The post-transcriptional steps of eukaryotic ribosome biogenesis.

One of the most important tasks of any cell is to synthesize ribosomes. In eukaryotes, this process occurs sequentially in the nucleolus, the nucleoplasm and the cytoplasm. It involves the transcription and processing of pre-ribosomal RNAs, their proper folding and assembly with ribosomal proteins and the transport of the resulting pre-ribosomal particles to the cytoplasm where final maturation events occur. In addition to the protein and RNA constituents of the mature cytoplasmic ribosomes, this intricate process requires the intervention of numerous protein and small RNA trans-acting factors. These transiently interact with pre-ribosomal particles at various stages of their maturation. Most of the constituents of pre-ribosomal particles have probably now been identified and research in the field is starting to unravel the timing of their intervention and their precise mode of action. Moreover, quality control mechanisms are being discovered that monitor ribosome synthesis and degrade the RNA components of defective pre-ribosomal particles.

Use of traditional medicine in Mongolia: a survey.

OBJECTIVES: To conduct a pilot investigation of the frequency with which individuals visit practitioners of Western and traditional Mongolian medicine and their motivations for making these visits. DESIGN: Survey based interviews were conducted in a sample of 90 adults. SETTING: Darkhan, Mongolia. MAIN OUTCOME MEASURES: Measures included the annual frequency of visits to practitioners of traditional and Western medicine as well as ratings of the importance of seven factors in choosing what type of practitioner to use. RESULTS: During the past year, 51% of subjects interviewed had used Western services exclusively, 8% had used traditional services exclusively, and 38% had used both types of services. Users and non-users of traditional medicine did not vary in terms of age, gender, occupation or rural vs urban residence. Traditional medicine users rated the knowledge base of traditional practitioners higher than did nonusers (5.3/7 vs 4.5/7, P < 0.01). A patient's specific illness appears to be important in deciding what type of treatment he will seek. CONCLUSIONS: Traditional medicine appears to be a more significant component of Mongolian health care than is reported in the international literature and consequently may deserve additional attention in future studies of the country's medical system.

Barriers to cervical cancer screening in rural Mexico.

Cervical cancer is a major health problem in Mexico. The national mortality rate due to cervical cancer was estimated at 21.8 per 100,000 among women over 15 years of age in 1994. Reasons for this high prevalence have not been defined, although it may be influenced by lack of access to health care, lack of knowledge about the Pap procedure, or cultural beliefs. While some studies have examined barriers to Pap screening, most have focused on urban samples. We conducted a pilot study using direct interviews to learn about factors that may influence cervical cancer screening among rural Mexican women. We interviewed 97 rural women between the ages of 16 and 66 and found that 52% had not received a Pap smear within the last 2 years (of that group, 62% had never received a Pap smear). In our sample, the most frequent reason for not obtaining a Pap smear was anxiety regarding physical privacy (50%). Less frequent reasons were lack of knowledge (18%) and difficulty accessing health care (14%). Women who had delivered children were significantly more likely to have received a Pap smear (71%) than women who had no children (10%), P < 0.05. The responses of many women suggest that compliance with cervical cancer screening would be enhanced by addressing cultural beliefs, encouraging conversations about women's health issues, and increasing the number of female health care providers.

The hypnotic dreams of healthy children and children with cancer: a quantitative and qualitative analysis.

In this study, the Stanford Hypnotic Clinical Scale for Children was administered to 52 healthy children and 47 children and adolescents with cancer. Responses to the dream item of this scale were analyzed for the type and detail of imagery. The hypnotizability scores of both groups were similar. However, children with cancer reported more pleasant than unpleasant fantasy in their hypnotic dreams, and their dream reports tended to contain less fantasy and detail overall. Rescoring the dream item based on extent of fantasy and detail resulted in a lower pass rate for that item, especially for children with cancer. Regardless of health status, older children experienced more self-involvement in their hypnotic dreams compared to younger children.

A randomized, controlled study of behavioral intervention for chemotherapy distress in children with cancer.

Fifty-four pediatric cancer patients were studied to determine the relative efficacy of two forms of behavioral intervention for reducing chemotherapy-related distress. Following baseline assessment, subjects were randomly assigned to receive either hypnosis, non-hypnotic distraction/relaxation, or attention placebo (control) during the subsequent identical chemotherapy course. Observational and interview measures of anticipatory and postchemotherapy nausea, vomiting, distress, and functional disruption served as outcome data. Results indicated that treatment condition was the single best predictor of change from baseline to intervention, with children in the hypnosis group reporting the greatest reduction of both anticipatory and postchemotherapy symptoms. The cognitive distraction/relaxation intervention appeared to have a maintenance effect in which symptoms did not get much worse or much better, while children in the control group had symptoms that consistently became worse over time. Emetic potential of the chemotherapy and the prophylactic use of antiemetics each appeared to contribute to the overall severity of symptoms. While the efficacy of hypnosis in the management of chemotherapy distress is supported, the complexities of interacting biologic and psychologic factors are highlighted.

The role of imagery in the treatment of a patient with malignant melanoma.

Feelings of hopelessness and apathy in critically ill patients can present significant obstacles to rational, logical solutions. Forms of psychotherapy which are entirely verbal are often limited in their effectiveness to resolve such existential crisis. Other modes of therapy which employ imagery may be more effective. The patient's own imagery appears to have particular value as a vehicle for resolving impossible dilemmas which are experienced by patients facing imminent death.

Assessment of quality of survival in children with medulloblastoma and cerebellar astrocytoma.

To determine the quality of survival for children with posterior fossa tumors, comprehensive neuropsychological, behavioral, and academic assessment and physician ratings of functional status were obtained on 15 brain tumor patients (ages 6-19 years) at a median of 20 months post-diagnosis. More than 50% of the children (whether irradiated or not) experienced major problems in academic, motor, sensory, cognitive, and emotional function. All but two children were reported by teachers to be "slow workers," and four of 15 patients were able to maintain their school work in regular classes. Although 80% of the patients were rated by physicians as having "excellent" or "good" functional status, no relationship was found between these global ratings and psychometric measures. Although the affected site was the posterior fossa, deficits also involved higher cortical function. These findings indicate the need for further evaluation of treatment effects and the provision of intervention for survivors.

Chemotherapy side effects in pediatric oncology patients: drugs, age, and sex as risk factors.

Nausea, vomiting, and the extent to which chemotherapy-bothered children were assessed by patient and parent ratings for 31 children (65 courses) receiving combination chemotherapy with either high-dose cyclophosphamide or doxorubicin/daunorubicin. Patients and parents both reported more severe vomiting with cyclophosphamide than with the anthracyclines. The use of antiemetics did not affect emesis for the former drug; for the anthracyclines, there was more severe emesis for courses with antiemetics than for those with none. Adolescents reported more severe nausea than children, and females reported both more nausea and bother than males. There were no significant age or sex findings for parent reports. The findings suggest that chemotherapy-related nausea and vomiting in children is a complex phenomenon not accounted for by drugs alone.

Hypnosis and hypnotizability: implications for clinical intervention.

Increasing laboratory and clinical research during the past 25 years has greatly enhanced understanding of hypnosis. Drawing on this research, the authors illuminate the many factors that define the domain of hypnosis, the most crucial of which is individual differences in hypnotizability. The important treatment ramifications of this factor are discussed, as are its pathogenic and diagnostic possibilities. The authors examine hypnotizability from a developmental perspective and conclude with an in-depth discussion of the clinical use of hypnosis with children, who have been shown to be particularly susceptible to hypnotic suggestion.

A controlled study of education for improving compliance with cromolyn sodium (Intal): the importance of physician-patient communication.

The effectiveness of an educational program to increase compliance with cromolyn sodium was assessed in 31 children and adolescents 6 to 17 years of age. Patients were randomly assigned to an education or noneducation group. A standard education program regarding asthma and asthma medications was provided to the education group during four monthly visits. At each visit, all patients were assessed in terms of knowledge of asthma and medications, asthma-related symptoms, and pulmonary function. Patients were also asked to self-rate their compliance. The education program increased the patients' knowledge of cromolyn, and appeared to result in increased cromolyn compliance. Post-hoc analyses, however, suggested that increased compliance did not correspond to improved medical status unless the quality of management (by physician and parents) of the child's asthma was taken into account. These results suggest that inadequate management of asthma in children may be a more serious problem than patient noncompliance.