Comparative outcomes among the problem areas of interpersonal psychotherapy for depression.

BACKGROUND: Although interpersonal psychotherapy (IPT) is an efficacious treatment for acute depression, the relative efficacy of treatment in each of the four IPT problem areas (grief, role transitions, role disputes, interpersonal deficits) has received little attention. We evaluated the specificity of IPT by comparing treatment success among patients whose psychotherapy focused on each problem area. Moreover, we sought to understand how the patient characteristics and interpersonal problems most closely linked to the onset of a patient's current depression contributed to IPT success. METHODS: Patients meeting DSM-IV criteria for an episode of major depressive disorder (n=182) were treated with weekly IPT. Remission was defined as an average Hamilton Rating Scale for Depression 17-item score of 7 or below over 3 weeks. Personality disorders were diagnosed using the Structured Clinical Interview for DSM-IV Personality Disorders. RESULTS: Contrary to our prediction that patients whose treatment was focused on interpersonal deficits would take longer to remit, survival analyses indicated that patients receiving treatment focused on each of the four problem areas did not differ in their times to remission. Nor were patients in the interpersonal deficits group more likely to have an Axis II diagnosis. Patients whose treatment focused on role transitions remitted faster than those whose treatment focused on role disputes, after controlling for covariates. CONCLUSION: With skillful use of IPT strategies and tactics and with careful medication management where appropriate, patients in this study whose treatment focused on each problem area were treated with equal success by trained IPT clinicians.

Association of childhood and adolescent anthropometric factors, physical activity, and diet with adult mammographic breast density.

Early-life exposures may influence the development of breast cancer. The authors examined the association of childhood and adolescent anthropometric factors, physical activity levels, and diet with adult mammographic breast density, a strong risk factor for breast cancer. Women in the Minnesota Breast Cancer Family Study cohort who had undergone mammograms but had not had breast cancer (n=1,893) formed the sample. Information on adolescent exposures, including relative height, weight, and physical activity at ages 7, 12, and 18 years and diet at age 12-13 years, was self-reported during two follow-up studies (1990-2003). Mammographic percent density was estimated using a computer-assisted thresholding program. Statistical analyses were performed using linear mixed-effects models with two-sided tests. Positive associations with height at ages 7 (p<0.001), 12 (p<0.001), and 18 (p<0.001) years and percent density were evident overall and within menopausal status categories. The minimum difference in percent density between the tallest and shortest girls was 3 percent, with a maximum of 7 percent. Weight at age 12 years (p=0.005) and adiposity at age 12 years (p=0.005) were both inversely associated with adult percent density. Adolescent physical activity and diet were unrelated to percent density. These results suggest that adolescent height, a known risk factor for breast cancer, is also associated with mammographic percent density.

Gabapentin in bipolar disorder: a placebo-controlled trial of adjunctive therapy. Gabapentin Bipolar Disorder Study Group.

OBJECTIVES: [corrected] To assess efficacy and safety of gabapentin in the treatment of bipolar disorder. METHODS: This was a double-blind, placebo-controlled trial of adjunctive gabapentin (dosed flexibly between 900 and 3,600 mg/day). Patients with a lifetime diagnosis of bipolar disorder (type I), and who were currently suffering from symptoms of either mania, hypomania or a mixed state despite ongoing therapy with lithium, valproate, or lithium and valproate in combination were eligible for inclusion. The primary efficacy measures were the baseline to endpoint change in total score on the Young Mania Rating Scale (YMRS) and the Hamilton Depression Rating Scale (HAM-D). RESULTS: Both treatment groups had a decrease in total YMRS from baseline to endpoint, but this decrease was significantly greater in the placebo group (-9) than the gabapentin group (-6) (p < 0.05). No difference between treatments was found for the total score on the HAM-D. Secondary efficacy measures were not different between treatment groups. More patients in the placebo group had changes made to their ongoing lithium therapy (n = 12) compared to the gabapentin group (n = 4). When these patients are removed from the efficacy analysis, the YMRS treatment difference still favors placebo, but is no longer statistically significant. Based on gabapentin plasma levels at termination, some patients did not take the study drug as prescribed. CONCLUSIONS: The findings of this study did not demonstrate that gabapentin is an effective adjunctive treatment when administered to outpatients with bipolar disorder.

Treatment of social phobia with gabapentin: a placebo-controlled study.

A randomized, double-blind, placebo-controlled, parallel-group study was conducted to evaluate the efficacy and safety of gabapentin in relieving the symptoms of social phobia. Sixty-nine patients were randomly assigned to receive double-blind treatment with either gabapentin (dosed flexibly between 900 and 3,600 mg daily in three divided doses) or placebo for 14 weeks. A significant reduction (p < 0.05) in the symptoms of social phobia was observed among patients on gabapentin compared with those on placebo as evaluated by clinician- and patient-rated scales. Results were similar for the intent-to-treat and week-2 completer populations. Adverse events were consistent with the known side effect profile of gabapentin. Dizziness (p = 0.05), dry mouth (p = 0.05), somnolence, nausea, flatulence, and decreased libido occurred at a higher frequency among patients receiving gabapentin than among those receiving placebo. No serious adverse events or deaths were reported. On the basis of these limited data, it seems that gabapentin offers a favorable risk-benefit ratio for the treatment of patients with social phobia. Further studies are required to confirm this effect and to determine whether a dose-response relationship exists.

Interpregnancy weight retention patterning in women who breastfed.

This study compares weight change in lactating women with an 18-month interpregnancy interval with woman who also breastfed but did not have an immediate subsequent pregnancy. Cases were women who breastfed an index infant for 6 months and subsequently became pregnant within 18 months (cases = 25), and the controls also breastfed an index infant for 6 months but had no ensuing pregnancy (controls = 20) within 18 months. The pattern of postpartum weight retention following the initial pregnancy was not statistically different in cases compared to the controls. However, following their ensuing subsequent pregnancy, cases were 1.3 kg heavier than their average weight after their baseline pregnancy (P = 0.02). The best predictor of this greater weight was their weight change during the interpregnancy interval (P = 0.03). Total weight gain during the gestational period of the subsequent pregnancy was not associated with the greater weight following the subsequent pregnancy. Likewise, estimates of the amount of energy as calories or physical activity levels were not significant predictors of this greater weight following the subsequent pregnancy. These findings suggest that monitoring of postpartum weight, even in breastfeeding women, is essential. These findings indicate that breastfeeding women begin the next postpartum interval weighing more than the amount observed in the initial postpartum period.

Role of calciotrophic hormones in calcium mobilization of lactation.

The postpartum period can be a time when profound changes in calcium metabolism and bone mineral density (BMD) occur, particularly in association with lactation. We investigated the hypothesis that calciotrophic hormones [1,25-dihydroxyvitamin D, 25-hydroxyvitamin D, and parathyroid hormone (PTH)] are different by lactation practice or hormone status [PTH-related peptide (PTHrP), estradiol, and prolactin] and have a potential role in the bone loss and recovery associated with lactation. 1,25-Dihydroxyvitamin D, 25-hydroxyvitamin D, PTH, femoral BMD, PTHrP, prolactin, estradiol, and bone turnover markers were measured at 2 wk and at 2, 4, 6, 12, and 18 mo postparturition in 115 postpartum women aged 20-40 y (parity: 0-1). Lumbar spine BMD was measured at 2 wk and at 6, 12, and 18 mo during the postpartum period. PTH, 1,25-dihydroxyvitamin D, and 25-hydroxyvitamin D concentrations were nonlinear across the 18-mo postpartum period. Between baseline and 18 mo postparturition, PTH and 1,25-dihydroxyvitamin D concentrations did not decline, while there was a substantial decline in 25-hydroxyvitamin D concentrations. PTH, 1,25-dihydroxyvitamin D, and 25-hydroxyvitamin D concentrations did not differ by lactation practice or by PTHrP, estradiol, or prolactin status. These classic calciotrophic hormones were not associated with concentrations of bone turnover markers or changes in BMD in lactating women. In summary, patterns of change in calciotrophic hormones (PTH, 1,25-dihydroxyvitamin D, and 25-hydroxyvitamin D) in the 18-mo postpartum period appeared to be independent of PTHrP, estradiol, prolactin, or lactation status and were not associated with bone turnover markers. These data do not support the hypothesis that these three calciotrophic hormones are a central part of the calcium mobilization associated with the bone loss of lactation.

Lactation and weight retention.

The effect of lactation on weight retention was investigated longitudinally, with data collected at 0.5, 2, 4, 6, 12, and 18 mo after parturition in 110 women aged 20-40 y who had been nulliparous or primiparous. At each evaluation women were categorized as fully breast-feeding, partly breast-feeding, or bottle-feeding including infants weaned to a bottle (bottle feeding/weaned). Postpartum weight retention was calculated by subtracting weight before pregnancy from weight at each evaluation. Lactation practices were found to be significantly associated (P < 0.05) with postpartum weight retention by longitudinal regression analysis. Women who bottle-fed their infants retained more weight over time than women who breast-fed their infants. Significantly slower rates of weight loss were observed when women ceased breast-feeding or switched from fully to partly breast-feeding. Weight retention over time was greater in women who were older, unmarried, or had greater weight gain during pregnancy (P < 0.05). A pattern of weight gain rather than weight loss was observed in unmarried women. Our findings suggest that lactation influences the pattern of postpartum weight retention; however, the effect of lactation on weight retention was sufficiently limited to warrant minimal emphasis on lactation as a means of minimizing postpartum weight retention.

Elevated parathyroid hormone-related peptide associated with lactation and bone density loss.

OBJECTIVE: To investigate the hypothesis that parathyroid hormone-related peptide (PRHrP) may be involved with bone loss and recovery as a means of providing adequate calcium and phosphate to infants. DESIGN: An 18-month prospective cohort study. SETTING: General community setting with recruitment occurring at birthing education classes. PARTICIPANTS: Volunteer sample of 115 postpartum healthy women aged 20 to 40 years, and 0 or 1 parity prior to parturition with no intent to breast-feed or intent to breast-feed at least 6 months. MAIN OUTCOME MEASURES: Parathyroid hormone-related peptide, prolactin, estradiol, 1,25-dihydroxyvitamin D, 24-hydroxyvitamin D, femoral bone mineral density, and bone turnover markers were measured in 115 postpartum women at 2 weeks, 2 months, 4 months, 6 months, 12 months, and 18 months postpartum. Lumbar bone mineral density was measured at 2 weeks, 6 months, 12 months, and 18 months postpartum. RESULTS: Elevated PTHrP values were significantly associated (P<.001) with breast-feeding status, elevated prolactin levels, and lower serum estradiol levels, conditions occurring during lactation. Furthermore, elevated PTHrP levels were negatively and significantly associated (P<.01) over time with bone mineral density change at both the spine and the femoral neck, even after accounting for prolactin levels, breast-feeding status, return of menstruation, estradiol levels, PTH levels, 1,25-dihydroxyvitamin D levels, dietary calcium intake, physical activity, and body size. CONCLUSION: These data clearly support the hypothesis that PTHrP is an alternative mechanism associated with bone loss and recovery during and subsequent to lactation.

Obesity, body fat distribution, and blood pressure in Nigerian and African-American men and women.

This article describes a study that assesses body fat distribution patterns in Nigerian and African-American males and females and determines the association between body fat distribution patterns and blood pressure in young adults of differing geographical and ethnic backgrounds. The study population was comprised of 275 African Americans (92 males and 183 females) and 282 Nigerians (219 males and 63 females). The mean ages for the African-American males and females were 18.7 and 18.9 years, respectively, compared with 21 and 19.2 years for the Nigerian males and females. African Americans were more likely to be obese and overweight compared with their Nigerian counterparts. However, there were no significant differences between the two ethnic groups within gender for body fat distribution patterns based on waist-to-hip ratio. Despite being leaner, the Nigerians had higher diastolic blood pressures than the African Americans. There were no significant associations observed between blood pressure and waist-to-hip ratio for either the Nigerian or the African-American males or females, and body mass index was associated consistently with blood pressure only among the African Americans. These findings suggest that body mass index, a general indicator of obesity, is a better correlate of blood pressure than the waist-to-hip ratio among African Americans.

Effect of ethnicity and geographical location on body weight, dietary restraint, and abnormal eating attitudes.

Previous studies have examined the effect of ethnicity on obesity, concerns about shape and weight, and attitudes about eating. We hypothesized that geographical location would also influence these variables, and that students growing up in the northern part of the United States and attending northern colleges would differ from students from the South. To examine this, we studied a random sample of 275 African-Americans (AA) and 224 white college students in the entering class of two northern colleges (University of Pittsburgh or University of Massachusetts) or two southern colleges (Augusta or Paine College). All subjects were weighed and completed the Revised Restraint Scale and the EAT-26. AA women were heavier than white women, with no differences due to geographical location. Despite being thinner, white women reported more dietary restraint than AA women. This difference between AA and white women was apparent in both northern and southern college students. In contrast, geographical location was the strongest determinant of bulimic attitudes; both men and women at northern colleges reported higher bulimia scores than those at southern schools. Thus ethnicity appears to be a major determinant of body weight and attitudes about shape and dieting, whereas geographical location appears to exert greater influence on bulimic attitudes.

The Physical Activity Scale for the Elderly (PASE): development and evaluation.

A Physical Activity Scale for the Elderly (PASE) was evaluated in a sample of community-dwelling, older adults. Respondents were randomly assigned to complete the PASE by mail or telephone before or after a home visit assessment. Item weights for the PASE were derived by regressing a physical activity principal component score on responses to the PASE. The component score was based on 3-day motion sensor counts, a 3-day physical activity dairy and a global activity self-assessment. Test-retest reliability, assessed over a 3-7 week interval, was 0.75 (95% CI = 0.69-0.80). Reliability for mail administration (r = 0.84) was higher than for telephone administration (r = 0.68). Construct validity was established by correlating PASE scores with health status and physiologic measures. As hypothesized, PASE scores were positively associated with grip strength (r = 0.37), static balance (r = +0.33), leg strength (r = 0.25) and negatively correlated with resting heart rate (r = -0.13), age (r = -0.34) and perceived health status (r = -0.34); and overall Sickness Impact Profile score (r = -0.42). The PASE is a brief, easily scored, reliable and valid instrument for the assessment of physical activity in epidemiologic studies of older people.

Strength training for prepubescent males: is it safe?

This study examined the safety of one type of strength training for prepubescent males. Eighteen males (average age, 8.3 +/- 1.2 years) participated in a 45 min/session, three session/week, 14 week supervised strength training program with an attendance rate of 91.5%. Concentric work was done almost exclusively. KinCom analysis showed significant strength gain in this group (P less than 0.05), while an age, sex, and activity matched control group did not gain strength. Safety was evaluated by injury surveillance, blood pressure and heart rate monitoring, scintigraphy, and creatine phosphokinase measurement. Effects on growth and development, flexibility, and motor performance were also investigated, as these are factors with an impact on sports injury occurrence. Results showed that in the short term, supervised concentric strength training results in a low injury rate and does not adversely affect bone, muscle, or epiphyses; nor does it adversely affect growth, development, flexibility, or motor performance. As the safety question is multifaceted, this should not lead to the conclusion that strength training for prepubescents is uniformly safe. Further research is needed.