A comparison of molecular and enzyme-based assays for the detection of thiopurine methyltransferase mutations

S-Methylation by thiopurine methyltransferase (TPMT) is an important route of metabolism for the thiopurine drugs. About one in 300 individuals are homozygous for a TPMT mutation associated with very low enzyme activity and severe myelosuppression if treated with standard doses of drug. To validate the use of molecular genetic techniques for the detection of TPMT deficiency, we have determined red blood cell TPMT activity in 240 adult blood donors and 55 normal children. Genotype was determined by restriction fragment length analysis of polymerase chain reaction products in a cohort of 79 of the blood donors and five cases of azathioprine-induced myelosupression, and this confirmed a close relationship between genotype and phenotype. In 17 of the 24 cases in which mutations were found, DNA was also available from remission bone marrow. In one of these cases, DNA from the remission marrow sample indicated the presence of a non-mutated allele that had not been seen in the blast DNA sample obtained at presentation. These results indicate that polymerase chain reaction-based assays give reliable and robust results for the detection of TPMT deficiency, but that caution should be exercised in relying exclusively on DNA obtained from lymphoblasts in childhood leukaemia.     

The primary care amplification model: taking the best of primary care forward

Background  

Primary care internationally is approaching a new paradigm. The change agenda implicit in this threatens to de-stabilise and challenge established general practice and primary care.     

Evidence,Theory and Context: Using intervention mapping to develop a worksite physical activity intervention

Background  

The workplace is an ideal setting for health promotion. Helping employees to be more physically active can not only improve their physical and mental health, but can also have economic benefits such as reduced sickness absence. The current paper describes the development of a three month theory-based intervention that aims to increase levels of moderate intensity physical activity amongst employees in sedentary occupations.     

Marital Satisfaction Among African Americans and Black Caribbeans: Findings From the National Survey of American Life

This study examines the correlates of marital satisfaction using data from a national probability sample of African Americans (N = 962) and Black Caribbeans (N = 560). Findings reveal differences between African Americans and Black Caribbeans, and men and women within those groups, in the predictors of marital satisfaction. Black Caribbean women reported overall higher levels of marital satisfaction than African American women. The findings amply demonstrate the significance of ethnic diversity within the Black population in the United States. Difficulties with finances (budgeting, credit issues, and debt management) are one of the key issues that generate conflict in marriages; stress generated as a result of financial problems can lower marital satisfaction. Because these issues are salient for couples at any given time in the family life cycle, counseling at critical points in the marriage (birth of children, launching of children from home, and retirement) may be helpful.     

Alkaloids in Sophora alopecuroides seed and relevant tests for activity]

Seven alkaloids were isolated from the seed of Sophora alopecuroides and identified to be oxymatrin, oxysophocarpine, cytisine, matrine, sophocarpine, sophoridine and nicotine respectively by comparing chromactographic and spectral characteristics with authentic known compounds. Nicotine was isolated from Sophora for the first time. The activity of extracts and alkaloids against cancer, virus, dermatophytes and bacteria was carried out in vitro.     

Validation of three food frequency questionnaires and 24-hour recalls with serum carotenoid levels in a sample of African-American adults

The validity of self-reported fruit and vegetable intake in minority populations has not been adequately established. In this study, the authors examined the association of three food frequency questionnaires (FFQs) and 24-hour dietary recalls with serum carotenoid levels. Approximately 1,000 African-American adults recruited from 15 churches in Atlanta, Georgia (1997-1998) completed three fruit and vegetable FFQs: a seven-item instrument assessing intake during the past month; a two-item measure assessing usual intake; and a 36-item measure adapted from the Health Habits and History Questionnaire. A total of 414 participants received a 24-hour recall by telephone, and 105 of them received two additional recalls. Serum levels of lycopene, lutein, cryptoxanthin, alpha-carotene, and beta-carotene were assessed in 813 participants and used as the validity criterion. The correlations of fruit and vegetable servings with specific and total serum carotenoid levels were generally higher for the 36-item FFQ than for the two-item and seven-item instruments. The strongest correlation of fruit and vegetable servings with total carotenoid levels was observed for the three recalls (r = 0.42), with the 36-item FFQ and the single 24-hour recall yielding comparable correlations (r = 0.35 and r = 0.37, respectively). The validity of the 36-item fruit and vegetable FFQ was generally as strong as the validity of both 1 and 3 days of recalls. Given the lower cost and time needed for administration relative to recalls, it appears that the 36-item FFQ has merit for evaluating fruit and vegetable health interventions.     

Prostate cancer and dietary carotenoids

This population-based case-control study investigated associations between prostate cancer risk and dietary intake of the carotenoids beta-carotene and lycopene and their major plant food sources, including carrots, green leafy vegetables, and tomato-based foods. The study was carried out in Auckland, New Zealand, during 1996-1997 and recruited 317 prostate cancer cases and 480 controls. The authors found that dietary intake of beta-carotene and its main vegetable sources was largely unassociated with prostate cancer risk, whereas intake of lycopene and tomato-based foods was weakly associated with a reduced risk. These results suggest that in contrast to the findings regarding many types of cancers, vegetables rich in beta-carotene are not protective against prostate cancer. However, lycopene from tomato-based foods was found to be associated with a small reduction in risk.     

Elevated Serum Alpha Fetoprotein and Normal Liquor Alpha Fetoprotein Values in Association with an Abdominal Pregnancy

Summary: A case report is described in which abdominal pregnancy was misdiagnosed by ultrasound scanning as a pregnancy within a horn of a bicornuate uterus. Two serum alpha fetoprotein (SAFP) results were greatly elevated and an amniocentesis was performed, the liquor alpha fetoprotein (LAFP) and karyotype were normal. Elective Caesarean section was performed at 38 weeks for a persistent transverse lie and an abdominal pregnancy was found. The outcome was excellent for both the mother and child.
This is the first reported case of amniocentesis and measurement of LAFP in an abdominal pregnancy and confirms abdominal pregnancy as a rare cause of an elevated SAFP.     

Development of a Cervical Cancer Control Intervention Program for Cambodian American Women

Southeast Asian immigrants have lower levels of Pap testing than any other racial/ethnic group in the US, and are particularly unfamiliar with western culture and biomedical concepts of prevention. We completed an ethnographic study (N = 42) focusing on cervical cancer screening among Cambodian American women. We also conducted a community-based survey (N = 413) to examine the generalizability of our qualitative results. This report summarizes the results, and describes how we used our findings to influence the content of a multifaceted intervention program targeting Cambodian immigrants. The following constructs were found to be barriers to cervical cancer control: a traditional orientation to the prevention, causation, and treatment of disease; lack of familiarity with western early detection concepts; low levels of knowledge about cervical cancer; concerns about the Pap testing procedure; and health care access issues. In general, the quantitative results confirmed our ethnographic findings. The intervention program, which is delivered by bicultural outreach workers, includes home visits, presentations at small group meetings, barrier-specific counseling, use of a Khmer-language video, and tailored logistic assistance (e.g., transportation and medical interpretation). Both the video and presentation provide cultural context while simultaneously addressing multiple barriers to screening (e.g., women's fear of surgery and preference for female providers). Outreach workers are trained to counsel women about 10 potential barriers including avoidance of biomedicine, perceptions that gynecologic exams are embarrassing, and lack of English proficiency. Our results reinforce the importance of considering health problems within the context of a population's traditional belief systems and daily routines.