Motivational interviewing to improve postabortion contraceptive uptake by young women: development and feasibility of a counseling intervention.

OBJECTIVE: The objective was to develop and test a postabortal contraception counseling intervention using motivational interviewing (MI) and to determine the feasibility, impact and patient acceptability of the intervention when integrated into an urban academic abortion clinic. STUDY DESIGN: A single-session postabortal contraception counseling intervention for young women aged 15-24 years incorporating principles, skills and style of MI was developed. Medical and social work professionals were trained to deliver the intervention, their competency was assessed, and the intervention was integrated into the clinical setting. Feasibility was determined by assessing ability to approach and recruit participants, ability to complete the full intervention without interruption and participant satisfaction with the counseling. RESULTS: We approached 90% of eligible patients and 71% agreed to participate (n=20). All participants received the full counseling intervention. The median duration of the intervention was 29 min. Immediately after the intervention and at the 1-month follow-up contact, 95% and 77% of participants reported that the session was helpful, respectively. CONCLUSIONS: MI counseling can be tailored to the abortion setting. It is feasible to train professionals to use MI principles, skills and style and to implement an MI-based contraception counseling intervention in an urban academic abortion clinic. The sessions are acceptable to participants. IMPLICATIONS: The use of motivational interviewing in contraception counseling may be an appropriate and effective strategy for increasing use of contraception after abortion. This study demonstrates that this patient-centered, directive and collaborative approach can be developed into a counseling intervention that can be integrated into an abortion clinic.

Immunomodulatory molecules are released from the first trimester and term placenta via exosomes.

The semiallogenic fetus is tolerated by the maternal immune system through control of innate and adaptive immune responses. Trophoblast cells secrete nanometer scale membranous particles called exosomes, which have been implicated in modulation of the local and systemic maternal immune system. Here we investigate the possibility that exosomes secreted from the first trimester and term placenta carry HLA-G and B7 family immunomodulators. Confocal microscopy of placental sections revealed intracellular co-localization of B7-H1 with CD63, suggesting that B7-H1 associates with subcellular vesicles that give rise to exosomes. First trimester and term placental explants were then cultured for 24 h. B7H-1 (CD274), B7-H3 (CD276) and HLA-G5 were abundant in pelleted supernatants of these cultures that contained microparticles and exosomes; the latter, however, was observed only in first trimester pellets and was nearly undetectable in term explant-derived pellets. Further purification of exosomes by sucrose density fractionation confirmed the association of these proteins specifically with exosomes. Finally, culture of purified trophoblast cells in the presence or absence of EGF suggested that despite the absence of HLA-G5 association with term explant-derived exosomes, it is present in exosomes secreted from mononuclear cytotrophoblast cells. Further, differentiation of cytotrophoblast cells reduced the presence of HLA-G5 in secreted exosomes. Together, the results suggest that the immunomodulatory proteins HLA-G5, B7-H1 and B7-H3, are secreted from early and term placenta, and have important implications in the mechanisms by which trophoblast immunomodulators modify the maternal immunological environment.

Parental age effects on cortical morphology in offspring.

The age at which a parent has a child impacts the child's cognition and risk for mental illness. It appears that this risk is curvilinear, with both age extremes associated with lower intelligence and increased prevalence of some neuropsychiatric disorders. Little is known of the neural mechanisms underpinning this phenomenon. We extracted lobar volumes, surface areas, and cortical thickness from 489 neuroanatomic magnetic resonance images acquired on 171 youth. Using linear mixed model regression, we determined the association between parental age and offspring's neuroanatomy, adjusting for offspring's age, sex, intelligence, and parental socioeconomic class. For gray matter volumes, quadratic paternal and maternal age terms contributed significantly (maternal quadratic age effect: t = -2.2, P = 0.03; paternal quadratic age effect: t = -2.4, P = 0.02) delineating an inverted "U" relationship between parental age and gray matter volume. Cortical volume increased with both advancing paternal and maternal age until around the early 30s after which it fell. Paternal age effects were more pronounced on cortical surface area, whereas maternal age impacted more on cortical thickness. There were no significant effects of parental age on white matter volumes. These parental age effects on cerebral morphology may form part of the link between parental age extremes and suboptimal neurocognitive outcomes.

Local and systemic options for hormone replacement therapy.

Women now have an array of options for hormone replacement therapy (HRT). Yet, the medical practitioner faces many challenges in helping women explore these options. Which therapy is right for which woman? What are the risks and benefits of each therapy? Providing hormone replacement therapy entails assessing the individual woman's need for hormone replacement therapy given her cardiovascular health, bone health, vasomotor symptoms, bleeding patterns, and attitudes. A woman who chooses to use HRT has many options, including therapies that vary in preparation, dosing schedule, route of administration, and systemic or local effects. This paper reviews the variety of preparations. Healthcare practitioners now can individualize HRT. The challenge is to evaluate, counsel, and treat women in a way that will promote satisfaction, and thus long-term use of HRT.

Barrier methods of contraception.

Despite the problems associated with coitus-dependent methods of contraception, barrier methods have an important role. The fact that they work as contraceptives without systemic effects makes them particularly appropriate for women with medical conditions that prevent the use of hormonal contraception. In addition, condoms and perhaps all barrier methods provide protection from sexually transmitted infections, making them essential for sexually active women at risk for STDs. Their continued importance is evidenced by the ongoing research to develop and improve barrier methods of contraception.

A radiographic survey of dental anomalies in Black pediatric patients.

During seemingly routine check-ups, the dental practitioner must be ever aware of "quiescent" abnormalities or irregularities. Knowledge of special problems occurring within a certain patient population is of great value to the practitioner when evaluating the individual patient. Numerous studies have been conducted evaluating the pediatric Caucasian population; however, no comparable studies for the Black pediatric population have been done. This study sought to establish prevalence rates for the Black pediatric population with regards to the following anomalies: congenitally missing teeth, supernumerary teeth, dens in dente, odontomas, dentinogenesis imperfecta, gemination, fusion and concrescence. The radiographs (panographs mandatory), history forms and treatment progress records of 2,267 children (1,136 males and 1,131 females) were analyzed. Radiographs of poor quality were eliminated and attempts were made to include only children of Black American heritage. Prevalence rates established for a predominantly Black pediatric population were: 4.4%, congenitally missing teeth; 1.49%, supernumerary teeth; 0.26%, dentinogenesis imperfecta (Brandywine type); 0.44%, odontomas; 0.22%, gemination; and 0.12%, fusion. Evidence of dens in dente was found in only one erupted supernumerary maxillary paralateral, and the detection of only one case of concrescence occurred; both have prevalence rates of 0.04%. No other study has produced such a high rate of dentinogenesis imperfecta (.26%), except that conducted within the tri-racial group itself. In addition, if assumptions are to be made from this investigation for the general population, supernumeraries and odontomas may be present significantly more often in the Black than Caucasian pediatric population.

A spectrophotometric assay for nitrate using NADPH oxidation by Aspergillus nitrate reductase.

An assay based on the oxidation of NADPH during the enzymatic conversion of nitrate to nitrate by Aspergillus nitrate reductase [EC 1.6.6.2] was developed for specific quantification of nitrate. This spectrophotometric method was used to measure nitrate present in human urine, human serum, and tissue culture medium. Used as a kinetic assay, the method exhibited (1) linearity over a range of 1.25 to 40 microM nitrate, (2) an upper sensitivity of 20 microM, (3) a lower sensitivity of 1.25 microM nitrate, and (4) intraday and interday variability ranging from 0.6 to 6.1%. To judge the acceptability of this method as a kinetic assay, we determined the Km for Aspergillus nitrate reductase to be 199 microM. The Km was based on analyzing three separate lots of commercially purified enzyme. Mean nitrate content of eight urine specimens analyzed by this assay (1111 microM) was not significantly different from that determined by a chemiluminescence method (1144 microM). Analysis of serum using the two methods showed mean nitrate concentrations of 23 and 36 microM, respectively. Based on serial dilutions of serum, the lower nitrate content of serum observed with nitrate reductase assay could not be explained by the presence of inhibitors. Rat pulmonary alveolar macrophages were induced to produce nitric oxide which oxidizes to nitrite and nitrate. Nitrite and nitrate present in tissue culture medium of unactivated and activated macrophages were in proportion to total nitrogen oxides (NO(x)) determined by the chemiluminescence method. We conclude that the Aspergillus nitrate reductase assay is an accurate spectrophotometric method for determining nitrate content of human urine and tissue culture supernatants.

Effects of pentoxifylline on in vivo leukocyte function and clearance of group B streptococci from preterm rabbit lungs.

OBJECTIVES: Pentoxifylline was evaluated for its ability to enhance inactivation of group B streptococci in lungs of prematurely born rabbits. Mechanisms associated with intrapulmonary streptococcal clearance and the pharmacodynamics of pentoxifylline were also investigated. DESIGN: Randomized, controlled animal trial. SETTING: University research laboratory. SUBJECTS: A total of 123 New Zealand rabbits were delivered prematurely by cesarean section and were used for clearance studies. Twenty-three preterm pups were additionally utilized to study the pharmacodynamics of pentoxifylline. INTERVENTIONS: Preterm rabbits were infected with group B streptococcal aerosols and given intraperitoneal injections of either pentoxifylline (25, 12.5, and 12.5 mg/kg) or placebo at 0, 6, and 12 hrs after infection. MEASUREMENTS AND MAIN RESULTS: At 0, 4, and 24 hrs, the numbers of streptococci were determined in the left lung, while the right lung underwent bronchoalveolar lavage to quantify intra-alveolar leukocytes, phagocytosis of inhaled bacteria, and concentrations of lysozyme and tumor necrosis factor. In a separate experiment, blood and bronchoalveolar fluid from infected animals were analyzed for pentoxifylline content. Streptococcal proliferation was less in pentoxifylline-treated animals than in controls at 24 hrs (p < .01). Pulmonary macrophages and polymorphonuclear leukocytes recovered from bronchoalveolar lavage fluid did not differ in numbers or phagocytic activity. Pentoxifylline-treated animals had lower levels of lysozyme (p < .02) and tumor necrosis factor (p < .005) in bronchoalveolar lavage fluid compared with placebo-treated pups. Therapeutic levels of pentoxifylline were achieved in blood and bronchoalveolar lavage fluid. CONCLUSIONS: Despite lowering lysozyme and tumor necrosis factor content in epithelial lining fluid, pentoxifylline improves the inactivation of group B streptococci in preterm rabbit lungs. These findings suggest that increased group B streptococcal clearance was coincident with an anti-inflammatory effect due to pentoxifylline. We conclude pentoxifylline may be clinically useful as an adjunctive therapy for group B streptococcal pneumonia in newborns.

Importance of filter structure for the trans-membrane migration studies of sperm motility.

Sperm migration through polycarbonate and nylon membrane filters was studied by the trans-membrane migration ratio method. Sperm crossed the former filters but not the latter because of the greater pore length and complexity of the relatively thick nylon membrane. Adhesion of spermatozoa to the nylon structure was also observed. Using the polycarbonate filter we were able to correlate trans-membrane migration with conventional motility and measure the effects of drugs on sperm motility.

A preliminary study of age-related difference in resistance to sepsis in the rat model.

Although the pathophysiology of intraabdominal sepsis is well established in the adult animal, there is a paucity of similar information in the newborn animal. Using the Wichterman (K.A. Wichterman, A.E. Baue, and I.H. Chaudry, Journal of Surgical Research 29: 189, 1980) model of intraabdominal sepsis, 42 Sprague-Dawley suckling rat pups and 42 adults underwent cecal ligation followed by a single needle puncture of the cecum. Whereas a mortality of 47.6% was noted in the adult animals, only 7.1% of the suckling animals succumbed by the end of 1 week. After the ip LD50 of Escherichia coli was determined independently in each age group, appropriate doses of the bacteria were injected into the peritoneums of 36 suckling and 30 adult rats. The peritoneal fluid was aspirated at 0, 2, 4, 8, 24, and 48 hr and the bacterial concentration in the suspension was determined. The rate of bacterial clearance from the peritoneum of the suckling rats was found to be significantly greater at 2, 4, and 8 hr as compared with the adult animal. In vitro assay of the phagocytic activity of the peritoneal macrophages demonstrated a significantly higher activity in the cells obtained from the suckling rats than in those from the adult (P less than 0.05). A more efficient bacterial clearance and a higher phagocytic activity in the peritoneal macrophages of the suckling rats may contribute to the difference in the mortality between the two age groups.

Utilization of evergreen and decidous oaks by the Californian oak moth Phryganidia californica.

The deciduous oak Quercus lobata was a better quality food source than the evergreen oak Q. agrifolia for the California oak moth Phryganidia californica: it supported higher growth rates, produced higher fecundity and survivorship, and higher efficiency of conversion of ingested food (ECI), efficiency of conversion of digested food (ECD) and efficiency of nitrogen utilization (NUE). Total polyphenols and astringency were similar in both oak speices, whereas water content was lower and leaf specific weight higher in Q agrifolia than in Q lobata. Nitrogen was higher in new leaves of Q agrifolia but higher in mature leaves of Q. lobata. Contrary to most other studies, total polyphenols and astringency were higher in new than in mature leaves. These results confirmed my hypothesis that the differences in leaf quality associated with the evergreen or deciduous life form would translate into food of differing quality for herbivores.