Traditional cultural values, such as duty to family, greatly influenced end-of-life care preferences and retained importance across generations. Clinicians caring for Asian Indian patients at the end of life may be better able to assess care preferences after exploring the complex interplay between traditional expectations and specific social realities for each patient. Particular attention should be given to attitudes toward death and suffering, family duty, and preferences for information disclosure and decision making.

The objective of this study was to test the hypothesis that older reproductive aged women ovulate at a smaller follicle diameter and are more likely to produce multiple follicles during their menstrual cycle compared with midreproductive aged women. We performed a comparative study of 16 midreproductive aged women (MRA; 22-34 yr old) and 34 older reproductive aged women (ORA; >45 yr old). Women underwent serial transvaginal ultrasounds to follow follicular growth over 1 menstrual cycle. A subset of women (nine MRA and 19 ORA) had daily blood sampling. Scans were initiated within 1 wk of menses and were performed at least 3 times/wk until evidence of follicular collapse was observed. If there was no evidence of follicle growth beyond 10 mm by 20 d, observations (ultrasounds and blood sampling) were ended. Follicle growth was organized backward from maximum presumed preovulatory diameter. Hormones were standardized to d 0, the day when progesterone levels exceeded 2 ng/ml. Group comparisons were performed using ANOVA with Mann-Whitney post hoc testing and Kruskal-Wallis testing for integrated hormones. The main outcome measures were peak follicle diameter, follicle growth patterns, and circulating LH, F OLLICLE GROWTH PATTERNS in the menstrual cycles of reproductive aged women have been characterized using ultrasonographic evaluation. Several small studies, with up to 25 women, documented similar findings (1-3). Follicles in spontaneous cycles of midreproductive aged (MRA) women grow at a rate of between 2-6 mm daily, and ovulation has been reported to occur at a mean follicle diameter of 16 -27 mm. The latter estimates were from a study that used transabdominal scanning, which may have resulted in larger estimates of follicle size (2). Nonetheless, follicle dynamics have been noted to be consistent in populations of normally cycling women. Some recent studies have described the ovarian morphology and patterns of follicle growth associated with reproductive aging. Ovarian volume has been reported to decrease with age in a population of 13,963 women undergoing ovarian cancer screening (4). The inclusion of women in the age group between 30 -50 yr who were already naturally menopausal may have contributed disproportionately to these results, however, and the menopausal status of the younger women in this study is not provided. The number of antral follicles (i.e. Ͼ2 mm) in the ovaries has been reported to be significantly decreased in women over an age range of 22-42 yr old (5). These differences in follicle counts were independent of the stage of the menstrual cycle. Another study of 162 women that was confined to the early follicular phase alone (6) reported a mean yearly decline of antral follicle counts of about 5%, which increased to almost 12% after the age of 37 yr. Taken together, these data suggest that follicles in various stages of growth constitute the bulk of ovarian volume and that declining numbers of observable follicles occur concomitant with reproductive aging.Others have observed the patterns of f...

While providers should avoid stereotyping patients, an awareness of common challenges and adoption of recommended strategies to address these challenges may enhance the provision of culturally responsive person-centered services for seriously ill South Asian patients and their families receiving care in the United States.

Despite reports of increasing non-medical prescription drug use, relatively few studies have systematically evaluated the prevalence and correlates of non-medical prescription drug use, particularly in populations that might be especially vulnerable (e.g., injection drug users [IDUs]). We examined factors associated with non-medical prescription drug use among a community-based cohort of current and former IDUs in Baltimore (The ALIVE Study). We conducted a cross-sectional analysis of data from cohort participants that responded to a survey that included questions on non-medical prescription drug use between 2005–06 (n=1320). Non-medical prescription drug use was considered to be use of any of the following: Opiates (Oxycontin, Percocet), Benzodiazepines or Clonidine, purchased on the street and taken orally within the last six months. Data on other covariates of interest (e.g., demographics, substance use, general health) was obtained through a standardized interview. The median age was 46 years; 66% were male, 85% were African-American. Twenty one percent reported any non-medical prescription drug use; 12% reported using more than one drug. Non-medical use of opiates was most common (17%). In multivariate analysis, non-medical prescription drug use was significantly associated with Caucasian race (prevalence ratio [PR]: 1.79), self-reported bodily pain (PR: 1.58), hazardous alcohol use (PR: 1.47), marijuana use (PR: 1.65), non-injection cocaine/heroin use (PR: 1.70), diverted use of buprenorphine (PR: 1.51) or methadone (PR: 2.51), and active injection drug use (PR: 3.50; p<0.05 for all). The association between bodily pain and non-medical prescription drug use was stronger among persons that were not using substances (marijuana, injecting drugs, snorting/smoking heroin, cocaine, using crack) as compared to those using these substances. The high prevalence of non-medical prescription drug use among this population warrants further research and action. Information on the risks of nonmedical prescription drug use especially overdose, should be incorporated into interventions targeted at IDUs.