bluuebunny/crossref_metadata_2025 huggingface dataset:
More Than Nutrition: Breastfeeding in Urban Mali
Authors: Dettwyler Katherine A.
Published: November 2004

Ethnographic research on infant feeding among women in Mali reveals that breast milk substitutes are not widely used, with only 15 out of 136 children (11%) ever having received a breast milk substitute. This is an exception to the general trend toward substantial use of breast milk substitutes in urban Third World contexts. Economic constraints, probreastfeeding government policies, and beliefs about the value of breast milk all function to support the maintenance of breastfeeding. In addition, traditional kinship beliefs strongly affect maternal perceptions of the opportunity costs of alternative infant feeding choices, since only breastfeeding creates maternal kinship.
A Sickly‐Sweet Harvest: Farmworker Diabetes and Social Equality
Authors: Scheder Jo C.
Published: November 2004

Type II diabetes mellitus (NIDDM) is used as a model in examining neuroendocrine and experiential linkages between social inequality and health outcome. Ethnographic, psychosocial, and biochemical data collected among Mexican‐American migrant farmworkers reveal that diabetic workers spent more years in migrant labor (p < .01), and reported a greater number of stressful life events (p < .001), than nondiabetics. Body mass index (BMI) did not differ significantly between the two groups. Dopamine‐beta‐hydroxylase, a regulating enzyme in the stress‐responsive catecholamine system, may contribute to diabetes risk for some individuals; other pathways for neuroendocrine mediation of psychosocial stress are discussed. It is proposed that the oppressive life conditions of migrant farmworkers contribute to adverse health outcomes through specific physiological responses to life experiences.
Toward a Phenomenology of Boundaries in Medicine: Chronic Illness Experience in the Case of Stroke
Authors: Kaufman Sharon R.
Published: November 2004

In this article I explore the ambiguous nature of the boundaries of authority and responsibility in medicine by discussing two dimensions of patients' response to long‐term ramifications of stroke. A phenomenological examination of the chronic illness experience is employed to identify how and the extent to which medicine's power both responds to and affects the individual sufferer. Rather than interpret the illness process as a dichotomy between medical control and patient autonomy, this article presents some assumptions about the boundaries of medical authority that are held by patients and practitioners alike. I suggest that dilemmas that patients face following a stroke are responses to medicine's limits and scope as well as reflections of medicine's goals and values. I argue that phenomenological studies of existential responses to illness are necessary in order to understand cultural sources of unmet expectations resulting from chronic conditions.
Last Chance Babies: Interpretations of Parenthood in an In Vitro Fertilization Program
Authors: Modell Judith
Published: November 2004

In this article I describe interpretations of parenthood that emerge in the context of an in vitro fertilization (IVF) program in an urban hospital. Through the notion of “odds,” which is used to communicate the likelihood of a successful pregnancy, patients and physicians negotiated a “high‐tech” fertilization, issues of medical expertise and authority, and the status of the patient's knowledge and experience of her own body. I suggest that while in vitro fertilization may be technologically innovative, it is conceptually conservative in upholding existing cultural assumptions about parenthood, sex, and marriage. In melding a cultural approach to kinship with an examination of the “contexts of meaning” in a medical setting, I seek to illuminate the cultural effects of medical technology, the rhetorical determinants of social relationships, and ideas about kinship in the United States.
The Cultural and Political Context of Patient Dissatisfaction in Cross‐Cultural Clinical Encounters: A Canadian Inuit Study
Authors: O'Neil John D.
Published: November 2004

In 1986 patient dissatisfaction with medical services in some Canadian Inuit communities reached alarming proportions. Many observers attributed the problem to poor communication. Through an analysis of the process of interpretation in the clinic from a historical and sociopolitical perspective, I investigated the relationship between patient satisfaction and clinical communication. Political and ideological barriers inherent in a colonial medical system were found to constrain Inuit medical interpreters from advocating for their patients' interests and thereby increasing satisfaction with the care. Enhancing Inuit interpreters' capacity to act as advocates may be possible only through changes in administrative priorities that result from macropolitical change.
The Charm of Medicines: Metaphors and Metonyms
Authors: van der Geest Sjaak , Whyte Susan Reynolds
Published: November 2004

The ready availability and extreme popularity of Western pharmaceuticals in developing countries poses important general issues for medical anthropology. In attempting to explain why medicines are so attractive in so many different cultures, this article suggests that they facilitate particular social and symbolic processes. The key to their charm is their con‐creteness; in them healing is objectified. As things, they allow therapy to be disengagedfrom its social entanglements. Medicines are commodities which pass from one context of meaning to another. As substances, they are “good to think with” in both metaphoric and metonymic senses. They enhance the perception of illness as something tangible, and they facilitate communication about experiences that may be difficult to express. In the course of their transaction, they bear with them associations to authoritative professionals and the potency and potential of other cultural contexts of which they once were a part.
SIDA: The Economic, Social, and Cultural Context of AIDS among Latinos
Authors: Singer Merrill , Flores Cándida , Davison Lani , Burke Georgine , Castillo Zaida , Scanlon Kelley , Rivera Migdalia
Published: November 2004

Statistics on reported cases demonstrate clearly that AIDS is disproportionately prevalent among U.S. Latinos. To help clarify the meaning of this information, this article situates current epidemiological data within the sociocultural and socioeconomic contexts of Latinos living in the U.S. The purpose of this paper is to develop a fuller understanding of the Latino AIDS crisis by reviewing existing literature and new research findings on: (1) demographic, socioeconomic, and general health characteristics of the Latino population; (2) prevalence of the disease by Latino subgroup, geographic region, gender, age group, and route of transmission; (3) patterns of Latino knowledge, attitudes, and cultural understandings of the disease; and (4) AIDS risk behaviors among Latinos, including IV drug use, sexual patterns, and gender relations.
Sexual Risk for HIV Transmission among Singles‐Bar Patrons in San Francisco
Authors: Stall Ron , Heurtin‐Roberts Suzanne , McKusick Leon , Hoff Colleen , Lang Sylvia Wanner
Published: November 2004

Sexual risk for HIV infection was measured among heterosexual male and female and homosexual male bar patrons in San Francisco. High levels of sexual risk for HIV transmission were reported, especially in comparison to other samples of heterosexual and homosexual populations in San Francisco. Interventions must do more than communicate knowledge about the routes of HIV transmission, since these bar patrons demonstrated high levels of AIDS knowledge and concern, yet were also characterized by high levels of risky sexual behavior. The crucial question in the prevention of the continuing spread of HIV infections is not whether education should be used to modify risky behavior, but rather what kinds of education will prove effective in reducing behavioral risk for AIDS.
Compelled to Try: The Never‐Enough Quality of Conceptive Technology
Authors: Sandelowski Margarete
Published: November 2004

In this article I use literature from the medical and social sciences, as well as interviews with women and couples with fertility impairments, to argue against locating the compelling character of conceptive technology exclusively in pronatalist or patriarchal agendas. I suggest that the attraction to this technology derives not only from these broader cultural values but also from the way that the technology itself works (or does not work). Studying conceptive techniques helps illuminate why enough never seems to be enough for couples and physicians in pursuit of fertility.
Flesh, Blood, Souls, and Households: Cultural Validity in Mortality Inquiry
Authors: Nations Marilyn K. , Amaral Mara Lucia
Published: November 2004

In the developing world the deaths of impoverished infants and young children are frequently unrecorded in vital event registries. The authors argue that cultural validity or contextual soundness grounds the meaning of mortality inquiries as much as statistical standards. Ethnographic findings from northeast Brazil are incorporated into an alternative method to survey death; this technique is compared with two standard approaches (household surveys and vital registries) and found to increase accuracy and enrich the meaning of mortality rates. Generating quality ethnographic data permits health workers to develop culturally attuned methods to calculate these rates. Techniques tailored to context, together with standardized approaches, can best portray the magnitude of human suffering and loss.
Urbanization, Dengue, and the Health Transition: Anthropological Contributions to International Health
Authors: Kendall Carl , Hudelson Patricia , Leontsini Elli , Winch Peter , Lloyd Linda , Cruz Fernando
Published: November 2004

A host of resurgent diseases, many in newly created urban environments, challenges the assumptions underlying anthropological contributions to international public health programs. Past programs validated local knowledge about acute and well‐known disease conditions and encouraged self‐help and participatory approaches to respond to these problems. This article discusses the changing picture of health conditions in urban settings by examining local responses to one problem, dengue hemorrhagic fever, in a new program designed to test several earlier assumptions.
Chinese Medicine and the Anthropology of Menstruation in Contemporary Taiwan
Authors: Furth Charlotte , Shu‐yueh Ch'en
Published: November 2004

Structured interviews with 54 Taiwanese women reveal three frameworks used in interpreting menstruation: biomedicine, traditional Chinese medicine, and popular Buddhist teachings concerning menstrual pollution. Age and class influence women's preferences in ways that only partially reflect traditional‐modern dualisms. Although it does not challenge the prestige of biomedicine, Chinese medicine provides an alternative to Western‐style medicalization of menstruation, while pollution beliefs are positioned within a discourse on social decency, seen as religious piety or symbolic cleanliness. Although most women did not criticize the negative images of female gender embedded in any approach, they interpreted them to serve their convenience and protect their sense of dignity. They represented themselves as making choices as individuals.

These findings modify models of Chinese women as simple victims of the culture's symbolic construction of menstruation as polluting, as well as questioning stereotypes of biomedicine as an unproblematic force for their liberation. Chinese medicine emerges as a symbolically multidimensional contributor to Taiwanese Chinese menstrual beliefs and practices.
The Social Construction of Sexual Relationships as a Determinant of HIV Risk Perception and Condom Use among Injection Drug Users
Authors: Sibthorpe Beverly
Published: November 2004

Injection drug users (IDUs) occupy an important position in the HIV pandemic, not only because of their high risk of contracting the virus through sharing injection equipment and unsafe sex, but also because of their potential to transmit the virus to their non‐injecting heterosexual partners and to infants. To date, only modest gains in safer sex practices have been reported among IDUs, in spite of their almost universal knowledge of the modes of sexual and vertical transmission and widespread generalized and targeted risk reduction education programs. This article explores the basis for low levels of condom use and the apparent cognitive barriers to perceiving personal risk of sexual transmission of HIV in this population. Analysis of the social meaning of risk behavior and of sexually transmitted disease points to the importance of the social construction of sexual relationships as a determinant of personal HIV risk perception and condom use.
Living with HIV: Resistance by Positive People
Authors: Whittaker Andrea M.
Published: November 2004

Efforts to destigmatize AIDS by a group of HIV‐positive people in an Australian city include a counter discourse that inverts the stigma of AIDS by confronting images of a hopeless disease and appropriating concepts from the alternative health movement and New Age philosophy. These strategies constitute a resistance to mainstream discourses about AIDS and echo the strategies employed by other stigmatized groups. The explanatory model used by the HIV‐positive people allows them to actively intervene in the disease process by collaboration with the medical profession, exploration of alternative therapies, and political action to urge more research.
Susto and Mal de Ojo among Florida Farmworkers: Emic and Etic Perspectives
Authors: Baer Roberta D. , Bustillo Marta
Published: November 2004

This article addresses emic and etic perspectives on two Mexican folk illnesses, susto and mal de ojo. The approaches of Mexican and Mexican American mothers to treating these illnesses in their own children are compared and contrasted to those stated by physicians in a local clinic. The physicians considered the vast majority of the sets of symptoms given for these folk illnesses to be worthy of medical attention and possibly life threatening if not treated. While folk illness diagnoses may not exactly label biomedical “diseases,” the folk diagnoses do indicate life‐threatening conditions to which biomedical healers should be sensitive and attentive. This research suggests that the perception of folk healers that these illnesses cannot be dealt with by biomedical healers may be as incorrect as the perception of biomedical healers that these are mere “culture bound syndromes,” that is, not real medical problems.
Professional Identities of Young Physicians: A Finnish National Survey
Authors: Kumpusalo Esko , Neittaanmäki Liisa , Mattila Kari , Virjo Irma , Isokoski Mauri , Kujala Santero , Luhtala Riitta , Jääskeläinen Manu
Published: November 2004

This report presents the results of a national survey of medical doctors carried out in Finland in 1988. Of the 1,745 physicians who completed the questionnaires, 48 percent worked in hospitals and 39 percent worked in primary care settings. An 18‐item, 5‐point Likert scale was used to assess the professional identities of the physicians. Principal component factor analysis with varimax rotation produced the following five factors to describe the professional identities of the physicians: humanist, bureaucrat, health promoter, scientist, and healer. The five‐factor solution accounted for 60 percent of the total variance. There were marked, statistically significant differences in identity between male and female doctors as well as among hospital, primary care, and other physicians. Female physicians identified themselves more as humanists, health promoters, and bureaucrats, whereas male physicians were more likely to consider themselves healers and scientists. Primary care physicians identified themselves more as humanists and bureaucrats, whereas hospital physicians considered themselves healers and scientists. The report considers the implications of these findings for health care and the medical profession.
Change and Continuity in the Medical Culture of the Hmong in Kansas City
Authors: Capps Lisa L.
Published: November 2004

The Hmong in the United States have undergone radical culture change through their recent experiences of the war in Laos, refugee resettlement, and Christian conversion. This article analyzes the influence of these changes on the health ideas and practices of the Hmong in Kansas City, the primary study population. Although shamanism and ancestor worship have been abandoned, attenuated concepts of spirit illness and soul loss exist in health beliefs and patterns of illness, notably fright illness (ceeb). Their eclectic set of ideas and practices is derived from several systems, including Chinese medicine, Protestant Christianity, and biomedicine. To explain the varied health ideas and practices, Last's concept of medical culture is useful because it provides a framework for understanding medical traditions drawn from differing cultural systems. The Hmong have created a unique medical culture through their incorporation of new therapies as well as the use of some traditional methods of healing.
Medical Pluralism and Islam in Swahili Communities in Kenya
Authors: Beckerleg Susan
Published: November 2004

This article analyzes relationships among religious ideology, Swahili identity, and illness treatment. It focuses on one Swahili man's efforts to find effective treatment for a severe bout of fever, including resort to poorly understood Western medicine, to home remedies, and to humoral‐based treatment. The sick man attributes his eventual cure to a medicine called the “equalizer.” The case study is part of wider research that examines individual knowledge of Islamic humoral medicine as part of the Swahili heritage. Versions of humoral theory are articulated by lay people and underlie the local understanding of fever. The growth of a reformed Islamic movement, as well as local economic change, influences treatment choice by leading people to reject consultations with descendants of the Prophet Mohammed who offer mystical healing powers. This rejection connects to individuality and to the physical and social mobility of the Swahili. Advice givers among family and friends do not constitute a therapy management group, and the manner in which the sick man retains control over treatment choice is typical of the Swahili. [Swahili, Kenya, humoral medicine, Islam, illness management]
Old Age, Disease, and the Discourse on Risk: Geriatric Assessment in U.S. Health Care
Authors: Kaufman Sharon R.
Published: November 2004

This article explores one way in which medical practice confronts old age, disease, and conceptions of risk through an examination of geriatric assessment, a recently created health care modality in the United States. The process of geriatric assessment is shown to extend medicine's gaze to all aspects of bodily, mental, and social existence, thereby contributing to widespread cultural confusion about the equation of old age with disease. Geriatric medicine's representation of old age and disease is embedded in a risk discourse permeating contemporary society. An analysis of geriatric assessment conferences suggests that the old become the field on which the imperative to reduce risk by behavior modification and supervision competes with the deeply held value of autonomy. Medicine is assumed to be the appropriate institution for managing both the risks associated with aging and disease and the conflict between surveillance and care on the one hand, and freedom and neglect on the other.
Beyond the Ivory Tower: Critical Praxis in Medical Anthropology
Authors: SINGER MERRILL
Published: November 2004

Recent discussion in critical medical anthropology has turned to the issue of application beyond the academy. Building on Gorz's notion of “non‐reformist reform,” that is, applied work that unmasks rather than mystifies the sources of social inequality and ill health, this article argues for the possiblity of an applied critical medical anthropology, suggests concrete opportunities for such work in health settings, and identifies problems and social conditions that affect the development of a critical health praxis. These points are illustrated by revieving case studies of anthropological work with the Farm Labor Organizing Committee in Indiana, the United Farm Workers Union in California, and the Hispanic Health Council in Connecticut. The article concludes with an examination of the skills and resources critical medical anthropology has to offer system‐challenging movements in health care.
Physicians' Norms and Health Care Decisions of Elderly Medicare Recipients
Authors: HURWICZ MARGO‐LEA
Published: November 2004

Using theory and methods from cognitive anthropology, this article examines, in a two‐step analysis, the degree to which health care decisions made by elderly Medicare recipients coincide with the norms of physicians. First, consensus theory (Romney et al. 1986) was used to establish that physicians specializing in geriatrics agreed which among many symptoms experienced by elderly patients should receive medical attention. By asking 22 physicians to rate the medical necessity of physician visits for 106 symptoms, a key was developed to assess which patient treatment decisions were deemed “biomedically appropriate” by physicians. Second, a comparison was made between the treatment decisions deemed biomedically appropriate by physicians and 2,091 actual decisions reported by 885 elderly study participants. This comparison showed, in the aggregate, that the treatment decisions made by the elderly study participants are congruent with the norms of the physicians. Rationales given by the elders for their treatment decisions are discussed using an ethnographic decision modeling framework in an effort to understand the patterning of criteria they used to arrive at biomedically appropriate and inappropriate decisions.
Narratives of Elder Parental Death: A Structural and Cultural Analysis
Authors: RUBINSTEIN ROBERT L.
Published: November 2004

This article reports on middle‐aged daughters' perceptions of the experience of parental death. One hundred three married women, aged 40‐62, were interviewed about six months after the deaths of their widowed elderly mothers using an in‐depth qualitative interview format. As part of the interview, informants were asked to “tell the story of your mother's death,” a question designed to elicit a subjectively based narrative account. Analysis of these narrative texts discovered a number of salient themes: the quality of medical care; the personality of the mother; issues of health decision making; the salience of the death scene; and mother‐daughter closeness at death. Issues of family dynamics were quite important and permeated each description. In general, the narratives disclosed four aspects of the elder parental death experience: the enmeshment of medical care with the story of the death; the occurrence of pervasive ageism in accounts of the death; impossible dilemmas in terminal care of the aged; and the irreducibility of subjectivity in the daughter's biography of her mother.
Practice‐Building Seminars in Chiropractic: A Petit Bourgeois Response to Biomedical Domination
Authors: Baer Hans A.
Published: November 2004

As biomedicine evolved into the preserve of upper‐class and upper‐middle‐class physicians, working‐class and lower‐middle‐class individuals turned to chiropractic as a vehicle of upward social mobility. Practice‐building seminars constitute a largely overlooked strategy by which many chiropractors have sought to address their marginal status within the U.S. medical system. Using archival and research data, this article discusses the role of these seminars in assisting chiropractors to convince their patients of the efficacy of their treatment modalities, increase their incomes, and bolster their confidence as heterodox medical practitioners.
“Women Come Here on Their Own When They Need To”: Prenatal Care, Authoritative Knowledge, and Maternal Health in Oaxaca
Authors: Sesia Paola M.
Published: November 2004

Physiological and anatomical concepts about reproduction held by traditional midwives in Southern Oaxaca differ considerably from those of biomedicine. Government training courses for traditional midwives disregard these deep‐seated differences, and also the underlying conceptual rationale of ethno‐obstetrics. These courses constantly reinforce and actively promote the biomedical model of care. But rural midwives, despite these training courses, do not substantially change their obstetrical vision and ways. The strength of their own authoritative knowledge, fully shared by the women and men of their communities, allows them to continue their traditional style of care, despite pressures to conform to biomedical values, beliefs, and practices. Suggestions for a mutual accommodation of biomedical and midwifery approaches to prenatal care include training medical personnel in ethno‐obstetric techniques and rationales, teaching midwives basic medical interventions, addressing in intervention programs all social actors participating in reproductive decision making, and adopting an interdisciplinary approach that includes nonmedical aspects of maternal care.
Maternal Health, War, and Religious Tradition: Authoritative Knowledge in Pujehun District, Sierra Leone
Authors: Jambai Amara , MacCormack Carol
Published: November 2004

In Sierra Leone constraints to ideal maternal health require a primary health care approach that includes collaboration with traditional midwives. They are authoritative figures embedded within local political structures and a powerful women's religion. The local causes of maternal risk are described, including civil war and refugee camp life. Traditional midwives provide vital services in the camp, are respected for their social status, and learn additional skills. Biomedical and traditional systems of authoritative knowledge, based on different kinds of legitimacy to heal, are in a complementary relationship. [midwives, primary care, Sierra Leone, risk, war, religion]
Arrested Pregnancy Syndrome in Haiti: Findings from a National Survey
Authors: Coreil Jeannine , Barnes‐Josiah Debora L. , Augustin Antoine , Cayemittes Michel
Published: November 2004

This report describes findings from a national survey of pregnant women in Haiti regarding the social epidemiology of pedisyon (perdition), or “arrested pregnancy syndrome,” a condition believed to be associated with infertility. Data collected on mortality of respondents' sisters were used to indirectly measure the prevalence of this culture‐bound syndrome in the adult female population and to compare its distribution in urban and rural areas. Perdition appears to be a fairly common event that affects a large proportion of Haitian women. Reported cases of pedisyon were significantly higher in urban areas, which also differed from rural areas on respondent education, economic status, use of prenatal care, and fertility. No differences were found on sociodemographic, health, or fertility variables when women reporting perdition deaths were compared with women who reported other sister deaths. The utility and limitations of the proxy respondent method are discussed. Possible explanations for the higher rate of pedisyon among urban Haitian women are discussed, and suggestions are made for future research on arrested pregnancy syndrome.
Book Review
Authors: Metcalf Peter
Published: November 2004

Secure the Shadow: Death and Photography in America. Jay Ruby. Cambridge, Mass. MIT Press. 1995.220 pp. 119 illustrations.
Book Reviews
Authors: Dobres Marcia‐Anne
Published: November 2004

The Shamans of Prehistory: Trance and Magic in the Painted Caves. J. Clottes and D. Lewis‐Williams. 1998, Harry N. Abrams, NY; French edition, 1996 Seuil, Paris.

Journey Through the Ice Age. P. Bahn and J. Vertut. 1997, University of California Press, Berkeley and Los Angeles.
Granisetron: An Update on its Clinical Use in the Management of Nausea and Vomiting
Authors: Aapro Matti
Published: November 2004

Nausea and vomiting are typical side effects of cytotoxic therapy and some surgical procedures. These symptoms can represent a major therapeutic challenge and, if inadequately controlled by antiemetic treatment, will result in increased mortality, morbidity, and health care costs. However, the management of nausea and vomiting has improved greatly in recent years following the introduction of the 5-HT3-receptor antagonists, known as ‘setrons.’ In light of recent developments in antiemetic care, including the approval of the first neurokinin-1-receptor antagonist aprepitant (Emend®; Merck and Company, Inc.; West Point, PA) and a new 5-HT3 receptor antagonist palonosetron (Aloxi®; MGI Pharma; Minneapolis, MN), this article provides an update on the clinical experience gained with the 5-HT3-receptor antagonist granisetron (Kytril®; Roche Laboratories, Inc.; Nutley, NJ) for the management of chemotherapy-induced, radiation-induced, and postoperative nausea and vomiting, and also reviews its use in special patient populations. Granisetron is a potent and highly selective 5-HT3-receptor antagonist that has little or no affinity for other receptors, a characteristic that is thought to underlie the favorable side-effect and safety profiles of this agent. Extensive clinical trial data have shown granisetron to be an effective and well-tolerated agent for the treatment of nausea and vomiting in the oncology and surgical settings. Granisetron has also been shown to be effective and well tolerated in special populations, such as patients refractory to antiemetic treatment, patients with hepatic or renal impairment, and children. Data also suggest that its safety profile and minimal potential for drug-drug interactions would make it an antiemetic agent of choice for elderly cancer patients.
Safety and Pain Palliation of Zoledronic Acid in Patients with Breast Cancer, Prostate Cancer, or Multiple Myeloma Who Previously Received Bisphosphonate Therapy
Authors: Vogel Charles L. , Yanagihara Ronald H. , Wood Albert J. , Schnell Frederick M. , Henderson Charles , Kaplan Barry H. , Purdy Malcolm H. , Orlowski Richard , Decker Jodi L. , Lacerna Leo , Hohneker John A.
Published: November 2004

An open-label study conducted in community centers assessed the safety of zoledronic acid 4 mg intravenously over 15 minutes every 3–4 weeks as treatment of bone metastases in patients with multiple myeloma, breast cancer, or prostate cancer with and without previous bisphosphonate exposure. Adverse events (AEs), pain, and quality-of-life (QOL) scores were recorded, and serum creatinine (SCr) levels were measured before each infusion. Of 638 patients, 415 patients (65%) had received prior bisphosphonate therapy. Fatigue, nausea, and arthralgia were the most frequent AEs. Nausea was more common in bisphosphonate-naïve patients. SCr levels increased notably in 6.6% of patients: 7.7% of patients who received prior bisphosphonate therapy and 4.5% of bisphosphonate-naïve patients. Treatment was delayed because of SCr-level increases in 1.4% of patients with prior bisphosphonate exposure and 0.4% of bisphosphonate-naïve patients. SCr-level increases and treatment delays did not correlate with duration of prior bisphosphonate therapy. There was a trend towards more treatment discontinuations in patients with prior bisphosphonate exposure compared with bisphosphonate-naïve patients. Pain scores decreased from baseline; total QOL scores remained constant. The results of this study suggest that, with proper SCr-level monitoring, cancer patients with bone metastases who have previously received intravenous bisphosphonate treatment can be safely converted to zoledronic acid therapy.
An in situ toxicity identification evaluation method part I: Laboratory validation
Authors: Jr. Burton G. Allen , Nordstrom Juanita F
Published: November 2004

Identification of individual chemical groups is critical in evaluating sediment quality and fractionating these groups of chemicals in a mixture is important to determine the primary chemicals causing toxicity. The in situ toxicity identification evaluation (iTIE) is a novel method that was developed to fractionate chemicals in contaminated sediments and waters and assess toxicity organisms. The study objectives were to verify that the iTIE can help identify contaminant chemical classes and improve the toxicity assessment process; and compare the iTIE and U.S. Environmental Protection Agency's (U.S. EPA) toxicity identification evaluation (TIE) methods. The iTIE exposure chamber is powered by a portable air pump that suctions pore water, via a Venturi system, through selective sorption materials. After passing through the sorptive materials, the pore water passes into an exposure chamber containing Daphnia magna. The chemical sorption materials included Ambersorb®; 563 for nonpolar organic chemical adsorption, Chelex®; for metals chelation, and multiple zeolite types for ammonia adsorption. The laboratory studies were performed using water and sediments spiked with ammonia, cadmium, and fluoranthene. The laboratory validation of the iTIE approach showed that different classes of compounds readily could be separated via the resin treatments, resulting in significant differences in concentrations and thus exposures to in situ exposed organisms. Ammonia, cadmium, and fluoranthene were significantly removed by zeolite, Chelex, and Ambersorb, respectively. Although there was some cross-adsorption to the other nontarget resins, it was limited and allowed for treatment differences to be detected. Survival in the treatment resins exposed to the target compounds was as high as control survivals. A 24-h exposure period appeared optimal, allowing for replacement of initial culture water with pore waters, while longer exposures occasionally allowed for breakthrough of contaminants. The iTIE was more sensitive than the U.S. EPA TIE method, in that it detected toxicity more readily due to the greater loss of contaminant concentrations in the TIE manipulation process.
Stress and immune responses of nestling tree swallows (Tachycinet bicolor) and eastern bluebirds (Sialia sialis) exposed to nonpersistent pesticides and p,p′-dichlorodiphenyldichloroethylene in apple orchards of southern ontario, canada
Authors: Mayne Gregory J , Martin Pamela A , Bishop Christine A , Boermans Herman J
Published: November 2004

To determine the relative effects of pesticides in current use and persistent residues of p,p′-dichlorodiphenyldichloroethylene (p,p′-DDE), we examined endocrine and immune responses in tree swallow (Tachycineta bicolor) and eastern bluebird (Sialia sialis) chicks from pesticide-sprayed apple orchards and reference sites in southern Ontario, Canada, during 2000 to 2001. Nests were exposed to as many as seven individual pesticide applications and up to five mixtures of pesticides during the egg-incubation and chick-rearing stage. Eggs collected from sprayed orchards contained higher p,p′-DDE concentrations than eggs from reference sites. In 16-d-old tree swallows, no significant differences were found in body mass, basal corticosterone concentration, or the corticosterone stress response following a 10-min restraint of chicks sampled from sprayed orchards and reference sites. Challenge with adrenocorticotrophic hormone (ACTH), however, produced a higher level of corticosterone secretion in tree swallow chicks from sprayed orchards relative to chicks from reference sites. Multiple regression analysis revealed no correlation between corticosterone concentrations and exposure to pesticide sprays or p,p′-DDE in tree swallow chicks. In contrast, bluebird chicks from sprayed orchards were less responsive to challenge with ACTH and a significant negative association was found between the response to ACTH challenge and p,p′-DDE concentration in eggs. The phytohemagglutinin (PHA)-induced cutaneous basophil hypersensitivity response was similar between exposure groups in both tree swallow and bluebird nestlings. Examination of immune organs revealed that tree swallow chicks from sprayed orchards had significantly greater thymic lymphocyte density and cortical/medullary ratios and significant splenic B-cell hyperplasia relative to reference chicks. Our results indicate that modulation in the hypothalamus-pituitary-adrenal axis in songbird chicks tested are most associated with high p,p′-DDE egg concentrations. An alteration in the endocrine or immune system may compromise songbird survival immediately after fledging or during migration.
Probabilistic environmental risk assessment of zinc in dutch surface waters
Authors: Van Sprang Patrick A , Verdonck Frederik A.M , Vanrolleghem Peter A , Vangheluwe Marnix L , Janssen Colin R
Published: November 2004

In the framework of the European Union (EU) New and Existing Chemicals Policy, a regional risk assessment for Zn according to the current technical guidance documents and a probabilistic approach, by mathematically integrating both best-fitting exposure concentrations and species-sensitivity distributions into a probabilistic risk quotient distribution using Monte Carlo analysis, was explored for The Netherlands. Zinc is an essential element, and the current probability distributions may not adequately deal with this property. The threshold Pareto distribution provided the best fit to the chronic Zn toxicity data, resulting in a predicted-no-effect concentration (PNECadd) for dissolved Zn of 34.2 μg/L, whereas use of the conventional normal distribution resulted in a PNECadd for dissolved Zn of 14.6 μg/L. The extracted exposure data resulted in a regional predicted environmental concentration (PEC) for dissolved Zn in the Dutch surface waters of 20.1 μg/L and in PECadd values for dissolved Zn of between 15.5 and 17.3 μg/L, depending on the background correction used. The conventional deterministic risk characterization identified a regional risk for Zn in the Dutch surface waters. The more comprehensive probabilistic approach used in the present study, however, identified only very limited potential risks for the Dutch region. A probabilistic median risk, that the environmental concentration is greater than the no-observed-effect concentration of a species in Dutch surface waters (0.5–0.6%), depending on the inclusion of background correction, was obtained from the best-fitting distributions. Because probabilistic approaches provide a quantifiable and improved assessment of risk and quantification of the uncertainty associated with that assessment, these techniques may be considered as a way to improve the EU risk assessment procedures for data-rich substances.
Intra- and interlaboratory calibration of the DR CALUX® bioassay for the analysis of dioxins and dioxin-like chemicals in sediments
Authors: Besselink Harrie T , Schipper Cor , Klamer Hans , Leonards Pim , Verhaar Henk , Felzel Emiel , Murk Albertinka J , Thain John , Hosoe Kazunori , Schoeters Greet , Legler Juliette , Brouwer Bram
Published: November 2004

In the Fourth National Policy Document on Water Management in the Netherlands [1], it is defined that in 2003, in addition to the assessment of chemical substances, special guidelines for the assessment of dredged material should be recorded. The assessment of dredged material is based on integrated chemical and biological effect measurements. Among others, the DR CALUX® (dioxin responsive—chemically activated luciferase expression) bioassay has tentatively been recommended for inclusion in the dredged material assessment. To ensure the reliability of this bioassay, an intra- and interlaboratory validation study, or ring test, was performed, organized by the Dutch National Institute for Coastal and Marine Management (RIKZ) in cooperation with BioDetection Systems BV (BDS). The intralaboratory repeatability and reproducibility and the limit of detection (LOD) and quantification (LOQ) of the DR CALUX bioassay were determined by analyzing sediment extracts and dimethyl sulfoxide (DMSO) blanks. The highest observed repeatability was found to be 24.1%, whereas the highest observed reproducibility was calculated to be 19.9%. Based on the obtained results, the LOD and LOQ to be applied for the bioassay are 0.3 and 1.0 pM, respectively. The interlaboratory calibration study was divided into three phases, starting with analyzing pure chemicals. During the second phase, sediment extracts were analyzed, whereas in the third phase, whole sediments had to be extracted, cleaned, and analyzed. The average interlaboratory repeatability increased from 14.6% for the analysis of pure compound to 26.1% for the analysis of whole matrix. A similar increase in reproducibility with increasing complexity of handlings was observed with the interlaboratory reproducibility of 6.5% for pure compound and 27.9% for whole matrix. The results of this study are intended as a starting point for implementing the integrated chemical—biological assessment strategy and for systematic monitoring of dredged materials and related materials in the coming years.
Comparative toxicity of oil, dispersant, and oil plus dispersant to several marine species
Authors: Fuller Chris , Bonner James , Page Cheryl , Ernest Andrew , McDonald Thomas , McDonald Susanne
Published: November 2004

Dispersants are a preapproved chemical response agent for oil spills off portions of the U.S. coastline, including the Texas—Louisiana coast. However, questions persist regarding potential environmental risks of dispersant applications in nearshore regions (within three nautical miles of the shoreline) that support dense populations of marine organisms and are prone to spills resulting from human activities. To address these questions, a study was conducted to evaluate the relative toxicity of test media prepared with dispersant, weathered crude oil, and weathered crude oil plus dispersant. Two fish species, Cyprinodon variegatus and Menidia beryllina, and one shrimp species, Americamysis bahia (formerly Mysidopsis bahia), were used to evaluate the relative toxicity of the different media under declining and continuous exposure regimes. Microbial toxicity was evaluated using the luminescent bacteria Vibrio fisheri. The data suggested that oil media prepared with a chemical dispersant was equal to or less toxic than the oil-only test medium. Data also indicated that continuous exposures to the test media were generally more toxic than declining exposures. The toxicity of unweathered crude oil with and without dispersant was also evaluated using Menidia beryllina under declining exposure conditions. Unweathered oil-only media were dominated by soluble hydrocarbon fractions and found to be more toxic than weathered oil-only media in which colloidal oil fractions dominated. Total concentrations of petroleum hydrocarbons in oil-plus-dispersant media prepared with weathered and unweathered crude oil were both dominated by colloidal oil and showed no significant difference in toxicity. Analysis of the toxicity data suggests that the observed toxicity was a function of the soluble crude oil components and not the colloidal oil.
Influence of natural organic matter source on acute copper, lead, and cadmium toxicity to rainbow trout (Oncorhynchus mykiss)
Authors: Schwartz Melissa L , Curtis P. Jefferson , Playle Richard C
Published: November 2004

Natural organic matter (NOM) was concentrated from various sites across Canada using a portable reverse-osmosis unit to obtain a range of NOM types, from mainly allochthonous (terrestrially derived) to mainly autochthonous (aquatically derived) NOM. The addition of NOM to Cu exposures in ion-poor water always decreased Cu toxicity to rainbow trout (Oncorhynchus mykiss, ∼1 g) over a 96-h period, and the degree of protection varied with respect to NOM source. A good correlation was found between the specific absorbance coefficient (SAC) and time to reach 50% mortality (LT50; p < 0.001), indicating that more optically dark, allochthonous-like NOM decreases Cu toxicity better than does optically light, more autochthonous-like NOM. A similar, good relationship between NOM source and Pb toxicity was seen (p < 0.001), once confounding effects of Ca binding to NOM were accounted for. No significant relationship between Cd toxicity and NOM optical quality was seen (p = 0.082), and in toxicity tests with Cd the presence of some of the NOM sources increased Cd toxicity compared to Cd-only controls. Specific absorbance coefficients were used as a proxy measurement of NOM aromaticity in our study, and fluorescence indices were run on some NOM samples to obtain percent aromaticity for each sample. A good correlation was found between SAC and percent aromaticity, indicating that the simple SAC measurement is a reasonable indication of NOM aromaticity and of metal binding by NOM.
Validation of an amphibian sperm inhibition toxicological test method using zinc
Authors: Christensen Jennie R , Bishop Christine A , Richardson John S , Pauli Bruce , Elliott John
Published: November 2004

Analysis of sperm has been investigated as a possible method to examine the toxicity of environmental contaminants. The amphibian sperm inhibition toxicological test (ASITT) method examines the effects of contaminants on Xenopus laevis (African clawed frog) sperm motility and path trajectories. As part of a preliminary validation of the method, the effects of increasing divalent metal ion, zinc (Zn2+), on X. laevis sperm motility were examined. We hypothesized that Zn2+ concentration would have significant inhibitory effects on percent sperm motility, velocities, and trajectories. The Zn2+ was added to a control solution in concentrations from 0 to 1,417 μg/L. Sperm cells were videotaped at 30 frames per second under X400 microscope, and percent motility was recorded and paths were mapped by marking the change in position of the sperm head over a period of 1 s. Sperm motility was categorized as progressive, hyperactivated, idle, or nonmotile, and velocities and trajectories were calculated on the basis of x,y coordinates. Increasing Zn2+ concentrations caused a significant exponential decay in percent total motility and progressive motility. Straight-line velocity increased with increasing Zn2+ concentrations. Overall, results suggest that Zn2+ may be interfering with cellular processes, such as cellular respiration, flagellar bending, or ion exchange, thereby inhibiting sperm motility.
Predicting maternal body burdens of organochlorine pesticides from eggs and evidence of maternal transfer in Alligator mississippiensis
Authors: Rauschenberger Richard H , Sepúlveda María S , Wiebe Jon J , Szabo Nancy J , Gross Timothy S
Published: November 2004

Few data exist regarding maternal–embryonal transfer of organochlorine pesticides (OCPs) in reptiles. The objective of the present study was to evaluate maternal transfer of OCPs in American alligators (Alligator mississippiensis) from low-, intermediate-, and high-OCP-exposure sites. Overall, total OCP burdens ranged from less than 0.8 ppb in blood to more than 44,000 ppb in abdominal adipose tissue (wet wt concentrations). Lipid-adjusted ratios of maternal adipose burdens (total OCPs) to yolk burdens were close to one (0.94 ± 0.31:1), suggesting that animals were in steady state and that OCPs in eggs originated from adipose lipids. In contrast, lipid-adjusted muscle and liver OCP burdens were greater than yolk OCP burdens, suggesting that lipids in muscle were not utilized during oogenesis and that nonlipid liver tissue sequesters OCPs. Predictive equations were derived for several tissues and several OCP analytes with r2 values ranging from 0.40 to 0.99 (p < 0.05). We suggest that yolk burdens are predictive of maternal tissue burdens for certain tissues and OCPs and that certain OCPs are maternally transferred in the American alligator. Furthermore, we suggest that future studies should investigate the applicability of these predictive equations for assessing maternal exposure in other crocodilian species.