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Background: The World Trade Center (WTC) attacks exposed thousands of workers to hazardous environmental conditions and psychological trauma. In 2002, to assess the health of these workers, Congress directed the National Institute for Occupational Safety and Health to establish the WTC Medical Monitoring and Treatment Program. This program has established a large cohort of WTC rescue, recovery, and cleanup workers. We previously documented extensive pulmonary dysfunction in this cohort related to toxic environmental exposures., Objectives: Our objective in this study was to describe mental health outcomes, social function impairment, and psychiatric comorbidity in the WTC worker cohort, as well as perceived symptomatology in workers' children., Methods: Ten to 61 months after the WTC attack, 10,132 WTC workers completed a self-administered mental health questionnaire., Results: Of the workers who completd the questionnaire, 11.1% met criteria for probable post-traumatic stress disorder (PTSD), 8.8% met criteria for probable depression, 5.0% met criteria for probable panic disorder, and 62% met criteria for substantial stress reaction. PTSD prevalence was comparable to that seen in returning Afghanistan war veterans and was much higher than in the U.S. general population. Point prevalence declined from 13.5% to 9.7% over the 5 years of observation. Comorbidity was extensive and included extremely high risks for impairment of social function. PTSD was significantly associated with loss of family members and friends, disruption of family, work, and social life, and higher rates of behavioral symptoms in children of workers., Conclusions: Working in 9/11 recovery operations is associated with chronic impairment of mental health and social functioning. Psychological distress and psychopathology in WTC workers greatly exceed population norms. Surveillance and treatment programs continue to be needed.

Background: Disaster workers responding to the events of September 11th were exposed to traumatic events. No study has systematically investigated the diverse mental health status and needs of the heterogeneous population of disaster workers responding to the events of September 11th., Methods: Using PubMed and Medline and the search terms of "September 11, 2001" or "September 11" or "9/11"or "WTC" or "World Trade Center", the authors reviewed all articles that examined the mental health outcomes of workers at one of the three September 11th crash sites or the Fresh Kills landfill in New York City., Results: In total, 25 articles met study inclusion criteria, often using different methodologies. The articles described varying degrees of mental health symptomatology, risk factors for adverse mental health outcomes, and utilization of mental health services., Conclusions: The mental health needs of workers exposed to the events of September 11th ranged from little to no care to pharmacotherapy. A range of risk factors, including exposures at the WTC site and occupational activities, impacted on these needs but the role of specific mental health interventions was less clear. These findings suggest the need for a future program for disaster workers consisting of an accessible mental health treatment service supported by comprehensive postdisaster surveillance and emphasis on pre-disaster mental wellness. A number of areas for further consideration and study were identified, including the need for a more diverse exploration of involved responder populations as well as investigation of potential mental health outcomes beyond post-traumatic stress disorder (PTSD)., (Copyright (c) 2008 Mount Sinai School of Medicine)

Introduction: The metabolic syndrome and insulin resistance represent growing concerns related to atypical antipsychotic (AAP) use as their incidence in the schizophrenia population is two-to-four-fold higher than the general population. Reduced methylenetetrahydrofolate reductase (MTHFR) activity, resulting in aberrant folate metabolism and hyperhomocysteinemia, has been linked to cardiovascular disease and is unstudied in relation to AAP associated metabolic complications., Purpose: To examine the relationship between MTHFR, metabolic syndrome, and insulin resistance in schizophrenia subjects receiving AAPs for >or=12 months., Methods: Fifty-eight subjects were included in this cross-sectional analysis and screened for the metabolic syndrome, insulin resistance and MTHFR 677C/T and 1298A/C genotype., Results: Overall, 23 subjects (40%) met metabolic syndrome criteria. There were no differences in age, gender, race, or AAP exposure between genotype groups. For the 677 T allele carriers, 53% met metabolic syndrome criteria, compared to 23% in the CC genotype group, giving an OR=3.7, (95% CI=1.24-12.66, p=0.02). Thus, for T allele subjects, the risk was almost four times greater, despite similar antipsychotic exposure. Both waist circumference and MTHFR genotype significantly predicted insulin resistance (F=8.35, df=5, 51, p<0.0001), with these two terms interacting (F=8.6, df=2, p=0.0006) suggesting that TT subjects are at greater risk for insulin resistance with increasing central adiposity, which is independent of age, gender, BMI, or metabolic syndrome diagnosis., Conclusion: Results should be taken cautiously due to the small sample size, but suggest the MTHFR 677C/T variant may predispose patients to AAP metabolic complications.

The National Response Plan (NRP) establishes the framework for the nation's response to major disasters. We offer seven recommendations related to surveillance of workers who respond to events under the NRP. These recommendations address the rationale for and principles of medical surveillance in the context of large-scale disasters and the NRP; means of identifying and registering the populations that should be included in surveillance activities; the role of exposure assessment in medical surveillance; behavioral health issues; and principles regarding the communication and use of surveillance data.

Objective: The objective of the current investigation was to determine the relationship between polymorphisms of the leptin system (leptin gene and leptin receptor) and olanzapine-induced weight gain in persons with schizophrenia., Design: Pharmacogenetic association reanalysis of a longitudinal, open label, six week, fixed dose trial of olanzapine response and adverse effects., Subjects: Thirty-seven males and females with clinically symptomatic schizophrenia (age, 23-52) meeting DSM-IV criteria., Measurements: Baseline and endpoint weight, BMI, olanzapine dose, plasma levels, and psychopathology measures were completed in a prior study. These subjects were subsequently genotyped for the -1548 G/A polymorphism of the leptin gene and the Q223R polymorphism of the leptin receptor. The relationship between alleles at each locus, olanzapine plasma levels, and percent change in body mass index (BMI) from baseline were conducted., Results: Genotypes and alleles for each locus were not individually associated with olanzapine-induced weight gain in this study population. Changes in BMI from baseline increased significantly in persons with olanzapine plamsa levels >20.6 ng/mL for subjects carrying at least one G allele at both candidate loci compared to those who did not have a G allele at each (P = 0.049)., Conclusions: This study suggests that genetic variability in the leptin gene and leptin receptor may predispose some individuals to excessive weight gain from increased exposure to olanzapine.

Background: Approximately 40,000 rescue and recovery workers were exposed to caustic dust and toxic pollutants following the 11 September 2001 attacks on the World Trade Center (WTC). These workers included traditional first responders, such as firefighters and police, and a diverse population of construction, utility, and public sector workers., Methods: To characterize WTCrelated health effects, the WTC Worker and Volunteer Medical Screening Program was established. This multicenter clinical program provides free standardized examinations to responders. Examinations include medical, mental health, and exposure assessment questionnaires; physical examinations; spirometry; and chest X rays., Results: Of 9,442 responders examined between July 2002 and April 2004, 69% reported new or worsened respiratory symptoms while performing WTC work. Symptoms persisted to the time of examination in 59% of these workers. Among those who had been asymptomatic before September 11, 61% developed respiratory symptoms while performing WTC work. Twenty-eight percent had abnormal spirometry; forced vital capacity (FVC) was low in 21%; and obstruction was present in 5%. Among nonsmokers, 27% had abnormal spirometry compared with 13% in the general U.S. population. Prevalence of low FVC among nonsmokers was 5-fold greater than in the U.S. population (20% vs. 4%). Respiratory symptoms and spirometry abnormalities were significantly associated with early arrival at the site., Conclusion: WTC responders had exposure-related increases in respiratory symptoms and pulmonary function test abnormalities that persisted up to 2.5 years after the attacks. Longterm medical monitoring is required to track persistence of these abnormalities and identify late effects, including possible malignancies. Lessons learned should guide future responses to civil disasters.

The occurrence of sexual side-effects from antidepressants is thought to be mediated through serotonin 2A (5HT2A) receptors. It is currently unknown if functional polymorphisms in the 5HT2A receptor or its G-protein second messenger complex are related to sexual dysfunction in patients taking an selective serotonin reuptake inhibitor (SSRI) for depression. The purpose of this study was to determine the relationship of the 5HT2A -1438 G/A and GNB3 C825T single nucleotide polymorphisms with overall sexual well-being and individual components of sexual health as measured by the Changes in Sexual Functioning Questionnaire (CSFQ). We evaluated 89 outpatients (18-40 years of age) at low risk for other causes of sexual dysfunction who were being treated for depression with an SSRI and did not have sexual difficulties before taking the antidepressant. Outcome measures were stratified by 5HT2A and GNB3 genotypes. After controlling for age, gender, anxiety scale scores, and depression scale scores, persons with a GG genotype of the 5HT2A -1438 single nucleotide polymorphisms (SNP) were significantly more likely to be categorized as having sexual dysfunction than persons with a GA or AA genotype (OR=3.6; 95% CI 1.03, 12.6; p=0.046). Furthermore, the 5HT2A -1438 GG genotype was a significant predictor of lower arousal scores (p=0.022) after accounting for other measures. There was no significant relationship between any outcome measure and GNB3 genotype.

Chronic diseases of environmental origin are a significant and increasing public health problem among the children of New York State, yet few resources exist to address this growing burden. To assess New York State pediatricians self-perceived competency in dealing with common environmental exposures and diseases of environmental origin in children, we assessed their attitudes and beliefs about the role of the environment in children's health. A four-page survey was sent to 1,500 randomly selected members of the New York State American Academy of Pediatrics in February 2004. We obtained a 20.3% response rate after one follow-up mailing; respondents and nonrespondents did not differ in years of licensure or county of residence. Respondents agreed that the role of environment in children's health is significant (mean 4.44 +/- 0.72 on 1-5 Likert scale). They voiced high self-efficacy in dealing with lead exposure (mean 4.16-4.24 +/- 0.90-1.05), but their confidence in their skills for addressing pesticides, mercury and mold was much lower (means 2.51-3.21 +/- 0.90-1.23; p < 0.001). About 93.8% would send patients to a clinic "where pediatricians could refer patients for clinical evaluation and treatment of their environmental health concerns." These findings indicate that New York pediatricians agree that children are suffering preventable illnesses of environmental origin but feel ill-equipped to educate families about common exposures. Significant demand exists for specialized centers of excellence that can evaluate environmental health concerns, and for educational opportunities.

In the aftermath of the September 11 World Trade Center (WTC) attack, a large number of people sustained potential exposures to smoke, dust, particulate matter, and a variety of toxins, including asbestos, pulverized concrete, glass fibers, polycyclic aromatic hydrocarbons (PAHs), and polychlorinated furans and dioxins. Additionally, many had exposure to psychological traumatogens. The most common effects seen to date are respiratory and mental health consequences. The long-term consequences of exposures are not yet known, and there remains concern about the potential for late-emerging diseases such as cancers. This article reviews WTC-related health effects, the spectrum of exposures and how they were documented, and discusses future preventive efforts.

Background: Despite advances in schizophrenia treatment, nearly 30% of patients do not respond to atypical antipsychotic agents, such as olanzapine. Furthermore, 30-60% of patients will gain significant weight during the course of olanzapine therapy. Little research has been done to investigate the relationship between antipsychotic treatment outcomes and genetic variability in second messengers coupled to serotonin (5HT) receptors. The purpose of this investigation was examine associations between the second messenger G-Protein Beta3 Subunit Gene (GNB3) C825T polymorphism and olanzapine response and weight gain treatment., Material/methods: We conducted a pharmacogenetic association study to examine GNB3 genotypes in relation to olanzapine clinical response (as measured by the Brief Psychiatric Rating Scale or Scale for the Assessment of Negative Symptoms) or weight gain. Subjects included forty-two individuals meeting DSM-IV criteria for schizophrenia that started olanzapine, were titrated to a fixed dose for 6 weeks, and subsequently genotyped for this investigation., Results: No statistically significant associations existed between our outcome variables and GNB3 genotypes. However we did observe trends suggesting a potential relationship between the TT genotype, response, and weight gain that warrant further investigation., Conclusions: Preliminary results showed no statistical relationship between the C825T polymorphism and olanzapine response or weight gain. Numerical differences in outcome measures between the TT vs. CT/CC genotype groups indicate that G-protein second messenger systems variability coupled to primary targets of atypical antipsychotics may relate to clinical outcomes in persons with schizophrenia and that future research in this area is warranted.

Purpose: The excitatory neurotransmitter glutamate has become an important area of focus for schizophrenia researchers. Polymorphisms in the type-three metabotropic glutamate receptor gene (GRM3) have been associated with the pathogenesis of schizophrenia. The purpose of this study was to determine whether a pharmacogenetic relationship exists between six polymorphisms of GRM3 and clinical improvement during olanzapine treatment in persons with schizophrenia., Method: Forty-two subjects meeting DSM-IV criteria for schizophrenia started olanzapine and were titrated to a fixed dose of 7.5-20 mg/day for 6 weeks. The Brief Psychiatric Rating Scale (BPRS) total score and the Scale for Assessment of Negative Symptoms (SANS) were completed at baseline and then weekly to assess psychopathology., Results: The principle finding of this study is that GRM3 polymorphisms were collectively significant predictors of negative symptom improvement in persons with schizophrenia treated with the atypical antipsychotic olanzapine. After controlling for baseline SANS scores, the genotypes as a whole were significant predictors of negative symptom improvement, accounting for approximately 28% of the variance in scores (F = 16.30, df = 29, p < 0.001). The single nucleotide polymorphism SNP1 (rs274622), located in a potential promoter region, had the most significant influence on SANS scores, but the effects of this locus could not be fully separated from the other polymorphisms. The mean decrease in SANS scores was 21% vs. 51% for SNP1 T/T + T/C and SNP1C/C subjects, respectively., Conclusion: These data suggest that polymorphisms in the GRM3 gene may be useful as predictors of negative symptom improvement in persons with schizophrenia treated with olanzapine.

Phenols are present in the environment and are prevalent in human populations, as environmental contaminants, dietary components, or their metabolites. Many are potential endocrine-altering agents. Currently available methods analyze single components or single families of chemicals as biomarkers of exposure. In order to assess multiple biologically relevant exposures to such substances, we evaluated the feasibility of determining several phenols simultaneously in urine, using an electrochemical detector (ECD) in combination with high performance liquid chromatography (LC). Based on reported analyses in the literature and the ECD response, we selected four xenobiotic residues, including three phytoestrogens (enterolactone, daidzein, and genistein) and bisphenolA [BPA]. These compounds had detection limits below 1 microg/L in urine using the cleanup procedure (glucuronidase hydrolysis and C18 column) and the urine volume (2 mL) we employed. As a pilot study to demonstrate the method's utility, we determined urinary enterolactone, daidzein, genistein and BPA in samples from nine children and 24 adults.

The wide but sporadic distribution of group I introns in protists, plants, and fungi, as well as in eubacteria, likely resulted from extensive lateral transfer followed by differential loss. The extent of horizontal transfer of group I introns can potentially be determined by examining closely related species or genera. We used a phylogenetic approach with a large data set (including 62 novel large subunit [LSU] rRNA group I introns) to study intron movement within the monophyletic lichen family Physciaceae. Our results show five cases of horizontal transfer into homologous sites between species but do not support transposition into ectopic sites. This is in contrast to previous work with Physciaceae small subunit (SSU) rDNA group I introns where strong support was found for multiple ectopic transpositions. This difference in the apparent number of ectopic intron movements between SSU and LSU rDNA genes may in part be explained by a larger number of positions in the SSU rRNA, which can support the insertion and/or retention of group I introns. In contrast, we suggest that the LSU rRNA may have fewer acceptable positions and therefore intron spread is limited in this gene.

Smoking markedly increases the risk of asbestos-related lung cancer. We conducted a randomized pilot trial of a telephone-based smoking cessation intervention in asbestos workers. Fifty-nine smokers were assigned to either a control or telephone-based smoking cessation treatment group and were followed-up at 6 months. Intent-to-treat analysis revealed a 16.7% quit rate at 6 months for the intervention group compared to 6.9% for the control group (P = 0.25). Treatment-received quit-rates were 33% for the intervention group and 6.9% for the control group (P = 0.05). The intervention group was twice as likely to use smoking cessation medicines and progressed further along the stage of change continuum compared with the control group. Incorporating telephone-based smoking cessation treatment into medical screening activities for asbestos workers is feasible and the intervention is effective in increasing quit rates at 6 months.

For almost 50 years, millions of Mexicans have been directly and/or indirectly exposed to (1,1,1-trichloro-2,2-bis[p-chlorophenyl]ethane) (p,p'DDT). The potential related health outcomes of this exposure are of international concern. The objective of the study was to determine the effect of breast-feeding on serum levels of 1,1-dichloro-2; 2'-bis(p-chlorophenyl)ethylene (p,p'DDE) and p,p'DDT in women of childbearing age who were residents of the state of Morelos, Mexico. In March 1999, we examined a sample of 24 women, ages 21 to 36 years, who came with their children to the outpatient facility of a county Health Center in the state of Morelos. The geometric mean for p,p'DDE was 21.8 ng/ml+/-2.58 (GSD) and 2.9 ng/ml+/-2.84 for p,p'DDT. For each month of breast-feeding we observed similar significant decreases for both p,p'DDE (beta=-0.0403 per log concentration unit, P=0.001) and p,p'DDT (beta=-0.0309, P=0.03) serum levels, adjusted by mothers' age and number of children. The adjusted half-life estimate for p,p'DDE serum levels was 17 months. It was concluded that breast-feeding leads to rapid removal of p,p'DDT from the body (<2 year half-life) compared to nonlactational elimination rates (<5 year half-life). In this population, serum p,p'DDE levels were similar to those found 20 years ago in the United States.

A pilot study was conducted in Morelos, Mexico in March 1999 to assess the body burden of lead in 24 Mexican women of childbearing age. Lead levels were measured in whole blood and at three bone sites: two primarily trabecular (calcaneus and patella) and one primarily cortical (tibia). Demographic and reproductive characteristics of the women and potential sources of lead exposure were gathered by a direct interview. An inverse relationship was noted between months of lactation and age-adjusted calcaneus lead level (P = 0.001). No association was observed between age-adjusted patella or tibia lead level and months of lactation (P = 0.15). Blood lead levels were positively associated with the use of lead-glazed ceramics (P = 0.01). Bone and blood lead levels were observed to be 77% higher in these rural Mexican women than in urban New York City women. This pilot study provides further limited evidence for the hypothesis that lead mobilization occurs during lactation.

The U.S. Bureau of National Affairs has conducted several surveys asking women to rate the seriousness of 11 hazards thought to affect female workers. In 1995 the women respondents ranked them in the following order: 1) stress, 2) repetitive motions, 3) AIDS, 4) violence, 5) VDTs, 6) indoor air pollution, 7) hepatitis, 8) injury on the job, 9) reproductive hazards, 10) tuberculosis, and 11) other infectious diseases. A parallel list of 11 hazards thought to affect male workers would look very different. The purpose of this paper is to explore why this is so and what it implies for the occupational health research agenda.

This report surveys the state of the art in applications of virtual environments and related technologies for health care. Applications of these technologies are being developed for health care in the following areas: surgical procedures (remote surgery or telepresence, augmented or enhanced surgery, and planning and simulation of procedures before surgery); medical therapy; preventive medicine and patient education; medical education and training; visualization of massive medical databases; skill enhancement and rehabilitation; and architectural design for health-care facilities. To date, such applications have improved the quality of health care, and in the future they will result in substantial cost savings. Tools that respond to the needs of present virtual environment systems are being refined or developed. However, additional large-scale research is necessary in the following areas: user studies, use of robots for telepresence procedures, enhanced system reality, and improved system functionality.

Noise-induced hearing loss has previously been reported among rock musicians. This study sought to determine whether a hazard of noise-induced hearing loss exists for music club employees other than musicians themselves. Sound levels at eight live-music clubs were measured and symptoms of noise exposure in 31 music club employees were assessed by questionnaire. The average sound level at the various clubs during performances ranged from 94.9 to 106.7 dBA. The overall sound level average, including both performance and ambient levels, ranged from 91.9 to 99.8 dBA. Symptoms of noise exposure, such as tinnitus and subjective hearing loss, correlated with sound intensity. Only 16% reported regular use of hearing protection. We conclude that employees of music clubs are at substantial risk of developing Noise-Induced Hearing Loss, due to chronic noise exposure which consistently exceeded safe levels. Hearing protection is used much too infrequently. The development of hearing conservation programs for this large group of workers is essential.

A cohort mortality study was carried out among workers of a plant producing hard metals using cobalt as a binder. This study was aimed at assessing possible lung cancer risks in relation with cobalt exposure. Seven hundred nine male workers with at least 1 year of employment were included in the cohort and followed for mortality from 1956 to 1989. Job histories were provided by the administration of the plant, whereas smoking habits were collected from medical records and by interview. The causes of deaths were ascertained from hospital and general practitioner records. The observed numbers of deaths (obs) were compared with the expected based on national rates with adjustment for age, sex, and calendar time (standardized mortality ratio; SMR). The overall mortality did not differ from that expected (obs = 75, SMR = 1.05), whereas mortality due to lung cancer was in significant excess (obs = 10, SMR = 2.13). This excess was higher among workers employed in the areas with the highest exposure (obs = 6, SMR = 5.03). No trend was observed, however, with duration of employment or time since first employment. Smoking data were available for 81% of the workers and 69% of the deceased and showed that smoking alone does not account for these lung cancer excesses, yet, because of the small numbers involved, no firm conclusion should be drawn from this study.

This detailed discussion of medical surveillance techniques addresses such issues as the administration and interpretation of the tuberculin skin test, the importance of BCG vaccine, preventive therapy with isoniazid, the identification of groups at high risk for TB, multidrug-resistant tuberculosis, and regulatory requirements for PPD testing, including CDC guidelines.

Pulmonary siderosis and bronchial cancer are respiratory risks in the long term in arc welders. We report a case of siderosis discovered from radiological abnormalities in a patient of 56 who had been an arc welder for 30 years. An analysis of the broncho-alveolar lavage liquid and transbronchial biopsy confirmed an iron overload and revealed patchy interstitial fibrosis. The toxic risks in arc welders arise from the gaseous fumes produced and inhaled particles at the alveolar level. The pulmonary siderosis is currently considered as a simple pneumoconiosis with a good prognosis. Some recent studies suggest the possibility of a more serious outcome with fibrosis even in the absence of any associated silicosis. The risks of bronchial cancer seem to be principally linked to exposure to chrome. A better understanding of these risks could be furnished by data from epidemiological studies which are still lacking.

A study was undertaken of the particle size of aerosols, emitted by a treatment plant for urban waste water, by counting the total flora, using and Andersen apparatus. Evidence of significant bacterial contamination was obtained on the perimeter of the installations. Calculations were made on the data obtained using a method to show the number of viable particles deposited at different levels within the pulmonary tree. During the working day approximately 10(4) viable particles, representing 1.5 x 10(6) organisms, products of the common flora of activated sludge were inhaled. Only a small fraction enters the pulmonary acini; the greater part are swallowed or excreted via the nose or on coughing.

1. The slow potentiel changes of the base line of the electrocardiogram recorded by cutaneous electrodes, here called EGEG (electrogastroenterogram) have been recorded simultaneously with the electromyogram and pressure variations of the stomach antrum. 2. Periodic fluctuations of EGEG, 400 microV amplitude, were correlated with activities of the antrum EMG consisting of 3 to 6 mV spikes superimposed on slow wave of depolarization, and with gastric intraluminal pressure of 5 to 7 cm of water. 3. An anticholinergic drug abolished all those activities. A gastric contracture flattened the EGEG. 4. Rhythmic distensions of the antrum induced a synchronous modulation of EGEG, the magnitude of which was correlated with the amplitude of distension. These result suggest that the origin of EGEG is essentially the movements of stomach.

In a factory processing Tungsten carbide and hard metals, of a hundred exposed workers, 15 showed signs of "irritation" which progressed in 5 to clinical, radiological and functional pulmonary fibrosis with altered CO transport. In one patient histological sections were studied and typical findings of dust inclusion seen. Diffuse interstitial fibrosis related to heavy metals is still not yet recognised as an industrial disease in France.

Recording of the electro-gastro-enterogram (E.G.E.G.) and the simultaneous taking of a 70 mm ampliphotography series shows the high degree of correlation between E.G.E.G. and peristaltis, with characteristic waves for each part of the digestive tract, both in the normal condition as well as in certain pathological states. The future and role of the E.G.E.G. appear very promising, on the one hand by virtue of its simplicity and secondly because of the information it is capable of providing from a functional viewpoint. In no case, however, can it replace the precise nature of radiological images.

Being regarded as a professional and having one's occupational group regarded as a profession are often deemed desirable. It is not immediately apparent why this is so. 'Professional' often contrasts simply with 'amateur', and as a label conveys not honor but the recognition that the one so labelled is paid for doing what others do for free. But there is a distinct, honorific sense in which the professional contrasts not with the amateur but with the person who simply has a job rather than a life-long calling. It is in this honorific sense that physicians, attorneys and members of the clergy serve as paradigm professionals. Aspiring professionals in disciplines other than the paradigm ones regard themselves as more nearly like these paradigms than is usually recognized, and this is their claim to recognition as professionals. The paper explores several possible points of similarity by developing an account of the ideal for professionals which has been held in Western society at least since the time of the Hippocratic Oath, which best captures its spirit. As the Oath makes clear, professionals have fiduciary relations with their patients or clients, and provide services of a personal nature. The paper explores the principal demands of this ideal, the principal steps which physicians have taken in pursuit of it, and some of the implications of this ideal for various groups of social scientists associated with medicine. Finally, it recognizes a professional spirit or attitude which transcends occupation.

Readings of peak-expiratory flow rate (PEFR) in twelve healthy alpinists at sea level (Lima) and at 3800 m (Yanganugo) show a significant slight fall with altitude (p less than 0.05). This study corroborates previous reports (Singh et al., 1969; Stockley et al., 1979). However, Forster (1983) taking in account the effect of air density on the functioning of peak-flow meter suggested that actual PEFR increases slightly with altitude. In the present study, corrected data show an increase of PEFR by about 3% at 3800 m, similar to Forster's results (at 4200 m). Air density must be considered in future studies in altitude and in estimation of clinical improvement of asthmatic people living in mountain health resort.

Functional digestive complaints are frequent in psychiatri patients: simple constipation, which cannot be explained solely by the loss of the sensation of rectal fullness; occlusions, occasionally hemorragies; the late complication of dolichomegacolon (Bourgeois, 1973). In 160 subjects, an attempt to understand the physio-pathology were made by recording diurnal digestive motor activity using skin electrodes placed on the abdomen and extremities (electrogastroenterography or E.G.E.G.). A hypoactive E.G.E.G. was observed in 2/3 of 18 psychotic depressive patients, in 3/4 of 36 schizophrenies. The nocive effect of giving sedative phenothiazine and antiparkinsonian drugs (trihexyphenidyl or ethybenzatropine) during long periods is clear. Whereas non sedative phenothiazine and clotiapine gicen in small doses, do not have an undesirable effect. Sulpiride has been used in gastroduodenal dyskinesia. The dyskinesia noted by the E.G.E.G., sometimes found in the large intestin, were found in 55% of 30 patients with caracter disorders; they coincide with the high frequency of electro-encephalogram dysrythmies. Finally, in hysterical patients, one usually observes normal E.G.E.G., tracings which confirms the clinical observation that hysterical and psychosomatic symptoms, may succeed each other, but do not appear at the same time. In the same categories of patients, no longer treated in a classical psychiatric environment but in a group with institutional objectives, the same clinic results were obtained with fewer digestive disturbances. This tends to show the inutility and nocivity of excessive doses of psychotropic drugs given alone or in complexe association.

A 60-year-old man had severe, recurrent rectal haemorrhages. Arteriography showed lesions suggestive of angiodysplasia located in the initial part of the ascending colon. Right-sided hemicolectomy was performed. Angiectasis of the colon is acquired and degenerative. It affects elderly people and is due to dilatation of the veins in the mucosa of the ascending colon. The lesions are usually too small to be detected by barium enema or colonoscopy, but arteriography of the superior mesenteric artery shows pathognomonic images. The only treatment is right-sided hemicolectomy.

Fifty nine asthmatic children were assessed by skin tests (prick-tests) (TC), specific serum IgE level (R.A.S.T.) and bronchial provocation tests (TPB) with house dust, mites, grass pollen, animal scales and moulds. The concordance of the skin and R.A.S.T. tests with the provocation test, chosen for reference and their diagnostic value was analysed using decision matrices. There was a significant connection between the results of the three tests. The concordance level was only moderate not passing 68%. By comparison to TPB there were numerous false positive Prick-tests and false negative R.A.S.T. The negative predictive value of TC was satisfactory. The most discriminatory threshold for the positive R.A.S.T. was the class 3 response. These results allow the following diagnostic possibilities to be considered. For a common allergen a negative prick-test (TC) would lead to the end of the investigations except for certain particular cases; for an allergen of low prevalence a positive TC should be taken into account, and completing this with RAST and TPB. One could envisage a reduction in the number of TPB and R.A.S.T. performed, reserving them for cases where a discordance between the clinical history and the T.C.