BACKGROUND: Data from the Carolina Breast Cancer Study, a population-based, case-control study of breast cancer in African-American and white women residents of North Carolina, were evaluated to determine whether specific aspects of lactation are associated with a reduction in the risk of breast cancer. METHODS: Analyses included 751 parous cases and 742 parous controls frequency-matched on age and race. Information on lactation, reproductive history, lifestyle characteristics and family history were obtained through a personal interview. RESULTS: When women who breastfed were compared to those who never breastfed, odds ratios and 95% confidence intervals of 0.8 (0.5-1.1) and 0.7 (0.5-0.9) were found for women 20-49 years and 50-74 years, respectively. Similar inverse associations were observed for each of three categories of lifetime duration (1-3, 4-12, 13+ months). The inverse associations persisted and did not vary when number of children breastfed, ages at first and last lactation and lactational amenorrhoea were examined. CONCLUSIONS: Our findings suggest that any lactation, regardless of duration or timing, is associated with a slight reduction in the risk of breast cancer among younger and older parous women. (+info)
Comparison of self-report data and medical records data: results from a case-control study on prostate cancer.
(18/2979)
BACKGROUND: Self-report and review of medical records are the most common methods for the assessment of past exposures. However, information obtained from self-reports and medical records may not be consistent. This study compared information provided in a self-administered questionnaire with medical records data. METHODS: Self-report and medical records data came from a case-control study on prostate cancer. Cases were 181 patients with primary prostate cancer and controls were 297 men without the disease, enrolled in Group Health Cooperative (GHC) in Seattle. The consistencies between the two data sources were examined. RESULTS: In general, agreement between the two data sources was almost perfect for demographic and anthropometric variables, substantial for the history of inguinal hernia and kidney stones, and moderate for vasectomy, family history of prostate cancer, smoking and alcohol consumption. However, the two data sources generally were poorly concordant for prior genitourinary diseases that have less explicit diagnostic criteria such as benign prostatic hyperplasia and prostatitis. Analyses of discordant data showed that men were more likely to report an exposure or medical condition that could not be verified from medical records. No discernible patterns in the difference of agreement were found according to age, GHC membership length or case-control status. CONCLUSIONS: This study suggests that agreement between self-reported data and medical records data varies depending upon the study variables. While both data sources are subject to some problems, self-report may provide more complete and comparable information, at least for variables unrelated to diagnosis. (+info)
The validity of drug users' self-reports in a non-treatment setting: prevalence and predictors of incorrect reporting methadone treatment modalities.
(19/2979)
BACKGROUND: Epidemiological studies among drug users are often based on retrospective self-reports. However, among others, memory failure, being under the influence of drugs, psychopathology, misunderstanding of questions and socially desirable answering may generate inaccurate reporting. METHODS: This study validated self-reported current (methadone dosage) and medium-term (main location of methadone dispensing and frequency of methadone programme attendance over the previous 4-6 months) aspects of methadone treatment in the Amsterdam AIDS cohort study among drug users, using data of the Central Methadone Register. In addition to descriptive measures, logistic regression analysis was used (adjusted for intra-individual correlation) to identify subgroups with incorrect reporting. Data collected at 4406 visits of 505 cohort participants were analysed. RESULTS: Current methadone dosage was accurately reported (unweighted kappa [kappa]: 0.94, weighted kappa [kappa W]: 0.97). A low methadone dosage, short duration of school education and depressive or euphoric mood during the interview were significant and independent predictors of incorrect reporting of methadone dosage. For main location of dispensing kappa was 0.82, for frequency of programme attendance kappa was 0.53 and kappa W 0.87. There was a tendency to reporting the extreme answering categories. Infrequent programme attendance was the only significant predictor of incorrectly reporting frequency of programme attendance. CONCLUSIONS: Drug users are able to give valid self-reports in a setting where social desirability does not play an important role. The main reasons of incorrect reporting were impaired cognitive functioning, memory failure and misunderstanding of questions. (+info)
Basal forebrain amnesia: does the nucleus accumbens contribute to human memory?
(20/2979)
OBJECTIVE: To analyse amnesia caused by basal forebrain lesions. METHODS: A single case study of a patient with amnesia after bleeding into the anterior portion of the left basal ganglia. Neuropsychological examination included tests of attention, executive function, working memory, recall, and recognition of verbal and non-verbal material, and recall from remote semantic and autobiographical memory. The patient's MRI and those of other published cases of basal forebrain amnesia were reviewed to specify which structures within the basal forebrain are crucial for amnesia. RESULTS: Attention and executive function were largely intact. There was anterograde amnesia for verbal material which affected free recall and recognition. With both modes of testing the patient produced many false positive responses and intrusions when lists of unrelated words had been memorised. However, he confabulated neither on story recall nor in day to day memory, nor in recall from remote memory. The lesion affected mainly the nucleus accumbens, but encroached on the inferior limb of the capsula interna and the most ventral portion of the nucleus caudatus and globus pallidus, and there was evidence of some atrophy of the head of the caudate nucleus. The lesion spared the nucleus basalis Meynert, the diagnonal band, and the septum, which are the sites of cholinergic cell concentrations. CONCLUSIONS: It seems unlikely that false positive responses were caused by insufficient strategic control of memory retrieval. This speaks against a major role of the capsular lesion which might disconnect the prefrontal cortex from the thalamus. It is proposed that the lesion of the nucleus accumbens caused amnesia. (+info)
Reliability of recall of physical activity in the distant past.
(21/2979)
Substantial data exist supporting the role of physical activity in the etiology of several chronic diseases. Many chronic diseases begin developing 20-30 years before they become clinically evident. Since researchers often must rely on recall to characterize the long term habits of study participants, the accuracy of recall of physical activity is an important methodological issue in etiologic studies. The purpose of this study was to examine the quality of recall of physical activity in the distant past in a cohort of western New York residents followed since 1960. Paired t tests and intraclass correlation coefficients (ICCs) were used to compare "original" (1960) and "recalled" (1992-1996) reports of weekday (occupational) and free-day (leisure time) physical activity. Results showed that the recalled reports underestimated past weekday activities when overall activity was examined; estimates closer to the originals were found when levels of activity were examined. Recall was best for weekday light (ICC = 0.43) and weekday moderate (ICC = 0.45) activity in both sexes and free-day hard activity in females (ICC = 0.45). Most participants underestimated past free-day activity, but males overestimated free-day hard activity. Correlations for free-day activity were highest for summer sports in females (ICC = 0.29) and winter sports in both sexes (ICC = 0.39) and were low for walking and "other activity." Considering the length of time between the original interviews and the recall interviews, the correlations found here are remarkable and close to those found in other studies where recall intervals were 10 years or less. (+info)
Risperidone versus haloperidol on secondary memory: can newer medications aid learning?
(22/2979)
The introduction of the new generation of antipsychotic medications for the treatment of schizophrenia has been accompanied by a growing interest in the neurocognitive effects of these drugs. The present study compared the effects of risperidone and haloperidol on secondary memory in a group of treatment-resistant schizophrenia patients. The study design included a baseline phase and two double-blind phases in which patients were randomly assigned to medication under two different dose conditions (fixed dose and flexible dose). Secondary memory was assessed at baseline, fixed-dose, and flexible-dose phases, using the California Verbal Learning Test (CVLT). Six measures were selected, which formed three factors (general verbal learning ability, retention, and learning strategy). Risperidone-treated patients showed greater improvement than haloperidol-treated patients in general verbal learning ability, a finding characterized by significant treatment effects on CVLT measures of learning acquisition, recall consistency, and recognition memory. After controlling for benztropine status, differences on the measures of learning acquisition and recall consistency remained significant, and differences in recognition memory weakened slightly (p = 0.07). No significant treatment effects were noted on retention or learning strategy. These findings suggest that risperidone may exert a facilitating effect on the acquisition of new verbal information, an effect that does not appear to be due to the activation of semantic encoding strategies. (+info)
The effects of clozapine, risperidone, and olanzapine on cognitive function in schizophrenia.
(23/2979)
Cognitive function is markedly impaired in most patients with schizophrenia. Antecedents of this impairment are evident in childhood. The cognitive disability is nearly fully developed at the first episode of psychosis in most patients. The contribution of cognitive impairment to outcome in schizophrenia, especially work function, has been established. Preliminary results indicate that cognitive function, along with disorganization symptoms, discriminate schizophrenia patients who are able to work full-time from those who are not. Typical neuroleptic drugs lack the ability to improve the various domains of cognitive function impaired in schizophrenia. Atypical antipsychotic drugs pharmacologically related to clozapine-quetiapine, olanzapine, risperidone, sertindole, and ziprasidone--share the ability to produce fewer extrapyramidal symptoms than typical neuroleptic drugs and more potent antagonism of serotonin2a relative to dopamine2 receptors. However, they have a number of different clinical effects. We have identified all the studies of clozapine, olanzapine, and risperidone that provide data on their effects on cognition in schizophrenia. Data for each drug are reviewed separately in order to identify differences among them in their effects on cognition. Twelve studies that report cognitive effects of clozapine are reviewed. These studies provide (1) strong evidence that clozapine improves attention and verbal fluency and (2) moderate evidence that clozapine improves some types of executive function. However, results of the effects of clozapine on working memory and secondary verbal and spatial memory were inconclusive. Risperidone has relatively consistent positive effects on working memory, executive functioning, and attention, whereas improvement in verbal learning and memory was inconsistent. Preliminary evidence presented here suggests that olanzapine improves verbal learning and memory, verbal fluency, and executive function, but not attention, working memory, or visual learning and memory. Thus, atypical antipsychotic drugs as a group appear to be superior to typical neuroleptics with regard to cognitive function. However, available data suggest that these drugs produce significant differences in specific cognitive functions. These differences may be valuable adjunctive guides for their use in clinical practice if cognitive improvements reach clinical significance. The effects of the atypical antipsychotic drugs on cholinergic and 5-HT2a-mediated neurotransmission as the possible basis for their ability to improve cognition are discussed. It is suggested that the development of drugs for schizophrenia should focus on improving the key cognitive deficits in schizophrenia: executive function, verbal fluency, working memory, verbal and visual learning and memory, and attention. (+info)
The effects of neurocognitive remediation on executive processing in patients with schizophrenia.
(24/2979)
Approaches to cognitive remediation have differed across studies. Most of the larger studies have concentrated on group treatments designed without the benefit of recent laboratory-based studies. The current study describes a randomized trial of an intensive cognitive remediation program involving individual daily sessions of 1 hour for up to 3 months. It targets executive functioning deficits (cognitive flexibility, working memory, and planning) that are known to be problematic in people with schizophrenia. Procedural learning, as well as the principles of errorless learning, targeted reinforcement, and massed practice, was the basis of the intervention. The program was compared with an alternative therapy (intensive occupational therapy) to control for some of the effects of therapeutic contact. Some improvements in cognition followed both therapies. A differential effect in favor of cognitive remediation therapy was found for tests in the cognitive flexibility and the memory subgroups. There was a trend for those receiving atypical antipsychotic medication to benefit more from cognitive remediation for tests of cognitive flexibility. Although there were no consistent changes in symptoms or social functioning between groups, if improvement in cognitive flexibility tasks reached a threshold then there is some evidence that social functioning improved, even over the short duration of the trial. In addition, cognitive remediation differentially improved self-esteem. This study supports the view that cognitive remediation can reduce cognitive deficits and that this reduction may affect social outcome, at least in the short term. (+info)