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PubMed2006

Primary health care for refugees and asylum seekers: a review of the literature and a framework for services.

OBJECTIVES: This paper aims to provide a framework for primary health care services to meet the recognized health needs of refugees and asylum seekers that can be used in planning and evaluating services for this group. REVIEW: Primary care services for refugees and asylum seekers are reviewed and presented in terms of a tripartite framework of gateway, core and ancillary services. Gateway services facilitate entry into primary care by identifying unregistered patients and carrying out health assessments. They are typically undertaken by nurse-led outreach services and specialist health visitors. Core services provide full registration and may be provided by dedicated practices or by mainstream practices, with or without additional support. Ancillary services are those that supplement and support core services' ability to meet the additional health needs of this group. They include language and information services, close links with community-based organizations, specialist mental health services and services for survivors of torture and organized violence, as well as targeted health promotion and training of health workers. CONCLUSIONS: The framework can be used for education and training, planning and commissioning, and to provide criteria for comparison and evaluation. The paper suggests that a lack of published evaluations and reports about interventions for refugees and asylum seekers constrains further policy development that could build on the strengths of such interventions. It also stresses the importance of ancillary services to successful mainstream provision.

Community Health Nursing↗

PubMed2006

Measurement of nitrogen dioxide in cigarette smoke using quantum cascade tunable infrared laser differential absorption spectroscopy (TILDAS).

Although nitrogen dioxide (NO(2)) has been previously reported to be present in cigarette smoke, the concentration estimates were derived from kinetic calculations or from measurements of aged smoke, where NO(2) was formed some time after the puff was taken. The objective of this work was to use tunable infrared laser differential absorption spectroscopy (TILDAS) equipped with a quantum cascade (QC) laser to determine if NO(2) could be detected and quantified in a fresh puff of cigarette smoke. A temporal resolution of approximately 0.16s allowed measurements to be taken directly as the NO(2) was formed during the puff. Sidestream cigarette smoke was sampled to determine if NO(2) could be detected using TILDAS. Experiments were conducted using 2R4F Kentucky Reference cigarettes with and without a Cambridge filter pad. NO(2) was detected only in the lighting puff of whole mainstream smoke (without a Cambridge filter pad), with no NO(2) detected in the subsequent puffs. The measurement precision was approximately 1.0 ppbVHz(-1/2), which allows a detection limit of approximately 0.2 ng in a 35 ml puff volume. More NO(2) was generated in the lighting puff using a match or blue flame lighter (29+/-21 ng) than when using an electric lighter (9+/-3 ng). In the presence of a Cambridge filter pad, NO(2) was observed in the gas phase mainstream smoke for every puff (total of 200+/-30 ng/cigarette) and is most likely due to smoke chemistry taking place on the Cambridge filter pad during the smoke collection process. Nitrogen dioxide was observed continuously in the sidestream smoke starting with the lighting puff.

Chemistry Techniques, Analytical↗

PubMed2006

Early postnatal exposure to cigarette smoke impairs the antigen-specific T-cell responses in the spleen.

Annually, approximately two million babies are exposed to cigarette smoke in utero and postnatally through cigarette smoking of their mothers. Exposure to mainstream cigarette smoke is known to impair both innate and adaptive immunities, and it has been hypothesized that the effects of in utero exposure to cigarette smoke on children's health might primarily stem from the adverse effects of cigarette smoke on the immune system. To simulate the environment that babies from smoking mothers encounter, we examined the effects of prenatal mainstream and postnatal sidestream cigarette smoke on spleen cell responses. Results show that postnatal exposure of newborn Balb/c mouse pups to sidestream cigarette smoke through the first 6 weeks of life strongly suppresses the antibody response of spleen cells to the T-cell-dependent antigen, sheep red blood cells. The reduction in the antibody response seen within 6 weeks of postnatal smoke exposure is much quicker than the published data on the time 25 weeks) required to establish reproducible immunosuppression in adult rats and mice. Moreover, the immunosuppression is not associated with significant changes in T-cell numbers or subset distribution. While the postnatal exposure to cigarette smoke did not affect the mitogenic response of T and B cells, the exposure inhibited the T cell receptor-mediated rise in the intracellular calcium concentration. These results suggest that the early postnatal period is highly sensitive to the immunosuppressive effects of environmental tobacco smoke, and the effects are causally associated with impaired antigen-mediated signaling in T cells.

Animals↗

PubMed2005

Smoke composition and predicting relationships for international commercial cigarettes smoked with three machine-smoking conditions.

The study objectives were to determine the effects of smoking machine puffing parameters on mainstream smoke composition and to express those effects as predicting relationships. Forty-eight commercial Philip Morris USA and Philip Morris International cigarettes from international markets and the 1R4F reference cigarette were machine-smoked using smoking conditions defined by the International Organization of Standardization (ISO), the Massachusetts Department of Public Health (MDPH), and Health Canada (HC). Cigarette tobacco fillers were analyzed for nitrate, nicotine, tobacco-specific nitrosamines (TSNA), and ammonia. Mainstream yields for tar and 44 individual smoke constituents and "smoke pH" were determined. Cigarette constituent yields typically increased in the order ISO<MDPH<HC. Relative yield increases were generally greater for cigarettes with higher initial filter ventilation and were also generally greater for vapor-phase constituents than for particulate-phase constituents. Predicting relationships were developed between ISO tar and ISO, MDPH, and HC constituent yields and between MDPH tar and HC tar and respective smoking condition yields. MDPH and HC constituent yields could be predicted with similar reliability using ISO tar or the corresponding smoking-condition tar. The reliability of the relationships varied from strong to weak, depending on particular constituents. Weak predicting relationships for nitrogen oxides and TSNA's, for example, were improved with inclusion of tobacco filler composition factors. "Smoke pH" was similar for all cigarettes at any one smoking condition, and overall marginally lower at HC conditions than at ISO or MDPH conditions.

Ammonia↗

PubMed1984

Deposition of sidestream cigarette smoke in the human respiratory tract.

The intake of sidestream cigarette smoke can be calculated if ventilation and smoke concentration are known. However, respiratory tract dose of smoke particulates cannot be determined unless the deposition fraction of inhaled smoke is known. The deposition fraction of mainstream smoke is 70-90%, far higher than expected for most particles in the size range, 0.2-0.5 micron, which is also the range for cigarette smoke. The deposition fraction of sidestream smoke was measured in five normal male subjects. The deposition, the dose of smoke particulates to the respiratory tract can be estimated. The deposition fraction of sidestream smoke is much lower than for mainstream smoke.

Humans↗

PubMed2002

Osteoarthritis: supplements and other alternative modalities.

Based on experimental evidence, a number of nontraditional approaches can serve as useful adjuncts to mainstream medical therapy for OA. The use of such therapies requires the same prudence and watchful eye as any prescription medication, with special attention to drug, food, and illness interactions. When used correctly, nontraditional approaches to OA can sometimes reduce the need for prescription medications, such as NSAIDs, along with their inherent side effect profile, or even delay the need to use prescription medications. Ultimately, the degenerative effect of OA is progressive, and neither conventional nor alternative therapies have been documented to alter disease progression. The use of these alternative therapies, when applied in an integrative medical approach, can often assist mainstream therapies in lessening pain and improving function.

Aged↗

PubMed2003

Development of the Behavioral Assessment and Research System (BARS) to detect and characterize neurotoxicity in humans.

The Behavioral Assessment and Research System (BARS) is a computer-based testing system designed to assess neurobehavioral function in humans. It was developed to provide a series or battery of neurobehavioral tests optimized for the detection of neurotoxicity in non-mainstream human populations, specifically people with limited education or literacy. Key to meeting this goal were simply-stated instructions divided into an elemental series of steps, a 9BUTTON response unit to replace the computer keyboard for responding, and spoken instructions. Modifications all underwent serial testing in target populations to successively hone the changes to be more effective. A similar process was followed when developing adjustable parameters, test reliability assessments, and when implementing these tests with populations from different cultural groups and children. The principles and experiences that guided the development of BARS should inform the development of future testing systems to ensure that the new tests can be used with non-mainstream populations, which may be increasingly subject to neurotoxic exposures.

Adolescent↗

PubMed2001

Models of acculturation and health behaviors among Latino immigrants to the US.

A basic premise of much of the health research conducted with immigrant groups is that culturally based behaviors change over time as a result of acculturation, i.e., interaction with the mainstream US culture. However, models of acculturation have not taken into account how group-specific characteristics and the varying social and political contexts immigrant groups face may impact the acculturation process. In this study of 150 families, we examined the inter-relationship of indicators of acculturation among two Latino groups to discern the impact of gender and country of origin on the relationship between variables. Results indicated that increased years of residence in the United States had the predictable impact of increased competence in English and increased use of English, but had differing impact by country of origin on the cultural orientation of the respondents' environment and on ethnic identification. Also, gender was associated with differing levels of English language use and with perceived social acceptance, such that males used more English and reported less social acceptance than females. Loading separately from the language and cultural behavior variables, this factor, perceived social acceptance, merits research as a predictor of service use given that respondents understood non-acceptance as resulting from being identified as Latino. not from behaving differently from the mainstream. The differing patterns of association by country of origin and by gender and the measurement issues these raise, highlight the importance of specifying more complex models of a cculturation than is done typically in research with Latinos.

Acculturation↗

PubMed2002

Youth homelessness in San Francisco: a life cycle approach.

HIV risk behaviors and seroprevalence are particularly high among street youth. Though many programs have been designed to serve them, street youth have low rates of service utilization. The aim of this street-based, ethnographic project was to study the social and cultural context of street life in this population. Data were collected by participant observation, exploratory interviews and semi-structured interviews. Twenty street youth (15-23 years old; six female), recruited from street sites in San Francisco, participated in the interviews. Field notes and transcriptions were analyzed using an inductive technique for model building. This analysis yielded a proposed model of the life cycle of youth homelessness. In the first on the street stage, youth face an intense psychological feeling of outsiderness, and an urgency to meet basic needs. These stresses either lead to an escape from street life or to a process of acculturation to the street. Initiation to the street is facilitated by street mentors, who provide youth with survival skills. In the stasis stage, youth reach a tenuous equilibrium in which they can meet their basic needs. A strong street ethic allows youth to rationalize significant conflicts and frequent physical suffering. Youth in stasis are repeatedly thrown into disequilibrium, crises that frequently cause them to come into greater contact with mainstream society. After repeated episodes of disequilibrium, some youth extricate themselves from street life, finding a new identity in mainstream society. Otherwise, youth return to the street, in an episode of recidivism. The life cycle model suggests that street youth who are most open to intervention are those who are in transitional states, i.e., those who have just arrived on the street or those who are in crisis (disequilibrium). If this model is validated in a larger population of youth, programs that are aimed at these two stages in the life cycle could potentially effectively complement existing programs, which are usually focused on youth in stasis.

Acculturation↗

PubMed1997

Contingent legitimacy: U.K. alternative practitioners and inter-sectoral acceptance.

Although alternative medicine has achieved an increasingly high profile in recent years, surprisingly little social research has been conducted in the area. This is noticeably the case when considering inter-sectoral contact and collaboration. This paper fills that gap by drawing on evidence from a large-scale study of non-orthodox practitioners in the U.K. By examining the lived experience of interaction the study aimed to discover the level of professional legitimacy which alternative practitioners routinely enjoy or are denied by mainstream practitioners. Results show that the last decade has been characterised by an increasing liberalisation of attitude toward inter-sectoral collaboration throughout the mainstream. However, the evidence also shows that this cannot be equated with the existence of a generalised acceptance of alternative practitioners, professional legitimacy. There is a schism within orthodoxy on this issue and that schism is occupationally based: at the extremes, consultants remain characteristically dismissive of alternative practitioners, nurses overwhelmingly enthusiastic. The nature of the non-orthodox practice being considered was of little significance. It is argued that the identification of differentiation within orthodoxy on this issue marks a significant point in developing an understanding of relations between the "sectors" and its component parts. There is a clear potential for conflicting developmental paths of action between orthodox groups, and for differing conceptions of who and what constitute a legitimate part of the medical totality. Cross-sectoral alignments, which challenge the state sanctioned dichotomy of mainstream/alternative, are viewed in quite different ways throughout orthodoxy. Knowledge of this intra-sectoral differentiation is essential to an understanding of emerging patterns of inter-sectoral relations.

Complementary Therapies↗

PubMed2002

Evaluation of the potential effects of ingredients added to cigarettes. Part 4: subchronic inhalation toxicity.

Mainstream smoke from blended research cigarettes with (test) and without (control) the addition of ingredients to the tobacco was assayed for inhalation toxicity. In total, 333 ingredients commonly used in cigarette manufacturing were assigned to three different groups. Each group of ingredients was introduced at a low and a high level to the test cigarettes. Male and female Sprague-Dawley rats were exposed nose-only either to fresh air (sham) or diluted mainstream smoke from the test, the control, or the Reference Cigarette 1R4F at a concentration of 150 microg total particulate matter/l for 90 days, 6h/day, 7 days/week. A 42-day post-inhalation period was included to evaluate reversibility of possible findings. There were no remarkable differences in in-life observations or gross pathology between test and control groups. An increase in activity of liver enzymes, known to be due to the high smoke dose, revealed no toxicologically relevant differences between the test and control groups. No toxicological differences were seen between the test and control groups for smoke-related hematological changes, such as a decrease in total leukocyte count. The basic smoke-related histopathological effects, which were more pronounced in the upper respiratory tract than in the lower respiratory tract, were hyperplasia and squamous metaplasia of the respiratory epithelium, squamous metaplasia and atrophy of the olfactory epithelium, and accumulation of pigmented alveolar macrophages. There were no relevant qualitative or quantitative differences in findings in the respiratory tract of the rats exposed to the smoke from the control and test cigarettes. The data indicate that the addition of these 333 commonly used ingredients, added to cigarettes in three groups, did not increase the inhalation toxicity of the smoke, even at the exaggerated levels used.

Administration, Inhalation↗

PubMed2003

Toxicological evaluation of propane expanded tobacco.

A tiered testing strategy has been developed to evaluate the potential for tobacco processes, ingredients, and other technological developments to increase or decrease the biological activity resulting from burning tobacco. The strategy is based on comparative chemical and biological testing. Propane expanded tobacco is an example of a processed tobacco used in the modern manufacture of cigarettes. Test cigarettes containing propane expanded tobacco were compared to control cigarettes containing tobacco expanded with a traditional expansion agent (Freon-11). The toxicological evaluation included chemistry studies using mainstream cigarette smoke (determination of selected constituent yields), in vitro studies using cigarette smoke condensate (Ames study in Salmonella typhimurium and sister chromatid exchange study in Chinese hamster ovary cells) and in vivo studies (13-week inhalation study of mainstream cigarette smoke in Sprague-Dawley rats and 30-week dermal tumor promotion study of cigarette smoke condensate in SENCAR mice). Although statistically significant differences in several smoke constituents were observed, most constituents from cigarettes containing 100% propane expanded tobacco were within market survey ranges. Furthermore, biological tests indicated that the cigarettes containing propane or Freon-11 expanded tobacco were not significantly different.

Administration, Inhalation↗

PubMed2001

Online resources for news about toxicology and other environmental topics.

Technology has revolutionized researchers' ability to find and retrieve news stories and press releases. Thanks to electronic library systems and telecommunications--notably the Internet--computer users in seconds can sift through millions of articles to locate mainstream articles about toxicology and other environmental topics. But that does not mean it is easy to find what one is looking for. There is a confusing array of databases and services that archive news articles and press releases: (1) some are free; others cost thousands of dollars a year to access, (2) some include hundreds of newspaper and magazine titles; others cover only one publication, (3) some contain archives going back decades; others have just the latest news, (4) some offer only journalistically balanced reports from mainstream news sources; others mix news with opinions and advocacy and include reports from obscure or biased sources. This article explores ways to find news online - particularly news about toxicology, hazardous chemicals, environmental health and the environment in general. The article covers web sites devoted to environmental news; sites and search engines for general-interest news; newspaper archives; commercial information services; press release distribution services and archives; and other resources and strategies for finding articles in the popular press about toxicology and the environment.

Environmental Health↗

PubMed1999

School performance and behaviour in extremely preterm growth-retarded infants.

OBJECTIVE: To describe school performance and behaviour of extremely preterm, growth-retarded infants. DESIGN: Cohort study at two tertiary care centres. Included were all surviving, singleton infants (N= 127) with fetal growth retardation due to placental insufficiency. All were delivered by caesarean section because of signs of fetal distress before the beginning of labour at a gestational age of 26 to 32 weeks during the years 1984-1989. Main outcome measures were special education, mainstream education below the appropriate age level and behaviour according to attention-deficit hyperactivity criteria at school age (4 1/2-10 1/2 yrs). The children were divided into two subgroups according to age at follow-up (> or =7 1/2 and <7 1/2 yr). A logistic regression analysis was performed with special school or repeating a grade and behavioural disturbance as dependent variables and gestational age, birth weight, sex of the infant, neonatal complications (intra cerebral haemorrhage, respiratory distress syndrome, bronchopulmonary dysplasia or sepsis), age category at follow-up and sociodemographic factors as independent variables. RESULTS: 114 (90%) had a complete follow-up. Special education was found in 14% of the assessed children. More children in the older age group than in the younger age group were placed in special school (20% versus 10%). Behavioural problems were scored in 39% of the assessed children attending mainstream education. Special education was related to neonatal complications (bronchopulmonary dysplasia), behavioural problems to the absence of either parent. CONCLUSION: This specific group of growth-retarded children is at serious disadvantage for adequate performance in school, although the incidence of special education and behavioural problems was comparable to other preterm infants. Both special education and behavioural problems were not related to obstetric variables as gestational age and/or birth weight.

Child↗

PubMed1999

Quantification of the co-mutagenic beta-carbolines, norharman and harman, in cigarette smoke condensates and cooked foods.

Co-mutagenic beta-carbolines, such as norharman and harman, were quantified in mainstream and sidestream smoke condensates of six Japanese brands of cigarettes, and also in 13 kinds of cooked foods, using a combination of blue cotton treatment and HPLC. Norharman and harman were detected in all the cigarette smoke condensate samples. Their levels in the mainstream smoke case were 900-4240 ng per cigarette for norharman, and 360-2240 ng for harman, and in sidestream smoke, 4130-8990 ng for norharman and 2100-3000 ng for harman. These beta-carbolines were also found to be present in all the cooked food samples, at levels of 2.39-795 ng for norharman and 0.62-377 ng for harman per gram of cooked food. The observed concentrations are much higher than those found for mutagenic and carcinogenic heterocyclic amines (HCAs), suggesting that humans are exposed to norharman and harman in daily life to a larger extent than to HCAs.

Carbolines↗

PubMed2003

The cytotoxic effect of volatile organic compounds of the gas phase of cigarette smoke on lung epithelial cells.

Health effects of cigarette smoke (CS) in humans are well known from both clinical and epidemiological studies. However, the mechanism behind CS toxicity and carcinogenicity remains mainly unknown. Recent studies have pointed to the major importance of the gas phase of CS in generating its cytotoxic effects. In the current study, an exposure system capable of introducing the gas phase of mainstream cigarette smoke deprived of its volatile organic constituents (VOCs) was used to study the role of the nonorganic components of the gas phase on the cytotoxicity of smoke to monolayer cultures of mouse lung epithelial cells. Cell viability was measured by Wst-1 and the lactate dehydrogenase (LDH) assays. In cells treated with increasing doses of mainstream cigarette smoke gas phase (one to nine puffs), a dose-dependent increase in cytotoxicity was observed (one puff, 95% viability; nine puffs, 40% viability). Cell viability of cultures exposed to gas phase with only the nonorganic components was found to be equivalent to control, unexposed cultures, indicating that removal of VOCs resulted in almost eliminating the cytotoxic ability of the gas phase of CS. Furthermore, the removal of VOCs seems to reduce the effects of protein tyrosine nitration mediated through the gas phase constituents. The results obtained suggest the important and decisive role of VOCs in inducing cytotoxic effects.

Animals↗

PubMed1993

Self-assessment of pubertal maturation in socially disadvantaged learning-disabled adolescents.

Reasonable concordance has been demonstrated between physicians assessment of pubertal maturation and self-assessment by healthy adolescents studying in the mainstream educational system. The purpose of this study was to determine whether pubertal maturation self-assessment may be used as a reliable screening instrument in learning-disabled adolescents. Self-assessment of sexual maturation, was investigated in 80 7th- and 8th-grade Israeli students studying in a residential school for socially disadvantaged learning-disabled adolescents of normal intelligence (LD group), and in 63 Israeli students of the same age group attending a mainstream urban school (C group). All 143 students were examined by one investigator for their annual physicals, and clinical assessment of Tanner stage was then performed. Following the examination students were asked to identify their present pubic hair maturation stage according to Tanner plates. Of the LD group, 58% assessed their pubertal stage in agreement with the investigator's assessment as did 70% of the C group. Underestimation of pubertal stage was more common in students more advanced in their pubertal development, and overestimation was more common among students who were less advanced in their maturation. Within approximation of one Tanner stage difference between the examiner and student assessments, concordance rate reached 95% in both groups. Self-assessment of pubertal development in school settings may be used as a reliable screening instrument in learning-disabled adolescents with normal intelligence, when an approximation of one developmental stage is accepted.

Adolescent↗

PubMed2003

Correlation of intimal hyperplasia development and shear stress distribution at the distal end-side-anastomosis, in vitro study using particle image velocimetry.

Low shear areas at the distal anastomosis of peripheral bypasses are thought to promote neointimal hyperplasia. In this study we evaluated the fluid dynamic environment at the distal anastomosis of peripheral bypasses by means of a new method for in vitro flow visualization and quantitative velocity field measurement. A silastic model of a distal end-side anastomosis was attached to a mock circulation loop driven by an artificial heart. High resolution velocity fields were measured by means of particle image velocimetry (PIV). The velocity vector data were used to calculate vorticity omega, strain rates ex, shear rates h and shear stresses tau. Two separations and a stagnation zone were identified by means of flow visualization. Measured velocities inside the three zones were significantly lower than in the high velocity mainstream. Calculated shear rates and shear stresses inside the zones were significantly lower than human wall shear rates. At the transition between the effective mainstream and the boundary layers high vorticity and compressive strain fields existed, indicating the presence of high shear forces. The locations of these areas corresponded to the well known zones of intimal hyperplasia. The high resolution shear stress analysis supports the low shear theory of intimal hyperplasia development. A wall diversion angle greater than 6 degrees leads to flow separation and presumed IH promotion until high shear transition areas are reached.

Anastomosis, Surgical↗