Merging education with measurement: a focus on the Hispanic community.

There is an increasing need for community health promotion efforts directed to populations that are often disenfranchised from the health care system. The rapidly growing Hispanic population can benefit from outreach efforts that provide health education and promote community awareness of health status and health problems. This article describes a cost effective survey system that measured health status, health needs and provided individualized health feedback and education to Hispanic residents. The results underscore the importance of culturally and linguistically appropriate community-based initiatives that assess health status to aid in setting policy, eliminate health disparities, and determine priorities to meet the health needs of the growing Hispanic population.

Design strategy for assessing multi-pathway exposure for children: the Minnesota Children's Pesticide Exposure Study (MNCPES).

Although children are exposed to a variety of environmental hazards, including pesticides, there is a scarcity of information available to estimate exposures realistically. This article reports on one of the first attempts to measure multi-pathway pesticide exposures in a population-based sample of urban and non-urban children. A design strategy was developed to assess multi-pathway pesticide exposures in children using personal exposure measurements in combination with complimentary measurements of biological markers of exposure, concentrations in relevant environmental media, and time spent in important microenvironments and participating in exposure-related activities. Sample collection and analysis emphasized measurement of three insecticides (i.e., chlorpyrifos, diazinon, and malathion) and one herbicide (i.e., atrazine). These compounds were selected because of their frequent use, presence in multiple environmental media, expected population exposures, and related hazard/toxicity. The study was conducted during the summer of 1997 in Minnesota and involved a stratified sample of households with children ages 3-12 years. Participants resided in either (a) the cities of Minneapolis and St. Paul (urban households), or (b) Rice and Goodhue Counties just south of the metropolitan area (non-urban households). Results from a residential inventory documenting storage and use of products containing the target pesticides were used to preferentially select households where children were likely to have higher exposures. The study successfully obtained pesticide exposure data for 102 children, including measurements of personal exposures (air, hand rinse, duplicate diet), environmental concentrations (residential indoor/outdoor air, drinking water, residential surfaces, soil), activity patterns (obtained by questionnaire, diary, videotaping), and internal dose (metabolites in urine).

Pesticide storage and use patterns in Minnesota households with children.

As part of the National Human Exposure Assessment Survey (NHEXAS), residential pesticide storage and use patterns were evaluated in a population-based sample of Minnesota households with children aged 3-13. In-home interviews and inventories were conducted to identify pesticide products stored and used in and around 308 households. This statistically based sample represents more than 49,000 urban and rural households in the census tracts sampled. More than 850 unique products were identified using Environmental Protection Agency (EPA) registration numbers. Pesticide products were found in 97% and reported used in 88% of study households. Population-weighted mean values for pesticide storage and use were 6.0 and 3.1 products per household, respectively. The most common active ingredients found were diethyl toluamide (DEET) and related compounds, piperonyl butoxide, pyrethrins, dimethylamine 2-[2-methyl-4-chlorophenoxyl propionate (MCPA) and chlorpyrifos. Household socio-demographic characteristics explained little of the variability in pesticide storage and use patterns, and there were no significant differences in residential storage and use patterns between households located in urban versus non-urban census tracts. Although the prevalence of households with pesticide products was similar to recent national surveys, observed storage and use rates were almost twice those obtained in recent national studies, reflecting improved inventory techniques used by this study and/or increased rates of pesticide presence and use in study households.

Measurement of multi-pollutant and multi-pathway exposures in a probability-based sample of children: practical strategies for effective field studies.

The purpose of this manuscript is to describe the practical strategies developed for the implementation of the Minnesota Children's Pesticide Exposure Study (MNCPES), which is one of the first probability-based samples of multi-pathway and multi-pesticide exposures in children. The primary objective of MNCPES was to characterize children's exposure to selected pesticides through a combination of questionnaires, personal exposure measurements (i.e., air, duplicate diet, hand rinse), and complementary monitoring of biological samples (i.e., pesticide metabolites in urine), environmental samples (i.e., residential indoor/outdoor air, drinking water, dust on residential surfaces, soil), and children's activity patterns. A cross-sectional design employing a stratified random sample was used to identify homes with age-eligible children and screen residences to facilitate oversampling of households with higher potential exposures. Numerous techniques were employed in the study, including in-person contact by locally based interviewers, brief and highly focused home visits, graduated subject incentives, and training of parents and children to assist in sample collection. It is not feasible to quantify increases in rates of subject recruitment, retention, or compliance that resulted from the techniques employed in this study. Nevertheless, results indicate that the total package of implemented procedures was instrumental in obtaining a high percentage of valid samples for targeted households and environmental media.

Case study of psychophysiological diary: infradian rhythms.

A 4-year case study was made of a 42-year-old white woman as seen through the psychophysiological diary. There was an awakening diary and a bedtime diary composed of 125 variables. The data are divided into two series: series I containing a manic episode, and series II as a control. Spectral analysis shows infradian rhythms in hypoglycemia and fear (11 days) and time to fall asleep (5 days). Depressed feelings showed a circatrigintan (28-day) rhythm, which was not correlated with menses. Mania had an annual rhythm (spring) but no circatrigintan or less rhythm. The following correlations have a P value less than or equal to 0.01: mania was directly correlated with number of sleeping pills, time to really wake up, need for rest, moodiness, and helplessness, and indirectly with expectations, pressure at work, sense of time, and emotional state. Interestingly, awakening pulse is directly correlated with awakening temperature, number of sleeping pills, bedtime pulse, tiredness at bedtime, hypoglycemia, and fear. Bedtime pulse is directly correlated with awakening pulse and awakening temperature. Both pulse and temperature at bedtime are directly correlated with negative variables such as tiredness, moodiness, helplessness, and depression, and inversely correlated with positive variables such as happiness, loving, performance at work, and thinking efficiency. This study demonstrates a significant correlation between physiological variables.

Use of clomipramine in treatment of obsessive-compulsive symptomatology.

An open clinical trial was conducted on the use of oral clomipramine in the treatment of obsessive-compulsive symptomatology in patients with various primary psychiatric diagnoses. The overall success rate of the 50 patients was 60%; those with a primary diagnosis of obsessive-compulsive disorder had an 80% success rate. No significant differences in outcome were observed by current age, age of illness onset, duration of illness, or severity of illness. Minnesota Multiphasic Personality Inventories of a subsample of the population revealed a significantly higher T score for depression in the successful patients. Since 83% of the successful patients had adequate prior treatments on other antidepressants without improvement in their obsessive-compulsive symptoms, it would appear that clomipramine is effective in treating obsessive-compulsive symptoms as well as depressive symptoms.

Quieting response training: predictors of long-term outcome.

Extensive personality, demographic, and symptom-related information from a heterogeneous group of more than 300 patients was examined for patterns that would discriminate between successful and unsuccessful outcomes in patients undergoing Quieting Response (QR) training, an 8-week program that integrated EMG and thermal biofeedback with a variety of relaxation exercises. Follow-up evaluations were at 3, 6, 12 and 24 months. Agreement between expected (from stepwise discriminant analyses) and observed outcomes was 65% (whole sample), 62% (headache only), and 70% (Raynaud's only). Unimproved patient MMPI scales D, Sc, F, Hy, and Pt were significantly elevated. A variety of additional measures used indicated elevated levels of psychological stress among unsuccessful patients. While stereotypical descriptions of successful and unsuccessful patients are proposed, patterns from outcome groups were more similar than dissimilar, and no combination of factors was identified that had sufficient predictive power for use with future patients. No statistical grounds for exclusion were found among patterns of responses to the measures employed. Factors contributing to the inaccuracy of outcome prediction are discussed.

Quieting response training: long-term evaluation of a clinical biofeedback practice.

Clinical evidence for the long-term effectiveness of biofeedback related relaxation training is accumulating. The purpose of this report is to describe the population, self-regulation procedure, outcome criteria, and final outcome for patients who received Quieting Response (QR) training. Data from 340 patients who completed at least the first follow-up at 3 months is presented. Primary presenting symptoms were headaches, 72%; primary and secondary Raynaud's, 14%; hypertension, 4%; irritable colon, 4%; and miscellaneous, 6%. QR training integrated EMG and thermal feedback with deep breathing, progressive relaxation, and autogenic exercises presented on cassette tapes. Eight 1-hour weekly sessions were given, with emphasis on daily home exercises. Follow-up evaluations were at 3 months, 6 months, 1 year, and 2 years. Outcome was based on change in frequency, severity, and duration of symptoms; changes in medication; and secondary benefits. Quieting Response training was found to be most beneficial for patients with primary Raynaud's disease (18 of 23 patients, or 78% successful), classic migraines (9 of 13, or 69%), and common migraines (20 of 32, or 62%), followed by mixed headaches (79 of 131, or 60%), Raynaud's plus other symptoms (9 of 15, or 60%), and the irritable colon syndrome (7 of 13, or 54%). Less successful were patients with headaches plus other symptoms (16 of 37, or 43%), muscle contraction headaches (13 of 33, or 39%), secondary Raynaud's phenomenon (4 of 10, or 40%), and essential hypertension (5 of 15, or 33%). Speculations about the differing outcomes across symptom groups were made.

Borderline personality subcategories.

A careful study of 106 patients, diagnosed as borderline using the criteria of the Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition, is in progress at a private psychiatric facility. Three distinct subcategories of the borderline personality disorder have been identified: history of no organicity, history of trauma, encephalitis, or epilepsy, and history of attentional deficit disorder/learning disabilities. A discriminant function analysis approach clearly distinguishes the three borderline subcategories from one another and from a schizophrenic control group. Borderline patients also show significant sex differences. The borderline personality disorder is viewed as either on a continuum with affective disorders and atypical psychoses, or with organic brain dysfunction including the episodic dyscontrol syndrome and/or adult minimal brain dysfunction. Future research should be directed toward further classifying homogeneous subgroups of borderline patients in order to provide more specific and effective treatment.

Quieting response training: treatment of psychophysiological disorders in psychiatric inpatients.

Self-regulation methods incorporating biofeedback are known to be useful in the treatment of psychophysiological disorders in psychologically normal patients. In this study, the effectiveness of Quieting Response (QR) training for the treatment of secondary psychophysiological complaints in psychiatric inpatients was assessed. Ten male and 27 female inpatients with a variety of secondary psychophysiological diagnoses were accepted into the study. Severely disturbed, confused, or depressed patients were excluded. All patients received QR training, which integrated EMG (electromyogram) and thermal feedback with breathing, progressive relaxation, and autogenic exercises. Daily practice of a 15-minute sequence of exercises was encouraged, and a 6-second reinforcement exercise was presented for use whenever an annoyance was encountered. No other therapeutic modalities were employed. Patients were followed for up to 2 years, and outcome was assessed with a multifactor quartile system. Rate of success at final follow-up for the inpatients (51%) was found to be equivalent to that of outpatients coming to the clinic with primary psychophysiological diagnoses (55%) and was not related to psychiatric diagnosis or nature of presenting complaint. Stepwise discriminant analysis indicated that older, less depressed individuals were more successful. Inpatients differed from nonpsychiatric patients only in the number of additional sessions received. Only one minor incident of increased psychopathology was observed. It was concluded that QR training was as effective for treating secondary psychophysiological disorders in all but the most severely disturbed inpatients as it was for the outpatient clinic population.

Motion sickness: an index of sensory conflict relating to behavior.

Diverse measures of behavior are examined in a student and large patient sample for the purpose of supporting the concept that conflict in sensory mechanisms may contribute to diminished or impaired function. Evidence supports the contention that two patterns of orientation may exist at the extremes of motion sickness susceptibility and that individuals showing transitional patterns of organization may be vulnerable to different kinds of central nervous system disorganization. The authors believe that a consideration of sensory function as it relates to patterns of behavior may contribute to an expansion in the medical model of mental illness.

Susceptibility to motion sickness and ego closeness, ego distance as measured by the autokinetic response tendency.

This paper reports results from one phase in an ongoing study of the relationship between vestibular function and various aspects of personality, cognitive style and symptom formation in mental illness. In the experiment reported here a measure of autokinesis was shown to relate to motion sickness experience as judged by actual stimulation in a rotating chair. Low and intermediate sensitive subjects showed less autokinesis than the most motion sick individuals (two-way analysis of variance F = 5.735, P = 0.006). Males in this sample showed a significantly greater autokinetic tendency than females (two-way analysis of variance F = 6.995, P = 0.011).