Fathers of children born to young urban mothers

Fathers of babies born to a sample of urban mothers younger than 18 at delivery ranged in age from 14-50 and were, on average, 2-4 years older than the mothers. Among the adolescent women who had given birth to their first child, 28 percent of the partners of black women and 45 percent of the partners of white women were 20 years of age or older. The educational attainment of the fathers was very low, particularly among older whites. At approximately 15 months after the child's birth, 36 percent of the fathers were neither in school nor working. Three-quarters of the pregnancies among the young white mothers and 95 percent of those among the black mothers were unplanned, but only six percent of the white mothers and 16 percent of the black mothers were using a contraceptive at the time of conception. Only 16 percent of the fathers were living with or married to the mother of their child at 15 months after birth. About 90 percent of the fathers had spent time with their child during that period, but frequency of contact declined markedly with time. Overall, 20 percent of the fathers had children by other women.     

The experiences of unpartnered men with prostate cancer: a qualitative analysis

Purpose  

The purpose of this study was to examine how men without partners make decisions about prostate cancer treatment, manage treatment side effects, and obtain information and support.     

Prevention of carcinogenesis and inhibition of breast cancer tumor burden by dietary stearate

Previous studies have shown that stearate (C18:0), a dietary long-chain saturated fatty acid, inhibits breast cancer cell neoplastic progression; however, little is known about the mechanism modulating these processes. We demonstrate that stearate, at physiological concentrations, inhibits cell cycle progression in human breast cancer cells at both the G(1) and G(2) phases. Stearate also increases cell cycle inhibitor p21(CIP1/WAF1) and p27(KIP1) levels and concomitantly decreases cyclin-dependent kinase 2 (Cdk2) phosphorylation. Our data also show that stearate induces Ras- guanosine triphosphate formation and causes increased phosphorylation of extracellular signal-regulated kinase (pERK). The MEK1 inhibitor, PD98059, reversed stearate-induced p21(CIP1/WAF1) upregulation, but only partially restored stearate-induced dephosphorylation of Cdk2. The Ras/mitogen-activated protein kinase/ERK pathway has been linked to cell cycle regulation but generally in a positive way. Interestingly, we found that stearate inhibits both Rho activation and expression in vitro. In addition, constitutively active RhoC reversed stearate-induced upregulation of p27(KIP1), providing further evidence of Rho involvement. To test the effect of stearate in vivo, we used the N-Nitroso-N-methylurea rat breast cancer carcinogen model. We found that dietary stearate reduces the incidence of carcinogen-induced mammary cancer and reduces tumor burden. Importantly, mammary tumor cells from rats on a stearate diet had reduced expression of RhoA and B as well as total Rho compared with a low-fat diet. Overall, these data indicate that stearate inhibits breast cancer cell proliferation by inhibiting key check points in the cell cycle as well as Rho expression in vitro and in vivo and inhibits tumor burden and carcinogen-induced mammary cancer in vivo.     

Sleep–wake functioning along the cancer continuum: focus group results from the Patient‐Reported Outcomes Measurement Information System (PROMIS®)

Objective: Cancer and its treatments disturb sleep–wake functioning; however, there is little information available on the characteristics and consequences of sleep problems associated with cancer. As part of an effort to improve measurement of sleep–wake functioning, we explored the scope of difficulties with sleep in a diverse group of patients diagnosed with cancer. Methods: We conducted 10 focus groups with patients recruited from the Duke University tumor registry and oncology/hematology clinics. Separate groups were held with patients scheduled to begin or currently undergoing treatment for breast, prostate, lung, colorectal, hematological, and other cancer types and with patients who were in posttreatment follow‐up. The content of the focus group discussions was transcribed and analyzed for major themes by independent coders. Results: Participants not only reported causes of sleep disturbance common in other populations, such as pain and restless legs, but they also reported causes that may be unique to cancer populations, including abnormal dreams, anxiety about cancer diagnosis and recurrence, night sweats, and problems with sleep positioning. Many participants felt that sleep problems reduced their productivity, concentration, social interactions, and overall quality of life. Many also shared beliefs about the increased importance of sleep when fighting cancer. Conclusions: The findings underscore the need for interventions that minimize the negative impact of cancer and its treatments on sleep. This study will inform efforts now underway to develop a patient‐reported measure of sleep–wake functioning that reflects the breadth of concepts considered important by patients with cancer. Copyright © 2009 John Wiley & Sons, Ltd.     

Effect of diabetes associated increases in lens optical density on colour discrimination in insulin dependent diabetes.

Optical density (OD) of the crystalline lens has been shown in non-diabetics to increase linearly with age over the first five decades and at an increased rate thereafter; in insulin dependent diabetic (IDDM) patients, lens OD increases with age and with duration of diabetes at a rate similar to that in non-diabetics over the age of 60 years. Recently, it has been established that colour discrimination is abnormal in a majority of young patients with uncomplicated IDDM and angiographically normal retinas. Colour discrimination loss was attributed to functional abnormalities in the retina or neural pathways; yet the possibility exists that increases in lens OD may account for part or all of the colour discrimination loss in IDDM. In the present study, colour discrimination was compared in aretinopathic IDDM patients and age-matched controls, and then in a group of aretinopathic IDDM patients individually matched to controls with respect to lens OD. Colour discrimination was significantly worse in diabetic patients than in age-matched controls, and was significantly worse when diabetic patients were compared with controls matched for OD. The magnitude of the difference in 100 hue error score between diabetic patients and OD matched controls was, however, considerably less than the difference between diabetic patients and age-matched controls. These data suggest that colour discrimination loss in aretinopathic IDDM patients cannot be explained solely on the basis of diabetes induced increases in lens OD, but must involve abnormalities of the retina or its neural connections.     

Knowledge, attitudes, and practices related to the Pap smear among women with cervical cancer

Despite screening programs, Brazil has a high cervical cancer mortality rate. The objective of this cross-sectional study was to analyze knowledge, attitudes, and practices related to the Pap smear and to understand why women fail to submit to this screening test. A structured questionnaire was used to interview 138 women: 90 with high grade intraepithelial neoplasia and 48 with invasive cervical cancer. Inadequate practices were more frequent among women with invasive cancer. In terms of difficulties in obtaining medical care, more than 80% of women reported lack of motivation, 60% reported that physicians failed to conduct a complete physical examination, and some 50% reported that physicians' schedules were busy. Having a Pap smear usually depended on a physician's request and the woman being symptomatic. Women over than 56 years old showed more frequent inadequate knowledge, attitudes and practices. However, those with more schooling were more knowledgeable of the Pap smear procedure. Age and less schooling could be barriers against women participating in screening programs, but socioeconomic problems must also be considered for improving practices related to the Pap smear.     

Drug release from HPMC matrices in milk and fat‐rich emulsions

“Biorelevant” media for the fed stomach, including fat emulsions, are routinely used during in vitro testing of solid dosage forms. However, their complexity undoubtedly creates difficulties in identifying factors which affect drug release. Here, we show fats can directly influence drug release from hydroxypropyl methylcellulose (HPMC; Methocel K4M) matrices which are often subjected to biorelevant testing. Model fat systems included milk (0.1%–3.5% fat) and the parenteral emulsion Intralipid® (20%–30% fat). The matrix showed good extended‐release properties for at least 12 h in these media (USP‐1/USP‐4), but at the highest fat concentration, release was retarded and shifted towards zero‐order release. Confocal imaging studies using a water‐soluble (fluorescein) and fat‐soluble (Nile red) fluorophore provided evidence of phase separation of Intralipid® at the surface of the emerging gel. Combined magnetic resonance imaging–USP‐4 drug release testing provided further evidence for deposition of fat on the tablets. We propose that the aqueous portion of the emulsion is removed by the hydrating matrix, causing coalescence and deposition of a fat layer at the surface, and these deposits cause slower drug release by reducing the matrix surface area available for release. Therefore, there is a risk of a direct interaction between fat emulsions and HPMC tablets, with resultant effects on drug release in vitro. © 2011 Wiley‐Liss, Inc. and the American Pharmacists Association J Pharm Sci 100:4823–4835, 2011     

An unusual multiple drug intoxication case involving citalopram

A 47-year-old male with a history of drug abuse and suicide attempts was found dead at home. The death scene investigation showed evidence of cocaine abuse and multiple drug ingestion. Citralopram, a new selective serotonin reuptake inhibitor, cocaine, oxycodone, promethazine, propoxyphene, and norpropoxyphene were identified and quantitated in the postmortem samples by gas chromatography-mass spectrometry. The concentration of citalopram in the femoral blood was 0.88 mg/L. The heart blood concentration was 1.16 mg/L. Femoral blood concentrations of the other drugs were as follows: cocaine, 0.03 mg/L; oxycodone, 0.06 mg/L; promethazine, 0.02 mg/L; propoxyphene, 0.02 mg/L; and norpropoxyphene, 0.07 mg/L. Other tissue samples were also analyzed. The concentrations of cocaine, oxycodone, promethazine, and propoxyphene in the blood, liver, brain, and gastric contents did not suggest an intentional overdose. However, the possibility of multiple drug interactions including citalopram was evident. In this case, the citalopram concentrations were consistent with those reported in fatal cases involving multiple drug use. Citalopram was present in urine at a concentration of 0.9 mg/L.     

In vitro maturation of oocytes

Only about 400 of the one million oocytes present at birth will be ovulated, while the rest will die by atresia. The ability to rescue oocytes destined to die and mature them in vitro would provide invaluable information about folliculogenesis and oocyte maturation, and could provide oocytes for infertile women. In vitro maturation (IVM) is challenging in the human because folliculogenesis is a lengthy process encompassing many complex cellular changes in the oocyte and its surrounding follicle cells. A few live births have resulted from the maturation and fertilization of immature human oocytes aspirated from small antral follicles. Furthermore, it is possible to grow primordial follicles to pre-antral stages in slices of ovarian tissue, and support antrum formation in isolated pre-antral follicles. However, we are still a considerable way from growing and maturing pre-antral follicles to pre-ovulatory stages in vitro. The importance of the follicular environment for producing a healthy and developmentally competent oocyte is illustrated by the oocyte's susceptibility to errors during meiosis. This counsels considerable caution in the development of IVM for clinical application.     

The role of prebiotics and synbiotics in critically ill patients

PURPOSE OF REVIEW: To examine current knowledge regarding the role of prebiotics in critical illness when administered singly or in combinations with probiotics (synbiotics). RECENT FINDINGS: Recent experimental and clinical studies support the fact that bioecological intestinal control with early enteral nutrition enriched with synbiotics may reduce systemic inflammation, improve the immunological status of the intestinal mucosa and help prevent infections in critically ill patients. Three prebiotics, oligofructose, galactooligosaccharides and lactulose are able to modify the balance of intestinal microbiota. It appears that treatment with synbiotics during critical illness should restore the balance of microbial communities in a beneficial way with positive effects on intestinal permeability and bacterial translocation. Only data from small trials are currently available to support use of prebiotics and synbiotics in the treatment of different clinical scenarios. However, in some critical conditions, this supplementation has so far not been effective. SUMMARY: Numerous questions about the molecular mechanisms of action or clinical indications of prebiotics remain unanswered. Large, randomized, multicentre trials are necessary to precisely define the role of prebiotics as therapeutic agents in critical illness. These trials must identify clinically significant improvements in relevant clinical endpoints before any large-scale usage is advocated for critical illness.