Reaching out to reduce health inequities for Maori youth.

AIM: This paper describes an initiative facilitating comprehensive assessment and delivery of brief interventions for Maori youth in Northland, New Zealand. BACKGROUND: The population in Northland is predominantly Maori and is one of New Zealand's most deprived populations. Maori youth have the highest youth suicide rate in the developed world and elevated numbers of youth displaying mental health issues and/or risk behaviours are of grave national concern. Like Indigenous peoples worldwide, inequities persist for Maori youth accessing and engaging with healthcare services. DESCRIPTION: Taking services out to Maori youth in remote and isolated areas, Northland's youth specialist nurses are reducing some barriers to accessing health care. The youth version of the Case-finding and Help Assessment Tool is a New Zealand-developed, e-screening tool for youth psychosocial issues, facilitating comprehensive assessment and brief intervention delivery. DISCUSSION: Early detection of, and timely intervention for, mental health and risk behaviours can significantly improve health outcomes in youth. However, for this to happen barriers preventing youth from accessing appropriate care need to be overcome. CONCLUSION: Youth specialist nurses could improve access to care for youth from ethnic minorities, rural and isolated regions, and areas of high deprivation without overwhelming the medical profession. IMPLICATIONS FOR NURSING POLICY: Specialist nurses are trained and empowered to practice at the top of their scope. With general practitioner oversight and standing order sign off specialist nurses can work autonomously to improve access to health services, without increasing the workload of doctors. IMPLICATIONS FOR NURSING PRACTICE: Encouraging continuous self-reflection of the nurse's effectiveness in meeting patient needs, holistically and culturally, facilitates the provision of accessible care that is patient-centred and culturally safe.

The performance of an efficient dairy system using a combination of nitrogen leaching mitigation strategies in a variable climate.

An efficient dairy system, that implemented a combination of nitrogen (N) leaching mitigation strategies including lower N fertilizer input, standing cows off pasture for part of the day in autumn and winter (stand-off), and importing limited amounts of low protein supplements was evaluated over four consecutive years of a farmlet study. This efficient system consistently demonstrated a lower measured annual N leaching of 40 to 50% compared with a baseline system representing current practice with no mitigations. To maximize return from this system fewer cows but of higher genetic merit were used resulting in an average decrease in milk production of 2% and operating profit by 5% compared with the baseline system. The magnitude of the N leaching reduction from mitigation strategies was predicted in pre-trial modelling. Using similar mechanistic models in a post-trial study, we were able to satisfactorily predict the trends in the observed N leaching data over the four years. This enabled us to use the calibrated models to explore the contributions of the different mitigation strategies to the overall leaching reduction in the efficient system. In one of the years half of the leaching reduction was achieved by the 'input' component of the strategy (less feed N flowing through the herd from lower fertilizer use, less grass grown, and low-protein supplement use), while the other half was achieved by the stand-off strategy. However, these contributions are determined by the weather of a particular year. We estimate that on average stand-off would contribute 60% and 'input' 40% to the reduction. The implication is that farmers facing nutrient loss limitations have some current and some future technologies available to them for meeting these limitations. A shift towards the mitigations described here can result in a downward trend in their own N-loss metrics. The challenge will be to negate any reductions in production and profit, and remain competitive.

Assessing the effectiveness of actions to mitigate nutrient loss from agriculture: a review of methods.

Diffuse nutrient loss from agriculture is degrading surface and groundwater quality throughout Europe, leaving water bodies at risk of not reaching targets set by the Water Framework Directive (WFD). Mitigation methods to reduce diffuse agricultural nutrient loss need to be implemented where water bodies have been identified as at risk of not reaching good status by 2015. Though the effectiveness of individual mitigation methods has usually been assessed in controlled experiments, it is necessary to quantify impact under a wider range of environmental and agricultural conditions and at the catchment scale to ensure that action taken now will be sufficient to meet WFD targets. Due to catchment buffering and long transit times (>50 years), it is unlikely that responses to intervention will be observed by 2015 in many water bodies. In this review, we compare the attributes and usefulness of different approaches (direct measurement, nutrient budgeting, risk assessment and modelling) to assess the efficacy of actions to mitigate sources and transport of nitrogen (N) and phosphorus (P) from agricultural land to water. Modelling and 'measured changes in farm activity' through budgeting avoid the time lags associated with direct measurement and enable rapid evaluations of different options before implementation. Budgeting approaches using on-farm data also provide a simpler, more communicable means of assessment but currently fail to consider the timing and transport aspects of mitigation and assume a direct causal relationship between potential and actual nutrient loss. Risk assessment and modelling applications are potentially more comprehensive and able to better reflect choice of mitigation at a range of scales, but assessments demand increased availability of data, and there is a large degree of uncertainty associated with their spatial and temporal dimensions which is difficult to validate adequately. The failings of individual approaches suggest that these assessment methods should be integrated to maximise their potential usefulness and positive attributes. This will enable nutrient inputs to be utilised most efficiently at broad scales and site specific actions to reduce nutrient transport and delivery can be targeted most cost-effectively at smaller scales. Such an integrated approach will also more effectively engage and involve the farmer in what must be an iterative process.

Rye bran and soy protein delay growth and increase apoptosis of human LNCaP prostate adenocarcinoma in nude mice.

BACKGROUND: In this study, we investigated whether dietary intervention could inhibit tumor growth of an androgen-sensitive human prostatic cancer. METHODS: LNCaP cells were transplanted subcutaneously in nude-mice. The animals were then put on different diets and tumor take, tumor growth and prostate specific antigen (PSA) secretion were studied during 9 weeks. RESULTS: Palpable tumors developed in 75% of the tumor-cell injected sites in animals fed a control diet (corn starch, sucrose, etc.) whereas, for animals given rye bran (RB), ethyl acetate extraction from rye bran supplemented cellulose based diets (CCEE), palpable tumors were seen in only 30% and for soy protein based diets (SCC) 50% of the transplantation sites, respectively. The tumors that grew to palpable size in the rye (RB) and soy (SCC) groups were smaller and secreted less PSA than those in the control group. In the rye and soy groups tumor cell apoptosis was increased, but cell proliferation was unaffected. Addition of fat to the rye diet reduced its effect on prostate cancer growth. CONCLUSIONS: Factors in rye bran and soy protein may inhibit prostate cancer growth. The effect is more apparent for rye than for soy. Further studies are needed to identify the effective substances and to explore the mechanism of action.

Quantitative gas chromatography-mass spectrometry isomer-specific measurement of hydroxy fatty acids in biological samples and food as a marker of lipid peroxidation.

We have developed a capillary gas chromatography-mass spectrometry method for the quantitative analysis of individual positional isomers of monohydroxy fatty acids derived from linoleic, arachidonic, eicosapentaenoic, or docosahexaenoic acid. Peroxidation of a particular polyunsaturated fatty acid results already in a complex mixture of positional isomers of hydroperoxy and hydroxy fatty acids. Catalytic hydrogenation of lipid extracts produces stable saturated hydroxy lipids from the complex mixtures typical of oxidized biological samples, simultaneously simplifying the analytical problem and eliminating oxidation artifacts. After saponification and methylation, monohydroxy fatty acid methyl esters are purified by solid-phase extraction and partially resolved using a CP Sil 19 column following on-column derivatization of the hydroxy groups with tetramethylammonium hydroxide. The resulting methoxy fatty acid methyl esters are subjected to electron impact mass spectroscopy. Two characteristic ions are produced for each positional isomer. Quantitative measurements were achieved by using odd chain C17 and C19 monohydroxy fatty acids as internal standards. The limit of detection of individual hydroxy fatty acid isomers is dependent on the total number of ions monitored. Monitoring 11 pairs of ions simultaneously gives limits of detection of 10 ng. Sensitivity is much higher by monitoring fewer ions and as little as 0.2 ng of a single isomer can be detected. The method has been applied for the quantitative analysis of hydroxy (plus hydroperoxy) fatty acids in plasma, adipose tissue, oils, and foods. To date over 1000 samples have been analyzed using the method described in this paper.

Modified on-column interface for coupled high-performance liquid chromatography-gas chromatography and its application to the determination of levamisole in milk.

A modified on-column interface is reported for the coupling of high-performance liquid chromatography with gas chromatography, incorporating an adapted, commercially available multidimensional gas chromatography switching system. Novel features include cryogenic analyte focusing, total solvent exclusion from the analytical column and independent carrier gas supplies to the analytical GC column and uncoated pre-column. The instrumentation was used for the determination of the veterinary anthelmintic drug levamisole in milk with analyte detection by both flame ionisation and nitrogen-phosphorus detectors. Detection limits for the assay were 2.2 micrograms l-1 and 0.4 micrograms l-1 by flame ionisation and nitrogen-phosphorus detectors, respectively. The assay was applied to a survey of fourteen milk samples from different dairy outlets.

A comparison between amoxycillin/clavulanate and mezlocillin in abdominal surgical prophylaxis.

A randomized comparative study was conducted to evaluate the clinical efficacy of amoxycillin/clavulanate (Augmentin) compared with mezlocillin for the prevention of wound infection in patients undergoing abdominal surgery. There was no difference in overall wound infection rates between the amoxycillin/clavulanate treated group and the mezlocillin group. When sub-groups were examined for total infections no significant difference was seen between antibiotic groups in patients undergoing clean/potentially contaminated operations or contaminated operations, although more deep infections were encountered in the amoxycillin/clavulanate group in comparison with the mezlocillin group, in contaminated operations. The type of operation performed also failed to show any difference in those patients undergoing upper gastro-intestinal, appendiceal, colonic, or biliary operations. The infections in those receiving amoxycillin/clavulanate were largely of bowel origin and predominantly sensitive to amoxycillin/clavulanate. Those in the mezlocillin group were predominantly staphylococcal in origin. Amoxycillin/clavulanate appears to be an effective antibiotic for use as a single agent in surgical prophylaxis.

A survey of the occurrence of aflatoxin B1 in peanut butters by enzyme-linked immunosorbent assay.

A survey was carried out in 1986 for the occurrence of aflatoxin B1 in peanut butters (129 samples) obtained from specialist Health Food outlets. The results showed that 6.2% of the samples exceeded 10 micrograms/kg of aflatoxin, 8% contained between 2.5 and 10 micrograms/kg, and in the remainder (86%) aflatoxin could not be detected at a limit of 2.5 micrograms/kg. These results show a lower contamination by aflatoxin than found in these products in previous surveys (1982-1984). An aflatoxin B1-specific enzyme-linked immunosorbent assay (ELISA) was employed for the first time in these analyses; and to make an assessment of its performance positive aflatoxin results, together with a random selection of those below the ELISA limit of detection, were additionally analysed by conventional extraction and clean-up followed by HPLC. The ELISA technique offered a significant improvement in speed of analysis over conventional approaches, enabling a six-fold increase in sample throughput compared to that required for conventional analysis, together with other advantages.

Intracellular mineralization of Bacterionema matruchotii.

Intracellular calcium phosphate mineral formation in Bacterionema matruchotii has been examined relative to two established points: the product of calcium and phosphorus levels at which spontaneous precipitation occurs (Ca x P), 50 (mg%)2, and the product at which calcium hydroxyapatite itself induces crystal growth, 35 (mg%) 2. The extent of intracellular mineralization in the defined calcifying medium was determined analytically after washing the cells. Electron micrographs of B. matruchotii cells revealed needlelike crystals of mineral, typical of calcium hydroxyapatite. Bacterionema matruchotii was found to be an efficient nucleator and can bring about the formation of solid phase at a Ca x P product as low as 35 (mg%)2.

N-acetyl-p-amino-phenol (paracetamol, acetaminophen) in the treatment of acute schizophrenia.

The hypothesis that schizophrenia is caused by the release of prostaglandin E into the hypothalamus and may sometimes be accompanied by an elevation of temperature was examined by a clinical trial of the prostaglandin E suppressant N-acetyl-p-amino-phenol (paracetamol, acetaminophen). Ten acute schizophrenic patients were included in a double-blind, crossover trial of paracetamol and a placebo, in which each treatment was given for a week. Regular 4-hourly temperatures were recorded in all these cases and in 5 non-schizophrenic patients for comparison. The findings provided no evidence that paracetamol mitigated the symptoms of schizophrenia. The temperatures of the schizophrenics were not elevated more than those of the controls, but the number of cases used was probably too small for this finding to be conclusive.

Mental health care in the community: an evaluative study.

A study was designed to assess the therapeutic value of attaching a social worker to a metropolitan group practice in the management of chronic neurotic illness. The psychiatric and social status of a group of patients before treatment and after one year was compared with the status of a control group treated more conventionally over the same period. The results indicate that the experimental service conferred some benefit on the patient population.