Environmental Health Information Partnership (EnHIP): Strengthening the capacity of minority serving institutions.

The U.S. National Library of Medicine's (NLM) Environmental Health Information Partnership (EnHIP) collaborates with Historically Black Colleges and Universities (HBCUs) and other minority-serving academic institutions to enhance their capacity to reduce health disparities through the access, use, and delivery of environmental health information on their campuses and in their communities. The partnership began in 1991 as the Toxicology Information Outreach Panel (TIOP) pilot project, and through successive iterations it is NLM's longest running outreach activity. EnHIP's continued relevance today as an information outreach and training program testifies to the prescience of NLM director, Donald A.B. Lindberg M.D's initial support for the program. Dr. Lindberg's seeing to its continued success to benefit participating institutions and help achieve the societal goals of environmental justice serve as well to benefit NLM by increasing its visibility, and use of its resources in the classroom, for research, and in community outreach. NLM envisions an expanding role for EnHIP in advancing health equity as the impact of environmental exposure, climate change, and increasing zoonotic diseases disproportionately impact their communities.

Primary mucosal melanoma of the palatine tonsil: Report of a case and review of the literature.

BACKGROUND: Mucosal melanoma of the palatine tonsil is extremely rare. Due to its poor prognosis, primary tonsillar melanoma requires prompt recognition and treatment. METHODS: A 62-year-old female presented with a deeply pigmented and exophytic lesion in the left tonsillar fossa. The patient underwent a partial pharyngectomy through a midline labio-mandibulotomy approach along with a left level I-V neck dissection. Reconstruction with a left radial forearm free flap and a pharyngeal constrictor advancement pharyngoplasty was performed. RESULTS: The patient remains free of disease at eight months after adjuvant proton therapy and eleven months after surgery. To our knowledge, less than thirty cases have been either reported or referenced in the literature since the early 1900's. This report is the first in English literature to compile all reported cases of primary tonsillar melanoma. CONCLUSION: Currently, evidence suggests that mucosal melanoma in the palatine tonsil should be treated in the same fashion as other head and neck mucosal melanomas, mindful of the high rates at which locoregional and distant metastases occur.

Public Support for Family Smoking Prevention and Tobacco Control Act Point-of-Sale Provisions: Results of a National Study.

OBJECTIVES: We assessed public and smoker support for enacted and potential point-of-sale (POS) tobacco-control policies under the Family Smoking Prevention and Tobacco Control Act. METHODS: We surveyed a US nationally representative sample of 17, 507 respondents (6595 smokers) in January through February 2013, and used linear regression to calculate weighted point estimates and identify factors associated with support for POS policies among adults and smokers. RESULTS: Overall, nonsmokers were more supportive than were smokers. Regardless of smoking status, African Americans, Hispanics, women, and those of older ages were more supportive than White, male, and younger respondents, respectively. Policy support varied by provision. More than 80% of respondents supported minors' access restrictions and more than 45% supported graphic warnings. Support was lowest for plain packaging (23%), black-and-white advertising (26%), and a ban on menthol cigarettes (36%). CONCLUSIONS: Public support for marketing and POS provisions is low relative to other areas of tobacco control. Tobacco-control advocates and the Food and Drug Administration should build on existing levels of public support to promote and maintain evidence-based, but controversial, policy changes in the retail environment.

Retailer opinions about and compliance with family smoking prevention and tobacco control act point of sale provisions: a survey of tobacco retailers.

BACKGROUND: The objectives of this study were to document retailer opinions about tobacco control policy at the point of sale (POS) and link these opinions with store level compliance with sales and marketing provisions of the Tobacco Control Act. METHODS: This study conducted interviews of 252 tobacco retailers in three counties in North Carolina and linked their opinions with in-person observational audit data of their stores' compliance with POS policies. We conducted analyses examining retailer factors associated with noncompliance using Generalized Estimating Equations (GEE) controlling for individual, store, neighborhood, and county factors. RESULTS: Over 90 % of retailers support minors' access provisions and a large minority (over 40 %) support graphic warnings and promotion bans. Low levels of support were found for a potential ban on menthol cigarettes (17 %). Store noncompliance with tobacco control policies was associated with both more reported retailer barriers to compliance and less support for POS policies. Awareness of and source of information about tobacco control regulations were not associated with compliance when accounting for neighborhood and county characteristics. CONCLUSIONS: Retailers expressed some support for a wide range of POS policies. Advocates and government agencies tasked with enforcement can work with retailers as stakeholders to enhance support, mitigate barriers, and promote compliance with tobacco control efforts at the point of sale.

Environmental Health Information Partnership (EnHIP): Strengthening the Capacity of Minority Serving Institutions.

The U.S. National Library of Medicine's (NLM) Environmental Health Information Partnership (EnHIP) collaborates with Historically Black Colleges and Universities (HBCUs) and other minority-serving academic institutions to enhance their capacity to reduce health disparities through the access, use, and delivery of environmental health information on their campuses and in their communities. The partnership began in 1991 as the Toxicology Information Outreach Panel (TIOP) pilot project, and through successive iterations it is NLM's longest running outreach activity. EnHIP's continued relevance today as an information outreach and training program testifies to the prescience of NLM director, Donald A.B. Lindberg M.D's initial support for the program. Dr. Lindberg's seeing to its continued success to benefit participating institutions and help achieve the societal goals of environmental justice serve as well to benefit NLM by increasing its visibility, and use of its resources in the classroom, for research, and in community outreach. NLM envisions an expanding role for EnHIP in advancing health equity as the impact of environmental exposure, climate change, and increasing zoonotic diseases disproportionately impact their communities.

The Central American Network for Disaster and Health Information.

PURPOSE: This paper describes an international outreach program to support rebuilding Central America's health information infrastructure after several natural disasters in the region, including Hurricane Mitch in 1998 and two major earthquakes in 2001. SETTING, PARTICIPANTS, AND DESCRIPTION: The National Library of Medicine joined forces with the Pan American Health Organization/World Health Organization, the United Nations International Strategy for Disaster Reduction, and the Regional Center of Disaster Information for Latin America and the Caribbean (CRID) to strengthen libraries and information centers in Central America and improve the availability of and access to health and disaster information in the region by developing the Central American Network for Disaster and Health Information (CANDHI). Through CRID, the program created ten disaster health information centers in medical libraries and disaster-related organizations in six countries. RESULTS/OUTCOME: This project served as a catalyst for the modernization of several medical libraries in Central America. The resulting CANDHI provides much needed electronic access to public health "gray literature" on disasters, as well as access to numerous health information resources. CANDHI members assist their institutions and countries in a variety of disaster preparedness activities through collecting and disseminating information.

The Impact of Medicare Part D on Self-Employment.

We explore the relationship between access to affordable health insurance and self-employment using exogenous variation from the introduction of Medicare Part D that reduced the out-of-pocket cost of prescription drugs and improved health outcomes in a difference-in-differences model using the American Community Survey. We find that our treatment group of individuals aged 65-69 were 0.5 percentage points (or 5%) more likely to be self-employed in relation to a control group aged 60-64.

Retrospective evaluation of a possible interaction between warfarin and levofloxacin.

STUDY OBJECTIVES: In order to clarify the clinical significance of a suspected drug interaction, we sought to determine if the international normalized ratio (INR) is affected when levofloxacin is administered in patients receiving long-term warfarin therapy. DESIGN: Retrospective cohort study using pharmacy and medical records. SETTING: Outpatient clinic. PATIENTS: Forty-three patients receiving long-term warfarin therapy who subsequently were prescribed either levofloxacin (22 patients) or felodipine (21 controls); felodipine was chosen as it has been shown not to interact with warfarin. Patients in both groups were required to have a documented INR before the start of levofloxacin or felodipine (pre-INR) and either during levofloxacin or felodipine therapy or within 15 days after the drug had been started (post-INR). MEASUREMENTS AND MAIN RESULTS: Patient demographics were similar between the two treatment groups. The mean +/- SD age of the patients in the levofloxacin and control groups was 59.5 +/- 8.7 and 65.3 +/- 11.5 years, respectively (p=0.07). The mean change between the pre- and post-INR (primary outcome measure) was 0.31 +/- 0.82 (pre-INR 2.46, post-INR 2.76) and 0.21 +/- 0.54 (pre-INR 2.46, post-INR 2.67) in the levofloxacin and felodipine groups, respectively (p=0.65). A post hoc power analysis, based on a sample-derived, weighted standard deviation of 0.68, revealed that the study had 66% power to detect a change of 0.5 in the INR value. The percentage of patients who required a warfarin dosage adjustment based on the post-INR (secondary outcome measure) was 41% (9 of 22 patients) in the levofloxacin group and 33% (7 of 21 patients) in the felodipine group. CONCLUSION: Although our primary analysis did not detect a warfarin-levofloxacin interaction, the potential for such an interaction, especially in idiosyncratic cases, cannot be ruled out. Clinicians should closely monitor INR values when levofloxacin is administered jointly with warfarin.

Effectiveness of a group outpatient visit model for chronically ill older health maintenance organization members: a 2-year randomized trial of the cooperative health care clinic.

OBJECTIVES: To compare the effectiveness of Cooperative Health Care Clinic ((CHCC) group outpatient model for chronically ill, older health maintenance organization (HMO) patients) with usual care. DESIGN: Two-year, randomized, controlled trial conducted with recruitment from February 1995 through July of 1996. SETTING: Nonprofit group model HMO. PARTICIPANTS: Two hundred ninety-four adults (145 intervention and 149 usual care), aged 60 and older (mean age 74.1) with 11 or more outpatient visits in the prior 18 months, one or more self-reported chronic conditions, and expressed interest in participating in a group clinic. INTERVENTION: Monthly group meetings held by patients' primary care physicians. MEASUREMENT: Differences in clinic visits, inpatient admissions, emergency room visits, hospital outpatient services, professional services, home health, and skilled nursing facility admissions; measures of patient satisfaction, quality of life, self-efficacy, and activities of daily living (ADLs). RESULTS: Outpatient, pharmacy services, home health, and skilled nursing facility use did not differ between groups, but CHCC patients had fewer hospital admissions (P=.012), emergency visits (P=.008), and professional services (P=.005). CHCC patients' costs were $41.80 per member per month less than those of control patients. CHCC patients reported higher satisfaction with their primary care physician (P=.022), better quality of life (P=.002), and greater self-efficacy (P=.03). Health status and ADLs did not differ between groups. CONCLUSION: The CHCC model resulted in fewer hospitalizations and emergency visits, increased patient satisfaction, and self-efficacy, but no effect on outpatient use, health, or functional status.

Protein kinase C mediates potentiation of synaptic transmission by phorbol ester at parallel fibers in the dorsal cochlear nucleus.

Many cells in the outer two layers of the dorsal cochlear nucleus (DCN) express high levels of the phospholipid-activated, calcium dependent kinase, protein kinase C (PKC), an enzyme that can phosphorylate numerous proteins involved in neurotransmission and postsynaptic signaling. We investigated the effects of stimulating PKC with phorbol esters (phorbol 12-13 diacetate; PDAc) on parallel fiber synaptic transmission in brain slices of the guinea pig DCN. Phorbol esters increased the amplitude of the postsynaptic components of the field potential, including the excitatory post-synaptic field potential (fEPSP) and the population spike following electric stimulation of parallel fibers. Phorbol esters simultaneously decreased paired-pulse facilitation, suggesting that transmitter release mechanisms were affected. Potentiation of synaptic transmission and diminished paired-pulse potentiation were also observed in intracellular recordings of DCN neurons. The effects of phorbol esters were antagonized by the specific PKC blockers bisindolylmaleimide and calphostin C. Although modulation of the synaptic potentials appears to be mediated by presynaptic PKC, the differential effects of PDAc on the fEPSP and the population spike also suggest the involvement of postsynaptic PKC and postsynaptic targets. These experiments demonstrate that protein kinase C is capable of profoundly modulating synaptic transmission at parallel fiber synapses in the DCN.

The National Library of Medicine's Native American outreach portfolio: a descriptive overview.

OBJECTIVES: This paper provides the most complete accounting of the National Library of Medicine's (NLM's) Native outreach since 1995, when there were only a few scattered projects. METHOD: The descriptive overview is based on a review of project reports, inventories, and databases and input from the NLM Specialized Information Services Division, National Network Office of the Library Operations Division, National Network of Libraries of Medicine, and Office of Health Information Programs Development of the Office of the NLM Director. The overview focuses on NLM-supported or sponsored outreach initiatives involving Native peoples: American Indians, Alaska Natives, and Native Hawaiians. RESULTS: The review of NLM's relevant activities resulted in a portfolio of projects that clustered naturally into the following areas: major multisite projects: Tribal Connections and related, Native American Information Internship Project: Sacred Root, tribal college outreach and tribal librarianship projects, collaboration with inter-tribal and national organizations, participation in Native American Powwows, Native American Listening Circle Project, Native American Health Information, and other Native American outreach projects. IMPLICATIONS: NLM's Native American Outreach reached programmatic status as of late 2004. The companion paper identifies several areas of possible new or enhanced Native outreach activities. Both papers highlight the importance of solid reporting and evaluation to optimize project results and programmatic balance and priorities.

Assessment of the National Library of Medicine's health disparities plan: a focus on Native American outreach.

OBJECTIVES: Overcoming health disparities between majority and minority populations is a significant national challenge. This paper assesses outreach to Native Americans (American Indians, Alaska Natives, and Native Hawaiians) by the National Library of Medicine (NLM). A companion paper details NLM's portfolio of Native American outreach projects. METHOD: NLM's Native American outreach is assessed in light of the presentations at a community-based health information outreach symposium and the goals set by NLM's plan to reduce health disparities. RESULTS: NLM's current portfolio of Native American outreach projects appears most advanced in meeting the goal set in area 1 of the health disparities plan, "Promote use of health information by health professionals and the public." NLM's portfolio also shows significant strength and good progress regarding area 2 of the plan, "Expand partnerships among various types of libraries and community-based organizations." The portfolio is weaker in area 3, "Conduct and support informatics research." More knowledge-building efforts would benefit NLM, the National Network of Libraries of Medicine, and Native American and community-based organizations. IMPLICATIONS: The current Native American outreach portfolio should be continued, but new approaches are needed for evaluating Native American outreach and for forging collaborations with Native American groups, approaches grounded in consultation and mutual understanding of needs and perspectives.