Showing papers by "Rush University Medical Center published in 1986"
TL;DR: The independent associations of diabetes and possibly asymptomatic hyperglycemia with coronary heart disease mortality, with greater relative significance in women than in men, are indicated.
Abstract: This epidemiologic study explored the sex differential in risk of death from coronary heart disease in persons with or without clinically diagnosed diabetes or asymptomatic hyperglycemia. Use was made of 9-year follow-up data from the Chicago Heart Association Detection Project in Industry for 11,220 white men and 8,030 white women aged 35-64 years at entry to the Project (November 1967-January 1973). Both clinically diagnosed diabetes and asymptomatic hyperglycemia were associated with an increased risk of death from coronary heart disease. The extent of this association was greater in women than in men in regard to relative risk. However, absolute excess risk for both diabetics and those with asymptomatic hyperglycemia was larger for men than for women. Clinical diabetes appeared to be an independent risk factor for coronary heart disease in both men and women based on multivariate Cox regression analyses. On the other hand, for men, no significant independent effect of asymptomatic hyperglycemia was apparent. Women with asymptomatic hyperglycemia had significantly higher coronary heart disease death rates than normoglycemic women, with adjustment for major coronary heart disease risk factors; in multivariate analyses, the relationship of asymptomatic hyperglycemia to risk of coronary heart disease was of borderline significance (p = 0.054). This study indicates the independent associations of diabetes and possibly asymptomatic hyperglycemia with coronary heart disease mortality, with greater relative significance in women than in men.
310 citations
TL;DR: The addition of cisplatin improves the chemotherapy of advanced ovarian carcinoma, and the response duration for patients with measurable disease and progression‐free interval for all patients showed a statistically significant advantage for CAP; however, there was no difference in survival of patients with nonmeasurable disease.
Abstract: A randomized clinical trial was conducted in women with bulky (suboptimal) Stage III and Stage IV ovarian carcinoma, using doxorubicin (Adriamycin) and cyclophosphamide with or without cisplatin. There were 440 evaluable cases, of which 227 had measurable disease. One hundred twenty of these latter patients were treated with cyclophosphamide and doxorubicin (CA), while 107 received cyclophosphamide, doxorubicin and cisplatin (CAP). The clinical complete response (CR) rate for CA was 26% (31/120) compared with 51% (55/107) for CAP (P = less than 0.0001). Of 23 CRs receiving CA who had a second-look laparotomy, only four were negative; of 39 CRs receiving CAP and a second-look, 13 were negative (not statistically significant). The response duration for patients with measurable disease (median 14.6 versus 8.8 months), progression-free interval for all patients (13.1 versus 7.7 months), and survival for patients with measurable disease (19.7 versus 15.7 months) showed a statistically significant advantage for CAP; however, there was no difference in survival of patients with nonmeasurable disease. Toxicity was more severe with CAP but was tolerable. Thus, the addition of cisplatin improves the chemotherapy of advanced ovarian carcinoma.
272 citations
TL;DR: Treatment of patients with nonbipolar major depressive disorders during the first eight weeks after entry into the National Institute of Mental Health-Clinical Research Branch Collaborative Program on the Psychobiology of Depression do not appear to be related to differences in patient characteristics.
Abstract: • We examined the treatment of 338 patients with nonbipolar major depressive disorders during the first eight weeks after entry into the National Institute of Mental Health—Clinical Research Branch Collaborative Program on the Psychobiology of Depression: Clinical Study. Of the 250 entered as inpatients, 31% received either no antidepressant somatotherapy or very low or unsustained levels, and only 49% received at least 200 mg of imipramine hydrochloride (or its equivalent) for four consecutive weeks. Of these patients, 19% received less than 30 minutes of psychotherapy per week. Among the 88 who entered as outpatients, 29% received no antidepressant somatotherapy; another 24% received very low or unsustained levels; only 19% received at least 200 mg of imipramine hydrochloride or its equivalent for four consecutive weeks. Of these patients, 52% received less than 30 minutes of psychotherapy per week. Only a few clinical factors were found to be predictive of treatment intensity. Very large differences in the amount and type of treatment across the five collaborating university centers do not appear to be related to differences in patient characteristics.
216 citations
TL;DR: Ten patients with comminuted intra-articular fractures of the proximal interphalangeal (PIP) joint were treated by dynamic traction splinting and early mobilizations, resulting in a pain-free final range of motion (ROM) of 87 degrees, with preservation of articular symmetry and space.
Abstract: Unstable intra-articular fractures that involve the proximal and middle phalanges often lead to joint stiffness and loss of function. Ten patients with comminuted intra-articular fractures of the proximal interphalangeal (PIP) joint were treated by dynamic traction splinting and early mobilizations. Distal traction, with a force of 300 g, was provided by a rubber band connecting a transosseous wire to a movable component on an arcuate splint made of thermoplastic material. Intermittent passive movement was carried out on a timed schedule. Follow-up at 16 months (5 months to 5 1/2 years) showed a pain-free final range of motion (ROM) of 87° (5° to 92°), with preservation of articular symmetry and space. This is the first report of treatment of intraarticular fractures in the hand by a combination of dynamic traction and passive movement.
183 citations
TL;DR: It appears that the hypoosmotic swelling test is a more accurate predictor of successful in vitro fertilization outcome than the conventional semen parameters.
Abstract: Human ejaculates (n = 83) were analyzed for standard sperm parameters (concentration, motility, and morphology), as well as for the ability of the spermatozoa to react (swell) in a hypoosmotic medium (Jeyendran et al, 1984) Subsequently, the fertilizing capacity of the spermatozoa was tested by their ability to fertilize human oocytes in vitro Although the sperm concentration was adjusted for in vitro fertilization, no adjustments were made for sperm motility and morphology Correlation of the in vitro fertilizing capacity of the spermatozoa with the hypoosmotic swelling test (r = 056) was much higher than with standard sperm parameters (r varied from -004 to 025) Complete overlap was noted with standard semen parameters whether the ejaculate did or did not fertilize oocytes and ranged from very low to very high values in both cases By contrast, all the semen samples that fertilized oocytes showed a 60% or higher reaction in the hypoosmotic swelling test, whereas the majority of the "infertile" semen samples showed less than 60% swelling It therefore appears that, under the conditions of our studies, the hypoosmotic swelling test is a more accurate predictor of successful in vitro fertilization outcome than the conventional semen parameters A combination of all parameters, however, is likely to be most useful The hypoosmotic swelling test is simple and economical, and it is recommended that this test be further scrutinized for its value as an additional tool in the assessment of the in vivo fertilizing capacity of ejaculated spermatozoa
145 citations
138 citations
TL;DR: It is demonstrated that some signs of parkinsonism can remain quite responsive to levodopa for more than 10 years while at the same time other manifestations of the disease are no longer as responsive to this form of treatment.
Abstract: Twenty-five consecutive patients with Parkinson's disease, who had been on levodopa for 10 or more years, were studied. Over the 12.9 years of treatment, the average Northwestern Disability Score had increased from 9.6 to 18.9. By this measure, 24 of 25 patients were worse, and one was unchanged. The progression of disability did not involve all pretreatment parkinsonian features equally in any of the patients studied. Instead a distinctive pattern of deterioration was seen: postural reflexes worsened in 24/25, speech in 24/25, and gait in 22/25. In contrast, rigidity was improved or unchanged in 17/25, tremor was improved or unchanged in 17/17, while handwriting was improved or unchanged in 21/22. Finger dexterity which was improved in 5/25, unchanged in 15/25, and worse in 5/25 which seemed to be between these two extremes. These observations demonstrate that some signs of parkinsonism can remain quite responsive to levodopa for more than 10 years while at the same time other manifestations of the disease are no longer as responsive to this form of treatment.
128 citations
TL;DR: It is concluded that in some patients, hyperactive stretch reflexes cause movement deficits.
Abstract: SUMMARY
Spastic patients were instructed to make accurate, rapid ankle dorsiflexion and plantarflexion movements over different distances to a target. Ankle position and surface electromyograms (EMGs) from tibialis anterior (TA) and soleus (SOL) muscles were recorded. In 3 of 8 spastic patients tested, dorsiflexion evoked velocity-dependent activation of the antagonist (SOL) muscle which impeded the movement to the extent that the limb unintentionally reversed movement direction. We propose that this activation is reflex in origin since it (1) is tightly synchronized, (2) has a large peak amplitude, (3) occurs about 50 ms after the initiation of the movement, and (4) is velocity dependent
One of the 3 patients who had reflex-induced antagonist activation in dorsiflexion also demonstrated sustained clonus during plantarflexion. This usually occurred only if the target had been overshot so that the return of the limb stretched the soleus muscle and triggered clonus We conclude that in some patients, hyperactive stretch reflexes cause movement deficits.
121 citations
TL;DR: It is proposed that heavy-snoring males may potentially serve as a population in which to model the neurobehavioral effects of Hypoxia, and reliable relationships between nocturnal hypoxia and measures of general intelligence, verbal and nonverbal memory, and expressive verbal fluency are indicated.
Abstract: Hypoxia is a well known cause of brain dysfunction. Neuropsychological impairments have been observed in normal subjects experiencing hypoxia iatrogenically as well as in patients with chronic lung disease. Recent investigations have demonstrated significant nocturnal hypoxia in subjects with sleep-disordered breathing. In the present study, heavy-snoring males, a group known to experience frequent episodes of sleep-disordered breathing received neuropsychological testing and a night of continuous monitoring of respiratory parameters. Partial correlations, controlling for age, weight, and education, indicated reliable relationships between nocturnal hypoxia and measures of general intelligence, verbal and nonverbal memory, and expressive verbal fluency. It is proposed that heavy-snoring males may potentially serve as a population in which to model the neurobehavioral effects of hypoxia. Further research in subjects with sleep-disordered breathing may help clarify the extent of the possible cognit...
112 citations
TL;DR: The observations suggested that the metabolism of homocysteine to cysteine was more efficient in pregnant women and the concentrations of total homocyst(e)ine in amniotic fluids were within narrow limits in normal pregnancies, which might be very valuable as a rapid assessment of fetuses for congenital defects of homocrysteine metabolism.
Abstract: Total homocyst(e)ine was determined by the quantitation of protein-bound homocyst(e)ine in the stored plasma and amniotic fluid from 25 pregnant women and in the stored plasma from 17 nonpregnant women. The mean ± SE of plasma total homocyst(e)ine was 29.8 ± 2.4 nmol/g protein in pregnant women and 52.4 ± 3.8 nmol/g protein in nonpregnant women. In contrast, the mean ± SE of total homocyst(e)ine in amniotic fluid obtained at 16 weeks of gestation was 36.3 ± 2.9 nmol/g protein. There was a statistically significant difference in the plasma total homocyst(e)ine concentrations from pregnant and nonpregnant women (P < 0.01). Similarly, there was also a statistically significant difference between plasma total homocyst(e)ine from nonpregnant women and amniotic fluid total homocyst(e)ine (P < 0.01). These observations suggested that the metabolism of homocysteine to cysteine was more efficient in pregnant women. In addition, the concentrations of total homocyst(e)ine in amniotic fluids were within narrow limits in normal pregnancies. Hence, total homocyst(e)ine concentration might be very valuable as a rapid assessment of fetuses for congenital defects of homocysteine metabolism.
97 citations
TL;DR: The traditional clinical description of aching and stiffness does not appear to accurately describe the complexity of the fibromyalgia pain syndrome.
Abstract: Pain properties of 50 fibromyalgia patients were examined and compared with pain properties of 50 rheumatoid arthritis patients. In both fibromyalgia and rheumatoid arthritis, pain was bilateral, involved multiple sites, and was of equal intensity (60.8 versus 58.7, respectively, on a scale of 100). Fibromyalgia pain, however, was less localized to the joints and suggested greater spatial diffusion. It involved more kinds of pain experiences (radiating, steady, spreading, spasms, gnawing, unlocalized, pricking, crushing, shooting, pressing, splitting, cramping, nagging, and pins and needles), and was dispersed over larger areas of the body. The anatomic sites best for discrimination between patients with fibromyalgia and patients with rheumatoid arthritis were the lower back, thigh, abdomen, head, and hips for fibromyalgia, and wrist, foot, and fingers for rheumatoid arthritis. The traditional clinical description of aching and stiffness does not appear to accurately describe the complexity of the fibromyalgia pain syndrome.
TL;DR: Findings indicate that extrapleural pneumonectomy for malignant mesothelioma can be done with an acceptable morbidity and mortality, and palliation is achieved in 24% of patients, and there may be an occasional long-term survivor.
TL;DR: A small increase in sarcomata was observed in animals bearing metal alloy implants containing high contents of cobalt, chromium, or nickel, when the number of malignancies in these rats was compared with control and sham‐operated animals.
TL;DR: Both factor analysis and internal consistency analyses indicate that the items of the Tolerance Questionnaire do not form a unidimensional measure of an underlying construct.
Journal Article•
TL;DR: It is concluded that while vimentin is the predominant intermediate filament expressed by the entire spectrum of nerve sheath neoplasms, at least occasional benign schwannomas are capable of co-expressing glial filament proteins.
TL;DR: Results indicated that children's healthy snack choices increased in the preschool training setting, that generalization to home was achieved only when procedures to program it were implemented, and that the best results were found when the generalization procedures were tailored to the individual child.
Abstract: We examined the effects of behavioral procedures to modify the food choices of preschoolers during a snack period at school (training setting) and at home (generalization setting). In the first experiment, we evaluated the usefulness of nutrition training and a generalization programming strategy of cueing to improve healthy snacking; in the second experiment we investigated the effect of nutrition training alone. In addition, three cases are presented that illustrate individualized procedures to facilitate generalization of healthy snacking to home. Results indicated that children's healthy snack choices increased in the preschool training setting, that generalization to home was achieved only when procedures to program it were implemented, and that the best results were found when the generalization procedures were tailored to the individual child.
TL;DR: Cough‐variant asthma was by far the most common cause of chronic cough, followed by sinusitis, aberrant innominate artery, psychogenic cough, and subglottic stenosis.
Abstract: Chronic cough is an important, sometimes frustrating problem, often encountered by the otolaryngologist-head and neck surgeon. Thirty-eight infants and children under age 16 with a normal chest roentgenogram were evaluated for chronic cough persisting for longer than 4 weeks. Specific therapy (rather than symptomatic treatment) of chronic cough lead to a resolution or control of the cough in 33 (87%). Cough-variant asthma was by far the most common cause of chronic cough, followed by sinusitis, aberrant innominate artery, psychogenic cough, and subglottic stenosis. In addition to a detailed history, physical examination, and chest roentgenogram, endoscopy, paranasal sinus roentgenograms, and pulmonary function studies with methacholine challenge testing were particularly effective for establishing a precise diagnosis. Chronic cough is best managed by determining the precise cause of the cough, then specifically treating the underlying disorder. Children with persistent cough and a normal chest roentgenogram should be referred promptly for evaluation by an otolaryngologist when the primary physician's initial efforts at diagnosis and treatment are unsuccessful. Endoscopy is under-utilized in practice and its importance is understated in the literature. It is particularly helpful in establishing a precise diagnosis in infants under 18 months of age.
TL;DR: The appearance of type X collagen in limb cartilage is environmentally regulated, demonstrating that environmental influences, probably inhibitory in nature, must regulate chondrogenesis in mesectodermal derivatives.
TL;DR: It is confirmed that immunoreactivity for NSE is present in a high proportion of breast carcinomas, but that neuroendocrine differentiation cannot be proved to be present in all these cases.
Abstract: Thirty-eight infiltrating ductal carcinomas, nine infiltrating lobular carcinomas, two tubular carcinomas and one papillary carcinoma were studied by light microscopy, immunocytochemistry and electron microscopy. Seventeen cases showed immunoreactivity for NSE. Immunostaining for different peptide-hormones was observed in 12 of these 17 cases and in none of the 10 NSE-negative cases used for controls. Scattered cells were positive for gastrin in five cases, pancreatic polypeptide in five, leu-enkephalin in three, sub-P in two, ACTH in one, bombesin in one and beta-endorphin in one case. Four cases revealed immunoreactivity for more than one peptide-hormone. Typical neuroendocrine granules were seen in five cases (all positively stained for NSE). Small, electron dense granules of possible neuroendocrine nature were not found in any of the 33 NSE-negative tumours. Our results confirm that immunoreactivity for NSE is present in a high proportion of breast carcinomas, but that neuroendocrine differentiation cannot be proved to be present in all these cases.
TL;DR: The MRFIT experience demonstrated for the first time that dietary changes and blood lipid reductions can be achieved after the initial intervention effect, despite a continued emphasis on high blood pressure management and smoking cessation.
Abstract: Nutrition counselors in the Multiple Risk Factor Intervention Trial (MRFIT) were able to help middle-aged men who were at high risk for coronary heart disease change their dietary habits, maintain those changes over time, and decrease their serum cholesterol levels. Most of a 7.5% mean serum cholesterol reduction achieved after 6 years of nutrition intervention occurred during the first year of the trial and was thereafter sustained. Total cholesterol and low-density lipoprotein cholesterol fraction decreases indicated improvement in terms of coronary heart disease risk. The food record rating, a numerical, semi-objective adherence technique that assesses a 3-day food record with respect to lipid-lowering potential, was used throughout the trial to measure adherence to recommended food patterns. Participants with lower food record rating scores, which indicate better adherence, demonstrated greater reductions in serum total cholesterol, plasma total cholesterol, and low-density lipoprotein fraction cholesterol determinations on a group basis. Subjective evaluations of the suitability of home and working environments, evidence of deviation from the MRFIT food patterns, and overall nutrition program motivation also showed that as ratings in each category became more favorable, lower food record rating scores and greater blood lipid reductions were consistently observed. The subgroup of participants who were non-smokers and not hypertensive demonstrated greater lipid responses and better dietary adherence. Continued smoking and antihypertensive medications appeared to adversely influence dietary adherence and/or lipid reductions. The MRFIT experience, however, demonstrated for the first time that dietary changes and blood lipid reductions can be achieved after the initial intervention effect, despite a continued emphasis on high blood pressure management and smoking cessation.
TL;DR: The results of this investigation suggest that longitudinal approaches should be added to cross-sectional approaches for the best definition of endogenous depression.
Abstract: • Depressive illnesses are subdivided into endogenous and nonendogenous types in psychiatry throughout the world. We used one method of validating this nosologic subdivision: the determination of the extent to which the disorder is familial. Rates of depression were examined in 2,942 first-degree relatives of 566 individuals diagnosed as having unipolar major depressive disorder. Because no single definition of endogenous depression is universally accepted, four different methods for defining endogenous depression were compared: the Newcastle Scale, the Research Diagnostic Criteria, DSM-III, and the definition of "autonomous depression" proposed by investigators at Yale University (New Haven, Conn). In general, no matter which definition was used, the relatives of the patients with endogenous illness did not have higher rates of depressive illness than those of the nonendogenous group. The Newcastle Scale was the most sensitive in picking up familial transmission of recurrent unipolar depression. The results of this investigation suggest that longitudinal approaches should be added to cross-sectional approaches for the best definition of endogenous depression.
TL;DR: Ejaculated human spermatozoa were subjected to nitrogen cavitation to remove the plasma membrane and electron microscopic examination revealed that 33% of the PM was removed from the sperm which includes both the head and tail regions.
Abstract: Ejaculated human spermatozoa were subjected to nitrogen cavitation (600 psi for ten min) to remove the plasma membrane (PM) Electron microscopic examination of the cavitated cells revealed that 33% of the PM was removed from the sperm which includes both the head and tail regions The released membrane was separated from the cavitated cells by centrifugation followed by a discontinuous sucrose density gradient centrifugation A single membrane population was resolved at the 10 M sucrose interface Examination of the isolated membranes by electron microscopy revealed vesicles of various sizes displaying unit membrane structures Biochemical analysis of the isolated membranes showed a threefold enrichment in the surface membrane marker 5' nucleotidase and also suggested little contamination by enzymes from the cytosol (lactate dehydrogenase) or mitochondria (cytochrome oxidase) Analytical lipid analysis of the isolated membranes revealed a 26-fold enrichment in the distribution of cholesterol, an 11-fold enrichment of phospholipids, and a cholesterol:phospholipid molar ratio of 083 Also found was a twofold increase in glycosphingolipids which are ubiquitous components of PM in eukaryotic cells These data indicate that the membrane vesicles isolated after nitrogen cavitation are primarily PM
TL;DR: The internal construct validity of the endogenous sub-type of major depression was investigated by statistically modelling the RDC endogenous and DSM-III melancholia diagnostic criteria, and results indicated that the symptoms in the criteria do not specify a dichotomous classification, melancholic-non-melancholic or endogenous-nonendogenous.
Abstract: The internal construct validity of the endogenous sub-type of major depression was investigated by statistically modelling the RDC endogenous and DSM-III melancholia diagnostic criteria. Data consisted of symptom ratings on 788 patients with major depression from NIMH Collaborative Depression Study. Results indicated that the symptoms in the criteria do not specify a dichotomous classification, melancholic-non-melancholic or endogenous-nonendogenous. Results did support the existence of two sub-typings, one related to anhedonia, and one related to vegetative symptoms. The vegetative sub-type rarely occurred in non-anhedonic patients. Previous studies may have found support for a simple endogenous sub-type because of this hierarchical relationship and as a result of methodological differences.
TL;DR: An abnormal pattern of ion channel expression has now been associated with a genetic defect in cells of the immune system.
Abstract: The observation that voltage-dependent K+ channels are required for activation of human T lymphocytes suggests that pathological conditions involving abnormal mitogen responses might be reflected in ion channel abnormalities. Gigaohm seal techniques were used to study T cells from MRL/MpJ-lpr/lpr mice; these mice develop generalized lymphoproliferation of functionally and phenotypically abnormal T cells and a disease resembling human systemic lupus erythematosus. The number and predominant type of K+ channels in T cells from these mice differ dramatically from those in T cells from control strains and a congenic strain lacking the lpr gene locus. Thus an abnormal pattern of ion channel expression has now been associated with a genetic defect in cells of the immune system.
TL;DR: Sulfated keratan sulfate was not detected in the serum of 16 patients with macular corneal dystrophy, but was present at normal levels in 66 patients with other cornea diseases, and this assay should prove useful in the diagnosis of macular Corneal Dystrophy.
TL;DR: Retrospective FCM analysis of paraffinized TCC tissue correlates well with conventional, prospective cytogenetic analysis and is applicable to the majority of urinary bladder transitional cell carcinomas.
Abstract: Both cytogenetic analysis and flow cytometry (FCM) have prognostic efficacy in the analysis of transitional cell carcinoma (TCC) of urinary bladder. To correlate results of the two methods, we studied a unique group of patients whose tumors had undergone prospective conventional cytogenetic analysis. Paraffin blocks of these tumors were processed for FCM, then analyzed for nuclear DNA content. Of the 34 tumors processed, 30 (88%) yielded interpretable DNA histograms. In 26 (87%) of these, there was good correlation between the two methods with respect to the presence or absence of a hyperdiploid cell line. Discrepancies may have resulted from sampling error or from interpretation of a tetraploid peak as a prominent G2M region. Retrospective FCM analysis of paraffinized TCC tissue correlates well with conventional, prospective cytogenetic analysis and is applicable to the majority of urinary bladder transitional cell carcinomas. Cancer 57:1594–1601, 1986.
TL;DR: This article reviews the literature on multiple murder from dual perspectives of how knowledge is developed and major methodologic problems encountered in accruing such knowledge.
Abstract: Cases of multiple murder stimulate intense feeling in both the public and scientific community. Because of this highly charged emotional climate and the statistical difficulties inherent in predicting low base rate behaviors, this topic has been difficult to evaluate scientifically. This article reviews the literature on multiple murder from dual perspectives of how knowledge is developed and major methodologic problems encountered in accruing such knowledge.
TL;DR: It is found that postural stability in paraplegic individuals using KAFOs compared favorably with the control group under conditions of eyes open and closed with hands on parallel bars; however, visual information was much more important for paraplegics individuals during quiet stance.
TL;DR: Four patients in the United States with the generalized atrophic benign form of junctional epidermolysis bullosa were encountered and correct diagnosis was finally established by either electron microscopic examination or immunofluorescence mapping of skin sections from induced blisters.
Abstract: • We encountered four patients in the United States with the generalized atrophic benign form of junctional epidermolysis bullosa (epidermolysis bullosa atrophicans generalisata mitis, nonlethal junctional epidermolysis bullosa). Prior to the performance of definitive diagnostic studies, each patient had been thought for at least a decade to have either a dystrophic or simplex form of epidermolysis bullosa. Each patient had generalized blisters since birth that healed with atrophy and mild scarring but without milia or contractures. Two of the four patients had experienced laryngeal involvement during childhood. In each patient, correct diagnosis was finally established by either electron microscopic examination or immunofluorescence mapping of skin sections from induced blisters. (Arch Dermatol1986;122:704-710)
TL;DR: In this article, a multi-component cognitive-behavioral smoking program with spouses attending and receiving training designed to increase spouse support was presented. But the results showed no significant differences due to spouse training at any assessment point.