Patients' experiences using a computerized program with a touch-sensitive video monitor for the assessment of health-related quality of life.

This study assessed patients' experiences using a computerized program with a touch-sensitive video monitor (TSVM) for the assessment of health-related quality of life (HRQoL). A software program was developed for a computerized form of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, the QLQ-C30. One hundred and seventy-eight patients completed the QLQ-C30, followed by a structured interview designed to assess perceived difficulties with the use of the TSVM. Patients were asked to evaluate the ease of use of different aspects of the TSVM system (using the touch-sensitive screen, entering the patient identification number, reading the screen and following the on-screen instructions). The majority of patients found all aspects of the TSVM system very easy to use. A few patients (1–2%) admitted finding any aspect of the TSVM use somewhat difficult and none ranked any aspect as very difficult. There were no unanswered items in the QLQ-C30. All patients found the amount of time spent on answering the questionnaire acceptable, (the mean time to complete was 6.8 min with a median of 5 min) and 96% stated they were willing to complete a similar questionnaire on a future occasion. From the patients' perspective the TSVM system appears to be a highly acceptable approach for the collection of HRQoL data in clinical practice.     

Polychlorobiphenyl congeners,p,p′-DDE,and sperm function in humans

170 seminal samples from fertile men, men with idiopathic oligospermia or azoospermia and men status post vasectomy were analyzed for 74 polychlorobiphenyl (PCB) congeners,p,p-DDE, mirex, and hexachlorobenzene using the technique of glass capillary gas chromatography with electron capture detection. Low concentrations of 32 PCB congeners were measured (mean total PCB residue of 5.8 ng/g wet weight). The application of multiple linear regression analysis to the data is described and the result is critically evaluated. There is a correlation between sperm motility and count. There are indications that the concentrations of three PCB congeners (2,4,5,245- and 2,4,5,234-hexachlorobiphenyl and 2,4,5,34-pentachlorobiphenyl) are inversely correlated with sperm motility index in samples with a sperm count less than 20 million cells/ml. The implications of the discerned associations are discussed.     

Concentrations and chromatographic profile of DDT metabolites and polychlorobiphenyl (PCB) residues in stranded beluga whales (Delphinapterus leucas) from the St. Lawrence Estuary,Canada

The concentrations and high resolution gas Chromatographic profiles of DDT metabolites and polychlorobiphenyl (PCB) congeners were determined in blubber, liver, kidney and lung tissue and milk samples of stranded beluga whales (Delphinapterus leucas) collected at localities along the coasts of the Saint Lawrence Estuary, Canada from November 1983 through December 1984. The analyses indicate that the major PCB components of the tissues were 2,2,5,5-tétra-, 2,2,4,4,5-penta-, 2,2,3,4,4,5-hexa-, 2,2,4,4,5,5-hexa-, 2, 2,3,3,4,5-hexa-, 2,3,3,5,5,6-hexa-, 2,2,3,4, 5,5,6-hepta- and 2,2,3,4,4,5,5-heptachlorobiphenyls. Although the highest organochlorine chemical concentrations were found primarily in the blubber, concentrations of 1.72 g/g for PCB and 2.04 g/g for DDT were determined in one milk sample. No correlation was established between PCB,p,p-DDE and DDT concentrations and the fat content of the kidney liver and lung tissues. The Chromatographie patterns of the PCB congeners were similar from one tissue to another with the exception of the kidney; the profile indicates the retention of PCB congeners which are minor components in the other tissues. Relations of residue concentrations between tissue are described and the significance of congener-specific PCB analysis is discussed in terms of the structureactivity effects on PCB persistence and toxicity.Portions of this work were presented at the Sixth Biennial Conference on the Biology of Marine Mammals, Vancouver, British Columbia, November 22–26, 1985.     

Polychlorobiphenyis (PCBs) in sediments of Tokyo Bay,Japan

Sediment cores were collected from five sites in Tokyo Bay. The sediment age was estimated by the²¹⁰Pb method and the polychlorobiphenyls (PCBs)(2,5,2,4,5 — pentachlorobiphenyl,3,4,2,4, 5-pentachlorobiphenyl, 3,4,2,3,4-pentachlorobiphenyl, 2,3,6,2,3,6-hexachlorobiphenyl, 2,4, 5,2,4,5-hexachlorobiphenyl, and 2,4,5,2,3,4, 5-heptachlorobiphenyl) profiles in the sediments were determined quantitatively by gas chromatography. With respect to the horizontal distribution of PCBs, the levels were highest off Tokyo and Kawasaki, the inner western part of the bay off the mouths of the Tama and Arakawa Rivers, and declined in the direction of the eastern and southern parts of the bay. It was assumed that most of the PCBs supplied to the bay from the adjacent rivers and the industrial zones along the western coast were coprecipitated with suspended particles near the river mouths and the western coast, while PCBs adsorbed by fine particles are carried throughout the bay by the current. The accumulation rate of PCBs in Tokyo Bay sediments gradually increased, starting about 1936, and reached a maximum value in 1972 and declined moderately thereafter. The time-dependent changes in the quantity released into the environment were estimated from the amount of PCBs manufactured and used. The accumulation rate of PCBs in Tokyo Bay sediments was then compared with the estimated rate of release into the environment.     

Assessment of occupational exposure to 4,4′-methylene-bis-(2-chloroaniline) “MOCA” by a new sensitive method for biological monitoring

Summary A new specific and sensitive method for the urinary determination of 4,4-methylene-bis-(2-chloroaniline) (MOCA), a known carcinogen in rats, mice and dogs, has been developed. After a brief study on rats to determine some peculiarities in MOCA urinary excretion, this method was used to assess occupational exposure in French industrial firms. Both the manufacture of MOCA and its use as a curing agent in the production of polyurethane elastomers were surveyed. MOCA excretion levels were distributed from non-detectable (<0.5 g/l) up to 1600 g/l. Concentrations of N-acetyl metabolites, when present, were largely lower than MOCA levels. The results seemed to reflect workers' overall exposure fairly. Preventive measures following analytical determinations often led to an obvious lowering of excretion levels.     

Organochlorine pesticides and polychlorinated biphenyls in maternal adipose tissue,blood, milk,and cord blood from mothers and their infants living in Norway

Samples of maternal blood, milk, and umbilical cord blood were collected from mothers and their infants at Ullevål University Hospital in Oslo, Norway. All the mothers had lived in Oslo during the last two years. Of the Norwegian mothers, 16 were delivered by Caesarean operation, and samples of subcutaneous fat tissues were collected. Hexachlorobenzene (HCB), polychlorinated biphenyls (PCBs),p,p-DDE,p,p-DDT, and dieldrin were found in 157, 135, 168, 22, and 12, respectively, of the 168 samples analyzed, while , and -hexachlorocyclohexane (HCH) were found in 93 and 26, respectively, of the 152 samples analyzed for these compounds. In the samples obtained from the Norwegian mothers and infants, PCBs andp,p-DDE were the major contaminants present. In contrast, only traces of PCBs were found in six immigrant samples, which, however, contained 4–6 times higher levels ofp,p-DDE plusp,p-DDT than the corresponding Norwegian samples. Of the HCH isomers, the -HCH was the predominant isomer present. Two to three times significantly higherp,p-DDE and PCBs levels were found in maternal serum than cord serum. No significant differences were found between the organochlorine residue levels in subcutaneous fat and milk fat. A significant positive linear correlation was found between the levels ofp,p-DDE and PCBs in maternal serum and in milk fat, and between the levels ofp,p-DDE in maternal serum and cord serum from Norwegian mothers giving birth normally.Significantly higher PCBs andp,p-DDE residues were found in the maternal and cord serum samples obtained after Caesarean operation than after normal delivery, while no other such differences were found in the milk samples 5 days post partum.The results demonstrate that organochlorines are transferred from mother to fetus and newborn babies through the placenta and milk and that human milk is a good indicator in monitoring human beings and their environment for organochlorine contamination. Possible toxicological implications of the present results are discussed.     

The New York City fire epidemic as a toxic phenomenon

Summary Reductions in the fire service in New York City from 1972 to 1976 appear to have caused a disproportionate increase in fire-fighter work load through several unexpected mechanisms of fire contagion. In turn, the work load increase has itself had a disproportionate physiologic impact: A classic dose-response relation has been observed between a composite measure of per capita structural fire work load and the percentage of the fire-fighting work force retiring under conditions of disability. After 1974, the increase in work load seems to have caused entry to the linear portion of the dose-response curve.Implications of this synergism are explored for both New York City and other American urban areas now suffering fiscal crises or planning fire service reductions.     

Pesticide residues in human colostrum: Seasonal variations,Yugoslavia

Levels of HCH, HCH, HCH,o,pDDE,p,pDDE andp,pDDT were measured in 59 samples of colostrum collected in the autumn 1982 and the spring 1983 from healthy nursing mothers on the third day after delivery. Pesticide residues were identified and quantitated on a gas chromatograph. Concentrations of HCH were significantly higher in the autumn (mean, 1.71g/L) than in the spring (0.67g/L), while concentrations of HCH were significantly lower in the autumn (0.49g/L) than in the spring (1.50g/L). The differences between the two seasons were not statistically significant for HCH (0.95 g/L vs 0.88g/L),o,pDDE (0.73g/L vs 1.34g/L),p,pDDE (68.63g/L vs 53.72g/L) andp,pDDT (20.00 (g/L vs 14.29 (g/L).Calculated average daily HCH (Lindane) intake of 0.04g/kg body wt (b.w.) and total DDT intake of 4.16 (/kg b.w. in a 3.5 kg newborn, ingesting 60 ml/kg b.w. of colostrum on the third day of life was below the upper limit of FAO/WHO Acceptable Daily Intake (ADI) (0.01 mg/kg b.w. for Lindane and 0.005 mg/kg b.w. for DDT) in the spring. In the autumn, Lindane intake of 1.10k/kg b.w. was below the FAO/WHO ADI and total DDT intake of 5.36 g/kg b.w. was slightly above the FAO/WHO ADI.     

Levels of β-HCH,HCB, p,p′-DDE,p,p′-DDT and PCBs in human milk from a continental town in Croatia,Yugoslavia

Summary Concentrations of -HCH, HCB, p,p-DDE, p,p-DDT and PCBs were determined by gas chromatography in 50 human milk samples collected from the general population during 1981/1982 in a continental town in Croatia (Yugoslavia). The samples were collected between one and 22 weeks after delivery from mothers breast-feeding one child only. The mothers' age was 18 to 31 years, and they were nursing their first or second child. All 50 samples contained -HCH, HCB, p,p-DDE and PCBs, whereas p,p-DDT was present in 37 samples. The concentrations of -HCH, HCB, p,p-DDE, p,p-DDT and PCBs expressed on a whole milk basis were (median in g/kg): 11, 7.1, 67, 7.3 and 22 respectively, and expressed on a fat basis (median in mg/kg): 0.28, 0.21, 1.9, 0.18 and 0.62 respectively. The fat content was 3.7% (median). PCBs were present in a mixture containing penta-, hexa- and heptachlorobiphenyls.     

Quality of life of caregivers in Parkinson’s disease

Objective: To assess the impact of PD on informal caregivers of patients and identify the main factors related to caregiver strain. Patients and methods: Pairs of PD patients and their caregivers. Evaluation by neurologists included the Hoehn and Yahr, Schwab and England, UPDRS (parts 1–3), ISAPD, and Pfeiffers SPMSQ rating scales. Patients completed the Euro-QoL 5D, PDQ-8, and Hospital Anxiety and Depression Scale. The SQLC was used to assess caregivers quality of life (QoL), with caregivers, in turn, applying the Euro-QoL and PDQ-8 to assess patients health-related quality of life (HRQoL). Multiple linear regression models were fitted to ascertain factors linked to the SQLC. Results: Significant correlations were in evidence between the following scores: SQLC and clinical rating scales and SQLC and patients HRQoL. Based on multiple regression analysis, patients functional state (ADL) proved to be the main predictor of caregivers QoL. Self- and caregiver-assessed patients HRQoL also proved to be a relevant factor. Conclusions: (1) Patients functional state was significantly related to caregivers psychosocial burden; (2) patients HRQoL proved to be an additional factor linked to caregiver QoL; (3) improvement of patient disability and HRQoL might alleviate caregiver strain.     

Towards a Theory of the Everyday: The Ordinary and the Special in Daily Living in Residential Care

This paper begins with a debate about the relative place of ordinary and special approaches to everyday living with young people in residential care and treatment. It argues for a considered approach to this distinction between the ordinary and the special, based on assessments of children's needs and stages of development, and on the purpose of their residential placement. From this beginning it enters into a broader proposal about the need for a comprehensive theory of the everyday in residential work. The argument focuses on the need for an underpinning framework for the planning and analysis of daily group care practice with young people. Finally, it explores how different assumptions and theoretical frameworks may operate in support of a programme for everyday practice which is differentiated according to the needs of the children and the task of the organisation.     

The Po River Delta epidemiological survey: Reference values of total serum IgE levels in a normal population sample of North Italy (8–78 yrs)

The aim of this paper was to define, for the first time in Italy, normal levels of total serum IgE in a general population sample of North Italy. Total serum IgE in 1905 subjects, living in Po Delta area (near Venice), were measured by PRIST method. Normal values were derived from 558 subjects without asthma and/or asthmatic/rhinitic symptoms, noncurrent smokers, skin prick-test negatives (normals). Cut-off values to differentiate normals from the remaining part of the sample (others), from asthmatic, and from rhinitic subjects, were established with the IgE value midway between the upper limit of the 95% confidence intervals (CI) of the geometric mean for normals and the lower limit for others, asthmatics, and rhinitics, respectively. Geometric mean of normal children–adolescents was 45 kU/L (SD: 2.6; 95% CI: 38–63). In normal adults geometric mean was 29 kU/L (SD: 3.3; 95% CI: 25–40) in males and 19 kU/L (SD: 3.8; 95% CI: 16–22) in females. The diagnostic sensitivity of IgE test was low, while the specificity was very high. A good positive predictive value in discriminating normals from others was found, on the contrary, we found a good negative predictive value in discriminating normals from asthmatics or from rhinitics. In conclusion, our results confirm that it is necessary to provide separate total serum IgE reference values for what concerns age in children–adolescents and in adults, and gender, in adults. Low level of total serum IgE are helpful to exclude allergic asthma or rhinitis.     

Chromatographic determination of dicofol and metabolites in egg yolks

Egg yolk was spiked withp,p-dicofol (p,p-DCF) (0.1–2.0 g/gm),p,p-dichlorobenzophenone (p,p-DCBP) (0.1–2.0 (g/gm), and 1,1-bis(4-chlorophenyl)-2,2-dichloroethylene (p,p- DDE) (0.05–1.0 g/gm). The fortified egg yolk (2–5 g) was mixed with acetonitrile to extract non-fat organic materials. After removal of acetonitrile, the spiked chemicals were separated with a column chromatograph packed with acid alumina. Recovery efficiencies forp,p-DCBP andp,p-DDE were determined by gas chromatography, and forp,p-dicofol by high performance liquid chromatography. The recovery efficiencies forp,p-dicofol,p,p-DCBP andp,p-DDE were 77.2–93.8%, 84.1–101.1%, and 88.5–96.0%, respectively.     

Effects of nabam on developingXenopus laevis embryos: Minimum concentration,biological stability,and degradative products

This study was carried out to determine 1) the minimum concentration at which the fungicide ethylenebisdithiocarbamate disodium salt (nabam) would induce malformations in developingXenopus laevis embryos, 2) whether nabam in solution retained toxicological and teratogenic effects over long periods of time, 3) to compare the toxic and teratogenic effects of nabam's degradative products ethylene thiourea and ethylene diamine, 4) to compare toxic and teratogenic effects of the related substances methyl isothiocyanate and sodium thiocyanate, and 5) to compare the effects of combinations of these substances.Xenopus laevis embryos at yolk plug stage (Nieukoop and Faber stages 10–12) were exposed to various concentrations of fresh and one- to seven-week old nabam solutions, ethylene thiourea, ethylene diamine, methyl isothiocyanate, sodium thiocyanate, and combinations of some of these substances. Fresh nabam solutions induced malformations of the notochord in a majority of embryos at concentrations as low as 40 g/L. Embryos treated with 40 g/L nabam stored 1–7 weeks developed normally. Embryos treated with 100 g/L nabam stored 1–7 weeks developed severe malformations of the notochord, delayed pigmentation of the eye, and increased mortality. In addition, embryos exposed to 100 g/L nabam stored 4–7 weeks also experienced delayed development of the gut and a general decrease in size. Embryos exposed to fresh 100 g/L nabam solutions developed only malformations of the notochord. Concentrations of methyl isothiocyanate of less than 1.0 g/L were sublethal. Methyl isothiocyanate (1.0–1,000 g/L) was extremely toxic with 100% mortality recorded by day 7 in all groups. Sodium thiocyanate, ethylene thiourea, and ethylene diamine (100–10,000 g/L) were neither toxic nor teratogenic. Combinations of ethylene thiourea and methyl isothiocyanate at or beyond 5,000 g/L, or 1.0 g/L respectively were acutely lethal. At concentrations of 100–1,000 /L ethylene thiourea and 0.01–0.1 g/L methyl isothiocyanate, the tadpoles that hatched had swollen and kinked notochords, similar to animals exposed to fresh 40 g/L nabam. Thus, the aquatic environment when contaminated with very low levels of the fungicide nabam is hazardous to the development of amphibian embryos.     

Comparative toxicokinetics of 2,2′- and 4,4′-dichlorobiphenyls in the pond snailLymnaea stagnalis (L.)

Pond snails (Lymnaea stagnalis (L.)) were treated with 2,2-dichlorobiphenyl (DCB) or 4,4-DCB, to examine the toxicokinetic profile of these compounds. Snails were treated orally with 210 g 4,4-DCB (impregnated on food) for 14 hr, or snails were injected with 50 g of 2,2-DCB or 4,4-DCB in the foot. At different times after starting feeding or injection, tissues (albumen gland, digestive gland and digestive tube, central nervous system, remainder parts), hemolymph and faeces were analyzed for unchanged 2,2- or 4,4-DCB. The results showed that in case of oral administration of 4,4-DCB after 144 hr, 97.5% of the dose was excreted unchanged in the faeces. During the first 48 hr 4,4-DCB was found in all tissues. Thereafter, an exponential elimination was found (the rate constant of elimination (k_el) varied from 0.010–0.021 per hr, t_1/2 from 33–60 hr and the apparent clearance from 0.02–0.3 g/hr for the different tissues). After injection, the compounds were found in all the above mentioned tissues, especially in the digestive gland. There was a clear difference between snails injected with 2,2- and 4,4-DCB. Firstly, k_el for 2,2-DCB was higher (0.028 per hr vs 4,4-DCB: 0.001 per hr). Secondly, 2,2-DCB was lethal; 63% of the animals died after 72 hr.     

Going off the dole: A prudential and ethical critique of the healthfare state

The present healthfare state in the United States in neither practically nor morally justified. The nation currently fails to provide adequate access to health care for tens of millions of uninsured citizens. To suggest that the United States' half-million physicians should provide their care as charity is an inadequate solution. The transfer of assets from the haves to the have-nots through taxation in a healthfare state undermines human compassion, and fails to respect minimal moral requirements. However, alternative strategies are possible. During the next 20 years health care could come to be financed on the basis of sound quasi-libertarian moral and prudential principles. In the interim deliberate political action is required to achieve novel health policy, available and affordable job and career training, and universal employment. It is possible to achieve universal access to adequate health care while sustaining individual choice, and at the same time to reduce or virtually eliminate taxpayersubsidised health care. This approach would, in time, eliminate the healthfare state and eventually encourage and even require citizens to go off the healthfare dole.     

The association of respiratory problems in a community sample with self-reported chemical intolerance

This epidemiological study evaluated respiratory histories in those individuals reporting chemical intolerance (CI) in a community population sample. The subsample of 181 completed standard Respiratory Health Questionnaires. CI was determined from self-ratings of feeling moderately to severly ill from exposure to at least three of five common chemicals (paint, pesticides, car exhaust, new carpet, and perfume); the prevalence rate was 22.7%. The comparison group (CN) (31.5% of the sample) were selected from their reports of never feeling ill from the same chemicals. The prevalence rate of CI in females was over twice that in males (28% vs 12.9%), a significant difference. There were no significant differences in smoking, age, or education between CI and CN. Prevalence rates for symptoms and Relative Risk Ratios (RR) indicated that the CI were significantly more likely to report chronic cough, phlegm, wheeze, chest tightness, exertional dyspnea, acute respiratory illnesses, hay fever, child respiratory trouble, and physician confirmed asthma. Several of these respiratory symptoms were significantly, though differentially, related to current asthma and hay fever reports. Results suggest a potential vulnerability to and greater interference from respiratory illness for the CI, which have implications for women's health and quality of life.     

Well-being: A philosophical basis for health services

This paper develops and defends the claim that the promotion of human well-being is a philosophical basis or rationale for health services. It first sketches a case for this thesis, then defends it against various objections arising from the contrary position, here dubbed The Sceptical View. Later sections of the paper elaborate on the meaning of well-being, the nature of well-being, and the scope of appropriate health service concern with well-being. In particular, distinctions are made between thick and thin well-being, and between well-being and its various measures. These discussions generate further defences of the philosophical centrality of human well-being to health services.     

Organochlorine chemicals in skin lipids as an index of their accumulation in the human body

Application of a noninvasive method of analyzing skin lipids was considered as a means of monitoring human exposure to organochlorine pesticides. Skin lipids were collected by wiping the face with cotton and purified by gel permeation chromatography and treatment with H₂SO₄. Organochlorine chemicals were determined by electron capture gas chromatography with a fused silica capillary column.p,p-DDE, -HCH and chemicals related to chlordane were detected in the skin lipids. Residue levels ofp,p-DDE, -HCH and oxychlordane in the skin lipids correlated with those in the adipose tissue; correlation coefficients forp,p-DDE, -HCH and oxychlordane were 0.93, 0.92, and 0.68, respectively. The correlation between skin lipids and adipose tissue for trans-nonachlor was poor ( = 0.46). The component pattern of chlordanes in skin lipids was similar to that of technical chlordane. The results suggested that chemicals in the skin lipids reflected both their accumulation in the body burden and dermal exposure.Skin lipids collected during 1986 to 1988 in Japan were determined forp,p-DDE, -HCH and the chlordanes. Residue levels ofp,p-DDE and -HCH in the aged were high compared with those in the young (=0.31–0.45). Chlordanes were detected from inhabitants in the southern area of Japan where chlordane had been used for termite control.     

Translation,cultural adaptation,and initial reliability and multitrait testing of the Kidney Disease Quality of Life instrument for use in Japan

Background: The Kidney Disease Quality of Life instrument (KDQOL) consists of 79 items: 36 asking about health-related quality of life (HRQOL) in general (the Medical Outcomes Study SF-36) and 43 asking about QOL as it is affected by kidney disease and by dialysis. Aim: Translation, cultural adaptation and initial reliability and multitrait testing of the KDQOL for use in Japan. Methods: Translation and cultural adaptation began with two translations into Japanese, two backtranslations into English, and discussions among the translators, the project coordinators in Japan, and the developers of the original (US-English) version. Focus-group discussions and field testing were followed by analyses of test–retest reliability, internal consistency, and convergent and discriminant construct validity. Results: All eight of the SF-36 scales met the criterion for internal consistency (Cronbach's ranged from 0.73 to 0.92) and were reproducible (intraclass correlations between test and retest scores ranged from 0.60 to 0.82). Of the 10 kidney-disease-targeted scales, only two had coefficients of less than 0.70: sleep (0.61) and quality of social interaction (0.35). One item on the quality of social interaction scale had a very weak correlation with the remainder of that scale (r = 0.10). Eliminating that item from scoring increased the coefficient of the scale from 0.35 to 0.64. All three items on the quality of social interaction scale had very strong correlations with other scales. Conclusions: First, in Japanese patients receiving dialysis the SF-36 scales are internally consistent and their scores are reproducible. Second, with the possible exception of the quality of social interaction scale, the Japanese version of the KDQOL,can provide psychometrically sound kidney-disease-targeted data on quality of life in such patients.