Bone sarcomas in Paget disease: a study of 85 patients

This is a comprehensive review of 85 patients who had bone sarcoma associated with Paget disease and who were seen at Memorial Sloan-Kettering Cancer Center between 1927 and 1982. There was an almost equal distribution of tumors in the axial and the appendicular skeletons. The pelvis, humerus, femur, and skull were the tumor sites in 80% of cases. The tumors were bulky large soft tissue masses. Lytic lesions were more common than sclerotic lesions. Mixed lytic and sclerotic lesions were much less common than either single type. Periosteal reaction was uncommon and found in less than 7%. Methylene diphosphonate scans of the bone often showed a cold area that was associated with marked increase in uptake on the gallium scan. Angiography, which was performed in 13 patients, was useful, but CT was much more helpful in showing the soft tissue mass as well as the extent of bony disease. Only three patients in this study survived for five years. Present chemotherapy protocols were disappointing in the treatment of this highly lethal tumor.     

Association of retail tobacco marketing with adolescent smoking

A survey of 2125 middle-school students in central California examined adolescents' exposure to tobacco marketing in stores and its association with self-reported smoking. Two thirds of sixth-, seventh-, and eighth-grade students reported at least weekly visits to small grocery, convenience, or liquor stores. Such visits were associated with a 50% increase in the odds of ever smoking, even after control for social influences to smoke. Youth smoking rates may benefit from efforts to reduce adolescents' exposure to tobacco marketing in stores.     

Self-disorders and Schizophrenia: A Phenomenological Reappraisal of Poor Insight and Noncompliance

Poor insight into illness is considered the primary cause of treatment noncompliance in schizophrenia. In this article, we critically discuss the predominant conceptual accounts of poor insight, which consider it as an ineffective self-reflection, caused either by psychological defenses or impaired metacognition. We argue that these accounts are at odds with the phenomenology of schizophrenia, and we propose a novel account of poor insight. We suggest that the reason why schizophrenia patients have no or only partial insight and consequently do not comply with treatment is rooted in the nature of their anomalous self-experiences (ie, self- disorders) and the related articulation of their psychotic symptoms. We argue that self-disorders destabilize the patients’ experiential framework, thereby weakening their basic sense of reality (natural attitude) and enabling another sense of reality (solipsistic attitude) to emerge and coexist. This coexistence of attitudes, which Bleuler termed “double bookkeeping,” is, in our view, central to understanding what poor insight in schizophrenia really is. We suggest that our phenomenologically informed account of poor insight may have important implications for early intervention, psychoeducation, and psychotherapy for schizophrenia.Key words: compliance, phenomenology, double bookkeeping, vulnerability     

Chronic Social Stress in the Community and Associations with Psychological Distress: A Social Psychological Perspective

Chronic social stress is strongly related to psychological distress in vulnerable groups such as the frail elderly and ill people. Little, however, is known about these phenomena in the general population. The validity and reliability of a new brief measure, the Bergen Social Relationships Scale (BSRS), were investigated in a Norwegian county; the prevalence of chronic social stress was measured using the BSRS, and the associations of chronic social stress and social support with three measures of psychological distress were investigated. Respondents with high BSRS scores had experienced longstanding, important interpersonal relationship problems rather than fleeting stressful incidents. Women reported higher levels of chronic social stress, 60% reporting positively on at least one of the six BSRS items, compared with 50% among men. Social support was negatively and significantly associated with various measures of psychological distress. Chronic social stress was positively and significantly associated with psychological distress. These effects were independent of one another. No buffering effect of social support on social stress was observed. The present data support the importance of positive social ties to health, but suggest that social stress is an independent aspect of social environment with regard to health. If social support and social stress have direct and independent effects on mental health, as the present results indicate, intervention on the one will not necessarily modify the other. Intervention programmes may need to consider explicitly both the lighter and the darker sides of social relationships in building environments that support mental health.     

Synthesis of a [18F]fluorobenzothiazole as potential amyloid imaging agent

This study describes the synthesis of a fluoroethylated derivative of [N‐methyl‐¹¹C]2‐(4′‐methylaminophenyl)‐6‐hydroxybenzothiazole ([¹¹C]6‐OH‐BTA‐1; Pittsburgh Compound B (PIB)), an already established amyloid imaging agent. The [¹¹C]methylamino group of [¹¹C]6‐OH‐BTA‐1 was formally replaced by a fluoroethyl group in a cold synthesis via N‐alkylation of N‐Boc‐2‐(4′‐aminophenyl)‐6‐(methoxyethoxymethoxy)benzothiazole with fluoroethyl tosylate. Subsequent deprotection gave the target compound 2‐[4′‐(2‐fluoroethyl)aminophenyl]‐6‐hydroxybenzothiazole (FBTA). In a radioligand competition assay on aggregated synthetic amyloid fibrils using N‐[³H‐methyl]6‐OH‐BTA‐1, 100 nM FBTA inhibited binding with 93 ± 1 and 83 ± 1% efficiency for Aβ_1–40 and Aβ_1–42, respectively. For the radiosynthesis a precursor carrying a tosylethyl moiety was prepared allowing the introduction of [¹⁸F]fluoride via nucleophilic substitution with [¹⁸F]tetra‐n‐butyl‐ammonium fluoride (TBAF). Subsequent removal of all protecting groups was performed in a one‐pot procedure followed by semi‐preparative HPLC, delivering the target compound [¹⁸F]FBTA in good radiochemical yield of 21% on average and radiochemical purity of ?98% at EOS. In vitro autoradiography on human postmortem AD brain tissue slices showed intense cortical binding of [¹⁸F]FBTA (1 nM), which was displaced in presence of 6‐OH‐BTA‐1 (1 µM). Brain up‐take was evaluated in wild‐type (wt) mice with microPET imaging. Based on these results, [¹⁸F]FBTA appears to be a suitable candidate tracer for amyloid imaging in humans. Copyright © 2008 John Wiley & Sons, Ltd.     

The Finnmark Intervention Study: Design, Methods and effects of a 2 year community-based intervention

Two fishing municipalities with a total population of 6,500in Finnmark county were exposed to different hearth interventionprogrammes, both aiming at minimizing inequalities in healththrough empowerment and community involvement. One intervention(Nordkapp) was mainly focused on factors related to the workingenvironment of fishermen and within the fishing industry, whilethe other (Bitsfjord) addressed the population as a whole indefining health problems, setting priorities and planning strategiesand implementation. This paper describes the design and methodsof intervention and evaluation and examines effects regardingknowledge about and discussions of the projects, acquisitionof new information, attitudes and serf-reported behaviour changesafter 2 years of intervention in a randomized sample of almost2,000 individuals in the 2 communities. In Nordkapp, 27% ofthe men and 20% of the women knew about the project, with thehighest level being among fishermen and the male employees inthe fishing industry. The corresponding percentages for BStsfjordwere 77 and 82%. Approximately 1 in 5 in Nordkapp and 2 in 5in Bitsfjord had discussed the projects with somebody. In particular,in Bitsfjord knowledge about and discussion of the projectsincreased with the length of formal education, whereas acquisitionof new information and self-reported behaviour change was highestamong those with the lowest level of education in both communities.Approximately 40% of those aware reported behaviour change dueto the interventions. These findings suggest that the projectshave favoured the target groups of the intervention.     

What is the gold standard for intrapartum fetal monitoring?

The health authorities of Stockholm county recently published a Health Technology Assessment report: "Fetal monitoring with computerized STAN analysis during labor - a systematic review" with the aim to ensure that high quality research information on costs, effectiveness and broader impact of health technologies is analysed and presented in the most efficient way for those who use, manage and work in this field. The report claims to analyse available research in relation to ST interval analysis of fetal electrocardiogram (STAN) and concludes that scientific evidence for advantages of the STAN technology for maternal and fetal outcome was insufficient and that clinical use cannot be recommended and should be restricted to research protocols. The Norwegian reference group for fetal surveillance points out that the report suffers from two insufficiencies: selection bias by not providing a complete collection of the evidence for the clinical performance of the STAN technology and, secondly, that it does not provide evidence-based alternative methods.