Framing tobacco control efforts within an ethical context.

Public health efforts to promote tobacco control are not performed within a vacuum. They are subject to interpretation and misinterpretation by consumers and policymakers based largely upon the initial framing of the issues. This paper notes how the tobacco industry has established a particular frame that it is the protector of individual rights and that the public health community is trying to eliminate those rights. This paper then shows how the public health community uses metaphors that may unintentionally support this framing and suggests that by reframing public health efforts in accordance with core ethical principles, the public health community can create more positive messages. A public health ethical framework is proposed to examine how the application of the principles can influence the tobacco control movement. Through the increased use of ethics in tobacco control, the public health community may be better positioned to claim the high road as the protector of the public's interests.

Batches of intravenous immunoglobulin associated with adverse reactions in recipients contain atypically high anti-Rh D activity.

BACKGROUND AND OBJECTIVES: The presence of anti-Rh D in intravenous immunoglobulin (IVIG) products has been claimed to be associated with adverse reactions in recipients. There is currently no regulatory specification to control the level of anti-D in IVIG products and it is unclear what this should be. Two reports of haemolysis occurring in recipients of IVIG manufactured from US plasma provided a rare opportunity to investigate whether high anti-D levels could have induced the haemolysis. MATERIALS AND METHODS: We developed a direct microtitre plate haemagglutination method suitable for screening IVIG products and starting plasma pools for haemagglutinating activity. RESULTS: Of 101 batches of IVIG tested, six were found to contain specific anti-D. Four of these batches had anti-D titres ranging from 64 to 256 (including the two batches each associated with a report of haemolysis) and could be linked, in each case, to a starting plasma pool also positive for anti-D. CONCLUSIONS: Our results show that IVIG products can contain appreciable anti-D levels. To avoid potential problems in recipients, we propose an anti-D titre of 8 as the maximum permissible limit of anti-D in IVIG products for batch acceptance and release. The availability of a reference preparation is essential for control of this proposed requirement.

Tobacco industry allegations of "illegal lobbying" and state tobacco control.

OBJECTIVES: This study assessed the perceived effect of tobacco industry allegations of "illegal lobbying" by public health professionals on policy interventions for tobacco control. METHODS: Structured interviews were conducted with state health department project managers in all 17 National Cancer Institute-funded American Stop Smoking Intervention Study (ASSIST) states. Documentation and media records related to ASSIST from the National Cancer Institute, health advocates, and the tobacco industry were analyzed. RESULTS: The tobacco industry filed formal complaints of illegal lobbying activities against 4 ASSIST states. These complaints had a temporary chilling effect on tobacco control policy interventions in those states. ASSIST states not targeted by the tobacco industry developed an increased awareness of the industry's tactics and worked to prepare for such allegations to minimize disruption of their activities. Some self-reported self-censorship in policy activity occurred in 11 of the 17 states (65%). CONCLUSIONS: Public health professionals need to educate themselves and the public about the laws that regulate lobbying activities and develop their strategies, including their policy activities, accordingly.

Gender and racial/ethnic differences in tobacco-dependence treatment: a commentary and research recommendations.

The preparation of the Public Health Service Report, Treating Tobacco Use and Dependence, brought to light a substantial gap in the smoking cessation literature; there is little or no research evidence regarding the success of formal tobacco-dependence treatment specific to gender or racial/ethnic status. Of the 192 articles included in the meta-analyses of the evidence-based PHS Report, none included results based on racial/ethnic group and only four reported results by gender. This commentary identifies tobacco use as a problem that crosses gender and racial/ethnic boundaries, reviews reasons that the different genders or racial/ethnic groups might require different tobacco-dependence treatments, provides suggestive evidence that both gender and racial/ethnic status influence tobacco-dependence treatment efficacy, and recommends changes and directions for future clinical research that will address gender and racial/ethnicity effects.

Promoting cessation of tobacco use.

Tobacco exacts an exorbitant toll on the nation's health, causing more than 450,000 deaths yearly. Although rates of smoking (the most common form of tobacco use) among adults have decreased in the past two decades, the decline has recently leveled off. Of additional concern is that youth tobacco use is increasing (1). A combination of recent scientific advances and social, legal, and public policy developments provides an unprecedented opportunity to reduce the burden of death and disease caused by tobacco use (2). Reducing tobacco use among adults and adolescents is an important public health goal.

Regional coupling between chest wall and lung expansion during HFV: a positron imaging study.

Apparently conflicting differences between the regional chest wall motion and gas transport have been observed during high-frequency ventilation (HFV). To elucidate the mechanism responsible for such differences, a positron imaging technique capable of assessing dynamic chest wall volumetric expansion, regional lung volume, and regional gas transport was developed. Anesthetized supine dogs were studied at ventilatory frequencies (f) ranging from 1 to 15 Hz and eucapnic tidal volumes. The regional distribution of mean lung volume was found to be independent of f, but the apex-to-base ratio of regional chest wall expansion favored the lung bases at low f and became more homogeneous at higher f. Regional gas transport per unit of lung volume, assessed from washout maneuvers, was homogeneous at 1 Hz, favored the bases progressively as f increased to 9 Hz, and returned to homogeneity at 15 Hz. Interregional asynchrony (pendelluft) and right-to-left differences were small at this large regional scale. Analysis of the data at a higher spatial resolution showed that the motion of the diaphragm relative to the excursions of the rib cage decreased as f increased. These differences from apex to base in regional chest wall expansion and gas transport were consistent with a simple model including lung, rib cage, and diaphragm regional impedances and a viscous coupling between lungs and chest wall caused by the relative sliding between pleural surfaces. To further test this model, we studied five additional animals under open chest conditions. These studies resulted in a homogeneous and f-independent regional gas transport. We conclude that the apex-to-base distribution of gas transport observed during HFV is not caused by intrinsic lung heterogeneity but rather is a result of chest wall expansion dynamics and its coupling to the lung.

Career choices of graduates from Washington University's Medical Scientist Training Program.

The Medical Scientist Training Program at Washington University has been in existence for 21 years; by 1990, 148 students had completed the program leading to the combined M.D./Ph.D. degree. Of these graduates, most (95%) chose to enter residency programs rather than postdoctoral fellowships. Of the 72 who had completed their residencies or postdoctoral training by 1990, the vast majority (89%) reported that they were returning to academic institutions or the National Institutes of Health. Those in academic institutions were primarily in clinical departments, with medicine being the first choice. Most said they were devoting much of their time to basic research. These graduates were progressing rapidly into tenured positions and appear to have been well funded.

Seborrheic keratoses of penis.

A case is reported of a forty-nine-year-old black man in whom numerous skin-colored papules and verrucoid plaques had developed on his penis over the course of fifteen years. He did not seek medical attention, and some of the lesions had become quite large. The initial clinical impression was condyloma acuminatum, and prior to therapeutic intervention histologic evaluation revealed findings diagnostic of seborrheic keratosis. Seborrheic keratoses should be considered in the differential diagnosis of penile lesions especially because of clinical similarities to condylomata acuminata.

Solid facial edema as a complication of acne vulgaris: treatment with isotretinoin.

A case of persistent solid facial edema is described in a 17-year-old boy with moderate papulocystic acne. After a 20-week course of isotretinoin, the acne vulgaris resolved, and there was a moderate reduction in the facial edema.

Granuloma annulare arising in herpes zoster scars. Report of two cases and review of the literature.

We present two patients who developed granuloma annulare in the scars from previous herpes zoster. The development of granuloma annulare in herpes zoster scars may represent an atypical delayed hypersensitivity immune reaction to herpes zoster/varicella virus antigen(s) or a tissue antigen altered by the virus.

Tinea corporis overlying the thyroid gland after radioiodine (131I) treatment of Graves' disease.

A case of tinea corporis involving the skin overlying the thyroid gland is described in a 36-year-old man who had received radioiodine treatment for Graves' disease. The dermatophytosis mimicked a delayed roentgen erythema. Radiation to the dermis may have locally altered the cell-mediated immunity and predisposed this patient to the dermatophytosis.

Gallium-67 citrate localization in disseminated sporotrichosis.

A 25-year-old woman demonstrated Ga-67 citrate accumulation within a facial cutaneous lesion and two subcutaneous nodules within the right lower extremity. Cultures of the facial lesion and one of the subcutaneous nodules grew Sporothrix schenckii. Ga-67 citrate uptake has not been reported previously with this fungal infection. Ga-67 citrate scintigraphy was helpful in defining the extent of the disease, following its course, and determining the response to therapy.

Papulosquamous diseases: a review.

Papulosquamous diseases are a heterogeneous group of disorders whose etiology primarily is unknown. The nosology of these disorders is based on a descriptive morphology of clinical lesions characterized by scaly papules and plaques. The major entities in this group include psoriasis, parapsoriasis (including pityriasis lichenoides et varioliformis acuta), lichen planus, lichen nitidus, lichen striatus, pityriasis rosea, pityriasis rubra pilaris, seborrheic dermatitis, and the Gianotti-Crosti syndrome. Many other conditions may become papulosquamous and should be considered in the differential diagnosis.

Treatment of palmoplantar pustulosis with intralesional triamcinolone injections.

Five patients with chronic intermittent palmoplantar pustulosis were treated with intralesional injections of 3.3 to 5.0 mg/mL of triamcinolone acetonide. Prompt clearing of symptoms and lesions ensued, lasting three to six months. Despite the discomfort experienced from the injections, patients preferred this treatment modality over others. Minor side effects included hypopigmentation, cutaneous atrophy, and, in one case, exacerbation of a latent dermatophyte infection.

Comparison of treatment modalities for epidermal nevus: a case report and review.

For the past 2 years, we have been treating a teenage girl for a disfiguring, extensive, inflammatory linear verrucous epidermal nevus (ILVEN). In this one patient, we examined the efficacy of numerous treatment modalities and compared our results with those reported in the literature. In our experience, cryotherapy using liquid nitrogen proved to be the most successful therapy, and we have subsequently used it to treat almost all of this patient's lesions. Although cryotherapy does not provide an easy or dramatic cure, we believe it does produce reasonably good cosmetic results.

Erythromycin therapy in bullous pemphigoid: possible anti-inflammatory effects.

Two patients with bullous pemphigoid treated with erythromycin demonstrated improvement. This response suggests that erythromycin may be a fairly safe supplemental drug which may allow a lower dose of systemic steroid, or may be of benefit when used alone or in combination with topical steroids in treating patients who are not ideal candidates for a systemic steroid. Erythromycin appears to have a significant anti-inflammatory effect, and possible mechanisms for this effect are proposed. One of the patients was a 4 1/2-year-old girl whose disease manifested several unusual features, making diagnosis difficult. A brief summary of differential immunofluorescent findings in childhood bullous diseases is also presented.