Alcohol Education in an Indigenous Community School in Queensland, Australia

The alcohol education package 'When You Think About It' was developed by the Queensland Department of Education in co-operation with an Aboriginal community in the Northern region of the State. The community identified a number of behaviours and issues that needed to be addressed and a systematic series of lessons with an associated community video was developed. The package was taught for the first time in the community high school in 1990, and research was undertaken to monitor implementation and impact. Students were surveyed prior to and after the package was taught; and information regarding teaching experience, opinions on alcohol education, and feedback on the students' enjoyment of and interest in the lessons were sought from the teachers. Interviews were held with community members at the completion of the teaching program to ascertain their reactions. Absentee rates were between 20-30% for each lesson and only 22 students completed both questionnaires and attended five lessons. The small sample size meant that statistical tests to measure the effectiveness of the educational package were not appropriate. The qualitative information obtained from all sources indicated that the video and associated role play lessons were highly acceptable to the students. Action-orientated, community-based resources and group activities were well received. To meet the issue of high rates of absenteeism, programs should limit their focus and reinforce it in a wide variety of media and across a number of occasions.     

Vitamin and mineral supplementation practices of adults in seven western states

Seven western states (Arizona, California, Idaho, Nevada, New Mexico, Oregon, and Wyoming) were surveyed in 1986 to determine the extent of vitamin/mineral supplementation and dosage levels of single supplements. Questionnaires were mailed to 3,500 individuals. A 57.8% response rate was obtained from the deliverable surveys, with a sample size of 1,730. The sample consisted of 54% women and 46% men and was predominantly white (88.9%). Fifty-four percent of the sample consumed some type of supplement; multiple vitamin/minerals were consumed with the greatest frequency. For single supplements, vitamin C was reported with the greatest frequency (23.1%), followed by some type of calcium supplement (22.5%) and vitamin E (11.1%). More than 80% of the vitamin C users indicated a dosage of 250 mg/day. Most respondents consumed calcium dosages of less than 1,000 mg/day. For vitamin E, 75% of the users consumed more than 200 IU/day. The data suggest that the potential for toxicity due to excess supplementation levels exists in the western states studied.     

Age of onset of phobic disorders: A reevaluation

The age of onset of agoraphobia with spontaneous panic attacks (DSM III) was studied in 100 consecutive patients. A uniform unimodal age of onset distribution was found. Mean age of onset was 24 years. Sixty-five percent of cases began in the 15–29 age group. Ninety-six percent first started before age 40 years. The finding in two other studies of a bimodal age of onset distribution may result from artifacts inherent in their small sample sizes.The age of onset of simple single phobias without spontaneous panic attacks or other psychopathology was studied in 62 consecutive monophobic patients. The age of onset in this variety of phobic disorder was evenly distributed over all age groups.No evidence was found for a facilitatory period in the development of phobias for the first decade as compared to the second or third life—although age may determine which environmental stimuli become phobic stimuli at different ages.There was a statistically significant difference between the age of onset distribution and the sex ratio in both groups of phobic disorder.The findings are consistent with the authors classification of phobic disorders, into endogenous and exogenous varieties based on the presence or absence of concurrent spontaneous panic attacks with the phobias. It is also consistent with the model that biological factors are preeminent in the genesis of endogenous phobias, while conditioning by environmental stress is preeminent in exogenous phobias.     

Reduction of morbidity and cytokine release in anti-CD3 MoAb-treated mice by corticosteroids.

In keeping with the in vitro mitogenic properties of anti-CD3 MoAbs, the first injections of anti-CD3 are invariably responsible for an in vivo cellular activation. This activation induces a massive cytokine release in the circulation (TNF, IFN gamma, IL-2, IL-6, and IL-3). Paralleling this release, a severe clinical reaction occurs in OKT3-treated patients and in 145 2C11-treated mice. Corticosteroids both in vitro and in vivo inhibit the production of several cytokines involved in the anti-CD3 reaction. A single 1 mg hydrocortisone dose was administered to 145 2C11-treated mice according to different kinetics schedules. When given 1 hr prior to the anti-CD3 MoAb, hydrocortisone exerted a beneficial effect on the mouse physical reaction. Hypothermia was totally abrogated at the 4-hr time point. Diarrhea decreased by 50%. Hypomotility improved although not significantly. This improvement correlated with a major modification in the anti-CD3 pattern of cytokine release. At the 90-min blood withdrawal time point cytokine serum levels showed a 100% decrease for IFN gamma, an 88% decrease for IL-6, and 85% decrease for IL-2, and a 75% decrease for TNF. At 4 hr IL-2 serum levels were diminished by 65%; IL-6, IL-3, and IFN gamma serum levels were comparable to controls; and, interestingly, TNF was still detected, whereas it has already disappeared when 145 2C11 was administered alone. Importantly, when given more than 1 hr prior to anti-CD3 injection, corticosteroids were ineffective. To conclude, high doses of corticosteroids must be given with a precise kinetics--i.e. 1 hr prior to anti-CD3 MoAb--to achieve their maximal beneficial effect in the prevention of the anti-CD3 reaction.     

Spirituality and the care of people with life-threatening illnesses

So what is a busy specialist in pain medicine to do when considering the issue of spirituality in caring for patients who are facing life-threatening illness? The purpose of this article has been to provide four major points.First, doctors need to be expert in assessment and treatment. That means attending with all their skill to a variety of issues. Spirituality is one of these issues.Second, for all the talk about spirituality in medicine, it can be treated as a basic human experience that may or may not involve religious belief but does recognize that serious illness carries with it questions of meaning that can be a source of pain as well as patterns of finding meaning that can be a source of strength and comfort. In other words, physicians should not worry that thinking and talking about spirituality is something weird, bizarre, or quackish. It might be if the doctor is weird, bizarre, or a quack! But so might be the use of opioids if the doctor is problematic.Third, addressing issues of spirituality does not mean developing a new expertise. It does mean thinking about some reasonable starter questions, listening to the answers carefully, and considering the need for further discussion as well as sources for referral.Fourth, in thinking about the spiritual issues of patients, doctors might want to think about the issues that affect them in their roles as physicians in continually caring for people in pain, many who are facing death in the near future. If the doctor feels that there are no issues and that he or she is unaffected by the patients under his/her care, then it may well be that there is an urgent need for the doctor to seek some personal help, since likely a lot of patients are not being treated well.