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PubMed2005

Behavioral science at the crossroads in public health: extending horizons, envisioning the future.

The social and behavioral sciences are at a crossroads in public health. In this paper, we attempt to describe a path toward the further integration of the natural and behavioral sciences with respect to the study of behavior and health. Three innovations are proposed. First, we extend and modify the "stream of causation" metaphor along two axes: time, and levels of nested systems of social and biological organization. Second, we address the question of whether 'upstream' features of social context are causes of disease, fundamental or otherwise. Finally, we propose the concept of a risk regulator to advance the study of behavior and health in populations. To illustrate the potential of these innovations, we develop a multilevel framework for the study of health behaviors and obesity in social and biological context.

Causality↗
PubMed2005

Anterior vaginal wall surgery in elderly patients: outcomes and assessment.

OBJECTIVES: To evaluate the efficacy, safety, and impact on quality of life of anterior vaginal surgery in the elderly. Incontinence in the elderly is a devastating medical and social condition accounting for 50% of admissions to nursing homes; the incidence of anterior vaginal wall prolapse also increases in the elderly. Most patients are treated conservatively, because of a reluctance to offer surgical treatment to this age group owing to the perceived increased risk of complications and decreased rate of treatment success. METHODS: We prospectively evaluated all consecutive elderly patients who underwent anterior vaginal wall surgery between November 1999 and May 2003. The surgical outcomes were determined by the symptom, bother, and quality-of-life questionnaires answered by the patients. The physicians were unaware of the patients' responses. RESULTS: A total of 209 patients were available for analysis. The mean age was 70 years (range 65 to 88) and the mean follow-up 15.3 months. All items in the symptom and bother questionnaires showed significant improvement. Significant improvement was also demonstrated in quality of life and pad use (P <0.005). No significant perioperative complications occurred. Only patients older than 71 years of age did not experience an improvement in the symptom scores for urge incontinence. Nevertheless, as for all other patients, older patients experienced improvement in stress urinary incontinence (SUI) symptoms, the bother scores of SUI and urge incontinence, and quality of life. CONCLUSIONS: Surgical treatment of anterior vaginal wall prolapse and SUI in the elderly is effective and safe and significantly improves the quality of life of these patients.

Aged↗
PubMed2006

Minimax regret optimization analysis for a regional solid waste management system.

Solid waste management (SWM) facilities are crucial for environmental management and public health in urban regions. Due to the waste management hierarchy, one of the greatest challenges that organizations face today is to figure out how to diversify the treatment options, increase the reliability of infrastructure systems, and leverage the redistribution of waste streams among incineration, compost, recycling, and other facilities to their competitive advantage region wide. Systems analysis plays an important role for regionalization assessment of integrated SWM systems, leading to provide decision makers with break-through insights and risk-informed strategies. This paper aims to apply a minimax regret optimization analysis for improving SWM strategies in the Lower Rio Grande Valley (LRGV), an economically fast growing region in the US. Based on different environmental, economic, legal, and social conditions, event-based simulation in the first stage links estimated waste streams in major cities in LRGV with possible solid waste management alternatives. The optimization analysis in the second stage emphasizes the trade-offs and associated regret evaluation with respect to predetermined scenarios. Such optimization analyses with multiple criteria have featured notable successes, either by public or private efforts, in diverting recyclables, green waste, yard waste, and biosolids from the municipal solid waste streams to upcoming waste-to-energy, composting, and recycling facilities. Model outputs may link prescribed regret scenarios in decision making with various scales of regionalization policies. The insights drawn from the system-oriented, forward-looking, and preventative study can eventually help decision-makers and stakeholders gain a scientific understanding of the consequences of short-term and long-term decisions relating to sustainable SWM in the fast-growing US-Mexico borderland.

Conservation of Natural Resources↗
PubMed2006

Variability of GnRH secretion in two goby species with socially controlled alternative male mating tactics.

Male reproductive phenotypic plasticity related to environmental-social conditions is common among teleost fish. In several species, males adopt different mating tactics depending on their size, monopolizing mates when larger, while parasitizing dominant male spawns when smaller. Males performing alternative mating tactics are often characterized by a strong dimorphism in both primary and secondary reproductive traits. According to studies on sex-changing species and on species where only one male morph is reproductively active, male alternative phenotypes are expected to vary also in gonadotropin-releasing hormone (GnRH) neurons in forebrain preoptic area (POA). Here, we compared the intra- and inter-sexual variations in number and size of GnRH neurons, along with gonads and male accessory structure investment, in two goby species, the grass goby, Zosterisessor ophiocephalus, and the black goby, Gobius niger, characterized by male alternative mating phenotypes. In both species, older and larger males defend nests, court and perform parental care, while younger and smaller ones try to sneak territorial male spawning. We found that grass goby and black goby have different patterns of GnRH expression. Grass goby presents a clear intra-sexual dimorphism in GnRH expression, related to the occurrence of alternative mating tactics, while in the black goby, only inter-sexual differences are observed. The inter- and intra-specific variability in the GnRH neurons in these two goby species is discussed in light of the differences in migratory behavior, nest type, and mating system.

Analysis of Variance↗
PubMed1996

Disposition and first-pass metabolism of ethanol in humans: is it gastric or hepatic and does it depend on gender?

OBJECTIVE: To assess the extent and site of the first-pass metabolism of ethanol and to examine whether first-pass metabolism and disposition of ethanol are dependent on gender. METHODS: After a standardized lunch, healthy subjects (six women and six men) received on two separate occasions a 60-minute intravenous infusion of ethanol (0.3 gm/kg) and concomitantly an equimolar dose of d3-ethanol/kg either orally (over 20 minutes) or intraduodenally (infused over 30 minutes). Blood levels, urinary excretion of d0- and d3-ethanol, and sedative effects were monitored for 6 hours. Disposition and first-pass metabolism of ethanol were evaluated by applying an open two-compartment model with Michaelis-Menten elimination. RESULTS: Comparison of the corresponding intravenous/oral versus intravenous/intraduodenal data of each individual revealed that total first-pass metabolism (gastric plus hepatic) was not pronounced in either males (9.1% +/- 4.0%; mean +/- SD) or females (8.4% +/- 3.1%) and that this first-pass metabolism was partly of gastric origin. Dose-corrected values for area under blood concentration-time curve were on average 28% higher (p < 0.0001) in the women than in the men. Mean total blood ethanol disappearance rate was higher (p < 0.001) in women (3.92 +/- 0.40 mmol/L . hr) than in men (3.19 +/- 0.48 mmol/L . hr). Renal clearance was gender-independent and negligible. A linear relationship (p < 0.001) could be found between the blood levels of ethanol and sedation index. Because the slope was steeper in women (1.04) than in men (0.42) a higher central nervous system sensitivity to the sedative effects of ethanol in women can be assumed. CONCLUSIONS: Under realistic life conditions (social drinking of moderate doses of ethanol after a light lunch) only a minor, gender-independent first-pass metabolism is observed that is partly of gastric origin.

Administration, Oral↗
PubMed1976

Destroyed lung. A report of cases in West Indians and Australian Aborigines.

A series of patients with total destruction of one lung by bronchiectasis and a normal contralateral lung is reported. Eight cases were West Indians of Negro race and four were Australian Aborigines. The bronchiectasis appears to be of post-infective type and is related to the poor social conditions under which the affected people live. It has also been noted in other developing countries or in under-privileged races in developed countries.

Adolescent↗
PubMed1997

Tuberculosis. Part I.

Tuberculosis has been a disease of human beings for thousands of years. In recent times it has waxed to become the feared White Plague of the eighteenth and nineteenth centuries and waned under the impact of effective chemotherapy until its elimination seemed possible by the early twenty-first century. The resurgence of tuberculosis in the past 10 to 15 years, caused by unanticipated events such as the appearance of the human immunodeficiency virus and deteriorating social conditions, also brought with it the problem of multiple drug resistance. Control measures such as tuberculin skin testing, perhaps somewhat forgotten when tuberculosis seemed to be a disease of the past, again became first-line defenses against spread of the disease. Environmental controls must be well understood and used effectively. Diagnosis of tuberculosis requires knowledge of the strengths and shortcomings of the various diagnostic methods and experience in their use. Practitioners are cautioned to remember that no diagnostic method, by itself, can be relied on to confirm or rule out tuberculosis. Well-tested diagnostic methods of chest radiograph, tuberculin skin testing, smear, and culture have been recently supplemented by rapid diagnostic tests based on amplification of bacterial RNA and DNA. More invasive diagnostic methods are sometimes required to diagnose extrapulmonary disease. Two-drug up to seven-drug therapy may be indicated for a case of tuberculosis, depending on evidence of the presence of multiple drug resistance. Duration of treatment can range from 6 to 12 months, also depending on identification of drug-sensitive or drug-resistant organisms. Failure of compliance can be a significant problem in patients who are homeless, or drug abusers, or who for various reasons cannot or will not complete a course of therapy. Directly observed therapy is strongly recommended for these patients, and for assistance in its administration the physician must cooperate with the local or state health department. The health department also must be notified whenever a case of tuberculosis is identified.

AIDS-Related Opportunistic Infections↗
PubMed2000

Role of feeding in the reproductive 'group effect' in females of the German cockroach Blattella germanica (L.).

We have found that whether a female German cockroach, Blattella germanica (L.), is kept alone or in the presence of another female has a major impact on how fast it reproduces and how much it eats. By the sixth day of adulthood, females paired since adult eclosion had substantially larger oöcytes than did females isolated during the same time, and females paired with intact females, or with ones rendered incapable of feeding, consumed more rat chow in the first six days of adulthood than did isolated females. The stimulatory effect of pairing on reproduction was, however, partially independent of feeding because the oöcytes of solitary and paired females differed in size on day 6 even when they were given, and had consumed, the same amount of food. This result was confirmed with analysis of covariance using the total food intake of a female as the covariate in the analysis. A female's social condition probably influenced the development of its oöcytes by affecting the quantity of juvenile hormone synthesized by its corpora allata. The corpora allata of paired females produced more hormone than did those of isolated ones, even when all females had consumed an equivalent amount of food. Moreover, females treated with a juvenile hormone analog, fenoxycarb, reproduced more quickly than identically reared and fed control females, showing that juvenile hormone could influence reproduction independently of feeding. We conclude that both group rearing and food intake accelerate oöcyte development by diminishing the brain's inhibition on the synthesis of juvenile hormone.

Journal Article↗
PubMed1998

Low education, high GP consultation rates: the effect of psychosocial factors.

The purpose of this study was to estimate the contribution of psychosocial factors to the increased use of a general practitioner (GP) among those with a lower level of education. The use of GP services was elicited from survey data from 2867 respondents from the Dutch Longitudinal Study on Socio-Economic Differences in the Utilization of Health Services (LS-SEDUHS) using a simple "Yes/ No" format. Psychosocial variables included long-term stressful conditions, social support, external locus of control, coping styles, and tendency to consult (a measure of people's propensity to go to a doctor with health problems). People with primary education used the GP services more than people with higher vocational training or a university degree (OR 1.87, p<0.05), adjusted for health status and health insurance. Only tendency to consult partially explained this difference (OR: 1.74, p>0.05). Most psychosocial factors do not seem very important in explaining high GP utilization rates among those with a low socioeconomic status. Alternative explanations are discussed.

Adaptation, Psychological↗
PubMed2003

Regional differences in healthy life expectancy in The Netherlands.

BACKGROUND: Healthy life expectancy has mainly been studied at the level of healthcare systems rather than at regional level within healthcare systems. In this article, healthy life expectancy at birth and at 65 years of age for men and women in the Netherlands has been described, and factors related to these regional variations have been explored. METHODS: Ecological study of 27 healthcare regions (hospital catchment areas). Life expectancy and healthy life expectancy were calculated using 1995 mortality data and pooled health interview survey data (1992-1997) from Statistics Netherlands. RESULTS: Healthy life expectancy shows a regional pattern, slightly different from that found in life expectancy and self-reported health. The regional distribution of male and female healthy life expectancy is different, especially at 65 years. Healthy life expectancy of women aged 65 years is independent of their total life expectancy. Social conditions and lifestyle differences between regions are negatively associated with healthy life expectancy in Dutch regions. Healthcare supply variables show no clear relationship. CONCLUSION: Although the Netherlands is a small, homogeneous country, substantial differences were found in healthy life expectancy.

Aged↗
PubMed1989

Psychological linguistics: implications for a theory of initial development and a method for research.

Presented here are an hypothesis of language development and a description of a method for studying language, both based on Kantor's psychological linguistics. According to our hypothesis, language develops in four stages. In the first, which spans the first 9 to 15 months, random movements evolve into body management, manual, and locomotor skills that enable an infant to engage in play activities, among other things, with the mother and others. Simple gestural communication soon follows. Random babbling progresses beyond the sounds that are more universal in the language to the family's particular pattern of intonations and inflections, and receptive speech begins, that is, the infant learns to react to simple verbal-vocal requests. During the second stage, which coincides with the child's second year, vocalizations evolve into "idiosyncratic expressions" and rough approximations of heard sound patterns. Language is now holophrastic--one-word utterances--mostly of the mediative variety. During the third stage, which extends to about 30 months of age, language skills are described as first-approximation referential interactions: they are longer and more detailed, include some narrative interchanges, and refer to past and future events. Typically the child now talks to him or herself, or engages in expressive referential interactions. In the fourth stage, when the child reaches the age of 52 months or so, second-approximation speech begins. By now the vocal apparatus is sufficiently developed to enable a child to make most of the vowel sounds, and the enhanced language skills set the occasion for more frequent linguistic interchanges. He or she also begins to respond to symbols and other representations of objects and events. In other words, he or she begins to engage in symbolizing behavior. Language obviously continues to develop beyond the fourth stage. Social conditions outside of the family further affect language style and generate specialized forms of speech, notably the jargon of a particular occupation or hobby. The method for studying language interactions involves, through the use of TV tapes, a description of the behavior of a speaker and the listener, the referent, and the setting conditions. The behavior of a speaker is analyzed in terms of the frequency with which he or she begins a language interchange, the average length of the initiation, the modality (verbal-vocal, gestural, or both) and the accompanying behavior. It is also analyzed for content, including time frame, actuality, and persons, animals, objects, activities, and others. Noted, too, are the feeling reactions regarding the referents.(ABSTRACT TRUNCATED AT 400 WORDS)

Child↗
PubMed1999

Some factors that endodontists may consider when selecting a practice location.

The distribution of endodontists per population is considered in terms of the ranking of states by the availability of a graduate endodontic training program and selected population demographic characteristics. Statistically significant positive relationships were found for the endodontist to population ratios, and (i) overall health and social conditions, (ii) per capita income, (iii) per capita spending for health care, and (iv) percentage of the population that is Hispanic and Asian-American. Negative relationships were found for (i) increases in the population that is underserved by dentists, (ii) higher levels of out-of-pocket spending for health care, and (iii) increases in the population below the poverty level. Further analysis at the local level (and for individual practitioners) is needed to better understand the decision process in the selection of a practice site.

Decision Making↗