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Eusideroxylon zwageri Teijsm. & Binn T has been reported to have bioactivity, one of which is the potential as an excellent cytotoxic agent using the BSLT method. So far, stage tests using cancer cells and analysis of the content of secondary metabolites have not been reported, Therefore, it is essential to analyze the content of secondary metabolites using Liquid Chromatography – Tandem Mass Spectrometry (LC-MS/MS) and determination of cytotoxic activity using Brine Shrimp Lethality Test (BLST) mwthod with various solvent polarities. Then separation by bioassay-guided isolation using column chromatography of the active extract assay BSLT. Furthermore, the cytotoxic activity of the active extract and the active isolate was tested against T47D cancer cells with Microculture Tetrazolium (MTT) method. The results of the analysis of the content of secondary metabolites using LC-MS/MS identified senbusine B and 6,7-Dehydroartemisinic acid on hexane extract, while the ethyl acetate extract produced 4 compounds, and 15 compounds were identified in the methanol extract. The results of the cytotoxic activity test using the BSLT method on each extract showed that the hexane extract was the most active, with an LC50 of 17.56 mg/L. Furthermore, the cytotoxic activity of hexane extract against T47D cells showed weak activity with an IC50 value of 237.5 mg/L, while the AB1 sub-fraction showed moderate activity with an IC50 value of 138.4 mg/L. The results of the analysis using HPLC indicated that the active isolate in the form of sub-fraction AB1 contained the compound senbusine B.

Semambu (C. surinamense L) plant is a shrub plant that is easy to find. Several terpenoid compounds have been isolated from this plant, previous studies have shown cytotoxic activity of terpenoid class compounds. Terpenoid compounds in a plant are mostly found in essential oils (monoterpenes and sesquiterpenes). So far, there has been no report on the cytotoxic potential of essential oils from the leaves of this plant. It is necessary to isolate the essential oils from C. surinamense L leaves and test their cytotoxic potential. Isolation of essential oil of C. surinamense L leaves was carried out by hydrodistillation method, the oil was obtained in the form of a light yellow liquid with a specific gravity of 0.968 g/mL. Analysis of chemical components with Gas Chromatography-Mass-Spectrometry (GC-MS) through comparison of data from the National Institute of Standards and Technologies (NIST) found that there were 55 compounds (monoterpene and sesquiterpene groups) with six main compounds, namely β-caryophyllene (30.4%), β-sesquiphellandrene (8.46%), 3 carene (8.16%), α-bisabolene (4.05%), α-humulene (4.0%), and epi- bicyclosesquiphellandrene (4.0%). The potential cytotoxic test of essential oil from isolation showed highly cytotoxic activity with the Brine Shrimp Lethality Test (BSLT) method against Artemia salina L shrimp larvae with LC50 value of 0.9261 μg/mL and Microculture tetrazolium test (MTT) method against T47D breast cancer cells and HeLa cervix with IC50 values of 12.72 μg/mL and 30.14 μg/mL.

The leaves of the temurui (Murraya koenigii (Linn.) Spreng) plant has long been known and used by Indonesian and even Asian people as a traditional medicine to treat stomach aches and diabetes. This study aimed to determine the secondary metabolite profile of the methanol extract of M. koenigii leaves. Murraya koenigii leaves fine powder was extracted in stages using n-hexane, ethyl acetate, and methanol. Each extract was prepared using a mixture of water, formic acid, acetonitrile, and formic acid, then injected into the UPLC-QTof-MS/MS tool, then analyzed with Masslynx and ChemSpider software. The results showed that the metabolite profile of the methanol extract of M. koenigii leaves contained 13 compounds, including phenolic, steroid, and alkaloid groups. Those compounds could be tested to identify their bioactivity.

Lantana camara Linn is a family of Verbenaceae that grows in tropical and subtropical areas and spread in about 50 countries in the world. This plant contains essential oils with different contents based on the difference in the place of growth. The purpose of this study was to isolate and determine the chemical content of the essential oil of L. camara Linn leaves obtained from Agam, Tanah Datar, Kampar Regency, Padang Panjang City and to determine its cytotoxic and antibacterial activity. Isolation was carried out by hydro distillation method and chemical content analysis using Gas Chromatography-Mass Spectrometry (GC-MS). The high yield from the isolation of essential oil from leaves of L. camara Linn obtained from Tanah Datar Regency was 0.095% (w/w). The results of the analysis of the essential oil content with the main compounds for all Regency and City being caryophyllene with the high area percent was Tanah Datar Regency (19.74%). Cytotoxic activity test using the Brine Shrimp Lethality Test (BSLT) method showed that L. camara Linn essential oil was highly toxic with an LC50 value of 28.34 µg/mL from Padang Panjang City. Antibacterial activity test by disc diffusion method showed that L. camara Linn essential oil had moderate antibacterial activity againts Staphylococcus aureus and Escherichia coli bacteria, with high clear zone from Agam Regency was 12.9 mm and Tanah Datar Regency was 7.8 mm, respectively, at concentration of 100%.

Seberang Padang Village, South Padang District, is next to Padang City, which has approximately 200 families. This location is a crossing area between Padang-Painan, in West Sumatra. The community consists of two existing traditional markets that sell daily necessities. Besides that, there is also one elementary school, two junior high schools, and one high school. The global Covid-19 pandemic certainly affects the community's daily activities and learning activities, including children, elementary school students, middle and high school students, and the village community to fulfil their basic needs. Furthermore, the main problem of Covid-19 is not only about the effects caused by the virus on sufferers but also about its high-speed transmission. Therefore, to educate the community around the Seberang Padang village, several Chemistry Lecturers and students at the Faculty of Mathematics and Natural Sciences at Andalas University did a community engagement. They taught the community about making disinfectants and hand sanitizers without alcohol that can overcome the occurrence of Covid-19 transmission. In addition, face masks were provided for the community, and the alms of food for underprivileged residents to push down the negative impact of Covid-19.

Hornstedtia scyphifera var. fusiformis Holttum is endemic plant of Zingiberaceae family that distributed in Sumatera. Hornstedtia scyphifera var. fusiformis Holttum contained some secondary metabolite such as phenolic, saponin, triterpenoid and alkaloid. The biological activity of methanol, ethyl acetate, and n-hexane extracts from Hornstedtia scyphifera var. fusiformis Holttum suspended roots was tested for antibacterial and antioxydant activity. Antioxidant activity was analized by DPPH method. The antibacterial activity was tested by used disk difussion method againts Staphylococcus aureus bacteria (gram-positive bacteria) and Escherichia coli (gram-negative bacteria). Almost all of Hornstedtia scyphifera var. fusiformis Holttum suspended roots extract were given antibacterial activity, nonetheless the biggest inhibition zone of Escherichia coli that was inhibited by n-hexane and ethyl acetate extracts which have inhibtion zone 10 mm at concentration 500 mg/L and also againts Staphylococcus aureus, the biggest inhibition by ethyl acetate and n-hexane extracts which have inhibition zone 10.30 mm at concentration 500 mg/L. Among all extracts tested, methanol extract of the possessed moderate free radical scavenging activity with IC50 = 51.89 mg/L.

Triterpenoid isolation from n-hexane extract of kayu ara leaves (Ficus aurata (Miq.) Miq) has been performed. The Isolation has been done by column chromatography method using silica gel as a stationary phase and n-hexane and ethyl acetate as mobile phase with isocratic method and it is continued by trituration method. Isolated compound has white amorphous shape, decomposed at 86-87ºC and gives single spot with reddish brown violet in LB reagent and in H2SO4 reagent on TLC test. UV spectra indicate the presence of double bonds in the isolated compound at 204 nm λmax and IR spectra showed -OH functional group at 3290 cm-1, -CH stretching at 2912,90 cm-1, C=C at 1676 cm-1, C-O stretching at 1054,93 cm-1, and at 1374 cm-1 is spectra of geminal dimethyl compound that are characteristic of triterpenoids which supports ultraviolet spectroscopic data. Antibacterial activity test showed that isolated compound is active in inhibiting the growth of gram-positive bacteria Staphyloccocus aureus and gram-negative bacteria Escherichia coli.

Betalains and anthocyanins are classes of natural and water soluble pigments. Now days, these pigments have been developed as a replacement colouring agents. One of betalain resource is dragon fruit and anthocyanin resource is tamarillo. These pigments are relative unstable in some condition, one of them is pH. This research aim is to determine stability of betalain and anthocyanin pigments by pH parameter. These pigments can be isolated by macerated methods, technically processed by chopping the fruit and than soaking in ethanol for ± 24 h. These extracts were condensed by rotary evaporator. These extracts were analysed by ultraviolet-visible spectrophotometer at wavelength (λ) 200-800 nm. The absorption spectrum showed two major absorption peaks at 269 nm and 536 nm for betalain and 531 nm for anthocyanins. The result showed the optimal pH for betalain stability was at pH 5 and pH 3 for anthocyanin

Paracetamol is generally used as analgesic and antipyretic drugs. Contamination paracetamol in the environment can occur because of waste material disposal from production site and immediate disposal of household that cause water pollution. Paracetamol is degraded by photolysis method under irradiation 10 watt UV-light (λ=365 nm), visible-light (Philips LED 13 watt 1400 lux) and solar-light with and without addition C-N-codoped TiO2catalyst. The solution is analyzed by UV-Vis spectrophotometer at λ 200-400 nm. Optimum weight of C-N-codoped TiO2 catalyst obtained is 20 mg under UV-light photolysis. Paracetamol 4 mg/L is degraded 45.48% after 120 minutes under UV-light irradiation without catalyst, and increases to be 69.31% by using 20 mg catalyst. While degradation percentage of paracetamol is 16.96 % without catalyst, the percentage increases to be 34.29% after using 20 mg catalyst for 120 minutes photolysis under visible-light. Degradation of paracetamol by solar light achieves only 12.27% in absance of catalyst for 120 minutes irradiation, but it increases significantly until 70.39% in presence of 20 mg catalyst.

The anthocyanins in Ficus padana were extracted and identified by using high-performance liquid chromatography/diode array detection and electrospray ionization/mass spectrometry (HPLC-DAD-ESI-MS). The individual anthocyanins were identified by comparing between their mass spectral data and published data. The first compound (peak 1) was identify as a pelargonidin 3-(6”-p-coumarylglucoside)-5-(4”’-Malonylglucoside) and the second compound was identify as a pelargonidin 3-(6’’-Malonylglucoside). The second one is a major compound that taking up to 91% of the total anthocyanin content in F. padana extract. The antioxidant activity was determined with 2,2-diphenyl-1-picrylhydrazyl (DPPH) assays and results showed that extract possessed high antioxidant capacity.

A brine shrimp toxic compound has been isolated from Mangifera foetida L. steam bark. Based on spectroscopic data (IR,1H- NMR, 13C-NMR 1D and 2D), the structure of this compound was identified as mangiferenes B, C30H47O2. In this study, the n-hexane, ethyl acetate, methanol extracts and isolated compound showed toxic effects (LC50 471.9543; 534.5209, 678.4421, and 22.1615 μg/mL, respectively). The toxicity degree among the three extracts and isolated compound is isolated compound > n-hexane extract > ethyl acetate extract > methanol extract.

ABSTRACT Tryterpenoid compound (3-hydroxyeupha-7-ene) were isolated from hexane fraction the steam bark of Toona sinensis (Meliaceae). The structures of these compounds were established base on spectroscopic evidence, including UV, IR, 3C-NMR, 1H-NMR, HMBC, HMQC and COSY spectra and literature survey this is new compound in family Meliaceae. Insect activity of the hexane fraction (1.0%) and against Crosidolomia pavonana were tested. The activity of hexane were mortality (37.5%), antifeeding (75.5%). The activity of the 3-hydroxyeupha-7-ene showed mortality (52.0%), Lc50; 0.39847 and Lt50; 5.53931. Keywords: Toona sinensis (Meliaceae), 3-hydroxyeupha-7-ene, Crosidolomia pavonana, Antifeeding, Mortality Lc50 and Lt50

ABSTRACT Volatile components from leafs of Toona sinensis (Meliaceae) were isolated by distillation water-vapour method and analyzed using GC/MS. Forty-eight component were identified, and eight major components are Germacrene-D, Germacrene-B, α-Terpinene, α-Humulene, β-Caryophyllene, α-Elemene, Bicyclogermacrene and α-copaene. Insect activity of the essential oil against Crosidolomia pavonana were tested. The activity of the essential oil with concentration 25% (mortality 73.3%), concentration 50% (mortality 83.3%) and concentration 75% (mortality 90%). Keywords : Toona sinensis (Meliaceae), essential oil, Crosidolomia pavonana, and mortality.

Objective: To achieve an excellent bowel preparation, it is routine to require a clear liquid diet on the day before the procedure. Unfortunately, this dietary modification may be poorly tolerated. We examine whether a change in precolonoscopy dietary restriction can lead to better patient tolerance without compromising examination quality., Methods: This is a prospective, blinded, randomized controlled trial of patients undergoing screening or surveillance colonoscopy. The primary objective measures the effect of dietary modification on bowel prep quality. Secondary endpoints include polyp detection, patient tolerance, withdrawal time, and patient acceptance. A total of 200 patients were randomized to either (a) a low-residue diet for breakfast and lunch the day before the procedure or (b) clear liquids all day before the procedure. All patients underwent an identical low-volume sodium sulfate split prep. Bowel prep quality was scored using the Boston Bowel Preparation Scale (BBPS). A t test with TOST was used for noninferiority. Secondary endpoints were compared using χ analysis., Results: Overall, 96.5% of patients had a good or excellent bowel prep (BBPS=6, 7, 8, or 9). LRD prep quality was noninferior to CLD prep quality (LRD 7.8 vs. CLD 8.1). Polyp detection rates were similar (68% vs. 65.4%, P=0.6899). Patient tolerance and acceptance did not differ. Withdrawal times were equivalent between both groups (16.2 vs. 16.5 min, P=NS)., Conclusions: Patients allowed to have a limited low-residue diet before colonoscopy achieve a bowel prep quality that is noninferior to patients on a strict clear liquid diet limitation. Furthermore, polyp detection rates, patient tolerance, and patient acceptance were similar between the 2 groups.

Objectives: This study represents a comprehensive assessment of differences between participants in an HIV/AIDS prevention program (SHAPE: Sustainability, Hope, Action, Prevention, Education) and non-participants in knowledge, attitudes and practices with a focus on cultural, sociological and economic variables., Methods: We developed an eight-page questionnaire that was administered to 933 randomly selected students at the University of Zimbabwe. Survey items addressed sexual decision-making, condom use, limiting sexual partners, cultural power dynamics and access to HIV testing., Results: Results show participants are statistically more likely to report being sexually abstinent, and understand the prevention benefits of condom use. SHAPE members had fewer sexual partners in the previous year than non-SHAPE members (1.4 vs. 2.2). SHAPE members were significantly more likely (67%) than non-SHAPE respondents (48%) to indicate that they knew their HIV sero-status and to state that they knew their status because they had been tested (85% vs. 71%)., Discussion: Though we found differences between the groups suggesting that program participation increases awareness concerning gender equity, there continue to be many intractable cultural attitudes in this age group. Findings suggest that the attitudes and practices of young men and women are changing, but that progress in some areas does not assure progress in all areas.

Background: Although opportunities for patients to review their medical records are increasing, nothing is known about which patients want to take advantage of those opportunities. The objective of this study was to determine the proportion and characteristics of patients who are very interested in examining their clinic medical record and the reasons for their interest., Methods: Cross-sectional, mailed survey (conducted in May 2001) to a random sample of 4500 adults who had a recent clinic visit., Results: The response rate was 81%; 36% were very interested in reading their medical record (dependent variable). In multivariate logistic regression, the significantly related factors were seeking health information (finding the Internet very important for health information [adjusted odds ratio, 2.09], having a health newsletter subscription [adjusted odds ratio, 1.23], and using a health resource book in last month [adjusted odds ratio, 1.36]); being very concerned about errors in care (adjusted odds ratio, 2.52); and lacking trust in their physician (adjusted odds ratio, 1.55). Health status, use of health care, education, and income were not independently related to patients' interest. The most common reasons for patients wanting to look at their medical record were to see what their physician said about them (74%), to be more involved in their health care (74%), and to understand their condition better (72%)., Conclusions: Patients' interest in reading their medical record is better predicted by their consumer approach to health care than it is by their clinical characteristics. Demographic characteristics of sex and race were related, while socioeconomic factors of education and income were not.

Study Objective: Demonstrate improved efficiency of initial and subsequent in-hospital care following emergency department (ED) physician-initiated primary angioplasty (1 PCI)., Methods: An observational study was undertaken in ST-elevation myocardial infarction patients presenting to a community hospital emergency department. Outcomes of patients who received ED physician-directed 1 PCI were compared with patients previously treated by a mix of ED physician and cardiologist co-determined thrombolysis or 1 PCI. A process improvement initiative supported the change to ED-directed 1 PCI., Results: The study included 287 eligible acute reperfusion patients. Median door-to-balloon time (MDBT) improved from 88 minutes (95% CI, 80 96) to 61 minutes (95% CI, 57 70; p < 0.0001). Necessary subsequent in-hospital interventions (NSI) occurred in 70 of 107 (65.4%; 95% CI, 55.6 74.4%) thrombolytic patients, versus 3 of 99 (3.0%; 95% CI, 0.6 8.6%) 1 PCI patients at baseline, and 1 of 81 (1.2%; 95% CI, 0.0 6.7%) 1 PCI patients after process change. Median length of stay (LOS) decreased from 4 days for thrombolytic patients and 3 days for 1 PCI patients at baseline, to 2 days for 1 PCI after adopting the improved process (p < 0.0001). Effectiveness outcomes demonstrating improvement included discharge on beta-blocker (p = 0.0039), angiotensin-converting-enzyme inhibitor (p < 0.0001) and anti-lipid therapy (p = 0.0039), with favorable trends in survival to discharge, and 30-day major adverse cardiac events (MACE)., Conclusions: Conversion to ED physician-initiated 1 PCI for ST-elevation myocardial infarction significantly improved efficiency of care as measured by MDBT, NSI and LOS. Effectiveness measures, including survival to discharge, discharge medications and 30-day MACE, demonstrated improvement or favorable trends.

Rinsing the mouth with water is recommended to remove inhaled corticosteroid (ICS) deposited on the oropharyngeal mucosa. Given the lipophilicity of fluticasone propionate (FP), an ethanol-based mouthwash was hypothesized to be superior to water. This study's purpose was to compare the effectiveness of water versus Listerine (Warner Lambert, Lititz, PA) in removing FP from the oropharyngeal mucosa. Asthma patients were randomly assigned water or a Listerine-rinsing vehicle. A 440-microgram dose of FP was inhaled. After the second puff, patients rinsed for 30 seconds with 20 mL of the assigned agent and then repeated the process, spitting each "wash" into the same cup. At visit 2, patients used the alternate vehicle and repeated the procedure. Samples were frozen until analyzed using liquid chromatography/mass spectrophotometry (lower limit of detection 0.067 microgram/mL). Thirty-six patients (mean age, 44 years; 66% female) participated. Mean inhaler technique score was 11.3 (scale of 1-12). Eighty-three percent used the closed-mouth technique. The mean concentration of FP removed by Listerine was not statistically different than that removed by water, 1.67 micrograms/mL (range, 0.067-4.195 micrograms/mL) and 1.42 micrograms/mL (range, 0.067-5.107 micrograms/mL), respectively, and the total milliliter returned was assumed to be 40 mL. Regression analysis using sex, age, and inhaler technique showed no statistical relationship with the amount of FP removed. Therefore, Listerine was not more effective than water in removing FP from the oropharyngeal mucosa (p = 0.53). Thus, water is an adequate rinsing vehicle for removal of ICS deposited on the oropharyngeal mucosa. Other factors besides the rinsing vehicle are strong factors in determining the amount of drug removed.

Objective: Decreased physician visits for dyspepsia were predicted with the histamine-2 receptor antagonists (H2RA) release to over-the-counter (OTC) status. The aim of this study was to examine the presentation frequency for dyspeptic complaints before and after the OTC release of the H2RA and the self-reported effectiveness of OTC H2RA., Methods: Two cross-sectional surveys were used in a community sample. The patients comprised a random age- and sex-stratified sample of 1600 ambulatory adults in 1993 and 1800 in 1997. Self-report, valid mail surveys gathered information on healthcare seeking and gastrointestinal symptoms in 1993 and 1997 and antisecretory use in 1997., Results: Presentation frequency for dyspepsia was 22% in 1993 versus 23.5% in 1997. Only 16% of chronic users of the OTC H2RA obtained complete relief of symptomatic episodes. Use of an OTC H2RA was highly associated with presentation to a physician in the past year., Conclusions: OTC H2RA infrequently provided the complete relief desired by patients. Presentation frequency to physicians for dyspeptic complaints did not change with availability of H2RA OTC.

Objectives: To assess the effect of incentive size on response rates, data quality, and cost in a digestive health status mail survey of a community sample of health plan enrollees., Data Sources/setting: The study population was selected from a database of enrollees in various health plans obligated to receive care at Park Nicollet Clinic-HealthSystem Minnesota, a large, multispecialty group in Minneapolis, Minnesota, and the nearby suburbs., Study Design: A total of 1,800 HealthSystem Minnesota enrollees were randomly assigned to receive a survey with an incentive of $5 or $2. The response rates for each incentive level were determined. Data quality, as indicated by item nonresponse and scale scores, was measured. Total cost and cost per completed survey were calculated., Principal Findings: The response rate among enrollees receiving $5 (74.3 percent) was significantly higher than among those receiving $2 (67.4 percent); differences were more pronounced in the first wave of data collection. Data quality did not differ between the two incentive groups. The total cost per completed survey was higher in the $5 condition than in the $2 condition., Conclusions: A $5 incentive resulted in a higher response rate among a community patient sample with one mailing than did a $2 incentive. However, the response rates in the $2 condition approached the level of the $5 incentive, and costs were significantly lower when the full follow-up protocol was completed. Response rates were marginally increased by follow-up phone calls. The incentive level did not influence data quality. The results suggest if a survey budget is limited and a timeline is not critical, a $2 incentive provides an affordable means of increasing participation.

Objectives: Brief, reliable, and valid self-administered questionnaires could facilitate the diagnosis of gastroesophageal reflux disease in primary care. We report the development and validation of such an instrument., Methods: Content validity was informed by literature review, expert opinion, and cognitive interviewing of 50 patients resulting in a 22-item survey. For psychometric analyses, primary care patients completed the new questionnaire at enrollment and at intervals ranging from 3 days to 3 wk. Multitrait scaling, test-retest reliability, and responsiveness were assessed. Predictive validity analyses of all scales and items used specialty physician diagnosis as the "gold standard.", Results: Iterative factor analyses yielded three scales of four items each including heartburn, acid regurgitation, and dyspepsia. Multitrait scaling criteria including internal consistency, item interval consistency, and item discrimination were 100% satisfied. Test-retest reliability was high in those reporting stable symptoms. Scale scores significantly changed in those reporting a global change. Regressing specialty physician diagnosis on the three scales revealed significant effects for two scales (heartburn and regurgitation). Combining the two significant scales enhanced the strength of the model. Symptom response to self-directed treatment with nonprescription antisecretory medications was highly predictive of the diagnosis also, although the item demonstrated poor validity and reliability., Conclusions: A brief, simple 12-item questionnaire demonstrated validity and reliability and seemed to be responsive to change for reflux and dyspeptic symptoms.

Background: Optimal treatment for persistent asthma requires multiple classes of medication, including antiinflammatory agents and bronchodilators. Inhaled corticosteroids are the most effective antiinflammatory agents available and are recommended by recent guidelines as first-line treatment. Salmeterol, a long-acting inhaled bronchodilator, is recommended as adjunctive therapy to inhaled corticosteroids. Non-adherence to prescribed medication is prevalent and has been implicated in asthma exacerbations. Salmeterol's benefits in terms of asthma control are readily perceived by patients whereas the benefits of inhaled corticosteroid therapy may be less apparent., Objective: To evaluate whether the addition of salmeterol to a medication regimen affects patient adherence to prescription refills for inhaled corticosteroids., Methods: A retrospective medical chart and pharmacy claims record review before and after the addition of salmeterol was used. Medication adherence rates were calculated for 67 patients requiring inhaled corticosteroids for at least 8 months before and after the addition of salmeterol., Results: Adherence with inhaled corticosteroid therapy before (49.7% +/- 29.3%) and after (56.5% +/- 28.6%) the introduction of salmeterol was not significantly different (P = .0785, pre versus post). Adherence with salmeterol was significantly higher (58.7% +/- 28.3%) than inhaled corticosteroids at baseline (P = .0202), but not with concurrent use. Dosing frequency of inhaled corticosteroid administration was not a significant factor in adherence, but increasing age was (r = 0.41788, P = .0048)., Conclusions: The addition of salmeterol does not adversely affect the adherence rates to prescription refills for prescribed inhaled corticosteroid therapy. On average, important antiinflammatory treatment should not be supplanted with salmeterol if prescribed in combination.

To determine the effect of survey-based, health plan report cards on employees as they selected their 1995 health plan, the authors surveyed two groups of Minnesota State employees, one of which received the report card and one that did not. Both groups were surveyed before and after their enrollment. The authors looked for report card effects on relative changes in the employees' knowledge of health plan benefits and their ratings of quality and cost attributes, as well as their plan choice, rates of switching plans, and willingness to pay higher premiums. The only report card effect found was an increase in perceived knowledge for employees with single coverage.

This article describes preliminary results from a natural experiment that tested the impact of report cards on employees. As part of the 1995 enrollment process, some members of the State of Minnesota Employee Group Insurance Program received report cards on the plans offered to them, and others did not. Both groups of employees had a chance to review a second community-wide report card covering all Minnesota plans that had been distributed by an independent organization through local newspapers. Both groups were surveyed before and after they made their health plan selections. We compare the likelihood of seeing, the intensity of reading, and the perceived helpfulness of the first, employer-specific report card with the second, community-wide report card for consumers who make plan selections.

Study Objective: To identify the oncology patient population presenting to the emergency department and examine the causes and clinical management of oncology symptoms in the ED., Design: Retrospective review of 5,640 adult patients, with the following variables identified for oncology patients presenting to the ED: age, sex, cancer type, cancer stage, previous cancer treatment, previous hospitalization, presenting symptoms, treatment provided in the ED, admission and discharge data, and day, time, and length of ED visit., Setting: Community teaching hospital with annual ED census of 31,000., Participants: All adult oncology patients who presented to the ED during the study period. We identified these patients by cross-referencing ED logs and tumor registry records., Results: Cancer history was identified for 284 of the 5,640 adult ED admissions (5%). Forty-three percent (n = 122) of the 284 patients with cancer history had an oncology-related ED visit. The most common symptoms of these patients were gastrointestinal (48%), pain (40%), neurologic (38%), cardiac (25%), and pulmonary (23%). Ten percent of patients with oncology-related ED visits died during the admission, and 48% died within 1 year of the ED visit., Conclusion: Oncology patients present to the ED with symptoms of undiagnosed malignancy, complications of cancer treatment, and acute disease-related symptoms. Knowledge of an individual's cancer history and ability to recognize oncologic symptoms are important to the management of oncology patients.

Background: Noncompliance with medications is one of the most serious problems facing health care today. However, methods to measure compliance have many limitations., Methods: To measure specific drug compliance and dosing frequency of two asthma medications, we used medical records data and pharmacy claims data from 276 patients who had concurrent prescriptions for inhaled anti-inflammatory agents and oral theophylline. Patients were randomly selected from the pharmacy claims data files of a health maintenance organization. The patients' medical records were reviewed, and records that did not contain clear documentation of the medication, dose, and dosing frequency were excluded. Data from the remaining 119 medical records were compared with data from pharmacy claims to calculate compliance rates for each medication., Results: Our calculations showed that patients were significantly more compliant with prescribed theophylline medication than with two inhaled anti-inflammatory medications (P = .0001). No significant differences in compliance were found relative to prescribed dosing frequency (twice daily or less compared with three times daily or more) for either medication (P = .6517)., Conclusions: Comparison of medical record data with pharmacy claims data is an effective indirect measure of patients' compliance with prescribed oral theophylline and inhaled anti-inflammatory agents. Additional interventions must be pursued for patients with asthma regarding adherence to regimens for their prescribed inhaled anti-inflammatory agents.

Examined dieting to lose weight in a population of 2,107 men and 2,540 women employed in 32 worksites in the upper Midwest. Lifetime prevalence of this behavior was estimated to be 47% in men and 75% in women, and point prevalence was reported as 13% and 25% in men and women, respectively. Lifetime prevalence of participation in organized weight-loss programs was 6% in men and 31% in women; current prevalence was 1% in men and 6% in women. The strongest correlate of dieting behavior was relative body weight. In logistic regression analyses, dieting tended to be associated positively with education and occupational status and, in men only, was more prevalent among those with a history of hypertension. Dieters reported lower food intakes than nondieters, but the two groups did not differ consistently in reported physical activity. Overall, dieting appears to be a pervasive behavioral U.S. phenomenon that may contribute in part to population differences in the prevalence of obesity.

Information on agricultural trauma is limited and difficult to find. Planning for effective prevention strategies and evaluation is compromised by lack of a good surveillance system. Several agencies and organizations have provided some data. Although their summation is at best an approximation of the real situation, a critical review of current data bases is presented. The literature is also reviewed attempting to characterize agricultural trauma. This characterization was classified into: 1) case descriptions, 2) reviews of general articles on the hazards of farming, and 3) descriptive surveys of agricultural injuries. A summary of the available literature still leaves a rather superficial understanding of the entire injury picture. A new approach to surveillance is necessary to overcome past deficiencies. A combined modality approach is suggested, utilizing on-site survey, mail survey, telephone interviewing, and medical record verification. Trial applications of two such systems in Minnesota are described.