Dental problems and Familismo: social network discussion of oral health issues among adults of Mexican origin living in the Midwest United States.

OBJECTIVE: To examine the influence of collectivist orientation (often called familismo when applied to the Latino sub-group in the United States) in oral health discussion networks. BASIC RESEARCH DESIGN: Through respondent-driven sampling and face-to-face interviews, we identified respondents' (egos) personal social network members (alters). Egos stated whom they talked with about oral health, and how often they discussed dental problems in the preceding 12 months. PARTICIPANTS: An urban community of adult Mexican-American immigrants in the Midwest United States. We interviewed 332 egos (90% born in Mexico); egos named an average of 3.9 alters in their networks, 1,299 in total. METHOD: We applied egocentric network methods to examine the ego, alter, and network variables that characterize health discussion networks. RESULTS: Kin were most often leveraged when dental problems arose; egos relied on individuals whom they perceive to have better knowledge about dental matters. However, reliance on knowledgeable alters decreased among egos with greater behavioral acculturation. CONCLUSIONS: This paper developed a network-based conceptualization of familismo. We describe the structure of oral health networks, including kin, fictive kin, peers, and health professionals, and examine how networks and acculturation help shape oral health among these Mexican-Americans.

Teaching professionalism to junior doctors: experience of a multidisciplinary approach in the Foundation Programme.

The Foundation Programme curriculum describes 'generic skills' for doctors, which illustrate many of the attributes of medical professionalism. Educators from the Dorset acute trusts have worked with faculty members of the School of Health and Social Care at Bournemouth University to create a course in professionalism for Foundation Programme Year 2 doctors. The course, held away from the hospital setting but facilitated by consultants as well as university staff, has six themes taught on different days: professionalism and judgement, relationship with society, accountability, teamworking and leadership, relationship with patients, and excellence and continuous improvement. The emphasis is on group discussion between the participants, and feedback to the whole group, rather than didactic lecture-based teaching, with the aim of encouraging Foundation Programme doctors to become more reflective in their practice, and to discover their own answers to their queries.

Psychological and behavioral acculturation in a social network of Mexican Americans in the United States and use of dental services.

OBJECTIVES: We used data from the TalaSurvey study to examine associations between dental health experiences, social network characteristics, and levels of behavioral and psychological acculturation in one location in the American Midwest. METHODS: Starting in parishes and community organizations, we identified adults of Mexican origin living in Indianapolis, who were 1st- or 2nd-generation immigrants from Tala, Mexico. Using a social networks methodology and following extensive formative research, we created an egocentric social network survey and administered it via face-to-face interviews. We identified the peers (alters) in interviewees' (egos) personal networks. We asked egos about multiple oral health and dental care variables for self and for alters. Acculturation (psychological and behavioral) was measured with a validated tool. Through logistic and negative binomial regression, we examined the effects of acculturation and network composition on ego's dental insurance status, dental office visits, and the reason for most recent dental office visit. RESULTS: A total of 332 egos (mean age 36; 63% female) were interviewed: 90% were born in Mexico; 45% had completed elementary school or lower; and most had low income. Each ego named 3.9 (SD±1.9) alters in his/her personal network, for a total of 1299 alters (mean age 39; 61% female). Both behavioral acculturation and psychological acculturation were moderately associated with dental insurance coverage, and greater behavioral acculturation predicted more frequent dental care. More psychologically acculturated egos were more likely to seek preventive care. Further, egos with more highly educated networks sought care more frequently and for preventive purposes, net of ego's own education and acculturation. CONCLUSIONS: This study contextualizes acculturation of Mexican Americans within the personal networks in which oral health discussion takes place. The findings underscore the critical importance of acculturation and social network factors in shaping a subgroup of Latinos' orientation toward dental care.

Biosynthesis and metabolism of cystathionine in Astragalus pectinatus.

Metabolism of L-[35S]cystathionine, L-[35S]cysteine and L-[35S]homocysteine has been investigated in Astragalus pectinatus. The results indicate that cystathionine undergoes both beta and gamma cleavage to give homocysteine and cysteine. Results also show that cystathionine is synthesized from both cysteine and homocysteine. Furthermore, in addition to the incorporation of 35S into cystathionine, incorporation of 35S from cysteine into methionine and from homocysteine into S-methylcysteine is not only in agreement with the above cystathionine cleavage activities, but also suggests, that transsulfuration in A. pectinatus proceeds in both directions, eg. cysteine leads to cystathionine leads to homocysteine and homocysteine leads to cystathionine leads to cysteine. It is suggested, that the latter reaction may be contributing to the net synthesis of cysteine.

Nutritional and medical status of lactating women and their infants in the Kathmandu valley of Nepal.

In six villages in the Kathmandu valley of Nepal, an intensive health and nutrition study was conducted on 26 lactating women and their 2--6-month-old infants. Analysis of 24-h duplicate diet composites indicated that the mothers were consuming approximately 2100 kcal energy/d. The diets contained approximately 62 g protein (11.6% of the calories), 392 g carbohydrate (73.3% of the calories), and 20.9 g fat (8.6% of the calories) and a mean of 24 g neutral detergent fiber. Although anthropometric measurements indicated that the mothers had mild protein malnutrition and inadequate energy reserves, their infants exhibited low-normal weight and length for age. All the mothers had hepatitis A antibodies; 92% had tropical eosinophilia, indicating intestinal parasites; 16% had cheilosis and angular stomatitis, indicating a possible B-vitamin deficiency; and 8% had elevated urinary nitrite, indicating urinary tract infection. There were no unusual physical findings on the infants. Although the children appeared healthy, the mothers showed evidence of multiple infections and possible nutrient deficiencies.

PIP: In 6 villages in the Kathmandu valley of Nepal, an intensive health and nutrition study was conducted on 26 lactating women and their 2-6-month-old infants. Analysis of 24-hour duplicate diet composites indicated that the mothers were consuming approximately 2100 kcal energy/d. The diets contained approximately 62 g protein (11.6% of the calories), 392 g carbohydrate (73.3% of the calories), and 20.9% g fat (8.6% of the calories) and a mean of 24 g neutral detergent fiber. Although anthropometric measurements indicated that the mothers had mild protein malnutrition and inadequate energy reserves, their infants exhibited low-normal weight and length for age. All the mothers had hepatitis A antibodies; 92% had tropical eosinophilia, indicating intestinal parasites; 16% had cheilosis and angular stomatitis, indicating a possible B-vitamin deficiency; and 8% had elevated urinary nitrite, indicating urinary tract infection. There were no unusual physical findings on the infants. Although the children appeared healthy, the mohters showed evidence of multiple infections and possible nutrient deficiencies.

Reduction of glutathione levels in livers of mice treated with N,N'-bis (2-chloroethyl)-N-nitrosourea.

N-methyl-N-nitrosourea (MNU), N-(2-chloroethyl)-N'-(trans-4-methylcyclohexyl)-N-nitrosourea (methylCCNU), and N,N'-bis(2-chloroethyl)-N-nitrosourea (BCNU) were examined for their effect on glutathione (GSH) levels of various tissues of normal and L1210-leukemic mice. BCNU produced significant decreases in the GSH levels of livers of both groups, but caused no change in the GSH content of the L1210 tumor or in the lungs. The GSH content of the kidneys of L1210 tumor-bearing mice, however, was significantly decreased by BCNU at early time points. A small increase in the liver content of oxidized glutathione could not account for the decrease content of GSH. Methyl CCNU and MNU were without effect on any of the tissues examined. These data are consistent with our previous observation that BCNU is a substrate for GSH S-transferase, and suggest that a GSH-dependent process is an important pathway for the metabolism of BCNU.

Distribution of Bratton-Marshall-positive material in mice following intravenous injections of nitrosoureas.

As determined by a colorimetric assay measuring parent compounds plus ether-extractable nitroso-containing metabolites, N,N'-bis(2-chloroethyl)-N-nitrosourea (BCNU) disappeared more rapidly than N-(2-chloroethyl)-N'cyclohexyl-N-nitrosourea (CCNU) and N-(2-chloroethyl)-N'-(4-transmethylcyclohexyl)-N-nitrosourea (MeCCNU) and their products from the tissues of mice injected IV. Assay of selected samples by high-pressure liquid chromatography revealed that the colorimetric assay for BCNU was specific in that the two assays gave equivalent results. Following IV-injections of CCNU and MeCCNU, however, levels of the parent compounds decreased much more rapidly than the total, color-producing material. Of seven tissues, the largest Cxt values for BCNU, as determined by the colorimetric assay, were noted for blood (442 microgram-min/ml) and large intestine (285 microgram-min/g). Liver (29 microgram-min/g) had the lowest Cxt value, reflecting rapid metabolism of the compound by this organ. Color-producing material related to CCNU disappeared from the solid tissues of mice in a manner generally parallel to that for blood. Of the Cxt values for this compound and its products, those for lung (1753 microgram-equivalents-min/g), kidney (1633 microgram-equivalents-min/g), and small intestine (1557 microgram-equivalents-min/g) were highest. Consistent with its slower rate of metabolism, MeCCNU and its color-producing metabolites remained in most tissues of mice for 12 h following injection. Except for brain (1434 microgram-equivalents-min/g), Cxt values for this nitrosourea and its metabolites in tissues were higher than those of blood (5485 microgram-equivalents-min/ml), with kidney (15,324 micrograms-equivalents-min/g), liver (12,921 microgram-equivalents-min/g), and large intestine (11,501 microgram-equivalents-min/g) being highest. For each nitrosourea, a fair correlation was observed between the Cxt values for tissues and the toxic and/or antitumor effects at those sites.

Does the disbursement of income increase psychiatric emergencies involving drugs and alcohol?

OBJECTIVE: To determine if the incidence of psychiatric emergencies involving drugs or alcohol supports the argument that mentally ill persons contribute to elevated mortality during the days following disbursement of private earnings and public income transfers. STUDY DESIGN: Interrupted time-series using Box-Jenkins methods. DATA COLLECTION/EXTRACTION METHODS: Daily counts of adults admitted to psychiatric emergency services in San Francisco after using drugs or alcohol were derived from medical records for the period January 1 through June 30, 1997. PRINCIPAL FINDINGS: Psychiatric emergencies among males who had used drugs or alcohol were elevated in the early days of the month. Such emergencies among females were not similarly elevated. Emergencies among females who had not used drugs or alcohol were elevated in the early days of the month. CONCLUSION: Elevated mortality in the first week of the month may be attributable, in part, to the "check effect" or use of drugs and alcohol by mentally ill males in the days after they receive income. The contribution of women is more complex and may be induced by drug or alcohol abuse among persons in their social networks. The check effect suggests that persons with a history of substance abuse and mental illness should be offered the opportunity to have their income managed by someone who can monitor and influence how the money is being spent. The fact that drug- or alcohol-related admissions among males exhibit temporal patterns suggests that the provision of preventive as well as treatment services may be strategically scheduled.

Pharmacokinetic study of (S)-(-)-2-(N-propyl-N-(2-thienylethyl)amino)-5-hydroxytetralin infusion in cynomolgus monkeys.

A pharmacokinetic study of the dopamine D2 receptor agonist (S)-(-)-2-(N-propyl-N-(2-thienylethyl)amino)-5-hydroxytetralin+ ++-HCl (N-0923) infused in female cynomolgus monkeys over a 4-h period was carried out at International Research and Development Corporation. The purpose of this study was to estimate the elimination half-life and elucidate the dose-clearance relationship in cynomolgus monkeys with a randomized three-way crossover intravenous (iv) infusion study design. Six female cynomolgus monkeys were dosed by iv infusion for 4 h with 0.1, 0.5, and 1.0 mg/kg/h. Plasma samples were drawn during the infusion and up to 4 h post infusion. The plasma concentrations were determined by a sensitive and specific HPLC assay with electrochemical detection after solid-phase extraction at the Department of Toxicology and Bioanalysis at the University Center for Pharmacy in Groningen, The Netherlands. The plasma data were best described by a two-compartment open model. Mean elimination half-lives of 36.8, 39.6, and 52.4 min and mean clearance values of 229 +/- 35, 202 +/- 85, and 191 +/- 36 mL/min/kg were obtained for doses of 0.1, 0.5, and 1.0 mg/kg/h, respectively. The steady-state volumes of distribution were estimated as 3.89 +/- 0.816, 3.53 +/- 1.62, and 4.70 +/- 3.67 L/kg for the same doses, respectively. There were no significant differences between any of the estimated pharmacokinetic parameters for any of the infusion doses. Clearance was not dose dependent and steady-state plasma concentration appeared directly proportional to dose, suggesting linear pharmacokinetics in this dose range for monkeys.

Psychiatric emergencies: the check effect revisited.

Federal income support to persons with alcohol and drug related disabilities was ended in 1997. The argument for ending the programs was that recipients were using their benefits to purchase drugs and alcohol. This supposedly led to the "check effect," an increase in psychiatric emergencies in American communities in the days following the receipt of disability benefits. We test two hypotheses implied by this argument. The first is that psychiatric emergencies are elevated in the fourth through eighth day of the month. The second is that the excess of emergencies in these days was significantly reduced when benefits were ended. The tests are based on 35,500 psychiatric emergencies in San Francisco, California occurring over 1,551 days. Results support the first hypothesis but not the second. The implications are that there is a general check effect and that it was not reduced by ending benefits to persons with drug and alcohol related disabilities.

A time-series test of the quarantine theory of involuntary commitment.

Persons believed to be mentally ill and imminently violent are often subjected to coerced treatment. Among the justifications for this practice is the argument that removing such people from the community is analogous to quarantine. We test the quarantine theory using daily data from San Francisco. Results suggest that the incidence of coerced treatment of males is inversely related to assaults and batteries by males one day later. The finding implies that persons who are involuntarily committed are at elevated risk of violent behavior. The implications of the findings for the prevention of assaultive behavior are briefly described.

Is choice of general practitioner important for patients having coronary artery investigations?

OBJECTIVE: To determine whether particular sociodemographic characteristics of patients with stable angina affected their general practitioners' (GPs') decisions to refer them for revascularisation assessment. DESIGN: Postal questionnaire survey. SETTING: Collaborative survey by the departments of public health medicine in each of the four health boards in Northern Ireland, serving a total population of 1.5 million. SUBJECTS: All (962) GPs. MAIN MEASURES: The relation between GPs' referral decisions and patients' age, sex, employment status, home circumstances, smoking habits, and obesity. RESULTS: 541 GPs replied (response rate 56%). Most were "neutral" towards a patient's sex (428, 79%), weight (331, 61%), smoking habit (302, 56%), employment status (431, 80%), and home circumstances (408, 75%) in making decisions about referral. In assigning priority for surgery most were neutral towards the patient's sex (459, 85%), employment status (378, 70%), and home circumstances (295, 55%). However, most GPs (518, 95%) said that younger patients were more likely to be referred, and a significant minority were less likely to refer patients who smoked (202, 37%) and obese patients (175, 32%) and more likely to refer employed patients (97, 18%) and those with dependents (117, 22%) (compared with patients with otherwise comparable clinical characteristics); these views paralleled the priority which GPs assigned these groups. The stated likelihood of referral of young patients was independent of the GPs' belief in ability to benefit from revascularisation, but propensity to refer and perception of benefit were significantly associated for all other patient characteristics. CONCLUSION: GPs' weighting of certain characteristics in reaching decisions about referral for angiography is not uniform and may contribute to unequal access to revascularisation services for certain patient groups.

Pathological, immunocytochemical and microbiological findings in calf pneumonias associated with Haemophilus somnus infection.

Pathological, immunocytochemical and microbiological findings in 32 cases of calf pneumonia associated with Haemophilus somnus infection are described. The majority of cases were "found dead" or died after a sudden onset pneumonia of less than 24 h duration. Lesions of exudative bronchopneumonia were present and the cases could be divided into two main groups on the basis of histopathological and immunocytochemical features. In group A, cases were dominated by necrotizing bronchiolitis, degeneration and necrosis of airway and alveolar exudates, severe alveolitis with accumulations of degenerate basophilic cells, interstitial inflammatory changes and the widespread distribution of H. somnus antigen in airways and alveoli. In Group B, necrotizing and degenerative changes were much less extensive and less severe and the overall appearance was of suppurative bronchopneumonia with H. somnus antigen much less widespread within the lungs. Alveolar oedema, hyaline membrane formation and alveolar epithelial hyperplasia were present in caudodorsal lung areas of several calves. No major differences were seen between the histopathology of lungs where H. somnus was the sole isolate and that of lungs where H. somnus was isolated along with other bacterial pathogens.

A confirmatory factor analysis of the BASIS-32 in racial and ethnic samples.

The present study performed confirmatory factor analysis across major racial and ethnic groups of the BASIS-32, a measure of functional status of persons receiving mental health treatment and suitable for routine assessment mental health care. The purpose was to perform a preliminary investigation of cross-cultural equivalence in a county-level mental health program in a major metropolitan area. The results indicated a factor structure similar to that reported in the literature, and they suggested acceptable levels of agreement in structure between racial and ethnic minority groups and whites. The study revealed little reason to believe that the BASIS-32 varied in underlying structure across racial and ethnic boundaries, although further research is indicated.

Clinical and laboratory findings in cases of toxic mastitis in cows in Northern Ireland.

This paper describes the clinical and laboratory findings from 264 cases of toxic mastitis in cows in Northern Ireland between October 1995 and May 1997. Nearly all the cases occurred during the winter housing period, with 84 per cent occurring between November and March inclusive, and 30 per cent in March. Sixty per cent of the cases occurred within one month of calving, and 29 per cent within four days of calving. The most common clinical signs were lethargy (92 per cent), discoloured milk (90 per cent), anorexia (72 per cent), tachypnoea (23 per cent), diarrhoea (23 per cent), recumbency (18 per cent) and staggering (15 per cent). Severe pyrexia (18 per cent) and clinical dehydration (44 per cent) were relatively common findings. Pure growths of Escherichia coli were isolated from 50 per cent of the milk samples, but 11 per cent yielded no bacterial growth. In vitro sensitivity tests indicated that enrofloxacin was effective against 98 per cent of the bacteria isolated, and framycetin and amoxycillin/clavulanic acid against 91 per cent. Abnormally high blood urea levels were observed in 31 per cent of cases, high blood creatinine levels in 42 per cent, and severe leucopenia in 56 per cent. Of the cases which were followed up, 14 per cent died, 21 per cent were culled early and a further 22 per cent lost milk production from the affected quarter.

Ambulatory surgery center joint ventures involving tax-exempt entities.

This article provides an overview of the tax-exempt related issues for ambulatory surgery center joint ventures involving tax-exempt entities. The article analyzes the key points of analysis of the guidance released by the IRS, in particular General Counsel Memorandum 39862, Revenue Ruling 98-15, and Redlands Surgical Services v. Commissioner of the Internal Revenue Service. These key points include whether the venture results in private inurement to insiders and whether the venture furthers the charitable purposes of the tax-exempt entity. The article also provides practical guidance to analyze the documents and structure of the joint venture to ensure compliance with the IRS guidance. These practical considerations include, among other things, whether the charitable purposes of the tax-exempt entity are clearly expressed in the documents and whether the tax-exempt entity has sufficient control over the joint venture to ensure the charitable purposes are being adhered to.

Enhancing program review for evaluation and management.

Program review has not received the attention it warrants as a program evaluation tool despite its wide use for evaluation and management purposes. The use of the program review will probably endure on the strength of its face validity and irrespective of other developments in the field of program evaluation. Evaluators should realize this and, accordingly, attempt to improve its effectiveness. This paper presents one organization's approach to achieving this objective through the explication of development principles, implementation guidelines and review items. This paper also discusses benefits that can be expected from a systematic development of this tool and presents various research directions and potentials in this area.