Alcohol policy and the young adult: establishing priorities, building partnerships, overcoming barriers.

Young adults (defined here as those 18-29 years of age) in the United States and Canada constitute a demographic group most likely to suffer serious alcohol problems, yet the alcohol policy field has made little effort to develop prevention strategies that respond specifically to their circumstances and needs. This paper briefly reviews relevant research, analyzes prevention policy priorities, presents the barriers to implementation and outlines strategies for overcoming them. Its main conclusions are: (1) Strategies to reduce alcohol availability and increase alcohol prices will significantly reduce alcohol problems among young adults. (2) A high priority should be given to harm reduction strategies and strategies that target the physical environments where young adults are likely to congregate. (3) The alcohol industries and the industries' allies will vigorously oppose these policy reforms, and their resistance constitutes a formidable barrier to implementation. (4) Resistance from other community institutions, which may benefit from the status quo, is an additional barrier that must be addressed. (5) There is a tendency to compromise with the alcohol industries and others and substitute individual-based prevention strategies for public policy reforms. Individual-based strategies complement public policy reforms but should not replace them. (6) Overcoming barriers will require community organizing, coalition building, media advocacy and policy advocacy and an expanded research effort. The field needs to develop new messages and themes in both media and policy advocacy that address the specific concerns and interests of young adults, thereby encouraging their active leadership in prevention policy development.

X-ray changes after expanded polytetrafluoroethylene (Gore-Tex) interpositional arthroplasty.

Thirty-one patients with degenerative osteoarthritis at the trapeziometacarpal joint underwent 34 expanded polytetrafluoroethylene interpositional arthroplasties. The average follow-up period for the group of patients was 41 months (range, 15-82 months). Subjective results and objective measurements for the patients at the time of review were favorable. X-ray analysis, however, revealed a high incidence of osteolytic lesions associated with microparticulate degeneration consistent with reactive particulate synovitis. Owing to the unacceptably high rate of secondary osteolysis, the authors recommend that use of this material for trapeziometacarpal or pantrapezial arthroplasty be abandoned.

The merchants, not the customers: resisting the alcohol and tobacco industries' strategy to blame young people for illegal alcohol and tobacco sales.

Reducing access of alcohol and tobacco to young people constitutes a pressing public health policy agenda. Research has established that alcohol and tobacco are readily available to young people and that early use of these products increases both short term and long term health problems. Research also shows that the most effective way to reduce underage access is to implement merchant compliance programs as part of a comprehensive prevention strategy. Successful merchant compliance programs involve the use of young people who attempt to purchase alcohol or tobacco from merchants. These attempted purchases should be conducted on a routine basis and should result in increasingly severe fines and civil penalties against merchants who violate the law. This article reviews the research outlined above and documents the industries' efforts to redirect public policy to blame the young person rather than the merchant for the problem of youth access to alcohol and tobacco. The industry is using several tactics to reach this goal. The article concludes with a nine point proposal for reducing youth access, outlining the key elements of a merchant compliance program, and presenting other essential components of a community-based, comprehensive strategy.

Carpal collapse and Sudeck's atrophy.

Acute posttraumatic (Sudeck's) atrophy of the upper extremity is well known. The symptoms and signs are out of proportion to what is to be expected from the inciting event. Typically, bone atrophy is characterized by a focal, patchy, periarticular demineralization pattern, which is usually transient. Remineralization occurs after successful treatment. This report describes a typical case of the clinical syndrome after a wrist sprain but with carpal dissolution and collapse before remineralization.

Subperiosteal osteoid osteoma of the hamate: a case report.

Osteoid osteoma is uncommon in the hand. The lesion can arise from either cortical or cancellous bone or subperiosteally. The latter localization is extremely rare in the hand, with only 4 reported cases in the English-language literature. Furthermore, characteristic radiographic findings of a central lucency surrounded by reactive sclerosis often emerge only late in the process, or not at all. Consequently, the diagnosis of osteoid osteoma of the hand can be delayed. We report a case of a subperiosteal osteoid osteoma of the hamate in which the diagnosis was delayed 2 years.

Long-term results of Swanson interpositional wrist arthroplasty: Part II.

Fifty-eight Swanson silicone interpositional wrist arthroplasties were done in 47 patients between 1974 and 1984. Thirty-nine of these original wrists were available for follow-up an average of 5.8 years after operation. This is a continuation of our study previously published in this Journal. With increased follow-up, progressive deterioration of clinical results was noted. With a follow-up of less than 2.5 years, 75% had relief of pain. After a follow-up of 4.8 years, 67% had relief of pain. Finally, with an average follow-up of 5.8 years, only 51% had relief of pain. Progressive radiographic changes are now obvious in each case compared with 70% of those cases reviewed at 4.8 years. Furthermore, we now have noted cystic changes in a significant proportion of the wrists radiographically. In several of these, silicone synovitis has been documented histologically. Our indications for this procedure have drastically narrowed.

Public health, not social warfare: a public health approach to illegal drug policy.

This article makes three major arguments: (I) the current War on Drugs undercuts public health values and premises, resulting in a war on the poor, disenfranchised, people of color, the homeless, and the unemployed; (2) drug problems should be addressed primarily within the realm of public health policy rather than criminal justice policy; and (3) to achieve a viable public health drug policy, the public health community needs to build grassroots support and become effective activists. The article reviews the history of past drug wars, analyzes recent trends in illegal drug use and problems, and critiques current policy initiatives and their consequences. It then outlines a comprehensive, public health approach to addressing illegal drug problems, and concludes with an analysis of what steps are needed to become effective in the public policy arena.

Alcohol-related problems and public hospitals: defining a new role in prevention.

Application of the public health model of primary prevention to the prevention of alcohol-related problems suggests that public hospitals can be significant partners in community-based prevention efforts. Injury and illness related to alcohol use place a high level of demand on public hospital resources, and their participation in prevention efforts is a promising and underutilized way of reducing this demand. Avenues of participation in prevention include improved data collection and reporting, identification and referral of problem-drinking patients, greater dissemination of data on alcohol-related problems to the general public, liaison with victim assistance groups and community-based alcohol-problem prevention organizations, involvement in public policy regarding alcohol use, and the development of prevention messages from a medical perspective. Implementing some or all of these approaches can be done with little extra cost, through using local government alcohol program staff and resources, integration of alcohol-related problem prevention issues into staff training, liaison with professional educational institutions with expertise on alcohol, networking with alcohol policy organizations, incentives for staff participation in health-related professional organizations giving alcohol policy issues higher priority, and the development of a permanent on-site prevention component.

Limited wrist arthrodesis: a laboratory study.

By means of an external fixator, 11 limited wrist "fusions" in eight freshly frozen cadaver wrists were studied. An electrogoniometer measured perfusion and postfusion range of motion, and the percentage of loss of motion was determined and then averaged for all eight wrists. The three fusions that crossed the radiocarpal row lost approximately 55% flexion/extension (F/E). The five fusions that crossed the intercarpal row lost approximately 27% F/E, and the three fusions within a single carpal row lost approximately 12% F/E. These results may be helpful to determine which limited wrist fusion to perform.