Cancer survivor perspectives on sharing patient-generated health data with central cancer registries.

PURPOSE: Central cancer registries collect data and provide population-level statistics that can be tracked over time; yet registries may not capture the full range of clinically relevant outcomes. Patient-generated health data (PGHD) include health/treatment history, biometrics, and patient-reported outcomes (PROs). Collection of PGHD would broaden registry outcomes to better inform research, policy, and care. However, this is dependent on the willingness of patients to share such data. This study examines cancer survivors' perspectives about sharing PGHD with central cancer registries. METHODS: Three U.S. central registries sampled colorectal, non-Hodgkin lymphoma, and metastatic breast cancer survivors 1-4 years after diagnosis, recruiting them via mail to participate in one of seven focus groups (n = 52). Group discussions were recorded, transcribed, and thematically analyzed. RESULTS: Most survivor-participants were unaware of the existence of registries. After having registries explained, all participants expressed their willingness to share PGHD with them if treated confidentially. Participants were willing to provide information on a variety of topics (e.g., medical history, medications, symptoms, financial difficulties, quality of life, biometrics, nutrition, exercise, and mental health), with a focus on long-term effects of cancer and its treatment. Participants' preferred mode for providing data varied. Participants were also interested in receiving information from registries. CONCLUSIONS: Our results suggest that registry-based collection of PGHD is acceptable to most cancer survivors and could facilitate registry-based efforts to collect PGHD/PROs. Central cancer registry-based collection of PGHD/PROs, especially on long-term effects, could enhance registry support of cancer control efforts including research and population health management.

Phosphodiesterase type 5 inhibitors' extended duration of response as a variable in the treatment of erectile dysfunction.

The phosphodiesterase type 5 (PDE5) inhibitors, sildenafil, tadalafil and vardenafil, are a class of medications that are safe and effective in treating erectile dysfunction (ED). Yet, resuming sexual activity following a period of abstinence in response to ED may be anxiety-provoking for the man, his partner and their relationship, causing the sexual encounter to become a stressful event. The differences between PDE5 inhibitors in terms of duration of action can be successfully utilized by healthcare professionals to mitigate some of the psychosocial barriers that interfere with treating ED. PDE5 inhibitors with a longer duration of responsiveness provide some men with ED and their partners, a treatment option that may offer greater flexibility and potentially less anxiety surrounding the resumption of sexual activity. Shorter-acting PDE5s may be preferred by men/couples with predictable sexual scripts, excellent communication strategies and concerns regarding the duration of side effects.

Hypertrophic osteopathy associated with infective endocarditis in an adult boxer dog.

A 20-month-old, entire male boxer dog was presented with lethargy and intermittent shifting limb lameness. Diagnostic tests revealed aortic valve vegetations suggestive of infective endocarditis causing severe aortic outflow obstruction, and hypertrophic osteopathy of all four limbs. The dog was treated symptomatically and euthanised four days later. The association of infective endocarditis and hypertrophic osteopathy has been poorly documented in the veterinary literature. The pathogenesis of hypertrophic osteopathy is unknown; however, four theories have been put forth to explain this disease: pulmonary shunting, vagal nerve stimulation, humoral substances produced by neoplastic cells and megakaryocyte/platelet clump hypothesis.

Effect of troglitazone on insulin sensitivity and pancreatic beta-cell function in women at high risk for NIDDM.

We conducted a randomized placebo-controlled study to determine the effects of the thiazolidinedione compound troglitazone on whole-body insulin sensitivity (SI), pancreatic beta-cell function, and glucose tolerance in 42 Latino women with impaired glucose tolerance (IGT) and a history of gestational diabetes mellitus (GDM), characteristics that carry an 80% risk of developing NIDDM within 5 years. After baseline oral (OGTT) and intravenous (IVGTT) glucose tolerance testing, subjects were assigned to take placebo or 200 or 400 mg troglitazone daily for 12 weeks (14 subjects per treatment group). An OGTT and IVGTT were repeated during the 12th week of treatment. Five subjects failed to complete the trial for personal reasons, and medication compliance averaged 90% in the remaining subjects, none of whom experienced a serious adverse event. SI, calculated by minimal model analysis of IVGTT results, changed by only 4 +/- 14% during 12 weeks of placebo administration, but increased 40 +/- 22 and 88 +/- 22% above basal during treatment with 200 and 400 mg troglitazone, respectively (P = 0.01 among groups). Troglitazone administration was also associated with a dose-dependent reduction in the total insulin area during IVGTTs, which was highly significant (P < 0.001), and with a reduction during OGTTs, which approached statistical significance (P = 0.09). Glucose tolerance improved slightly in all groups, but the magnitude of change did not differ significantly among groups, whether it was assessed as the number of subjects who continued to manifest IGT at 12 weeks (P = 0.64 among groups), the change in total glucose area during OGTTs (P = 0.58), or the change in fractional glucose disappearance rates during IVGTTs (P = 0.28). Among the women who received troglitazone, the greatest improvement in SI occurred in the women who had the highest diastolic blood pressures and the best IVGTT insulin responses during baseline testing. Our findings indicate that troglitazone improved whole-body insulin sensitivity and lowered circulating insulin concentrations in women with prior GDM who are at very high risk for NIDDM. The lack of improvement in glucose tolerance despite improved insulin sensitivity may be a manifestation of the beta-cell defect that predisposes the women to NIDDM. The overall pattern of response to troglitazone in our high-risk patients indicates that the drug is an ideal agent with which to test whether the amelioration of insulin resistance can delay or prevent diabetes in women with limited beta-cell reserve.

Estrogen replacement therapy in older women. Comparisons between Alzheimer's disease cases and nondemented control subjects.

OBJECTIVES: We hypothesized that oral estrogen replacement therapy would be less common among elderly women meeting criteria for Alzheimer's disease (AD) than among nondemented elderly women. For women with AD, we hypothesized that estrogen users would perform better on a cognitive task than would nonusers. DESIGN: A case-control study of estrogen replacement therapy, in which hierarchical procedures were used to control for potentially confounding effects of age and education. When cognitive performances were compared between estrogen users and nonusers with AD, the duration of dementia symptoms was an additional control variable. SETTING: Alzheimer's Disease Research Center at the University of Southern California, Los Angeles. SUBJECTS: Subjects were a volunteer sample of consecutively enrolled elderly women, recruited primarily from the community, who met clinical criteria for probable AD (n = 143) or met criteria for nondemented control status (n = 92). Seventy case patients who have subsequently died met histopathologic criteria for AD; one other demented woman who did not meet the autopsy criteria for AD was excluded from all analyses. MAIN OUTCOME MEASURES: Current use of estrogen replacement at the time of enrollment as reported by control subjects or by the primary caregivers of AD case patients. Among cases, performances on a brief cognitive screening instrument were compared between estrogen users (n = 10) and nonusers (n = 128) for whom this information was available. RESULTS: Alzheimer's disease case patients were significantly less likely than control subjects to use estrogen replacement (7% vs 18%), but groups did not differ with regard to the total number of prescription medications or to the most frequently prescribed class of drug (thyroid medication). Demented case patients using estrogen did not differ significantly from those not using estrogen in terms of age, education, or symptom duration, but their mean performance on a cognitive screening instrument was significantly better (Mini-Mental State examination scores of 14.9 vs 6.5). CONCLUSIONS: Findings are consistent with contentions that postmenopausal estrogen replacement therapy may be associated with a decreased risk of AD and that estrogen replacement may improve cognitive performance of women with this illness.

Gender differences on a brief measure of cognitive functioning in Alzheimer's disease.

OBJECTIVE: We evaluated scores on a brief psychometric screening instrument--the Mini-Mental State Examination (MMSE)--for possible effects of gender, hypothesizing that women with Alzheimer's disease (AD) would perform more poorly than men. A significant gender difference was to be explored with post hoc item analyses. DESIGN: Case-study design. A hierarchical regression procedure controlled for the possible influence on MMSE performance of demographic variables (eg, age, duration of dementia symptoms, education, and family history of dementia) before the effect of gender was analyzed. SETTING: Data were gathered by trained neuropsychological examiners from subjects enrolled in the Alzheimer's Disease Research Center at the University of Southern California, Los Angeles. SUBJECTS: One hundred forty-two subjects who met strict criteria for probable AD and 121 nondemented elderly subjects were included in the study. All subjects underwent periodic neuropsychological testing. We extracted MMSE scores and demographic data to test the hypothesis that women would perform more poorly than men on the MMSE. CRITERION MEASURE: The MMSE was chosen because of its wide use in clinical and research settings to screen for the presence or severity of dementia. RESULTS: After controlling for the demographic variables for subjects with AD, we observed a significant difference in the predicted direction for total MMSE score, but there was no significant gender effect on the MMSE for the nondemented elderly sample. Among subjects with AD, gender-associated differences were limited to only a subset of MMSE items. CONCLUSIONS: Results imply that MMSE performance may differ between men and women with AD and that differences might pertain only to discrete areas of cognitive functioning. Although gender effects were relatively small, findings indicate the relevance of gender to studies of AD.

Psychological perspectives of sex and aging.

Older patients have many assaults on their sexuality. Our culture often discourages sexual interest in older persons. Changes in sexual physiology and the effects of chronic illness and medications can further contribute to negative expectations and can impair sexual performance. The emotional and relational stresses of aging can lead to depression, thus further compounding sexual slowdown. Failure to appreciate psychological factors can result in inappropriate treatment by the physician and actually add to the patient's distress. This report considers the mind/body relationship in sexual performance and offers guidance to the physician in the diagnosis of physical and emotional factors affecting the older person's sexual life.

Risk factors associated with rapid growth of small abdominal aortic aneurysms.

BACKGROUND: Approximately 50% of patients who have a ruptured abdominal aortic aneurysm will die. To identify those patients who may be at high risk for rupture, we determined the risk factors for the rapid expansion of the aorta. METHODS: The growth of 514 aneurysmal aortas was followed in this study. The size of each was measured by ultrasonography at 6- to 12-month intervals until a critical size was reached or a rapid expansion of the aorta occurred. Possible risk factors for rapid expansion were determined from both initial evaluation and clinical laboratory results. RESULTS: The initial size varied from 2.5 cm to 6.0 cm. The expansion rate of the aorta was 0.5 cm/yr or less in 401 patients (78%), between 0.5 and 1.0 cm/year in 50 patients (10%), and 1.0 cm/year or more (rapid expansion) in 63 patients (12%). Elective repair of aneurysms was done before rupture. Multivariate analysis indicated that the risk factors associated (p < 0.03) with rapid expansion were advanced age, severe cardiac disease, previous stroke, and history of cigarette smoking. The incidence for rapid expansion increased (p < 0.01) in older patients with aneurysms larger than 3 cm and in younger patients with aneurysms larger than 4 cm. CONCLUSIONS: Risk factors associated with rapid expansion of the aorta have been determined and may help identify the patient at high risk for rupture. Ultrasonographic surveillance should be performed more frequently in these patients to help prevent rupture.

Age and drinking-related differences in the memory organization of alcohol expectancies in 3rd-, 6th-, 9th-, and 12th-grade children.

To advance the theoretical modeling of the development of alcohol expectancies as a parallel processing memory network, this study assessed expectancies and alcohol consumption of 2,324 children in Grades 3, 6, 9, and 12 from a large suburban-rural school district. Individual-differences scaling (INDSCAL), a variant of multidimensional scaling, mapped expectancies into a hypothetical memory network format, and preference mapping (PREFMAP) modeled hypothetical paths of association within this network. Throughout this age range, older and higher drinking youth appeared to associate positive and arousing effects with alcohol cues, in contrast to lower drinking children, who appeared to mainly associate undesirable effects. These drinking-related differences in the organization of expectancy information are discernible well before onset of regular drinking habits and may influence the development of drinking in adolescence.

Efficacy of relapse prevention: a meta-analytic review.

Although relapse prevention (RP) has become a widely adopted cognitive-behavioral treatment intervention for alcohol, smoking, and other substance use, outcome studies have yielded an inconsistent picture of the efficacy of this approach or conditions for maximal effectiveness. A meta-analysis was performed to evaluate the overall effectiveness of RP and the extent to which certain variables may relate to treatment outcome. Twenty-six published and unpublished studies with 70 hypothesis tests representing a sample of 9,504 participants were included in the analysis. Results indicated that RP was generally effective, particularly for alcohol problems. Additionally, outcome was moderated by several variables. Specifically, RP was most effective when applied to alcohol or polysubstance use disorders, combined with the adjunctive use of medication, and when evaluated immediately following treatment using uncontrolled pre-post tests.

Cell-sized microspheres in the hippocampus show cleavage planes and passive displacement.

Fluorescent microspheres (6 or 10 micron in average diameter) dispersed in fluid were injected into the hippocampus, neocortex or striatum. In the hippocampus the microspheres were located in one of three cleavage planes. Cleavage planes were found above the alveus, in the obliterated hippocampal fissure and on the hilar side of the dentate granule cells. When the injections were made into the infragranular cleavage plane, the adjacent granule cells degenerated, presumably because the cavity separated the axons from their cell bodies. Some microspheres were passively displaced beyond the boundary of the injection site. If the microspheres gained access to the subarachnoid space, some of the displaced microspheres were found at considerable distances from the injection site. There were no cleavage planes in neocortex or striatum but there was passive displacement of microspheres into the host parenchyma. In cell suspension transplants, the passive displacement of cells should be distinguished from migration and the possibility of a widespread distribution of transplanted cells needs to be considered.

Experience in the management of odontoid process injuries: an analysis of 128 cases.

The authors present a retrospective analysis of 128 cases of odontoid process injury treated at the University of Minnesota and affiliated hospitals between the years 1967 and 1983. Of these 128 cases, 110 were acute fractures, while 18 patients suffered from old, unstable odontoid injuries. Motor vehicle accident was the leading cause of injury, and the largest group of patients was in their second decade. Type II fractures were the most commonly encountered type of injury, and anterior subluxation was the most common displacement. Posterior subluxation, however, had the highest incidence of associated neurological deficit. Regarding treatment, the 110 acute fracture patients fell into the following groups: 16 patients died during the acute phase, 14 patients underwent early posterior cervical fusion, and 80 patients underwent a course of external skeletal fixation. The remaining 18 patients with old unstable injuries underwent posterior cervical fusion. An analysis of the results in these groups led to the elucidation of certain factors that likely are important in determining the treatment of each individual patient. These factors include age of the patient, type of odontoid fracture, direction and degree of fracture displacement, and diagnostic delay. Fracture reduction and halo immobilization are the treatments preferred for patients who are diagnosed within 1 week of injury, who are less than 65 years of age and who have anteriorly, nondisplaced, or minimally posteriorly subluxed (less than 2 mm) Type II fractures, or who have any Type III injury.(ABSTRACT TRUNCATED AT 250 WORDS)

Development and fine structure of murine Purkinje cells in dissociated cerebellar cultures: neuronal polarity.

Cerebellar Purkinje cells (PC) display a highly distinctive form of polarity. We have cultured murine PCs from dissociated E16 cerebellar anlagen for 1 week to investigate the early stages of neuronal compartmentalization and synaptic interactions, features which are important for the establishment of neuronal polarity. To unequivocally identify the PCs we utilized light and electron microscopic immunocytochemistry with an anti-serum to the cell class-specific marker L7/pcp2 gene product. The PCs typically show a single, long axon, numerous short appendages classified as filopodia and protospines, and a small number of protodendrites. The nucleus is positioned asymmetrically in both the horizontal and vertical axes of the soma. The Golgi apparatus, coated and uncoated vesicles, and mitochondria are prominent ultrastructural features, while the endoplasmic reticulum is highly fragmented. The cell body receives rudimentary synapses on its smooth surfaces and appendages and no consistent morphological differences were detected between these elementary contacts. The axon is clearly identifiable; it emanates from either the cell body or a protodendrite, bifurcates at predominantly right angles, forms beaded collaterals, and terminates with relatively large growth cones. The varicosities of the PC axon contain pleomorphic synaptic vesicles and form rudimentary synapses primarily with the dendritic shafts of immunonegative neurons. The protodendrites are short, quickly tapering and sparsely branched; they emit numerous filopodia and immature spines and terminate with small growth cones. Rudimentary synapses are received on the proximal dendritic shafts and filopodia, and more mature synapses occur frequently on protospines. With few exceptions, PCs lie atop an astrocytic bed layer and glial processes are apposed to the various aspects of the PC body left free by the afferent axons. By contrast, PC processes are largely free of glial sheaths. We conclude that the "stellate stage" of PC development in situ is replicated rather faithfully in culture and that PCs have established polarity and have begun to form intercellular contacts by 1 week in vitro. Moreover, the PCs are already morphologically distinct from other cell types in the 1 week cultures, although they have yet to develop the differentiated features that distinguish mature PCs.

Development and fine structure of murine Purkinje cells in dissociated cerebellar cultures: dendritic differentiation, synaptic maturation, and formation of cell-class specific features.

The morphological differentiation of E16 murine Purkinje cells (PCs) in dissociated cerebellar cultures was analyzed by light and electron microscopic immunocytochemistry after 2-5 weeks in vitro (wiv), with particular emphasis on dendritic differentiation, synaptic maturation, and formation of stereotypical fine structural features. This study complements a companion paper on the features of PCs after 1 wiv. After 2 wiv, the PCs have an eccentric nucleus and the cytoplasmic organelles appear immature; the axon has a distinct initial segment and beaded axon collaterals but its boutons still contain sparse synaptic vesicles; dendrites show few bifurcations and tufts of spiny branchlets. After 3 wiv, the PCs display a centered nucleus, an extensive hypolemmal cisternal system, and stacks of up to four cisterns of granular endoplasmic reticulum; there is an increased number of dendritic bifurcations, spiny branchlets, mature spines, and axonal branches; dendritic tips still contain vesicle clusters, suggesting growth, and many synapses and afferent boutons continue to display immature features. After 4 wiv, elaborate perinucleolar coiled body rosettes, subsurface cistern-mitochondrion complexes and large stacks of granular endoplasmic reticulum finally appear within the soma; dendrites show a further increase in the numbers of bifurcations, segments and spines; most spines are synaptic and show mature features; afferent synapses are differentially distributed; PC boutons consistently display mature features and show a considerable degree of target specificity, although naked spines and reduced glial sheaths persist. After 5 wiv, PCs do not show further maturation and some dystrophic features appear. We conclude that under standard conditions and despite the disruption of normal tissue organization, PCs in dissociated cultures differentiate maximally after 4 wiv, at which stage they display many of the light and electron microscopic features that characterize mature PCs in situ. This prolonged developmental time-frame resembles that in the normal cerebellum. In view of the increasing usage of dissociated cerebellar cultures to study aspects of neuronal differentiation, synaptic activation and neuronal-glial interactions, an elucidation of the neurocytology of dissociated cerebellar cultures as presented in this study provides important clues for the interpretation of experimental data.

Activation of alcohol expectancies in memory in relation to limb of the blood alcohol curve.

Attempts to understand the mechanism by which alcohol expectancies might influence drinking have related activation of expectancies in memory to alcohol use. Limb of the blood alcohol curve, however, has not been considered. In the present study, 527 undergraduates completed the Anticipated Biphasic Alcohol Effects Scale and a drinking measure. Multidimensional scaling was used to map expectancies into memory network format, and likely activation of expectancies was empirically modeled. Heavier drinkers were most likely to activate positive and arousing expectancies associated with the ascending limb, whereas lighter drinkers were most likely to activate negative and sedating expectancies associated with the descending limb. These findings add to the literature suggesting that activation of expectancies in memory may be an important determinant of drinking behavior and a promising target for intervention strategies.

Experimental demonstration of the influence of alcohol advertising on the activation of alcohol expectancies in memory among fourth- and fifth-grade children.

Previous work has demonstrated that children's organization and activation of alcohol expectancies in memory vary as a function of alcohol use, even among children as young as in the 3rd grade. To advance the understanding of influences on the development of alcohol expectancies in children, 551 4th- and 5th-grade children were exposed to 5 beer commercials or 5 soft drink commercials. After viewing the advertisements, all children reported their 1st associate to an alcohol prompt and completed a memory model-based measure of children's alcohol expectancies. Multidimensional scaling was used to map expectancies into hypothetical memory network format, and preference mapping was used to derive possible paths of activation. Children who viewed beer commercials were more likely to activate positive and arousing alcohol expectancies. In view of previous findings demonstrating that this pattern of activation corresponded to higher drinking among 3rd, 6th, 9th, and 12th graders, the present findings suggested that antecedents to drinking like exposure to advertising may promote heavier drinking among children by influencing the activation of expectancies in memory.

Consumption-related differences in the organization and activation of marijuana expectancies in memory.

Using a methodology that has advanced the study of alcohol expectancies, the authors modeled a semantic network of marijuana expectancies stored in memory. They used individual-differences scaling, a form of multidimensional scaling, to map expectancies into memory network format and preference mapping to model likely paths of expectancy activation. Organization and activation of marijuana expectancies were found to vary with consumption level. Heavy marijuana consumers emphasized a relaxed-agitated dimension and were most likely to activate positive expectancies of relaxation, cognitive enhancement, and social facilitation. Nonconsumers, however, emphasized a detached-aware dimension and were more likely to activate negative expectancies of cognitive impairment and social impediment. Future efforts to alter likely activation patterns may be successful in changing use patterns.

Changes in activation of alcohol expectancies in memory in relation to changes in alcohol use after participation in an expectancy challenge program.

Memory model-based expectancy studies have shed light on the process by which expectancies may influence drinking but have not related changes in expectancy activation to drinking changes. In the present study, 38 undergraduates completed a drinking measure and factor-based and memory model-based expectancy measures, before and after an expectancy challenge intervention designed to alter expectancies. Expectancies were mapped into memory network format with individual differences scaling and likely paths of activation were modeled with preference mapping. Results indicated that exposure to the expectancy challenge led to a change in likely activation of expectancies for men, but not for women. In the 30 days after the intervention, alcohol use among men decreased significantly but did not change among women. Therefore, changes in likely activation corresponded to changes in drinking. These findings support a memory model conceptualization of expectancy influence on drinking.

Alcohol expectancies, social and environmental cues as determinants of drinking and perceived reinforcement.

Increasing evidence suggests that outcome expectancies and environmental cues interact to influence post-drinking behaviors. Using an experimental methodology in a simulated social drinking setting, this research tested the potential influence of expectations for the effects of drinking, environmental cues, and beverage content on ad lib consumption and post-drinking self-perception. Eighty-eight moderate to heavy-drinking males were randomly assigned to one of eight experimental conditions in which beverage content (alcohol or placebo), social environment (friendly or unfriendly), and physical environment (simulated bar or residence) were varied. Subjects were further divided into high and low groups on three outcome expectancy factors. Unaffected by environmental cues, beverage self-administration increased when subjects strongly expected behavioral impairment from drinking but received placebo beverage. Post-drinking reports of disinhibition increased in response to friendly social cues but were not affected by beverage content or amount. Results therefore suggest that individual's beliefs about the effects of drinking influence the amounts of beverage they consume, whereas social cues more greatly affect post-drinking self-perception.

Alcohol expectancies of women and men in relation to alcohol use and perceptions of the effects of alcohol on the opposite sex.

The present study was intended to identify specific alcohol expectancies of women and men that could be targeted in expectancy-based interventions to maximize their impact on alcohol use. The Alcohol Expectancy Questionnaire (AEQ) was revised to specifically refer to women, men, or the respondent, and was administered to 433 undergraduates with a measure of alcohol use. When asked about expectancies for themselves, females' and males' drinking correlated most highly with expectations of social facilitation. When asked about expectancies for the opposite sex, however, several other types of expectancies were related to respondents' alcohol use in addition to expectations of enhanced social experiences. Males' drinking corresponded to beliefs that women will be happier, more confident, and will sleep better if they have consumed alcohol. Females' drinking corresponded to beliefs that men will be less sexually inhibited and more romantic after drinking. These findings link past expectancy work with more recent attempts to model the mechanism by which expectancies influence alcohol use and may guide development of maximally effective expectancy-based interventions to reduce drinking.