Continual smoking of mentholated cigarettes may mask the early warning symptoms of respiratory disease

BACKGROUND: Continual use of cold preparations including those containing menthol for relief from congestion, cough, or difficulty in breathing can mask the early warning symptoms of respiratory dysfunction.These products usually carry a warning label on the packaging that indicates that they are not for continuous use and may mask the early warning symptoms of a more serious condition. Menthol can be delivered in many dosage forms including the smoke of a mentholated cigarette. METHODS: Literature searches were done for the NLM databases (e.g., MEDLINE from 1966, TOXLINE, OLDMEDLINE (1958-1965), CANCERLIT), plus tobacco industry documents and hardcopy indices. The evidence was evaluated with application to mentholated cigarette smoking. RESULTS: A logical progression is presented to attempt to demonstrate that the continuous smoking of mentholated cigarettes may also mask the early warning symptoms of respiratory distress. The early warning symptoms caused by chronic irritation of the respiratory tract may be reduced in severity when the menthol found in a mentholated cigarette is continually delivered to the tract. CONCLUSION: This masking of the symptoms of an underlying respiratory disease can lead to delays in seeking medical attention resulting in a poor prognosis, additional suffering, and eventual death.     

Feelings About Risk and the Epidemic Diffusion of Adolescent Sexual Behavior

Rapid initiation of sexual risk behavior in adolescents can be explained by diffusion processes similar to those used to model epidemics. These models suggest that novel behavior can spread to all individuals exposed to the behavior. An alternative interpretation places greater emphasis on developmental changes in feelings toward risk behavior that can explain or limit the diffusion process. This research examined the initiation of sexual behavior in adolescents living in high-poverty urban environments. A cross-section of African American youth (N = 355) ages 9–17 living in public housing were interviewed using privacy-enhancing talking computers. Sexual risk behavior (unprotected sexual intercourse) was assessed along with perceived sexual behavior of friends and personal feelings about sexual intercourse and condom use. Age trends in both peer-group perceptions and personal feelings displayed increasing attraction toward risky sex. Diffusion processes were strongly related to sexual initiation and condom use even after controlling for changes in personal feelings. Nevertheless, feelings toward sexual risk behavior moderated the diffusion process. Adolescents with less favorable feelings toward sex were less susceptible to the diffusion of sexual initiation and those with more favorable feelings toward condoms were more likely to use them consistently. Interventions that focus on adolescents' feelings toward risk behavior can help to limit the diffusion of risk behavior in high-risk urban environments.     

Laparoscopic management of omental torsion secondary to an occult inguinal hernia

Torsion of the greater omentum is an uncommon surgical emergency. Most of the reported cases have been primary omental torsion with infarction, in which the underlying cause is largely unknown. Right-sided abdominal symptoms are the predominant complaint. Left-sided omental torsion is rather infrequent, and the preoperative diagnosis is extremely difficult. We report a case of omental torsion secondary to an occult left indirect inguinal hernia that was successfully diagnosed and managed laparoscopically.     

Leptomeningeal metastases

Leptomeningeal metastases typically have been a rare complication of systemic cancers. The incidence is increasing for cancers of the breast and lung, primarily because of more effective treatment modalities and longer survival. Presentation consists of multiple symptoms related to areas in the central nervous system, including the brain, cranial nerves, and spinal nerve roots. Diagnosis is made by magnetic resonance imaging with contrast enhancement and cerebral spinal fluid pathology. Treatment frequently involves combination therapy with radiation and intrathecal chemotherapy. Outcomes are poor, with short survival of six weeks to six months. Nurses play a key role in the care of patients with leptomeningeal metastases. Nursing care for this patient population includes baseline assessment and monitoring for changes in central nervous system function, symptom management, chemotherapy administration, education about the disease and treatment, identification of psychosocial issues, and assessment of coping strategies of patients and families.     

Impact of timing of pubertal maturation on growth in black and white female adolescents: The National Heart, Lung, and Blood Institute Growth and Health Study

OBJECTIVES: To evaluate the impact of early, mid-onset, and late maturation, as assessed by timing of menarche, on height, height velocity, weight, body mass index, and sum of skinfolds in a group of white and black girls. STUDY DESIGN: The Growth and Health Study recruited 9- and 10-year-old girls from Richmond, California, Cincinnati, Ohio, and Washington, DC. There were 616 white and 539 black participants recruited at age 9 and 550 white and 674 black participants recruited at age 10. Participants were seen annually for 10 visits. Longitudinal regression models were used to test for differences in each growth measure by timing of menarche across all ages and to determine whether these differences change with age. RESULTS: Mean age at menarche among white participants was 12.7 years, and among black participants, 12.0 years. According to race-specific 20th and 80th percentiles, early maturers were tallest at early ages and shortest after adult stature had been attained. Peak height velocity and post-menarche increment in stature were greatest in early maturers and least in late maturers. Weight was greatest in early and least in late maturers, as was body mass index. Sum of skinfolds was also greatest in early and least in late maturers. There was no impact of timing of maturation on two common measures of regional fat distribution. CONCLUSIONS: Girls who matured early were shorter in early adulthood, despite having greater peak height velocity and post-menarchal increment in height. Throughout puberty, early maturers had greater ponderosity and adiposity, although there was no association with regional distribution of fat.     

Social, educational, and psychological correlates of weight status in adolescents

OBJECTIVES: The purpose of this research was to examine the social, educational, and psychological correlates of weight status in an adolescent population. It was hypothesized that obese adolescents would differ on psychological, social, and educational variables compared with their non-overweight peers. RESEARCH METHODS AND PROCEDURES: In this cross-sectional study, a population-based sample of 4742 male and 5201 female public school students in the 7th, 9th, and 11th grades responded anonymously to a classroom administered questionnaire. Body mass index was calculated from self-reported height and weight and categorized into four classes of weight status: underweight (<15th percentile), average weight (15th to 85th percentile), overweight (>85th to 95th percentile), and obese (>95th percentile). The questionnaire also included questions about social experiences, psychological well-being, educational experiences, and future goals. Associations of weight status with social, psychological, and educational variables and future goals were explored. RESULTS: After adjustment for grade level, race, and parental socioeconomic status, obese girls, when compared with their average weight counterparts, were 1.63 (95% confidence interval [CI]: 1.16, 2.30) times less likely to hang out with friends in the last week, 1.49 (95% CI: 1.12, 1.98) times more likely to report serious emotional problems in the last year, 1.79 (95% CI: 1.20, 2.65) times more likely to report hopelessness, and 1.73 (95% CI: 1.21, 1.98) times more likely to report a suicide attempt in the last year. Obese girls were also 1.51 (95% CI: 1.09, 2.10) times more likely to report being held back a grade and 2.09 (95% CI: 1.35, 3.24) times more likely to consider themselves poor students compared with average weight girls. Compared with their average weight counterparts, obese boys were 1.91 (95% CI: 1.43, 2.54) times less likely to hang out with friends in the last week, 1.34 (95% CI: 1.06, 1.70) times more likely to feel that their friends do not care about them, 1.38 (95% CI: 1.08, 1.76) times more likely to report having serious problems in the last year, 1.46 (95% CI: 1.05, 0.03) times more likely to consider themselves poor students, and 2.18 (95% CI: 1.45, 3.30) times more likely to expect to quit school. Compared with average weight boys, underweight boys were 1.67 (95% CI: 1.30, 2.13) times more likely to report hanging out with friends in the last week, 1.22 (95% CI: 1.01, 1.49) times more likely to report disliking school, and 1.40 (95% CI: 1.06, 1.86) times more likely to consider themselves poor students. DISCUSSION: Associations of weight status with social relationships, school experiences, psychological well-being, and some future aspirations were observed. Among girls, the pattern of observations indicates that obese girls reported more adverse social, educational, and psychological correlates. Obese as well as underweight boys also reported some adverse social and educational correlates. These findings contribute to an understanding of how adolescent experiences vary by weight status and suggest social and psychological risks associated with not meeting weight and body shape ideals embedded in the larger culture.     

Treatment regimen and hypnotic self-administration

RATIONALE AND OBJECTIVES: Previous studies have shown that insomniacs self-administer hypnotics at high nightly rates. This study determined whether prior experience with different treatment regimens (i.e., instructions and capsule availability) would alter the previously observed high hypnotic self-administration rates. METHODS: Sixty-four healthy men and women with (n = 32) and without (n = 32) insomnia, 21-55 years, self administered placebo or triazolam (0.25 mg) after different prior treatment regimens. They received one of three different treatment regimens enforced for 11 nights: a capsule each night, a capsule as needed, or a capsule every third night. On 14 subsequent nights they choose to self-administer a capsule or not, placebo during 1 week and triazolam (0.25 mg) the other (counterbalanced in order). RESULTS: Insomniacs self-administered more capsules than normals and triazolam was self-administered more than placebo. For both groups, treatment regimen had a minimal effect on capsule self-administration. During the treatment phase, triazolam improved self-ratings of sleep relative to placebo. During the choice phase, nightly variations in self-rated sleep predicted self-administration of a capsule on the following night, regardless of whether the capsule was active drug or placebo. CONCLUSIONS: The data of this study are consistent with the view that hypnotic self-administration by insomniacs is therapy-seeking behavior and not drug abuse.     

Autoimmune lymphoproliferative syndrome (ALPS): a case with congenital onset.

We describe a case of autoimmune lymphoproliferative syndrome (ALPS), which is very unusual with regard to a clinical onset soon after birth, and a clinical picture dominated by splenomegaly, jaundice, and consumptive peripheral blood cytopenias, with minimal lymphadenopathy. Our documented close follow up demonstrated initial involvement of the spleen, followed by involvement of the bone marrow and the peripheral blood. The patient underwent bone marrow transplant and is alive and well 20 months after diagnosis.     

An embedded decisional model of stress and coping: implications for exploring treatment decision making by women with breast cancer

Treatment decision making by women with breast cancer has been recognized to be an inherently stressful process. However, past decisional theory and research has failed to fully elucidate the personal, transactional and relational nature of choice behaviour. The purpose of this paper is to explore an embedded decisional model of stress and coping that locates key assumptions of Janis and Mann's conflict-theory model (CTM) of decision making within Lazarus and Folkman's transactional framework. Through combining decisional and stress and coping theories, a model is developed that addresses the theoretical limitations of the CTM and provides greater specificity within decision-making research. The paper examines the complexity of treatment decision making within the context of the constructs of causal antecedents, primary appraisal, secondary appraisal, coping and adaptational outcomes. Examples specific to women with breast cancer are provided to illustrate the potential application of the embedded model. The implications of this inclusive and comprehensive decisional theory for future knowledge development and research in the area of treatment decision making are also discussed.