A Fluoroscopia é uma técnica de obtenção de imagens de raios X, através de um detector de imagens dinâmicas, que permite o acompanhamento de exames de órgãos em tempo real. Os detectores atualmente utilizados são os intensificadores de imagem (II) e os Flat Panel (FP), os primeiros (do tipo válvula) tem a principal função de aumentar o brilho na imagem e mais recentemente os segundos (de estado sólido), também sido utilizados nos equipamentos de fluoroscopia para melhorar a qualidade da imagem (contraste e detalhe), diminuindo ruídos e artefatos na mesma. Os exames gerais que utilizam a técnica de fluoroscopia servem para cabeça, tórax e abdômen, que antes eram realizados com um mesmo tipo de equipamento, mas devido a evolução da tecnologia equipamentos dedicados à esses exames passaram a ser utilizados. O objetivo deste trabalho é analisar especificamente um grupo de equipamentos de fluoroscopia cardíaca (de diferentes instituições e fabricantes) para inferir como estão os parâmetros de contraste, detalhe e taxa de exposição no detector (também interessante para os serviços de manutenção) em relação a sua média e também como estão em relação às referências internacionais. Para tal, foi desenvolvido um objeto simulador e um protocolo de testes incluindo medidas de taxa de exposição e análises dos parâmetros obtidos, a saber: a) testes preliminares para aceitação do equipamento para a amostragem, b) de detalhe e de contraste (utilizando o objeto simulador desenvolvido) para a obtenção do seu produto denominado por FOM (Figure of Merit), c) as medidas de taxa de exposição que chega no detector e d) as análises das distribuições dos resultados obtidos com os dois grupos de detectores, quanto as suas médias e comparação dessas (equipamentos utilizados no Brasil) com os valores de referência da literatura internacional. Do trabalho realizado foi possível comprovar que o objeto simulador e o protocolo desenvolvido, juntos à metodologia aplicada, foram adequados para auxiliar no controle de qualidade dos equipamentos selecionados, vii classificando-os quanto aos potenciais de otimização de FOM e TEEDI. Os FOMs médios do II e do FP distam do FOM referência de 35,5 % e 35,0 % e as TEEDIs médias para os II e FP distam da TEDDI referência respectivamente de 13,8% e 24,9% Estes últimos deverão ser ajustados pela manutenção para trazê-los mais próximos das referências utilizadas nas distribuições obtidas. / Fluoroscopy is a X ray technique used to obtain images through a dynamic image detector or sensor that allows to follow the organs movements in real time exams. Nowadays the detectors used are the image intensifier (II) e the Flat Panel (FP). The first one type valve has the main function to enhance the image brightness and more recently was developed the second one, (solid state technology) which the main function is to enhance the image quality (contrast and detail) minimizing the noise and artifacts in itself. Head, thorax and abdomen are the body sections which the general fluoroscopy deals and that was performed with one only type of equipment. Actually these exams are performed with dedicated machines due to the technology evolution and several manufactures are responsible for theirs development and assembly in several continents (Americas, Europe and Asia). The scope of this work is to analize two groups of fluoroscopy equipments (II and FP detectors), dedicated only for cardiac fluoroscopy and from different institutions and manufacturers, in order to infer how the parameters of contrast, detail and exposure rate at the entrance of the detector are in a Quality Control that the maintenance service would be also interested, besides a medical physicist. With these results one could know how the cited groups (through their average results) would be doing related to others groups of equipments or an specific one and even to international references. With this purpose a PMMA simulator object (OS) was developed with an protocol derived from the literature that was composed of exposure rate in the entrance of the detector (TEEDI), tests related to the selection of the equipments to be part of theirs samples, tests of contrast and detail (using the OS) to obtain their product named by FOM (Figure of Merit) and with all results obtained, to analyse the two distribution groups through their averages and comparing them not only with themselves, but also with the references from abroad. With this work it was possible to confirm that the OS, as well the protocol developed together the methodology used, were adequate to perform the quality control of the selected ix equipment samples, classifying them related theirs optimization potentials of FOM and TEEDI. The average FOMs for II and FP are far from the reference by 35,5 % and 35,0 % respectively and the average TEEDIs for II and FP are far from the reference TEDDI respectively by 13,8% and 24,9%. These last one has to be adjusted for the maintenance service (mainly the FP one) in order to bring them more near to the reference used to obtain the distributions.

Neste estudo, foram determinadas as atividades de duas enzimas de membrana: alanina-aminopeptidase (AAP) e Y-glutamil-transpeptidase (YGT) e da enzima lisossomal N-acetil-B-D-glucosaminidase (NAG), bem como os níveis de proteína total (PT), albumina (ALB) e ácido delta-aminolevulínico (ALA) em urinas de indivíduos expostos ocupacionalmente ao chumbo (grupo exposto) e de indivíduos não expostos ao chumbo e nem a outras substâncias químicas (grupo controle). Todos os indivíduos apresentavam creatinina sérica inferior a 1,5 mg/dL. Ao mesmo tempo foram determinados os níveis sangfiíneos de chumbo (Pb-S) e aferidas pressão arterial diastólica (PD) e pressa-o arterial sistólica (PS). O objetivo foi investigar a toxicidade renal crônica do chumbo e sua possível correlação com a pressão arterial em indivíduos com função renal normal. A mediana de chumbo no sangue no grupo controle foi de 11,5 pg/dL contra 36,8 pg/dL no grupo exposto, mostrando-se dependente do tempo de exposição (p < 0,001). O valor mediano da NAG-U corrigido pela creatinina foi mais alto no grupo exposto (31,74 U/g creatinina) e significativamente diferente do grupo controle (25,28 U/g creatinina), p < 0,001. A atividade NAG-U se correlacionou com o Pb-S (p < 0,001), tempo de exposição (p < 0,001) e ALA-U (p < 0,001), mas não houve correlação com a pressão arterial. Os demais indicadores de função renal, Y GT-U, AAP-U, PT-U e ALB-U não se mostraram mais elevados no grupo controle e nem mostraram correlação com o Pb-S, tempo de exposição ou pressão arterial. A pressão arterial diastólica foi maior no grupo exposto (83 mmHg contra 78 mmHg no grupo controle) mas não se observaram diferenças quanto à pressão sistólica. Observaram-se correlações das pressoes arteriais diastólica e sistólica com tempo de exposição (p < 0,001 e p < 0,05 ) e com chumbo no sangue (p < 0,05 e p < 0,05 ) respectivamente, enquanto somente a pressão diastólica se correlacionou com o ALA-U (p < 0,05). / In the present study we determined the activity of two renal tubule membrane enzymes: alanine-aminopeptidase (AAP) and Y-glutamyl-transpeptidase (YGT), and of the renal tubule lysosomal enzyme N-acetyl-B-D-glucosaminidase (NAG), as well as the levels of total protein (TP), albumin (ALB) and delta-aminolevulinic acid (ALA) in the urine of individuais occupationally exposed to lead (exposed group) and in individuais not exposed to lead or to any other chemical substances (control group). All individuais presented serum creatinine levels of less than 1.5 mg%. All subjects were also submitted to measurement of blood lead levels (B-Pb) and of diastolic and systolic arterial pressure. The objective was to investigate the chronic renal toxicity of lead and its possible correlation with arterial pressure in individuais with normal renal function. Median B-Pb levels were 11.5 pg/dL for the controls versus 36.8 Pg/dL for the exposed group, with the level being proportional to time o f exposure (p < 0.001). Median NAG-U values corrected for creatinine were higher in the exposed group (31.74 U/g creatinine) and significantly different from the control (25.28 U/g creatinine), p < 0.001. NAG-U activity was correlated with B-Pb (p < 0.001), time of exposure (p < 0.001) and ALA-U (p < O. 001), but not with arterial pressure. The remaining indicators of renal function, YGT-U, AAP-U, TP-U and ALB-U were not more elevated in the control group and were not correlated with B-Pb, time of exposure or arterial pressure. Diastolic arterial pressure was higher in the exposed group (83 mmHg versus 78 mmHg for the controls), but the two groups did not differ in systolic pressure. Diastolic and systolic pressure values were correlated with time of exposure (p < 0.001 and p < 0.05) and blood lead (p < 0,05 e 0,05) respectively but only diastolic pressure was correlated with ALA-U ( p < 0.05).

Os estudos de metabolômica ganham importância a cada dia, por ajudarem a explicar processos biológicos em situações normais (fisiológicas) ou patológicas. Oferecem uma nova visão sobre o impacto funcional da expressão gênica, complementando os estudos de sequenciamento gênico, que negligenciam o impacto da exposição ao meio ambiente na etiologia de doenças. A metabolômica tem sido aplicada na toxicologia, mostrando que o perfil metabólico comparativo de duas situações, controle e teste, pode desempenhar um papel importante na descoberta e validação de biomarcadores, além de contribuir para o entendimento e consequente interpretação dos mecanismos de ação tóxica de xenobióticos. Este projeto de pesquisa tem por objetivo utilizar uma abordagem metabolômica para avaliar o impacto de alterações metabólicas no cérebro da prole de camundongos, ocorridas após exposição (via inalação) à fumaça decorrente da queima de maconha (Cannabis sativa). Fêmeas gestantes foram expostas a doses diárias de Cannabis sativa ou ar filtrado durante todo o período gestacional. Após o nascimento, os filhotes machos ao atingirem a idade para o desmame, considerado como fase adolescente, foram separados de suas respectivas mães e expostos à Cannabis sativa ou ar filtrado por mais 60 dias. As amostras de cérebro da prole foram submetidas a análises por cromatografia em fase gasosa acoplada a espectrometria de massas (CG-MS) numa abordagem metabolômica global (untargeted metabolomics). Os perfis metabólicos dos cérebros dos animais expostos (grupo teste) foram comparados com os obtidos na análise do grupo controle (não expostos), sendo identificados os metabólitos discriminadores candidatos. Estavam alterados os metabólitos: isoleucina, uréia, leucina, GABA, ácido succínico, ácido fumárico, serina, treonina, creatinina, ácido glutâmico, ácido acetilaspártico, glicerol -1 -fosfato, ácido ascórbico, tirosina, ácido cítrico, adenina, hipoxantina, inosina e uracila. A partir dos resultados apresentados, pode-se observar, que tanto a exposição gestacional à Cannabis sativa, quanto a exposição da prole na fase adolescente, provocam alterações metabólicas importantes. Os metabólitos significativamente alterados estão envolvidos no ciclo do ácido tricarboxílico, responsável pela respiração mitocondrial, na produção de energia, atuam na biossíntese de aminoácidos, glicólise, estresse oxidativo, podendo alterar o desenvolvimento e maturação do cérebro. Os resultados são preliminares, mas contribuem para o melhor entendimento dos mecanismos toxicológicos envolvidos na exposição crônica causada por essa droga, contribuindo para a prevenção e diagnóstico de danos no desenvolvimento fetal e adolescente. / Metabolomics studies gain importance each day because they help explain biological processes in normal (physiological) or pathological situations. They provide a new insight into the functional impact of environmental gene expression, complementing gene sequencing studies that neglect the impact of environmental exposure on the etiology of diseases. Metabolomics has been applied in toxicology, showing that the comparative metabolic profile of two situations, control and test, can play an important role in the discovery and validation of biomarkers, in addition to contributing to the understanding and interpretation of the toxic action mechanisms of xenobiotics. This research project aims to use a metabolomic approach to evaluate the impact of metabolic changes in the brain of the offspring of mice, which occurred after exposure (via inhalation) to the smoke from the burning Cannabis sativa. Pregnant females were exposed to daily doses of Cannabis sativa or filtered air throughout the gestational period. After birth, male offspring were reached adolescents weaning age were separated from their respective mothers and exposed to Cannabis sativa or to the filtrate for another 60 days. Offspring brain samples were analyzed by gas chromatography coupled to mass spectrometry (GC-MS) in a global metabolomic approach (non-target metabolomics). Metabolic profiles of the exposed animals brains (test group) were compared with those obtained in the control group (non-exposed), and the candidate discriminant metabolites were identified. The metabolites were altered: isoleucine, urea, leucine, GABA, succinic acid, fumaric acid, serine, threonine, creatine, glutamic acid, acetyl aspartic acid, glycerol-1-phosphate, ascorbic acid, tyrosine, citric acid, adenine, hypoxanthine, inosine and uracil were altered. From the results presented, it can be observed that both the gestational exposure in Cannabis sativa and the exposure of the adolescent phase exposure, induced important metabolic alterations. Significantly altered metabolites are involved in the tricarboxylic acid, which are responsible for mitochondrial respiration, in energy production, act at the amino acid biosynthesis, glycolysis, oxidative stress, which may alter the development and maturation of the brain. The results are preliminary but contribute to a better understanding of the mechanisms of toxicity and of fetal and adolescent infection.

Student Number : 0110574V - MPh research report - School of Public Health - Faculty of Health Sciences / Pesticide poisoning poses a health risk to individuals throughout the world although the reported global and local risk are not consistent in the literature. Mpumalanga Province has areas of epidemic malaria. Spray teams, applying local insecticides to indoor surfaces operate just prior to the rainy season (October to May) to control malaria. The purpose of this cross sectional study was to compare prescribed safe handling and application practices of Mpumalanga malaria spray operators mixing and applying insecticides versus actual practices in the field. All members of the spray operating teams were included in the study. A tick list and questionnaire was utilized to observe field practices and enquire about reasons for non-compliance. Only 28% of all operators complied with prescribed safety practices and differences in compliance between mixing (38%) and application (36%) were marginal. Gloves, face shields and dust masks were not utilized as recommended and contributed to the highest levels of non-compliance. Compliance was found to be dependent on gender, age, years of experience, education level and employment status. The low compliance rate necessitates further investigation of the malaria programme occupational safety management system. All stakeholders need to be aware of the consequences of pesticide poisoning and collaborate in efforts to work towards prevention rather than cure.

Faculty of health sciences School of Public Health 0204521g dgresie@yahoo.co.uk;dgresie@hotmail.com / Ethylene oxide is used widely in hospitals as a gaseous sterilant for heat-sensitive medical items, surgical instruments and other objects and fluids that come into contact with biological tissues. Although ethylene oxide is recognised as a reproductive toxicant in humans, so far few studies have been carried out to investigate the association between exposure to ethylene oxide and the occurrence of adverse reproductive outcomes (Hemminki et al 1982 and 1983; Rowland et al, 1996; Yakubova et al, 1976). The results of these studies suggested that ethylene oxide is capable of causing reproductive dysfunction and that further research is needed in order to understand its effects on reproductive health. This study investigated the association between exposure to ethylene oxide during pregnancy and adverse reproductive outcome in women sterilising staff working in sterilising units using ethylene oxide in Gauteng province, South Africa. The study had the following objectives: 1) to describe the extent and nature of ethylene oxide use in sterilising units operational in medical facilities in Gauteng; 2) to assess the current exposure to ethylene oxide in sterilising units in Gauteng; 3) to collect information on the last recognised pregnancy using a questionnaire; 4) to assess the validity of the information on the evolution and outcome of the last recognised pregnancy collected by the means of the questionnaire; 5) to assess the association between occupational exposure to ethylene oxide during pregnancy and adverse reproductive outcome. The study population was represented by singleton pregnancies that: 1) occurred in women currently working in sterilising units using ethylene oxide in Gauteng province, South Africa; 2) were the last recognised pregnancy occurring in these women after the 1st January 1992; 3) occurred while the mother was employed. The adverse reproductive outcome was defined as the occurrence of any the following: spontaneous abortion, still birth, pregnancy loss (spontaneous abortion or still birth), low birth weight and combined adverse reproductive outcome (spontaneous abortion, still birth or low birth weight). The study enrolled 68.8% of the medical facilities in Gauteng that were using ethylene oxide to sterilise medical equipment. The majority of the employees working in the sterilising units included in the study were women (96.6%) and they were employed in one of the following jobs: technician (operator), instrument packer and cleaner. xiii Most of the sterilising units participating in the study used ethylene oxide sterilisation daily and only 15.4% of them reported that the employees operating the ethylene oxide steriliser used protective clothing. Recorded levels of ethylene oxide were provided by 46.2% of the sterilising units; they were all bellow 0.25 ppm (the South African long-term exposure limit for occupational exposure to ethylene oxide is 5 ppm). Changes in ethylene oxide sterilisation equipment and or technology were reported by 42.3% of the sterilising units and they were all engineering control measures aimed at reducing exposure to ethylene oxide. Measurements of the current levels of ethylene oxide were performed at the time of the study by the National Institute for Occupational Health using hydrobromic acid-coated petroleum charcoal tubes connected to calibrated Gilian pumps through which air containing ethylene oxide was drawn. The samples were analysed by the Analytical Services of the National Institute for Occupational Health. A total of 418 samples were collected (100 blank samples, 97 personal samples and 221 static samples). Quality control was ensured by the following methods: 1) verification by an Approved Inspection Authority; 2) collection of duplicate samples; 3) collection of blank samples. These measurements showed that exposure to ethylene oxide still occurred in sterilising units (ethylene oxide was detected in 9 out of the 10 public hospitals) and that the employees most exposed are the ones working with the ethylene oxide steriliser (technician or operator). There were 113 women working in the sterilising units enrolled in the study who had been pregnant after the 1st January 1992; 109 of them agreed to participate in the study and to complete the questionnaire. Information on exposure to ethylene oxide during pregnancy was obtained from three sources: walk-through survey, questionnaire-collected data and measurements of the levels of ethylene oxide in sterilising units at the time of the study. Information on the evolution and outcome of these pregnancies was gathered from the mother using a questionnaire. The questionnaire collected demographic data, reproductive history, medical data, risk factors for the adverse reproductive outcome (environmental and occupational exposures, lifestyle), and data regarding the evolution and outcome of the last recognised pregnancy. The questionnaire also collected detailed information on the job held at the time of the last recognised pregnancy (if the woman was working with ethylene oxide, she was asked to provide a complete list of daily tasks she was performing). Prior to administration, the questionnaire was tested on a small sample of working women. xiv The validity of the questionnaire-collected information on the evolution and outcome of the last recognised pregnancy was assessed by comparing this information against medical records (considered the “gold standard”). The assessment showed that mothers’ recall was accurate for the following variables: medical facility were the pregnancy was recorded, date of the reproductive event, gestation length, vital status of the newborn, number of foetuses, child gender, disease/medical problems during pregnancy and treatment received during pregnancy. There was an error in the mothers’ reporting of the birth weight of their babies. The possible misclassification of outcome resulting from this error was shown to be nondifferential (the proportion of subjects misclassified on outcome did not depend on exposure). Therefore, this misclassification could bias the effect estimate towards the null value or it could not produce any bias at all. The analysis carried out to detect possible associations between exposure to ethylene oxide and adverse reproductive outcomes included 98 of the initial 109 pregnancies on which information had been collected (11 pregnancies were excluded from the analysis for the following reasons: 2 were multiple pregnancies, 4 were conceived before 1st January 1992 and 5 were conceived while the mother was not employed). Amongst the 98 singleton pregnancies included in the analysis, 19 were classified as exposed and 79 as unexposed to ethylene oxide. The relative risk for spontaneous abortion was RR=16.63 (95%CI=1.97-140.42; p=0.004), for stillbirths RR=3.47 (95%CI=0.63-19.01; p=0.18), for pregnancy loss RR=6.24 (95%CI=1.95- 19.93; p=0.003), for low birth weight RR=0.61 (95%CI=0.09-4.30; p=0.51) and for combined adverse reproductive outcome RR=2.09 (95%CI=1.00-4.36; p=0.06). No confounders were detected for any of the associations between exposure to ethylene oxide and the adverse reproductive outcomes under study. For the association between exposure to ethylene oxide and combined adverse reproductive outcome the analysis detected three effect modifiers: paternal age (father aged 40 or older at conception), passive smoking and maternal age (mother aged 35 or older at conception). In conclusion, this study, the first in South Africa on ethylene oxide exposure and adverse reproductive outcomes, confirmed the widespread use of ethylene oxide, exposure to this agent in public sector hospitals and associations between exposure to ethylene oxide and spontaneous abortion and between exposure to ethylene oxide and pregnancy loss (either spontaneous abortion or stillbirth). xv Moreover, the study provided data on reproductive outcomes in employed women (on which scant data are available in South Africa) and added information on the validity of selfreported pregnancy data relative to medical records. The findings of the study support the conclusions of the previous studies that had suggested that exposure to ethylene oxide during pregnancy could lead to adverse reproductive outcomes. The study detected no associations between exposure to ethylene oxide and stillbirth, low birth weight or between exposure to ethylene oxide and combined adverse reproductive outcome.

Background: Limited epidemiologic studies have investigated the effects of pesticide exposure during pregnancy on low birth weight in offspring in rural China.Methods: A survey of a total of 503 women was conducted in Ling county of Shandong Province of China following delivery from 1 November 2009 to 8 February 2010.Results: After adjustment for confounding and compared with no pesticide exposure, multiple logistic regression showed a non-significant increased likelihood of low birth weight for both children of mothers exposed to pesticides when not pregnant (OR = 1.80, 95% CI: 0.62, 5.22) and mothers exposed to pesticides during pregnancy (OR = 2.42, 95% CI: 0.73, 8.08); multiple linear regression showed a non-significant reduced birth weight for both children of mothers exposed to pesticides when not pregnant (β=–0.59, p=0.28) and mothers exposed to pesticides during pregnancy (β=–0.89, p=0.15).Conclusions: Exposure to pesticides during pregnancy was associated with a non-significant increase in low birth weight in this rural Chinese population. Future studies using larger sample sizes and longer follow-up periods are warranted.

No description available.

Organophosphates (OPs) and Pyrethroids (PYRs) are widely used pesticides in both agricultural and non-agricultural environments. In agricultural work settings, typically more than one pesticide is used in combination, or sequentially, to kill pests. There is currently a gap in research that looks at how exposures to multiple pesticides can impact human health – particularly among adolescents who work in these environments. The goal of this dissertation research was to examine the use of OP (chlorpyrifos, and profenofos) and PYR (λ-Cyhalothrin, α-Cypermethrin) pesticides across an application season and how exposure is associated with symptoms and cholinesterase enzyme activity, and to examine the impact of a sequential exposure to multiple OPs, and exposure to both OPs and PYRs. Urine and blood samples, questionnaire data, and a medical exam were collected over a 10-month period from adolescent pesticide applicators in Egypt. Overall, applicators had higher exposure than non-applicators to all four pesticides. The non-applicators were also exposed and had levels 4 times higher in urine metabolite levels than the general population in the U.S. In addition, these exposures caused increased symptoms and severity of symptoms among both applicators and non-applicators. In conclusion, adolescent agriculture workers in the Egyptian cotton fields are exposed to multiple pesticides and are susceptible to the impact of those exposures on their health.

Inhalation exposure to semi-volatile polychlorobiphenyls (PCBs) that ubiquitously exist in the environment has the potential to cause adverse health effects. Recently identified sources of airborne PCBs, especially non-legacy sources, stress the importance of risk assessment for inhalation exposure. However, the fate of inhaled airborne PCBs in biological systems and the resultant toxicity remain unexplored. The objective of this thesis research was to investigate the distribution and elimination of semi-volatile PCBs in biological systems after inhalation exposure and evaluate the biologic and toxicologic consequences. This objective was achieved by conducting the following inhalation studies in rats: a short-term exposure study of the body burden and elimination; a subchronic exposure toxicity study; an acute exposure study of PCB11 metabolism; and a mass balance study of [14C]PCB11 following lung exposure. PCBs found in technical Aroclor mixtures and PCB11 were readily absorbed and distributed following nose-only inhalation exposure. PCBs accumulated in adipose tissue, but decayed in other tissues with biological half-lives of several hours. Their elimination was dependent on the structure of the PCB congeners and the metabolic nature of the organ. Lower-chlorinated PCBs exhibited more rapid clearance than higher-chlorinated congeners yet differential rates of elimination were also seen within the homologue. A distinct congener pattern was found in tissues, ranging from tri- to pentachorobiphenyls after subacute and subchronic exposure. Rapid elimination of PCB11 and its metabolite, 4-OH-CB11, were detected in liver following nose-only inhalation exposure by our established methodology. Further investigation revealed that [14C]PCB11 was 99.8% absorbed in lung. Elimination of the [14C]PCB11 and products consisted of an initial fast phase followed by a slow clearance phase. [14C]PCB11 underwent rapid and extensive metabolism in liver. The major products were phase II metabolites which dominated in the non-adipose tissues and were eliminated via the large intestine and urine. Overall, differential congener elimination was found after inhalation of airborne PCBs, with minimal toxicity. Lower-chlorinated congeners were rapidly and extensively metabolized to phase II products and eliminated within hours.

It is estimated that US children 2 to 18 years of age spend an average of 5.5 hours, daily, using media of all types. 1 During these years, it is estimated they will have viewed over 200,000 acts of violence just on television. 2 In this issue of the Southern Medical Journal, Dr. Robert DuRant and colleagues reported on their findings that an increased frequency of watching professional wrestling on television was associated with an increase in reported date fighting and other violent behaviors, risky sexual behavior, and smoking cigarettes, among a multistate random sample of adolescents aged 16 to 20 years. 3 In this cross-sectional study, 22.4% of males and 13.6% of females reported watching professional wrestling on television during the 2 weeks before the survey. Prior research, including experimental and longitudinal studies, has consistently demonstrated strong associations between exposure to media violence and desensitization to violence, greater acceptance of violence as a means of solving problems, and violent behavior, as well as depression, anxiety, and sleep disturbance. 4