Pregnant adolescents in chemical dependency treatment. Description and outcomes.

This study examines the treatment, maternal and infant outcomes of pregnant adolescents (16-19 years) enrolled in an adult perinatal chemical dependency treatment program. Twenty-one adolescent subjects were compared to 323 adult women (mean age, 27.4 years) after enrollment into a randomized treatment trial consisting of intensive outpatient or short-term residential conditions. The results show a similar treatment retention rate. Adolescents differed from adult women on marital status, drugs of choice (alcohol, marijuana vs. opiates and cocaine) and method of administration, with no injection drug users in the adolescent cohort. Tobacco use was high (> 85%) in both groups. Obstetric, maternal, and infant outcomes to 1 year were comparable. Older adolescents who are chemically dependent and pregnant have treatment needs similar to adult women and can benefit from programs designed to treat older women. Recruitment difficulties for adolescents in need of treatment is discussed.

PIP: This study describes a sample of 21 pregnant women aged 16-19 years in treatment for substance abuse through the MOMS Project in Seattle, Washington, during 1991-94 who were followed for at least 90 days after the beginning of treatment with regard to a number of variables. The treatment, maternal, and infant outcomes of these pregnant adolescents enrolled in an adult perinatal chemical dependency treatment program are compared with like outcomes for 323 randomized adults of mean age 27.4 years in the program. The randomized treatment trial involved either intensive outpatient or short-term residential conditions. 27% of adolescents and 32% of adults remained in treatment for longer than 90 days, a statistically nonsignificant difference. The adolescents did, however, differ from adult women on marital status, preferred drugs, and the method of drug administration, with no IV drug users among the adolescents. A larger proportion of the adolescents drank alcohol compared to the adults. More than 85% of the women in both groups smoked cigarettes. Obstetric, maternal, and infant outcomes to 1 year were comparable. These findings demonstrate that older adolescents who are chemically dependent and pregnant have treatment needs similar to adult women and can benefit from programs designed to treat older women.

The integration of investigative toxicology in the drug discovery process.

Integrating toxicology early in the drug discovery process adds value by providing the earliest possible identification of a compound's potential for toxicological and pathological effects relevant to intended clinical use. With this approach true 'lead' candidates, with a high probability of clinical success, are identified and advanced while reducing effort and resources expended on compounds without the requisite therapeutic index. Resources are focussed on the speed of getting a discovery 'lead' into early clinical development, defining the mechanisms of observed preclinical toxicity and their relevance to human use, and developing early safety data with in vitro test systems ahead of in vivo systems where possible, thus reducing animal use.

Effects of long term 2% fish oil supplements on tissue fatty acids, phospholipids, cholesterol, and arterial histology in Japanese quail (Coturnix coturnix japonica).

The effects of 2% olive oil (OO) or fish oil (FO) (Super epa500) dietary supplementation (9 months) on Japanese "SEA" quail was investigated. The animals were examined for tissue biochemical changes and possible blood vessel fatty deposition. The fatty acids of blood and tissue extracts from heart, liver and fat were analyzed by gas-chromatography/mass spectrometry. The ratio of arachidonic acid to eicosapentaenoic or docosahexaenoic acid was markedly decreased in FO treated animals compared to OO or control diet treated animals. Tissue cholesterol and total phospholipids were present in elevated amounts in the heart and liver of FO treated animals. After the 9-month regimen many animals had residual atherosclerotic lesions but the FO treated birds had considerably more fatty streaks and fatty deposition in their large vessels compared to control or OO treated animals. Although the lipid composition of tissues of FO treated animals would indicate that the purported cardioprotective omega-3 fatty acids are enriched in the various tissues examined compared to olive oil and control diet treated animals, the possible detrimental effect of saturated fat, cholesterol, or some other component of the fish oil preparations is suggested from the histological appearance of fatty deposition in the blood vessels (aortae) of these inbred animals. These results in quail are strikingly similar to that seen in the omega-3 FA treated WHHL rabbit (15).

Effect of coffee on exercise-induced angina pectoris due to coronary artery disease in habitual coffee drinkers.

The acute effects of coffee on exercise-induced angina were studied in 17 men with coronary artery disease using a double-blind treadmill protocol. Ingestion of either 1 or 2 cups of caffeinated coffee increased the exercise duration until onset of angina (8 and 12%, respectively, p less than 0.05), whereas decaffeinated coffee had no effect. The extent of ST-segment depression and the heart rate-blood pressure product at angina were similar after drinking caffeinated and decaffeinated coffee. Exercise duration until 0.1 mV of ST-segment depression, as well as the heart rate, blood pressure and double product at angina and at 0.1 mV of ST-segment depression were similar after drinking caffeinated or decaffeinated coffee. The mean serum caffeine levels (+/- standard deviation) after ingestion of 1 and 2 cups of caffeinated coffee were 1.97 +/- 1.0 and 3.89 +/- 1.6 micrograms/ml, respectively. The acute ingestion of 1 to 2 cups of caffeinated coffee had no deleterious effect on exercise-induced angina pectoris in patients with coronary artery disease.

Chemical and morphologic alterations of rabbit bone induced by adriamycin.

Long term, low dose administration of adriamycin (ADR) to young growing rabbits resulted in significant alterations in bone structure and chemistry. Morphologic changes were most pronounced at epiphyseal and metaphyseal areas of long bones. Epiphyseal cartilage plates were thin and there was derangement of growth zones. Areas of primary and secondary spongiosa were deficient in trabeculae, osteoblasts and osteoclasts. Analysis of femora, humeri and lumbar vertebrae from ADR-treated rabbits revealed increased water and fat content and significant decreases in bone density compared to age-matched controls. Cortices of long bones were roentgenographically thin and contained large irregular spaces evident microscopically. Evaluation of bone ash from ADR treated rabbits revealed significant increases in the percentage of calcium and phosphorus, although Ca/P ratios were not different from controls. Results of in vitro studies indicate that ADR binds readily to nondemineralized, but not demineralized, fresh cortical bone powder. The findings of decreased bone density, histopathologic alterations, and a paucity of osteogenic cells in ADR treated rabbits are interpreted as retardation of bone maturation. It is suggested that ADR affects adversely both the organic and inorganic fractions of bone. Due to its unique characteristics of cytostatic action, binding to metal cations and orange-red fluorescence, ADR is a novel chemical agent that may be useful in experimental bone studies.