Abstract P6-20-04: Activation of AR inhibits growth of endocrine-resistant breast cancer

Introduction

Resistance to endocrine therapy is a major clinical problem in estrogen receptor positive (ER+) breast cancer. The androgen receptor (AR) is expressed in ˜90% of all ER+ breast cancers and high expression of AR is associated with a better patient outcome in this subtype. In agreement, AR activation in breast cancer cell line models reduces proliferation of cells via antagonism of ER signaling. However, uncertainty surrounding the role of AR in endocrine resistance is reflected in current clinical trials in which both AR agonists and antagonists are being investigated. In this study, we sought to investigate the optimal approach in targeting AR in endocrine-resistant breast cancer.

Methods

We evaluated the consequences of AR activation, using AR cognate ligand 5α-dihydrotestosterone (DHT) and selective AR modulator enobosarm, and AR antagonism using enzalutamide on in vitro and in vivo models of endocrine-resistance. The efficacy of these AR modulators were assessed in vitro using tamoxifen-resistant (TamR) and long-term estrogen derived (LTED) models of MCF7 cells, and in vivo using ESR1 mutant E2-dependent (HCI-005) and ESR1 wild-type E2-independent (Gar15-13) endocrine-resistant PDX models

Results

Treatment with DHT and enobosarm inhibited the growth of MCF7 TamR and LTED cells but enzalutamide had no effect. AR activation was associated with loss of ER in MCF7 TamR cells and loss of ER-regulated PR expression in MCF7 LTED which suggests that this growth suppression was mediated through the antagonism of ER signaling. Notably, an additive anti-proliferative effect was observed with the combination of enobosarm and CDK4/6 inhibitor palbocilib in the MCF7 TamR cells. A similar pattern was observed in vivo with DHT strongly inhibiting the proliferation of both PDX models. Enobosarm similarly suppressed the proliferation of HCI-005, and to a lesser extent in Gar15-13. The benefit of enobosarm in Gar15-13 was significant given that this model is fulvestrant-resistant. Antagonizing AR with enzalutamide had no effect on growth of Gar15-13 model, similar to our in vitro data. AR agonists reduced expression levels of ER and PR in HCI-005, and transcriptomic analysis of AR agonist-treated Gar15-13 identified significant negative enrichment of genes related to proliferation and estrogen response. These observations indicate that the growth-suppressive effects of AR activation in vivo were mediated through inhibiting ER signaling. We identified an AR gene signature, through RNA-seq analysis of DHT-treated Gar15-13 PDX, which is strongly associated with good outcome in the METABRIC dataset, supporting the hypothesis that an active canonical AR signaling is tumor suppressive in both endocrine-sensitive and -resistant disease contexts. Lastly, we present in vivo data demonstrating enhanced suppression of Ki-67 with the combination of enobosarm and palbociclib in the Gar15-13 PDX.

Conclusion

We have demonstrated that activating AR is an effective therapeutic approach in endocrine-resistant breast cancer, and the combination of an AR agonist with a CDK4/6 inhibitor warrants further investigation in this breast cancer subtype.

Citation Format: Chia KM, Milioli H, Portman N, Laven-Law G, Yong A, Swarbrick A, Caldon L, Tilley W, Hickey T, Lim E. Activation of AR inhibits growth of endocrine-resistant breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-20-04.

Evaluation of Testosterone Supplementation during Anastrozole Therapy in a Breast Explant Model

Background: Aromatase inhibitors (AI) are currently used as first line adjuvant therapy for postmenopausal women with estrogen receptor (ER) positive breast cancer. Side effects of AI therapy, such as arthralgia, can cause significant patient discomfort leading to compliance issues. This may be exacerbated by low tissue testosterone (T), which is naturally lower post-menopause and may be decreased further following chemotherapy. T supplementation has emerged as a potential means to treat AI-associated arthralgia and has generated favourable results in a phase II clinical trial (NCT00497458). However, T replacement in breast cancer had been contraindicated until the advent of powerful 3rd generation AIs such as anastrozole. AIs are highly efficacious in blocking conversion of T to estrogen, thereby increasing the potential for 5α-reduction of T to its more active tissue form, 5α-dihydrotestosterone (DHT), which counterbalances estrogen induced proliferative effects in hormonally sensitive breast tumors1. Our objective was to test the effects of T supplementation during AI administration on tumor growth in a human breast explant system.Materials and Methods: Fresh breast tumor samples collected from 17 post-menopausal women were cut into 3 mm3 pieces, cultured for 24h on gelatine sponges submersed in culture media with 10% steroid depleted fetal calf serum and treated with vehicle (control), T (5nM) and/or AI (25ng/ml). Tissues were stained with antibodies for ER, progesterone receptor (PR), androgen receptor (AR), and Ki67, a marker of cell proliferation that has been used to predict the outcome of therapy with anastrozole2. Tissue sections were scanned using a high resolution image scanner (NanoZoomer) and the percent Ki67 positive cells was determined by counting at least 2000 cells per slide.Results: All tumor tissues were positive (>30%) for ER, AR and PR, with the exception of 1 tumor that lacked PR. As expected for primary tissues, percent Ki67 positivity (mean; range) in the control was highly variable (6.45; 1-43.2). Tissue responses to T (7.9; 0.1-46), AI (6.06; 1.4-35.3), and T+AI (4.97; 0.7-26.1) were not significantly different from control (Wilcoxon signed rank test). However, the combination of T+AI showed a trend towards reduced Ki67 positivity compared to AI alone (p=0.07). In two patients T significantly increased Ki67 positivity by 2-4 fold, and in both instances this stimulatory effect of T was reduced to or below control values by treatment with AI.Discussion: Our results suggest that T supplementation during adjuvant AI therapy does not compromise AI-mediated inhibition of breast tumor growth. Indeed, combined therapy with T and AI may further enhance tumor suppression through elevation of DHT levels in the breast. This finding supports the clinical potential of T supplementation in post-menopausal women on adjuvant AI therapy to prevent or relieve AI-associated side effects.1. Peters A et al Cancer Res (In Press)2. Dowsett M et al JNCI 2007

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 4089.

415. Increased expression of an androgen receptor regulated gene, kit ligand, in polycystic ovaries

Polycystic ovaries (PCO) are induced by pathological or pharmacological female androgen excess, but the role of the androgen receptor (AR) in the pathogenesis of PCO is unknown. We therefore tested the hypothesis that PCO have increased expression of AR or kit ligand (KITL), a cytokine that was recently identified as a candidate AR-regulated gene in the ovary (1). Immunohistochemical analysis of AR and KITL expression was performed on archival paraffin-embedded sections of 8 morphologically normal and 8 polycystic ovaries from women under the age of 40 years. Stained sections were scanned with a NanoZoomer Digital Pathology System and immunoreactivity was qualitatively assessed using a 0-3+ scale, where 3+ represents the most intense staining. Electronic images of follicles at different stages of folliculogenesis were assessed by two independent observers who were blinded to the morphology of the source ovary. Each individual ovary contributed a minimum of 1 follicle per size class and a minimum of 10 follicles per size class were analysed. AR immunoreactivity was present in granulosa cells at all stages of folliculogenesis, in thecal cells of large antral follicles, and in the ovarian stroma. Staining intensity for AR did not differ between normal and polycystic ovaries. KITL expression, summarised in Table 1, was found to be significantly elevated in the oocytes of primordial and primary follicles and in the granulosa cells of follicles at all stages of folliculogenesis. These results show that AR expression is normal in PCO but expression of an AR-regulated gene is increased, potentially due to an excess of androgen hormone that is characteristic of women with PCO. Based on the roles of KITL established by murine studies, increased expression of KITL could explain many of the features of PCO including follicle excess, hyperthecosis and abnormal androgen secretion.

Characterization and biocompatibility studies of novel humic acids based films as membrane material for an implantable glucose sensor

Multilayered films of humic acids (HAs) (naturally occurring biopolymers) were investigated as a potential semipermeable membrane for implantable glucose sensors. These films were grown using a layer-by-layer self-assembly process of HAs and oppositely charged ferric ions. The growth of these assemblies exhibited strong dependence on the pH and ionic strength of HAs solutions, which correlated with the degree of ionization of the carboxyl groups and neutralization-induced surface spreading. Quartz crystal microbalance (QCM) and ellipsometric studies have shown repeatable, stepwise increase in mass (as high as 5.63 microg/cm(2)) and in film thickness (ca. 24.3 nm per layer) for these assemblies. The permeability of glucose through these membranes can be regulated by varying the number of self-assembled HAs/Fe(3+) layers. Moreover, a 200 nm thick HAs/Fe(3+) film (in its hydrated state) had a shear modulus of about 80 MPa, implying stability upon implantation. These films were determined to be biocompatible since in vivo studies indicated only mild tissue reaction along with some neovascularization.

In vivo evaluation of a dexamethasone/PLGA microsphere system designed to suppress the inflammatory tissue response to implantable medical devices

The purpose of this research effort was to evaluate in vivo a newly developed dexamethasone/PLGA microsphere system designed to suppress the inflammatory tissue response to an implanted device, in this case a biosensor. The microspheres were prepared using an oil/water (O/W) emulsion technique. The microsphere system was composed of drug-loaded microspheres (including newly formulated and predegraded microspheres) and free dexamethasone. The combination of the drug and drug-loaded microspheres provided burst release of dexamethasone followed by continuous release from days 2-14. Continuous release to at least 30 days was achieved by mixing predegraded and newly formulated microspheres. The ability of our mixed microsphere system to control tissue reactions to an implant then was tested in vivo using cotton thread sutures to induce inflammation subcutaneously in Sprague-Dawley rats. Two different in vivo studies were performed, the first to find the dosage level of dexamethasone that effectively would suppress the acute inflammatory reaction and the second to show how effective the dexamethasone delivered by PLGA microspheres was in suppressing chronic inflammatory response to an implant. The first in vivo study showed that 0.1 to 0.8 mg of dexamethasone at the site minimized the acute inflammatory reaction. The second in vivo study showed that our mixed microsphere system suppressed the inflammatory response to an implanted suture for at least 1 month. This study has proven the viability of microsphere delivery of an anti-inflammatory to control the inflammatory reaction at an implant site.

Dexamethasone/PLGA microspheres for continuous delivery of an anti-inflammatory drug for implantable medical devices

The purpose of this research was to develop polylactic-co-glycolic acid (PLGA) microspheres for continuous delivery of dexamethasone for over a 1-month period, in an effort to suppress the acute and chronic inflammatory reactions to implants such as biosensors, which interfere with their functionality. The microspheres were prepared using an oil-in-water emulsion technique. The oil phase was composed of 9:1 dichloromethane to methanol with dissolved PLGA and dexamethasone. Some microspheres were predegraded for 1 or 2 weeks. Ten percent of polyethylene glycol was added to the oil phase in alternative formulations to delay drug release. The in vitro release studies were performed in a constant temperature (37 C) warm room, in phosphate-buffered saline at sink conditions. Drug loading and release rates were determined by HPLC-UV analysis. The standard microsphere systems did not provide the desired release profile since, following an initial burst release, a delay of 2 weeks occurred prior to continuous drug release. Predegraded microspheres started to release dexamethasone immediately but the rate of release decreased after only 2 weeks. A mixed standard and predegraded microsphere system was used to avoid this delay and to provide continuous release of dexamethasone for 1 month.

The androgen receptor CAG repeat polymorphism and X-chromosome inactivation in Australian Caucasian women with infertility related to polycystic ovary syndrome

The human androgen receptor (AR) gene contains a polymorphic trinucleotide (CAG) repeat sequence in exon 1. The number of CAG repeats may confer differential receptor activity, and specific ranges of variants have been correlated with androgen-sensitive disease processes. Polycystic ovary syndrome (PCOS) is a female condition characterized by androgen excess and infertility, many features of which are effected through the AR. We compared frequency distributions of CAG repeat alleles and their pattern of expression via X-inactivation analysis among 83 fertile women and 122 infertile women with PCOS, all of Australian Caucasian ethnicity. A population comparison with 831 predominantly fertile Australian women was also used. PCR-based assays were used to genotype each woman and assess allele inactivation patterns after digestion of DNA with methylation-sensitive HpaII. Infertile women with PCOS exhibited a greater frequency of CAG alleles or biallelic means greater than 22 repeats compared with both the fertile control group (P < 0.05) and the general population (P < 0.01). Preferential expression of longer CAG repeat alleles was also observed in PCOS and correlated with increased serum T. We conclude that the AR (CAG)n gene locus and/or its differential methylation patterns influence the disease process leading to PCOS.

Cognitive impairment and functional status in elderly institutionalized patients with schizophrenia

OBJECTIVE

The relationship of cognitive impairment to functional status in older adults with schizophrenia was investigated.

PATIENTS

Ninety-three psychiatric inpatients with schizophrenia between the ages of 65 and 88 years. Two subsets of this sample, consisting of 48 and 24 patients, were studied with a greater number of assessment instruments.

MEASURES

The Mini-Mental State Examination (MMSE) was used for brief assessment of overall cognitive functioning, and the Psychogeriatric Dependency Rating Scale (PGDRS) was administered to assess functional status. The cognitive test battery from the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) and/or an expanded neuropsychological battery, was given to a subset of the patients.

RESULTS

In the overall sample, patients with greater global cognitive impairment had higher levels of rated impairment on the individual items that comprised the Orientation and Physical, but not Behavior, subscales of the PGDRS. Furthermore, in the two subsamples, specific neuropsychological measures of problem-solving, word list learning, naming and constructional praxis were related to overall measures of outcome.

CONCLUSIONS

Neuropsychological deficit and psychosocial outcome are multi-dimensional entities that relate to one another in complex ways.

Effect of adults' self-regulation of diabetes on quality-of-life outcomes

OBJECTIVE

To examine the relationships among cognitive representations of diabetes, diabetes-specific health behaviors, and quality of life using Leventhal and Diefenbach's self-regulation model of illness (Leventhal H, Diefenbach M: The active side of illness cognition. In Mental Representation in Health and Illness. SkeltonJA, Croyle RT, Eds. New York, Springer-Verlag, 1991, p. 247-272).

RESEARCH DESIGN AND METHODS

This research involved secondary analysis of a mailed survey completed by 296 adults (ages 20-90 years). Structural equation modeling was conducted to investigate relationships among cognitive representations, diabetes-specific health behaviors, and quality of life. Model differences by diabetes type were also investigated.

RESULTS

Findings indicated that certain cognitive representation constructs were related to increased diabetes-specific health behaviors, decreased sense of burden, and positive quality-of-life outcomes. Individuals levels of understanding of diabetes and their perceptions of control over diabetes were the most significant predictors of outcomes. However, diabetes-specific health behaviors were related to an increased sense of burden that was negatively associated with quality of life. Multigroup analyses indicated that this self-regulatory model provided a good fit for individuals with type 1 diabetes, those with type 2 diabetes who take insulin, and those with type 2 diabetes who do not take insulin.

CONCLUSIONS

These findings advance what is known about cognitive representations of illness and the self-regulation of diabetes as well as the relationships between cognitive representations of illness, quality of life, and behavioral factors. In particular, results from this study suggest the need for further study to address ways of reducing the burden of diabetes associated with health behaviors and decreased quality of life.

Enteropathogens and other factors associated with severe disease in children with acute watery diarrhea in Lima, Peru

To evaluate enteropathogens and other factors associated with severe disease in children with diarrhea, 381 children <5 years of age with diarrhea and moderate to severe dehydration (in-patients) and 381 age-, sex-, and date-of-visit-matched children with mild diarrhea (out-patients) presenting to a hospital in Peru, were studied. Rotavirus was detected in 52% of the in-patients and 35% of the out-patients (odds ratio [OR]=2.3, 95% confidence interval [95% CI]= 1.6-3.2); 95% of the rotaviruses among in-patients were of serotypes G1-G4. The risk of severe diarrhea was particularly great in children who were not exclusively breast-fed in early infancy and who also lacked piped water in their homes (for children with both characteristics OR=6.8, 95% CI=3.6-12.8). The high prevalence of rotavirus and its association with severe diarrhea underscores the need for rotavirus vaccines. Interventions to educate mothers and improve access to safe water should augment the impact of rotavirus vaccines in preventing severe diarrhea.

Designing a system for ambulatory obstetric case management

The authors describe the development of critical pathways for ambulatory obstetric case management. When case management was identified as needed, but published work in outpatient obstetrics could not be found, four nurses used this opportunity to design a cost-effective system leading to quality outcomes. The driving force was the need for a format that directed comprehensive consistent care delivered by a large multidisciplinary health care team. Design issues included capturing leading edge standards of care and user friendly formats for all caregivers. Throughout a period of 2 years, a trifold format was developed for all obstetric patients, and 15 bifold formats were developed for patients with specific high-risk diagnoses. The format design facilitated cost-effective quality care and is expected to improve patient outcomes. A research study has been initiated to measure effectiveness of the design.

The pattern of change in leisure activity behavior among older adults with arthritis

This study employed a "ceasing participation" framework to examine changing leisure activity patterns. Respondents of the Living With Arthritis project were classified into four participation pattern categories. Results confirmed that older adults with arthritis are more likely to experience changes to their activity regimen than older adults without arthritis. A multi-group discriminant function analysis showed that arthritis severity distinguished those who tend to cease activity. Social network and age best distinguished those who quit activities without replacement. Results are placed in the context of coping strategies. Those who do not replace forfeited activities with other activities are least flexible in their response to their chronic condition and face challenges to their well-being.

Effects of a one-year physical activity intervention for older adults at congregate nutrition sites

The effects of a physical activity intervention on strength, balance, motor coordination, and mobility were tested in a quasi-experiment at rural congregate nutrition sites. Twice-weekly sessions of low intensity movements were conducted for one year. Logistic regression results showed significant differences between intervention (n = 61) and comparison (n = 49) groups on several performance-based measures. Intervention subjects perceived significantly greater improvements in physical functioning over the previous year than did comparison subjects. A qualitative evaluation revealed perceived program benefits of pain reduction, increased flexibility, muscle strengthening, increased walking speed, and improved mental outlook.

Exercise participation in a frail elderly population

A low-intensity exercise demonstration project was developed jointly by researchers, social service practitioners, and program participants to actively involve frail older people in their own health maintenance. This article describes this collaborative process and its impact on the success of the health promotion program, which was conducted at three senior centers serving a low-income, urban elderly population. Participants were predominantly sedentary women over age 70 with multiple chronic conditions. The program was conducted with peer leaders to facilitate its continuation after the research demonstration phase. In addition to positive health outcomes related to functional mobility, blood pressure maintenance, and overall well-being, this intervention was successful in sustaining active participation in regular physical activity through the use of peer leaders selected by the program participants. The planning, implementation, and outcomes of this project illustrate the benefits and challenges of combining research and practice perspectives in conducting health promotion interventions with older populations.

Activity participation and well-being among older people with arthritis

This study tests the hypotheses that (a) severity of arthritis is inversely associated with frequency of activity participation, and (b) arthritis sufferers who maintain higher levels of participation, particularly in activities which are social in nature, are less likely to experience a decline in well-being. Three activity types are considered: social, physical, and solitary. Results indicate that well-being is influenced by social activity, whereas solitary and physical activity have minimal impact. This suggests that elders with arthritis need not remove themselves from the pursuit of activity and should be encouraged to develop new interests when physical functioning fails. The study also demonstrates the utility of considering activity as multidimensional.

Adaptation of a general optimism scale for use with older women

The Life Orientation Test has been widely used with various populations since its development, but its psychometric properties among older adults have not been assessed. This study employed exploratory factor analysis to examine the factor structure of a modified version of the test for 90 frail older women. The results do not support a unidimensional conceptualization of optimism. Internal consistency reliability was lower for the entire scale than for separate factors representing positively versus negatively framed questions. Some support for construct validity was shown by small to moderate correlations with several related constructs. The results were likely to have been affected both by the modification of the test to simplify data collection with an elderly population and by a differing manifestation of the construct among functionally impaired older adults as compared to previous research with younger, healthier samples.

Identifying formulas in first language acquisition

With the increase in interest in formulas, or apparently non-productive utterances in children's speech, a range of definitions has emerged and sometimes conflicting criteria have been proposed for their identification. These definitions of formulas are compared, and the criteria of Brown (1973), Wong Fillmore (1976), Peters (1983) and Plunkett (1990) for the recognition of formulas are reviewed. A preference rule system is proposed, which distinguishes necessary, typical and graded conditions for the recognition of formulas. Using these conditions, some of the formulas found in the data of one child acquiring Irish between 1;4 and 2;1 are examined. Issues such as length of units, frequency of occurrence and appropriateness of use are discussed. The methods developed in this study could be used to assess the importance of formulas in the language acquisition of other children.

Mortality and the attribution of health problems to aging among older adults

This study examined the association between mortality and attributing health problems to aging among 1391 respondents from the Longitudinal Study of Aging who indicated difficulty with activities of daily living. Of this number, 72 persons attributed impairment primarily to "old age." Logistic regression controlling for demographics, physical health problems, self-rated health, and social involvements showed an association with mortality (adjusted odds ratio = 1.78, CI = 1.05, 3.00). Attributing health problems to aging may carry a risk of adverse health events.

The continuity of gerontological themes

Based on the premise that scientists should periodically examine the history of their ideas and methodologies, this article focuses on the issue of continuity in the evolution of scientific knowledge about aging. Taking a twenty-five-year perspective, selected research questions and priorities in the biomedical, behavioral, and social domains of aging are used to exemplify the continuity of the gerontological knowledge base. This article concludes that there is considerable evidence of continuity, despite the strong influences of changing cohorts of people and external forces that have shaped new ideas and research questions in gerontology.

Health promotion for older people: all is not well

The changing nature of disease risks and functional health status with aging suggests the need to focus health promotion efforts in the older population where they will be most effective in reducing morbidity, mortality, and disability. However, there is little consensus in the literature regarding the efficacy of various health promotion practices and the appropriate target groups within a diverse older population. Careful research on and thoughtful application of findings to this older population are needed to ensure the effective use of limited health promotion resources.

Ethical dimensions of intergenerational reciprocity: implications for practice

This paper reviews the moral and ethical context of family relationships and caregiver stress, with an emphasis on the implications for professional interventions. Three views of filial responsibility are presented: parental reverence, a debt of gratitude, and caregiving as an expression of friendship and love. Case studies are presented to illustrate how an exploration of ethically defensible limits to caregiving might proceed.

Daily illness characteristics and health care decisions of older people

Although investigations of health care decision making typically deal with patterns of health service use, increasing attention has focused on lay- and self-care actions in response to illness symptoms. This study examined the health care actions of a community sample of 142 older adults, who recorded illness symptoms and corresponding health care actions in daily health diaries for a 14-day period. Self-treatment and no-action decisions were found to be the most frequent response to illness symptoms. Professional-care decisions were associated with greater health care need, such as multiple symptoms and increased pain. Lay-care decisions were significantly related to symptoms of shorter duration. Women were also more likely than men to self-treat their illness symptoms. Results suggest that older people deal with a greater number of recurrent chronic symptoms than previously thought and that they make most treatment decisions without consulting their doctors or other health care providers. This investigation underscores the importance of a prospective diary methodology for studying the daily complexities of chronic illness experiences and for validating and conducting useful interventions.

Preventive health practices among older men and women

The preventive health practices of older men and women were examined from interviews with a community sample of 172 adults aged 64-96. Differences between men and women were found with only 10 of the 37 individual health practices. A mixed pattern was found in the relationship of personal and demographic characteristics, life outlook, self-health perceptions, and social network with health practices. The results suggest caution in interpreting how age and gender interact to influence the preventive health practices and health behaviors of older adults.

Daily symptoms and behavioral responses. Results of a health diary with older adults

Research on the health care behavior of older adults in response to symptoms will benefit from having data collection methods that can monitor health actions as they occur on a daily basis. In the present study, symptom experiences over a 2-week period and the actions taken in response to them were studied with a self-kept daily diary. Participants were 142 community-resident older persons, aged 62-94. Diary information about number of daily symptoms and the accompanying pain/discomfort was correlated with health perceptions and psychosocial indices obtained in an interview prior to the diary period. Women tended to take a more active response to symptoms than men, particularly in the area of personal care actions. Preventive health behaviors were not strongly related to symptom-related actions. Satisfaction with one's income was the only predictor of seeking professional assistance. Overall, the diary method is feasible to use with older adults, although certain groups may require special consideration (e.g., the visually impaired, persons with multiple symptoms per day, or those with a limitation on writing ability).

Correlates of preventive health behavior in late life

A sample of 172 community-resident older adults (aged 64-96) were interviewed to investigate correlates of their preventively oriented, health-related practices. Four health practice groupings were used: Information-Seeking, Regular Health Routines, Medical and Self-Examination, and Risk Avoidance. Results indicated modest associations among individual behaviors and among the four health practice groups. Gender (i.e., women) and a supportive family environment were among the consistent predictors of good health practices, although each of the four behavior groups tended to have its own set of major predictors.

Congruence of health and treatment perceptions among older patients and providers of primary care

High utilization of primary health care services by older adults, and factors which promote discrepancies between personal and professional health judgments, create a need for effective communication between providers and patients. The present study was designed to extend existing reports on the congruence of health ratings among older adult patients and their primary care physicians and nurses. Congruence ranged from 29 to 69 percent across fourteen health and treatment questions (N = 108 patient/provider pairs). Patients appeared to be more favorable on most questions, and questions with a present orientation exhibited greater congruence than those with a future orientation. Few variables predicted congruence. Providers' ratings were associated with congruence more strongly than were patients' ratings. Further research should examine the uniformity of content and structure in patient/provider communication both across providers, and with their individual patients.

Emerging trends in gerontology and geriatrics: implications for the self-care of the elderly

Increases in the world's older population have posed a significant challenge to available health care resources. For many older people, informal initiatives represent a necessary, rather than an optional health care strategy in the absence of alternatives. Those individuals with the greatest health and economic dependencies are often held responsible for their reliance on subsidized long-term care services. This tendency to blame the victim appears to transcend fundamental philosophic differences which have traditionally distinguished some collectivist and individualist societies. Although health care has been viewed traditionally by health professionals as their domain, self-care and lay initiatives have recently been recognized by professionals as important to the health care of different population groups including older people. The concept of self-care has been used in various ways by different people to describe a wide range of personal health behaviors encompassing lay care, self-help, enlightened consumerism, and various preventive measures as antidotes to the impairments of old age. This paper reports some of the outcomes of an international project which reviewed geriatric self-care in different countries and health care systems. Various influences on the evolution of interest in geriatric self-care were identified including: similarities and differences in health care systems: demographic changes; cohort differences; the emergence of professionals with specialized training in geriatric health care; and, the salience of biomedical models in addressing the health problems of aging. The role of professionals, especially those trained in geriatrics, is examined with an acknowledgment of the importance of a self-care strategy that is independent of professional dominance.(ABSTRACT TRUNCATED AT 250 WORDS)

Retinoic acid enhances the displacement of newly synthesized hyaluronate from cell layer to culture medium during early phases of chondrogenesis

Chondrogenic differentiation in mouse limb bud mesenchymal cells cultured at high density was suppressed by supplementation of the medium with retinoic acid (1 microgram/ml or 3.3 X 10(-6) M). Since in control medium overt chondrogenesis begins on day 3, retinoic acid was introduced on day 2 so that the relationship between initial biosynthetic changes and inhibition of chondrogenesis could be studied. During the first 24 h of exposure the treated cells remained viable but suffered 10% inhibition in growth and synthesized [3H]glucosamine-labeled glycosaminoglycan at a level 24% below untreated cells. The amount of labeled hyaluronic acid released into the culture medium by the treated cells was, however, 2-fold greater, on a per cell basis, than that in the untreated cultures. It is suggested that the displacement of hyaluronate may play a role in the disruption of mesenchymal cell differentiation and of limb morphogenesis as observed in other systems.

A brief life-graft technique for work with geriatric patients

Patients aged over 60 or older from the practice of a private physician (n = 32) and from a geriatric outpatient clinic (n = 132) responded to a questionnaire designed to assess perceived present and future health, treatment expectations, and general future projection. Of interest was the extent to which present health, as measured by a brief life-graft technique, might be predictive of perceptions in these other areas. Results from two samples were consistent in suggesting that present health ratings were related to anticipated future health, general future projection, and certain treatment expectations. However, expectations of when benefits from treatment would begin, and of the probable duration of treatment, were not predicted in either sample. The life-graft technique seems useful for practitioners' interactions with older patients and for understanding these patients' extended view of their health.

Consistency in patients' health and treatment expectations at a geriatric clinic

This study focused on predictors of consistency and inconsistency in health and treatment expectations among 77 new patients (mean age, 73) at a geriatric outpatient clinic. Just before their first appointment, and again one week afterward, the patients were asked about their overall health status, their specific illness complaints, their reasons for visiting the clinic, and their expectations regarding treatment and the future outlook. Few predictors of consistency were found for such outcome measures as the number of health problems reported, present and future health status, and the duration, difficulty and benefits of treatment. Inconsistency and uncertainty were more evident in these geriatric outpatients' perceptions, especially among those with self-rated poor health and mobility. This study emphasizes: 1) the importance to the treatment context of geriatric patients' inconsistencies about their health, and 2) the additional burden clinicians must bear in dealing with such discrepancies.

Mistreatment of the elderly in the domestic setting: an exploratory study

Professionals and practitioners (N = 228) involved in providing services to the elderly were interviewed regarding their experiences with the mistreatment of older people by their families. Semi-structured questions dealt with: case identification and follow-up procedures; perceptions of etiological factors; and descriptive typologies from illustrative case histories. Findings indicated that domestic mistreatment of the elderly was familiar to most professionals interviewed, to the extent that 60 per cent of the respondents dealt with such cases on a weekly basis. Among the 10 professional groups interviewed, there was little variation in their experiences with neglect; police officers, lawyers, community mental health and aging services workers had greater exposure to cases of physical abuse. Intentional mistreatment was typically viewed as a consequence of inadequacies in the caretaker, while unintentional cases were related to the victims' isolation. Most respondents indicated that there were no established procedures for dealing with, or following-up mistreatment cases, and over one-half reported that nothing was done. Differences in perception of the etiology of domestic mistreatment of the elderly were closely related to the occupational perspectives of the various respondent groups. Although incidence rates could not be established, 89 illustrative cases of domestic mistreatment of the elderly were indicative of the severity of the occurrences and the absence of appropriate interventions.

Aging opinion survey: a report on instrument development

Attitude instrument development remains a necessary task in aging research, for the eventual explication of attitude-behavior relationships. The present report describes initial development of the Aging Opinion Survey, an instrument based upon a multidimensional view of attitudes towards aging and the elderly. After identifying substantive attitudinal content areas, an initial 120-item pool was constructed, balanced across referent groups and direction of wording. Pilot analysis eliminated sixty items with minimal variances. Administration of the reduced item set to a subsequent sample of 200 gerontological practitioners and students produced four meaningful factors. Poor items were again eliminated and replacements constructed. Another administration (n=226) again produced four meaningful factors, three of which met the criterion of reliability: (1) Stereotypic age decrement, (2) Personal anxiety toward aging, and (3) Social value of the elderly. These scales appeared to reflect peer, personal, and generalized-elderly referents, respectively. Development and refinements of attitudes scales such as the Aging Opinion Survey are necessary elements for proceeding beyond the current theoretical and empirical difficulties in gerontological attitude literature.

Attitude instrument analysis: an examination of factor consistency across two samples

The factor analytic model of the practitioner-oriented opinions about people (OAP) was tested with a population of gerontological practitioners (N =558). A confirmatory factor analysis was performed to ascertain the degree-of-fit between these data and the published OAP factor model. After results supported the hypothesis that the two samples differed, a second factor analysis was designed to yield estimates of communalities by a least squares multiple regression technique. This analysis eliminated nine items not warranting inclusion in the instrument, redistributed the factors, and brought out a completely new factor. Finally, to test the hypothesis that attitudes toward aging and the aged are uncorrelated, a third analysis was performed in which the six scales of the oblique solution were refactored. The resulting higher order dimensions tended to support this hypothesis.

Attitudes toward aging as a function of in-service training and practitioner age

Age differences in attitudes toward aging were investigated as a function of a 3-hour training program with 322 women (18-74 years) from various geriatric health care and social service contexts. Using a quasi-experimental pre- and posttest design, sites were randomly divided into initial experimental and control groups, with all control participants receiving training following the research program. Results indicated few instances of unfavorable attitudes toward aging in any age group, with younger women evidencing less cynicism toward aging, less social distance from the aged, and slightly less stereotyping. Training appeared to result in less cynicism, stronger endorsements of family and public responsibility, and slightly greater anxiety. No Age X Pretest/Posttest interactions were found. The results are discussed in terms of their implications for service provider-client interaction, the correspondence of attitudinal and behavioral change, and appropriate instruments for assessing program impact.

Training for a supportive geriatric environment: a preliminary report

Gerontological manpower development is the goal of an ongoing project where various training modules are designed, tested, and evaluated within the institutional or community context where the service is delivered. This paper reports initial data on program effectiveness and attitudinal and work assessment changes resulting from staff training in environmental therapy.