Associations of High-Dose Melphalan Pharmacokinetics and Outcomes in the Setting of a Randomized Cryotherapy Trial.

High-dose melphalan followed by autologous stem cell transplantation remains the standard of care for eligible patients with multiple myeloma, but disease response and toxicity, including severe mucositis, varies among patients. Our randomized trial investigated duration of cryotherapy (2 and 6 h) for reduction of mucositis prevalence and severity and explored factors associated with variability in pharmacokinetics and outcomes from melphalan therapy. The results demonstrate that 2-h is at least as effective as 6-h cryotherapy in decreasing severe mucositis. From a population pharmacokinetic model, we identified that fat-free mass, hematocrit, and creatinine clearance were significant covariates, as reported previously. Furthermore, we observed the rs4240803 SLC7A5 polymorphism was significantly associated with pharmacokinetic variability, and pharmacokinetics was associated with both mucositis and neutropenia. However, melphalan exposure was not associated with progression-free or overall survival in our dataset. These findings contribute to ongoing efforts to personalize melphalan dosing in transplant patients.

Fullerenes for applications in biology and medicine.

Fullerenes as a unique class of carbon allotropes have been studied extensively for their distinctive material properties and potential technological applications, including those in biology and medicine. Since a major focus in the latter has been on drug development and formulation, in this paper we highlight some representative studies related to such a focus, including the use of fullerenes for drug-like functions and for their improving the formulation of established drugs. Also discussed are some other potential medically relevant applications of fullerenes, such as their serving as potent agents in photodynamic therapy and magnetic imaging.

Assistance programs available for medications commonly used in transplant patients.

Pharmaceutical manufacturers have programs available to supply medications to indigent patients at little or no cost. Enrolling needy patients into these programs should increase patient compliance to medications, minimize patient and institution financial burdens, and decrease adverse events associated with medication noncompliance. However, access to assistance programs by patients in need is limited if physicians and other health care providers are unaware of the existence of such programs or not informed of each program's enrollment process. The literature is void of a manuscript describing assistance programs available for commonly prescribed medications used in transplant patients. This article offers a concise summary of medication assistance programs available through the pharmaceutical industry to assist in the procurement of medications that are commonly prescribed for the transplant population, including immunosuppressants, antibacterials, gastrointestinal, cardiovascular, and hypoglycemic agents. This article should be used by health care professionals as a guide to the availability and requirements of medication assistance programs.

Physiological correlates of childhood abuse: chronic hyperarousal in PTSD, depression, and irritable bowel syndrome.

OBJECTIVE: During the past 10 years, researchers have documented how trauma--especially severe trauma--can alter the functioning of the brain. In some cases, these alterations create a state of chronic hyperarousal. The present review serves as an introduction to this research. FINDINGS: Persons who have experienced traumatic events are often "primed" to over-react to subsequent stressors, making them more vulnerable to these events. CONCLUSION: Chronic hyperarousal underlies three common and often co-occurring sequelae of childhood abuse: post-traumatic stress disorder (PTSD), depression, and irritable bowel syndrome. Knowledge of these physiological correlates can affect treatment decisions as well as our theories about the mechanisms underlying the development of symptoms.

Breastfeeding and the sexual abuse survivor.

In this paper, the possible effects of child sexual abuse on a mother's breastfeeding experience are described. The long-term effects of sexual abuse are divided into seven domains that may impact breastfeeding behavior: posttraumatic stress disorder, cognitive distortions, emotional distress, impaired sense of self, avoidance, interpersonal difficulties, and health problems. In each section, the potential impact of past sexual abuse on current breastfeeding behavior and the mother-infant relationship is described. Finally, specific suggestions and strategies for lactation consultants are offered.

The effects of neglect on academic achievement and disciplinary problems: a developmental perspective.

The present study examines the effect of child neglect, alone and in combination with abuse, on academic achievement and school disciplinary problems for elementary, junior high, and senior high students. The sample included 324 neglected children and adolescents, and a matched nonmaltreated sample of 420 children and adolescents. All subjects were in grades K through 12 in a small city in New York state. The results revealed that neglected children did perform more poorly than their nonmaltreated counterparts, having lower grades, more suspensions, more disciplinary referrals, and more grade repetitions, even when controlling for gender of child and SES. Neglect alone and neglect in combination with physical or sexual abuse was related to lower grades and more suspensions. The combination of abuse and neglect had a particularly strong effect on the number of disciplinary referrals and grade repetitions. Abused/neglected students in junior high had the highest number of grade repetitions. The number of disciplinary referrals continued to increase through senior high for both neglected and abused/neglected students. Interestingly, the academic performance of all subjects dropped during junior high. Neglect and neglect in combination with abuse appeared to exacerbate a decline in academic performance that occurs as children enter junior high school.

Weaning ages in a sample of American women who practice extended breastfeeding.

This research examined age and method of weaning in a sample of 179 women who practiced extended breastfeeding. The average age for weaning was between 2 years 6 months and 3 years 0 months and ranged from 1 month to 7 years 4 months. Fourteen women had each weaned at least three children, and the youngest children were significantly older at the time of weaning than were their older siblings. Weaning was described as being "gradual" and "child-led" by the majority of women. A smaller, but substantial, percentage of women cited reasons for weaning related to a subsequent pregnancy. Weaning ages for women who practice extended nursing were substantially older than were those of more typical North American mothers and were similar to those in traditional cultures with similar parenting practices.

The social consequences of long-term breastfeeding.

This study examined the social consequences for mothers of long-term breastfeeding in a non-supportive culture, and how mothers learned to cope with negative reactions and comments from others. One hundred seventy-nine women who were recruited from La Leche League area conferences nationwide from 1989 to 1991 completed a self-administered closed-ended questionnaire which asked about their breastfeeding and weaning experiences. The percentage of mothers who cited "social stigma" as a negative aspect of breastfeeding increased dramatically as the age of the child increased; 29 percent cited social stigma for breastfeeding past six months, 44 percent for breastfeeding past 12 months, and 61 percent for breastfeeding past 24 months. In spite of the social stigma, the women cited more positive aspects for breastfeeding (M = 6.18 aspects) than they did negative aspects (M = .85 aspects). The positive aspects of breastfeeding emphasized the strong emotional bond between mother and child, and the emotional benefits they both received. Mother-to-mother support, spousal support, and a woman's own sense of confidence were important buffers against the criticism of others. And while the criticism of others was likely to cause negative feelings, the mothers reported that it had very little impact on their breastfeeding behaviors.

Assessment of the magnitude of anxiety in adults undergoing first oxygen treatment in a hyperbaric chamber.

The purpose of this study was to determine the magnitude and specific foci of anxiety experienced by patients receiving their initial hyperbaric treatment. The Spielberger State-Trait Inventory questionnaire and a personal interview were administered to 24 patients to determine anxiety levels. Upon arrival at the hyperbaric clinic and prior to any type of health teaching, the State and Trait questionnaire was administered to the patients. One hour prior to the treatment, the State questionnaire was repeated to determine any significant changes in anxiety levels. No significance was found in anxiety levels between pre-health and pre-treatment. The Trait questionnaire revealed that this specific group of patients, regardless of the circumstances, felt they were not very anxious individuals. Post-treatment, the State questionnaire was administered again and these anxiety levels did differ significantly from the pre-health and pre-treatment levels. The findings indicate the need to continue to validate clients' perceived needs during hyperbaric treatment, which will help direct future nursing practice.

Recruitment and retention in a clinical trial for low birth weight, premature infants.

We report on recruiting and retaining a sample of low birth weight, premature infants for a clinical trial as well as results of tests evaluating sampling and retention biases. A total of 4551 infants were screened, and 1302 were found eligible. Consent was obtained for 1028 infants. After randomization and the presentation of group assignment, the number of infants enrolled was 985 (75.7% of those eligible). Of these, 92.7% completed the 3-year study. Tests to evaluate recruitment bias revealed significant relationships between nonenrollment and site, maternal race, and infant birth weight. Tests to evaluate retention bias revealed a significant relationship between dropout and maternal education. Additionally, infant birth weight and maternal age interacted with treatment in predicting dropout. Despite these statistically significant recruitment and retention biases, there was no evidence of problems with sample representativeness to the population of interest or of treatment group differences on study-relevant background variables.

Impact of sexual abuse on children: a review and synthesis of recent empirical studies.

A review of 45 studies clearly demonstrated that sexually abused children had more symptoms than nonabused children, with abuse accounting for 15-45% of the variance. Fears, posttraumatic stress disorder, behavior problems, sexualized behaviors, and poor self-esteem occurred most frequently among a long list of symptoms noted, but no one symptom characterized a majority of sexually abused children. Some symptoms were specific to certain ages, and approximately one third of victims had no symptoms. Penetration, the duration and frequency of the abuse, force, the relationship of the perpetrator to the child, and maternal support affected the degree of symptomatology. About two thirds of the victimized children showed recovery during the first 12-18 months. The findings suggest the absence of any specific syndrome in children who have been sexually abused and no single traumatizing process.

Professionals' standards of "normal" behavior with anatomical dolls and factors that influence these standards.

Do professionals have a consistent standard of what constitutes normal behavior with anatomical dolls? To answer this question, 201 professionals who work with child sexual abuse victims were asked to rate the normalcy of various behaviors with the dolls for nonabused children ages 2 to 5.9 years. The majority of respondents agreed that overtly sexual behaviors, such as demonstrating oral-genital contact or vaginal intercourse, were abnormal for nonabused children. For less obvious behaviors, such as touching the sex parts of dolls, there was more disagreement among professionals about what these behaviors mean. The ratings of these ambiguous behaviors varied depending on profession of the respondent, gender of the respondent, and number of years of experience. Law enforcement professionals, women, and those with the least amount of experience were more likely to view ambiguous behaviors as abnormal. These findings are discussed in the context of past research, with suggestions for future studies.

Use of anatomical dolls by Boston-area professionals.

Anatomical dolls are a widely used but controversial tool for interviewing child victims of sexual abuse. The present research examines how a representative sample of professionals who evaluate children actually use the dolls. Contrary to past reports, the results revealed that 96.6% of professionals who use the dolls had received training in anatomical doll use, 77.8% followed some standard protocol for interviewing, and 97.3% had at least 1 year of experience with anatomical dolls. The results also revealed that the majority of professionals did not engage in the "leading" behaviors of presenting unclothed dolls to children or undressing the dolls for the child, again contrary to past reports. The present research indicates that the professionals in this sample are more experienced and better trained than is typically thought.

The influence of children's facial maturity on parental expectations and punishments.

It was hypothesized that the perception of maturefaced children as more able to follow complicated instructions, more likely to know right from wrong, more shrewd, and physically stronger than their babyfaced peers would lead parents to assign more demanding tasks to these children and to judge their misbehavior more harshly. Study 1 revealed that parents allocated more cognitively demanding, but not more physically demanding, chores to maturefaced 11 year old depicted in photographs than to babyfaced children of the same age and attractiveness. Study 2 revealed that parents perceived the misbehaviors of maturefaced 4- and 11-year-old children as more intentional than those of their babyfaced peers, an effect that was significant only when parents judged children of the opposite sex. Study 2 further revealed that, with perceived intentionality held constant, a babyface mitigated the severity of punishment recommended for relatively serious infractions by preschoolers, while increasing it for older children. The latter finding was discussed in light of other evidence that people react negatively to the disconfirmation of their benign expectations regarding babyfaced individuals, and that parents perceived the misbehaviors as more unexpected for 11 year olds than 4 year olds.

Molestation and the onset of puberty: data from 365 adults molested as children.

This study examines whether molestation is most likely to occur before or after the onset of puberty and also whether molestation is likely to be a one-time occurrence or last for a long time. The study analyzed intake interviews from 365 adults molested as children (AMACs). The AMACs were entering treatment at the Child Sexual Abuse Treatment Program, San Jose, CA. This paper presents data on the age of onset and end of the molestation and the duration of the molestation in years. For this sample, the average age of onset was 7.5; the average age at the end of the molestation was 13. The overwhelming majority of molestations lasted one year or more. We discuss results in the context of past studies and suggest areas for further research.