(+),(-)和(±)棉酚在雌大鼠抗早孕作用的研究

妊娠第6～9天大鼠,分别ig(±)和(-)棉酚80mg·kg^-1·d^-1和40mg·kg^-1·d^-1,结果有明显的抗早孕作用。然而(+)棉酚40mg·kg^-1·d^-1对大鼠生育无明显影响。(-)棉酚30μg·ml^-1能抑制体外培养黄体细胞孕酮的分泌。(+)棉酚10μg·ml^-1能促进黄体细胞分泌孕酮。hCG1IU·ml^-1能明显刺激体外培养颗粒细胞孕酮的分泌。(±)棉酚10和30μg·ml^-1皆能明显降低颗粒细胞对hCG的反应性。     

Measuring Adherence with the Doser CT in Children with Asthma

Non-adherence with prescribed asthma treatment causes compromised treatment effectiveness, including greater morbidity, mortality, and health care utilization costs. As a result, there is an increasing interest in measuring patient adherence behaviors. Electronic monitoring devices offer a promising method for assessing patient adherence behavior patterns. The reliability of the Doser Clinical Trials (CT) (Meditrack Products, Hudson, MA), an inexpensive, pressure-actuated device that monitors metered-dose inhaler (MDI) usage, was evaluated in a field study of outpatient pediatric asthmatics. Canister weight and various Doser CT measures of patient medication use were compared to determine the reliability and usefulness of the device. Doser CTs were dispensed to 16 research subjects for use on corticosteroid MDIs over a period of several months. One Doser CT per month was dispensed to each subject. Doser CTs were collected at 30-60 day intervals, with a total of 61 months of Doser CT data obtained across the subjects. MDI canister weights were monitored for a subset of 6 subjects. Usable Doser CT data were summarized and average adherence estimates were computed. Adherence estimates differed from one another and the adherence estimate, as measured by canister weight, was significantly higher than each Doser CT estimate. However, overall, the Doser CT showed adequate reliability as evidenced by high correlations among the Doser CT estimates of adherence and the existing gold standard of canister weight. The Doser CT is likely to be useful for monitoring MDI use in clinical care and research, potentially providing greater accuracy than the standard of canister weight.     

Cardiac arrhythmias secondary to hormone therapy in trans women

Introduction: With greater social acceptance and the evolution of transgender medicine as a specialty, more trans women are seeking hormone therapy (HT). Several studies have identified an increase in cardiovascular disease in trans women, however no studies have investigated the incidence of arrhythmias. Using two cases from the authors’ clinic as examples, we propose that hormone therapy in trans women may increase the risk of cardiac arrhythmias.

Areas covered: A literature search of sex hormones and cardiac arrhythmias was conducted. Using sex hormone studies completed in cis individuals and animal models we identified several similarities to trans women on HT. In cis men, low levels of testosterone are associated with increased rates of atrial fibrillation and right ventricular outflow tract arrhythmias. The role of estradiol remains less clear but there is evidence to suggest that the administration of exogenous estrogen may increase the rates of cardiac arrhythmias in cis women.

Expert opinion: Research in the field of transgender medicine is expanding. As more trans women initiate HT, we will have a larger database from which to collect information regarding the benefits and risks of treatment, including the potential side effect of arrhythmias.     

Behavioral and characterological self-blame in chronic obstructive pulmonary disease

ObjectiveTo assess behavioral and characterological self-blame, identify demographic and relational correlates of self-blame, and determine the association of self-blame with psychological and clinical outcomes of chronic obstructive pulmonary disease (COPD).MethodsData were collected via self-report questionnaires completed by 398 individuals with COPD who had at least a 10 pack-year history of smoking. Behavioral and characterological self-blame were measured, and multiple regression was used to identify correlates of both types of self-blame. Multiple regression was also used to determine the association of self-blame with outcomes of COPD.ResultsMore than one-third of participants endorsed the maximum possible score on the measure of behavioral self-blame. The perception that family members blamed the individual for having COPD (p = .001), tobacco exposure (p = .005), and general family functioning (p = .002) were associated with behavioral self-blame. Current smoking status (p = .001) and perception of blame from family (p < .001) were associated with characterological self-blame. While behavioral self-blame was associated with fewer symptoms of depression (p = .02), characterological self-blame was associated with more symptoms of depression (p = .02).ConclusionsIndividuals with COPD tend to blame themselves for smoking and other behaviors that may have led to their COPD. Smoking-related variables and the perception that family members blamed the individual for having COPD were associated with self-blame. Findings support the importance of distinguishing between behavioral and characterological self-blame in COPD, as behavioral self-blame had a negative association with depression and characterological self-blame had a positive association with depression.     

Role of the family in the onset and outcome of childhood disorders: selected research findings

OBJECTIVE: Three areas of basic family research were selected for review as being of special importance to the clinically oriented child and adolescent psychiatrist: behavioral genetics, expressed emotion, and the interaction of family dynamics and childhood illness. METHOD: Medline and PSYCINFO searches using appropriate keywords were obtained for each of the 3 major areas. All English-language articles published after 1989 that included empirical research pertaining to children or adolescents were reviewed. RESULTS: Behavioral genetics research indicates that the shared environment, including issues of parental monitoring and discipline, is important in the development and outcome of externalizing disorders. Differential parental treatments of one sibling are critical in internalizing disorders. Criticism (as measured by expressed emotion) is associated with poor outcome of many childhood medical and psychiatric disorders. Chronic illness in a child changes the family dynamics toward being more structured and less emotionally warm and communicative. The family's role in adherence to treatment is critical, and families with high levels of criticism have more difficulty. CONCLUSIONS: Families can cause problems, but many times the problems families have are in response to a child's problems. There is a continued need to empirically assess which family processes are important for specific childhood disorders.     

Do family mealtime interactions mediate the association between asthma symptoms and separation anxiety?

Background: Respiratory problems have been shown to be associated with the development of panic anxiety. Family members play an essential role for children to emotionally manage their symptoms. This study aimed to examine the relation between severity of respiratory symptoms in children with asthma and separation anxiety. Relying on direct observation of family interactions during a mealtime, a model is tested whereby family interactions mediate the relation between asthma severity and separation anxiety symptoms. Methods: Sixty‐three children (ages 9–12 years) with persistent asthma were interviewed via the Diagnostic Interview Schedule for Children IV; family interactions were assessed via direct observation of a mealtime; primary caregivers completed the Childhood Asthma Severity Scale; youth pulmonary function was ascertained with pre‐ and post‐bronchodilator spirometry; adherence to asthma medications was objectively tracked for six weeks. Results: Poorer pulmonary function and higher functional asthma severity were related to higher numbers of separation anxiety symptoms. Controlling for medication adherence, family interaction patterns mediated the relationship between poorer pulmonary function and child separation anxiety symptoms. Conclusions: Family mealtime interactions may be a mechanism by which respiratory disorders are associated with separation anxiety symptoms in children, potentially through increasing the child’s capacity to cognitively frame asthma symptoms as less threatening, or through increasing the child’s sense of security within their family relationships.     

A Comparison of Two Spirituality Instruments and Their Relationship With Depression and Quality of Life in Chronic Heart Failure

Spirituality is a multifaceted construct related to health outcomes that remains ill defined and difficult to measure. Spirituality in patients with advanced chronic illnesses, such as chronic heart failure, has received limited attention. We compared two widely used spirituality instruments, the Functional Assessment of Chronic Illness Therapy—Spiritual Well-Being (FACIT-Sp) and the Ironson-Woods Spirituality/Religiousness Index (IW), to better understand what they measure in 60 outpatients with chronic heart failure. We examined how these instruments related to each other and to measures of depression and quality of life using correlations and principal component analyses. The FACIT-Sp measured aspects of spirituality related to feelings of peace and coping, whereas the IW measured beliefs, coping, and relational aspects of spirituality. Only the FACIT-Sp Meaning/Peace subscale consistently correlated with depression (r = ?0.50, P < 0.0001) and quality of life (r = 0.41, P = 0.001). Three items from the depression measure loaded onto the same factor as the FACIT-Sp Meaning/Peace subscale (r = 0.43, ?0.43, and 0.71), whereas the remaining 12 items formed a separate factor (Cronbach's alpha = 0.82) when combined with the spirituality instruments in a principal component analysis. The results demonstrate several clinically useful constructs of spirituality in patients with heart failure and suggest that psychological and spiritual well-being, despite some overlap, remain distinct phenomena.