Preventing alcohol misuse: the impact of refusal skills and norms.

The purpose of this study was to determine the extent to which refusal skills and norm setting mediated the impact of a school-based prevention program from the Alcohol Misuse Prevention Study (AMPS) on adolescent alcohol overindulgence. The AMPS is a randomized, pre-post, experimental-control study. Respondents in the present study included 6th through 10th graders (ns ranged from 232 to 371). Structural equation modeling analyses using EQS indicated that norm setting mediated the effect of the intervention on alcohol overindulgence at the 7th through the 8th grade and at the 8th through the 10th grade. In contrast, although the prevention program served to increase refusal skills, refusal skills did not mediate the effect of the program on alcohol misuse.

The mediating influence of refusal skills in preventing adolescent alcohol misuse.

Alcohol is the most frequently used psycho-active substance during adolescence. Adolescents who misuse or overindulge in alcohol are at risk for serious social and psychological consequences. Several preventive approaches can help adolescents deal with peer pressure that contributes to alcohol use experimentation and escalation. One promising approach involves teaching adolescents skills to refuse offers of alcohol and other drugs. Few studies, however, have examined how this approach works; that is, the connection between the prevention effort, refusal skills, and drinking behavior. This paper investigates the relationships among the intervention, refusal skills, and alcohol misuse in the Alcohol Misuse Prevention Study, a randomized, pre/post experimental study. Based on data from sixth through tenth graders (average N per grade = approximately 400), regression analyses indicate that refusal skills are significant mediators of the effect of the intervention on alcohol misuse.

Effect of heating-ventilation-air conditioning system sanitation on airborne fungal populations in residential environments.

Commercial air duct sanitation services are advertised to the public as being effective in reducing indoor aeroallergen levels despite the absence of published supporting data. Eight residential heat-ventilation-air conditioning (HVAC) systems in six homes and seven HVAC systems in five homes in winter and summer, respectively, were sampled to determine fungal colony forming units (CFUs) prior to and after an HVAC sanitation procedure was performed by a local company. Two houses in which no sanitation procedure was performed served as controls in each study phase. Two sample sets were obtained at each HVAC system prior to cleaning in order to determine baseline CFU levels. The test HVAC systems were then cleaned, and the HVAC systems allowed to operate as desired by the residents. Posttreatment sampling was performed 48 hours and then weekly after cleaning for 8 weeks. The HVAC systems were analyzed by exposing sterile 2% malt extract media plates at a 90-degree angle to the air flow at the air supply and air return vents. The baseline CFUs were similar in the control and study houses. Eight weeks after sanitation, the study houses demonstrated an overall CFU reduction of 92% during winter and 84% during summer. No reduction in CFU values was observed over the 8-week study period for the houses selected as controls. Further, HVAC sanitation appeared to reduce the number of fungal colonies entering and leaving the HVAC system, suggesting that the HVAC contained a significant percentage of the total fungal load in these homes. These data suggest that HVAC sanitation may be an effective tool in reducing airborne fungal populations in residential environments.

Anaphylaxis at school.

Anaphylaxis is a life-threatening allergic reaction. It can occur after insect stings or food intake in susceptible children and adolescents while at school. The respiratory, cutaneous, gastrointestinal, and cardiovascular systems are often affected, and prompt treatment with injected epinephrine may be life saving. It is important for school nurses to be familiar with the early recognition, prompt treatment, and prevention of anaphylaxis.

Purification of tryptase from a human mast cell line.

The neutral protease tryptase has been isolated from a human mast cell line, HMC-1. The HMC-1 line was established from the peripheral blood of a patient with mast cell leukemia and maintained as continuously proliferating clones in vitro and as solid mast cell tumors in nude mice. HMC-1-derived tryptase was purified by sequential chromatography on Dowex 1, DEAE 5 PW, and heparin-agarose. Purified tryptase has an apparent molecular weight of 150,000, as determined by molecular sieve HPLC, but migrates as a doublet of bands of 32/35,000 on SDS-PAGE gels. Maximal enzymatic activity was observed at pH 8.5. Cleavage of tosyl-L-arginine methyl ester by purified tryptase was inhibited by dansyl-L-glutamyl-glycyl-L-arginine chloromethyl ketone 2 HCl, HgCl2, tosyl-L-lysine chloromethyl ketone, leupeptin, and PMSF but not by benzamidine, aprotinin, tosyl-L-phenyl-alanine chloromethyl ketone, soybean trypsin inhibitor, human plasma, ovomucoid inhibitor, or lima bean trypsin inhibitor. Microsequencing of purified tryptase yielded an amino terminal sequence that was identical to that previously reported for human pituitary-derived tryptase.

Exercise cardiorespiratory function in adolescents with pectus excavatum. Observations before and after operation.

We studied 12 children with pectus excavatum (mean age, 13.8 years) using pulmonary function and exercise testing. Eight patients had surgical repair and were studied before and after repair. Four patients did not have repair and were tested twice. The degree of chest wall deformity in the two groups was similar. All patients reached 86% or more of their maximal predicted heart rate with exercise. Total lung capacity decreased 8% (p less than 0.01) after operation. In the nonoperated control group, total lung capacity was similar during both studies. The ratio of ventilation at maximal exercise to maximal voluntary ventilation was 68% +/- 12% before and 66% +/- 9% after operation in the operated group and 69% +/- 18% and 79% +/- 30% at two studies in the nonoperated group (nonsignificant changes). Maximal oxygen uptake was 36.1 +/- 4.4 ml/kg/min preoperatively and 38.1 +/- 8.1 postoperatively and 41.2 +/- 7.3 ml/kg/min and 43.0 +/- 6.9 on two studies in the nonoperated group (nonsignificant changes). Cardiac output and stroke volume increased appropriately with exercise both before and after operation. Operation had no physiologically significant effect on the cardiorespiratory response to exercise. Slight changes in cardiorespiratory function occurred in both operated and nonoperated subjects. These results emphasize the importance of studying patients before and after operation and of using a control group.

Alternative approaches to asthma.

On the basis of studies of the pathophysiology of asthma, we now know that agents to control chronic asthma must do more than reverse bronchoconstriction caused by a hyperreactive airway. They must also control the inflammatory response engendered by the triggers of asthma. Three types of antiinflammatory agents are now used for this purpose: corticosteroids, cromolyn sodium, and a new anticholinergic drug, ipratropium bromide. These drugs are discussed in terms of their mechanisms of action, clinical uses, and side effects reported in studies of children with asthma.

Immunochemical quantitation, size distribution, and cross-reactivity of lepidoptera (moth) aeroallergens in southeastern Minnesota.

With an immunochemical method, we analyzed outdoor air samples during a 3-year period for concentrations of the predominant local species of moth, Pseudaletia unipuncta (Haworth). Airborne particulates were collected on fiberglass filter sheets with an Accu-Vol sampler located 1.5 m above ground on the southeastern Minnesota prairie. Filter eluates analyzed by RIA inhibition contained concentrations of moth protein peaking in June and August to September of each year, with levels comparable to reported immunochemically measured levels of pollen and mold allergens. These peaks also corresponded with total numbers of moths captured in light traps. Moth-allergen activity was distributed in particle sizes ranging from 0.8 to greater than 4.1 micron when sized samples were obtained by use of an Andersen cascade impaction head. By RIA inhibition, there was cross-reactivity between P. unipuncta and insects of different genera, families, and orders, but not with pollens or molds. Forty-five percent of 257 patients with immediate positive skin tests to common aeroallergens had positive skin tests to one or more commercially available whole body insect extracts. Of 120 patients with allergic rhinitis believed to be primarily caused by ragweed sensitivity, 5% also had elevated specific IgE to moths. We conclude that airborne concentrations of Lepidoptera can be measured immunochemically and that moths may be a seasonal allergen in the United States.

Women in medicine: past, present, and future.

Women now constitute 14% of all physicians in practice and are concentrated in the primary care specialties. Thirty-five percent of all medical students are female, and their numbers are increasing yearly. Female physicians frequently combine career and family, and the average woman physician has one child during residency and one child in the early years of practice. Maternity leave, therefore, is a common concern among women physicians, three fourths of whom are less than 45 years of age.

Long-term prognosis for children with nephrotic syndrome.

Follow-up survival and health information were obtained, after a median of 27.5 years, from 132 patients who had been seen originally as children with nephrotic syndrome between 1951 and 1967. Ninety seven patients were alive. Recurring edema or proteinuria, or both, persisted in 15 percent of those still alive. Eight of 11 parous women reported relapses during pregnancy. There was no apparent increase in malignancies, atopic diseases, clinical defects in cell-mediated immunity, or cardiovascular diseases. Twenty two patients (17%) died of renal causes between 3 months and 8 years after the onset of nephrotic syndrome. Steroid resistance was the presenting feature universally predictive of a poor outcome; nine of the 11 such patients died and the other two are now receiving hemodialysis. Hematuria was present initially in 41 percent of the patients who died of renal causes, compared with 14 percent of those still alive. Hypertension was noted on the first examination in 22 percent of those who died of renal causes, compared with 10 percent of those alive.

Identification of a German cockroach-specific allergen by human IgE and rabbit IgG.

To further study the immunology of insect hypersensitivity, we identified and partially characterized the principal allergens in whole body German cockroach (WBGCR) (Blattella germanica) and compared this extract to whole body antigens prepared from other insects. WBGCR extract was fractionated over a calibrated Sephadex G-200 column; peak allergenic activity was contained in fraction 3 (GCR3), containing components with apparent molecular weights ranging from 12,500 to 75,000 daltons. The antigenicity, allergenicity, and specificity of GCR3 components were tested by using rabbit antisera raised to GCR3 or true armyworm (Pseudaletia unipuncta). Radioimmunoassay, cross-inhibition and immunoblot studies revealed, particularly in the IgE system, that GCR3 contained an allergen with a pI of 6.7 and MW of 36,000 daltons that was unique to WBGCR extracts and not present in other insect species, including true armyworm, caddis fly, lakefly, yellow jacket, or honeybee. This GCR3 component may represent a specific marker for the diagnosis of cockroach hypersensitivity in an insect-sensitive population of individuals.

Exercise-induced "asthma" as a presentation of bronchial carcinoid.

Exercise-induced wheezing developed in a previously healthy 14-year-old boy. Chest radiographs revealed hyperlucency of the left lung. Bronchial tomography and bronchoscopy revealed a mass in the left mainstem bronchus, identified as a carcinoid tumor after surgical excision. The patient is now asymptomatic. Exercise-induced wheezing as the sole manifestation of this tumor has not been previously reported.