Examining the perspectives of Texas minors cited for possession of tobacco

This study examined the personal experiences of twenty 14-to-19-year-old Texas youth cited for tobacco possession and attending a court-mandated tobacco awareness class. Guided by labeling theory, focus group questions addressed the process of citation, how youth viewed themselves following citation, how parents and peers viewed youth following citation, and youths' views on the purpose and effects of the policy. Many youth felt stupid for being caught or determined that they were unlucky. Parents were upset that youth were caught smoking; however, most knew their children smoked. Peers felt sympathy for cited youth or made fun of them for being caught. Participants felt that the law was in existence to deter younger children from initiating smoking or to encourage older minors to quit smoking. However, youth also indicated that there was no purpose to the law and that instead of decreasing smoking it could lead to its continuation. Implications for practice are discussed.     

Texas Tobacco Prevention Pilot Initiative: processes and effects

The study was designed to examine how intensity of anti-smokingmedia campaigns and differing types of anti-smoking community-basedprograms influence young adolescents' tobacco use and relatedpsychosocial variables. Sixth grade students attending 11 middleschools in eight study communities assigned to varying interventionconditions were assessed by a pre-intervention survey conductedin spring 2000. The assessment was followed by summer and fall2000 media and community interventions that were evaluated bypost-intervention data collection taking place with a new cohortof sixth graders in the same 11 schools in late fall 2000. Inanalyses conducted at the school level, the enhanced schooland comprehensive community program conditions outperformedthe no intervention program condition to reduce tobacco useand intentions to use tobacco. Combining the intensive or lowmedia campaign with the comprehensive community program wasmost effective in suppressing positive attitudes toward smoking,while the enhanced school program alone was less effective ininfluencing attitudes. The most consistent changes, at leastshort-term, to reduce teen tobacco use, susceptibility to smokingand pro-smoking attitudes were achieved by combining the intensivemedia campaign with the comprehensive community program condition.     

Ophthalmology on the internet: what do our patients find?

The Internet has become a favorite source of medical information for a growing number of patients. At the same time, content on the Internet represents an amalgamation of viewpoints, commercial interests, and various biases. A common way to access Internet information is through commercial portals with proprietary search engines. Often these search engines prioritize their rank list based on commercial interests. We evaluated whether Internet searches of ophthalmic issues are slanted toward commercial sites and whether any differences exist among the various search engines. We used age-related macular degeneration as an example. In this study, we found that some search engines are heavily tilted toward commercial partnerships, whereas others emphasize sites run by nonprofit and educational organizations. Our findings may guide physicians in recommending to their patients some internet portals rather than others. This type of evaluation can be conducted intermittently by physicians and other health care professionals to assess the type of information that reaches their patients and what biases may be influencing patient knowledge and decision making.     

Developmental stages in public health partnerships: a practical perspective

Health education practitioners often form and provide support to partnerships directed toward public health goals. The authors viewed the start-up of a state health department/multiuniversity partnership for the evaluation of the state's tobacco settlement pilot project using the lens of the Tuckman four-stage model of group development. The four stages--forming, storming, norming, and performing--occurred in sequence but with pronounced overlap. Two types of performing--institutional and group performing--were observed. An awareness of group developmental stages can allow leaders and members to improve the ways their partnership works together. Applying Tuckman's model also can allow expectations about the group's progress and members' interactions to be managed so that tasks are aligned with the appropriate stage of development. Finally, for partnerships that have a long life span, understanding that the stages may occur several times throughout the group's existence can acclimate members to shifting responsibilities and relationships over time.     

Ageing and immunosuppression in kidney transplantation

Modern approaches to tailor-made, individualized immunosuppressive therapy for patients receiving organ transplantation require a rethinking of therapeutic strategies when it comes to older persons receiving kidney transplants, especially from deceased older donors. This review article makes the case for the use of calcineurin-inhibitor-free immunosuppressive induction/maintenance protocols in this "worst-case scenario" and discusses the theoretical and clinical data that support this recommendation. We will discuss modern theories of ageing, emphasizing the free-radical theory in relation to new insights into the mechanisms of innate immunity. In this context, a new, modified theory of ageing is presented. Increased generation of reactive oxygen species during ageing, via increased leakage of these oxidizing molecules from mitochondria, may contribute to senescence and age-related diseases by direct damage to intracellular DNA, proteins, and lipids. In addition, free-radical-mediated tissue injury, accompanied by induction of damage-associated molecular patterns, may result in activation of both inflammatory and vascular cells of the innate immune system, contributing (via inflammatory processes) to ageing and age-related diseases such as atherosclerosis. Calcineurin-inhibiting agents have been shown to induce oxidative stress and are thus defined as "proageing" drugs. Their use in older patients may aggravate the preexisting oxidized intracellular state and therefore should be avoided. In contrast, inosine-monophosphate dehydrogenase-inhibiting agents such as mycophenolate mofetil have been shown to even ameliorate oxidative stress and are thus defined as "antiageing" drugs. Therefore, their use for immunosuppression in older patients receiving kidney transplantation is suggested. This recommendation is supported by data from a prospective trial on the application of a calcineurin inhibitor-free, mycophenolate-mofetil--based induction/ maintenance immunosuppressive protocol in older recipients of kidneys from deceased older donors: the 5-year patient and 5-year allograft survival rates are currently 87% and 70%, respectively.     

Small-dose dopamine increases epidural lidocaine requirements during peripheral vascular surgery in elderly patients

We studied 20 patients over the age of 65 yr undergoing prolonged peripheral vascular surgery under continuous lidocaine epidural anesthesia, anticipating that the increased hepatic metabolism caused by small-dose IV dopamine would lower plasma lidocaine concentrations. Subjects were assigned (random, double-blinded) to receive either a placebo IV infusion or dopamine, 2 microg. kg(-1). min(-1) during and for 5 h after surgery. Five minutes after the IV infusion was started, 20 mL of 2% lidocaine was injected through the epidural catheter. One-half hour later, a continuous epidural infusion of 2% lidocaine at 10 mL/h was begun. The epidural infusion was temporarily decreased to 5 mL/h or 5 mL boluses were added to maintain a T8 analgesic level. Arterial blood samples were analyzed for plasma lidocaine concentrations regularly during and for 5 h after surgery. Plasma lidocaine concentrations increased continuously during the epidural infusion and, despite wide individual variation, were similar for the two groups throughout the observation period. During the observation period, the mean maximal plasma lidocaine concentration was 5.8 +/- 2.3 microg/mL in the control group and 5.7 +/- 1.2 microg/mL in the dopamine group. However, the mean hourly lidocaine requirement during surgery was significantly different, 242 +/- 72 mg/h for control and 312 +/- 60 mg/h for dopamine patients (P < 0.03). At the end of Hour 4, the last period when all 20 patients were still receiving the epidural lidocaine infusion, the total lidocaine requirement was significantly different, 1088 +/- 191 mg for the control group and 1228 +/- 168 mg for the dopamine group (P < 0.05). Despite very large total doses of epidural lidocaine (1650 +/- 740 mg, control patients, and 1940 +/- 400, dopamine patients) mean maximal plasma concentrations remained below 6 microg/mL, and no patient exhibited signs or symptoms of toxicity. We conclude that small-dose IV dopamine increased epidural lidocaine requirements, presumably as a consequence of increased metabolism. IMPLICATIONS: We tested dopamine, a drug that increases liver metabolism of the local anesthetic lidocaine to determine if it would prevent excessively large amounts of lidocaine in the blood during prolonged epidural anesthesia in elderly patients. Dopamine did not alter the blood levels of lidocaine, but it did increase the lidocaine dose requirement to maintain adequate epidural anesthesia.