Controversies Regarding Postmenopausal Hormone Replacement Therapy for Primary Cardiovascular Disease Prevention in Women.

The debate over the safety and benefit of hormone replacement therapy (HRT) in postmenopausal women for primary prevention of cardiovascular disease (CVD) has been ongoing for the past several decades. Observational trials in the 1980s suggested a benefit of HRT for primary CVD prevention. However, randomized controlled trials in the 1990s suggested potential harm. Because of these discrepancies, recommendations from authorities on the usage of postmenopausal HRT have fluctuated. Many believed that the timing of HRT initiation relative to the onset of menopause, also known as the "timing hypothesis," was the factor that could explain the differences among these studies. Some recent investigations have concluded that HRT initiated in postmenopausal women near the onset of menopause confers a cardioprotective benefit, while others simply showed that HRT does not cause harm. Research has expanded to evaluate alternative doses, preparations, routes, and formulations, including selective estrogen receptor modulators, to demonstrate their suitability for this purpose. This article is a review of the major research studies of HRT in postmenopausal women with respect to its safety and efficacy for the primary prevention of CVD.

Menthol cigarette pricing at military and community retail outlets in the United States.

BACKGROUND: Cigarette prices at military exchanges historically have been discounted. DoD Instruction 1330.9 has mandated that prices be within 5% of the price offered in the local community since 2001. Because minorities are highly represented in the military, we determined whether menthol cigarette prices, the leading choice of African Americans, were compliant with the instruction. METHODS: We collected, via telephone, menthol cigarette price data from 48 randomly selected US military installation exchanges and matched local area Walmarts. We collected prices after taxes to determine the cost to consumer. Newport was selected as the index brand for menthol cigarettes because it is the leading and second leading brand smoked by African Americans and by Hispanics, respectively and has the second overall highest market share in the US. RESULTS: Smokers purchasing menthols at exchanges would realize average savings of 22.78%. There were no significant differences in savings based on military service (F = 1.850, p = 0.152) or US Census Division (F = 1.226, p = 0.311: data not shown). In addition, not a single exchange price was compliant with the DoD instruction. CONCLUSIONS: Newport menthol cigarettes at military exchanges cost substantially less than the nearest Walmart, with an average savings of 23%. Our findings demonstrate that menthol cigarettes are substantially discounted on military installations, in a manner similar to other cigarette prices, and that DoD Instruction 1330.09 is not enforced.

Use of fresh osteochondral allograft in repair of distal femur after trauma.

Preserving the ability to maintain an active lifestyle is a major concern in the reconstruction of the knee in young patients. For the healthy individual who desires to maintain a relatively active lifestyle, fresh osteochondral allografts may serve as an alternative to total joint reconstruction. The use of fresh allografts is primarily indicated in the patient suffering from a traumatic loss of articular segments, who is too young or active for arthroplasty. In addition, fresh osteochondral allografts have a number of advantages over arthroplasty such as providing surgeons with a source of large grafts that can be fitted to replace osteochondral defects and cover the majority or entirety of articular surfaces without any donor site morbidity. In this case, a young, active patient lost a 7 x 8 cm portion of their distal femur, including a large portion of the articulating surface. Using a fresh osteochondral allograft, harvested within 24 hours of donor death, a segment was fitted to match bony apposition, articular congruity, and congruity with the femoral notch and affixed with four partially threaded cancellous screws. Joint function was restored with the allograft in place, allowing the patient to delay the need for a total joint replacement.

A longitudinal study of student-teacher relationship quality, difficult temperament, and risky behavior from childhood to early adolescence.

This study examines the mediating role of student-teacher relationship quality (conflict and closeness) in grades 4, 5, and 6 on the relation between background characteristics, difficult temperament at age 4 1/2 and risky behavior in 6th grade. The longitudinal sample of participants (N=1156) was from the NICHD Study of Early Child Care and Youth Development. Structural equation modeling was used to estimate paths from (a) background characteristics to student-teacher relationship quality and risky behavior, (b) temperament to student-teacher relationship quality and risky behavior, and (c) student-teacher relationship quality to risky behavior. Findings indicate that students' family income, gender, receipt of special services, and more difficult temperament were associated with risky behavior. In addition, student-teacher conflict was a mediator. Students with more difficult temperaments were more likely to report risky behavior and to have conflict in their relationships with teachers. More conflict predicted more risky behavior. Closer student-teacher relationships were associated with less risky behavior. Results suggest negative relationships, specifically student-teacher relationships, may increase the risk that certain adolescents will engage in risky behavior.

Total revision of the hip using allograft to correct particle disease induced osteolysis: a case study.

Total hip replacement is considered to be a highly successful and routine surgery; however, the internal components produce particles through friction and wear in the device. These particles are identified as one of the main reasons for total hip revisions. The generated, biologically active, particles provoke the formation of osteolytic areas through the inhibition of bone formation and increased fluid production. The resulting bone loss can be managed through the use of allograft bone in combination with bone chips and cement. In addition, implants constructed with highly porous trabecular metal can be used to further facilitate rapid and extensive tissue infiltration resulting in strong implant attachment. In this case study we show the use of a tibial allograft coupled with bone chips and cement to cover and support a lytic cyst in the proximal femur, distal to the greater trochanter. Additionally, we detail the use of a trabecular metal cup to halt the migration of the component into the acetabulum and promote greater fixation and bone ingrowth.

Factors which influence tobacco use among junior enlisted personnel in the United States Army and Air Force: a formative research study.

BACKGROUND: Despite the implementation of a host of tobacco control initiatives, tobacco use among active duty members of the U.S. Military remains high. It has been suggested that a positive culture of tobacco, which drives consumption, exists in the military. However, little is know about factors that impact tobacco use among military personnel. OBJECTIVE: This study provides the first formative data on the culture of tobacco in the U.S. Military. METHODS: A total of 15 focus groups on six military installations were conducted (n = 189). These military installations were located throughout the continental United States and were of average size for each service. RESULTS: Participants suggested that the primary method the military uses to discourage use is tobacco bans. Unfortunately, they also believed that the military accommodates tobacco use so that smoking remains convenient despite the bans on tobacco use. Smoking was believed to be encouraged through liberal smoking breaks, social interaction within designated smoking areas, and cheap and convenient tobacco products sold on military installations. Additionally, smoking was seen as an effective method to combat the stress and boredom of military life and to avoid weight gain. CONCLUSIONS: Suggestions for addressing the culture of tobacco are suggested.

An analysis of messages about tobacco in the Military Times magazines.

The Military Times magazines are seen as an independent source of news and information on the military and are widely read by military members. Given the influence of Military Times as a powerful media outlet within the military and marketing to military personnel by the tobacco industry, we examined tobacco messages and advertisements in a one-year sample from each service. No advertisements for cigarettes or other forms of smoked tobacco were found in any issue published in 2005. However, smokeless tobacco products were advertised frequently, with 11 distinct ads occurring in 105 ad placements. During the year targeted in the present study, smokeless tobacco advertising generated approximately US$564,249 in revenue for the publishers of Military Times. A content analysis suggested that the advertisements intended to pair smokeless tobacco use with a pleasant mood and enjoyable events not directly associated with the product itself. In addition, magazine articles about anti-tobacco topics received among the lowest amount of coverage among all pro-health articles. These findings may partially explain the recent significant increase in smokeless tobacco use among military personnel.

Smoking and deployment: perspectives of junior-enlisted U.S. Air Force and U.S. Army personnel and their supervisors.

Smoking during deployments is a growing problem, particularly among junior-enlisted personnel, who have the highest smoking rates in the military. Few studies have examined reasons for smoking initiation among never smokers, relapse among former smokers, or increased smoking frequency among current smokers. We conducted 24 focus groups at four Air Force and two Army installations (N = 189) to examine the extent of smoking during deployment and to elucidate factors thought to contribute to new initiation, relapse, and increased smoking in a sample of junior-enlisted personnel and their supervisors. Important reasons for smoking included: (1) managing stress, boredom, anxiety, and sleep deprivation; (2) lack of alternate activities and privileges; (3) the perception that dangers in the field trumps the health impact of smoking; and (4) the role of the military environment in encouraging smoking. In addition, the phenomenon of new initiation and relapse to smoking in the field was discussed.

A formative examination of messages that discourage tobacco use among junior enlisted members of the United States military.

Smoking prevalence among junior enlisted members of the United States armed forces significantly exceeds that of civilians. Furthermore, nearly 40% of junior enlisted who smoke reported they initiated smoking after joining the military. Although the tobacco industry has attempted to develop messages that encourage military members to use tobacco, no research has examined messages that would counteract industry messages and effectively discourage military members from using tobacco. This study conducted 24 focus groups on four Air Force and two Army installations (N = 189 personnel) to discover effective messages that discourage tobacco use among junior enlisted personnel. Four message themes were identified that hold promise for tobacco control efforts in the military: (a) smoking harms one's ability to positively influence others, (b) smoking increases the chance a military member will be discharged from the military prematurely, (c) smoking lowers readiness to fight and win wars, and (d) smokers are not as productive as other military personnel. In contrast, messages focusing on manipulation by the tobacco industry and the health effects of tobacco use were not strongly supported by military personnel.

Relationship between patterns of alcohol use and negative alcohol-related outcomes among U.S. Air Force recruits.

The negative impact of alcohol use on workplace performance is of significant concern to the U.S. military, given the costs associated with recruiting, hiring, and training personnel. However, little is known about the extent of potential alcohol use problems of recruits. We examined the history of alcohol-related problems among recruits entering the Air Force (N=37858). Although the average age of recruits was <21 years, 78% reported consuming alcohol and 49% reported binging before basic military training. Recruits who drank reported having negative alcohol-related outcomes (NAROs). In fact, >95% reported that they or someone else had been injured as a result of their drinking and that a relative, friend, doctor, or other health care worker has been concerned about their drinking. The remaining NAROs were reported by approximately one-quarter of those who drank. However, recruits who reported binge drinking were substantially more likely to report more NAROs, such as morning drinking, inability to stop drinking, having others be concerned about their drinking, having blackouts, fighting, having injured or been injured, feeling guilty about their drinking, and wanting to reduce the amount they drink. Results suggest that alcohol-related problems are common among recruits before basic military training and screening for future problems may be beneficial.

Examination of hard segment and soft segment phase separation in polyurethane medical materials by electron microscopy techniques.

A combination of transmission electron microscopy (TEM) and in situ tensile testing in an environmental scanning electron microscopy (ESEM) was used to evaluate the static bulk and dynamic surface morphologies of medical polyurethanes. TEM results showed phase-separated hard segment and soft segment structures. Surface morphology as a function of strain was studied using ESEM in conjunction with a tensometer.

An analysis of messages about tobacco in military installation newspapers.

OBJECTIVES: We sought to gauge the relative attention that tobacco control receives in military newspapers by comparing coverage of tobacco use with that of other health topics of importance to the military. METHODS: We examined tobacco-related articles and industry advertisements in 793 newspapers published during 1 year at 16 representative military installations (4 Air Force, 6 Army, 2 Marine, 4 Navy). Newspaper content was coded with a standardized coding manual developed through previous research. RESULTS: Tobacco use received the fewest instances of coverage and the least print space in military installation newspapers of all the health topics examined. The primary "message frame" used in tobacco control articles was that smokers are putting themselves at health risk, a theme that has not been found to have a strong effect on smokers. Nearly 10% of the newspapers contained tobacco advertisements. CONCLUSIONS: Tobacco control messages are underrepresented in military installation newspapers compared with other health issues. Furthermore, military newspapers send mixed messages to military personnel by providing advertisements for tobacco while also claiming that tobacco use is harmful.

Extent of iron pick-up in deforoxamine-coupled polyurethane materials for therapy of chronic wounds.

Polyurethane net substrates (PNS) coupled with deferoxamine (DFO) have been studied to determine the extent of Fe2+ pick-up for use in chronic wound therapy. A m solution of ferrous sulphate (FeSO4) was used to generate ferrous ions similar to those found in chronic wounds. The concentration of Fe as a function of position through the dressings was evaluated using a variety of techniques. Atomic force microscopy (AFM) and energy-filtered transmission electron microscopy (EFTEM) revealed a rough precipitated layer at the surface of activated PNS exposed to FeSO4 solution. Optical microscopy (OM) and backscattered environmental scanning electron microscopy (ESEM) showed a clear layer of Fe(3+)-enriched material in the surface regions exposed to DFO. The penetration depth of DFO into activated dressings was found to be 20-30 microm. Energy-dispersive X-ray (EDX) analysis was used to approximate the distribution of bound- and unbound-Fe as a function of position within BPNS and DFO-activated dressings after immersing them in a FeSO4 solution for various times. These studies have shown the activity of iron with respect to ionic state in DFO-activated PNS for potential using as dressing for chronic wounds.

Saturation of tobacco smoking models and risk of alcohol and tobacco use among adolescents.

PURPOSE: To examine how saturation of an adolescent's environment with models of cigarette smoking (e.g., parents, siblings, friends) affects the probability of tobacco and alcohol use among junior high and high school students. METHODS: The Health and Smoking Questionnaire was administered to 806 adolescents (182 smokers and 624 nonsmokers; 57.2% female) average age of 15.1 years (SD = 1.6) in a mid-size Midwestern town. The questionnaire contains standardized items in five domains: demographics, smoking status and history, perceptions of risk and risk reduction, risk factors for tobacco use, and parenting style. RESULTS: Risk for smoking or using alcohol increased dramatically as the number of models who smoke increased in an adolescent's environment. For instance, adolescents with one significant other who smoked were nearly four times (OR = 3.76, p <.001) more likely to smoke than someone with no significant others who smoked. However, if an adolescent had four significant others who smoked, they were over 160 times more likely to smoke (OR = 161.25, p <.001). Similar results were found for alcohol use; adolescents who had one significant other who smoked were more than 2.5 (OR = 2.66, p <.001) times more likely to drink than those without smoking models. Adolescents who had four significant other smoking models were 13 times (OR = 13.08, p <.001) more likely to drink. CONCLUSIONS: As the number of cigarette smokers in an adolescent's environment increases, risk of tobacco and alcohol use increases substantially. These data suggest that multiple models of tobacco use will substantially increase risk for substance use in adolescents.

Delivery of bioactive, gel-isolated proteins into live cells.

The delivery of proteins into live cells is a promising strategy for the targeted modulation of protein-protein interactions and the manipulation of specific cellular functions. Cellular delivery can be facilitated by complexing the protein of interest with carrier molecules. Recently, an amphipatic peptide was identified, Pep-1 (KETWWETWWTE WSQPKKKRKV), which crosses the plasma membrane of many cell types to carry and deliver proteins as large as antibodies. Pep-1 effectively delivers proteins in solution; but Pep-1 is not suitable for delivering sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) isolated proteins because Pep-1 complexes with cargo proteins are destroyed by SDS. Here, we report cellular delivery of SDS-PAGE-isolated proteins, without causing cellular damage, by using a nonionic detergent, Triton X-100, as carrier. To determine the specificity of our method, we separated antibodies against different intracellular targets by nonreducing SDS-PAGE. Following electrophoresis, the antibody bands were detected by zinc-imidazole reverse staining, excised, in-gel refolded with Triton X-100, and eluted in detergent-free phosphate-buffered saline. When overlaid on cultured NIH 3T3 cells, the antibodies penetrated the cells localizing to their corresponding intracellular targets. These results are proof-of-principle for the delivery of gel-isolated bioactive proteins into cultured cells and suggest new ways for experimental protein therapy and for studying protein-protein interactions using gel-isolated protein.

Smoking and health outcomes after percutaneous coronary intervention.

BACKGROUND: This study was designed to describe the impact of smoking on health status and mortality after percutaneous coronary intervention (PCI). METHODS: A cohort of 271 consecutive PCI patients at the Mid-America Heart Institute of St Luke's Hospital in Kansas City, Mo, were observed in a prospective, observational study. Surveys that included health status assessments were administered at baseline and at 6 and 12 months after intervention. Primary outcome was health status as measured by the Short Form-12 (SF-12) and the Seattle Angina Questionnaire (SAQ). RESULTS: Risk-adjusted statistical models demonstrated that, across a number of health-related quality of life domains, patients who were current smokers had poorer health status outcomes than other patients after revascularization. For instance, patients who had never smoked (P <.001) and patients who were former smokers (P <.001) scored significantly higher than patients who were current smokers on the physical component score of the SF-12, which indicated a better sense of overall physical function. Similarly, patients who had never smoked and patients who were former smokers reported significantly fewer physical limitations, less angina, and a higher quality of life on the SAQ than patients who were current smokers. Smoking status was unrelated to mortality rate in the 12 months after revascularization. CONCLUSIONS: Smoking substantially limits the potential health status benefits of PCI.

Neurocognitive sequelae following coronary artery bypass graft. A research agenda for behavioral scientists.

Several studies have demonstrated that a sizeable proportion of patients undergoing coronary artery bypass graft (CABG) demonstrate persistent declines in cognitive functioning. However, several important questions remain regarding cognitive changes following CABG. First, can patients vulnerable to cognitive decline after CABG be identified, providing valuable information that can be factored into clinical decisions? Second, the specificity of CABG as a cause of cognitive decline, when compared to other coronary procedures such as percutaneous coronary interventions, has not been established. Third, what mechanisms account for the neurocognitive decline after CABG? Several mechanisms have been proposed to lead to post-CABG neurocognitive deficits, including pre-CABG neurocognitive deficits, physiological injury, psychosocial factors, and/or the patient's perceptual processes. Finally, no study has demonstrated that cognitive changes, as measured by neuropsychological tests, have ecological validity. Specifically, behavioral sciences research is needed to demonstrate that measured cognitive changes significantly impact health status independent of other risk factors.

Depression predicts disability in long-term chronic pain patients.

PURPOSE: Investigators have examined factors that predict treatment outcome and disability status in chronic pain patients, including psychopathology and personality characteristics with equivocal results. The purpose of this study was to evaluate the usefulness of personality characteristics, depression, and personality disorders in predicting disability status in pain patients with long-term follow-up. The setting was a rehabilitation hospital in Southern Sweden. METHOD: Subjects were 184 pain patients (mean age = 43.4 (10.8) years; 72.8% female) who had no more than 365 sick leave days (Mean sick leave days = 132.7 (128.2)) prior to the baseline personality and psychiatric evaluation. The baseline evaluation consisted of a psychiatric interview that included the administration of the Structured Clinical Interview for DSM-IV Screen Questionnaire (SCID-II), the Montgomery-Asberg Depression Rating Scale (MADRS), and the Karolinska Scales of Personality (KSP). Disability status was assessed by insurance record review a minimum of two-and-a-half years after baseline evaluation. RESULTS: Multivariate logistic regression suggests that age (OR = 1.09, 95% CI = 1.02-1.18; p = 0.013), number of sick leave days prior to evaluation (OR= 1.01, 95% CI= 1.01-1.02; p = 0.018), and baseline diagnosis of depression significantly predicted subsequent disability status (OR = 7.04, 95% CI = 1.15-42.93; p = 0.034). Baseline personality traits and the diagnosis of a personality disorder were not useful predictors of disability status in our sample. CONCLUSIONS: These data suggest that depression, but not personality disorders characteristics, was an important disability predictor in chronic pain patients with extended follow-up.