Small structural changes of the imidazopyridine diacylglycerol acyltransferase 2 (DGAT2) inhibitors produce an improved safety profile.

Small molecule DGAT2 inhibitors have shown promise for the treatment of metabolic diseases in preclinical models. Herein, we report the first toxicological evaluation of imidazopyridine-based DGAT2 inhibitors and show that the arteriopathy associated with imidazopyridine 1 can be mitigated with small structural modifications, and is thus not mechanism related.

Unintended pregnancy and preterm birth.

About one-third of all pregnancies that result in live births in the US are unintended. Despite the large number of these births, little is known about the outcomes of unintended pregnancies. The purpose of the current study was to evaluate the association between intendedness of pregnancy and preterm birth in a large prospective cohort of women who reported for prenatal care. Pregnant, black, low-income women were enrolled into this study at four hospital-based prenatal care clinics and one off-site hospital-affiliated prenatal clinic in Baltimore City. A self-administered questionnaire to assess demographic and psychosocial data was completed by each woman in the cohort at the time of enrolment in the study. The questionnaire contained an item to measure intendedness of the pregnancy. A total of 922 women comprised the final sample for analysis. For the analyses, intendedness was dichotomised as: intended (wanted now or sooner) vs. unintended (mistimed, unwanted or unsure). Overall, 13.7% of all births to women in the sample were preterm. In a logistic regression model, after controlling for potential confounding by clinical and behavioural predictors of preterm delivery, unintended pregnancy was significantly associated with preterm delivery (adjusted RR = 1.82, 95% confidence interval [1.08,3.08], P = 0.026). In this study of a cohort of urban, clinic-attending, low-income, pregnant black women, unintended pregnancy had a statistically significant association with preterm birth. After adjustment for behavioural and clinical risks, women with unintended pregnancies had almost twice the risk of a preterm delivery as women with intended pregnancies.

Race, clinical factors and pre-term birth in a low-income urban setting.

UNLABELLED: While infant mortality rates have declined for both White and African-American populations, the perennial two-fold excess in risk for African Americans remains unchanged, and indeed, may have increased since 1985. One potential explanation for the excess risk in African Americans might be racial differences in maternal clinical risk factors, such as prior pregnancy history and pregnancy complications. This paper examines the contributions of such clinical indicators to racial differences in pre-term delivery in a study sample of urban, low-income women, aged 18 to 43 years. METHODS: Study participants were enrolled during their first prenatal care visit at one of four hospital-based, prenatal care clinics in Baltimore City. Medical history and pregnancy outcome data were abstracted from clinical records. Multiple logistic regression models were used to assess the independent relationship between race and pre-term birth, after controlling for clinical factors. RESULTS: Without adjustment for clinical risk factors, African-American women were 1.8 times more likely than White women to have a pre-term birth outcome (95% confidence interval 1.20-2.78). After statistical adjustment for the clinical variables, however, the association between race and pre-term birth was diminished (OR = 1.64, 95% confidence interval: 0.99-2.72). Moreover, the associations between certain clinical risks and pre-term birth were stronger for African-American than White women. CONCLUSION: These results suggest that attention to clinical risk factors among African-American women may be an important avenue for reducing Black/White racial disparities in pre-term birth.

Psychosocial stressors and low birthweight in an urban population.

INTRODUCTION: Low birthweight is a major determinant of infant mortality, as well as a contributor to infant and childhood morbidity. A key issue is how to reduce the incidence of low birthweight in the United States. One emerging factor is exposure to psychosocial stressors. In this research, we evaluated the association between exposure to psychosocial stressors and low birthweight in a population of urban, low-income pregnant women. METHODS: Over 2,000 pregnant women 18 years of age and older were enrolled in this prospective study and recruited at their first prenatal care visit. We obtained information on maternal exposure to stressors. After the pregnancy, we abstracted clinical records of each woman enrolled in the study. Logistic regression was used to estimate the adjusted odds ratio for the association between stressor group membership and low birthweight, controlling for the effects of confounding factors. RESULTS: In logistic regression analyses stratified by race, for African-American women, the following variables were significantly associated with low birthweight: smoking, hypertension, low prepregnancy weight, hospitalization during pregnancy, previous preterm birth, and exposure to stressors. For Caucasian women, significant predictors were: smoking, drug use, hospitalization during pregnancy, hypertension, and previous preterm birth. Exposure to stressors was also significantly associated with many clinical and behavioral risks for low birthweight. CONCLUSION: Our results suggest two potential mechanisms for an association between stressors and low birthweight. Exposure to stressors may be indirectly associated with low birthweight through a relationship with clinical and behavioral risks for low birthweight. Exposure to psychosocial stressors may also be directly associated with risk of low birthweight among African-American women.

Use of laboratory reports to assess cervical cancer screening in a community.

Cancer of the uterine cervix, the sixth most common cancer among women, is still considered a significant health problem, despite declining mortality rates during recent decades. In Baltimore, the age-adjusted mortality rates for cervical cancer are significantly higher than the U.S. average, for both black and white women. Early detection of cervical cancer through screening with the Papanicolaou (Pap) test has shown to decrease mortality by preventing development of invasive disease, and intervention programs have been developed to increase use of Pap testing. However, the evaluation of those programs is difficult, as self-reports of Pap screening may be inaccurate, and repeated inquiries about Pap tests may influence the behavior being studied. We report in this article a method to use data from cytopathology laboratories to estimate the use of Pap screening by women in a defined population. This approach can be used to evaluate changes in receipt of Pap smears and to provide feedback to intervention programs.

Depressive symptoms and risk factors for HIV acquisition among black women attending urban health centers in Baltimore.

Blacks comprise 55% of all AIDS cases among women, and have 9 times the risk of white women of mortality from AIDS. Thus, prevention of HIV infection is critical among black women. Programs to prevent HIV infection have focused upon the adoption of behavioral strategies such as limiting the number of sexual partners, avoiding intercourse with i.v. drug users, and using condoms. However, such programs are dependent upon the ability of the woman to assume responsibility for her health and successfully adopt behavior changes. Generally overlooked in the development of health education interventions are those factors, such as depressive symptoms, which may make it very difficult for an individual to adopt healthy behaviors. In the present study, an analysis was conducted of the association between depressive symptoms and risk factors for the acquisition of HIV infection among black women using two urban health centers. Those women with higher levels of depressive symptoms were significantly more likely than other women to report more risk factors for HIV acquisition. The implications of these findings for the development of preventive interventions are discussed.

Psychosocial stressors and low birth weight: development of a questionnaire.

Low birth weight is a major public health problem because it is a major contributor to infant mortality as well as to various types of morbidity among young children. Of particular concern is that black women have an increased risk of low birth weight babies compared with white women. Many etiologic factors for low birth weight have been identified, but even within homogeneous strata of risk, black women have a greater risk of low birth weight babies than do white women. The reasons for this excess risk are not well understood. Available evidence suggests that exposure to psychosocial stressors is associated with adverse pregnancy outcomes. However, prior work in this area has been limited by the lack of a valid and reliable tool to assess exposure to stressors among pregnant women. We report on the development and testing of such a questionnaire, the Prenatal Social Environment Inventory. In this questionnaire, exposure to stressors is conceptualized and measured in the context of chronic stressful conditions. The questionnaire is self-administered and can be used in clinical settings with pregnant women. Findings of psychometric evaluations showed that the questionnaire has acceptable levels of 30-day temporal stability (reliability), internal consistency, and construct validity.

A Social Environment Inventory for the pediatric office.

Exposure to psychosocial stressors is associated with deleterious physical and mental health outcomes among children and adults, as well as with school-related and behavioral problems among children. However, research and intervention in this area have been hampered by the lack of a valid measurement tool to assess exposure to stressors among mothers. This paper reports on the development and testing of a self-administered questionnaire for use in the pediatric setting to assess maternal exposure to stressors. The questionnaire was developed to facilitate the early identification of mothers exposed to high levels of stressors, since exposure to stressors often precedes the onset of problems. Early identification of mothers and children, in the pediatric office, could facilitate the prevention of various behavioral, school, and other problems among children.

Chronic stressors and maternal depression: implications for prevention.

We report on the use of an instrument to measure exposure to stressors among 149 women presenting with their children for pediatric care at an urban primary care center. Overall, 38.3 percent of the women had significant levels of depressive symptoms; 71.4 percent of those in the "high stress" group had an adjusted prevalence odds ratio of 5.00 [95% CI = 2.12, 11.82]. We conclude that screening in the pediatric office is feasible for identifying women at high risk of becoming depressed.

Seizures and seizure care in an emergency department.

We evaluated the nature and significance of seizure problems in an emergency department (ED) by studying seizures in an urban community hospital. In 6 months, there were 29,131 ED visits; of these, 200 (0.7%) were for diagnosed seizures. Among these 200 seizure visits, were 69 (34.5%) new-onset seizures, 30 (15%) febrile seizures, and 92 (46%) seizures in epilepsy patients with prescribed antiepileptic drugs (AEDs). These seizures were often serious and complicated by medical and psychosocial problems; e.g., 37 patients (18.5%) had multiple seizures, 14 (7%) had status epilepticus, and 63 (31.5%) required hospitalization. Associated psychosocial problems included 61 patients (31%) who had no medical insurance, 62 others (31%) who were judged indigent, and 60 (30%) who abused alcohol. Of 92 epilepsy patients receiving AEDs, 52 (56.5%) had subtherapeutic blood levels and were noncompliant with AED prescription patients. Problems with continuity of care were demonstrated by the failure of the ED to communicate with primary care providers about drug levels, noncompliance, and changes in therapy in greater than 85% of patients. A hospital ED is a major source for epilepsy and seizure care, but this care is not always optimum. EDs need to be prepared to manage common acute seizure problems. However, EDs must also place greater emphasis on significant nonemergency aspects of seizure care such as AED compliance, associated psychosocial problems, and effective communication with primary care providers.

Use of health services by black children according to payment mechanism.

The use patterns of approximately 2,600 black children, categorized according to type of insurance (Medicaid, private health insurance or no insurance), were analyzed. All children were enrolled in an urban pediatric primary care program that attempted to increase access to health care by poor children. Medicaid recipients used health-care services more than their counterparts who had private or no insurance. All groups received significant levels of preventive care. The percentage of health care received in the emergency room did not vary significantly among the groups. These results suggest that special delivery systems can be effective in reaching poor children and eliminating usage differentials according to income.

Performance status assessment among oncology patients: a review.

Performance status is a global assessment of a patient's ability for self-care and ambulation. It is an important and widely used prognostic variable for patients with cancer. Several different scales to assess performance status are in use, and scale scores are used for a variety of purposes, including patient selection and stratification for cancer clinical trials. New uses for life quality evaluations have also been proposed. Despite the widespread use of the scales, little information is available about the reliability and validity of these measures. Improved and extended application of these scales requires that several types of data about measurement properties of the scales be collected and analyzed. Various issues related to the measurement properties of the scales and their implications for oncology need to be understood to best develop their use.

Treatment approaches for lung cancer patients in a community hospital.

During the past decade, a number of new and successful treatments for cancer have been introduced at many cancer centers. During the same period, increasing numbers of cancer patients were treated outside of major cancer centers (i.e., in the community hospital) by an expanding number of trained oncologists. However, it is unclear to what extent new therapeutic approaches have been adopted in the community hospital setting. Recent studies have raised important questions about the patterns of treatment of patients outside of cancer centers. The present study was undertaken to describe the processes of treatment for lung cancer patients in a 514-bed community hospital in a metropolitan area. The study sample consisted of all patients with lung cancer entered into the hospital's tumor registry during 1980 and 1981 (n = 147). Medical oncologists were consulted regarding the care of a large number of patients, particularly those with small cell carcinoma for whom medical oncologists can offer therapy which has been demonstrated to be effective. As judged by patients with small cell carcinoma, patients are being treated appropriately, for the most part, with chemotherapy. Fourteen percent of all patients received no treatment for their cancer, and this may be a source of concern. Future research in this area should be directed at conducting similar studies in smaller hospitals, comparing the quantity and quality of survival for patients treated in various types of settings, and assessing the determinants of processes of care (e.g., no treatment) in various treatment settings.

Differences in use of health services by children according to race. Relative importance of cultural and system-related factors.

Black children make substantially less use of health services than do their white counterparts, despite their demonstrably poorer health status. This relationship is true regardless of income. Various authors have suggested that such differences are due to system-related barriers to access to care by black children. Alternatively, others have noted that blacks have cultural patterns related to health and illness, and these culturally determined beliefs and behaviors may account for the observed differences. The present study compared use of health services by black and white children within a system of care that has sought to decrease barriers to access to care by black children. Within this system, black and white children used health services in a similar fashion, suggesting that system-related factors that assure equity of access to health services may be more important than client-related cultural factors, or that these cultural factors may be overcome.

Maternal depression in an urban pediatric practice: implications for health care delivery.

A scale to measure depressive symptomatology was administered to mothers attending an urban pediatric primary care center. Over 50 per cent of the female heads of households were Black or low income and depressed. This suggests that the provider of pediatric primary care should recognize depression and make appropriate referrals or intervention, since depressed mothers may have a diminished ability to respond to the emotional needs of their children.