DDT vs.Wildlife Relationships Between Quantities Ingested, Toxic Effects and Tissue Storage*
TL;DR: Young and adult quail and pheasants were fed diets containing DDT and chemical analysis of tissues indicated that quantities of DDT stored were not proportional to total amounts administered nor to duration of exposure, but were related to the severity of toxic symptoms.
Abstract: Young and adult quail and pheasants were fed diets containing DDT.Chemical analysis of tissues indicated that quantities of DDT stored were not proportional to total amounts administered nor to duration of exposure, but were related to the severity of toxic symptoms.Concentration of the toxicant in breast muscle of birds dying of acute DDT poisoning was approximately 34 jug./ Gm.in adult quail and 22 jug./Gm.in adult pheasants.
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TL;DR: To have an impact on adherence, healthcare providers must understand the barriers to adherence and the methods or tools needed to overcome them and identify interventions and compliance aids that practitioners and organizations can implement.
Abstract: Estimates of adherence to long-term medication regimens range from 17% to 80%, and nonadherence (or nonpersistence) can lead to increased morbidity, mortality, and healthcare costs. Multifaceted interventions that target specific barriers to adherence are most effective, because they address the problems and reinforce positive behaviors. Providers must assess their patients’ understanding of the illness and its treatment, communicate the benefits of the treatment, assess their patients’ readiness to carry out the treatment plan, and discuss any barriers or obstacles to adherence that patients may have. A positive, supporting, and trusting relationship between patient and provider improves adherence. Individual patient factors also affect adherence. For example, conditions that impair cognition have a negative impact on adherence. Other factors—such as the lack of a support network, limited English proficiency, inability to obtain and pay for medications, or severe adverse effects or the fear of such effects—are all barriers to adherence. There are multiple reasons for nonadherence or nonpersistence; the solution needs to be tailored to the individual patient’s needs. To have an impact on adherence, healthcare providers must understand the barriers to adherence and the methods or tools needed to overcome them. This report describes the barriers to medication adherence and persistence and interventions that have been used to address them; it also identifies interventions and compliance aids that practitioners and organizations can implement.
288 citations
TL;DR: A summary of the existing literature on medication nonadherence, health literacy, and use of written patient information in health care and pharmacy in particular is presented in this paper, where the complexities inherent in non-adherence behavior and health literacy are summarized, and suggestions for enhancing medication adherence are provided.
Abstract: Objectives To present a summary of the existing literature on medication nonadherence, health literacy, and use of written patient information in health care and pharmacy in particular. Data sources Searches of Medline, PubMed, and International Pharmaceutical Abstracts databases were conducted using one or more of the following terms adherence/nonadherence, compliance/noncompliance, printed/written information, literacy, patient education, communication , and health literacy . These terms were combined with the following search terms: drug information, readability, medication/drug, patient, pharmacy/pharmacist , and prescription . References of pertinent articles were hand searched to retrieve additional articles. Data extraction By the author. Data synthesis Articles were grouped and summarized into three broad categories (nonadherence, health literacy, and communicating health information to patients), with an emphasis on the use of written patient information in health care and pharmacy practice in particular. The complexities inherent in nonadherence behavior, health literacy, and patient education are summarized, and suggestions for enhancing medication adherence, especially for patients with low health literacy skills, are provided. Conclusion The health literacy skills of American adults have not changed considerably during the previous decade. This makes use of written patient medication information in pharmacy practice problematic for some patients. Limited health literacy has been associated with poorer health, medication nonadherence, medication errors, higher medical expenses, and increased hospitalization. A need exists for identifying patients with limited health literacy and tailoring medication counseling to their needs.
224 citations
TL;DR: Of all methods, simulated-patient methods appear to be a more reliable method of evaluating counseling practice in pharmacies, and in providing information to consumers with prescriptions, pharmacists appear to have fulfilled the minimum legislative requirements or practice standards.
Abstract: Background Counseling has become an integral part of community pharmacy practice. Previous reviews of research into pharmacists' counseling practices on prescription medicines have primarily focused on activities at a national level. None have adopted an international perspective. Objectives To review (1) verbal counseling rates and (2) types of information provided for prescription medicines in community pharmacies and (3) to compare the research methods used in evaluating counseling practice. Methods Published articles in English (1993-2007) were identified based on searches of on-line databases (International Pharmaceutical Abstracts, PubMed, Medline, EMBASE, CINAHL, and Cochrane Database of Systematic Reviews) and cited references in the articles. Results Forty research articles met inclusion criteria for studies investigating verbal counseling rates and/or types of information provided for prescription medicines in community pharmacies. The counseling rates reported varied from 8% to 100%, depending on the research methods used. On average, lower counseling rates were found from consumer and observational studies compared with pharmacist- and simulated-patient studies. The type of prescription also influenced the rate. Higher rates were found in counseling consumers with new compared with regular prescriptions. Information on directions for use, dose, medicine name, and indications was more frequently given than information on side effects, precautions, interactions, contraindications, and storage. Most findings came from self-report and observational methods, each of which has limitations. Few studies used triangulation to overcome methodological limitations. In recent studies, simulated-patient methods have been used increasingly to evaluate counseling practice in the natural environment. Conclusions The actual counseling rates are difficult to obtain due to the differences and limitations of each research method. Of all methods, simulated-patient methods appear to be a more reliable method of evaluating counseling practice in pharmacies. In providing information to consumers with prescriptions, pharmacists appear to have fulfilled the minimum legislative requirements or practice standards.
174 citations
TL;DR: It is revealed that most studies have focused on a one way communication of pharmacists to patients, and a need for examining the patient-pharmacist dyad is apparent.
Abstract: Background Pharmacist-patient communication in community pharmacies has been studied for over 25 years with little effort to evaluate this research comprehensively. Objective The main objective of this review is to examine and summarize how researchers have conceptualized, defined, and measured pharmacist-patient communication across studies and identify gaps in the literature. Methods Articles were compiled from a search of (1) Medline, IPA, CINAHL, and PubMed databases using the keywords, "counseling", "patient communication", "patient counseling", "patient education", "patient consult ∗ ", and/or "pharmacists", (2) bibliographies of selected articles. The search generated 56 studies on community pharmacy, of which 39 studies met the inclusion criteria. Results Most studies (72%) have used the term patient counseling, although pharmacist-patient communication and patient education were also used. The definition of patient counseling varies across studies. Almost half of the studies (49%) conceptualized pharmacist-patient communication solely as a pharmacist information provision activity. A total of 16 studies (41%) also focused on pharmacists' interpersonal behavior in addition to the information provision activity of the pharmacist. In contrast, patient communication behavior and the exchange process between both parties has been understudied. A total of 16 studies (41%) used a retrospective design. All studies used a cross-sectional design, with varying modes of data collection such as mail surveys, telephone interviews, nonparticipant observation, and shopper studies. Taped encounters are rare. Summary/Implications This review revealed that most studies have focused on a one way communication of pharmacists to patients. A need for examining the patient-pharmacist dyad is apparent. Future research could explore a greater use of taped encounters to analyze the interactive communication process, affective components of communication such as collaborative problem solving, interpersonal relationship development, and the expertise that patients bring into the encounter.
153 citations
TL;DR: Current challenges include the need to more thoroughly estimate and predict exposure and effects of chemical-related anthropogenic activities on wildlife and their supporting habitat, and potential population-level effects of some compounds.
Abstract: The field of wildlife toxicology can be traced to the late nineteenth and early twentieth centuries. Initial reports included unintentional poisoning of birds from ingestion of spent lead shot and predator control agents, alkali poisoning of waterbirds, and die-offs from maritime oil spills. With the advent of synthetic pesticides in the 1930s and 1940s, effects of DDT and other pesticides were investigated in free-ranging and captive wildlife. In response to research findings in the US and UK, and the publication of Silent Spring in 1962, public debate on the hazards of pollutants arose and national contaminant monitoring programs were initiated. Shortly thereafter, population-level effects of DDT on raptorial and fish-eating birds were documented, and effects on other species (e.g., bats) were suspected. Realization of the global nature of organochlorine pesticide contamination, and the discovery of PCBs in environmental samples, launched long-range studies in birds and mammals. With the birth of ecotoxicology in 1969 and the establishment of the Society of Environmental Toxicology and Chemistry in 1979, an international infrastructure began to emerge. In the 1980s, heavy metal pollution related to mining and smelting, agrichemical practices and non-target effects, selenium toxicosis, and disasters such as Chernobyl and the Exxon Valdez dominated the field. Biomarker development, endocrine disruption, population modeling, and studies with amphibians and reptiles were major issues of the 1990s. With the turn of the century, there was interest in new and emerging compounds (pharmaceuticals, flame retardants, surfactants), and potential population-level effects of some compounds. Based upon its history, wildlife toxicology is driven by chemical use and misuse, ecological disasters, and pollution-related events affecting humans. Current challenges include the need to more thoroughly estimate and predict exposure and effects of chemical-related anthropogenic activities on wildlife and their supporting habitat.
130 citations
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Journal Article•
TL;DR: With the exception of muscle, it was indicated that the DDT of other tissues could be explained by their fat content, and the concentration ofDDT in fatty tissue was found to be correlated with the level of DDT in the diet in the range of 100 to 800 p.m.
Abstract: Rats were fed diets containing from 100 to 1200 p.p.m. DDT for periods ranging from six months to two years. The following effects were noted.
1. At 800 and 1200 p.p.m. DDT in the diets, rats showed characteristic symptoms of poisoning which terminated fatally in some cases. There was definite depression of growth.
2. At 800 and 1200 p.p.m. DDT in the diets rats showed an increase of 43% and 19% respectively in the weights of their livers and kidneys over those of the controls.
3. At 800 and 1200 p.p.m. DDT in the diets, the oxygen consumption of the livers was reduced 40% below that of the controls.
4. DDT was found in all tissues of animals exposed to DDT. Due apparently to its preferential solubility in fat, the concentration of DDT in perirenal fat was roughly 50 to 100 times as great as in other tissues. With the exception of muscle, it was indicated that the DDT of other tissues could be explained by their fat content.
5. As far as storage is concerned, the rat did not distinguish between p,p and o,p isomers of DDT, but laid these down in the same proportions at which they were fed in the diet.
6. The concentration of DDT in fatty tissue was found to be correlated with the level of DDT in the diet in the range of 100 to 800 p.p.m.
25 citations
TL;DR: In this article, the birds populations on three tracts near Scranton, Lackawanna County, Pennsylvania were determined by repeated, systematic census trips between April 18 and June 28, 1945.
Abstract: Between April 18 and June 28, 1945, the birds populations on three tracts near Scranton, Lackawanna County, Pennsylvania were determined by repeated, systematic census trips. One tract ("Mile Square") comprised about 40 acres adjacent to a 1-mile trail in Spring Brook Valley, 6 miles south of Scranton. The trail extends from one edge to beyond the center of a forested area of about 600 acres that in late May and early June was sprayed by airplane with 5 pounds of DDT per acre for experimental control of gypsy moth larvae and to determine the effect of DDT upon other insects. This dosage is several times that needed for control of the gypsy moth and is the maximum considered necessary by entomologists for any forest insect pest. The second tract ("Maple Lake"), 6 miles southeast of Scranton and one mile west of Maple Lake, comprised 40 acres in an area of about 350 acres of rolling land mostly forested. The area was sprayed by airplane on June 9 with 1 pound of DDT per acre for experimental control of gypsy moth larvae and to determine the effect of this concentration on other insects. The third tract ("Check"), 6 miles southeast of Scranton and a mile northwest of Maple Lake, was a 40-acre portion of an extensive untreated forest
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TL;DR: Results would appear to be applicable to the Dutch elm disease problem as it exists elsewhere in the nation and this report summarizes results of the first summer's work on the problem.
Abstract: Dutch elm disease, the causal agent of which is a fungus, Ceratostomella ulmi, is spread from tree to tree by certain bark beetles of the family Scolytidae. In eastern United States two important carriers are the native elm bark beetle (Hylurgopinus rufipes) and the smaller European elm bark beetle (Scolytus multistriatus). In the area of this study the latter is of greater importance. Control of the disease involves control of the beetle vectors which introduce spores of the fungus at the time of feeding. Spraying programs are based on the application of sufficient DDT to elm trees to kill the bark beetles before feeding takes place. Since adult beetles emerge and fly to new trees during several spring and summer months, it is necessary to make two applications of spray in order to provide residual amounts during this period. The first is put on before the leaves are developed in the spring and the residual DDT is presumed to remain effective until the time of the second application in July. Preliminary investigations by the Bureau of Entomology and Plant Quarantine indicated that this procedure was an effective means of safeguarding valuable shade elms. However, frequent reports of bird mortality were received and it appeared advisable to review the program in terms of its effect on songbirds and other wildlife. This report summarizes results of the first summer's work on the problem. While the information was obtained from investigations in Princeton, New Jersey, the results would appear to be applicable to the Dutch elm disease problem as it exists elsewhere in the nation and
16 citations