Kelly A. McGarry

Evidence for a multi-site model of the rat brain σ receptor

Irradiation of rat brain membranes with light of 254 nm, a treatment which modifies ultra-violet absorbing residues in proteins, decreased binding of both [3H](+)-3-(3-hydroxyphenyl)-N-(1-propyl)piperidine ([3H](+)-3-PPP) and [3H]1,3-di-o-tolylguanidine ([3H]DTG) to σ receptors. For [3H](+)-3-PPP, this was due to a decreased Bmax. In contrast, irradiation markedly increased binding of [3H](+)-N-allylnormetazocine ([3H](+)-SKF 10,047) due to a decrease in the Kd. Both unlabeled DTG and haloperidol were competitive inhibitors of [3H](+)-3-PPP binding to untreated membranes, causing an increase in the Kd and no change in the Bmax. The benzomorphans, (+)-SKF 10,047 and (+)-pentazocine, were uncompetitive inhibitors, causing a decrease in both the Kd and Bmax for [3H](+)-3-PPP. Finally, the ability of DTG and (+)-3-PPP to inhibit binding of [3H](+)-SKF 10,047 was markedly reduced by ultra-violet irradiotion, whereas irradiation had little effect on the potency of unlabeled (+)-SKF 10,047 and (+)-pentazocine. These data suggest that σ-related (+)-benzomorphans and non-benzomorphans interact either with distinct, allosterically coupled sites on the same σ receptor macromolecule or with different populations of σ receptor types.

Interest in smoking cessation among injection drug users.

We describe the degree of nicotine addiction and readiness to quit smoking among people with a history of injection drug use, comparing those in a methadone maintenance treatment program (MMTP) with active illicit drug injectors in a needle exchange program (NEP). Interview data were collected from 452 persons in Providence, RI, from July 1997 to March 1998. Ninety-one percent (91%) of the population currently smoked cigarettes. Smokers were more likely to be female and from an NEP. Higher nicotine dependence by the Fagerstrom Test for Nicotine Dependence was found in Caucasians, those with a Methadone dose greater than 80 mg per day, those with less than high school education, and those with active alcohol abuse. Those more likely to be contemplating smoking cessation in the next six months were those from MMTP, older than 35, and without alcohol abuse. Although smoking cessation counseling should be offered to all smokers, interventions directed towards older individuals enrolled in MMTP may target the group most interested in smoking cessation.

Patient–Provider Communication About Sexual Health Among Unmarried Middle-aged and Older Women

BACKGROUNDAlthough past studies have highlighted the importance of patient–provider communication about sexual health and intimate relationships (SHIR), much of the research has focused on young women’s or married women’s experiences when discussing SHIR with their providers.OBJECTIVETo describe experiences of unmarried, middle-aged and older women in communicating about SHIR with their health care providers.DESIGN AND PARTICIPANTSQualitative interviews were conducted with 40 unmarried women aged 40–75 years. We compared the responses of 19 sexual minority (lesbian and bisexual) women and 21 heterosexual women.RESULTSWomen varied in their definitions of intimate relationships. Not all women thought providers should ask about SHIR unless questions were directly related to a health problem, and most were not satisfied with questions about SHIR on medical intake forms. However, the themes women considered to be important in communication about SHIR were remarkably consistent across subgroups (e.g. previously married or never married; sexual minority or heterosexual). Sexual minority women were more hesitant to share information about SHIR because they had had prior negative experiences when disclosing their sexual orientation or perceived that clinicians were not informed about relevant issues.CONCLUSIONSSome women felt that providers should ask about SHIR only if questions relate to an associated health problem (e.g. sexually transmitted infection). When providers do ask questions about SHIR, they should do so in ways that can be answered by all women regardless of partnering status, and follow questions with non-judgmental discussions.

Postmenopausal osteoporosis. Strategies for preventing bone loss, avoiding fracture.

PREVIEW Osteoporosis causes fractures in more than a million and a half Americans each year. About 80% of these fractures occur in women, often at or shortly after menopause. Can the factors responsible for bone loss at menopause be modified to reduce risks? In this article, Drs McGarry and Kiel explain who should undergo bone density testing, which tests are most helpful, and who should be offered preventive therapy.

Comprehensive Cancer Screening among Unmarried Women Aged 40–75 Years: Results from the Cancer Screening Project for Women

OBJECTIVES We explored self-reported rates of individual on-schedule breast, cervical, and colorectal cancer screenings, as well as an aggregate measure of comprehensive screenings, among unmarried women aged 40-75 years. We compared women who partner with women (WPW) or with women and men (WPWM) to women who partner exclusively with men (WPM). We also compared barriers to on-schedule cancer screenings between WPW/WPWM and WPM. METHODS Comparable targeted and respondent-driven sampling methods were used to enroll 213 WPW/WPWM and 417 WPM (n = 630). Logistic regression models were computed to determine if partner gender was associated with each measure of on-schedule screening after controlling for demographic characteristics, health behaviors, and cancer-related experiences. RESULTS Overall, 74.3% of women reported on-schedule breast screening, 78.3% reported on-schedule cervical screening, 66.5% reported on-schedule colorectal screening, and 56.7% reported being on-schedule for comprehensive screening. Partner gender was not associated with any of the measures of on-schedule screening in multivariable analyses. However, women who reported ever putting off, avoiding, or changing the place of screenings because of sexual orientation were less likely to be on-schedule for comprehensive screening. Women who reported barriers associated with taking time from work and body image concerns were also less likely to be on-schedule for comprehensive screening. CONCLUSIONS Barriers to cancer screening were comparable across types of examinations as well as between WPW/WPWM and WPM. Developing health promotion programs for unmarried women that address concomitant detection and prevention behaviors may improve the efficiency and effectiveness of healthcare delivery and ultimately assist in reducing multiple disease risks.

Patient-provider communication and cancer screening among unmarried women.

OBJECTIVES Unmarried women are less likely than married women to receive recommended cancer screenings. Patient-provider communication is a consistent predictor of cancer screening among women. The purpose of this study was to investigate the relationship between patient and provider communication, barriers to cancer screening, and on-schedule breast and cervical cancer screening (BCCS) among unmarried women. METHODS Data were from the Cancer Screening Project for Women, a 2003-2005 survey examining cancer screening practices. We computed polytomous logistic regression models to examine the relationship between communication (communication about tests, communication about sexual and intimate relationships), barriers to screening, and on-schedule BCCS among unmarried women. RESULTS A total of 630 women were enrolled, and 605 women completed the baseline questionnaire. Overall, more than 60% reported on-schedule BCCS. More than half reported that their providers communicated about BCCS most or all of the time. Fewer than half communicated about sexual history and intimate relationships. Women who reported that their providers communicated about screening tests and their sexual and intimate relationships were more likely to be on-schedule for BCCS. CONCLUSION Patient-provider communication about multiple topics may encourage women to remain on-schedule for their recommended cancer screenings. Longitudinal research should be conducted to examine whether communication predicts BCCS, and to examine how patient and provider characteristics may influence communication in order to promote adherence to screening guidelines for unmarried women. PRACTICE IMPLICATIONS Comprehensive communication that goes beyond information about screening tests may impact adherence to cancer screening guidelines.

Alcohol use disorders in women. Screening methods and approaches to treatment.

PREVIEW Alcohol use disorders are a significant problem among women in the United States. The epidemiologic factors, physiologic effects, psychosocial and medical consequences, and detection and management of these disorders in women differ from those in men. Primary care physicians are in a unique position to identify, educate, and counsel women with alcohol problems and to refer them for treatment. In this article, Drs Cyr and McGarry discuss the consequences of drinking in women and outline ways in which physicians can guide them to the help they need.

Caring for Vulnerable Populations: Curricula in U.S. Internal Medicine Residencies

ABSTRACT The Accreditation Council for Graduate Medical Education (ACGME) encourages internal medicine training programs to include specific curricula devoted to health care issues of vulnerable populations. Our aim was to determine the prevalence of curricula involving selected vulnerable populations among U.S. Internal Medicine residencies. We conducted a survey of Program Directors of all US Internal Medicine Residencies assessing whether the program had a curriculum for six vulnerable populations (racial and ethnic minorities, non-English speaking patients, lesbians, gay men, victims of domestic violence and patients with substance abuse problems). Most residencies address substance abuse and victims of domestic violence, while there remains a lack of dedicated teaching on other vulnerable populations, including lesbians, gay men, racial and ethnic minorities and non-English speaking patients.

Hormone therapy for the prevention of bone loss in menopausal women with osteopenia: is it a viable option?

Osteopenia is a state of low bone mass, the appropriate clinical management of which is not always clear. The use of hormone therapy for postmenopausal bone loss has become controversial given recent data regarding the risks of therapy. Fragility fractures are common, and result in substantial morbidity and mortality. Although the fracture rate is higher among osteoporotic women, the substantially larger population of osteopenic women accounts for a higher absolute number of fractures. Osteopenia is defined solely according to the statistical properties of the distribution of bone mineral density (BMD) values, which limits its usefulness in clinical care. BMD, although inversely related to fracture risk, should not be used as the sole criterion for fracture risk. Limited data suggest that benefits of treatment seen in women with documented osteoporosis may not extend to osteopenic women. Although estrogen prevents postmenopausal bone loss, preservation of BMD does not necessarily translate into reduced fracture risk. In making decisions about whether to treat a woman with osteopenia, it is critical to estimate how treatments will affect the individual’s risk of fracture. Treatment decisions should be based on whether the net benefits of treatment outweigh the anticipated risks, which will depend on the age of the patient and her risk profile. In our opinion, there is insufficient evidence to support treatment for women with a BMD in the osteopenic range in the absence of fragility fracture. For osteopenic women with higher risk, the availability of other treatments with a more favourable risk-benefit profile eliminates the role of hormone therapy for fracture prevention.

Utilization of preventive health services by HIV-seronegative injection drug users.

Abstract Little is known about the use of preventive health services by HIV-seronegative IDUs. This study examines screening and preventive health services use by two populations of HIV-seronegative IDUs recruited from a needle exchange program and methadone program. We found high rates of HIV and tuberculin skin testing in the past year as well as tetanus vaccination among both groups of IDUs. Hepatitis B and C testing was significantly higher in the methadone group than the needle exchange group. Syphilis testing and pneumovax administration was disappointingly low in both groups. Given the burden of disease among IDUs, our findings suggest the need for a distinct set of testing and vaccination guidelines for the HIV-seronegative IDU population.