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PubMed1990

Effects of mainstream and environmental tobacco smoke on the immune system in animals and humans: a review.

This review evaluates the available information on the effects of mainstream and environmental tobacco smoke on the immune system in animals and humans. The primary emphasis is on mainstream smoke since little information is available on the effects of environmental smoke. The effects of mainstream tobacco smoke on the immune system in humans and animals are similar. Animals exposed to mainstream tobacco smoke for periods of a few weeks generally exhibit a slight immunostimulation. However, subchronic and chronic exposure studies indicate that immunosuppressive changes develop. Lymphocyte proliferation in response to the mitogens PHA and LPS is decreased, suggesting compromise of cell function. Antibody production can be suppressed. Smoke-exposed animals that are challenged with metastasizing tumors or viruses have been shown to exhibit a higher incidence of tumorigenic and infectious diseases, respectively. Localized immunological changes in the lung can include reduction of bronchus-associated lymphoid tissue and immunoglobulin levels. Smoking-related changes in the peripheral immune system of humans have included elevated WBC counts, increased cytotoxic/suppressor and decreased inducer/helper T-cell numbers, slightly suppressed T-lymphocyte activity, significantly decreased natural killer cell activity, lowered circulating immunoglobin titers, except for IgE which is elevated, and increased susceptibility to infection. The effects of environmental tobacco smoke on the immune system, in contrast to mainstream tobacco smoke, have just begun to be investigated and information available in the literature, to date, is limited. Immunoreactive substances are known to be present in environmental tobacco smoke, but to date, environmental tobacco smoke has been more closely associated with irritation than sensitization. A few studies have indicated a potential for environmental smoke-induced hypersensitivity and suppression of immunoregulatory substances. In contrast, other investigators have failed to detect immunological or other biological changes associated with environmental smoke. Clearly, more research is needed to resolve these differences.

Animals↗

PubMed1993

The ethics of germ-line gene therapy: challenges to mainstream approaches by a feminist critique.

Many mainstream bioethicists visualize the ethical debate surrounding germ-line gene therapy (GLGT) as a conflict of rights and duties between a woman and her fetus and as representative of the larger tension between the principles of autonomy and beneficence and its corollary duty to nonmaleficence. Many feminist ethicists attempt to circumnavigate the purported inadequacies of mainstream ethical approaches and take a much broader, context-oriented approach to reproductive freedom. The first section will describe many of the mainstream conflicts surrounding GLGT and offer a feminist critique of the inadequacies of mainstream approaches. Instead of merely achieving a stalemate in ethical dialogue from the mainstream viewpoint, the application of a feminist view of the fetus and reproductive freedom provides a more equitable and ethically inclusive adjudication of the central issue surrounding the ethics of GLGT, as the second section will show.

Beneficence↗

PubMedDate not supplied

Pediatric nurse practitioners and educational mainstreaming.

Educational mainstreaming provides an opportunity for a developmentally delayed child to interact in an environment with nondelayed children. It fosters growth by providing opportunities that other methods of education do not have. Mainstreaming can be initiated by the pediatric nurse practitioner. As the result of the developmental assessment skills of the practitioner, early intervention, a plan of care, referral, and ongoing evaluation can be accomplished. This article looks at the pros and cons of mainstreaming, at reaching a compromise on mainstreaming, at legislation affecting the developmentally delayed child, and at how the pediatric nurse practitioner can use the integrated multidisciplinary model with these children with special needs.

Child↗

PubMed2006

Educational performance of pediatric cochlear implant recipients in mainstream classes.

OBJECTIVES: The present study documents the school performance of 20 pediatric cochlear implant recipients who attended mainstream classes and compares their educational performance with their normally hearing peers. METHODOLOGY: All 20 school-aged children who underwent cochlear implantation at the Universiti Kebangsaan Malaysia cochlear implant programme participated in this study. Three measures were employed to assess the school performance. First, using the SIFTER teacher-rating scale, the second measure was the child's examination results, and the third was the child's standing compared to his/her peers in language subject, mathematics, and the overall academic performance during the end of semester examinations. RESULTS: The SIFTER rating scale indicated that only 11.8% of the children were identified as not educationally at risk, 17.6% passed four of the SIFTER subtests, whereas the other 71.6% failed in at least two of the subtests on SIFTER. The highest pass rate was obtained in behavior subtest (76.5%), followed by classroom participation (70.6%), attention (58.8%), academic (47.1%), and communication (11.8%). On the educational performance, the cochlear implant recipients performed significantly better in mathematics (mean scores 62.67%; S.D. 22.24) than in language (mean scores 49.96%, S.D. 25.88) (p<0.01). In the overall examination performance, 25.00% had above average performance (>75th percentile), 18.75% had average performance (25-75th percentile), and another 56.25% performed at below average (<25th percentile). CONCLUSION: Children with cochlear implant were rated poorly in the SIFTER communication subtest. It is possible that language deficit presents an educational challenge in these children. The educational performance of children with cochlear implants in mainstream classes varies. Although 43.75% of them thrive well in a full-time mainstream setting, a significant percentage of them (56.25%) performed at below the average level. These findings reemphasize that although a cochlear implant has successfully provided deaf children with a good hearing potential, the majority of its recipients still require additional educational supports in order to function well in the mainstream educational setting.

Child↗

PubMed1999

Peer problems of 9- to 11-year-old children with hemiplegia in mainstream schools. Can these be predicted?

Is it possible to predict relatively early in the life of children with disabilities those who are likely to develop peer problems if they get no extra help? This question is examined in our prospective study of a representative sample of children with hemiplegia attending mainstream schools. Hemiplegia is a particularly suitable model for studying integration as it is a relatively homogeneous condition that does not usually preclude mainstream placement. Our aim was to investigate whether the excess of peer problems could be predicted from information obtained some 4 years earlier. A representative sample of 55 children with hemiplegia in mainstream education was followed prospectively from a mean age of 7.1 years (Time 1) to a mean age of 10.7 years (Time 2). Using standardized measures of peer rejection, lack of friends, and victimization, two-thirds of the sample had at least one of these problems at Time 2. A greater number of peer problems was primarily predicted by two Time-1 variables: lower IQ and more teacher-reported externalizing problems (disruptiveness and hyperactivity). A risk index based on these two variables identified a high-risk subgroup that might particularly have benefited from early intervention to reduce behavioural problems, and nurture social skills. As more children with special needs are integrated into mainstream schools, it is increasingly important to remember that supporting these children requires appropriate provision to foster their social as well as their academic and physical development.

Child↗

PubMed1987

Attitudes of elementary, middle and high school teachers toward mainstreaming: implications for job satisfaction.

Little attention has been paid to the job satisfaction experienced by human services personnel, including classroom teachers. This study examines teacher's response to postal questionnaires seeking information about job satisfaction and attitudes to the mainstreaming of children with special needs. Results suggest that teachers at secondary or high school level experience lower job satisfaction than those working in middle or elementary schools. Comparison between teachers with or without experiences of mainstreaming reveals further differences between these groups with regard to their attitude toward the value of special educator involvement in the classroom; the importance of special assessments; discipline; the role of mainstreaming in enhancing peer relationships; and appreciation of school administrators' awareness of the implications of mainstreaming.

Attitude↗

PubMed2004

Pupils' perceptions of self and of labels: moderate learning difficulties in mainstream and special schools.

BACKGROUND: The study is set in the context of international moves towards more inclusion of children with disabilities into mainstream schools and the greater importance attached to the child's voice in decision making in education. AIMS: To examine how children with moderate learning difficulties (MLD) in mainstream and special schools see themselves; to investigate their positive, negative and mixed self-perceptions; to explore their evaluations of the terms and labels used by others to describe them; and to examine whether their perceptions vary according to special educational placement, age or gender. SAMPLE: One hundred and one children; 50 in special and 51 in mainstream schools, of whom 51 were age 10-12 and 50 13-14 years; within each age group half were boys and half were girls. METHOD: Semi-structured in-depth interviews based on a common framework derived from the research questions. RESULTS: Most pupils were aware of their learning difficulties and felt mainly negative about their difficulties. Pupils in special schools had more positive self-perceptions of educational abilities than those in mainstream schools. Self-perceptions of general characteristics were mainly a mixture of positive and negative with no differences by placement. 'Stupid' and 'thick' were perceived as the most negative labels, while 'has help' was the most positive label. The SEN term was infrequently recognized. CONCLUSIONS: The findings are discussed within the context of a multi-dimensional, complex and contrary framework of self-perceptions, and reference groups as the bases for self-perceptions and as an active and interpretive process in the formation of self-perceptions.

Adolescent↗

PubMed2001

The long-term stability of sociometric status classification: a longitudinal study of included pupils who have moderate learning difficulties and their mainstream peers.

This study investigated the longitudinal stability of sociometric classification in two groups of children aged 8 to 10 years over a 2-year period. Two simple, but sensitive and valid forced-choice sociometric measures were completed by 41 children with moderate learning difficulties (MLD) and 375 mainstream children. On both occasions and on both measures (one using a "work with" and one a "play with" sociometric criterion) MLD pupils were significantly less likely to be classified as popular and more likely to be classified as rejected. Over the 2-year period just over half of the children, whether MLD or mainstream, were classified in the same sociometric category. However, the stability coefficients for the rejected and popular sociometric status groups were found to be higher in the included sample than in the mainstream sample. The results of this study are compared with previous longitudinal studies in the area that have focused on mainstream pupils, and implications for the use of sociometric measures in evaluating the outcomes of inclusion are discussed.

Child↗

PubMed1996

Immediate effects of mainstreamed settings on the social interactions and social integration of preschool children.

The immediate effects of mainstreamed and specialized settings on the peer interactions of preschool children with and without developmental delays were examined. Mainstreamed and specialized playgroups were established involving unacquainted peers and using a methodology that ensured appropriate matching of child and family characteristics. For each 2-week playgroup, the social and play interactions of each child were observed during a designated free-play period. Peer sociometric ratings also were obtained. Results indicated higher levels of peer interactions in mainstreamed settings for both typically developing children and children with developmental delays. The immediate impact of mainstreamed settings appeared to be attributed to the social demands and higher interaction levels of the former group. Children with developmental delays were not fully accepted nor totally socially integrated based on sociometric measures and behavioral indices of peer preferences. Implications of these findings for developing intervention programs to maximize children's peer-related social competence was discussed.

Child, Preschool↗

PubMed1995

A comparison of the mutagenicity of mainstream cigarette smoke condensates from a representative sample of the U.S. cigarette market with a Kentucky reference cigarette (K1R4F).

The Salmonella mutagenicity assay has been used to investigate the mutagenicity of cigarette smoke and cigarette smoke condensate. The Kentucky reference (K1R4F) cigarette is designed to be representative of full-flavor, low-tar cigarettes sold in the U.S. and to serve as a reference standard for comparative studies on the chemistry and biological activities of cigarette smoke and condensate. The objective of this study was to determine if the mutagenicity of mainstream smoke condensate from the K1R4F, as measured by the Salmonella mutagenicity assay, is representative of the mutagenic activity of U.S. cigarettes. Mainstream smoke condensates prepared in dimethyl sulfoxide from the K1R4F and 73 brand styles (representing greater than 70% of the total U.S. cigarette market) were assayed using Salmonella typhimurium TA98 and TA100 (+S9) at concentrations of 0, 25, 50, 75, 100, 125 and 250 micrograms/plate. Revertants/mg condensate were determined by calculating the slopes of the dose-response curves using linear and nonlinear regression models. Revertants/cigarette were determined by multiplying the revertants/mg condensate by the mg condensate/cigarette. No significant differences (p > 0.05) were observed between the mean mutagenicity of U.S. market and K1R4F mainstream smoke condensates in terms of revertants/mg condensate or revertants/cigarette. Increased variability in mutagenicity was observed among the U.S. brands versus that of the K1R4F. This is not surprising since variability among the U.S. brands would be expected to have both measurement error and brand style variability while the K1R4F variability contains only the measurement error portion. These results demonstrate that the K1R4F is a representative model for the U.S. cigarette market in comparative Salmonella mutagenicity studies using mainstream smoke condensates.

Mutagenicity Tests↗

PubMed2000

A comparison of the mainstream smoke chemistry and mutagenicity of a representative sample of the US cigarette market with two Kentucky reference cigarettes (K1R4F and K1R5F).

The incorporation of technologies into cigarettes such as filters, filter ventilation, porous cigarette papers, expanded tobacco and reconstituted tobacco sheet has resulted in cigarettes with a wide range of "tar" yields. The objectives of this study were to characterize the US cigarette market according to "tar" category (i.e. full flavor, FF; full flavor low tar, FFLT; or ultra low tar, ULT) and to determine whether the Kentucky reference cigarettes K1R4F and K1R5F are representative of FFLT and ULT cigarettes, respectively. As a means of characterization and comparison, the mainstream smoke from a representative sample of commercially available cigarettes from each market segment and the K1R4F and K1R5F Kentucky reference cigarettes was analyzed for the presence and level of 18 selected chemical constituents. In addition, a measure of the mutagenic activity of the mainstream smoke condensate from these cigarettes was determined using an Ames Salmonella mutagenicity assay. All cigarettes were smoked according to US Federal Trade Commission (FTC) guidelines. Results indicated that, overall, mainstream smoke constituent levels are well predicted by FTC "tar" yield--constituent levels increased as "tar" delivery increased. Based on the selected analytes measured in mainstream smoke, the K1R4F reference cigarette was generally representative of the FFLT segment of the US cigarette market. The K1R5F reference cigarette was representative of the ULT segment of the US cigarette market for cigarettes with "tar" deliveries approximate to it. In terms of mutagenic activity, a direct relationship was also demonstrated on a per cigarette basis-revertants per cigarette increased with increasing "tar" delivery. There was a weak tendency (R-square = 0.12, P = 0.08) for specific activity (revertants/mg "tar") to increase with decreasing "tar" yield-lower "tar" products had a slightly higher specific activity. No significant differences (P > 0.05) were observed when the specific activities of the condensates from the K1R4F and K1R5F reference cigarettes were compared to the market segments that they were designed to represent, FFLT and ULT, respectively. Overall, these results support the use of the K1R4F and the K1R5F as acceptable reference cigarettes for comparative mutagenicity and smoke chemistry studies of cigarettes available on the US market.

Animals↗

PubMed2006

Determination of 14 polycyclic aromatic hydrocarbons in mainstream smoke from U.S. brand and non-U.S. brand cigarettes.

Tobacco smoke contains thousands of chemical compounds, including many carcinogenic polycyclic aromatic hydrocarbons (PAHs). To determine the concentration ranges of PAHs in tobacco smoke and to understand what factors alter their levels, we quantitatively measured 14 PAHs in mainstream smoke from a transnational U.S. brand (Marlboro) and from locally popular brand cigarettes from 14 countries. We used standardized machine smoking conditions (35-mL puff volume, 60-s puff interval, and 2-s puff duration), extraction of total particulate matter from the Cambridge filters, and gas chromatography/mass spectrometry detection. Deliveries of total PAHs in mainstream smoke of local brands were statistically significantly higher (p < 0.01) than Marlboros in seven countries. In four countries, Marlboro cigarettes had mainstream smoke total PAH levels that were statistically significantly higher (p < 0.01) than local brands. In the remaining three countries, the differences in PAH levels were not statistically significant. Under standard machine smoking conditions, PAH levels were negatively correlated with cigarette filter ventilation levels. We found that several local brands containing primarily flue-cured tobacco filler had relatively high mainstream smoke PAH deliveries, in agreement with findings by previous researchers that flue-cured tobacco typically delivers more PAHs than other tobacco types. We also observed that PAHs were inversely correlated with total carcinogenic tobacco-specific nitrosamines and nitrate content, but these correlations were not statistically significant at the 95% confidence interval. The findings suggest that tobacco blend and nitrate levels may influence PAH deliveries, but other factors may confound this relation.

Air Pollutants↗

PubMed1987

Toxic and carcinogenic agents in undiluted mainstream smoke and sidestream smoke of different types of cigarettes.

The mainstream and sidestream smoke of four types of popular US cigarettes were analyzed for toxic and carcinogenic agents. The cigarettes included one without a filter tip, and one filter cigarette each with medium, low and ultra-low smoke yields. The analyses clearly demonstrated that 12 toxic agents determined in this study were significantly reduced in the mainstream smoke of filter cigarettes, as compared with smoke yields from the nonfilter cigarette. In the case of the ultra-low yield cigarette, mainstream smoke emissions were reduced by about 90%. In contrast to this finding, the emissions of the same toxic and carcinogenic components into sidestream smoke of the filter cigarettes were not greatly reduced. Sidestream smoke is the major contributor to environmental tobacco smoke, to which both smokers and non-smokers are exposed. Although the exposure of the smoker to mainstream smoke components is decreased due to proportionally greater consumption of low and ultra-low yield cigarettes, and lower rates of consumption of cigarettes with high smoke yields, the carcinogenic potential of indoor pollutants originating from tobacco products is not diminished.

Ammonia↗

PubMed1990

Implications of mainstream classrooms for adolescents with spina bifida.

This study examined the social and academic implications of mainstream, mainstream and special (combined) or special-class education for 31 adolescents with spina bifida, and for their primary caretakers. The Peabody Picture Vocabulary Test and the UCLA Loneliness Scale (adolescents) and the Personality Inventory for Children (caretakers) were administered. Adolescents in mainstream classes had the most normal scores for academic and social skills, those in combined classes had intermediate scores and those in special classes had the lowest scores. Paradoxically, adolescents in combined classes reported the least loneliness. This study suggests that even among students with relatively good social skills, mainstream placement is associated with greater subjective experience of loneliness than is combined placement.

Adolescent↗

PubMed1996

Self-disclosure experience of people with HIV infection in dedicated and mainstreamed dental facilities.

OBJECTIVES: People infected with HIV choose dental care in dedicated or mainstreamed facilities. In this study, people with HIV were asked whether they sought care in dedicated or mainstreamed dental facilities, their reasons for choosing this source of care, their HIV disclosure experiences, and what, if any, consequences the disclosure had on access to dental care. METHODS: Patients in a dedicated AIDS medical clinic (n = 84) responded to questions in a telephone survey. The sample was predominantly gay, white males with symptomatic HIV infection, from randomly chosen clinic appointments. RESULTS: The study found that 67.6 percent of respondents who had seen a dentist since their HIV diagnosis chose mainstreamed dental facilities. The majority of study participants (70%) disclosed their HIV status. Of those subjects who chose disclosure, discrimination was minimal (2.7%). CONCLUSIONS: Results suggest support for public policy encouraging people with HIV to go to any dentist with whom they feel most comfortable and with whom they will receive the best possible care, regardless of whether the dentist practices in a dedicated or mainstreamed facility.

Adult↗

PubMed2003

Differences between mainstream and sidestream cigarette smoke extracts and nicotine in the activation of platelets under static and flow conditions.

BACKGROUND: Cigarette smoke is a primary risk factor for cardiovascular diseases. Enhanced function of the hemostatic system, in which platelets play a major role, is a significant underlying mechanism in cardiovascular disease and its progression. Epidemiological studies, complemented by physiological and biochemical data, show that cigarette smoke adversely affects platelet function, both in smokers and in nonsmokers exposed to sidestream smoke. METHODS AND RESULTS: The thrombogenic potential of platelets subjected to mainstream smoke extracts, sidestream extracts, and nicotine was measured in vitro under static and dynamic flow conditions. Platelet activation state was measured with a modified prothrombinase-based method. Mainstream and sidestream smoke extracts caused increased platelet activation. Although low-tar mainstream extracts activated platelets less than high-tar extracts, the sidestream extracts were almost equally potent. Modification of the filters of low-tar cigarettes, by blocking the air-bypass holes, raised activation rates by mainstream extracts to the level of high-tar extracts. Nicotine (50 nmol/L and 5 micromol/L) inhibited platelet activation under both flow and static conditions. CONCLUSIONS: Cigarette smoke extracts directly cause platelet activation but also markedly increase the susceptibility of platelets to activation by shear stress. In contrast, nicotine, although also a constituent of cigarette smoke, significantly reduces platelet susceptibility to shear stress.

Adult↗

PubMed2001

A comparative study by electron paramagnetic resonance of free radical species in the mainstream and sidestream smoke of cigarettes with conventional acetate filters and 'bio-filters'.

Tobacco smoking is the most important extrinsic cause, after the diet, for increasing morbidity and mortality in humans. Unless current tobacco smoking patterns in industrialised and non-industrialised countries change, cigarettes will kill prematurely 10 million people a year by 2025. Greece is at the top of the list of European countries in cigarette consumption. In 1997, a Greek tobacco company introduced a new 'bio-filter' (BF) claiming that it reduces substantially the risks of smoking. In a recent publication [Deliconstantinos G, Villiotou V, Stavrides J. Scavenging effects of hemoglobin and related heme containing compounds on nitric oxide, reactive oxidants and carcinogenic volatile nitrosocompounds of cigarette smoke. A new method for protection against the dangerous cigarette constituents. Anticancer Res 1994; 14: 2717-2726] it was claimed that the new 'bio-filter' (activated carbon impregnated with dry hemoglobin) reduces certain toxic substances and oxidants (like NO, CO, NOx, H2O2, aldehydes, trace elements and nitroso-compounds) in the gas-phase of the mainstream smoke. We have investigated by electron paramagnetic resonance (EPR) the mainstream and sidestream smoke of the BF cigarette, in comparison with three other cigarettes with similar tar and nicotine contents, that have conventional acetate filters. We found that BF cigarette smoke has similar tar radical species with the same intensity EPR signals to those of the other cigarettes. The ability of the aqueous cigarette tar extracts to produce hydroxyl radicals (HO*), which were spin trapped by DMPO, was very similar to, or even higher than, the other 3 brands. The gas-phase of the mainstream smoke of the BF cigarette showed a 30-35% reduction in the production of oxygen-centered radicals (spin trapped with PBN). In the case of the sidestream smoke, BF cigarettes produced substantially higher concentrations of gas-phase radicals, compared to the other brands. These results suggest that BF is partially effective at removing some of the gas-phase oxidants but not effective in the reduction of tar and its radical species in the mainstream and sidestream smoke. It is well known from epidemiological studies that tar content is strongly associated with increasing risk to smokers of lung cancer. In our experiments, BF cigarettes produce a higher amount of tar and stable free radical species than the other 3 brands in the sidestream smoke (between puffs), thus potentially increasing risk to the smoker and passive smoker.

Acetates↗

PubMed1994

Environmental tobacco smoke is just as damaging to DNA as mainstream smoke.

This study demonstrates the ability of tar isolated from environmental tobacco smoke (ETS) to nick DNA in mammalian cells. Solutions of ETS tar behave similarly to aqueous solutions of cigarette tar from mainstream smoke. Both solutions contain the tar semiquinone radical, and this radical associates with the DNA in viable rat alveolar macrophages. Solutions of tar from ETS cause single-strand DNA breaks in rat thymocytes in proportion to the amount of tar present, until a plateau is reached. ETS tar solutions, like mainstream tar solutions, produce hydrogen peroxide. Hydrogen peroxide appears to be an essential component of the mechanism by which both ETS tar and mainstream tar cause DNA damage in rat thymocytes, as catalase substantially protects against DNA damage. Glutathione also protects against DNA nicking by both ETS and mainstream tar solutions by scavenging radicals and/or oxidants. The chelator diethylenetriamine pentaacetic acid also provides partial (40%) protection. The studies demonstrate that the water-soluble components of ETS tar can enter cells, associate with, and then nick DNA.

Air Pollutants↗