BACKGROUND: The purpose of this study was, to identify predictors of quitting following general practitioners' (GP) anti-smoking counseling. METHODS: We studied determinants (characterized following the Precede framework) of successful quitting (1 year sustained abstinence, biochemically confirmed at 6- and 12-month follow-up) among 861 smokers randomized to the intervention groups based on repeated counseling (RC), RC + spirometric testing, and RC + nicotine gum, in a smoking cessation trial carried out in Turin, Italy. RESULTS: GPs' intervention worked best for male (OR = 2.30; 95% CI, 1.13-4.52) and married (OR = 3.63; 95% CI, 1.37-9.59) smokers, for smokers who had maintained abstinence for at least 1 month in the past (OR = 6.78; 95% CI, 1.56-29.52) or at their first quit attempt (OR = 10.91; 95% CI, 2.37-50.13), and for those who spontaneously reduced their coffee consumption (OR = 3.30; 95% CI, 1.59-6.82); heavy smokers (> = 20 cig/day OR = 0.48; 95% CI, 0.24-0.93) and those living with other smokers (> = 1 smokers in the household: OR = 0.44; 95% CI, 0.22-0.90) were less likely to give up. Previous antismoking advice by the GP represented a strong barrier to success for healthy smokers (OR = 0.19; 95% CI, 0.07-0.52), but not for those reporting symptoms of shortness of breath (OR = 0.63; 95% CI, 0.39-9.20). There were no interactions between predictors and treatment conditions. CONCLUSIONS: Assessment of factors influencing quitting would allow GPs to tailor their message to address existing barriers and to help patients utilize their resources for change.

Adult↗

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Distribution of patients between faculty and residents in a teaching hospital clinic.

The authors tried to determine whether housestaff are systematically assigned clinic patients who are more "difficult": the elderly, the poor, those with many problems, and those who cannot speak English. This cross-sectional study was carried out in the outpatient department of a university health care insurance. A systematic sample of 1,870 patient visits to the medical clinic from 1980 to 1986 was studied. Housestaff were more likely to see patients who did not speak English, who had four or more medical problems, who had visited the clinic five or more times, who had been admitted to the hospital or emergency ward, or who had a skin problem. Multivariate analysis of these individual factors, allowing for the effect of each upon the others, showed that only previous hospital or emergency ward admission, native language, and skin disease retained a significant association with housestaff physicians. None of these factors was strongly associated with physician status, as shown by poor predictive accuracy when the multivariate models were used to predict accuracy when the multivariate models were used to predict physician status in 105 patient visits in 1987. While some factors were statistically associated with physician status, the magnitude of the effect of each was small. An explantation, other than bias in patient assignment, was usually apparent. It is possible to organize an outpatient clinic where housestaff care for patients who are similar to those seen by faculty.

Appointments and Schedules↗

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Concentric membranous bodies and giant mitochondria in hepatocytes from a patient with AIDS.

The cytoplasm of hepatocytes in a liver biopsy from a patient with acquired immunodeficiency syndrome (AIDS) treated with sulfamethazole-trimethoprim contained concentric membranous bodies (CMB) and giant mitochondria. By light microscopy the general architecture of the liver was unaltered. By electron microscopy one to three CMB were present in random distribution within several cells in equal periportal and centrilobular localization. CMB were irregularly rounded or ovoid, loosely ribosome-studded lamellar whorls. Some were agranular or in parallel arrangement. Giant mitochondria often with paracrystalline inclusions were frequently in close association with CMB. Tubuloreticular inclusions were noted in Kupffer cell cytoplasm. Since CMB have been infrequently observed in human hepatocytes, are rare in nonneoplastic human liver, and have not been previously reported in association with AIDS, their appearance may relate to regenerative changes and/or sulfamethazole-trimethoprim therapy.

Acquired Immunodeficiency Syndrome↗

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Rhodamine B fluorescence as a stain for amniotic fluid squames in maternal pulmonary embolism and fetal lungs.

Rhodamine B fluorescence is presented as a simple, rapid, highly sensitive, permanent method for the histologic detection of squames in maternal amniotic fluid emboli and fetal lungs in cases of intrauterine asphyxia. The method may be used on alcohol fixed smears or formalin fixed paraffin sections. The application of this procedure allows for identification of sparsely distributed fetal squames which otherwise may be overlooked by less sensitive tinctorial methods which may also be more tedious in technical preparation and screening.

Amniotic Fluid↗

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Light and electron microscopy of hepatocellular changes in griseofulvin fed mice. Particular reference to Mallory bodies.

Male Swiss Webster mice were fed a diet containing 2.5 percent griseofulvin (GF). Serially progressive light and electron microscopic hepatic altertions were present from one day on and grossly visible hepatomegaly from two weeks until termination at 22 weeks. GF induced liver changes included hepatocyte nuclear and cytoplasmic hypertrophy, increased incidence of necrosis and mitosis, Kupffer cell activation, bile duct proliferation and portal fibrosis. Protoporphyrin crystals were present in hepatocyte cytoplasm as early as one day after GF feeding. Hepatocellular hyalin was initially noted at seven weeks. Thereafter, the hyalin increased in prominence and frequency of occurrence. Ultrastructurally, three types of hyalin have been presently demonstrated to correspond to Mallory bodies (MB) reported in human liver disease. Forms intermediate in appearance between various MB types suggested transition from one to another. Areas of organelle free cytosol with abundant, loosely scattered filamentous elements as well as vesicular, smooth surfaced endoplasmic reticulum and ribosomes appeared preceding and closely associated with MB formation. Similarities of hepatocellular MB observed in GF fed mice and reported earlier in human alcoholic liver disease suggest a common pathway in its formation as a response to divergent noxious insults.

Animals↗

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RNA virus associated antigen in human placenta.

Using indirect immunofluorescence microscopy, it was demonstrated that human cytotrophoblast of six to ten weeks gestation contains mouse mammary tumor virus associated antigen. This antigen appeared predominantly in the periphery of the cells.

Animals↗

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Block grants in ambulatory care: the role of local health departments.

Explore the source record for details and available documents.

Ambulatory Care↗

PubMedDate not supplied

Ultrastructural changes of intrahepatic bile ductules in griseofulvin fed mice.

Intrahepatic bile ductules in male Swiss Webster mice, fed a diet containing 2.5 percent griseofulvin (GF), showed marked hypertrophy and hyperplasia within two weeks. Thereafter, this reaction gradually increased in prominence until nine weeks. Cytoplasmic acid phosphatase and succinic dehydrogenase deposits were more prominent and abundant after 12 to 14 weeks. Ultrastructural changes in ductular epithelial cells included enlargement of nuclei and nucleoli and increased abundance of cytoplasmic rough surfaced endoplasmic reticulum (RER), ribosomes and mitochondria until nine to 12 weeks. At this interval, duct lumina appeared widely dilated with small clumps of electron dense material at the periphery adjoining apical cell membranes with severely flattened or absent microvilli. Electron dense needle-like crystals resembling protoporphyrin were clustered centrally in the lumina. After twelve weeks occasional mitochondria were markedly swollen and contained vacuolated areas. Numerous multivesicular bodies were noted. Mallory bodies were seen in a few duct cells. The spectrum of duct cell changes just noted gives further evidence of extensive liver injury after GF feeding. These changes, in addition to diverse hepatocyte alterations previously reported, constitute morphologic features of GF induced murine porphyria, also common to human porphyria and human alcoholic liver disease.

Acid Phosphatase↗

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Focal nodular hyperplasia of the liver: ultrastructural observations.

Ultrastructural studies of the liver from a non-alcoholic 21 year old male with focal nodular hyperplasia (FNH) showed hepatocyte cytoplasmic alterations including swollen and bizarre mitochondria, rough endoplasmic reticulum (RER) in short parallel stacks or whorl-like arrangements, and Mallory bodies (MB). Proliferated bile duct cells contained occasional MB-like inclusions. Small hepatic blood vessels were dilated and some showed interruption and partial loss of their endothelial cell cytoplasm and thickened basement membranes. Liver tissue outside of the lesion appeared unaltered.

Adult↗

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Hepatocyte mitochondrial alterations in griseofulvin fed mice.

Ultrastructural changes in mitochondria from hepatocytes of male Swiss Webster mice were observed during the course of porphyria induced by ingestion of a powdered diet containing 2.5 percent griseofulvin (GF). A variety of sporadic mitochondrial alterations were noted between three days and 22 weeks. Mitochondria appeared intact in hepatocytes from control mice fed powdered diet alone. The abundance and prominence of altered mitochondria increased after seven weeks and was particularly apparent after 15 weeks, concurrent with pronounced hepatomegaly and Mallory body (MB) formation. One or more changes observed in some mitochondria of several hepatocytes included: swelling, associated myelin bodies, increased matrix density, disoriented cristae, intracristal swelling, bizarre shapes, paracrystalline inclusions and elongated or spherulated giant forms. Many mitochondria showed intimate association with rough surface endoplasmic reticulum (RER) adjacent to smooth surface endoplasmic reticulum (SER). GF-induced mitochondrial defects appear to represent nonspecific morphologic alterations similar to many reported in human hepatocytes in alcoholic liver disease, porphyria and various other toxic and metabolic liver diseases. They may reflect another common site of metabolic insult between two such diverse processes as GF-induced mouse porphyria and human alcoholic liver disease.

Animals↗

PubMedDate not supplied

Serial light and electron microscopic changes in renal glomeruli in mice fed griseofulvin.

The renal glomerular mesangium in male, Swiss Webster mice, fed a diet containing 2.5 percent griseofulvin (GF), showed hypercellularity and mesangial thickening within three weeks. These changes gradually increased, peaking in prominence at 11 to 16 weeks and persisted up to 22 weeks. The tubular epithelium showed minimal light microscopic changes. There was focal hyperplasia of parietal cells of the Bowman's capsule. Ultrastructurally, the changes in the mesangial region of the glomeruli included increase in mesangial cells and mesangial matrix. The renal tubular epithelial cells showed dilatation of mitochondria and smooth endoplasmic reticulum. These changes, in addition to diverse cellular alterations in other organs previously reported, constitute the morphologic features of GF-induced renal disease.

Animals↗