Media coverage of cervical cancer and the HPV vaccine: implications for geographic health inequities

Objective To describe the content of newspaper articles about cervical cancer and the human papillomavirus (HPV) vaccine published in Appalachia and identify potential differences in coverage as compared to the content of newspaper articles published in non‐Appalachia Ohio. Background Individuals rely on media as an important source of health information. Inadequate coverage of health issues may reinforce health inequities such as the elevated cervical cancer incidence and mortality rates in Appalachia Ohio. Methods A content analysis was conducted of all newspaper articles about cervical cancer and the HPV vaccine published in Appalachia and non‐Appalachia Ohio during 2006. Findings A total of 121 published newspaper articles (42 in Appalachia and 79 in non‐Appalachia) about cervical cancer and the HPV vaccine were identified. Articles published in Appalachia Ohio were significantly less likely than articles published in non‐Appalachia Ohio to provide information about the threat of cervical cancer and the efficacy of the HPV vaccine. Specifically, few articles published in Appalachia included information about the ability of the vaccine to prevent cervical cancer, the cost of the vaccine and the availability of assistance programmes for the un‐ and underinsured. Conclusions Newspaper articles printed in the Appalachia region lacked vital information that could help promote uptake of the HPV vaccine. Health educators and healthcare providers should be aware that women from underserved geographic regions like Appalachia may have greater information needs regarding their risk of cervical cancer and the potential benefits of the HPV vaccine as compared to the general patient population.     

Pharmacokinetics,Safety, and Tolerability of GS-9851, a Nucleotide Analog Polymerase Inhibitor for Hepatitis C Virus,following Single Ascending Doses in Healthy Subjects

To investigate the pharmacokinetics, safety, and tolerability of GS-9851 (formerly PSI-7851), a new nucleotide analog inhibitor of hepatitis C virus (HCV), we conducted a double-blind, parallel, placebo-controlled, randomized, single-ascending-dose study. Healthy subjects received oral doses of 25 to 800 mg GS-9851. Peak concentrations of GS-9851 in plasma were achieved more rapidly than those of the metabolites GS-566500 (formerly PSI-352707) and GS-331007 (formerly PSI-6206), with time to maximum concentration of drug in plasma (t_max) values of 1.0 to 1.8 h, 1.5 to 3.0 h, and 3.0 to 6.0 h, respectively. The majority of systemic drug exposure was from the nucleoside GS-331007, with maximum concentration of drug in plasma (C_max) and area under the concentration-time curve to the last measurable concentration (AUC_0–t) values at least 7- and 41-fold higher, respectively, than those obtained for GS-9851 after adjusting for differences in molecular weight. The terminal elimination half-life (t_1/2) of GS-331007 increased with the dose, achieving a t_1/2 of 25.7 h at 800 mg GS-9851. Dose proportionality was not observed for GS-331007. The majority of drug recovered in urine was in the form of GS-331007, with the percentage of this metabolite in urine samples ranging from 57% to 27% with increasing dose. GS-9851 was generally well tolerated, with no maximum tolerated dose identified. In conclusion, GS-9851 and its metabolites demonstrated a favorable pharmacokinetic profile consistent with once-daily dosing, and therefore, further clinical studies evaluating GS-9851 in HCV-infected patients are warranted.     

The Rewards and Challenges of Becoming a Clinical Instructor

Frontline nurses working in the clinical area are a vital component to nursing education. Taking on the role of adjunct clinical instructor can be a rewarding way to increase one's own knowledge while performing the important task of educating the next generation of nurses.     

A key role for beta-cell cytosolic phospholipase A(2) in the maintenance of insulin stores but not in the initiation of insulin secretion.

Cytosolic phospholipase A(2) (cPLA(2)) is a Ca(2+)-sensitive enzyme that has been implicated in insulin secretion in response to agents that elevate beta-cell intracellular Ca(2+) ([Ca(2+)](i)). We generated clones of the MIN6 beta-cell line that stably underexpress cPLA(2) by transfection with a vector in which cPLA(2) cDNA had been inserted in the antisense orientation. Reduced expression of cPLA(2) was confirmed by Western blotting. The insulin content of cPLA(2)-deficient MIN6 cells was reduced by approximately 90%, but they showed no decrease in preproinsulin mRNA expression. Measurements of stimulus-dependent changes in [Ca(2+)](i) indicated that reduced expression of cPLA(2) did not affect the capacity of MIN6 cells to show elevations in Ca(2+) in response to depolarizing stimuli. Perifusion experiments indicated that cPLA(2) underexpressing MIN6 pseudoislets responded to glucose, tolbutamide, and KCl with insulin secretory profiles similar to those of cPLA(2) expressing pseudoislets, but that secretion was not maintained with continued stimulus. Analysis of the ultrastructure of cPLA(2)-deficient MIN6 cells by electron microscopy revealed that they contained very few mature insulin secretory granules, but there was an abundance of non-electron-dense vesicles. These data are consistent with a role for cPLA(2) in the maintenance of insulin stores, but they suggest that it is not required for the initiation of insulin secretion from beta-cells.     

,Retrogades autologes Priming’ verhindert den Anstieg des extravasalen Lungenwassers während der extrakorporalen Zirkulation und verbessert den postoperativen Verlauf bei Patienten nach koronarer Bypassoperation

Zusammenfassung In einer prospektiven, randomisierten Studie sollte der Effekt eines reduzierten Füllvolumens (Priming) für die extrakorporale Zirkulation (EKZ) durch retrogrades autologes Priming (RAP) auf das Ausma? der postoperativen interstitiellen ?dembildung untersucht werden. 20 Patienten, die sich einer elektiven koronaren Bypassoperation unterzogen, wurden entweder einer Gruppe mit Standardpriming (SP, 1602±202ml kristalloide Vorfüllung, n=10) oder einer RAP-Gruppe (395±150ml) zugeordnet. RAP wurde vor Beginn der EKZ durch langsames Ersetzen der kristalloiden Vorfüllung der arteriellen und ven?sen Linien mit Patientenblut durchgeführt. Perioperativ wurden die kardiale und pulmonale Funktion, das extravasale Lungenwasser (EVLW), der plasma kolloidosmotische Druck (KOD), die kristalloide Flüssigkeitsbilanz sowie das K?rpergewicht der Patienten aufgezeichnet. Ergebnisse Hinsichtlich demographischer und operativer Parameter waren die Patienten gleicherma?en auf die Gruppen verteilt. Durch RAP konnte der Abfall des KOD w?hrend der EKZ von 54% in der SP-Gruppe auf 41% signifikant reduziert werden. 2 Std. nach Ende der EKZ war das EVLW im Vergleich zu pr?operativ in der Standard-Gruppe um 21% signifikant erh?ht, w?hrend es in der RAP-Gruppe im gleichen Zeitraum unver?ndert blieb. Die Bilanz der kristalloiden Flüssigkeiten von OP-Beginn bis EKZ-Ende waren in der RAP-Gruppe signifikant niedriger als in der SP-Gruppe (1857±521 gegenüber 28310±637ml). Zwei Tage postoperativ ergab sich für die Standard-Gruppe eine Zunahme des K?rpergewichts um 1,5±1,2kg (p<0,05), w?hrend das Gewicht in der RAP-Gruppe unver?ndert blieb (0,1±0,9kg). Auch die Dauer des station?ren Aufenthaltes war in der RAP-Gruppe signifikant kürzer als in der Standard-Gruppe. Schlussfolgerungen Durch RAP kann die ausgepr?gte H?modilution und der Abfall des KOD mit Beginn der EKZ vermindert werden. Dadurch kann das Ausma? interstitieller ?deme am Beispiel des EVLWs sowie die perioperative Gewichtszunahme signifikant gesenkt werden, was schlie?lich zu einem verkürzten Klinikaufenthalt der Patienten führte. Besonders günstig k?nnte sich RAP auf den postoperativen Verlauf bei Patienten mit eingeschr?nkten Organfunktionen auswirken. Eingegangen: 1. Oktober 2001 Akzeptiert: 3. Januar 2002     

Demographics, outcomes, and risk factors for adverse events associated with primary and revision total hip arthroplasties in the United States

We conducted a study to analyze nationally representative data on patient and health care system characteristics and in-hospital outcomes associated with primary and revision total hip arthroplasties in the United States. Between 1990 and 2004, there were an estimated 2,748,187 hospital discharges after total hip arthroplasty. The risk factors we identified for procedure-related complications and in-hospital mortality included revision procedures, increased age, and male sex. Compared with smaller hospital capacity (number of beds), large hospital capacity was associated with a decreased odds ratio for complications but an increased risk for in-hospital mortality. Additional studies are warranted to determine causal relationships.     

Effectiveness of bisphosphonates on nonvertebral and hip fractures in the first year of therapy: The risedronate and alendronate (REAL) cohort study

Introduction Randomized clinical trials have shown that risedronate and alendronate reduce fractures among women with osteoporosis. The aim of this observational study was to observe, in clinical practice, the incidence of hip and nonvertebral fractures among women in the year following initiation of once-a-week dosing of either risedronate or alendronate. Methods Using records of health service utilization from July 2002 through September 2004, we created two cohorts: women (ages 65 and over) receiving risedronate (n = 12,215) or alendronate (n = 21,615). Cox proportional hazard modeling was used to compare the annual incidence of nonvertebral fractures and of hip fractures between cohorts, adjusting for potential differences in risk factors for fractures. Results There were 507 nonvertebral fractures and 109 hip fractures. Through one year of therapy, the incidence of nonvertebral fractures in the risedronate cohort (2.0%) was 18% lower (95% CI 2% – 32%) than in the alendronate cohort (2.3%). The incidence of hip fractures in the risedronate cohort (0.4%) was 43% lower (95% CI 13% – 63%) than in the alendronate cohort (0.6%). These results were consistent across a number of sensitivity analyses. Conclusion Patients receiving risedronate have lower rates of hip and nonvertebral fractures during their first year of therapy than patients receiving alendronate. This work was presented in part at the 28th annual meeting of the American Society for Bone and Mineral Research, Philadelphia, PA; September 15–19, 2006.     

Attentional functioning in children with ADHD – predominantly hyperactive-impulsive type and children with ADHD – combined type

Summary. Although particular importance has been attributed to attention deficits in attention deficit hyperactivity disorder (ADHD), there is no consensus as to the exact nature of inattention in ADHD or which components of attention are affected. The present study was based on a neuropsychological model of attention and assessed various components of attention in 23 children with ADHD/predominantly hyperactive-impulsive type (ADHD-H), 32 children with ADHD/combined type (ADHD-C) and healthy children (N₁ = 23 and N₂ = 32). A computerized test battery consisting of reaction time tasks of low complexity was used for the assessment of attention (alertness task, vigilance task, divided attention task, visual scanning task, incompatibility task, test of crossmodal integration, flexibility task). In comparison to healthy participants, patient groups were impaired in measures of vigilance, divided attention, selective attention and flexibility but not in measures of alertness. Analysis of the test performance of patient groups revealed no differences between children with ADHD-H and children with ADHD-C. The results of the present study suggest that both children with ADHD-H and children with ADHD-C are seriously impaired in attentional functioning. Children with ADHD-H and children with ADHD-C produced comparable results in measures of attention.