Relationship between readiness for and processes of change in a sample of alcohol dependent males.

Previous research (Isenhart, 1997) has shown a relationship between pre-treatment stages of change and outcome. The objective of this project was to evaluate whether certain processes of change measures predicted stages of change measures. A stepwise multiple regression model used Contemplation, Determination, and Action scores as dependent variables and process of change scores and measures of alcohol dependence severity and pre-treatment alcohol consumption as independent variables. The only process of change scale consistently correlated with the Contemplation, Determination, and Action scales was Self-reevaluation. Self-reevaluation was negatively correlated with Contemplation and positively correlated with Determination and Action. These results suggest that as patients become more discouraged and frustrated with their alcohol use, they experience less ambivalence, are more likely to acknowledge that a problem exists, and are more willing to take action to address that problem. Implications and limitations of these findings are provided and inconsistencies between previous studies and these results are discussed.

Pretreatment readiness for change in male alcohol dependent subjects: predictors of one-year follow-up status.

OBJECTIVE: The objective of this study was to test a model using pretreatment readiness for change scores (Contemplation, Determination and Action) to predict 1-year alcohol use and recovery activities (AA affiliation and having a sponsor). METHODS: Subjects were 125 middle-aged, mostly white, high school educated, mostly unemployed, male patients who met DSM-III-R criteria for alcohol dependence. The patients participated in a 21-day, Minnesota model, inpatient treatment program. Pretreatment readiness for change was assessed using a modified version of the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES). The prediction model also included four pretreatment variables: DSM-III-R criteria, alcohol consumption, AA affiliation and presence of a sponsor. Logistic regression procedures were used to test the model. RESULTS: High Action scores (and not having a sponsor at pretreatment) were predictive of no reported alcohol use at any time during the 1-year posttreatment period. High Determination scores (and low DSM-III-R criteria scores) were predictive of reported affiliation with AA. Having a sponsor at pretreatment and low Contemplation scores were predictive of reports having a sponsor at follow-up. There were no relationships between the pretreatment readiness for change measures and the actual quantity and frequency of alcohol consumed. There were indications that at follow-up those patients who affiliated with AA or had a sponsor consumed less alcohol than those patients who did not affiliate with AA or have a sponsor. CONCLUSIONS: These results demonstrated a relationship between pretreatment readiness for change and both the decision to drink and to engage in recovery activities; however, it appeared that, once drinking begins, variables other than pretreatment readiness for change influence frequency and quantity of alcohol consumption.

On the role of platelet Fc gamma RIIa phenotype in heparin-induced thrombocytopenia.

Heparin induced thrombocytopenia (HIT) is characterized by the formation of antibodies that activate normal donor platelets in vitro in the presence of heparin. We asked whether the commonly observed donor-specific variation in the platelet aggregation response to HIT antibodies is influenced by the density of Fc gamma RII on platelets or by the Arg/His 131 allelic polymorphism of platelet Fc gamma RII. We found that platelets with His/His 131 Fc gamma RII phenotype were unresponsive to HIT antibody (0/9) whereas platelets with the Arg/Arg 131 phenotype responded well (7/9). His/His 131 platelets were largely unresponsive also to a murine IgG1 antiplatelet monoclonal antibody (UR1) known to activate platelets by Fc gamma RII clustering. We then determined the frequency distribution of Fc gamma RIIa Arg/His 131 phenotypes on a series of 200 patients evaluated for HIT and 100 non-thrombocytopenic hospitalized patients. The frequency of the His/His 131 phenotype was significantly increased (34.4%) in the 96 thrombocytopenic patients with HIT antibody compared to the 104 thrombocytopenic patients without HIT antibody and the 100 non-thrombocytopenic patients (approximately 19%). Thus, the Fc gamma RII phenotype regulates the in vitro activation response of normal platelets to HIT antibody and is a risk factor for the thrombocytopenia of HIT.

Efficacy of smoking cessation strategies in a treatment program.

Efficacy of a total smoking ban on an inpatient drug and alcohol rehab program was assessed by urine cotinine levels and indicated a continued smoking rate of 70%. In spite of these results, however, some staff were concerned that removal of the smoking ban would lead to a dramatic increase in patients' smoking. However, other staff were concerned over the apparent dishonesty undermining the objectives of the program. Therefore, a change in policy was initiated. Under this new approach, where smoking was no longer punished, cotinine levels were 60% positive. Although this was not a statistically significant reduction, it was clinically significant. Patients were openly encouraged to discuss their smoking, and therapies were designed to match patients' level of motivation. A significant reduction in number of cigarettes smoked (mean = 26 pretreatment, mean = 17 posttreatment; p < 0.01), increased interest to stop smoking (on a linear scale from 1 to 5, mean = 1.86 pretreatment and mean = 2.61 posttreatment; p < 0.01), and increased patient satisfaction was noted in a subsequent sample. Nonprohibitive counseling approaches were just as effective as prohibition of smoking. Change in smoking behavior and motivation were demonstrable with programming that emphasized behavior change and motivational counseling. Relationships between nicotine dependence, depression and other substance use disorders are discussed.

Motivational subtypes in an inpatient sample of substance abusers.

Motivational subgroups in a sample of inpatient substance abusers were identified to facilitate future development of treatment interventions aimed at enhancing compliance and involvement. The modified Stages of Change Readiness and Treatment Eagerness Scales from 165 subjects were subject to factor and cluster analyses. Results suggest the instrument assesses three dimensions: determination, action, and contemplation. Using these dimensions, three subgroups were identified: Uninvolved, Ambivalent, and Active. There were no differences on demographic or background variables or Minnesota Multiphasic Personality Inventory 2 (MMPI-2) profiles. The Uninvolved group scored significantly lower than the other two groups on measures of alcohol use and abuse. The Ambivalent and Active groups did not differ on any of the measures of alcohol use and abuse. The Ambivalent group demonstrated a high level of conflict and inaction. The Active group appeared to be aware of their dependence and were ready to change their behavior. The results have implications for treatment matching and enhancing treatment motivation.

Identification of occult micrometastases in pericolic lymph nodes of Duke's B colorectal cancer patients using monoclonal antibodies against cytokeratin and CC49. Correlation with long-term survival.

BACKGROUND: Patients with transmurally invasive, lymph node negative colorectal carcinoma (Dukes' B) have a 5-year survival rate ranging from 53.9% to 84.9%. The authors postulate that patients with Dukes' B colon cancer who die of their disease have occult micrometastases in their pericolic lymph nodes at the time of original diagnosis. In an attempt to identify these occult micrometastases, pericolic lymph nodes from Dukes' B colon cancer resections were stained retrospectively with antibodies against cytokeratin (anti-keratin AE1/AE3, Boehringer Mannheim, Indianapolis, IN) and CC49 (a second-generation monoclonal antibody directed against TAG-72. METHODS: The authors reviewed all Dukes' B (transmurally invasive, lymph node negative) primary colorectal carcinoma resection specimens from the surgical pathology files of the Ohio State University Hospitals between 1984 and 1987. Survival data were obtained from the Tumor Registry of the Arthur G. James Cancer Hospital and Research Institute, Columbus, Ohio. The results were analyzed by univariate and multivariate analysis. RESULTS: Fifty cases with 568 lymph nodes (11.3 per case) were examined with each antibody using standard immunoperoxidase techniques. Positive staining for cytokeratin was seen in 14 patients (33 lymph nodes), 6 of whom died of colon cancer within 66 months (43%). Only 1 of the 36 patients with cytokeratin-negative lymph nodes died of colon cancer over the same time period (3%, P = 0.0009 univariate, P = 0.0013 multivariate). There was no significant difference in survival between the CC49-positive and CC49-negative groups. CONCLUSION: Immunoperoxidase techniques are capable of identifying micrometastatic disease in lymph nodes missed by routine hematoxylin and eosin staining. Further, the presence of cytokeratin-positive cells within lymph nodes correlated with a significantly poorer prognosis. Therefore, cytokeratin staining of pericolic lymph nodes in patients with Dukes' B colorectal cancer is recommended. Larger multicenter studies are needed, however, to confirm these results and to evaluate the appropriateness of adjuvant chemotherapy in patients whose disease is upstaged by immunohistochemical staining.

Psychometric evaluation of a short form of the inventory of drinking situations.

The Inventory of Drinking Situations (IDS) was developed to assess the likelihood of alcoholic relapse in eight high-risk situations. Previous research questioned the factor stability of the instrument; therefore, an alternative, short form of the IDS (IDS42) was developed and subjected to preliminary examination. This project reports on the further examination of the psychometric characteristics of the IDS42. The instrument's primary factor stability and higher-order factor structure were examined, and subscale means, standard deviations, alpha coefficients, interscale correlations and independence (unique variance) were determined. Also, the relationships between the IDS42 subscale scores and alcohol dependence, social desirability and demographic characteristics were explored. Results of the principal components analysis support the instrument's primary factor stability and indicate that the scales load onto one higher order dimension. The subscale internal consistency estimates were very high. Significantly high positive correlations were found between the IDS42 subscales and alcohol dependence. The IDS42 is influenced by a socially desirable response set that may result in spuriously low IDS42 scale elevations. The subscales initially demonstrated high interscale correlations; however, estimates of unique variance show that the IDS42 scales have an acceptable level of independence. Except for a significant negative correlation with age for three subscales, demographic characteristics do not appear to influence IDS42 results. These findings support the use of the IDS42 in assessing the extent to which heavy alcohol use has occurred in five situations. With this information, it may be possible to prepare to avoid or cope with these situations in the future and, consequently, to reduce the potential for relapse.(ABSTRACT TRUNCATED AT 250 WORDS)

Platelet aggregation studies for the diagnosis of heparin-induced thrombocytopenia.

Heparin-induced thrombocytopenia (HIT) is a serious clinical disorder characterized by the sudden onset of thrombocytopenia and is often associated with paradoxic thrombosis in patients receiving heparin. The diagnosis of HIT has been hampered by problems with the laboratory methods used to establish the diagnosis. The authors evaluated the role of the source of heparin and donor platelets on the results of an ex vivo platelet aggregation assay for the diagnosis of HIT. Bovine lung and porcine mucosal heparins were equally effective at mediating ex vivo platelet aggregation induced by 17 of 17 known HIT-positive plasma samples. Plasma from 11 patients with a history of thrombocytopenia, exposure to heparin, and previously negative aggregation assays remained negative with both heparins on repeat testing. High concentrations of either heparin inhibited the aggregation response of normal platelets to HIT-positive samples but also inhibited the aggregation response of normal platelets to adenosine diphosphate (ADP) and collagen. Thus the inhibitory effect of high heparin concentrations was not specific for HIT. Platelets from different donors varied in their response to HIT-positive plasma and heparin; three donors were identified whose platelets did not respond to any HIT-positive plasma. The rest of the donors' platelets responded to HIT-positive plasma but varied in the degree of aggregation. These findings indicate that the source of heparin used for ex vivo assays does not affect the assay results but that selection of donors does have a significant impact on the outcome. Under appropriate conditions, platelet aggregation appears to be a sensitive and specific assay for the diagnosis of HIT.

Factor structure of the Inventory of Drinking Situations.

The Inventory of Drinking Situations (IDS; Annis, 1982) was developed to help identify situations in which a person may return to alcohol use after a period of abstinence. In this project, the IDS protocols of 543 male veterans were subject to factor analytic techniques to assess the factorial validity of the instrument. The results suggest that it is premature to assume the IDS items can be subsumed into eight high-risk categories. There is strong evidence that the IDS assesses three categories of high-risk situations, and some suggestion that two additional situations also may be assessed. Additional reliability and validity studies using a variety of populations are encouraged.