Preventing cigarette smoking with youth

A repeated measures, control group design compared skills-building with attitude modification approaches to prevent cigarette smoking of 234 sixth graders. Subjects in a skills-building condition, more than those in an attitude modification condition or in a control condition, had better posttest scores on cognitive and interpersonal precursors of nonsmoking. Greater pretest to posttest changes in cigarette use were reported for attitude modification condition subjects than for skills-building and control condition subjects. Compared with attitude modification and control condition subjects, skills-building condition subjects had lower reported increases in cigarette use from posttest to 6 months and from 6 to 12 months.The authors thank Cheryl Kelso, Thomas Glynn, Catherine Bell, Lois Holt, Virginia Senechal, Deborah Lodish, Janet Bobo, William Snow, and David Finke. Funding was provided by Division of Cancer Prevention and Control Grant, CA 29640: from the National Cancer Institute, National Institutes of Health, United States Public Health Service, Department of Health and Human Services.Steven Paul Schinke is Chairman, and Lewayne D. Gilchrist is Research Scientist, Social Work Research, Child Development and Mental Retardation Center, University of Washington, Seattle, Washington 98195.     

Sequential half-body irradiation (SHBI) and combination chemotherapy as salvage treatment for failed Ewing's sarcoma--a pilot study

This study was undertaken to evaluate the toxicity of sequential half-body irradiation (SHBI) and combination chemotherapy (5-FU, VM-26 and BCNU) in patients who had failed primary aggressive therapy for their Ewing's sarcoma. A secondary goal was to evaluate the response of these previously treated patients to the combination of systemic radiation and multi-agent chemotherapy. The first patient in the study was treated with SHBI only and died 139 days following retreatment. Four subsequent patients successfully received the first cycle of combination chemotherapy. However, only one completed both upper and lower half-body irradiation while the remaining three patients, because of rapid progression of their disease, completed either the upper or the lower portion of their half-body irradiation (HBI). The time from retreatment to disease progression in these four patients ranged from 45 to 97 days (mean 79 days) and the time from retreatment to death ranged from 72 to 193 days (mean 126 days). The combination chemotherapy was tolerated well by all the patients, and the SHBI was accompanied by mild nausea and some vomiting within the first few hours following treatment. Failure to give the second half of the half-body irradiation and to complete further chemotherapy in three of the patients was a result of the progressive nature of the patients' disease and not to any limitations imposed by poor blood counts. Half-body irradiation provided good pain relief within 24 hours for all of the patients. Systemic radiation contributes to the palliative treatment of patients with failed Ewing's sarcoma, but appears to be relatively ineffective when the tumor burden is high.     

Cysts of serendipity

Purpose

Primary intradiaphragmatic cysts are diagnostically challenging lesions. Often serendipitously discovered on radiological examination, intradiaphragmatic cysts are uncommon and require surgical resection for accurate identification.

Methods

Two children, aged 16 and 4 years, presented for surgical evaluation of what were believed to be asymptomatic cystic lesions of hepatic origin.

Conclusion

Imaging studies of the 2 intradiaphragmatic cysts suggested lesions of extradiaphragmatic origins, and surgical excision was necessary for accurate diagnosis. The limitations of imaging studies in determining malignancy necessitate surgical intervention for lesions of the diaphragm and peridiaphragmatic structures.     

G alpha12/G alpha13 subunits of heterotrimeric G proteins mediate parathyroid hormone activation of phospholipase D in UMR-106 osteoblastic cells

PTH, a major regulator of bone remodeling and a therapeutically effective bone anabolic agent, stimulates several signaling pathways in osteoblastic cells. Our recent studies have revealed that PTH activates phospholipase D (PLD) -mediated phospholipid hydrolysis through a RhoA-dependent mechanism in osteoblastic cells, raising the question of the upstream link to the PTH receptor. In the current study, we investigated the role of heterotrimeric G proteins in mediating PTH-stimulated PLD activity in UMR-106 osteoblastic cells. Transfection with antagonist minigenes coding for small peptide antagonists to G alpha 12 and G alpha13 subunits of heterotrimeric G proteins prevented PTH-stimulated activation of PLD, whereas an antagonist minigene to G alphas failed to produce this effect. Effects of pharmacological inhibitors (protein kinase inhibitor, Clostridium botulinum exoenzyme C3) were consistent with a role of Rho small G proteins, but not of cAMP, in the effect of PTH on PLD. Expression of constitutively active G alpha12 and G alpha13 activated PLD, an effect that was inhibited by dominant-negative RhoA. The results identify G alpha12 and G alpha13 as upstream transducers of PTH effects on PLD, mediated through RhoA in osteoblastic cells.     

Physician and patient gender concordance and the delivery of comprehensive clinical preventive services

BACKGROUND: Understanding the role of patient- and physician-gender on delivery of preventive services has important implications for identifying strategies to increase preventive service delivery. We attempt to overcome methodological limitations of previous studies in examining the association of the patient-physician gender interaction on the delivery of preventive screening, counseling, and immunization services. METHODS: In this cross-sectional study, research nurses directly observed 3256 consecutive adult patient visits to 138 family physicians. Delivery of gender neutral US Preventive Services Task Force (USPSTF) recommended screening, health behavior counseling, and immunization services was assessed by direct observation and medical record review. Multilevel regression analyses were used to test the interaction effect of physician and patient gender with preventive service delivery, controlling for patient age, insurance type, number of office visits in the past 2 years and physician age. RESULTS: The interaction effect of physician and patient gender was not significantly associated with delivery of gender neutral screening, counseling, or immunizations. Patients of female physicians were more up-to-date on counseling services (P < 0.01) and immunizations (P < 0.05) than patients of male physicians. Male patients, independent of physician gender, were more up-to-date on counseling and immunizations (P < 0.01). CONCLUSIONS: Physician-patient gender concordance is not associated with delivery of more preventive services. Rather, female physicians provide more counseling and immunization services to all of their patients. Previous research showing higher rates of gender-specific screening achieved by women physicians may have been an indication of an overall greater prevention orientation among women physicians rather than a specific benefit of gender concordance.