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PubMedDate not supplied

"Shut up and listen": feminist health care with out-of-the-mainstream adolescent females.

PURPOSE: Models of women's health care have focused on the needs and issues of adult women and have not included those of adolescent women. This bias is true even for feminist-identified researchers and practitioners. Most health services for young women tend to deal exclusively, or in large measure, with their reproductive health, are planned by adults using an adult health care model and do not approach health care provision from a feminist perspective. In addition, there is a lack of information on the special health needs and issues of out-of-the-mainstream adolescent females such as homeless, immigrant, lesbian/bisexual identified young women. The main purpose of this paper is to describe guiding principals, as well as some of the practical pitfalls and ethical dilemmas in the provision of feminist health care for out-of-the-mainstream adolescent women.

Adolescent↗

PubMed2006

Lung inflammation in rats following subchronic exposure to cigarette mainstream smoke.

Female Sprague-Dawley rats were exposed to mainstream smoke from standard reference cigarettes and a nontobacco cellulose cigarette for 35 days. Whole smoke and smoke fractions were investigated. Lung inflammation was evaluated by differentiation of bronchoalveolar lavage cells and lymphocytes in thoracic lymph nodes. Histopathological changes in the nose and larynx were assessed. Results showed that the particulate phase of cigarette mainstream smoke is mostly responsible for inflammation in the lung (neutrophil increase up to 240-fold) and hyperplastic and metaplastic epithelial changes in the larynx, whereas irritative volatile constituents in the gas phase are mostly responsible for changes in the nose.

Animals↗

PubMed2001

Subchronic inhalation by rats of mainstream smoke from a cigarette that primarily heats tobacco compared to a cigarette that burns tobacco.

A subchronic, nose-only inhalation study comparing the potential biological activity of mainstream smoke from a cigarette that primarily heats tobacco (Eclipse) to mainstream smoke from a 1R4F reference cigarette was conducted using Sprague-Dawley rats of each gender. Smoke exposures were for 1 h/day, 5 days/wk for 13 wk, at concentrations of 0, 0.16, 0.32, or 0.64 mg wet total particulate matter (WTPM)/L air. Smoke was generated at the Federal Trade Commission standard of a 2-s puff of 35 ml, taken once per minute. Clinical signs, body and organ weights, clinical chemistry, hematology, carboxyhemoglobin, serum nicotine, plethysmography, gross pathology, and histopathology were determined. Plethysmography indicated that respiratory rate was decreased at all concentrations of 1R4F smoke, but only at the high concentration of Eclipse smoke. Tidal volume was depressed and minute volume was lower for all smoke-exposed rats. Rats exposed to Eclipse smoke inhaled more smoke at the low and mid-concentration exposures than rats exposed to equivalent concentrations 1R4F smoke. Carboxyhemoglobin and serum nicotine were directly related to the exposure concentrations of carbon monoxide (CO) and nicotine in an exposure-dependent manner. Body weights were slightly lower in smoke-exposed rats, while no treatment-related effects were seen in clinical signs, clinical chemistry, hematology, or gross changes at necropsy. The only treatment-related effect seen in organ weights was an increase in heart weight in females in the Eclipse high-concentration exposure group, attributed to higher CO in the Eclipse exposure atmosphere. Higher CO resulted from the lower dilution of Eclipse smoke required to maintain WTPM concentrations equal to those of the 1R4F smoke, and not from a higher CO yield from Eclipse cigarettes. Nasal epithelial hyperplasia and ventral laryngeal squamous metaplasia were noted after exposure to either the 1R4F or Eclipse smoke. The degree of change was less in Eclipse smoke-exposed rats. Lung macrophages were increased to a similar extent in the Eclipse and 1R4F smoke-exposed groups. Brown/gold pigmented macrophages were detected in the lungs of rats exposed to 1R4F smoke, but not those exposed to Eclipse smoke. Subsets of rats from each group were maintained for an additional 13 wk without smoke exposures. Most of the changes noted at the end of the smoke exposures had disappeared, while those that remained were regressing toward normal. Evaluation of these findings indicated the overall biological activity of Eclipse smoke was less than 1R4F smoke at comparable exposure concentrations.

Animals↗

PubMed2006

Mainstreaming interprofessional education in the United Kingdom: a position paper.

Interprofessional education (IPE) is being built into the mainstream of professional education for all health and social care professions throughout the United Kingdom (UK) driven by the Labour Government elected in 1997, coincidentally the year that this Journal hosted the first All Together Better Health conference in London. The incoming government prioritized pre-qualifying IPE to be provided in partnership by universities and service agencies supported regionally by workforce development confederations, later absorbed into strategic health authorities (SHAs), and centrally by educational, professional and regulatory bodies. Ambitious agenda for pre-qualifying IPE set by government are being tempered by realistic assessment of current outcomes borne of experience and corroborated by evidence. This paper suggests some ways to ease constraints and improve outcomes, but emphasizes the need to generate continuing interprofessional learning opportunities that build on the basics. It argues that accumulating experience and evidence must be brought to bear in formulating criteria for the approval and review of IPE within regulatory systems for professional education. Can IPE be sustained within mainstream professional education once initial enthusiasm ebbs and earmarked funds run dry? That is the issue.

Health Personnel↗

PubMed2006

Interdisciplinary benefits in Project MAINSTREAM: a promising health professions educational model to address global substance abuse.

Our purpose was to evaluate the interdisciplinary aspects of Project MAINSTREAM, a faculty development program that trained 39 competitively selected health professional tutors in substance abuse education. Mid-career faculty fellows (tutors) from 14 different health professions across the US dedicated 20% of their academic time for two years to Project MAINSTREAM. Teams of three fellows carried out curricular enhancement and service-learning field project requirements in mentored Interdisciplinary Faculty Learning Groups (IFLGs). Formative and summative evaluations were conducted via written questionnaires and confidential telephone interviews. The importance of interdisciplinary education was rated positively (mean of 3.57 on 1 - 5 scale). Using 18 parameters, fellows preferred interdisciplinary over single disciplinary teaching (means ranged from 3.40 - 4.86), and reported high levels of benefit from their interdisciplinary collaborations (means ranged from 3.53 - 4.56). Fellows reported that interdisciplinary educational collaborations were feasible (3.31) at their home institutions. The majority (63%) said that their trainees, colleagues, supervisors and institutions valued interdisciplinary training either "highly" or "somewhat", but 22% did not value it. The fellows identified scheduling conflicts (3.46), and lack of faculty rewards (3.46) such as pay or credit toward promotion, as two barriers that they encountered.

Adult↗

PubMed1985

Cadmium and nickel in mainstream particulates of cigarettes containing tobacco grown on a low-cadmium soil-sludge mixture.

Cigarettes were prepared from tobaccos grown in the greenhouse on a soil to which a low rate of a municipal sewage sludge was applied. The cigarettes were smoked by machine and the mainstream particulate fraction was analyzed for total cadmium and nickel content. Sludge-grown and control (soil-grown) tobaccos contained, respectively, 5.33 and 1.87 ppm of cadmium and 1.15 and 0.64 ppm of nickel. The average quantities of cadmium and nickel (ng/cigarette) found in the mainstream particulate fractions were, respectively, 220.5 and 78.5 for the sludge-grown and 147.4 and 72.6 for the control treatments. The difference between treatments was highly significant (p less than 0.001) for cadmium but not significant for nickel.

Cadmium↗

PubMed2006

The need for the development and evaluation of preventive psychosocial forensic interventions in mainstream adult community mental health services.

OBJECTIVE: This paper provides a selective review of forensic research with the aim of making recommendations for the development and evaluation of psychosocial interventions for the mainstream community mental health setting to address the needs of patients with a history of offending. CONCLUSION: Mainstream community mental health services can be guided by existing findings in the design of psychosocial intervention and prevention programmes. There is growing need to develop and evaluate such interventions.

Adult↗

PubMed2003

Complementary and alternative medicine in mainstream public health: a role for research in fostering integration.

In light of the increased utilization of complementary and alternative medicine (CAM) in recent years, there is an increased possibility that CAM approaches could prove to be important factors in public health, particularly if used within an integrative framework together with mainstream medicine. There exists a defined need for research to explore the integration of conventional health care and CAM approaches, as well as define mechanisms of CAM-based therapies to facilitate such integration. Essential to these goals is the accumulation of a database derived from outcomes-based clinical and basic science investigations. We posit that that CAM clinicians need to be more thoroughly trained as researchers, skilled in developing and recording results of pragmatic studies that could provide credible evidence for the use of CAM in the public sector health care. It is proposed that this may be best achieved through a three-tiered system in which (1) clinician-scientists of both mainstream and alternative disciplines recognize the value of research designed to foster such integration; (2) educational and health care institutions must develop academic and clinical training programs that examine and delineate each disciplines' respective strengths and weaknesses; and (3) such programs are attractive to, and receive continued extramural subsidy. In the broadest sense, such a paradigmatic approach to CAM integration could create a common basis for scientific dialogue, encourage exchanges between medical communities, and establish policies for the development of a true multidisciplinary health care cooperative that is consistent with the current public health model.

Complementary Therapies↗

PubMed1999

Teaching an integrated approach to complementary, alternative, and mainstream therapies for children: a curriculum evaluation.

BACKGROUND: Increasing numbers of patients seek information about complementary and alternative medicine (CAM) from their primary physicians. We sought to evaluate our 4-year old curriculum integrating mainstream and CAM care for common outpatient pediatric problems within a family medicine residency. DESIGN: Cross-sectional survey. METHODS: Subjects included current (1998) third-year residents and recent graduates from our program and nearby University of Washington-affiliated family medicine residency programs. The survey included items on training experiences, knowledge, attitudes and behavior regarding CAM. RESULTS: Among the 18 respondents from our program and 21 from comparison programs, the average age was 32 years and one-third were male. Over 80% of respondents felt that residencies should provide training in CAM. Substantial numbers of respondents from all programs recommended CAM therapies to patients in the past year. All respondents had recommended special diets and nutritional supplements; more than 50% recommended herbal remedies, acupuncture, meditation or progressive relaxation, massage or home remedies. Respondents from all groups had similar attitudes and knowledge about integrative medicine; those from the intervention program were more likely than comparison respondents to agree that their residency training had prepared them to answer patients' questions about CAM (50% vs. 19%, p = 0.04). CONCLUSIONS: Primary care residents increasingly seek training to answer patients' questions and are already recommending a variety of CAM therapies. Primary care residencies need to develop and evaluate responsible, evidence-based curricula integrating mainstream and CAM therapies.

Adult↗

PubMed1989

Tobacco-specific nitrosamines in mainstream smoke of West German cigarettes--tar alone is not a sufficient index for the carcinogenic potential of cigarette smoke.

Fifty-five types of commercial cigarettes on the West German market were analyzed for tobacco-specific nitrosamines (TSNA) in mainstream smoke. The cigarettes included filter and nonfilter cigarettes with very high, high, medium, low and ultra-low tar and nicotine yields. The observed range for N'-nitrosonornicotine was from 5 to 625 ng/cigarette and for 4-(methylnitrosoamino)-1-(3-pyridyl)-1-butanone from not detected (less than 4 ng/cigarette) to 432 ng/cigarette. The highest TSNA values were obtained for nonfilter cigarettes made of dark tobaccos and the lowest values for nonfilter Oriental-type cigarettes. Relatively high TSNA yields were also observed in filter cigarettes with moderate and lower tar deliveries. The results demonstrated that there is no correlation between TSNA and tar deliveries in mainstrain smoke. The TSNA deliveries in mainstream smoke depended on the actual tobacco composition. According to these results the tar delivery, although crucial, is not a sufficient index for the biological activity and the carcinogenic potential of cigarette smoke.

Filtration↗

PubMed1990

Analysis of 1,3-butadiene and other selected gas-phase components in cigarette mainstream and sidestream smoke by gas chromatography-mass selective detection.

An analytical procedure was developed for the analysis of 1,3-butadiene, acrolein, isoprene, benzene and toluene in the gas phase of cigarette smoke and environmental tobacco smoke (ETS) utilizing cryogenic gas chromatography-mass selective detection (GC-MSD). The MSD was operated in the selective ion monitoring (SIM) mode. The compounds of interest eluted in less than 15 min. The gas phase of freshly generated mainstream smoke was introduced into the GC-MSD via a 10-port gas sampling valve on a puff-by-puff basis. This method minimizes the ageing of tobacco smoke. The levels of 1,3-butadiene in the mainstream smoke ranged from 16 to 75 micrograms/cigarette. The gas phase of sidestream smoke was trapped in methanol using three midget impingers at -78 degrees C. The amount of 1,3-butadiene in the sidestream smoke ranged from 205-361 micrograms/cigarette. The concentration of 1,3-butadiene in ETS in a smoke-filled bar amounted to 2.7-4.5 micrograms/m3.

Acrolein↗

PubMed2003

Identity Issues for Hard-of-Hearing Adolescents Aged 11, 13, and 15 in Mainstream Setting.

This study examined identity issues and aspects of the health behaviors of mainstreamed hard-of-hearing (HOH) students aged 11, 13, and 15 compared with their peers. A sample of 52 HOH students was matched with 470 peers of the same age, gender, and ethnicity. A survey based on the World Health Organization Health Behaviours of School Aged Children was administered and the results of the hearing and the HOH groups compared. Although there were few statistically significant differences, there were indications that the HOH students more often experienced a sense of loneliness than their hearing peers did. The majority of HOH students (55.8%) did not self-identify as having a hearing disability. When examined by the willingness to self-identify, the reported frequencies of loneliness and bullying were statistically significant. These findings support the view that the school experience of a significant number of mainstreamed HOH students is not supportive. Those students who do self-identify are physically and psychologically more at risk. The reluctance to self-identify may reflect the prevalence of negative stigma.

Journal Article↗

PubMed1996

Deaf college students' perceptions of communication in mainstream classes.

Fifty deaf and hard-of-hearing students who were mainstreamed in postsecondary classes rated their classroom communication ease with hearing instructors, hearing peers, and deaf peers. A subgroup of these students participated in an in-depth interview that focused on perceptions of communication ease, support services, and attitudes of teachers and students toward deaf students in mainstreamed classes. Quantitative analyses indicated that students more comfortable in using speech in this setting reported being able to receive and send a greater amount and a higher quality of information than did students who were less comfortable in using speech. Both quantitative and qualitative results indicated that students varied considerably in their communication with hearing peers and professors, in their relations with deaf peers, and in their concerns about access. It is a challenge for interpreting and other support services to serve these various needs, especially when it is not unusual for these variations to occur in the same classroom.

Journal Article↗

PubMed1997

Balancing between deaf and hearing worlds: reflections of mainstreamed college students on relationships and social interaction.

This qualitative study of the social aspects of mainstreaming from the perspective of deaf college students indicates that for some students, social adjustment to college is complicated by experiences of separation and alienation from both deaf and hearing peers. Data were collected through open-ended interviews with deaf students who had little or no previous experience with or exposure to deaf culture or language before their arrival at a mainstream college environment. Feelings of isolation, loneliness, and resentment were most intense during orientation and first year, when alienation from the deaf student community appeared to be caused by lack of sign language skills, unfamiliarity with norms and values of deaf culture, and perceived hostility from deaf peers. Simultaneous experiences of separation from hearing peers appeared to be caused by physical barriers inherent in the classroom, residence hall, and cafeteria environments, as well as by discrimination from hearing peers, who tended to stereotype deaf students. Findings suggest that those involved in the administration and delivery of postsecondary programs for the deaf should investigate the experiences of students who arrive on campus without knowledge of sign language or familiarity with deaf culture and evaluate currently existing programs and services designed to meet these students' needs.

Journal Article↗

PubMed2004

In utero and lactation exposure of rats to 1R4F reference cigarette mainstream smoke: effect on prenatal and postnatal development.

Childhood cognitive and behavioral deficits have been reported in children born to mothers who smoked during pregnancy (Institute of Medicine, 2001). To investigate these potential responses in an animal model, reproductive and neurotoxicity evaluations based on the U.S. FDA guidelines were used to examine the offspring of male and female Sprague-Dawley rats exposed 2 h/day, 7 days/week by nose-only inhalation to whole mainstream smoke total particulate matter (TPM). Concentrations of 150, 300, or 600 mg/m(3) were used (males: 4 weeks prior to and during mating; and females: 2 weeks prior to mating, during mating, and through weaning at postnatal day 21). Sham air controls receiving filtered air and cage controls were also maintained. F(1) rats were weighed, identified by gender, examined for clinical signs of toxicity, and evaluated for neurobehavioral effects through postnatal day 65. Parental exposure was evidenced by smoke concentration-related increases in blood carboxyhemoglobin, nicotine, and cotinine and by characteristic cigarette smoke-related rodent respiratory tract histopathology. Also, nicotine and cotinine were found in F(1) blood through the lactation period. Maternal toxicity occurred at concentrations of 300 and 600 mg TPM/m(3), where total body weight gain during gestation was significantly (p < or = 0.05) decreased compared to sham controls. While smoke concentration-related decreases in F(1) birth weight and growth were evident (600 mg TPM/m(3), significantly different from sham at all time points), no adverse effects on developmental landmarks, including age at vaginal patency or preputial separation, motor activity, acoustic startle response or learning, and memory, were observed in the F(1) generation. This study confirmed that maternal exposure to high levels of mainstream cigarette smoke during gestation and lactation reduces birth weight and retards growth in the rat neonate; however, the developmental and neurobehavioral testing methodologies employed did not appear to be sensitive for an evaluation of neonatal behavioral effects following parental smoke exposure.

Administration, Inhalation↗

PubMed2006

Effect of smoking conditions and methods of collection on the mutagenicity and cytotoxicity of cigarette mainstream smoke.

There is a history for the use of in vitro bioassays to assess the toxicological properties of mainstream cigarette smoke (MSS). The results described in the literature were, for the most part, obtained with MSS collected under Federal Trade Commission (FTC) or International Organization for Standardization (ISO) conditions. However, numerous studies have shown that smokers smoke their cigarettes more intensely (e.g., they take larger puffs and/or more frequent puffs and/or partially occlude filter ventilation) than they are smoked on smoking machines operated under FTC (or ISO) conditions. It has also been reported that MSS composition changes with changes in smoking conditions. Furthermore, some governmental agencies have adopted regulations that specify more intensive protocols (i.e., Health Canada Intensive, HCI) for the collection of MSS for in vitro toxicological assays. Consequently, the performance of the Ames assay (TA98+S9, TA100+S9) and neutral red uptake assay under ISO and HCI protocols was studied with two blended (KR1R4F/KR2R4F, KR1R5F) and one flue-cured (CIM-7) reference cigarettes. The main outcome was when results were reported on a per milligram TPM (that portion of the mainstream smoke which is trapped in the smoke trap, expressed as milligrams per cigarette) basis generated under ISO conditions was more mutagenic and more cytotoxic than was TPM generated under HCI conditions. However, the decrease in biological activity could not be explained only by the increased in the water content of the TPM on going from ISO to HCI smoking conditions, and the results may be influenced by differences in smoke chemistry as a result of differing smoke collection systems.

Analysis of Variance↗

PubMed1998

The impact of vasodilators on random-pattern skin flap survival in the rat following mainstream smoke exposure.

This study demonstrates that acute mainstream cigarette smoke exposure is deleterious to dorsal random-pattern skin flap survival in the rat. Three vasodilators were also studied for their ability to mediate flap survival after smoke exposure. Sprague-Dawley rats (10 per group) were exposed to two cigarettes per day over a 14-day period. This is an exposure equivalent to that of an average cigarette smoker. Dorsal McFarlane caudally based random-pattern skin flaps (4 x 10 cm) were created on day 7 of the smoke exposure. Enteral phenoxybenzamine (0.56 mg per kilogram per day), enteral nifedipine (10 mg per kilogram per day), and topical nitroglycerin (1.3 cm or 7.5 mg per day) were administered after creation of the dorsal skin flaps in two doses daily during smoke exposure. Fluorescein was used to delineate areas of viability accurately. A pad digitizer was utilized to calculate designated skin flap areas to +/-1.0 mm2. Experimental animals demonstrated a 23% decrease (p < 0.01) in skin flap area survival compared with the control animals. The phenoxybenzamine group demonstrated a 5.5% increase in flap area survival (p=0.068), the nifedipine group demonstrated a 4.1% increase in flap area survival (p=0.049), and the nitroglycerin group demonstrated an 8.9% increase in flap area survival (p=0.049). These data suggest that phenoxybenzamine appears to affect skin flap survival marginally after smoke exposure. However, nifedipine and nitroglycerin improve random-pattern skin flap survival significantly after mainstream cigarette smoke exposure in the rat. These results imply that pharmacological intervention with vasodilators may ultimately prove clinically useful for random-pattern skin flap salvage in the cigarette-smoking patient.

Animals↗

PubMed1981

Mildly handicapped children in the mainstream--implications for the health educator.

The Education for All Handicapped Children Act of 1975, PL 94-142, will cause mildly handicapped children to be integrated into mainstream academic classes including health education. Because of the disparate needs of these children, health educators will have to provide for a diverse group of learners. Since it is clear that health education encompasses topics crucial to the overall social and personal development of the handicapped, it is essential that health educators become prepared to maximize learning opportunities for the handicapped child in the mainstream.

Child↗