Monoamine oxidase inhibitors: have they a place, have they a future?

The legacy of the hepatotoxic effect and the "cheese reaction" of monoamine oxidase inhibitors still overshadows these useful drugs, despite near-resolution of many of the problems. This short article reviews the indications, adverse effects and progress and future of these agents in psychopharmacology.     

Monitoring local safety-net providers: do they have adequate capacity?

The safety-net providers that serve the nation's thirty-nine million uninsured residents are vulnerable organizations even in good economic times, yet efforts to monitor their capacity have been limited at best. This study of the safety-net in five cities found that capacity was strained for specialty services and that access to pharmaceuticals was difficult, while primary care capacity was more often adequate to serve those who presented themselves for care. Also, free clinics grew during the 1990s, while many other safety-net providers focused on improving their efficiency and collecting more fees from patients.     

Workforce literacy: do we have a choice?

Rapidly occurring demographic change and the demand for higher and higher skills in the workforce present a challenge for business and education. The investment the workplace makes in basic education for its employees will not only increase skills, but positively affect attitudes toward the employer, stimulate a desire for education and promotion and raise self-esteem. The rich mix of racial, ethnic and global experiences represented in today's workforce is a great potential advantage. We must face the question of best developing this potential for the future. Investment in personnel is not only worth-while--there is no other choice. We must not lose the opportunity.     

Household smoking bans: which households have them and do they work?

BACKGROUND: This study characterized Oregon households according to type and degree of restrictions on smoking and explored whether smoking restrictions are associated with decreased environmental tobacco smoke (ETS) exposure. METHODS: A population-based, random-digit-dialed cross-sectional telephone survey of 6,199 adult Oregonians was performed in 1997 to provide baseline data on tobacco use in Oregon. RESULTS: Seventy percent of Oregon households were composed of nonsmokers only, and 85% of those had a full ban on smoking inside the home. Of the households containing one or more smokers, 38% had a full household ban on smoking. Among respondents with a full ban in place, 99% of nonsmoker-only households reported that no one smoked in the home in the previous month, compared with 91% of households with at least one smoker. In both nonsmoker-only households and those with at least one smoker, full bans were strongly associated with awareness of the harm of ETS (OR = 12.8, 95% CI 7.3-22.3, and OR = 6.6, 95% CI 3.6-12.3, respectively). The presence of children in the household was also closely associated with full bans in the two types of households (OR = 4.6, 95% CI 2.8-7.6, and OR = 3.0, 95% CI 2.1-4.4, respectively). Nevertheless, 50% of households with children and a smoker present did not have a full ban in place. CONCLUSIONS: While the prevalence of household smoking restrictions is high in Oregon, there remains room for improvement, since 50% of households with a smoker and a child present do not have a full ban on indoor smoking. Public health messages that focus on household smoking restrictions may help protect nonsmokers from exposure to ETS.     

Early adopters of olestra-containing foods: who are they?

OBJECTIVE: To identify the characteristics of people consuming olestra-containing foods when first introduced at a test-marketing site. DESIGN: Data are from the Olestra Postmarketing Surveillance Study (OPMSS). After the introduction of olestra into a large test-marketing site, study participants received 3 follow-up telephone calls, at 3-month intervals, in which they were questioned about their diets during the previous month. SUBJECTS/SETTING: 1,007 adults in Indianapolis, Ind, who participated in a baseline clinic visit (before introduction of olestra into the food market) and completed at least 2 of 3 follow-up telephone calls (after the introduction of olestra into the market). STATISTICAL ANALYSES PERFORMED: Logistic regression was used to examine associations between olestra consumption and sociodemographic characteristics, health conditions, attitudes toward health and diet, and health-related behaviors. RESULTS: Olestra consumption on at least 1 of the follow-up telephone calls was reported by 41.5% of the study sample, and consumption on 2 or more telephone calls was reported by 20.0% of the sample. Factors associated with early adoption of olestra-containing foods included white ethnicity, higher education, overweight, absence of diabetes, attitudes indicative of diet and health concerns (e.g.; perceptions that there is a strong relationship between diet and disease), and a lower fat intake. APPLICATIONS/CONCLUSIONS: In spite of the controversy surrounding the introduction of olestra into the food market persons with attitudes indicative of diet and health concerns were likely to be early adopters of olestra-containing foods. Dietitians and other health care providers should inquire about intake levels of foods with fat substitutes and ensure that these foods are not being consumed in excessive amounts or being consumed instead of nutrient-dense foods that are naturally low in fat.     

Dietary antioxidants: Do they have a role to play in the ongoing fight against abnormal glucose metabolism?

Overfeeding, an increased intake of saturated fatty acids, and sugary foods are key dietary changes that have occurred in recent decades in addition to the emergence of the obesity epidemic. In addition to an increase in energy storage as fat, these dietary changes are accompanied by an increase in mitochondrial macronutrient oxidation, leading to an excessive free radical production and, hence, oxidative stress. The latter has long been considered a central mechanism linking nutrient overload, insulin resistance, the metabolic syndrome, and diabetes. However, food, through fruit and vegetable consumption, also can be a great source of antioxidants that protect the body against oxidative damage and insulin resistance and thus help cope with the metabolic backlash of the energy-dense Westernized diet. Experimental data are in favor of the beneficial role conveyed by antioxidants in glucose metabolism, but clinical data in humans remain controversial. This review therefore aimed to sort out any underlying discrepancies and provide an overall clear view of the role of antioxidants in the ongoing fight against abnormal glucose metabolism.     

Do SCFA have a role in appetite regulation?

The recently discovered SCFA-activated G-coupled protein receptors FFA receptor 2 and FFA receptor 3 are co-localised in l-cells with the anorexigenic 'ileal brake' gut hormone peptide YY, and also in adipocytes, with activation stimulating leptin release. Thus, SCFA such as acetate and propionate show promise as a candidate to increase satiety-enhancing properties of food. We therefore postulate SCFA may have a role in appetite regulation and energy homeostasis. SCFA can be delivered either directly within food, or indirectly via the colon by the provision of fermentable non-digestible carbohydrates. A review of studies investigating the effects of oral SCFA ingestion on appetite suggests that while oral SCFA ingestion is associated with enhanced satiety, this may be explained by product palatability rather than a physiological effect of SCFA. Colon-derived SCFA generated during microfloral fermentation have also been suggested to explain satiety-enhancing properties of non-digestible carbohydrates. However, findings are mixed from investigations into the effects of the prebiotic inulin-type fructans on appetite. Overall, data presented in this review do not support a role for SCFA in appetite regulation.     

Influenza and pneumococcal vaccination: do older people know if they have been vaccinated?

Objective: To estimate influenza and pneumococcal immunisation rates by self‐report and validate this with immunisation providers. Method: A random population telephone survey. This was followed by contacting immunisation providers of those reporting having an influenza vaccination (2009 or 2010 only) and/or pneumococcal vaccination to confirm vaccination or not. Results: A total of 680 people aged 65 and older responded to the telephone survey. Seventy‐five per cent of respondents self‐reported influenza vaccination in 2010 and 26% self‐reported having ever had the pneumococcal vaccination. Following up with immunisation providers, we found recall for influenza vaccination was confirmed in 96% of cases. For the pneumococcal vaccination, recall for vaccination was confirmed in 87% of cases. People saying they were not vaccinated for pneumococcal were subsequently confirmed as vaccinated in 77% of cases. Conclusions: In this study, self‐reported influenza vaccination was reliable. The term ‘pneumococcal vaccination or Pneumovax’ was poorly recognised by our telephone survey respondents as evident by the low rate of self‐reported pneumococcal vaccination compared to a much higher rate of pneumococcal vaccinations recorded by GPs. Implications: While pneumococcal vaccination is an accurate term, researchers should be aware of the terminology used in general practice and the community when designing their survey.