RESUMEN

Based on the vulnerability model of depression, this study tested the hypothesis that caregivers with prior depression are more likely to be depressed during caregiving than caregivers without prior depression. We further hypothesized an interaction effect in which caregivers with prior depression would be affected more by care-recipient dependency in activities of daily living and care-recipient depressive symptoms than those without prior depression. In a sample of 111 caregivers of persons with Alzheimer's disease, in an additive regression model, neither 'prior depressive symptoms' nor the clinically more serious 'prior depressive syndrome' was related to depressive symptoms during caregiving. In an interaction model, for caregivers with either 'no prior depression' or 'prior depressive symptoms,' the greater the care-recipient dependencies in instrumental activities of daily living (IADL), the greater were the depressive symptoms during caregiving. For caregivers with a 'prior depressive syndrome', however, the greater the IADL dependency, the fewer were the depressive symptoms during caregiving. This unexpected finding suggests that caregivers with a history of clinically significant depression are not necessarily more prone to depressive symptoms when caregiving responsibilities, at least for instrumental activities, are high. This result questions the vulnerability model of depression when applied to older caregivers.

Asunto(s)

Actividades Cotidianas/psicología , Enfermedad de Alzheimer , Cuidadores/psicología , Depresión/diagnóstico , Trastorno Depresivo/fisiopatología , Atención Domiciliaria de Salud/psicología , Estrés Psicológico/fisiopatología , Adulto , Anciano , Anciano de 80 o más Años , Enfermedad de Alzheimer/enfermería , Enfermedad de Alzheimer/psicología , Actitud Frente a la Salud , Síntomas Conductuales , Depresión/etiología , Trastorno Depresivo/terapia , Femenino , Predicción , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Ohio , Factores de Riesgo , Autoimagen , Factores Sexuales

RESUMEN

OBJECTIVE: To assess whether linkage of tuberculosis (TB) and HIV/AIDS increases the perception of stigma among TB patients on Community-Based Directly Observed Therapy (CB-DOT) compared to similar TB patients on self-administered therapy (SAT). DESIGN: A Cross-sectional study. SETTING: Kiboga (CB-DOT) and Mubende (SAT) districts, Uganda in 2000. SUBJECTS: One hundred and five tuberculosis patients on CB-DOT and 202 patients on SAT. One hundred and twenty one (39%) of these patients agreed to be tested for HIV. RESULTS: Patients on CB-DOT and patients on SAT were similar on most of the domains used to assess stigma associated with a TB diagnosis, except for the domain of TB diagnosis and general belief that TB and HIV/AIDS are linked. Patients on CB-DOT were more likely to believe that neighbours knew they had TB compared to patients on SAT (91% vs. 62%, p < 0.001), but the groups did not differ in their perception that neighbours thought they have HIV because of TB (46% vs. 46%, p = 0.954). HIV prevalence was similar in both groups. CONCLUSION: The study demonstrates that TB patients on CB-DOT did not differ from SAT patients in their perception of stigma as a result of TB. Therefore, HIV-related stigma may not limit wide implementation of CB-DOT in countries like Uganda.

Asunto(s)

Servicios de Salud Comunitaria/estadística & datos numéricos , Terapia por Observación Directa/psicología , Terapia por Observación Directa/estadística & datos numéricos , Conocimientos, Actitudes y Práctica en Salud , Prejuicio , Percepción Social , Tuberculosis/terapia , Adolescente , Adulto , Estudios Transversales , Análisis Factorial , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/terapia , Humanos , Masculino , Población Rural/estadística & datos numéricos , Autoadministración/psicología , Tuberculosis/etiología , Uganda

RESUMEN

OBJECTIVE: To investigate the association between Alzheimer disease (AD) and worker functions and traits associated with occupations. BACKGROUND: Studies have reported that occupational attainment is related to AD. However, most have not identified specific worker functions and traits (i.e., occupational demands) of occupations that may explain the association, nor have they accounted for changing occupational demands over time. METHODS: Within- and between-group differences in mental, motor, physical, and social occupational demands of 122 AD cases and 235 control subjects were compared across four decades of life (20s, 30s, 40s, and 50s) using repeated-measures analyses of covariance adjusted for race, gender, year of birth, and education. RESULTS: Overall, mental occupational demands were significantly lower and physical occupational demands were significantly higher for cases than for control subjects. Case/control differences in mental demand scores were not found in their 20s but only in later decades. Differences in physical demands were found in all decades but their 30s. Social and motor demands did not differ between cases and control subjects. Among cases only, there were no significant occupational demand score differences across decades. In contrast, mental and social demand scores of control subjects increased in later decades, and motor demand scores declined. Like cases, physical demand scores of control subjects remained stable across the decades. CONCLUSIONS: The authors' results may indicate a relatively early influence of Alzheimer disease neuropathology on capacity to pursue mentally demanding occupations. However, results also are consistent with the notion that mentally demanding occupations have a direct influence on Alzheimer disease neuropathology.

Asunto(s)

Logro , Enfermedad de Alzheimer/epidemiología , Ocupaciones , Factores de Edad , Anciano , Enfermedad de Alzheimer/psicología , Estudios de Casos y Controles , Escolaridad , Femenino , Humanos , Relaciones Interpersonales , Perfil Laboral , Masculino , Competencia Mental , Procesos Mentales , Persona de Mediana Edad , Actividad Motora , Examen Neurológico , Pruebas Neuropsicológicas , Ocupaciones/clasificación , Ohio , Competencia Profesional

RESUMEN

OBJECTIVE: To examine the presence and extent of bias introduced by using surrogate respondents for healthy controls in a case-control study of Alzheimer's disease (AD). DESIGN: Comparative study of matched responses to questionnaire ascertaining lifestyle issues. SETTING: University Hospitals/Case Western Reserve University Alzheimer Center. PARTICIPANTS: Controls (n = 50) were identified through the Research Registry. Surrogates (n = 50) were their healthy relatives or friends. MEASUREMENTS: Answers in the areas of demographic and occupational history, smoking habits, medical history, dietary intake, and leisure and work activities were recorded. The analysis was based on methods for paired data. Continuous variables were analyzed, focusing on paired differences between self and surrogate responses. RESULTS: For occupations and exposures, over 80% of the surrogates agreed with the subjects on over 80% of the questions. On smoking history, over 90% of the surrogates agreed with the subjects on over 70% of the questions. On leisure and work activities, over 70% of the surrogates agreed with the subjects on over 50% of the questions. There was less agreement regarding medical history. For continuous variables, most paired t-tests of zero mean difference between self and surrogate responses resulted in nonrejection of this hypothesis. Computed mean differences were not always positive or always negative. CONCLUSION: We did not find systematic under- or overreporting by the surrogates of the controls. Therefore, if there are biases in the responses of surrogates of the AD cases in our case-control study, they would not be canceled out by using surrogates for the controls.

Asunto(s)

Enfermedad de Alzheimer/etiología , Sesgo , Estudios de Casos y Controles , Estilo de Vida , Anamnesis/normas , Proyectos de Investigación/normas , Encuestas y Cuestionarios/normas , Anciano , Enfermedad de Alzheimer/epidemiología , Interpretación Estadística de Datos , Escolaridad , Exposición a Riesgos Ambientales/estadística & datos numéricos , Ejercicio Físico , Femenino , Humanos , Actividades Recreativas , Masculino , Anamnesis/métodos , Ocupaciones/estadística & datos numéricos , Características de la Residencia/estadística & datos numéricos , Factores de Riesgo , Fumar/efectos adversos

RESUMEN

The purpose of this study was to examine the effects, over time, of depressive symptoms in persons with Alzheimer's disease on depression in their family caregivers. In a sample of 353 patients and caregivers, multilevel longitudinal analysis was used to accommodate an observational design in which the number of observation points and the intervals between points varied across caregivers. The rate of change (increase) in caregiver depression was predicted by the rate of change (increase) in patient depressive symptoms and by increase in patient dependency in instrumental activities of daily living (ADLs). Acceleration of the increase in caregiver depression was predicted by acceleration in patient dependency in instrumental and basic ADLs but not by acceleration in patient depressive symptoms. These findings indicate the importance of measuring the rate and acceleration of change in patient characteristics in order to understand caregiver depression. They also support early interventions for caregivers.

Asunto(s)

Enfermedad de Alzheimer/epidemiología , Cuidadores/psicología , Depresión/epidemiología , Actividades Cotidianas/clasificación , Actividades Cotidianas/psicología , Adulto , Anciano , Anciano de 80 o más Años , Enfermedad de Alzheimer/diagnóstico , Enfermedad de Alzheimer/psicología , Comorbilidad , Depresión/diagnóstico , Depresión/psicología , Femenino , Evaluación Geriátrica , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Ohio/epidemiología

RESUMEN

The development of Alzheimer's disease (AD) later in life may be reflective of environmental factors operating over the course of a lifetime. Educational and occupational attainments have been found to be protective against the development of the disease but participation in activities has received little attention. In a case-control study, we collected questionnaire data about 26 nonoccupational activities from ages 20 to 60. Participants included 193 people with probable or possible AD and 358 healthy control-group members. Activity patterns for intellectual, passive, and physical activities were classified by using an adaptation of a published scale in terms of "diversity" (total number of activities), "intensity" (hours per month), and "percentage intensity" (percentage of total activity hours devoted to each activity category). The control group was more active during midlife than the case group was for all three activity categories, even after controlling for age, gender, income adequacy, and education. The odds ratio for AD in those performing less than the mean value of activities was 3.85 (95% confidence interval: 2.65-5.58, P < 0.001). The increase in time devoted to intellectual activities from early adulthood (20-39) to middle adulthood (40-60) was associated with a significant decrease in the probability of membership in the case group. We conclude that diversity of activities and intensity of intellectual activities were reduced in patients with AD as compared with the control group. These findings may be because inactivity is a risk factor for the disease or because inactivity is a reflection of very early subclinical effects of the disease, or both.

Asunto(s)

Actividades Cotidianas , Enfermedad de Alzheimer/epidemiología , Adulto , Enfermedad de Alzheimer/psicología , Estudios de Casos y Controles , Femenino , Estado de Salud , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Ohio/epidemiología , Encuestas y Cuestionarios

RESUMEN

The "reserve" hypothesis suggests that education should affect the clinical expression of Alzheimer's disease (AD), but results from studies examining this idea are not consistent. In a single study, we evaluated the effects of educational attainment on three aspects of the clinical expression of AD: age at symptom onset, rate of cognitive decline, and survival. Subjects were 258 persons with mild- or moderate-stage Alzheimer's, drawn from our AD Research Registry. With statistical adjustment for confounding variables present in a clinic-based design, we found that higher educational attainment was associated with slightly earlier reports of symptom onset and a slower rate of cognitive decline on the Mini-Mental State Exam (MMSE). Education did not affect time of survival until death. We conclude that, for subjects in our sample, education had modest effects on aspects of the clinical expression of AD. These effects were not fully consistent with predictions derived from the "reserve" hypothesis.

Asunto(s)

Enfermedad de Alzheimer/epidemiología , Sistema de Registros , Enseñanza , Anciano , Trastornos del Conocimiento/diagnóstico , Trastornos del Conocimiento/epidemiología , Femenino , Humanos , Masculino , Índice de Severidad de la Enfermedad

RESUMEN

Malathion resistance has been shown to be the result of a single point mutation in the LcalphaE7 gene in four independently isolated chromosomes of Lucilia cuprina. The resultant amino acid substitution specifies high malathion carboxylesterase (MCE) activity. We have assayed MCE activities and resistance to malathion in three sets of field-derived samples, two sets of isogenic lines and five mass populations, and show that resistance to malathion in these samples is associated with high MCE activity in both sets of isogenic lines and four of the five mass populations. Additional mechanisms contributing to MCE activity or malathion resistance may be present in one of the mass populations. A second point mutation in LcalphaE7 is responsible for conferring diazinon resistance by encoding an increased organophosphate (OP) hydrolase activity. We also assayed diazinon resistances from the same three samples and show that diazinon and malathion resistances were in complete disequilibrium, with two exceptions. One exception involves the mass population with additional resistance mechanism(s) and the other involves three isogenic lines that are resistant to both insecticides. The molecular data for these lines suggest that they carry a duplication of the LcalphaE7 gene.

Asunto(s)

Hidrolasas de Éster Carboxílico/metabolismo , Dípteros/efectos de los fármacos , Dípteros/fisiología , Resistencia a los Insecticidas/genética , Sustitución de Aminoácidos , Animales , Australia , Hidrolasas de Éster Carboxílico/efectos de los fármacos , Hidrolasas de Éster Carboxílico/genética , Inhibidores de la Colinesterasa/farmacología , Diazinón/farmacología , Variación Genética , Homocigoto , Insecticidas/farmacología , Malatión/farmacología , Mutación Puntual

RESUMEN

This study examined the efficacy of a worksite-based intervention in reducing blood pressure and personal strain in African-American women. The experimental group (n = 22) was taught a 7-muscle group progressive relaxation intervention. The women, for home practice, used audiocassette tapes and diaries. The control group (n = 21) was asked to set aside 30 minutes for relaxation. All women who participated in the study were visited at the worksite weekly for eight weeks. At the conclusion of the study, the experimental group had a significantly lower mean physical strain score (23.23 [SD = 6.85] v. 27.41 [SD = 8.49]) and interpersonal strain (25.81 [SD = 6.25] v. 23.57 [SD = 6.06]); both groups had significant reductions in psychological strain scores. Although there were no significant differences in the blood pressure of the two groups at the end of the 8-week intervention (121.95 [SD = 13.28] v. 129.33 [SD = 14.30]), the mean systolic blood pressure of the treatment group did decrease from 130 mmHg to 121 mmHg. Findings from this study support the use of the work-place as a means of improving the cardiovascular health of working African-American women.

Asunto(s)

Negro o Afroamericano/psicología , Hipertensión/etnología , Hipertensión/prevención & control , Servicios de Salud del Trabajador/normas , Terapia por Relajación/normas , Estrés Psicológico/etnología , Estrés Psicológico/prevención & control , Servicios de Salud para Mujeres/normas , Mujeres Trabajadoras/psicología , Lugar de Trabajo , Adulto , Población Negra , Femenino , Estudios de Seguimiento , Humanos , Hipertensión/diagnóstico , Hipertensión/genética , Persona de Mediana Edad , Evaluación de Programas y Proyectos de Salud , Índice de Severidad de la Enfermedad , Sudeste de Estados Unidos , Estrés Psicológico/diagnóstico , Encuestas y Cuestionarios , Salud de la Mujer

Asunto(s)

Atención a la Salud/economía , Cicatrización de Heridas , Heridas y Lesiones/terapia , Atención a la Salud/tendencias , Humanos , Heridas y Lesiones/enfermería

RESUMEN

The purpose of this study was to compare a conventional system and a managed care clinical system for the care of high-risk neonates. The variables selected for the comparison of these two systems included neurobehavioral organization as evidenced by feeding behaviors, length of stay, severity of illness, readmissions, and cost of care. The sample consisted of 260 neonates (111 in the conventional system, 149 in the managed care system). In addition, two neonatal diagnosis-related groups were selected: 386 (extreme immaturity) and 387 (prematurity with major problems). Findings showed that the managed care clinical system enhanced neurobehavioral organization specifically in the feeding behaviors by reducing the number of days needed to master oral feedings. Although there was an increase in complications, costs were controlled.

Asunto(s)

Manejo de Caso/organización & administración , Vías Clínicas/organización & administración , Cuidado Intensivo Neonatal/organización & administración , Programas Controlados de Atención en Salud/organización & administración , Enfermería Neonatal/organización & administración , Evaluación de Resultado en la Atención de Salud/organización & administración , Grupos Diagnósticos Relacionados/clasificación , Costos de Hospital/estadística & datos numéricos , Humanos , Recién Nacido , Tiempo de Internación/estadística & datos numéricos , Investigación en Administración de Enfermería , Investigación en Evaluación de Enfermería , Readmisión del Paciente/estadística & datos numéricos

RESUMEN

Proteasomes are multicatalytic complexes that function as the major proteolytic machinery in regulated protein degradation. The eukaryotic 20S proteasome proteolytic core structure comprises 14 different subunits: 7 alpha-type and 7 beta-type. DTS7 is a dominant temperature-sensitive (DTS) lethal mutation at 29 degrees that also acts as a recessive lethal at ambient temperatures. DTS7 maps to cytological position 71AB. Molecular characterization of DTS7 reveals that this is caused by a missense mutation in a beta-type subunit gene, beta2. A previously characterized DTS mutant, l(3)73Ai1, results from a missense mutation in another beta-type subunit gene, beta6. These two mutants share a very similar phenotype, show a strong allele-specific genetic interaction, and are rescued by the same extragenic suppressor, Su(DTS)-1. We propose that these mutants might act as "poison subunits," disrupting proteasome function in a dosage-dependent manner, and suggest how they may interact on the basis of the structure of the yeast 20S proteasome.

Asunto(s)

Cisteína Endopeptidasas/genética , Drosophila melanogaster/enzimología , Complejos Multienzimáticos/genética , Secuencia de Aminoácidos , Animales , Secuencia de Bases , Mapeo Cromosómico , Clonación Molecular , Cisteína Endopeptidasas/química , Drosophila melanogaster/genética , Genes de Insecto , Datos de Secuencia Molecular , Complejos Multienzimáticos/química , Mutagénesis , Fenotipo , Complejo de la Endopetidasa Proteasomal , Conformación Proteica , Análisis de Secuencia de ADN , Homología de Secuencia de Aminoácido , Temperatura , Transgenes

RESUMEN

The proteasome plays essential roles in a variety of cellular processes, including degradation of the bulk of cellular proteins, degradation of short-lived proteins such as cell cycle regulators, generation of antigenic peptides, and mediating programmed cell death. One of the best characterized subunits of the 26S proteasome is encoded by the yeast gene SUG1. We report here the cloning and characterization of the Drosophila homolog of this gene, Pros45. At the protein level, Pros45 is highly conserved with respect to its homologs in a variety of taxa: it shows 74% identity to yeast Sug1; 86% to mouse m56/mSug1/FZA-B; 87% to human Trip1; and 97% to moth 18-56. Using a genomic clone as a probe for in situ hyridization to polytene chromesomes, we demonstrated that Pros45 maps to 19F, near the base of the X chromosome. Use of a pros45 cDNA clone as a probe revealed a second site of hybridization at 99CD. Pros45 mRNA is found in the unfertilized egg and in all cells of the early embryo. By the end of embryogenesis, Pros45 is expressed predominantly in the central nervous system. Targeted expression of Pros45 in a variety of different cells using the Gal4 UAS P-element system failed to generate an overt phenotype. This study provides the foundation for further examination of the role of the 26S proteasome in homeostasis and development in Drosophila.

Asunto(s)

Proteínas Portadoras/química , Proteínas Portadoras/genética , Proteínas de Drosophila , Drosophila melanogaster/enzimología , Drosophila melanogaster/genética , Endopeptidasas , Proteínas Fúngicas/genética , Péptido Hidrolasas/química , Péptido Hidrolasas/genética , Complejo de la Endopetidasa Proteasomal , Proteínas Represoras/genética , Proteínas de Saccharomyces cerevisiae , Homología de Secuencia de Aminoácido , Adenosina Trifosfatasas , Secuencia de Aminoácidos , Animales , Secuencia de Bases , Mapeo Cromosómico , Clonación Molecular , Drosophila melanogaster/embriología , Regulación del Desarrollo de la Expresión Génica , Datos de Secuencia Molecular , Saccharomyces cerevisiae , Análisis de Secuencia de ADN , Homología de Secuencia de Ácido Nucleico

RESUMEN

Proteasomes are large multisubunit particles that act as the proteolytic machinery for the ubiquitin-dependent proteolytic pathway. The core of this complex, the 20S proteasome, is made up of seven alpha-type and seven beta-type subunits, arranged in an (alpha1-alpha7)(beta1-beta7)(beta1-beta7)(alpha1-al pha7) configuration. Previous work had shown that there exist alternative isoforms of the Drosophila melanogaster alpha4-type subunit, encoded by two distinct genes, alpha4t1_dm and alpha4t2_dm, and that these are expressed exclusively in the germline of the testes. We sought to investigate the evolutionary conservation of this phenomenon by screening for orthologs of the alpha4-type gene family in the distantly related Drosophila species, D. virilis. We isolated the D. virilis orthologs of the somatically expressed gene, alpha4_dm, and the testes-specific gene, alpha4t2_dm. We failed to find an ortholog of the other testes-specific gene, alpha4t1_dm. The alpha4_dv gene maps to the X chromosome at 12A-C, its product shares 90% amino acid identity with alpha4_dm, and it is expressed at high levels in both males and females. The other gene, alpha4t_dv, encodes a protein most similar to the testes-specific alpha4t2_dm proteasome subunit (59% a.a. identity), and it maps to position 27 on chomosome 2. The expression of the alpha4t_dv gene is testes-specific, like that of alpha4t2_dm. The existence of testes-specific alpha4-type subunits in two widely diverged subgenera of Drosophila suggests that these subunit isoforms have important functional roles in spermatogenesis.

Asunto(s)

Cisteína Endopeptidasas/genética , Proteínas de Drosophila , Drosophila/genética , Genes de Insecto/genética , Complejos Multienzimáticos/genética , Proteínas/genética , Testículo/enzimología , Secuencia de Aminoácidos , Animales , Secuencia de Bases , Mapeo Cromosómico , Clonación Molecular , Secuencia Conservada/genética , ADN/química , ADN/genética , Drosophila/química , Drosophila/enzimología , Evolución Molecular , Expresión Génica/genética , Regulación Enzimológica de la Expresión Génica , Masculino , Datos de Secuencia Molecular , Filogenia , Complejo de la Endopetidasa Proteasomal , Análisis de Secuencia de ADN , Homología de Secuencia de Aminoácido , Factores Sexuales

RESUMEN

This study aimed to examine differences in subjective psychological well-being between husband and wife caregivers of persons with Alzheimer's disease in comparison to the psychological states of noncaregiver husbands and wives similar in age and ethnicity. The principal comparison of interest was whether differences between husband and wife caregivers were greater than those between comparison group husbands and wives. Significant interactions for six out of nine psychological measures indicate that gender-related differences between spouse caregivers were specifically associated with the caregiving role. Possible explanations for the discrepancy between husband and wife caregivers as well as practice implications are discussed.

Asunto(s)

Adaptación Psicológica , Enfermedad de Alzheimer , Cuidadores/psicología , Autoevaluación (Psicología) , Esposos/psicología , Anciano , Análisis de Varianza , Femenino , Humanos , Masculino , Ohio , Factores Sexuales

RESUMEN

Critically ill patients are exposed to many physiologic and environmental stressors, which can result in deleterious physiological and psychological effects. Stress and coping within Lazarus and Folkman's transactional model is used as a basis for describing patient responses in critical care. The authors propose specific strategies to reduce stress and maximize coping in the critically ill patient.

Asunto(s)

Adaptación Psicológica , Cuidados Críticos/psicología , Modelos de Enfermería , Modelos Psicológicos , Infarto del Miocardio/psicología , Estrés Psicológico/enfermería , Análisis Transaccional , Humanos , Masculino , Persona de Mediana Edad , Diagnóstico de Enfermería

RESUMEN

OBJECTIVES: To identify sociodemographic and clinical characteristics associated with the use of do-not-resuscitate (DNR) orders in hospitalized patients with stroke. To examine whether the use of DNR orders varies across hospitals. METHODS: This observational cohort study used data collected for 13337 consecutive eligible patients with a primary diagnosis of stroke. These patients were discharged in 1991 through 1994 from 30 hospitals in a large metropolitan area. Study data were abstracted from patients' hospital records using standard forms. Admission severity of illness was measured using a validated multivariable model. Sociodemographic and clinical factors independently associated with the use of DNR orders were identified using stepwise logistic regression. RESULTS: Do-not-resuscitate orders were written for 2898 patients (22%). Patient characteristics independently (P < .01) associated with increased use of DNR orders included increasing age (odds ratio [OR], 1.06 per year); admission from a skilled nursing facility (OR, 2.44) or through the emergency department (OR, 1.49); cancer (OR, 2.73), intracerebral hemorrhage (OR, 2.12), coma (OR, 7.47), or lethargy or stupor on admission neurological assessment (OR, 3.38); and increasing admission severity (OR; 1.29 per decile). In contrast, African American race was associated with lower use of DNR orders (OR, 0.54). Although substantial variation in the use of DNR orders was observed across hospitals, with rates ranging from 12% to 32%, adjusting for the above patient characteristics eliminated much of this variation, including differences between major teaching and other hospitals and between hospitals with and without religious affiliations. CONCLUSIONS: In our community-based analysis of patients with stroke, the use of DNR orders was common and was strongly related to several patient characteristics. These factors explained much of the variation across hospitals. While our analysis did not account for differences in patient preferences for treatment, the differences we observed in the use of DNR orders across sociodemographic groups are suggestive of variations in care and may have important implications for the cost and quality of hospital care.

Asunto(s)

Encefalopatías , Trastornos Cerebrovasculares , Hospitales/estadística & datos numéricos , Órdenes de Resucitación , Anciano , Estudios de Cohortes , Femenino , Humanos , Modelos Logísticos , Masculino , Oportunidad Relativa

RESUMEN

BACKGROUND: Exposure to noise in a critical care unit may trigger a response by the sympathetic nervous system, thereby increasing cardiovascular work in patients recovering from cardiac surgery. OBJECTIVE: To investigate the effects of a music intervention given twice on the first postoperative day on noise annoyance, heart rate, and arterial blood pressure in subjects with high (n = 22) and low (n = 18) sensitivity to noise. METHODS: A prospective, quasi-experimental, repeated-measures design was used. Based on results of power analysis, the sample size was 40. Subjects were recruited preoperatively, and their sensitivity to noise was assessed. On the first postoperative day, repeated-measures data were collected on levels of noise annoyance and physiological variables during 15 minutes of baseline and 15 minutes of music intervention on two occasions. Subjects completed a follow-up questionnaire regarding their perceptions of the noise in the critical care unit and the music intervention. RESULTS: Repeated-measures analysis of variance showed that subjects had lower levels of noise annoyance during music intervention than at baseline. Heart rate and systolic blood pressure decreased during the music intervention compared with baseline. Diastolic blood pressure decreased during the music intervention from baseline during time 2, but not time 1. Subjects with high baseline scores of noise sensitivity preoperatively had higher baseline levels of noise annoyance in the critical care unit the first postoperative day. Subjects rated the music intervention as highly enjoyable regardless of their baseline noise sensitivity or noise annoyance. CONCLUSION: Results of this study support the idea that noise annoyance is a highly individual phenomenon, influenced by a transaction of personal and environmental factors. Use of a music intervention with cardiac surgery patients during the first postoperative day decreased noise annoyance, heart rate, and systolic blood pressure, regardless of the subject's noise sensitivity.

Asunto(s)

Actitud Frente a la Salud , Presión Sanguínea , Procedimientos Quirúrgicos Cardíacos/psicología , Frecuencia Cardíaca , Musicoterapia/normas , Ruido/efectos adversos , Análisis de Varianza , Procedimientos Quirúrgicos Cardíacos/enfermería , Investigación en Enfermería Clínica , Femenino , Ambiente de Instituciones de Salud , Humanos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Encuestas y Cuestionarios

RESUMEN

Esterase activities associated with organophosphate insecticide resistance in the Australian sheep blowfly, Lucilia cuprina, are compared with similar activities in other Diptera. The enzymes making the major contribution to methyl butyrate hydrolysis ("ali-esterase") in L. cuprina, M. domestica, and D. melanogaster comigrate during electrophoresis. The enzymes in L. cuprina and D. melanogaster correspond to the naphthyl acetate hydrolyzing E3 and EST23 isozymes of those species. These and previously published data suggest that the ali-esterases of all three species are orthologous. Strains of L. cuprina fall into four groups on the basis of quantitative determinations of their ali-estesterase, OP hydrolase, and malathion carboxylesterase activities and these groups correspond to their status with respect to two types of OP resistance. Strains susceptible to OP's have high ali-esterase, low OP hydrolase, and intermediate MCE activities; those resistant to malathion but not diazinon have low ali-esterase, intermediate OP hydrolase, and high MCE activities; those resistant to diazinon but not malathion have low ali-esterase, high OP hydrolase, and low MCE activities; those resistant to both OPs have low ali-esterase, high OP hydrolase, and high MCE activities. The correlated changes among the three biochemical and two resistance phenotypes suggest that they are all properties of one gene/enzyme system; three major allelic variants of that system explain OP susceptibility and the two types of OP resistance. Models are proposed to explain the joint contribution of OP hydrolase and MCE activities to malathion resistance and the invariant association of low ali-esterase and elevated OP hydrolase activities in either type of resistance.

Asunto(s)

Dípteros/efectos de los fármacos , Dípteros/enzimología , Esterasas/fisiología , Resistencia a los Insecticidas , Insecticidas/toxicidad , Animales , Carboxilesterasa , Hidrolasas de Éster Carboxílico/efectos de los fármacos , Hidrolasas de Éster Carboxílico/genética , Diálisis , Dípteros/genética , Drosophila melanogaster/efectos de los fármacos , Drosophila melanogaster/enzimología , Drosophila melanogaster/genética , Electroforesis en Gel de Poliacrilamida , Inhibidores Enzimáticos/farmacología , Esterasas/efectos de los fármacos , Esterasas/genética , Femenino , Variación Genética , Concentración de Iones de Hidrógeno , Isoflurofato/farmacología , Cinética , Larva , Muscidae/efectos de los fármacos , Muscidae/enzimología , Muscidae/genética , Mutación , Monoéster Fosfórico Hidrolasas/efectos de los fármacos , Monoéster Fosfórico Hidrolasas/genética , Monoéster Fosfórico Hidrolasas/metabolismo , Especificidad de la Especie

RESUMEN

This paper summarizes the measurement choices made by selected current or recently completed multi-site projects with a common emphasis on measuring outcomes in dementia. Information on number of items and scoring, reason(s) for selecting the measure, and reliability and validity of the measure (either citations providing this information or a report of pertinent unpublished findings) is presented for eight domains: cognition, behavioral symptoms, physical health status, physical functioning and self-care abilities, quality of life, family/staff caregiver outcomes, service use, and cost. We found considerable reliance on the published literature as a guide to measurement choice, motivated largely by measures' superior psychometric properties, their ubiquity in the literature, and/or their brevity or ease of use. There is still evidence of "starting from scratch" in some domains, however. To the extent that these projects reflect the state of the art in dementia-relevant outcomes research, we conclude that comparison of outcomes across studies will continue to be problematic. However, as long as dissemination of methodological as well as substantive findings continues to characterize outcome studies in dementia, there is hope that a more congruent view of how to assess key outcomes in dementia will emerge.

Asunto(s)

Demencia/terapia , Evaluación de Resultado en la Atención de Salud , Cuidadores , Toma de Decisiones , Investigación sobre Servicios de Salud , Humanos , Metaanálisis como Asunto , Proyectos Piloto , Calidad de Vida