Time-dependent melatonin secretion is associated with mitochondrial function in peripheral blood mononuclear cells (PBMC) of male volunteers.

Melatonin blood levels vary depending on the circadian rhythm. It also stimulates antioxidant enzymes and has positive effects on mitochondrial function. The current study investigated the effects of endogenously released melatonin on adenosine triphosphate (ATP) levels and mitochondrial respiration in peripheral blood mononuclear cells (PBMC). The current study included 20 healthy adults (mean age 25,7 ± 3.4 years). Blood was collected at 8 a.m. and 2 p.m. The activity of mitochondrial respiratory complexes and ATP levels were determined in isolated PBMC. Melatonin concentrations were determined in serum samples. Sleep behavior was assessed. In PBMCs isolated from blood samples of males, respiration of mitochondrial complex IV and ATP levels as well as serum melatonin concentration were significantly lower at 2 a.m. compared to the samples collected at 8 p.m. Mitochondrial parameters and melatonin blood levels were equal at both time points in the samples isolated from females. Although our results show that the amount of melatonin secreted may have had an influence, further investigation is needed to determine the importance of melatonin and other factors in measuring the mitochondrial function of PBMC.

Impact of adult attention deficit hyperactivity disorder and medication status on sleep/wake behavior and molecular circadian rhythms.

Attention deficit hyperactivity disorder (ADHD) is a common neuropsychiatric condition that has been strongly associated with changes in sleep and circadian rhythms. Circadian rhythms are near 24-h cycles that are primarily generated by an endogenous circadian timekeeping system, encoded at the molecular level by a panel of clock genes. Stimulant and non-stimulant medication used in the management of ADHD has been shown to potentially impact on circadian processes and their behavioral outputs. In the current study, we have analyzed circadian rhythms in daily activity and sleep, and the circadian gene expression in a cohort of healthy controls (N = 22), ADHD participants not using ADHD-medication (N = 17), and participants with ADHD and current use of ADHD medication (N = 17). Rhythms of sleep/wake behavior were assessed via wrist-worn actigraphy, whilst rhythms of circadian gene expression were assessed ex-vivo in primary human-derived dermal fibroblast cultures. Behavioral data indicate that patients with ADHD using ADHD-medication have lower relative amplitudes of diurnal activity rhythms, lower sleep efficiency, more nocturnal activity but not more nocturnal wakenings than both controls and ADHD participants without medication. At the molecular level, there were alterations in the expression of PER2 and CRY1 between ADHD individuals with no medication compared to medicated ADHD patients or controls, whilst CLOCK expression was altered in patients with ADHD and current medication. Analysis of fibroblasts transfected with a BMAL1:luc reporter showed changes in the timing of the peak expression across the three groups. Taken together, these data support the contention that both ADHD and medication status impact on circadian processes.

A community prevention model to prevent children from inhaling and ingesting harmful legal products.

Children's misuse of harmful legal products (HLPs), including inhaling or ingesting everyday household products, prescription drugs, and over-the-counter drugs, constitutes a serious health problem for American society. This article presents a community prevention model (CPM) focusing on this problem among pre and early adolescents. The model, consisting of a community mobilization strategy and environmental strategies targeting homes, schools, and retail outlets, is designed to increase community readiness and reduce the availability of HLPs, which is hypothesized to reduce HLPs use among children. The CPM is being tested in Alaskan rural communities as part of an inprogress eight-year National Institute on Drug Abuse randomized-controlled trial. This paper presents the CPM conceptual framework, describes the model, and highlights community participation, challenges, and lessons learned from implementation of the model over a 21-month period.

Detection of pulsed gamma rays above 100 GeV from the Crab pulsar.

We report the detection of pulsed gamma rays from the Crab pulsar at energies above 100 giga-electron volts (GeV) with the Very Energetic Radiation Imaging Telescope Array System (VERITAS) array of atmospheric Cherenkov telescopes. The detection cannot be explained on the basis of current pulsar models. The photon spectrum of pulsed emission between 100 mega-electron volts and 400 GeV is described by a broken power law that is statistically preferred over a power law with an exponential cutoff. It is unlikely that the observation can be explained by invoking curvature radiation as the origin of the observed gamma rays above 100 GeV. Our findings require that these gamma rays be produced more than 10 stellar radii from the neutron star.

Radio imaging of the very-high-energy gamma-ray emission region in the central engine of a radio galaxy.

The accretion of matter onto a massive black hole is believed to feed the relativistic plasma jets found in many active galactic nuclei (AGN). Although some AGN accelerate particles to energies exceeding 10(12) electron volts and are bright sources of very-high-energy (VHE) gamma-ray emission, it is not yet known where the VHE emission originates. Here we report on radio and VHE observations of the radio galaxy Messier 87, revealing a period of extremely strong VHE gamma-ray flares accompanied by a strong increase of the radio flux from its nucleus. These results imply that charged particles are accelerated to very high energies in the immediate vicinity of the black hole.

Learning from healthcare errors: effective reporting systems.

Healthcare errors represent the seventh leading cause of death in this country and are largely the result of systems errors as opposed to individual incompetence. In order to correct systems errors, it is essential that known adverse events b e reported so that the underlying causes can be determined and corrective action taken. However, despite their importance, the majority of known errors are not reported. This article describes the barriers to reporting errors and offers several recommendations to increase reporting of adverse events and, thus, improve the quality of healthcare.

Effect of community-based interventions on high-risk drinking and alcohol-related injuries.

CONTEXT: High-risk alcohol consumption patterns, such as binge drinking and drinking before driving, and underage drinking may be linked to traffic crashes and violent assaults in community settings. OBJECTIVES: To determine the effect of community-based environmental interventions in reducing the rate of high-risk drinking and alcohol-related motor vehicle injuries and assaults. DESIGN AND SETTING: A longitudinal multiple time series of 3 matched intervention communities (northern California, southern California, and South Carolina) conducted from April 1992 to December 1996. Outcomes were assessed by 120 general population telephone surveys per month of randomly selected individuals in the intervention and comparison sites, traffic data on motor vehicle crashes, and emergency department surveys in 1 intervention-comparison pair and 1 additional intervention site. INTERVENTIONS: Mobilize the community; encourage responsible beverage service; reduce underage drinking by limiting access to alcohol; increase local enforcement of drinking and driving laws; and limit access to alcohol by using zoning. MAIN OUTCOME MEASURES: Self-reported alcohol consumption and driving after drinking; rates of alcohol-related crashes and assault injuries observed in emergency departments and admitted to hospitals. RESULTS: Population surveys revealed that the self-reported amount of alcohol consumed per drinking occasion declined 6% from 1.37 to 1. 29 drinks. Self-reported rate of "having had too much to drink" declined 49% from 0.43 to 0.22 times per 6-month period. Self-reported driving when "over the legal limit" was 51% lower (0. 77 vs 0.38 times) per 6-month period in the intervention communities relative to the comparison communities. Traffic data revealed that, in the intervention vs comparison communities, nighttime injury crashes declined by 10% and crashes in which the driver had been drinking declined by 6%. Assault injuries observed in emergency departments declined by 43% in the intervention communities vs the comparison communities, and all hospitalized assault injuries declined by 2%. CONCLUSION: A coordinated, comprehensive, community-based intervention can reduce high-risk alcohol consumption and alcohol-related injuries resulting from motor vehicle crashes and assaults. JAMA. 2000;284:2341-2347.

Social control and workplace drinking norms: a comparison of two organizational cultures.

OBJECTIVE: This article reports on an investigation of the relationship of social control mechanisms at work to drinking practices of 10,000 salaried and hourly employees working in the same U.S. industry, with the same union, but in two different work environments. One work environment reflected an organizational culture that is traditional to U.S. management; the other was based on a nontraditional Japanese transplant model. METHOD: The research team used a combination of methods including in-home surveys (N = 1,723; 1,378 men) and ethnography (110 semistructured interviews and 200 hours of direct observation inside the plants). Respondents were asked about general and work-related drinking, perceptions of drinking norms, strengths or weaknesses of alcohol-related policies and procedures for policy enforcement. RESULTS: Although overall consumption rates in both populations were similar, significant differences between the two samples existed regarding work-related drinking. The Traditional (i.e., U.S.) model was associated with more permissive norms regarding drinking before or during work shifts (including breaks) and higher workplace drinking rates than the Transplant (i.e., Japanese) model. Analyses revealed that alcohol policies, and the extent to which policies are actually enforced, predicted drinking norms and alcohol availability at work. Drinking norms, in turn, predicted work-related drinking and accounted for differences in alcohol consumption between the two worksites. Analyses of ethnographic data provided descriptive understandings of aspects of the two organizational cultures that disabled mechanisms for social control of drinking in one setting and enabled those mechanisms in the other. CONCLUSIONS: These understandings of how social control mechanisms predict work-related drinking practices provide guidelines for alcohol problem prevention in a specific kind of occupational environment. However, our identification of aspects of social control that successfully regulate workplace drinking is applicable to other kinds of occupational settings as well.

Alcohol availability and workplace drinking: mixed method analyses.

OBJECTIVE: This article investigates the relationship between subjective social and physical availability of alcohol at work and work-related drinking. METHOD: We integrated survey and ethnographic methods to determine if and why physical and social availability of alcohol predicted work-related drinking in a manufacturing plant with approximately 6,000 employees. Survey data were obtained from in-home interviews with 984 randomly selected workers. Respondents were asked about their overall and work-related drinking, their perceptions of the ease of obtaining or consuming alcohol in the plant, the work-related drinking of others and their approval/disapproval of work-related drinking by co-workers. Ethnographic data were obtained from 3 years of periodic onsite observations and semistructured interviews with key informants to investigate factors underlying alcohol availability and drinking at work. RESULTS: Structural equations modeling of the survey data revealed that subjective social availability of alcohol at work, and particularly perceived drinking by friends and co-workers, was the strongest predictor of work-related drinking. Typical frequency and quantity of alcohol consumption and heavy drinking were predictive also. Subjective physical availability of alcohol was not significantly related to drinking at or before work. Findings from the ethnographic analyses explained survey findings and described characteristics of the work culture that served to encourage and support alcohol availability and drinking. CONCLUSIONS: These results are the first to show significant relationships between alcohol availability and drinking at work, to explain dynamics of that relationship and to demonstrate the potential risks of using only quantitative or only qualitative findings as the basis for prevention.

Predicting likelihood of seeking help through the employee assistance program among salaried and union hourly employees.

AIMS: This research investigated belief, social support and background predictors of employee likelihood to use an Employee Assistance Program (EAP) for a drinking problem. DESIGN: An anonymous cross-sectional survey was administered in the home. Bivariate analyses and simultaneous equations path analysis were used to explore a model of EAP use. SETTING: Survey and ethnographic research were conducted in a unionized heavy machinery manufacturing plant in the central states of the United States. PARTICIPANTS: A random sample of 852 hourly and salaried employees was selected. MEASUREMENTS: In addition to background variables, measures included: likelihood of going to an EAP for a drinking problem, belief the EAP can help, social support for the EAP from co-workers/others, belief that EAP use will harm employment, and supervisor encourages the EAP for potential drinking problems. FINDINGS: Belief in EAP efficacy directly increased the likelihood of going to an EAP. Greater perceived social support and supervisor encouragement increased the likelihood of going to an EAP both directly and indirectly through perceived EAP efficacy. Black and union hourly employees were more likely to say they would use an EAP. Males and those who reported drinking during working hours were less likely to say they would use an EAP for a drinking problem. CONCLUSIONS: EAP beliefs and social support have significant effects on likelihood to go to an EAP for a drinking problem. EAPs may wish to focus their efforts on creating an environment where there is social support from coworkers and encouragement from supervisors for using EAP services. Union networks and team members have an important role to play in addition to conventional supervisor intervention.

A community prevention trial to reduce alcohol-involved accidental injury and death: overview.

The 5-year "Preventing Alcohol Trauma: A Community Trial" project in the United States was designed to reduce alcohol-involved injuries and death in three experimental communities. The project consisted of five mutually reinforcing components: (1) Community Mobilization Component to develop community organization and support, (2) Responsible Beverage Service Component to establish standards for servers and owner/managers of on-premise alcohol outlets to reduce their risk of having intoxicated and/or underage customers in bars and restaurants, (3) Drinking and Driving Component to increase local DWI enforcement efficiency and to increase the actual and perceived risk that drinking drivers would be detected, (4) Underage Drinking Component to reduce retail availability of alcohol to minors, and (5) Alcohol Access Component to use local zoning powers and other municipal controls of outlet number and density to reduce the availability of alcohol. This paper gives an overview of the rationale and causal model, the research design and outline of each intervention component for the entire prevention trial.

Preventing sales of alcohol to minors: results from a community trial.

This paper reports an evaluation of a community-based approach to prevent underage sales of alcohol. The interventions focused on (a) enforcement of underage sales laws, (b) responsible beverage service (RBS) training and (c) media advocacy. The interventions were implemented in three experimental communities located in California and South Carolina. Purchase survey data were obtained before and after the interventions in each experimental community and in three matched comparison communities. Logistic regression analyses of the purchase survey data for the individual community pairs and for the combined communities showed that sales to apparent minors were significantly reduced in the experimental sites. The findings indicate that these environmental interventions are promising prevention tools for communities that seek to reduce underage drinking.

Summing up: lessons from a comprehensive community prevention trial.

This paper presents the findings and lessons from a community prevention trial involving three experimental communities in the United States to reduce alcohol-involved trauma. The paper provides recommendations for other community prevention efforts. Effectiveness was demonstrated by: (a) 78 fewer alcohol-involved traffic crashes as a result of the Drinking and Driving Component alone (approximately a 10% reduction); (b) a significant reduction in underage sales of alcohol, i.e. off-premise outlets sold to minors about one-half as often as in comparison communities; (c) increased implementation of responsible beverage service policies by bars and restaurants; and (d) increased adoption of local ordinances and regulations to reduce concentrations of alcohol outlets.

Correlates of change in adolescent alcohol consumption in Ireland: implications for understanding influences and enhancing interventions.

Studies of two similar cohorts of students in Ireland in 1984 and 1992 showed a dramatic increase in the consumption of alcohol, especially in the frequency with which students reported being drunk. A comparison of measures obtained at both times showed that there were major changes with regard to beliefs about consequences of alcohol consumption in a direction favorable to consumption as well as increases in the perceived social support for drinking. However, there were no strong indications that changes in problem behavior were associated with the observed increases in drinking patterns. These results are supportive of some explanatory models of initiation to substance use and have associated implications for programs designed to reduce consumption.

Evaluation design for a community prevention trial. An environmental approach to reduce alcohol-involved trauma.

The Community Prevention Trial was 5-year effort to reduce alcohol-involved injuries and death through a comprehensive program of community awareness and policy activities. The three experimental communities were of approximately 100,000 population each (one in Northern California, one in Southern California, and one in South Carolina). Matched comparison communities were used for each experimental community. This article describes the evaluation approach used in a program that sought to change environmental factors not a specific population or target group. This approach demanded unique evaluation approaches for determining overall community aggregate effects, that is, distal outcomes, as well as changes in key mediating variables, that is, process effects. The problem of trending and lagged effects of community prevention programs are discussed.

Monitoring youth behavior in response to structural changes. Alternative approaches for measuring adolescent drinking.

Random digit dial (RDD) telephone and self-administered school-based surveys of drinking and drinking and driving were compared for adolescents from two Northern California communities. The RDD and school-based surveys resulted in very different samples. The telephone sample contained a greater proportion of European Americans and a smaller proportion of Asian Americans and "other" ethnicities. Respondents to the telephone sample also tended to be older and of higher socioeconomic status (SES). The telephone survey captured very few school dropouts. Moreover, it resulted in lower self-reports of drinking and drinking and driving. Survey mode appeared to influence respondents equally, regardless of their gender, age, ethnicity, or SES.

Summing up. Recommendations and experiences for evaluation of community-level prevention programs.

This article provides recommendations and observations about evaluation of a locally based prevention project to reduce problems at a total community or aggregate level. The shift from targeting specific individuals or subpopulations to the overall structure and environment of a community is most demanding. Evaluation tools and analysis techniques have lagged behind program development because community-level interventions are not linked to a specific target group who can be separately studied. Thus assumptions about using random assignment and/or comparison communities as means to control for confounding variables are weakened when the unit of analysis is the community itself and dependent measures are subject to trending and the effects of history.

The relationship of drinking and hangovers to workplace problems: an empirical study.

OBJECTIVE: This article reports on the relationship between drinking patterns and workplace problems in a manufacturing facility operated by a Fortune 500 industry. METHOD: The data come from a survey of 832 hourly employees (88% male) and from ethnographic research in the plant. This study is distinctive because it examined a large random sample of workers, rather than an impaired subpopulation. Moreover, the study is among the few that has asked employees how much they drank prior to and during working hours and how frequently they had been hungover at work. Respondents were also asked about their overall alcohol consumption and their experience of various problems in the workplace. RESULTS: Bivariate analyses indicated that overall drinking, heavy drinking outside of work, drinking at or just before work and coming to work hungover were related to the overall number of work problems experienced by respondents, and to specific problems such as conflicts with supervisors and falling asleep on the job. Multivariate analyses revealed that workplace drinking and coming to work hungover predicted work-related problems even when usual drinking patterns, heavy drinking and significant job characteristics and background variables were controlled. Overall drinking and heavy drinking outside the workplace did not predict workplace problems in the multivariate analyses. The analyses show that workplace problems were also related to age, gender, ethnicity, work shift and departments. Survey results are explicated with findings from a plant ethnography. CONCLUSIONS: Although the relationships are modest, they support the hypothesis that work-related drinking and hangovers at work are related to problems within the workplace and may lead to lowered productivity and morale.