Recruitment and retention of healthy minority women into community-based longitudinal research

This report examines the impact of individualized, population-based recruitment and retention approaches on the development of a subject pool, enrollment, and retention at 12 months of healthy, community-based women in three ethnic groups: African Americans, non-Hispanic European Americans, and Mexicans/Central Americans. Of 722 women contacted and screened, 346 (48%) were eligible and consented to participate. Attrition at 12 months was low (10%) compared with other published reports. The largest group of potential subjects was identified through broadcast media approaches, but this method produced the highest number of ineligible women and highest rate of attrition. Printed matter produced the next largest group of potential subjects, but ineligibility was high (53%). Face-to-face interactions enrolled the highest proportion of eligible women (84%) and lowest overall attrition (7%). Direct referral yielded fairly efficient enrollments (57%) and average attrition. Multiple approaches for recruitment can produce a diverse sample of healthy, community-based women. Face-to-face recruitment results in the highest yield of participants with the lowest attribution but is presumed to require more resources.

REM sleep and mood state in childbearing women: sleepy or weepy?

STUDY OBJECTIVES

To test the hypotheses that: 1) an increase in endogenous progesterone levels during the luteal phase of the menstrual cycle will alter REM sleep and mood state, and 2) a decrease in endogenous progesterone levels during postpartum will also alter REM sleep and mood state.

DESIGN

A longitudinal descriptive study utilizing ambulatory polysomnography for two consecutive nights at seven time points.

SETTING

Subject's homes.

PARTICIPANTS

The first hypothesis was tested with 34 women studied during both the follicular and luteal phases of their menstrual cycle. The second hypothesis was tested with 31 women who completed the sleep studies during pregnancy and at one month postpartum.

INTERVENTIONS

N/A.

MEASUREMENTS AND RESULTS

Women who ovulated (high levels of serum progesterone in the luteal phase) had shorter REM latency, more REM sleep, and more positive mood state compared to those who did not ovulate (low luteal progesterone). Compared to the third trimester (high progesterone), REM latency was significantly shorter at one month postpartum (low progesterone). Mood state was most positive at the second trimester and most negative at one month postpartum.

CONCLUSIONS

REM sleep and mood state were related to low progesterone levels during the menstrual cycle, but postpartum REM sleep and mood state were related to increased wake time rather than changes in progesterone levels.

Glucosidase inhibitor from Umbilicaria esculenta

Inhibitory activity toward beta-glucosidase was detected in extracts of the lichen, Umbilicaria esculenta. The extract showed strong inhibition of disaccharide hydrolytic enzymes of mold and mammalian origin, but weak or no inhibition of polysaccharide hydrolytic enzymes except glucoamylase and laminarinase. The inhibitor in the extract was very stable, retaining more than 95% of its activity when treated with heat, acid, alkali, and some hydrolytic enzymes. Purified inhibitor was identified as 1-deoxynojirimycin (1,5-dideoxy-1,5-immino-D-glucitol) by NMR spectrometry, which was known to be produced by Streptomyces sp. and the plant Morus sp. Extracts from Parmelia austrosinensis, Parmelia praesorediosa, and an unidentified lichen species, showed glucosidase inhibitory activities similar to U. esculenta.

Transcriptional activation by the Ewing's sarcoma (EWS) oncogene can be cis-repressed by the EWS RNA-binding domain

The Ewing's sarcoma (EWS) oncogene contains an N-terminal transcriptional activation domain (EWS activation domain, EAD) and a C-terminal RNA-binding domain (RBD). Although it has been established that the EAD is a potent trans-activation domain that is required for the oncogenic activity of several EWS fusion proteins (EFPs), the precise function of the RBD and the normal role of intact EWS are poorly characterized. Here we show that a cis-linked RBD can strongly and specifically repress trans-activation by the EAD. Fusion proteins containing the RBD are expressed at normal levels, are nuclear-localized, and can bind to DNA both in vitro and in vivo, demonstrating that the RBD represses trans-activation directly at the promoter. The RNA recognition motif within the RBD is not required for repression, whereas regions of the RBD containing multiple RGG motifs play a critical role. The finding that the RBD can antagonize transcriptional activation by EWS provides the first direct evidence of a role for the RBD in transcription. Further studies of the repression phenomenon should illuminate key molecular interactions that distinguish EWS from EFPs and provide insights into the normal cellular function of EWS.

Phospholipase D1 is phosphorylated and activated by protein kinase C in caveolin-enriched microdomains within the plasma membrane

Activities of phospholipase D (PLD) in diverse subcellular organelles have been identified but the details of regulatory mechanisms in such locations are unknown. Protein kinase C (PKC) is a major regulator of PLD. Serine 2, threonine 147, and serine 561 residues of phospholipase D1 (PLD1) were determined as sites of phosphorylation by PKC (Kim, Y., Han, J. M., Park, J. B., Lee, S. D., Oh, Y. S., Chung, C., Lee, T. G., Kim, J. H., Park, S. K., Yoo, J. S., Suh, P. G., Ryu, S. H. (1999) Biochemistry 38, 10344-10351). In our present study, a triple mutation of these phosphorylation sites diminished markedly phorbol 12-myristate 13-acetate (PMA)-induced PLD1 activity in COS-7 cells. We looked at the location of the PLD1 phosphorylation by PKC by observing PMA induced band shifts and by use of anti-phospho-PLD1 monoclonal antibody. The shifted PMA-induced proteins and the immunoreactivity of the anti-phospho-PLD1 antibody were mainly found in the caveolin-enriched membrane (CEM) fraction. Depletion of cellular cholesterol led to a loss of this compartmentalization of phosphorylated PLD1 in the CEM. Replacement of the cellular cholesterol led to the restoration of phosphorylated PLD1 in the CEM. Immunocytochemical studies of COS-7 cells revealed that PLD1 was localized in the plasma membrane as well as in the vesicular structures in the cytoplasm, but the phosphorylation of PLD1 occurred only in the plasma membrane. Our results, therefore, show that phosphorylation, and thereby activation, of PLD1 by PKC occurs in the caveolin and cholesterol-enriched low density domain of the plasma membrane in COS-7 cells.

Acculturation and perinatal health outcomes among rural women of Mexican descent

Research has shown that health outcomes for urban women of Mexican descent are related to acculturation. The purpose of this research was to compare perinatal outcomes of 773 women of Mexican descent who gave birth in three rural northern California hospitals, in relation to acculturation measured three different ways: by place of birth, by language spoken, and by the two factors combined as an Acculturation Index (AI). The prenatal and birth records of 773 Mexico-born or U.S.-born women of Mexican descent were reviewed. Results showed that language spoken was a less useful indicator of acculturation associated with perinatal complications than place of birth or the AI. The categorization of acculturation with the AI enhanced understanding of more specific groups of rural women and their particular health outcomes.

The cellular oncogene EWS/activating transcription factor 1 is unable to activate adenovirus-borne promoters: implications for cytotoxic prodrug therapy of malignant melanoma of soft parts

The cellular oncoprotein Ewing's sarcoma oncogene (EWS)/activating transcription factor 1 (ATF1) is a highly specific marker for malignant melanoma of soft parts (MMSP) and is a potent activator of several cAMP-inducible promoters, including the somatostatin promoter. Here we explored the potential for using the somatostatin promoter to direct toxic gene expression in MMSP cells. When introduced into MMSP cells, a somatostatin-herpes simplex virus thymidine kinase fusion gene confers strong and cell-specific sensitivity to the cytotoxic prodrug ganciclovir. Ganciclovir sensitivity requires the ATF-binding site present in the somatostatin promoter, indicating that toxic gene expression is caused by EWS/ATF1. We also tested the efficacy of recombinant adenoviruses adenoviruses for gene delivery and expression in two MMSP cell lines (DTC1 and Su-ccs-1). Surprisingly, several promoters (including somatostatin) that are strongly activated by EWS/ATF1 in transient assays are not activated in DTC1 and Su-ccs-1 cells when present in an adenovirus vector. In summary, our findings demonstrate the potential for using the somatostatin promoter for cytotoxic prodrug therapy for MMSP. However, first-generation adenovirus vectors cannot be used as promoter delivery vehicles for toxic gene expression in MMSP cells.

Owls, larks and the significance of morningness/eveningness rhythm propensity in psychiatric-mental health nursing

In the last decade there has been an upsurge in the research focusing on the interplay between the human circadian timing system and behavioral patterns in health and illness. Of particular interest in this area of inquiry is the overlay of what has been termed chronotype. What this refers to is the propensity of biological rhythms to express themselves in certain patterns of behavior. Commonly, these patterns have received names such as owl (evening chronotype) or lark (morning chronotype). Many people are neither a strong morning nor evening chronotype. If illness represents a change in the way a person's body functions within a given environment, then it is reasonable to believe that an "owl's" symptom presentation may vary significantly from the patterns of a "lark" who becomes ill. Recognizing that psychiatric nurses at both the generalist and the advanced practice levels have a strong interest in patterns of behavior, it stands to reason that using a lens that incorporates notions of the body's clock becomes essential. The interplay between the body's timing system and the thousands of other psychobiological rhythmic functions occurring everyday and within every human being is referred to as chronobiology. This article provides a primer for psychiatric nurses on issues of chronobiology related to morningness and eveningness rhythm propensity.

Parity and sleep patterns during and after pregnancy

OBJECTIVE

To describe changes in women's sleep patterns from prepregnancy to postpartum.

METHODS

Polysomnography was done in women's homes for 2 consecutive nights. Forty-five women were studied during the follicular and luteal phases of their menstrual cycles, and 33 conceived and were studied during each trimester of pregnancy. Twenty-nine were studied at 1 and 3 months postpartum.

RESULTS

Compared with prepregnant sleep characteristics, significant changes in sleep patterns were evident by 11-12 weeks' gestation, with a significant increase in total sleep time but less deep sleep and more awakening during sleep. By the third month postpartum, there was improvement in sleep characteristics; however, sleep efficiency remained significantly lower than baseline prepregnancy values.

CONCLUSION

Sleep disturbance was greatest during the first postpartum month, particularly for first-time mothers.

Cultural competence of measurement scales of menopausal symptoms: use in research among Korean women

Even though there are advancements in research related to culturally competent care, there is an increasing realization that coherent theories and a research base to guide health care that is culturally competent is yet to be fully developed. In this paper, cultural competence of the scales measuring menopausal symptoms are critically analyzed in light of their limitations for Korean women--a population other than for whom it was developed. The analyses indicate that there are issues of contextuality, relevance, communication style, authenticity, power relationships and time constraints.

Left ventricular fibroma masquerading as postinfarction myocardial rupture

A large left ventricular fibroma was encountered perioperatively for what was presumed to be a sealed ventricular rupture after thrombolytic therapy for an acute myocardial infarction. We review the pertinent literature concerning the diagnosis of ventricular rupture and this rare benign tumor of the heart.

Symptom experience during menopausal transition: low income Korean immigrant women

The symptoms experienced during menopausal transition of a vulnerable group of women, low income Korean immigrants, are described in this paper. The findings demonstrated that (a) the types of the symptoms that the women reported were different from those reported by Western women; (b) the women tended to normalize their symptoms; and (c) their symptom experience was influenced by immigration transition and its contextual variables. We suggest that symptom experience of immigrant women during menopausal transition be understood within the contexts of their immigration transition, and that their own views of normality of the menopausal transition be respected.

Sleep patterns of sheltered battered women

PURPOSE

To describe sheltered battered women's sleep patterns and resulting daytime fatigue. The model for symptom management framed this study to describe one component of the model--symptom experience. Beginning evidence suggests that sheltered battered women experience disturbed sleep and fatigue that can interfere with vital activities.

DESIGN

Descriptive using a convenience sample of 50 ethnically diverse women residing at least 21 days in battered women's shelters located in one western U.S. city. The study was done in 1997.

METHODS

The Pittsburgh Sleep Quality Index (PSQI), the Mini Motionlogger Actigraph, a sleep diary, the Visual Analogue Scale for Fatigue, and an open-ended interview were used to collect data. Descriptive and inferential statistics were used to analyze the quantitative data. Qualitative data were analyzed to determine patterns and themes.

FINDINGS

Seventy percent of the women had global PSQI scores of greater than five indicating poor sleep and 17 (34%) had a sleep efficiency index of 80% or less. Fourteen (28%) of the women went to bed very fatigued (> 66 mm) and 20 (40%) woke up very fatigued (> 33 mm).

CONCLUSIONS

The majority of sheltered battered women experienced disturbed sleep and daytime fatigue. Both personal and environmental variables were found to significantly affect sleep patterns. Sheltered battered women can benefit from information about sleep disturbances and sleep enhancing self-care strategies.

Sudden death due to ischaemic heart disease in young aboriginal sportsmen in the Northern Territory, 1982-1996

OBJECTIVE

To estimate the incidence of sport-related sudden cardiac death due to ischaemic heart disease (IHD) in competitive young Aboriginal sportsmen.

SETTING

Northern Territory (NT), 1982-1996.

DESIGN

Retrospective case series with cases identified from Australian Bureau of Statistics cause-of-death listings and NT coronial autopsy records.

MAIN OUTCOME MEASURES

Circumstances and incidence of sport-related sudden cardiac deaths due to IHD; autopsy findings.

RESULTS

Between 1982 and 1996, there were eight sudden cardiac deaths due to IHD and related to sporting activity among Aboriginal sportsmen aged 15-37 years in the NT. Six were associated with games of Australian (rules) football. All occurred in the Top End of the NT in the wet season, and all occurred after the first half, or within an hour of, a game. Four of the players had macrosopic myocardial abnormalities (hypertrophy or previous infarcts) on autopsy. The estimated incidence of IHD-related sudden cardiac death among Aboriginal Australian football players in the NT was 19-24 per 100,000 player-years, compared with 0.54 per 100,000 player-years among Australian rules footballers of similar ages in Victoria.

CONCLUSIONS

Incidence of sudden cardiac death attributable to underlying IHD was extremely high among young NT Aboriginal Australian footballers. Prevention will best be achieved by funding culturally appropriate long-term strategies to reduce the incidence of IHD. However, in the short-term, community-controlled programs with education of athletes, heat-stress reduction strategies, and cardiovascular screening should reduce the incidence of sudden cardiac death in sport.

Pain, fatigue, and sleep disturbances in oncology outpatients receiving radiation therapy for bone metastasis: a pilot study

Pain and fatigue are two of the most common problems experienced by oncology patients. This study evaluated 24 oncology patients who were receiving radiation therapy for bone metastases to (1) describe the patterns of pain intensity and fatigue severity over a 48-hour period; (2) evaluate for sleep disturbances; (3) describe the relationships between these symptoms and various treatment characteristics; and (4) describe the self-care strategies used by patients to manage pain and fatigue. Patients reported moderate amounts of pain and fatigue. Average pain scores did not vary significantly over a 48-hour period. However, patients reported significantly lower fatigue scores in the morning compared to the evening. In addition, patients experienced significant sleep disturbances, with a mean sleep efficiency index of 70.7% (estimated using wrist actigraphy). Patients with lower Karnofsky Performance Status scores reported more sleep disturbances. In addition, patients who had received a higher percentage of their radiation treatment reported more sleep disturbances. Patients used a variety of self-care strategies to manage pain and fatigue. Additional research is warranted to describe more completely the patterns of pain, fatigue, and sleep disturbances in oncology outpatients receiving radiation therapy.

Longitudinal changes in fatigue and energy during pregnancy and the postpartum period

OBJECTIVE

To describe perceived levels of fatigue and energy before, during, and after pregnancy in a group of healthy women experiencing uncomplicated pregnancies; and to examine relationships between their perception of fatigue and energy, parity, and physiologic indicators of sleep disturbances, thyroid function, and iron deficiency.

DESIGN

Prospective, longitudinal.

SETTING

Participants' homes.

PARTICIPANTS

Convenience sample of 24 primiparous and 1 8 multiparous women.

MAIN OUTCOME MEASURES

Change in fatigue and energy over time. Measures were obtained at follicular and luteal phases of the menstrual cycle before pregnancy, at each trimester, and at 1 and 3 months after delivery.

RESULTS

Younger age and lower prepregnancy levels of iron, ferritin, and hemoglobin explained 1st trimester fatigue. Less total sleep was related to fatigue in the 3rd trimester. Postpartum fatigue was related to reduced amounts of sleep and low levels of ferritin and hemoglobin.

CONCLUSIONS

With the exception of premenstrual (luteal) fatigue, progesterone levels were unrelated to fatigue. Neither paid employment nor family variables influenced perception of fatigue. Nurses working with childbearing populations should counsel women about significant 1st trimester fatigue so they can prepare their work and home environments in an attempt to achieve adequate rest.

The fatigue experience for women with human immunodeficiency virus

PURPOSE

To examine fatigue as a symptom experienced by women with human immunodeficiency virus (HIV).

SAMPLE

A convenience sample of 100 women with HIV.

ANALYSIS

Independent sample t-tests were used to test for mean differences in fatigue related to variables in the women's sociocultural and home environment (ethnicity, employment, marital status, and parenting). Pearson product moment correlations were used to examine significant relationships between fatigue and physiologic variables (age, CD4 cell count, and sleep).

FINDINGS

Lower CD4 cell counts were related to more daytime sleep, higher evening fatigue, and higher morning fatigue. Morning fatigue was related to duration of wake episodes during the night, napping, and perception of sleep disturbance during the past week. The number of awakenings during the first night predicted the severity of fatigue the next evening.

CONCLUSION

To understand the fatigue experienced by women with HIV, researchers and clinicians must focus on the relative contributions of sociocultural, home, and physiologic environments within which these women live. Additional research is ongoing to identify the strategies these women use to manage daily activities such that gender-relevant and culturally relevant interventions for alleviating fatigue can be tested in women with a variety of chronic illnesses, including HIV and acquired immune deficiency syndrome.

Gender differences in sleep patterns for early adolescents

PURPOSE

To describe gender differences in self-reported sleep disturbances and daytime sleepiness in an urban sample of early adolescents (11-14 years of age).

METHODS

One hundred and forty-four racially diverse sixth- to eighth-grade students responded to an investigator-developed sleep questionnaire. Variables included school night and weekend sleep patterns as well as factors that influence sleep and daytime sleepiness, such as sleep/wake routine and alcohol and caffeine consumption.

RESULTS

Boys consumed significantly more caffeinated beverages than girls, but this did not correlate with self-reports of waking after sleep onset. Caffeine intake was significantly related to self-reported parasomnias. Significant gender differences were found for self-reports of daytime sleepiness. There were also large variations between weekday and weekend sleep schedules. Weekday wakeup time for boys was significantly later compared to girls. Those who reported consumption of alcohol during the past week were likely to fall asleep in the classroom before lunch. Girls, who awakened earlier than boys on school days, were more likely to report falling asleep on the way home from school.

CONCLUSIONS

These descriptive data support the need for further investigation into the relationship between caffeine intake and parasomnias, as well as into the observed gender differences.

Herpes simplex virus type 1 vector-mediated expression of nerve growth factor protects dorsal root ganglion neurons from peroxide toxicity

Nerve growth factor beta subunit (beta-NGF) transgene delivery and expression by herpes simplex virus type 1 (HSV-1) vectors was examined in a cell culture model of neuroprotection from hydrogen peroxide toxicity. Replication-competent (tk- K mutant background) and replication-defective (ICP4(-);tk- S mutant background) vectors were engineered to contain the murine beta-NGF cDNA under transcriptional control of either the human cytomegalovirus immediate-early gene promoter (HCMV IEp) (e.g., KHN and SHN) or the latency-active promoter 2 (LAP2) (e.g., KLN and SLN) within the viral thymidine kinase (tk) locus. Infection of rat B103 and mouse N2A neuronal cell lines, 9L rat glioma cells, and Vero cells with the KHN or SHN vectors resulted in the production of beta-NGF-specific transcripts and beta-NGF protein reaching a maximum at 3 days postinfection (p.i.). NGF protein was released into the culture media in amounts ranging from 10.83 to 352.86 ng/ml, with the highest levels being achieved in B103 cells, and was capable of inducing neurite sprouting of PC-12 cells. The same vectors produced high levels of NGF in primary dorsal root ganglion (DRG) cultures at 3 days. In contrast to HCMV IEp-mediated expression, the LAP2-NGF vectors showed robust expression in primary DRG neurons at 14 days. The neuroprotective effect of vector produced NGF was assessed by its ability to inhibit hydrogen peroxide-induced neuron toxicity in primary DRG cultures. Consistent with the kinetics of vector-mediated NGF expression, HCMV-NGF vectors were effective in abrogating the toxic effects of peroxide at 3 but not 14 days p.i. whereas LAP2-NGF vector transduction inhibited apoptosis in DRG neurons at 14 days p.i. but was ineffective at 3 days p.i. Similar kinetics of NGF expression were observed with the KHN and KLN vectors in latently infected mouse trigeminal ganglia, where high levels of beta-NGF protein expression were detected at 4 wks p.i. only from the LAP2; HCMV-NGF-driven expression peaked at 3 days but could not be detected during HSV latency at 4 weeks. Together, these results indicate that (i) NGF vector-infected cells produce and secrete mature, biologically active beta-NGF; (ii) vector-synthesized NGF was capable of blocking peroxide-induced apoptosis in primary DRG cultures; and (iii) the HCMV-IEp functioned to produce high levels of NGF for several days; but (iv) only the native LAP2 was capable of long-term expression of a therapeutic gene product in latently infected neurons in vivo.

The Hispanic teen mother's origin of birth, use of prenatal care, and maternal and neonatal complications

The purpose of this study was to describe and compare differences in demographics, prenatal care use, and pregnancy, labor, postpartum, and neonatal complications for 129 pregnant Mexican-American adolescents who were either born in the United States or born in Mexico. A significant finding was that 25% of the teens, regardless of origin of birth, received either inadequate or no prenatal care. The findings of this study will be useful to clinicians providing health care for Hispanic teens and for administrators and policy makers who affect the types of health care and education available to these young mothers.

The EWS/ATF1 fusion protein contains a dispersed activation domain that functions directly

Naturally occurring chromosomal fusion of the Ewings Sarcoma Oncogene (EWS) to distinct cellular transcription factors, produces aberrant transcriptional activators that function as dominant oncogenes. In Malignant Melanoma of Soft Parts the N-terminal region of EWS is fused to C-terminal region of the cAMP-inducible transcription factor ATF1. The EWS/ATF1 fusion protein binds to ATF sites present in cAMP-responsive promoters via the ATF1 bZIP domain and activates transcription constitutively in a manner that is dependent on an activation domain (EAD) present in EWS. To further define the requirements for trans-activation we have performed mutational analysis of EWS/ATF1 in mammalian cells and report several new findings. First, trans-activation by EWS/ATF1 does not require dimerisation with other ATF family members present in mammalian cells. Second, in contrast to the earlier suggestion of an allosteric role, the EAD can act directly. Third, determinants of trans-activation are dispersed throughout the EAD and cooperate synergistically to produce potent trans-activation. We also report that the region of EWS containing the EAD can activate transcription in Yeast. This latter finding might enable a genetic approach to understanding the mechanism of transcriptional activation by EWS and development of high-throughput screens for EWS inhibitors.

MMSP tumor cells expressing the EWS/ATF1 oncogene do not support cAMP-inducible transcription

Malignant Melanoma of Soft Parts (MMSP) is associated with the EWS/ATF1 fusion protein that arises due to chromosomal fusion of the Ewings Sarcoma oncogene (EWS) and the cellular transcription factor ATF1. EWS/ATF1 can activate several cAMP-inducible promoters, suggesting that cellular transformation in MMSP might involve constitutive activation of cAMP-inducible promoters. To assess this possibility we have examined the status of the cAMP-signaling pathway in the available MMSP-derived cell lines (DTC1 and Su-ccs-1) and find that both cell lines share several features. First, in contrast to previous effects observed in transient assays, three chromosomal promoters containing ATF binding sites are not constitutively activated by endogenous EWS/ATF1 in MMSP cells. Second, all the components that are known to be required for cAMP-inducible transcription are present. Third, phosphorylation of the cAMP-response-element-binding protein (CREB) can be efficiently induced by cAMP. Fourth, cAMP is unable to activate transcription, as assessed by a GAL4/ATF1 reporter assay and analysis of the c-fos and adenovirus early promoters. Thus, cell lines derived from MMSP have a block to cAMP-signaling that lies downstream of CREB phosphorylation. In light of the cAMP-responsiveness of almost all mammalian cell types, our findings suggest that the inability to respond to cAMP might be an important feature of MMSP cells.