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This study investigated issues raised in qualitative data from our previous studies of health professionals and community members, which suggested that being opposed to euthanasia legislation did not necessarily equate to being anti-euthanasia per se. A postal survey of 1002 medical practitioners, 1000 nurses and 1200 community members was undertaken. In addition to a direct question on changing the law to allow active voluntary euthanasia (AVE), four statements assessed attitudes to euthanasia with or without a change in legislation. Responses were received from 405 doctors (43%), 429 nurses (45%) and 405 community members (38%). Compared with previous studies there was a slight increase in support for a change in the law from medical practitioners, a slight decrease in support from community members and almost no change among nurses. Different interpretations of the results of the four attitude questions are possible, depending on the perspective of the interpreter.

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OBJECTIVE: The characteristics of male and female gamblers utilizing a gambling helpline were examined to identify gender-related differences. METHOD: The authors performed logistic regression analyses on data obtained in 1998-1999 from callers to a gambling helpline serving southern New England. RESULTS: Of the 562 phone calls used in the analyses, 349 (62.1%) were from male callers and 213 (37.9%) from female callers. Gender-related differences were observed in reported patterns of gambling, gambling-related problems, borrowing and indebtedness, legal problems, suicidality, and treatment for mental health and gambling problems. Male gamblers were more likely than female gamblers to report problems with strategic or "face-to-face" forms of gambling, e.g., blackjack or poker. Female gamblers were more likely to report problems with nonstrategic, less interpersonally interactive forms of gambling, e.g., slot machines or bingo. Female gamblers were more likely to report receiving nongambling-related mental health treatment. Male gamblers were more likely to report a drug problem or an arrest related to gambling. High rates of debt and psychiatric symptoms related to gambling, including anxiety and depression, were observed in both groups. CONCLUSIONS: Individuals with gambling disorders have gender-related differences in underlying motivations to gamble and in problems generated by excessive gambling. Different strategies may be necessary to maximize treatment efficacy for men and for women with gambling problems.

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The case report of a newborn female with osteogenesis imperfecta type II who underwent cardiopulmonary resuscitation (CPR) with manual chest compressions for several minutes is presented. Chest radiographs taken before and after the chest compressions were administered were reviewed by several radiologists from 3 different hospitals and demonstrated no new radiographically visible rib fractures. Collagen analysis, the patient's clinical appearance, and clinical course, as well as a consultant's opinion aided in confirmation of the diagnosis of osteogenesis imperfecta type II. A review of 4 previous studies concerning rib fractures and CPR is included. This unique case supports previous articles that have concluded that rib fractures rarely, if ever, result from CPR in pediatrics, even in children with a lethal underlying bone disease, such as osteogenesis imperfecta type II. cardiopulmonary resuscitation, chest compressions, osteogenesis imperfecta, rib fractures, bone disease.

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Problem gambling behaviors, particularly the most severe form, which is pathological gambling (PG), represent an emerging public health problem. Compared with the general population, individuals with problem gambling are more likely to have reports of legal issues, including commission of crimes, arrest, and incarceration. The goal of the present study is to examine the characteristics of individuals seeking help for gambling problems with regard to reports of illegal behavior secondary to gambling. Individuals with gambling problems were identified through use of a 24-hour gambling helpline, and information regarding the identified problem gambler was investigated with respect to reported presence or absence of gambling-related illegal behaviors. Identified gamblers with reported gambling-related illegal behaviors compared with those without such behaviors appeared to experience more severe gambling-related problems. Despite being on average younger, gamblers with acknowledged gambling-related illegal behaviors were more likely to have reports of having problems with multiple forms of gambling, debts to acquaintances, been suicidal secondary to gambling, used alcohol or drugs excessively, and received mental health treatment. Secondary analyses of the subgroup of gamblers with gambling-related illegal behaviors revealed that those with reports of arrest or incarceration secondary to gambling compared with those with gambling-related illegal behaviors but without arrest or incarceration secondary to gambling were more likely to have features similar to those described for individuals with antisocial personality disorder (ASPD). That is, the gambler with reported arrest or incarceration secondary to gambling was more likely to be male, unemployed, single, and have reports of problems with excessive drug or alcohol use. In contrast, the gamblers acknowledging gambling-related illegal behaviors but not arrest or incarceration secondary to gambling were predominantly female and more likely to have reports of problems with non-strategic forms of gambling (e.g., slot machine), owing money to legitimate sources of borrowing, having filed for bankruptcy, and having family problems related to gambling. The findings indicate: (1) individuals with reported legal problems secondary to gambling represent a more ill subpopulation of problem gamblers; and (2) there exist separate subgroups of gamblers with gambling-related illegal behaviors (i.e., those with or without reported arrest or incarceration secondary to gambling) with strikingly different characteristics and possibly different treatment needs. The results of the present study highlight the importance of the identification and treatment of individuals with gambling problems with respect to legal issues.

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OBJECTIVES: To examine health practitioner and community concerns, priorities and preferred options regarding patient self-determination in terminal care. METHOD: A postal questionnaire was sent to 229 general practitioners in two areas of Queensland (Brisbane and Wide Bay) and to 1100 community members throughout Queensland. Questions covered a range of end of life decision making issues, including where people wish to die, the use of advance directives and proxy decision makers, and possible barriers to such options. RESULTS: GPs and community members held very different opinions on most issues: community members were divided between home, hospital and hospice as a preferred place to die, while GPs strongly favoured home as their preferred place to die. Both groups supported the use of advance directives and proxies, but differed significantly with respect to barriers preventing the use of such options. CONCLUSION: Clarifying differences in perceptions and preferred options between the two groups on end of life decision making should not only improve communication and interactions between GPs and their patients but also allow both groups to become full participants in current policy and practice debates on end of life decisions.

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OBJECTIVE: To examine current attitudes and knowledge of the community and medical practitioners in Queensland to end-of-life decisions. DESIGN: Cross-sectional survey by postal questionnaire. PARTICIPANTS: 387 general practitioners and medical specialists and 910 community members from the Queensland electoral roll. MAIN OUTCOME MEASURES: Responses to five questions about end-of-life decision-making, and to legislative changes relating to such decisions. RESULTS: The overall response rate for medical practitioners was 67% and for community members was 53%. 78% of community members (age adjusted) and 54% of doctors thought that a doctor should comply with a patient's request to turn off a life-support system; 68% of doctors through people would still ask to have their life ended even if pain were controlled, compared with 54% of community members; 70% of community members thought the law should be changed to allow active voluntary euthanasia, compared with 33% of doctors; and 65% of community members thought that a doctor should be allowed by law to assist a terminally ill person to die, but only 36% of doctors agreed. 79% of doctors and 75% of community members agreed that people would still ask for assistance to end their lives even if optimal palliative care were freely available. CONCLUSION: Community members supported greater choice and control over end-of-life decisions, while doctors were less supportive of some of the options canvassed. In a climate of community participation in health care decisions, it is important to better understand the basis and meaning of these different views. Further detailed research is recommended.

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Recent studies in this laboratory have shown that benzo[a]pyrene (BaP) modulates growth factor-related gene expression and proliferation of renal glomerular mesangial cells (GMCs) in vitro. Because many of the toxic and biochemical effects of this polycyclic aromatic hydrocarbon are mediated through oxidative metabolism, the present studies were conducted to examine the patterns of cytochrome P450IA1 (CYP1A1) and P4501B1 (CYP1B1) inducibility in mesangial cells and the molecular consequences of this response. Exposure of cultured GMCs to BaP (30 microM) or 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD, 10 nM) for 24 hr induced CYP1A1 mRNA levels, a response abolished by cotreatment with 10 microM cycloheximide. The pattern of hydrocarbon inducibility was atypical in that BaP was a more effective inducer of CYP1A1 gene expression than TCDD, and both hydrocarbons induced aryl hydrocarbon hydroxylase (AHH) activity, but not ethoxyresorufin-O-deethylase activity. Cotreatment with alpha-naphthoflavone (alpha NF, 1 microM) or ellipticine (ELLIP, 0.1 nM) only partially inhibited the induction of AHH activity by BaP (30 microM). BaP and TCDD also induced expression of the CYP1B1 protein and the pattern of induction was comparable to that observed for CYP1A1. Treatment of GMCs with 30 microM BaP was associated with the formation of eight DNA adducts, and their occurrence could be inhibited by pretreatment with alpha NF (1 microM), but not ELLIP (0.1 nM). These results demonstrate that CYP1A1 and CYP1B1-related activities are induced in GMCs by BaP and TCDD and this induction is associated with metabolism of BaP to reactive intermediates that bind covalently to DNA.

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In MCF-7 cells treated with 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), 12-O-tetradecanoylphorbol-13-acetate (TPA) causes a time- and concentration-dependent modulation of TCDD-induced CYP1A1 gene expression. Treatment of MCF-7 cells with 1 nM TCDD for 24 h resulted in the induction of ethoxyresorufin O-deethylase (EROD) activity and CYP1A1 mRNA levels. In cells treated with TCDD for 24 h and 100 ng/ml TPA for 26 and 30 h, the TCDD-induced CYP1A1 gene expression was detected. For example, TCDD-induced EROD activity decreased from 122 pmol/min/mg to 25.5 pmol/min/mg after treatment of MCF-7 cells with TPA for 26 h and this was also paralleled by a 44% decrease in CYP1A1 mRNA levels. There was also a decrease in nuclear Ah receptor levels and the binding of nuclear extracts to a 32P-labeled dioxin responsive element (DRE) in a gel mobility shift assay. In parallel studies which measured EROD activities, similar TCDD/TPA interactions were observed in wild-type Hepa 1c1c7 cells, whereas no interactive effects were observed in T47-D human breast cancer cells. In MCF-7 cells treated with TPA for 36 or 48 h, the TCDD-induced EROD activity and CYP1A1 mRNA levels were restored and in cells exposed to TPA for 72 or 96 h superinducibility of CYP1A1 gene expression was observed; there was a 2.8- and 2.2-fold increase in EROD activity and CYP1A1 mRNA levels, respectively, compared to MCF-7 cells treated with TCDD alone. The biphasic temporal effects of TPA on TCDD-induced CYP1A1 gene expression in MCF-7 cells were paralleled by comparable changes in nuclear Ah receptor levels and binding to a synthetic DRE. In contrast, prolonged exposure of the wild-type Hepa 1c1c7 or T47-D cells to both TCDD plus TPA gave results similar to those observed after 24 h. These data show that the effects of TPA on TCDD-induced expression of CYP1A1 are cell-specific and suggest that the proposed protein kinase C (PKC)-dependent activation of the nuclear Ah receptor complex may not be required in MCF-7 cells since TPA downregulates PKC activity within 11 h and this inactivation persists for at least 96 h.

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Success in dental implant-supported prostheses has traditionally been measured in terms of successful osseointegration of implant fixtures. Clearly, this is not the true measure of success in terms of patient expectations. Patients expect prostheses with which they can function, without embarrassment or insecurity. Therefore, patient evaluation and treatment planning must be concerned with final prosthetic results and how patients will look and function. This article introduces a simple classification system that will help eliminate confusion in treatment-planning with implant patients and will also allow dentists to better advise patients about the goals of treatment. The classification system is based primarily on the prosthetic design that patients will receive and offers a means of quantitating the complexity and, therefore, the predictability of treatment.

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Concentrations of vancomycin in bones of 14 patients undergoing total hip arthroplasty (group 1) and 5 patients with osteomyelitis (group 2) were studied. Group 1 received vancomycin, 15 mg/kg intravenously, 1 h prior to anesthesia. Group 2 received doses adjusted to achieve peak levels in serum of 20 to 30 micrograms/ml and trough levels of less than 12 micrograms/ml; bone specimens were collected during surgical debridement. The specimens were pulverized and eluted into phosphate buffer, and the supernatants were analyzed for vancomycin content by fluorescence polarization immunoassay. In group 1, vancomycin was detectable in all cancellous specimens with a mean concentration of 2.3 +/- 4.0 micrograms/g (range, 0.5 to 16 micrograms/g); 10 of 14 cortical specimens had detectable vancomycin; the mean cortical concentration was 1.1 +/- 0.8 micrograms/g (range, not detectable to 2.6 micrograms/g). In group 2, vancomycin was detectable in only two of five cortical bone specimens (mean concentration, 5.9 +/- 3.5 micrograms/g). Cancellous bone was obtained in one patient; the vancomycin concentration was 3.6 micrograms/g. In most patients the vancomycin levels in bones were higher than the MIC for susceptible staphylococci following single prophylactic doses. In the few infected patients studied, penetration was variable and deserves further study.

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As educational services accept responsibility for the provision of appropriate education for a wider range of disabled children, therapists and other support personnel will increasingly be called upon to work in an educational model. Team approaches - multidisciplinary, interdisciplinary or transdisciplinary - provide effective ways of organising staff to service the educational system. The therapists and other support professionals within the teams may work in at least three ways: traditionally; as a consultant; or as a resource person/information source. The advantages and disadvantages of each role are discussed.

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Two hundred and thirty-eight preschool children were divided into four groups according to the method of referral. Chi-square analysis following a clinical examination in the preschool showed highly significant differences between the groups, particularly in proprioceptive, vestibular and related functioning. Achievement and classroom behaviour in Grade 1, examined in a structured teacher interview, showed highly significant differences between the groups in general performance, english, mathematics, general knowledge and behavioural characteristics. Formal educational assessment in Grade 2 indicated a similar pattern, except that children referred by guidance and medical officers (group 4) deteriorated, and randomly sampled children with vestibular and proprioceptive dysfunction on the preschool examination (group 2) improved.

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This paper describes the findings of a study tour investigating the provision of physiotherapy services for children with developmental disabilities. It was found that early intervention programmes were paramount, particularly in the U.S.A. Major trends, such as the use of transdisciplinary approaches, as well as the specific techniques evolving from them, including task analysis and the use of written behavioural objectives, should be noted and utilised by physiotherapists. Efforts to improve the lifestyle of the children and of their families were studied, including successful family support services in Norway. Finally, several recommendations relating to early intervention and to preschool and school services have been suggested.

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This paper is the report of a preliminary study undertaken to examine how normal five-year-old children respond to spinning with particular reference to post-rotatory nystagmus. A simple method is described.

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A research project undertaken within the Department of Physiotherapy, University of Queensland (Steinberg, 1973) investigated the feasibility of establishing a pilot clinic for the study and treatment of very young children with minimal cerebral dysfunction. A neurodevelopmental approach to assessment and treatment was emphasised.

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