The paradox of the contented working woman in intercollegiate athletics administration.

We investigated the paradox of the contented working woman among middle and first-line intercollegiate athletics administrators. In this paradox, women report lower salaries than men but express comparable job satisfaction. The sample comprised 143 women and 371 men in 106 National Collegiate Athletic Association (NCAA) Division I-A institutions. Job satisfaction was measured with the Job Descriptive Index (Smith, Kendall & Hulin, 1969) and Job in General (Ironson, Smith, Brannick, Gibson & Paul, 1989) scales. Analyses revealed the existence of the paradox: Women were paid significantly less, but were equally satisfied with their jobs. Neither gender was satisfied with promotion opportunities or pay, but both were highly satisfied with their jobs in general--another apparent paradox. The disproportionate number of male respondents raised questions about gender equity in athletics administration.

Serum uric acid levels and gout: what does this herald for the population?

OBJECTIVE: To compare the Rome and New York criteria for gout. METHODS: The Rome and New York criteria were compared in 59 patients with gout and in 761 with non-gout by calculating statistical indices such as sensitivity, specificity, relative value (sensitivity + specificity) and the log-likelihood ratio. RESULTS: The best individual criterion was one or more attacks of podagra (New York version) which had a relative value of 194. In contrast, the presence of a tophus was the least valuable criterion with a discriminatory value which was less than three times the most valuable (podagra). The rarity with which either response to Colchicine therapy or measurement for urate crystals were sought makes them poor criteria. Serum uric acid (SUA) followed an approximate Normal Distribution in both sexes, although there were some interesting differences across age strata. In males, SUA showed a progressive rise with age interrupted by a hiccup in the mid-40s. In females, SUA fell slowly as menstruation started, followed by a gradual postmenopausal rise. The mean SUA in males was 294 mumol/l (95% CI = 278-330 mumol/l) and in females 230 mumol/l (95% CI = 224-236 mumol/l). CONCLUSION: Despite higher levels of SUA in gouty patients, there was no lower level of SUA from which gout was not diagnosed, which vindicates its removal from the New York criteria set.

Observations on diagnostic criteria for ankylosing spondylitis.

The Rome and New York criteria for ankylosing spondylitis (AS) have been compared in a clinical sample of patients with this disease and other joint disorders. The best individual clinical discriminator was the first Rome criterion, low back pain and stiffness lasting for three months and, in contrast, the New York criterion of dorsolumbar pain performed poorly. On the other hand, the more stringent New York formulation of lumbar spine limitation in all three planes came out as a better discriminator than its Rome counterpart. Both sets of radiographic criteria performed well. Ethical problems remain, which suggests that new criteria need to be developed for use in population surveys. Peripheral joint involvement was also assessed, but there did not appear to be any merit in taking this into account in any subsequent revision of diagnostic criteria for AS.

The effects of phorbol myristate acetate on the intracellular degradation of bovine parathyroid hormone.

The suppression of PTH release by high extracellular calcium (Ca2+) has been associated with secretion of biologically inactive carboxyl-terminal fragments of PTH (C-PTH), while relatively more intact PTH is released under low extracellular Ca2+ conditions. In the presence of high extracellular Ca2+, phorbol myristate acetate (PMA) has been shown to stimulate PTH release to levels observed at low Ca2+, suggesting that protein kinase-C (PKC) is involved in the regulation of PTH secretion. We have examined the effect of PMA on PTH secretion and the release of PTH fragments at high and low calcium concentrations. Primary cultures of bovine parathyroid cells were incubated for 90 min in 0.5 mM (low) or 2.0 mM (high) Ca2+ with or without 1.6 microM PMA. Reverse phase HPLC using an 18-60% gradient of acetonitrile in 0.1% trifluoroacetic acid was performed on the medium from these incubations, and the eluant fractions were analyzed with a carboxyl (C)-terminal-specific PTH RIA. Medium from cultures exposed to low Ca2+ exhibited two large peaks of PTH immunoreactivity, coeluting with intact PTH-(1-84) and a synthetic human C-PTH-(39-84). PMA treatment at low Ca2+ resulted in the secretion of a greatly reduced amount of intact PTH, suggesting that PKC may increase the production of PTH fragment. At high extracellular Ca2+ PMA caused an increase in total immunoreactive PTH release similar to that seen at low Ca2+. However, on HPLC analysis, proportionally more PTH eluted in the position of the C-PTH fragment than was seen with low Ca2+ stimulation of PTH secretion. It, therefore, appears that the degradation of PTH to C-PTH may be linked to activation of PKC and can be separated from the Ca2+ regulation of PTH release occurring at the cell membrane.

The lateral metacarpophalangeal/metatarsophalangeal squeeze: an alternative assignment criterion for rheumatoid arthritis.

We have proposed an alternate assignment criterion for rheumatoid arthritis (RA), pain on squeezing the MCP or MTP joints. The performance of this criterion has been evaluated in 90 patients with RA and in 122 patients with other rheumatological disorders (non-RA). The proportions of patients with various numbers of sites positive (from 0 to 4) were assessed according to diagnosis; most patients with RA had at least one site positive, in comparison to non-RA where most patients had no sites positive. The diagnostic performance of 2+ or 3+ sites was similar, but 3+ is probably preferable because this simultaneously indicated both symmetry and hand and foot involvement. In conclusion, the lateral MCP/MTP squeeze performs well in comparison to many other existing clinical criteria for RA and could substitute for non-independent features (e.g. swelling and arthritis). It is easier to elicit than searching for pain and/or tenderness as fewer sites have to be examined and inter-observer variation was less than with many other clinical criteria.

Organochlorine pesticides and polychlorinated biphenyls in human adipose tissue.

Halogenated organic compounds are highly lipophilic chemicals that are persistent in the environment as a result of their use and chemical stability. Some of these compounds are also present in the environment as metabolites or oxidation products of a parent compound or as by-products formed in the production of chlorinated compounds. Chronic exposure to the general population results mainly through the food chain. Because they are lipophilic, and because many are metabolized slowly, these chemicals tend to concentrate in body fat tissue. This contribution has described these halogenated organic compounds, discussed their use, regulation and prohibition throughout the world, and reviewed published studies on the levels of these chemicals found in the adipose tissue of humans and animals. For many years, residues of halogenated organic compounds have been detected in the human adipose tissue of individuals in a number of countries, including those in Europe, Asia, and Africa, as well as in the U.S. The levels detected have been used as an index of the level of general population exposure of these compounds over time. Over the past two decades, most countries have observed a steady decline of this level of exposure, reflecting a reduction in the use of these compounds, restrictions on or banning of their use, and a corresponding decrease in their environmental levels. The levels of concentrations vary from chemical to chemical as well as from isomer to isomer. Since the use of aldrin and dieldrin has now been banned or restricted in the U.S. and a number of other countries, residue levels have slowly decreased. Mean values in human adipose tissue in the U.S. and some foreign countries ranged from 0.04 to 0.40 ppm for dieldrin. Aldrin was detected only in Argentina and Poland in the 1970s and endrin was not detected anywhere at anytime. By 1978, all products containing BHC registered in the U.S. has been either discontinued or reformulated to incorporate lindane rather than BHC. The potential for exposure to BHC is virtually nonexistent in the U.S.; however, exposure to lindane is possible since products containing this chemical are still marketed, and used particularly in the manufacture of human medicine. DDT was banned for agricultural purposes in the U.S. in 1972, although it is still used elsewhere for public health vector control. Since the decline in use of DDT, however, the average levels of concentration have also declined. Heptachlor, chlordane, and trans-nonachlor (a component of both heptachlor and chlordane) are chlorinated cyclodienes.(ABSTRACT TRUNCATED AT 400 WORDS)

The assessment of physical independence handicap: experience in a community disablement survey.

Two approaches to the ascertainment of physical independence handicap have been explored using data from a survey of disablement in the population. The survey used a two-stage methodology with an initial postal shift to ascertain those with selected disabilities, a stratified random sample of whom were followed-up with an in-depth interview. The first approach to handicap was direct ascertainment of the scale categories by means of a question in the interview schedule. The second approach was to synthesize the scale categories from the answers to interview questions about disabilities in activities of daily living and other relevant factors. The final synthesized algorithm gave a 75% match within one scale point with the direct question and 85% agreement with receipt of attendance allowance, a state benefit paid to those meeting certain criteria for dependence on others. The lessons learned from the work have been incorporated in a revised and expanded scale, which is suggested as a starting point for revision of physical independence dimension of handicap.

Applications of the International Classification of Diseases.

A brief outline is given of how various types of adaptation of the ICD for use in different situations have arisen. The application includes condensed lists, national adaptations, studies of morbidity, specialty adaptations (including for primary care), and augmentation by supplementary material. The major purposes of different applications are reviewed and an indication is given of factors influencing selection of the condition of primary interest in such situations. The article concludes by suggesting guidance for the development of applications and adaptations of the ICD.

A review of assignment criteria for rheumatoid arthritis.

A comparative evaluation of existing assignment criteria for rheumatoid arthritis has been undertaken as a preliminary to exploring how simpler and more efficient standards could be developed. The performances of alternative formulations of individual criteria have been evaluated, and the various criteria have been assessed singly and in combination. The two individual criteria giving rise to the greatest difficulty are morning stiffness and pain and/or tenderness, with its optional formulation. An alternative criterion, pain in at least three sites on squeezing the MCP or MTP joints, performed well. Taken in combination, better epidemiological discrimination was achieved with the threshold for the 1958 ARA criteria midway between 'definite' and 'classical' disease, with six criteria fulfilled. Most of the discriminatory power of these criteria stemmed from inclusion of radiographic and serological characteristics, which is scarcely surprising. The Rome criteria for Inactive RA and the New York criteria for RA, which were derived from them, achieved better discrimination, which suggests ways in which improvements in assignment criteria might be approached. The 1987 revision of the ARA criteria achieves disappointingly little, as important difficulties have not been resolved.

Selective suppression of follicle-stimulating hormone secretion in anterior pituitary cells by the gonadal steroid 3 alpha-hydroxy-4-pregnen-20-one.

The effect of 3 alpha-hydroxy-4-pregnen-20-one (3HP), a Sertoli cell steroid, on the secretion of gonadotropins from rat anterior pituitary cells in culture was examined and subsequently compared with the action of other gonadal steroids and steroids structurally related to 3HP. Pituitary cells from randomly cycling, sexually mature female rats were isolated and maintained in culture 72 h before use. On the day of treatment, medium was changed, steroids (10(-16)-10(-4) M) and/or LHRH (10(-8) M) were added, and cells were allowed to incubate for a further 24 h. Medium was then examined for gonadotropin content by RIA. 3HP treatment of anterior pituitary cells resulted in a significant reduction of both basal and LHRH-induced FSH secretion, while LH secretion was unaffected. The lowest effective dose of 3HP (10(-16) M) significantly decreased basal FSH secretion to 65.6% of control levels. The lowest effective dose of 3HP that significantly inhibited (by 31%) LHRH-induced FSH secretion was 10(-14) M 3HP. Maximum suppression by 3HP of basal FSH secretion occurred between 10(-10)-10(-8) M, and maximum suppression of LHRH-induced secretion occurred at 10(-12) M. None of the other gonadal steroids tested (progesterone, testosterone, 5 alpha-dihydrotestosterone, 17 beta-estradiol, 20 alpha-hydroxy-4-pregnen-3-one, and 5 alpha-pregnane-3,20-dione) had a similar selective effect on FSH secretion; progesterone, testosterone, and 17 beta-estradiol actually resulted in increased FSH release, and 5 alpha-pregnane-3,20-dione resulted in significant increase in basal LH. A number of metabolites and structural variations of 3HP were examined in this in vitro system at concentrations of 10(-12)-10(-6) M, and none exhibited a similar selective FSH-suppressing activity as 3HP. The data suggest that the selective FSH-suppressing effect of 3HP seen previously in vivo and here in vitro is due to 3HP itself and not the result of a metabolite of this molecule.

Measuring the consequences of illness.

The International Classification of Impairments, Disabilities, and Handicaps (ICIDH) was developed as a means for measuring the impact of illness and its consequences, although there was much delay before the classifications became at all well known. After giving an outline of how the ICIDH came into being, this article considers the basis of different types of health problem and of the potential of the International Classification of Diseases (ICD) and the ICIDH to reveal useful information on such problems. The ICIDH is based on a tripartite distinction between impairment, disability and handicap. It can be used as a resource at four different levels--for enlightenment about the nature of disablement problems and how they might relate to policies and services; as three detailed classification schemes to facilitate structuring of data about impairment, disability and handicap respectively; as a framework which provides an agenda for appraisal and assessment; and for facilitating management functions, perhaps especially the evaluation of care. Philosophical and ideological criticisms of the ICIDH are discussed, and means for applying what has proved to be the most controversial component or dimension, the handicap code, are illustrated. At the root of many difficulties is people's failure to appreciate that the same pieces of information can be used to illuminate complementary aspects of problems when the data are regarded from different perspectives. Further experience along the lines currently being undertaken should not only resolve many of the difficulties, but should also encourage more widespread adoption of the approach underlying the ICIDH.

A man's reach should exceed his grasp. The 1988 Philip Nichols Memorial Lecture.

Dr P. J. R. Nichols was the spark for two complementary initiatives, foundation of the Society for Research in Rehabilitation in Great Britain and establishment of this Journal. These initiatives were based on two insights, that rehabilitation would not make significant progress unless there was more rigorous and scholarly scrutiny of practice, and that responsibility for such advance would rest on multidisciplinary involvement. The development of the Society for Research in Rehabilitation is reviewed from these perspectives, and the Society's interaction with the relevant government department is examined. It is suggested that the focus on rehabilitation in the title of the Society poses problems, tending to foster differences between the various professional groups involved. The latter are reviewed in terms of their training and previous experience, making contrasts between an intellectual or scientific discipline and a branch of professional expertise; the dubious value of all-purpose research methods courses emerges from the analysis. There is a crisis in disability research--funding is hard to come by, there are no significant career prospects for those who might take up this work, and, in Great Britain at least, it has become increasingly difficult to make time for research because of the pressure of service commitments. At a deeper level, disability studies still await a paradigm; behavioural insights have yet to be assimilated fully, too often being regarded as factors to be woven into some mechanistic thread of understanding rather than appreciating that the challenge is existential rather than abstract.(ABSTRACT TRUNCATED AT 250 WORDS)

Coming to terms with chronic illness: the negotiation of autonomy in rheumatoid arthritis.

This paper examines ways in which daily life is sustained in the face of chronic illness. Using data from interviews with people with rheumatoid arthritis, we try to capture the complexity of the interdependence between individuals with chronic illness and society. The main areas focused on cover the disordered body, disruption of relationships, and management of a deviant identity. What emerges is the relativities in everyday negotiations involved as people assimilate or come to terms with the circumstances of disablement. A great deal of research by rehabilitation specialists and advocates of independent living makes use of an abstract notion of the individual and a categorical definition of independence. We suggest that through the subtle relativities individuals in fact sustain considerably more self-determination than is suggested by prevalent notions of independence. This state of affairs is more appropriately referred to as autonomy. The implications of this perspective for health care professionals are discussed.

Individual and collective initiatives in disablement.

After setting a historical background for health care activities this paper relates the development of self-care to changes that have taken place. Relatively recent technological possibilities in medicine have altered the tensions in regard to self-care, highlighting demands for greater knowledge and the search for means of coming to terms with the existential challenge of chronic illness or disablement. The characteristics of self-help groups are discussed briefly, and problems are noted in relation to condition-specific orientation and the emphasis on personal identity and personal responsibility. Various contradictions in attitudes to self-help are also reviewed, notably those associated with the almost opposing traditions of mutual aid and individual self-sufficiency, in moral as well as economic dimensions. The ambiguous liberation provided by self-care and self-help has to be set against political attempts to promote the notion that we can all look after ourselves. Among other things, this rhetoric serves to conceal the real challenges for improvements in community care.

Chemiluminescent responses of alveolar macrophages from normal and Mycobacterium bovis BCG-vaccinated rabbits as a function of age.

Luminol-dependent chemiluminescence (CL) responses of alveolar macrophages (AM) from normal and Mycobacterium bovis BCG-vaccinated infant and adult rabbits were compared. AM from 1-, 7-, and 14-day-old normal rabbits exhibited much lower peak CL responses than did AM from 28- and 42-day-old normal animals as well as rabbits 2 to 3 or 5 to 6 months and 1 to 2 years of age. The most striking differences among AM from infant and adult rabbits were noted when AM were obtained from 28-day-old and 5- to 6-month old rabbits 21 days after the rabbits were immunized with 200 micrograms of BCG intravenously. In this case, AM from 5- to 6-month-old animals gave peak counts per minute of 400,000 to 500,000 whereas AM from 28-day-old rabbits vaccinated with BCG (harvested at 49 days of age) gave peak counts per minute of only 40,715 +/- 2,688. These data reveal that AM from neonatal animals are grossly deficient as responders to phorbol myristate acetate-induced CL. This deficiency, which improved with age, is still apparent in AM from 28-day-old animals. The data also reveal that BCG vaccination of 28-day-old animals yields AM that are poor responders to phorbol myristate acetate compared with AM from BCG-vaccinated animals 2 to 3 and 5 to 6 months of age. AM from animals vaccinated with BCG at 28 days of age contained fewer and smaller electron-dense lysosomelike structures than did AM from adult rabbits similarly vaccinated. These findings provide an explanation for the difficulties infants have in developing effective cell-mediated immune responses against intracellular parasites.

Selective suppression of follicle-stimulating hormone by 3 alpha-hydroxy-4-pregnen-20-one, a steroid found in Sertoli cells.

Previous reports have not identified a naturally occurring steroid that selectively inhibits FSH secretion without also inhibiting LH secretion. The effect of 3 alpha-hydroxy-4-pregnen-20-one (3-HP), a steroid produced in Sertoli cells, on gonadotropin secretion in intact and castrate male and female, prepubertal and adult rats and in cultures of anterior pituitary cells was investigated. Intact prepubertal male rats were treated with a single sc injection of 0.2 mg/kg 3-HP, and castrate male and female rats were given a daily sc injection of 0.2 mg/kg 3-HP for 4 days. Serum FSH levels were suppressed by 26-44% (P less than 0.001-0.05), with no similar effect on serum LH levels. The acetyl derivative of 3-HP (3-HPA), administered to castrate prepubertal and adult rats for 4 days (0.625 mg/kg), resulted in significant decreases (P less than 0.001) in serum FSH to 45% and 19% of castrate control levels, respectively, without a significant effect on LH levels. Treatment of castrate prepubertal male rats with various doses of 3-HPA (0.001-0.625 mg/kg X day) for 4 days resulted in a dose-related suppression of serum FSH. Similar results were obtained with chronic (14-day) treatment of intact male rats with 3-HPA. Treatment of young (15-day-old) intact males with either 3-HP or 17 beta-hydroxy-5 alpha-androstan-3-one (DHT) for 14 days showed that DHT resulted in significant increases in prostate and seminal vesicle weights, while 3-HP showed no apparent androgenic activity. The effects of treatment with 3-HP, 3 beta-HP, 17 beta-estradiol, and DHT (0.025-0.625 mg/kg X day) were compared. Treatment with 3 beta-HP resulted in significant increases in serum FSH levels; 17 beta-estradiol and DHT suppressed both gonadotropins (at the higher doses administered), while 3-HP suppressed only FSH. 3-HP (3.16 X 10(-11) M) and/or LHRH (3 X 10(-8) M) were employed in primary cultures of anterior pituitary cells. Addition of LHRH resulted in 6- to 8-fold increases in the secretion of FSH and LH, while 3-HP suppressed basal (P less than 0.05) and LHRH-stimulated (P less than 0.001) FSH secretion by 26% and 77%, respectively. We conclude that 3-HP selectively suppresses FSH secretion and may be involved in the normal regulation of FSH secretion in the male.