Identifying intimate partner violence: comparing the Chinese Abuse Assessment Screen with the Chinese Revised Conflict Tactics Scales

OBJECTIVE

To assess the measurement accuracy and the utility of the Chinese Abuse Assessment Screen (AAS).

DESIGN

A cross-sectional study.

SETTING

An antenatal clinic of a public hospital and a community centre in Hong Kong.

SAMPLE

A total of 257 Chinese women consisting of 100 pregnant women and 157 nonpregnant women.

METHOD

The Chinese AAS was administered first, followed by the Chinese Revised Conflict Tactics Scales (CTS2). This was performed in the same sitting, and each participant was interviewed once either at an antenatal clinic (for the pregnant women sample) or at a community centre (for the nonpregnant women sample).

MAIN OUTCOME MEASURES

Estimates of the sensitivity, specificity, positive and negative predictive values and positive and negative likelihood ratios.

RESULTS

Using the Chinese CTS2 as the standard, the specificity estimates of the Chinese AAS for emotional, physical and sexual abuse were > or = 89%, while the sensitivity estimates varied from 36.3 to 65.8%. The sensitivity improved in the screening for more severe cases (66.7%). The positive predictive values were > or = 80%, and the negative predictive values varied from 66 to 93%. Factors such as the age difference between the couple and the woman's need for financial assistance were found to be associated with intimate partner violence (IPV).

CONCLUSION

The Chinese AAS has demonstrated satisfactory measurement accuracy and utility for identifying IPV when the Chinese CTS2 was used as the standard.

Tamoxifen, hot flashes, and breast cancer recurrence: Support for pharmacogenetics

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Background: Knowledge of the pharmacogenetics of the CYP2D6 enzyme has been shown to correlate with the efficacy of adjuvant tamoxifen. Women who are ‘extensive metabolizers” of CYP2D6 have an improved relapse free survival and experience more hot flashes than women who have impaired metabolism (Goetz, JCO 2005;23:9312–18). We hypothesized that the development of hot flashes on adjuvant tamoxifen was an indicator of drug metabolism and would correlate with a more favorable outcome than women who did not experience hot flashes. Methods: The WHEL trial enrolled 3,088 breast cancer survivors with stages I (T1c)-IIIA breast cancer, within 2–48 months of initial diagnosis, and age < 75 years to either a dietary intervention (n=1,537) or a control group (n=1,551). Data on the primary tumor, cancer treatment, disease status, and quality of life measures were collected at baseline and annually. Bivariate associations of vasomotor symptoms with age, race/ethnicity, menopausal status, cancer stage, ER and PR status, and time since diagnosis were tested using chi-square tests for categorical and t-tests for continuous variables. A left-truncated Cox proportional hazards model tested the association between recurrence-free survival and hot flashes, adjusting for tumor stage and grade and patient age. Women who died without a new breast cancer event were censored at their date of death; those without a new breast cancer event were censored at December 1, 2006 or the date of their most recent self-report of their breast cancer status. Results: The study sample includes 864 women treated with adjuvant tamoxifen 78% who reported hot flashes, and 69% of those reporting hot flashes also reported night sweats; 4% reported night sweats without hot flashes, and 18% reported neither hot flashes nor night sweats. A delayed entry Cox proportional hazards model adjusting for tumor stage and grade showed that those reporting hot flashes had a hazard ratio of 0.51 of recurrence during the follow-up period (95% CI 0.32–0.79) and that hot flashes were more predictive of outcome for tamoxifen treated patients than were age, grade, hormone receptor status, or stage II cancer. Conclusions: Our results contribute to the data that suggest tamoxifen side effects and efficacy may relate to an individual’s pharmacogenetics.

No significant financial relationships to disclose.

A randomised controlled trial of empowerment training for Chinese abused pregnant women in Hong Kong

OBJECTIVE

To evaluate the effectiveness of an empowerment intervention in reducing intimate partner violence (IPV) and improving health status.

DESIGN

Randomised controlled trial.

SETTING

Antenatal clinic in a public hospital in Hong Kong.

SAMPLE

One hundred and ten Chinese pregnant women with a history of abuse by their intimate partners.

METHODS

Women were randomised to the experimental or control group. Experimental group women received empowerment training specially designed for Chinese abused pregnant women while the control group women received standard care for abused women. Data were collected at study entry and six weeks postnatal.

MAIN OUTCOMES MEASURES

IPV [on the Conflict Tactics Scale (CTS)], health-related quality of life (SF-36) and postnatal depression [Edinburgh Postnatal Depression Scale (EPDS)].

RESULTS

Following the training, the experimental group had significantly higher physical functioning and had significantly improved role limitation due to physical problems and emotional problems. They also reported less psychological (but not sexual) abuse, minor (but not severe) physical violence and had significantly lower postnatal depression scores. However, they reported more bodily pain.

CONCLUSION

An empowerment intervention specially designed for Chinese abused pregnant women was effective in reducing IPV and improving the health status of the women.

Effect of pramlintide on satiety and food intake in obese subjects and subjects with type 2 diabetes

AIMS/HYPOTHESIS

Long-term trials in insulin-treated subjects with type 2 diabetes have shown that adjunctive treatment with the amylin analogue pramlintide reduces HbA(1)c levels and elicits weight loss. While amylin reduces food intake in rodents, pramlintide's effect on satiety and food intake in humans has not yet been assessed.

METHODS

In this randomised, double-blind, placebo-controlled crossover study, 11 insulin-treated men with type 2 diabetes (age 60+/-9 years, BMI 28.9+/-4.8 kg/m(2)) and 15 non-diabetic obese men (age 41+/-21 years, BMI 34.4+/-4.5 kg/m(2)) underwent two standardised meal tests. After fasting overnight, subjects received single subcutaneous injections of either pramlintide (120 microg) or placebo, followed by a preload meal. After 1 h, subjects ate an ad libitum buffet meal. Energy intake and meal duration were measured, as were hunger ratings (using visual analogue scales), and plasma cholecystokinin, glucagon-like peptide-1 and peptide YY concentrations over time.

RESULTS

Compared with placebo, pramlintide reduced energy intake in both the type 2 diabetes (Delta-202+/-64 kcal, -23+/-8%, p<0.01) and obese (Delta-170+/-68 kcal, -16+/-6%, p<0.02) groups, without affecting meal duration. Hunger and hormonal analyte profiles provided evidence that pramlintide may exert a primary satiogenic effect, independently of other anorexigenic gut peptides.

CONCLUSIONS/INTERPRETATION

The results indicate that enhanced satiety and reduced food intake may explain the weight loss observed in long-term pramlintide trials.

The Biomolecular Interaction Network Database and related tools 2005 update

The Biomolecular Interaction Network Database (BIND) (http://bind.ca) archives biomolecular interaction, reaction, complex and pathway information. Our aim is to curate the details about molecular interactions that arise from published experimental research and to provide this information, as well as tools to enable data analysis, freely to researchers worldwide. BIND data are curated into a comprehensive machine-readable archive of computable information and provides users with methods to discover interactions and molecular mechanisms. BIND has worked to develop new methods for visualization that amplify the underlying annotation of genes and proteins to facilitate the study of molecular interaction networks. BIND has maintained an open database policy since its inception in 1999. Data growth has proceeded at a tremendous rate, approaching over 100 000 records. New services provided include a new BIND Query and Submission interface, a Standard Object Access Protocol service and the Small Molecule Interaction Database (http://smid.blueprint.org) that allows users to determine probable small molecule binding sites of new sequences and examine conserved binding residues.

Structural Mechanism of Oxidative Regulation of the Phosphatase Cdc25B via an Intramolecular Disulfide Bond,

Cdc25B phosphatase, an important regulator of the cell cycle, forms an intramolecular disulfide bond in response to oxidation leading to reversible inactivation of phosphatase activity. We have obtained a crystallographic time course revealing the structural rearrangements that occur in the P-loop as the enzyme goes from its apo state, through the sulfenic (Cys-SO(-)) intermediate, to the stable disulfide. We have also obtained the structures of the irreversibly oxidized sulfinic (Cys-SO(2)(-)) and sulfonic (Cys-SO(3)(-)) Cdc25B. The active site P-loop is found in three conformations. In the apoenzyme, the P-loop is in the active conformation. In the sulfenic intermediate, the P-loop partially obstructs the active site cysteine, poised to undergo the conformational changes that accompany disulfide bond formation. In the disulfide form, the P-loop is closed over the active site cysteine, resulting in an enzyme that is unable to bind substrate. The structural changes that occur in the sulfenic intermediate of Cdc25B are distinctly different from those seen in protein tyrosine phosphatase 1B where a five-membered sulfenyl amide ring is generated as the stable end product. This work elucidates the mechanism by which chemistry and structure are coupled in the regulation of Cdc25B by reactive oxygen species.

Remote hot spots mediate protein substrate recognition for the Cdc25 phosphatase

Cdc25B is a phosphatase that catalyzes the dephosphorylation and activation of the cyclin-dependent kinases, thus driving cell cycle progression. We have identified two residues, R488 and Y497, located >20 A from the active site, that mediate protein substrate recognition without affecting activity toward small-molecule substrates. Injection of Cdc25B wild-type but not the R488L or Y497A variants induces germinal vesicle breakdown and cyclin-dependent kinase activation in Xenopus oocytes. The conditional knockout of the cdc25 homolog (mih1) in Saccharomyces cerevisiae can be complemented by the wild type but not by the hot spot variants, indicating that protein substrate recognition by the Cdc25 phosphatases is an essential and evolutionarily conserved feature.

Long-term effects of advice to consume a high-protein, low-fat diet, rather than a conventional weight-loss diet, in obese adults with type 2 diabetes: one-year follow-up of a randomised trial

AIMS/HYPOTHESIS

This study compared the long-term weight loss and health outcomes at 1-year follow-up, after a 12-week intensive intervention consisting of two low-fat, weight-loss diets, which differed in protein content.

METHODS

We randomly assigned 66 obese patients (BMI: 27-40 kg/m2) with type 2 diabetes to either a low-protein (15% protein, 55% carbohydrate) or high-protein diet (30% protein, 40% carbohydrate) for 8 weeks of energy restriction (approximately 6.7 MJ/day) and 4 weeks of energy balance. Subjects were asked to maintain the same dietary pattern for a further 12 months of follow-up.

RESULTS

The study was completed by 38 of the subjects, with equal dropouts in each group. At Week 64, weight reductions against baseline were -2.2+/-1.1 kg (low protein) and -3.7+/-1.0 kg (high protein), p<0.01, with no diet effect. Fat mass was not different from baseline in either group. At Week 12, both diets reduced systolic and diastolic blood pressure by 6 and 3 mm Hg respectively, but blood pressure increased more with weight regain during follow-up in the low-protein group (p< or =0.04). At Week 64, both diets significantly increased HDL cholesterol and lowered C-reactive protein concentrations. There was no difference in the urinary urea : creatinine ratio at baseline between the two groups, but this ratio increased at Week 12 (in the high-protein group only, p<0.001, diet effect), remaining stable during follow-up in both diets.

CONCLUSIONS/INTERPRETATION

A high-protein weight-reduction diet may in the long term have a more favourable cardiovascular risk profile than a low-protein diet with similar weight reduction in people with type 2 diabetes.

An integrated treatment delivery system for CSRS and CSRT and clinical applications

An integrated treatment delivery system for conformal stereotactic radiosurgery (CSRS) and radiotherapy (CSRT) has been developed through a collaboration involving Siemens Medical Systems, Inc., Tyco/Radionics, Inc., and The University of Texas M. D. Anderson Cancer Center. The system consists of a 6-MV linear accelerator (LINAC) equipped with a Tyco/Radionics miniature multileaf collimator (mMLC). For the conventional SRS treatment, the circular collimator housing can be attached to the opening window of the mMLC. The treatment delivery system is integrated with a radiotherapy treatment planning system and a record-and-verify system. The purpose of this study is to report the characteristics, performance, benefits, and the clinical applications of this delivery system. The technical specifications of the LINAC and mMLC were tested, and all the specifications were met. The 80% to 20% penumbral width for each mMLC leaf is approximately 3 mm and is nearly independent of the off-axis positions of a leaf. The maximum interleaf leakage is 1.4% (1.1% on average) and the maximum intra-leaf leakage is 1.0% (0.9% on average). The leaf position precision is better than 0.5 mm for all the leaves. The integration of the SRS/SRT treatment planning system, mMLC, and LINAC has been evaluated successfully for transferring the patient treatment data file through radiotherapy treatment planning system to the patient information and treatment record-and-verify server and the mMLC controller. Subsequently, the auto-sequential treatment delivery for SRS, CSRS/CSRT, and the step-and-shoot intensity-modulated radiotherapy has also been tested successfully. The accuracy of dose delivery was evaluated for a 2-cm spherical target in a Radiological Physics Center SRS head phantom with GAFChromic films and TLD. Five non-coplanar arcs, using a 2-cm diameter circular collimator, were used for this simulation treatment. The accuracy to aim the center of the spherical target was within 0.5 mm and the deviation of dose delivery to the isocenter of the target was within 2% of the calculated dose. For the irregularly shaped tumor, a tissue-equivalent head phantom was used to evaluate the accuracy of dose delivery for using either geometric conformal treatment or IMRT. The accuracy of dose delivery to the isocenter was within 2% and 3% of the calculated dose, respectively. From October 26, 1999 to September 30, 2002, we treated over 400 SRS patients and 70 SRT patients. Four representative cases are presented to illustrate the capabilities of this dedicated unit in performing conventional SRS, CSRS, and CSRT. For all the cases, the geometric conformal-plan dose distributions showed a high degree of conformity to the target shape. The degree of conformity can be evaluated using the target-volume-ratio (TVR). Our preferred TVR values for highly conformed dose distributions range from 1.6 to 2.0. The patient setup reproducibility for the Gill-Thomas-Cosman (GTC) noninvasive head frame ranges from 0.5 to 1 mm, and the head and neck noninvasive frame is within 2 mm. The integrated treatment delivery system offers excellent conformation for complicated planning target volumes with the stereotactic setup approach, ensuring that dose delivery can be achieved within the specified accuracy. In addition, the treatment time is comparable with that of single isocenter multiple-arc treatments.

The CLS uncemented expansion cup: six cases of component failure

We report six cases of fracture of the metal backing of the CLS expansion cup. The aim of this paper is to draw attention to this mode of failure and recommend that in cases of unexplained hip pain in those with a CLS acetabular component X-rays in at least two planes are performed. (Hip International 2004; 14: 28-33).

Synovial sarcoma of the pleura: a clinical and pathologic study of three cases

Synovial sarcomas are rare soft tissue malignancies that most commonly affect the extremities in the vicinity of large joints. These malignancies typically occur in adolescents and young adults between the ages of 15 and 40 years.(1,2) Historically they are believed to originate from primitive pluripotent mesenchyme capable of synovial differentiation. This belief is consistent with the malignancy's origin from sites devoid of normal synovium, such as the pleural cavity. A variety of pleural cavity sarcomas have been described, including liposarcoma,(3) chondrosarcoma,(4) osteosarcoma,(5) and malignant schwannoma.(6) Pleural synovial sarcoma, however, is a much rarer entity. In fact, pleural synovial sarcoma was first described only 6 years ago(7) and has not yet been reported in the surgical literature. Because of its rarity, pleural synovial sarcoma is often mistaken for the histologically similar malignant mesothelioma, the most common of the pleural neoplasms. This is a critical distinction, because synovial sarcoma may be extremely aggressive. Studies in the last 10 years have shown it to be extremely sensitive to ifosfamide-based chemotherapy, and survival of patients with synovial sarcoma has recently increased with chemotherapy, with 5-year survivals now as high as 57%.(8-10) In this report, we describe 3 cases of synovial sarcoma of the pleura. Clinical findings are correlated with pathologic features, including immunohistochemical stains and fluorescence in situ hybridization (FISH) for the identification of the diagnostic chromosomal translocation, t(X;18)(p11.2;q11.2). This delineation of the clinical and pathologic aspects of this rare, newly recognized tumor should increase awareness among the surgical community.

Effects of energy-restricted diets containing increased protein on weight loss, resting energy expenditure, and the thermic effect of feeding in type 2 diabetes

OBJECTIVE

To determine the effect of a high-protein (HP) diet compared with a low-protein (LP) diet on weight loss, resting energy expenditure (REE), and the thermic effect of food (TEF) in subjects with type 2 diabetes during moderate energy restriction.

RESEARCH DESIGN AND METHODS

In this study, 26 obese subjects with type 2 diabetes consumed a HP (28% protein, 42% carbohydrate) or LP diet (16% protein, 55% carbohydrate) during 8 weeks of energy restriction (1,600 kcal/day) and 4 weeks of energy balance. Body weight and composition and REE were measured, and the TEF in response to a HP or LP meal was determined for 2 h, at weeks 0 and 12.

RESULTS

The mean weight loss was 4.6 +/- 0.4 kg (P < 0.001), of which 4.5 +/- 0.4 kg was fat (P < 0.001), with no effect of diet (P = 0.6). At both weeks 0 and 12, TEF was greater after the HP than after the LP meal (0.064 vs. 0.050 kcal x kcal(-1) energy consumed x 2 h(-1), respectively; overall diet effect, P = 0.003). REE and TEF were reduced similarly with each of the diets (time effects, P = 0.02 and P < 0.001, respectively).

CONCLUSIONS

In patients with type 2 diabetes, a low-fat diet with an increased protein-to-carbohydrate ratio does not significantly increase weight loss or blunt the fall in REE.

Intimate partner violence against women

Intimate partner violence against women has received considerable attention from nurse-researchers over the past 10 years. Although the amount and sophistication of both quantitative and qualitative research have changed over time, nursing research on intimate partner violence against women has not lost its perspective; nurse-researchers have continued to address women survivors' full range of human responses to violence. Research into violence during pregnancy and battered women's psychological responses to abuse have received considerable attention. Research into violence during pregnancy and battered women's psychological responses to abuse have received considerable attention. Research into violence during pregnancy accounts for fully 20% of all the reviewed nursing research. The largely qualitative research into women's psychological responses to violence is particularly rich and remarkably similar across multiple studies. International studies on intimate partner violence are beginning to appear in the literature and research that addresses the unique experience of ethnically diverse women is occurring with greater frequency. The purpose of this chapter is to review nursing research on intimate partner violence against women in the past decade. Future directions for nursing research, practice, and education are included.