A trend of increase in periodontal interleukin-6 expression across patients with neither diabetes nor periodontal disease, patients with periodontal disease alone, and patients with both diseases.

BACKGROUND AND OBJECTIVE: Epidemiological studies have established that patients with diabetes have increased prevalence and severity of periodontal disease. However, the periodontal expression of inflammatory cytokines and matrix metalloproteinases (MMPs) in diabetic patients has not been well characterized. The objective of this study was to determine the difference in the periodontal expression of MMP-1, MMP-8, interleukin-6, tumor necrosis factor-alpha and interleukin-1beta between diabetic and nondiabetic patients. MATERIAL AND METHODS: Periodontal tissue specimens were collected from nine nondiabetic patients without periodontal disease (group 1), from 11 nondiabetic patients with periodontal disease (group 2) and from seven diabetic patients with periodontal disease (group 3). The expression of MMP-1, MMP-8, interleukin-6, tumor necrosis factor-alpha and interleukin-1beta was quantified using real-time polymerase chain reaction. RESULTS: The nonparametric Kruskal-Wallis test showed that the difference in interleukin-6 expression among the groups was statistically significant (p = 0.04). Furthermore, the generalized Kruskal-Wallis nonparametric linear-by-linear association test showed a statistically significant trend of increase in the expression of interleukin-6 from group 1 to group 2 to group 3 (p = 0.02) and a suggestion of such a trend for MMP-1 (p = 0.05). No increase in MMP-8 expression was observed in patients in group 3 compared to patients in groups 1 and 2. Although the average expression levels of MMP-1, interleukin-1beta and tumor necrosis factor-alpha were increased from group 1 to group 3, the differences were not statistically significant. CONCLUSION: A trend of increased interleukin-6 expression in periodontal tissues was observed across patients with neither diabetes nor periodontal disease, patients with periodontal disease alone, and patients with both diseases.

Brief sexual counseling during cardiac rehabilitation.

Advances in the understanding and treatment of myocardial infarction have appeared over the past decade. One intervention technique receiving increasing emphasis is the development of multidisciplinary "rehabilitation teams" whose chief aim is to assist individuals in returning to former levels of medical and psychosocial functioning. Within the team approach, the mental health specialist clearly plays a significant role. Counselors can provide support and reassurance in the midst of the medical crisis and help to minimize stress related to rearrangements in family roles and routines. In this instance, brief sex counseling as part of an ongoing rehabilitation program serves to clarify misconceptions, reduce fears, and facilitate return to sexual activities after infarction. It is important to remember, however, that an accurate physiologic evaluation provides the foundation on which to base counseling efforts. Without adequate medical information, no amount of counseling expertise will succeed. Certainly the final decision to resume sexual behavior remains with the individual couple. The counselor's primary task is to emphasize that the myth of total abstinence is not applicable for most cardiac patients. In reality, it is possible and even highly beneficial for patient and spouse to return to their normal sexual relationship.

Using a problem-based learning format to teach CLS students interdisciplinary health care practice.

OBJECTIVE: To simulate interdisciplinary collaborative practice using a problem-based format so students can increase their knowledge and understanding of health care disciplines other than their own. The basic premise of this approach is that learners are more likely to master necessary subject matter if it is presented in a manner that is realistic. SETTING: University of Kentucky Center for Rural Health. PARTICIPANTS: Eight student participants-three undergraduate clinical laboratory science students, three students in the masters degree nursing program, one family practice resident, and one visiting student from a physician's assistant program. MAIN OUTCOME MEASURES: Group discussion, peer review, and student questionaires. CONCLUSION: The interdisciplinary, case-study approach to learning offers the clinical laboratory science student an opportunity to work with other health care providers in an informal setting as an introduction to group interaction, interdisciplinary health care, and evaluation of health care access in any community.

Teaching at a distance using interactive video.

The University of Kentucky Center for Rural Health has used interactive video (IAV) instruction for place-committed students since 1991. Without adequate planning and training, new IAV instructors are likely to underestimate the differences between IAV and traditional instruction. This paper focuses on problems encountered in early stages of IAV implementation. The problems related to preparation and delivery of course materials, instructional coordination, student-faculty interaction, instructional technique, and equipment. Instructors initially emphasized control of IAV technology rather than adopting appropriate instructional methods or graphics, and misjudged the time needed to prepare and deliver course materials. Team teaching diminished student-faculty interaction, and faculty interacted more with local-site than remote-site students. Traditional teaching methods were less effective when applied to IAV. Equipment failures forced development of contingency plans. Recommendations for the avoidance or minimization of such problems are provided. Methods for the evaluation of student mastery of course content are briefly described.

Treatment of gender dysphoria (transsexualism).

Gender dysphoria, or transsexualism, is a condition involving incongruity between an individual's anatomic sex and personal sense of gender identity. Only in the last 15 years have Standards of Care been established and a professional organization developed to bring definition and consistency to the field (Harry Benjamin International Gender Dysphoria Association). A typical course of treatment lasts several years and includes psychological/psychiatric evaluations, completion of the "real life" test, administration of hormone therapy to create desired secondary sex characteristics, and finally sex reassignment surgery. As the field has developed and health-care professionals and the public have become more aware, increasing numbers of individuals are coming forward to seek evaluation and treatment. Published follow-up studies documenting long-term outcome are needed now. Current intervention techniques have progressed beyond the "experimental" stage and can be regarded as accepted medical practice.

Policy development for the control of sex-offending behavior.

Sexual violence is among the foremost problems that our society faces today. Addressing this problem will require more direct public education, effective and accessible resources for victims, punishment for offenders, and treatment of offenders to prevent recidivism. Although the 74th Texas legislative session began a concentrated approach to addressing this problem, further legislation is needed to provide a cost-effective method to increase public safety from sexual violence over the long term.

Observations on the influence of water and soil pH on the persistence of insecticides.

The pH-disappearance rate profiles were determined at ca. 25 degrees C for 24 insecticides at 4 or 5 pH values over the range 4.5 to 8.0 in sterile phosphate buffers prepared in water-ethanol (99:1 v/v). Half-lives measured at pH 8 were generally smaller than at lower pH values. Changes in half lives between pH 8.0 and 4.5 were largest (greater than 1000x) for the aryl carbamates, carbofuran and carbaryl, the oxime carbamate, oxamyl, and the organophosphorus insecticide, trichlorfon. In contrast, half lives of phorate, terbufos, heptachlor, fensulfothion and aldicarb were affected only slightly by pH changes. Under the experimental conditions described half lives at pH8 varied from 1-2 days for trichlorfon and oxamyl to greater than 1 year for fensulfothion and cypermethrin. Insecticide persistence on alumina (acid, neutral and basic), mineral soils amended with aluminum sulfate or calcium hydroxide to different pH values and four natural soils of different pH was examined. No correlation was observed between the measured pH of these solids and the rate of disappearance of selected insecticides applied to them. These observations demonstrate the difficulty of extrapolating the pH dependent disappearance behaviour observed in homogeneous solution to partially solid heterogeneous systems such as soil.

Obstetric practice patterns among family practice residency graduates.

Obstetric services are a critical health care need in the southeastern United States. Until recently, many family physicians included obstetrics as a part of their practice. In recent years there has been significant attrition from the practice of obstetrics among family physicians. This survey looks at attrition among graduates of the Tuscaloosa Family Practice Residency Program and their practice patterns, as well as the reasons family physicians give for discontinuing obstetric practice. We also discuss implications for residency curricula and remedial measures at the state and national levels.

Participants' reactions to components of a rapid-treatment workshop for sexual dysfunction.

As part of a follow-up evaluation participants in a short-term rapid-treatment program for sexual dysfunction were asked to respond to items soliciting their reactions to program procedures and exercises. These questions were not designed as the sole evaluative instrument for the work, but rather as an additional attempt to explore an important process variable--participants' attitudes toward treatment. This article includes a description of the intervention procedures and summary tablets of participants' reactions. Findings suggest that attitudinal information collected directly from participants can be valuable in evaluating and modifying the therapeutic process.

Comorbidity of gender dysphoria and other major psychiatric diagnoses.

Previous studies suggest that many transsexuals evidence an Axis I diagnosis according to the DSM-IV classification (e.g., psychoses, major affective disorder). The current study examined retrospectively the comorbidity between gender dysphoria and major psychopathology, evaluating the charts of 435 gender dysphoric individuals (318 male and 117 female). All had undergone an extensive evaluation, addressing such areas as hormonal/surgical treatment, and histories of substance abuse, mental illness, genital mutilation, and suicide attempts. In addition, a subgroup of 137 individuals completed the MMPI. Findings revealed over two thirds were undergoing hormone reassignment, suggesting a commitment to the real-life cross-gender process. One quarter had had problems with substance abuse prior to entering treatment, but less than 10% evidenced problems associated with mental illness, genital mutilation, or suicide attempts. Those completing the MMPI (93 female and 44 male) demonstrated profiles that were notably free of psychopathology (e.g., Axis I or Axis II criteria). The one scale where significant differences were observed was the Mf scale, and this held true only for the male-to-female group. Psychological profiles as measured by the MMPI were more "normal" in the desired sex than the anatomic sex. Results support the view that transsexualism is usually an isolated diagnosis and not part of any general psychopathological disorder.

The impact of sex therapy on sexual behaviors and marital communication.

The evaluation results of a short term intensive sex dysfunction workshop are presented. The evaluation research design involves before and after measures of sexual behaviors, sexual expectations, sexual communication, and marital communication. The results indicate that participants changed with regard to each of these variables. The workshop appears to impact couples in three ways: (1) there is a narrowing of the gap between actual and desired sexual behaviors, (2) there is improved sexual communication, and (3) there is improved marital communication. The results indicate that a combination of group instruction and individual therapy is an effective intervention technique in treating couples with sexual problems.

A comparison of couples who have sought sex therapy with couples who have not.

The basic complaint of couples seeking sex therapy is that their sexual relationship is no longer satisfying to them, that they cannot deal with it. Although all couples who seek sex therapy feel that they have sex problems, not all couples experiencing sex problems seek sex therapy. We hypothesized that the way in which couples differ in their reaction to sex problems and their abilities to handle them is an important factor in determining their sexual satisfaction. To investigate this hypothesis, we looked at couples who attended a sex therapy clinic and at a demographically similar group of couples who have not sought sex therapy. The results suggest that factors in their relationship (marital functioning and communication and sexual communication) are a major difference between couples who seek therapy and those who do not.

The myth of symptomatic versus asymptomatic partners in the conjoint treatment of sexual dysfunction.

Although sex researchers and therapists alike talk about treating "couples," there persists an assumption that "symptomatic" partners vary significantly from "asymptomatic" partners with respect to early background and personality variables. Indeed, these differences have been sometimes viewed as primary causal factors for the couple's presenting state of sexual discord. Data from a short-term intensive treatment program was analyzed to compare factors such as parental-familial background, sexual attitudes and knowledge, and marital histories for individuals diagnosed as symptomatic and their partners who received no specific sexual diagnosis. Results indicated few significant differences between these identified groups. There were also few differences between groups based upon items from a follow-up evaluation, suggesting that the prognostic value of these classifications may likewise be placed in question. In general, the couple's ongoing relationship (rather than individual characteristics) appears responsible for establishing satisfactory levels of sexual intimacy. Suggestions were made toward developing couple-oriented diagnostic and outcome categories.

Anatomic variation of the corpus callosum in persons with gender dysphoria.

Previous postmortem anatomical studies have demonstrated differences between male and female in the size and shape of the splenium of the corpus callosum. The current study using the magnetic resonance imager compares the corpus callosum in 20 transsexuals and 40 controls to determine if the anatomic variance is related to anatomic sex or gender identity. No statistical differences were found in the cross-sectional areas of the entire corpus callosum, regardless of genetic sex or gender. However, the genetic males did have a larger whole-brain cross-sectional area. Also, even though there was a wide range of differences in shape and size in the splenium, the study found no significant differences between the sexes or between transsexual patients of either sex and the controls.