Prognostic impact of inter-metastatic heterogeneity of viable tumour cells in colorectal liver metastases.

BACKGROUND: Heterogenous response to neoadjuvant chemotherapy in patients with multiple colorectal liver metastases (CRLM) has been associated with an acquired resistance to systemic therapy. This study evaluated the occurrence of a heterogenous inter-metastatic tumour response with regards to the proportion of viable tumour cells, and its prognostic impact. METHODS: A retrospective cohort study was conducted, including all patients with CRLM surgically treated at Karolinska University Hospital, Stockholm, Sweden, from 2013 to 2018. Factors associated with the proportion of viable tumour cells and inter-metastatic heterogeneity were analysed with regression and survival analyses. RESULTS: Out of 640 surgically treated patients, 405 patients (1357 CRLM), received neoadjuvant chemotherapy. Multiple CRLM were present in 314 patients (78%), out of whom 72 patients (23%) presented with a heterogenous tumour response. The median overall survival (OS) for patients with a heterogenous inter-metastatic tumour response was 36 months, compared to 57 months for patients with a homogenous inter-metastatic tumour response (p < .001). Poor OS in patients receiving preoperative chemotherapy was significantly associated with a heterogenous inter-metastatic tumour response (hazard ratio (HR) 1.68 (1.02-2.78)), right-sided primary tumour (HR 2.01 (1.29-3.43)) and CRLM diameter >5 cm (HR 1.83 (1.06-3.17)). CONCLUSION: Outcome in patients with a heterogenous inter-metastatic tumour response, illustrated by the proportion of viable tumour cells, is inferior to that of patients with a homogenous response. These results suggest that heterogeneity in treatment response is an important marker of aggressive disease and could be of clinical value for decisions on post-operative therapy.

Psychological distress and substance use by adolescent mothers: associations with parenting attitudes and the quality of mother-child interaction.

This study examines associations between psychological distress and alcohol and drug use across the first five years of raising a child and parenting quality at child age six for 185 adolescent mothers. Overall, alcohol and other drug use in this sample was relatively low, but drug use was associated with more mother-reported unrealistic expectations of child behavior and more attributions of child intent to annoy parent by misbehaving. Maternal psychological distress was associated with maternal reports of negative control (yelling, pushing, spanking, etc.), and alcohol use moderated the association between psychological distress and negative control. At low levels of alcohol use, more maternal distress was associated with greater negative control; at higher levels of alcohol use, maternal distress was not related to negative control, but the absolute level of negative control was similar to that reported by more distressed mothers. Neither psychological distress nor alcohol and other drug use were related to maternal behavior during an interaction task. Overall, much stronger associations with parenting outcomes were found for an index of maternal vocabulary, compared with maternal psychological distress or maternal alcohol and other drug use.

Drug use among adolescent mothers: prepregnancy to 18 months postpartum.

PURPOSE: Little is known about the substance use patterns of adolescent mothers, particularly in the postpartum period. This study provides descriptive, longitudinal data on the substance use behavior of a cohort of adolescent mothers. METHODS: A total of 241 pregnant adolescents, under 18 years old and planning to carry the pregnancy to term, completed the initial interview. Respondents were interviewed again at 1, 6, 12, and 18 months postpartum. The data reported here are based on the 229 respondents who completed all five interviews. RESULTS: Use of all substances decreased substantially during pregnancy, but increased steadily in the first 6 months postpartum. A similar pattern was observed for regular use of multiple substances. Regular use before and after the pregnancy, but not during it, was the most common pattern of substance use. CONCLUSIONS: The prevalence of substance use among adolescent mothers is significant. To capitalize on the large decreases in use during pregnancy, drug prevention programs for adolescent mothers should target the first 6 months postpartum.

PIP: To characterize patterns of legal and illicit drug use among pregnant and parenting adolescents, 241 unmarried US teens 17 years of age and younger were recruited from an urban, publicly funded prenatal clinic for a prospective study. Respondents were interviewed during pregnancy and at 1, 6, 12, and 18 months postpartum. 229 (95%) of these adolescents completed all five interviews. A substantial reduction in regular use of tobacco, alcohol, marijuana, and crack/cocaine occurred during pregnancy (e.g., 55% of respondents reported regular alcohol consumption before pregnancy, but only 4% admitted regular use during pregnancy); however, a steady increase in drug use occurred after delivery, especially in the first 6 months postpartum. 38.6% of respondents discontinued drug use during pregnancy, but resumed it in the postpartum period. Another 20.6% reported no use before, during, or after pregnancy. 16.7% initiated drug use in the postpartum period, while 14.5% were continuous users. These findings suggest a need for drug prevention interventions in the first few postpartum months aimed at capitalizing on young mothers' voluntary reductions in drug use during pregnancy. Such interventions could emphasize the findings that secondary cigarette smoke inhaled by children can increase their respiratory problems and alcohol passes to infants through breast milk. ¿

Substance use and other factors associated with risky sexual behavior among pregnant adolescents.

A study of the relationship between substance use and risky sexual behavior was conducted among 241 unmarried pregnant adolescents aged 17 and younger who lived in a metropolitan area in the Northwest. The respondents had comparable or higher lifetime use rates for all substances than did women in a national sample of high school seniors, even though the pregnant adolescents were younger. Ninety-four percent had used alcohol, 78% marijuana, 30% cocaine and 30% stimulants, compared with 92%, 48%, 14% and 23%, respectively, among women in the national sample. Among the pregnant adolescents, 84% had had more than one sexual partner, 39% had had a sexually transmitted disease and 60% had used contraceptives during less than half of their sexual encounters. At the bivariate level, use of cigarettes and alcohol in general and use of alcohol and drugs during sex were positively associated with risky sexual behavior. However, when other characteristics associated with risky sexual behavior--family bonding, parental monitoring, commitment to conventional values, peer associations, self-esteem and delinquent activities--were included in the multivariate analysis, the effect of substance use disappeared.

PIP: Among adolescents, rates of premarital intercourse have increased, age at first intercourse has decreased, and couples are delaying marriage to a greater extent since the 1970s. These factors effectively combine to increase the risk of female adolescents becoming pregnant and/or infected with sexually transmitted diseases (STD). As might be expected, birth and STD rates have also increased dramatically over the past two decades, confirming that youths continue to engage in unprotected sexual activity. Pregnant adolescents deserve particular attention from prevention interventions, for they show tangible evidence of a history of unprotected sexual activity. This study specifically considers risky sex behavior within a target group of 241 urban, unmarried pregnant adolescents aged 17 and younger and the behavioral relationship with substance use. Compared to women from a national sample of high school seniors, these pregnant women had higher or comparable lifetime use rates for all substances. 94% had used alcohol, 78% marijuana, 30% cocaine, and 30% stimulants compared to 92%, 48% 14%, and 23%, respectively, among women in the national sample. 84% of pregnant adolescents had had more than one sexual partner, 39% had had an STD, and 60% had used contraception in less than half their sexual encounters. Further, 70% ran away from home before pregnancy, 62% were suspended or expelled from school, and 24% served time in jail/detention. Cigarettes and alcohol in general, and alcohol and drug use during sex, were positively associated with risky sexual behavior. The effect of substance use, however, disappeared when controlling through multivariate analysis for family bonding, parental monitoring, commitment to conventional values, peer associations, self-esteem, and delinquent activities. These results suggest that both substance use and increased risk of pregnancy in the study sample may be associated with a syndrome of problem behaviors and life circumstances. While more research is needed, it appears that the messages "just say no" and "always use condoms" will be inadequate to bring about positive change.

Factors related to substance use by pregnant, school-age adolescents.

This study provides information on substance use among pregnant adolescents, and examines social influence, intrapersonal, and environmental factors associated with substance use during pregnancy in adolescence. The sample consists of premaritally pregnant adolescents (N = 241), who were interviewed as part of a longitudinal study of patterns of drug use among pregnant and parenting school-age adolescents. The findings indicate that, although the sample demonstrated a high rate of prepregnancy substance use, a significant drop in use occurred during pregnancy. Logistic regression analysis indicated that perceived harm of using substances while pregnant, best friend's substance use, boyfriend's substance use, and school status were related to substance use during pregnancy, even after controlling for the effects of prepregnancy substance use. The findings have implications for substance use prevention and intervention programs for pregnant and parenting adolescents.

Factors related to cigarette smoking during adolescent pregnancy.

Previous research suggests that maternal smoking during pregnancy remains prevalent, particularly among adolescents. However, little is known about the factors related to smoking during adolescent pregnancy. The goal of the present study is to identify intrapersonal, familial, and peer factors that are related to smoking during adolescent pregnancy, and to determine the relative degree to which they affect this behavior. Interviews were conducted with 241 unmarried pregnant adolescents who planned to carry their pregnancies to term. Consistent with previous studies, 27% of the respondents reported daily smoking during pregnancy, and whites reported higher rates of use than members of other racial groups. Smoking during adolescent pregnancy was related to intrapersonal, familial, and peer factors. The results of a regression analysis suggest that perceived parental disapproval of smoking during pregnancy, friends' cigarette use, and race play a particularly important role in this behavior. The implications of these findings for preventive programs are discussed.

Drug use among pregnant adolescents.

Despite concern over the co-occurrence of substance use, unplanned pregnancy and other problem behaviors in adolescence, little information is available on substance use before, during, and after adolescent pregnancy. The authors report data from the first 100 Ss enrolled in an ongoing longitudinal study on drug use before and during pregnancy in adolescence. Unmarried pregnant adolescents, ages 17 and under, were recruited for the study from urban alternative school programs and community social and health service agencies. Findings indicate that although lifetime prevalence of drug use was relatively high and pregnant respondents appear embedded in drug prevalent environments, substance use declined voluntarily and substantially during pregnancy. Prepregnancy drug use predicted substance use during pregnancy, but neither best friends' nor boyfriends' use of alcohol or marijuana predicted subjects' use of these substances during pregnancy after taking prepregnancy use into account.

The relationships of coping responses to physical health status and life satisfaction among older women.

This study examined a model specifying the causal links between the physical, functional, and subjective components of physical health status and life satisfaction among older women, and assessed the effects of three coping responses (direct-action, positive-cognitive, and passive-cognitive coping) at each point in the process. Based on interview data with 281 older women, a series of regression analyses indicated that, before the inclusion of the coping variables, physical conditions directly contributed to functional impairment, and both indirectly lowered life satisfaction through their direct negative effects on subjective health assessments. Further analyses indicated that positive-cognitive coping buffered the effects of physical conditions at each point in the model, that passive-cognitive coping generally had deleterious effects on health status, although it prevented negative health assessments from lowering life satisfaction, and that direct-action coping had little effect. These findings emphasize the importance of a multidimensional conceptualization of physical health status in understanding its relationship with life satisfaction as well as the specific functions of coping at different points in the process for older women.

Peer-group affiliation and adolescent self-esteem: an integration of ego-identity and symbolic-interaction theories.

To evaluate expectations derived from ego-identity theory and symbolic-interaction theories about the association between self-concept and peer-group affiliations in adolescence, we examined the self-esteem of 221 7th through 12th graders associated by peers with one of five major school crowds and 106 students relatively unknown by classmates and not associated with any school crowd. Among crowd members, self-esteem was directly related to the position of one's crowd in the peer-group status hierarchy (based on both peer-rated and self-perceived crowd affiliation). Outsiders' self-esteem differed in relation to the accuracy of their reflected appraisal of and the salience they attached to crowd affiliation. Crowd members as a whole exhibited higher self-esteem than outsiders as a whole. Differences, however, were mediated by crowd status, salience of crowd affiliation, and the accuracy of reflected appraisals. An adequate interpretation of the findings required an integration of Festinger's (1954, 1957) social comparisons and cognitive-dissonance theories, Cooley's (1902) notions of reflected appraisal, and Newman and Newman's (1976) extrapolations from ego-identity theory.

Intimacy and depression in older women.

This study examines the effects of the qualities of intimate relationships on depression in older women. The data are from a study of women over 50, randomly selected from five census tracts in Madison, Wisconsin, who were given questionnaires about depression and the quality of their intimate relationships on two occasions (summer of 1978 and summer of 1979). The results showed that some dimensions of the relationships that the women described with their most significant others predicted depression. The more depressed the women were, the more they felt that (1) the relationship was less friendly, (2) their friendly feelings were not reciprocated by the significant other, (3) their relationship was less consistent and predictable, and (4) there was less time spent with the significant other in the best state. These findings are discussed as partially consistent with Seligman's arguments on the comparability of his "learned helplessness" model and depression and with the focus of cognitive theories of Beck and others on the role of perceptions and expectations in depression.