Feasibility of a text-based smoking cessation intervention in rural older adults.

Text-based interventions are effective for smoking cessation, but have not been tested in rural older adults. The purpose of this study was to compare the feasibility, acceptability and preliminary efficacy of a text-based Scheduled Gradual Reduction (SGR) program to a non-SGR text messaging support condition among rural older adults. Adults over 60 years were randomized to either: (i) the SGR program (n = 20), a text-based program to reduce smoking over 4-weeks plus text-based support messages; or (ii) control (n = 20), receipt of text-based support messages only. Participants completed surveys at baseline and end of program to assess feasibility and acceptability of the intervention, and biochemically validated 7-day point prevalence cessation was assessed at end of treatment. Most participants (81%) reported reading all the messages they received. Participants found both interventions useful in quitting smoking (SGR = 57%, Control = 63%) and would recommend it to a friend (SGR = 72%, Control = 79%). Although not statically significant, the SGR group had a higher rate of biochemically validated cessation (SGR = 15%, Control = 5%, Cohen d = 0.67). Among those still smoking, the median percent reduction in cigarettes was 33.3% for both groups. Text-based cessation interventions are feasible, acceptable and can be easily disseminated to rural older adult tobacco users.

The stigma of mental illness in Arab families: a concept analysis.

ACCESSIBLE SUMMARY: The stigma of mental illness varies significantly from culture to culture and from person to person. To date, little is known about how mental illness stigma manifests within the Arab community. This study aimed at bringing clarity to the concept of 'mental illness stigma' as it applies to Arab families. Nursing's holistic and patient-centered approach is integral to helping Arab patients and their families appropriately incorporate individual values, beliefs, and cultural perspectives into treatment plans. This study establishes a scientific alert for professionals at all levels to avoid making false generalizations about a specific culture that are not based on specific research findings from that culture. ABSTRACT: Accessing mental health services is a critical step towards reducing the burden of mental illness. The stigma of mental illness is one of the most common reasons for not seeking mental health care leading to negative health consequences and undue suffering for many individuals and their families. Stigma is embedded in its social context. What may be considered acceptable in one society may be considered unacceptable and open to stigmatization in other societies. Arabs have a shared set of values, beliefs, and traditions that are substantially different from those of Westerners. Further, in most Arab countries, formal mental health resources are scarce and people with mental illness experience the compounded disadvantages of poverty and illness stigma. To date, little is known about how mental illness stigma manifests within the Arab community making it difficult to design and test interventions that support Arab individuals with mental illness and their families in treatment seeking and adherence. Using Rodger's concept analysis method, we examined how 'mental illness stigma' operates within an Arab context as a first step towards elucidating culturally competent approaches to treatment. This analysis provides a foundation for future work in the areas of mental illness diagnosis, education, and treatment that reflect the unique characteristics of Arab culture.

Personalized medicine in women's obesity prevention and treatment: implications for research, policy and practice.

The prevalence of obesity in America has reached epidemic proportions, and obesity among women is particularly concerning. Severe obesity (body mass index ≥35 kg m(-2) ) is more prevalent in women than men. Further, women have sex-specific risk factors that must be considered when developing preventive and therapeutic interventions. This review presents personalized medicine as a dynamic approach to obesity prevention, management and treatment for women. First, we review obesity as a complex health issue, with contributing sex-specific, demographic, psychosocial, behavioural, environmental, epigenetic and genetic/genomic risk factors. Second, we present personalized medicine as a rapidly advancing field of health care that seeks to quantify these complex risk factors to develop more targeted and effective strategies that can improve disease management and/or better minimize an individual's likelihood of developing obesity. Third, we discuss how personalized medicine can be applied in a clinical setting with current and emerging tools, including health risk assessments, personalized health plans, and strategies for increasing patient engagement. Finally, we discuss the need for additional research, training and policy that can enhance the practice of personalized medicine in women's obesity, including further advancements in the '-omics' sciences, physician training in personalized medicine, and additional development and standardization of innovative targeted therapies and clinical tools.

Mixed methods study of management of health conditions in rural low-income families: implications for health care policy in the USA.

INTRODUCTION: The purpose of this mixed methods study was to examine the health issues and health management strategies utilized by rural low-income women and their families to inform the design, implementation, and evaluation of health reform in rural areas of the USA. METHODS; Quantitative data was analyzed from 271 rural, low-income women and their families and qualitative data from a sub-sample of 44. Specifically explored were the: (1) types and perceived severity of health conditions rural, low-income individuals report; (2) perceived value and utilization of a usual source of care; and (3) strategies these individuals employ to manage their health. RESULTS: Rural American families manage multiple healthcare needs with limited resources; 42.1% reported 1-4 chronic conditions in the family, 31.4% reported 5-8 conditions, and 17.7% reported 9 or more conditions. The majority of participants (79.0%) reported having a doctor or other healthcare professional that they usually see; 61.3% reported their partners had a usual provider, and 91.7% reported their children had a usual provider. Analysis of the qualitative data revealed two main themes regarding management of health conditions: (1) lack of engagement in managing overall health; and (2) ineffective utilization of health care. CONCLUSIONS: Rural low-income individuals in the US may benefit from new policies that promote patient-centered, personalized care. However, any policy change must be carefully designed to consider the ways in which rural American families manage their health in order to improve individual health status and reduce rural health disparities.

Development of a novel self-medicating applicator for control of internal and external parasites of wild and domestic animals.

Four trials, three in the United States and one in South Africa, were conducted to evaluate the potential value of a novel self-medicating applicator in the passive control of gastrointestinal nematodes in cattle and deer, and of files and ticks on cattle using oil-based treatments. The results of the trials demonstrated that this applicator is an effective and practical device for the passive treatment of both deer and cattle for trichostrongyle infections using the endectocide, moxidectin (Cydectin. Fort Dodge Animal Health, USA), of cattle for hom fly (Haemotobia irritans) infestations using the insecticide, cyfluthrin (CyLence, Bayer AG, Germany) and of cattle for tick infestations (in particular Amblyomma hebraeum and Rhipicephalus appendiculatus) using the acaricides deltamethrin and amitraz (Delete All, Intervet, South Africa).

Exotic ticks introduced into the United States on imported reptiles from 1962 to 2001 and their potential roles in international dissemination of diseases.

Since 1962, a total of 29 species of exotic ticks have been introduced into the United States on imported reptiles, with 17 species from the genus Amblyomma, 11 from the genus Aponomma and one from the genus Hyalomma. In the absence of measures to control introduction of these importations, some exotic tick species will develop breeding colonies and become established as indigenous species and some tickborne diseases may be introduced to wreak havoc among susceptible native populations. However, formulation of risk assessments and rational control measures have been hampered by a lack of knowledge of these exotic ticks, with much of the available data published in older and relatively obscure publications. This report is an attempt to collate information for all 29 exotic tick species, including previously unpublished data from our laboratory, with particular reference to their geographical distribution, hosts, life cycles and vector potential, and to review methods to minimize their global dissemination.

Introduction of the exotic tick Amblyomma hebraeum into Florida on a human host.

A resident of Florida returned from a short visit to southern Africa to find a male Amblyomma hebraeum tick attached to the skin behind her knee. Amblyomma hebraeum is a major vector of 2 pathogens that cause important diseases in southern Africa, heartwater of ruminants and African tick-bite fever of humans. The tick was tested by polymerase chain reaction assay for evidence of infection with Cowdria ruminantium and Rickettsia africae (the causative agents of heart-water and African tick-bite fever, respectively) and was found to be negative for both agents. This is the second record of the exotic tick, A. hebraeum, being introduced into the United States on a human host.

Ixodid ticks on white-tailed deer and feral swine in Florida.

A state-wide survey was conducted in Florida during the 1997-99 hunting seasons to examine white-tailed deer (Odocoileus virginianus) and feral swine (Sus scrofa) for potential indigenous vectors of the rickettsial agent of heartwater, Cowdria ruminantium. A total of 504 white-tailed deer and 166 feral swine was examined from 30 wildlife management areas across the state. Amblyomma maculatum, an experimental vector of C. ruminantium, was common on both deer and feral swine throughout the state. Of the collection of 3,169 ticks, 34.5% were Ixodes scapularis Say, 34.0% Amblyomma americanum (L.), 25.5% Amblyomma maculatum Koch, 5.8% Dermacentor variabilis (Say), 0.4% Ixodes affinis Neumann, 0.03% Rhipicephalus sanguineus (Latreille) and 0.01% Amblyomma auricularium (Conil). The only exotic tick collected was A. auricularium, which is found on armadillos in Central and South America and is not known to be associated with any disease. Overall, the most prevalent species on deer were I. scapularis (51.1%) and A. maculatum (35.8%), with A. americanum less prevalent (16.0%) and D. variabilis (3.0%) and I. affinis (1.9%) rare. On feral swine, the most prevalent species were I. scapularis (69.7%) and D. variabilis (56.9%), with A. maculatum (16.2%) and A. americanum (4.6%) less common. The geographic distribution of ticks differed significantly throughout the state. Both A. maculatum and Dermacentor variabilis were more prevalent on deer from southern Florida compared to northern and central Florida. In contrast, A. americanum were more prevalent in northern and central Florida but rare in southern Florida, and I. scapularis were more common in southern compared to northern Florida. These geographic differences may reflect differences in the risk of tick-borne diseases to domestic animals, wildlife and humans within Florida.

Evidence of Cowdria ruminantium infection (heartwater) in Amblyomma sparsum ticks found on tortoises imported into Florida.

Amblyomma marmoreum and A. sparsum ticks were collected from tortoises imported into Florida from Africa and were tested for Cowdria ruminantium infection using a C. ruminantium-specific pCS20 polymerase chain reaction assay. In I shipment imported from Zambia, 15 of the 38 A. sparsum male ticks collected from the leopard tortoises (Geochelone pardalis) were found to be positive for infection with C. ruminantium. In contrast, all 148 A. marmoreum tested were negative for C. ruminantium infection. This is the first reported evidence of the introduction of heartwater-infected ticks into the United States, but there were no opportunities to confirm isolation of C. ruminantium from the ticks by either culture or transmission studies.

The immediate effects of glare and electrochromic glare-reducing mirrors in simulated truck driving.

In this experiment 12 experienced truck drivers drove a fixed-base driving simulator for three 8-h sessions under simulated nighttime driving conditions. Sessions included (a) no glare, (b) intermittent glare presented in the exterior rearview mirrors to simulate following vehicles, and (c) intermittent glare with electrochromic glare reduction. The driving task combined vehicle control on straight and curved road segments with detection of pedestrians appearing alongside the road and targets appearing in the rearview mirrors. The presence of glare slowed detection of pedestrians and, to a lesser extent, slowed the detection of targets appearing in mirrors. Glare was also associated with increased lane position variability, reduced speed on curves, and, most consistently, increased steering variability. We found only meager evidence that electrochromic glare reduction improved target detection performance and no evidence that glare reduction improved vehicle control, despite the fact that participants consistently voiced positive preferences for glare reduction. The results will aid decision making that requires incorporation of the benefits of electrochromic glare-reducing mirrors.

Introduction of potential heartwater vectors and other exotic ticks into Florida on imported reptiles.

Following the discovery of establishment of the African tortoise tick Amblyomma marmoreum in Florida, the present study was undertaken to determine the extent of introduction of exotic ticks into Florida on imported reptiles. Exotic ticks were identified on 29 (91%) of 32 reptile premises in 18 counties of Florida. The ticks, found on a variety of imported tortoises, snakes, and monitor lizards, belonged to 4 Amblyomma species (A. marmoreum, Amblyomma nuttalli, Amblyomma sabanerae, and Amblyomma sparsum) and 4 Aponomma species (Aponomma exornatum, Aponomma flavomaculatum, Aponomma latum, and Aponomma varanensis). The most commonly encountered ticks were A. latum and A. marmoreum. The identifications of A. marmoreum on 8 premises in 7 counties, and of A. sparsum on 1 premises, are of great concern because both species are vectors of heartwater, a lethal disease of cattle, sheep, goats, and deer.

Uteroplacental blood flow and placental vascular endothelial growth factor in normotensive and pre-eclamptic pregnancy.

OBJECTIVE: To determine whether placental vascular endothelial growth factor (VEGF) is increased in pre-eclampsia. DESIGN: Prospective cohort study. SETTING: Royal Prince Alfred Hospital, Sydney, Australia. SAMPLE: Eleven normotensive women and eight women with pre-eclampsia matched for age and gestation. METHODS: Uterine artery Doppler ultrasound flow velocity profiles were recorded in the third trimester and resistance index calculated as (Vs-Vd)/Vs (Vs = peak systolic flow velocity, Vd = end diastolic flow velocity). Placental tissue at delivery was examined for VEGF distribution with avidin-biotin-peroxidase immunohistochemistry. RESULTS: Uterine resistance index [median (range)] was significantly increased in pre-eclamptic women (normotensive: 0.42 (0.36-0.51); pre-eclampsia: 0.59 (0.40-0.75); P = 0.005). Notching of the uterine artery waveform, consistent with a high resistance circulation, was evident in early diastole in five women with pre-eclampsia but only one normotensive woman (P = 0.013). Placental VEGF was increased in women with pre-eclampsia in the decidual trophoblast (normotensive: 34% (4-59) cells stained for VEGF; pre-eclampsia: 58% (15-95); P = 0.033) and in the villous syncytiotrophoblast (normotensive: VEGF count 1.4 arbitrary units (1.1-2.1); pre-eclampsia: 1.8 arbitrary units (1.4-2.2); P = 0.041). Analysis indicated that uterine artery resistance index was directly correlated with placental VEGF staining, mean arterial pressure and birthweight. CONCLUSIONS: Abnormal uterine artery Doppler ultrasound flow velocity profiles in pre-eclampsia indicate increased uteroplacental resistance. The associated increase in placental VEGF may represent a compensatory mechanism attempting to restore blood flow towards normal.

Plasma leptin association with body composition and energy expenditure in sickle cell disease.

OBJECTIVE: To examine the association between fasting plasma leptin concentrations and the hypercatabolic state observed in sickle cell disease (SCD). METHODS: Plasma leptin concentration and resting energy expenditure (REE) were measured in 37 SCD patients (10 men, 12 boys 14 to 18 years-old, seven women, and eight girls 14 to 18 year-old) and in 37 age, gender and fat mass (FM) matched controls. Body composition was measured hydrostatically, REE by whole room-indirect calorimeter, and plasma leptin using an RIA kit. RESULTS: Plasma leptin concentration and leptin normalized for body fat (ng/dL*kg FM(-1)) were significantly lower in SCD patients than in non-SCD controls (4.00+/-3.23 vs. 9.94+/-14.69, p=0.021 and 0.406+/-0.260 vs. 0.643+/-0.561, p=0.024, respectively). A positive linear association between log plasma leptin and FM was observed in both males and females, adjusting for age and SCD status. The strength of this association was greater in females compared with males (slope=0.699 and 0.382 log ng/mL per 10 kg FM, respectively; p=0.013). SCD patients on average demonstrated a higher REE, adjusting for FFM (p<0.0001). Log plasma leptin and FM were not statistically significant predictors of REE after adjustment for FFM and SCD. CONCLUSIONS: Once corrected for body composition, mean plasma leptin concentration was significantly lower among female SCD patients than among non-SCD matched controls. Although REE was higher in SCD patients, there is no simple association between leptin and REE in SCD.

A deficiency of placental IL-10 in preeclampsia.

Accommodation of the fetoplacental unit in human pregnancy requires maternal immune tolerance to this "semiallograft". Local antiplacental immunity is modified by synthesis of uncommon histocompatibility Ags (e.g., HLA-G), growth factors, and cytokines by the placenta. Placental interleukins have been identified in reproductive tissues, but their roles in adaptive maternal immunity and determining term pregnancy outcomes have not been fully clarified. This study examined the distribution of IL-10 and TNF-alpha staining in term placentas. Women with proteinuric hypertension (PE, n = 10) were compared with an age-matched group with normal pregnancy (NP, n = 14) and gestational hypertension (GH, n = 6). Using immunohistochemistry of parrafin-fixed tissues, trophoblast cells were identified by cytokeratin 7 and cytokeratin 18 staining. The cytokine binding of villous trophoblast cells was scored depending on the extent of circumferential cytoplasm staining (<25%; intermediate or >75%). The cytokine positive decidual cells were scored as a percentage of total extravillous trophoblast cells. There was a reduction in villous IL-10 immunostaining compared with normal term placenta (PE, 10.2 +/- 1.1, mean +/- SEM; NP, 14.07 +/- 1.16 Mann-Whitney U test; p = 0.02). In these patients, there was an increase in TNF-alpha immunostaining. Sparse endovascular extravillous trophoblast cells demonstrated nuclear IL-10 staining in 30% of patients with preeclampsia. Serum IL-10 was diminished in women with preeclampsia compared with normal pregnancy. In conclusion, villous trophoblast demonstrated diminished immunostaining of IL-10 in preeclampsia. This abnormality may be associated with heightened maternal antifetal immunity and therefore inadequate placental development in preeclampsia.

Prolonged exposure to glare and driving time: effects on performance in a driving simulator.

Twelve experienced truck drivers drove a fixed-base driving simulator for two 8 h sessions, including: (1) no glare and (2) intermittent glare presented in the exterior rear-view mirrors to simulate headlights from following vehicles. The driving task combined vehicle control on straight and curved road segments with detection of pedestrians appearing alongside the road and targets appearing in the rear-view mirrors. The results provided no evidence to support the hypothesis that prolonged exposure to glare impairs driving performance. However, we found time-related changes in target-detection and critical tracking performance, some of which were consistent with established patterns of diurnal variation. Subjective sleepiness ratings also increased over time. The results were interpreted within a model according to which drivers are able to maintain effective performance at early levels of impairment, thus compensating for increasing feelings of subjective tiredness.

Spontaneous regression of a pituitary cyst.

We present a pituitary cyst discovered on MRI in an amenorrheic patient that regressed over months. Although the precise etiology of the cyst is unproven, documentation of pituitary cyst regression has not to our knowledge been described previously.

The effects of a high fat diet on leptin mRNA, serum leptin and the response to leptin are not altered in a rat strain susceptible to high fat diet-induced obesity.

Osborne-Mendel (OM) and S5B/Pl rats differ in their sensitivity to develop obesity when fed a high fat (HF) diet; OM rats become obese, whereas S5B/Pl rats remain thin. We have investigated the possibilities that either an impaired leptin response or resistance to leptin action underlies the sensitivity to this form of obesity in OM rats. In Experiment 1, OM and S5B/Pl rats fed a nonpurified diet were killed at d 0 or were fed either a HF (56% fat energy) or a low fat (LF, 10% fat energy) diet for 2 or 7 d. The HF diet increased serum leptin significantly by d 2 to levels that were similar in both rat strains. At 7 d, leptin levels were lower than at d 2 but remained higher than levels in the d 0 control groups. The leptin mRNA:18S RNA ratio in epididymal adipose tissue increased to higher levels in HF-fed OM rats than in S5B/Pl rats fed that diet. However, although the LF diet had no effect in S5B/Pl rats, it increased leptin mRNA levels in epididymal adipose tissue of OM rats compared with the controls fed the nonpurified diet. In Experiment 2, OM and S5B/Pl rats were fed HF or LF diets for 5 wk. At that time, their feeding response to a range of leptin doses (0, 1, 5 or 10 microgram) given intracerebroventricularly was tested after overnight food deprivation. There was a similar dose-dependent reduction in energy intake in response to leptin in both OM and S5B/Pl rats. These responses were independent of the diet. The data suggest that the susceptibility of OM rats to HF diet-induced obesity is not related to either a loss of central sensitivity to leptin or a failure to enhance leptin production acutely, although the failure to maintain chronically increased levels of serum leptin could contribute to the obesity.

Establishment of the tortoise tick Amblyomma marmoreum (Acari: Ixodidae) on a reptile-breeding facility in Florida.

The tortoise tick Amblyomma marmoreum Koch was found to be established on a reptile facility in central Florida. Over a 5-mo period, 443 ticks were collected from tortoises, dogs, and vegetation. Collections from hosts were primarily from 3 species of exotic tortoises, including leopard tortoises, Aldabra tortoises, and yellow-footed tortoises. The total numbers of ticks present, the presence of all life stages, and the slow development of this species indicate that this is not a recent infestation. The source of the infestation is unknown because no tortoises were imported or moved onto this premise within the previous year. The propensity of this tick to feed on mammals and reptiles as immatures, its status as an experimental heartwater vector, and potential for further accidental introductions to the United States elicit concern toward the more widespread establishment of this species.

Ascaris suum infection in pigs sensitizes lymphocytes but suppresses their responsiveness to phytomitogens.

The effect of Ascaris suum infection and treatment with fenbendazole on the blastogenic response of peripheral blood lymphocytes to A. suum antigens and to three phytomitogens was assayed by the lymphocyte transformation technique. Repeated infections with A. suum led to the development of sensitized lymphocytes primarily responding to egg hatching fluid antigen. Treatment with fenbendazole decreased the number of specific sensitized lymphocytes, but favorably increased the resistance of pigs to reinfection. Immunity to reinfection did not correlate with the strength of the blastogenic response to A. suum antigens. Repeated infection with A. suum negatively affected the development of the blastogenic response to phytomitogens in the pigs, leading to a partial depression of the responsiveness of lymphocytes and to the partial suppression by serum. Responses to pokeweed mitogen were affected more than the responses to concanavalin A and phytohemagglutinin.