Adolescent Female Text Messaging Preferences to Prevent Pregnancy After an Emergency Department Visit: A Qualitative Analysis

BackgroundOver 15 million adolescents use the emergency department (ED) each year in the United States. Adolescent females who use the ED for medical care have been found to be at high risk for unintended pregnancy. Given that adolescents represent the largest users of text messaging and are receptive to receiving text messages related to their sexual health, the ED visit represents an opportunity for intervention.ObjectiveThe aim of this qualitative study was to explore interest in and preferences for the content, frequency, and timing of an ED-based text message intervention to prevent pregnancy for adolescent females.MethodsWe conducted semistructured, open-ended interviews in one urban ED in the United States with adolescent females aged 14-19 years. Eligible subjects were adolescents who were sexually active in the past 3 months, presented to the ED for a reproductive health complaint, owned a mobile phone, and did not use effective contraception. Using an interview guide, enrollment continued until saturation of key themes. The investigators designed sample text messages using the Health Beliefs Model and participants viewed these on a mobile phone. The team recorded, transcribed, and coded interviews based on thematic analysis using the qualitative analysis software NVivo and Excel.ResultsParticipants (n=14) were predominantly Hispanic (13/14; 93%), insured (13/14; 93%), ED users in the past year (12/14; 86%), and frequent text users (10/14; 71% had sent or received >30 texts per day). All were interested in receiving text messages from the ED about pregnancy prevention, favoring messages that were “brief,” “professional,” and “nonaccusatory.” Respondents favored texts with links to websites, repeated information regarding places to receive “confidential” care, and focused information on contraception options and misconceptions. Preferences for text message frequency varied from daily to monthly, with random hours of delivery to maintain “surprise.” No participant feared that text messages would violate her privacy.ConclusionsAdolescent female patients at high pregnancy risk are interested in ED-based pregnancy prevention provided by texting. Understanding preferences for the content, frequency, and timing of messages can guide in designing future interventions in the ED.     

A p38 mitogen-activated protein kinase inhibitor arrests active alveolar bone loss in a rat periodontitis model

BACKGROUND: Gram-negative bacterial species, such as Actinobacillus actinomycetemcomitans, contain lipopolysaccharide (LPS) that initiates the innate immune system, resulting in inflammatory alveolar bone loss. LPS activates Toll-like receptors on membrane surfaces, stimulating many intracellular signaling cascades, including the p38 mitogen-activated protein kinase (MAPK). Activation of p38 signaling mediates inflammatory cytokine expression, contributing toward osteoclastogenesis and bone loss. The aim of this study was to determine whether the novel, orally active p38 MAPK inhibitor SD282 could arrest progression of LPS-induced alveolar bone destruction in rats. METHODS: Three groups of female Sprague-Dawley rats received LPS injections to the palatal molar gingiva three times per week for 4 weeks to establish periodontitis. From weeks 5 through 8, two groups received the drug SD282 (N = 14) or 1% polyethylene glycol drug vehicle (N = 14) via oral gavage in addition to LPS injections. The third group continued to receive only LPS injections (N = 8). Microcomputed tomography was used to measure volumetric alveolar bone loss, expressed as bone volume fraction (BVF). Expression of interleukin (IL)-1 and -6 and tumor necrosis factor-alpha (TNF-alpha) was assessed by immunohistochemistry, and osteoclasts were enumerated by tartrate-resistant acid phosphatase staining. RESULTS: By 4 weeks, severe alveolar bone resorption was seen in LPS-injected animals. Administration of SD282 significantly blocked additional volumetric bone loss in the LPS-only versus LPS + SD282 groups (0.37 +/- 0.01 BVF versus 0.43 +/- 0.01 BVF; P < 0.01). Significant reductions in IL-1beta (P < 0.01 ), TNF-alpha (P < 0.05), and osteoclast formation (P < 0.01) occurred in the presence of SD282. CONCLUSIONS: An orally active p38 MAPK inhibitor reduced LPS-induced inflammatory cytokine expression, osteoclastogenesis, and alveolar bone loss in rats. Within the limits of the current study, SD282 arrested periodontal disease progression, thus highlighting the therapeutic potential of this novel class of inhibitors.     

Mediastinal bronchogenic cyst manifesting as a catastrophic myocardial infarction

Congenital bronchogenic cysts of the lung and mediastinum develop from the ventral foregut during embryogenesis. These cysts are often incidental radiologic findings in adults, but patients can be seen with symptoms of chest pain, cough, dyspnea, or any combination of these. Acute presentations are unusual and have rarely been reported. We present the unique case of a 36-year-old man seen with an acute coronary syndrome and sudden hemodynamic collapse. The patient sustained a massive and ultimately fatal myocardial infarction, compression of the left main coronary artery by a bronchogenic cyst was demonstrated at postmortem examination. If detected, bronchogenic cysts should be surgically excised to limit associated morbidity and mortality.     

Stereotactic Radiotherapy for Treatment of Subfoveal Choroidal Neovascularization in Age-Related Macular Degeneration

Age-related macular degeneration (AMD) is the leading cause of visual loss among adults 65 years and older in western countries. Of patients with AMD who experience severe loss of vision, approximately 90% do so because of choroidal neovascularization (CNV). Visual loss is most severe when the CNV occurs directly under the fovea. Radiation-treated patients show some stabilization of visual acuity and reduction in extent of CNV compared to similar patients managed by observation alone. Various external beam radiation field arrangements were used to deliver the radiation treatments. The stereotactic radiation delivery technique employed in this study allows precise delivery of radiation to the target with much less radiation delivered to nearby sensitive structures (i.e., lens, optic nerves, optic chiasm, and contralateral eye). This aim of this paper is to describe our stereotactic technique for treatment of CNV, and the method we used for target definition and eye immobilization. We also compare the stereotactic technique with other techniques reported in the literature with regard to dose distributions, dose-volume histograms, and normal tissue complication probabilities (NTCP). We found that the position of the eye can be reproduced from one treatment fraction to the next, that the target can be localized accurately, and that stereotactic radiotherapy minimizes the dose to adjacent and surrounding normal structures while providing a homogeneous dose to the target area.     

Factors relating to pregnant adolescents' decisions to complete a smoking cessation intervention.

Adolescence is a time when young people are confronted with critical health-related decision-making responsibilities. Choices associated with smoking behavior and cessation represent one specific family of relevant adolescent decision tasks. This study examined differences between pregnant girls who decided to complete a smoking cessation intervention and those who decided not to complete the program. The comparison was made across variables representing intrapersonal, familial, and peer domains. The sample consisted of 53 pregnant teenagers. Measures included a demographic questionnaire, the Spielberger State-Trait Anxiety Inventory (STAI), and selected items from a smoking history questionnaire and the Health Behavior Questionnaire: High School Form. Significant group differences were found for age (P = .01), race (P = .05), duration of smoking (P = .02), type of smoker (P = .01), and parents' approval of teenage smoking (P = .01). A trend in differences between the two groups was evident for religious attitudes (P = .09).     

Disablement following stroke.

PURPOSE: Stroke is the most disabling chronic condition, newly affecting 35000 persons in Canada each year. Because of declining fatality, a growing number of persons will have to cope with stroke-related disability. The purpose of this paper is to describe the disabilities experienced by persons with stroke during the first year and explore the evolution of impairment, disability, handicap and health-related quality of life. SUBJECTS: The data for this paper come from a series of longitudinal and cross-sectional studies, collectively known as the McGill Stroke Rehabilitation Research Program. RESULTS: Within the first week post-stroke, getting out of bed and walking over a short distance, even with assistance, was a strong predictor of discharge home. Most of the improvement in measures of impairment and disability occurred during the first month and, by 3 months, there was still considerable room for improvement in all measures: 85% of persons were still impaired on gait speed, 78% had not reached age-specific norms for upper extremity function, 68% still demonstrated slow physical mobility, 37% needed some assistance with basic activities of daily living and 29% were still impaired on balance. By 1 year, 73% of persons scored the maximum for basic activities of daily living but 51 and 67% of persons reported their physical health and mental health to be lower than expected. Among a hardy group of stroke survivors, still living in the community 1 year post-stroke, the most striking area of difficulty was endurance, as measured by the 6 minute walk test. Those subjects well enough to complete this task (50% of sample) were able to walk, on average, only 250 metres, equivalent to 40% of their predicted ability. This series of snapshots taken at different points in time suggests that much of the improvement in impairment and disability occurs during the first month and then reaches a plateau. Handicap and quality of life continue to be issues later. Rehabilitation strategies need to consider the multifaceted nature of disablement, which in itself changes with time post-stroke.     

Fas分子与肝细胞凋亡

近年来细胞分子生物学领域中的两个重要进展,即细胞凋亡概念的提出和Ｆａｓ分子的分离与鉴定对肝病的研究有重要影响,加深了人们对肝细胞损伤与死亡的认识．１９９３年Ｏｇａｓａｗａｒａｅｔａｌ［１］进行的Ｆａｓ单抗毒性实验证实了Ｆａｓ分子系统在肝细胞凋亡或损伤...