Comparison of intravenous versus intraperitoneal administration of oncolytic herpes simplex virus 1 for peritoneal carcinomatosis in mice.

hrR3 is an oncolytic herpes simplex virus 1 (HSV-1) mutant that replicates preferentially in tumors compared with normal tissues. Portal venous administration of hrR3 in mice bearing diffuse colorectal carcinoma liver metastases significantly reduces tumor burden and prolongs animal survival. In this study, we compared survival benefit and biodistribution of hrR3 following intravenous (i.v.) administration versus intraperitoneal (i.p.) administration in immunocompetent mice bearing colon carcinoma peritoneal metastases. Mice bearing peritoneal metastases received 1 x 10(8) plaque-forming units hrR3 or mock-infected media every other day for three doses and were randomized to have the viruses administered by either an i.p. or i.v. route. Biodistribution was assessed by PCR amplification of HSV-1-specific sequences from tumor and normal tissues including the small bowel, liver, spleen, kidney, lung, heart and brain. LD(50) for i.p. administration was compared with the LD(50) for i.v. administration. In subsequent experiments, animals were monitored for survival. The frequency of HSV-1 detection in peritoneal tumors was similar in mice randomized to either i.p. or i.v. administration. However, i.p. administration resulted in a more restricted systemic biodistribution, with a reduced frequency of virus detected in the kidney, lung and heart. The LD(50) associated with i.p. administration was higher than that with i.v. administration. Tumor burden was more effectively reduced with i.p. compared with i.v. administration. Median survival following i.p. administration was approximately twice that observed with i.v. administration. I.p. administration of an HSV-1 oncolytic mutant is associated with a more restricted biodistribution, less toxicity and greater efficacy against peritoneal metastases compared with i.v. administration.

Group psychotherapy for victims of incest.

Group psychotherapy is a recommended part of treatment for victims of incest--male and female--in childhood or adulthood. Self-help groups, treatment groups, individual treatment, family therapy, and other modalities may be used concurrently or sequentially. Special techniques include art therapy, play therapy, psychodrama, bibliotherapy, wilderness encounters, and educational techniques.

Changing treatment of breast cancer in New Mexico from 1969 through 1985.

A review of information from the New Mexico Tumor Registry on women diagnosed as having primary breast cancer from 1969 through 1985 revealed temporal changes in the surgical treatment of this disease. After 1980 the percentage of women receiving breast-conserving surgery for local-stage disease increased from 6% to 25%. Most surgeons performing operations for breast cancer had not performed a breast-conserving operation before 1981 but had used this procedure at least once in the period from 1981 through 1985. Women younger than 50 years or older than 80 years were most likely to undergo this procedure. In that period, radiotherapy after breast-conserving surgery could not be documented for 26% of the women 65 years old or younger or for 56% of the women aged 65 years or older. Thus, there has been a marked shift in New Mexico in the surgical approach to local-stage breast cancer in the 1980s. This shift involved most surgeons treating the disease and included women of all age groups. The apparent lack of adjuvant radiotherapy in some women receiving conservative surgeries may prove to be a deleterious consequence of this change in surgical management.

Alcohol intake in a healthy elderly population.

The relationship between amount of alcohol consumption and social, psychological, and cognitive status was examined in 270 healthy, independently living men and women over age 65. Forty-eight per cent of the sample recorded some alcohol intake during a three-day diet record, with 8 per cent drinking 30 or more grams of alcohol daily. Alcohol intake was positively associated with male gender, income, and amount of education and negatively associated with age. Alcohol intake was not associated with any changes in social or psychological status, but was positively associated with several measurements of cognitive status. These correlations were weak, however, and tended to disappear after controlling for income, education, gender, and age. Past alcohol intake was not associated with any indicators of present social, psychological, or cognitive functioning.

Effect of social support on stress-related changes in cholesterol level, uric acid level, and immune function in an elderly sample.

Strong social support systems, which in epidemiologic studies are associated with decreased morbidity and mortality, have been hypothesized to mitigate the harmful effects of stressful stimuli on the individual. The authors found that, among 256 healthy elderly adults, individuals with good social support systems tended to have lower serum cholesterol and uric acid levels and higher indices of immune function; these correlations were independent of age, body mass, tobacco use, alcohol intake, and degree of perceived psychological distress. Thus, social support systems may intervene between the stressful stimulus and the physiologic response to that stimulus.

Social bonds in a healthy elderly sample: characteristics and associated variables.

Social bonds were examined in 256 healthy, independent-living elderly men and women using the Interview Schedule for Social Interaction (ISSI). Multivariate techniques were used to test for relationships between six dimensions of social bonds, as measured by the ISSI, and demographic characteristics as well as scores from the Kellner-Sheffield Symptom Questionnaire, the Jacobs Cognitive Screening Exam, the Halstead Category Test and the Wechsler Memory Scale. The study participants reported involvement in a range of satisfying, supportive, interpersonal relationships. Significant associations were found between social bonds and income, marital status, work status and health status. Emotional status, cognitive functioning, and memory were found to be independent of social bonds in our statistical model.

The relationship between dietary intake of choline, choline serum levels, and cognitive function in healthy elderly persons.

This study was designed to obtain information on normal dietary intake and serum levels of choline in a healthy elderly population and to observe the relationship between blood levels of choline and cognitive function. Two hundred fifty-eight healthy volunteers with a mean age of 72 years were recruited, and blood samples and dietary histories were obtained. All subjects were ambulatory, living at home, free of serious medical illnesses, and taking no prescription medications. Cognitive abilities were assessed by the Halstead Category Test, a nonverbal test measuring abstract thinking, and the Wechsler Memory Scale, using the multiple scoring method, which measures both long- and short-term memory. The mean value for serum choline was 13.16 micron with a standard deviation of 3.31. Serum choline levels were found to increase with age, but no difference was found between serum choline levels for men and women. There was no association between dietary intake and serum choline levels, nor could a relationship be found between serum choline levels and cognitive function.

Association between nutritional status and cognitive functioning in a healthy elderly population.

We evaluated the association between nutritional status and cognitive functioning in 260 noninstitutionalized men and women older than 60 years who had no known physical illnesses and were receiving no medications. Nutritional status was evaluated by three-day food records and also by biochemical determination of blood levels of specific nutrients. Cognitive status was evaluated by the Halstead-Reitan Categories Test (a nonverbal test of abstract thinking ability) and by the Wechsler Memory Test. Subjects with low blood levels of vitamins C or B12 scored worse on both tests. Subjects with low levels of riboflavin or folic acid scored worse on the categories test. These differences remained significant after controlling for age, gender, level of income, and amount of education. "Subclinical" malnutrition may play a small role in the depression of cognitive function detectable in some elderly individuals, or depressed cognitive function may result in reduced nutrient intake.

Hearing acuity in a healthy elderly population: effects on emotional, cognitive, and social status.

Hearing acuity and the relationships between untreated hearing deficits and emotional state, cognitive functioning, and social integration were examined in 239 physically healthy, independent-living elderly men and women with a mean age of 72 years. Air-conduction, pure-tone thresholds in both ears were determined at high- and mid-frequencies, and participants were also given the Speech Perception in Noise test. Multivariate techniques were used to test for associations between hearing acuity and scores from the Kellner-Sheffield Symptom Questionnaire, the Jacobs Cognitive Screening Exam, the Halstead Category Test, the Wechsler Memory Scale, and the Interview Schedule for Social Interaction. No deleterious effects of untreated hearing deficits on emotional status or social integration were found. The findings suggest that those with a hearing loss perform less well on verbal but not on nonverbal tests of cognition.

Patient characteristics that influence physician behavior.

We examined whether four patient characteristics (age, ethnicity, sex and appearance) influenced five physician behaviors with the patient (interviewing, nonverbal attention, courtesy, information giving and empathy). Ten physician-patient interactions were observed through a one-way mirror for each of 15 physicians. Physicians were rated higher on information giving (p = 0.002) and empathic skills (p = 0.02) when they were with female patients; on interviewing (p = 0.02) and empathy (p = 0.0007) with Anglo-American compared with Spanish-American patients; on interviewing (p = 0.01), nonverbal attention (p = 0.001) and courtesy (p = 0.02) when with the best groomed patients; and on courtesy (p = 0.03) with elderly patients. In addition, there were fewer physician-initiated interruptions with female patients (p = 0.03) and with well-groomed patients (p = 0.02). Each of the four patient characteristics studied acted independently in influencing physician behavior. The recognition that patient characteristics influence physician behavior should stimulate physicians to examine their reactions in order to insure that all types of patients receive thorough, courteous and empathic care.

Physician behaviors that correlate with patient satisfaction.

The behavior of 15 internal medicine residents, each with 10 patients, was observed through a one-way mirror. Ratings by the patients of satisfaction with their physicians were also obtained. Patient satisfaction correlated strongly with ratings for physician courtesy and information-giving, Nonverbal behaviors such as eye contact, bodily positioning, and physical contact did not correlate with patient satisfaction. The correlations between physician behavior and patient satisfaction did not hold for the four women physicians studied.

PIP: The behavior of 15 internal medicine residents at the University of New Mexico Hospital, each with 10 patients, was observed through a 1-way mirror and the 150 patients rated their satisfaction with their physician. The mean ratings of patient satisfaction were between 6 and 7 on a 7-point scale. Satisfaction ratings did not vary significantly between male or female patients or between Hispanics and Anglos, although patients under 40 years of age tended to provide lower ratings than those over this age. Patient satisfaction correlated highly with physician courtesy (formal greeting and formal closure of the interview) and with information giving. Listening behavior also correlated with patient satisfaction. Physician empathy correlated only weakly with patient satisfaction, while physical attention (eye contact and body positioning) did not correlate at all with this factor. Additional factors that were not significant determinants of patient satisfaction in this study included the physical appearance of the physician, the total time of physician-patient interaction, and the amount of physical contact between patient and physician. There were no significant differences between male and female physicians in the mean ratings of caring behaviors or satisfaction. The satisfaction scores of male patients with female physicians were the same as patients of either sex with male physicians; however, female patients expressed greater satisfaction with their female physicians than did male patients with female physicians or female patients with male physicians. This study confirms the findings of earlier investigators that patient satisfaction is beneficially influenced by friendliness and information provision on the part of the physician.

The therapeutics of placebo.

The use of placebo is not old-fashioned, ineffective or unethical. It requires an ongoing, trusting relationship between the physician and the patient. Deception of the patient and self-deception must be avoided. Under these conditions, there are specific situations in which placebo is the treatment of choice.