Contingent reinforcement for reduced breath carbon monoxide levels: Target-specific effects on cigarette smoking

This study determined the effects on smoking behavior of providing contingent reinforcement for nonsmoking versus reduced smoking afternoon breath carbon monoxide (CO) target levels. Twenty-eight hired chronic smoker volunteers were randomly assigned to one of three experimental conditions during a 10-day intervention: (a) 8 ppm target CO, $5 per day incentive (n = 11); (b) 16 ppm target CO, $4 per day incentive (n = 8); or (c) 8 ppm target CO, no incentive (n = 9). Both payment groups showed significantly lower CO levels and greater amounts of daytime smoking reduction than the no-pay group. A specific effect of CO target was also seen; 45% of subjects in the 8 ppm group compared with 0% of subjects in the 16 ppm target and no-pay groups produced average afternoon CO levels of 8.5 ppm or lower during the intervention. Average levels of CO and smoking reduction did not differ for the two paid groups, however, because some subjects in the 8 ppm group failed to reduce CO sufficiently to contact the reinforcer. Contingent reinforcement based on expired air CO levels can exercise powerful and precise (target-specific) control over smoking behavior, but there may be individual differences in ability to meet reinforcement contingencies if difficult targets are introduced abruptly.     

Long-term breast cancer survivors' use of complementary therapies: perceived impact on recovery and prevention of recurrence

OBJECTIVE: Many cancer survivors use some form of complementary therapy (CT); this is particularly true for women with breast cancer. The majority of reports on CT use in women with breast cancer have focused on CT use during cancer treatment or within a year or two of treatment completion. The purpose of this study was to evaluate longer-term breast cancer survivors' (average, 8.7 years) frequency of CT use and their beliefs about the role of CT in cancer recovery and the prevention of cancer recurrence, as well as the relationship of CT use with current life satisfaction. METHODS: A mail survey was completed by 608 breast cancer survivors a minimum of 2 years after their most recent cancer diagnosis. Participants were contacted through the American Cancer Society Reach to Recovery program in Florida. The self-report questionnaire inquired about the use of various CTs, beliefs about CT, current life satisfaction, demographic characteristics, and cancer treatment history. RESULTS: Most of the respondents were older than 50, were Caucasian, were married, had attended or completed college, and were at least 5 years after breast cancer treatment. The most commonly used CTs included exercise, vitamins, prayer/spiritual practice, support groups, humor, self-help books, and relaxation. These survivors used CT therapies because they wanted to play a more active role in their cancer recovery, to manage stress, and to maintain hope. A majority of them reported that they used CT to reduce the risk of cancer recurrence. Use of CT was not correlated with life satisfaction. CONCLUSIONS: Most of the breast cancer survivors in this study had used some form of CT since the time of their most recent cancer diagnosis and believed that such therapies could be of significant benefit, despite a lack of correlation between CT use and current life satisfaction. Many believed that use of CT may prevent cancer recurrence. It is important, therefore, to investigate the efficacy of various CTs among longer-term cancer survivors, especially with regard to their potential in preventing cancer recurrence.     

Comparison of conventional bacteriology with nucleic acid amplification (amplified mycobacterium direct test) for diagnosis of tuberculous meningitis before and after inception of antituberculosis chemotherapy

The role of nucleic acid amplification techniques in the rapid diagnosis of tuberculous meningitis remains uncertain. We compared the performance of Ziehl-Neelsen (ZN) staining, the Gen-Probe amplified Mycobacterium tuberculosis direct test (MTD), and culture with 341 cerebrospinal fluid specimens from 152 adults (73 with and 79 without tuberculous meningitis) before and after inception of antituberculosis chemotherapy. The sensitivity, specificity, and positive and negative predictive values of ZN staining before treatment were 34/66 (52%), 79/79 (100%), 34/34 (100%), and 79/111 (71%), compared with 25/66 (38%), 78/79 (99%), 25/26 (96%), and 79/120 (66%) for MTD. The sensitivity of combined ZN staining and MTD (either positive) was 45/66 (68%). The sensitivity of staining and culture fell more rapidly than that of MTD after the start of treatment: after 5 to 15 days of treatment, MTD was more sensitive than ZN staining (12/43 [28%] versus 2/43 [2%]; P = 0.013). Slower bacterial clearance was observed if M. tuberculosis was resistant to isoniazid and/or streptomycin: resistant organisms were more likely to be cultured from cerebrospinal fluid after 2 to 5 days of treatment than fully sensitive organisms (P < 0.001). The sensitivities of ZN staining, MTD, and the two tests combined were improved by repeated sampling to 38/59 (64%), 35/59 (59%), and 49/59 (83%), respectively. In conclusion, ZN staining of the cerebrospinal fluid is at least as good as MTD for the rapid diagnosis of tuberculosis and is much faster and less expensive. However, the combination of these methods on serial samples detects more cases. Alternative tests are still urgently required.     

Dehydroepiandrosterone sulfate (DHEAS) and health: does the relationship differ by sex?

This study uses data from a large, nationally representative sample of older Taiwanese (aged 54 and older in 2000) to investigate sex differences in the relationship between DHEAS and various health outcomes. Data collection included an individual interview, a physical examination, and samples of blood and (12-h) urine. Regression models of health outcomes on DHEAS are estimated in two steps: first, including only controls for age and sex as well as an interaction between DHEAS and sex; and second, adding covariates likely to be related to both DHEAS and health outcomes (e.g. smoking). Results reveal that higher levels of DHEAS are associated with fewer mobility limitations (especially for women), better cognitive function (among women but not men), and better self-rated health (significant only for men but of similar magnitude for women). These findings are in contrast to previous studies conducted in the US and Europe that generally find stronger associations for men than women. Also unlike previous studies, which often demonstrate a negative relationship between DHEAS and depressive symptoms at least for women, we find little evidence of such a relationship for either sex.     

Chronic mild stress exacerbates the effects of permanent bilateral common carotid artery occlusion on CA1 neurons

The effect of chronic mild stress (CMStress) was examined in an animal model of chronic cerebral hypoperfusion. Eight-month-old male Sprague-Dawley rats underwent permanent bilateral occlusion of the carotid arteries (2VO) or sham surgery. At 7 days postsurgery, animals from these groups were randomly assigned to undergo CMStress consisting of relatively mild stressor exposure 6 days a week for 6 weeks or a no-stress regimen. They were perfused 24 h thereafter and stereology was used to estimate the total number of hippocampal CA1 and CA3 pyramidal cells. Glial fibrillary acid protein (GFAP) immunoreactivity in the hippocampus was also measured. Degenerating neurons were quantified with the Fluoro-Jade B staining technique. CMStress significantly potentiated CA1 cell loss in 2VO rats (17% loss), compared to a 7% loss of CA1 cells in nonstressed 2VO rats. CMStress had no effect on CA3 cell number. CMStress also caused a significant reduction in GFAP-immunoreactive astrocyte density in CA1, CA3, and the hilus of both sham and 2VO rats. Fluoro-Jade staining was absent, indicating that cell loss probably occurred in the early stage of combined 2VO and CMStress. It was concluded that CMStress exacerbates the consequences of chronic cerebral hypoperfusion on CA1 probably by reducing astrocytes, thereby increasing extracellular glutamate and/or diminishing free radical defense systems. These findings have particular relevance to understanding the contribution of chronic stress to Alzheimer's disease, which, in its premorbid stage, is characterized by cerebral hypoperfusion, and, in its clinical stage, is characterized by CA1 cell loss.     

Antenatal screening: why do women refuse?

Due to the large number of children with disabilities in the local area, Calderdale and Kirklees Health Authority commissioned a research project. The aim was to explore the issues surrounding antenatal screening--the needs of parents and the risk of giving birth to a baby with a disability. Triangulation using both qualitative and quantitative methods was used and data was collected through questionnaires, interviews and focus groups. Findings led to the identification of themes: access of local services, parents knowledge of antenatal screening tests and local services, and professionals beliefs around antenatal screening issues. The project highlights professional's lack of knowledge and therefore the need for antenatal screening coordinators in all Trusts, in-service training, improved information for parents and education in the community, especially for 'at risk' groups such as ethnic minorities.     

Is absolute amount or change in exercise more associated with quality of life in adult cancer survivors?

BACKGROUND: The present study examined the association between quality of life (QOL) in adult cancer survivors and the (a) absolute current amount of exercise and (b) change in exercise since cancer diagnosis. METHODS: Three hundred fifty-two (mean age = 59.6) adult cancer survivors recruited from outpatient clinics in four states (Iowa, Wisconsin, Minnesota, and Georgia) and a minority support groups completed a survey including demographic, medical, exercise behavior, and QOL questions. RESULTS: Hierarchical multiple regression analyses controlling for important demographic and medical variables showed that adult cancer survivors who currently exercised three times per week had significantly higher QOL than those who did not (beta = 0.13, P < 0.05). Furthermore, compared to adult cancer survivors who exercised less since their cancer diagnosis, those who maintained (beta = 0.28, P < 0.08) or increased (beta = 0.24, P < 0.01) the amount of exercise they performed since their cancer diagnosis had significantly higher QOL. Finally, examination of the DeltaR(2)(adjusted) between the two exercise models showed that the absolute current amount of exercise explained an additional 1% (DeltaR(2)(adjusted) = 0.01 P < 0.05) of the variance in QOL whereas the change in exercise explained an additional 7% (DeltaR(2)(adjusted) = 0.07, P < 0.01). CONCLUSION: Change in exercise since cancer diagnosis may be a more important correlate of QOL in adult cancer survivors than the absolute current amount of exercise.     

Health-related quality of life of cancer and noncancer patients in Medicare managed care

BACKGROUND: Data from the Health Care Financing Administration's (HCFA) Medicare Health Outcomes Survey (MHOS) of patients enrolled in managed care services through Medicare were analyzed. The MHOS provided baseline estimates of quality of life of cancer survivors in comparison to a frequency age-matched cohort of noncancer patients. METHOD: In 1998, the MHOS was mailed to a random sample of 279,135 beneficiaries. Completed surveys were received from 167,096 respondents (60%). Some 22,747 respondents who had been diagnosed with cancer were frequency age matched to an equal number of noncancer patients. RESULTS: Cancer survivors had statistically significantly poorer scores than noncancer patients on all eight subscales as well as on the Physical Component and Mental Component summary measures of the Medical Outcomes Study Short Form-36 (MOS SF-36). Comparisons by type and number of cancers for which an individual was currently in treatment showed lowest quality of life for those in treatment for lung carcinoma, followed by those who were in treatment for more than one type of cancer. CONCLUSION: The data suggest that cancer shows negative effects on health-related quality of life that are not explainable by simple effects of age because frequency age-matched cancer survivors had statistically significantly lower scores on all 10 scores of the MOS SF-36. Effect sizes are evaluated to determine the clinical significance of these differences in health-related quality of life. The MHOS offers useful data for planning and improving cancer policy and programs.     

The N200 abnormalities of auditory event-related potentials in patients with panic disorder

Cognitive impairment in patients with panic disorder (PD) has been studied using event-related potentials (ERPs). However, previous studies obtained ERP data only at a few scalp sites, and seldom investigated N200 measurements from the difference waveforms. In the present study, auditory ERPs were recorded at 16 scalp sites during an active discrimination task of oddball paradigm. Fourteen PD patients (8 with agoraphobia; 6 without agoraphobia) were compared with 14 sex- and age-matched control subjects. For the nontarget waveforms, P2 amplitude was reduced in PD patients. For the target waveforms, a topographical difference between female PD patients and female controls was found for N200 amplitude, which attenuated in female PD patients over the parietal area. Two subcomponents of N200, N2a and N2b, were measured from the difference waveforms. A significant group difference was found for N2b amplitude, which reduced in PD patients compared with unaffected control subjects. It is suggested that N2b reduction reflects an abnormally controlled processing of stimulus information in PD.