Moderate chronic pain, weight and dietary intake in African-American adult patients with sickle cell disease.

In this exploratory study, we evaluated weight status and dietary intake patterns during painful episodes in adult patients with SCD. Specifically, we explored the relation between pain severity and body mass index (BMI), and we tested the hypothesis that dietary intake would be reduced and dietary content altered during periods of increased pain. We conducted an analysis of survey data from 62 patients involved in a longitudinal evaluation of the relationship of medical and psychosocial factors to pain. Nearly half of patients with SCD were overweight, and 20% were obese. BMI was positively related to interference associated with pain. Although BMI was not statistically associated with reported pain severity, >40% of patients reported that they perceived their pain to be affected by their weight. Less than 20% of patients reported that they perceived that their weight affected their pain. Regarding dietary patterns, the majority of patients reported eating less during episodes of pain and significantly decreasing their intake of fats and proteins. We conclude that there is a need to better understand the relation among weight, dietary patterns and pain in patients with SCD in order to provide patients with accurate education and effective treatment recommendations for managing their disease and reducing current and future risks of lifestyle and disease-related morbidities.

Client-related predictors of early treatment drop-out in a substance abuse clinic exclusively employing individual therapy.

The present study examined predictors of early drop-out in a heterogeneous male and female outpatient sample enrolled in an addiction program. Clients who failed to attend five or more individual therapy sessions were considered "non treatment-engaged." Sixty-four percent of the sample engaged in initial treatment, compared to 36% who were early drop-outs. The latter group, compared to the former group, was significantly less educated and was more likely to be African American, female, report cocaine as the primary drug of choice, and be referred from outside the larger medical center (p <.05). In multivariate models, female gender and African American ethnicity were independent predictors of early treatment drop-out (p <.00001). Although substance-related factors influenced treatment outcomes, their effects were weakened when taken into consideration with demographic factors such as gender and ethnicity. Continued examination of ethnicity, gender, and other potential negative prognostic factors for attendance in various addiction treatment milieus may aid in provision of appropriate services especially for high-risk clients.

Estrogen replacement therapy, subsyndromal depression, and orthostatic blood pressure regulation.

Although estrogen replacement therapy (ERT) alleviates depressed moods in postmenopausal women, it is not known whether ERT is equally effective in reducing affective and somatic depressive complaints. One of the authors' goals in this study was to examine possible differences between women receiving and not receiving ERT. The authors studied a group of postmenopausal women. Somatic symptoms in the ERT group were significantly lower than in the Non-ERT group. Affective scores were only marginally lower in the ERT group (p = .06). After controlling for affective depression, the advantage of ERT remained significant with respect to somatic levels, but control for somatic levels essentially eliminated the effects of ERT on affective depression values. Second, in response to orthostatic challenge, the change in systolic blood pressure was significantly smaller in the ERT group. Apparently ERT is associated with more effective blood pressure regulation. Thus there are several potential benefits of ERT, despite recent evidence finding several untoward effects of long-term treatment.