Self-referred Individuals Research Articles

Factors Associated with SARS-CoV-2 Infection Evaluated by Antibody Response in a Sample of Workers from the Emilia-Romagna Region, Northern Italy.

Factors associated with SARS-CoV-2 infection risk are still debated. This case-control study aims to investigate the possible relationship between SARS-CoV-2 infection, evaluated through antibody response, and the main sociodemographic, occupational, clinical-anamnestic, and biochemical factors in a population of Modena province (Northern Italy), mainly workers. Both workers who voluntarily joined the screening campaign proposed by companies and self-referred individuals who underwent serological testing were enrolled. Subjects with antibody positivity were recruited as cases (n = 166) and subjects tested negative (n = 239) as controls. A questionnaire on sociodemographic, occupational, and clinical data was administered through telephone interviews. Serum zinc/iron/copper/chromium/nickel, vitamins D/B12, folates, triglycerides, and LDL/HDL/total cholesterol were measured. Cases lived more often in urban areas (61.8% vs. 57%). Cases and controls did not differ significantly by working macrocategories, but the percentage of workers in the ceramic sector was higher among cases. Low adherence to preventive measures in the workplace was more frequent among seropositives. Folate concentration was significantly lower among cases. Therefore, adequate folate levels, living in rural areas, and good adherence to preventive strategies seem protective against infection. Workers in the ceramic sector seem to be at greater risk; specific factors involved are not defined, but preventive interventions are needed.

Seroprevalence Survey of Anti-SARS-CoV-2 Antibodies in a Population of Emilia-Romagna Region, Northern Italy.

Italy was the first Western European country to be severely hit by the COVID-19 pandemic. Variations in seroprevalence rates were reported according to geographical and temporal differences of previous surveys, as well as depending on demographic and occupational factors. In this cross-sectional study, we evaluated the prevalence of anti-SARS-CoV-2 antibodies in a population of the Emilia-Romagna region in Northern Italy after the first wave in the period from 26 September 2020–26 March 2021. We included 5128 subjects who voluntarily underwent serological tests to determine anti-SARS-CoV-2 antibody positivity, including both self-referred individuals (24.2%) and workers adhering to company screening programs (76.8%). Overall, seroprevalence was 11.3%, higher in self-referred (13.8%) than employed-referred (10.5%) individuals. A slightly higher seroprevalence emerged in women compared to men (12.3% and 10.7%), as well as in the extreme age categories (18.6% for 60–69 years, 18.0% for ≥70 years, and 17.1% for <20 years compared to 7.6% for 20–39 years). Healthcare professionals showed the highest prevalence of seropositivity (22.9%), followed by workers in direct contact with customers, such as the communication, finance, and tourism sectors (15.7%). Overall subgroups seroprevalence increased compared to the first wave data but the trends agreed between the first and subsequent waves, except for an increase in the younger age group and in the sector in direct contact with customers. Among the occupational categories, our study confirms that healthcare workers and workers in the sports sector were at high risk of exposure to SARS-CoV-2.

Acceptance of Sexual Interest in Minors in Self-Referred Individuals Under Treatment – An Exploratory Pilot Study

Some therapists/scientists argue that “acceptance” of sexual interest in minors (SIM), i.e., the integration of the sexual preference into the individual self-concept, is a prerequisite for dealing with SIM in a responsible way. However, if one assumes that – even in some persons – SIM might change over time, “acceptance” could also run counter to therapeutic targets because the motivation to change as well as the specific self-efficacy for modifying SIM might be reduced. This exploratory pilot study analyzes the relationship between acceptance of SIM and (1) dynamic risk for contact sexual reoffending, (2) SIM and frequency of the use of child/adolescent (sexual abuse) imagery, (3) frequency of sexual desire/behavior toward children/adolescents, and (4) the change of the level of acceptance of SIM during the course of treatment. The majority of the participants (N = 79) was not exclusively interested in children (85%) and used child pornography but did not commit child sexual abuse (54%). Acceptance of SIM, frequency of the use of child/adolescent (sexual abuse) imagery and frequency of sexual desire/behavior toward children/adolescents are assessed via self-report questionnaires, dynamic risk for contact sexual reoffending is measured by STABLE-2007. Pretreatment data are analyzed via Spearman’s correlation (N = 79). Intragroup analysis compares acceptance of SIM from pre- and posttreatment (n = 35). There was no correlation between acceptance of SIM and dynamic risk for contact sexual reoffending. However, there was a medium, positive correlation between acceptance of SIM and the frequency of the use of legal imagery of children, a positive correlation between the item “My inclination is an integral part of my personality” and the frequency of the use of legal imagery of children, and a positive correlation between acceptance of SIM and the frequency of sexual activities with minors. Acceptance of SIM did not change during the course of treatment. The results suggest that “acceptance” of SIM has to be discussed in a differentiated way, i.e., as possibly being associated with positive and negative outcomes as well.

Referral for group or individual treatment? Factors for consideration in the case of self-referred individuals with a sexual interest in minors.

In Germany, several treatment programs offer psychotherapy for individuals with a sexual interest in minors (SIM) who are currently not in contact with the criminal justice system. The patients present anonymously in relation to the health insurance and judicial system. Group therapy plays an important role in these programs. However, to date there is poor empirical evidence on indication criteria for group vs. individual treatment for this specific group of individuals. This study examined individuals with SIM who voluntarily participated in a treatment program in Hamburg. We investigated via post-hoc analysis whether there were significant differences regarding readiness to participate in group therapy, dynamic risk factors, psychopathic characteristics, impulsivity and empathy between individuals indicated for group therapy (n = 26) and individuals referred for individual therapy (n = 47). Results show that individuals referred for individual therapy were significantly more impulsive than individuals referred for group therapy, but comparable in respect to readiness to participate in group therapy, dynamic risk, psychopathy, and empathy. These findings suggest that assignment to group vs. individual therapy is mainly based on other criteria than these characteristics. Implications for clinical practice and future research are discussed.

Symptom Preoccupation in Fibromyalgia: Prevalence and Correlates of Somatic Symptom Disorder in a Self-Recruited Sample

Somatic symptom disorder (SSD) is characterized by a persistent and distressing psychological reaction to somatic symptoms. In pain disorders, the preoccupation with physical symptoms is associated withpoor long-term outcomes. SSD may therefore be of use to identify and help chronic pain patients with particular needs. To test the hypothesis that in fibromyalgia, SSD is associated with higher anxiety sensitivity, health anxiety, and reactivity to pain, in addition to lower nonreactivity to inner experiences. In addition, to investigate if individuals with SSD report a larger impact of fibromyalgia core symptoms, more somatic symptoms, and higher psychiatric comorbidity. Using data from a clinical trial involving self-referred individuals with fibromyalgia, we compared participants with SSD to participants without SSD using t-tests and logistic regression. Forty-nine out of 140 participants (35%) had SSD. Most findings corroborate that individuals with fibromyalgia who also meet criteria for SSD are worse off in terms of traits previously found to be predictive of a poor course in pain disorders. Post hoc analyses indicated that this could not be explained merely by a higher level of fibromyalgia core symptoms. SSD appears to be associated with a higher symptom burden in fibromyalgia, but further research is needed todraw firm conclusions regarding the reliability, acceptability, and utility of the SSD diagnosis in the clinic.

The Association of Blood Glucose and Diabetes with Abdominal Aortic Aneurysm, Carotid Stenosis and Peripheral Arterial Disease: An Observational Study of 630,000 Patients Attending Vascular Screening

Introduction - Diabetes is an important risk factor for atherosclerotic vascular disease, and previous studies have also shown a positive continuous association between blood glucose concentrations throughout the “normal” reference range and cardiovascular disease. However, diabetes appears to be inversely associated with abdominal aortic aneurysm (AAA). This study reports associations between blood glucose concentration and diabetes with AAA, carotid stenosis and peripheral arterial disease (PAD). Methods - Between 2008 and 2013, 3.3 million self-referred individuals attended cardiovascular screening clinics (Life Line Screening) in the US and UK. Assessments included an aortic ultrasound scan, a carotid duplex, and ankle-brachial pressure index (ABPI). Major cardiovascular risk factors and medical history were recorded, and approximately one fifth of participants also underwent blood glucose assays. Diabetes was defined according to previous diagnosis or treatment. Participants with incomplete data or prior cardiovascular disease were excluded, yielding 628 246 individuals in the current report. Results - The mean age at screening was 63 ± 10 years, and 64% of attendees were women. The following prevalences were observed: AAA (infra-renal aorta ≥ 30mm) = 0.5%; carotid artery stenosis (peak systolic velocity generally ≥110cm/s) = 3.5%; PAD (ABPI <0.9) = 2.6%. A prior diagnosis of diabetes was associated with higher risk of PAD (OR, 95%CI: 1.77, 1.71-1.84) and carotid stenosis (1.71, 1.66-1.76), and among participants without a prior diagnosis of diabetes the prevalence of carotid stenosis and PAD increased with higher blood glucose levels across the normal reference range. For AAA, a prior diagnosis of diabetes was associated with a significantly lower risk (0.83 0.77-0.90), however among attendees without diabetes, the prevalence of AAA increased with higher blood glucose levels across the normal reference range. Conclusion - Across the normal reference range, higher blood glucose concentrations are associated with increased risk of carotid stenosis, PAD and AAA, but a diagnosis of diabetes was associated with a lower risk of AAA. This raises the possibility that the “protection” conferred by diabetes against AAA could be due to a treatment effect, but this hypothesis needs to be tested in randomised trials.

Readiness to Change as a Predictor of Treatment Engagement and Outcome for Partner Violent Men

Resistance to change has been long recognized as a barrier to successful intervention for partner violent individuals. Using archival data from a community-based intimate partner violence (IPV) intervention program, the current study investigated readiness to change as a predictor of treatment engagement and outcome in cognitive behavioral therapy (CBT) for IPV, and examined whether court referral status, antisocial personality characteristics, and borderline personality characteristics moderate these associations. During program intake, male IPV perpetrators (N = 195) provided structured interview data on demographics and referral source, and self-report data on readiness to change, borderline personality traits, and antisocial personality traits. During group CBT, participants and their therapists completed measures of the working alliance, and the therapists completed ratings of compliance with behavior change homework assignments. Criminal recidivism data were gathered from public records for 2 years after scheduled completion of treatment. Readiness to change significantly predicted client ratings of the working alliance, but not therapist ratings of the working alliance, CBT homework compliance, or criminal recidivism. Court referral status moderated predictive associations between readiness to change and working alliance ratings, and borderline and antisocial characteristics moderated predictive associations between readiness to change and working alliance as well as criminal recidivism. Interestingly, readiness to change is a stronger predictor of positive treatment response for court- versus self-referred individuals and for those with either very low or very high levels of borderline and antisocial characteristics. Hence, strategies to enhance motivation to change may be particularly be important for IPV perpetrators with these characteristics.

Experience With Patient Referrals for Upper Extremity Transplantation at a U.S. Academic Medical Center

To date, there have been over 100 upper extremity transplantations (UET) performed worldwide. However, little data are available regarding institutional screening practices or description of the population of patients that seek transplantation as a treatment modality for their upper extremity disabilities. We performed a review of our institutional experience in an attempt to better understand our referral patterns and identify factors that may be associated with successful screening. Contact demographic data, injury characteristics, and mode of referral were retrospectively reviewed from 2010 through 2015. Differences in demographic data, injury-related characteristics, and clinical trial outcomes were assessed with the Chi-square test or Fisher exact test. There were a total of 89 UET contacts. The average age was 35.2 years, with most contacts being white (n= 24). The majority were male (n= 66; 75.0%) and the most common indication for referral was trauma (n= 43; 55.8%). Of the 89 contacts, 20 (22.5%) were physician referrals and 69 (77.5%) were self-referrals. Physician referrals led to the most screened and accepted contacts, whereas self-referrals more often led to immediate exclusion. This study gives an overview of the demographic composition of our UET contacts, with a specific emphasis on mode of referral. We have identified that physician referrals have led to more screened and accepted patients versus self-referred individuals. Therapeutic, Level IV.

Increased Prevalence of Moderate and Severe Peripheral Arterial Disease in the American Indian (AI)/Alaskan Native (AN) Population; a Study of 96,000 AI/AN

Peripheral arterial disease (PAD) disproportionally affects racial groups in the United States. Few studies have analyzed the rates of PAD in the American Indian (AI)/Alaskan Native (AN) population. In this article, we compare the prevalence of PAD in the AI/AN as compared with white and nonwhite Americans. The study data were provided by Life Line Screening (Independence, OH). Thecohort consists of self-referred individuals who paid for vascular screening tests. Mild-to-moderate and severe PAD were defined as having an ankle-brachial index (ABI) inat least one extremity of<0.9 and<0.5, respectively. Univariate and multivariate analyses were performed to compare the rates of PAD between AI/AN, Caucasians, and nonwhites. The original sample for which this study was obtained included 3,444,272 people. Of this group there was a predominance of females 64.5% (2,221,555) compared with 35.5% (1,222,716) males. The Native American/AN population was 2.8% of the sample (96,440). In our univariate analysis AI/AN had the highest rates of mild-moderate and severe PAD when compared with whites (odds ratio [OR] 1.78 and 2.14, respectively) and nonwhites (OR 1.52 and 1.82, respectively). We then controlled for atherosclerotic risk factors in our multivariate analysis, and the AI/NA cohort had persistently higher rates of both moderate and severe PAD compared with whites (OR 1.32 and 1.40) but not compared with nonwhites (OR 0.95 and 0.92). Here we present the largest epidemiology study of PAD in AI/AN to date. AI/NA people have disproportionately high rates of both mild to-moderate and severe PAD when compared with whites and nonwhite Americans. After controlling for atherosclerotic risk factors the rates of PAD remain high for AI/NA when compared with whites but not when compared with nonwhites. While it is possible that a combination of diet and lifestyle choices are responsible for the high rates of PAD in this population, genetic factors may be involved as well, and deserve further investigation. Optimal medical management may help to prevent the complications of PAD in this patient population.

The prevalence of carotid artery stenosis varies significantly by race

Certain races are known to be at increased risk for stroke, and the prevalence of carotid artery stenosis (CAS) is thought to vary by race. The goal of this report was to study the prevalence of CAS in different races by analyzing a population of subjects who underwent vascular screening examinations. The study data were provided by Life Line Screening. The cohort consists of self-referred individuals who paid for vascular screening tests. Subjects<40 and >100 years of age and those who reported a prior stroke or carotid artery intervention were excluded. Of the remaining 3,291,382 subjects, 3.7% did not self-identify a race. CAS was defined as stenosis in either internal carotid artery ≥50% by duplex ultrasound velocity criteria. The 3,291,382 subjects available for analysis consisted of Caucasian (2,845,936 [90%]), African American (97,502 [3.1%]), Hispanic (75,240 [2.4%]), Asian (60,982 [1.9%]), and Native American (87,757 [2.8%]) individuals. The prevalence of CAS was 3.4% in females and 4.2% in males (P ≤ .001). Controlling for gender and age, there was marked variation in the prevalence of CAS (P< .001) by race. Native American subjects had the highest prevalence of CAS across all age categories and in both sexes. Caucasian subjects had the second highest prevalence of CAS across most age decades and in both sexes. Among males, African American individuals had the lowest prevalence of CAS in nearly all age categories. In contrast to males, Asian females had the lowest prevalence of CAS compared with females of other races in most age groups. Multivariate analysis adjusting for atherosclerotic risk factors in addition to age confirmed race as a significant independent predictor of CAS. Compared with Caucasian subjects, African American (odds ratio [OR], 0.65), Asian (OR, 0.69), and Hispanic (OR, 0.74) subjects had a significantly lower risk of CAS, whereas Native American (OR, 1.3) subjects had a significantly higher risk of CAS. The prevalence of clinically significant CAS varies significantly by race. Native American and Caucasian individuals have the highest prevalence of CAS, whereas African American males and Asian females appear to have the lowest prevalence. This information adds evidence to the hypothesis that the increased stroke rate in African American subjects is likely not related to extracranial cerebrovascular disease. Furthermore, this is a novel report of an extremely high prevalence of CAS in the Native American population.

Self‐Help Treatment for Insomnia Symptoms Associated with Chronic Conditions in Older Adults: A Randomized Controlled Trial

To evaluate the effectiveness of a self-help cognitive behavioral intervention in improving sleep quality in older adults reporting insomnia symptoms associated with chronic disease. A pragmatic two-arm randomized controlled trial comparing supported self-help with treatment as usual (TAU). Primary care. One hundred ninety-three self-referred individuals aged 55 to 87 with long-term conditions and chronic insomnia symptoms (as defined according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition). Self-help participants received six consecutive booklets, at weekly intervals, providing structured advice on important components of cognitive behavioral therapy for insomnia (CBT-I, including self-monitoring, sleep restriction, stimulus control procedures, and cognitive strategies), plus access to a telephone helpline. Control group participants received a single sheet of advice detailing standard sleep hygiene measures. The primary outcome was sleep quality, measured by the Pittsburgh Sleep Quality Index (PSQI). Secondary outcomes were the Insomnia Severity Index (ISI), the subjective sleep efficiency index, and the Fatigue Severity Scale. In the self-help group, sleep outcomes showed significant improvements after treatment (PSQI, P<.001; ISI, P<.001; sleep efficiency, P<.001) and at 3-month (PSQI, P=.002; ISI, P=.006; sleep efficiency, P=.001) and 6-month (PSQI, P=.003; ISI, P=.003; sleep efficiency, P=.001) follow-up. Effect sizes were moderate (range of adjusted Cohen d=0.51-0.75). Treatment had no effect on levels of daytime fatigue. Most treated participants (73%) said they would recommend the self-help program to others. Self-help CBT-I offers a practical first-line response to individual reporting insomnia symptoms associated with chronic disease in primary care settings. In these individuals, symptoms of daytime fatigue may be more closely associated with disease processes than with sleep quality.

Newly diagnosed HIV patients in Lima, Peru: a comparison of individuals diagnosed through an intervention program versus self-referred individuals

Background: An extensive intervention program to promote awareness, HIV testing, diagnosis and access to medical care in at-risk populations was developed by Via Libre between Nov 2007 and Oct 2009 in Lima, Peru (Proyecto Somos). Supplement: Abstracts of the Tenth International Congress on Drug Therapy in HIV Infection http://www.biomedcentral.com/content/pdf/1758-2652-13-S4-info.pdf Conference: Tenth International Congress on Drug Therapy in HIV Infection 7-11 November 2010 Glasgow, UK (Published: 8 November 2010) doi:10.1186/1758-2652-13-S4-P171 Cite this article as: Hidalgo et al.: Newly diagnosed HIV patients in Lima, Peru: a comparison of individuals diagnosed through an intervention program versus self-referred individuals. Journal of the International AIDS Society 2010 13(Suppl 4):P171. Full text: PubMed Central: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3112951/

Is DSM-IV Bereavement Exclusion for Major Depressive Episode Relevant to Severity and Pattern of Symptoms?

To assess the DSM-IV major depressive episode (MDE) bereavement exclusion criterion by comparing severity and pattern of symptoms in bereavement-excluded individuals satisfying all other DSM-IV MDE criteria to these same variables in MDE controls. A case-control, cross-sectional study of self-referred individuals seeking treatment for depressive symptoms was conducted. A total of 17,988 subjects met DSM-IV MDE symptom criteria. Of these, 1,521 individuals (8.5%) met all MDE criteria except the bereavement exclusion. They were matched by age, gender, marital status, and educational level with 1,521 MDE controls. Among the MDE controls, 292 had a recent bereavement and 1,229 did not. Severity of depression was measured by the number of MDE symptoms and the Montgomery-Asberg Depression Rating Scale (MADRS) score. Symptom cues of the bereavement-exclusion criterion were analyzed. The study was conducted between September 2003 and May 2004. Bereavement-excluded subjects were more severely depressed than MDE controls without bereavement and similar to MDE controls with bereavement. Two symptom cues, suicidal ideation and worthlessness, and the majority of other depressive symptoms were more pronounced in bereavement-excluded individuals than in MDE controls. Symptom cues of the DSM-IV MDE bereavement exclusion criterion should be modified since they could result in patients failing to be correctly diagnosed and treated.

Letter to the Editor

Calcifications are part of the development of atherosclerosis; they occur exclusively in atherosclerotic arteries and are absent in the normal vessel wall.1 Studies have demonstrated calcification in both coronaries and aortic arteries to be a specific marker of underlying atherosclerosis in the respective vascular beds.1 Extensive evidence exist that men are more likely to have calcification in the coronary arteries2,3; however, whether similar difference exists in other vascular beds is not well established. The purpose of this study is to evaluate whether the lower risk of atherosclerosis observed in coronary circulation in women compared with men is also observed in thoracic aorta. This is a cross-sectional study on a consecutive sample of 8549 asymptomatic individuals (69% men, mean age: 52±9 years) patients who presented to a single EBT scanning facility for CHD risk stratification.4 A history of cigarette smoking was considered present if a subject was a current or former smoker. Dyslipidemia was coded as present for any individual self-reporting a history of high total cholesterol, high LDL, low HDL, and/or high triglycerides, or current use of lipid-lowering therapy. Patients were considered to have diabetes if they reported using oral hypoglycemic agents, insulin sensitizers, or subcutaneous insulin and hypertension if they reported a history of high blood pressure or used antihypertensive medications. A family history of CHD was considered premature if the immediate family (parents or siblings) experienced a fatal or nonfatal myocardial infarction before age of 55 years. Individuals …

A meta-analysis of the effectiveness of bibliotherapy for alcohol problems.

There has been increased interest in the use of brief interventions and the delivery of alcohol treatment services through nonspecialist health care settings. One possible resource for reaching untreated individuals is "bibliotherapy," the provision of self-help materials to motivate and guide the process of changing drinking behavior. Research on the effectiveness of self-help materials for problem drinkers has been done for three decades. This report summarizes a meta-analytic review of 22 studies evaluating the effectiveness of such self-help materials. Each study was rated on 12 methodological criteria, and effect sizes of bibliotherapy were computed. The methodological quality of studies was generally high relative to other treatment-outcome studies. Modest support was found for the efficacy of self-help materials in decreasing at-risk and harmful drinking. The weighted mean pre/post-effect size for bibliotherapy was .80 with self-referred individuals seeking help for drinking problems, and .65 for individuals identified through health screening. Between-group comparisons of bibliotherapy with no-intervention controls appear to have a small to medium effect, with a weighted mean effect size of .31 with self-referred drinkers; effect size was more variable in opportunistic interventions based on health screening. Finally, between-group comparisons of effects on drinking of bibliotherapy versus more extensive interventions yielded effect size values near zero. These findings provide support for the cost-effective use of bibliotherapy with problem drinkers seeking such help to reduce their consumption, and to a lesser extent with drinkers who are identified through screening as at risk.

Multicultural competence: Criteria and case examples.

How do you as a professional psychologist know if you are competent to treat clients whose cultural origins values differ from your own? What awareness, knowledge, skills do you need? With whom should you consult? When should you Adopting an idiographic, inclusive approach, the authors identify 12 minimal multicultural competencies for practice illustrate their usefulness through 3 case examples. Suggestions for how professional psychologists can augment evaluate their own multicultural competencies are offered as well as implications for professional psychology educators. Consider the following scenario: Dr. Mary Ann Smith is a European American licensed clinical psychologist trying to build her private practice in a medium-sized town in the upper Midwest. She has worked to become listed on provider panels realizes how important self-referred individuals with good insurance are to her livelihood. In 1 week, she receives three new clients: a recently fired Native American male nurse filing a discrimination lawsuit against the school district; a Spanish-speaking Mexican American lesbian fighting a custody battle with her ex-husband; a blind, indigent, 70-year-old Irish American man with depression. Am I competent to treat these clients? wonder^ Dr. Smith, and if not, to whom do I refer? For professional psychologists like Dr. Smith, working with diverse clients will soon become the norm rather than the exception. Shortly after the year 2050, racial ethnic minorities will become a numerical majority in the United States (U.S. Bureau of the Census, 1995). Nearly 75% of the current entering labor force are racial ethnic minorities or women, when baby

Pilot survey of urinary porphyrins from persons transiently exposed to a PCB transformer fire.

In rats and humans chronically exposed to large amounts of PCB (polychlorinated biphenyls) and PCDF (polychlorinated dibenzofurans), the urinary excretion of uroporphyrin and coproporphyrin are altered. However, porphyrin excretion in humans after acute transient low level exposure has not been evaluated. Following such an exposure in which bystanders and firefighters were in contact with smoke from a PCB transformer fire, we surveyed 90 self-referred individuals by questionnaire and by determining single 24 hour urinary excretion of uroporphyrin and coproporphyrin 2-4 weeks after the fire. Questionnaire variables that assessed exposure were not associated with the magnitude of either uroporphyrin or coproporphyrin excretion. Uroporphyrin excretion was slightly elevated in nine subjects (range 66-106 micrograms/24 hours, normal less than 60), which is much less than in clinical cases of porphyria cutanea tarda. Uroporphyrin excretion was inversely correlated with coproporphyrin excretion (r = -0.3844, p = 0.0002). For 5 subjects (3 with elevated initial uroporphyrin excretion) retested at 3-4 weeks after the fire, all 5 showed increases in uroporphyrin and decreases in coproporphyrin excretion when compared to initial determinations. These two reciprocal relationships would be the expected result from inhibition of uroporphyrinogen decarboxylase, a known experimental effect of PCB and PCDF in mice. Overall, urinary porphyrin excretions were not altered or sensitive measures of exposure.

An evaluation of a controlled drinking program for drinking drivers.

The purpose of this study was to test the effectiveness of Behavioral Self-Control Training in terms of reductions in alcohol consumption and blood alcohol concentration generally, and determine if changes on these indices effect reductions in drinking-and-driving incidents, blood alcohol concentration during drinking-and-driving incidents, and reductions in life problems. Self-referred individuals who drink and drive were randomly assigned into one of two experimental conditions: 1) Behavioral Self-Control Training (BSCT), or 2) Conventional Alcohol Education (CAE). Behavioral Self-Control Training resulted in nonsignificant ( p &gt; .05) reductions of: 1) alcohol consumption, 2) peak blood alcohol concentration, 3) drinking-and-driving episodes, 4) blood alcohol concentration during drinking-and-driving episodes, and 5) the severity of life problems. No significant differences were found between conditions on these variables. These results suggest that a controlled drinking goal may not be feasible for all drinking-and-driving populations.