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Treatment compliance of older alcoholics: an elder-specific approach is superior to "mainstreaming".

A sample of 24 alcoholics (mean age, 58.8 years) treated in typical mixed-age outpatient groups, is compared to a sample of 25 alcoholics (mean age, 60.2 years) treated in special elderly peer groups. Patients treated in the special peer group program remained in treatment significantly longer and were more likely to complete treatment than those treated in mixed-age groups. These findings support the continued development and evaluation of elder-specific treatment approaches for older alcoholics.

Adult↗

Mainstream end-tidal carbon dioxide monitoring in the neonatal intensive care unit.

BACKGROUND: Continuous noninvasive monitoring of arterial carbon dioxide (CO2) in neonatal intensive care unit (NICU) patients would help clinicians avoid complications of hypocarbia and hypercarbia. End-tidal CO2 monitoring has not been used in this population to date, but recent technical advances and the introduction of surfactant therapy, which improves ventilation-perfusion matching, might improve the clinical utility of end-tidal monitoring. OBJECTIVE: To determine the accuracy and precision of end-tidal CO2 monitoring in NICU patients. DESIGN: Nonrandomized recording of simultaneous end-tidal and arterial CO2 pairs. SETTING: Two university NICUs. PATIENTS: Forty-five newborn infants receiving mechanical ventilation who had indwelling arterial access, and a predefined subsample of infants who were <1000 g birth weight, <8 days of age, and who received surfactant therapy (extremely low birth weight -ELBW- <8). OUTCOME MEASURES: The correlation coefficient, degree of bias, and 95% confidence interval were determined for both the overall population and the ELBW <8 subgroup. Those factors which significantly influenced the bias were identified. The ability of the end-tidal monitor to alert the clinician to instances of hypocarbia or hypercarbia was determined. RESULTS: There were 411 end-tidal/arterial pairs analyzed from 45 patients. The correlation coefficient was 0.833 and the bias was -6. 9 mm Hg (95% confidence interval, +/-11.5 mm Hg). The results did not differ markedly in the ELBW <8 infants. Measures of the degree of lung disease, the ventilation index and the oxygenation index, had small influences on the degree of bias. This type of capnometry identified 91% of the instances when the arterial CO2 pressure was between 34 and 54 mm Hg using an end-tidal range of 29 to 45 mm Hg. End-tidal values outside this range had a 63% accuracy in predicting hypocarbia or hypercarbia. CONCLUSION: End-tidal CO2 monitoring in NICU patients is as accurate as capillary or transcutaneous monitoring but less precise than the latter. It may be useful for trending or for screening patients for abnormal arterial CO2 values.

Capnography↗

Depression and primary care: drowning in the mainstream or left on the banks?

OBJECTIVE: To discuss the treatment, barriers, and successful strategies to treat depression in a primary care setting. SUMMARY: Historical, conceptual, and individual barriers hinder the treatment of depression. Additionally, a lack of clarity about whether the responsibility for care lies with primary care or behavioral health providers further leads to fragmented and uncoordinated systems. Depression is a chronic illness, not unlike diabetes, heart failure, and asthma. Therefore, disease models used to treat these chronic illnesses can also be applied to successfully treat depression. CONCLUSION: Appropriately managing patients with depression and other behavioral health conditions will require changing the entire health care system. Future strategies should include developing a continual quality improvement process, developing bridges between behavioral health and primary care, eliminating clinical and financial barriers between systems, and viewing the mind and body as a whole.

Adolescent↗

Dealing with an innovative industry: a look at flavored cigarettes promoted by mainstream brands.

Product and marketing innovation is key to the tobacco industry's success. One recent innovation was the development and marketing of flavored cigarettes as line extensions of 3 popular brands (Camel, Salem, and Kool). These products have distinctive blends and marketing as well as innovative packaging and have raised concerns in the public health community that they are targeted at youths. Several policy initiatives have aimed at banning or limiting these types of products on that basis. We describe examples of the products and their marketing and discuss their potential implications (including increased smoking experimentation, consumption, and "someday smoking"), as well as their potential impact on young adults.

Commerce↗

The policy implications of gender mainstreaming for healthcare research in the EU.

Scientific and technological progress in the life sciences and modern biotechnology is continuing at a breathtaking pace. At the same time, the potential implications for individuals and society are giving rise to intense debate. This article gives a background to the European Institute of Women's Health (EIWH) and the work of the organisation in contributing to and developing policy at a European level. We will identify the policy issues related to gender-based healthcare research arising from the EU 6th Framework Programme for Research, which was introduced this year, and the implications for the EU Public Health Strategy. Additionally, the issues of personalized medicine and the promise of biotechnology for improved medicines and healthcare will be addressed from a gender perspective. What are the prospects in the medium and long term? How can we best address the ethical and socio-economic implications?

Economics, Pharmaceutical↗

Classroom Interpreting and Visual Information Processing in Mainstream Education for Deaf Students: Live or Memorex?

This study examined visual information processing and learning in classrooms including both deaf and hearing students. Of particular interest were the effects on deaf students' learning of live (three-dimensional) versus video-recorded (two-dimensional) sign language interpreting and the visual attention strategies of more and less experienced deaf signers exposed to simultaneous, multiple sources of visual information. Results from three experiments consistently indicated no differences in learning between three-dimensional and two-dimensional presentations among hearing or deaf students. Analyses of students' allocation of visual attention and the influence of various demographic and experimental variables suggested considerable flexibility in deaf students' receptive communication skills. Nevertheless, the findings also revealed a robust advantage in learning in favor of hearing students.

Journal Article↗

Effectiveness of cigarette filter tips for reducing cadmium in relation to other mainstream smoke constituents.

The effectiveness of filter tips for reducing cadmium, tar, nicotine, carbon monoxide and carbon dioxide in cigarettes was studied. The cigarettes were made from tobacco grown on municipal sewage sludge-amended soil and were therefore high in cadmium. When machine-smoked, filter tips did not result in a significant reduction of cadmium deposited on Cambridge filters. This may indicate that a considerable fraction of cadmium is present in the vapor phase of the smoke and therefore not reduced to the same extent as the tar by certain filters. Nicotine and carbon monoxide were reduced to a lesser extent than tar. This indicates that the filter tip has influenced the combustion of the tobacco column during smoking.

Cadmium↗

Mainstreaming alternatives in veterinary medical education: resource development and curricular reform.

Veterinary medical educators are charged with preparing students to enter practice in veterinary medicine during a four-year, intensive, professional education program. This requires giving students in laboratory training that involves dead, anesthetized, or conscious animals, so that they become proficient in the expected range of veterinary knowledge, skills, and abilities. Undeniably, experience with animals is essential to prepare students for a profession in which animals comprise the total domain. However, the consumptive use of animals for teaching students, especially in laboratories, is increasingly subject to regulatory requirements, while also being scrutinized by animal protection groups, and has become a common focus of contention among veterinary students. Not surprisingly, the use of animals in teaching has sharply declined over the past few decades, as new teaching resources and methods, involving less consumptive use of animals, have been incorporated. This change in veterinary medical education has occurred on such a wide scale, in almost all veterinary schools and colleges, that the educational approach can serve as a model for further developments within the veterinary educational community and, indeed, for animal-related material in secondary schools and undergraduate higher education. This article highlights examples of the leadership provided by veterinary educators in developing alternative teaching resources and methods, while maintaining the high level of proficiency expected from traditional educational approaches.

Animal Testing Alternatives↗