Margarita Island, Exporter of People

Margarita Island, Venezuela, located at the southeastern corner of the Caribbean, has been exporting people to mainland Venezuela for over 450 years (Fig. 1). However, over the years the reasons for the migration and the character of the migrants have changed. Within a few years of the island's discovery in 1498, some of the aboriginal inhabitants, the Guayquerí Indians, moved to the mainland. Perhaps this was the result of a falling out with the Spaniards. Others became loyal allies of the Spaniards and accompanied them as auxiliary troops in the Spanish invasions of the mainland. About 1550, some Guayquerí began to move from Margarita into areas along the Paria-Cumaná coast which, as the result of Spanish invasions and slave raids, had lost much of their native Indian population. Eventually, the Guayquerí remaining on the island were almost entirely absorbed into the mestizo population of Margarita. The islanders — Margariteños now — continued migrating to the mainland.

Pulsed-coil magnet systems for applying uniform 10-30 T fields to centimeter-scale targets on Sandia's Z facility

Sandia has successfully integrated the capability to apply uniform, high magnetic fields (10-30 T) to high energy density experiments on the Z facility. This system uses an 8-mF, 15-kV capacitor bank to drive large-bore (5 cm diameter), high-inductance (1-3 mH) multi-turn, multi-layer electromagnets that slowly magnetize the conductive targets used on Z over several milliseconds (time to peak field of 2-7 ms). This system was commissioned in February 2013 and has been used successfully to magnetize more than 30 experiments up to 10 T that have produced exciting and surprising physics results. These experiments used split-magnet topologies to maintain diagnostic lines of sight to the target. We describe the design, integration, and operation of the pulsed coil system into the challenging and harsh environment of the Z Machine. We also describe our plans and designs for achieving fields up to 20 T with a reduced-gap split-magnet configuration, and up to 30 T with a solid magnet configuration in pursuit of the Magnetized Liner Inertial Fusion concept.

Inoperable early stage non-small cell lung cancer: comorbidity, patterns of care and survival

PURPOSE

To evaluate comorbidities, patterns of care and outcomes for patients with inoperable stage I and II non-small cell lung cancer (NSCLC).

MATERIALS AND METHODS

Patients diagnosed with stage I or II NSCLC in British Columbia between 1996 and 2005 who did not undergo primary surgery and were referred for oncology assessment were identified in a retrospective analysis. Baseline comorbidity and pulmonary function data for patients treated with curative radiotherapy (CurRT; biologically effective dose [BED]>58 Gy(10)) were abstracted by chart review. Kaplan-Meier and Cox regression were used to determine factors associated with overall survival (OS) and cause-specific survival (CSS) based on treatment group [no radiotherapy (NoRT), palliative radiotherapy (PallRT), or CurRT].

RESULTS

Of 1043 patients identified, approximately 1/3 received CurRT, and these patients had better performance status and lower stage disease than the other groups. There was a high prevalence of comorbid conditions in the CurRT group; 90% of CurRT patients had an age-adjusted Charlson comorbidity index (CCI) score ≥5. CurRT patients had a median survival 1-year longer than patients treated with PallRT or NoRT (p < 0.0001). In CurRT patients, CCI was predictive of OS (HR 1.1 per point CCI increase; p = 0.044), but not CSS. Patients receiving PallRT with a BED > 50 Gy(10) had significantly longer OS than those receiving PallRT of ≤50 Gy(10) (p < 0.0001).

CONCLUSIONS

Treatment of medically inoperable early stage NSCLC patients with CurRT is associated with a significantly longer survival, and for these patients CCI is a significant predictor of OS. For patients treated with PallRT, higher doses of palliative thoracic RT is associated with improved OS.

Anemia is a common but neglected complication of adjuvant chemotherapy for early breast cancer

In this study, we set out to determine the frequency and severity of anemia and the corrective interventions used during adjuvant chemotherapy for breast cancer.

We conducted a retrospective electronic chart review of 702 patients who received adjuvant breast cancer chemotherapy at four BC Cancer Agency centres in 2002 and 2003. For these patients, we recorded the initial hemoglobin reading and the date of the first hemoglobin reading in the ranges 110–119 g/L, 100–109 g/L, 90–99 g/L, and <90 g/L. We also recorded any discussion about, or delivery of, interventions for anemia [transfusion, epoetin (epo) or both].

Median age of the study population was 51 years, and it varied with chemotherapy type. Among the patients, 12% had a hemoglobin reading <120 g/L before the start of chemotherapy. Overall, the proportion of patients with at least one hemoglobin reading <120 g/L was 78%; <110 g/L, 54%; <100 g/L, 31%; and <90 g/L, 14%. Depending on chemotherapy type, a hemoglobin reading <100 g/L occurred in 5% to 54% of patients. Intervention rates increased as hemoglobin declined. For 99 patients with a hemoglobin reading <90 g/L, a discussion of anemia was documented in the treatment chart in 49% of cases, a transfusion was delivered in 23%, epo was used in 11%, and transfusion and epo were both delivered in 5%.

Anemia was relatively common and varied with chemotherapy type. Documentation of a discussion of anemia occurred in fewer than 20% of the patients with a hemoglobin reading of 90–99 g/L and in only half the patients with a hemoglobin reading <90 g/L. Intervention rates were low at hemoglobin readings for which randomized trials have shown that intervention can improve quality of life.

Sensitivity to disorder of the metallic state in the ruthenates

We report the results of transport measurements on SrRuO3, Sr3Ru2O7, and CaRuO3. In SrRuO3 and Sr3Ru2O7, our findings are consistent with the predictions of Fermi liquid theory, in contrast to previous reports based on samples with much shorter mean free paths. In CaRuO3, however, a T1.5 power law is seen in the resistivity in the high purity samples studied here. Our work gives concrete evidence that even the metallic state of the ruthenates is highly sensitive to disorder.

Management of common symptoms in terminally ill patients: Part II. Constipation, delirium and dyspnea

In addition to pain, patients who are approaching the end of life commonly have other symptoms. Unless contraindicated, prophylaxis with a gastrointestinal motility stimulant laxative and a stool softener is appropriate in terminally ill patients who are being given opioids. Patients with low performance status are not candidates for surgical treatment of bowel obstruction. Cramping abdominal pain associated with mechanical bowel obstruction often can be managed with morphine (titrating the dosage for pain) and octreotide. Delirium is common at the end of life and is frequently caused by a combination of medications, dehydration, infections or hypoxia. Haloperidol is the pharmaceutical agent of choice for the management of delirium. Dyspnea, the subjective sensation of uncomfortable breathing, is often treated by titration of an opioid to relieve the symptom; a benzodiazepine is used when anxiety is a component of the breathlessness.

Management of common symptoms in terminally ill patients: Part I. Fatigue, anorexia, cachexia, nausea and vomiting

Physical symptoms other than pain often contribute to suffering near the end of life. In addition to pain, the most common symptoms in the terminal stages of an illness such as cancer or acquired immunodeficiency syndrome are fatigue, anorexia, cachexia, nausea, vomiting, constipation, delirium and dyspnea. Management involves a diagnostic evaluation for the cause of each symptom when possible, treatment of the identified cause when reasonable, and concomitant treatment of the symptom using nonpharmacologic and adjunctive pharmacologic measures. Part I of this two-part article discusses fatigue, anorexia, cachexia, nausea and vomiting. Fatigue is the most common symptom at the end of life, but little is known about its pathophysiology and specific treatment. Education of the patient and family is the foundation of treatment with the possible use of adjunctive psychostimulants. Anorexia and cachexia caused by wasting syndromes are best managed with patient and family education, as well as a possible trial of appetite stimulants such as megestrol or dexamethasone. For appropriate pharmacologic treatment, it is helpful to identify the pathophysiologic origin of nausea in each patient.

The social context of smoking among African-American and white adolescents in Baltimore City

OBJECTIVE

To describe and understand variations in social influences on smoking behavior among African-American and white male and female adolescents in Baltimore City, USA.

DESIGN

A qualitative study where adolescents, both smokers and non-smokers, were interviewed individually (n = 21) and participated in focus groups (n = 18 focus groups, 3-10 participants per group).

RESULTS

Social contexts emerged as most relevant and salient themes related to smoking behavior. White females perceived the most permissive parental messages around smoking, while males, especially African-American males, reported receiving the strictest parental sanctions. Females' need to fit in with peers contrasted with males' being coerced to smoke. Possible reasons for African-Americans' non-use of cigarettes include a desire not to disrespect parents and being turned off by parental addiction to nicotine. All adolescents cited the school's lax anti-smoking policy as a reason teens smoke at school.

CONCLUSION

Interventions targeted at schools and families offer promise for reducing adolescent cigarette use.

HIV protease and reverse transcriptase variation and therapy outcome in antiretroviral-naive individuals from a large North American cohort

OBJECTIVE

To assess the effect of baseline HIV reverse transcriptase (RT) and protease sequence variation on virologic outcomes in a large cohort of antiretroviral-naive patients in British Columbia, Canada.

METHODS

Population sequencing of RT and protease was performed on baseline viral RNA of all antiretroviral-naive patients first seeking treatment in British Columbia between June 1997 and August 1998 (n = 479). Relative risks of virological failure associated with genotypic differences from a 'standard' HIV strain (HXB2) were assessed for up to 18 months.

RESULTS

The prevalence of key baseline mutations known to confer resistance to RT and protease inhibitors (PI) was 3.4 and 3.8%, respectively. No statistically significant impact on virologic outcomes could be established for these patients. However, the data suggest that some individuals (harboring a M184V mutation in RT or a V82I in protease) may have benefited from pre-therapy resistance tests. 'Secondary' mutations in the protease associated with resistance (e.g. codons 10, 36 or 63) were common, but the presence of these secondary mutations, either alone or in combination, did not appear to result in early loss of therapeutic virological suppression. Preliminary analyses suggest that an amino acid change at codon 35 in the protease may be associated with early treatment failure.

CONCLUSIONS

The results suggest that routine genotyping of naive patients about to start antiretroviral therapy would be of benefit to a relatively small proportion of the population. Secondary mutations associated with resistance to PI alone were not found to affect virologic outcomes significantly.

Human immunodeficiency virus-infected persons with mutations conferring resistance to zidovudine show reduced virologic responses to hydroxyurea and stavudine-lamivudine

The baseline predictors of poor virologic response (<0.5 log decrease in plasma virus load) were examined in two 1996 pilot trials of combination nucleoside-analogue therapy. One trial examined the addition of hydroxyurea to didanosine therapy; the other examined stavudine-lamivudine in combination. In both, predictors of virologic response included the presence of mutations associated with zidovudine resistance. For hydroxyurea, the odds ratio (OR) of failure to achieve a short-term (4 weeks) virologic response in a bivariate logistic regression model was 30.8 (95% confidence interval [CI], 1.75-543; P=.02) for use of lower dose hydroxyurea (500 mg/day) and 14.7 (95% CI, 1.1-200; P=.04) for the presence of a zidovudine-related mutation. For the stavudine-lamivudine study, the OR of failure to achieve a virologic response at 4 weeks in a multivariate logistic regression model was 23 (95% CI, 2.7-199; P=.004) for the presence of a mutation at codon 215.

Taking a first puff: cigarette smoking experiences among ethnically diverse adolescents

OBJECTIVES

To study the social contexts and physiological consequences of an initial cigarette smoking experience among adolescents from four ethnic groups (African American, European American, Hispanic, Native American) who vary by gender and locale (e.g. urban vs rural).

METHOD

A qualitative study using individual interviews and focus groups.

RESULTS

Results both amplify and reinforce conclusions about peer and family influences on adolescent smoking initiation reported in quantitative studies of teen smoking. Within the broader themes of peers and family, several important sub-themes emerged. The study findings suggest that peer influence can be characterized as social conformity or social acceptance. Males were more likely than females to describe experiences involving peers exerting strong messages to conform to smoking behaviors. Roles played by family members in the initiation process were complex and included those of initiator, prompter, accomplice, and inadvertent source of cigarettes. European American and Hispanic girls provided descriptions of parents/family members as instigators of their first smoking experience. Hispanic adolescents descripted instances in which family members prompted cigarette use at a young age by encouraging the young person to light the adult's cigarette. Finally, ethnic differences in the physiological responses to initial smoking suggest the need to further explore the role of brand preference and variations in inhaling among ethnically diverse adolescents.

CONCLUSION

In order to design effective cigarette smoking prevention programs for adolescents, it is important to understand the meaning of smoking behaviors for adolescents from different ethnic and social backgrounds.

Trauma-related hospitalizations among urban adolescents in New Zealand: priorities for prevention

PURPOSE

To: (a) determine the magnitude, characteristics, and in-patient costs of injury among hospitalized urban adolescents in New Zealand (NZ); (b) identify regional priorities for injury prevention and investigative research; and (c) compare the study findings with published data from other industrialized countries.

METHODS

The 1989-1993 files of the NZ Hospital Discharge Database were accessed to identify and analyze trauma-related admissions of adolescents residing in NZ's largest metropolitan region.

RESULTS

The estimated 9569 hospitalizations for injury accounted for one-fourth of all adolescent admissions in the region, a mean annual hospitalization rate of 1292/100,000 population and a minimum annual cost of NZ $5.8 million for in-patient care. Males and indigenous Maori youth had comparatively higher rates of hospitalizations for most major causes of injury. Falls, pedal cyclist injury, cuts, and piercing injuries were leading causes of hospitalization for trauma in early adolescence. Admission rates for motorcylist and other motor vehicle occupant trauma and self-inflicted injury increased substantially among older adolescents. Sport and recreational activities comprised at least one-sixth of injury admissions.

CONCLUSIONS

The overall rates of injury resulting in hospitalization among Auckland adolescents were comparable to those reported from Australia and France, but higher than those from the United States, Canada, and Israel. By identifying priority issues and high-risk groups, this study provides a foundation for regional injury control initiatives. It also demonstrates the utility and limitations of E-coded hospital discharge registries in defining the burden of serious nonfatal trauma.

Prevalence of primary HIV drug resistance among seroconverters during an explosive outbreak of HIV infection among injecting drug users

OBJECTIVES

This study examined the frequency of transmission of drug resistant HIV in the population of injecting drug users (IDU) in Vancouver, Canada during a period of particularly high virus transmission.

DESIGN

All subjects enrolled in the Vancouver Injection Drug Users Study who seroconverted from HIV negative to positive status (n = 61) between December 1996 and February 1998 were eligible for analysis. The first seropositive sample from 57 individuals with plasma samples available was analyzed for resistance to antiretroviral agents by population based sequencing of the HIV protease and reverse transcriptase genes.

METHODS

Plasma viral RNA was extracted and the viral reverse transcriptase and protease regions were amplified by nested reverse transcription-PCR. The presence of mutations associated with antiretroviral drug resistance was assessed by automated sequence analysis.

RESULTS

Protease and reverse transcriptase sequences were successfully obtained from the 57 recent seroconverters. No cases of transmission of variants associated with significant resistance to protease inhibitors or nucleoside and non-nucleosides reverse transcriptase inhibitors were detected.

CONCLUSION

The frequency of transmission of drug resistant HIV amongst these recently infected IDU is extremely low, with no protease or reverse transcriptase inhibitor resistant strains detected soon after seroconversion. The data provide no rationale for withholding treatment from this already marginalized population.

Selection of drug-resistant HIV

Resistance to antiretroviral drugs by HIV develops from competition among several different virus variants within an individual. Recent studies have measured the changing proportions of HIV populations, which differ by single nucleic acids, under the selective pressures exerted by the addition or removal of antiretroviral drugs.

Determinants of condom use to prevent HIV infection among youth in Ghana

PURPOSE

To identify the psychosocial and behavioral factors that influence condom use to reduce the risk of human immunodeficiency virus (HIV) infection among young men in Ghana.

METHODS

This study used a cross-sectional design in which data on a community-based sample of 601 young men, 15-24 years of age, were collected by a household survey instrument. For a conceptual framework, the study used constructs from the Health Belief Model (HBM) and Social Learning Theory (SLT) in the Ghanaian context.

RESULTS

While 65% of the sexually active male respondents had used condoms at least once, only 25% had used condoms at last intercourse. Findings from multiple logistic regression analysis indicate that perceived susceptibility to HIV infection, perceived self-efficacy to use condoms, perceived barriers to condom use, and perceived social support were significant predictors of condom use. The most important finding, however, is that perceived barriers significantly interacted with perceived susceptibility and self-efficacy. Subjects who perceived a high level of susceptibility to HIV infection and a low level of barriers to condom use were almost six times as likely to have used condoms at last intercourse, compared to others. Similarly, young men who perceived a high level of self-efficacy to use condoms and a low level of barriers to condom use were nearly three times more likely to have used condoms at last intercourse when compared to others.

CONCLUSION

These results suggest that HIV prevention programs for youth should emphasize personal vulnerability to acquired immunodeficiency syndrome, instill in youth the self-belief that they can use condoms any time, and address how to overcome barriers to condom use.

Palliative medicine and HIV/AIDS

This article provides an introduction to the field of palliative medicine as it applies to the care of HIV/AIDS. Issues of pain management, end-of-life care, ethics, and bereavement are discussed with the intention of providing the primary care physician additional resources in the provision of care to patients with HIV/AIDS.

Gender differences in injuries among rural youth

GOAL

This paper presents injury data from the first year of a three year longitudinal study of risk taking behaviors among adolescents.

SAMPLE

Study subjects were a cohort of 758 rural students from Maryland's Eastern Shore who were in the eighth grade in 1987.

METHODS

Students completed a 45 minute, self administered survey in which they reported numbers of injuries experienced in the past year, risk taking behaviors, anger expression, delinquency, alcohol and drug use, physical exercise, work experience, and level of parental supervision. In addition, students had their height and weight measurements taken by trained research staff and completed a self rating of pubertal development using Tanner drawings.

RESULTS

Slightly more than half (53.2%) of the boys and over one third (37.7%) of the girls reported experiencing one or more medically attended injuries during the last year. Poisson regression analyses were conducted to estimate the extent to which gender differences in injuries could be accounted for by adolescent behaviors. Gender effects became non-significant when adjustments were made for risk taking, school discipline problems, and exercise frequency. Gender differences in injuries were reduced but remained significant when substance use, employment, and anger were controlled. Poisson regression analyses were conducted separately for males and females to assess whether factors associated with injuries were similar across genders. For boys, risk taking, anger, and school discipline problems were significantly related to number of injuries. Boys with a low body mass index and late pubertal development (mean ratio 3.09), as well as those with high body mass index and early pubertal development (mean ratio 2.16), reported greater numbers of injuries than average boys. For girls, substance use, cruising, risk taking, anger, and exercise frequency were significantly associated with injuries. Girls with an early onset of menses reported, on average, twice the number of injuries than those who were on time. Girls with high body mass index who were late in their pubertal development reported, on average, five times more injuries than other girls.

CONCLUSIONS

Although gender is a significant risk factor for injuries, certain behaviors like risk taking, school related delinquency, and physical exercise partially explain the higher number of injuries among adolescent males in this study. For both males and females, indicators of pubertal and physical development are important factors to consider in studies of injuries during early adolescence.

Behavioral risk factors for injury among rural adolescents

This 3-year, longitudinal, prospective study examined behavioral risk factors for medically attended injuries among a cohort of 758 rural students from Maryland's Eastern Shore region who were 12-14 years of age in 1987. Students were surveyed annually in the eighth, ninth, and tenth grades with a self-administered questionnaire. Information was obtained on the number of injuries experienced, risk-taking behaviors, delinquency, alcohol and drug use, physical exercise and sports, parental supervision, and work experience. Information on the parents' education was obtained from a parental interview. Slightly more than half (53.5%) of the students reported having experienced one or more injuries in the eighth grade as compared with one-third of the students in ninth grade, and 38% of those in the tenth grade. Poisson regression analyses were conducted to examine the association of eighth grade variables with ninth grade injuries and ninth grade variables with tenth grade injuries. Results from these analyses indicated that, in addition to sex and race, a high degree of risk taking, frequent cruising, and having high and low parental supervision in the eighth grade significantly increased the number of injuries in ninth grade. In the tenth grade, risk taking continued to be associated with injuries. In addition, students who reported disciplinary problems in school, working 1-10 hours per week, drinking on 1-2 days during the past month, lifetime use of marijuana equal to 1-5 occasions, and involvement in sports experienced greater numbers of injuries in the tenth grade.

Maternal satisfaction with primary care for children with selected chronic conditions

One hundred forty mothers of children with chronic illnesses seen in two pediatric specialty clinics of a major urban teaching hospital were surveyed regarding their primary care arrangements and satisfaction with care received. Three dimensions of maternal satisfaction were measured: general satisfaction, satisfaction with access to care and satisfaction with doctor conduct (physician humaneness and technical quality). Results of multivariate analyses indicate that receipt of anticipatory guidance, access to care during evening hours and having a child in excellent reported health status were significantly associated with at least two of the three dimensions of maternal satisfaction. Findings have implications for organizing comprehensive, accessible primary care in the community, which is consistent with recent trends in child health policy. Results supported the need for enrichment of primary care for children with chronic illnesses to allow for physician continuity, provision of information and advice to families and extended office hours.

[Etiology and occurrence of periodic eye inflammation of horses in the area of Berlin]

Over 130 cases of equine periodic ophthalmia (p.o.), which were treated as in-patients at the Equine Clinic of the Free University of Berlin in the last 35 years, were examined statistically in relation to the age and gender of the animals involved as well as to the development of the illness and the season in which it arose. As regards aetiology, the extraction of 71 affected Trotters was investigated. Antibodies to toxoplasmosis, leptospirosis and intestinal parasites were found only in some of the patients. Younger animals, aged between one and four years, and male animals (63.6%) were predominantly affected. The results of the examinations of faeces showed no correlation between cases of p.o. and a vermination of the horses. The examinations for antibodies to toxoplasmosis gave no indication of a participation of the toxoplasmas in the aetiology of recurrent uveitis. In contrast, the results of the examinations for antibodies to leptospirosis, of which 58.8% were positive, showed a seven to ten times higher infection than in healthy horses in Berlin. Breed analysis showed that in certain breeds of Trotters and warm-blooded horses, p.o. illnesses were frequent, supporting the hypothesis that the occurrence of p.o. is due to a hereditary, allergic reaction, triggered by various factors, in particular an infection without clinical signs.

Situational and financial barriers to prenatal care in a sample of low-income, inner-city women

The relationship between the use of prenatal care and factors that may impede access to care was examined in a sample of low-income, inner-city women. Situational and financial barriers to care were not important correlates of utilization. In unadjusted analyses, only insurance status and employment status were associated with utilization. Of the sociodemographic characteristics studied, only parity was strongly associated with the use of prenatal care. When the apparent associations between utilization and insurance status and utilization and employment were analyzed controlling for parity, the estimated strength and statistical significance of these relationships diminished considerably. Multiparous women who were more likely than primiparous women to be underutilizers were also more likely to be on medical assistance and to be unemployed. These findings suggest that situational and financial barriers are not important correlates of utilization for low-income, adult women living in urban areas where there are accessible clinic facilities and public transportation. Efforts to identify and surmount other kinds of barriers may prove to be a more effective approach to prenatal outreach for women in these circumstances.

Acute gastrointestinal illness and child care arrangements

This study uses data from the 1981 National Health Interview and the 1981 Child Health Supplement to assess the extent to which family day care homes and child care centers pose a risk of acute gastrointestinal illness among preschool children. The study uses a nationally representative sample of children 0-5 years of age (n = 4,845). Acute gastrointestinal illness was identified from parental reports of acute illness in a 2-week period. Information on type and duration of child care, as well as a variety of sociodemographic and environmental factors (e.g., crowding, seasonality), were obtained. The authors hypothesize that risk of acute gastrointestinal illness would vary by group size. Center attendees were thought to have the greatest exposure to infectious agents, followed by children in day care homes, and lastly by those receiving care in their own homes. Risk models were estimated separately for children less than 3 years of age and for children aged 3-5 years. Our results show that an elevated risk of acute gastrointestinal illness associated with child care is confined to children less than 3 years of age who regularly attend centers/nursery schools (odds ratio = 3.49, 95% confidence interval 0.99-4.77), controlling for other confounding variables. For children aged 3-5 years, low socioeconomic status, poverty, and seasonality are stronger predictors of acute gastrointestinal illness than is center care. Family day care appears to be unrelated to the risk of illness for both age groups.

Early sexual activity among adolescents in small towns and rural areas: race and gender patterns

A 1987 survey of 758 eighth-grade students from three rural counties in Maryland revealed that 61 percent of males and 47 percent of females have engaged in sexual intercourse, and that 77 percent of black students and 40 percent of whites have ever had intercourse. A logistic regression analyzing the effects of race and gender shows that the odds that young black teenagers would have had intercourse are over five times those for whites, and that the odds for males are about twice those for females. The introduction of developmental, individual, academic and behavioral factors into the regression model has little effect on these odds ratios. Separate logistic analyses of four subgroups--white males, white females, black males and black females--reveal no consistent associations between sexual activity and the factors examined. For example, such types of problem behavior as cigarette smoking and use of alcohol or certain other drugs are associated with the likelihood of sexual activity, but the specific type of behavior involved differs by subgroup: Cigarette smoking is related to an increased likelihood of sexual activity just among white females, while alcohol consumption is associated with sexual experience among black females and white males only. Use of drugs other than marijuana or alcohol is linked to a 5-9 times greater risk of sexual activity among whites, but not to any significantly increased risk among blacks, whereas living in a town (rather than in the country) is significantly associated with the likelihood of sexual intercourse among both white and black males, but not among females of either race.(ABSTRACT TRUNCATED AT 250 WORDS)

Social network structure and prenatal care utilization

The associations between social network structural characteristics, sociodemographic factors, and prenatal care utilization were examined in a sample of 185 low-income, inner-city, maternity patients. It was predicted that the networks of women who underutilized care would be larger and of higher density than those of women who utilized care appropriately. They were also expected to be less disperse, with members living near one another; less diverse, with members drawn mainly from immediate family and extended kin; and composed primarily of strong relational ties between members. Findings indicated that women were more likely to underutilize care if they were embedded in strong-tie, nondisperse networks where most members were immediate family or relatives. Of the sociodemographic variables, only parity was associated with prenatal care utilization. The findings support the underlying assumption that social networks have a significant influence on individuals' utilization of prenatal services. This suggests that providers of services to pregnant women may need to revise their current strategies for bringing women into care and their methods of delivering educational services to women already in care.

Drug use and illnesses among eighth grade students in rural schools

We examined the relationship between drug use by young adolescents and two indicators of illness, frequency of illness and numbers of days absent from school owing to illness. Data were from a general health survey of all eighth grade students enrolled in public schools in two rural Maryland counties. A total of 745 students completed a self-administered questionnaire during school hours in January 1984. Information was obtained on a variety of sociodemographic characteristics and on the students' use of tobacco, alcohol, and marijuana. Correlational analyses were used to examine the relationships among cigarette smoking, beer or wine drinking, whiskey or hard liquor drinking, and marijuana use. Logistic regression was used to model the effects of drug use behaviors on the likelihood of being absent from school 3 or more days, adjusting for the student's age, sex, race, parents' education, illness frequency, and concerns about learning problems in school. We found substantial covariation among the use of cigarettes, alcohol, and marijuana. After adjusting for the background variables of illness, frequency, and learning problems, we found that students who are frequent cigarette smokers experienced a 2.6 risk of school absenteeism. Other drug use behaviors were not associated significantly with increased risk of missing school. Findings are discussed within the context of health-related consequences of drug use.

Maternal employment and use of pediatric clinic services

This article explores the relative importance of maternal employment as a determinant of pediatric care utilization using data from a 6-month longitudinal study of pediatric clinic use. This study sample (N = 167) was taken from a population of users of a pediatric ambulatory care clinic of a large urban hospital. The clinic served an inner city with a predominantly low-income, working-class population. Independent variables come from personal interviews conducted with the mothers of the preschoolers and from a 4-week health diary. Data on episodic illness care use were obtained from the children's medical records. Results indicate that children of working mothers made fewer visits to the clinic than children of housewives. Somewhat different factors were associated with clinic use for children with employed mothers as compared with children with nonemployed mothers. Findings from multivariate analyses suggested that mother's employment influenced utilization through its relationship with social support and daily stress. Work outside of the home was associated with greater social support as well as greater daily stress. Both social support and stress predicted utilization. Implications of these findings for future research are discussed.

Curtailment of well child services by a local health department: impact on rural 2-year-olds

The impact of changes in the delivery of well child health services by a rural health department on the reported health status, immunization status, and patterns of health care use is evaluated for poor children born in 1981, when well child clinic services were reduced. Using birth certificate records, all 1981 resident births were enumerated for the case county in Maryland and for a demographically similar comparison county that had continued to operate health department well child clinics. Trained local interviewers tracked and interviewed mothers or guardians of the 1981 cohort. Data were obtained on 567 of 589 eligible children, reflecting a 96 percent response rate. Children in each county were defined as poor if their mothers reported receiving AFDC (Aid to Families with Dependent Children), food stamps, or medical assistance or reported annual household incomes of below +5,000. This poverty status indicator was significantly correlated with health department use in the comparison county. Findings indicate that mothers of poor children in both counties were as likely as mothers of nonpoor children to assess their 2-year-old's health status as good, to identify a regular source of preventive care, and to report complete immunizations for their toddler. Although many private physicians in the case county appear to be seeing poor children in their offices, the distribution of study children among physicians was highly skewed. Out of 19 physicians or health facilities in the case county, one pediatrician was reported as the primary source of pediatric care for 52 percent of the 2-year-olds, one-third of whom were poor. In contrast, no one physician or facility was reported as providing pediatric care for more than 10 percent of 2-year-olds in the comparison county. Findings are discussed in light of these differences in physician supply and practice patterns.

Determinants of staff nurses' perceptions of autonomy within different clinical contexts

Studies of nurses and other health professionals indicate that autonomy is an important determinant of job satisfaction and turnover. This study analyzed selected characteristics of hospital nursing units to identify those features of the work setting that influence staff nurses' perceptions of autonomy: comparisons among nurses who work in different clinical areas were made. Data were collected by interviewing 789 nonsupervisory registered nurses who were employed full time at one large university-affiliated hospital. Personal and job-related information was obtained for each nurse. Structural features of units, such as workload, were gathered from head nurse reports and hospital records. Findings indicated that nurses' perceptions of autonomy are influenced by both personal characteristics of the nurse and structural features of the units. The nurse's sense of personal efficacy and the relationship she has with her head nurse are two important determinants of autonomy across all units. Workload, primary nursing, and staffing patterns are influential factors in predicting autonomy for nurses who work in critical care areas. Implications of these findings for nursing administrators are discussed.

Evaluating reasons for nursing turnover: comparison of exit interview and panel data

Data from a study of nursing turnover are used to compare findings based on two techniques for evaluating the reasons for resignations within the same population of hospital nurses during one year. The techniques are: (1) exit interviews, in which resigning nurses were asked to report in an open-ended format their major reasons for leaving their jobs; and (2) a prospective panel study, in which nurses who resigned are compared with nurses who remained, and actual turnover is predicted. Results show that due to the absence of a comparison group of remaining nurses and of baseline data, causal inferences based on exit interview data alone are overly simplistic and misleading for management purposes. Results of the panel study are more informative, although implications for hospital management are more complex. Use of the prospective panel design is recommended for hospitals concerned with evaluating nursing job conditions during a period of high turnover and staff nurse shortages.

Employment patterns among newly hired hospital staff nurses; comparison of nursing graduates and experienced nurses

Comparison of newly hired nursing graduates in their first hospital staff nurse positions and newly hired experienced nurses employed in the same hospitals revealed that the two groups were indistinguishable with respect to turnover patterns and rates, job hunting behavior, and job satisfaction levels. Type of basic nursing education did not alter results. Differences between the two groups were in the opposite direction from that expected based on the literature which emphasizes problems associated with role transition among new graduates. These findings imply that the process of job acclimation is fundamentally the same for the two groups. Implications for hospital and nursing administrators are discussed.

Determinants of hospital staff nurse turnover

Organizational and nonorganizational determinants of staff nurse turnover are investigated in a panel study of 1,259 nurses employed in two university-affiliated hospitals. Findings are consistent with a causal chain in which perceived autonomy, job satisfaction, intent to leave the hospital and turnover are a sequence of outcomes reflecting the successive stages of a nurse's decision to resign. Both personal characteristics and job-related attributes are predictive at various stages of the process, although family status variables have no significant effects. Implications for hospital management of turnover are discussed.

Evaluating primary nursing in hospitals: examination of effects on nursing staff

Despite widespread support in the nursing literature for the adoption of primary nursing as the optimal method of organizing hospital nursing care, little empirical evidence exists as to its effects on patients or nursing staff. This study compares units that have employed primary nursing for at least five months (N = 31) with nonprimary units (N = 20) in two large university-affiliated hospitals. Comparisons are made with respect to structural attributes of nursing units, nurses' perceptions of their jobs and units, and three outcomes: nurses' job satisfaction, absenteeism rates and resignation rates for the units. No significant differences are found between primary and nonprimary nursing with respect to measures of job satisfaction. Primary units at one hospital exhibit lower resignation and absenteeism rates than do nonprimary units. The adoption of primary nursing is discussed in light of these findings.

Job satisfaction among hospital nurses: a longitudinal study

Data from a two-wave panel study of staff nurses in two hospitals are used to assess the relative importance of several types of independent variables as determinants of job satisfaction. Both organizational and nonorganizational determinants are examined, with the formed including both perceptual and structural measures. Job satisfaction is measured in two ways using both Overall and Multi-Facet indicators. The independent variables were measured five months before the dependent variables were measured in order to attenuate contamination problems. Findings indicate that perceptions of job and nursing unit attributes, particularly autonomy and task delegation, predict satisfaction most strongly. In addition, a nurse's own characteristics are found to be more important than either structural attributes of nursing units or job characteristics in predicting job satisfaction.

Cardiac amyloidosis in hereditary neuropathic amyloidosis diagnosed by endomyocardial biopsy

A 57 year old male first developed progressive neuropathy of the lower extremities and then similar involvement in the upper extremities. Two years later he developed dyspnea and then complete atrioventricular block requiring the use of a permanent cardiac pacemaker. An older brother had an almost identical clinical course, including the installation of a permanent pacemaker. Both died of left ventricular failure. An endomyocardial biopsy revealed extensive amyloidosis and fibrosis of the myocardium. This is the first report of a myocardial biopsy showing amyloid on electron microscopy.

Bradycardia with mitral valve prolapse: a potential mechanism of sudden death

Eleven members of a family with a high prevalence of mitral valve prolapse were investigated. Seven had documented sinus bradycardia, and five had mitral valve prolapse. Three patients with both mitral valve prolapse and bradycardia had recurrent syncope reproduced by simple head-up tilting, and in one patient this resulted in asystole. The hemodynamic response to isoproterenol and phenylephrine administration were normal. Supine plasma norepinephrine levels were normal in all three and increased appropriately in two of three patients after tilting. Atrial pacing studies documented marked prolongation of atrial-His intervals and inability to maintain 1:1 atrioventricular conduction when paced at a rate of 120/min. These findings were reversed by atropine. This family shows a close correlation between mitral valve prolapse and potentially lethal bradycardia. Excessive vagal tone is believed to be responsible for both bradycardia and sinus arrest, which in two patients was prevented by permanent demand pacing.

Ethanol metabolism by the rat heart and alcohol dehydrogenase activity

Rat hearts perfused with oxygenated buffer containing [1-14C]ethanol metabolized small amounts of the ethanol to carbon dioxide. Very sensitive techniques are required to separate the resulting 14CO2 from the ethanol. This metabolism is not inhibited by levels of pyrazole which markedly inhibit NAD dependent liver alcohol dehydrogenase (EC 1.1.1.1). In vitro studies suggest that NADP functions as a cofactor for the rat heart alcohol dehydrogenase activity of crude heart homogenates. The kinetics parameters, the specific activity, and the pH dependence of the enzyme activity measured in these experiments suggest that it may have a minor role in ethanol metabolism by the rat.

Lowering of blood acetaldehyde levels-a possible approach to prevention of alcoholic cardiomyopathy

Based on the assumption that circulating acetaldehyde (AcH) is cardiotoxic, D-penicillamine was administered to dogs given alcohol orally, or given AcH intravenously. Paralleling the increase in plamsa norepinephrine (NE) and epinephrine (E) induced by AcH infusion, hemodynamic measurements showed a positive inotropic response with increase in pulse, blood pressure, left ventricular contractility, and cardiac output. Infusion of D-penicillamine abruptly lowered circulating levels of AcH and catecholamines, which was accompanied by an appropriate hemodynamic response.