Concentrations of mercury in tissues of beluga whales (Delphinapterus leucas) from several communities in the Canadian Arctic from 1981 to 2002.

Beluga whales have been hunted for food by Native People in the Canadian Arctic since prehistoric time. Here we report the results of analyses of total mercury in samples of liver, kidney, muscle and muktuk from collections over the period 1981-2002. We compare these results with human consumption guidelines and examine temporal and geographic variation. Liver has been analyzed more frequently than other organs and it has been used as the indicator organ. Mercury accumulates in the liver of the whales over time so that the whale ages are usually linked statistically to their levels of mercury in liver. Virtually all the samples of 566 animals analyzed contained mercury in liver at concentrations higher than the Canadian consumption guideline of 0.5 microg g-1 (wet weight) for fish. (There is no regulatory guideline for concentrations in marine mammals in Canada.) Samples from locations in the Mackenzie Delta in the western Canadian Arctic and from Pangnirtung in the eastern Canadian Arctic were obtained more often than from other location and these offered the best chances to determine whether levels have changed over time. Statistical outlier points were removed and the regressions of (ln) mercury in liver on age were used to calculate the level of mercury in whales of age 13.1 years in order to compare age-adjusted levels at different locations. These age-adjusted levels and also the slopes of regressions suggested that levels have increased in the Mackenzie Delta over the sampling period although not in a simple linear fashion. Other locations had fewer collections, generally spread over fewer years. Some of them indicated differences between sampling times but we could not establish whether these differences were simply temporal variation or whether they were segments of a consistent trend. For example, the levels in whales from Arviat were considerably higher in 1999 than in 1984 but we have only two samples. Similarly, samples from Iqaluit in 1994 exceeded considerably those in 1993 and the interval seems too short to reflect any regional temporal trend and more likely represent an extreme case of year-to-year variation. Previous analyses of data from geographically distinct groups had suggested that whales in the western Canadian Arctic had higher levels of mercury than those from the eastern Canadian Arctic. The present analysis suggests that such regional differences have diminished and are no longer statistically significant. No site has indicated significant decreases in more recent samples. The levels of total mercury in the most analyzed organs fell in the order of liver (highest levels), kidney, muscle and muktuk (lowest level). While muktuk had the lowest level of the organs most frequently analyzed, it is the preferred food item from these whales and it still exceeded the consumption guideline in most instances.

Quality of life and health-risk behaviors among adolescents.

PURPOSE: To assess the association between health-risk behaviors and self-perceived quality of life among adolescents METHODS: A sample of 2801 students (957 seventh and eighth graders and 1844 ninth through twelfth graders) completed the Teen Assessment Survey (TAP) and the surveillance module of the Youth Quality of Life Instrument (YQOL-S). TAP responses were used to determine health-risks related to tobacco use, alcohol use, illicit drug use, and high risk sexual behavior. Separate multivariate analyses of variance showed mean differences in contextual and perceptual items of the YQOL-S for each health-risk behavior. Differences among engagers (adolescents who often engage), experimenters (occasionally engage), and abstainers (never engage) in the health-risk behavior were evaluated by gender and junior/senior high school groups. RESULTS: In general, adolescent abstainers reported higher quality of life (QoL) than engagers and experimenters on YQOL-S items. Adolescents who engaged in multiple risk behaviors scored even lower than those who engaged in only one health-risk behavior. Experimenters tended to rate their QoL more similar to that of abstainers than to that of engagers. CONCLUSIONS: The framework of QoL proved useful in the evaluation of adolescents' engagement in health-risk behaviors. Additionally, assessing the areas of QoL that differ between the groups may provide information for planning interventions aimed at risk reduction among engagers and experimenters.

Changing the vocal characteristics of a postoperative transsexual patient: a longitudinal study.

The vocal characteristics of a 63-year-old individual who underwent male-to-female sex reassignment surgery were evaluated. Treatment was designed to alter inappropriate male voice characteristics. Speech goals were to (1) encourage use of successively higher pitch levels, and (2) modify tongue carriage to change resonance. After 11 months of therapy, average fundamental frequency for /i, a, u/ vowels changed from 110 to 205 Hz. Also, second formant frequency values changed remarkably for each of these vowels, with the greatest frequency change being 291 Hz for /i/. These acoustic differences could account for the perception of femininity in her posttreatment voice. Maintenance of these acoustic features was found five years posttreatment.

Professional representation and the free-lance medical illustrator.

We researched factors related to the success or failure in working relationships between free-lance medical illustrators and artist's representatives. In the fall of 1992, surveys were mailed to 230 medical illustrators; 105 (46%) completed surveys were returned. Respondents were divided into three categories: 1) medical illustrators currently represented, 2) medical illustrators previously represented, and 3) medical illustrators who had never been represented. Comparisons made among illustrators from the three groups included business practices, clientele, experience, and self-promotion techniques. These comparisons revealed notable differences and similarities between the three groups and were subsequently analyzed to identify the characteristics of medical illustrators who would benefit from professional representation.

Nurse-assisted smoking counseling in medical settings: minimizing demands on physicians.

BACKGROUND: In an effort to find more practical smoking intervention models for primary-care settings, three physician-and-nurse team approaches to patient counseling were compared with brief physician advice alone. METHODS: Subjects were 3,161 adult smokers surveyed while waiting to see 1 of 40 primary-care physicians. Physicians delivered a brief stop-smoking prompt to 2,707 (86%) of these smokers and referred them to an on-site smoking counselor (e.g., nurse) who randomly provided a two-page pamphlet (advice-only control) or one of three brief nurse-assisted interventions: (a) self-quit training, (b) recruitment to a group program, or (c) a combination intervention. Smokers usually (87%) agreed to see the counselor. RESULTS: After 3 months, subjects in the three nurse-assisted conditions were more likely to report a serious quit attempt (50% vs 39%, P less than 0.001) than were physician-advice-only subjects. Quit rates at 3 months were also higher (P less than 0.001) in the nurse-assisted self-quit (12.9%), recruitment (14.1%), and combination (13.0%) conditions, compared with those for brief physician advice only (7.6%). CONCLUSION: If long-term efficacy is confirmed, these nurse-assisted counseling approaches will serve as practical smoking intervention models for most medical-care delivery settings.

Implementation and effectiveness of a brief smoking-cessation intervention for hospital patients.

OBJECTIVES: Previous research has documented that hospital-based smoking-cessation counseling is efficacious and cost-effective when delivered by research staff. This study evaluated the implementation and effectiveness of this intervention program when delivered by respiratory therapists chosen from the regular hospital staff. METHODS: A total of 1,173 hospitalized smokers were randomly assigned to either usual care or a stage-based bedside counseling program supplemented with a videotape, self-help materials, and a follow-up telephone call. RESULTS: Using an intent-to-treat analysis and counting those lost to follow-up as smokers, we did not find a significant difference in outcome between intervention (14.2% reported being abstinent for > or =6 months at the 1-year follow-up) and usual care conditions (13.6% abstinence). Process analyses revealed that these results were due to a combination of failure to reach many patients and reduced effectiveness of respiratory therapist interventionists compared with experienced professional counselors in a previous study conducted in the same hospitals. CONCLUSIONS: We recommend implementation of hospital-based smoking-cessation counseling by professional counselors whose primary responsibility is to deliver the intervention. Recommendations for future research and for innovative ways to reach hospitalized smokers who are not receiving intervention are discussed.

Effective group behavioral intervention for older periodontal patients.

A randomized clinical trial assessed the effect of a group-based behavior modification intervention on oral hygiene skills, adherence and clinical outcomes for older periodontal patients. Subjects (n = 107) were aged 50-70 yr with moderate periodontal disease. They were randomly assigned to usual care or intervention. Intervention consisted of 5 weekly, 90-min sessions that included skill training, self-monitoring, weekly feedback about bleeding points and group support focused on long-term habit change. Four-month follow-up indicated significant improvements in the intervention versus the usual periodontal maintenance group for oral hygiene skills and self-reported flossing (p < 0.001), plaque, gingival bleeding, bleeding upon probing throughout the mouth, and pocket depth for sulcus depths that measured between 3 and 6 mm at baseline (p < 0.009). Group oral health intervention provides an effective and relatively inexpensive means of helping patients improve their self-care skills and achieve high levels of adherence to an effective self-care regimen.