Integrating behavioral and social science into a public health agency: A case study of New York City

In the last century, both the health and life expectancy of Americans improved dramatically. These gains were primarily the result of advances in public health. But the approaches used may not be adequate to achieve the next level of improvements in health. Because health exists in the context of social, environmental, community, religious, political, and other spheres, ecological approaches that incorporate behavioral and social science theory and methodologies may provide the best avenue for advancing health in the 21st century. In 1999, the New York City Department of Health (NYCDOH) undertook the task of integrating behavioral and social science into its public health practice. The experience serves as a case study on the integration process at a public health agency.     

Neuromelanin-containing neurons of the substantia nigra accumulate iron and aluminum in Parkinson's disease: a LAMMA study

The Laser Microprobe Mass Analyzer (LAMMA) is a sensitive instrument for identifying and localizing trace elements in tissue samples. Using LAMMA, we have examined melanin-containing neurons of the substantia nigra in patients with Parkinson's disease (PD) and controls. We found that iron significantly accumulates within neuromelanin granules of patients with PD compared to controls. Increased aluminum was found in the neuromelanin granules of 2 of 3 PD cases but in no controls. The accumulation of iron and aluminum, which are known to promote oxidant stress, may account for the selective degeneration of neuromelanin-containing neurons in PD.     

A twin study of ethanol metabolism

Blood alcohol measurements were obtained for 206 pairs of twins who had ingested a standard dose of alcohol (0.75 g/kg body weight) and repeat measurements were obtained for 40 of these pairs on a second occasion. The repeatability of the peak blood alcohol concentration (BAC) was 0.66, that of the rate of elimination was 0.39, and that of the time to peak BAC was 0.27. Only a small portion of the nonrepeatable variance could be explained by measurement error or drinking experience. It is concluded that short-term environmental factors exercise considerable influence on alcohol metabolism, particularly in the absorption phase. All of the repeatable variance in peak BAC and rate of elimination was due to genetic factors. Only a small proportion of any of the genetic variance could be explained by individual differences in weight, adiposity, or lung function. Likewise, these three factors were unable to account for the fact that females had higher BACs than males during both absorption and elimination.This work was supported by a grant in aid from the Australian Associated Brewers.     

Leukocyte apoptosis and its significance in sepsis and shock

Sepsis and multiple organ failure continue to be significant problems among trauma, burn, and the critically ill patient population. Thus, a number of laboratories have focused on understanding the role of altered apoptotic cell death in contributing to immune and organ dysfunction seen in sepsis and shock. Immune cells that undergo altered apoptotic changes include neutrophils, macrophages, dendritic cells, as well as various lymphocyte populations. Evidence of epithelial as well as endothelial cell apoptotic changes has also been reported. Although mediators such as steroids, tumor necrosis factor, nitric oxide, C5a, and Fas ligand (FasL) appear to contribute to the apoptotic changes, their effects are tissue- and cell population-selective. As inhibiting Fas-FasL signaling (e.g., gene deficiency, Fas fusion protein, or Fas short interfering RNA administration), caspase inhibition (caspase mimetic peptides), and/or the overexpression of downstream antiapoptotic molecules (e.g., Bcl-2, Akt) improve survival of septic mice, it not only demonstrates the pathological significance of this process but points to novel targets for the treatment of sepsis.     

Hypocretin-2 (orexin-B) modulation of superficial dorsal horn activity in rat

The hypothalamic peptides hypocretin-1 (orexin A) and hypocretin-2 (Hcrt-2; orexin B) are important in modulating behaviours demanding arousal, including sleep and appetite. Fibres containing hypocretin project from the hypothalamus to the superficial dorsal horn (SDH) of the spinal cord (laminae I and II); however, the effects produced by hypocretins on SDH neurones are unknown. To study the action of Hcrt-2 on individual SDH neurones, tight-seal, whole-cell recordings were made with biocytin-filled electrodes from rat lumbar spinal cord slices. In 19 of 63 neurones, Hcrt-2 (30 n m to 1 μ m ) evoked an inward (excitatory) current accompanied by an increase in baseline noise. The inward current and noise were unaffected by TTX but were blocked by the P_2X purinergic receptor antagonist suramin (300–500 μ m ). Hcrt-2 (30 n m to 1 μ m ) increased the frequency of spontaneous inhibitory postsynaptic currents (sIPSCs) in the majority of neurones. The sIPSC increase was blocked by strychnine (1 μ m ) and by TTX (1 μ m ), suggesting that the increased sIPSC frequency was glycine and action potential dependent. Hcrt-2 increased the frequency of spontaneous excitatory postsynaptic currents (sEPSCs) in a few neurones but had no effect on dorsal root-evoked EPSCs in these or in other neurones. Neurones located in outer lamina II, particularly radial and vertical cells, were most likely to respond to Hcrt-2. We conclude that Hcrt-2 has excitatory effects on certain SDH neurones, some of which exert inhibitory influences on other cells of the region, consistent with the perspective that hypocretin has a role in orchestrating reactions related to arousal, including nociception, pain and temperature sense.     

Myelinated afferent fibres innervating the primate skin and their response to noxious stimuli

1. The functional characteristics of cutaneous receptors in the squirrel monkey were determined by recording discharges of single myelinated afferent fibres in peripheral nerves with micro-electrodes or from fine filaments prepared by dissection. One hundred and sixty-nine fibres of the posterior femoral cutaneous nerve and 209 of the superficial radial nerve with conduction velocities between 4 and 88 m/sec were classified according to the nature of the most effective stimulus, discharge characteristics, adaptation rate and organization of the receptive field.2. Twenty per cent of the fibres innervating either hairy or glabrous skin required strong mechanical stimuli for activation; thresholds ranged from moderate to overtly damaging pressures. This class showed little or no sensitivity to thermal changes including noxious heat. Their receptive fields consisted of numerous, mechanically-excitable points or spots. All such fibres gave higher impulse frequencies to noxious than to innocuous mechanical stimuli and a large fraction were considered to be nociceptors because they responded only to noxious deformation. The conduction velocities of nociceptors were distributed between 5 and 28 m/sec.3. All but a few of the other fibres encountered responded vigorously to innocuous stimuli and were readily identified as corresponding to one of the receptor types known to exist in either the primate or the cat. These sensitive receptors were systematically tested by intense cutaneous stimuli; their response to injurious stimuli always could be mimicked by innocuous ones.4. Therefore, in the primate a particular class of slowly-conducting myelinated fibres is partially responsible for signalling mechanically-induced cutaneous damage. The probable relation between such afferent fibres and certain kinds of cutaneous pain is explored.     

Contributions of arachidonic acid derivatives and substance P to the sensitization of cutaneous nociceptors.

1. The role of presumed chemical mediators of inflammation in the heat-induced sensitization of cutaneous C-polymodal nociceptors (CPNs) was examined in a rabbit ear preparation maintained in vitro by intra-arterial perfusion with a solution free of protein and cellular elements. 2. In this preparation, CPNs consistently showed enhanced responsiveness after repeated exposure of their receptive fields to noxious levels of heat. The average magnitude of sensitization was quantitatively similar to that observed in vivo, suggesting that blood-born factors are not essential for development of sensitization. 3. Sensitization in one-half of randomly selected CPNs was blocked or reduced when the perfusate contained a cyclooxygenase inhibitor, indomethacin or dipyrone, or the dual cyclooxygenase/lipoxygenase inhibitor, BW755C, even though initial responsiveness to heat and pressure was unaltered. These observations suggest that arachidonic acid breakdown products, possibly prostaglandins, are intermediaries in the sensitization of some, but not all, C-fiber nociceptors of the skin. In addition, heat-induced sensitization for some C-fiber cutaneous nociceptors is the result of processes that are at least partially independent of those involved in excitation. 4. Substance P (SP) or the putative SP antagonists, [D-Pro2, D-Trp7.9]-SP or [D-Pro2, D-Phe7, D-Trip9]-SP, produced no significant effect on heat-responsiveness or sensitization, although ongoing activity may have marginally increased over control levels after repeated heat stimulations. We conclude that SP in an in vitro preparation is not involved in the enhancement of cutaneous C-fiber nociceptor responsiveness after repeated thermal insults.