Identifying substance misuse in primary care: TAPS Tool compared to the WHO ASSIST.

BACKGROUND: There is a need for screening and brief assessment instruments to identify primary care patients with substance use problems. This study's aim was to examine the performance of a two-step screening and brief assessment instrument, the TAPS Tool, compared to the WHO ASSIST. METHODS: Two thousand adult primary care patients recruited from five primary care clinics in four Eastern US states completed the TAPS Tool followed by the ASSIST. The ability of the TAPS Tool to identify moderate- and high-risk use scores on the ASSIST was examined using sensitivity and specificity analyses. RESULTS: The interviewer and self-administered computer tablet versions of the TAPS Tool generated similar results. The interviewer-administered version (at cut-off of 2), had acceptable sensitivity and specificity for high-risk tobacco (0.90 and 0.77) and alcohol (0.87 and 0.80) use. For illicit drugs, sensitivities were >0.82 and specificities >0.92. The TAPS (at a cut-off of 1) had good sensitivity and specificity for moderate-risk tobacco use (0.83 and 0.97) and alcohol (0.83 and 0.74). Among illicit drugs, sensitivity was acceptable for moderate-risk of marijuana (0.71), while it was low for all other illicit drugs and non-medical use of prescription medications. Specificities were 0.97 or higher for all illicit drugs and prescription medications. CONCLUSIONS: The TAPS Tool identified adult primary care patients with high-risk ASSIST scores for all substances as well moderate-risk users of tobacco, alcohol, and marijuana, although it did not perform well in identifying patients with moderate-risk use of other drugs or non-medical use of prescription medications. The advantages of the TAPS Tool over the ASSIST are its more limited number of items and focus solely on substance use in the past 3months.

Red meat and colorectal cancer: a critical summary of prospective epidemiologic studies.

Meat consumption and cancer has been evaluated in hundreds of epidemiologic studies over the past three decades; however, the possible role of this food group on carcinogenesis is equivocal. In this comprehensive review, the currently available epidemiologic prospective studies of red meat intake and colorectal cancer are summarized to provide a greater understanding of any potential relationships. Specifically, salient demographic, methodological and analytical information is synthesized across 35 prospective studies. Collectively, associations between red meat consumption and colorectal cancer are generally weak in magnitude, with most relative risks below 1.50 and not statistically significant, and there is a lack of a clear dose-response trend. Results are variable by anatomic tumour site (colon vs. rectum) and by gender, as the epidemiologic data are not indicative of a positive association among women while most associations are weakly elevated among men. Colinearity between red meat intake and other dietary factors (e.g. Western lifestyle, high intake of refined sugars and alcohol, low intake of fruits, vegetables and fibre) and behavioural factors (e.g. low physical activity, high smoking prevalence, high body mass index) limit the ability to analytically isolate the independent effects of red meat consumption. Because of these factors, the currently available epidemiologic evidence is not sufficient to support an independent positive association between red meat consumption and colorectal cancer.

A pilot study of oral bioavailability of dioxins and furans from contaminated soils: Impact of differential hepatic enzyme activity and species differences.

An in vivo pilot study of the oral bioavailability of polychlorinated dibenzo-p-dioxins (PCDDs) and polychlorinated dibenzofurans (PCDFs) in two soils with distinct congener profiles (one dominated by PCDDs, the other by PCDFs) was conducted in rats and juvenile swine. The pilot study revealed potential confounding of relative bioavailability estimates compared to bioavailability in spiked corn oil gavage for tetrachlorodibenzofuran (TCDF) in the rat study due to differential EROD induction between groups receiving soil and those receiving spiked control PCDDs/PCDFs. A follow-up study in rats with the furan-contaminated soil was then conducted with reductions in the spiked control doses to 20%, 50% and 80% of the soil-feed dose in order to bracket hepatic enzyme induction levels in the soil group. When hepatic enzyme induction was matched between the soil and spiked control groups, the apparent relative bioavailability for TCDF was reduced significantly. Overall, after controlling for hepatic enzyme induction, estimates of relative bioavailability in rats and swine differed for the two soils. In the rat study, the relative bioavailability of the two soils were approximately 37% and 60% compared to corn oil administration for the PCDD- and PCDF- dominated soils, respectively, on a TEQ basis. In swine, both soils demonstrated relative bioavailability between 20% and 25% compared to administration in corn oil. These species differences and experimental design issues, such as controlling for differential enzyme induction between corn oil and soil-feed animals in a bioavailability study, are relevant to risk assessment efforts where relative bioavailability inputs are important for theoretical exposure and risk characterization.

A neglected lesbian health concern: cervical neoplasia.

Many health care providers believe that lesbian women do not need routine Papanicolaou smears. This erroneous assumption fails to recognize that the majority of lesbian women have had prior heterosexual relationships and thus may be at risk for developing cervical neoplasia. The following case report describes a lesbian woman who denied prior heterosexual intercourse but who developed cervical intraepithelial neoplasia grade 2 (CIN 2) associated with a high oncogenic risk human papillomavirus (HPV) type. Sexual contact with multiple lesbian partners who had previous heterosexual relationships likely explains her cervical disease.

Anatomical urinary stress incontinence in women with rheumatoid arthritis: its frequency and coping strategies.

OBJECTIVE: The objectives of this study were to develop a valid screening tool for anatomical urinary stress incontinence (AUSI), to use it to determine the frequency of AUSI in women with RA, and to identify the cognitive, behavioral, and psychological coping strategies used by these women to deal with incontinence. METHODS: A screening tool concerning AUSI was validated by comparing self-reported incidences of AUSI with clinical evaluation. Questionnaires regarding presence of AUSI and cognitive, behavioral, and psychological coping strategies were sent to 750 women clinically diagnosed with RA. RESULTS: Of the 262 respondents (35% response rate), 21% had characteristics of AUSI, a rate similar to general population studies. Coping strategies varied depending on whether the women were at home or away from home and whether the women were alone or with others. CONCLUSIONS: There is a need for women with incontinence and the health care workers who serve them to be educated about AUSI and its treatments.

Interactions of estrogen-receptor and antiestrogen-receptor complexes with nuclei in vitro.

Interactions of the estrogen-receptor complex (ER) with nuclei in vitro were shown to be dose, time, temperature, and tissue dependent. Specificity was demonstrated by the ability of ER charged with unlabeled 17 beta-estradiol to compete with [3H]ER for the nuclear acceptor sites. The ionic environment affected [3H]ER nuclear interactions; [3H]ER binding varied inversely with ionic strength, and apparent nuclear saturation was observed in the presence of 0.1 M KCl. Nuclear interactions of estrogen receptor charged with 17 beta-estradiol (ER) or monohydroxytamoxifen (AER) were compared. While both ER and AER (nonradiolabeled) were efficient competitors for [3H]ER nuclear binding, differences were observed when 3H-labeled ligands were used for saturation analysis of the nuclear acceptor sites. Scatchard analysis of the data revealed similar apparent Kd values for [3H]ER and [3H]AER binding to the nuclear sites (mean +/- SD, 1.2 +/- 0.5 X 10(-9) and 2.6 +/- 0.2 X 10(-9) M, respectively). However, the relative number of nuclear binding events consistently differed, with 28,000 +/- 7,300 sites/nucleus (mean +/- SD) for ER vs. 17,800 +/- 6,300 sites/nucleus for AER. Treatment of nuclei with 0-300 unit-min/ml DNAase I before incubation with receptor complexes resulted in a parallel percent decrease in the number of ER and AER nuclear binding sites. Saturation analysis performed with nuclei previously digested with 0-30 unit-min/ml DNAase I demonstrated that the apparent affinities of the receptor complexes for nuclear sites remained unchanged. Therefore, we suggest that both AER and ER bind to acceptor sites in the small portion of the chromatin hypersensitive to DNase I, but that fewer AER than ER can bind at least some of the ER nuclear acceptor sites. The lower binding capacity for AER may result in a pattern of gene expression that produces the agonist/antagonist effects observed with antiestrogens.

Periphyton: autoradiography of zinc-65 adsorption.

The major site of sorption of zinc-65 in natural, matlike periphyton is on the upper surface of the community. There is a diffusion gradient within the community. Expression of results from short-term spiking experiments should thus be presented on an areal rather than gravimetric basis.