Factors Associated with Psychological Distress during COVID-19: A Cross-Sectional Study of Sub-Saharan African Migrant Workers across Australia and Canada.

Objective: Ensuring the sustainability of the migrant workforce requires a comprehensive understanding of the psychological challenges faced by this sub-population due to concerns about the wellbeing and financial situation of family members in their home countries. Therefore, this study investigates the factors associated with psychological distress among sub-Saharan Africa (SSA) migrant workers across Australia and Canada during the COVID-19 pandemic. Method: Data were collected from 378 first-generation migrant workers with SSA ancestry residing in Australia and Canada using the Depression Anxiety and Stress Scale 21 (DASS-21). Multivariate logistic regression analysis was used to determine socio-demographic factors associated with depression, anxiety, and stress among SSA migrants' populations. Results: Across both countries, migrants with lower levels of education were more prone to reporting feelings of depression, anxiety, and stress during the pandemic. Female participants in Australia were more likely to report feeling of depression. Participants in Australia and Canada who were separated/divorced/widowed were less likely to report stress and depression, respectively. Participants in Australia who had lived in Australia between 11 and 20 years and those between 36 and 50 years old were more likely to report feelings of depression. Participants residing in Australia whose SSA ancestry was Southern Africa/Central Africa were more likely to report anxiety. Participants in Australia who worked as part-time permanent workers and those who worked as fixed-term workers/short-term/casual workers were less likely to report anxiety. Finally, participants in Canada who reported two or more people living with them had higher odds of reporting anxiety. Conclusions: The findings from this study highlight key factors associated with SSA migrant workers' psychological distress during the pandemic. The results can inform policies and provide insight to the development of mental health intervention strategies for migrant workers to minimize similar distress during pandemics.

Association between obesity and miscarriage among women of reproductive age in Nepal.

BACKGROUND: Obesity is a major health problem in low and middle income countries (LMICs) and is associated with miscarriage. This study aims to examine the association between obesity and miscarriage among reproductive age women (15-49 years) in Nepal. METHODS: The combined 19160 cross-sectional pregnancy data from the Nepal Demographic and Health Survey (NDHS) for the years 2001, 2006, 2011 and 2016 was utilized. Miscarriage was defined as a spontaneous loss of pregnancy that occurred before the foetus reached 7 months of gestational age. Logistic regression analyses that adjusted for clustering, stratification and sampling weights were used to examine the association between obesity and miscarriage among women of reproductive age. RESULTS: The odds of miscarriage were 1.45 times higher (Adjusted odds ratio (AOR) = 1.45; 95%Cl: 1.06, 1.98, P = 0.021) among women with obesity. Women who did not use contraception, younger (15-19 years), and older women (35 years or more) were significantly more likely to have miscarriage. Women who smoked tobacco reported higher odds of miscarriage than women who did not smoke tobacco (AOR = 1.27; 95%Cl: 1.07,1.50, P = 0.006). Stratification of maternal smoking status by maternal Body Mass Index (BMI), after adjusting for contraception, mother age and year of survey revealed that tobacco smoking and obesity are associated with miscarriage (AOR = 1.46; 95%Cl: 1.05,2.04, P = 0.025). CONCLUSIONS: Findings from this study show that obesity and tobacco smoking are associated with miscarriage. Smoking cessation, pregnancy planning and counselling on healthy weight for women of reproductive age in Nepal may help promote healthy behaviours and decrease the likelihood of miscarriage.

Breastfeeding in the Community-How Can Partners/Fathers Help? A Systematic Review.

Support from partners/fathers and families can play a significant role in a mother's decision to initiate, continue or cease breastfeeding postnatally. This study systematically reviewed published studies to determine the impact of specific types of partner support on breastfeeding initiation, duration and exclusivity. We used the 2015 Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines for the review. Seven computerized bibliographic databases (Embase, ProQuest Central, Scopus, PsycINFO, Web of Science, MEDLINE/PubMed and CINAHL) were searched. Of a total of 695 articles retrieved from the databases, seven studies met the inclusion criteria and reported on breastfeeding initiation, duration and exclusivity. Four of the seven studies found that partner support in the form of verbal encouragement to new mothers increased breastfeeding duration and exclusivity. Other types of partner supportive actions that led to improved breastfeeding behavior included sensitivity of the partner to the nursing mother's needs, assistance in preventing and managing breastfeeding difficulties, and helping with household and child care duties. This review showed that specific supportive actions of partners/fathers in the community positively improved breastfeeding practices. To maximise the impact of breastfeeding policies and interventions among new mothers, breastfeeding programmes should consider the involvement of partners/fathers and their specific roles.

Association of Psychosocial Factors With Risk of Chronic Diseases: A Nationwide Longitudinal Study.

INTRODUCTION: This study examines the prospective association between a range of psychosocial factors and common noncommunicable diseases. METHODS: In October 2018, nationally representative data were analyzed from 11,637 adults followed annually between 2003 and 2013. Participants reported on psychosocial factors they experienced in the 12 months preceding each wave. The onset of noncommunicable diseases was defined based on self-reported physician's diagnosis. Generalized estimating equations estimated the ORs and 95% CIs of psychosocial factors on noncommunicable diseases, controlling for other confounders. RESULTS: Social support index was inversely associated with the onset of anxiety or depression in men (OR=0.95, 95% CI=0.93, 0.98) and women (OR=0.96, 95% CI=0.95, 0.98) and with emphysema in women (OR=0.96, 95% CI=0.93, 0.99). Psychological distress was positively associated with the onset of heart diseases (OR=2.38, 95% CI=1.16, 4.89 for men; OR=2.30, 95% CI=1.10, 4.78 for women), emphysema (OR=1.11, 95% CI=1.03, 1.20 for men; OR=1.08, 95% CI=1.04, 1.12 for women), and circulatory diseases (OR=1.04, 95% CI=1.02, 1.08 for women). Financial stress increased the onset of anxiety or depression (OR=1.36, 95% CI=1.26, 1.63 for men; OR=1.30, 95% CI=1.10, 1.52 for women) and type 2 diabetes in women (OR=1.60, 95% CI=1.18, 2.18). Significant associations of parenting stress and the likelihood of the onset of anxiety or depression were only evident in women. CONCLUSIONS: These findings suggest that several adverse psychosocial risk factors are independently associated with the onset of noncommunicable diseases.

High 3He/4He ratios in lower East Rift Zone steaming vents precede a new phase of Kilauea 2018 eruption by 8 months.

On May 1, 2018, a magnitude 5.0 earthquake heralded the collapse of the Pu'u O'o Vent on the middle East Rift Zone (ERZ) of Kilauea Volcano, active since 1983. Increased seismicity was recorded on the middle to lower ERZ from April 30 until May 2, 2018. The active lava lakes within both Pu'u O'o Vent and Halema'uma'u Crater began to drain and the summit caldera began to deflate, with the summit collapse ending on August 2, 2018 and lower ERZ eruptive lava activity ending by 4 September 2018. Herein we report on elevated 3He/4He ratios in steaming vents in the lower ERZ from samples collected in early September 2017. Gas isotopic measurements were made with a new, field-portable He isotope detector capable of sub-daily monitoring of the 3He/4He ratio. When corrected for air contamination, these values exceed those previously reported for Kilauea by nearly twofold, resembling a purer hotspot plume signature, such as those measured directly over the mantle plume at Loihi Seamount to the SE of Hawaii Island, and in older basalt flows when Kilauea and its sister Hawaiian shield volcanoes were located more directly over the plume. The discovery, which presages the eruption there by more than eight months, suggests that we either sampled a 3He/4He rich magma already in place in the lower ERZ or a shallow groundwater reservoir in the lower ERZ (Puna district) with anomalously low values of 4He relative to their 3He/4He ratio, similar to previous findings there and suggestive of a previously unknown He isotopic fractionation.

Estimating the Double Burden of Malnutrition among 595,975 Children in 65 Low- and Middle-Income Countries: A Meta-Analysis of Demographic and Health Surveys.

INTRODUCTION: Given the changing global nutrition landscape, the double burden of malnutrition is a major public health challenge in many developing countries. The main aim of this study is to estimate the double burden of malnutrition among children in low- and middle-income countries (LMICs). METHODS: This study used cross-sectional data from Demographic and Health Surveys (2001-2016). A meta-analysis was conducted to estimate the prevalence of malnutrition indicators in 595,975 children under five years from 65 LMICs. Significant heterogeneity was detected among the various surveys (I2 >50%), hence a random-effect model was used. Sensitivity analysis was also performed, to examine the effects of outliers. RESULTS: The pooled estimate for stunting, wasting, underweight, and overweight/obesity was 29.0%, 7.5%, 15.5%, and 5.3% respectively. Countries with the highest coexistence of undernutrition and overweight/obesity were: South Africa (stunting 27.4% (95% CI: 25.1, 29.8); overweight/obesity 13.3% (95% CI: 11.5, 15.2)), Sao Tome and Principe (stunting 29.0% (95% CI: 26.8, 31.4); overweight/obesity 10.5% (95% CI: 9.0, 12.1)), Swaziland (stunting 28.9% (95% CI: 27.3, 30.6); overweight/obesity 10.8% (95% CI: 9.7, 12.0)), Comoros (stunting 30.0% (95% CI: 28.3, 31.8); overweight/obesity 9.3% (95% CI: 8.3, 10.5)), and Equatorial Guinea (stunting 25.9% (95% CI: 23.4, 28.7); overweight/obesity 9.7% (95% CI: 8.0, 11.6)). CONCLUSIONS: There is an urgent need to strengthen existing policies on child malnutrition to integrate and scale up opportunities for innovative approaches which address the double burden of malnutrition in children under five years in LMICs.

Childhood undernutrition in three disadvantaged East African Districts: a multinomial analysis.

BACKGROUND: Undernutrition is an important public health indicator for monitoring nutritional status and survival. In spite of its importance, undernutrition is a significant problem health problem in many East African communities. The aim of this study was to identify factors associated with childhood undernutrition in three disadvantaged East African Districts. METHODS: We examined data for 9270 children aged 0-59 months using cross-sectional survey from Gicumbi District in Rwanda, Kitgum District in Uganda and Kilindi District in Tanzania. We considered the level of undernutrition (stunting, wasting and underweight) as the outcome variables with four ordinal categories (severely undernourished, moderately undernourished, mildly undernourished, and nourished). Generalized linear latent and mixed models (GLLAMM) with the mlogit link and binomial family that adjusted for clustering and sampling weights were used to identify factors associated with undernutrition among children aged 0-59 months in three disadvantaged East African Districts. RESULTS: After adjusting for potential confounding factors, the odds of a child being stunted were higher in Gicumbi District in Rwanda while the odds of a child being wasted and underweight were higher in Kitgum District in Uganda. Having diarrhoea two weeks prior to the survey was significantly associated with severe undernutrition. Wealth index (least poor household), increasing child's age, sex of the child (male) and unavailability of water all year were reported to be associated with moderate or severe stunting/wasting. Children of women who did not attend monthly child growth monitoring sessions and children who had Acute Respiratory Infection (ARI) symptoms were significantly associated with moderate or severe underweight. CONCLUSIONS: Findings from our study indicated that having diarrhoea, having ARI, not having water availability all year and not attending monthly child growth monitoring sessions were associated with undernutrition among children aged 0-59 months. Interventions aimed at improving undernutrition in these disadvantaged communities should target all children especially those children from households with poor sanitation practices.

Trends in socioeconomic inequalities in child undernutrition: Evidence from Nigeria Demographic and Health Survey (2003 - 2013).

OBJECTIVE: The aim of this study was to examine the trend in socioeconomic inequalities in child undernutrition in Nigeria. METHODS: The study analysed cross-sectional data from the Nigeria Demographic and Health Survey (NDHS) 2003 to 2013. The outcome variables were stunting, wasting and underweight among children under-five years. The magnitude of child undernutrition in Nigeria was estimated via a concentration index, and the socioeconomic factors contributing to child undernutrition over time were determined using the decomposition method. RESULTS: The concentration index showed an increase in childhood wasting and underweight in Nigeria over time. The socioeconomic factors contributing to the increase in child undernutrition were: child's age (0-23 months), maternal education (no education), household wealth index (poorest household), type of residence (rural) and geopolitical zone (North East, North West). CONCLUSIONS: To address child undernutrition, there is a need to improve maternal education and adopt effective social protection policies especially in rural communities in Nigeria.

Resilience to Climate-Induced Disasters and Its Overall Relationship to Well-Being in Southern Africa: A Mixed-Methods Systematic Review.

The available literature suggests that natural disasters, especially droughts and floods, were occurring in southern Africa in the early 1900s. However, their frequency and intensity increased during the 1980s. The aim of this systematic review was to assess the relationship between resilience to droughts and people's well-being in southern Africa. A combination of keywords was used to search the following 13 electronic bibliographic databases: Africa Journal Online (AJOL), MEDLINE, Academic Search Complete, Environment Complete, Humanities International Complete, Psychology and Behavioral Sciences Collection, PsycINFO, Embase, Scopus, Web of Science, Applied Social Science Index and Abstracts, ProQuest Central, and CINAHL. Relevant websites were also searched and potential studies for inclusion were downloaded in an EndNote database and screened for eligibility using pre-determined criteria. Quality assessment of the studies was undertaken using the Joana Briggs Qualitative Assessment and Review Instrument, the National Institutes of Health (NIH) checklist, and the Authority, Accuracy, Coverage, Objectivity, Date, Significance (AACODS) checklist. Resilience and well-being scales used in the studies for inclusion were also assessed using pre-defined criteria. Nineteen studies met the inclusion criteria. Poverty alleviation policies were important in strengthening resilience and well-being outcomes. Resilience and well-being were connected by old age, gender, race, adaptive farming and livelihoods diversification, security, and knowledgeability. Resilience and well-being outcomes were advanced by the synergistic effect of household, community and governance level capacities encapsulated in knowledgeability. This systematic review is critical to improving southern Africa context-specific resilience, and well-being policies and interventions.

Perinatal Mortality in South Asia: Systematic Review of Observational Studies.

BACKGROUND: This study aimed to systematically review observational studies on perinatal mortality in South Asia. METHODS: This review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Five computerized bibliographic databases: MEDLINE, CINAHL, Embase, PsycINFO, and Scopus were searched for published studies which reported factors associated with perinatal mortality in South Asia from 1 January 2000 to 20 March 2018. All relevant observational studies (cohort, cross-sectional and case-control) were reviewed. RESULTS: Fourteen studies met the selection criteria. The most common factors associated with perinatal mortality were: low socioeconomic status, lack of quality health-care services, pregnancy/obstetric complications and lack of antenatal care. CONCLUSIONS: Interventions to reduce perinatal mortality in the South Asia should focus on the provision of adequate antenatal care and quality healthcare services which are accessible to women of low socioeconomic status.

Stunting, Wasting and Underweight in Sub-Saharan Africa: A Systematic Review.

Introduction: Child undernutrition is a major public health problem. One third of all undernourished children globally reside in Sub-Saharan Africa (SSA). The aim of this study was to systematically review studies to determine the factors associated with stunting, wasting and underweight in SSA and contribute to the existing body of evidence needed for the formulation of effective interventions. Methods: This systematic review was conducted using the 2015 Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines. Five computerized bibliographic databases were searched: Scopus, PubMed, PsycINFO, CINAHL and Embase. The included studies were rated using eight quality-appraisal criteria derived from the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) checklist: sample size, sampling methodology, response rate, outcome measures, statistical analyses, control for confounding, study limitation, and ethical consideration. Results: Of a total of 2810 articles retrieved from the five databases, 49 studies met our inclusion criteria. The most consistent factors associated with childhood stunting, wasting and underweight in SSA were: low mother's education, increasing child's age, sex of child (male), wealth index/SES (poor household), prolonged duration of breastfeeding (>12 months), low birth weight, mother's age (<20 years), source of drinking water (unimproved), low mother's BMI (<18.5), birth size (small), diarrhoeal episode, low father's education and place of residence (rural). Conclusions: The factors that predispose a child to undernutrition are multisectoral. To yield a sustainable improvement in child nutrition in SSA, a holistic multi-strategy community-based approach is needed that targets the factors associated with undernutrition, thereby setting the region on the path to achieving the WHO global nutrition target by 2025.

Child malnutrition in sub-Saharan Africa: A meta-analysis of demographic and health surveys (2006-2016).

BACKGROUND: Sub-Saharan Africa has one of the highest levels of child malnutrition globally. Therefore, a critical look at the distribution of malnutrition within its sub-regions is required to identify the worst affected areas. This study provides a meta-analysis of the prevalence of malnutrition indicators (stunting, wasting and underweight) within four sub-regions of sub-Saharan Africa. METHODS: Cross-sectional data from the most recent Demographic and Health Surveys (2006-2016) of 32 countries in sub-Saharan Africa were used. The countries were grouped into four sub-regions (East Africa, West Africa, Southern Africa and Central Africa), and a meta-analysis was conducted to estimate the prevalence of each malnutrition indicator within each of the sub-regions. Significant heterogeneity was detected among the various surveys (I2 >50%), hence a random effect model was used, and sensitivity analysis was performed, to examine the effects of outliers. Stunting was defined as HAZ<-2; wasting as WHZ<-2 and underweight as WAZ<-2. RESULTS: Stunting was highest in Burundi (57.7%) and Malawi (47.1%) in East Africa; Niger (43.9%), Mali (38.3%), Sierra Leone (37.9%) and Nigeria (36.8%) in West Africa; Democratic Republic of Congo (42.7%) and Chad (39.9%) in Central Africa. Wasting was highest in Niger (18.0%), Burkina Faso (15.50%) and Mali (12.7%) in West Africa; Comoros (11.1%) and Ethiopia (8.70%) in East Africa; Namibia (6.2%) in Southern Africa; Chad (13.0%) and Sao Tome & Principle (10.5%) in Central Africa. Underweight was highest in Burundi (28.8%) and Ethiopia (25.2%) in East Africa; Niger (36.4%), Nigeria (28.7%), Burkina Faso (25.7%), Mali (25.0%) in West Africa; and Chad (28.8%) in Central Africa. CONCLUSION: The prevalence of malnutrition was highest within countries in East Africa and West Africa compared to the WHO Millennium development goals target for 2015. Appropriate nutrition interventions need to be prioritised in East Africa and West Africa if sub-Saharan Africa is to meet the WHO global nutrition target of improving maternal, infant and young child nutrition by 2025.

Multilevel Analysis of Factors Associated with Wasting and Underweight among Children Under-Five Years in Nigeria.

Wasting and underweight reflect poor nutrition, which in children leads to retarded growth. The aim of this study is to determine the factors associated with wasting and underweight among children aged 0-59 months in Nigeria. A sample of 24,529 children aged 0-59 months from the 2013 Nigeria Demographic and Health Survey (NDHS) was used. Multilevel logistic regression analysis that adjusted for cluster and survey weights was used to identify significant factors associated with wasting/severe wasting and underweight/severe underweight. The prevalence of wasting was 18% (95% Confidence Interval (CI): 17.1, 19.7) and severe wasting 9% (95% CI: 7.9, 9.8). The prevalence of underweight was 29% (95% CI: 27.1, 30.5) and severe underweight 12% (95% CI: 10.6, 12.9). Multivariable analysis revealed that the most consistent factors associated with wasting/severe wasting and underweight/severe underweight are: geopolitical zone (North East, North West and North Central), perceived birth size (small and average), sex of child (male), place/mode of delivery (home delivery and non-caesarean) and a contraction of fever in the two weeks prior to the survey. In order to meet the WHO's global nutrition target for 2025, interventions aimed at improving maternal health and access to health care services for children especially in the northern geopolitical zones of Nigeria are urgently needed.

Nematodes Relevance in Soil Quality Management and their Significance as Biomarkers in Aquatic Substrates: Review.

BACKGROUND: The interaction of man with the ecosystem is a major factor causing environmental pollution and its attendant consequences such as climate change in our world today. Patents relating to nematodes' relevance in soil quality management and their significance as biomarkers in aquatic substrates were reviewed. Nematodes are useful in rapid, easy and inexpensive method for testing the toxicity of substance (e.g. aquatic substrates). OBJECTIVE: This review paper sets out to examine and discuss the issue of soil pollution, functions of nematodes in soil and aquatic substrates as well as bio-indicators in soil health management in terrestrial ecology. METHODS: The information used were on the basis of secondary sources from previous research. CONCLUSION: It is abundantly clear that the population dynamics of plant parasitic or free-living nematodes have useful potentials as biomonitor for soil health and other forms of environmental contamination through agricultural activities, industrial pollution and oil spillage, and the analysis of nematode community structure could be used as complementary information obtained from conventional soil testing approaches.

Acute Toxicity of the Pesticides, Dichlorvos and Lindane against the African air-breathing catfish, Heterobranchus longifilis, Valenciennes, 1840 (Siluriformes: Clariidae).

BACKGROUND: This study raises awareness to the use of toxic pesticides and reiterates the well-known danger of these pesticides. The acute toxicity of two pesticides, dichlorvos and lindane against the African air-breathing catfish, Heterobranchus longifilis fingerlings was investigated under static bioassay in the laboratory. Relevant patents relating to acute toxicity of pesticides against fish were reviewed. Invention concerning the detection of biomarkers in material from a living organism relates to a method of testing whether a living organism has been exposed to stress, such as pesticide exposure. METHODS: Range finding bioassays were conducted to get the range of concentrations for the definitive bioassays. The range of concentrations of test media for dichlorvos was 0.2 - 1.5 mg l-1 while that of lindane was 35 - 80 mg l-1. The median lethal concentrations were determined using probit analysis. RESULTS: The test pesticides were found to be differentially toxic to the test species. The 96h LC50 values of 0.8187 and 41.566 mg l-1 for dichlorvos and lindane respectively indicated that dichlorvos was highly toxic while lindane was slightly toxic to the test species. Computed toxicity factor showed that dichlorvos was 50.8 times more toxic than lindane. The unpaired t-test showed that dichlorvos was significantly (0.05) more toxic than lindane. The physical and chemical parameters data showed that over the 96h periods, the test pesticides caused slight increase in temperature, dissolved oxygen and ammonia of the test media, when compared with the untreated control. But they differentially altered pH, conductivity and alkalinity. CONCLUSION: Since H. longifilis is sensitive to the test pesticides, it can therefore be considered as a good test species for the determination of acute toxicity and poisoning resulting from the pesticides and possibly for other compounds with similar intrinsic characteristics.

Bioconcentration of Lead in the Catfish, Heterobranchus longifilis, Valenciennes (1840) (Siluriformes: Clariidae).

BACKGROUND: Although many studies have been conducted on heavy metals in fish, there is no available information on the bioconcentration of lead in the African, air-breathing catfish, Heterobranchus longifilis (Valenciennes, 1840). Relevant patents relating to bioconcentration of lead in fish species were reviewed. Fish are useful in the evaluation of bioconcentration of lead and other metal pollutants in water. METHODS: The bioconcentration (uptake and depuration) of lead was determined by exposure of Heterobranchus longifilis (Valenciennes, 1840) fingerlings to untreated control and five sublethal concentrations of lead (0.0 - 0.3 mg-1) in three replicates under laboratory conditions. After acclimation of the test species for 7 days, the experiments were undertaken in two phases for 28 days, comprising 14 days for uptake and 14 days for depuration. Samples of fish were taken out at three-day intervals for lead analysis. Lead concentrations were determined using Flame Atomic Absorption Spectrophotometer (UNICAM 969 model). RESULTS: Essential physical and chemical parameters of test media were determined, and the results were within the international standards. Generally, the concentration of lead increased from 0.0001 mg kg-1 (control) from 1 day of the experiment to 0.3305 mg kg-1 on the 14 day of uptake phase, and decreased to 0.3019 mg kg-1 on the 28 day of the depuration phase. CONCLUSION: This study indicated that H. longifilis showed potential to accumulate and depurate lead.

Humane killing of fishes for scientific research: a comparison of two methods.

Two killing methods were compared on the clupeid, bony bream Nematolosa erebi and it was found that ice-slurry immersion was more humane than benzocaine overdose. The use of ice-slurry for killing N. erebi should be accepted as a standard humane method and considered similarly for other warm-water species.

Phase II evaluation of capecitabine in refractory nonsquamous cell carcinoma of the cervix: a Gynecologic Oncology Group study.

We conducted a multi-institutional study to assess the activity and toxicity of capecitabine in patients with persistent or recurrent nonsquamous cancer of the cervix. Eligible patients were required to possess adequate renal, hepatic and bone marrow function and a Gynecologic Oncology Group performance status of 0-2. Histologic confirmation of the original primary cancer was mandated. Patients must have received one prior systemic chemotherapeutic regimen for cervical cancer that did not include the chemotherapy that may have been administered in conjunction with prior radiation therapy. The initial dose schedule was 2500 mg/m2 orally daily in two divided doses for 14 consecutive days, followed by a 7-day rest, such that each cycle was 21 days. Responses were assessed using response evaluation criteria in solid tumors. Twenty-one patients were entered into the trial. One patient was declared ineligible for wrong cell type; thus, 20 were evaluable for toxicity. A median of 2.5 cycles was administered (range 1-11). There was one septic death. Grade 4 neutropenia, renal, neurologic, and pulmonary toxicity was seen in 5%, 5%, 5%, and 10% patients, respectively. There were no responses. Nine patients (45%) each had stable disease and nine showed progression. The remaining two cases (10%) did not have subsequent disease assessment and response could not be assessed. Oral capecitabine at the dose and schedule tested has insignificant activity in nonsquamous cervical cancer patients previously treated with chemotherapy.

Evaluation of tamoxifen in persistent or recurrent nonsquamous cell carcinoma of the cervix: a Gynecologic Oncology Group study.

This study was undertaken to estimate the antitumor activity of tamoxifen in patients with persistent or recurrent nonsquamous cell carcinoma of the cervix. Furthermore, the nature and degree of adverse effects from tamoxifen in this cohort of individuals was examined. Tamoxifen citrate was to be administered at a dose of 10 mg per orally twice a day until disease progression or unacceptable side effects prevented further therapy. A total of 34 patients (median age: 49 years) were registered to this trial; two were declared ineligible. Thirty-two patients were evaluable for adverse effects and 27 were evaluable for response. There were only six grades 3 and 4 adverse effects reported: leukopenia (in one patient), anemia (in two), emesis (in one), gastrointestinal distress (in one), and neuropathy (in one). The objective response rate was 11.1%, with one complete and two partial responses. In conclusion, tamoxifen appears to have minimal activity in nonsquamous cell carcinoma of the cervix.

Paclitaxel in the treatment of carcinosarcoma of the uterus: a gynecologic oncology group study.

OBJECTIVE: The goal of this study was to estimate the clinical activity of paclitaxel in patients with persistent or recurrent carcinosarcoma of the uterus who have failed other treatments. METHODS: The Gynecologic Oncology Group (GOG) conducted a phase II study of paclitaxel 170 mg/m(2) (135 mg/m(2) in those with prior irradiation) intravenously every 3 weeks in patients with histologic confirmation of carcinoma and measurable disease who had failed appropriate local therapy. RESULTS: A total of 53 patients were entered into the study between September 1994 and January 1997; 44 patients were evaluable for response. The median age of the patients treated was 65 years (range: 38-79). Twenty-six patients had heterologous mixed mesodermal tumors (MMTs) and 18 patients had homologous tumors. A median of three courses were administered (range: 1-18). Fifteen patients had previous radiation therapy and 33 patients had failed prior chemotherapy. Eight patients (18.2%) had a response to paclitaxel: four patients had a complete response and four had a partial response. Neutropenia was the most common toxic effect. CONCLUSIONS: Paclitaxel had moderate activity in patients with carcinosarcoma of the uterus. The GOG is currently studying the combination of paclitaxel and ifosfamide versus ifosfamide alone for patients with advanced or recurrent carcinosarcoma of the uterus.