Exploring the relationship between timing of menarche and eating disorder symptoms in Black and White adolescent girls.

OBJECTIVE: This study examined the relationship between timing of sexual maturation and eating disorders symptoms in adolescent girls. METHOD: Data were collected over 10 years for a cohort of 1,213 Black girls and 1,166 White girls who were either 9 or 10 years old at study entry. Annually, girls' height and weight were measured and, biannually, girls completed self-report measures of eating disorders symptoms. RESULTS: Early-onset menarche is a risk factor for the development of body image and dieting concerns, but the effect of timing is due to the impact of early and late maturation on body weight. DISCUSSION: Findings underscore the importance of adiposity as a risk factor for poor mental health.

Practice patterns of neurologists regarding bone and mineral effects of antiepileptic drug therapy.

BACKGROUND: Antiepileptic drug (AED) therapy has been linked to bone disease that can be treated and prevented with calcium and vitamin D. However, because there have been no definitive studies on this subject, many physicians might not be aware of this association. OBJECTIVE: To determine the approaches of neurologists to skeletal disorders in patients taking AEDs. DESIGN: A self-administered mail survey. PARTICIPANTS: United States board-certified or board-eligible pediatric (n = 404) and adult (n = 624) neurologists. MAIN OUTCOME MEASURES: Practice patterns of neurologists regarding methods of screening for bone disorders and recommendations for treatment and prophylaxis. RESULTS: Few pediatric (41%) and adult (28%) neurologists routinely evaluate AED-treated patients for bone and mineral disease. Of physicians who detect bone disease through diagnostic testing, 40% of pediatric and 37% of adult neurologists prescribe calcium or vitamin D, and about half (54% of pediatric and 57% of adult neurologists) refer patients to specialists. Few neurologists (9% of pediatric and 7% of adult neurologists) prescribe prophylactic calcium or vitamin D for patients taking AEDs. CONCLUSIONS: There is a lack of consensus among neurologists concerning the impact of AED therapy on bone. Because considerable evidence suggests that much of the bone pathology caused by AED therapy can be treated or prevented by administration of calcium and vitamin D, raising physician awareness of this problem could significantly improve the skeletal health of AED-treated individuals.

Relapse and maintenance issues for smoking cessation.

This article reviews short-term (6 months) and longer term (12-24 months) maintenance of cessation and relapse in adult smokers and the factors and treatments that affect these outcomes. MedLine and PsycLIT searches were done for research published in English between 1988 and 1998 meeting a defined set of criteria. Intensive intervention, telephone counseling, and use of pharmacotherapy were found to improve outcomes; however, compared with public health approaches, they reach relatively few smokers. Brief interventions during medical visits are cost-effective and could potentially reach most smokers but are not consistently delivered. Predictors of relapse include slips, younger age, nicotine dependence, low self-efficacy, weight concerns, and previous quit attempts. Potential areas for research, recommendations for longer follow-up assessments, and standard definitions for slip, relapse, and long-term maintenance are discussed.

Effect of nitric oxide upon gas transfer and structural integrity of a polypropylene membrane oxygenator.

Gaseous nitric oxide (NO) may act as a membrane passivator during cardiopulmonary bypass by inhibition of platelet and leukocyte adhesion, activation, and aggregation. However, NO and its by-product nitrogen dioxide (NO2) are potently reactive and may be capable of degradation of membrane oxygenator constituents in an oxygen-rich environment. To test these concepts, nine polypropylene hollow fiber membrane oxygenators received 224 +/- 10 ppm NO and 6.7 +/- 1.7 ppm NO2 in 73% oxygen (O2), and six oxygenators received 73% O2, while being perfused with heparinized thrombocytopenic bovine blood for 6 hours. Oxygenators were used for measurement of O2 and carbon dioxide (CO2) transfer rates, structural integrity by pulsing with 22 psi water at 0.5 Hz for 6 hours, and scanning electron microscopic (SEM) examination of structural integrity. Transfer rates between groups at 0, 1, 3, and 6 hours revealed no differences in O2 or CO2. No oxygenator failed hydraulic tests of structural integrity or exhibited "wet-out" during bypass. No evidence of material degradation was shown in the SEM appearance of oxygenators. There were no differences in hematologic values. These data support the safety of gaseous NO in polypropylene membrane oxygenators for limited-term cardiopulmonary bypass.

Reducing cigarette sales to minors in an urban setting: issues and opportunities for merchant intervention.

INTRODUCTION: Intervention studies to reduce cigarette sales to minors have been conducted primarily in suburban settings. Little is known about sociocultural factors influencing cigarette sales to minors in urban settings. This study sought to determine sociodemographic and cultural factors that may play a role in cigarette sales and in efforts to reduce sales to minors in urban areas. METHODS: Merchant education and follow-up surveys were conducted in small local stores in predominantly African-American urban census tracts in Baltimore. The stores had prior evidence of cigarette sales to minors. RESULTS: Merchants reported hostility (66%) and foul language (64%) when they requested youth identification. Youthful-oriented advertising of cigarettes was highly prevalent in all stores and moreso in stores owned and staffed by Asian merchants. Advertising with specific youthful content was predictive (OR = 3.97; 95% CI = 1.70, 9.23; P = .0014) of higher requests for cigarettes from minors. CONCLUSIONS: Youth-oriented cigarette advertising is a prevalent environmental risk for urban youth. Differences between Asian and African-American merchants suggest socioethnic factors may be an influential component of illegal sales and educational campaigns to reduce smoking among minors.

Cigarette sales to African-American and white minors in low-income areas of Baltimore.

OBJECTIVES: This study documented illegal sales of cigarettes to minors in low-income African-American and White urban areas in East Baltimore. METHODS: Six youths, aged 14 through 16 years, were sent to a random sample of 83 corner stores to attempt to purchase cigarettes. The youths provided the investigators with data on merchant, store, and purchase characteristics. RESULTS: The youths successfully purchased cigarettes in 85.5% of the stores; 58% of the stores displayed five or more cigarette advertisements outside their premises. CONCLUSIONS: Cigarette sales to minors and associated advertising remain prevalent in this urban community.

Heart, body, and soul: impact of church-based smoking cessation interventions on readiness to quit.

BACKGROUND: Given the relatively low spontaneous quit rates and poor treatment outcomes among African American smokers, this study was designed to evaluate the effects of a multimodal culturally relevant intervention for smoking behavior change compared with a self-help strategy among urban African Americans in Baltimore churches. METHOD: This randomized controlled trial in urban African American churches used the stages of change model to compare the effectiveness of two interventions in moving smokers along a continuum toward smoking cessation. Twenty-two churches were randomly assigned to either an intensive culturally specific intervention or a minimal self-help intervention. Smokers were interviewed at baseline church health fairs and at a 1-year follow-up. Self-reported quitters at follow-up were evaluated using saliva cotinine and exhaled carbon monoxide levels (CO). Stages of change were measured by applying a standardized stages of change instrument to individual interview response sequences. Analysis compared the two intervention groups at 1-year follow-up with baseline stages. Outcomes included quit rates and positive progress along the stages of change. RESULTS: Multiple logistic regression results, controlling for intrachurch correlation and demographic and baseline smoking characteristics, showed that the multimodal cultural intervention group was more likely to make positive progress along the stages of change continuum, compared with self-help intervention group (OR = 1.68; P = 0.04). Church denomination and intervention status interacted in the multivariate model; Baptists in the intensive intervention were three times (OR = 3.23; P = 0.010) more likely to make progress than all the other denomination groups. CONCLUSION: The multimodal culturally relevant intervention was more likely than a self-help intervention to positively influence smoking behavior. This is the first community-based intervention study to report progress along the stages of change as a process-oriented measure of success. It is notable that a spiritually based model focusing on environmental sanctions was more likely than a standard church disseminated self-help intervention to positively influence smoking behavior in an urban African American population.

The birthday: lifeline or deadline?

This study of deaths from natural causes examined adult mortality around the birthday for two samples, totalling 2,745,149 people. Women are more likely to die in the week following their birthdays than in any other week of the year. In addition, the frequency of female deaths dips below normal just before the birthday. The results do not seem to be due to seasonal fluctuations, misreporting on the death certificate, deferment of life-threatening surgery, or behavioral changes associated with the birthday. At present, the best available explanation of these findings is that females are able to prolong life briefly until they have reached a positive, symbolically meaningful occasion. Thus, the birthday seems to function as a 'lifeline' for some females. In contrast, male mortality peaks shortly before the birthday, suggesting that the birthday functions as a 'deadline' for males.

The chronaxie for myocardium and motor nerve in the dog with chest-surface electrodes.

The chronaxie (i.e., the duration for a stimulating current having twice the rheobasic, or minimum, value) was determined for ventricular myocardium in 12 pentobarbital-anesthetized dogs. Current was applied transthoracically via chest-surface electrodes located at the optimal axillary site for producing inspiration by stimulation of the phrenic nerve (electroventilation). In four dogs the chronaxie for motor-nerve was determined using electrodes at the same location. After using hand-held electrodes to identify the optimal stimulation site for electroventilation, 4.1 cm diameter electrodes were applied bilaterally to the optimal site on the thorax. In 12 dogs, the threshold current for producing ventricular ectopic beats was determined for single rectangular current pulses ranging from 0.1-10 ms in duration. From these data, strength-duration curves were determined and the average chronaxie for ventricular myocardium was found to be 1.82 ms. In four dogs the relationship between inspired volume and maximum stimulus intensity was determined using a 0.8 s burst of stimuli (60/s) with pulse durations ranging from 20-500 microseconds. From these data, strength-duration curves for current were constructed and the average chronaxie for motor-nerve was found to be 0.17 ms. The results of this study show that, because of the differing chronaxies, the current required to produce inspiration with short-duration stimuli is much less than that required to evoke an ectopic heart beat.

Ventricular fibrillation produced by stimulation of external transthoracic electrodes--an experimental study.

The threshold for ventricular fibrillation was determined in 12 pentobarbital anesthetized dogs using transthoracic electrodes located at the optimal axillary electroventilation sites. Electroventilation is the name used to designate inspiration produced by stimuli applied to body surface electrodes. The optimal stimulation site for electroventilation was first determined using hand-held electrodes. Then electrodes, 4.1 cm in diameter, were sutured bilaterally to the optimal anterior axillary stimulation site. The threshold current for producing ventricular fibrillation was determined using single pulses ranging from 0.1-10 msec in duration delivered during the vulnerable period of the cardiac cycle. Fibrillation was produced in all dogs with the 10- and 5-msec pulse durations, in 11 dogs with 0.3-msec, in 6 dogs with 0.2-msec, and in 1 dog with 0.1-msec pulse duration. In all dogs, the current required to produce ventricular fibrillation increased greatly as the pulse duration was decreased. The current required for fibrillation was much in excess of that required to produce one tidal volume. With the longer duration pulses, the ratio was about 80. With the 8 microseconds duration pulses used for electroventilation the estimated ratio is about 800.

Artificial respiration in the anesthetized horse using bilateral, percutaneous, cervical phrenic-nerve stimulation with needle electrodes: a preliminary report.

In this preliminary study, artificial respiration was produced in four anesthetized horses using trains of stimuli applied to long needle electrodes inserted bilaterally at the base of the neck. The needles were insulated to within 1 cm of the tips. The frequency of the stimuli (0.1 msec) was 35/sec and the train duration (duration of inspiration) was 1 sec. Inspired volume increased with increasing stimulus intensity. In two animals, inspired volumes of 6 liters were achieved. In another animal 4.5 liters was achieved and in another, 2.5 liters. This lower value probably represented less-than-optimal electrode placement. Artificial percutaneous electrophrenic respiration was maintained for half an hour in every animal using a minute volume equivalent to that when breathing spontaneously.

Evaluation of platelet damage in extracorporeal circuits using a visual platelet morphology method.

Platelet damage in extracorporeal circuits occurs as the result of contact with foreign surfaces, shear stress, gas interface, and other nonphysiologic conditions. A scoring method developed to determine platelet activation was modified for evaluating platelet damage in extracorporeal circuits. This method assigns a numerical score to platelet damage, as assessed by direct visualization with phase microscopy. Various commercially available blood oxygenators were tested by using a modified AAMI/ASAIO in vitro blood trauma protocol. Direct gas contact oxygenators showed a marked decrease in total platelet count and significant platelet damage. Platelet depletion and platelet damage were lower in membrane oxygenators than in direct gas contact oxygenators. Differences in platelet damage were observed between membrane oxygenators. The observed differences between devices demonstrate the influence of materials and hemodynamic design on platelet depletion and damage. The method developed allows quantitative evaluation of platelet damage caused by extracorporeal devices and is a sensitive indicator of lethal and sublethal trauma.

The influence of general and case-related experience on primary care treatment decision making.

In an effort to examine how general vs case-related clinical experience influenced physicians' treatment decisions, four clinical case vignettes (rheumatoid arthritis, fever of undetermined origin, exercise-induced asthma, and cor pulmonale) were presented to 387 primary care physicians. For each case, physicians indicated (1) their willingness to proceed with treatment without seeking additional information, (2) their preferences for sources of supplementary information, and (3) their preferences for continued care responsibility. The results indicated that the nature of the particular vignette had a major impact on how physicians made treatment decisions. Also, having greater case-related experience and being younger led to greater willingness to proceed with treatment and preferences for continued care responsibility. Preferences for information sources were largely independent of either form of experience. Treatment decision making appears to be quite dependent on experience with similar problems and being up-to-date on current treatment procedures.

Information-seeking strategies and differences among primary care physicians.

Differences in the sources of information that physicians utilize in their practice have several implications for the quality of care delivered and the dissemination of medical information. In order to examine the extent of differences in information preferences in primary care settings, 98 general internal medicine physicians and 73 family physicians were asked to indicate which of six alternative information sources they relied on most when faced with difficult medical problems. The alternatives were: journals, textbooks, informal consultations with colleagues, consultations with community specialists, consultations with outside specialists, and transfer of the patient to another physician. The results indicated that primary care internists have a greater preference for consulting the medical literature, while family physicians more often rely on colleagues and specialists as sources of information. These differences suggest that the focus of information dissemination through journals or textbooks may be more effective for internists, while colleagues or "educationally influential" physicians in the community may be more effective vehicles for information dissemination to family physicians.

Reconstructive hand surgery for quadriplegic persons.

Reconstructive hand surgery is one approach to restoring lost hand function in quadriplegic patients. This paper describes Craig Hospital's experience with the two-stage procedure for achieving active grasp and pinch for C7 spinal cord-injured patients. It describes the hand clinic, patient selection and education, the surgery itself, and postsurgical occupational therapy. It also includes follow-up results on all patients treated since the program's inception.