Behavior modification, behavior therapy, and environmental design.
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Behavior Therapy↗
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Modern biotechnology: a review of current regulatory status and identification of research and regulatory needs.
Modern biotechnology encompasses many technologies. The one that has generated the most public interest is that of genetic engineering. The field has advanced dramatically since the early 1970's, when concern was so high that a moratorium was declared on research using recombinant DNA. Today there are numerous products such as human growth hormone, interferon and monoclonal antibody diagnostic kits on the market. Despite the obvious benefits of these products, there are still concerns over the environmental application of genetically engineered organisms. Many countries have assessed their existing legislation to ascertain its adequacy to regulate such intended releases. Numerous international organizations are becoming involved as well, and optimistically, regulations that are being developed in various countries may be harmonized. These activities have identified several areas where more information is required, including microbial taxonomy and classification, pathogenicity in target and non-target species, environmental behavior and risk assessment processes. Consensus at this time appears to be that our predictive capabilities are still developing and that new organisms should be evaluated on a case-by-case basis.
Biotechnology↗
Time dependent ethnic convergence in colorectal cancer survival in Hawaii.
BACKGROUND: Although colorectal cancer death rates have been declining, this trend is not consistent across all ethnic groups. Biological, environmental, behavioral and socioeconomic explanations exist, but the reason for this discrepancy remains inconclusive. We examined the hypothesis that improved cancer screening across all ethnic groups will reduce ethnic differences in colorectal cancer survival. METHODS: Through the Hawaii Tumor Registry 16,424 patients diagnosed with colorectal cancer were identified during the years 1960-2000. Cox regression analyses were performed for each of three cohorts stratified by ethnicity (Caucasian, Japanese, Hawaiian, Filipino, and Chinese). The models included stage of diagnosis, year of diagnosis, age, and sex as predictors of survival. RESULTS: Mortality rates improved significantly for all ethnic groups. Moreover, with the exception of Hawaiians, rates for all ethnic groups converged over time. Persistently lower survival for Hawaiians appeared linked with more cancer treatment. CONCLUSION: Ethnic disparities in colorectal cancer mortality rates appear primarily the result of differential utilization of health care. If modern screening procedures can be provided equally to all ethnic groups, ethnic outcome differences can be virtually eliminated.
Adult↗
Field ecology of toxic Pfiesteria complex species and a conservative analysis of their role in estuarine fish kills.
Within the past decade, toxic Pfiesteria outbreaks have been documented in poorly flushed, eutrophic areas of the largest and second largest estuaries on the U.S. mainland. Here we summarize a decadal field effort in fish kill assessment, encompassing kills related to Pfiesteria (49 major kills in North Carolina estuaries since 1991 and 4 in Maryland estuaries in 1997) and to other factors such as low oxygen stress (79 major fish kills in North Carolina estuaries). The laboratory and field data considered in developing our protocols are described, including toxic Pfiesteria behavior, environmental conditions conducive to toxic Pfiesteria activity, and impacts of toxic clonal Pfiesteria on fish health. We outline the steps of the standardized fish bioassay procedure that has been used since 1991 to diagnose whether actively toxic Pfiesteria was present during estuarine fish kills. Detailed data are given for a 1998 toxic Pfiesteria outbreak in the Neuse Estuary in North Carolina to illustrate of the full suite of diagnostic steps completed. We demonstrate that our conservative approach in implicating toxic Pfiesteria involvement in fish kills has biased in favor of causes other than Pfiesteria. Data are summarized from experiments that have shown stimulation of toxic Pfiesteria strains by nutrient (N, P) enrichment, supporting field observations of highest abundance of toxic strains in eutrophic estuaries. On the basis of a decade of research on toxic Pfiesteria, we present a conceptual model of the seasonal dynamics of toxic strains as affected by changing food resources and weather patterns. We also recommend protocols and research approaches that will strengthen the science of fish kill assessment related to Pfiesteria and/or other causative factors.
Animals↗
Health effects of air pollution in southern Europe: are there interacting factors?
Recent results suggest that adverse health effects of air pollution exist at levels of pollutants around or even below air quality standards set by national and international institutions. Furthermore, there are indications that air pollution effects on health may be partly determined by specific mixtures of air pollutants and may be altered by other environmental, behavioral, and social patterns. Southern European countries share some common characteristics in terms of climate, geography, and life activity patterns. Results from studies undertaken in France, Greece, Italy, Portugal, and Spain investigating short- and long-term air pollution health effects are presented and their consistency demonstrated. These results provide adequate evidence that health effects--particularly short-term--of the currently measured urban air pollution levels exist. However, information available so far does not allow an assessment of regional differences in the health effects of air pollution as far as the Mediterranean region of Europe is concerned. It is suggested that the interaction between the traditional pollution (mainly characterized by high levels of black smoke and SO2) and photochemical pollution must be investigated in this area, as well as the possible interaction between air pollution and high temperature and other meteorologic factors. In addition, measurements of individual exposure to different pollutants, affected by the pollutant's levels in specific micro-environments and the individual's time-activity pattern, must be undertaken for a better understanding of the air pollution-health link. Finally, the importance of the reported air pollution health effects in terms of public health must be addressed more closely.
Air Pollution↗
Familial obesity as a proxy for omitted variables in the obesity-mortality relationship.
In a conventional survival analysis of a sample of the U.S. population in 1971-1974, the association between mortality and obesity is compared with the analogous risk from the presence of an obese person in a household. The two factors have similar risk profiles, with a hazard ratio of 1.44 for nonmorbid obesity and 1.48 for nonmorbid familial obesity in one sample. If "familial obesity" cannot directly affect personal longevity, and if shared factors determine both personal and familial obesity, the mortality risk of family and actual personal obesity is similarly overstated. This false positive in the estimated risk arises from correlations among obesity and unobserved environmental, behavioral, or genetic factors.
Adult↗
System dynamics modeling for public health: background and opportunities.
The systems modeling methodology of system dynamics is well suited to address the dynamic complexity that characterizes many public health issues. The system dynamics approach involves the development of computer simulation models that portray processes of accumulation and feedback and that may be tested systematically to find effective policies for overcoming policy resistance. System dynamics modeling of chronic disease prevention should seek to incorporate all the basic elements of a modern ecological approach, including disease outcomes, health and risk behaviors, environmental factors, and health-related resources and delivery systems. System dynamics shows promise as a means of modeling multiple interacting diseases and risks, the interaction of delivery systems and diseased populations, and matters of national and state policy.
Chronic Disease↗
Incidence and predictors of smokeless tobacco use among US youth.
OBJECTIVES: The purpose of this study was to provide estimates of the cumulative incidence of initiation of smokeless tobacco use in a cohort of young persons and to explore sociodemographic, environmental, behavioral, and personal predictors of experimentation with and regular use of snuff or chewing tobacco. METHODS: The data for this cohort study were derived from the 1989 Teenage Attitudes and Practices Survey and its 1993 follow-up. The study included 7830 young people 11 through 19 years of age at baseline. RESULTS: During the 4 years, 12.7% of participants (20.9% of male participants) first tried smokeless tobacco, and 4.0% (8.0% of male participants) became self-classified regular users. This suggests that, each year, approximately 824000 young people in the United States 11 to 19 years of age experiment with smokeless tobacco and about 304 000 become regular users. Cumulative incidence was highest for male non-Hispanic Whites. Predictors of regular use included age, geographic region, cigarette smoking, participation in organized sports, and perceived friends' approval or indifference. CONCLUSIONS: Public health approaches to preventing use of smokeless tobacco should include development of skills for responding to pressures to use tobacco.
Adolescent↗
Significant others and fear of crime among the elderly.
The authors examine demographic, environmental, behavioral, and social psychological factors that affect fear of crime among the elderly. Using a structural equation model, relevant variables are examined. Confirming earlier studies, elderly women are found to be more fearful than other groups. Further, social isolation, type of housing, length of residence, and area of the city are all related to fear of crime in a predicted direction. The fearful individual expressed low satisfaction with the job being done by the police in providing protection from crime. Social interaction with neighbors and friends reduces the fear of crime among the elderly. Surprisingly, the more they socialize with their relatives, the more fear they express.
Aged↗
Depression in intensive care units.
There is thought to be a high incidence of depression in intensive care units (ICUs), both as a result of the psychological toll of serious illness and threat to life as well as the physiologic derangements caused by illnesses and treatments. The authors outline a strategy to classify ICU depressions into major depressive illness, adjustment disorders, dysthymic disorder, or organic affective syndrome. Other psychiatric disturbances which may simulate depression are also discussed. A summary of environmental, behavioral, psychotherapeutic, and psychopharmacologic treatments for these disorders and their special application in the ICU setting is presented. The limitations and precautions with antidepressant drugs in this clinical site are reviewed.
Adjustment Disorders↗
Design of a socio-ecologic caries model and testing on 50-year-old citizens of Oslo, Norway.
The purpose of the present study was to design a socio-ecologic caries model based on a general health model and to test the fit of data collected from a random sample of 200 50-year-old Oslo citizens to this designed model. The intention was also to investigate the relative importance of the four items environmental, behavioral, human biology, and health care organization factors. The dependent variable, number of carious surfaces, was recorded clinically and radiologically. The mean number of carious surfaces was 3.0 (SD, 3.5), with a range from 0 to 17, and the four items explained 5%, 25%, 28%, and 13% of the variance in number of carious surfaces, respectively. The complete model explained 42%, whereas traditionally used variables on the basis of the Keyes triad explained only 22% of the variance. The findings from the present study indicate that dental caries is a multifactorial disease with both behavioral and biologic determinants, and the socio-ecologic caries model represents a relevant supplement to the Keyes triad.
Attitude to Health↗
Computerized chronothermodynamic breast examinations under ambulatory conditions.
A new approach to the assessment of breast health was developed based upon continuous ambulatory recording of breast temperature for 24 hrs. A new data acquisition system consisting of a portable, multi-channel, microprocessor-based recorder worn on a belt was developed to record temperatures. Dramatic thermal fluctuations were noted during the recordings in response to multiple stimuli (physiological, behavioral, environmental). Specific algorithms and software programs were developed to process the thermobiologic and chronobiologic information. Data processing was fully automatic and included an examination report indicating a score and a chronothermodynamic class for each of the five areas examined on each breast. The preliminary clinical studies have concerned more than 450 patients with healthy or diseased breasts.
Ambulatory Care↗
Cocaine: an overview of current issues.
A period of ascendancy of cocaine use has had implications in matters of science, public health, and national and international politics and has been the subject of numerous reviews. The present paper provides a critical overview concerning use and prevalence, and addresses a range of current issues of interest. Patterns of use, dose, tolerance, sensitization, routes of administration, and hazards of use are considered based on laboratory, epidemiological, and clinical data. Aspects of treatment are discussed. The need for developing a model of drug abuse recognizing pharmacological-neurochemical-behavioral-environmental interactions is noted. Suggestions are made concerning future directions of policy and research. The need to develop scientific goals and public policy vis-à-vis cocaine, and other stimulants, based on a historical perspective as well as current concerns is emphasized.
Cocaine↗
Shaken baby syndrome: identification, intervention, and prevention.
More than 1 million children are severely abused annually. Shaken baby syndrome (SBS), one example of physical abuse, is a leading cause of morbidity and mortality in infants. There is a national annual incidence in the United States of 750 to 3,750 cases of SBS. Shaken baby syndrome is defined as vigorous manual shaking of an infant who is being held by the extremities or shoulders, leading to whiplash-induced intracranial and intraocular bleeding with no external signs of head trauma. Shaken baby syndrome should be suspected in infants with a wide spectrum of clinical signs and symptoms. The classic findings of SBS are retinal hemorrhages, usually bilateral, and intracranial injury. One third of the victims of SBS survive with few or no sequelae, one third suffer permanent injury, and one third die. Parental behaviors, environmental factors, and child characteristics all may contribute to a shaking event. The nurse practitioner, in a wide variety of clinical settings, is in a strategic position for the early identification and intervention for families at risk for SBS. Prevention through parent, caregiver, and community-wide education programs is the only option for infants who are at risk for SBS.
Battered Child Syndrome↗
Major histocompatibility complex class II polymorphisms and risk of cervical cancer and human papillomavirus infection in Brazilian women.
Infection with high-risk human papillomavirus (HPV) is the major risk factor for the development of malignant lesions in the uterine cervix. Environmental, behavioral, and ill-defined genetic factors also have been implicated in the pathogenesis of this disease. Associations between human leukocyte antigens (HLAs) and cervical cancer, precursor lesions, and HPV infections have been reported in several populations. To verify whether HLA-DRB1, -DQA1, and -DQB1 diversity is related to cervical cancer in the Brazilian population, 161 cases and 257 controls were HLA typed. Variants of DQA1 and DQB1 promoter regions were also typed in 92 cases and 228 controls. Polymorphism in HLA genes and promoters was distinguished by PCR-based methods, and the magnitude of associations was determined by logistic regression analysis. DRB1*15 [confounder-adjusted odds ratio (OR), 2.24; 95% confidence interval (CI), 1.29-3.90], DRB1*1503 (OR, 2.52; 95% CI, 1.16-5.48), and haplotype DRB1*15-DQB1*0602 (OR, 2.04; 95% CI, 1.15-3.61) were positively associated with cervical cancer. When we considered only DR15 haplotypes that did not carry the DQB1*0602 allele, the risk attributed to DRB1*15 more than doubled. A negative association was found between DQB1*05 and cervical cancer (OR, 0.57; 95% CI, 0.35-0.92), and similar trends were observed for DQA1*0101/04, DRB1*0101, and DRB1*1302. HPV positivity among controls was associated with DRB1*1503 (OR, 4.60; 95% CI, 1.33-15.9), DRB1*0405 (OR, 6.21; 95% CI, 1.66-23.2), and DQB1*0602 (OR, 2.48; 95% CI, 1.06-5.80). We suggest that HLA class II polymorphisms are involved in genetic susceptibility to cervical cancer and HPV infection in a Brazilian population from an area with a high incidence of this neoplasia.
Adolescent↗
The role of neuroendocrine system in the pathogenesis of rheumatic diseases (minireview).
Interactions between the neuroendocrine and immune system play an important role in maintaining and restoring homeostasis. In susceptible individuals a dysfunction of the neuroendocrine system may be one of the risk factors involved in the pathogenesis of rheumatic diseases. Specific causes of altered neuroendocrine function are still not fully elucidated. Accumulation of genetical, environmental, behavioral and other risk factors during long preclinical period may result in chronic imbalances in homeostatic mechanisms maintained by neuroendocrine, microvascular and immune systems. Chronic inflammatory stress mediated by humoral and neural signals during active stages of the disease and autoantibodies against the structures of the neuroendocrine system may further participate in the neuroendocrine dysfunction. In a subset of patients with rheumatoid arthritis (RA), an assumed defect of the hypothalamic-pituitary-adrenocortical axis may be implicated in the pathogenesis. Results of some studies support the concept of adrenal dysfunction in women with premenopausal onset of the RA. Significantly lower levels of dehydroepiandrosterone sulfate (DHEAS) plasma levels of women who subsequently developed RA indicate that neuroendocrine dysfunction may be present already in preclinical period and thus are not only secondary due to ongoing inflammatory process. These findings are sketching the new prospects of possible primary prevention of RA in the future. The role of some other hormones including prolactin, growth hormone, sex hormones and involvement of autonomic nervous system in relation with the rheumatic diseases is also reviewed in the paper. Further research concerning their role in the pathogenesis of other rheumatic diseases will possibly provide new prospects in optimizing their therapy.
Autonomic Nervous System↗
[Addiction: a disease like no other?].
Addiction is undoubtedly a prototypical complex disorder owing to its multidimensional characteristics: socio-political, environmental, behavioral and cognitive, cellular-molecular, and perhaps genetic. At least four main questions are now open to debate: 1. the definition (what is drug dependence) posits that at the core of the syndrome three constructs must be considered: compulsive use, loss of control and a spiralling affective negative state, suggesting that complex neuropsychological-cognitive and emotional processes are involved; 2. there are huge individual differences concerning vulnerability to drugs and finally few subjects using drugs in a recreational way will succomb, a fact not reflected in the animal model; 3. at the neurospsychiatric level many brain regions, as well as hormonal systems, are functionally intricated, well beyond the classical dopamine-reward system; 4. the neurobiological adaptation that occurs in the course of dependence is often labelled as sensitization, which constitutes an oversimplification.
Cognition↗
Family history, diabetes, and other demographic and risk factors among participants of the National Health and Nutrition Examination Survey 1999-2002.
INTRODUCTION: Family history of diabetes has been recognized as an important risk factor of the disease. Family medical history represents valuable genomic information because it characterizes the combined interactions between environmental, behavioral, and genetic factors. This study examined the strength and effect of having a family history of diabetes on the prevalence of self-reported, previously diagnosed diabetes among adult participants of the National Health and Nutrition Examination Survey 199-2002. METHODS: The study population included data from 10,283 participants aged 20 years and older. Gender, age, race/ethnicity, poverty income ratio, education level, body mass index, and family history of diabetes were examined in relation to diabetes status. Diabetes prevalence estimates and odds ratios of diabetes were calculated based on family history and other factors. RESULTS: The prevalence of diabetes among individuals who have a first-degree relative with diabetes (14.3%) was significantly higher than that of individuals without a family history (3.2%), corresponding to a crude odds ratio of five. Both prevalence and odds ratio estimates significantly increased with the number of relatives affected with diabetes. Family history was also associated with several demographic and risk factors. CONCLUSION: Family history of diabetes was shown to be a significant predictor of diabetes prevalence in the adult U.S. population. We advocate the inclusion of family history assessment in public health prevention and screening programs as an inexpensive and valuable source of genomic information and measure of diabetes risk.
Adult↗