Weight concerns affect motivation to remain abstinent from smoking postpartum

Background: Although many women quit smoking during pregnancy, most resume smoking postpartum. One factor that may be important in postpartum relapse is a pregnant woman's motivation to remain abstinent after delivery.Purpose: We assessed motivation for postpartum abstinence among pregnant women who had quit smoking and examined the relationship of weight concerns and mood to abstinence motivation.Methods: Pregnant former smokers, recruited between February 2000 and November 2004, completed assessments of smoking, weight concerns, depressive symptoms, and perceived stress.Results: Sixty-five percent were highly motivated to remain abstinent postpartum.Women who were and were not motivated were similar in age, race, and nicotine dependence. However, motivated women reported more stress, greater self-efficacy for weight management, less hunger, and less smoking for weight control than did less motivated women. After controlling for intention to breast-feed, nicotine dependence, years of smoking, partner smoking, and race, self-efficacy for weight control was related to motivation to maintain postpartum abstinence.Conclusions: These data suggest that weight concerns are associated with motivation for postpartum smoking abstinence, and interventions designed to prevent postpartum smoking relapse may need to target eating, weight, and shape concerns. This research was supported by grant K01 DA04174 from the National Institute on Drug Abuse awarded to Michele D. Levine.We are grateful to Donielle Neal, Meghan Currie, and Gillian Miller for assistance with data collection.     

Genetic variation in dopamine pathways differentially associated with smoking progression in adolescence

Objective:To clarify the nature of the association between dopamine genes and smoking by examining whether genetic variability in components of the dopamine pathway could explain refined phenotypes in adolescent smoking progression.Method:Data are from an ongoing prospective study of the long-term outcome of early risk factors studied since birth. At age 15 years, 220 participants (108 males, 112 females) completed a self-report questionnaire measuring smoking behavior and were genotyped for five dopamine gene variants.Results:Smoking initiation was related to allelic variation in the dopamine D4 receptor gene (DRD4), whereas smoking continuation and dependence showed association with the dopamine D2 receptor gene (DRD2). Adolescents with the seven-repeat allele of the common DRD4 exon 3 polymorphism had rates of ever smoking that were significantly higher than in those with other genotypes. Once smoking started, carriers of the T allele of a single nucleotide polymorphism of DRD2 (rs4648317) reported higher rates of current smoking and scored higher on nicotine dependence than their allelic counterparts. Among current smokers, intention to quit was significantly lower in adolescents homozygous for the 10-repeat allele of the common dopamine transporter 3′ untranslated region polymorphism.Conclusions:Our results provide preliminary evidence of genetic influences on different stages of smoking and suggest the importance of specific dopamine genes in smoking progression in adolescence.     

Has there been a delay in the age of regular smoking onset among African Americans?

Background: It is not clear whether the decline in African American adolescent smoking in the 1980s reflected a delay in age of onset of regular smoking initiation rather than success in preventing initiation completely.Purpose: The purpose of this study is to identify whether the marked reductions in African American adolescent smoking in the 1980s were offset by increased initiation in young adults.Methods: We combined data from the Tobacco Use Supplements of the 1992–1993, 1995–1996, and 1998–1999 Current Population Surveys (n = 512,258), and reconstructed year of smoking initiation and calculated age-specific incidence of initiation from 1970 to 1992. We then compared detailed age-specific rates of initiation for two 5-year periods selected to be before and after the documented large declines in African American adolescent smoking.Results: In the time period after marked declines in African American adolescent smoking (1987–1991), the incidence of initiation of regular smoking decreased for African Americans ages 14 to 16 and increased for ages 18 to 20. Such a delay was not as evident among non-Hispanic Whites. The delay that was slight in regular smoking initiation among African Americans relative to non-Hispanic Whites in 1975–79 had increased substantially by 1987–91.Conclusions: Reductions in African American adolescent smoking in the 1980s were offset by increased initiation among young adults ages 18 to 20 during this time period and suggest that the window for uptake of regular smoking shifted to older ages for African Americans more so than non-Hispanic Whites. Efforts to combat smoking should remain aggressive into young adulthood, when the tobacco industry’s efforts to gain new smokers intensify. This research was supported by Grant 9RT-0036 from the University of California Tobacco Related Diseases Research Program.     

The relationship between self-monitoring,outcome expectancies,difficulties with eating and exercise,and physical activity and weight loss treatment outcomes

Background/Purpose: During a behavioral weight loss program (BWLP), weight loss and exercise can vary considerably from week to week. Weekly fluctuations in outcome expectancies and perceived difficulties with eating and exercise may be associated with weekly variability in weight loss and exercise. Also, inconsistent self-monitoring of exercise may be associated with poor weight loss and physical activity treatment outcomes.Methods:Forty obese, sedentary participants completed a 6-month BWLP. Body weight, outcome expectancies, and difficulties with eating and exercise were assessed weekly. Weekly self-monitoring of exercise was computed from physical activity diaries. Physical activity, VO₂ max, and caloric intake were assessed pre-and posttreatment.Results:Within-subjects analyses indicated that participants exercised less during weeks that participants reported greater difficulties with exercise, relative to weeks participants reported fewer difficulties. Participants lost significantly more weight during weeks that participants reported more positive outcome expectancies and greater difficulties with exercise, compared to weeks participants reported less positive outcome expectancies and fewer difficulties with exercise. Consistent self-monitoring of exercise was associated with fewer difficulties with exercise and greater exercise and weight loss.Conclusions:Interventions that are targeted to increase self-monitoring and to improve transient difficulties with exercise and diminished outcome expectancies may improve BWLP treatment outcomes.     

Adolescent expectancies,parent-adolescent communication and intentions to have sexual intercourse among inner-city,middle school youth

Background: The incidence and prevalence of pregnancy and sexually transmitted infections among American adolescents remain unacceptably high.Purpose: This research examines adolescent intentions to have sexual intercourse, their expectancies about having sexual intercourse, and maternal communication about the expectancies of engaging in sexual intercourse.Methods: Six hundred sixty-eight randomly selected inner-city middle school students and their mothers completed self-administered questionnaires. Adolescents reported their intentions to have sexual intercourse and the perceived positive and negative expectancies of doing so. Both mothers and adolescents reported on the frequency of communication about these expectancies.Results: Boys reported higher intentions, more positive expectancies, and lower levels of maternal communication than did girls. Expectancies statistically significantly associated with intentions focused on the positive physical, social, and emotional advantages of having sex rather than on concerns about pregnancy and HIV/AIDS. With some exceptions, maternal communication was associated with adolescents’ expectancies about engaging in sexual intercourse. However, only modest correlations between maternal and adolescent reports of communication were observed.Conclusions: Results indicate that intervention programs should address the positive expectancies youth have about having sex, not just the threat of pregnancy and HIV/AIDS, and should address potential gender differences in expectancies between boys and girls. This research was conducted as part of the Linking Lives Health Education Program efficacy evaluation and was supported by funding from the Centers for Disease Control and Prevention (CDC), Cooperative Agreement # U87/CCU220155-3-0. The findings and conclusions in this article are those of the authors and do not necessarily represent the views of the CDC.     

Persistent heavy smoking as risk factor for major depression (MD) incidence--evidence from a longitudinal Canadian cohort of the National Population Health Survey

BackgroundReports of bidirectional associations between smoking and major depression (MD) have been interpreted as providing evidence for confounding by shared-vulnerability factors (SV) that predispose individuals to both conditions. If this is true, then smoking cessation may not reduce the risk of MD. From clinical practice and public health perspectives, the long-term outcomes associated with smoking persistence and cessation are potentially important and deserve exploration. To this end, the 12-year risk of MD in persistent heavy smokers and abstainers who were former-heavy smokers with and without adjustment for potential confounders were compared.MethodsFollow-up data from the National Population Health Survey (NPHS) was used. Multinomial logistic (ML) models were fit to identify potential confounders. Using proportional hazard (PH) models, unadjusted and adjusted hazard ratios (HRs) for MD outcome were estimated for different smoking patterns.ResultsThe unadjusted HR relating the risk of MD among current-heavy versus former-heavy smokers was 4.3 (95% CI: 2.6–6.9, p < 0.001). Current-heavy smoking predicted onset of MD (HR = 3.1, 95% CI: 1.9–5.2, p < 0.001) even after adjustment for age, sex and stress – the main confounders. However, this was not the case for the never, former-light, and current-light categories. Evidence of decreased risk of MD among former-heavy relative to current-heavy smokers as function of smoking cessation maintenance time was also found.ConclusionsContrary to common beliefs about the benefits of smoking for mental health, our results suggest that current-heavy rather than ever-heavy smoking is a major determinant of MD risk and point towards the benefits of smoking cessation maintenance.     

Association between tobacco smoking and bipolar affective disorder: clinical, epidemiological, cross-sectional, retrospective study in outpatients

PurposeAlthough high rates of smoking have been reported among psychiatric patients, only a few studies examined the prevalence of smoking in bipolar disorder, and findings are inconsistent. We investigated smoking among bipolar patients.MethodsWe examined the prevalence of smoking in of 102 patients that met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for bipolar I disorder in Israel and evaluated the relationship between smoking and demographic and clinical data.ResultsFifty-five of the bipolar patients (53.9%) smoked, with a rate that is 2.36 times higher than among the general population in Israel (22.8%). Significant relationships were revealed between smoking and lifetime history of alcohol dependence/abuse (P = .02), between smoking and history of drug use (P ≤ .01), and between smoking and age of illness onset (P = .04).LimitationsThe cross-sectional nature of the study and the relatively small sample size preclude generalization of the findings. Nicotine levels were not measured; thus, the information regarding smoking was subjective.ConclusionsBipolar patients smoke more than the general population. Bipolar patients that are moderate or heavy smokers are more likely than nonsmokers to consume alcohol and abuse psychoactive substances. Contrary to findings of previous studies, no association was found between clinical variables of bipolar patients and smoking.     

The relationship between smoking history and current functioning in disabled community-living older adults

Purpose: This study was conducted to determine characteristics associated with continued cigarette use in frail older adults and to examine how smoking history relates to current psychiatric, cognitive, and occupational functioning.Methods: Archival records were gathered for 1,064 patients (69% women) who entered On Lok SeniorHealth Services between January 1996 and December 2000. Participants were interviewed on program entry and assessed for smoking history, depressive symptoms, affective disorders, cognitive functioning, alcohol use, and physical functioning (activities of daily living [ADLs] and instrumental ADLs). Cross-sectional analyses were conducted to examine functioning at enrollment relative to smoking history.Results: Smoking history was related to age at program entry, with current smokers entering On Lok at an earlier age than former or never smokers. Current smokers were more likely to be male, to be of Caucasian or African American descent, to consume alcohol on a regular basis, and to be more independent on ADLs. Specifically, they were more independent on tasks related to their capacity to procure cigarettes or continue smoking, including shopping, using transportation, managing money, dressing themselves, and walking. Smoking history was related to depression, with symptoms lower for current and former smokers.Conclusions: Current smokers present for services at an earlier age and have higher levels of independence on ADLs instrumental to nicotine use. Data indicate characteristics associated with continued smoking and provide a foundation for targeting older individuals for cessation efforts. This study was funded in part by a pilot study grant from the San Francisco Treatment Research Center (P50–DA09253) awarded to Dr. Haas and an institutional postdoctoral fellowship awarded to Dr. Hall (T32–DA07250). Dr. Haas is now with Santa Clara University. We thank Kathy Rice-Trumble of On Lok for her assistance in data collection and management and Patricia Gill for her help in data acquisition.     

Comparison of magnetoencephalography,functional MRI,and motor evoked potentials in the localization of the sensory-motor cortex

Abstract

To clarify the topographical relationship between peri-Rolandic lesions and the central sulcus, we carried out presurgical functional mapping by using magnetoencephalography (MEG), functional magnetic resonance imaging (f-MRI), and motor evoked potentials (MEPs) on 5 patients. The sensory cortex was identified by somatosensory evoked magnetic fields using MEG (magnetic source imaging (MSI)). The motor area of the hand region was identified using f-MRI, during a hand squeezing task. In addition, transcranial magnetic stimulation localized the hand motor area on the scalp, which was mapped onto the MRI. In all cases, the sensory cortical vein or the lack of any functional activation in the area of peri-lesional edema. MEPs were also unable to localize the entire motor strip. Therefore, at present, MSI is considered to be the most reliable method to localize peri-Rolandic lesions. [Neurol Res 1995; 17: 361-367] cortical vein or the lack of any functional activation in the area of peri-lesional edema. MEPs were also unable to localize the entire motor strip. Therefore, at present, MSI is considered to be the most reliable method to localize peri-Rolandic lesions. [Neurol Res 1995; 17: 361-367]     

Effects of diabetes and smoking on lumbar spinal surgery outcomes

Smoking and diabetes have long been considered risk factors for poor surgical outcome. However, the precise role of smoking and diabetes in the development of poor outcome in lumbar spinal surgery remains ambiguous. This study was undertaken to determine the effects of diabetes and smoking specifically on lumbar spinal surgery outcomes. A retrospective cohort study studied 902 patients who underwent lumbar spinal surgery at the Royal Melbourne Hospital, Australia, between 2001 and 2005, inclusively. Four groups were formed: control; diabetic; positive smoking history; and diabetic and positive smoking history. Multivariate analysis was used to analyse the likelihood of developing complications with a history of diabetes and/or smoking. Our findings indicate that diabetes was significantly associated with an increased risk of developing complications. Patients in the diabetic groups were also significantly older and had a longer length of stay than the other patients (p < 0.05 for all significant findings). We conclude that diabetes does increase the risk of poor outcome following lumbar spinal surgery. However, we found no association between a positive smoking history and an increased rate of poor outcome.     

Changes in smoking associated with an acute health event: Theoretical and practical implications

Background: Experiencing a serious adverse behavior-related consequence may motivate behavior change.Purpose: To examine how a sentinel health event is associated with changes in smoking.Methods: We used a prospective cohort design. Adult emergency department (ED) patients provided demographic data, a smoking history, ratings of quit intentions, and endorsement of self-identified smoking-related health problems. A chart review collected data on acuity, ED disposition, and medical diagnoses. Smoking was reassessed 1 month postvisit. Hierarchical regression analyses were conducted to predict (a) intention to quit, (b) any quit attempt of 24 hr or more, and (3) 7-day abstinence.Results: Of 717 smokers enrolled, 189 (26%) intended to quit within the next month. Of the 253 participants reached 1 month postvisit, 126 (50%) reported they had attempted to quit, with 44 (19%) reporting 7-day abstinence. After controlling for other predictors, several event-related variables, such as having a smoking-related ED visit and being admitted to the hospital, were strong predictors of outcomes.Conclusion: Compared to community-based estimates, many more smokers in our sample attempted to quit and achieved 7-day abstinence. This was especially true among smokers who attributed their ED visit to a smoking-related health problem and who were admitted to the hospital. We discuss the implications for tobacco intervention design in medical settings. This study was supported by a NIH/NID K23 Research Career Award (EDB) Grant (DA-16698-01) and a UMDNJ Foundation Seed Grant.     

Physical activity,global physical self-concept,and adolescent smoking

Background: Previous research supports a possible protective effect for physical activity against adolescent smoking. However, it is not clear whether the effect of physical activity on smoking is direct (e.g., time spent in physical activity) or indirect through another variable. One such variable is global physical self-concept (GPSC). Briefly, GPSC is a general perception of one’s physical self, including appearance and physical activity competence.Purpose: This study tested a structural equation model of the relationship between physical activity and smoking, with direct effects from physical activity to smoking and an indirect effect through GPSC.Methods: Participants were 983 12th graders taking part in a study of the biobehavioral predictors of adolescent smoking adoption.Results: Controlling for covariates of adolescent smoking (e.g., peer smoking, alcohol use) and GPSC (e.g., body mass index, perceived physical appearance), physical activity had an indirect effect on smoking through its effects on GPSC, suggesting that the potential beneficial effects of physical activity on adolescent smoking may depend, in part, on GPSC.Conclusions: These results suggest that an adolescent’s perception of the physical self may be one important factor to consider in youth smoking interventions. Further research is necessary to evaluate the longitudinal relationship between physical activity, GPSC, and smoking. This study was supported by a Transdisciplinary Tobacco Use Research This study was supported by a Transdisciplinary Tobacco Use Research This study was supported by a Transdisciplinary Tobacco Use Research We acknowledge Nicholas Carson, Jocelyn Cuevas, Freda Patterson, and Kelly Rogers for their contribution in the collection and/or processing of these data. We also acknowledge and extend appreciation to the high school faculty members, administrative personnel, and students involved in the research.     

Behavioral approaches to smoking cessation—II. Topical bibliography 1969–1979

This topical bibliography covers the past decade of research into behavioral approaches to smoking cessation. Using multiple sources, including Psychological Abstracts, 335 references were compiled from over 50 psychology, medicine, and related behavioral science journals. All references were comprehensively coded for each of 28 topical areas of interest to behavioral researchers and clinicians. Topics include specific behavioral smoking cessation techniques (e.g. aversive smoking, relaxation techniques, stimulus control), treatment problems (e.g. maintenance problems and procedures, treatment “side-effects”) and important research issues (e.g. predictors of treatment success, physiological correlates of smoking behavior, therapist and treatment factors influencing outcome). An index defining each topic and listing by number all articles related to each topic is included with the bibliography (Tables 1 and 2). With this index, users with specialized interests can quickly locate all citations concerning a particular topic or combination of topics. The preceding article (Orleans et al., 1981) gives guidelines for expanding this bibliography for personal reference use.     

Chronic Kidney Disease and Clinical Outcomes in Patients with Intracerebral Hemorrhage

Background and PurposeThe influence of chronic kidney disease (CKD) on functional outcome in intracerebral hemorrhage (ICH) is scarcely investigated and reported findings are conflicting mostly because of nonaccounting for imbalances. Aim of the present study was to determine the impact of CKD on functional long-term outcome in ICH-patients.MethodsIn this observational cohort study of spontaneous ICH-patients admitted to our Department of Neurology between 2006 and 2015 we investigated retrospectively as primary outcome the dichotomized functional status (modified-Rankin-Scale = 0-3-versus-4-6) at 12 months according to renal function (CKD versus non-CKD), including categorial estimates of the glomerular filtration rate subanalyses. Confounding was addressed by propensity-score(ps)-matching and adjusted multivariable regression analyses.ResultsWe identified 1076 eligible ICH-patients, of which 131 (12.2%) suffered from CKD on hospital admission. Confounders associated with CKD consisted of hypertension (P = .023), Diabetes mellitus (P = .001), prior ischemic stroke and/or transitory ischemic attack (TIA) (P = .021), congestive heart failure (P < .01), impaired liver function (P < .01), antiplatelet therapy (P = .01), poorer premorbid functional status (P < .01), and deep ICH-location (P = .006). After balancing for confounding, patients with CKD showed a significantly decreased rate of favorable functional outcome at 12 months (CKD:29 of 111(26.1%)-versus-non-CKD:78 of 206 (37.9%); P = .035). Subanalyses showed that stages of CKD were evenly associated with mortality at 12 months (GFR category G3a, OR:2.811; CI (1.130-6.994); P = .026; GFR category G3b, OR:1.874; CI (.694-5.058); P = .215; GFR category G4, OR:10.316; CI (1.976-53.856); P = .006; GFR category G5, OR:8.989; CI (1.900-42.518); P = .006).ConclusionsAs compared to ICH-patients without CKD, those with CKD show increased rates of mortality and worse functional outcomes even after statistical correction for imbalanced baseline characteritsics. This finding is presumably linked to comorbidity and warrants further investigation in prospective studies.     

Effect of smoking status on outcome after acute ischemic stroke

BACKGROUND: The status of smoking as a risk factor for the occurrence of stroke is well established. However, there is a paucity of data on the relationship between smoking status and acute stroke outcomes. We evaluated the role of recent smoking as a prognostic factor following acute ischemic stroke. METHODS: We analyzed data from patients enrolled in the Intravenous Magnesium Efficacy in Stroke (IMAGES) trial. Outcome measures studied included change in IMAGES stroke score, poor functional outcomes at day 30 and 90 (defined as Rankin Scale >1 and Barthel Index <95), and survival over the first 3 months after stroke. The independent effect of smoking status (subjects who had smoked in the past year) on outcome was evaluated by logistic regression analysis and Cox's proportional hazards model, adjusting for variables known to predict outcome after ischemic stroke. RESULTS: There were 2,386 subjects in the IMAGES efficacy dataset, including 615 recent or current smokers and 1,771 nonsmokers, among whom smokers were younger (p < 0.0001). After adjusting for covariates, smokers had increased odds of poor 90-day functional outcome independently of other statistically significant predictor variables, as assessed by Rankin Scale (odds ratio 1.38; 95% confidence interval 1.09-1.75) and Barthel Index (odds ratio 1.42; 95% confidence interval 1.13-1.79) at day 90. Smoking status did not affect survival at day 90. CONCLUSIONS: Current or recent smokers experience poorer functional outcomes than nonsmokers 3 months after acute ischemic stroke.     

Clinical relevance of source location in frontal lobe epilepsy and prediction of postoperative long-term outcome

PurposeTo evaluate the value of magnetoencephalography (MEG) source localization in localization of epileptic activities and predicting surgical outcome in frontal lobe epilepsies (FLE).MethodsForty-six patients with presurgical MEG evaluation and intractable FLE surgery (28 male patients) were analyzed retrospectively with a mean follow-up of 5 years. Dipole analysis was performed for MEG source imaging (MSI). The localization of dipole clusters in relation to the dominant hemisphere, lesions, resection cavity and functional cortex were analyzed. The predictive value of MSI in respect to clinical outcome with long-term postoperative follow up was evaluated.ResultsInterictal focal epileptic activities were found in 82.6% (38/46) patients with monofocal activity 81.6% (31/38) and multifocal activities 18.4% (7/38). Seizure free rate was 47.9% at the mean follow-up of 5.0 ± 4.0 years (median 11.5, range 2–57). Seizure recurrence mainly occurred in the first 1 year after surgery. In the monofocal epileptic activity group, 58.1% (18/31) of the patients were seizure free, predicitng postoperative seizure freedom better than multifocal localization 0% (0/7) (p = 0.028). Dipole clusters were completely resected in 70.9% of monofocal activity patients, which had higher seizure free rates compared to partial resection (p = 0.002). In patients with surgery in the dominant hemisphere, seizure control was less likely (p = 0.006).ConclusionMSI contributes to the clinical prediction of postoperative outcome in FLE patients. MSI may non-invasively disclose early epileptogenic lesions, pointing to a resectable lesion, and it then facilitates shortcut route of presurgical evaluation.     

Case-Fatality and Functional Outcome after Subarachnoid Hemorrhage (SAH) in INternational STRoke oUtComes sTudy (INSTRUCT)

BackgroundThere are few large population-based studies of outcomes after subarachnoid hemorrhage (SAH) than other stroke types.MethodsWe pooled data from 13 population-based stroke incidence studies (10 studies from the INternational STRroke oUtComes sTudy (INSTRUCT) and 3 new studies; N=657). Primary outcomes were case-fatality and functional outcome (modified Rankin scale score 3-5 [poor] vs. 0-2 [good]). Harmonized patient-level factors included age, sex, health behaviours (e.g. current smoking at baseline), comorbidities (e.g.history of hypertension), baseline stroke severity (e.g. NIHSS >7) and year of stroke. We estimated predictors of case-fatality and functional outcome using Poisson regression and generalized estimating equations using log-binomial models respectively at multiple timepoints.ResultsCase-fatality rate was 33% at 1 month, 43% at 1 year, and 47% at 5 years. Poor functional outcome was present in 27% of survivors at 1 month and 15% at 1 year. In multivariable analysis, predictors of death at 1-month were age (per decade increase MRR 1.14 [1.07-1.22]) and SAH severity (MRR 1.87 [1.50-2.33]); at 1 year were age (MRR 1.53 [1.34-1.56]), current smoking (MRR 1.82 [1.20-2.72]) and SAH severity (MRR 3.00 [2.06-4.33]) and; at 5 years were age (MRR 1.63 [1.45-1.84]), current smoking (MRR 2.29 [1.54-3.46]) and severity of SAH (MRR 2.10 [1.44-3.05]). Predictors of poor functional outcome at 1 month were age (per decade increase RR 1.32 [1.11-1.56]) and SAH severity (RR 1.85 [1.06-3.23]), and SAH severity (RR 7.09 [3.17-15.85]) at 1 year.ConclusionAlthough age is a non-modifiable risk factor for poor outcomes after SAH, however, severity of SAH and smoking are potential targets to improve the outcomes.     

Interictal MEG/MSI in intractable mesial temporal lobe epilepsy: Spike yield and characterization

ObjectiveTo evaluate the ability of MEG to detect medial temporal spikes in patients with known medial temporal lobe epilepsy (MTLE) and to use magnetic source imaging (MSI) with equivalent current dipoles to examine localization and orientation of spikes and their relation to surgical outcome.MethodsWe prospectively obtained MSI on a total of 25 patients previously diagnosed with intractable MTLE. MEG was recorded with a 275 channel whole-head system with simultaneous 21-channel scalp EEG during inpatient admission one day prior to surgical resection. The patients’ surgical outcomes were classified based on one-year follow-up after surgery.ResultsNineteen of the 22 patients (86.4%) had interictal spikes during the EEG and MEG recordings. Thirteen of 19 patients (68.4%) demonstrated unilateral temporal dipoles ipsilateral to the site of surgery. Among these patients, five (38.5%) patients had horizontal dipoles, one (7.7%) patient had vertical dipoles, and seven (53.8%) patients had both horizontal and vertical dipoles. Sixty percent of patients with non-localizing ictal scalp EEG had well-localized spikes on MSI ipsilateral to the side of surgery and 66.7% of patients with non-localizing MRI had well-localized spikes on MSI ipsilateral to the side of surgery. Concordance between MSI localization and the side of lobectomy was not associated with a likelihood of an excellent postsurgical outcome.ConclusionsMSI can detect medial temporal spikes. It may provide important localizing information in patients with MTLE, especially when MRI and/or ictal scalp EEG are not localizing.SignificanceThis study demonstrates that MSI has a good ability to detect interictal spikes from mesial temporal structures.     

A randomized pilot study of cognitive-behavioral therapy versus basic health education for smoking cessation among cancer patients

Background: Previously, we have linked theoretically based cognitive and emotional variables to the ability of cancer patients to quit smoking.Purpose: In this study, we evaluated the impact of cognitive-behavioral therapy (CBT), which addressed these theoretically derived cognitive and emotional variables linked to tobacco use in this population, for promoting smoking cessation in a sample of cancer patients and assessed longitudinal predictors of smoking cessation.Methods: Cancer patients (N=109) were randomized to either the theoretically based CBT intervention or to a general health education (GHE) condition, and all patients received nicotine replacement therapy.Results: Contrary to our expectation, no significant difference in 30-day point-prevalence abstinence between the CBT and GHE conditions was detected at either a 1-month (44.9% vs. 47.3%, respectively) or 3-month (43.2% vs. 39.2%, respectively) follow-up evaluation. Higher quit motivation and lower cons of quitting were related to smoking cessation.Conclusions: Implications for the implementation of smoking cessation behavioral treatments in the oncologic context are discussed, as are directions for future research in this area. National Institutes of Health grants CA88610 and CA95678 provided support for this study.     

Prenatal smoking and internalizing and externalizing problems in children studied from childhood to late adolescence

ObjectiveTo study whether prenatal smoking only relates to externalizing problems or whether it is associated with both internalizing and externalizing problems from childhood into late adolescence.MethodChild Behavior Checklist-derived, parent-reported internalizing and externalizing problems of 396 children were longitudinally assessed at ages 5, 10 to 11, and 18 years. The influence of self-reported prenatal smoking on the course of internalizing and externalizing problems over these ages was assessed, controlling for the co-occurrence of internalizing and externalizing problems and co-occurring pre- and perinatal risk factors, demographic characteristics, maternal mental health, and child social and attention problems.ResultsChildren whose mothers had smoked during pregnancy had increased levels of both internalizing and externalizing problems over the period of ages 5 to 18 years when compared with children whose mothers did not smoke during pregnancy. These associations remained significant after controlling internalizing for externalizing and vice versa and possible confounding variables.ConclusionsMaternal smoking during pregnancy is a predictor of internalizing as well as externalizing psychopathology in offspring. The association between prenatal smoking and internalizing and externalizing problems persists throughout childhood and late adolescence. J. Am. Acad. Child Adolesc. Psychiatry, 2008; 47(7):779–787.