Psychosocial outcomes of group prenatal care

Journal of Public Health - Group prenatal care provides an alternative model of prenatal care that allows for collaboration with peers, education, discussion, and self-management training in...     

Inability to demonstrate physiologic correlates of subjective improvement among patients taught the relaxation response

Objective:To assess whether the regular elicitation of the relaxation response produces sustained physiologic changes coincident with symptomatic relief or improved psychological state. Design:Prospective, cohort pilot study. Setting:Clinical research center within a teaching hospital. Patients:Thirteen athletic men, mean age 44.8 years, with borderline or labile hypertension, taking no medication. All 13 completed the study. Interventions:Three baseline assessments of psychological state, symptom checklist, and assessment of autonomic response to infusion of beta agonist (isoproternol). Daily relaxation response exercises for five consecutive weeks followed by repeat assessment of all parameters. Discontinuation of relaxation exercises for subsequent five weeks followed by repeat assessment of all parameters. Measurements and main results:After eliciting the relaxation response, subjects demonstrated significant decreases in anxiety (p<0.014) and somatic symptoms (p<0.02). Psychological and somatic variables returned toward baseline after the subsequent discontinuation of relaxation exercises. No significant concomitant change in urinary catecholamines, heart rate response to isoproterenol, blood pressure, pulse rate, or serum cholesterol was demonstrated. Conclusion:The regular elicitation of the relaxation response can improve psychological performance and reduce symptoms. However, the physiologic mechanism whereby these psychological and symptomatic improvements occur remains poorly understood and warrants further investigation. Received from the Divisions of General Medicine and Primary Care and Endocrinology, Beth Israel Hospital, the Department of Medicine, Harvard Medical School, the Charles A. Dana Research Institute, and the Harvard Thorndike Laboratory, Boston Massachusetts. Presented in part at the annual meeting of the Society of General Internal Medicine, Arlington, VA, April 28, 1988.     

The activity of lenalidomide with or without dexamethasone in patients with primary systemic amyloidosis

Primary systemic amyloidosis (AL) is an incurable plasma cell disorder. Lenalidomide, especially in conjunction with dexamethasone, is highly active in patients with multiple myeloma. We studied the toxicity and efficacy of lenalidomide in patients with AL. Patients with symptomatic AL, a measurable plasma cell disorder, and adequate hematologic and renal reserve were eligible. Patients received single-agent lenalidomide. If there was no evidence of progression after 3 months or of hematologic response after 3 cycles, dexamethasone was added. Twenty-three patients were enrolled. Thirteen were previously treated. Organ involvement was cardiac (64%), renal (73%), hepatic (23%), and nerve (14%). Within the first 3 cycles of therapy, 10 patients discontinued treatment: 4 early deaths, 3 adverse events, and 3 other causes. With a median follow-up of 17 months, 10 patients responded to treatment. In these patients, responses included 9 hematologic, 4 renal, 2 cardiac, and 2 hepatic. All but one of the responders had dexamethasone added to their treatment program. The most common grade 3 or 4 adverse events at least possibly attributable to lenalidomide were neutropenia (45%), thrombocytopenia (27%), rash (18%), and fatigue (18%). In AL patients, we saw limited activity of single-agent lenalidomide, but significant activity of the combination with dexamethasone, which warrants further investigation.     

FGFR1 amplification and the progression of non-invasive to invasive breast cancer

A recent prospective clinical trial provides further evidence that breast cancers arising in germline BRCA1 mutation carriers are highly sensitive to cisplatin chemotherapy. The potential significance of these data for the management of patients with BRCA1-related and BRCA2-related breast cancer is discussed.     

Presumed and definite bacteremia in extremely low gestational age newborns

Aim: To explore risk patterns for presumed and definite, early and late neonatal bacteremia. Methods: We studied 1106 extremely low gestational age newborns who survived until postnatal day 28. We defined early definite bacteremia as a positive bacterial culture in the first week and definite late bacteremia as a positive bacterial culture in week 2, 3 or 4. Bacteremia was presumed if antibiotics were given for more than 72 h despite negative blood cultures. Results: Risk patterns did not differ much for presumed and definite bacteremia in the first postnatal month. While maternal and pregnancy characteristics were associated with early bacteremia, neonatal comorbidities, especially NEC, were the main antecedents/correlates of late bacteremia. All four categories of bacteremia were associated with younger gestational age and lower birth weight. Infants with presumed and definite bacteremia had similar distributions of days of ventilation and oxygenation. Conclusion: Definite and presumed late bacteremias have rather similar risk patterns, while those of early and late bacteremia differ appreciably.     

Executive Dysfunction Early Postnatal Biomarkers among Children Born Extremely Preterm

Journal of Neuroimmune Pharmacology - We evaluated the relationship between blood levels of inflammatory and neurotrophic proteins during the first postnatal month in 692 children born before the...