Differential effects of intra-midbrain raphe and systemic 8-OH-DPAT on VTA self-stimulation thresholds in rats

RATIONALE

Intra-median raphe nucleus (MRN) administration of the 5-HT(1A) receptor agonist 8-OH-DPAT decreases lateral hypothalamic self-stimulation thresholds and is reported to have biphasic effects following systemic administration. These experiments attempted to extend the previous findings to mesolimbic pathway self-stimulation at ventral tegmental area (VTA) electrodes.

OBJECTIVES

This study was conducted to provide comparative data for systemic and intra-dorsal raphe nucleus (DRN) and intra-MRN effects of 8-OH-DPAT on VTA self-stimulation.

METHODS

Male Sprague-Dawley rats with VTA electrodes were trained to respond for electrical stimulation. Systemic and intra-midbrain raphe 8-OH-DPAT effects on rate-frequency thresholds were measured. Systemic administration of WAY 100635 was used to confirm 5-HT(1A) receptor mediation of 8-OH-DPAT effects.

RESULTS

8-OH-DPAT (0.003-0.3 mg kg(-1) SC) increased rate-frequency thresholds and decreased maximal response rates. WAY 100635 alone (0.0125-0.1 mg kg(-1) SC) did not alter these measures. Intra-DRN and intra-MRN 8-OH-DPAT (5.0 microg) decreased rate-frequency thresholds without altering maximal response rates. Intra-DRN 8-OH-DPAT (0.1-5.0 microg) induced a slight decrease and intra-MRN 8-OH-DPAT a slight increase in locomotor activity. WAY 100635 (0.1 mg kg(-1)) blocked effects of 8-OH-DPAT on VTA self-stimulation.

CONCLUSION

These results confirm threshold-decreasing effects of intra-MRN 8-OH-DPAT and extend this to the DRN and to VTA thresholds. Monophasic dose dependent increases in VTA thresholds following systemic 8-OH-DPAT are not equivalent to reports for hypothalamic self-stimulation. Differences between studies may be attributable to stimulation site and/or differences in threshold measurement procedures. Effects of WAY 100635 in this study indicate 5-HT(1A) receptor mediation of these 8-OH-DPAT effects.

Measuring cognition in menopause research: a review of test use

OBJECTIVE

To examine critically how various aspects of memory functions have been assessed in menopause-related research.

METHOD

Twenty peer-reviewed articles on the menopause and cognitive functioning published between 1991 and 2000 were identified through a computerized Medline search. All studies utilized healthy non-demented women, and assessed specific aspects of cognitive functioning using standardized tests rather than self-reporting of perceived functioning.

RESULTS

Measures used to assess attention and concentration, verbal memory, learning and verbal expression, visual memory, concept formation and reasoning have all been reviewed. Findings from studies assessing attention and concentration demonstrate inconsistent results with regard to hormone levels or menopausal status. Although five measures of verbal learning and memory have been considered, no articles published in the past decade have reported unequivocal results for any one measure. Only one study reviewed found significant differences in measures of verbal expression between hormone therapy users and non-users. In addition, no strong association between estrogen level and visual memory was identified in the studies reviewed.

CONCLUSIONS

This careful analysis demonstrates that, within the studies of cognitive abilities of menopausal women reviewed in this article, a wide variety of tests have been used. However, the body of literature considered neither consistently nor conclusively demonstrates a clear effect of exogenous hormone therapy on memory. It is suggested that verbal memory, visual memory, concept formation and reasoning should be simultaneously investigated in future research, and that covariate measures of attention and concentration, verbal expression and reasoning are also included. In addition, within each specific domain, the psychometric properties of tests, the populations they were intended to assess and the specific aspects of cognitive function they were designed to address need to be more closely considered.

Managing the pain of traumatic injury

Management of pain in the trauma patient is a complex issue requiring the ability to selectively match different injuries and patient situations with the most optimal pain management methods. Having an understanding of the various stages of trauma care helps clinicians to best support the goals of patient care while decreasing the detrimental effects of the stress response through good pain control interventions. When nurses have a good understanding of the various pain management interventions they are better able to assess the effectiveness, potential side effects, and goals of therapy. The following is a list of clinical pearls to help guide nurses to better manage the pain of traumatic injuries: Encourage your trauma team to standardize pain medications (particularly opioids). A protocol that uses a couple of opioids with varving routes of administration, onset, duration, mechanism of action, and side effects helps the team to become extremely familiar with them and better able to assess effectiveness and side effects. Frequent motor and sensory assessments are necessary in the injured-patient (especially with extremity and head injuries), and drug therapy choices must allow for a thorough baseline assessment and periodic checks to follow. Patients with multiple rib fractures or flail segments (particularly elderly patients) and no contraindications deserve serious consideration for treatment with an epidural. When using various pain management techniques, the nurse needs to be prepared to treat complications if they should arise. Airway equipment, drugs (i.e., oxygen, opioid antagonists, pressors), and resuscitation means must be immediately available. Nurses need to be extremely careful when receiving pain medication and other central nervous system depressant orders from various doctors involved in patients' care. If a pain management specialist is involved, all pain medication therapies should be supervised and ordered by that individual, particularly when spinal analgesia is employed. Nurses must be knowledgeable regarding the effects of spinal medications (local anesthetics and opioids) at varying spinal levels so as to assess therapeutic as well as untoward effects. Institute a diligent bowel protocol when using opioids. Opioid administration combined with the immobility and altered nutrition often associated with trauma can easily result in constipation, abdominal distention, and bowel obstruction. It is not uncommon for epidural blocks to need supplementation with other drug therapy, and this should not be considered a failure of the epidural. Any addition needs to be ordered and closely supervised by one primary team of doctors. Use of nonopioid drugs, if not contraindicated should be considered in all trauma patients. This is especially true for patients sustaining trauma and being discharged to home within 24 hours. They need to be educated about the pain they can expect the next day and how to judge if it is normal and expected or possibly the sign of a missed injury or developing complication (i.e., compartment svndrome infection).

Activated protein C resistance, factor V Leiden and peripheral vascular disease

Activated protein C resistance caused by factor V Leiden is an important thrombophilia disorder which predisposes to venous thromboembolism. Some studies also suggest a role in the pathogenesis of arterial thrombosis and atherosclerosis. The authors have investigated the prevalence of activated protein C resistance and factor V Leiden in a series of 45 patients with peripheral vascular disease. Twelve patients were receiving warfarin. The activated protein C resistance ratios were significantly lower in the group of 33 non-warfarinized patients with peripheral vascular disease (median 2.82 (range 1.36-3.83)) compared with 33 age- and sex-matched controls (median 2.97 range 2.24-4.11); P<0.005; Wilcoxon rank sum). Eight patients (24%) had activated protein C resistance (ratio <2.2). The prevalence of factor V Leiden in patients with peripheral vascular disease was 17.8% (8/45). This is significantly increased compared with the local population and UK published frequency of 3.5% for this genotype. The presence of factor V Leiden did not affect the late outcome of arterial reconstructive surgery in terms of graft patency (P=0.5, Fisher's Exact test).

Evaluation of a new, integral, whole blood filter (RS2000) system for prestorage leucodepletion of SAG-M red cells

Residual donor leucocytes are responsible for many adverse transfusion reactions. Prestorage leucodepletion may ameliorate these effects and enhance product quality. We studied a bottom and top (BAT) system incorporating an integral filter for whole blood leucodepletion. Our evaluation assessed leucodepletion efficiency as well as in vitro SAG-M red cell quality and storage characteristics. Sixty-six units of blood were collected; test units into the Optipac-pLuS system and controls into the standard triple pack configuration. Test units were held for 4-6 h at room temperature (rt) or 12-18 h at 4 degrees C. The mean leucocyte counts for the SAG-M red cells in the quality and storage trial were 0.6 x 10(6) (rt hold), 0.05 x 10(6) (4 degrees C hold) and 2500 x 10(6) (controls). We observed no significant differences between the groups for Na+, ATP, 2,3-DPG, glucose, lactate and pH during the 49 d storage. The control group, however, showed a greater increase in haemolysis and K+ with time. Autologous in vivo 24 h red cell recovery, after 42 d storage, was > 75%. Adjustment of processing parameters in subsequent studies gave leucodepleted SAG-M red cells with minimal cell loss (9.19%) plus acceptable haemoglobin content (46-76 g/U) and haematocrit (54-62%). This system achieved > 3.5 log leucodepletion with all but one unit containing < 1 x 10(6) leucocytes. The product quality is good and the system suitable for routine use in blood centres.

The endocrinology of the menopausal transition: a cross-sectional study of a population-based sample

In a study of the endocrinology of the perimenopausal years, levels of serum FSH, estradiol (E2), immunoreactive inhibin (INH), testosterone, and sex hormone-binding globulin were measured in a population-based sample of 380 women (mean age, 49.4 yr; range, 45.6-56.9 yr). Subjects were divided into women who reported continuing regular menstrual cycles (27%; group I), a change in menstrual flow without a change in frequency (23%; group II), a change in frequency but no change in flow (9%; group III), changes in both frequency and flow (28%; group IV), and at least 3 months since their last menstrual period (13%; group V). After adjusting for age and body mass index, the geometric mean FSH increased across menstrual groups and, compared with group I, was 53% higher in group IV (P < 0.0005) and 253% higher in group V (P < 0.0001). Age- and body mass index-adjusted geometric means for E2 and INH in group V were 54% and 53% of those in group 1, respectively (P < 0.005, P < 0.0001). Women in group V who did not have a menstrual period in the next year had higher FSH and lower E2 and INH levels than those who subsequently went on to have at least one more menstrual period (P < 0.05). FSH was negatively correlated with E2 (r = -0.30) and INH (r = -0.39), whereas INH was positively correlated with E2 (r = 0.45). We conclude that an increase in serum FSH and decreases in E2 and INH are the major endocrine changes associated cross-sectionally with the menopausal transition.

Human Rh D monoclonal antibodies (BRAD-3 and BRAD-5) cause accelerated clearance of Rh D+ red blood cells and suppression of Rh D immunization in Rh D- volunteers

The use of prophylactic anti-D to prevent Rh D immunization in Rh D- women and subsequent hemolytic disease in Rh D+ infants is widespread, but has led to shortages of the anti-D Ig. With the aim of substituting monoclonal anti-D for Rh D prophylaxis, we have compared the abilities of monoclonal and polyclonal anti-D to clear Rh D+ red blood cells (RBCs) infused into Rh D- male volunteers and to suppress Rh D immunization. Two human monoclonal antibodies (MoAbs), BRAD-3 (IgG3) and BRAD-5 (IgG1), produced from stable Epstein-Barr virus-transformed B-lymphoblastoid cell lines, were selected because of their proven in vitro activity in promoting RBC lysis in antibody-dependent cell-mediated cytotoxicity assays. RBC clearance was assessed by intravenous injection of 3 mL of 51chromium-labeled D+ RBCs into 27 volunteers 48 hours after intramuscular injection of monoclonal or polyclonal anti-D. Further 3-mL injections of unlabeled D+ cells were administered at 6 and 9 months to induce immunization. Blood samples were taken throughout the 12-month period of study for the serologic detection of anti-D. The mean half-life (t50%) of RBCs in 7 recipients of 300 micrograms BRAD-5 (5.9 hours) was similar to that in 8 recipients of 500 IU polyclonal anti-D (5.0 hours), whereas D+ cells were cleared more slowly in some of the 8 subjects injected with 300 micrograms BRAD-3 (mean t50% 12.7 hours) and in 1 individual administered 100 micrograms BRAD-3 (t50% 41.0 hours). The rate of RBC clearance in both groups administered 300 micrograms monoclonal anti-D correlated with the amount of antibody bound per cell, determined by flow cytometry. There was no evidence of primary immunization having occurred in any subject after 6 months of follow-up. Five of 24 subjects produced anti-D after one or two further injections of RBCs, confirming that they were responders who had been protected by the monoclonal or polyclonal anti-D administered initially. Four of these responders were recipients of monoclonal anti-D (3 BRAD-3, 1 BRAD-5). One individual who received BRAD-5 produced accelerated clearance of D+ RBCs at the third unprotected RBC challenge but did not seroconvert. This study shows that the human MoAbs BRAD-3 and BRAD-5 can prevent Rh D immunization, and indicates that they may be suitable replacements for the polyclonal anti-D presently used in prophylaxis of Rh D hemolytic disease of the newborn.(ABSTRACT TRUNCATED AT 400 WORDS)

Physical activity and the menopause experience: a cross-sectional study

A randomly selected community cohort of 2000 Australian born women aged 45 to 55 were interviewed on the telephone and information obtained on their health and well-being. These women were divided into pre-, peri-, natural and surgical menopausal groups on their menstrual history. A physical activity questionnaire was sent to 1181 women in the first three of these groups. These questionnaires were completed and returned by 61.6% of the women. The response rate in all groups was significantly associated with the years of education, employment status, body mass index (BMI) and self-rated health of the participants. The aim of the study was to test the hypothesis that physical activity is a major contributor to health and well-being by establishing the relationships between physical activity and certain health outcomes, such as menopausal symptoms, psychological well-being, self-rated health and BMI in this cohort of mid-life women. The inter-relationship between physical activity and other variables, including menopausal status, interpersonal stress, health related and preventive health behaviours was examined. Levels of physical activity were significantly associated with better self-rated health, lower BMI measurements, moderate alcohol intake and self-breast examination. There was no significant association between levels of physical activity, psychological well-being and women's experience of symptoms during the natural menopause transition.

Psychological well-being, mid-life and the menopause

Few studies of women's health in the menopausal years have formally assessed well being. The present study aimed to determine whether well-being during mid-life related to menopausal status, social circumstance, health status, interpersonal stress, attitudes and lifestyle behaviours. A random sample of 2000 Melbourne women aged 45-55 years were sought by random digital telephone dialling. A response rate of 70.6% was achieved. Interviews conducted on the telephone included a well-being scale--the Affectometer 2. The final data set, comprising 1503 individuals, was subjected to analyses of variance. Menopausal status did not significantly affect well-being. Well-being was found to be significantly related to current health status variables of general psychosomatic symptoms, general respiratory symptoms, history of premenstrual complaints, overall health assessment and interpersonal stress. Attitudes to ageing and to menopause were also significantly related to well-being scores. Lifestyle behaviors of smoking, exercise and marital status were also significantly related to well-being. Thus well-being of urban Australian-born, mid-aged women was related to current health status, psychosocial and lifestyle variables rather than to endocrine changes of the menopause.

Menopausal symptoms in Australian women

OBJECTIVES

To describe Australian-born women's experience of symptoms during the natural menopause transition and the relative contribution of menopausal and health status, social factors and lifestyle behaviours.

DESIGN

A community based cross-sectional survey by telephone interview was carried out on a randomly derived sample of Melbourne women.

PARTICIPANTS

The participants were 2000 Australian-born women, aged between 45 and 55 years.

OUTCOME MEASURES

A list of 22 symptoms was used. Explanatory variables were: sociodemographic variables; menopausal and health status; lifestyle behaviours; attitudes to ageing and to menopause.

RESULTS

A 70% response rate was achieved for eligible women who could be contacted during the study. Premenopausal women were the least symptomatic and perimenopausal women the most symptomatic. Factor analysis found seven common factors from the 22 symptoms studied. Menopausal status based on menstrual history was significantly related to two groups of symptoms: vasomotor symptoms, which increased through the menopausal transition; and general somatic symptoms which were more frequent in the perimenopause. Analysis of variance of factor scores found fewer symptoms with increasing years of education, better self-rated health, the use of fewer non-prescription medications, the absence of chronic health conditions, a low level of interpersonal stress, the absence of premenstrual complaints, not currently smoking, exercise at least once a week, and positive attitudes to ageing and menopause.

CONCLUSIONS

Many factors unrelated to hormonal changes contributed to the symptoms. Longitudinal investigation is needed to determine the relative importance of hormonal, psychosocial and lifestyle variables in the aetiology of mid-life symptoms.

Menstrually Related Disorders: points of consensus, debate, and disagreement

It seems that during the past decade we have been witnessing an evolution of a consensus on the phenomenology and time course of various types of MRDs. We are in a stage in which definitions and diagnostic criteria can be developed, but their broad acceptance is still not assured. The etiology and pathophysiology are still fiercely debated, but reasonable and feasible methods for scientific elucidation of the various hypotheses are in place and are followed by solid groups. Despite the uncertainty concerning the etiology of MRDs, reasonably efficient treatment modalities do exist, and most sufferers of MRDs should expect an eventual alleviation of their symptoms if they are treated in a specialized, established, and up-to-date program.

Psychopathology among substance abusing juvenile offenders

The prevalence of substance abuse and coexisting DSM-III psychiatric disorders was evaluated in 111 juvenile offenders. As expected, a high rate of conduct disorder (91%) was present in both substance abusing and nonsubstance abusing juvenile offenders. However, significantly higher rates of attention deficit disorder and aggressive subtype of conduct disorder were present in those offenders who abused drugs and alcohol (54%). Excluding all conduct and oppositional disorder diagnoses, 39% of substance abusers versus 14% of the nonsubstance abusers demonstrated comorbid psychiatric diagnoses. These findings suggest that careful psychiatric evaluation of juvenile substance abusers may be necessary to optimize treatment planning.

The role of protein kinase C in interleukin 1 and tumor necrosis factor alpha induction of fibroblasts to produce and release granulocyte-macrophage colony-stimulating activity

The process of signal transduction by interleukin 1 (IL-1) or tumor necrosis factor alpha (TNF alpha) for the production of hematopoietic growth factors by cultured fibroblasts was studied using inhibitors for protein kinase C, cyclic nucleotide-dependent protein kinases, calmodulin-dependent protein kinases, and the Na(+)-H+ antiport system. The protein kinase C inhibitor H-7 was shown to inhibit both IL-1 beta- and TNF alpha-induced granulocyte-macrophage colony-stimulating activity (GM-CSA) production and release from cultured fibroblasts in a dose-dependent manner, with 40 microM H-7 demonstrating maximum suppression of the GM-CSA response. In addition, 100-200 nM staurosporine, a more potent inhibitor of protein kinase C, also completely suppressed GM-CSA from IL-1 beta- and TNF alpha-induced fibroblasts. In contrast, a potent inhibitor of cyclic nucleotide-dependent protein kinases, HA1004, showed no effect when used at 10-40 microM. In addition, an inhibitor of calmodulin-induced protein kinases, W-7, also showed no effect when used at 10-30 microM. Prior incubation with H-7 did not inhibit the ability of fibroblasts to subsequently respond to IL-1 beta or TNF alpha, nor did H-7 directly inhibit the granulocyte-macrophage colony-forming assay. Both dibutyryl cyclic adenosine monophosphate (10-30 microM) and forskolin (1-100 nM), activators of adenylate cyclase, in the presence or absence of the phosphodiesterase inhibitor isobutylmethylxanthine, failed to stimulate a GM-CSA response from cultured fibroblasts, indicating a lack of effect of cyclic nucleotide-dependent protein kinases. Furthermore, the addition of H-7 30 min after induction with IL-1 beta or TNF alpha showed little effect on the synthesis of GM-CSA by cultured fibroblasts, indicating that the signal transduction process probably occurred within the first 30 min of ligand-receptor interaction. Finally, amelioride, an inhibitor of the Na(+)-H+ antiport, was shown to inhibit IL-1 beta-induced GM-CSA in a dose-dependent manner.

Predicting substance abuse in juvenile offenders: attention deficit disorder versus aggressivity

The relative predictive significance of attention deficit disorder (ADD) and aggressive behavior for consequent substance abuse was examined in 114 juvenile offenders. ADD, aggressivity, and substance abuse were assessed according to DSM-III criteria. Results from logistic regression indicate that aggressivity, but not an ADD diagnosis, significantly predicts substance abuse. Therefore, previously reported associations between ADD and substance abuse may be confounded by concurrent symptoms of aggression.

Urinary 6-sulphatoxy melatonin levels within the menstrual cycle and in patients with premenstrual syndrome

The present investigation examined the production of urinary 6-sulphatoxy melatonin (aMT.6S) during the early follicular and late luteal (premenstrual) phases in healthy, normal women and in patients with premenstrual syndrome (PMS). There was no significant difference in levels of aMT.6S on either day 6 or 26 of the menstrual cycle between control subjects and those with PMS. There also was no significant change in urinary aMT.6S levels within the menstrual cycle. These findings do not support an involvement of melatonin in the development of PMS symptomatology and are not supportive of the proposed role of melatonin in regulating ovulation in humans. However, our analysis of 12-hr urine samples may have been insensitive to small, yet possibly biologically significant, changes in the amplitude and period of melatonin excretion during the early hours of the morning.

Lactoferrin decreases monocyte-induced fibroblast production of myeloid colony-stimulating activity by suppressing monocyte release of interleukin-1

Lactoferrin (Lf) is a negative regulator of myelopoiesis which operates by suppressing the release from mononuclear phagocytes of GM colony-stimulating factor (GM-CSF) or monokines which can then induce the release of GM-CSA from accessory cells. In this study, endotoxin-depleted, purified iron-saturated human Lf was assessed for its effect on the production of interleukin-1 by cultured monocytes and their subsequent effect on colony-stimulating factor release from cultured fibroblasts. Monocytes were grown with or without Lf and Lf that had previously been incubated with monoclonal anti-Lf. The monocyte-conditioned medium was then either assayed for the presence of interleukin-1 (IL-1) with an enzyme-linked immunosorbent assay or for its ability to stimulate fibroblasts to release growth factors for CFU-GM, BFU-E, or CFU-Mix colonies. In the presence of Lf (10(-7) or 10(-8) mol/L), GM colony-stimulating activity (GM-CSA) was suppressed by 31% to 73%, whereas stimulating activities for BFU-E and CFU-mix colony formation were suppressed by 93% to 100%. Antibody to Lf completely abrogated the suppressive effects observed with Lf, whereas antibody to IL-1 ablated the induction by monocyte-conditioned medium of CSA release by fibroblasts. Lf at 10(-7) and 10(-8) mol/L also reduced IL-1 synthesis by cultured monocytes from 60% to 77%. The inhibitory effects of Lf were only observed when Lf was added before adherence of the monocytes for culture. If Lf was added at the time of adherence or after adherence, no suppression was observed. We conclude that the inhibition of GM-CSA production/release by Lf is mediated through inhibition of the synthesis/release of IL-1 by mononuclear phagocytes. This inhibition of IL-1 prevents accessory cells from producing and/or releasing GM-CSA.

Menstrual migraine: a double-blind trial of percutaneous estradiol

The present study investigated whether administration of percutaneous estradiol for the 7 days encompassing menstruation (the paramenstruum) would be effective in alleviating menstrual migraine. The study was a double-blind cross-over placebo comparison of percutaneous estradiol in gel form. Twenty-two women who suffered from regular recurring menstrual migraine were studied during 2 assessment menstrual cycles, 4 treatment cycles (2 of estradiol gel, 2 of placebo gel), and 1 follow-up (no treatment) cycle. Women completed daily records of the occurrence and severity of migraine and medication used. Eighteen women completed the study. There was a significant reduction in the frequency of migraine in the paramenstruum and in the amount of medication taken during use of percutaneous estradiol. Women expressed a significant preference for continuation of therapy with percutaneous estradiol.

Treatment of premenstrual syndrome. A double-blind trial of dydrogesterone

A double-blind randomised crossover trial of oral micronised progesterone and placebo had demonstrated that progesterone had beneficial effects over placebo for some mood and physical premenstrual symptoms. A further trial using identical methodology was carried out to assess whether dydrogesterone would have the same beneficial effects. Prospective assessment confirmed the presence of a premenstrual syndrome in 30 women. Of these, six withdrew during the 4 months of the study. Twenty-four women completed the double-blind crossover protocol. All women were interviewed premenstrually before treatment and in each month of treatment. They completed the Moos Menstrual Distress Questionnaire, Beck Depression Inventory, Spielberger State Anxiety Inventory, Mood Adjective Checklist and a Daily Symptom Record. Analysis of data found an overall beneficial effect of being treated for most variables. Further analysis showed that the most major effects occurred in the first 2 treatment months. This study could find no evidence that dydrogesterone was more effective than placebo in treating premenstrual complaints.

Psychological issues in IVF

The role of psychological factors in IVF is complex. Psychological issues intertwine with physical ones, often with additive effects. The very diagnosis of infertility is likely to cause stress. In addition, the many investigations and procedures may have compounded distress. There are probably a small number of patients in whom psychological factors may induce infertility. But in the majority, psychological factors may exacerbate infertility and influence the patient's and partner's responses. Mental, sexual, marital and social adjustment may all be affected. The procedure of IVF is likely to have a further impact. A pilot study of couples entering an IVF programme revealed the women to be highly anxious and to conform strongly to feminine stereotypes. Many had received psychiatric help in the past. The idiopathic group appeared to cope less well with stress and had higher anxiety and neuroticism scores. Follow-up revealed that IVF had a profound impact on many of the women. Most had received no counselling in the interim. In those who completed questionnaires at follow-up, a differential effect was observed between the organic and idiopathic groups. State anxiety fell in the idiopathic group but so did marital adjustment. The clinician is advised to incorporate consideration of the psychological aspects of IVF into every aspect of the programme. The addition of a psycho-social team may assist the gynaecologist in this and help the couple to make an optimal adjustment.

An evaluation of the alternatives approach to drug abuse prevention

An alternatives-oriented, school-based drug abuse prevention program, Positive Alternatives for Youth (PAY), was evaluated over a 2-year period. Using a random-assignment, pretest-posttest control group design, 135 PAY students and 106 control group students were assessed on several attitudinal and behavioral measures of drug use. During the first year significant differences were detected between PAY and control students. Fewer differences were found in the second year, although a special analysis showed evidence of impact on PAY students rated as more involved in program activities. Reasons for specific results are discussed and implications are drawn for the alternatives approach and the field of drug abuse prevention.

Alcohol and marijuana: comparison of use and abuse in regular marijuana users

Alcohol and marijuana use were compared in 97 regular marijuana users who had used marijuana for 6-8 years. Although onset of alcohol use had occurred 3 years before marijuana use, current usage patterns of the two drugs were similar. Nine subjects met criteria for marijuana abuse and 9 met criteria for alcoholism. Although both drugs were used frequently by these subjects, most reported few or no problems from their use.