Effect of postnatal age and a beta(3)-adrenergic agonist (Zeneca D7114) administration on uncoupling protein-1 abundance in the lamb.

We examined the effect of time after birth and beta(3)-adrenergic agonist (Zeneca D7114) administration on uncoupling protein-1 (UCP1) abundance and thermoregulation in the lamb. Forty twin lambs, all born normally at term, were maintained at a cold ambient temperature of between 3 and 8 degrees C. At 0.5, 1.75, 5.25, 11.25 and 23.25 h after birth eight sets of twins were fed 20 ml of formula milk +/- 10 mg kg(-1) of beta(3)-adrenergic agonist, and 45 min after feeding brown adipose tissue (BAT) was sampled. Colonic temperature was measured and BAT analysed for UCP1 abundance, GDP-binding to mitochondrial protein (i.e. thermogenic activity) and catecholamine content. Colonic temperature declined between 1.25 and 6 h from 40.2 degrees C to 39.2 degrees C and then increased to 39.8 degrees C at 12 h, but increased after feeding at all ages. UCP1 abundance increased from 1.25 h after birth, to peak at 2 h after birth in controls, compared with 6 h after birth in beta(3)-adrenergic agonist-treated lambs. The level of GDP-binding to mitochondrial protein did not change significantly with age but was increased by beta(3)-adrenergic agonist treatment. The noradrenaline (norepinephrine) content of BAT increased between 1.25 and 12 h after birth, irrespective of beta(3)-adrenergic agonist administration. The total weight of perirenal BAT plus its lipid, protein and mitochondrial protein content declined over the first 6 h of life. UCP1 development continues over the first 24 h of neonatal life, and can be manipulated by beta(3)-adrenergic agonist administration. This may represent one method of improving thermoregulation in newborn lambs. Experimental Physiology (2001) 86.1, 65-70.

Quality of data in multiethnic health surveys.

OBJECTIVE: There has been insufficient research on the influence of ethno-cultural and language differences in public health surveys. Using data from three independent studies, the authors examine methods to assess data quality and to identify causes of problematic survey questions. METHODS: Qualitative and quantitative methods were used in this exploratory study, including secondary analyses of data from three baseline surveys (conducted in English, Spanish, Cantonese, Mandarin, and Vietnamese). Collection of additional data included interviews with investigators and interviewers; observations of item development; focus groups; think-aloud interviews; a test-retest assessment survey; and a pilot test of alternatively worded questions. RESULTS: The authors identify underlying causes for the 12 most problematic variables in three multiethnic surveys and describe them in terms of ethnic differences in reliability, validity, and cognitive processes (interpretation, memory retrieval, judgment formation, and response editing), and differences with regard to cultural appropriateness and translation problems. CONCLUSIONS: Multiple complex elements affect measurement in a multiethnic survey, many of which are neither readily observed nor understood through standard tests of data quality. Multiethnic survey questions are best evaluated using a variety of quantitative and qualitative methods that reveal different types and causes of problems.

The fall, recovery, orbit, and composition of the Tagish Lake meteorite: a new type of carbonaceous chondrite.

The preatmospheric mass of the Tagish Lake meteoroid was about 200,000 kilograms. Its calculated orbit indicates affinity to the Apollo asteroids with a semimajor axis in the middle of the asteroid belt, consistent with a linkage to low-albedo C, D, and P type asteroids. The mineralogy, oxygen isotope, and bulk chemical composition of recovered samples of the Tagish Lake meteorite are intermediate between CM and CI meteorites. These data suggest that the Tagish Lake meteorite may be one of the most primitive solar system materials yet studied.

Effect of feeding level and thyroxine on adipose tissue development and growth in postnatal lambs.

We investigated the influence of exogenous thyroxine (T4) administration in conjunction with level of feeding on adipose tissue and liver growth in postnatal lambs. Pairs of lambs were fed either 100 g (i.e. low fed) or 200 g (i.e. high fed) of milk powder per litre of reconstituted milk replacer over the first month of life. Half of the pairs of lambs were fed a bolus dose of T4 (15 mg (kg body weight)-1) daily until 8 days of age. Perirenal adipose tissue and hepatic tissue were sampled at either 8 or 35 days of age. High fed lambs grew faster, possessed more adipose tissue and had larger livers than low fed lambs at 8 and 35 days of age. T4 administration resulted in a lower thermogenic activity (i.e. GDP binding) in adipose tissue at 8 days of age in low, but not high fed lambs. There was no difference between groups in colonic temperature or oxygen consumption. Between 17 and 35 days of age high fed lambs previously treated with T4 had lower daily milk consumption than untreated siblings, but still attained the same growth rate. Plasma insulin-like growth factor-I concentrations were greater in high than low fed lambs, a relationship that was not influenced by T4 treatment. In adipose tissue, iodothyronine 5' deiodinase activity was not influenced by T4 administration and was greater in high than low fed lambs. Hepatic iodothyronine 5' deiodinase activity was not influenced by T4 administration in low fed lambs, but was reduced by T4 in high fed lambs. In conclusion, T4 administration over the first 8 days of life can accelerate the rate of decline in thermogenic activity of uncoupling protein-1. This effect is not observed when the level of feeding is increased. Following withdrawal of T4 treatment, high fed T4-treated lambs were able to maintain the same growth rate as untreated lambs despite having a lower food intake.

Effect of delivery temperature on endocrine stimulation of thermoregulation in lambs born by cesarean section.

We examined the hypothesis that exogenous stimulation with physiological doses of 3,5,3'-triiodothyronine (T(3)) and/or norepinephrine at birth can improve thermoregulation in near-term lambs delivered by cesarean section. This was achieved by investigating the effect of delivery temperature [i.e., warm (30( degrees )C) vs. cool (15( degrees )C) ambient temperatures] on hormonal stimulation on uncoupling protein-1 (UCP1) abundance in brown adipose tissue. In vivo measurements of temperature control (i. e., colonic temperature, oxygen consumption, and incidence of shivering) were made over the first 2.5 h after birth. Each lamb was injected with saline with or without T(3), norepinephrine, or T(3) plus norepinephrine. Irrespective of delivery temperature, abundance of UCP1 increased and incidence of shivering decreased by all hormonal treatments, but this only reduced the rate of decline in colonic temperature of cool-delivered lambs. Oxygen consumption was higher in cool-delivered lambs that were able to fully restore body temperature, an adaptation not observed in controls or any warm-delivered groups. Exogenous administration of endocrine stimulatory factors can enhance the abundance of UCP1 in cesarean-section-delivered lambs with the magnitude of thermoregulatory response being greater at cool than warm delivery temperatures.

Effect of a media-led education campaign on breast and cervical cancer screening among Vietnamese-American women.

BACKGROUND: Previous research has shown that breast and cervical cancer screening rates are low among Vietnamese women. METHODS: Over a 24-month period, we implemented a media-led community education campaign to promote recognition, intention, receipt, and currency of routine checkups, clinical breast examinations, mammograms, and Pap tests among Vietnamese-American women in Alameda and Santa Clara Counties in northern California. Women in Los Angeles and Orange Counties in southern California served as controls. To evaluate its impact, pretest telephone interviews were conducted of 451 randomly selected women in the intervention area and 482 women in the control area and posttest interviews with 454 and 422 women, respectively. RESULTS: At posttest, after controlling for demographic differences in the surveyed populations, the odds ratios for the intervention effect were statistically significant for having heard of a general checkup, Paptest, and clinical breast examination (CBE); planning to have a checkup, Pap test, CBE, and mammogram; and having had a checkup and Pap test. The intervention had no effect on being up to date for any of the tests. CONCLUSIONS: A media-led education intervention succeeded in increasing recognition of and intention to undertake screening tests more than receipt of or currency with the tests.

Influence of thyrotrophin-releasing hormone on thermoregulation in newborn lambs.

This study examined the effect of thyrotrophin-releasing hormone (TRH) administration on thermoregulation in the newborn. Twin lambs were either delivered near-term by caesarean section or born vaginally at term. Colonic temperature, O2 consumption, CO2 production, breathing and heart rates, plus plasma thyroid hormone and nonesterified fatty acid (NEFA) concentrations and thermogenic activity (i.e. GDP binding) of brown adipose tissue (BAT) were measured. In caesarean section delivered lambs colonic temperature decreased rapidly after birth, a response that was greater in the group designated for TRH treatment, in which colonic temperature fell to below 36.0 degrees C at 80 min of life, prior to TRH administration. At this age colonic temperature had been restored to a mean of 38.70 degrees C in controls. TRH had no influence on the composition or thermogenic activity of BAT. The incidence of shivering was not influenced by TRH, but treated lambs maintained a higher rate of O2 consumption and ventilation compared with controls after colonic temperature had been restored to 38.56 degrees C. TRH appeared to promote fat oxidation as O2 consumption remained unchanged and CO2 production declined by a greater rate in treated lambs, resulting in a lower respiratory quotient compared to controls. Heart rate and plasma concentrations of NEFA increased following TRH administration although this did not result in values greater than controls. Normothermic lambs born vaginally had BAT with a greater thermogenic activity, higher plasma thyroid hormone and NEFA concentrations compared with caesarean section delivered lambs, but a thermogenic response was not observed to TRH despite a rise in thyroid hormone concentrations. In conclusion, TRH can improve thermoregulation, an effect that could be linked to an increase in fat oxidation.

Opening pathways to cancer screening for Vietnamese-American women: lay health workers hold a key.

PURPOSE: We describe a controlled trial of a community outreach intervention to promote recognition, receipt, and screening-interval maintenance of clinical breast examinations (CBE), mammograms, and Pap smears among Vietnamese-American women. METHODS: Over a 3-year period, indigenous lay health workers conducted small-group sessions of Vietnamese women in a low-income district of San Francisco, California. Women in Sacramento, California, served as controls. Lay workers conducted 56 sessions on general prevention, 86 on cervical cancer, and 90 on breast cancer. Surveys of 306 to 373 women were conducted in the study communities in 1992 and 1996. RESULTS: In the intervention community, recognition of screening tests increased significantly between pre- and postintervention surveys: CBE, 50 to 85%; mammography, 59 to 79%; and Pap smear, 22 to 78% (P = 0.001 for all). Receipt of screening tests also increased significantly: CBE, 44 to 70% (P = 0.001); mammography, 54 to 69% (P = 0.006); and Pap smear, 46 to 66% (P = 0.001). Best-fitting logistic regression models, adjusting for preintervention rates and significant covariates, also showed statistically significant odds ratios for the intervention effect (P < 0.0001). CONCLUSIONS: Trained Vietnamese lay health workers significantly increased Vietnamese women's recognition, receipt, and maintenance of breast and cervical cancer screening tests.

Barriers to breast and cervical cancer screening among Vietnamese-American women.

INTRODUCTION: We investigated barriers to breast and cervical cancer screening among Vietnamese women in San Francisco and Sacramento, California. METHODS: Face-to-face interviews were conducted in 1992 of 306 Vietnamese women in San Francisco and of 339 women in Sacramento. RESULTS: In both communities, only about one half of Vietnamese women had ever had routine check-ups, clinical breast examinations, mammograms, and Pap smear tests, and only about one third were up-to-date for these screening examinations. Among women age 40 or older, 35% had never even contemplated having a mammogram. This study identified several significant barriers to recognition, receipt, and currency of screening tests. Negative predictors of test recognition included low level of education and not having a regular physician. Negative predictors of test receipt included low level of education, not having a regular physician, short duration of residence in the United States, and never having been married. A major negative predictor of test currency was low level of education. With a few exceptions, attitudes and beliefs generally were not important predictors. CONCLUSIONS: Health education and screening programs for early breast and cervical cancer detection among Vietnamese women must be culturally appropriate and conducted in the Vietnamese language. Special outreach efforts are needed to assist recent immigrants in obtaining recommended breast and cervical cancer screening examinations.

Factors associated with breast and cervical cancer screening practices among Vietnamese American women.

PURPOSE: To investigate predictors of breast and cervical cancer screening tests among Vietnamese women in California in preparation for developing and testing interventions to promote such screening. METHODS: Cross-sectional telephone survey of 933 randomly selected Vietnamese women in four California counties. RESULTS: Overall, 70% of the respondents had had at least one prior clinical breast examination, but only 30% had had a mammogram and 53% a Pap test. Among women who had been screened, more than two-thirds were up-to-date and among those who had not been screened, more than two-thirds were planning future tests. Factors positively associated with receipt of one or more of the tests included age (among women < 40 years old), number of years in the United States, having ever married, and having health insurance. Factors negatively associated with test receipt included having a Vietnamese doctor, being unemployed, and being of Chinese-Vietnamese background. CONCLUSION: The multiple factors associated with utilization suggest intervention targets for promoting breast and cervical screening among new immigrant women. Increasing screening test receipt to recommended levels will require a two-pronged approach directed at both Vietnamese consumers and Vietnamese physicians.

Effect of beta 3-adrenergic agonist (Zeneca D7114) on thermoregulation in near-term lambs delivered by cesarean section.

We investigated the effect of a beta 3-adrenergic agonist, Zeneca D7114, on thermoregulation in near-term lambs delivered by cesarean section. Lambs were delivered into a cool ambient temperature of 15 degrees C, and between 60 and 80 min of life were given an oral dose of Zeneca D7114 (10 mg.kg body weight-1) dissolved in 20 mL of milk, or milk alone. During the first 0.5 h of life colonic temperature decreased in all lambs, and then increased to plateau levels (39.6-40.4 degrees C) after 120-150 min of life, in 19 out of 23 lambs studied. In the remaining lambs, colonic temperature failed to return to normothermic values, plateauing at 34.3 degrees C. All control lambs were observed to shiver throughout the study, but after Zeneca D7114 treatment 7 out of 10 normothermic lambs stopped shivering, and plateau colonic temperature was 0.8 degree C higher. Hypothermic beta 3-agonist-treated lambs had significantly lower rates of heat production, breathing frequency, and plasma triiodothyronine and cortisol concentrations than normothermic lambs. the level of GDP binding and norepinephrine content of brown adipose tissue (BAT) sampled from hypothermic beta 3-agonist-treated lambs was significantly lower than in normothermic lambs. There was no difference in GDP binding in BAT between control and Zeneca D7114-treated groups, but the Hb content was higher in the latter group. It is concluded that administration of Zeneca D7114 to euthyroid lambs enhances their ability to thermoregulate and restore colonic temperature without altering the thermogenic activity of BAT. This response may be mediated by increasing blood flow to BAT and/or an improvement in the animal's thermal efficiency (i.e. decreased heat loss) due to a reduced reliance on shivering thermogenesis.

Endocrine and metabolic adaptation following caesarean section or vaginal delivery.

The endocrine profile (umbilical venous plasma) of three groups of infants was compared. Samples were taken after eight vaginal deliveries, 11 emergency caesarean sections during labour, and 13 elective caesarean sections before labour. Mean umbilical plasma concentrations of thyroxine and triiodothyronine were significantly higher and cortisol concentration were lower after elective caesarean section compared with the two labour groups. Mean umbilical plasma thyroid stimulating hormone (TSH) concentration was significantly lower after vaginal delivery compared with elective caesarean section. These results suggest that labour reduces plasma thyroid hormone concentrations at birth in association with a rise in cortisol. These adaptations may be the stimulus for the subsequent surge in triiodothyronine previously reported to occur over the first few hours after birth in vaginally delivered infants.

Effect of fetal thyroidectomy on brown adipose tissue and thermoregulation in newborn lambs.

The effect of fetal thyroidectomy on thermoregulation in newborn lambs was investigated. Seven of 14 lambs born normally at term were thyroidectomized at Day 127 of gestation. Colonic temperature and oxygen consumption were measured during non-rapid eye movement sleep 6-45 h after birth. All lambs were then killed and perirenal brown adipose tissue was sampled for measurement of thermogenic activity (guanosine diphosphate binding), uncoupling protein and lipid contents. Thyroidectomized lambs tended to have a mean colonic temperature 2.35 degrees C lower (P = 0.067) than controls and two became hypothermic (i.e. colonic temperature < 35 degrees C). Thyroidectomized lambs exhibited lower rates of oxygen consumption (P = 0.05) and an increased incidence of shivering thermogenesis. The perirenal adipose tissue of these lambs had a lower thermogenic activity (P < 0.01), less uncoupling protein (P < 0.01) and higher lipid content (P = 0.072) compared with intact controls. It is concluded that fetal thyroidectomy results in a decreased ability of newborn lambs to utilize nonshivering thermogenesis in brown adipose tissue as well as increasing the incidence of hypothermia. These changes are associated with decreased synthesis of uncoupling protein and functional development of brown adipose tissue in the late gestation fetus.

The impact of clinical pharmacists' consultations on geriatric patients' compliance and medical care use: a randomized controlled trial.

This study assessed the impact of clinical pharmacists' consultations on drug regimens, compliance, and health service use of geriatric hospitalized patients (N = 706) discharged on 3 or more medications. Pharmacists consulted with experimental patients at discharge and 3 months thereafter, and with physicians as needed. Controls received usual care. At 6-8 weeks after enrollment, experimental patients were more knowledgeable about regimens than controls. At 12-14 weeks, they were on fewer medications and less complex regimens, and had better compliance scores. There was no effect on service use or charges, perhaps due to inadequate sample size and lack of targeted drug groups analysis. The authors conclude that clinical pharmacists' consultations can improve geriatric patients' drug regimens and compliance. Findings further suggest the need for replication among large cohorts of patients at high risk, due to the use of medications most likely to have a potential for serious outcomes and to be vulnerable to physician prescribing error.

Drug utilization review in ambulatory settings: state of the science and directions for outcomes research.

There are escalating national pressures to analyze pharmaceutical outcomes and to develop drug-related clinical guidelines. These interests coincide with passage of the Medicaid Rebate Law (OBRA, 1990), which mandates the implementation of prospective and retrospective drug utilization review (DUR) programs by Medicaid in 1993. This report investigates DUR programs that target outpatient drug therapies. The authors present a conceptual framework that identifies the factors influencing drug prescribing and the range of potential patient outcomes. Current types of DUR interventions and their applications are described, in addition to problems that hinder implementation or evaluation of DUR programs. DUR evaluation studies are reviewed, and a critique identifies the limitations of available DUR research. The authors recommend an expanded DUR policy research agenda, strongly suggesting that priority be given to studies in the following areas: DUR criteria development and validation; prevalence of prescribing problems and their association with patient outcomes; efficacy, toxicity and costs of therapeutic alternatives; and DUR program evaluation. The overall conclusion is that the state of the science pertaining to DUR is not well developed. The potential of DUR may not be realized due to the lack of resources needed to design, implement, and evaluate effective programs. Instead, DUR efforts may be limited to cost-containment issues without due consideration of quality-of-care outcomes. The authors call for rigorous evaluation efforts to inform DUR design and implementation, thereby assuring more rational prescribing and enhancing patient outcomes.

Assessing the appropriateness of physician prescribing for geriatric outpatients. Development and testing of an instrument.

OBJECTIVE: In a randomized, controlled trial evaluating the impact of clinical pharmacists' consultations on physicians' prescribing decisions, a seven-member physician/pharmacist panel developed an instrument to characterize and quantify the full range of drug-prescribing problems. The instrument was tested for validity and reliability. SAMPLE: The instrument was applied in reviewing prescribing for 236 geriatric outpatients. METHODS: To ensure internal validity of the instrument, five panel meetings were devoted to reaching a consensus on procedures, categories, criteria, and scoring. Each case was evaluated independently by two reviewers and each drug in the regimen was evaluated for drug-drug interactions, dosage, schedule, allergic reactions, therapeutic duplication, use of drugs without established diagnoses, and inappropriate drugs for the patient's clinical conditions; discrepancies were adjudicated by the panel chairperson. Self-reported adverse effects of 60 study patients who were interviewed, and hospital readmissions of all study patients were used to test the external validity of the instrument. RESULTS: Inter-rater reliability improved over time, reaching a high of 97.1 percent after six months. A positive association was determined between the prescribing scores and the number of reported adverse effects (rho = 0.28, p = 0.02). Although the number of patients with drug-related hospital readmissions was too few to establish a significant association between the prescribing scores and readmissions, the findings were expected. CONCLUSIONS: Given current requirements for drug utilization reviews in hospitals, health maintenance organizations, and Medicaid programs, this instrument may prove to be very useful.

The impact of clinical pharmacists' consultations on physicians' geriatric drug prescribing. A randomized controlled trial.

The impact of clinical pharmacists' consultations on geriatric drug prescribing was studied in a prospective randomized controlled trial of patients 65 years of age and over discharged on 3 or more medications for chronic conditions from a 450-bed community hospital. The pharmacists provided consultation to experimental patients and their physicians at hospital discharge and at periodic intervals for 3 months postdischarge. Using a standardized tool, a physician-pharmacist panel, blinded to study group assignment of patients, evaluated the appropriateness of prescribing for a random sample of 236 patients. Eighty-eight percent had at least one or more clinically significant drug problems, and 22% had at least one potentially serious and life-threatening problem. Drug-therapy problems were divided into six categories: 1) inappropriate choice of therapy; 2) dosage; 3) schedule; 4) drug-drug interactions; 5) therapeutic duplication; and 6) allergy. Experimental patients were less likely to have one or more prescribing problems in any of the categories (P = 0.05) or in the appropriateness (P = 0.02) or dosage (P = 0.05) categories. A summary score, measuring the appropriateness of the patient's total drug regimen, indicated that experimental patients' regimens were more appropriate than those of controls (P = 0.01). Results of this trial reveal that clinical pharmacists can improve the appropriateness of geriatric drug prescribing in outpatient settings.