Hydrolysis of an organophosphate ester by manganese dioxide.

Amorphous manganese dioxide facilitates the hydrolysis of p-nitrophenyl phosphate to p-nitrophenol and orthophosphate despite insignificant adsorption of p-nitrophenyl phosphate or p-nitrophenol to the manganese dioxide. At pH 8, the orthophosphate product is released into solution; at pH 4 and pH 6, some remains adsorbed. The rate of hydrolysis is an order of magnitude more rapid than the same reaction facilitated by iron oxides. Because manganese dioxides are ubiquitous components of soils and sediments, this suggests the possibility of significant abiotic pathways for the formation of bioavailable orthophosphate from phosphate ester precursors.

Benzocaine-associated methemoglobinemia following bronchoscopy in a healthy research participant.

Benzocaine (ethyl aminobenzoate) is a local anesthetic commonly used to achieve topical anesthesia of the skin and mucous membranes prior to endoscopic procedures. Methemoglobinemia, a condition in which hemoglobin cannot bind and deliver oxygen normally, has been associated with benzocaine use in various patient populations. This is the first report of benzocaine-associated methemoglobinemia occurring in a healthy research participant. The research participant developed a methemoglobin level of 27% and marked cyanosis. No adverse sequelae other than cyanosis were identified. This report extends the population in which benzocaine-associated methemoglobinemia has been described. Additionally, this report supports the observation that methemoglobin levels approaching 30% may be tolerated in otherwise healthy individuals, producing few clinically important effects. Finally, this case also indicates that, in obtaining informed consent for a procedure in which benzocaine will be administered, patients and research participants should be specifically informed of the risk of benzocaine-induced methemoglobinemia. This information is especially important in those settings in which the manufacturer-recommended dose of benzocaine may either intentionally or inadvertently be exceeded.

Exploring young people's difficulties in talking about contraception: how can we encourage more discussion between partners?

Interviews were conducted with 56 young men and women aged 16-19 within the Southampton Community Health NHS Trust to explore difficulties in talking about contraception. Concern about a partner's hostile or negative reaction to any discussion about contraception was central to explaining why some people found it so difficult to initiate such discussions. Admitting the intention to have intercourse, together with a perceived association between condom use and disease prevention, were the main concerns. There was some indication of gender differences in these findings. Furthermore, this negative reaction is perceived to be exacerbated according to the partner's reputation, the potential for harming one's own reputation and whether there is a desire for a longer-term relationship with this partner. The most important outcome of the interviews was that these concerns about a partner's negative reaction were largely unjustified, with the vast majority of participants showing only positive responses to scenarios of future partners initiating discussions with them about contraception. In addition to the need to improve communication skills, the data suggest that greater awareness about the positive reactions towards such discussions should be encouraged.

PIP: This study explored the difficulties that prevent some young people from discussing contraception, particularly prior to their first intercourse with a new partner. A total of 56 young people (43 females, 13 males) in Southern England were interviewed. The results showed that the most prominent explanations as to why some people face difficulties in talking about contraception to their partners relate to their concern about a partner's hostile or negative reaction to such discussion. The main concerns were admitting the intention to have intercourse, together with a perceived association between condom use and disease prevention. Moreover, this negative reaction was perceived to be exacerbated according to the partner's reputation, the potential for harming one's own reputation, and whether there was a desire for a longer-term relationship with this partner. The most important finding of this interview was that the concern about a partner's negative reaction was largely unjustified. Therefore, there is a need to improve communication skills and to encourage greater awareness about the positive reactions towards such discussions.

Effects of religiosity and racial socialization on subjective stigmatization in African-American adolescents.

The direct effects of religiosity and racial socialization on subjective stigmatization among 50 African-American adolescents were investigated. A stigma is a characteristic about which others hold negative attitudes and stereotypes. Subjective stigmatization measures the degree to which an individual internalizes such negative attitudes and stereotypes toward a social group of which he or she is a member. Participants who showed strong commitment to the church were more destigmatized than were participants who did not. Further, participants who received racial socialization messages stemming from a single "primary" category were more destigmatized than those who did not. Unexpectedly, the more racial socialization messages participants received, the more self-stigmatized they were. The importance of religiosity and racial socialization in the lives of African-American adolescents are discussed.

An extensive literature review of the evaluation of HIV prevention programmes.

This paper draws out and distils three key themes that have emerged from a substantial bibliographical review of a range of HIV intervention programmes, implemented throughout the world between years 1987 and 1995. Specifically, the paper assesses (1) to what extent intervention programmes have been tailored to meet the requirements and needs of specific target groups; (2) to what extent intervention programmes are supported by social and psychological theory of attitudinal and behavioural change, and also to what extent the results and findings from the interventions have amended existing theory; and, finally, (3) the range of methodologies employed in evaluating intervention programmes and also to what extent behavioural measures have been used in examining a programme's effectiveness. In light of these themes, the paper presents and discusses the principal factors thought to contribute towards the effectiveness of HIV intervention programmes.

PIP: An extensive review of the evaluation literature on global human immunodeficiency virus (HIV) prevention programs implemented during 1987-95 identified three key areas of focus: 1) the extent to which interventions have been tailored to meet the needs of target populations; 2) the extent to which programs are supported by social and psychological theories of attitudinal and behavioral change; and 3) assessment of the methodologies used in program evaluation, especially behavioral measures. The literature reveals a shift over time from interventions aimed at the general public to those tailored to the needs of four risk groups: young people, homosexual/bisexual men, commercial sex workers, and intravenous drug users. Only a minority of programs were based on a specific theoretical approach to behavioral change, and there has been little refinement of existing psychosocial theory; however, awareness of the inadequacy of purely cognitive, information-giving approaches has increased. A trend toward inclusion of an evaluation component has enhanced program design. The ideal evaluation strategy would include explicit theoretical grounding, both process and outcome evaluation methodologies, baseline testing of attitudes and behaviors, use of equivalent control groups, evaluation of both cognitive and behavioral impacts, post-test measures of behavioral change, and longitudinal evaluation of sustained change over time. The literature indicates that prevention programs should involve a significant pre-planning component to assess the nature and extent of salient behaviors. Most effective have been multifaceted efforts that encompass not only knowledge acquisition, but also social skills, role-plays, communication techniques, assertiveness training, and improvements in self-efficacy. Finally, community participation (especially with hard-to-reach or stigmatized groups) and establishment of referral linkages to local health care agencies have been critical to program success.

Perceived race-based discrimination, employment status, and job stress in a national sample of black women: implications for health outcomes.

Previous research has not systematically examined the relationship of perceived race-based discriminations to labor force participation or job related stresses-problems experienced by Black women. The present study investigated the relative contributions of perceived race-based discriminations and sociodemographic characteristics to employment status and job stress in a national probability sample (the National Survey of Black Americans; J. S. Jackson, 1991) of Black women in the United States. Logit and polychotomous logistic regression analyses revealed that Black women's current employment status was best explained by sociodemographic measures. In contrast, the combination of perceived discrimination and sociodemographics differentially affects patterns of employment status and perceived job stress in the work environment of Black women. Implications of these findings for the health of African American women are discussed.

Use of unproven therapies by people with Alzheimer's disease.

OBJECTIVE: To describe the use of unproven therapies for Alzheimer's disease. DESIGN: Descriptive survey using a written questionnaire. PARTICIPANTS: 101 primary caregivers of people with Alzheimer's disease who attended Alzheimer's disease support group meetings. RESULTS: Fifty-five percent of caregivers reported that they had tried at least one alternative therapy to improve the patient's memory. Twenty percent of caregivers tried three or more unproven therapies. Vitamins were used most frequently (84%), and health foods (27%), herbal medicines (11%), "smart pills" (9%), and home remedies (7%) were also tried. Most caregivers reported trying the therapies in the early stage of the illness and did not notice significant improvement in the patient's memory. Twenty-five percent of caregivers had tried unproven therapies for behavior problems. There was no correlation between the use of alternative therapies and the sex of the caregiver, age of the caregiver, level of caregiver frustration, presence of problem behaviors, or perceived level of physician support. CONCLUSIONS: The use of unproven therapies by people with early Alzheimer's disease is common and cannot be predicted by characteristics of the primary caregiver. Although this use may be understandable, it exposes vulnerable people to possible side effects, increased costs, and possible exploitation. Health care workers should actively inquire about the use of alternative therapies, and explore the reasons behind their use, so that they can better understand and meet the needs of their patients and their caregivers.

A causal analysis of employment and health in midlife women.

According to the "healthy worker" hypothesis, good health selects women into the employment role; conversely, the social causation hypothesis argues that important social roles such as employment can contribute to health. The relationship between these two variables may be of special concern to women at midlife, as both issues become increasingly salient. In this paper a model hypothesizing a nonrecursive (reciprocal) causal relationship between employment (hours employed) and health was presented. Because of the importance of both employment and health for women at midlife, the model was tested in a sample of 463 women ages 40-64 from a national cross-sectional dataset. Two-stage least squares regression supported the hypothesis that employment and health have a positive reciprocal relationship for women at midlife. In addition, married women and those with a child had better health but were likely to work fewer hours for pay. The same model tested in 21 to 39-year-old women was not significant. The results serve to emphasize the importance of examining assumptions about direction of causality in research on work and well-being at midlife.

Talking to children, foreigners, and retarded adults.

Speech addressed to different categories of listeners was examined in a study in which undergraduate women taught a block design task to either a 6-year-old child, a retarded adult, a peer who spoke English as a second language (foreigner), or a peer who was an unimpaired native speaker of English. The speech addressed to children differed from the speech addressed to native adults along every major dimension that emerged in this study: It was clearer, simpler, and more attention maintaining, and it included longer pauses. Speech addressed to retarded adults was similar in numerous ways to the speech addressed to 6-year-olds; in some ways (e.g., repetitiveness), it was even more babyish. However, speech to the retarded adults did differ in timing from the other styles of speaking in that it included fewer and somewhat shorter pauses. Speech addressed to foreigners was more repetitive than speech addressed to native speakers, but in all other ways it was very similar. There was some evidence that speakers fine-tuned their communications to the level of cognitive and linguistic sophistication of their particular listener; for example, speakers addressing the more sophisticated foreigners (relative to those addressing the less sophisticated foreigners) used speech that included fewer devices for clarifying, simplifying, and maintaining the listeners' attention. We discuss the hypothesis that baby talk (the speech addressed to children) is a prototypical special speech register from which other special registers are derived.