NB housing study protocol: investigating the relationship between subsidized housing, mental health, physical health and healthcare use in New Brunswick, Canada.

BACKGROUND: Income and housing are pervasive social determinants of health. Subsidized housing is a prominent affordability mechanism in Canada; however, waitlists are lengthy. Subsidized rents should provide greater access to residual income, which may theoretically improve health outcomes. However, little is known about the health of tenants who wait for and receive subsidized housing. This is especially problematic for New Brunswick, a Canadian province with low population density, whose inhabitants experience income inequality, social exclusion, and challenges with healthcare access.  METHODS: This study will use a longitudinal, prospective matched cohort design. All 4,750 households on New Brunswick's subsidized housing wait list will be approached to participate. The survey measures various demographic, social and health indicators at six-month intervals for up to 18 months as they wait for subsidized housing. Those who receive housing will join an intervention group and receive surveys for an additional 18 months post-move date. With consent, participants will have their data linked to a provincial administrative database of medical records.  DISCUSSION: Knowledge of housing and health is sparse in Canada. This study will provide stakeholders with a wealth of health information on a population that is historically under-researched and underserved.

Low immunoglobulin A levels detected via the tissue transglutaminase assay can reveal previously undetected monoclonal proteins.

Increased awareness of coeliac disease and the 2009 NICE guidance has led to an increase in patients being screened for Immunoglobulin A deficiency. We have shown previously that this provides an opportunity for the early identification of other underlying primary immunodeficiency, e.g. common variable immunodeficiency. In this context, the underlying gastrointestinal problem appears to be related to bacterial overgrowth. Here, we demonstrate that in addition this also provides an opportunity to reveal underlying secondary immunodeficiency due to other causes in patients with gastrointestinal presentation, notably lymphoproliferative disorders. In one 3-month period, of 60 cases reviewed for low Immunoglobulin A, we found four new paraproteins through this testing route; one symptomatic multiple myeloma, one asymptomatic multiple myeloma, one monoclonal gammopathy of uncertain significance and one in a known chronic lymphocytic leukaemia patient.

Expression of Ia in mouse kidney.

Expression of Ia antigens in mouse kidney was studied by absorption of diluted anti-Ia sera with crude suspensions of kidney issue. Specific absorption of anti-Ia activity was seen for all Ia specificities tested: Ia.1,2, Ia.3, Ia.4,5,12, Ia.7, Ia.8, Ia.9, Ia.15, and Ia.16. Certain polyspecific antisera (against the I-Ak products Ia.1,2,3,15) were more difficult to absorb than oligo-specific antisera against other Ia specificities (e.g., Ia.7 and Ia.9). This observation may indicate that polyspecific sera are less absorbable by limited numbers of antigenic sites because of steric hindrance, although differences in the extent of antigen expression in kidney have not been excluded. Ia absorption could be demonstrated either in microcytotoxicity or in 51Cr release assays. Both mechanically disrupted and enzyme-disrupted kidney tissue suspensions absorbed Ia specifically, although the former method was used routinely. As estimated from the efficiency of absorption, the amount of Ia in kidney was small, about 2 to 5% of that in spleen. One kidney was equivalent in absorptive capacity to about 3 X 10(6) splenocytes, and to greater than 3 X 10(6) buffy coat cells. Comparisons of the rates of absorption indicated that the amount of Ia in kidney was less than the amount of an H-2K or D alloantigen. Ia was expressed in kidney in an immunogenic form, since animals immunized repeatedly with I region-incompatible kidney tissue produced anti-Ia antibodies. Thus, Ia antigens are expressed in and are immunogenic in mouse kidney and can be studied by conventional serological techniques.

Expression of Ia in mouse kidney. II. Evidence for expression on resident marrow-derived and nonmarrow-derived cells.

The origins of Ia antigens in perfused mouse kidney were investigated. Three possible sources were considered: leukocytes in residual blood which was trapped in kidney, bone marrow-derived cells resident in kidney, and nonbone marrow-derived renal parenchymal or vascular cells. Leukocytes in trapped blood seemed to make no significant contribution to renal Ia expression because (1) perfused kidney had approximately as much Ia as nonperfused kidney, even though the perfusion reduced the blood content by 90%; (2) the estimated number of leukocytes in trapped blood was at least three orders of magnitude less than that needed to account for Ia expression by kidney; and (3) perfused kidney, volume for volume, absorbed more anti-Ia than did whole blood, so that no amount of blood contamination could account for all renal Ia expression. Thus most Ia in kidney must be on resident cells, either bone marrow-derived or parenchymal. To demonstrate bone marrow-derived Ia-positive cells, we created radiation chimeras of (B10 X B10.D2)F1 bone marrow into B10 hosts. Ia of (B10 X B10.D2)F1 bone marrow donor origin was easily detectable in kidneys of these chimeras at 4 months. However, we also demonstrated Ia of nonbone marrow donor origin in chimera kidney: long-term B10.A into (BALB/c X A)F1 chimeras and C57BL/6 into (C57BL/6 X DBA/2)F1 chimeras continued to express renal Ia of bone marrow recipient origin. Thus, some renal Ia is produced by bone marrow-derived cells, and some is produced by cells which are nonmarrow derived (or are marrow derived but are resistant to replacement in bone marrow chimeras). The cells expressing Ia in kidney were unlikely to be thymus derived because anti-Thy-1.2 was not absorbable by the same kidney preparations which absorbed anti-Ia.

Effects of vitamin A and/or thyroidectomy on liver microsomal enzymes and their induction in 2,3,7,8-tetrachlorodibenzo-p-dioxin-treated rats.

Vitamin A and thyroid hormone status have been shown previously to alter the toxicity of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) in rats. In the present study, we have examined the effects of a vitamin A-excess and a vitamin A-deficient diet on thyroid hormone levels, on selected drug-metabolizing enzymes in liver microsomes, and on their inducibility by TCDD in male Sprague-Dawley rats. Except for a slight increase in serum T3 levels, none of these end points was affected by feeding rats the vitamin A-deficient diet. In contrast, excess dietary vitamin A caused a decrease in serum thyroxine (T4) and triiodothyronine (T3) levels, although the levels of T3 remained in the euthyroid range (60-80 ng/dl). The concentration of liver microsomal cytochromes P-450 and b5 and the basal activity of benzo[a]pyrene hydroxylase and 7-ethoxyresorufin O-de-ethylase were unaffected by excess dietary vitamin A. This result is consistent with our previous observation that the basal activity of these enzymes is dependent more on T3 than on T4 levels. Vitamin A excess markedly suppressed the activity of liver microsomal UDP-glucuronosyl transferase toward 1-naphthol. However, no such enzyme suppression was observed in thyroidectomized rats. This suggests that the suppressive effect of vitamin A on UDP-glucuronosyl transferase activity may be dependent on T3. Neither vitamin A nor thyroid status had any major effect on the inducibility of UDP-glucuronosyl transferase and cytochrome P-450-dependent enzyme activities by TCDD. However, vitamin A and TCDD had a nearly additive effect on suppression of serum T4. It is concluded that liver microsomal enzyme induction is not associated with the modulatory effect of vitamin A and thyroid hormones on the toxicity of TCDD.

Financial, organizational and professional factors affecting health care utilization.

This paper explores the effects of specific provider and system features on patients' use of health care, including financial, time and organizational barriers, practice patterns and physician characteristics. The data are from a survey of 3058 family members and their usual providers in Washington, D.C. Findings indicate that a low-income practice clientele and high charges were the most significant deterrents to use, followed by absence of Medicaid, distance, limited hours and patient-sharing by physicians. Charges and distance had a disproportionate impact on the poor. The combined impact of structural barriers in hospital outpatient departments reduced access by roughly 50% compared with private settings. Policy implications are discussed.

Mothers' satisfaction with the cost of children's care: the role of practice settings and actual expenses.

This paper analyzes mothers' satisfaction with the cost of children's care in six widely-varying ambulatory settings: fee-for-service solo and group practices, a prepaid group, public clinics, hospital outpatient departments, and an emergency room. Data are from a household survey in Washington, DC and represent 638 children. Findings indicate significantly higher satisfaction with cost in public clinics than in solo practice, fee-for-service groups, and the emergency room, adjusting for patient characteristics, attitudes and financial coverage. In fee-for-service settings, both provider charges and out-of-pocket costs had a nonlinear relation to satisfaction with cost; to a point, increasing costs and charges were associated with decreasing satisfaction, but thereafter higher costs and charges appeared to lead, other things equal, to higher satisfaction. Out-of-pocket costs had a significantly greater negative effect on poor mothers' satisfaction than on the more affluent. Implications for current policy trends are discussed.

Hematocrit levels and race: an argument against the adoption of separate standards in screening for anemia.

The average hematocrit levels of black children have been widely reported to be about two to three percent lower than those of white children. Until recently, the relative contributions of economic, nutritional, and genetic factors to these differences have been unspecified. Based on new evidence and reanalysis of past data, however, some investigators now argue that genetic differences exist which transcend economic status. Separate screening standards are thus recommended for black children-standards which would define fewer as anemic. The present paper discusses methodological inadequacies in the evidence supporting the separate standards argument, focusing on the skewed economic distributions by race which suggest economic disparities within the racial subgroups compared. Findings are presented from a study of children in Washington, DC, to illustrate the role of particular risk factors known to be differentially distributed by income (eg, multiparity, birthweight, source of medical care). These factors are associated with varying hematocrit levels, even among blacks, and they also appear to account for a large part of the black-white hematocrit differentials. Study findings cast doubt on conclusions about the genetic basis of hematocrit differences and suggest that, without better evidence, it would be inappropriate to adopt lower standards for blacks in screening for anemia.

Relationship between marbling group and major muscle contribution to beef carcass mass.

Left sides from 18 beef carcasses (9 steers and 9 heifers) were divided equally among three marbling groups (low = traces or slight; intermediate = small or modest; high = slightly abundant) and evaluated to determine the relationship between longissimus composition and the percentage each major muscle contributes to the weight of the beef carcass. The adductor (A), biceps femoris (BF), deep pectoral (DP), gluteal group (GL), infraspinatus (I), longissimus (L), psoas major (PM), rectus abdominis (RA), rectus femoris (RF), semimembranosus (SM), semitendinosus (ST), serratus ventralis (SV), spinalis (SP), supraspinatus (SU) and triceps brachii (TB) were removed, trimmed of external fat and weighed. Muscle weights were expressed as a percentage of hot carcass weight: A = .76%; BF = 3.30%; DP = 1.89%; GL = 1.81%; I = 1.10%; L = 3.35%; PM = .95%; RA = 1.12%; RF = .94%; SM = 2.35%; ST = 1.14%; SV = 2.26%; SP = .82%; SU = .69% and TB = 1.83%. The deep pectoral and triceps brachii were heavier (P less than .05) in steer carcasses than in heifer carcasses. No other significant sex effects were noted. Percentage of muscle tended to decrease with increasing marbling level; however, the linear regression of relative muscle weight on marbling level was significant for the BF, DP, PM, SM, SU and TB. Using marbling score or yield grade factors to predict the percentage of individual muscles in the carcass resulted in R/ values greater than .4 in 7 of the 15 muscles evaluated.(ABSTRACT TRUNCATED AT 250 WORDS)

Are accident and emergency consultants as accurate as consultant radiologists in interpreting plain skeletal radiographs taken at a minor injury unit?

The objective of this study was to compare the accuracy of an accident and emergency (A&E) consultant in interpreting plain skeletal radiographs with that of a consultant radiologist (CR). It took the form of a retrospective study of 2133 radiographs taken in a Minor Injury Unit (MIU). A&E consultant reports on these films were compared with those of a CR and also with a gold standard. The A&E consultant diagnoses achieved an accuracy of 98.5% (CR 97.8%), sensitivity of 97.8% (CR 98.1%), specificity of 98.8% (CR 97.7%), positive predictive value of 97.3% (CR 95.1%) and negative predictive value of 98.97% (CR 99.07%) (gold standard of 100%). In conclusion, the A&E consultant reports of plain skeletal radiographs generated from an MIU were as accurate as those of a consultant radiologist. This could have significant implications for the wet reporting of A&E departmental radiographs.

Ablation of the cranial portion of the preputial cavity in a pig.

A technique for surgical ablation of the cranial portion of the preputial cavity including the preputial diverticulum in pigs is described. The technique was performed on a 5-month-old 83.2-kg (183-lb) Hampshire barrow that had ulceration and fibrosis of the preputial cavity secondary to chronic preputial diverticulitis. The pig recovered without difficulties and was able to urinate normally after surgery.

Nonsurgical treatment of suprascapular nerve injury in horses: 8 cases (1988-1998).

OBJECTIVE: To determine the outcome of horses with suprascapular nerve injury treated with stall rest alone. DESIGN: Retrospective case series. ANIMALS: 8 horses. PROCEDURE: Information on signalment, history, limbs affected, severity of lameness, degree of muscle atrophy, gait abnormalities, and results of radiography and electromyography was obtained from medical records. All horses were treated with stall rest. Follow-up information on severity of lameness, gait abnormalities, degree of muscle atrophy, time between injury and resolution of gait abnormalities, and outcome was obtained during reexamination at the hospital or through telephone conversations with owners. RESULTS: In 4 horses, the injury was a result of trauma; in the other 4, the injury was suspected to be a result of trauma. All horses had pronounced instability of the shoulder joint during the weight-bearing phase. Follow-up information was available for 7 horses. Shoulder joint instability resolved in all 7 horses within 3 to 12 months (mean, 7.4 months) after the original injury. Two horses had complete return of the supraspinatus and infraspinatus muscle mass 15 and 18 months after the injury. Two horses used as broodmares before the injury and 4 of 5 horses used for riding or in race training before the injury were able to return to preinjury activities. CLINICAL IMPLICATIONS: Horses with suprascapular nerve injury treated with stall rest alone have a good prognosis for recovery of normal gait and return to performance; however, the recovery period may be prolonged.

Treatment response and athletic outcome of foals with tarsal valgus deformities: 39 cases (1988-1997).

OBJECTIVE: To evaluate the response to various treatments and long-term outcome of foals with tarsal valgus deformities. DESIGN: Retrospective study. ANIMALS: 39 foals with tarsal valgus deformities. PROCEDURE: Data collected from medical records, included signalment, history, reason for admission, and clinical findings. Radiographic views of the tarsus were evaluated for incomplete ossification of tarsal bones and were classified as normal in appearance, type-I incomplete ossification, or type-II incomplete ossification. Treatment and athletic outcome were documented for each foal. RESULTS: Radiographic assessment revealed that 22 of 39 foals (56%) had concomitant tarsal valgus deformities and incomplete ossification of the tarsal bones. Eight of 19 foals with tarsal valgus deformities that were treated with periosteal stripping responded favorably. Foals < or = 60 days old were significantly more likely to respond to periosteal stripping than older foals. Five of 8 foals with tarsal valgus deformities that were treated with growth plate retardation responded favorably. Eleven of 21 foals with long-term follow-up performed as intended. Compared with foals with type-II incomplete ossification, foals with tarsal bones that had a normal radiographic appearance or type-I incomplete ossification were significantly more likely to perform as intended. CONCLUSIONS AND CLINICAL RELEVANCE: Foals with tarsal valgus deformities should have lateromedial radiographic views of the tarsus obtained to assess the tarsal bones for incomplete ossification, which will affect athletic outcome. Because foals with type-II incomplete ossification of the tarsal bones respond poorly to periosteal stripping alone, treatment by growth-plate retardation is recommended.

Gastrointestinal ulceration and pulmonary aspergillosis in a llama treated for parelaphostrongylosis.

A 9-year-old llama examined because of hind limb paresis was found to have parelaphostrongylosis. Despite treatment with ivermectin, fenbendazole, cimetidine, and ceftiofur, the llama developed gastrointestinal ulceration and pulmonary aspergillosis and was euthanatized. Parelaphostrongylus tenuis is a parasite of white-tailed deer, but ruminants can serve as aberrant or dead-end hosts after accidentally ingesting snails or slugs carrying third-stage larvae of the parasite. Gastrointestinal ulceration and pulmonary aspergillosis can develop secondarily in llamas with chronic disease. Treatment of gastrointestinal ulceration in llamas is difficult, because efficacy of commonly used antiulcer drugs in llamas has not been established.

Incomplete ossification of the tarsal bones in foals: 22 cases (1988-1996).

OBJECTIVE: To determine outcome for foals with incomplete ossification of the tarsal bones and to determine whether clinical and radiographic abnormalities at the time of initial examination were associated with outcome. DESIGN: Retrospective study. ANIMALS: 22 foals. PROCEDURE: Information on signalment, history, owner's initial complaint, clinical findings, whether tarsus valgus was evident, and radiographic abnormalities was obtained from medical records. Radiographic lesions were classified as type I (i.e., incomplete ossification with < 30% collapse of the affected bones) or type II (incomplete ossification with > 30% collapse and pinching or fragmentation of the affected bones). Follow-up information was obtained via telephone conversations with owners. RESULTS: Foals were between 1 day and 10 months old when first examined. Eleven were premature (i.e., < 320 days of gestation) or were twins. Sixteen had tarsus valgus. Severity of radiographic lesions was associated with outcome; 4 of 6 foals with type-I incomplete ossification of the tarsal bones performed as intended, but only 3 of 16 foals with type-II incomplete ossification of the tarsal bones performed as intended. CLINICAL IMPLICATIONS: For foals with incomplete ossification of the tarsal bones, severity of the radiographic lesions was associated with outcome. Foals with type-II incomplete ossification of the tarsal bones have a guarded prognosis for athletic soundness.

The battered woman syndrome: effects of severity and intermittency of abuse.

The concept of a battered woman syndrome was tested by assessing 50 battered women and 25 emotionally abused women who had recently left their relationships. For both groups, essential features of the syndrome were present and were significantly interrelated. Dynamic features of the prior abusive relationship correlated significantly with these sequelae. The concept of intermittency is proposed as an alternative to the cycle of violence theory as main contributor to the syndrome. Predictability of abuse was found to be unrelated to the intermittency measure.

Adolescent parricide: an integration of social cognitive theory and clinical views of projective-introjective cycling.

Case histories of parricide by adolescents frequently reveal a history of abuse on the part of the victim and acute depression and suicidal ideation by the adolescent. This paper seeks to integrate an established concept of suicide as escape from "aversive self-awareness" through cognitive deconstruction with clinical observations of "projective-introjective cycling" of aggressive impulses, as a means of better understanding and preventing violence toward intimate others.

Profiling of wife assaulters: preliminary evidence for a trimodal analysis.

A review of the experimental literature on wife assault causation indicates that differing "profiles" of wife assaulters have been developed by different research strategies. Profiles based on interviews with victims suggest a tyrannical, personality-disordered type of wife assaulter. Clinical assessments reveal several profiles, only one of which is consistent with this view. Other types of wife assaulters are dependent and unassertive. By comparing the emerging data on wife assaulters with the initial clinical descriptions, an assessment is made of the contribution of empirical studies to date. While the potential for a major contribution to our understanding of wife assaulters exists through use of systematic empirical methods, it is concluded that this potential has not yet been fulfilled. Some suggestions are made for future research strategies to improve empirical capabilities in furthering this understanding, including a more thorough assessment of early trauma as a major causative factor affecting a large subcategory of wife assaulters and greater attention to the self-selection of wife assault samples.

The outcome of court-mandated treatment for wife assault: a quasi-experimental evaluation.

This study represents an attempt to assess the effectiveness of court-mandated treatment for wife assault. A quasi-experimental design examined post-conviction recidivism rates for men convicted of wife assault. Fifty men who completed a 16-week treatment program had a 4% recidivism rate for a posttreatment period of up to 3 years. A comparable group who were not treated had a 40% recidivism rate in the same period. Hence, the "success" rate of treatment was 36% according to police records (Rosenthal, 1983). Straus Conflict Tactics Scale scores reported both by the treated men and their wives demonstrated significant posttreatment decreases from pretreatment levels. Treated husbands' average annual use of severe violence dropped from 10.6 to 1.7 times per year (p less than 0.01). Eighty-four percent of wives reported no posttreatment violence. Rates of verbal aggression also dropped significantly from pretreatment levels. Comparison with CTS scores of a group of men who were arrested but not treated for wife assault (Jaffe, Wolfe, Telford, & Austin 1986) revealed significant decreases in the use of Physical Aggression subscale tactics (as reported by their wives) as a result of treatment. Interpretative difficulties with the quasi-experimental design used in this study are discussed and a randomized design with appropriate psychological assessment of subjects is recommended.

Patriarchy and wife assault: the ecological fallacy.

A critical review is made of feminist analyses of wife assault postulating that patriarchy is a direct cause of wife assault. Data are reviewed from a variety of studies indicating that (a) lesbian battering is more frequent than heterosexual battering, (b) no direct relationship exists between power and violence within couples, and (c) no direct relationship exists between structural patriarchy and wife assault. It is concluded that patriarchy must interact with psychological variables in order to account for the great variation in power-violence data. It is suggested that some forms of psychopathology may lead to some men adopting patriarchal ideology to justify and rationalize their own pathology.