Obesity and risk of multiple myeloma: A case-control study

Introduction. Several studies have reported a positive association of body mass index (BMI) with multiple myeloma; however, the period of adulthood where BMI is most important remains unclear. In addition, it is well known that body fat is associated with both sex-steroid hormone storage and with increasing insulin levels; therefore, it was hypothesized that the association between obesity and multiple myeloma may be attributed to increased aromatization of androgen in adipose tissue. Objective. The overall objective of this case-control study was to determine whether multiple myeloma cases had higher BMI and greater adult weight gain relative to healthy controls. In addition, we tested the hypothesis that hormone replacement therapy use among women will further increase the association between BMI and risk of multiple myeloma. This study used data from a pilot case-control study at M.D. Anderson Cancer Center (MDACC), entitled Etiology of multiple myeloma, directed by Dr. Sara Strom and Dr. Sergio Giralt. Methods. The pilot study recruited a total of 122 cases of histopathologically confirmed multiple myeloma from MDACC. Controls (n=183) were selected from a database of random digit dialing controls accrued in the Department of Epidemiology at MDACC and were frequency matched to the cases on age (±5 years), gender, and race/ethnicity. Demographic and risk factor information were obtained from all participants who completed a self-administered questionnaire. Items included in the questionnaire include demographic information, height and weight at age 25, 40 and current/diagnosis, medical history, family history of cancer, smoking and alcohol use. Statistical analysis. Initial descriptive analysis included Student's t-test and Pearson's chi-squared tests. Odds ratios and 95% confidence intervals were calculated to quantify the association between the variables of interest and multiple myeloma. A multivariable model will be developed using unconditional logistic regression. Results. MM cases were 1.79 times (95% CI=0.99-3.32) more likely to have been overweight or obese (BMI > 25 kg/m2) at age 25 relative to healthy controls after controlling for age, gender, race/ethnicty, education and family history of cancer. Being overweight or obese at age 40 was not significantly associated with mutliple myeloma risk (OR=1.42, 95% CI=0.86-2.34) nor was being overweight or obses at diagnosis (OR=1.43, 95% CI=0.78, 2.63). We observed a statistically significant 2-fold increased odds of multiple myeloma in individuals who gained more than 4.7 kg during between 25 and 40 years (OR=1.97, 95% CI=1.15-3.39). When assessing HRT as a modifier of the BMI and multiple myeloma association among women (N=123), no association between obesity and MM status was observed among women who have never used HRT (OR=0.60, 95% CI=0.23-1.61; n=73). Yet among women who have ever used HRT (n=50), being overweight or obese was associated with an increase in MM risk (OR=2. 93, 95% CI=0.81-10.6) after adjusting for age; however, the association was not statistically significant. Significance. This study provides further evidence that increased BMI increases the risk of multiple myeloma. Furthermore, among women, HRT use may modify risk of disease. ^

Are school nurses effective in the fight against childhood obesity?

Background. With childhood obesity on the rise in the United States, school nurses are faced with the task of preventing, identifying and treating obese children in their schools. This study reviews current literature and examines the effectiveness of the school nurse regarding obesity prevention and treatment services and the barriers they face.^ Methods. Ovid, Ebsco, Google Scholar and other professional websites were searched for school-based obesity interventions that included school nurses and that took place in the United States between 1996 and present day. This resulted in 8 studies.^ Results. Of the 8 studies identified, the majority were conducted in the Midwest, all of the studies were cross-sectional in design or qualitative in nature and only half of these studies were based off theoretical design. The most common barriers school nurses face include: lack of time, lack of support from both the school and parents, lack of confidence in counseling students and their parents and lack of specific guidelines for their role. ^ Conclusions. This study further reflects the need for more research using experimental research designs to evaluate nurse-driven interventions and nurse-related policies for childhood obesity prevention and treatment, the need to create specific guidelines for school nurses, the need for further education for nurses relating to counseling, and the need for more support from the school and community for school-based obesity prevention. ^

Family to Family: Child Welfare for the 21st Century

Child welfare services have undergone many revisions and transformations since their initiation. Some scholars trace the beginning of child welfare in the United States to events such as a 1655 Massachusetts conviction for maltreatment leading to the death of a 12-year-old boy (Watkins, 1990). The predominant philosophy of child welfare has shifted over time from an early emphasis on child saving, to child protection, to family preservation. Building on family preservation, one of the current transformations in child welfare that is taking place in isolated pockets to whole states, is family-centered, neighborhood-based services. One force behind implementation of this transformation is the Family to Family Initiative of the Annie E. Casey Foundation. This paper places family-centered, neighborhood-based child welfare services within the historical context of development of child welfare and within the recent move to reinvent human services (Adams & Nelson, 1995). Against this backdrop, a locality-based implementation of the Family to Family Initiative is described.

Walking Our Talk in the Neighborhoods: Building Professional/Natural Helper Partnerships

This article describes our efforts in Tacoma, Washington, to establish professional and natural helper partnerships to work with families involved in the child protective service system. It uses our experiences to describe the ways that natural helpers and professionals can help one another in getting better results for families.

Family Preservation Journal, 2003, Volume 7. (Entire issue)

Entire issue (large pdf file) Articles include: Social Workers' Perceptions of Family Preservation Programs. Elaine M Maccio, David Skiba, Howard J Doueck, Karen A. Randolph, Elisabeth A. Weston, and Lorie E. Anderson Targeting Special Populations for Family Preservation: The Influence of Worker Competence and Organizational Culture. Ramona W: Denby, Keith A. Alford, and Carla M Curtis Understanding and Fostering Family Resilience. Robert G. Blair Walking Our Talk in the Neighborhoods: Building Professional/Natural Helper Partnerships. Jill Kinney and Margaret Trent Intersystem Collaboration: A Statewide Initiative to Support Families. Elizabeth M Tracy, David E. Biegel, Ann C. Rebeck, and Jeffrey A. Johnsen

A global seasonal surface ocean climatology of phytoplankton types based on CHEMTAX analysis of HPLC pigments

Much advancement has been made in recent years in field data assimilation, remote sensing and ecosystem modeling, yet our global view of phytoplankton biogeography beyond chlorophyll biomass is still a cursory taxonomic picture with vast areas of the open ocean requiring field validations. High performance liquid chromatography (HPLC) pigment data combined with inverse methods offer an advantage over many other phytoplankton quantification measures by way of providing an immediate perspective of the whole phytoplankton community in a sample as a function of chlorophyll biomass. Historically, such chemotaxonomic analysis has been conducted mainly at local spatial and temporal scales in the ocean. Here, we apply a widely tested inverse approach, CHEMTAX, to a global climatology of pigment observations from HPLC. This study marks the first systematic and objective global application of CHEMTAX, yielding a seasonal climatology comprised of ~1500 1°x1° global grid points of the major phytoplankton pigment types in the ocean characterizing cyanobacteria, haptophytes, chlorophytes, cryptophytes, dinoflagellates, and diatoms, with results validated against prior regional studies where possible. Key findings from this new global view of specific phytoplankton abundances from pigments are a) the large global proportion of marine haptophytes (comprising 32 ± 5% of total chlorophyll), whose biogeochemical functional roles are relatively unknown, and b) the contrasting spatial scales of complexity in global community structure that can be explained in part by regional oceanographic conditions. These publicly accessible results will guide future parameterizations of marine ecosystem models exploring the link between phytoplankton community structure and marine biogeochemical cycles.

Turbidite sedimentology and history at DSDP Site 89-585

At Site 585 in the East Mariana Basin, a 900-m section of Aptian-Albian to Recent sediments was recovered. The upper 590 m are pelagic components (carbonate, siliceous, and clay); small-scale graded sequences and laminations are common. The underlying sediments are volcaniclastic sandstones with a large proportion of shallow-water carbonate debris; sedimentary structures including complete Bouma sequences, cross-laminae, and scouring are common. These structures indicate that the entire section was deposited by turbidity currents. The change in lithology upward in the section reflects the evolution of the surrounding seamounts, from their growth stages during the middle of the Cretaceous to the later subsidence phases. Several black layers containing pyritized organic debris and associated turbidite structures were cored near the Cenomanian/Turonian boundary; this material has been transported from the flanks of the seamounts where it was deposited within a shallow anoxic zone. Seismic data extends the stratigraphy across the entire Basin, showing the reflectors onlapping the seamounts, and indicating at least 1200 m of sediment at Site 585. The crust is placed at 6900 m after correcting for sediment loading, and the subsidence curve indicates that the Basin has been deeper than 5500 m since before the Aptian.

High fever following postpartum administration of sublingual misoprostol

Gynuity

Misoprostol in addition to routine treatment of postpartum hemorrhage: A hospital-based randomized-controlled trial in Karachi, Pakistan

Background: Postpartum hemorrhage (PPH) remains a major killer of women worldwide. Standard uterotonic treatments used to control postpartum bleeding do not always work and are not always available. Misoprostol's potential as a treatment option for PPH is increasingly known, but its use remains ad hoc and available evidence does not support the safety or efficacy of one particular regimen. This study aimed to determine the adjunct benefit of misoprostol when combined with standard oxytocics for PPH treatment. Methods: A randomized controlled trial was conducted in four Karachi hospitals from December 2005 – April 2007 to assess the benefit of a 600 mcg dose of misoprostol given sublingually in addition to standard oxytocics for postpartum hemorrhage treatment. Consenting women had their blood loss measured after normal vaginal delivery and were enrolled in the study after losing more than 500 ml of blood. Women were randomly assigned to receive either 600 mcg sublingual misoprostol or matching placebo in addition to standard PPH treatment with injectable oxytocics. Both women and providers were blinded to the treatment assignment. Blood loss was collected until active bleeding stopped and for a minimum of one hour after PPH diagnosis. Total blood loss, hemoglobin measures, and treatment outcomes were recorded for all participants. Results: Due to a much lower rate of PPH than expected (1.2%), only sixty-one patients were diagnosed and treated for their PPH in this study, and we were therefore unable to measure statistical significance in any of the primary endpoints. The addition of 600 mcg sublingual misoprostol to standard PPH treatments does, however, suggest a trend in reduced postpartum blood loss, a smaller drop in postpartum hemoglobin, and need for fewer additional interventions. Women who bled less overall had a significantly smaller drop in hemoglobin and received fewer additional interventions. There were no hysterectomies or maternal deaths among study participants. The rate of transient shivering and fever was significantly higher among women receiving misoprostol Conclusion: A 600 mcg dose of misoprostol given sublingually shows promise as an adjunct treatment for PPH and its use should continue to be explored for its life-saving potential in the care of women experiencing PPH. Trial Registration: Clinical trials.gov, Registry No. NCT00116480

Treatment of post-partum haemorrhage with sublingual misoprostol versus oxytocin in women not exposed to oxytocin during labour: a double-blind, randomised, non-inferiority trial

Gynuity

Client-Provider Communication in Postabortion Care

Muchos trabajadores de la salud que tratan a las mujeres que sufren complicaciones de aborto inducido o espontáneo están dispuestos a admitir que estas mujeres necesitan asesoría, pero a menudo ven la consejería como una función no médica que requiere una formación específica, un tiempo especialmente designado, aparte de la prestación de servicios postaborto y otras instalaciones separadas y privadas. De este modo, los proveedores de servicios de atención postaborto a menudo creen que el asesoramiento no es una de sus responsabilidades de trabajo y que carecen de la formación y las instalaciones para hacerlo

Pliocene-Pleistocene oxygen isotope record DSDP Site 586, Ontong Java Plateau, Pacific Ocean i

Oceanographic changes in the western equatorial Pacific during the past 6 Ma are inferred from oxygen isotopic analyses of planktic and benthic foraminifera from Ontong Java Plateau (DSDP Site 586). The taxa are Globigerinoides sacculifer, Pulleniatina, Cibicidoides wuellerstorfi, and Oridorsalis umbonatus. Cooling and ice buildup are indicated by an 18O enrichment of 0.3 per mil in the planktic species near 3.4 Ma. This shift apparently is compensated in the benthic data by a warming of the deep waters by between 1° and 2° C. We suggest that the dominant source of upper deep water supply to the Pacific changed from Antarctic to North Atlantic at that time, the North Atlantic-derived water being warmer. Near 2.8 Ma (approximately) the planktic foraminifera again record an enrichment in 18O (Delta delta18O=0.25 per mil). We suggest ice buildup in the northern hemisphere as the cause, because of subsequent sharp increase in fluctuations of the delta18O signal, that is, instability. The enrichment is magnified in the benthic foraminifera (Delta delta18O = 0.5 per mil) by a cooling of the deep water by 1.5° at the time, presumably signalling a glacial-type reduction of North Atlantic Deep Water (NADW) production. Episodic divergence between the signals of G. sacculifer and Pulleniatina in the Pleistocene apparently reflects periods of increased upwelling in the western equatorial Pacific. The amplitude of ice volume fluctuations cannot be reconstructed from delta18O data alone, unless there are constraints on temperature variations. The increase in amplitude of fluctuation of the benthic and planktic signals during the Pleistocene may be attributed either to an increase in maximum ice volume, or to an increase in the fractionation of continental ice, or a combination of both causes.

Relaçoes áridas : Ausência de humanidade em O céu que nos protege

O presente artigo surgiu com o intuito de trazer à luz a análise do filme O céu que nos protege, de Bernardo Bertolucci (1990). Baseado no livro homônimo de Paul Bowles - publicado pela primeira vez em Londres (1949), pela John Lehmann Ltda. - o filme O céu que nos protege narra a história de um casal (Kit, Debra Winger, e Port, John Malkovich) que, em meio à deterioraçao que se instalou na Europa após a Segunda Guerra Mundial, decide conhecer o deserto africano, ao lado de um amigo, Tunner (Campbell Scott), que mais tarde tornar-se-ia amante de Kit. Na trajetória pela Africa, o casal e o amigo terao parcialmente a companhia da família Lyle (Jill Bennett, sra. Lyle, e Timothy Spall, Eric Lyle). Ainda que sob o impacto de uma nova geografia, e, portanto, distante do caos que varria a Europa, Port e Kit traziam consigo a aridez afetiva de um casamento que se arrastava há mais de dez anos. O deserto do Saara anunciar-se-ia como o espelho do próprio estado desertificado do casal - a incomunicabilidade. Frente à ausência de um diálogo genuíno, restava-lhes a frivolidade comportamental, fato que os levaria a uma avalanche de acontecimentos. Impossibilitados de dizerem a verdade acerca de seus anseios e aversoes, Port e Kit deixavam sempre em suspenso aquilo que mais lhes incomodava. Diante de um turbilhao de sentimentos, restava-lhes o medo do ridículo, da impotência, já que é comum tornarmo-nos vulneráveis diante do "outro" para o qual confessamos o nosso sentimento: dá lhe força e insubmissao; e a nós, que despimos nossa alma, dao-nos suscetibilidade e fraqueza, como se estivéssemos à beira de uma mendicância de afeto - seria humilhante. Portanto, Port e Kit caminhavam para o oposto do que pulsava internamente - para o silêncio, e, por conseguinte, para a fugacidade da própria verdade submersa de ambos