Starting young? Children's experiences of trying smoking during pre-adolescence.

Although the risks smoking poses to health are now well known, many young people continue to take up the habit. While numerous cross-sectional studies of adolescents have identified correlates of smoking initiation, much less prospective, longitudinal research has been conducted with young children to gather their accounts of early experiences of smoking, and this study fills that significant gap. Quantitative and qualitative data, collected using questionnaires, interviews and focus groups, are presented from the pre-adolescent phase of the Liverpool Longitudinal Study of Smoking. By age 11, 27% of the cohort had tried smoking, 13% had smoked repeatedly and 3% were smoking regularly. Rates of experimentation increased over time. Qualitative data revealed that curiosity and the role of peers were central to children's accounts of early smoking. By pre-adolescence, children are at different stages in their smoking careers, therefore interventions must be targeted to their varied experiences. Current prevention strategies often focus on restricting access to cigarettes, but a broad range of intervention measures is required which take account of the multifactorial nature of smoking onset. To be effective, policies that aim to prevent smoking must be grounded in children's lived experiences.

Why do primary school children smoke? A longitudinal analysis of predictors of smoking uptake during pre-adolescence.

The objectives of this longitudinal study were to determine the prevalence of smoking among primary school children in Liverpool, and to identify the predictors of experimentation with cigarettes during pre-adolescence. A cohort of children (n = 270) completed questionnaires that elicited patterns of child smoking behaviour and children's experiences of smoking in their families and communities each year between the ages of 9 and 11 years. Parents also completed questionnaires. Children's first trials with cigarettes and repeated smoking were reported. The independent variables measured were socio-economic status, familial and peer smoking, and intentions to smoke. By age 11, 27% of children had tried smoking, 12% had smoked repeatedly and 3% were smoking regularly. Variables measured at age 9 predicting experimentation with cigarettes by age 11 were male gender 9P = 0.041) paternal smoking (P = 0.001) fraternal smoking (P = 0.017) a best friend who smoked (P = 0.026) and knowing someone with a smoking-related disease (P = 0.006) Intentions to smoke at age 9 did not predict smoking at age 11 (P < 0.001). In univariate analyses, child smoking was also associated with maternal smoking (P = 0.002 at age 11), living in a low-income household (P < 0.001 at age 10) and living in a deprived area ( P = 0.025 at age 11). Early smoking presents a considerable challenge to health promoters, not least because it is socially patterned. The interventions required must tackle the structural and social pressures that shape smoking behaviour during childhood.

Maternal smoking and the risk of congenital birth defects: a cohort study.

BACKGROUND: The literature linking gestational smoking to congenital defects has been very inconsistent. The purpose of this study was to reinvestigate the relation between gestational smoking and congenital malformations. METHODS: This study was a retrospective cohort (N = 18,016) of live births in the TriHealth Hospital system from 1 January 1998 to 31 December 1999. The cohort included 1,943 mothers who were smokers. Congenital defects were grouped into 22 different categories. Multifactorial logistic regression was used to find any association between exposure and the possible outcomes. RESULTS: Mothers who smoked were significantly younger and had babies of lower birth weight and shorter gestational age (P < .05). Of the 22 categories of congenital defects, only cardiovascular system abnormalities showed a significant difference (P < .01) between the two groups. The remaining 21 categories of congenital defects showed no statistical difference. CONCLUSION: Women who smoke during pregnancy have infants that are significantly smaller and of shorter gestational age compared with mothers who do not smoke. Based on these data and findings from most of the available literature, however, gestational smoking is unlikely to cause a large increase in congenital birth defects.

Collegial networking and faculty vitality.

BACKGROUND: This research explored the relationship between collegial networking and faculty "vitality" among graduates of the family medicine faculty development fellowship at the University of North Carolina at Chapel Hill. Faculty vitality was defined by retention in full-time teaching, job satisfaction, academic activity, and contributions to the discipline. METHODS: A questionnaire was mailed to 170 family physician graduates of the 1980-1992 fellowship classes. After a mail and telephone follow-up, the response rate was 85%. Data were collected on career history, professional interests, professional relationships, assessment of fellowship, and professional activities. RESULTS: Respondents with collegial networks were more likely to participate in several academic activities and were more likely to remain in full-time teaching. No association was found between collegial networks and satisfaction or contributions to the discipline. There were only small differences in effect between intra-departmental and extra-departmental collegial networks. Stratification by program type and gender revealed no evidence of effect modification or confounding. CONCLUSIONS: Collegial networks influence some aspects of faculty vitality, particularly retention in full-time teaching. Further research is needed to fully understand its impact.

Children's activity levels and lesson context during third-grade physical education.

Little is known about children's activity levels during physical education classes and how they relate to the national health objectives for the year 2000 (U.S. Public Health Service, 1991). We systematically observed students' physical activity and associated variables in 293 third-grade physical education lessons in 95 schools in 4 Child and Adolescent Trial for Cardiovascular Health (CATCH) centers in California, Louisiana, Minnesota, and Texas. The influence of independent variables was assessed simultaneously by analysis of variance. Significant differences among study centers were evidenced for both physical activity and lesson context variables. Additionally, there were differences among variables for lesson location and teacher specialty, but not for teacher gender. Boys were more active than girls, but only during free play opportunities. The findings have widespread implications for educators responsible for developing and implementing health-related physical education programs, as well as for designing and conducting staff development.

A curriculum for teaching faculty budgeting and financial management skills.

BACKGROUND: As funding sources diminish, it is critical for faculty members in primary care residency programs to better utilize available resources. The curriculum presented here, a practice management course for academicians, can provide fellows and new faculty with some of the budgeting and financial management skills necessary to perform in an academic environment. METHODS: The curriculum described is a 6-hour seminar series that relates essential budgeting and financial management concepts with academic practice. RESULTS: Pre- and postassessments displayed a statistically significant increase in the learner's fund of knowledge. One year after instruction, six of seven participants had used an aspect of the curriculum. All seven recommended its continuation. CONCLUSION: This curriculum should be considered for implementation in all fellowship programs that train future faculty.

Fetal alcohol syndrome.

The most notable features of fetal alcohol syndrome involve the face and eyes, and include microcephaly, short palpebral fissures, an underdeveloped philtrum and a thin upper lip. Evidence of intrauterine or postnatal growth retardation, mental retardation or other neurologic abnormalities, and at least two of the typical facial features are necessary to make the diagnosis. Newborns with the syndrome may be irritable, with hypotonia, severe tremors and withdrawal symptoms. Mild mental retardation, the most common and serious deficit, and a variety of other anomalies may accompany fetal alcohol syndrome. Sensory deficits include optic nerve hypoplasia, poor visual acuity, hearing loss, and receptive and expressive language delays. Atrial and ventricular septal defects, as well as renal hypoplasia, bladder diverticula and other genitourinary tract abnormalities, may occur. Complete abstinence during pregnancy is recommended, since alcohol consumption in each trimester has been associated with abnormalities, and the lowest innocuous dose of alcohol is not known.

Developing a medical informatics education program to support a statewide health information network.

The Florida Health Information Network (FHIN) was established in October 1989 to provide biomedical information services to the University of Florida Health Science Center (HSC) and to health professionals throughout the state--especially the northern thirty-nine counties of the state. FHIN services are available to all affiliates of the HSC and by annual subscription to nonaffiliates. At present, FHIN services include database access, circulation services, document delivery, and information services. Training network users has been an objective since the inception. Training has targeted both the HSC Library staff and HSC users and now is expanding to include remote users. Because many users have had insufficient experience with computers, the library has to teach the mechanics of access and network use and to instruct users regarding applications and database searching. This paper describes the development and implementation of the medical informatics education program. Topics include library staff training; educational offerings for HSC faculty, staff, and students; development and implementation of the remote training program; and organizational and budgetary implications for the construction of such a program.

Primary prevention of coronary heart disease in women. Should asymptomatic women 50 years of age take aspirin regularly?

Based on the results of the Physician's Health Study, the US Preventive Services Task Force currently recommends low doses of aspirin on alternate days for men over age 50 years to prevent first myocardial infarction. Although there are no clinical trials involving women, three female cohort studies of aspirin and prevention of myocardial infarction have been published with conflicting results. We conducted a critical review of the three female cohort studies. Although a general recommendation for asymptomatic women to take aspirin to prevent myocardial infarction is not currently indicated, the best available data suggest a beneficial effect, particularly in women at high risk of coronary artery disease. The clinician should therefore consider aspirin use in each patient individually.

CATCH: physical activity process evaluation in a multicenter trial.

This paper presents the process evaluation model for the physical activity intervention component of the Child and Adolescent Trial for Cardiovascular Health (CATCH) and describes the major procedures used to monitor CATCH PE, the physical education intervention. The paper focuses on CATCH PE teacher training and in-service support as well as on the curriculum implementation. Monitoring training and support included assessing the in-service training workshops and the follow-up on-site assistance provided by staff. Monitoring the implementation included assessing the quantity and quality of CATCH PE instruction in terms of student physical activity engagement and lesson context, the fidelity of the curricular implementation, and the opportunities for other physical activity by children throughout the school day.

Alcoholic hepatitis.

Anorexia, weight loss, fatigue, symptoms of alcohol withdrawal and hepatomegaly are common early presenting signs and symptoms of alcohol abuse. The clinical diagnosis of alcoholic hepatitis can be made in alcoholics with associated fever, leukocytosis, jaundice and tender hepatomegaly. Associated laboratory abnormalities may include leukocytosis or leukopenia, anemia, a prolonged prothrombin time and elevated liver enzymes, including aspartate amino-transferase (AST), alanine aminotransferase (ALT), alkaline phosphatase and bilirubin. An AST-to-ALT ratio greater than 2 is common in patients with alcoholic hepatitis. Liver biopsy may be required to establish the diagnosis and to identify other pathology, such as cirrhosis. Histologic diagnosis of alcoholic hepatitis requires the presence of liver cell damage, an inflammatory infiltrate and fibrosis. Biopsy-proven cirrhosis with alcoholic hepatitis or a significantly elevated total bilirubin level and prolonged prothrombin time are associated with a worse prognosis. Abstinence from alcohol, nutritional supplementation and corticosteroids are the mainstays of treatment for severe alcoholic hepatitis.

Living in two worlds: the identity management strategies used by lesbian physical educators.

Twelve lesbian physical educators participated in an in-depth phenomenological study of their work experiences in relation to their identities as lesbians and teachers. All study participants held two assumptions: that they would lose their jobs if their lesbianism were revealed, and that female physical education teachers are negatively stereotyped as being lesbian. Participants most often engaged in identity management strategies designed to conceal their lesbianism, such as passing as heterosexual, self-distancing from others at school, and self-distancing from issues pertaining to homosexuality. The less common risk-taking behaviors included obliquely overlapping their personal lives with their professional, actively confronting homophobia and supporting gay and lesbian students, and overtly overlapping the details of their personal and professional lives. The authors conclude this paper with recommendations for challenging homophobia and heterosexism in physical education.

Biofeedback-assisted relaxation training for the aging chronic pain patient.

The older segments of the U.S. population are expanding rapidly and account for a disproportionate amount of health care, including treatment for pain-related musculoskeletal disorders. In a prospective study with objective measures and one-year follow-up, Middaugh et al. (1988) found that older patients (55-78 yr; N = 17, 76% success) treated in a multidisciplinary chronic pain rehabilitation program enjoyed a success rate equal to that of younger patients (29-48 yr, N = 20, 70% success). The current study presents additional data on these two groups of patients to compare their ability to learn the physiological self-regulation skills taught in the biofeedback/relaxation component of the multimodal program. This component included progressive muscle relaxation training, diaphragmatic breathing instruction, and EMG biofeedback. Repeated measures ANOVA showed significant increases in digital skin temperature (peripheral vasodilation) and decreases in respiration rate both within and across training sessions (p values = .04 to .0001) with no differences between age groups (p greater than .05). EMG measures for the upper trapezius ms in patients with cervical pain showed similar deficits in muscle control at evaluation and similar improvements with biofeedback training for the two age groups. These findings indicate that older pain patients responded well to the biofeedback/relaxation training component of the multimodal pain program.

OLIO+: an osteopathic medicine database.

OLIO+ is a bibliographic database designed to meet the information needs of the osteopathic medical community. Produced by the American Osteopathic Association (AOA), OLIO+ is devoted exclusively to the osteopathic literature. The database is available only by subscription through AOA and may be accessed from any data terminal with modem or IBM-compatible personal computer with telecommunications software that can emulate VT100 or VT220. Apple access is also available, but some assistance from OLIO+ support staff may be necessary to modify the Apple keyboard.

Wilson's disease.

Wilson's disease, an autosomal recessive disorder of copper metabolism, most often becomes apparent in adolescence and may present with a multitude of signs and symptoms. Early diagnosis and treatment can prevent irreversible damage to the liver and the central nervous system. The diagnosis is confirmed by hepatic biopsy and quantitation of copper in the tissues. Treatment is chelation of excess copper. If untreated, Wilson's disease is fatal.

Modulation of ceroid accumulation in macrophages in vitro.

Mouse resident peritoneal macrophages (MPM) cultured with artificial lipoprotein consisting of cholesteryl linoleate complexed with bovine serum albumin (CL/BSA) rapidly accumulate ceroid in the form of rings. Experiments with various phenolic radical scavenger antioxidants and derivatives showed that the radical scavengers which are strongly lipophilic, and possess a free (i.e. non-esterified) phenolic hydroxyl group are inhibitors of ceroid ring formation. Time-course experiments with MPM and CL/BSA in which either or both of the components of the artificial lipoprotein have been oxidised before feeding showed that such oxidation accelerated ceroid accumulation, and suggested that oxidation of the lipoprotein is rate-determining in ceroid accumulation. Copper appeared to be a good catalyst for this. Agents able to activate the respiratory burst production of reactive oxygen species appeared to have no accelerating effect on ceroid accumulation from CL/BSA by MPM in a time-course. A novel method has been attempted for quantitating ceroid in MPM by means of its autofluorescence, using a Fluorescence-activated Cell Sorter (FACS). The results from FACS agree qualitatively with those from alcohol-xylene treatment followed by oil-red-o staining (AX/ORO). MPM cultured with CL/BSA for up to 4 days showed a 2.7-4.6-fold increase in mean fluorescence (at wavelengths greater than 490 nm) over MPM cultured with cholesteryl oleate/BSA (CO/BSA), with CL/BSA/butylated hydroxytoluene (CL/BSA/BHT), with CL/BSA/probucol, and with no artificial lipoprotein. The implications of the findings with respect to human atherosclerosis are discussed.

Accelerated periodontal disease in a patient with essential mixed cryoglobulinemia.

A 32-year-old woman diagnosed as having Type III essential mixed cryoglobulinemia presented with a history of gingival swelling and hemorrhage. Further clinical findings, in addition to sequential radiographs, revealed the presence of an unusual case of rapidly progressive periodontitis. An association between the presence of cryoglobulinemia and the periodontitis is implicated.

Home screening for the detection of urinary tract infection in infancy.

One hundred sixty-five infants of both sexes, 2 weeks to 2 years of age, were screened by their parents at home for bacteriuria. Parents were instructed during a single brief period during the initial office visit to collect and to culture their infants' urine at home. Urine was collected by specimen bag and cultured promptly at cribside using a newly developed culture kit and inoculating swab. The same specimen was cultured by the office laboratory staff by kit and swab and, as a reference standard, by the loop-MacConkey method. Infants were screened at home after three consecutive office visits. Then, 870 specimens were processed. Urinary tract infection (UTI) was diagnosed in 3.6% of the study population. Results show that home screening of infants for UTI by the parent compares favorably with screening by the office laboratory.