Bupropion in breast milk: an exposure assessment for potential treatment to prevent post-partum tobacco use.

OBJECTIVES: To assess potential infant exposure to bupropion and its active metabolites in breast milk such as would occur during treatment to prevent post-partum relapse to tobacco use, and to compare the concentrations of bupropion in urine and saliva with plasma and breast milk. DESIGN AND SETTING: Cohort study, outpatient clinical research centre. SUBJECTS: Ten healthy post-partum volunteers who agreed to take bupropion for seven days, pump and discard their breast milk, and have samples of breast milk, plasma, saliva, and urine analysed. INTERVENTION: Bupropion 150 mg a day for three days and then 300 mg a day for four days. MAIN OUTCOME MEASURES: Concentrations of bupropion and its active metabolites (hydroxybupropion, erythrohydrobupropion, threohydrobupropion) in breast milk, plasma, saliva, and urine. Determination of average infant exposure. RESULTS: The calculated average dosage of bupropion in breast milk was 6.75 microg/kg/day. Therefore, the average infant exposure is 0.14% of the standard adult dose of bupropion, corrected for the difference in body weight. Considering the sum of bupropion and its active metabolites, the average infant exposure is expected to be 2% of the standard maternal dose on a molar basis. The concentration of bupropion and its active metabolites in breast milk was not associated with age, body mass index, use of oral contraceptive pills, age of infant, or the frequency of breast feeding at the time the study was initiated. The coefficient of determination (r2) between the concentration of bupropion in breast milk and in urine was 0.77 (p < 0.01). CONCLUSIONS: Bupropion and its active metabolites are present in the breast milk of lactating women. The concentrations of bupropion in breast milk and urine were highly correlated. These results indicate that the daily dose of bupropion and metabolites that would be delivered to an infant of a woman taking a therapeutic dose of bupropion is small. These results suggest that the effectiveness of bupropion to prevent post-partum relapse to tobacco use should be evaluated without excluding women who plan to breast feed.

Does willingness to pay vary by race/ethnicity? An analysis using mammography among low-income women.

As part of a population-based intervention to improve periodic mammogram screening, we examined WTP for mammography in five ethnic groups. Through random digit dialing, we contacted households in low-income census tracts of Alameda County, California (San Francisco Bay area). Women who met the ethnicity, age and cancer-free eligibility criteria were invited to participate. For the baseline assessment, women were surveyed over the phone in their preferred language. Of the 1465 surveyed women, 499 identified themselves as African-American, 199 were Chinese, 167 were Filipino, 300 were Latina, and 300 were non-Hispanic white. Bivariate and multivariate analysis showed that WTP varied significantly by ethnicity (P<0.05). We also found that when Filipino and Chinese women had a female relative with breast cancer, they were willing to pay less money for a mammogram. African-American, Latino, and non-Hispanic white women, however, were willing to pay more money for a mammogram if a female relative had had breast cancer. This ethnic difference, when there is a familial link to breast cancer, needs further study as it has implication for genetic testing. Nevertheless, WTP studies that do not account for ethnic differences may be overstating net benefits to society.

The effect of data collection mode on smoking attitudes and behavior in young African American and Latina women. Face-to-face interview versus self-administered questionnaires.

Evaluating smoking prevention and cessation programs requires valid data collection. This study examined two survey modes--face-to-face (FTF) interview and self-administered questionnaire (SAQ)--comparing response rates, sample characteristics, data quality, and response effects. From two family planning clinics, 601 female Latina and African American clients ages 12 to 21 were recruited and randomized to either group. Results reveal that neither mode is superior to the other. The SAQ may therefore be preferable for this population, despite its higher rate of incompletes, because it yields results similar to the FTF yet is more cost effective and less disruptive to clinic routines.

The community integration questionnaire with new scoring guidelines: concurrent validity and need for appropriate norms.

OBJECTIVE: To investigate the influence of demographic variables and concurrent validity when new scoring guidelines are used with the Community Integration Questionnaire (CIQ). METHOD: Thirty-three adult outpatients with biopsy confirmed malignant brain tumours were evaluated prior to chemotherapy. In contrast to TBI subjects, the brain tumour sample was older (x age= 46.3 years), better educated (x = 13.7 years); and gender was more evenly represented (16 male, 17 female). RESULTS: Demographic variables mediated CIQ scores. Gender effects were still seen, with women significantly higher on Home Integration (r = 0.40, p < 0.05). Older subjects had lower CIQ scores: CIQ total (r = -0.54, p < 0.005); Home Integration (r = -0.42, p < 0.01); Social Integration (r = -0.44, p < -0.005); and Productivity (r = -0.45, p < 0.005). More education was related to higher CIQ total (r = 0.31, p < 0.05); Social Integration (r = 0.30, p < 0.05); and Productivity (r = 0.35, p < 0.05). Significant relationships were seen between CIQ scores and both the Social Activity and Inactivity subscales of the Chronic Illness Problem Inventory (r = -0.43, p < 0.005 and r = -0.68, p < 0.005, respectively). CONCLUSIONS: CIQ norms for age, education, sex, and marital status are strongly recommended. Moderate concurrent validity remained with new scoring guidelines.

Smoking acquisition among adolescents and young Latinas: the role of socioenvironmental and personal factors.

This paper examined the effects of socioenvironmental and personal factors on two stages of the smoking continuum--onset of smoking and regular smoking--among a sample of 1411 Latina clients, ages 14-24, at two federally funded family planning clinics. The socioenvironmental factors included cultural indicators, smoking behavior of family and peers, and norms. The personal factors were risk-taking behaviors and intention to smoke in the future. Results showed that the indicators associated with experimentation were different than those linked with regular smoking. Socioenvironmental factors associated with the transition from never having smoked to trying cigarettes included acculturation, as measured by language and familialism, and peer smoking behavior. Among the personal factors, risk-taking behavior (past use of drugs, alcohol, and general risk attitude) and smoking intentions were correlates of experimentation. The transition from experimenter to regular smoker was associated with peer smoking behavior (P< .05) in the socioenvironmental domain and drug use and intention to smoke in the future among the personal factors (both P values <.001). Age, years of education, marital status, norms, and parental smoking did not independently predict either of the smoking outcomes. Intention to smoke was the strongest predictor of experimentation (OR = 8.3, Cl 5.87-11.60) and regular smoking (OR= 19.9, CI 12.31-29.21) and could help identify those most likely to benefit from smoking prevention and cessation interventions.

Identification and characterisation of PEX6 orthologues from plants.

The sunflower (Helianthus annuus) orthologue of PEX6, an AAA ATPase essential for the biogenesis of peroxisomes in yeasts and mammals, was isolated. HaPex6p is immunologically related to Pichia pastoris Pex6p. Like other genes involved in peroxisome biogenesis and function HaPEX6 mRNA and protein levels peak in early post-germinative growth and mRNA levels also increase in senescent tissue. HaPEX6 identifies probable orthologues in Arabidopsis and rice.

Young Latinas and abortion: the role of cultural factors, reproductive behavior, and alternative roles to motherhood.

Latina women have often been portrayed as holding strong traditional family values leading to a greater propensity for rejection of contraception and abortion. Increasingly, the literature has consistently shown that Latina women use contraception effectively when available; however, much less is known about the prevalence of abortion and the factors related to its use in this population. In this article we examine Latinas' use of abortion and identify factors affecting its use among 1,207 ever-pregnant Latina women age 14-24 recruited at two federally-funded family planning clinics in the Los Angeles metropolitan area. Only a small proportion of the young women in our sample (7.5%) had ever had an induced abortion. In multivariate analysis the variables significantly associated with past abortion included less traditional attitudes about women's roles, higher gravidity, shorter periods of sexual activity, and a higher number of lifetime sexual partners. We conclude that use of abortion among Latinas is driven by role orientation and reproductive variables.

Improving follow-up after an abnormal pap smear: results from a quasi-experimental intervention study.

The success of cervical cancer control programs depends on regular screening with the Pap smear test and prompt and appropriate treatment of early neoplastic lesions. Recognizing the potentially grave consequences of lack of follow-up for abnormal Pap smears, numerous intervention studies have tested the impact of a variety of strategies to increase return for follow-up. The majority of these studies were evaluated under controlled experimental conditions. Despite the encouraging findings of these trials, the next step in the research continuum requires that the effectiveness of these interventions be demonstrated in real world settings before full implementation is initiated. We report the results of an evaluation study assessing the combined effectiveness of three intervention modalities found effective in prior randomized studies: a tracking follow-up protocol, transportation incentives, and financial incentives. This study used a before-after, nonequivalent control group design to assess the impact of a multifaceted intervention that included a computerized tracking protocol with transportation and financial incentives. The study was implemented at two major hospitals, two comprehensive health centers (CHC), and nine public health centers (PHC) under the jurisdiction of the Los Angeles County Department of Health Services. One hospital, one CHC, and the four PHC located in the catchment area of the CHC were selected as experimental sites. The control sites - one hospital, one CHC, and five PHC - provided usual care. All women with an abnormal Pap smear at the intervention and control sites were included in the study. The study consisted of a 1-year period of baseline data collection (September 1989-August 1990), followed by a 2(1/2)-year intervention period (September 1990-February 1993). During the intervention period, the intervention protocol was implemented at the experimental sites, and the control sites provided usual care. Overall, we found that the rates of receipt of follow-up care were consistent with those found in similar studies. In contrast to results obtained in these prior randomized trials, we did not find strong and consistent evidence for intervention effects. Significant findings emerged only at the CHC and hospital levels and only for selected years. Results underscore the importance of testing interventions in real world conditions before large-scale implementation is initiated. In addition, this study highlights the challenge of detecting intervention effects in large-scale studies because of the greater measurement difficulties in field studies as compared with controlled experiments.

Community Integration Questionnaire for patients with brain tumor: a comparative study.

OBJECTIVES: This study compares mean scores obtained on the Community Integration Questionnaire among patients with brain tumor and published data for traumatic brain injury and nonpatient groups. DESIGN: Subjects included 33 adult outpatients with biopsy-confirmed high-grade malignant brain tumors. Both sexes were represented. Subjects were older and better educated than historic samples. The Community Integration Questionnaire was positively skewed. RESULTS: Subjects had higher scores on the Social Integration Scale than on Productivity. Higher education was associated with Productivity and the Community Integration Questionnaire total score. However, greater age was associated with lower scores. Significant gender effects were obtained. CONCLUSIONS: Women with brain tumors had significantly higher Home Integration Scores than males with tumors. However, Home Integration was lower for persons with brain tumors than for either the corresponding gender in the traumatic brain injury model systems group for males and females, respectively. Similarly, compared with community-dwelling persons with traumatic brain injury, males, but not females, with cerebral tumors had significantly lower Social Integration scores. When compared with nondisabled adults, persons with brain tumors reported significantly lower Productivity and Community Integration Questionnaire total scores.

Relationships: importance for patients with cerebral tumours.

OBJECTIVE: To investigate the influence of relationships on psychosocial status in patients with Stage III and IV brain tumours. PATIENTS AND METHODS: Thirty-three outpatients at a university medical centre were referred to the study by their treating physician prior to the initiation of aggressive chemotherapy. All subjects underwent a comprehensive psychosocial assessment. RESULTS: Depressive and anxious complaints were common, but not related to gender. Single/divorced status suggested greater vulnerability to anxiety as 88% of singles and only 48% of patients with partners reported clinical levels of anxiety. Single patients' anxiety was related to inactivity (r = 0.78, p < 0.05) and fears of financial difficulties (r = 0.72, p < 0.05). State and trait anxiety related differently to married patients' complaints. Married patients more frequently reported clinical levels of depressive symptoms (44% partnered vs 28% singles). Depression among married patients was predicted by problems with sex, finances, marital difficulties, and inactivity [R2 = 0.803; F = 20.420, df(4,20), p < 0.0001)]. Problems with relationships were disassociated from problems with sex. Married patients' problematic relationships were predicted by overprotection, inactivity, concerns of bodily deterioration, depression, and anxiety [R2 = 0.775, F = 13.060, df(5, 19) < 0.0001]. CONCLUSIONS: Married neuro-oncology patients may experience depressive symptoms arising from the marriage, but appear to be buffered from anxiety when compared with single/divorced patients. The prevalence of anxiety among single patients suggests modifications of interventions by relationship status.

Maximizing qualitative responses about smoking in structured interviews.

This article addresses the important methodological issue of whether face-to-face or self-administered interviews elicit better qualitative data on reasons for smoking and quitting among 173 current and former smokers. The data are from a study of smoking behaviors among 601 African American and Latina women age 14 to 21 years recruited from family planning clinics in Los Angeles from 1995 to 1996. Results suggest that responses to closed questions about smoking behavior are similar in both methods but that self-administered surveys elicit more responses to open-ended questions than face-to-face interviews. The authors encourage the use of self-administered surveys in smoking research because they are cheaper to administer, yield similar data on closed-question items, and elicit richer and more provocative responses to open-ended questions.

Cognitive outcome after emergent treatment of acute herpes simplex encephalitis with acyclovir.

Longitudinally designed case studies, reporting cognitive and psychosocial outcome of herpes simplex virus encephalitis (HSVE), were conducted prior to current antiviral medication usage and primarily in persons with either left hemispheric or bilateral temporal lobe involvement. The current study demonstrated relatively better outcome (cognitive recovery and functional independence for activities of daily life) in an individual treated with IV Acyclovir within hours of initial symptoms and whose CT scans showed right hemispheric involvement. In contrast with earlier case reports, no semantic specific categories of memory impairment were noted on serial assessment. The time from first symptoms to antiviral medical treatment appears to be the best predictor of outcome from HSVE. Historical case studies with relatively poorer outcome and differing deficits suggest survivors of HSVE are a heterogenous group. Variability in anatomic lesions and time to treatment contribute to outcome.

Anoxic-hypotensive brain injury: neuropsychological performance at 1 month as an indicator of recovery.

DESIGN: This case control study included assessments at 3 and 8 weeks post brain injury. Controls were the non-brain injured subjects whose normative data has been published for neuropsychological measures. Data and medical information were obtained with informed consent. OBJECTIVE: This study explored cognitive sequella of anoxic-hypotensive brain injury following cardiac arrest in a 49 year old man with high premorbid function. RESULTS: Improvement was noted at 3 weeks post-injury. By 8 weeks neuropsychological test scores including verbal and visual memory were in the normal range, although they were likely to be lower than premorbid levels. CONCLUSIONS: Relatively good cognitive function within the first month post-anoxia likely indicates improved recovery and benefit from continued rehabilitation. Despite initial presentation, steep recovery curves can be found among survivors of anoxia with eventual return to independent function including driving/child care and return to gainful employment. Rehabilitation teams are encouraged to remember that good cognitive function is not predicted by initial Glasgow Coma Scores, but may be predicted by return of recall memory during the first month post-anoxic event. Serial cognitive screens can identify individuals with the potential for better recovery.

SCL 90-R interpretation and brain tumour: a correction factor?

OBJECTIVE: Determine whether spurious SCL 90-R profiles resulting from endorsement of neurologic treatment items can be corrected and still retain ecological validity. DESIGN: The proportion of subjects' item endorsement was compared with the adult non-patient norm group. Items with discriminative power (chi 2 > 25, p < 0.001 and endorsement by at least 25% of subjects) underwent principal-components analysis with somatic treatment and psychiatric factors identified. Items in the somatic treatment factor were extracted as the corrective factor. The resultant corrected T scores were plotted against original SCL 90-R profiles. SETTING: University medical centre. PATIENTS: Thirty community dwelling adults with biopsy confirmed malignant brain tumours referred by their treating physician for evaluation prior to aggressive treatment. INTERVENTIONS: The SCL 90-R was part of a neuropsychological test battery. MAIN OUTCOME MEASURE: The SCL 90-R was selected prior to data collection because it is the second most frequently used psychosocial instrument in medical settings, yet has demonstrated attenuated validity with neurologic patients. RESULTS: Extraction of 10 somatic treatment items resulted in lower profiles on Somatization, OBSESSIVE: Compulsive, Depression, and Anxiety dimensions and the global indicators. However, clinical caseness for individuals remained greater than indicated by clinical interview. CONCLUSION: Correction for SCL 90-R neurologic treatment items resulted in reduced sensitivity and poorer ecological validity.

Does the SCL 90-R obsessive-compulsive dimension identify cognitive impairments?

OBJECTIVE: To investigate the relevance of the Symptom Checklist 90-R Obsessive-Compulsive subscale to cognition in individuals with brain tumor. DESIGN: A prospective study of patients assessed with a neuropsychological test battery. SETTING: A university medical center. PATIENTS: Nineteen adults with biopsy-confirmed diagnoses of malignant brain tumors were assessed prior to aggressive chemotherapy. MAIN OUTCOME MEASURES: Included in the assessment were the Mattis Dementia Rating Scale, California Verbal Learning Test, Trail Making Test B, Symptom Checklist 90-R, Mood Assessment Scale, Beck Anxiety Inventory, and Chronic Illness Problem Inventory. RESULTS: The SCL 90-R Obsessive-Compulsive subscale was not related to objective measures of attention, verbal memory, or age. It was related significantly to symptoms of depression (r = .81, P < .005), anxiety (r = .66, P < .005), and subjective complaints of memory problems (r = .75, P < .005). Multivariate analyses indicated that reported symptoms of depression contributed 66% of the variance in predicting SCL 90-R Obsessive-Compulsive Scores, whereas symptoms of anxiety contributed an additional 6% (P < .0001). CONCLUSIONS: Our data suggest that the SCL 90-R is best viewed as an indicator of unidimensional emotional distress and somatic effects of structural brain injury.

Reducing loss-to-follow-up among women with abnormal Pap smears. Results from a randomized trial testing an intensive follow-up protocol and economic incentives.

OBJECTIVES: This study evaluates the efficacy of two interventions designed to reduce loss-to-follow-up among women with abnormal Pap smears. METHODS: The two interventions were evaluated in two large public hospitals using a randomized 2 x 2 factorial design. One intervention involved an intensive follow-up protocol that relied on multiple attempts (mail and telephone) to contact the patient. The second intervention provided patients with economic vouchers to offset out-of-pocket expenses associated with the follow-up visits. Loss-to-follow-up was addressed by medical chart reviews and telephone interviews. RESULTS: The study population (n = 1453) was primarily Hispanic, married or otherwise living with a significant other, relatively young in age, and with no source of payment for health care. Overall, 30% of the total sample was loss-to-follow-up (i.e., no return visits). Among patients assigned to the control condition, loss-to-follow-up was 36.1% compared with 27.8% for the intensive follow-up condition, 28.8% for the voucher condition, and 29.0% for the intensive follow-up plus voucher condition. Both intervention conditions significantly improved follow-up rates. The odds ratio for intensive follow-up was 1.56 compared with 1.50 for the voucher intervention. The combined intervention condition (intensive follow-up x voucher program) did not have a significant effect after taking into account the main effects of the two interventions. Correlates of loss-to-follow-up included age (younger women had lower return rates), race/ethnicity (African American women had lower return rates), live-in relationship (women who were not married or living as married had lower return rates), and severity of the abnormal Pap smear (less severe abnormalities were associated with lower return rates). CONCLUSIONS: Both interventions were associated with moderate reductions in loss-to-follow-up in this underserved population. The implications of these findings are discussed relative to implementing cervical cancer control programs within state and local health departments.

Interpretive risks: the use of the Hopkins Symptom Checklist 90-Revised (SCL 90-R) with brain tumour patients.

Patients with brain tumours often report distress. Interpretive problems ensue when measures normed on healthy persons are utilized to quantify distress. This study investigated potentially spurious elevations on the Hopkins Symptom Checklist 90 Revised (SCL 90-R). Responses of 17 patients were obtained prior to aggressive chemotherapy. Traditional interpretation indicated that 47% of the patients endorsed clinical levels of somatization, 53% obsessive-compulsive and 59% psychotic disorders. Elevations were attributable to common consequences of brain tumours, medication and the emotional reaction to prognosis. Conventional interpretation would lead to inappropriate classifications. The majority of SCL 90-R item endorsements were significantly different than those of the norm group. Appropriate interpretation of scores is discussed.

Isolation of a cDNA encoding an Arabidopsis galactokinase by functional expression in yeast.

A cDNA clone encoding Arabidopsis thaliana galactokinase was fortuitously isolated during the course of a screen for plant homologues of a Saccharomyces cerevisiae peroxisome assembly gene, PAS9. Clones were sought which restored the ability of pas9 cells to grow on oleate as a sole carbon source, as oleate metabolism requires peroxisomal beta-oxidation and therefore functional peroxisomes. Subsequent experiments showed that high level expression of the galactokinase cDNA did not complement the peroxisomal assembly defect, but instead permitted the cells to grow on agar plates in the absence of an external carbon source. Agar plates were shown to contain a small amount of galactose released from the agar as a result of autoclaving. The galactokinase clone was shown to be functional, as it could complement a S. cerevisiae galactokinase mutant. Galactokinase is a single copy gene in Arabidopsis, which has been designated AGK1, and is expressed in all the major organs of the plant.

Pseudotumour cerebri: risk for cognitive impairment?

Does increased intracranial pressure in patients with pseudotumour cerebri (PTC) result in cognitive impairments? The results of previous investigations have not clarified this question. It may be that there is a subgroup within those diagnosed with PTC that does experience cognitive decline with increased intracranial pressure. However, elevated intracranial pressure, headache, and emotional distress also can contribute to reduced cognitive performance and increased self-monitoring. As a result of the lack of clarity regarding the impact of PTC on cognition clinicians are left with no empirically derived practice guidelines. A case study demonstrates subjective complaints of concentration and memory deficits in a depressed patient with PTC whose neuropsychological stores (except Seashore Rhythm Test) were in the normal range.

Anxiety and depression in elderly patients receiving treatment for cerebral tumours.

Little is known regarding affect and the quality of life of elderly persons with malignant brain tumours. More elderly patients are currently being diagnosed with primary malignant CNS tumours and current, aggressive treatment has extended median life expectancy. This case study indicated significant levels of clinical depression and anxiety may be experienced. Additionally, trait anxiety was found to increase with tumour progression. The patient's concern regarding loss of conjugal closeness and social inactivity was identified for the first time in persons with malignant brain tumours. Being progressively less active physically, and more isolated emotionally, this patient used her relatively good general intellectual abilities to worry about her situation. At the present time integration into the community and distress over her ability to be assertive decreased. Practical barriers to the delivery of psychological services were encountered and are likely to have been under appreciated.