Residential Homes with Extremely High Indoor Radon Concentrations in Southern Lehigh County, Pennsylvania.

ABSTRACT: A housing development of 87 new homes on approximately 300 acres of former farm land was found to have 19 homes with basement radon-222 ( 222 Rn) concentrations greater than 37,000 Bq m -3 , with the highest recorded result to date being 648,000 +/- 1,031 Bq m -3 , based upon the diffusion barrier charcoal canister result. The US Environmental Protection Agency (EPA) Action Level for 222 Rn is 148 Bq m -3 . This single-family housing development is in the southeast corner of Lehigh County, Pennsylvania, about 58 km northwest of Philadelphia, in a geologic unit known as the Epler Formation. Radon testing in homes in this development began in the fall of 2014 and is now complete. Initial testing consisted of charcoal canisters mailed to homeowners. Subsequent testing in newly built homes consisted of testing prior to occupancy. This testing was quite extensive, with continuous radon monitors, passive radon monitors, and grab sampling for radon gas and progeny in the basement and on the first floor of each home as well as gamma surveys in the basement, on the first and second floors, and outside of each home. All but one of the new houses in this development had passive radon resistant features installed during the construction phase. In all cases, fans were added to the passive systems to make them active systems, which were needed to control these extremely high radon levels. Additional radon mitigation work such as adding additional suction points was also needed in several homes to reduce levels to below EPA guidelines. The unique geology and high 226 Ra soil concentrations in this specific area are the causes of these extremely high radon levels. Radon measurement data both inside these homes and in the outdoor ambient air, as well as 238 U and 222 Ra rock and soil concentrations, are presented.

Identification of candidate genes in ulcerative colitis and Crohn's disease using cDNA array technology.

Inflammatory bowel disease (IBD) follows a multigenic mode of inheritance, encompassing the clinically discrete phenotypes of ulcerative colitis (UC) and Crohn's disease (CD). The risk of malignant transformation of the colon increases with the duration and extent of IBD and is particularly high for patients with a longstanding history of UC. We wished to identify candidate genes that might be involved in disease pathogenesis based on functional plausibility and their putative role in IBD carcinogenesis. Polyadenylated mRNA (PolyA+ mRNA) preparation from inflamed intestinal mucosa of patients with a longstanding history of UC and CD was performed with subsequent hybridization of alpha phosphorus [alpha-32P]-deoxyadenotriphosphate-labeled complementary deoxyribonucleic acid (DNA) populations to nucleic acid arrays. Of 588 different human gene transcripts arrayed, secreted apoptosis-related protein 1 (Sarp1), frizzled (fz) homologues, and disheveled (dvl) were differentially expressed, being elevated in UC as compared to CD. These genes encode proteins involved in the Wingless-type (Wnt)/beta-catenin signaling pathway. The autonomous expression of Sarp1 and Sarp1-compatible fz receptor genes suggests that the Wnt pathway may be involved in UC carcinogenesis.

Assessing the health attitudes, beliefs, and behaviors of African Americans attending church: a comparison from two communities.

Public health officials and researchers continue to be increasingly concerned about the health of populations of color, especially African Americans. A survey was administered in African American churches in two communities (Wichita, KS and Tuscaloosa, AL) to gather information concerning health behaviors and beliefs and to design interventions that might improve their health status. The study examined the homogeneity of attitudes, beliefs, and behaviors across these samples and to determine the readiness to change using the Transtheoritical Model. Individuals completed a 33-item survey: 6 demographic questions, 12 health behavior questions, 8 health belief questions, 3 church attendance questions, and 4 church-based health promotion program questions. The total sample consisted of 429 respondents. The results showed that 93% of respondents have had their blood pressure checked in the past 2 years. While only 44% indicated eating a high fiber diet during the week. Thirty percent of respondents indicated that their health was dependent on fate or destiny. The findings from this study confirm that among both samples that health attitudes, beliefs, and behaviors need to be changed to lower the risk of certain diseases and disorders. The findings also indicate that both samples have similar beliefs about health that may have important implications for disseminating information to the community. Innovative and culturally sensitive programs are needed in the African American community if disparities in health are to diminish.

Effects of a replication of a multicomponent model for preventing adolescent pregnancy in three Kansas communities.

CONTEXT: A significant amount of attention has been devoted to the complex issue of teenage pregnancy and to programs for reducing pregnancy among adolescents. Careful evaluations of such programs are needed to ascertain what strategies will be most effective at reducing teenage pregnancy. METHODS: A pretest-posttest comparison group design was used to analyze the effects of a comprehensive multicomponent school and community intervention on estimated pregnancy rates and birthrates among young people in three Kansas communities: Geary County, Franklin County and selected neighborhoods of Wichita. RESULTS: There were high levels of program activity in all three communities during the intervention period, including teacher training and sexuality education for students. Survey respondents rated highly such project interventions as the extension of school-linked clinic hours to accommodate student schedules and support groups established in middle schools. Between 1994 and 1997, the proportions of adolescents reporting that they had ever had sex decreased significantly among all ninth and 10th graders in Geary County, from 51% to 38% among females and from 63% to 43% among males. In Franklin County, more males in grades 11 and 12 reported using condoms in 1996 (55%) than had done so in 1994 (39%). Age at first intercourse remained relatively stable in Franklin and Geary counties during the intervention period. The estimated pregnancy rate among adolescents aged 14-17 decreased between 1994 and 1997 in Geary Country, while it increased in comparison areas. The estimated pregnancy rates among 14-17-year-olds decreased in both Franklin County and its comparison communities. The birthrate declined both in one target area of Wichita and in its comparison area from 1991-1993 to 1994-1996. Over the same time period, the birthrate increased in a second target area of Wichita, while it decreased in the comparison community. CONCLUSIONS: This evaluation of a comprehensive multicomponent program for adolescent pregnancy prevention contributes to our understanding of this model and its replicability in diverse communities. Ongoing program evaluation is important for developing initiatives and for refining strategies so they respond to local conditions.

PIP: This paper evaluates a multi-component program for reducing pregnancy among adolescents in the US. The study employed a pretest-posttest comparison group design to analyze the effects of a comprehensive multi-component school and community intervention on estimated pregnancy rates and birthrates among young people in three Kansas communities: Geary County, Franklin County and selected neighborhoods of Wichita. Results revealed high levels of program activity in all three communities during the intervention period, including teacher training and sexuality education for students. From 1994-97, the proportion of adolescents who reported that they had experienced sex decreased significantly among all 9th and 10th graders in Geary County. Condom use among males in grades 11 and 12 in Franklin County increased from 39% in 1994 to 55% in 1996. In Franklin County and its comparison areas, the estimated pregnancy rates decreased among adolescents aged 14-17 years. The birthrate declined both in one target area of Wichita and in its comparison area from 1991-93 and 1994-96. In general, this research contributed to an understanding on the impact of multi-component school- and community-based interventions on adolescent pregnancy rates.

Evaluating community coalitions for prevention of substance abuse: the case of Project Freedom.

In the United States alone, there are more than 2,000 community coalitions to address local concerns about abuse of alcohol, tobacco, and other drugs. This article describes an evaluation system used to examine the process, outcome, and impact of coalitions for the prevention of substance abuse. The evaluation addresses five key questions: (a) Was the community mobilized to address substance abuse (Process)? (b) What changes in the community resulted from the coalition (Outcome)? (c) Is there a change in reported use of alcohol and other substances by youths (Outcome)? (d) Does the coalition have a community-level impact on substance abuse (Impact)? and (e) Is community-level impact related to changes facilitated by the coalition (Impact)? To address these and other questions, using eight core measurement instruments, the evaluation system collects 15 distinct measures. This evaluation system is illustrated with a multiyear study of Project Freedom, a substance abuse coalition in a large midwestern city.

Evaluating a statewide partnership for reducing risks for chronic diseases.

We describe a case study evaluation of Kansas LEAN, a statewide partnership with the mission of reducing risks for chronic diseases through dietary and exercise modification. We used a case study design to examine five primary questions related to process and outcome: (a) were the goals of the partnership important to constituents? (process), (b) were constituents satisfied with the partnership (process), (c) were community or systems changes (new or modified programs, policies, or practices) facilitated by partnership efforts (outcome)?, (d) were these changes important to the partnership's mission (outcome)?, and (e) what critical events helped facilitate community changes (outcome)? several measurement instruments--a monitoring and feedback system, constituent surveys, and semistructured interviews--were used to address key evaluation questions. Kansas LEAN is a strong statewide partnership with involvement from key representatives throughout Kansas. It is an ongoing, comprehensive health promotion program that plans and implements multiple components, in a variety of settings, to create awareness, behavior change, and a supportive environment. Kansas LEAN has facilitated several important community or systems changes related to its mission. We conclude with a discussion of the challenges of evaluating partnerships that seek to reduce risks for chronic diseases.

Patient counseling--a focus on maintenance therapy.

Pharmacist counseling of patients receiving long-term medications for chronic diseases is discussed. Patient counseling should be viewed as one component of the overall drug-use process. Pharmacists counseling patients prescribed long-term medications need to understand the lifestyle effects of chronic illness, particularly the different types of "work" the chronically ill patient must undertake. Pharmacists need to go beyond traditional sender-message-receiver communication models in counseling patients and to adopt a problem-solving approach through which each patient's needs and level of understanding are taken into account. Patients should be actively involved in their therapy decisions. Patients will be at varying stages in terms of making any behavioral changes needed to maximize therapeutic outcomes, and counseling must be adapted to fit the stage of change. The Indian Health Service (IHS) model of counseling uses open-ended questions to determine patients' knowledge of their disease and medications; this enables the pharmacist to fill in any gaps and review specific points. The health communication model provides strategies for enhancing patient compliance and recall and complements the IHS model. In practice, the techniques used will depend on whether the patient is a new-prescription patient or an established patient. The models can be adapted to counseling care-givers and can be complemented by compliance aids. The demand for pharmacist counseling of patients with chronic illnesses is likely to increase, and, to effectively counsel patients about long-term medication use, pharmacists need to appreciate the personal impact of chronic illness beyond the direct effects of the biomedical disease itself, and must understand modern communication models.

Suppository administration of chemotherapeutic drugs with concomitant radiation for rectal cancer.

PURPOSE: Preoperative radiation with combined chemotherapy is effective in shrinking advanced rectal cancer locally and facilitating subsequent surgery. Suppository delivery of 5-fluorouracil is associated with less toxicity and higher rectal tissue concentrations than intravenous administration. This prompted us to evaluate suppository and intravenous administration of 5-fluorouracil and mitomycin C with concomitant radiation to determine associated toxicity. METHODS: Rectal, liver, lymph node, and lung tissue and systemic and portal blood were collected serially from male Sprague Dawley rats to determine drug concentrations following suppository or intravenous delivery of 5-fluorouracil or mitomycin C. Thirty-six animals were randomly assigned to treatment groups and received 5-fluorouracil suppositories, mitomycin C suppositories, or an equivalent intravenous dose of 5-fluorouracil or mitomycin C 30 minutes before radiation therapy. Before and 3, 6, 10, and 15 days following this treatment, blood was collected, colonoscopy was performed, and rectal tissue was harvested for histologic examination. RESULTS: Mitomycin C suppository was significantly less toxic compared with intravenous delivery, and higher rectal tissue concentrations were observed from 10 to 30 minutes (P < 0.05). Compared with intravenous 5-fluorouracil administration and radiation, 5-fluorouracil suppository and radiation resulted in additive myelosuppression at day 6 (P < 0.05) with rapid recovery. CONCLUSIONS: 5-Fluorouracil and mitomycin C suppository delivery combined with radiation causes less systemic toxicity and is more effective than intravenous administration.

Evaluating the effects of a community coalition's efforts to reduce illegal sales of alcohol and tobacco products to minors.

Minors' access to alcohol and tobacco is a major public health concern because of the many deaths and disabilities associated with use and the ease with which minors purchase these products. We evaluated the effects of a community-based substance abuse coalition's efforts to reduce alcohol and tobacco products to minors. The intervention--implemented entirely by coalition members--consisted of adults and minors issuing citations to clerks in supermarkets, convenience stores and liquor stores, who were willing to sell alcohol and tobacco products to minors and issuing commendations to clerks who refused to sell. For those liquor stores receiving the citizen's surveillance, there was a marked decrease in alcohol sales to minors, from 83% to 33%; and in those liquor stores not experiencing the intervention, there was a smaller decrease in alcohol sales, from 45% to 36%. This study's findings suggest that citizen surveillance and feedback may be effective in reducing alcohol sales to minors when the intervention is fully implemented, but may be ineffective, at least in these doses, with tobacco sales.

Using empowerment theory in collaborative partnerships for community health and development.

Models of community empowerment help us understand the process of gaining influence over conditions that matter to people who share neighborhoods, workplaces, experiences, or concerns. Such frameworks can help improve collaborative partnerships for community health and development. First, we outline an interactive model of community empowerment that describes reciprocal influences between personal or group factors and environmental factors in an empowerment process. Second, we describe an iterative framework for the process of empowerment in community partnerships that includes collaborative planning, community action, community change, capacity building, and outcomes, and adaptation, renewal, and institutionalization. Third, we outline activities that are used by community leadership and support organizations to facilitate the process of community empowerment. Fourth, we present case stories of collaborative partnerships for prevention of substance abuse among adolescents to illustrate selected enabling activities. We conclude with a discussion of the challenges and opportunities of facilitating empowerment with collaborative partnerships for community health and development.

Comprehensive services in an ambulatory care pharmacy.

The development of a comprehensive model of pharmacy practice in an ambulatory care setting is described. From 1991 to 1994, the department of ambulatory care pharmacy services at The University of Illinois at Chicago Medical Center converted its main outpatient pharmacy into a Pharmaceutical Care Center to serve as a model for community and hospital-based ambulatory care pharmacy services. The Pharmaceutical Care Center includes a waiting area, five private patient-assessment rooms, an examination room, a place for reviewing patient profiles and reference materials, space for storage and automation, an i.v. admixture area, a conference room, and office space. It serves 120-150 patients per day (10% just discharged from the hospital, 90% seen in the clinic system). Pharmacy clerkship students and residents, under the oversight of faculty, conduct patient assessments, educate patients and family, monitor outcomes, and intervene when drug-related problems are detected. Patient assessments and therapeutic interventions are documented in the patient's medical record. Computers, automated medication filling, and technical support are used to enable pharmacists to concentrate on patient care. A model ambulatory care pharmacy provides both drug distribution and direct patient care services.

Assessment and treatment of acetaminophen overdose.

The assessment and treatment of acute acetaminophen toxicity are reviewed, and several unresolved issues are discussed. The drug most commonly involved in analgesic ingestions, as a single agent or in combination, is acetaminophen. Hepatotoxicity, the major manifestation of acetaminophen ingestion, is believed to result from the accumulation of a toxic metabolite, N-acetylimidoquinone. The clinical features of acetaminophen toxicity are divided into four stages ranging from minor symptoms, such as gastrointestinal irritation, to coma and death. The most reliable method for assessing the severity of acetaminophen ingestion is comparison of serum acetaminophen concentrations with the Rumack-Matthew nomogram. Delaying the start of antidotal therapy for more than 10 hours after the ingestion increases the risk of toxicity; no benefit is observed when antidotal therapy is initiated more than 24 hours after ingestion. Acetaminophen is often marked in combination with other drugs; a detailed patient history and a urine toxicology screen help determine whether multiple toxic ingestions have occurred. The roles of ipecac, gastric lavage, and activated charcoal in therapy are controversial. The mainstay of treatment for acetaminophen intoxication is a 17-dose course of acetylcysteine.

Theophylline reversal of electroconvulsive therapy (ECT) seizure inhibition.

Oral sustained-release theophylline 200-400 mg, given 10 hours prior to electroconvulsive therapy (ECT) increased ECT seizure length in each of eight male patients who had shown unacceptably short seizures. The increase was on average 13.9 (+/- 6.0, SD) sec (p = .00016 by t test; p = .0000034 by exact probability). The absence of unduly prolonged seizures was attributed to previously demonstrated high seizure thresholds and to relatively low concentrations of theophylline. No adverse effects from theophylline were seen.

Inconsistencies in the drug use process.

Rational drug therapy has historically been viewed as the right drug, in the right dose, at the right time, for the right patient. Today, the emphasis on cost containment has added an extra dimension: cost-effective therapeutic regimens. Most stages of the DUP have not been extensively studied. Evidence presented to date reflects duplication of efforts and suboptimal decisions, with little concerted effort to identify means for improvements that may have a favorable impact on cost and patient outcome. The increasing use of drugs as the primary mode to treat diseases, the reduction in the number of hospital employees at a time increased severity of patient illness, the nursing shortage, and the increasing cost and complexity of drugs, along with the inconsistencies that exist in drug use, demonstrate a need for a complete review of the DUP. The DUP, as it currently operates, is not conducive to the provision of a systematic approach to therapy. The stages in this process are often independent of each other and poorly performed by a variety of health professionals. The subsequent development of strategies for improving the chance for optimal drug therapy through the use of pharmacists as drug therapy experts is needed. The pharmacy profession is in a prime position where expanded patient care services and supervision of the entire DUP may actually decrease the total cost of health care. This expansion represents the key to increasing acceptance of pharmacists' clinical role and for ensuring long-term survival of the profession.

Termination of "ventricular" arrhythmias from digoxin by selective production of complete atrioventricular block with physostigmine in the dog.

In previous studies we have come to doubt that ventricular rhythms of an automatic nature will arise spontaneously from the peripheral Purkinje system. In 20 anesthetized dogs, digoxin was administered i.v. (0.1-1.0 mg/kg) and in 12 dogs by selectively perfusing the atrioventricular (AV) node artery (2 ml; 40 microgram/ml). We obtained the following results. First, selective pharmacological production of complete AV block (acetylcholine or physostigmine) interrupts the "ventricular" arrhythmias considered characteristic of digitalis intoxication.Second, digitalis arrhythmias are difficult to produce when this type of complete heart block had been previously established. Third, abolition of ventricular arrhythmias by selective pharmacological production of heart block can be reversed (i.e., the arrhythmia restored) with atropine. Fourth, rapid pacing of the ventricles during complete heart block in dogs poisoned with digitalis can eventually induce ventricular arrhythmias, but not quickly. We interpret that these digitalis arrhythmias originated within the acetylcholine-sensitive portion of the AV node-His bundle region.