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Introduction: This study aimed to develop and validate a 3-year dementia risk score in individuals with mild cognitive impairment (MCI) based on variables collected in routine clinical care. Methods: The prediction score was trained and developed using data from the National Alzheimer's Coordinating Center (NACC). Selection criteria included aged 55 years and older with MCI. Cox models were validated externally using two independent cohorts from the Prospective Registry of Persons with Memory Symptoms (PROMPT) registry and the Alzheimer's Disease Neuroimaging Initiative (ADNI) database. Results: Our Mild Cognitive Impairment to Dementia Risk (CIDER) score predicted dementia risk with c-indices of 0.69 (95% confidence interval [CI] 0.66-0.72), 0.61 (95% CI 0.59-0.63), and 0.72 (95% CI 0.69-0.75), for the internally validated and the external validation PROMPT, and ADNI cohorts, respectively. Discussion: The CIDER score could be used to inform clinicians and patients about the relative probabilities of developing dementia in patients with MCI.
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BACKGROUND: Mild behavioral impairment (MBI) describes later life acquired, sustained neuropsychiatric symptoms (NPS) in cognitively normal individuals or those with mild cognitive impairment (MCI), as an at-risk state for incident cognitive decline and dementia. We developed an operational definition of MBI and tested whether the presence of MBI was related to caregiver burden in patients with subjective cognitive decline (SCD) or MCI assessed at a memory clinic. METHODS: MBI was assessed in 282 consecutive memory clinic patients with SCD (n = 119) or MCI (n = 163) in accordance with the International Society to Advance Alzheimer's Research and Treatment - Alzheimer's Association (ISTAART-AA) research diagnostic criteria. We operationalized a definition of MBI using the Neuropsychiatric Inventory Questionnaire (NPI-Q). Caregiver burden was assessed using the Zarit caregiver burden scale. Generalized linear regression was used to model the effect of MBI domains on caregiver burden. RESULTS: While MBI was more prevalent in MCI (85.3%) than in SCD (76.5%), this difference was not statistically significant (p = 0.06). Prevalence estimates across MBI domains were affective dysregulation (77.8%); impulse control (64.4%); decreased motivation (51.7%); social inappropriateness (27.8%); and abnormal perception or thought content (8.7%). Affective dysregulation (p = 0.03) and decreased motivation (p=0.01) were more prevalent in MCI than SCD patients. Caregiver burden was 3.35 times higher when MBI was present after controlling for age, education, sex, and MCI (p < 0.0001). CONCLUSIONS: MBI was common in memory clinic patients without dementia and was associated with greater caregiver burden. These data show that MBI is a common and clinically relevant syndrome.
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Síntomas Conductuales/epidemiología , Cuidadores/psicología , Disfunción Cognitiva/epidemiología , Demencia/epidemiología , Anciano , Disfunción Cognitiva/diagnóstico , Disfunción Cognitiva/psicología , Demencia/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Prevalencia , Estudios ProspectivosRESUMEN
ABSTRACT Background: Geriatric psychiatry hospital beds are a limited resource. Our aim was to determine predictors of hospital length of stay (LOS) for geriatric patients with dementia admitted to inpatient psychiatric beds. Methods: Admission and discharge data from a large urban mental health center, from 2005 to 2010 inclusive, were retrospectively analyzed. Using the resident assessment instrument - mental health (RAI-MH), an assessment that is used to collect demographic and clinical information within 72 hours of hospital admission, 169 geriatric patients with dementia were compared with 308 geriatric patients without dementia. Predictors of hospital LOS were determined using a series of general linear models. Results: A diagnosis of dementia did not predict a longer LOS in this geriatric psychiatry inpatient population. The presence of multiple medical co-morbidities had an inverse relationship to length of hospital LOS - a greater number of co-morbidities predicted a shorter hospital LOS in the group of geriatric patients who had dementia compared to the without dementia study group. The presence of incapacity and positive psychotic symptoms predicted longer hospital LOS, irrespective of admission group (patients with dementia compared with those without). Conversely, pain on admission predicted shorter hospital LOS. Conclusions: Specific clinical characteristics generally determined at the time of admission are predictive of hospital LOS in geriatric psychiatry inpatients. Addressing these factors early on during admission and in the community may result in shorter hospital LOS and more optimal use of resources.
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This case study reports the clinical, skin biopsy and molecular findings in a 56-year-old Filipino man with the autosomal recessive ectodermal dysplasia disorder, Schöpf-Schulz-Passarge syndrome, the precise nature of which was established only after reading of a similar case in this journal. In addition to the late diagnosis, successful clinical management of his acral hyperkeratosis and ulceration has been difficult, with oral retinoids exacerbating the skin fragility.
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Anodoncia/diagnóstico , Diagnóstico Tardío , Glándulas Ecrinas/anomalías , Displasia Ectodérmica/diagnóstico , Neoplasias de los Párpados/diagnóstico , Hipotricosis/diagnóstico , Queratodermia Palmoplantar/diagnóstico , Factores de Edad , Anodoncia/etiología , Anodoncia/terapia , Displasia Ectodérmica/etiología , Displasia Ectodérmica/terapia , Neoplasias de los Párpados/etiología , Neoplasias de los Párpados/terapia , Humanos , Hipotricosis/etiología , Hipotricosis/terapia , Queratodermia Palmoplantar/etiología , Queratodermia Palmoplantar/terapia , Masculino , Persona de Mediana EdadRESUMEN
This study examined physical activity in leisure time and at work as estimated by the Global Physical Activity Questionnaire (GPAQ) and the associations between both total and domain-specific physical activity with cardiovascular risk factors in a population-based Vietnamese sample. Participants (n = 1978) were 25- to 64-year-old adults selected by stratified multistage sampling. Leisure activity contributed to <5% of total moderate and vigorous activity and was not associated with cardiovascular risk factors. Total moderate and vigorous activity was associated with body composition (r = -0.16 to -0.22; P < .001), blood glucose (r = -0.07; P < .05), and total cholesterol (r = -0.17; P < .001) for men and with total cholesterol (r = -0.07; P < .05) for women after adjusting for age. Further adjustment for smoking and alcohol intake made negligible changes. These associations were largely driven by work activity, which accounted for 80% of total activity.
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Enfermedades Cardiovasculares/epidemiología , Actividad Motora , Adulto , Empleo , Femenino , Humanos , Actividades Recreativas , Masculino , Persona de Mediana Edad , Factores de Riesgo , Vietnam/epidemiologíaRESUMEN
Panic disorder has been associated with both an increased risk of coronary events as well as an increased risk of stroke. Hemoconcentration, with both a decrease in plasma volume and an increase in plasma viscosity, is a possible contributor to the risk of acute ischemic events. Our objectives were to demonstrate the process of hemoconcentration in response to induced panic symptoms and to assess the effect of pretreatment with ethinyl estradiol on panic-induced hemoconcentration. Fifteen male patients with panic disorder and 10 male healthy volunteers were included in a double-blind cross-over placebo-controlled design consisting of two injections of pentagastrin following randomized pretreatment with placebo and ethinyl estradiol. Plasma levels of hematocrit and hemoglobin were assessed at baseline and post-injections, and used to calculate an indirect estimation of the change in plasma volume. Pentagastrin-induced panic symptoms were associated with a mean decrease in plasma volume of 4.8% in the placebo pretreatment condition. Pretreatment with ethinyl estradiol attenuated this effect. The acute hemoconcentration observed in relation to pentagastrin-induced panic symptoms may be relevant to the increased risk of stroke and acute coronary events found in patients with panic disorder.
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Viscosidad Sanguínea/efectos de los fármacos , Estrógenos/farmacología , Etinilestradiol/farmacología , Trastorno de Pánico/sangre , Pánico/efectos de los fármacos , Pentagastrina/efectos adversos , Volumen Plasmático/efectos de los fármacos , Estudios Cruzados , Método Doble Ciego , Estrógenos/administración & dosificación , Etinilestradiol/administración & dosificación , Hematócrito , Hemoglobinas/análisis , Humanos , Masculino , Pentagastrina/farmacología , Escalas de Valoración PsiquiátricaRESUMEN
BACKGROUND: As chronic obstructive pulmonary disease (COPD) progresses, exacerbations can occur with increasing frequency. One goal of therapy is to prevent these exacerbations, thereby reducing morbidity and associated healthcare costs. Pneumococcal vaccinations are one strategy for reducing the risk of infective exacerbations. OBJECTIVES: To determine the safety and efficacy of pneumococcal vaccination in COPD. The primary outcomes assessed were episodes of pneumonia and acute exacerbations. Secondary outcomes of interest included hospital admissions, adverse events related to treatment, disability, change in lung function, mortality, and cost effectiveness. SEARCH STRATEGY: We searched the Cochrane Airways Group COPD trials register and the databases CENTRAL, MEDLINE and EMBASE using pre-specified terms. The latest searches were performed in March 2010. SELECTION CRITERIA: Randomised controlled trials assessing the effects of injectable pneumococcal vaccine in people with COPD were included. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and three review authors independently assessed trial quality. MAIN RESULTS: Seven studies were identified that met the inclusion criteria for this review and were included in the 2010 review update. Two older trials used a 14-valent vaccine and five more recent trials used a 23-valent injectable vaccine.In six studies involving 1372 people, the reduction in likelihood of developing pneumonia with pneumococcal vaccination compared to control did not achieve statistical significance, the odds ratio (OR) was 0.72 (95% confidence interval (CI) 0.51 to 1.01), with moderate heterogeneity present between studies. The reduction in likelihood of acute exacerbations of COPD from two studies involving 216 people was not statistically significant (Peto OR 0.58; 95% CI 0.30 to 1.13).Of the secondary outcomes for which data were available there was no statistically significant effect for reduction in hospital admissions (two studies) or emergency department visits (one study). There was no significant reduction in pooled results from three studies involving 888 people for odds of all-cause mortality for periods up to 48 months post-vaccination (OR 0.94; 95% CI 0.67 to 1.33), or for death from cardiorespiratory causes (OR 1.07; 95% CI 0.69 to 1.66). AUTHORS' CONCLUSIONS: The limited evidence from randomised controlled trials (RCTs) included in this review suggests that, while it is possible that injectable polyvalent pneumococcal vaccines may provide some protection against morbidity in persons with COPD, no significant effect on any of the outcomes was shown. Further large RCTs in this population would be needed to confirm effectiveness of the vaccine suggested by results from longitudinal studies.
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Infecciones Neumocócicas/prevención & control , Vacunas Neumococicas/administración & dosificación , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Humanos , Persona de Mediana Edad , Infecciones Neumocócicas/mortalidad , Enfermedad Pulmonar Obstructiva Crónica/mortalidad , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
The question driving research on after-school programs is shifting from "do programs make a difference," to "why are some programs effective while others are not?" This article draws on the work in this volume and related studies to suggest that there is an emerging consensus on the importance of staff-youth interactions as a determinant of program effectiveness. The commentary recommends that future research should continue to focus on understanding and improving program practices at the point-of-service. In doing so, two lines of inquiry seem promising. The first involves linking measures of changes in staff-youth interactions to changes in developmental outcomes. The second is to examine how policies or other interventions intended to improve program effectiveness affect the practices of line staff.
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Evaluación de Programas y Proyectos de Salud/métodos , Instituciones Académicas/organización & administración , Adolescente , Familia , Humanos , Modelos Organizacionales , Desarrollo de Programa/métodos , Investigación , EstudiantesRESUMEN
To address the critical shortage of physician scientists in the field of adolescent medicine, a conference of academic leaders and representatives from foundations, National Institutes of Health, Maternal and Child Health Bureau, and the American Board of Pediatrics was convened to discuss training in transdisciplinary research, facilitators and barriers of successful career trajectories, models of training, and mentorship. The following eight recommendations were made to improve training and career development: incorporate more teaching and mentoring on adolescent health research in medical schools; explore opportunities and electives to enhance clinical and research training of residents in adolescent health; broaden educational goals for Adolescent Medicine fellowship research training and develop an intensive transdisciplinary research track; redesign the career pathway for the development of faculty physician scientists transitioning from fellowship to faculty positions; expand formal collaborations between Leadership Education in Adolescent Health/other Adolescent Medicine Fellowship Programs and federal, foundation, and institutional programs; develop research forums at national meetings and opportunities for critical feedback and mentoring across programs; educate Institutional Review Boards about special requirements for high quality adolescent health research; and address the trainee and faculty career development issues specific to women and minorities to enhance opportunities for academic success.
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Servicios de Salud del Adolescente/organización & administración , Medicina del Adolescente/educación , Actitud del Personal de Salud , Educación Médica/organización & administración , Comunicación Interdisciplinaria , Grupo de Atención al Paciente/organización & administración , Centros Médicos Académicos/organización & administración , Adolescente , Servicios de Salud del Adolescente/tendencias , Medicina del Adolescente/organización & administración , Medicina del Adolescente/tendencias , Competencia Clínica , Congresos como Asunto , Curriculum , Becas/organización & administración , Femenino , Humanos , Internado y Residencia/organización & administración , Grupo de Atención al Paciente/tendencias , Estados Unidos , Adulto JovenRESUMEN
OBJECTIVE: The association between tobacco smoking and blood pressure in epidemiological studies remains unclear despite experimental evidence that smoking elevates blood pressure. This study examined the association between smoking and hypertension in a population-based sample of Vietnamese men. METHODS: The study utilized a population-based sample of men (n = 910) from a survey of risk factors of noncommunicable diseases in Vietnam. Measurements including behavioural risk factors, body composition, and blood pressure were performed according to internationally standardized protocols. Poisson regression was used to obtain prevalence ratios and 95% confidence intervals (CIs). All analyses were performed using complex survey methods. RESULTS: There were significant trends of increasing prevalence of hypertension with increasing years (P = 0.05) and pack-years (P = 0.03) of smoking after adjusting for age, BMI, and alcohol intake. Relative to never-smokers, the risk of hypertension for those who had smoked for 30 years or more and those who had smoked 20 pack-years or more were 1.52 (95% CI 0.95-2.44) and 1.34 (95% CI 0.94-1.91), respectively. Overall, however, current smokers were not at higher risk of hypertension than never-smokers (prevalence ratio = 1.08, 95% CI 0.70-1.68), and ex-smokers were more likely to be hypertensive than either never-smokers (prevalence ratio = 1.81, 95% CI 1.07-3.06) or current smokers (prevalence ratio = 1.67, 95% CI 1.25-2.23), similarly adjusted. CONCLUSION: In this population-based sample, hypertension was associated with smoking in a dose-response manner when characterized as number of years of smoking and lifetime cigarette consumption, but was not associated with current smoking status.
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Hipertensión/epidemiología , Hipertensión/etiología , Fumar/efectos adversos , Adulto , Presión Sanguínea , Humanos , Hipertensión/fisiopatología , Masculino , Persona de Mediana Edad , Factores de Riesgo , Fumar/fisiopatología , Encuestas y Cuestionarios , Factores de Tiempo , Vietnam/epidemiologíaRESUMEN
BACKGROUND: Despite the increasing burden of non-communicable diseases (NCD) in Vietnam, information on the prevalence of preventable risk factors for NCD is restricted to the main urban centres of Ha Noi, and Ho Chi Minh City (HCMC). This population-based survey aimed to describe the prevalence of risk factors for NCD in a rural Vietnamese sample. METHODS: This survey was conducted using the WHO "STEPwise approach to surveillance of non-communicable diseases" (STEPS) methodology. Participants (n=1978) were residents of the Mekong Delta region selected by multi-stage sampling. Standardised international protocols were used to measure behavioural risk factors (smoking, alcohol consumption, fruit and vegetable consumption, physical activity), physical characteristics (weight, height, waist and hip circumferences, blood pressure--BP), fasting blood glucose (BG) and total cholesterol (TC). Data were analysed using complex survey analysis methods. RESULTS: In this sample, 8.8% of men and 12.6% of women were overweight (body mass index (BMI)>or=25 kg/m2) and 2.3% of men and 1.5% of women were obese (BMI>or=30 kg/m2). The prevalence of hypertension (systolic BP>or=140 mmHg and/or diastolic BP>or=90 mmHg, or taking medication for hypertension) was 27.3% for men and 16.2% for women. There were 1.0% of men and 1.1% of women with raised BG (defined as capillary whole BG of at least 6.1 mmol/L). CONCLUSION: We provide the first NCD risk factor profile of people living in the Mekong Delta of Vietnam using standardised methodology. Our findings for this predominantly rural sample differ from previous studies conducted in Ha Noi and HCMC, and suggest that it is inappropriate to generalise findings from the big-city surveys to the other 80% of the population.
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Enfermedad , Adulto , Enfermedad/clasificación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Encuestas y Cuestionarios , Vietnam/epidemiologíaRESUMEN
A 14-year-old girl had a 3-month history of headache and blurred vision. Funduscopy showed bilateral optic disc edema. Findings on brain imaging were normal, and a diagnosis of idiopathic intracranial hypertension was confirmed after lumbar puncture showed an elevated opening pressure of 32 cm H(2)O. Optic nerve head drusen were noted on computed tomography scan and confirmed with B-scan ultrasound. After 2 years, resolution of symptoms coincided with variable compliance to treatment with acetazolamide and concomitant papilledema. In general, optic disc edema poses a clinical conundrum due to the more common occurrence of optic nerve head drusen, potentially resulting in delayed diagnosis and treatment of idiopathic intracranial hypertension.
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Hipertensión Intracraneal/complicaciones , Drusas del Disco Óptico/etiología , Adolescente , Diagnóstico Diferencial , Femenino , Estudios de Seguimiento , Humanos , Hipertensión Intracraneal/diagnóstico , Hipertensión Intracraneal/fisiopatología , Presión Intracraneal , Imagen por Resonancia Magnética , Drusas del Disco Óptico/diagnóstico , Tomografía Computarizada por Rayos X , Agudeza VisualRESUMEN
Understanding how to assess and improve what happens within out-of-school-time (OST) programs is a critical challenge facing the field. This article explores key developments related to the issue of quality in the OST field during the past several years and then looks ahead at opportunities for future progress. From a practice perspective, one of the most notable recent developments is the proliferation of intentional, systemic efforts to improve program quality. From a policy perspective, discussions related to quality within the OST field reflect broader trends within human services and education toward increased accountability. In addition to holding systems accountable for producing client outcomes, there is an emerging trend toward holding systems and programs accountable for what it is they do with clients. Funders are increasingly focused on quality, and many now express specific expectations related to quality assessment for grantees. On the research side, there is increased interest among social science researchers to better understand OST settings, including a push to develop and refine point-of-service measures that can help researchers capture data on the specific practices that drive youth outcomes. These promising developments position the field to evolve in some important ways in the coming years. In particular, there is an opportunity to refine and expand approaches to quality improvement using lessons from practice and research. From a policy perspective, quality can become further embedded in the accountability movement in ways that support program improvement by focusing attention on and directing resources toward the point of service.
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Desarrollo del Adolescente , Desarrollo de Programa/normas , Recreación , Responsabilidad Social , Adolescente , Humanos , Mejoramiento de la CalidadAsunto(s)
Desarrollo del Adolescente , Enseñanza/normas , Adolescente , Humanos , Relaciones Interpersonales , MentoresRESUMEN
BACKGROUND: Human studies of dietary fat as a possible risk factor for cutaneous malignant melanoma (CMM) and non-melanoma skin cancer (NMSC)--principally basal cell carcinoma (BCC) and squamous cell carcinoma (SCC)--have produced inconsistent results. We had the opportunity to examine the association concurrently for all three types of skin cancer in a population-based study in Tasmania, Australia, involving 652 cases of CMM, BCC and SCC and a common set of 471 controls. METHODS: Histopathologically-confirmed cases of CMM, BCC and SCC were ascertained from the Tasmanian Cancer Registry (TCR), and controls were selected at random from the state's electoral roll. We compared subjects categorised by thirds of dietary fat intake score measured by the 'Dobson short fat questionnaire', with logistic regression models that adjusted for age, sex, skin type and usual sun exposure. We then followed all subjects for 56-80 months until 31 August, 2004 for a new NMSC using record linkage with both the TCR and the Births, Deaths, and Marriages registry. Incidence rates were calculated and ratios of rates were estimated using Poisson models. RESULTS: Relative to subjects in the lowest fat intake category, the odds ratios (OR) comparing cases and controls were OR = 0.76 (95% CI: 0.56-1.03) for medium fat intake, and OR = 0.62 (95% CI: 0.45-0.85) for high fat intake, with a significant (p < 0.01) trend of reduced odds ratio with higher category dietary fat intake. Among cases, the incidence rate ratio (IRR) relative to those with lowest fat score was IRR = 0.72 (95% CI: 0.50-1.03) for medium fat intake, and IRR = 0.82 (95% CI: 0.56-1.20) for highest fat intake (linear trend p = 0.30). CONCLUSION: Using the same dietary instrument with two study designs in the same Caucasian population, we found no evidence that high fat intake increases the risk of developing melanoma or non-melanoma skin cancers. Instead, our results suggest a risk reduction for high fat intake.
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Carcinoma Basocelular/epidemiología , Carcinoma de Células Escamosas/epidemiología , Grasas de la Dieta/administración & dosificación , Melanoma/epidemiología , Neoplasias Cutáneas/epidemiología , Adulto , Australia/epidemiología , Carcinoma Basocelular/diagnóstico , Carcinoma de Células Escamosas/diagnóstico , Estudios de Casos y Controles , Estudios de Cohortes , Femenino , Humanos , Incidencia , Masculino , Melanoma/diagnóstico , Persona de Mediana Edad , Factores de Riesgo , Neoplasias Cutáneas/diagnósticoRESUMEN
BACKGROUND: Bicycling, skateboarding, and inline skating are popular recreational activities, with the potential of causing severe injury. METHODS: A retrospective, population-based, trauma registry analysis of severe injuries and deaths from nonmotorized wheeled vehicles (NMWV) over a 10-year period was performed. RESULTS: During the study period, 1475 cyclists, 141 skateboarders, and 112 inline skaters sustained injury meeting registry criteria (length of stay > or = 3 days or death). The majority were male. Lone crashes were the most common mechanism of injury, although collisions with motor vehicles accounted for 63.6% (n = 44) of observed deaths. Thoracic trauma and head injuries were more common in nonsurvivors. CONCLUSION: NMWV injuries pose a public health concern. We recommend enforcement of mandatory helmet laws and expansion of the existing law to include skateboarders and inline skaters. Education initiatives should also be expanded to include the adult population. NMWV should be separated from motorized vehicles as much as possible.
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Traumatismos en Atletas/epidemiología , Ciclismo/lesiones , Vigilancia de la Población , Patinación/lesiones , Adolescente , Adulto , Distribución por Edad , Anciano , Traumatismos en Atletas/diagnóstico , Colombia Británica/epidemiología , Traumatismos Craneocerebrales/diagnóstico , Traumatismos Craneocerebrales/epidemiología , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Traumatismo Múltiple/diagnóstico , Traumatismo Múltiple/epidemiología , Estudios Retrospectivos , Distribución por Sexo , Tasa de Supervivencia , Traumatismos Torácicos/diagnóstico , Traumatismos Torácicos/epidemiología , Índices de Gravedad del TraumaRESUMEN
Nicotine addiction leads to withdrawal symptoms in many persons who quit smoking. In addition to craving, the most commonly experienced symptoms are: depression; difficulty sleeping; irritability, frustration, or anger; anxiety; difficulty concentrating; restlessness; decreased heart rate; and increased appetite or weight gain. The severity of withdrawal symptoms are variable, and often lead to relapse. By altering the course of withdrawal symptoms it is possible to improve the chances of the quit attempt and reduce the risk of relapse. There is strong evidence that dopamine is the primary neurotransmitter in the reward pathway in addiction. The use of nicotine replacement therapies and Zyban (sustained release bupropion hydrochloride), both of which are suspected of exploiting dopamine's role in addiction, enhance the likelihood of long-term smoking cessation. Anecdotal reports of oxygen's capacity to reduce both the desire for nicotine and withdrawal symptoms suggest that this may be a therapeutic possibility for those who do not experience success with more traditional cessation approaches. Oxygen may have a favorable effect on nicotine withdrawal, as it appears to alter the balance of central neurotransmitters such as dopamine.
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Encéfalo/efectos de los fármacos , Encéfalo/metabolismo , Dopamina/metabolismo , Nicotina/efectos adversos , Oxígeno/uso terapéutico , Cese del Hábito de Fumar/métodos , Síndrome de Abstinencia a Sustancias/prevención & control , Tabaquismo/complicaciones , Humanos , Modelos BiológicosRESUMEN
We report on the synthesis of a platinum(IV) compound containing a di-2-pyridyl ketone (dpk) ligand that is stable both in its anhydrous form [Pt(dpk)Cl(4)] (1) and in its hydrated form [Pt(dpk-O-OH)Cl(3)].H-phenCl (2). The crystal structure of the hydrated form shows that one of the hydroxide groups from the resulting gem-diol has undergone a cyclometalation/condensation reaction resulting in an oxygen atom directly coordinated to the Pt(IV) center and the formation of H-phenCl. We correlate our physical data with predictions made by molecular modeling, and we propose an explanation for the unusual activity found for this dpk ketone. Spectroscopic and solubility studies are presented here, as well. Electrochemical studies of 1 indicate that it undergoes a highly irreversible reduction at a potential of about -0.45 V vs Ag(+)/Ag in CH(3)CN and that the irreversibility is likely due to an EC mechanism, the nature of which is currently under further investigation. Another distinct redox pair, apparently reversible, appears at a potential of about -1.1 V vs Ag(+)/Ag.
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This chapter describes a framework for conceptualizing interventions intended to create the conditions linked to positive youth development. These interventions involve strategies designed to enhance either the will or the capacity of individuals, organizations, systems, or communities to change.
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Conducta del Adolescente/psicología , Redes Comunitarias , Procesos de Grupo , Desarrollo Humano , Modelos Organizacionales , Adolescente , Humanos , Desarrollo de ProgramaRESUMEN
BACKGROUND: Blunt vascular neck injuries (BVNIs) are rare, often occult, and potentially devastating injuries. The purpose of this study was to identify a high-risk group, which would benefit from screening. METHODS: Patients with BVNIs were identified from our trauma registry and charts were reviewed. Potential risk factors for BVNI were evaluated by univariate and multivariate logistic regression. RESULTS: Thirty-one BVNIs were identified in 22 patients. The stroke rate was 60% and the mortality rate was 25%. Univariate analysis showed Glasgow Coma Scale score < or = 8, head injury (Abbreviated Injury Scale [AIS] score > or = 3), basal skull fracture, facial injury, other neck injury, thorax injury (AIS score > or = 3), abdominal injury, and cervical spine injury to be significant (p < 0.05). The multivariate predictive model had two predictors remaining significant: thorax injury (AIS [thorax] score > or = 3) and Glasgow Coma Scale score < or = 8. CONCLUSION: Screening should be undertaken for patients at increased risk for BVNI: those with risk factors identified in our regression analysis and factors previously reported.