in the first cycle after spontaneous abortion, the majority of women have a rapid return to ovulation, making the early use of contraception necessary for those wishing to avoid conception.

Occult biochemical pregnancy: fact or fiction?

Daily urine samples were obtained from 38 women of proven fertility, who were attempting to conceive, to assess the frequency of clinically unsuspected "biochemical pregnancies' on the basis of late luteal phase rises of hCG. In 25 clinically confirmed conception cycles, the earliest pregnancy-induced hCG rises from baseline occurred 8 days after the endocrinologically defined date of ovulation (mean 11.1 days, SD 1.3). Urine samples obtained throughout 50 non-conception ovulatory cycles provided no evidence of any 'biochemical pregnancies' on the basis of late luteal phase rises of hCG occurring 8 or more days after the endocrinologically defined date of ovulation. If, as in previous studies, the date of ovulation had been estimated on the basis of menstrual cycle length and only the relatively non-specific NIH antiserum had been used in RIAs, 7 of the 50 (14%) cycles would have been classified as resulting in biochemical pregnancies on the basis of hCG greater than 50 m-i.u./ml on one occasion or greater than 20 m-i.u./ml on two or more occasions after day 20 of the cycle. These levels of 'hCG' occurred at or soon after ovulation and could be explained by LH cross-reacting in the RIA. The rises of 'hCG' were not confirmed when the urine samples were retested with an antiserum (Wellcome 895) of very high specificity for hCG. These results raise the possibility that the frequency of clinically unsuspected 'biochemical pregnancy' may have been substantially overestimated.

Quantitation of drug levels and platelet receptor blockade caused by a thromboxane antagonist

SQ 28,668 is a structural analog of thromboxane A2. It inhibits the effects of thromboxane in vitro. Fifty-six healthy male subjects were given either placebo or three equal daily doses of SQ 28,668 ranging from 25 to 1200 mg. Plasma drug concentrations increased in a dose-dependent manner. The shape of the plasma drug concentration-time curve was consistent with enterohepatic recirculation. The effects of SQ 28,668 on ex vivo platelet aggregation suggested that SQ 28,668 is a specific competitive antagonist of thromboxane A2 with a platelet receptor dissociation constant (estimated by Schild analysis) of about 19 nmol/L. Approximately 94% occupation of thromboxane receptors by SQ 28,668 was required to produce a small but measurable increase of the template bleeding time. Dose-ranging studies of antithrombotic drugs are difficult and expensive. For this reason, a method was developed that allows estimation of the dose of a thromboxane receptor antagonist that would be expected to be therapeutically equivalent to a given dose of aspirin.

Douglas House: a new type of hostel ward for chronic psychotic patients

A new type of hostel ward is described in which domestic activities take the place of attendance at a day centre or industrial workshop. Residents no longer depend on the institution for meals, cleaning, or social activities. The programme is resident-orientated, and individual treatment plans are designed and effected using a points system. The emphasis of group activities is on communication and living skills. The hostel ward is able to care for our most disabled patients who are thought to need 24-hour nursing care.

Sulpiride and the potentiation of progestogen only contraception

A progestogen (norethisterone) and a dopamine antagonist (sulpiride) were given alone and in combination to volunteers to examine their effects on excretion of ovarian steroids. Compared with non-treatment cycles (n = 15), contraception with a progestogen alone (n = 10) was associated with increased excretion of oestrone and partial suppression of excretion of pregnanediol, suggesting partial luteinization of unruptured follicles. By contrast, the combination of norethisterone and sulpiride (n = 9) suppressed both ovarian steroids to basal values, the suppression being even greater than with sulpiride alone (n = 5). These results suggest that a combination of a progestogen with a dopamine antagonist might have a role in contraception.