An Investigation of the Impact of Posttraumatic Stress Disorder on Physical Health

In a large sample of Gulf War veterans (N = 2301) we examined the relations between PTSD symptoms assessed immediately upon returning from the Gulf War and self-reported health problems assessed 18–24 months later. PTSD symptomatology was predictive of self-reported health problems over time for both men and women veterans, even after the effects of combat exposure were removed from the analysis. Female veterans reported significantly more health problems than male veterans, however, there was no interactive effect of gender and PTSD on health problems. These findings provide further support for the theory that psychological response to stressors impacts health outcome.     

Phase II study of 1alpha-hydroxyvitamin D(2) in the treatment of advanced androgen-independent prostate cancer.

PURPOSE: In this single institution Phase II trial, we evaluated the efficacy of the vitamin D analogue, 1alpha-OH-D(2), in patients with advanced hormone-refractory prostate cancer. Experimental Design: The patients initially received 1alpha-OH-D(2) at 12.5 micro g p.o. every day, which was dose adjusted for hypercalcemia. Given the cytostatic nature of the drug, the primary study end point was progression-free survival for a minimum of 6 months. The secondary end point was further characterization of drug toxicity. RESULTS: A total of 26 patients was enrolled. Using the intent-to-treat population, stable disease was seen for an average of 19.2 weeks (median 12 weeks, range 3-108 weeks). Twenty patients were evaluable for response. The one patient that achieved disease stabilization for >2 years elected to come off-study because of patient preference. His last disease evaluation showed no evidence of progression. No objective responses were seen. Previous and ongoing clinical observations strongly imply that PSA could be a misleading surrogate marker for clinical effect with this type of drug. Therefore, prostate-specific antigen was not used as a marker for disease response. Toxicity was as expected with mild hypercalcemia and associated symptoms like constipation and prerenal azotemia seen in some patients. Six (30%) evaluable patients experienced stable disease for >6 months, suggesting possible cytostatic activity. CONCLUSION: The results of this and other trials suggest further clinical investigation in this disease with vitamin D analogues alone or in combination with other agents, such as chemotherapy, should be pursued.     

Transfusion use in curatively operated patients with colorectal carcinomas. Swiss Study Group for Clinical Cancer Research

OBJECTIVE: Is there an improvement of the behaviour for restrective blood transfusions after the data in the literature and especially the preliminary data of the SAKK 40/81 study have been published? They have shown a worsening of the prognosis in patients with colorectal cancer after pre-/postoperative blood transfusions have been given. MATERIAL AND METHODS: Analysis of the retrospective transfusion data of the SAKK 40/81 study in comparison with the prospective transfusion data of the study SAKK 40/87. RESULTS: The analysis of the data showed that in the SAKK 40/81 study more patients received blood transfusions than in the SAKK 40/87 study (77% versus 49%). Especially there was a diminution from 90% in the SAKK 40/81 to 59% in the SAKK 40/87 study for the rectal cancer patients respectively from 70% to 44% in the colon cancer patients having received blood transfusions. The mean value of hemoglobin of the patients not having received transfusions has decreased from 11.2 (7.8-15) g/100 ml in the SAKK 40/81 to 10.6 (5.4-15) g/100 ml in the SAKK 40/87 study (p = 0.0001). CONCLUSION: The data of the two SAKK studies showed that in Switzerland the donation of blood transfusions in patients with colorectal cancer has continuously been handled more and more restrictive. An even more restrective use may be possible in future due to new operation techniques and the possibility of preoperative administration of erythropoetin to increase the hemoglobin level.     

Anesthesia practices in the united states common to in vitro fertilization (IVF) centers

Purpose: Our purpose was to characterize and describe anesthesia practice in programs performing IVF in the United States. Methods: We used a telephone survey requiring respondents to be either the program director, a physician, or a nurse familiar with the practice. Two hundred seven (78%) Society of Assisted Reproductive Technology (SART) registered programs agreed to participate. Programs were divided by geographic region and type of practice (academic versus private). Results: Ninety-one private (68%) and 41 academic (56%) programs used personnel provided by the Department of Anesthesiology. Conscious sedation was performed most commonly (95%). The remaining 5% used primarily either general, regional, or local anesthesia. Typical recovery times were 90 to 120 min. Average costs of anesthetic administration were $300–$400 and were similar among groups except for the Eastern academic programs, with a higher mean cost of $543. Programs using personnel from anesthesiology reported higher costs compared to programs utilizing their own staff ($391±15 vs $157±11; P<0.05). Complications were infrequent (<10%); no hospitalizations or serious life-threatening incidents were reported. Conclusions: A large number of programs safely used their own trained personnel to deliver anesthesia, and realized a significant reduction in cost.     

Screening for gestational diabetes mellitus in adolescent pregnancies

Objective: Our purpose was to determine the incidence of gestational diabetes mellitus in an adolescent population and to determine the cost of screening. Study Design: A retrospective review of 509 adolescent pregnancies was performed. The incidence of gestational diabetes mellitus was determined and the cost of screening analyzed. Results: Five hundred nine adolescent pregnancies were screened for gestational diabetes mellitus with a 1-hour, 50 gm oral glucose challenge test. Twenty-three of the screens (4.5%) had positive results at a plasma glucose level of ≥140 mg/dl. Three-hour 100 gm oral glucose tolerance tests were performed on screen-positive women, six of whom were diagnosed with gestational diabetes mellitus, for an incidence of 1.18%. The cost per case diagnosed was $2733. Conclusions: The incidence of gestational diabetes mellitus in an adolescent population is low. The cost of universal screening may be prohibitive in this population. Large prospective studies are needed to better analyze outcome data and efficacy of screening in adolescent pregnancies. (Am J Obstet Gynecol 1998;178:1251-6.)     

Reasons for Teachers' Adaptation of Substance Use Prevention Curricula in Schools with Non-White Student Populations

In this study we investigate reasons why teachers adapt substance use prevention curricula in the nation's middle schools. We hypothesize that these reasons will be most salient in schools with racially and ethnically diverse student populations, for whom teachers may believe it appropriate to tailor their curricula. The study sample comprised a nationally representative sample of lead substance use prevention teachers in the nation's middle schools. Respondents answered questions concerning eight student problems or needs that constituted reasons why they might adapt their prevention lessons. Controlling for a variety of school and teacher characteristics, we found that teachers in high minority schools were more likely to adapt curricula in response to three of the eight characteristics presented: youth violence, limited English proficiency, and various racial/ethnic or cultural groups. We suggest that curriculum developers make a systematic effort to understand how teachers are adapting their curricula in high minority schools and incorporate these modifications, if found effective, into their curricula.