Comorbidities in head and neck cancer: agreement between self-report and chart review.

OBJECTIVES: To determine the accuracy of self-reported comorbidities compared with medical record review and the clinical and sociodemographic characteristics associated with accuracy of self-reported comorbidities. STUDY DESIGN: We conducted a prospective study of 458 newly diagnosed head and neck cancer patients using self-administered questionnaire and medical chart review data. Overall and itemwise consistency between self-report and chart review was evaluated. Social, clinical, and demographic characteristics of consistent versus inconsistent responders were analyzed. RESULTS: Seventy-four percent of patients had at least one comorbidity. There was good overall consistency between self-report and chart review (kappa = 0.50). Compared with consistent responders, inconsistent responders were found to be older (P < 0.05), have lower sleep (P < 0.05) and physical activity scores (P < 0.05), be more depressed (P < 0.05), and have more severe comorbidities (P < 0.05). CONCLUSIONS AND SIGNIFICANCE: Self-report may be considered as an alternative to chart review for comorbidity assessment in head and neck cancer patients. Younger patients, those with good general health, fewer depressive symptoms, and mild comorbidities, are more likely to give responses consistent with chart review.     

Type 1 diabetic mice are protected from acetaminophen hepatotoxicity.

Streptozotocin (STZ)-induced diabetic (DB) mice challenged with single ordinarily lethal doses of acetaminophen (APAP), carbon tetrachloride (CCl4), or bromobenzene (BB) were resistant to all three hepatotoxicants. Mechanisms of protection against APAP hepatotoxicity were investigated. Plasma alanine aminotransferase, aspartate aminotransferase, and liver histopathology revealed significantly lower hepatic injury in DB mice after APAP administration. HPLC analysis of plasma and urine revealed lower plasma t1/2, increased volume of distribution (Vd), and increased plasma clearance (CLp) of APAP in the DB mice and no difference in APAP-glucuronide, a major metabolite in mice. Interestingly, covalent binding of 14C-labeled APAP to liver target proteins; arylation of APAP to 58, 56, and 44 kDa acetaminophen binding proteins (ABPs); and glutathione (GSH) depletion in the liver did not differ between nondiabetic (non-DB) and DB mice in spite of downregulated hepatic microsomal CYP2E1 and 1A2 proteins in the DB mice, known to be involved in bioactivation of APAP. Compensatory cell division measured via 3H-thymidine pulse labeling and immunohistochemical staining for proliferating cell nuclear antigen (PCNA) indicated earlier onset of S-phase in the DB mice after exposure to APAP. Antimitotic intervention of liver cell division by colchicine (CLC) after administration of APAP led to significantly higher mortality in the DB mice suggesting a pivotal role of liver cell division and tissue repair in the protection afforded by diabetes. In conclusion, the resistance of DB mice against hepatotoxic and lethal effects of APAP appears to be mediated by a combination of enhanced APAP clearance and robust compensatory tissue repair.     

Once-A-Day therapy for sinusitis: A comparison study of cefixime and amoxicillin

The efficacy and safety of a once-a-day antibiotic in the treatment of sinusitis was studied. Two randomly assigned groups were treated with either once-a-day cefixime, a third generation cephalosporin, or amoxicillin three times a day. One hundred and fourteen patients were evaluated with antral punctures, microbiologic evaluation, and radiographic studies. Cultures revealed 40% gram-negative organisms, 48% gram-positive, and 12% anaerobes. The most common bacteria were Haemophilus influenzae, Streptococcus pneumoniae, Staphylococcus aureus and viridans group streptococci. Ninety-four percent of the cefixime group were cured compared with 96% of the amoxicillin group. Staphylococcus resistance was a problem in both groups, necessitating an occasional change to amoxicillin-clavulanate potassium in the amoxicillin group. Once-a-day antibiotics offer the potential for improved compliance in the treatment of sinusitis. Cefixime offers an additional benefit of covering β-lactamase producing strains of bacteria which are increasing in incidence and resistant to many penicillins.     

Pulsatile blood alcohol and CYP2E1 induction during chronic alcohol infusions in rats

Adult male Sprague-Dawley rats were treated with alcohol for 35 days using a total enteral nutrition model. Intragastric cannulae were inserted into rats and they were infused with a diet designed to promote normal growth in male rats. Alcohol was infused at 35% of total calories for 35 days. Urine and blood alcohol concentrations were determined and found to be pulsatile during continuous alcohol infusion, having values between near zero and greater than 500 mg/dl. Twenty-four-hour urine alcohol concentrations were found to be excellent indicators of blood alcohol concentrations (BACs). Cytochrome P450 CYP2E1 was induced in a two-step manner. Step one occurred at BACs below 250 mg/dl and was characterized by significant (p ≤ 0.05) elevations in activities and apoprotein levels with no changes in steady-state mRNA. Step two occurred with BACs greater than 300 mg/dl and resulted in significant (p ≤ 0.05) elevations in steady-state mRNA levels. We propose that the pulsatile BACs are caused by an ethanol concentration-dependent regulation of an ethanol metabolizing system, perhaps CYP2E1.     

Soy protein isolate and protection against cancer

OBJECTIVE: Results from epidemiological and animal studies suggest that consuming soy-containing diets reduces the incidence of certain cancers. The purpose of this presentation was to evaluate the potential of soy protein to prevent occurrence of prostate, breast and colon cancer. METHODS: Meta-analyses of published epidemiologic studies associating cancer risk with soy intake were performed. The incidence of chemically-induced mammary or colon tumors was determined for rats fed AIN-93G diets made with either casein or soy protein isolate (SPI). Western and Northern blot and microarray analyses were performed on rat mammary and colon tissues to study mechanisms underlying the effects of soy. RESULTS: Meta-analyses revealed reductions in the mean overall risk estimate for mammary (0.78, p < 0.001), colon (0.70, p < 0.001) and prostate (0.66, p < 0.001) cancer for soy consumers. The incidence of AOM-induced colon tumors and DMBA-induced mammary tumors was reduced (p < 0.05) in rats fed SPI-containing diets. Lower incidence of mammary tumors in SPI-fed rats was associated with: 1) reduced terminal end bud numbers (p < 0.05), 2) lower expression of the phase I enzyme CYP1B1 (p < 0.05) and 3) reduced expression of the Ah Receptor and ARNT (p < 0.05). CONCLUSIONS: SPI may protect against cancer via multiple mechanisms, including: 1) increased mammary gland differentiation, 2) decreased activation of procarcinogens to carcinogens and 3) regulation of genes in signal transduction pathways underlying tumor initiation, promotion and/or progression.     

The Professor of Public Psychiatry Model in Ohio: The Impact on Training,Program Innovation,and the Quality of Mental Health Care

The Ohio Department of Mental Health and five of Ohio's University-based Departments of Psychiatry have developed strong working partnerships that have improved the quality of psychiatric residency education and Ohio's mental health services. Strategies integral to Ohio's Public Psychiatry Model include identifying a strong champion, integrating expert consultation, and developing consensus expectations using a small amount of catalytic funding. Successful outcomes include the establishment of public psychiatry leadership roles in Ohio's community and academic settings; positive community-focused residency training experiences; revised curricula; and spin-off opportunities, such as "Coordinating Centers of Excellence" to accelerate adoption of evidence-based practices in community settings.     

Disability in patients with head and neck cancer

BACKGROUND: Patients with head and neck cancer often experience debilitating speech, eating, and respiratory problems as well as the psychological effects of loss of function and change in body image. These patients often become unemployed as a result of their disease process, which adds financial burden to their already stressful lives. Yet the specific factors associated with unemployment have not been systematically studied. METHODS: This multisite study used survey and chart data to determine the predictors of work-related disability. RESULTS: Of the 384 patients who were working prior to their diagnosis of head and neck cancer, 52% (n = 201) were disabled by their cancer treatment. Multivariate analysis demonstrated significant links between disability and chemotherapy (odds ratio [OR], 3.4; P <.001), neck dissection status (OR, 2.3; P =.01), pain scores (OR, 1.2; P =.01), and time since diagnosis (OR, 0.9; P =.04). CONCLUSIONS: More than half of the patients in this study were disabled by their head and neck cancer or treatment. Patients with head and neck cancer who have undergone chemotherapy or neck dissection or have high pain scores are at increased risk for disability from their cancer or their treatment. Efforts to prevent (if possible), better assess, and treat pain and other adverse effects of head and neck cancer treatments may also have the potential to reduce patient disability.     

Physical activity, self-efficacy, and perceived exertion among adolescents

The relationship of self-efficacy, a sense of confidence in personal physical activity (PA) skills, to perceived exertion during activity was explored among 168 African American and European American boys and girls between 9 and 17 years of age. Participants walked/ran on a treadmill at a speed equivalent to 60% of their peak VO2 for 20 minutes and provided ratings of exertion every 4 minutes. Pre-activity self-efficacy predicted perceived exertion for boys only. Girls were lower than boys in pre-activity self-efficacy and subsequently reported greater perceived exertion. For both genders, lower perceived exertion during PA resulted in higher post-activity self-efficacy. Uncomfortable perceptions of exertion during initial efforts to increase PA are likely to discourage future activity. Interventions that can lower perceptions of exertion may enhance self-efficacy and promote a sense of competence in PA skills.