Laparoscopy in dogs and cats.

Laparoscopic techniques have been developed in veterinary medicine for noninvasive evaluation of several organs, including liver, extrahepatic biliary system, pancreas, kidneys, spleen, bowel, and genitourinary tract. Biopsy procedures of these organs with minimal risk can be performed in most patients. This article reviews the equipment and technique necessary to perform laparoscopy in dogs and cats.

Differences among African American light, moderate, and heavy smokers.

This study examined differences in demography, behavior, attitude, and physician intervention among African American light, moderate, and heavy smokers. Data were derived from an intervention study designed to assess whether a smoking status stamp would increase screening for smoking status and cessation counseling by physicians. Current analysis included 879 African American smokers categorized into three groups: light (<10 cigarettes/day), moderate (10-19 cigarettes/day), or heavy (> or =20 cigarettes/day) smokers based on number of cigarettes per day smoked. Light smokers constituted 40% of study sample, 33% were moderate smokers, and 27% were heavy smokers. Light smokers were more likely to be female (p<0.001) and have a shorter smoking history (p<0.001). Light smokers were not different in age (p=0.334), or the number of previous quit attempts (p=0.551). Although light smokers were more likely than moderate and heavy smokers to be preparing to quit (p<0.001), they were less likely to be asked their smoking status (p=0.031) or told to arrange follow-up for smoking cessation (p=0.034) by their physicians. Many African American smokers are light smokers. Light smokers are more likely to be female and have a shorter smoking history. Despite their readiness to quit, compared to heavier smokers, African American light smokers are asked about smoking less often by their physicians. Programs are needed to enhance physician intervention in this understudied population of smokers.

Tobacco use and quit attempts among methadone maintenance clients.

OBJECTIVES: This study examined tobacco use prevalence, types of tobacco used, interest in quitting, and prior quit attempts among persons in methadone maintenance treatment. METHODS: Counselors collected surveys from 84% (550 of 655) of all clients in a 4-county metropolitan area. RESULTS: Most clients (77%) smoked cigarettes. Of the 59 former tobacco users, only 6 reported using a cessation pharmacotherapy to quit. Three quarters of the current smokers had attempted to quit at least once, with an average of 5 attempts. Most smokers (80%) were "somewhat" or "very" interested in quitting. CONCLUSIONS: The quit ratio among methadone maintenance treatment clients was 12%, compared with 50% nationwide. To reduce morbidity and mortality, cessation interventions must be developed and disseminated.

A case for addressing cigarette use in methadone and other opioid treatment programs.

Most persons attending drug treatment smoke cigarettes. They will eventually experience predictable, but devastatingly high, tobacco-related mortality. Recent studies indicate that many clients are ready to quit smoking and that quitting does not threaten progress made in treatment. Methadone and other opioid treatment providers are in an excellent position to address tobacco use among their clients. The present paper describes the prevalence of smoking among methadone clients, reviews promising interventions, and describes how programs can implement a systematic approach to smoking cessation that includes creating a cue system for identifying smokers, providing brief on-site intervention, and arranging follow-up or more intensive treatment.

"They should have them all over the place": a health program for children of illicit drug users.

A peer-based support and advocacy group for illicit drug users in collaboration with a community nurse developed an innovative program for the children of users. The program provides well-baby checks, immunization monitoring, parenting advice, monitoring of children's safety, a free lunch and education about nutrition, as well as activities for the children and mothers. In addition, it allows mothers to have time out in a friendly, relaxed, safe, and nonjudgmental environment. The program has been running for more than 7 years, costs little, and gives a hard-to-reach population access to valuable health care.

The use of nicotine patches with minimal intervention.

BACKGROUND: This paper describes a natural, prospective, open-label study designed to evaluate the impact of free nicotine patches with minimal support for smoking cessation. METHODS: Surveys were administered to 223 participants who received nicotine patches from the American Lung Association. All participants received a 6-week supply of 15-mg/16-h transdermal nicotine patches, a self-help book Freedom from Smoking, and information about area smoking cessation classes. Follow-up telephone surveys were administered 6 weeks after the patches were distributed. Abstinence was measured through self-report exclusively. RESULTS: The overall quit rate at 6-weeks was 21% (47/223). Among nonquitters, the mean number of cigarettes smoked per day dropped from 25 at baseline to 14 at 6 weeks. There was a significant difference in the average number of patches used by quitters and nonquitters (26 versus 11, P < 0.001). CONCLUSIONS: Nicotine patches with minimal support can be effective in smoking cessation and smoking reduction. The availability of patches may have motivated participants to quit. Efforts to increase access to and use of nicotine patches may result in increased attempts to quit and successful quitting.

A hierarchy of strategies heroin-using mothers employ to reduce harm to their children.

The present paper explores strategies that drug-using women employ to protect their children from drug-related harm. Twenty-two mothers were recruited through word-of-mouth, field recruitment, and flyers. Semi-structured interviews were used to collect mother's views on parenting and heroin use. Analysis was conducted using a standard qualitative software package. A hierarchy of seven strategies was identified: (1) stop using; (2) go into treatment; (3) maintain a stable small habit; (4) shield children from drug-related activities; (5) keep the home environment stable, safe, and secure; (6) stay out of gaol; and, if the children's needs still cannot be met, (7) place them with a trusted caregiver and maintain as active a parental role as possible. These strategies, derived innovatively from mothers' experiences, provide progressive goals for treatment and can also serve as measures of success. In addition, they may determine how well children fare in drug-affected families.

Thoracoscopic partial pericardiectomy in 13 dogs.

Thirteen dogs with cardiac tamponade resulting from pericardial effusion were prospectively evaluated to determine feasibility and outcome of thoracoscopic partial pericardiectomy. A lateral thoracoscopic approach allowed adequate exposure to remove a 4- to 5-cm-diameter section of pericardium in all dogs. Complete resolution of cardiac tamponade occurred in all dogs for which there was follow-up (11 dogs). Ten of 13 dogs (76.9%) had neoplastic pericardial effusion. One of these dogs remains alive at 220 days postoperatively and is asymptomatic. The mean survival of the remaining 9 patents with neoplastic effusion was 128 days (range, 14-544 days; median, 38 days). Three of 13 patients (23.1%) had idiopathic pericardial effusion. Two of these dogs remain alive at 585 and 1,250 days postoperatively. One dog with idiopathic pericardial effusion developed cardiomyopathy and was euthanized 18 days after the procedure. Results indicate that the procedure was technically successful in all dogs. No anesthetic complications occurred. Procedural complications included phrenic nerve transection (1 dog), lung laceration (1 dog), and moderate intraoperative bleeding (1 dog). No adverse clinical manifestations of the complications were apparent. We conclude that thoracoscopic partial pericardiectomy is technically feasible and offers several advantages over conventional open thoracic surgical pericardiectomy.

Evaluating community coalitions for prevention of substance abuse: the case of Project Freedom.

In the United States alone, there are more than 2,000 community coalitions to address local concerns about abuse of alcohol, tobacco, and other drugs. This article describes an evaluation system used to examine the process, outcome, and impact of coalitions for the prevention of substance abuse. The evaluation addresses five key questions: (a) Was the community mobilized to address substance abuse (Process)? (b) What changes in the community resulted from the coalition (Outcome)? (c) Is there a change in reported use of alcohol and other substances by youths (Outcome)? (d) Does the coalition have a community-level impact on substance abuse (Impact)? and (e) Is community-level impact related to changes facilitated by the coalition (Impact)? To address these and other questions, using eight core measurement instruments, the evaluation system collects 15 distinct measures. This evaluation system is illustrated with a multiyear study of Project Freedom, a substance abuse coalition in a large midwestern city.

Evaluating a statewide partnership for reducing risks for chronic diseases.

We describe a case study evaluation of Kansas LEAN, a statewide partnership with the mission of reducing risks for chronic diseases through dietary and exercise modification. We used a case study design to examine five primary questions related to process and outcome: (a) were the goals of the partnership important to constituents? (process), (b) were constituents satisfied with the partnership (process), (c) were community or systems changes (new or modified programs, policies, or practices) facilitated by partnership efforts (outcome)?, (d) were these changes important to the partnership's mission (outcome)?, and (e) what critical events helped facilitate community changes (outcome)? several measurement instruments--a monitoring and feedback system, constituent surveys, and semistructured interviews--were used to address key evaluation questions. Kansas LEAN is a strong statewide partnership with involvement from key representatives throughout Kansas. It is an ongoing, comprehensive health promotion program that plans and implements multiple components, in a variety of settings, to create awareness, behavior change, and a supportive environment. Kansas LEAN has facilitated several important community or systems changes related to its mission. We conclude with a discussion of the challenges of evaluating partnerships that seek to reduce risks for chronic diseases.

Evaluating the effects of a community coalition's efforts to reduce illegal sales of alcohol and tobacco products to minors.

Minors' access to alcohol and tobacco is a major public health concern because of the many deaths and disabilities associated with use and the ease with which minors purchase these products. We evaluated the effects of a community-based substance abuse coalition's efforts to reduce alcohol and tobacco products to minors. The intervention--implemented entirely by coalition members--consisted of adults and minors issuing citations to clerks in supermarkets, convenience stores and liquor stores, who were willing to sell alcohol and tobacco products to minors and issuing commendations to clerks who refused to sell. For those liquor stores receiving the citizen's surveillance, there was a marked decrease in alcohol sales to minors, from 83% to 33%; and in those liquor stores not experiencing the intervention, there was a smaller decrease in alcohol sales, from 45% to 36%. This study's findings suggest that citizen surveillance and feedback may be effective in reducing alcohol sales to minors when the intervention is fully implemented, but may be ineffective, at least in these doses, with tobacco sales.

Using empowerment theory in collaborative partnerships for community health and development.

Models of community empowerment help us understand the process of gaining influence over conditions that matter to people who share neighborhoods, workplaces, experiences, or concerns. Such frameworks can help improve collaborative partnerships for community health and development. First, we outline an interactive model of community empowerment that describes reciprocal influences between personal or group factors and environmental factors in an empowerment process. Second, we describe an iterative framework for the process of empowerment in community partnerships that includes collaborative planning, community action, community change, capacity building, and outcomes, and adaptation, renewal, and institutionalization. Third, we outline activities that are used by community leadership and support organizations to facilitate the process of community empowerment. Fourth, we present case stories of collaborative partnerships for prevention of substance abuse among adolescents to illustrate selected enabling activities. We conclude with a discussion of the challenges and opportunities of facilitating empowerment with collaborative partnerships for community health and development.

Promoting the use of advance directives. An empirical study.

OBJECTIVE: To examine the effects of a practical method to increase patient completion and filing of advance directives. METHODS: Randomized controlled trial to examine the effects of structured discussions, information, and mailed reminders on completion of advance directives by internal medicine outpatients. MAIN OUTCOME MEASURE: Presence of advance directives in patients' medical files. Secondary analyses include (1) participant satisfaction with procedures, (2) data on delayed effects of discussion, and (3) data on discrepancies in patients' completion of forms. RESULTS: Six months following the intervention, 23% of patients in the experimental group and 3% of patients in the control group had directives on file. The findings were statistically significant. Patients, nurses, and physicians were satisfied with intervention procedures. Chart reviews at 6 weeks and 6 months indicated that intervention effects were delayed. CONCLUSIONS: Structured discussions and follow-up mailings substantially increased use of advance directives and were time effective and cost-effective.

[Sonographic evaluation of changes in testicular tissue by ultrasound spectroscopy]. / Sonographische Beurteilung von Hodengewebeveränderungen durch die Ultraschallspektroskopie.

Experimental investigations were carried out under in vitro conditions on 25 normal human testicular specimens and on 60 pathological testicular specimens to ascertain the ultrasound attenuation using an ultrasound spectroscopic measuring technique. The ultrasound attenuation was established by calculating the ultrasound attenuation coefficient alpha. The average values of ultrasound attenuation (alpha) in normal testicular tissue were distinctly lower than in pathologically altered testicular specimens. A comparison of the various pathologically altered testes showed higher attenuation in the case of malignant neoplasms whilst the highest average values of wore recorded for non-neoplastic pathological alterations in the testicular tissue. The results of the investigations show that certain alterations in the tissue can be ascertained by ultrasound spectroscopy. The analysis of further acoustic parameters in future investigations, such as ultrasound back-scattering and velocity, along with the recording of ultrasound attenuation, gives scope for improved assessment of the tissue. Thus ultrasound spectroscopy increases the sonographic accuracy acquired through analysis and the weighing up of symptoms of tissue dependent ultrasound parameters.

Primary hyperparathyroidism in cats: seven cases (1984-1989).

The medical records of 7 hypercalcemic cats with primary hyperparathyroidism were evaluated. Mean age was 12.9 years, with ages ranging from 8 to 15 years; 5 were female; 5 were Siamese, and 2 were of mixed breed. The most common clinical signs detected by owners were anorexia and lethargy. A cervical mass was palpable in 4 cats. Serum calcium concentrations were 11.1 to 22.8 mg/dl, with a mean of 15.8 mg/dl calculated from each cat's highest preoperative value. The serum phosphorus concentration was low in 2 cats, within reference limits in 4, and slightly high in 1 cat. The BUN concentration was greater than 60 mg/dl in 2 cats, 31 to 35 mg/dl in 2 cats, and less than 30 mg/dl in 3 cats. Abnormalities were detected in serum alanine transaminase, aspartate transaminase, and alkaline phosphatase activities from 2 or 3 cats. Parathormone (PTH) concentrations were measured in 2 cats before and after surgery. The preoperative PTH concentration was within reference limits in 1 cat and was high in 1 cat. The PTH concentrations were lower after surgery in both cats tested. A solitary parathyroid adenoma was surgically removed from 5 cats, bilateral parathyroid cystadenomas were surgically resected in 1 cat, and a parathyroid carcinoma was diagnosed at necropsy in 1 cat. None of the cats had clinical problems with hypocalcemia after surgery, although 2 cats developed hypocalcemia without tetany, one of which was controlled with oral administration of dihydrotachysterol and the other with oral administration of 1,25 dihydroxyvitamin D. All 5 of the cta that underwent removal of an adenoma were alive at least 240 days after surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

[Tissue characterization of the liver using ultrasound attenuation in an animal experiment]. / Zur Gewebecharakterisierung der Leber mittels Ultraschallschwächung im Tierexperiment.

Frequency-dependent attenuation of sound is considered a characteristic parameter of the interaction between sound and tissue and has been studied particularly in the liver via many different techniques. Due to the relatively wide scatter of the measured single values, especially in pathological liver samples, a clinically feasible application of the procedure has not yet been found. In the present paper, the suitability of the frequency-dependent coefficient of sound attenuation for tissue characterization with comparable experimental conditions in vitro was tested in a statistically representative collection of histologically defined tissue specimens of rat liver. Several statistical procedures were used (cluster analysis, discrimination analysis). Normal livers can be usually distinguished from pathological specimens by means of the frequency-dependent coefficient of sound attenuation with only slight scatter of the individual values. Although the latter differ on the average from normal specimens, they diverge considerably in respect of single values resulting in significant differences only in case of extensive tissue damage (cirrhosis). On the basis of tissue classifications in clinical and pathological use, only a rough tissue differentiation is possible. By using additional parameters of the interaction between sound and tissue, sonographic differentiation of pathologically changed tissue my be improved.