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Making the best of consumer participation.

Organizations that have engaged consumers in their work using traditional patient satisfaction tools have accomplished a number of significant outcomes. However, organizations are now being challenged to move into more meaningful collaborations with consumers regarding evaluating and improving services. This study describes and evaluates the effectiveness of consumer partnerships established to cover a project that lasted for about 4 months. Surveys were conducted with staff and consumers involved in the project. Structured questionnaires were used for both groups and the consumers were invited to focus interviews to explore specific issues. Issues regarding recruitment, preparation and management of consumers are important if satisfactory outcomes are to be realised. Further, staff attitudes and behaviours were examined that indicated staff shared the view that engagement of consumers was a worthwhile exercise. Quality consumer collaborations can bring about organizations being a highly valued community assets.

Attitude of Health Personnel↗

Fostering self-help on an inpatient unit.

A self-help movement for people with chronic mental illness is growing but is not as advanced as the system of self-help for the chemically dependent. Barriers to organized self-help among those with chronic mental illness include stigma, denial, and the debilitating effects of the illnesses themselves. The authors developed a coping group on a 12-bed psychiatric unit to address these problems. The group was designed to strengthen ties with a local self-help club and to foster the idea that people with chronic mental illness can have a positive impact on the course of their illness. Mental health consumers who were successfully coping with their illnesses were guest speakers and role models for group members. The coping group, which was well received by participants, stimulated research questions and suggested potential modifications of clinical practice. In recent years, a mental health consumer movement has gathered momentum. Individuals who have been receiving psychiatric services are now clamoring for a more active role. There are currently several national consumer organizations that are growing in power and visibility. Some self-help groups, like Recovery Inc., are primarily therapy groups concerned with personal growth. Others, like the National Mental Health Consumers Association, are involved in supporting research and empowerment through political action as well as focusing on mutual-aid groups.

Adaptation, Psychological↗

Pharmaceutical regulation in the European Community: barriers to single market integration.

The European Community (EC) plans to create a single market for pharmaceutical medicines, but the drug industry is closely linked to cultural and societal values concerning health; to the national regulatory agencies responsible for the evaluation of safety, quality, and efficacy of new drugs; to multinational and domestic companies competing in national and international markets; and to varied interest groups of professionals and consumers organized along national and multinational lines. We review the history of the EC's policy proposals, examine reactions from all these interested parties, and assess the prospects for integration into a single market. The contentious debate that continues among the parties over national prerogatives, industrial interests, professional mandates, and consumer concerns clouds the prospects for a system of centralized drug registration that will be acceptable to all EC member states.

Community Participation↗

Variations in BOD, algal biomass and organic matter biodegradation constants in a wind-mixed tropical facultative waste stabilization pond.

This study considered the impact of wind mixing on the efficiency of BOD removal and the first order biodegradation constant for organic matter in a primary facultative pond. Wind speeds of 1-4 m/s blowing from the effluent end of the pond towards the influent created surface-water flows of up to 0.94 m/s as determined by orange and coconut drogues moving in the opposite direction to the bulk hydraulic flow of 0.217 m/s. This was sufficient to cause mixing of the water column resulting in loss of stratification in terms of chlorophyll a, temperature and dissolved oxygen. BOD and chlorophyll a concentrations were spatially and temporally homogeneous throughout this large pond. BOD removal efficiency was only 50.30% as opposed to a projected value of 79% despite an acceptable surface organic loading of 350 kgBOD5/ha/d and an actual k value for BOD removal using influent sewage samples of 0.29 d-1 close to the projected value of 0.30 d-1. It would seem that wind mixing reduced pond efficiency by destroying stratification and thus reducing the microbial activity necessary to consume organic material. Mixing also increased the mean chlorophyll a concentration compared to stratified facultative ponds receiving similar loads and non-motile algae dominated the water column.

Biodegradation, Environmental↗

Comparative ecology of H2 cycling in sedimentary and phototrophic ecosystems.

The simple biochemistry of H2 is critical to a large number of microbial processes, affecting the interaction of organisms with each other and with the environment. The sensitivity of each of these processes to H2 can be described collectively, through the quantitative language of thermodynamics. A necessary prerequisite is to understand the factors that, in turn, control H2 partial pressures. These factors are assessed for two distinctly different ecosystems. In anoxic sediments from Cape Lookout Bight (North Carolina, USA), H2 partial pressures are strictly maintained at low, steady-state levels by H2-consuming organisms, in a fashion that can be quantitatively predicted by simple thermodynamic calculations. In phototrophic microbial mats from Baja California (Mexico), H2 partial pressures are controlled by the activity of light-sensitive H2-producing organisms, and consequently fluctuate over orders of magnitude on a daily basis. The differences in H2 cycling can subsequently impact any of the H2-sensitive microbial processes in these systems. In one example, methanogenesis in Cape Lookout Bight sediments is completely suppressed through the efficient consumption of H2 by sulfate-reducing bacteria; in contrast, elevated levels of H2 prevail in the producer-controlled phototrophic system, and methanogenesis occurs readily in the presence of 40 mM sulfate.

Bacteria↗

To prevent alcohol problems in Europe by community actions--various national and regional contexts.

The European transformation during the 1990s, concerning political, economic, social and cultural changes, has made alcohol policy in many countries very fragile and uncertain because of new social and economic conditions and decreasing power of national governments. On this background, regions, municipalities, nongovernmental organizations and the civic society are to play a more prominent role in the European alcohol policy arena. In December 1997 the first European research and evaluation symposium on community action alcohol programs was held in Malmö, Sweden. The themes were: Research-based evaluation of community action programs; The interaction between local, national, and European prevention strategies; Local programs in schools, workplaces, health sectors, primary health care, and other community contexts; The role of citizens' movements, consumer organizations, women's groups, and other voluntary organizations; Local political action. This paper is the first attempt to summarize the similarities and differences in the programs presented at the symposium.

Alcohol Drinking↗

Sensitivity of ecotoxicological tests in analysis of superfund sites.

During the analysis of environmental risk posed by hazardous waste disposal sites, ecological impact on whole ecosystems should be assessed. It requires a complex testing scheme where surrogate species represent key elements of the ecosystem. However, different organisms are exposed to a differing degree, also, their sensitivity to the same contaminant may vary. A possible way to determine which test reflects most the actual toxic conditions, correlation can be calculated between the measured ecological parameter (such as growth inhibition, mortality, etc.) and a contaminant gradient. The basic aim of this study was to determine which ecotoxicological test shows the best correlation with the measured analytical parameters. The selected tests were Lemna minor (representing primary producers), Thamnocephalus platyurus (a primary consumer organism) and Vibrio fischeri (decomposer). When testing soil samples, the Thamnocephalus test showed excellent consistency with most contaminants but was oversensitive in the case of groundwater samples. The Vibrio fischeri bioluminescence inhibition test (ToxAlert) behaved in a different way, reflecting well the distribution of most contaminants in groundwater samples. Finally, Lemna test proved to be completely inadequate.

Aliivibrio fischeri↗

Safeguards at risk: John Graham and Corporate America's Back Door to the Bush White House Excerpts from a Public Citizen report.

The non-profit consumer organization Public Citizen released an investigatory report in March about the activities of industry-backed academic John Graham, head of the Harvard Center for Risk Analysis, who has been nominated by President Bush to lead the Office of Information and Regulatory Affairs (OIRA) within the White House s Office of Management and Budget (OMB). Public Citizen said at the time that the appointment would give industry a back door to the White House and enable it to step up its campaign to dismantle basic consumer protections under the pretense of applying sound science. Graham s nomination poses troubling implications, Joan Claybrook, president of Public Citizen, said. Rather than being a fair-minded assessor, Graham would continue to conspire with the chemical polluters, the tobacco industry, automakers, the oil and gas industries and others to stop the issuance of safety protections. The Senate must delve into the many conflicts he would bring to the job and reject this nomination. Below, we excerpt two portions of the Public Citizen report. One shows Graham s many corporate relationships; the other explains his involvement in environmental tobacco smoke issues. The full report, including the references that are omitted here, is available at www.publiccitizen.org. The report was researched and written by Laura MacCleery, with assistance from Paul Schmitt, Debbie Quint, Daniel Becker, and Ed Ricci. Editorial assistance and direction were given by Joan Claybrook, Booth Gunter, Angela Bradbery, Melissa Luttrell and David Vladeck.

Journal Article↗

Diffusion of the Interspecies Electron Carriers H(2) and Formate in Methanogenic Ecosystems and Its Implications in the Measurement of K(m) for H(2) or Formate Uptake.

We calculated the potential H(2) and formate diffusion between microbes and found that at H(2) concentrations commonly found in nature, H(2) could not diffuse rapidly enough to dispersed methanogenic cells to account for the rate of methane synthesis but formate could. Our calculations were based on individual organisms dispersed in the medium, as supported by microscopic observations of butyrate-degrading cocultures. We isolated an axenic culture of Syntrophomonas wolfei and cultivated it on butyrate in syntrophic coculture with Methanobacterium formicicum; during growth the H(2) concentration was 63 nM (10.6 Pa). S. wolfei contained formate dehydrogenase activity (as does M. formicicum), which would allow interspecies formate transfer in that coculture. Thus, interspecies formate transfer may be the predominant mechanism of syntrophy. Our diffusion calculations also indicated that H(2) concentration at the cell surface of H(2)-consuming organisms was low but increased to approximately the bulk-fluid concentration at a distance of about 10 mum from the surface. Thus, routine estimation of kinetic parameters would greatly overestimate the K(m) for H(2) or formate.

Journal Article↗

A 96-well single-pot liquid-liquid extraction, hydrophilic interaction liquid chromatography-mass spectrometry method for the determination of muraglitazar in human plasma.

A single-pot liquid-liquid extraction (LLE) with hydrophilic interaction liquid chromatography/tandem mass spectrometry (HILIC/MS/MS) method has been developed and validated for the determination of muraglitazar, a hydrophobic diabetes drug, in human plasma. To 0.050 ml of each plasma sample in a 96-well plate, the internal standard solution in acetonitrile and toluene were added to extract the compound of interest. The plate was vortexed, followed by centrifugation. The organic layer was then directly injected into an LC/MS/MS system. Chromatographic separation was achieved isocratically on a Thermohypersil_Keystone, Hypersil silica column (3 mmx50 mm, 3 microm). The mobile phase contained 85% of methyl t-butyl ether and 15% of 90/10 (v/v) acetonitrile/water with 0.3% trifluoroacetic acid. Post-column mobile phase of 50/50 (v/v) acetonitrile/water containing 0.1% formic acid was added. Detection was by positive ion electrospray tandem mass spectrometry on a Sciex API 4000. The standard curve, ranged from 1 to 1000 ng/ml, was fitted to a 1/x weighted quadratic regression model. This single-pot LLE approach effectively eliminated time-consuming organic layer transfer, dry-down, and sample reconstitution steps, which are essential for a conventional liquid-liquid extraction procedure. The modified mobile phase was more compatible with the direct injection of the commonly used extraction solvents in LLE. Furthermore, the modified mobile phase improved the retention of muraglitazar, a hydrophobic compound, on the normal phase silica column. The validation results demonstrated that this method was rugged and suitable for analyzing muraglitazar in human plasma. In comparison with a revised-phase LC/MS/MS method, this single-pot LLE, HILIC/MS/MS method improved the detection sensitivity by more than four-fold based upon the LLOQ signal to noise ratio. This approach may be applied to other hydrophobic compounds with proper modification of the mobile phase compositions.

Chromatography, Liquid↗

Rehabilitation Medicine Summit: building research capacity.

The general objective of the "Rehabilitation Medicine Summit: Building Research Capacity" was to advance and promote research in medical rehabilitation by making recommendations to expand research capacity. The five elements of research capacity that guided the discussions were: 1) researchers; 2) research culture, environment, and infrastructure; 3) funding; 4) partnerships; and 5) metrics. The 100 participants included representatives of professional organizations, consumer groups, academic departments, researchers, governmental funding agencies, and the private sector. The small group discussions and plenary sessions generated an array of problems, possible solutions, and recommended actions. A post-Summit, multi-organizational initiative is called for to pursue the agendas outlined in this report.

Cooperative Behavior↗

[SAR values of mobile phones. Safety evaluation and risk perception].

The specific absorption rate (SAR) is a prominent topic in the discussion about precautionary health protection. An experimental study investigated the effect of information about various SAR values (below the existing partial body limit value of 2 W/kg) on safety judgments of potential mobile phones users. It turns out that about 94% of the participants do not know the SAR value of their own mobile phone. SAR values below existing limits are not perceived as equally safe. Rather, the lower the SAR value, the higher the perceived safety. However, a majority of the participants does not consider these SAR values to be 100% safe, even if they are clearly below the existing limits. Explicitly indicating a precautionary limit value (referring to the Federal Office for Radiation Protection or to consumer organizations) does not change this safety evaluation. As expected, safety evaluation of the SAR values is also related to the perception of mobile phone risks. Those who are concerned about mobile phone communication give lower safety judgments than the unconcerned-independent of the level of the SAR values. Irrespective of that, our results suggest that establishing the SAR value as a criterion for mobile phones depends first of all on making it known to the public.

Adult↗

Using the WTO/TBT enquiry point to monitor tendencies in the regulation of environment, health, and safety issues affecting the chemical industry.

The growing importance of technical regulation affecting the use and sale of chemical products is a topic of interest not only for the chemical industry, but also for governments, nongovernmental organizations, consumers, and interested communities. The results of such regulation on behalf of the environment, health and safety of individuals, as well as its economic effects on industrial activity, are well understood in the United States and recently in the European Union. In less developed countries, however, the general level of public understanding of these issues is still minimal. It is common knowledge that the so-called "regulatory asymmetry" between countries at different levels of development contributes to the establishment of technical barriers to trade. Such asymmetries, however, also have other impacts: the displacement of polluting industrial sectors to countries which have less demanding regulations, the concentration of unsafe and harmful environmental conditions in certain parts of the globe, and the competitive disadvantage for industries located in countries where control is more rigid. This study analyses information on a wide range of technical regulations issued by World Trade Organization (WTO) members, and focuses on those regulations that affect the chemical industry. This information is available through the WTO Enquiry Points, organizations created in each country to administrate the Technical Barriers to Trade Agreement (TBT). This article consists of an analysis of 4,301 notifications of technical regulations by WTO member states in the 7-year period following the establishment of the WTO in 1995. Starting from this mass of information, 585 notifications that affect the circulation or use of chemical products were isolated. Of this group, 71% refer to only 15 countries. This group of notifications was further classified according to their motivation (the environment, health, safety), by the type of product affected (medications, fuels, hazardous products, etc.), by the type of country where it was established (developed, emerging or developing) and the existing conformity assessment mechanism (prohibition, licenses, certification, labeling, etc.). Beyond identifying tendencies in specific industrial sectors, the notifications studied here reach more than 100 chemical products, substances, preparations and other materials, which are subject to various levels of restrictions in different parts of the globe because of their composition or adverse reactions during their life cycles.

Chemical Industry↗

Financing global mental health services and the role of WHO.

A concrete indicator of a government's commitment to mental health services is the amount of financial resources it allocates. To encourage the government to increase mental health funding, it would require additional research and dissemination findings on the economic consequences of mental health disorders, cost-effectiveness benefits of alternatives treatment, and alternative methods of financing for mental health illnesses. In addition, an organized consumer group can be an effective means in informing legislative and government policy makers. Public financing alone is not sufficient for treating mental illness. Private financing may supplement public funding. It would be important to combine both public and private funding to deliver adequate services for mental illness patients. WHO has been very effective in global tobacco control and SARS epidemic. The new administration should use this successful momentum to initiate a global funding campaign for mental health disorder as a top priority.

Financing, Government↗

[Carbon monoxide contamination: an environmental health problem].

Carbon monoxide is considered to be a major factor contaminating earth's atmosphere. The main sources producing this contamination are cars using gasoline or diesel fuel and industrial processes using carbon compounds; these two are responsible for 80% of carbon monoxide being emitted to the atmosphere. This substance has a well-known toxic effect on human beings and its acute poisonous effects (including death) have been widely studied; however, its long-term chronic effects are still not known. During the last few years, experimental research on animals and studies of human epidemiology have established the relationship between chronic exposure to low and middle levels of carbon monoxide in breathable air and adverse effects on human health, especially on organs consuming large amounts of oxygen such as the heart and brain. Harmful cardiovascular and neuropsychological effects have been documented in carbon monoxide concentration in air of less than 25 ppm and in carboxyhaemoglobin levels in blood of less than 10%. The main cardiac damage described to date has been high blood pressure, cardiac arrhythm and electrocardiograph signs of ischemia. Lack of memory, attention, concentration and Parkinson-type altered movement are the neuropsychological changes most frequently associated with chronic exposure to low levels of carbon monoxide and carboxyhaemoglobin.

Adult↗

Bioavailability, bioaccumulation and tolerance of chromium: consequences in the food chain of freshwater ecosystems.

Many abiotic and biotic factors can influence the partitioning equilibrium of heavy metals, thus influencing metal impact on aquatic environments. Unicellular algal species release soluble organic substances able to complex metals. In our laboratory a Cr-tolerant strain was selected and isolated from a wild type strain of Scenedesmus acutus. The exudates released by the two strains counteracted the growth inhibition caused by Cr(VI) and the exudates of the Cr-tolerant strain were more effective. On the contrary, the exudates did not reduce chromium toxicity to the cladoceran Daphnia magna. The reduction of chromium effect on algae seems the consequence of an algae-specific interaction among Cr(VI), exudates and algal cells. Chromium uptake resulted to be energy-dependent since bioaccumulation rate in subdued light condition was lower than at high light intensity. The effect of Cr(VI) on algae changed depending on metabolism of the cells and in particular it seemed to be related to the bioaccumulation rate. Tolerance in the selected strain could not be ascribed to a lower uptake of chromium. The difference in sensitivity to chromium between the two strains was exploited to evaluate if tolerance acquired by algae could have consequences for Daphnia. After treatment with Cr(VI), the two strains of S. acutus were used as food source for D. magna. The results indicate that chromium is accumulated by algae in a form not available for daphnids and that Cr tolerance acquired by the algae can be of some advantage to the consumer organism.

Animals↗

Incidence of emergency department-treated eye injury in the United States.

OBJECTIVE: To present the descriptive epidemiology of emergency department-treated eye injury in the United States. METHODS: Data from the Consumer Product Safety Commission's National Electronic Injury Surveillance System All Injury Program was used to estimate the number of patients treated in US emergency departments for eye injuries. Eye injury rates were calculated according to age, sex, and race, and characteristics of the injury event were determined. RESULTS: The rate of emergency department-treated eye injury in the United States is 3.15 per 1000 population (95% confidence interval, 2.66-3.63). Rates were highest among those in their 20s and 30s, among males, and among American Indians and African Americans. The majority of injuries occurred in the home, and contusions and abrasions were the most common types of injury. CONCLUSION: This study documents the burden of eye injury in the United States and identifies areas wherein future research activities should be directed.

Adolescent↗

The ecological background of food production.

In the industrialized countries dramatic decreases in the number of people employed in agriculture have been made possible by a rise in soil and labour productivity. There is scope for these to improve further, particularly in developing countries. Potential yields are determined by the characteristics of the crop, local temperature and sunlight. Because the availability of nutrients and that of water are limiting for at least part of the growing season in most agricultural lands, attainable yields are lower than potential yields. Proper management of nutrient inputs, such that optimum use is made of each, can reduce this gap without causing negative environmental side-effects. Actual yields are lower than attainable yields because of growth-reducing factors, such as pests, diseases and weeds. For sustainable agriculture these should be controlled mainly by biological measures. There are many possibilities for this, thus biocides may be used as a last resort not as preventive insurance. Potential yields of rice and sugarcane can reach 30,000 kg ha-1 per year of consumable organic matter, sufficient to feed 120 people. Such yields cannot be achieved on all agricultural land, but it is estimated that world food production could support a population of 80 thousand million, if they were all vegetarian and required only 1500 m2 for non-food-related purposes. The green revolutions that occurred in the Western industrialized countries in the late 1940s and early 1950s and in Asia in the late 1960s and early 1970s need to be followed by a similar increase in agricultural productivity in Africa and West Asia to feed their rapidly growing populations. Better use of fertilizers and good water management require well-educated farmers with the financial means to implement long-term strategies. If these developments are managed properly, food production for the ever-increasing human population can be guaranteed and the burden on the environment and natural habitats reduced, enabling the development of sustainable agricultural systems.

Agriculture↗