The cystic fibrosis delta F508 gene mutation and cancer

Following the observation that relatives of cystic fibrosis (CF) patients have an increased mortality due to leukaemia, a study was initiated to determine whether leukaemia patients had an increased prevalence of the delta F508 CF mutation. No increase in carriers were found among leukaemias; however the carrier frequency of the delta F508 mutation appeared to be reduced in patients with malignant melanoma analysed as a control group compared to the normal population. This paper extends our previous study and investigates several other common human tumours, including those of the colon, breast, and lymphoma tissue. Fewer than expected carriers remained among the melanoma group from South Wales. There were fewer than expected carriers among patients with colon cancer compared to the normal population. The prevalence of the delta F508 mutation was normal in lymphomas and leukaemias.

A randomized, controlled trial of child psychiatric assessments conducted using videoconferencing

We used a PC-based videoconferencing system to conduct child psychiatry assessments. The telecommunications link was six digital lines, giving a total bandwidth of 336 kbit/s. Twenty-three patients (aged 4-16 years), accompanied by their parents, completed two psychiatric assessments, one via videoconferencing and another face to face (FTF). The order of assessments was randomized. Questionnaires were used to record the diagnosis, treatment recommendations and the psychiatrists', patients' and their parents' satisfaction with each assessment. An independent evaluator concluded that in 22 cases (96%) the diagnosis and treatment recommendations made via the videoconferencing system were the same as those made FTF. The psychiatrists stated that videoconferencing assessments were an adequate alternative to FTF assessments and did not interfere with diagnosis. However, the responses from the psychiatrist satisfaction questionnaire showed that they preferred FTF assessments. No significant difference was found in the patients' or parents' satisfaction responses after the two types of assessment. The majority of children (82%) 'liked' using the telepsychiatry system and six (26%) preferred it to a FTF assessment. Most parents (91%) indicated that they would prefer to use the videoconferencing system than to travel a long distance to see a psychiatrist in person.

A comparison of the abuse liability and dependence potential of nicotine patch, gum, spray and inhaler

RATIONALE

Nicotine replacement therapy (NRT) in varying forms is becoming widely used. Clinicians, therapists and regulatory authorities are interested in the abuse liability and dependence potential of the different forms.

OBJECTIVES

To compare the abuse liability and dependence potential of nicotine gum, transdermal patch, spray and inhaler.

METHODS

504 male and female smokers seeking help with stopping smoking were randomly allocated to the four products. Measures were taken at the designated quit date, then 1 week, 4 weeks, 12 weeks and 15 weeks later. Smokers were advised to use the product for up to 12 weeks. Those still using the product at the 12-week visit were advised to cease use by week 14. Measures included: pleasantness and satisfaction ratings at weeks 1 and 4 (used as a marker of abuse liability); ratings of feeling dependent on NRT at weeks 1, 4, 12 and 15 (used as a marker of subjective dependence); mood and physical symptoms ratings at weeks 12 and 15 (the change being used to assess physical dependence on NRT), continued usage of NRT at week 15 (used as an marker of behavioural dependence).

RESULTS

Average ratings of pleasantness were low. The nicotine patch was rated as less unpleasant to use than all other products. There were no significant differences between the products in terms of satisfaction or subjective dependence except at week 15 when no patch users rated themselves as dependent. Continued use of NRT at week 15 was related to rate of delivery of nicotine from the products - 2% for patch, 7% for gum and inhaler, 10% for spray (P<0.05 for linear association). Among those

The operative management of screen-detected breast cancers

BACKGROUND

Mammographic screening for breast cancer not only reduces the overall mortality from breast cancer but allows greater opportunities for breast-conserving operations. The predicted degree of breast conservation is not being realized, but is increasing in centres that have published their results.

METHODS

The operative management of breast cancers diagnosed by BreastScreen Central and Eastern Sydney Screening and Assessment Service were compared between two time periods: January 1988-December 1992 (group 1) and January 1993-December 1995 (group 2). The rate of breast conservation, and other data were compared between the two periods. An attempt was made with multivariate analysis to identify some of the factors that made mastectomy rather than conservation more likely.

RESULTS

There were 723 cancers detected that were suitable for analysis (group 1, n = 273; group 2, n = 450). In group 1 the breast conservation rate was 42.9%; this increased significantly to 60.4% in group 2 (P < 0.001). The data were examined to determine if there was any other factor that had changed over the time periods which might account for the increased rate of breast conservation. The use of pre-operative diagnostic techniques such as fine needle aspirate cytology and core biopsy increased significantly. Multivariate analysis comparing the differences in patient age, diagnostic technique, tumour type, grade, size, location and lymph node status, both independently and compositely did not account for the increase in breast conservation in group 2.

CONCLUSION

The increase in breast conservation is due to other factors such as the surgeons' approach and patient attitude. The use of pre-operative, minimally invasive tissue sampling techniques is increasing.

Age-related decline in inhibitory control contributes to the increased Stroop effect observed in older adults

Past research has demonstrated an age-related increase in the Stroop effect. Some theorists have suggested that this increase results from a decline in the ability to inhibit word information on incongruent trials, whereas others have suggested that the decline reflects general slowing. These two hypotheses were evaluated using event-related brain potentials (ERPs) measured while younger and older adults performed the Stroop task. As expected, the Stroop effect was greater for older than younger adults. The ERP data revealed a selective age-related attenuation of two modulations reflecting the inhibition of word information on incongruent trials. Latency of the P3 wave did not increase to a greater extend for older than younger adults from the congruent to incongruent trials as expected based on the general slowing hypothesis. Taken together, these findings support the inhibitory deficit hypothesis by demonstrating an age-related decline in a conceptual level inhibitory process that supports the suppression of word information in the Stroop task.

Symptom attribution and the recognition of psychiatric morbidity

OBJECTIVE

Patients' interpretation of ambiguous physical symptoms may influence illness presentation in primary care. The present study sought to investigate the influence of symptom attribution style on the recognition of psychiatric morbidity by general practitioners (GPs).

METHODS

Patients consulting GPs completed assessments of attribution style and General Health Questionnaires (GHQs), while GPs provided independent ratings of psychiatric distress. Analysis examined the relationship between patient demographic variables, attribution style (using the Symptom Interpretation Questionnaire [SIQ]), and GP and GHQ assessments of patients' mental health.

RESULTS

The results indicate that severity of disorder and patient age were reliable predictors of recognition: normalizing and psychological attributions were additional predictors in some analyses, but their effects were inconsistent.

CONCLUSIONS

The results provide some support for the role of symptom attribution in the recognition of psychiatric morbidity, but suggest that the predictive value of such attributions may be relatively modest. The SIQ may not be the optimum instrument for the measurement of attributions.

Does exercise aid smoking cessation? A systematic review

AIMS

To assess the effectiveness of exercise-based interventions in smoking cessation.

DESIGN

A systematic review was conducted of articles published between 1980 and 1999. The review focused on randomized controlled trials (RCTs) in which the specific effects of exercise on smoking abstinence were examined. The primary dependent variable was smoking abstinence. Other studies which had both exercise programming as an independent variable and smoking behaviour as a dependent variable are briefly discussed.

PARTICIPANTS

The review included interventions targeting both healthy individuals and those with specific medical conditions.

SETTINGS

The interventions were delivered in both community and inpatient settings.

MEASUREMENTS

Information extracted from each article included details of the participants, exercise and smoking cessation programmes, control conditions, exercise adherence rates, length of follow-up and outcomes.

FINDINGS

Of the eight trials satisfying our inclusion criteria, only two trials found a positive effect for exercise on smoking abstinence. The others showed no effect.

CONCLUSIONS

There is some evidence for exercise aiding smoking cessation. Of the two trials finding a positive effect one was rigorously designed, the other was found to have numerous methodological limitations. Trials showing no effect lacked sensitivity. This was principally because of small sample sizes and inadequate measurement and control of exercise adherence. There is a need for more rigorously designed studies in this area.

Addressing regulatory barriers to licensing nicotine products for smoking reduction

This paper examines the current regulatory obstacles to extending the permitted use of NRT, and to include smoking reduction ways of addressing these. There are major differences between different countries in regulations concerning NRT. These differences appear to be due to different attitudes to cigarette smoking as an issue and different preconceptions about nicotine as an addictive and potentially toxic drug. The paper considers how existing WHO and American Psychiatric Association definitions of mental disorders may be used in submitting proposals for use of NRT as an aid to smoking reduction and how concerns over safety and abuse and dependence liability can be addressed. It also examines what new evidence may be needed. Coordinating the efforts of the pharmaceutical industry, clinicians and researchers will probably be important in moving regulatory authorities further in the direction of accepting NRT for widespread use in smoking reduction.

Exercise interventions for smoking cessation

BACKGROUND

Taking exercise may help people give up smoking by moderating the effects of nicotine withdrawal.

OBJECTIVES

To determine whether exercise-based interventions combined with a smoking cessation programme are more effective than a smoking cessation intervention alone.

SEARCH STRATEGY

We searched The Cochrane Tobacco Addiction group specialised register for studies including the terms 'exercise' or 'physical activity' in February 2000.

SELECTION CRITERIA

We included randomised trials comparing an exercise programme as an adjunct to a cessation programme with a cessation programme alone, recruiting smokers or recent quitters, and with a follow-up of 6 months or more.

DATA COLLECTION AND ANALYSIS

We extracted data on study characteristics and smoking outcomes. Because of differences in studies we summarised the results narratively, making no attempt at meta-analysis.

MAIN RESULTS

We identified eight trials, six of which had fewer than 25 people in each treatment arm. They varied in the timing and intensity of the smoking cessation and exercise programmes. Only one trial showed a significant benefit from the exercise programme at long term follow-up.

REVIEWER'S CONCLUSIONS

Only one of the eight trials offered evidence for exercise aiding smoking cessation but the other trials were too small to exclude reliably an effect of intervention. Trials are needed with larger sample sizes, equal contact control conditions, tailored and lifestyle exercise programmes and measures of exercise adherence.

Acute effect of glucose tablets on desire to smoke

RATIONALE

Previous research suggests that glucose may reduce desire to smoke during periods of abstinence but a definitive test is needed.

OBJECTIVE

The present study aimed to determine whether a single administration of oral glucose would reduce desire to smoke in abstaining smokers.

METHODS

Thirty-eight smokers attended the laboratory in the afternoon having not smoked since the previous evening. They rated their desire to smoke immediately before and at 5-min intervals for 20 min after chewing four 3-g glucose tablets (experimental group) or four matched placebo tablets (control group).

RESULTS

Ratings of desire to smoke decreased to a greater extent in the experimental than the control group. The effect was apparent after 10 min. There was no difference between the groups in terms of feeling "sick" or "satisfied".

CONCLUSION

A single dose of glucose has a relatively rapid and detectable effect on desire to smoke and the effect is not mediated by feeling sick. Glucose tablets may be useful in helping to control desire to smoke during periods of abstinence.

Visual distraction, working memory, and aging

In two experiments, the effects of taxing selective attention processes on the efficiency of working memory processes were considered in relation to normal aging. In both experiments, the presence of task-irrelevant information disrupted the efficiency of working memory processes, and the effect was generally greater for older than for younger adults. The presence of distracting information increased the frequency of intrusion errors in both younger and older adults and of memory-based errors in older adults. These findings suggest that distraction disrupts both the ability to maintain a coherent stream of goal-directed thought and action in younger and older adults and the encoding and retention of relevant information in older adults.

Randomized comparative trial of nicotine polacrilex, a transdermal patch, nasal spray, and an inhaler

BACKGROUND

There are several nicotine replacement products on the market, and physicians are likely to be asked with increasing frequency about which of these products their patients should use.

OBJECTIVE

To provide a basis for rational advice by comparing nicotine polacrilex (gum), a transdermal patch, nasal spray, and an inhaler.

DESIGN

Randomized trial with assessments at the quit date and 1, 4, and 12 weeks later.

SETTING

Hospital smokers' clinic.

PATIENTS

Male and female community volunteers (N = 504) smoking 10 or more cigarettes per day and seeking help to stop smoking.

INTERVENTIONS

Patients were given brief advice, and purchased their nicotine replacement treatment at approximately half the regular retail price.

MAIN OUTCOME MEASURES

Nicotine replacement treatment use, ratings of withdrawal symptoms, ratings of product characteristics and helpfulness, and biochemically validated continuous lapse-free abstinence.

RESULTS

The products did not differ in their effects on withdrawal discomfort, urges to smoke, or rates of abstinence. The continuous validated 12-week abstinence rates were 20%, 21%, 24%, and 24% in the gum, patch, spray, and inhaler groups, respectively. Compliance with recommended nicotine replacement treatment use was high for the patch, low for gum, and very low for the spray and the inhaler. The spray was underused because of adverse effects more often than the other products. In the subjects using the spray, the level of use among abstainers at week 1 predicted outcome at week 12. The inhaler was rated as more embarrassing to use than the other products, but provided at least as much nicotine as the gum.

CONCLUSION

When asked about nicotine replacement treatment products available, physicians should note that, despite low compliance with the recommended dose of the spray and inhaler and differences in product ratings, overall, there are no notable differences between the products in their effects on withdrawal discomfort, perceived helpfulness, or general efficacy.

Age-related decline in prospective memory: the roles of cue accessibility and cue sensitivity

In two experiments the authors evaluated the hypothesis that age-related decline in prospective memory reflects momentary lapses of intention (MLIs), and explored two factors, cue sensitivity and accessibility, that may contribute to MLIs. MLIs were reliably greater than zero in Experiment 1, indicating that performance fluctuated over the course of the task. Analysis of the response latency data (RL) revealed that older adults demonstrated elevated RL for missed prospective cues and were much slower to respond correctly to prospective cues than younger adults. These findings indicate preserved cue sensitivity in later adulthood and an age-related decline in cue accessibility. Experiment 2 demonstrated that cue sensitivity did not result from an orienting response to the perceptual novelty associated with the prospective cues.

A cephalometric study of class II Division 1 malocclusions treated with the Jasper Jumper appliance

This lateral cephalometric study investigated the dental and skeletal effects of the Jasper Jumper appliance used in the correction of Class II Division 1 malocclusions. A sample of 36 growing patients treated with the Jasper Jumper appliance was divided into two groups: (1) 24 patients with records obtained at the start and completion of orthodontic treatment, and (2) 12 patients with records available at the beginning and end of the Jumper phase of treatment. Treatment effects were determined by statistical comparisons of cephalometric changes in the patients relative to age-adjusted cephalometric standards, and from structural superimpositions. While the Jumpers were in place, maxillary incisors were retroclined and the molars were moved distally, tipped back, and intruded. The mandibular incisors were proclined and intruded, while the molars were translated mesially, tipped forward, and extruded. Skeletal measures showed reduced forward maxillary displacement and no significant alteration of horizontal mandibular growth. During orthodontic finishing, molar tipping and maxillary incisor retroclination were corrected, although the mandibular incisors remained proclined. In summary, this study found that the Jasper Jumper appliance corrected Class II discrepancies largely through maxillary and mandibular dentoalveolar effects and, to a limited extent, by restraint of forward maxillary growth.

Event-related neural activity associated with the Stroop task

The time course of neural activity supporting performance during the Stroop task was investigated using event-related brain potentials (ERPs). Four spatially and temporally distinct modulations were observed differentiating the ERPs elicited by incongruent trials from the ERPs elicited by congruent, neutral, or word identification trials. Two of these modulations reflected increased negativity over the fronto-central region and positivity over the fronto-polar region for incongruent trials and may reflect conflict detection and resolution processes. The other modulations, distributed over the left parietal and temporo-parietal regions, may reflect the activity of a meaning-based conceptual level system active during congruent, neutral, and word identification trials; and the activity of a perceptual level system supporting task performance when only color information can guide an efficient response on incongruent trials.

Age-related decline in prospective memory: the roles of cue accessibility and cue sensitivity

In two experiments the authors evaluated the hypothesis that age-related decline in prospective memory reflects momentary lapses of intention (MLIs), and explored two factors, cue sensitivity and accessibility, that may contribute to MLIs. MLIs were reliably greater than zero in Experiment 1, indicating that performance fluctuated over the course of the task. Analysis of the response latency data (RL) revealed that older adults demonstrated elevated RL for missed prospective cues and were much slower to respond correctly to prospective cues than younger adults. These findings indicate preserved cue sensitivity in later adulthood and an age-related decline in cue accessibility. Experiment 2 demonstrated that cue sensitivity did not result from an orienting response to the perceptual novelty associated with the prospective cues.