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1.
J Postgrad Med ; 70(1): 36-42, 2024.
Article in English | MEDLINE | ID: mdl-38197593

ABSTRACT

INTRODUCTION: Sleep apnea (SA) is an important comorbidity in end-stage renal disease (ESRD) patients. The association between SA and cardiac and neurological disease is known. This study investigates the relationship between SA and cardiovascular and cerebrovascular outcomes in the ESRD population. METHODS: In a retrospective cohort study, the United States Renal Data System was queried to identify ESRD patients aged 18-100 years in whom hemodialysis had been initiated between 2005 and 2013. Diagnoses of SA and clinical comorbidities were determined from International Classification of Disease-9 codes. Demographic variables were obtained from Centers for Medicare and Medicaid Services Form-2728. Logistic regression was used to examine the association of SA with myocardial infarction (MI) or with stroke, controlling for demographic and clinical variables. RESULTS: Of 858,131 subjects meeting the inclusion criteria, 587 had central SA, and 22,724 had obstructive SA. The SA cohort was younger, more likely to be male and Caucasian compared to the non-SA cohort. Patients with SA also had more tobacco and alcohol use, hypertension, heart failure, and diabetes. Central SA (aRR = 1.69, 95% CI = 1.28-2.23) and obstructive SA (aRR = 1.15, 95% CI = 1.09-1.21) were associated with an increased risk of stroke but not MI. CONCLUSION: In the ESRD population, a diagnosis of central SA or obstructive SA increased the risk of stroke, but not MI. Early identification and treatment of SA in the ESRD population may help reduce the risk of stroke in these patients.


Subject(s)
Kidney Failure, Chronic , Myocardial Infarction , Sleep Apnea Syndromes , Sleep Apnea, Obstructive , Stroke , Humans , Male , Aged , United States/epidemiology , Female , Retrospective Studies , Risk Factors , Medicare , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/epidemiology , Sleep Apnea Syndromes/complications , Sleep Apnea Syndromes/epidemiology , Sleep Apnea Syndromes/diagnosis , Sleep Apnea, Obstructive/diagnosis , Stroke/complications , Stroke/epidemiology
2.
J Endocrinol Invest ; 46(10): 2125-2132, 2023 Oct.
Article in English | MEDLINE | ID: mdl-37012521

ABSTRACT

PURPOSE: Hashimoto's thyroiditis (HT) is a common autoimmune thyroid disorder that can disrupt thyroid function and homeostasis. As HT results from a dysregulated immune system, we hypothesized that these patients might be more susceptible to transplant failure; however, literature on this association is limited. The purpose of this study is to examine the association of HT with the risk of renal transplant failure. METHODS: We utilized the United States Renal Database System dataset collected from 2005 to 2014 and compared the time from first renal transplant to transplant failure in end-stage renal disease (ESRD) patients with a HT diagnosis to ESRD patients without a HT diagnosis that underwent renal transplant. RESULTS: A total of 144 ESRD patients had International Classification of Disease-9 claim codes for HT prior to renal transplant, amongst a total cohort of 90,301 renal transplant patients aged 18-100 and meeting criteria. Patients with HT were significantly more likely to be female, white, and to have a diagnosis of cytomegalovirus compared to patients without. ESRD patients with a HT diagnosis that underwent renal transplant had a significantly increased risk of renal transplant failure compared to those ESRD renal transplant patients without an HT diagnosis. There was a significantly increased adjusted hazard ratio for graft failure in patients with a HT diagnosis compared to those without. CONCLUSION: Thyroid health and HT may play a significant role in the development of the increased risk of renal transplant failure observed in this study. Additional studies are needed to investigate the underlying mechanisms for this association.


Subject(s)
Hashimoto Disease , Kidney Diseases , Kidney Failure, Chronic , Kidney Transplantation , Humans , Female , Male , Kidney Transplantation/adverse effects , Hashimoto Disease/complications , Kidney Failure, Chronic/etiology , Kidney Failure, Chronic/surgery
3.
Lupus ; 27(1): 17-24, 2018 Jan.
Article in English | MEDLINE | ID: mdl-28530467

ABSTRACT

Background The incidence of end stage renal disease (ESRD) in patients with systemic lupus erythematosus (SLE) is rising. However, the relationship between osteoporotic fractures and SLE in the setting of ESRD remains uninvestigated. The purpose of this study was to compare the frequency of incident osteoporotic fractures in patients with ESRD with and without SLE, to identify risk factors for fractures in patients with SLE and ESRD, and to examine the contribution of these fractures to mortality. Methods Retrospective cohort study of patients with SLE ( n = 716) and a 5% random sample of controls without SLE ( n = 4176) in the United States Renal Data System (USRDS) from years 2006-2008 enrolled in Medicare Part D. Results Fractures occurred in 10.6% ( n = 76) of patients with SLE and ESRD and 12.1% ( n = 507) of patients with ESRD without SLE ( p = 0.24). Older age (adjusted relative risk 1.02, 95% confidence interval 1.01-1.04) was associated with an increased risk for fracture in patients with SLE and ESRD. In multivariable analyses, vertebral and hip fractures more than doubled the risk for mortality. Conclusions The frequency of osteoporotic fractures in patients with SLE and ESRD is similar to the general population of patients with ESRD. Vertebral and hip fractures are significant contributors to mortality in patients with SLE and ESRD. Fracture prevention, in particular, for elderly patients with SLE and ESRD, should be considered. Summary SLE is not an independent risk factor for fractures in patients with ESRD. However, among patients with SLE and ESRD, vertebral and hip fractures are significant contributors to mortality.


Subject(s)
Kidney Failure, Chronic/complications , Lupus Erythematosus, Systemic/complications , Osteoporotic Fractures/etiology , Registries , Adult , Aged , Female , Humans , Incidence , Male , Middle Aged , Osteoporotic Fractures/epidemiology , Retrospective Studies , United States/epidemiology
4.
J Clin Psychol Med Settings ; 21(4): 347-55, 2014 Dec.
Article in English | MEDLINE | ID: mdl-25194308

ABSTRACT

Depression, a frequent concomitant disorder in multiple sclerosis (MS), can impact MS treatment adherence and quality of life. Depression screening in MS care settings may facilitate needed intervention when providers are responsive to screening findings. This study sought to examine the relationship between depression screening results and provider depression treatment recommendations documented in the medical records of 283 patients receiving care in an integrated MS clinic. Forty-six percent of patients screening positive for depression received a treatment recommendation; females, those with past mental health diagnoses, on psychotropic medications, and those with higher symptom severity were more likely to receive a treatment recommendation. On subsequent screenings, patients reported fewer depressive symptoms regardless of whether a formal treatment recommendation was documented. These findings suggest that while depression screening does lead to depression related intervention in many cases, more research is necessary to determine who is most likely to benefit and under what conditions.


Subject(s)
Depressive Disorder/diagnosis , Depressive Disorder/therapy , Multiple Sclerosis/psychology , Referral and Consultation/statistics & numerical data , Depressive Disorder/complications , Female , Humans , Male , Middle Aged , Multiple Sclerosis/complications , Primary Health Care/methods , Quality of Life/psychology , Sex Distribution , Treatment Outcome
5.
Neuroscience ; 146(3): 1316-32, 2007 May 25.
Article in English | MEDLINE | ID: mdl-17434684

ABSTRACT

First and second generation antipsychotics (FGAs and SGAs) ameliorate psychotic symptoms of schizophrenia, however, their chronic effects on information processing and memory function (i.e. key determinants of long term functional outcome) are largely unknown. In this rodent study the effects of different time periods (ranging from 2 weeks to 6 months) of oral treatment with the FGA, haloperidol (2.0 mg/kg/day), or the SGA, risperidone (2.5 mg/kg/day) on a water maze repeated acquisition procedure, the levels of nerve growth factor receptors, and two important cholinergic proteins, the vesicular acetylcholine transporter and the high affinity choline transporter were evaluated. The effects of the antipsychotics on a spontaneous novel object recognition procedure were also assessed during days 8-14 and 31-38 of treatment. Haloperidol (but not risperidone) was associated with impairments in water maze hidden platform trial performance at each of the time periods evaluated up to 45 days, but not when tested during days 83-90. In contrast, risperidone did not impair water maze task performance at the early time periods and it was actually associated with improved performance during the 83-90 day period. Both antipsychotics, however, were associated with significant water maze impairments during the 174-180 day period. Further, haloperidol was associated with decrements in short delay performance in the spontaneous novel object recognition task during both the 8-14 and 31-38 day periods of treatment, while risperidone was associated with short delay impairment during the 31-38 day time period. Both antipsychotics were also associated with time dependent alterations in the vesicular acetylcholine transporter, the high affinity choline transporter, as well as tyrosine kinase A, and p75 neurotrophin receptors in specific brain regions. These data from rats support the notion that while risperidone may hold some advantages over haloperidol, both antipsychotics can produce time-dependent alterations in neurotrophin receptors and cholinergic proteins as well as impairments in the performance of tasks designed to assess spatial learning and episodic memory.


Subject(s)
Antipsychotic Agents/pharmacology , Haloperidol/pharmacology , Memory/drug effects , Neurons/drug effects , Parasympathetic Nervous System/drug effects , Psychomotor Performance/drug effects , Receptors, Nerve Growth Factor/biosynthesis , Risperidone/pharmacology , Animals , Enzyme-Linked Immunosorbent Assay , Hand Strength/physiology , Hippocampus/drug effects , Male , Maze Learning/drug effects , Membrane Transport Proteins/metabolism , Motor Activity/drug effects , Parasympathetic Nervous System/cytology , Postural Balance/drug effects , Rats , Rats, Wistar , Receptor, Nerve Growth Factor/biosynthesis , Receptor, trkA/metabolism , Recognition, Psychology/drug effects , Vesicular Acetylcholine Transport Proteins/metabolism
6.
Br J Sports Med ; 40(5): 406-10, 2006 May.
Article in English | MEDLINE | ID: mdl-16632570

ABSTRACT

OBJECTIVE: To examine differences in ad libitum fluid intake, comparing a 6% carbohydrate/electrolyte drink (CHO-E) and water, and associated differences in core temperature and other selected physiological and perceptual responses in adolescent athletes during tennis training in the heat. METHODS: Fourteen healthy, fit, young tennis players (nine male; five female; mean (SD) age 15.1 (1.4) years; weight 60.6 (8.3) kg; height 172.8 (8.6) cm) completed two 120 minute tennis specific training sessions on separate days (randomised, crossover design) in a warm environment (wet bulb globe temperature: CHO-E, 79.3 (2.6) degrees F; water, 79.9 (2.2) degrees F; p>0.05). RESULTS: There were no significant differences (p>0.05) between the trials with respect to fluid intake, urine volume, fluid retention, sweat loss, perceived exertion, thirst, or gastrointestinal discomfort. However, there was a difference (p<0.05) in the percentage body weight change after training (CHO-E, -0.5 (0.7)%; water, -0.9 (0.6)%). Urine specific gravity before training (CHO-E, 1.024 (0.006); water, 1.025 (0.005)) did not correlate significantly (p>0.05) with any of these measurements or with core body temperature. In examining the main effect for trial, the CHO-E trial showed a significantly lower (p<0.001) mean body temperature (irrespective of measurement time) than the water trial. However, the mean body temperature in each trial was not associated (p>0.05) with fluid intake, fluid retention, sweat loss, or percentage body weight change. CONCLUSION: Ad libitum consumption of a CHO-E drink may be more effective than water in minimising fluid deficits and mean core temperature responses during tennis and other similar training in adolescent athletes.


Subject(s)
Body Temperature/physiology , Dehydration/prevention & control , Drinking/physiology , Rehydration Solutions/administration & dosage , Tennis/physiology , Adolescent , Cross-Over Studies , Dietary Carbohydrates/administration & dosage , Electrolytes/administration & dosage , Female , Humans , Male , Thirst/physiology , Water-Electrolyte Balance/physiology
7.
Neuroscience ; 140(4): 1277-87, 2006 Jul 21.
Article in English | MEDLINE | ID: mdl-16626873

ABSTRACT

Several postmortem and neuroimaging studies suggest that central nicotinic and muscarinic acetylcholine receptors are important in both the pathophysiology and pharmacotherapy of schizophrenia. However, while antipsychotic drugs are routinely used in the therapeutics of schizophrenia, little is known about their effects on the densities of these receptors when they are administered for extended periods of time (a common practice in the clinical setting). In the present study in rats, the residual effects of prior chronic exposure to representative first generation antipsychotics and second generation antipsychotics on the densities of high affinity nicotinic acetylcholine receptors and muscarinic acetylcholine receptor in the brain were investigated. Test subjects were treated with the first generation antipsychotics, haloperidol (2.0 mg/kg/day) or chlorpromazine (10.0 mg/kg/day) or the second generation antipsychotics, risperidone (2.5 mg/kg/day) or olanzapine (10.0 mg/kg/day) in drinking water for periods of 90 or 180 days, given a drug-free washout period (i.e. returned to normal drinking water) for two weeks and then killed. Quantitative receptor autoradiography was subsequently performed using 16 mum sagittal slices of whole brain incubated with [3H]-epibatidine, [3H]-pirenzepine or [3H]-AFDX-384 to measure high affinity nicotinic acetylcholine receptors, M1 and M2 muscarinic acetylcholine receptors, respectively. The most notable experimental result was a moderate, but significant (P<0.01) increase in [3H]-AFDX-384 binding sites in a number of brain regions (including cortex, hippocampus, subiculum, substantia innominata, and thalamus) associated with prior exposure to olanzapine for 90, but not 180 days. Olanzapine was also associated with a significantly higher density of [3H]-pirenzepine binding sites in cortex lamina I after 90 days of prior drug exposure. These data indicate that chronic treatment with a commonly used second generation antipsychotic, olanzapine is associated with modest increases in M2 muscarinic acetylcholine receptors in memory-related brain regions that may eventually abate with longer periods of chronic drug exposure.


Subject(s)
Antipsychotic Agents/administration & dosage , Brain/drug effects , Brain/metabolism , Receptors, Muscarinic/metabolism , Receptors, Nicotinic/metabolism , Animals , Male , Protein Binding/drug effects , Protein Binding/physiology , Rats , Rats, Wistar
8.
J Pharmacol Exp Ther ; 316(2): 679-94, 2006 Feb.
Article in English | MEDLINE | ID: mdl-16214877

ABSTRACT

This study was designed to determine 1) whether repeated exposures to the acetylcholinesterase inhibitors (AChEIs) galantamine (GAL) or donepezil (DON) resulted in positive effects on nerve growth factor (NGF) and its receptors, cholinergic proteins, and cognitive function in the aged rat, and 2) whether GAL had any advantages over DON given its allosteric potentiating ligand (APL) activity at nicotinic acetylcholine receptors. Behavioral tests (i.e., water maze and light/dark box) were conducted in aged Fisher 344 rats during 15 days of repeated (subcutaneous) exposure to either GAL (3.0 or 6.0 mg/kg/day) or DON (0.375 or 0.75 mg/kg/day). Forty-eight hours after the last drug injection, cholinergic receptors were measured by [(125)I]-(+/-)-exo-2-(2-iodo-5-pyridyl)-7-azabicyclo[2.2.1]heptane ([(125)I]IPH; epibatidine analog), (125)I-alpha-bungarotoxin ((125)I-BTX), [(3)H]pirenzepine ([(3)H]PRZ), and [(3)H]-5,11-dihydro-11-[((2-(2-((dipropylamino)methyl)-1-piperidinyl)ethyl)amino)carbonyl]-6H-pyrido(2,3-b)(1,4)-benzodiazepin-6-one methanesulfonate ([(3)H]AFDX-384, or [(3)H]AFX) autoradiography. Immunochemical methods were used to measure NGF, high (TrkA and phospho-TrkA)- and low (p75 neurotrophin receptor)-affinity NGF receptors, choline acetyltransferase (ChAT), and the vesicular acetylcholine transporter (VAChT) in memory-related brain regions. Depending on dose, both GAL and DON enhanced spatial learning (without affecting anxiety levels) and increased [(125)I]IPH, [(3)H]PRZ, and [(3)H]AFX (but decreased (125)I-BTX) binding in some cortical and hippocampal brain regions. Neither AChEI was associated with marked changes in NGF, NGF receptors, or VAChT, although DON did moderately increase ChAT in the basal forebrain and hippocampus. The results suggest that repeated exposures to either GAL or DON results in positive (and sustained) behavioral and cholinergic effects in the aged mammalian brain but that the APL activity of GAL may not afford any advantage over acetylcholinesterase inhibition alone.


Subject(s)
Aging/metabolism , Cholinesterase Inhibitors/pharmacology , Galantamine/pharmacology , Indans/pharmacology , Memory/drug effects , Nerve Growth Factor/metabolism , Piperidines/pharmacology , Receptors, Cholinergic/metabolism , Acetylcholinesterase/blood , Aging/drug effects , Animals , Autoradiography , Brain/drug effects , Brain/enzymology , Brain/metabolism , Choline O-Acetyltransferase/metabolism , Cholinesterase Inhibitors/administration & dosage , Donepezil , Enzyme-Linked Immunosorbent Assay , Galantamine/administration & dosage , Indans/administration & dosage , Injections, Subcutaneous , Male , Maze Learning/drug effects , Motor Activity/drug effects , Piperidines/administration & dosage , Rats , Rats, Inbred F344 , Vesicular Acetylcholine Transport Proteins/metabolism
9.
Neuroscience ; 136(2): 519-29, 2005.
Article in English | MEDLINE | ID: mdl-16216423

ABSTRACT

A decrease in alpha7 nicotinic acetylcholine receptors in the hippocampus has been hypothesized to contribute to alterations in auditory gating and other behavioral impairments in schizophrenia. However, while both typical and atypical neuroleptics are routinely used in the therapeutics of schizophrenia, little is known about their effects on auditory gating or alpha7 nicotinic acetylcholine receptor expression particularly when they are administered for extended periods of time (which is common in the clinical setting). In the present study in normal rats, the residual effects of prior chronic treatment (90 or 180 days) with representative typical and atypical neuroleptics (oral haloperidol, 2.0 mg/kg/day; chlorpromazine, 10.0 mg/kg/day, risperidone, 2.5 mg/kg/day; or olanzapine, 10.0 mg/kg/day) on prepulse inhibition of the auditory gating response were investigated. The densities of alpha7 nicotinic acetylcholine receptors were subsequently measured using [125I]-alpha-bungarotoxin autoradiography. The results indicated that none of the compounds significantly altered the startle amplitude or prepulse inhibition response either during drug treatment (day 60) or after 90 or 180 days of treatment (i.e. during a drug free washout). However, prior exposure to chlorpromazine, risperidone and olanzapine for 90 days resulted in modest but significant (P<0.01) decreases in [125I]-alpha-bungarotoxin binding sites in some brain regions (e.g. posterior cortical amygdala). After 180 days of treatment, decreases in [(125I]-alpha-bungarotoxin binding ranging from approximately 12% (lateral dentate gyrus) up to 24% (e.g. CA1 hippocampal region) were evident in the risperidone group in 13 of the 36 regions analyzed while decreases associated with the other neuroleptics agents were still present, but not statistically significant. These data indicate that the commonly used atypical neuroleptic, risperidone is associated with time dependent and persistent negative effects on an important biological substrate of memory (i.e. the alpha7 nicotinic receptor), but that the magnitude of the deficits was not sufficient to impair auditory gating.


Subject(s)
Antipsychotic Agents/pharmacology , Brain Chemistry/drug effects , Receptors, Nicotinic/drug effects , Acoustic Stimulation , Animals , Antipsychotic Agents/blood , Autoradiography , Bungarotoxins/pharmacokinetics , Densitometry , Male , Rats , Rats, Wistar , Reflex, Startle/drug effects , Time Factors , alpha7 Nicotinic Acetylcholine Receptor
10.
Caries Res ; 39(2): 100-7, 2005.
Article in English | MEDLINE | ID: mdl-15741721

ABSTRACT

The results of a recent study by Whitford et al. [Caries Res 2002;36:256-265] with subjects whose drinking water was fluoridated led to two major conclusions: (1) Compared to the use of a placebo dentifrice, plaque fluoride concentrations ([F]) throughout much of the day are not significantly increased by the use of an F dentifrice but (2) they are positively related to plaque [Ca] (p = 0.0001). The present double-blind, double-crossover study with 16 subjects used the same protocol and was done to: (1) determine the effects of the use of an F dentifrice on salivary and plaque [F] in a community without water fluoridation and (2) further examine the relationship between plaque [Ca] and [F]. Following the use of an F dentifrice or placebo for one week, whole saliva and plaque were collected 1.0 and 12 h after the last use of the products. The study was repeated to include rinsing with a 20 mmol/l CaCl(2) solution immediately before the use of the dentifrices. The CaCl(2) rinse had only minor effects on salivary [Ca] and [F] and none on the plaque concentrations. Unlike the results found in the fluoridated community, all salivary and plaque [F] associated with the use of the F dentifrice were significantly higher than those associated with the use of the placebo. The results suggest that the cariostatic effectiveness of an F dentifrice should be greater in areas without water fluoridation. As noted previously, plaque [F] were positively related to plaque [Ca] (p = 0.0001).


Subject(s)
Calcium/analysis , Cariostatic Agents/analysis , Dental Plaque/chemistry , Dentifrices/therapeutic use , Fluorides/analysis , Adolescent , Brazil , Calcium/therapeutic use , Calcium Chloride/therapeutic use , Cariostatic Agents/therapeutic use , Child , Cross-Over Studies , Double-Blind Method , Fluoridation , Fluorides/therapeutic use , Humans , Mouthwashes/therapeutic use , Placebos , Saliva/chemistry , Saliva/metabolism , Secretory Rate/physiology , Spectrophotometry, Atomic , Time Factors
11.
Psychopharmacology (Berl) ; 164(4): 360-8, 2002 Dec.
Article in English | MEDLINE | ID: mdl-12457265

ABSTRACT

RATIONALE: In psychiatric patients, haloperidol (HAL) induces a number of adverse extrapyramidal and cognitive symptoms, which appear to be less problematic with olanzapine (OLZ). In animals, HAL may initiate a number of harmful effects on central nervous system neurons, including damage to cholinergic pathways - an effect that could be especially deleterious to those experiencing memory dysfunction. The identification of the neurobiological substrates of such effects in animal models may help to improve the algorithms used for proper drug selection especially for long-term neuroleptic use. OBJECTIVES: The aim of this study was to compare the effects of chronic (45-day and 90-day), continuous oral exposure to HAL with OLZ for effects on cognitive performance and cholinergic markers in rats. METHODS: After chronic neuroleptic exposure (and a 4-day washout) spatial memory performance was measured in a water maze task, and choline acetyltransferase (ChAT) immunoreactivity was assessed with immunofluorescence staining. RESULTS: In water maze experiments, HAL and OLZ (relative to vehicle) administered for 90 days (but not 45 days) significantly impaired learning performance (i.e., higher mean latencies across several trials to reach a hidden platform). HAL administered for 90 days was associated with impairment across a greater number of trials than OLZ and it also impaired probe trial performance, as indicated by a reduced number of crossings over the previous platform area (when compared with OLZ or vehicle). Both 45 days and 90 days of HAL treatment reduced ChAT staining in the cortex and hippocampus when compared with OLZ or vehicle. CONCLUSIONS: The results in the rat suggest that OLZ (relative to HAL) may be more desirable as an antipsychotic for patients suffering from memory dysfunction especially for those in which cholinergic deficits may already be present.


Subject(s)
Brain/drug effects , Haloperidol/pharmacology , Maze Learning/drug effects , Mental Recall/drug effects , Orientation/drug effects , Pirenzepine/analogs & derivatives , Pirenzepine/pharmacology , Receptors, Cholinergic/drug effects , Animals , Benzodiazepines , Brain/pathology , Choline O-Acetyltransferase/metabolism , Cholinergic Fibers/drug effects , Drug Administration Schedule , Escape Reaction/drug effects , Male , Microscopy, Fluorescence , Olanzapine , Rats , Rats, Wistar , Reaction Time/drug effects
12.
J Dent Res ; 81(1): 43-7, 2002 Jan.
Article in English | MEDLINE | ID: mdl-11820366

ABSTRACT

Sublethal plasma membrane disruption (PMD) is an established mechanism for signaling in several cell types, including endothelial cells and skeletal muscle. We used a rat model of orthodontic tooth movement to test the hypothesis that periodontal ligament (PDL) cells communicate stretch to changes in bone cell activity in part via PMD. To produce PMD, we used a 50-g load from a spring activated in the buccal direction against the maxillary first molars for 5 min. Uptake of endogenous serum albumin was used as a PMD marker. Immunohistochemistry demonstrates albumin in PDL cells surrounding moved first molar tips. Image analysis shows significantly more albumin in cells of the buccal side (tension) of the moved teeth compared with those of the lingual, distal, and mesial sides, and those of the unmoved control. Albumin localization within cells of the PDL, after only 5 min of mechanical loading, suggests that PMD could promote uptake or release of signaling molecules.


Subject(s)
Cell Membrane/physiology , Periodontal Ligament/cytology , Tooth Movement Techniques , Analysis of Variance , Animals , Blotting, Western , Dental Stress Analysis , Female , Immunoenzyme Techniques , Rats , Rats, Inbred Strains , Serum Albumin/analysis , Signal Transduction , Statistics, Nonparametric , Stress, Mechanical
13.
Am J Hypertens ; 14(10): 1003-6, 2001 Oct.
Article in English | MEDLINE | ID: mdl-11710777

ABSTRACT

BACKGROUND: The relationship between urinary vasoactive factors and sodium excretion has not been adequately addressed in humans. PROCEDURE: Excretion rates of sodium, nitrates/nitrites (NOx), cGMP, and endothelin-1 (ET-1) were measured before and after ingestion of a mixed electrolyte solution (8 oz Gatorade) while undergoing a routine cardiovascular evaluation in a sample of 51 normotensive young adults. RESULTS: Significant correlations were detected for changes in excretion between all four variables, r ranged from 0.50 to 0.86 (P < .001). Correlations were higher in African Americans than white Americans. CONCLUSIONS: The association of renal ET-1 and NO activity with sodium excretion supports the hypothesis that these factors play a role in the physiologic response to acute changes in sodium intake, particularly in African Americans.


Subject(s)
Cyclic GMP/urine , Endothelin-1/urine , Nitric Oxide/urine , Sodium/urine , Adolescent , Adult , Black People , Cyclic GMP/physiology , Endothelin-1/physiology , Female , Humans , Hypertension/etiology , Male , Natriuresis , Nitric Oxide/physiology , United States , White People
14.
Prev Med ; 33(5): 415-21, 2001 Nov.
Article in English | MEDLINE | ID: mdl-11676582

ABSTRACT

BACKGROUND: This study evaluated the effect of primary care providers' adherence with the AHCPR Smoking Cessation Guideline after receiving a multicomponent intervention. METHODS: A quasi-experimental study with one intervention and one control team was conducted in a southeastern Veterans Affairs Medical Center primary care setting. During phase I, chart reviews were conducted to measure baseline provider adherence and documentation of the four A's (ask, advise, assist, arrange). In phase II, the intervention team received a single educational session on the AHCPR Guideline, four A's, and tobacco dependence treatment. This was followed by chart reviews of patients seen 4 to 8 weeks after the educational intervention to measure provider adherence and documentation of the four A's. During phase III, the intervention team received individual and team feedback from the chart reviews in phases I and II and booster education on the AHCPR Guideline. Chart reviews were conducted from patient visits 4 to 8 weeks after the feedback and booster education to determine provider adherence and documentation of the four A's. RESULTS: A nested repeated measures two-factor analysis of variance was performed for each of the following outcomes: ask, advise, assist, and arrange. Data analyses revealed that both the control and the intervention teams had 100% compliance in asking the patient about smoking status. There was a prestudy implementation of the vital sign stamp that included smoking status in this setting. Education on tobacco dependence and the AHCPR Guideline had no significant impact on provider performance with the advisement, assistance, and arrangement of follow-up. However, significant improvements occurred in the intervention team in the advisement (P = 0.05), assistance (P = 0.001), and arrangement of follow-up (P = 0.001) phase after individual and team feedback was provided. This research supports the fact that feedback impacts individuals and team performances and facilitated positive system changes to improve provider adherence with the AHCPR recommendations in treating tobacco dependence.


Subject(s)
Feedback , Guideline Adherence/statistics & numerical data , Internal Medicine/standards , Practice Patterns, Physicians'/statistics & numerical data , Primary Health Care/standards , Smoking Cessation/statistics & numerical data , Georgia , Hospitals, Veterans , Humans , Internal Medicine/education , Practice Guidelines as Topic , South Carolina , United States , United States Agency for Healthcare Research and Quality
15.
Brain Res Bull ; 55(3): 375-86, 2001 Jun.
Article in English | MEDLINE | ID: mdl-11489345

ABSTRACT

A transient ischemic middle cerebral artery occlusion model of stroke was used to examine the role of the transcription factor NF-kappaB in cell death as measured by DNA fragmentation and infarction volume. The left middle cerebral artery was occluded for either 30 min or 2 h in rats. One set of animals was pretreated with diethyldithiocarbamate (DDTC), an inhibitor of NF-kappaB, 30 min prior to reperfusion. The animals were reperfused and allowed to survive for 2 or 7 days. DNA fragmentation was assayed by in situ end labeling in the stroke core and penumbral regions. Specific cortical and subcortical regions were measured using quantitative image analysis. DNA fragmentation was seen only on the ischemic side of the brains in all cases. Overall, the DDTC-treated groups showed significantly increased DNA fragmentation within the ischemic side compared to the saline control groups. DDTC treatment also caused an increase in stroke volume based on triphenyl tetrazolium chloride staining. Electrophoretic mobility shift assays showed NF-kappaB activation peaking 15 min following reperfusion and that this activation was blocked by the DDTC treatment. This study suggests that the use of NF-kappaB inhibitors to block cell death following stroke needs to be carefully examined because global inhibitors may not promote neuronal survival.


Subject(s)
Brain/physiopathology , Ditiocarb/pharmacology , Ischemic Attack, Transient/physiopathology , NF-kappa B/antagonists & inhibitors , Animals , Brain/pathology , Cell Death , Cerebral Infarction/pathology , DNA Fragmentation , Ischemic Attack, Transient/genetics , Ischemic Attack, Transient/pathology , Male , NF-kappa B/physiology , Rats , Rats, Wistar , Reperfusion Injury/genetics , Reperfusion Injury/pathology , Reperfusion Injury/physiopathology
16.
J Behav Health Serv Res ; 28(1): 1-11, 2001 Feb.
Article in English | MEDLINE | ID: mdl-11329994

ABSTRACT

This study examines longitudinal mental health service use patterns of a school-based sample of adolescents. Based on the Center for Epidemiologic Studies Depression Scale scores, a stratified sample of middle-school students was interviewed using the Schedule for Affective Disorders and Schizophrenia for School-Aged Children: cycle one (n = 579; mean age 12.83) and cycle two (n = 490; mean age 18.65). Service use also was assessed by mailed questionnaire: cycle three (n = 330; mean age 20.60). Service use decreased over time. Whites and males received significantly more treatment in the first cycle. In the second cycle, service use by race and gender was equal; in the third cycle, females received more treatment. Those with a psychiatric diagnosis (first cycle, 54%; second cycle, 33%) received treatment in the prior year. Under-treatment of youth with psychiatric diagnoses is a significant problem, with differences in service use by race and gender over time.


Subject(s)
Adolescent Health Services/statistics & numerical data , Adolescent Psychiatry/statistics & numerical data , Mental Disorders/diagnosis , Mental Health Services/statistics & numerical data , Adolescent , Adult , Black or African American/psychology , Black or African American/statistics & numerical data , Age Factors , Child , Female , Follow-Up Studies , Humans , Incidence , Longitudinal Studies , Male , Mass Screening/methods , Mental Disorders/epidemiology , Mental Disorders/ethnology , Population Surveillance , Psychiatric Status Rating Scales , Schools , Sex Factors , Southeastern United States/epidemiology , Surveys and Questionnaires , White People/psychology , White People/statistics & numerical data
17.
Assessment ; 6(3): 225-34, 1999 Sep.
Article in English | MEDLINE | ID: mdl-10445960

ABSTRACT

Internal consistency, temporal stability, and principal components structures of two self-report anger expression scales used in pediatric health research were examined in 415 youth (216 White, 199 Black; 191 boys, 224 girls; mean age 14.7 years). Participants completed the Anger Expression Scale (AXS) and the Pediatric Anger Expression Scale (PAES) on two occasions separated by approximately 1 year. Psychometric properties of the two scales were examined and compared with those reported by the scale authors. For both the AXS and the PAES, estimates of internal consistency (Cronbach s alpha) were acceptable and comparable to values reported by scale authors. Temporal stability of both scales was significant over 1 year. Principal components structures for both scales were similar to those reported by scale authors. Results were generally consistent for age groupings (<13, 13 years), ethnicity, and gender. It is concluded that further research using the AXS and PAES is warranted. The stability of anger expression over time and the assessment of anger suppression is discussed.


Subject(s)
Anger , Expressed Emotion , Psychological Tests , Psychometrics/methods , Adolescent , Adult , Black or African American/psychology , Age Factors , Child , Factor Analysis, Statistical , Female , Humans , Male , Sex Factors , White People/psychology
18.
Telemed J ; 5(4): 349-56, 1999.
Article in English | MEDLINE | ID: mdl-10908450

ABSTRACT

OBJECTIVES: To determine patient satisfaction with telemedicine encounters among adults with sickle cell disease and compare their scores with SCD patients who have standard medical encounters (as controls). METHODS: Adults patients were recruited from a list of participants in sickle cell telemedicine clinics and prospectively at the time of clinic encounter. Patients were assigned to telemedicine or standard encounter groups. Demographic and pertinent clinical data were obtained for all subjects, and the Client Satisfaction Questionnaire (CSQ-8) was administered. Patients were also asked for open-ended comments regarding their satisfaction with the service. Their responses were recorded verbatim. RESULTS: Patients with telemedicine (n = 60) and standard encounters (n = 60) were comparable in gender, genotype, education, employment, and mean number of sickle cell disease-related complications. Patients in the telemedicine group were younger (p< 0.005), more likely to have Medicaid insurance (p = 0.009), and more likely be taking hydroxyurea (p = 0.003) than patients in the control encounter group. Mean CSQ scores for the telemedicine group were high (total: 28.82+/-3.06), and there was no difference for any item between encounter groups (p = 0.389). Patients in the standard encounter group were more likely to provide positive open-ended comments regarding the encounter (95% vs. 70%; p = 0.001). Negative comments were generally in the area of confidentiality. CONCLUSIONS: While some patients expressed concern about confidentiality with telemedicine, the benefits of improved access and continuity of care were recognized, and overall satisfaction with telemedicine was high. These findings support the use of telemedicine as an acceptable health care delivery option for rural, underserved populations with sickle cell disease.


Subject(s)
Patient Satisfaction/statistics & numerical data , Remote Consultation , Sickle Cell Trait , Adult , Confidentiality , Female , Georgia , Humans , Male , Regional Medical Programs , Rural Health Services , Surveys and Questionnaires
20.
J Am Acad Child Adolesc Psychiatry ; 37(6): 612-9, 1998 Jun.
Article in English | MEDLINE | ID: mdl-9628081

ABSTRACT

OBJECTIVE: This analysis examines 1-year transition probabilities and baseline predictors for suicidal behaviors in young adolescents. METHOD: Adolescents from a two-stage, community-based longitudinal study were classified into suicidal behavior categories (attempt, plan, ideation, and none) for baseline and follow-up years. Transition probabilities for movement among categories were calculated, and polytomous logistic regression analysis was used to examine predictors of suicidal behaviors. RESULTS: Among those with no suicidal behaviors at baseline, 1-year incidence rates were 1.3% for attempts and 1.7% each for plans and ideation. Increasing family cohesion was protective for suicide attempts (odds ratio [OR] = 0.9). Female subjects were more likely than males to report plans (OR = 8.9) and ideation (OR = 4.1). Increasing impulsivity (OR = 2.3), prior suicidal behavior (OR = 10.6), and undesirable life events (OR = 1.1) were significant predictors of plans. CONCLUSIONS: While there are a number of predictors of suicidal behaviors, the false-positive rate is high. Focusing on proximal risk factors, particularly stressors in adolescent development, may overlook the fundamental role of underlying mental disorder and familial factors--both biological and environmental. Suicide and suicidal behaviors are the result of a constellation of adverse factors requiring a range of interventions for prevention.


Subject(s)
Suicide, Attempted/statistics & numerical data , Adolescent , Child , Female , Humans , Logistic Models , Longitudinal Studies , Male , Odds Ratio , Risk Factors , South Carolina/epidemiology , Suicide/psychology , Suicide, Attempted/psychology , Suicide Prevention
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