Old carbon reservoirs were not important in the deglacial methane budget.

Permafrost and methane hydrates are large, climate-sensitive old carbon reservoirs that have the potential to emit large quantities of methane, a potent greenhouse gas, as the Earth continues to warm. We present ice core isotopic measurements of methane (Δ14C, δ13C, and δD) from the last deglaciation, which is a partial analog for modern warming. Our results show that methane emissions from old carbon reservoirs in response to deglacial warming were small (<19 teragrams of methane per year, 95% confidence interval) and argue against similar methane emissions in response to future warming. Our results also indicate that methane emissions from biomass burning in the pre-Industrial Holocene were 22 to 56 teragrams of methane per year (95% confidence interval), which is comparable to today.

Information needs of the 'frontline' public health workforce.

OBJECTIVES: To explore the information needs of the 'frontline' public health workforce, whether needs are being met and barriers to meeting needs. STUDY DESIGN: A qualitative research study using in-depth semi-structured interviews. METHODS: A qualitative study, comprising eight semi-structured interviews, was conducted with one representative of each of eight categories of frontline public health professional (children's centre manager, community development worker, community midwife, district nurse, health visitor, community pharmacist, practice nurse and school nurse) to determine their public health role, information needs and barriers to meeting needs. Interviews were tape-recorded and data were analysed to identify themes for each category and common themes. RESULTS: Respondents expressed similar needs, some of which could be met by a dedicated library and knowledge service, given adequate funding, and some of which need input from management. The library could supply: news bulletins and up-to-date information, especially local information; targeted local websites and databases; training in literature-searching skills, basic information technology (IT) skills and critical appraisal; course and work support, with access to local library facilities; a literature search support service; signposting, with a named library contact; and access to information for patients. Management input is required to remedy basic structural barriers, including: lack of IT equipment and training; lack of time to access information; lack of funding for courses and professional development; and lack of communication of information from higher levels. CONCLUSIONS: Some information needs can be met by improvements and widening of access to library services, which may need increased funding. However, some barriers to meeting information needs require action elsewhere in the public health management structure. Changes need to be made in communication of public health strategy, and engagement needs to be improved between higher managerial levels and the frontline workforce.

Short-term costs of conventional vs laparoscopic assisted surgery in patients with colorectal cancer (MRC CLASICC trial).

The short-term clinical results of the CLASICC trial indicated that clinical outcomes were similar between laparoscopic and open approaches. This study presents the short-term (3 month) cost analysis undertaken on a subset of patients entered into the CLASICC trial (682 of 794 patients). As expected the costs associated with the operation were higher in the 452 patients randomised to laparoscopic surgery (lap) compared with the 230 randomised to open procedure (open), Pounds 1703 vs Pounds 1386. This was partially offset by the other hospital (nontheatre) costs, which were lower in the lap group (Pounds 2930 vs Pounds 3176). The average cost to individuals for reoperations was higher in the lap group (Pounds 762 vs Pounds 553). Overall costs were slightly higher in the lap group (Pounds 6899 vs Pounds 6631), with mean difference of Pounds 268 (95%CI -689 to 1457). Sensitivity analysis made little difference to these results. The cost of rectal surgery was higher than for colon, for lap (Pounds 8259 vs Pounds 5586) and open procedures (Pounds 7820 vs Pounds 5503). The short-term cost analysis for the CLASICC trial indicates that the costs of either laparoscopic or open procedure were similar, lap surgery costing marginally more on average than open surgery.

Assessment of hepatic perfusion parameters with dynamic MRI.

Quantification of hepatic perfusion parameters greatly contributes to the assessment of liver function. The purpose of this study was to describe and validate the use of dynamic MRI for the noninvasive assessment of hepatic perfusion parameters. The signal from a fast T(1)-weighted spoiled gradient-echo sequence preceded by a nonslice-selective 90 degrees pulse and a spoiler gradient was calibrated in vitro with tubes filled with various gadolinium concentrations. Dynamic images of the liver were obtained after intravenous bolus administration of 0.05 mmol/kg of Gd-DOTA in rabbits with normal liver function. Hepatic, aortic, and portal venous signal intensities were converted to Gd-DOTA concentrations according to the in vitro calibration curve and fitted with a dual-input one-compartmental model. With MRI, hepatic blood flow was 100 +/- 35 mL min(-1) 100 mL(-1), the arterial fraction 24 +/- 11%, the distribution volume 13.0 +/- 3.7%, and the mean transit time 8.9 +/- 4.1 sec. A linear relationship was observed between perfusion values obtained with MRI and with radiolabeled microspheres (r = 0.93 for hepatic blood flow [P < 0.001], r = 0.79 for arterial blood flow [P = 0.01], and r = 0.91 for portal blood flow [P < 0.001]). Our results indicate that hepatic perfusion parameters can be assessed with dynamic MRI and compartmental modeling.

Biomechanical assessment of a new type of flexor tendon repair.

A four-strand adaptation of the Kessler repair is described and the results of biomechanical testing in pig tendons are reported. The strength of our repair was compared against standard Kessler repairs using Ethibond or Ti.cron as the core sutures. The average tensile strength for the Ethibond Kessler repair was 33 Newtons and that of the Ti.cron Kessler repair was 31 Newtons. The average tensile strength for the Evans repair was 52 Newtons. This new method of flexor tendon repair is significantly stronger than the modified Kessler repair and is simpler to use than other multi-strand repair techniques.

Personal and social factors influencing age at first sexual intercourse.

Early initiation of sexual activity is a concern, in part because of increased risk of sexually transmitted diseases, including HIV, and unwanted pregnancies among young people. In this study, 241 high schoolers were administered a questionnaire to establish the relationships between age at first sexual intercourse and personal qualities (sexual style, attractiveness, physical maturity, restraint, autonomy expectations, and attitudes to gender roles), smoking and drug use, and aspects of the social context (social activities, media impact, peer norms). There were few effects of sex of respondent and none in which respondents' sex impacted on age of initiation. Overall (and among the male sample), perceptions of greater physical maturity, greater use of uncommon (mostly illicit) drugs, and expectations of earlier autonomy significantly differentiated between early and later initiators. This group of factors tends to confirm the view that early experience of sexual intercourse is correlated with problem behaviors and a press toward "adult" behaviors. For girls, this pattern was even clearer, with use of uncommon drugs being replaced as a significant contributor to early sexual experience by relative lack of restraint. We conclude that the desire to achieve the transition to adulthood at an earlier age than their peers constitutes a powerful incentive for young people to become sexually active.

The relationship between caregiver burden and TBI survivors' cognition and functional ability after discharge.

This exploratory correlational clinical study examines the relationship between reported caregiver burden (as measured by the Burden Interview) and cognition and functional ability (as measured by the Functional Independence Measure instrument) of people who had experienced traumatic brain injury (TBI). The purpose of the research was to explore the impact of cognition and functional ability in adults with TBI on perceived caregiver burden. Forty-two subjects with TBI and their caregivers were studied during the follow-up clinic appointment 3 months after discharge from a 31-bed inpatient rehabilitation unit. Demographic data and relationships to previous studies were explored. Pearson correlation matrixes and a simple single regression model were used to examine the relationships. Functional ability and cognition both negatively affected reported caregiver burden, although the relationship was not statistically significant.

Patterns of smoking among inner-city teenagers: smoking has a pediatric age of onset.

OBJECTIVES: (1) To test the hypothesis that the prevalence of smoking among African-American teenagers is lower than among whites and Hispanic inner-city senior high school students; (2) to assess the patterns of smoking among inner-city teenagers; and (3) to ascertain the relationship between smoking status and their knowledge, attitudes, beliefs, and behaviors. METHODS: All students attending inner-city senior high schools in two cities in New Jersey were included in the survey (n = 8,900). Response Rate was 85%; 89% of respondents were minority teenagers. RESULTS: The overall point prevalence rate of cigarette smoking was 9%. Almost all smoking began before the age of 16 years. The factors that significantly (p < .001) contributed to the initiation of cigarette smoking were: peer influence, self-initiation, and the influence of relatives' cigarette smoking. The factors that were stated to play a major role in progression to regular smoking were: perceptions that smoking relieves stress and feelings of induced pleasure while smoking. In addition, smokers were significantly (p < .0005) less knowledgeable about smoke-related diseases than exsmokers or nonsmokers. Over two-thirds of smokers and exsmokers believed that it is the physician's responsibility to advise patients to quit smoking and the majority of the current smokers contemplated quitting smoking. The data support the hypothesis that smoking prevalence among African-American teenagers is significantly lower than among white and Hispanic teenagers who attended the senior high school and resided in the inner city. CONCLUSION: These data suggest that multidimensional antismoking strategies are needed to address the smoking among predominately minority teenagers. This includes supportive messages from physicians, relatives, friends along with public policy to act as motivating factors to discourage early smoking.

Papanicolaou test status among inner-city adolescent girls.

BACKGROUND: The English medical literature for the past decade lacks any reports on Papanicolaou (Pap) test status among inner-city adolescent girls. Our objectives were (1) to assess the pattern of Pap test status among inner-city adolescent girls and (2) to ascertain the association of the Pap test status with their knowledge, beliefs, and behaviors. METHODS: All 3,980 inner-city senior high school adolescent female students in two cities in New Jersey were included in the survey. Response rate was 84%; 89% of respondents were minority adolescents. RESULTS: The factors that significantly increased the probability of obtaining a Pap smear were physician recommendation for Pap test, being knowledgeable of Pap test, awareness that other family members had obtained Pap tests, family income and parents' education levels. The age of initiation of first Pap test almost always was before 18 years of age; 13% of sexually active girls were smokers. The major barriers for never having had a Pap test were lack of physician's recommendation, ignorance about the Pap test, cost of the test, lack of information on how and where to obtain it, belief that they were not at risk for cancer, and embarrassment over requesting the test. CONCLUSION: Inner-city predominantly minority adolescent girls who have considerable sexual activity, multiple sex partners, initiation of intercourse at an early age, and smoking are at high risk for cervical cancer. It makes sense to initiate Pap screening for such high-risk adolescents. Individualized Pap test educational intervention programs adopted to the adolescents' barriers to undergoing Pap testing and physicians' recommendations for this preventive care are needed to encourage high-risk adolescent girls to undergo regular Pap tests and appropriate follow-up.

Continuing education and short courses.

Requirements for healthcare professionals in the United Kingdom to undertake continuing education are discussed. For nurses, midwives and many career-grade doctors, formal arrangements are in place; for other professionals, continuing education is recommended but not yet a formal requirement. In order to explore what is available, courses, conferences and seminars advertised in the Hospice Information Service's publication Choices for the academic year September 1994 to July 1995 are reviewed in terms of number, intended audience, participants and duration. Comment is offered on size of events and their financing. Issues of approval, quality assurance and evaluation are addressed. Suggestions are offered with regard to future financing of courses, and co-ordination of planning and provision. It is suggested that the National Council for Hospice and Specialist Palliative Care might encourage increasing co-operation between units in the provision of education.

Use of hormone replacement therapy by Melbourne women.

Hormone replacement therapy (HRT) is used for relief of symptoms related to the menopause and for the prevention of postmenopausal osteoporosis and cardiovascular disease. Patterns of use of HRT are thought to be changing rapidly, but little is known about who is using the therapy, for what purpose or for what period of time. Telephone interviews were conducted in May 1991 with a randomly selected sample of 2001 Australian-born women aged 45 to 55 years living in Melbourne, as part of the Melbourne Women's Midlife Health Project. Questions related to use of HRT, health status, use of health services, sexual functioning, attitudes to menopause and aging, and sociodemographic characteristics. Twenty-one per cent of the sample were using HRT. Use was more prevalent among women 50 years and over (28 per cent) than those under 50 (15 per cent). Seventeen per cent of nonhysterectomised women, 31 per cent of hysterectomised women and 49 per cent of women who had undergone hysterectomy and bilateral oophorectomy were current users. Almost 60 per cent had been using the therapy for two years or less, and 34 per cent for one year or less. Just over half reported control of hot flushes as a benefit, and 10 per cent mentioned prevention of bone loss as a benefit. Logistic regression analysis identified differences between users and nonusers in experience of hot flushes, health status, use of preventive and treatment services, sexual functioning, wellbeing, attitudes to menopause and aging, and sociodemographic characteristics. These differences may relate to risk of later cardiovascular disease.

Medical coverage for multievent sports competition: a comprehensive analysis of injuries in the 1994 Star of the North Summer Games.

OBJECTIVE: To determine the incidence and type of requests for medical assistance and the treatment required in 21 sports at the 1994 Star of the North Summer Games and to develop a plan, based on these findings, for efficient allocation of medical supplies and staff. DESIGN: We reviewed our experience with a large multisport amateur athletic event and analyzed the pattern of injuries for participants in the various sports. MATERIAL AND METHODS: Injury evaluation forms and medical supply kits were given to the health-care volunteers, who received preliminary instructions on classifications and definitions of injuries and on appropriate completion of the forms. When a medical contact occurred, an evaluation form was completed. The data from these forms were subsequently compiled and analyzed. RESULTS: Of 6,243 athletes who participated in the 1994 Star of the North Summer Games, 55 (0.88%) received medical attention (2 officials also required medical assistance). The sports with the greatest number of medical contacts were soccer and track and field--31 and 16 contacts for medical assistance, respectively. The lower extremities were the anatomic site most frequently involved in injury (62% of the medical contacts). The most common types of injury were contusions, strains, and sprains. CONCLUSION: Because few injuries were sustained and most were of minor severity, basic medical supplies (such as ice bags and compression wraps) were sufficient. For locations with a scarcity of medical personnel, a triage system can be established in which athletic trainers or registered nurses manage the initial assessments and refer cases, as needed, to physicians for specialized care. An effective communication system can also considerably reduce volunteer hours.

Menopausal symptoms in Australian women.

OBJECTIVES: To describe Australian-born women's experience of symptoms during the natural menopause transition and the relative contribution of menopausal and health status, social factors and lifestyle behaviours. DESIGN: A community based cross-sectional survey by telephone interview was carried out on a randomly derived sample of Melbourne women. PARTICIPANTS: The participants were 2000 Australian-born women, aged between 45 and 55 years. OUTCOME MEASURES: A list of 22 symptoms was used. Explanatory variables were: sociodemographic variables; menopausal and health status; lifestyle behaviours; attitudes to ageing and to menopause. RESULTS: A 70% response rate was achieved for eligible women who could be contacted during the study. Premenopausal women were the least symptomatic and perimenopausal women the most symptomatic. Factor analysis found seven common factors from the 22 symptoms studied. Menopausal status based on menstrual history was significantly related to two groups of symptoms: vasomotor symptoms, which increased through the menopausal transition; and general somatic symptoms which were more frequent in the perimenopause. Analysis of variance of factor scores found fewer symptoms with increasing years of education, better self-rated health, the use of fewer non-prescription medications, the absence of chronic health conditions, a low level of interpersonal stress, the absence of premenstrual complaints, not currently smoking, exercise at least once a week, and positive attitudes to ageing and menopause. CONCLUSIONS: Many factors unrelated to hormonal changes contributed to the symptoms. Longitudinal investigation is needed to determine the relative importance of hormonal, psychosocial and lifestyle variables in the aetiology of mid-life symptoms.

Associations of social status and health-related beliefs with dietary fat and fiber densities.

BACKGROUND: Lower social status groups have higher mortality rates from some diet-related diseases and higher dietary fat and lower dietary fiber intakes. Such dietary patterns have been found to be related to social status, environmental influences, and health-related beliefs and expectations. METHODS: Associations of social status and diet-related and health-related beliefs and expectations with dietary fat and fiber densities were examined in a population sample of 874 respondents to a postal questionnaire. A food frequency listing of 172 foods was used to assess usual dietary intake. RESULTS: More positive beliefs and expectations were associated with lower dietary fat and higher dietary fiber densities in univariate models; beliefs and expectations differed little between social status groups. In multivariate models, stronger perceptions of external influences on food choices, fewer perceived barriers to eating a healthy diet, and social status were independently associated with low dietary fat density. Diet-related and health-related beliefs and perceptions of external influences on food choices, but not social status, were independently associated with high dietary fiber density. The belief that diet is a major cause of stroke, diabetes, and hypertension was weakly associated with the dietary fiber density of lower social status groups. CONCLUSIONS: Social status and perceptions of external influences on dietary choice, as well as personal beliefs, have independent associations with food intake. Although exclusive targeting of lower social status groups is not indicated, interventions to increase dietary fiber intake should address expectations, attitudes, and beliefs about dietary fiber and health and perceptions of external influences on food choices, especially among lower status groups; interventions to lower dietary fat intake should address a broad range of external and social factors, as well as personal beliefs.