Marijuana use among minority youths living in public housing developments

Youths residing in public housing developments appear to be at markedly heightened risk for drug use because of their constant exposure to violence, poverty, and drug-related activity. The purpose of this study was to develop and test a model of marijuana etiology with adolescents (N=624) residing in public housing. African-American and Hispanic seventh graders completed questionnaires about their marijuana use, social influences to smoke maijuana, and sociodemographic and psychosocial characteristics. Results indicated that social influences, such as friends' marijuana use and perceived ease of availability of marijuana, significantly predicted both occasional and future use of marijuana. Individual characteristics such as antimarijuana attitudes and drug refsul skills also predicted marijuana use. The findings imply that effective prevention approaches that target urban youths residing in public housing developments should provide them with an awareness of social influences to use marijuana, correct misperceptions about the prevalence of marijuana smoking, and train adolescents in relevant psychosocial skills.     

Screening methods for thyroid hormone disruptors

The U.S. Congress has passed legislation requiring the EPA to implement screening tests for identifying endocrine-disrupting chemicals. A series of workshops was sponsored by the EPA, the Chemical Manufacturers Association, and the World Wildlife Fund; one workshop focused on screens for chemicals that alter thyroid hormone function and homeostasis. Participants at this meeting identified and examined methods to detect alterations in thyroid hormone synthesis, transport, and catabolism. In addition, some methods to detect chemicals that bind to the thyroid hormone receptors acting as either agonists or antagonists were also identified. Screening methods used in mammals as well as other vertebrate classes were examined. There was a general consensus that all known chemicals which interfere with thyroid hormone function and homeostasis act by either inhibiting synthesis, altering serum transport proteins, or by increasing catabolism of thyroid hormones. There are no direct data to support the assertion that certain environmental chemicals bind and activate the thyroid hormone receptors; further research is indicated. In light of this, screening methods should reflect known mechanisms of action. Most methods examined, albeit useful for mechanistic studies, were thought to be too specific and therefore would not be applicable for broad-based screening. Determination of serum thyroid hormone concentrations following chemical exposure in rodents was thought to be a reasonable initial screen. Concurrent histologic evaluation of the thyroid would strengthen this screen. Similar methods in teleosts may be useful as screens, but would require indicators of tissue production of thyroid hormones. The use of tadpole metamorphosis as a screen may also be useful; however, this method requires validation and standardization prior to use as a broad-based screen.     

Interventional Radiology for Treating Soft Tissue Sarcomas

The role of interventional radiology for soft tissue sarcomas is only occasionally addressed in the literature. However, different techniques such as embolization, selective chemotherapy, chemoembolization, and acrylic cement osteoplasty can be helpful with the primary tumor, recurrences, and metastases. This article discusses these techniques and their complications in treatment of soft tissue sarcomas.     

The Massachusetts Behavioral Health Program Year 5: Transition to a New Managed Care Organization

Year 5 of the Massachusetts Behavioral Health Program was a transition to management by a new private managed care organization. Fifty-eight providers interviewed for an ongoing panel survey reported slightly lower levels of quality, access, utilization, and length of stay than a year earlier. Relationships with providers and advocates improved after an initial difficult period, while consumer and family involvement at all levels remained low. The greatest changes in managed care appeared to take place during the initial transition from fee-for-service care, but intractable problems continue, and full participation of stakeholders seems difficult to achieve.     

Elderly Cardiac Rehabilitation Patients Show Greater Improvements in Ventilation at Submaximal Levels of Exercise

The minute ventilation (VE) and carbon dioxide output (VCO&sub2;) adaptations to 12 weeks of cardiac rehabilitation were investigated in diagnosis-matched elderly patients (ELD) and younger patients (YNG). Thirty ELD (25 males, 5 females; age equals 69.2?+/-3.9 years) and 30 YNG (27 males, 3 females; age equals 48.3?+/-7.0 years) were exercise tested at program entry (T1) and completion (T2). Peak oxygen uptake (VO&sub2; peak) and ventilatory threshold (VT) (ml kg-1 min-1) were greater for YNG at both T1 and T2 (p is less than 0.01). Both ELD and YNG showed significant T1 to T2 improvements (p is less than 0.01) for VO&sub2; peak (21.1% and 23.4%) and VT (20.1% and 12.4%). The VE/VCO&sub2; ratio was greater (p is less than 0.01) for ELD but approached YNG values after training. The VCO&sub2;/VO&sub2; slope showed a greater T1 to T2 reduction in ELD (12.4% vs 3.4%). There was no relationship (r(2) equals 0.15; NS) between the percentage change in VO&sub2; peak and VE/VCO&sub2; indicating unrelated mechanisms of improvement. We conclude that ELD showed similar improvements in VO&sub2; peak but greater improvements in their ventilatory tolerance for submaximal exercise. These changes indicate improvements in aging-enhanced exercise ventilation, are important for performance of normal activities of daily living, and would have been undetectable without gas exchange analysis.     

Proceedings of the Symposium ‘Angiotensin AT1 Receptors: From Molecular Physiology to Therapeutics’: STRUCTURAL CHANGES IN THE RENAL VASCULATURE IN THE SPONTANEOUSLY HYPERTENSIVE RAT: NO EFFECT OF ANGIOTENSIN II BLOCKADE

• 1 There is strong evidence for a renal basis to the development of hypertension in the spontaneously hypertensive rat (SHR). Alterations of the SHR renal vasculature, including the glomerulus, may be involved in the initiation and maintenance of hypertension in this animal model.
• 2 The arterial walls of pre-glomerular vessels of the SHR are hypertrophied compared with WKY vessels. Unlike other vascular beds in the SHR, this hypertrophy is independent of angiotensin II (AngII).
• 3 Glomerular number and volume are similar between SHR and the normotensive Wistar-Kyoto (WKY) rats. These results provide no support for the theory that a reduced filtration surface area within the kidneys of the SHR contributes to the elevated blood pressure in these animals.
• 4 Intrarenal hypertrophy may have similar haemodynamic consequences to clipping of the main renal artery, as in Goldblatt hypertension. Further analysis of the role of pre-glomerular arterial hypertrophy is warranted to determine its involvement in the initiation and maintenance of hypertension in the SHR.

     

The evolving role of the health care supervisor: shifting paradigms, changing perceptions, and other traps

As health care comes under mounting pressure to reduce costs, organizations are restructuring. Delivery systems are changing. As layoffs occur and changes are made in numbers and responsibilities of managers, supervisors find themselves in dramatically changing roles. Job security has become as illusory in health care as elsewhere. Morale among health workers is sagging, and motivational concerns are increasing. The supervisor has been put in the position of having to do more with less and to do it in the face of demoralized forces. The paradigms that were once operational are shifting, and the evolving role of the health care supervisor suggests that a completely new set of paradigms is taking over that suggests the supervisor's future security lies in the ability to learn new things and to shift and change with the environment.     

After reduction in force: reinvigorating the survivors

In these days of reengineering health care and downsizing many health organizations, a great deal of attention is given to means of reducing the work force. Not nearly as much attention is paid to the survivors of a staff reduction and the problems that arise in the wake of a generally demotivating activity. However, it is the survivors--those who remain after downsizing--that will have the greatest influence on the organization's future performance. Therefore, the survivors must be remotivated and reinvigorated. Such is the task of surviving supervisors and middle managers, and their primary tools are communication, education, and people-centered management.