Predictors for clinical trial participation in the rare lung disease lymphangioleiomyomatosis.

BACKGROUND: Lymphangioleiomyomatosis (LAM) is a rare, progressive and frequently lethal cystic lung disease that almost exclusively affects women and has no proven therapies. An improved understanding of the pathogenesis has identified promising molecular targets for clinical trials. Although barriers, modifiers, and benefits for clinical trial participation in common diseases such as cancer have been studied, we are unaware of such evaluations concerning rare diseases. METHODS: We performed a survey of a population-based registry of 780 LAM subjects in North America to identify predictors of trial participation. Logistic regression analysis evaluated the association of demographic and clinical features with trial participation. RESULTS: 41 of 263 (16%) LAM patient respondents in North America had participated in a clinical trial. Age, disease duration, lack of any college education, use of oxygen therapy, and presentation without chest pain were associated with trial participation in unadjusted analyses. Multivariate analyses indicate that patient age was the strongest independent predictor for trial participation (OR=2.07, p=0.004 per decade greater of patient age). Common reasons reported against trial participation included not meeting enrollment criteria (44%), drug toxicity (25%), and stable disease (20%). The most frequent reason reported for trial participation was to help future patients (85%). CONCLUSIONS: Study entry criteria, drug toxicity, and stability of disease are barriers to trial enrollment among subjects with LAM. Older LAM patients and those with more advanced disease are more likely to have participated in clinical trials. Altruism is commonly a motivating factor.

Parkinson's disease: focus on management alternatives.

AUDIENCE: This activity is designed for physicians, pharmacists, nurses, health planners, directors of managed care organizations, and payers of health services. GOAL: To understand the impact that Parkinson's disease has on patients and to identify areas of drug therapy that can be optimized to improve a patient's quality of life. OBJECTIVES: 1. Discuss the epidemiology and pathophysiology of idiopathic Parkinson's disease (IPD). 2. Identify causes of secondary parkinsonism and medications associated with drug-induced parkinsonism. 3. Discuss the cardinal and secondary manifestations of IPD. 4. Outline the 6 stages of IPD. 5. Identify therapeutic alternatives for various levodopa treatment failures. 6. Identify the 3 newer antiparkinson agents and state their mechanisms of action, common adverse effects, drug interactions, and appropriate use. 7. Identify the appropriate use, common adverse effects, and drug interactions of dopamine agonists, anticholinergic agents, monoamine oxidase inhibitors, and catechol-O-methyltransferase inhibitors in Parkinson's disease therapy.

Portion sizes in dietary assessment: issues and policy implications.

Accurate estimates of energy and nutrient intake of individuals and populations are contingent on the reliability of information obtained about food intake, food composition, and portion size. This article reviews issues related to the definition, determination, and use of portion sizes in dietary assessment and public education.

Age, interpersonal attraction, and social interaction. A review and assessment.

This essay reviews over 40 extant research reports on attraction and aging. The review indicated that (a) perceived agreement in attitude tends to neutralize young adults' general perception of older adults as unattractive, (b) elders prefer to associate with middle-aged and older adults more than they desire to associate with younger adults, regardless of the relative physical attraction of the target individuals, and (c) elders' marital satisfaction appears to be related to perceived physical attractiveness of the husband, not the wife. The authors provide critique and analysis of the research methods employed in the reviewed studies. Avenues for further research are identified.

Farm background, socioeconomic status, and fertility: the two-generation hypothesis.

PIP: This paper examines whether the effects of farm background on socioeconomic differentials in fertility are diminished among nonfarm couples. The data are for a sample of white ever-married women belonging to the 1901-1910 birth cohorts. The research provides another test of the 2 generation-urbanite hypothesis 1st advanced by the Goldberg studies of Detroit and Indianapolis. Unlike a number of other studies, the findings do not support the hypothesis. Thus, a number of questions arise concerning the results obtained by previous investigators in support of this hypothesis. Different types of samples measuring farm background and socioeconomic status may be plausible explanations for the differing results. It is also important to note that both the Detroit and Indianapolis samples can hardly be considered representative of US urban populations in the 1940s and 1950s. A further difficulty with the Detroit study was that Goldberg aggregated the data of a relatively large number of cohorts. The Indianapolis sample was constrained by the eligibility requirements of the original study. The difficulties of adequately testing Goldberg's hypothesis may have been compounded by the extension of the hypothesis to nationally representative samples. Moreover, The hypothesis was not supported when education was used as a measure of socioeconomic status in the Detroit study. Until other studies can be carefully replicated, definitive answers to such questions as to whether fertility differentials by socioeconomic status will disappear or have become attenuated must remain an unanswered question.^ieng