Convergent and Discriminant Validity of the Personality Inventory for Children

The Personality Inventory for Children (PIC) was compared with measures of cognitive functioning (e.g., WISC-R) and classroom behavior (e.g., WPBIC). The results demonstrated that the PIC can identify salient personality and cognitive features of learning-disabled, emotionally disturbed, and intellectually handicapped children. Furthermore, correlations between the PIC profile scales and the WISC-R showed that the majority of significant correlations clustered around PIC scales intended to identify cognitive deficits, whereas significant correlations with the WPBIC were with PIC scales intended to identify disruptive, acting-out behavior. These relationships provide support for both the construct validity and diagnostic potential of the PIC with children referred for special education services.

MMPI-2 Personality Profiles of High-Functioning Adults With Autism Spectrum Disorders

The Minnesota Multiphasic Personality Inventory-Second Edition was administered to 20 adults with autism spectrum disorders (ASD) who fell in the average to above average range of intelligence and 24 age-, intelligence-, and gender-matched college students. Large group differences, with the ASD group scoring higher, were found on the L validity scale, Clinical Scales 2 (D) and 0 (Si), Content scale Social Discomfort (SOD), Supplementary scale Repression (R), and Personality Psychopathology Five (PSY-5) scale INTR (Introversion). The proportion of ASD adults scoring in the clinical range on these scales was between 25% and 35%. High scores on these scales are consistent with the clinical picture of Asperger syndrome and high-functioning autism in adulthood. Future directions and implications for identifying adults in need of a specialized autism assessment are discussed.

Self-Esteem, Gender-Role Perception, Gender-Role Orientation and Attributional Style as a Function of Academic Competence: Smart Girls are Different, But a Boy is a Boy is a Boy

This investigation examined adolescent self-esteem, gender-role perception, gender-role orientation, and attributional style as a function of academic achievement by having 3 groups of 10th-, 11th-, and 12th-grade males and females (n = 540) respond to (a) a self-esteem inventory under 2 sets of instructions, a standard set and a set in which participants responded as they thought a member of the same age and grade but of the opposite gender would respond; and (b) to an attributional style and a gender-role inventory under the standard set of instructions. The results of the self-esteem inventory under standard instructions revealed a significant difference in favor of males. Under opposite-gender instructions, academically below average and average females ascribed significantly higher levels of self-esteem to males. Males at all academic levels ascribed significantly lower levels of self-esteem to females. However, females in the above average academic group constituted an exception in that they attributed significantly lower self-esteem to males. Reported levels of self-esteem, positive attributional style, and androgynous gender-role orientation all significantly increased commensurate with higher academic achievement for both genders.

Face processing in children with autism

Recent eye tracking studies of face processing have produced differing accounts of how and whether children with autism differ from their typically developing peers. The two groups' gaze patterns appear to differ for dynamic videos of social scenes, but not for static photos of isolated individuals. The present study replicated and extended previous research by comparing the gaze patterns of individuals with and without autism for four types of stimuli: social dynamic, social static, isolated dynamic, and isolated static. Participants with autism differed from their typically developing peers only for social-dynamic stimuli; fixation durations were decreased for eye regions and increased for body regions. Further, these fixation durations predicted scores on a measure of social responsiveness. These findings reconcile differences in previous reports by identifying the specific social and dynamic task components associated with autism-related face processing impairments.

A Comparison of Two Theory-Based Measures of Intelligence: Are They Measuring the Same Thing?

Current intelligence tests are only weakly grounded in underlying theories of intelligence. Two current theories of intelligence are described, and a study is presented in which measures derived from these theories are compared with each other and traditional tests of ability. Measures derived from Jensen's neural oscillation theory were found to be related to motor speed. Measures derived from Sternberg's triarchic theory were found to be related to spatial reasoning and verbal ability. The two theories appear to measure different facets of intelligence, with neither, as operationalized here, giving a complete picture.

Personality Inventory for Children

The scores of 70 learning disabled (LD), 47 emotionally disturbed (ED) and 24 intellectually handicapped (IH) children were compared on the Personality Inventory for Children (PIC). The data were submitted to a series of 2 x 2 x 3 ANOVAs. The results indicated that the IH group was differentiated from the others on PIC scales reflecting cognitive weaknesses (Intellectual Screening and Development) and limited reality testing (Psychosis), and that the ED group was discriminated from the LD group on scales which predict general maladjustment (Adjustment) and from the IH group on scales which predict hyperactive behavior (Hyperactivity). When the protocols were analyzed using actuarial guidelines, the majority of children in all three groups showed significant elevations on scales intended to measure cognitive deficits and general maladaptive behavior (e.g. 100 percent of the IH group had significant scores on the Intellectual Screening and Development scales; a similarly high proportion of ED children had marked elevations on the Adjustment scale). It was actually the degree of scale elevation relative to the remaining profile which defined each group.

Self-Modeling with Preschoolers

A complex reversal design was used to investigate the effectiveness of self-modeling procedures in reducing aggression and noncompliance in six preschool-age children. Self-modeling was compared with peer modeling and a control condition over a ten-week period. Follow-up and maintenance of behavior change was studied, as was generalization. No positive effects were found for the selfmodeling intervention in reducing instances of aggression or noncompliance. Supplementary analysis of four subjects' data further showed no increase in prosocial behavior as a function of the self-modeling intervention.

Effectiveness of Stimulant Drug Treatment for Attention Problems

Using a within-subject, repeated measure, double-blind design, methylphenidate was shown to be effective in treating the attention deficits of children with head injuries. Eight head-injured children, ages 7-15, meeting DSM III-R criteria for ADHD, were placed on a 2-week trial of methylphenidate (Ritalin), and similar 2-week trial of placebo. During the methylphenidate trial, all eight children were rated by parents as improved in their attentional capacities, and all but one, a child diagnosed as ADHD prior to injury and described as conduct-disordered, showed a pattern of general improvement across most attentional measures. Measures which showed less consistent results were the attentional tasks comprised of more complex stimuli requiring greater memory capacity. Implications for school psychologists working with head-injured children are discussed.

School Psychology and Infantile Autism

This paper presents an overview of infantile autism which includes theories of aetiology, definition of the condition, overlapping conditions, assessment procedures and prognosis. A model treatment that can be implemented by school psychologists is also presented.

Comparison of the spatial QRS-T angle derived from digital ECGs recorded using conventional electrode placement with that derived from Mason-Likar electrode position

BACKGROUND

The spatial QRS-T angle is ideally derived from orthogonal leads. We compared the spatial QRS-T angle derived from orthogonal leads reconstructed from digital 12-lead ECGs and from digital Holter ECGs recorded with the Mason-Likar (M-L) electrode positions.

METHODS AND RESULTS

Orthogonal leads were constructed by the inverse Dower method and used to calculate spatial QRS-T angle by (1) a vector method and (2) a net amplitude method, in 100 volunteers. Spatial QRS-T angles from standard and M-L ECGs differed significantly (57°±18° vs 48°±20° respectively using net amplitude method and 53°±28° vs 48°±23° respectively by vector method; p<0.001). Difference in amplitudes in leads V4-V6 was also observed between Holter and standard ECGs, probably due to a difference in electrical potential at the central terminal.

CONCLUSION

Mean spatial QRS-T angles derived from standard and M-L lead systems differed by 5°-9°. Though statistically significant, these differences may not be clinically significant.

Predicting colostrum quality from performance in the previous lactation and environmental changes

Nine New Hampshire Holstein dairies contributed to a study to investigate if colostrum quality could be predicted by cow performance in the previous lactation and by environmental factors during the 21-d prepartum period. The numbers of days below 5°C (D<), days above 23°C (D>), and days between 5 and 23°C (D) were used in the development of the regression equation. Between 2011 and 2014, 111 colostrum samples were obtained and analyzed for IgG. Producers recorded cow identification number, calf date of birth, sex of the calf, colostrum yield, hours from parturition to colostrum harvest, and weeks on pasture during the dry period (if any). Dairy Herd Improvement data from each cow and weather data were compiled for analysis. Information accessed was predicted transmitting abilities for milk, fat (PTAF), protein (PTAP), and dollars; previous lactation: milk yield, fat yield, fat percent, protein percent, protein yield, somatic cell score, days open, days dry, days in milk, and previous parity (PAR). Colostrum yield was negatively correlated with IgG concentration (r=-0.42) and D (r=-0.2). It was positively correlated with D> (r=0.30), predicted transmitting ability for milk (r=0.26), PTAF (r=0.21), and PTAP (r=0.22). Immunoglobulin G concentration (g/L) was positively correlated with days in milk (r=0.21), milk yield (r=0.30), fat yield (r=0.34), protein yield (r=0.26), days open (r=0.21), PAR (r=0.22), and tended to be positively correlated with DD (r=0.17). Immunoglobulin G concentration (g/L) was negatively correlated with D> (r=-0.24) and PTAF (r=-0.21) and tended to be negatively correlated with PTAP (r=-0.18). To determine the best fit, values >0 were transformed to natural logarithm. All nontransformed variables were also used to develop the model. A variance inflation factor analysis was conducted, followed by a backward elimination procedure. The resulting regression model indicated that changes in Ln fat yield (β=2.29), Ln fat percent (β=2.15), Ln protein yield (β=-2.25), and Ln protein percent (β=2.1) had largest effect on LnIgG. This model was validated using 27 colostrum samples from 9 different farms not used in the model. The difference between means for actual and predicted colostrum quality (IgG, g/L) was 13.6g/L. Previous lactation DHI data and weather data can be used to predict the IgG concentration of colostrum.

A cautionary tale; squamous cell carcinoma of the gingiva

BACKGROUND AND OBJECTIVES

Oral squamous cell carcinoma is characterised by varied clinical manifestations and is often diagnosed at an advanced stage. This article highlights a case of gingival squamous cell carcinoma which was initially diagnosed and treated as localised periodontitis.

METHODS

A 64-year-old Caucasian male had a 2-year history of discomfort and swelling around his upper anterior teeth. His dentist diagnosed localised periodontitis around tooth 11. The patient was treated with regular scaling but showed no improvement. Teeth 11 and 21 were subsequently extracted. He returned later with a swelling in his anterior maxilla and was referred to the Whangarei Hospital Dental Department.

RESULTS

The histopathological report confirmed a diagnosis of squamous cell carcinoma. The patient was referred to Auckland for treatment and underwent a tracheostomy, maxillectomy, bilateral selective neck dissection and fibula free flap reconstruction. All lymph nodes retrieved and margins of the lesion were clear, and the patient did not require radiotherapy. He will be monitored over the next 5 years for recurrence.

CONCLUSIONS

Gingival squamous cell carcinoma can be easily misdiagnosed. Suspicious lesions which are non-responsive to conventional therapy should be biopsied, even if they are not in the classic high risk anatomical areas of the oral cavity.

Comparison of automated measurements of electrocardiographic intervals and durations by computer-based algorithms of digital electrocardiographs

BACKGROUND AND PURPOSE

Automated measurements of electrocardiographic (ECG) intervals are widely used by clinicians for individual patient diagnosis and by investigators in population studies. We examined whether clinically significant systematic differences exist in ECG intervals measured by current generation digital electrocardiographs from different manufacturers and whether differences, if present, are dependent on the degree of abnormality of the selected ECGs.

METHODS

Measurements of RR interval, PR interval, QRS duration, and QT interval were made blindly by 4 major manufacturers of digital electrocardiographs used in the United States from 600 XML files of ECG tracings stored in the US FDA ECG warehouse and released for the purpose of this study by the Cardiac Safety Research Consortium. Included were 3 groups based on expected QT interval and degree of repolarization abnormality, comprising 200 ECGs each from (1) placebo or baseline study period in normal subjects during thorough QT studies, (2) peak moxifloxacin effect in otherwise normal subjects during thorough QT studies, and (3) patients with genotyped variants of congenital long QT syndrome (LQTS).

RESULTS

Differences of means between manufacturers were generally small in the normal and moxifloxacin subjects, but in the LQTS patients, differences of means ranged from 2.0 to 14.0 ms for QRS duration and from 0.8 to 18.1 ms for the QT interval. Mean absolute differences between algorithms were similar for QRS duration and QT intervals in the normal and in the moxifloxacin subjects (mean ≤6 ms) but were significantly larger in patients with LQTS.

CONCLUSIONS

Small but statistically significant group differences in mean interval and duration measurements and means of individual absolute differences exist among automated algorithms of widely used, current generation digital electrocardiographs. Measurement differences, including QRS duration and the QT interval, are greatest for the most abnormal ECGs.

Abstract P4-12-10: Safety of pertuzumab (P) with trastuzumab (T) and docetaxel (D) in patients (pts) from Asia with HER2-positive metastatic breast cancer (MBC): Results from the phase III trial CLEOPATRA

Background: CLEOPATRA is a phase III study of placebo (Pla)+T+D and P+T+D in HER2-positive first-line MBC. The combination of both HER2-targeted antibodies, P+T, with D resulted in significantly improved progression-free survival (PFS) and overall survival (OS). The incidence of febrile neutropenia (FN) was higher with P+T+D versus Pla+T+D. We present analyses of adverse events (AEs) and treatment patterns for pts from Asia.

Methods: Pts were from Asia, Europe, North and South America. Study drugs were given intravenously, q3w: P/Pla, 840 mg initial dose, then 420 mg; T, 8 mg/kg initial dose, then 6 mg/kg; D, 75 mg/m2 with escalation to 100 mg/m2 if tolerated. Treatment was given until disease progression or unacceptable toxicity; 6 cycles of D were recommended, &gt;6 cycles were at investigator's discretion. Dose modifications of P or T were not permitted. Two D dose reductions by 25% to 75 mg/m2 and 55 mg/m2 were allowed in order to manage toxicities; re-escalation was not permitted.

Results: The safety population comprised 253 pts from Asia (Pla+T+D: 128; P+T+D: 125) and 551 pts from other regions (Pla+T+D: 269; P+T+D: 282). The incidences of neutropenia, FN, diarrhea, mucosal inflammation, grade ≥3 AEs overall, and serious AEs were higher with P+T+D versus Pla+T+D. In the P arm, the largest increase in AEs in pts from Asia versus other regions was observed for FN and mucosal inflammation. D dose was more frequently reduced in pts from Asia; however, the incidence of AEs leading to discontinuation of all study treatment was balanced between pts from Asia and other regions. PFS and OS were improved with P+T+D in pts from all regions. In the whole study population, the hazard ratios (HR) for PFS and OS were 0.63 (95% CI 0.52-0.76) and 0.66 (0.52-0.84), respectively. In pts from Asia, the HR was 0.68 (0.48-0.95) for PFS and 0.64 (0.41-1.00) for OS. These efficacy analyses were unstratified.

Pts with event, n (%)Other regionsAsia Pla+T+DP+T+DPla+T+DP+T+D n = 269n = 282n = 128n = 125Neutropenia123 (46)141 (50)74 (58)74 (59)FN15 (6)24 (9)15 (12)32 (26)Diarrhea118 (44)179 (63)66 (52)93 (74)Mucosal inflammation56 (21)67 (24)23 (18)46 (37)Grade ≥3 AEs194 (72)199 (71)95 (74)103 (82)Serious AEs69 (26)82 (29)35 (27)58 (46)AEs leading to discontinuation of all study treatment15 (6)21 (7)6 (5)4 (3)D dose escalation to 100 mg/m256 (21)47 (17)5 (4)1 (1)D dose reduction to &lt;75 mg/m232 (12)42 (15)57 (45)62 (50)Use of granulocyte colony-stimulating factor (G-CSF) to treat FN8 (3)11 (4)12 (9)30 (24)Subsequent G-CSF prophylaxis in pts with FN6 (2)3 (1)1 (1)11 (9)Study treatment cycles, median15181520D cycles, median8799

Conclusions: AEs did not result in reduction of the median number of cycles administered in pts from Asia compared with other regions. However, given that 47% of pts from Asia had D dose reductions &lt;75 mg/m2 with comparable survival benefits to pts from other regions, a reduction in the D starting dose should be considered in these pts. Based on the efficacy and safety profile of P+T+D, this regimen is the preferred treatment option for pts with HER2-positive first-line MBC from all geographic regions.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-12-10.

Antidepressant and neurocognitive effects of isoflurane anesthesia versus electroconvulsive therapy in refractory depression

Background

Many patients have serious depression that is nonresponsive to medications, but refuse electroconvulsive therapy (ECT). Early research suggested that isoflurane anesthesia may be an effective alternative to ECT. Subsequent studies altered drug, dose or number of treatments, and failed to replicate this success, halting research on isoflurane's antidepressant effects for a decade. Our aim was to re-examine whether isoflurane has antidepressant effects comparable to ECT, with less adverse effects on cognition.

Method

Patients with medication-refractory depression received an average of 10 treatments of bifrontal ECT (n = 20) or isoflurane (n = 8) over 3 weeks. Depression severity (Hamilton Rating Scale for Depression-24) and neurocognitive responses (anterograde and retrograde memory, processing speed and verbal fluency) were assessed at Pretreatment, Post all treatments and 4-week Follow-up.

Results

Both treatments produced significant reductions in depression scores at Post-treatment and 4-week Follow-up; however, ECT had modestly better antidepressant effect at follow-up in severity-matched patients. Immediately Post-treatment, ECT (but not isoflurane) patients showed declines in memory, fluency, and processing speed. At Follow-up, only autobiographical memory remained below Pretreatment level for ECT patients, but isoflurane patients had greater test-retest neurocognitive score improvement.

Conclusions

Our data reconfirm that isoflurane has an antidepressant effect approaching ECT with less adverse neurocognitive effects, and reinforce the need for a larger clinical trial.

Health-related quality-of-life assessment in CLEOPATRA, a phase III study combining pertuzumab with trastuzumab and docetaxel in metastatic breast cancer

BACKGROUND

The phase III CLEOPATRA study demonstrated that combining pertuzumab with trastuzumab plus docetaxel significantly improves progression-free and overall survival in previously untreated HER2-positive metastatic breast cancer. Here, we report health-related quality-of-life (HRQoL) results from CLEOPATRA.

PATIENTS AND METHODS

Participants were randomly assigned to pertuzumab or placebo, each given with trastuzumab plus docetaxel every 3 weeks. Pertuzumab and trastuzumab were administered until progression and six or more docetaxel cycles were recommended. Time from randomization to a ≥ 5-point decrease in Trial Outcome Index-Physical/Functional/Breast (TOI-PFB) of the Functional Assessment of Cancer Therapy-Breast (FACT-B) questionnaire was analyzed as a prespecified secondary end point. A post hoc exploratory analysis investigated time to ≥ 2-point deterioration in Breast Cancer Subscale (BCS) score.

RESULTS

Time to ≥ 5-point decline in TOI-PFB did not differ significantly between the pertuzumab and placebo arms [hazard ratio (HR), 0.97; P = 0.7161]. The median times to TOI-PFB deterioration were 18.4 and 18.3 weeks, respectively (approximately six cycles). The mean TOI-PFB declined slightly until week 18 and recovered thereafter. Pertuzumab increased time until BCS deterioration versus placebo (median 26.7 versus 18.3 weeks; HR, 0.77; P = 0.0061).

CONCLUSIONS

Combining pertuzumab with trastuzumab and docetaxel had no adverse impact on HRQoL and may prolong time to worsening of breast cancer-specific symptoms.

Abstract P5-18-01: Pertuzumab (P) in combination with trastuzumab (T) and docetaxel (D) in elderly patients with HER2-positive metastatic breast cancer in the CLEOPATRA study

Background: The incidence of cancer increases with age as does the risk of treatment-related adverse events (AEs) due to underlying comorbidities. A better understanding of cancer therapy-related AEs in elderly pts may help identify the optimal therapy by balancing treatment benefit and risk. CLEOPATRA, a double-blind Phase III trial, compared placebo (Pla)+T+D with P+T+D in pts with HER2-positive 1L MBC (Baselga 2012). Here we report safety and efficacy by age group.

Methods: P/Pla: 840 mg initial dose, 420 mg q3w iv; T: 8 mg/kg initial dose, 6 mg/kg q3w iv; D: 75 mg/m2 q3w iv, escalating to 100 mg/m2 if tolerated. P/Pla+T were given until progressive disease (PD) or unacceptable toxicity. At least 6 cycles of D were recommended; &lt;6 cycles were allowed for PD or unacceptable toxicity, &gt;6 cycles were allowed at investigators' discretion. At baseline, pts were required to have ECOG PS of 0 or 1, LVEF ≥50% and no decline to &lt;50% during or following prior T therapy. The cumulative exposure to prior doxorubicin must not have exceeded 360 mg/m2 or its equivalent. The primary endpoint was independently assessed PFS; secondary endpoints included overall survival, objective response, safety.

Results: In the safety population, 678 pts (332 Pla arm, 346 P arm) were &lt;65 yrs and 126 pts (65 Pla arm, 61 P arm) were ≥65 yrs. In pts &lt;65 yrs, the median number of D cycles was 8 (1–41) in the Pla arm (median D dose intensity: 24.8 mg/m2/week) and 8 (1–35) in the P arm (24.5 mg/m2/week). The median number of D cycles was lower in pts ≥65 yrs, with 6.5 (1–26) in the Pla arm (24.8 mg/m2/week) and 6 (1–16) in the P arm (24.8 mg/m2/week). In elderly pts, the incidence of diarrhea, fatigue, and dysgeusia appeared to be higher in both arms, whereas neutropenia and febrile neutropenia were reported less frequently. Grade ≥3 diarrhea was reported in 4.8% (Pla arm) and 6.6% (P arm) of pts &lt;65 yrs and in 6.2% (Pla arm) and 14.8% (P arm) of pts ≥65 yrs. In a univariate Cox regression analysis, age had no statistically significant association with the development of asymptomatic or symptomatic left ventricular systolic dysfunction (LVSD); however, due to the low number of LVSD events overall this analysis has limited sensitivity to detect differences in time to event by age group. An exploratory post hoc analysis of independently assessed PFS in the ITT population showed a median PFS of 12.5 months in the Pla arm and 17.2 months in the P arm (HR = 0.65, 95% CI 0.53–0.80) in pts &lt;65 yrs. In pts ≥65 yrs, the median PFS was 10.4 months in the Pla arm and 21.6 months in the P arm (HR = 0.52, 95% CI 0.31–0.86).

The experience of young people with depression: a qualitative study

People who develop depression experience a maelstrom of emotions as they struggle to understand what is happening to them. While the experience has been comparatively well documented in older adults, much less is known about the depression experience and responses of young people. In this study, we aimed to explore the experience of young people diagnosed with depression. Twenty-six young people were recruited from a youth mental health service. A qualitative interpretative design was used, incorporating semi-structured, audio-recorded interviews. Results provided four overlapping themes, reflecting the young people's difficulties in coming to terms with, and responding in self-protective, harmful and at times life-threatening ways to their depression: (1) struggling to make sense of their situation; (2) spiralling down; (3) withdrawing; and (4) contemplating self-harm or suicide. Study conclusions are that young people faced considerable difficulties coming to terms with, and responding to, depression. Improving young people's understanding of depression and its treatment, reducing community stigma and providing accessible and youth-focused services remain important targets for intervention. It is also important to improve mental health literacy in the community to increase awareness of depression and how mental health professionals, including nurses, respond effectively to the young person.

Diagnosis of myocardial infarction following hospitalisation for exacerbation of COPD

Cardiovascular disease is common in chronic obstructive pulmonary disease (COPD) and raised troponin is common in exacerbations. However, the prevalence of myocardial infarction following hospitalisation for exacerbation of COPD is unknown. Patients aged ≥ 40 yrs hospitalised with acute exacerbation of COPD (n = 242) with ≥ 10 pack-yrs of cigarette smoking were included in a prospective case series conducted in four hospitals. Patients whose primary presenting complaint was chest pain or who had an alternative diagnosis were excluded. Chest pain histories, serial ECGs and troponin levels were obtained. The mean ± SD age was 69 ± 9 yrs; 108 (45%) patients were male and almost half were current smokers. 124 (51%; 95% CI 48-58%) patients had chest pain, which was exertional in 62 (26%). 24 (10%) had raised troponin, among whom, 20 (8.3%; 95% CI 5.1-12.5%) had chest pain and/or serial ECG changes, fulfilling the 2007 Universal Definition of Myocardial Infarction. Neither chest pain (p = 0.77) nor serial ECG changes (p = 0.39) were associated with raised troponin. Raised troponin, chest pain and serial ECG changes are common in patients admitted to hospital with exacerbation of COPD. Overall, one in 12 patients met the criteria for myocardial infarction. Whether these patients would benefit from further cardiac investigation is unknown.

Advancing maternal age is associated with lower bone mineral density in young adult male offspring

SUMMARY

Advancing maternal age has been related to increased risk of fetal death and morbidity, as well as higher fracture risk during childhood, in the offspring. In the present study, we demonstrate that advancing maternal age is independently associated with reduced bone mass in the young adult male offspring.

INTRODUCTION

In Sweden the maternal age in both primi- and multipara mothers has steadily increased during the last three decades. It has been previously reported that advancing maternal age increases the risk of fetal death, but also of morbidity in the offspring, such as chromosome abnormalities, leukemia, diabetes mellitus type 1, and schizophrenia. Whether or not maternal age influences peak bone mass has not been reported. The aim of the present study was to investigate whether a high maternal age was associated with lower peak bone mass, as measured using DXA in a large cohort of male offspring [the Gothenburg Osteoporosis and Obesity Determinants study (GOOD)].

METHODS

Through the Swedish multi-generation register, we identified the mothers of 1,009 GOOD study subjects. From the Swedish medical birth register detailed information about the medical circumstances at the time of child birth were obtained, including maternal and offspring anthropometrics (birth height and weight), maternal age, and smoking habits, parity and length of pregnancy.

RESULTS

Maternal age was inversely correlated to areal BMD (aBMD) at the total body (r =-0.07, p = 0.03) and the lumbar spine (r =-0.09, p < 0.01). Using a linear regression model (with covariates including current physical activity, smoking, calcium intake, weight, present height and birth height, total body lean and fat mass in the offspring, and length of pregnancy), we found that maternal age negatively independently predicted lumbar spine aBMD (β =-0.08, p < 0.01) in the male offspring.

CONCLUSIONS

In conclusion, our results suggest that advancing maternal age could negatively affect bone mass in young adult men.

S5-5: A Phase III, Randomized, Double-Blind, Placebo-Controlled Registration Trial To Evaluate the Efficacy and Safety of Pertuzumab + Trastuzumab + Docetaxel vs. Placebo + Trastuzumab + Docetaxel in Patients with Previously Untreated HER2−Positive Metastatic Breast Cancer (CLEOPATRA)

Background: Pertuzumab (P) is a fully humanized investigational monoclonal antibody that binds to human epidermal growth factor receptor 2 (HER2), preventing dimerization of HER2 with other HER family members and inducing antibody-dependent cell-mediated cytotoxicity. Its mechanisms of action are complementary to those of the anti-HER2 antibody trastuzumab (H) and the two antibodies combined have superior activity compared with either antibody alone in preclinical and clinical studies. In patients with advanced disease, P in combination with H has been shown to be active in patients whose disease has progressed while on H therapy (Baselga et al. J Clin Oncol 2010). Furthermore, P has been shown to improve the activity of H and docetaxel (T) in a randomized neoadjuvant study (Gianni et al. SABCS 2010, S3-2). No increase in overall toxicity and, in particular, no increase in cardiac events was observed with the addition of P to H and HT regimens.

Methods: In this double-blind Phase III study patients with centrally confirmed HER2−positive metastatic or locally recurrent, unresectable breast cancer were randomized to receive either placebo+H+T or P+H+T. Patients could have received one prior hormonal treatment for metastatic breast cancer and/or prior systemic neoadjuvant or adjuvant therapy including prior H and T. Patients had to have a baseline left ventricular ejection fraction ≥50% and no history of declines to &lt;50% during or after prior H therapy.

Study medication was as follows: P 840 mg loading dose followed by 420 mg q3w; H 8 mg/kg loading dose followed by 6 mg/kg q3w; T 75 mg/m2 q3w (with subsequent dose escalation to 100 mg/m2 if 75 mg/m2 was well tolerated). Patients were recommended to receive at least 6 cycles of T. In the case of chemotherapy discontinuation due to cumulative toxicity, antibody therapy was continued until disease progression, unacceptable toxicity, or withdrawal of consent.

Patients were stratified according to region and prior treatment status (adjuvant therapy or de novo metastatic breast cancer).

The primary endpoint for the study was progression-free survival (PFS) as determined by independent review. The primary analysis was planned to take place when approximately 381 independently confirmed PFS events had occurred. This would provide 80% power to detect a 33% improvement in PFS (HR=0.75) at the two-sided significance level of 5%. Secondary endpoints included overall survival, investigator-determined PFS, overall response rate, duration of response, safety, and quality of life.

Patient safety was monitored throughout the study by an independent data monitoring committee and a cardiac review committee.

This study is registered at ClinicalTrials.gov: NCT00567190.

Results: 808 patients were recruited between February 2008 and July 2010. The required number of PFS events for analysis of the primary endpoint has been reached and independent assessment PFS is currently being performed. Results of the primary analysis of efficacy and safety will be presented.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr S5-5.

Evaluation of effectiveness and satisfaction outcomes of a mental health screening and referral clinical pathway for community nursing care

The study aimed to explore the effectiveness of a mental health screening and referral clinical pathway for generalist community nursing care of war veterans and war widow(er)s in Australia on outcomes of client self-reported mental health, quality of life, and client and carer satisfaction. The pathway was developed by literature review and consultation, then trialled and evaluated. Validated screening tools were embedded within the pathway to support generalist nurses' mental health decision making. Pre- and post-measures were applied. Clients on whom the pathway was trialled were invited to complete an evaluation survey questionnaire, as were their informal carers. Most clients and carers who responded to these questionnaires were highly satisfied or satisfied with care provided through application of the pathway. This study adds understanding about one way that community nurses might identify people with mental health difficulties. The trialled pathway, which was modified and refined following the study, is now available on the Internet as an evidence-based resource for community nurses in Australia to guide practice and maximize holistic care for war veterans and war widow(er)s where that care is funded by Department of Veterans' Affairs.

First-time primary caregivers' experience accessing first-episode psychosis services

AIM

Easy access to first-episode psychosis (FEP) services is critical in reducing the duration of untreated illness. However, primary caregivers can encounter difficulties accessing services on behalf of young people with FEP. This qualitative study describes the lived experience of first time primary caregivers of young adults with FEP, with a focus on examining how they access specialist FEP services.

METHODS

A qualitative study was undertaken using semi-structured, in-depth interviews with 20 caregivers in Melbourne.

RESULTS

Most carers were women (85%, n = 17) and parents (85%, n = 17). Nearly all lived in the same households as the young people with FEP (90%, n = 18). The mean duration of their involvement with the FEP service was 14.5 months (standard deviation = 8.9). Three competing themes were identified in the data, reflecting caregivers' polarized experiences accessing FEP services. First, general practitioners were regarded as either a resourceful or an unresourceful means of access to FEP services. Second, caregivers often encountered service-focused and carer-focused barriers when initially accessing services. Third, a combination of acquired knowledge, experience with services and caregiver assertiveness enhanced access on subsequent occasions.

CONCLUSION

This study highlights the important contribution and experience of first-time primary caregivers and the difficulties they face accessing services. The findings suggest access should be influenced more by clinical need and less by caregivers'perseverance. The findings also underline the importance of providing clinical training that acknowledges the needs and contributions of caregivers, as well as interventions that meet the unique challenges faced by first-time caregivers accessing services after the onset of FEP.