Perfluorooctanoate and changes in anthropometric parameters with age in young girls in the Greater Cincinnati and San Francisco Bay Area.

METHODS: We conducted a study of per- and polyfluoroalkyl substance biomarkers, including PFOA, in girls from Greater Cincinnati (CIN, N = 353) and the San Francisco Bay Area (SFBA, N = 351). PFOA was measured in the baseline serum sample collected in 2004-2007 of 704 girls at age 6-8 years. Mixed effects models were used to derive the effect of PFOA on BMI, waist-to-height and waist-to-hip ratios over increasing age in this longitudinal cohort. RESULTS: Median PFOA serum concentrations were 7.3 (CIN) and 5.8 (SFBA) ng/mL, above the U.S. population median for children 12-19 years in 2005-2006 (3.8 ng/mL). Log-transformed serum PFOA had a strong inverse association with BMIz in the CIN girls (p = 0.0002) and the combined two-site data (p = 0.0008); the joint inverse effect of PFOA and Age*PFOA weakened at age at 10-11 years. However, in the SFBA group alone, the relationship was not significant (p = 0.1641) with no evidence of changing effect with age. The effect of PFOA on waist:height ratio was similar to BMIz at both sites, but we did not find a significant effect of PFOA on waist:hip ratio in either the CIN or SFBA girls. CONCLUSIONS: PFOA is associated with decreased BMI and waist:height ratio in young girls, but the strength of the relationship decreases with age. Site heterogeneity may be due to greater early life exposure in Cincinnati. DISCLAIMER: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Use of trade names is for identification only and does not imply endorsement by the CDC, the Public Health Service, or the US Department of Health and Human Services.

Antivenom for snakebite envenoming in Sri Lanka: the need for geographically specific antivenom and improved efficacy.

Sri Lanka is a tropical developing island nation that endures significant economic and medical burden as a result of snakebite envenomation, having not only a high prevalence of envenomations, but also one of the highest incidence rates (200 snakebites/100,000 people/year) of venomous snakebite in the world (Kasturiratne et al., 2005). Ironically, the very snakes responsible for this human morbidity and mortality are a valuable biomedical and ecological national resource, despite the medical and economic consequences of envenomation. Currently, no snake antivenom is produced using venoms from native Sri Lankan snakes as immunogens, and there is a true need for an efficacious Sri Lanka, poly-specific snake antivenom. An approach to fulfilling this need via combining the scientific, technological and economical resources from Costa Rica and the United States with the knowledge and talent of Sri Lankan official governmental agencies, legal counsels, environmental, medical and veterinary academic institutions, and religious and cultural leaders has been initiated, coordinated and funded by Animal Venom Research International (AVRI), a nonprofit charity. This bridging of nations and the cooperative pooling of their resources represents a potential avenue for antivenom development in a developing country that suffers the consequences of few specific resources for the medical management of venomous snakebite. The desired final outcome of such an endeavor for Sri Lanka is, most importantly, improved medical outcomes for snakebite patients, with enhanced and expanded science and technology relating to snake venoms and antivenoms, and the collateral benefits of reduced economic cost for the country.

Results of a multimodal treatment program for patients with chronic symptoms after a whiplash injury of the neck.

STUDY DESIGN: A descriptive case series pre- and post-treatment design, including a 6-month follow-up. OBJECTIVES: The objective of this study was to document the improvements of patients with chronic symptoms after a "whiplash" injury of the neck, who attended a 4-week multimodal treatment program at the Rug AdviesCentra Nederland. SUMMARY OF BACKGROUND DATA: To the authors' knowledge, no studies have been conducted on the effectiveness of multidisciplinary treatment of chronic symptoms after whiplash injury. METHODS: Twenty-six patients who experienced Quebec type 1 or 2 lesions of the neck (whiplash) with persisting symptoms of longer than 6 months' duration participated in the study. The measures included were pain intensity (according to the visual analog scale), number of painful sites (determined by pain drawing), self-reported disability Quebec Back Pain Disability Scale; and symptoms of somatic and psychological distress and cognitive symptoms (according to selected Minnesota Multiphasic Personality Inventory-2 scales). Furthermore, objective outcome criteria were used regarding return to work, medication, and medical and paramedical treatment. Statistical and clinical significance of treatment results were both assessed. RESULTS: The patients' symptoms improved significantly on nearly all self-report measures. Their scores for objective outcome criteria reported during the 6-month follow-up evaluation were: complete return to work (65%); complete or partial return to work (92%); no use of analgesics in the past 6 months (58%); and no medical or paramedical treatments in the past 6 months (81%). CONCLUSION: These early results indicate that a multimodal treatment program has the potential to be an effective treatment for patients with chronic symptoms after a whiplash injury of the neck--a group of patients who have in the past been considered intractable or, at the very least, puzzling.

An interdisciplinary mental health consultation team in a nursing home.

The Mental Health Consultation Team (MHCT) at the Portland Veterans Affairs Medical Center nursing home is an interdisciplinary group of mental health professionals and primary care providers established to triage mental health consultations, improve communication between consultants and primary care providers, help staff translate consultants' recommendations into patient care, and furnish education in the management of mental health problems. The MHCT has decreased the demands for formal psychiatry and psychology consultations while increasing mental health services through innovative use of existing staff.

The effects of a work hardening program on cardiovascular fitness and muscular strength.

STUDY DESIGN: This study analyzed improvements in cardiovascular fitness and muscular strength after a 6-week work hardening program. OBJECTIVES: The objective of this study was to document fitness gains after a 6-week work hardening program. SUMMARY OF BACKGROUND DATA: Studies expounded on the success of a functional restoration approach in return-to-work rates, but few documented the physical fitness gains of a work hardening program. METHODS: Thirty-one subjects from the Rehability Center in Lubbock, Texas, who were diagnosed with lower back dysfunction, completed the 6-week study. A submaximal cycle ergometer protocol was used to determine patients' cardiovascular fitness levels, and the Arcon Static Strength Testing Device was used to measure static strength. Pre- and post-tests were identical. RESULTS: A paired Student's t test was used to analyze the significance of difference from pre- to post-testing. For cardiovascular fitness there was a 28% improvement, t(29) = 5.56, P < 0.001; there was a 76% improvement for the static arm lift, t(29) = 7.86, P < 0.001; there was a 57% improvement in the static pull, t(29) = 9.53, P < 0.001; and an 89% improvement in the static push, t(29) = 9.08, P < 0.001. CONCLUSIONS: Analyzed data clearly show a marked improvement in cardiovascular and muscular fitness. There was not a difference in fitness levels between those who returned to work and those who did not, which suggests return-to-work rates are not entirely based on level of fitness.

Adrenergic interaction in mucin secretion of rat submandibular gland in vitro.

Previous studies have reported that maximally effective concentrations of the "mixed" alpha and beta adrenoceptor agonists, epinephrine and norepinephrine, cause greater amounts of mucin secretion than the "pure" beta adrenoceptor agonist, isoproterenol, and that this response requires extracellular calcium. The purpose of the present study was to examine directly the nature of the effect of the putative pure alpha adrenoceptor agonist, phenylephrine, on isoproterenol-induced mucin secretion and the role of extracellular calcium in this interaction. We used a graphical method which provides a procedure for determining whether interaction between two drugs is additive, antagonistic or synergistic to analyze this interaction. Submandibular glands were removed from male rats, divided into sections and placed in modified Hank's balanced salt solution. Mucin secretion was measured as acid precipitable disintegrations per minute after labeling the submandibular gland with [14C]glucosamine. Phenylephrine caused a small but significant secretion of mucin which was blocked partially by phentolamine and completely by propranolol. Phenylephrine caused a significant shift of the isoproterenol concentration-response curve to the left of the theoretical curve expected if two drugs act additively. Mucin secretion induced by isoproterenol alone was independent of extracellular calcium concentration; however, the combination of isoproterenol and phenylephrine caused a concentration-dependency on extracellular calcium.

Kahweol and cafestol: inhibitors of hamster buccal pouch carcinogenesis.

Kahweol and cafestol, two compounds extracted from green coffee beans, were tested for cancer chemopreventive activity. For the experiment, 60 hamsters were divided into three equal groups and placed on one of three diets. The animals in Group I received a normal diet, whereas the animals in Groups II and III received the same diet supplemented with a 50:50 mixture of kahweol and cafestol. The content of the kahweol and cafestol mixture in these two diets was 0.2 g/kg of food (Group II) and 2.0 g/kg of food (Group III). After the hamsters adjusted to their respective diets, 16 hamsters from each group were selected. The left buccal pouches of these animals were painted three times weekly with a 0.5% solution of 7,12-dimethylbenz[a]anthracene (DMBA) in mineral oil. The 12 remaining hamsters were used as controls. The left buccal pouches of these animals were painted three times weekly with mineral oil. After 13 weeks (39 applications) the hamsters were killed. Multiple tumors were common in animals treated with DMBA; however, the animals receiving kahweol and cafestol in the diet (2 g/kg of food) exhibited a 35% reduction in tumor burden. Further comparisons between Groups I and III showed that this reduction in tumor burden was due to a decrease in tumor number. The results for Group II were inconclusive. Some reduction in tumor number was found, but this was offset by an increase in the size of the tumors.