Newly diagnosed patients with advanced non-small cell lung cancer: A clinical description of those with moderate to severe depressive symptoms.

OBJECTIVES: The aims of this observational study were to 1) accrue newly diagnosed patients with advanced-stage non-small cell lung cancer (NSCLC) awaiting the start of first-line treatment and identify those with moderate to severe depressive symptoms and, 2) provide a clinical description of the multiple, co-occurring psychological and behavioral difficulties and physical symptoms that potentially exacerbate and maintain depressive symptoms. MATERIALS AND METHODS: Patients with stage IV NSCLC (N = 186) were enrolled in an observational study (ClinicalTrials.gov Identifier: NCT03199651) and completed the American Society of Clinical Oncology-recommended screening measure for depression (Patient Health Questionnaire-9 [PHQ-9]). Individuals with none/mild (n = 119; 64 %), moderate (n = 52; 28 %), and severe (n = 15; 8 %) depressive symptoms were identified. Patients also completed measures of hopelessness, generalized anxiety disorder (GAD) symptoms, stress, illness perceptions, functional status, and symptoms. RESULTS: Patients with severe depressive symptoms reported concomitant feelings of hopelessness (elevating risk for suicidal behavior), anxiety symptoms suggestive of GAD, and traumatic, cancer-specific stress. They perceived lung cancer as consequential for their lives and not controllable with treatment. Pain and multiple severe symptoms were present along with substantial functional impairment. Patients with moderate depressive symptoms had generally lower levels of disturbance, though still substantial. The most salient differences were low GAD symptom severity and fewer functional impairments for those with moderate symptoms. CONCLUSIONS: Depressive symptoms of moderate to severe levels co-occur in a matrix of clinical levels of anxiety symptoms, traumatic stress, impaired functional status, and pain and other physical symptoms. All of the latter factors have been shown, individually and collectively, to contribute to the maintenance or exacerbation of depressive symptoms. As life-extending targeted and immunotherapy use expands, prompt identification of patients with moderate to severe depressive symptoms, referral for evaluation, and psychological/behavioral treatment are key to maximizing treatment outcomes and quality of life for individuals with advanced NSCLC.

Functional trajectories before and after a new cancer diagnosis among community-dwelling older adults.

BACKGROUND: To characterize functional trajectories in the year before and after a new cancer diagnosis among older adults and to identify risk factors for worsening disability post-diagnosis. METHODS: We identified 170 participants 70+ years with monthly assessments of thirteen basic, instrumental, and mobility activities and with a new cancer diagnosis from 1998 to 2014. A group-based trajectory model identified distinct functional trajectories based on a total disability score during the twelve months pre- and post-diagnosis. We evaluated associations between potential risk factors at the time of cancer diagnosis and worsening disability post-diagnosis, explored functional transitions from pre- to post-diagnosis and identified participants whose functional trajectories worsened. RESULTS: Three pre-diagnosis functional trajectories were identified among 170 participants (mean age at diagnosis: 83 years (range: 73-105 years): mild, moderate, and severe disability. Three post-diagnosis functional trajectories were identified among 158 non-decedents: mild, moderate, and severe disability. Most participants (93.9%) with severe disability pre-diagnosis had severe disability post-diagnosis. Risk factors independently associated with worsening disability post-diagnosis included moderate or severe disability pre-diagnosis (adjusted risk ratio, aRR: moderate: 2.96; 95%CI: 2.11-4.16; severe: 5.11; 95%CI: 3.07-8.52) vs. mild (reference), poor physical capability (aRR: 1.57; 95%CI: 1.07-2.30), and incurable stage (aRR:1.99; 95%CI: 1.41-2.80). 40% of participants with a mild or moderate disability trajectory pre-diagnosis transitioned to a worse functional trajectory post-diagnosis. CONCLUSION: Older adults followed distinct functional trajectories in the twelve months before and after cancer diagnosis. Functional trajectory pre-diagnosis, poor physical capability, and incurable stage were independent risk factors for worsening disability post-diagnosis.

Misperceptions of the norms for the frequency of alcohol and other drug use on college campuses.

Data from surveys of students representing 100 diverse college campuses were used to investigate the difference between the self-reported frequency of a drug's use and students' perceptions of the frequency of use. Students were asked about the frequency of their own use of 11 drugs (alcohol, tobacco, marijuana, cocaine, amphetamines, sedatives, hallucinogens, opiates, inhalants, designer drugs, and steroids) and how often they thought "the average student" on their campus used these drugs. Respondents typically misperceived their peer norms (designated as the median of self-reported use) by substantially overestimating how often the average student used each drug, both in campus samples where abstinence or infrequent use were the median of self-reports and in samples where the median of self-reports revealed more frequent use. To the extent that they may promote or reinforce students' actual use, these misperceptions should be considered in designing college drug prevention programs.

Alcohol use and related consequences among students with varying levels of involvement in college athletics.

Alcohol use, binge drinking, and substance abuse-related consequences among students with varying levels of participation in intercollegiate athletics were examined. Between October 1994 and May 1996, 51,483 students at 125 institutions answered questions about their involvement in athletics, ranging from noninvolvement to participant to leadership positions, on the long form of the Core Alcohol and Drug Survey. In comparisons with nonathletes, both male and female athletes consumed significantly more alcohol per week, engaged in binge drinking more often, and suffered more adverse consequences from their substance use. No support was found for the hypothesis that athletic leaders were more responsible than other team participants in using alcohol. Male team leaders appeared to be at significantly greater risk than female team leaders; they also consumed more alcohol, binged more often, and suffered more consequences than other team members.

Alcohol use in the Greek system: follow the leader?

OBJECTIVE: This study was designed to identify drinking patterns, consequences of use, and belief systems about alcohol among college students according to their level of involvement in campus fraternity and sorority life. METHOD: This study of 25,411 (15,100 female) students who completed the Core Alcohol and Drug Survey, from 61 institutions, compared alcohol consumption, binge drinking, consequences of use and beliefs about drinking according to students' level of involvement in fraternities and sororities, ranging from no involvement to that of attending functions only, to active involvement, to leadership positions within Greek organizations. RESULTS: Analyses indicated that students in the Greek system averaged significantly more drinks per week, engaged in heavy drinking more often and, with minor exceptions, suffered more negative consequences than non-Greeks. The leaders of fraternities and sororities consumed alcohol, engaged in heavy drinking and experienced negative consequences at levels at least as high and in some cases higher than that of other Greek members. In terms of their views about alcohol, fraternity and sorority members believed that alcohol was a vehicle for friendship, social activity and sexuality to a greater extent than non-Greeks. The beliefs of the leaders did not stand out compared to other members. CONCLUSIONS: In addition to corroborating earlier reports that show that fraternity and sorority members use more alcohol than nonmembers, this study indicates that the leadership of Greek organizations are participating in setting heavy-drinking norms. Suggestions are made concerning targeting prevention programming efforts toward this group.

Understanding the three national databases on collegiate alcohol and drug use.

An overview of the three major databases used to examine alcohol and other drug use habits of American college students is provided. The databases are compared in terms of purpose, study population, subject selection, method of administration, focus, utility for institutional use, and trend analyses. The authors conclude that no one source of data is "best." Rather, the studies represent three different sources of data. Although information from these databases overlaps to some extent, each database makes a unique contribution to the field.

Weapon carrying and substance abuse among college students.

Results from administering the Core Alcohol and Drug Survey on 61 US campuses during the 1994/95 academic year were analyzed to assess weapon carrying among college students. Seven percent of the 26,225 students (11.1% of the men and 4.3% of the women) responded that they had carried weapons (gun, knife, etc) during the last 30 days. A comparison with a matched sample of nonweapon carriers revealed that a greater percentage of the armed than the unarmed students had experienced harassment, violence, and threats of violence, and that they felt less safe on their campuses. The weapon-carrying men consumed significantly more alcohol than their unarmed counterparts, and a higher percentage reported binge drinking, use of other drugs, and adverse consequences from substance abuse. Differences between armed and unarmed female students were not as clearly consistent in terms of substance abuse and consequences.

Average weekly alcohol consumption: drinking percentiles for American college students.

Data obtained from 44,433 students who reported the average number of drinks they consumed per week in response to the Core Alcohol and Drug Survey at 105 college campuses between October 1994 and June 1996 are discussed. The majority of the students indicated that, on an average weekly basis, they consumed little or no alcohol. Forty-eight percent of the students at 2-year schools and 38% of the students at 4-year schools reported consuming no alcoholic drinks per week. When responses from these students were combined with those of students who consumed only one drink per week, the total included 50% of the students at 2-year and 51% of students at 4-year colleges. Approximately 10% of the students reported they consumed 15 or more drinks on an average weekly basis. The authors provide a detailed table showing the cumulative percentages of student drinking at various levels and offer suggestions for clinical and programmatic intervention.

SARs of annonaceous acetogenins in rat liver mitochondria.

The Annonaceous acetogenins represent a class of compounds with diverse bioactivities, including promising cytotoxicites. These are due, at least in part, to inhibition of complex I in the oxidative phosphorylation pathway in mitochondria. Fourteen Annonaceous acetogenins were tested in a rat liver mitochondrial oxygen uptake assay to probe additional structure-activity relationships. In this subcellular assay, the activity of non-adjacent bis-THF ring acetogenins depends on the distance between the two THF rings; the activity decreases to that of a mono-THF ring acetogenin if the distance is too long. When one THF ring is replaced with a tetrahydropyran ring, the activity remains comparable. The configuration of the THF ring, in mono ring compounds, seems to be more important than stereochemical differences in the rings of adjacent bis-THF ring compounds. Bullatacin, an adjacent bis-THF ring acetogenin, was used as a standard compound in every run to normalize the data.

Beyond performance enhancement: polypharmacy among collegiate users of steroids.

The extremely low prevalence of steroid use among college students makes it virtually impossible to conduct analyses on any single college campus. By studying a cohort of 58,625 college students from 78 institutions that administered the Core Alcohol and Drug Survey in 1990 and 1991, a critical mass of 175 users on which it was possible to conduct statistical analyses was identified. Compared with a randomly selected group of nonusers, the steroid users reported consuming dramatically more alcohol and demonstrated higher rates of binge drinking. In addition, a significantly higher percentage of steroid users reported using tobacco, marijuana, cocaine, amphetamines, sedatives, hallucinogens, opiates, inhalants, and designer drugs. A higher percentage of steroid users than nonusers also reported experiencing negative consequences as a result of substance abuse, and a greater percentage of the steroid users reported family histories of abuse of alcohol and other drugs. Implications from the standpoint of student development are discussed.

An instrument to assess adolescent alcohol involvement.

This study was the beginning of a validation process for the Presley Adolescent Alcohol Scale (PAAS). The instrument is intended for youth of ages 11 to 24 and involves six subscales: Quantity and Frequency of Use, School Functioning, Family Functioning, Social Functioning, Driving and Legal Functioning, Physical and Psychological Functioning. Items identify Use, Misuse, Problematic Use, and Dependency. Three groups of students in Southern Illinois were used (N = 216): high school students in grades 7 to 12 (N = 51), undergraduate students at Southern Illinois University (N = 129), and patients at an adolescent alcohol inpatient treatment center (N = 36). ANOVA showed a significant difference between these three groups (p < .0001). In general, results from the study supported initial validity and reliability for the PAAS.

Development of the Core Alcohol and Drug Survey: initial findings and future directions.

To assist universities in obtaining accurate information about the effectiveness of their efforts to prevent substance abuse, a committee of grantees of the US Department of Education's Fund for the Improvement of Postsecondary Education (FIPSE) developed an assessment tool known as the Core Alcohol and Drug Survey. This self-report instrument is designed to examine the nature, scope, and consequences of the use of alcohol and other drugs among college students. To date, the survey has been administered to nearly half a million students on 800 campuses, and the findings have been aggregated to create what is presently the largest national database on substance use in the higher education setting. The Core survey has often been used by campus health service personnel in assessment and programming efforts. This article describes the development and administration of the Core Alcohol and Drug Survey and provides a sampling of findings from the 1989-1991 FIPSE drug prevention group. This cohort included 58,625 students who completed the survey. Findings regarding consumption patterns, consequences of use, underage drinking, and regional differences are delineated, along with information regarding the future direction of Core survey projects.