Amethocaine versus EMLA for successful intravenous cannulation in a children's emergency department: a randomised controlled study.

BACKGROUND: Topical anaesthetics reduce the pain of venous cannulation. The emergency department at the Starship Children's Hospital in Auckland uses EMLA (an eutectic mixture of 25 mg/g lidocaine and 25 mg/g prilocaine) for topical anaesthesia. Amethocaine has recently been shown to be a more effective topical anaesthetic. It is suggested that, because amethocaine does not vasoconstrict veins, it may increase the success of cannulation. AIM: The primary aim was to determine if amethocaine improves the success of cannulation compared with EMLA. The secondary aim was to determine if amethocaine is a more effective topical anaesthetic in a children's emergency department. METHODS: A parallel, randomised, double-blind controlled study was performed in children aged 3 months to 15 years who were offered topical anaesthesia for venous cannulation. Caregivers gave verbal consent at triage, followed by written consent. Children were randomised into amethocaine or EMLA groups. Those who went on to have an intravenous cannula were analysed on an intention-to-treat basis. The primary outcome was a successful first attempt at cannulation. A convenience cohort was also observed for distress using a visual analogue scale and the Faces, Legs, Activity, Cry and Consolability Score. RESULTS: From November 2006 to June 2007, 2837 children were enrolled and 809 were known to have had intravenous cannulation. 679 complete data and consent forms were returned. There was no significant difference between the first attempt success rates (75.8% amethocaine vs 73.9% EMLA) or between pain scores for the 65 observed cannulations. CONCLUSION: Amethocaine is not more successful than EMLA for first attempt intravenous cannulation in a children's emergency department.

Twenty-five sacrospinous ligament fixation procedures in a district general hospital: our experience.

The aim of this study was to assess the safety and medium term efficacy of sacrospinous ligament fixation procedure for grade 2 and grade 3-uterovaginal prolapse. This retrospective case study was performed between 1 July 2000 - 4 July 2003 at a District General Hospital in Scotland. For data collection, patient files, theatre records and the computer database were reviewed. The procedure was performed on 25 women. The subjective cure rate in our department was 23/25 (92%) and the recurrence rate was 2/25 (8%). These two patients underwent repeat surgery successfully. The mean follow-up time was 2 years (range 6 months to 3 years). The immediate postoperative complication rate was 2/25 (8%). The late postoperative complications rate was 7/25(28%). We concluded that the sacrospinous ligament fixation is safe and effective with good medium-term results and few postoperative complications. It should be regarded as a good primary procedure in a District General Hospital.

Bovine teat atresia associated with horn fly (Haematobia irritans irritans (L.))-induced dermatitis.

Mammary gland lesions characterized primarily as mammary teat atresia were observed in a Limousin beef cattle herd in eastern Texas. Atresia of multiple teats per mammary gland was reported in first-calf heifers at the time of calving. Pathogens were not identified in eight mammary glands collected at slaughter. Histology of affected glands demonstrated superficial and deep perivascular inflammation and fibrosing dermatitis of teat and mammary gland skin that resulted in formation of the atretic lesions of glandular tissue. Institution of a horn fly (Haematobia irritans irritans (L.)) control program using insecticide-impregnated ear tags was associated with elimination of the problem from the herd.

Alcohol-related problems among black, Hispanic and white men: the contribution of neighborhood poverty.

OBJECTIVE: We examined the cross-sectional relationships between race/ethnicity, neighborhood poverty and alcohol-related problems among black, Hispanic and white male drinkers. Test hypotheses were that black and Hispanic men living in more impoverished neighborhoods would report increased numbers of alcohol-related problems than comparable white men. METHOD: Study hypotheses were tested in a sample of 744 black, Hispanic and white men participating in the 1992 National Alcohol Follow-up Survey. Study hypotheses were analyzed using generalized linear model regression analysis. RESULTS: Neighborhood poverty had a greater effect on alcohol-related problems in black than in white men, partially supporting our hypothesis. Black men living in more impoverished neighborhoods reported greater numbers of alcohol-related problems than comparable white men; there were no race differences among more affluent men. Neighborhood poverty had little effect on alcohol-related problems in Hispanic men. CONCLUSIONS: Findings suggest that, giving unfavorable economic conditions, black men will report greater numbers of alcohol-related problems than comparable white men.

Sex ratios of drinking patterns and problems among blacks and whites: results from a national survey.

OBJECTIVE: The purpose of this study is to explore whether there are differences in sex ratios of drinking patterns and related problems among blacks and whites, and if so to explain these differences. METHOD: The study is based on a national survey including 1,947 (male, 723; female, 1,224) black and 1,777 (male, 743; female, 1,034) white men and women who were sampled from U.S. adult households using probability methods. Hierarchical regression methods were used to test whether there are significant racial differences in the sex ratio of drinking patterns and problems in the two racial groups. RESULTS: The findings showed that there were no substantive differences in drinking sex ratios along racial lines. However, white women were at the highest risk of experiencing alcohol-related problems as rates of heavier drinking increased, and the effects of heavier drinking differed much more among the sexes for whites than blacks. CONCLUSIONS: The findings for whites are consistent with previous research showing that, due to both biological and psychosocial factors, women when consuming the same amounts of alcohol as men may be at more risk for experiencing intoxication and alcohol-related problems. However, the findings for blacks, which show less problem vulnerability among women than men, have rarely been reported. It was suggested that the comparative risk of alcohol problems may be lower for black women due to possible physiological differences and differences in the normative climate of women's drinking in the two racial groups.

Racial differences in women's drinking norms and drinking patterns: a national study.

This study explored whether norms regarding women's drinking were more or less liberal among African American than among Caucasian women, and whether female-specific drinking norms influence drinking rates and drinking problems among the two groups of women. The study is based on data from a 1984 national survey of subsamples of 1,224 African American and 1,034 Caucasian women. Logistic and multiple regression analyses showed that African Americans reported more conservative drinking norms for women than Caucasians even when controlling for general drinking norms and social characteristics. Other findings were that female-specific drinking norms affect the proportion of women drinkers, usual quantity of alcohol consumption, and symptoms of alcohol dependence. African American and Caucasian women were not found to differ in the effect of female-specific drinking norms on alcohol use or on alcohol-related problems. Future research should explore differences in cultural factors that may affect attitudes towards women's drinking as well as more detailed aspects of the relationship between women's drinking norms and problem drinking.

Black identity and drinking in the US: a national study.

The relationship between ethnic identity and drinking patterns was explored in 1947 black adults from a nation-wide study of drinking behavior. Factor analysis revealed that a multi-dimensional construct which included four factors-media preferences, socio-political awareness, endogamy and social networks-was necessary to operationalize and measure the concept of ethnic identity. Using structural equation modeling, a model was tested which analyzed the impact of ethnic identification on religiosity and drinking norms, which in turn were predictors of drinking and heavier drinking latent variables. The results showed that ethnic identity influenced drinking behavior indirectly through its effects on drinking norms and religiosity as well as directly. Most aspects of ethnic identity decreased drinking levels. Respondents who scored higher on involvement with black social networks and black social and political awareness drank at lower levels than other respondents. These results were attributed to the prevalence of norms for abstinence and high levels of social control regarding drinking in black communities. However, high scores on using black media increased drinking rates. It was suggested that the promotion of alcohol use in black orientated media as well as the social settings attended by those who prefer black media might increase alcohol consumption.

The influence of religious affiliation on sociocultural predictors of drinking among Black and White Americans.

Although religious denominations have been shown to affect the drinking behavior of their members, few studies have examined this topic among Black Americans. The following study explored whether a model predicting drinking from religious denominations through a series of intervening cognitive and social variables (drinking attitudes and norms, social contexts, social networks, and home use of alcohol) would be the same for Blacks and Whites. The results showed that there are a number of racial differences in how religious background influences intervening social characteristics, but few in the predictors of drinking behavior. Many significant racial differences were observed among Baptists, a moderate number among Catholics, and few or none were observed for Conservative Protestants and Methodists.

Use of performance ratios to calculate the economic impact of thin cows in a beef cattle herd.

OBJECTIVE: To determine gross income lost that was attributable to thin cows in a beef cattle herd, to estimate the cost of added nutrition necessary to prevent thin cows in the herd, and to determine the financial outcome of the improved nutritional practices. DESIGN: Prospective, observational study. ANIMALS: Four hundred and twenty-two Santa Gertrudis cows and their calves. PROCEDURE: At pregnancy examination in the fall of 1992, cows were assigned a body condition score (BCS), using a scale of 1 (emaciated) to 9 (obese), and the ratio of the productivity of BCS-3 and BCS-4 cow groups (thin cows), compared with the mean productivity of BCS-5 and BCS-6 cows (cows in good condition), was determined. Measures of productivity evaluated included pregnancy rates, weaning weights, and prices per hundredweight of calves. The performance ratios of BCS-3 and BCS-4 cows were multiplied by the mean gross income of BCS-5 and BCS-6 cows to calculate their gross income. This was then subtracted from the mean income of BCS-5 and BCS-6 cows to estimate the amount of lost gross income per thin cow. The cost of a nutritional program that would prevent thin cows in the herd was subtracted from the lost gross income of the thin cows to yield the amount of increased net income that could be generated from a nutritional program that would maintain cows in the herd at a BCS of 5 or 6. RESULTS: Cows with a BCS of 3 were 0.48 as productive, and cows with a BCS of 4 were 0.74 as productive as the average of the BCS-5 and BCS-6 cows combined. Each BCS-3 cow generated $215.06 less, and each BCS-4 cow generated $107.53 less gross income than the average gross income of BCS-5 and BCS-6 cows. The added cost of nutrition that would have reconditioned BCS-3 and BCS-4 cows to a BCS of 5.5 was $91.48/BCS-3 cow and $43.67/BCS-4 cow. Implementation of the reconditioning nutrition program the previous fall would have resulted in an extra net income of $123.58/BCS-3 cow and $63.86/BCS-4 cow, received over a 2-year period. The 262 thin cows in the herd accounted for a total net income loss of $19,897. CLINICAL IMPLICATIONS: The time of pregnancy examination is a strategic intervention point to estimate the past negative economic impact of thin cows and to implement a plan to prevent these losses in the future. Pregnancy examinations should be performed at least 100 days before the beginning of the calving season, and thin pregnant cows should be sorted into a special group and fed a reconditioning diet that will improve their body condition to an average BCS of 5.5 by the onset of the calving season.

The effects of parental influences and respondents' norms and attitudes on black and white adult drinking patterns.

A model predicting drinking patterns among adult respondents from parental influences and respondents' norms and attitudes was tested with data from a nationwide survey of 1,947 black and 1,777 white Americans. The results showed that relationships between parental drinking background, respondents' norms and attitudes, and respondents' drinking behavior are identical for blacks and whites. Among both groups, parental influences are indirect and have a moderate influence on the respondents' norms and attitudes, which in turn are the most powerful predictors of drinking behavior. However, racial differences did emerge in the model, and they illustrate that race moderates relationships between social characteristics and norms, parental demographics and parent drinking attitudes and behavior, and respondents' social characteristics and drinking patterns. These differences were traced to religion, social status, and cultural variation between the two groups.

Predicting drinking problems among black and white men: results from a national survey.

This study describes the prevalence of alcohol-related problems and develops predictive models to explain racial differences in subsamples of 494 black and 568 white men from a national probability survey of drinking patterns and problems. The results showed that although black men exhibited higher mean scores on many types of alcohol-related problems, they did not report significantly higher rates of heavier drinking and drunkenness, nor did they score higher on a scale of permissiveness of drinking norms. A hierarchical regression analysis indicated that race independently predicts problem scores even when controlling for other social and demographic factors. Moreover, an interactive model showed that race interacts significantly with the frequency of heavier drinking and some sociodemographic characteristics. As the frequency of heavier drinking increases, rates of drinking problems rise faster among black men than white men. Religion and unemployment also had different effects on rates of alcohol-related problems in each group of men. These findings suggest that racial differences in the prevalence of drinking problems might be related to differences in the sociocultural context of drinking and in the material conditions under which black and white men live.

Drinking contexts and drinking problems among black and white women.

This study explored whether black and white women differ in how often they drink in particular types of social settings and if drinking in different contexts independently predicts alcohol-related problems. The analysis was based on the interview responses of 635 black and 663 white women drinkers who represent sub-samples from a nationwide survey of 5221 respondents conducted in 1984. The findings revealed that white women are more likely to attend restaurants, bars and parties away from home than black women and that a larger proportion of their alcohol consumption occurs in these settings than among black women. Factor analysis was used to develop scales on the the frequency of drinking in different social contexts. The results confirmed a three-dimensional factor structure that distinguished between drinking at home; drinking in social settings such as bars, restaurants and parties; and drinking in outdoor public areas like streetcorners and parks. A simultaneous equations path analysis was used to model the relationships among drinking contexts, the frequency of heavier drinking, drinking problems, race and other social characteristics. The major findings of the resulting models were that drinking contexts independently predict drinking problems and that race is not directly associated with drinking contexts or alcohol-related problems. However racial differences do exert significant indirect effects on social settings and drinking problems through differences in socio-economic status and normative attitudes. The conclusion emphasizes the complexity of the interrelationships of ethnic and social characteristics that underlie visible racial differences in the social patterns and situational contexts of alcohol use.

Correlates of heavy drinking and alcohol related problems among men and women in drug treatment programs.

A series of analyses were conducted to explore if there were significant differences in heavy drinking and alcohol-related problems in clients admitted to different types of drug treatment programs and whether such differences, if found, could be attributed to variation in social characteristics, drug use behavior, drinking norms, drinking contexts, or in reasons for combining alcohol and drug use. Men and women (N = 246) in four types of publicly funded treatment programs were interviewed at intake regarding drinking and drug use patterns and related problems. The results of the study showed significant differences in drinking behavior and alcohol-related problems of clients in different treatment modalities. Men in a county jail substance abuse program exhibited the highest frequency of heavy drinking and highest rates of alcohol problems; clients of methadone programs reported the lowest rates and those in therapeutic communities described intermediate rates. A series of regression analyses showed that the only significant predictors of the frequency of heavier drinking and drunkenness were drinking context and reasons for combining alcohol and drug use. In addition, age (youthfulness) was associated with the frequency of getting drunk. The most powerful predictors of alcohol-related problems were the frequency of getting drunk and drinking to enhance the effects of other drugs. Heavy drinking and drinking to prevent getting sick from drugs were also significantly associated with drinking problems. The frequency of drug use (by specific type) and most social characteristics showed no direct association with drinking patterns or problems.

The use of glass ionomer as a root canal sealer--a pilot study.

The use of a resin-based glass ionomer as an endodontic sealer was studied in vitro. The root canals of extracted single-rooted human teeth with mature apices were prepared using a stepback technique. Subsequently, the smear layer was removed with 40% citric acid and the canals obturated using lateral condensation of cold gutta-percha and a resin-based glass ionomer as the sealer. The relationship between the sealer and the wall of the root canal was studied using scanning electron microscopy. The shear bond strength of gutta-percha to this glass ionomer was also determined. Finally, the uptake of fluoride into the wall of the root canal was studied using scanning electron microprobe analysis after storage for 2 weeks, 1 month and 3 months following root filling with gutta-percha and glass ionomer cement. The results showed that removal of the smear layer allowed the sealer to enter some of the dentinal tubules. This was observed most frequently in the middle third of the root canal, where there was good adaptation of the sealer. The shear bond strength of gutta-percha to the glass ionomer sealer was not significantly different from that obtained between gutta-percha and a proprietary zinc oxide-eugenol endodontic sealer. The concentration of fluoride in the dentine in the coronal part of the root canal increased after obturation with gutta-percha and the glass ionomer sealer at every time interval. The increase in fluoride concentration varied widely between teeth. It is concluded that a resin-based glass ionomer cement may have potential as a root canal sealer.

Ideology, history and changing models of liver cirrhosis epidemiology.

This analysis describes changes in assumptions about beverage alcohol use as a major cause of liver cirrhosis since the turn of the century. The findings reveal that social and political views shaped by the temperance movement, Repeal era and modern alcoholism movement have had a profound impact on medical and public health interpretations of the role of alcohol use in liver disease. Current clinical and epidemiological approaches that stress the importance of alcohol as a direct etiological agent for liver cirrhosis were popular during the 19th century in the wake of the temperance and prohibition movements, but were greatly modified to attribute a secondary role to alcohol use as a cause of cirrhosis during the Repeal and post-World War II eras. The changes during the Repeal and post-World War II eras coincided with the expansion of alcohol consumption and the liberalization of drinking norms in US society. As a result, the role of alcohol in causing cirrhosis among the general population was minimized and the disease was attributed to industrial toxins and air pollution. Contemporary research has affirmed the importance of beverage alcohol as a causal agent of liver cirrhosis using both clinical and epidemiological studies.

Subgroup differences in drinking patterns among black and white men: results from a national survey.

Despite major increases in alcohol-related health problems and indications of shifts in the cultural role of alcoholic beverages among U.S. blacks, few studies have examined drinking patterns in this population. To address gaps in the literature, data from a 1984 national survey were used to compare drinking patterns and their sociocultural correlates among male, black (n = 723) and male, white (n = 743) Americans. Findings from the survey indicate that, at the aggregate level, black and white men exhibit very similar drinking patterns. The proportion of abstainers, infrequent, frequent and heavier drinkers is very similar for the two groups of men. However, major black-white differences occur when the relationship between drinking rates and major social characteristics is considered. Bivariate tables suggest that frequent heavier drinking among whites is associated with youthfulness, high-income status and residing in "wetter" areas, whereas among blacks these patterns are reversed or absent. Log-linear analysis confirmed some of these findings. When drinking behavior was modeled with respect to race, age, income and region, race emerged as an independent predictor and the effects of age and income varied by race. When the two groups of men were analyzed separately, age and region were the only significant determinants of heavier drinking among whites. Among blacks, income and age emerged as significant variables and the influence of age differed from the findings for whites. The results suggest that there may be important differences in the cultural environments of drinking in black and white men.

Drinking in different social contexts among white, black, and Hispanic men.

This paper describes alcohol use by White, Black, and Hispanic men in eight different social settings. Data were obtained from a multi-stage probability sample of the household population of White, Black, and Hispanic adults aged 18 years and over, residing in the 48 contiguous United States. The response rate was 73 percent for Whites, 76 percent for Blacks, and 72 percent for Hispanics. Results show that Whites go more frequently and drink more frequently than Blacks and Hispanics at restaurants, in clubs or organizational meetings, and in bars. Blacks go more frequently than Whites and Hispanics to public settings such as parks, streets, and parking lots; however, the mean number of drinks consumed in these public places and the proportion of men drinking five or more drinks is higher for Hispanics than for Whites and Blacks. Other places where heavier drinking is common in all three ethnic groups are bars, taverns and cocktail lounges, and parties. In all three ethnic groups, men who are younger and those who are single go more frequently than other men to bars or public places such as streets, parks, and parking lots. Men who are younger and those who are single also have a higher rate of heavy drinking and of drunkenness than other men.