Emergency contraception in Mexico City: knowledge,attitudes, and practices among providers and potential clients after a 3-year introduction effort

Emergency contraception (EC) has the potential to reduce unwanted pregnancy significantly, in Mexico as elsewhere. Recent years have seen tremendous growth in programs and research devoted to expanding access to emergency methods worldwide. In Mexico City, we conducted a pre-intervention/post-intervention research study of one way to introduce EC. Following a baseline survey of family planning providers and clients in 1997, we organized and implemented a three-year program of training for health care providers and a multi-faceted information campaign for the general public, including a national toll-free hotline and website. In 2000, we again surveyed family planning clinic providers and clients, using instruments similar to those employed in the baseline study. EC awareness increased significantly from 13% of clients to 32%, and support jumped from 73% to 83%. Providers at study clinics improved method recognition from 88% to 100%.     

Synaptic glutamate receptor clustering in mice lacking the SH3 and GK domains of SAP97

Postsynaptic targeting of the Drosophila tumour suppressor discs-large (Dlg) critically depends on its SH3 and GK domains. Here, we asked whether these domains are also involved in subcellular targeting of the mammalian Dlg homolog SAP97 and its interacting partners in CNS cortical neurons by analysing a recently described mouse mutant lacking the SH3 and GK domains of SAP97. Both wildtype and truncated SAP97 were predominantly expressed in perinuclear regions, in a pattern suggesting association with the endoplasmic reticulum. Weaker immunoreactivity was found in neurites colocalizing with both dendritic and axonal markers. As SAP97 has been implicated in the early intracellular processing of the glutamate receptor GluR1, we studied biochemical maturation and subcellular localization of GluR1 in the mutants. Both the glycosylation pattern and synaptic clustering of GluR1 were indistinguishable from wildtype mice. Synaptic clustering of the guanylate kinase domain interacting protein GKAP was also intact. Our data demonstrate that truncation of the SH3 and GK domains of SAP97 in mice does neither change its subcellular distribution nor does it disrupt synaptic structure or protein clustering, as opposed to severe missorting of the respective mutant Dlg protein in Drosophila.     

Constitutive overexpression of cyclin D1 but not cyclin E confers acute resistance to antiestrogens in T-47D breast cancer cells

Cyclin D1 and cyclin E are overexpressed in approximately 45% and 30% of breast cancers, respectively, and adverse associations with patient outcome have been reported. The potential roles of cyclin D1 and cyclin E expression as markers of therapeutic responsiveness to the pure steroidal antiestrogen ICI 182780 were investigated using T-47D breast cancer cell lines constitutively overexpressing cyclin D1 or cyclin E. Measurement of S phase fraction, phosphorylation states of the retinoblastoma protein, and cyclin E-cyclin-dependent kinase (Cdk) 2 activity demonstrated that overexpression of cyclin D1 decreased sensitivity to antiestrogen inhibition at 24 and 48 h. Overexpression of cyclin E produced a less pronounced early cell cycle effect indicating only partial resistance to antiestrogen inhibition in the short-term. In ICI 182780-treated cyclin D1-overexpressing cells, sufficient Cdk activity was retained to allow retinoblastoma protein phosphorylation and cell proliferation, despite an increase in the association of p21 and p27 with cyclin D1-Cdk4/6 and cyclin E-Cdk2 complexes. After longer-term (>7 days) treatment, antiestrogens inhibited colony growth in cyclin D1- or cyclin E-overexpressing breast cancer cells, but with an approximately 2-2.5-fold decrease in dose sensitivity. This was associated with a fall in cyclin D1 levels, a reduction in the half-life of cyclin D1 protein and a decline in cyclin E-Cdk2 activity in cyclin D1-overexpressing cells, and the maintenance of cyclin E-p27 association in the cyclin E-overexpressing cells. These data confirm that cyclin D1 expression and cyclin E-p27 association play important roles in antiestrogen action, and suggest that cyclin D1 or cyclin E overexpression has subtle effects on antiestrogen sensitivity. Additional studies to elucidate the contribution of alterations in cyclin D1 stability to antiestrogen action and to assess the relationship between antiestrogen sensitivity and expression of cyclin D1, cyclin E, or p27 in a clinical setting are required.     

Eating disorder management in hospital patients: Current practice among dietitians in Australia

Aim:  To examine dietetic practice during the management of eating disorders in inpatient and daypatient settings.
Methods:  A survey was sent to dietitians working in the clinical management of eating disorders within Australia. Thirty-six qualified dietitians including all dietitians working at the specialist units in Australia participated in the study.
Results:  Most dietitians aim to meet patients' nutritional requirements by food alone without artificial feeding. High-energy supplements are the preferred method of increasing energy intake to eating disorder patients. Nasogastric feeding was a standard feeding practice for anorexia nervosa reported by one-third of dietitians. Total parenteral nutrition was not considered an option for nutritional rehabilitation. In the treatment of anorexia nervosa, variable energy intakes for individual patients were prescribed aiming for weight gain of up to 1.0 kg/week in inpatients and 0.5 kg/week in outpatients.
Conclusion:  In Australia, there is no standard nutritional management for anorexia and bulimia nervosa. This survey establishes a baseline for nutritional management and practice of dietitians working with patients with eating disorders. Further research is needed regarding use of nasogastric feeding, and weight gain targets in anorexia nervosa.     

Mutagenesis of the epithelial polarity gene, discs large 1, perturbs nephrogenesis in the developing mouse kidney

BACKGROUND: During development of the permanent mammalian kidney (metanephros) several key epithelial events occur such as ureteric branching morphogenesis and nephrogenesis. One of the first stages of nephrogenesis involves the conversion of mesenchymal cells to epithelial cells, and thus the metanephros provides an excellent model to study epithelial polarization. The aim of this study was to investigate the role of the epithelial polarity gene, discs large 1 (dlg1), during development of the mouse kidney. METHODS: We utilized mice with a gene trap vector insertion within dlg1 (dlg(gt)) resulting in a truncated Dlg1 protein, lacking the SH3, protein 4.1 and guanylate kinase-like (GUK) domains, fused to a LacZ reporter. These mice were used to analyze the expression of Dlg1 during kidney development, the subcellular localization of Dlg1 in epithelial cells, and the ability of Dlg1 to bind to calmodulin-associated serine/threonine kinase (CASK). Metanephric organ culture was used to study branching morphogenesis and nephrogenesis in wild-type and dlg(gt) mutant mice. RESULTS: Dlg1 was expressed in ureteric and mesenchyme-derived epithelial cells during kidney development. Truncation of Dlg1 altered the normal basolateral localization of Dlg1 restricting it to the adherens junction. Due to the loss of the SH3 domain the binding capacity of Dlg1 to CASK was reduced. Nephrogenesis was altered in dlg(gt)/dlg(gt) metanephroi with a 30% decrease in nephron number. CONCLUSION: Our results indicate that the loss of the SH3, protein 4.1 and/or GUK domains of Dlg1 disrupt epithelial polarity and perturb nephrogenesis either as a secondary consequence to a defect in ureteric branching morphogenesis and/or delay in mesenchyme-to- epithelial transition.     

Differences in the use of family planning methods by adolescent females according to the education model utilized during pregnancy. Monterrey, Mexico

BACKGROUND: The objective was to compare the use of family planning methods during the immediate postpartum period and two years following childbirth among the adolescent females who had followed two different intervention programs during their pregnancies. METHODS: A quasi-experimental study was designed. A total of 62 pregnant adolescents were selected to comprised two intervention groups, the PRECEDE model and the Health Belief model (MCS) groups. Non-parametric statistical tests were employed and 95% confidence intervals estimated. RESULTS: The average starting knowledge in the MCS groups was 69.12 points (95% CI 63.27-74.97) and ending 89.71 points (95% CI 86.24-93.17), while the starting knowledge for the PRECEDE group was 49.39 points (95% Cl 42.24-56.54) and ending 75.25 points (95% CI 71.12-79.38). IN the immediate postpartum, 93% (95% CI 83.5-100) of the adolescents in the PRECED group accepted the use of a family planning method similar to that employed by the MCS group, of 94.2 (95% CI 86.3-100). As regards the continued use of the method, that is, two years later, the PRECEDE strategy had a greater effect that the MCS strategy, respectively 92% (95% Cl 82-100) and 72% (95% CI 56.9-87.1). CONCLUSIONS: A difference was found to exist between models as regards the use of family planning methods 2 years following childbirth. The PRECEDE program is proposed as the education strategy for preventing a second pregnancy among adolescent females.     

Case series of use of Manuka honey in leg ulceration

Gethin G, Cowman S. Case series of use of Manuka honey in leg ulceration. Abstract The historical and current literature reports the successful use of honey to manage a diversity of wound aetiologies. However, only in the last 40 years is research on its mode of action and contribution to wound healing being investigated. The challenge of managing chronic non healing wounds generated interest in researching non standard therapies. The aims of the study were to gain insight into the practical use of Manuka honey in wound management. The objective was to test the feasibility of further rigorous research into the use of honey in the management of chronic wounds. Instrumental case series were used to examine the use of Manuka honey in eight cases of leg ulceration. To collect the necessary data, photographs, acetate tracings, data monitoring and patient comments and observations were used to add greater reliability and validity to the findings. The wounds were dressed weekly with Manuka honey. The results obtained showed three males and five females with ulceration of different aetiologies were studied. A mean initial wound size for all wounds of 5.62 cm(2) was obtained. At the end of four-week treatment period, the mean size was 2.25 cm(2). Odour was eliminated and pain reduced. The conclusions drawn were that the use of Manuka honey was associated with a positive wound-healing outcome in these eight cases. Arterial wounds showed minimal improvement only.