Some implications of time-limited general hospital psychiatric inpatient treatment for outcome of hospitalization

Patients hospitalized in the same general hospital psychiatric unit and treated by the same staff during two consecutive periods of time are compared as to outcome. Average duration of stay during the first period, 31.7 days, was reduced to 18.5 days for the second period. The percentage of patients transferred to a state hospital rose from 17.5% to 29.1%, an increase of 66% in the rate of transfer. There was a concomitant decrease in the percentage of discharges to the community and a sharp increase in rate of requirement for aftercare by the staff of the unit, a disposition generally reserved for patients deemed still quite symptomatic at discharge.An earlier version of this paper was read at the Annual Meeting of the American Psychiatric Association, Miami, 1969.     

Determinants of child morbidity in Latin America: a pooled analysis of interactions between parental education and economic status

Diarrhea and respiratory infections account for more than two-fifths of all deaths among children under five. Parental education and economic status are well-known risk factors for child morbidity, but little is known about whether education and economic status operate synergistically or independently to influence children's health. Confirming the presence and direction of such interactions is important to better target education and development policies. Our objective is to test for interactions between parental education and economic status in predicting the risk of diarrhea and respiratory illness among children under five, before and after adjusting for key proximate risk factors. We pool 12 Demographic and Health Surveys (DHS) and nine Living Standards Measurement Surveys (LSMS) from Latin America, creating two large databases. Quintiles of economic status are constructed from principal components asset indices. We use logistic regression to analyze episodes of diarrhea and respiratory illness, and interactions between economic quintile and maternal and paternal education are evaluated via likelihood ratio tests. We find that mother's education and quintile interact synergistically in the DHS data, while results are inconclusive in the LSMS data. The effect of increasing maternal education appears to be more protective for children in wealthy families than for children in poor families. Conversely, improvements in economic status reduce health risks more for children whose mothers are better educated. Father's education is protective and operates independently of economic status. Our findings imply that poverty alleviation efforts occurring in concert with programs to educate women and girls will be more effective for improving children's health than either approach alone.     

Changes in juvenile coho salmon electro-olfactogram during and after short-term exposure to current-use pesticides

For anadromous salmonids, olfaction is a critical sense, enabling return migration. In recent years, several pesticides have been identified that interfere with salmonid olfaction at concentrations in the microg/L range; thus, they may pose a risk to species longevity. In the present study, we investigated the acute effects of five agricultural pesticides on juvenile coho salmon (Oncorhynchus kisutch) olfaction using the electro-olfactogram (EOG), a measure of odorant-evoked field potentials. Electro-olfactogram responses to the odorant L-serine were measured during and following a 30-min exposure of the left olfactory rosette to chlorothalonil, endosulfan, glyphosate acid, iodocarb (IPBC), trifluralin, and 2,4-dichlorophenoxyacetic acid. With the relatively insoluble pesticides endosulfan and trifluralin, decreases in EOG amplitude were only apparent at relatively high concentrations (100 and 300 microg/L, respectively) following 20 min of exposure and were absent for chlorothalonil (1 mg/L). With the water-soluble herbicide glyphosate, significant EOG reductions occurred within 10 min of exposure to 1 mg/L and more rapidly with higher concentrations. Recovery of EOG post-glyphosate exposure was concentration-dependent, and complete recovery was not observed with some concentrations at 60 min postexposure. Dichlorophenoxyacetic acid only affected EOG at high concentration (100 mg/L), where it eliminated EOG within 2 min of exposure. With IPBC, EOG was decreased at 25 min of exposure to 1 microg/L; higher concentrations caused decreases to occur more rapidly. Excluding IPBC and glyphosate, all EOG reductions occurred at concentrations greater than the current Canadian water-quality guidelines and reported 96-h lethality values. Our results show that olfactory neurons can be impaired rapidly by some current-use pesticides, even at exposures in the low-microg/L range.     

Quantifying facial expression recognition across viewing conditions

Facial expressions are key to social interactions and to assessment of potential danger in various situations. Therefore, our brains must be able to recognize facial expressions when they are transformed in biologically plausible ways. We used synthetic happy, sad, angry and fearful faces to determine the amount of geometric change required to recognize these emotions during brief presentations. Five-alternative forced choice conditions involving central viewing, peripheral viewing and inversion were used to study recognition among the four emotions. Two-alternative forced choice was used to study affect discrimination when spatial frequency information in the stimulus was modified. The results show an emotion and task-dependent pattern of detection. Facial expressions presented with low peak frequencies are much harder to discriminate from neutral than faces defined by either mid or high peak frequencies. Peripheral presentation of faces also makes recognition much more difficult, except for happy faces. Differences between fearful detection and recognition tasks are probably due to common confusions with sadness when recognizing fear from among other emotions. These findings further support the idea that these emotions are processed separately from each other.     

A small-molecule inhibitor of Bcl-XL potentiates the activity of cytotoxic drugs in vitro and in vivo

Inhibition of the prosurvival members of the Bcl-2 family of proteins represents an attractive strategy for the treatment of cancer. We have previously reported the activity of ABT-737, a potent inhibitor of Bcl-2, Bcl-X(L), and Bcl-w, which exhibits monotherapy efficacy in xenograft models of small-cell lung cancer and lymphoma and potentiates the activity of numerous cytotoxic agents. Here we describe the biological activity of A-385358, a small molecule with relative selectivity for binding to Bcl-X(L) versus Bcl-2 (K(i)'s of 0.80 and 67 nmol/L for Bcl-X(L) and Bcl-2, respectively). This compound efficiently enters cells and co-localizes with the mitochondrial membrane. Although A-385358 shows relatively modest single-agent cytotoxic activity against most tumor cell lines, it has an EC(50) of <500 nmol/L in cells dependent on Bcl-X(L) for survival. In addition, A-385358 enhances the in vitro cytotoxic activity of numerous chemotherapeutic agents (paclitaxel, etoposide, cisplatin, and doxorubicin) in several tumor cell lines. In A549 non-small-cell lung cancer cells, A-385358 potentiates the activity of paclitaxel by as much as 25-fold. Importantly, A-385358 also potentiated the activity of paclitaxel in vivo. Significant inhibition of tumor growth was observed when A-385358 was added to maximally tolerated or half maximally tolerated doses of paclitaxel in the A549 xenograft model. In tumors, the combination therapy also resulted in a significant increase in mitotic arrest followed by apoptosis relative to paclitaxel monotherapy.     

Observed use of sunglasses in public outdoor settings around Melbourne, Australia: 1993 to 2002

BACKGROUND: Wearing sunglasses may reduce the risk of cataract and of skin cancer in the periorbital area. Understanding predictors of sunglasses use may help identify groups with lower usage patterns. METHODS: An annual observational field survey of teenagers and adults at leisure at outdoor venues around Melbourne, Australia was conducted between 11 am and 3 pm on mainly sunny, summer weekends (n=42,207). The serial cross-sectional survey assessed sun protection behaviors, including use of sunglasses from 1993 to 2002, and other variables hypothesized to predict sun-related behavior (sex, age, SES, activity level and setting, size of social group, and weather conditions). Predictors of use of sunglasses were assessed using multivariate logistic regression. RESULTS: 36.2% of those observed wore sunglasses, and this increased only slightly over the years. Sunglasses use was most common among those observed on sunny days, in no or partial shade, in parks/gardens and at pools/beaches, less active people and people on their own or in pairs, people observed in higher socio-economic areas, females, people 20-50 years of age, and people wearing head and clothes cover. CONCLUSION: Sunglasses use should be encouraged among the population in general and especially among golfers, tennis players, teenagers, males, and people in lower SES areas.     

The effect of financial incentives on gatekeeping doctors: evidence from a natural experiment

In many health care systems generalist physicians act as gatekeepers to secondary care. Under the English fundholding scheme from 1991/1992 to 1998/1999 general practices could elect to be given a budget to meet the costs of certain types of elective surgery (chargeable electives) for their patients and could retain any surplus. They did not pay for non-chargeable electives or for emergency admissions. Non-fundholding practices did not bear the cost of any type of hospital admissions. Fundholding is to be reintroduced from April 2005. We estimate the effect of fundholding using a differences in differences methodology on a large 4-year panel of English general practices before and after the abolition of fundholding. The abolition of fundholding increased ex-fundholders' admission rates for chargeable elective admissions by between 3.5 and 5.1%. The effect on the early wave fundholders was greater (around 8%) than on later wave fundholders. We also use differences in differences for two types of admissions (non-chargeable electives, emergencies) not covered by fundholding as additional controls for unobserved temporal factors. These differences in differences in differences estimates suggest that the abolition of fundholding increased ex-fundholders' chargeable elective admissions by 4.9% (using the non-chargeables DID) and by 3.5% (using the emergencies DID).     

Growing the field of health impact assessment in the United States: an agenda for research and practice

Health impact assessment (HIA) methods are used to evaluate the impact on health of policies and projects in community design, transportation planning, and other areas outside traditional public health concerns. At an October 2004 workshop, domestic and international experts explored issues associated with advancing the use of HIA methods by local health departments, planning commissions, and other decisionmakers in the United States.Workshop participants recommended conducting pilot tests of existing HIA tools, developing a database of health impacts of common projects and policies, developing resources for HIA use, building workforce capacity to conduct HIAs, and evaluating HIAs. HIA methods can influence decisionmakers to adjust policies and projects to maximize benefits and minimize harm to the public's health.