Kashinath D. Patil

Health Status and Access to Care Among Rural Minorities

This paper provides a review of the scholarly and applied literature published between 1970 and 1993 on health and health care access problems among racial and ethnic minority group members living in rural U.S. areas. Results on the distribution of specific illnesses and diseases, and utilization of medical services are summarized for two major minority groups—African Americans and Hispanic Americans. Findings generally document the expected pattern of rural and minority disadvantage. A review of the conceptual and methodological limitations of existing research suggests that research does not yet permit any clear understanding of the underlying structures and processes that give rise to racial health disparities. Very little is known about the health of rural minorities living in some areas of the country, for example, the west north central United States (Kansas, Missouri, Nebraska, Iowa, North Dakota, South Dakota and Minnesota).

The effect of feedback in learning clinical diagnosis

There is evidence that students who are given information about how they appear to weight information in reaching a judgment can learn to make judgments more accurately. In teaching medical diagnosis, the present authors used a microcomputer system to generate simulated cases and then calculate the relationship between the data presented and the students diagnosis. Students who were given feedback comparing their apparent weighting of clinical information with the correct weighting learned to diagnose urinary tract infection more accurately than control students who received feedback only on the outcome of their diagnosis.

Reproducibility of the signal-averaged electrocardiogram

Variation in measurements made from signal-averaged electrocardiograms was examined. Averaging 200 beats in 18 normal subjects, pairs of high-frequency QRS and low-amplitude signal durations correlated at immediate, short-term, and long-term intervals. The percent high-frequency (60 Hz to 120 Hz) voltages in the late potential region had modest correlations. However, 95% confidence intervals of differences in paired measurements were as much as 7% for high-frequency QRS, 20% for a low-amplitude signal, and 53% for percent high-frequency, similar at all time intervals. With electrocardiograms averaged to 0.3 microV noise, high-frequency QRS and low-amplitude signals prolonged, but variation was similar to that of 200 beat pairs. In contrast, low noise reduced percent high-frequency and lessened variation to 29%. Therefore variation in signal-averaged electrocardiographic measurements was considerable (high-frequency voltage greater than durations). Noise did not appreciably influence variation in durations but was critical to consistent voltage measurements in the frequency domain.

Smoking cessation among patients with chronic obstructive pulmonary disease (COPD)

Abstract Nine variables were assessed to determine which were most associated with the ability to quit smoking among 107 pulmonary rehabilitation patients with chronic obstructive pulmonary disease (COPD). Most (67%) patients were ex-smokers at the time of admission. Discriminant analysis revealed that psychosocial factors were significantly related to the ability to stop smoking prior to hospitalization, and pack-years smoking history significantly differentiated smokers from ex-smokers at follow-up 5–54.5 months after hospitalization. None of the other variables were significantly associated with smoking cessation, and even the two significant variables (psychosocial assets and pack-years) were not able to separate smokers from ex-smokers beyond base-rate expectations. While most smokers with COPD did quit smoking, those who failed to do so prior to their hospitalization were likely to continue their habit indefinitely.

Lifespan carcinogenicity tests with native carrageenan in rats and hamsters

Native carrageenan (Gelcarin), a widely used food additive, was tested for carcinogenicity in MRC rats and Syrian golden hamsters through lifespan studies. Three groups of 30 males and 30 females from these species received carrageenan at dose levels of either 5%, 2.5% or 0.5% in the diet daily for the animals lifespan. A trend toward an increased incidence of benign mammary tumors in females and testicular neoplasms in males occurred at the median dose level (2.5%); however, the incidence of these tumors was not statistically significant. Hamsters did not develop neoplasms in response to treatment at any dose levels. From the results of this experiment, carrageenan demonstrated no carcinogenic effects in either species.

Total indoor smoking ban and smoker behavior

METHODS To assess smoking policy support and effects, 1,083 hospital employees (203 smokers) were surveyed by anonymous questionnaire 1 year after the announcement (5 months after implementation) of a new total indoor smoking ban. A second follow-up, limited to smoker respondents only, was conducted 2 years postannouncement. RESULTS A total indoor smoking ban was supported by the vast majority of nonsmokers (89%) and ex-smokers (86%) and by nearly half of the then-smoking population (45%). Consistent with previous reports, the smoking ban was associated with a significant decrease in cigarette use during work hours, particularly among moderate to heavy smokers. However, the ban did not result in increased institutional quit rates. Light smokers (< 10 cig/day), compared with heavy smokers (> or = 30 cig/day), were more likely to support the no-smoking policy and had fewer problems observing the ban. They were also less apt to report a decrease in work productivity. CONCLUSION A total indoor smoking ban had little effect on overall institutional quit rates. Heavy smokers will, predictably, experience the greatest difficulty complying with a total indoor nonsmoking policy.

Carcinogenic effects in the Syrian golden hamster of N-methyl-N-formylhydrazine of the false morel mushroom Gyromitra esculenta.

ZusammenfassungN-Methyl-N-formylhydrazin (MFH)_wurde als 0,0078% ige Lösung in Trinkwasser an Syrische Goldhamster eigener Kolonie ab einem Alter von 6 Wochen auf Lebenszeit verabreicht. Die Behandlung rief benigne und maligne Leberzelltumoren, maligne Histiocytome und Tumoren der Gallenblase und der Gallengänge vor. Die Tumorinzidenz erreichte in diesen vier untersuchten Geweben 43, 34, 11 bzw. 8%, während sie bei den unbehandelten Kontrollen jeweils 0% betrug. Histologisch wurden die Tumoren als benigne Hepatome, hepatozelluläre Carcinome, maligne Histiocytome, Adenome und Ardenocarcinome der Gallenblase, Cholangiome und Cholangiocarcinome klassifiziert. Die eßbare Frühlingslorchel enthält eine beträchtliche Menge an N-Methyl-N-formylhydrazin. In Anbetracht seiner bereits früher berichteten Carcinogenität an Mäusen und jetzt an Hamstern, sollten Menschen auf den Genuß dieses Pilzes verzichten.SummaryN-Methyl-N-formylhydrazine (MFH) was administered in drinking water as a 0.0078% solution oto randomly bred Syrian golden hamsters for life beginning at 6 weeks of age. The treatment gave rise to benign and malignant liver cell tumors, malignant histiocytomas and tumors of tha gall bladder and bile ducts. The tumor incidence in these four treated tissues was 43, 34, 11,8%, while in untreated controls it was 0, 0, 0, 0%, respectively. Histopathologically, tumors were classified as benign hepatomas, liver cell carcinomas, malignant histiocytomas, adenomas and adenocarcinomas of the gall bladder, cholangiomas, and cholangiocarcinomas.The edible false morel mushroom contains a substantial amount of N-methyl-N-formylhydrazine. In view of its earlier reported carcinogenicity in mice and now in hamsters, the human population should obviously abandon the consumption of this fungus.

Cochran's Q Test: Exact Distribution

Abstract A relatively simple method for computing the exact probability and distribution of the Q statistic is proposed.

Tumorigenic effect of 4-methylphenylhydrazine hydrochloride in Swiss mice.

4-Methylphenylhydrazine hydrochloride was administered as 10 weekly subcutaneous injections of 140 μg/g body weight and as 7 weekly intragastric instillations of 250 μg/g body weight in physiological saline to randomly bred Swiss mice. Treatments given subcutaneously resulted in induction of lung tumors in incidences of 36% in females and 44% in males, while intragastric treatment caused a 40% incidence in females. In addition, it gave rise to blood vessel tumors by intragastric route in incidences of 32% in females and 18% in males. In the two physiological saline-treated control groups, the lung tumor incidence (combined) was 20% in females and 21% in males, while the blood vessel tumor incidence (combined) was 7% in females and 6% in males. Histopathologically, the lesions were classified as adenomas and adenocarcinomas of the lungs, and angiomas and angiosarcomas of blood vessels. 4-Methylphenylhydrazine was postulated to be a metabolite of 4-hydroxymethylphenylhydrazine, an ingredient of the commonly eaten mushroom Agaricus bisporus. The implications are discussed with respect to the tumorigenesis data.

Smoking cessation in the workplace: Evaluation of relapse factors

Relapse factors associated with a well-supported worksite smoking cessation program were examined in a prospective study. Of 104 employee-participants, 81 (78%) were confirmed as abstinent at 8 days after quit day. Forty-six employees (44%) continued to report total abstinence at 1 year. Stepwise regression analysis of baseline variables found two significant, but weak, predictors of 1-year smoking status: Fagerstrom score and number of other smokers residing in the home. Analysis of tobacco withdrawal symptom data of confirmed abstainers found only self-reported anxiety scores to be predictive of smoking status at 1 year. Early abstainers with elevated anxiety scores appear to be at high risk for smoking relapse.