Psychological functioning in African American women at an increased risk of hereditary breast and ovarian cancer.

Despite attention to psychological issues during genetic counselling and testing for hereditary breast and ovarian cancer risk, limited information is available on cancer-specific distress among African American women being targeted for participation in counselling and testing. Therefore, the purpose of this study is to examine cancer-specific distress in African American women at an increased risk of hereditary breast and ovarian cancer and to identify factors having significant associations with distress in this population. Respondents were 141 African American women identified for participation in genetic counselling and testing for BRCA1/2 mutations. Overall, respondents reported moderate levels of cancer-specific distress. Younger age (coefficient=6.0, p=0.001), being unemployed (coefficient=-5.0, p=0.01), and having a personal history of cancer (coefficient=5.0, p=0.02) had significant associations with intrusion. Younger age was also associated significantly with greater avoidance (r=6.0, p=0.02). These results suggest that African American women aged 50 and younger, those who are unemployed and women with a personal history of breast or ovarian cancer may be the most vulnerable to experiencing elevated levels of distress during genetic counselling and testing. Greater attention to psychological issues, including concerns about cancer and cancer risks, may be needed during genetic counselling and testing for BRCA1/2 mutations with these women.

The impact of type of employment on women's use of prenatal-care services and family planning in urban Cebu, the Philippines.

This study re-evaluates the relationship of urban women's employment to their health-service and contraceptive use, drawing on data from the Cebu Longitudinal Health and Nutrition Survey. Multivariate analyses reveal significant differences across types of work for the likelihood of both obtaining timely prenatal care and practicing contraception at one year postpartum. Wage workers in white-collar jobs are significantly more likely than those not employed for pay to have obtained prenatal care and are substantially more likely to have adopted a contraceptive method in the year following childbirth. Women who are self-employed also are significantly more likely than those not employed for pay to be using contraceptives. Blue-collar wage work and piecework employment have no relationship to either dependent variable. These findings suggest that work-related autonomy encourages women to exercise control in other areas of their lives.

PIP: This article examined the relationship between women's employment and use of prenatal care services and family planning in Cebu, the Philippines. Data were obtained from the Cebu Longitudinal Health and Nutrition Baseline and Follow-up Survey among a 12-month birth cohort of 2695 Filipino infants and their mothers, residing in a sample of 33 urban and rural barangays in 1983 and 1984. The largest percentage of women who had early prenatal care were white collar workers (WCWs) and professionals (57%), followed by blue collar, service, and self-employed workers (22%), and non-wage workers (23%). The smallest percentage of women obtaining prenatal care were pieceworkers (15%). Modern contraceptive use at 1 year postpartum was greatest among WCWs (34%), followed by self-employed workers (32%) and non-wage workers (26%). The lowest proportion were pieceworkers among modern method users, and blue collar workers and service workers among traditional method users. Logistic models indicate that WCWs were 2.5 times more likely than non-wage workers to obtain care within the first 5 months of pregnancy. Among women who received free care, WCWs still had the best prenatal care patterns. The likelihood of prenatal care was the same for blue collar workers, self-employed workers, and pieceworkers. Women aged 25-34 years were more likely than older women to obtain early prenatal care. Husband's education, a resident grandmother, and household assets contributed to a higher likelihood of seeking early prenatal care. The degree of autonomy on the job was more closely related to contraceptive and health service use.

Neighborhood context and the transition to sexual activity among young black women.

Previous studies report that neighborhood characteristics influence pregnancy and childbearing risk among African-American adolescent women. These studies, however, leave unidentified the effects of many neighborhood properties on the proximate determinants of nonmarital fertility. In this study I examine the effects of neighborhood characteristics on the risk of nonmarital first intercourse and on contraceptive use among black female adolescents. The results suggest that neighborhood socioeconomic status, female employment and marital dissolution rates, and peers' departure from mainstream lifecourse trajectories influence young black women's sexual and contraceptive behavior. The effects of female employment and socioeconomic status are greater for teens in urban neighborhoods than for teens living elsewhere.

Metabolism of thiodiglycol (2,2'-thiobis-ethanol): isolation and identification of urinary metabolites following intraperitoneal administration to rat.

1. The metabolism of thiodiglycol, 2,2'-thiobis-ethanol, was investigated following i.p. administration to rat. 2. Approximately 90% of the administered dose was excreted in the 0-24-h urine. Four metabolites were isolated by h.p.l.c. and identified by mass spectrometry. Structural assignments were confirmed by comparison with authentic synthetic standards. 3. Thiodiglycol sulphoxide was the major metabolite accounting for approximately > or = 90% of the excreted radioactivity following i.p. injection of 13C4, 35S-thiodiglycol. Thiodiglycol sulphone, S-(2-hydroxyethylthio)acetic acid and S-(2-hydroxy-ethylsulphinyl)acetic acid were identified as minor metabolites. 4. Analysis for thiodiglycol by GC-MS indicated approximately 0.5-1% of the applied dose was excreted unmetabolized.

Determinants of contraceptive choice among single women in the United States.

Data from the 1983 National Survey of Unmarried Women are used to analyze characteristics that affect contraceptive decision-making among single women aged 20-29 who are exposed to the risk of pregnancy. Factors found to affect whether these women use a relatively effective method such as the pill or the IUD, use coitus-dependent methods or use no method include family structure at age 15, educational level, work status, religious affiliation, fertility relative to desired fertility, and past contraceptive failure. Bivariate analyses revealed notable differences between whites and blacks in contraceptive behavior. Multivariate analyses showed that while the decision to use a contraceptive method was somewhat affected by race, method choice was not. Overall, contraceptive decision-making was relatively unaffected by race, length of the relationship and current living arrangement.

PIP: The Battelle group analyzed 1983 data on 1314 20-29 year old women who had never married and lived in the continental US (National Survey of Unmarried Women) to identify determinants of contraceptive decision making among single women at risk of pregnancy. Blacks at risk of pregnancy were 2 times as likely to not use contraceptives than Whites (23.5% vs. 10.1%; p .05). Women who had more than high school education were more likely to use any method other than oral contraceptives (OCs) and the IUD than those with a high school education or less (p .01). Further, working in a professional or technical capacity had a significant positive effect on contraceptive use (p .01 for OCs and IUD vs. No use and p .05 for other methods vs. no use). Conservative Protestants were significantly less likely to use any contraceptive method (p .01 for OCs and IUD vs. no use and p .05 for other methods vs. no use). Catholicism had the same effect, but it was significant. Women who lived with both parents at age 15 were more likely to use any method other than OCs and the IUD than those who lived with either 1 or no parent (p .01). Women whose actual fertility either equalled or was higher than desired fertility were apt to use any method other than OCs and the IUD than those whose actual fertility was lower than desired fertility (p .01). The same was true for women who were in less than a year old relationship (p .01). The multivariate analyses revealed that race did not influence method choice. They also demonstrated that, generally, race, length of relationship, and current living arrangement did not greatly influence contraceptive decision making.

Biological fate of sulphur mustard, 1,1'-thiobis(2-chloroethane): isolation and identification of urinary metabolites following intraperitoneal administration to rat.

1. The metabolism of sulphur mustard, 1,1'-thiobis(2-chloroethane), in vivo was investigated following i.p. administration to rat. 2. Approx. 60% of dose was excreted in the 24 h urine. Many metabolites were present; nine have been isolated by h.p.l.c. and characterized by mass spectrometry. Structural assignments were confirmed by comparison with authentic synthetic standards. 3. Some metabolites result from initial hydrolysis of the sulphur mustard, but the majority are formed by conjugation with glutathione. These are further metabolized to N-acetylcysteine conjugates, or to methylthio/methylysulphinyl derivatives by a pathway probably involving beta-lyase, accompanied by oxidation of the mustard sulphur atom to sulphoxide or sulphone. 4. Thiodiglycol sulphoxide, 1,1'-sulphonylbis[2-S(N-acetylcysteinyl)ethane] and 1,1'-sulphonylbis[2-methylsulphinyl)ethane] or 1-methylsulphinyl-2-[2-(methylthio ethylsulphonyl]ethane were the most prevalent metabolites resulting from the three major pathways. Metabolic pathways for the formation of the excretion products are proposed.

The fate of 2-chlorobenzylidene malononitrile (CS) in rats.

1. The fate of 3H-ring labelled, 14C-cyanide labelled and (14C = C) side chain labelled 2-chlorobenzylidene malononitrile (CS), 2-chlorobenzyl alcohol and 2-chlorobenzyl malononitrile (dihydro CS) in rats and isolated rat liver cells has been examined. 2. CS was administered both i.v. and i.g. to rats at doses from 0.08 to 159 mumol/kg and in most cases the greatest proportion of the dose was eliminated in the urine (44-100%). The principal urinary metabolites were 2-chlorohippuric acid, 1-O-(2-chlorobenzyl) glucuronic acid, 2-chlorobenzyl cysteine and 2-chlorobenzoic acid. Lesser amounts of 2-chlorophenyl acetyl glycine, 2-chlorobenzyl alcohol and 2-chlorophenyl 2-cyano propionate were identified. 3. The major urinary metabolite from 2-chlorobenzyl alcohol was 2-chlorohippuric acid (43%), 2-chlorobenzyl cysteine, 2-chlorobenzoic acid and 2-chlorobenzyl glucuronic acid were identified. 4. The products of dihydro-CS metabolism were 2-chlorophenyl acetyl glycine, 2-chlorophenyl 2-cyanopropionate and 2-chlorophenyl proprionamide. 5. Urinary thiocyanate levels increased with the dose of CS up to 159 mumol/kg. At 212 mumol/kg there was a large increase in the amount of thiocyanate produced (molar conversion: 21.5-29.9%). Similarly malononitrile, the hydrolysis product of CS, gave a dose related increase in urinary thiocyanate levels. However at a higher dose (212 mumol/kg) the molar conversion was greater than 60%. 6. The metabolism of CS by isolated rat liver cells confirmed the results in vivo but demonstrated a marked limitation of this preparation to form conjugates. 7. It is concluded that CS in vivo is hydrolysed mainly to 2-chlorobenzaldehyde which is then either oxidized to 2-chlorobenzoic acid for subsequent glycine conjugation, or reduced to 2-chlorobenzyl alcohol for ultimate excretion as 2-chlorobenzyl acetyl cysteine or 1-O-(2-chlorobenzyl) glucuronic acid. Malononitrile is converted to thiocyanate via the formation of cyanide.

Is the dream of a voluntary society still possible? The 1980 Harvey Cushing oration.

The United States Ambassador to the Court of St. James reviews the historic search for a society which is as voluntary as possible for the greatest number of citizens. Under the rule of law, there must continue to exist freedom of choice, freshness of start and opportunity, and the promise of mobility. The citizenry should not become dependent upon public administrators or political masters. Growth and expansion should not be constrained beyond reasonable limits, and openness of opportunity must be given high priority. The variety of State and private educational resources should be tapped for the design of educational communication programs.