Non-pharmacological interventions to improve mental health outcomes among female carers of people living with a neurological condition: a systematic review.

PURPOSE: This systematic review aims to examine the effectiveness of non-pharmacological interventions for improving mental health outcomes among female carers of people living with a neurological condition. MATERIALS AND METHODS: A narrative synthesis of English-language randomized controlled trials was undertaken. RESULTS: 18 unique studies were included. Intervention components that were found to have improved mental health outcomes were: delivered in person, to groups, on an intermittent schedule with ≥10 sessions; had a duration between 3-6 months; and were facilitated by research staff or allied health professionals. As the review had few robust studies, results of mental health outcomes reported in studies assessed as low risk of bias were highlighted in the review. Psychoeducation interventions, cognitive behavioural interventions, and support group interventions were found to improve depression. Psychoeducation interventions were also found to improve burden. CONCLUSIONS: There is a clear need for adequately powered, high-quality randomised controlled trials to determine the effectiveness of non-pharmacological interventions for female carers of people living with a neurological condition.

Female carers experience worse mental health and well-being outcomes and are at a higher risk of developing chronic health issues compared to their male counterparts.This review identified only very few, generally small, randomised controlled trials of non-pharmacological interventions in female carers of patients with neurological conditions.Interventions that provide psychoeducation, are group-based, face-to-face, and have an intervention duration between >3 months and <6 months, may be successful in improving some mental health outcomes, such as depression and coping.

Unconventional natural gas development and hospitalizations: evidence from Pennsylvania, United States, 2003-2014.

OBJECTIVES: To examine relationships between short-term and long-term exposures to unconventional natural gas development, commonly known as fracking, and county hospitalization rates for a variety of broad disease categories. STUDY DESIGN: This is an ecological study based on county-level data for Pennsylvania, United States, 2003-2014. METHODS: We estimated multivariate regressions with county and year fixed effects, using two 12-year panels: all 67 Pennsylvania counties and 54 counties that are not large metropolitan. RESULTS: After correcting for multiple comparisons, we found a positive association of cumulative well density (per km2) with genitourinary hospitalization rates. When large metropolitan counties were excluded, this relationship persisted, and positive associations of skin-related hospitalization rates with cumulative well count and well density were observed. The association with genitourinary hospitalization rates is driven by females in 20-64 years group, particularly for kidney infections, calculus of ureter, and urinary tract infection. Contemporaneous wells drilled were not significantly associated with hospitalizations after adjustment for multiple comparisons. CONCLUSIONS: Our study shows that long-term exposure to unconventional gas development may have an impact on prevalence of hospitalizations for certain diseases in the affected populations and identifies areas of future research on unconventional gas development and health.

Ethics and community-based education: balancing respect for the community with professional preparation.

Community-based education and service learning are becoming increasingly common in health and human services education. As students enter the community, several ethical dilemmas arise regarding the university's interaction with the community. This article explores clinical, agency, and community placements in terms of the relationships they engender between the university and the community. The article then outlines some ethical obligations of universities and faculty members and ethical dilemmas that arise in different placements. Finally, a fundamental ethical framework that may guide universities and faculty members in planning community-based educational experiences is proposed.

A comparison of clinical outcome studies among cholesterol-lowering agents.

OBJECTIVE: To review and compare clinical trials of cholesterol-lowering agents that evaluated clinical end points as the primary outcome measure; specifically, to determine whether all agents that decrease cholesterol impact clinical outcomes similarly. DATA SOURCES: Primary articles were identified through a MEDLINE search (1966-February 2001) and through secondary sources. STUDY SELECTION AND DATA EXTRACTION: All of the articles identified from the data sources were evaluated. Articles that included clinical end points as the primary outcome measure were included in this review. DATA SYNTHESIS: Clinical trials were assessed according to study population (primary vs. secondary prevention of coronary artery disease), baseline and follow-up lipid profiles, and clinical outcome data. Both cardiac and noncardiac morbidity and mortality were evaluated. The differences in study populations, study methods, and changes in lipid values were compared and contrasted between trials to evaluate their effect on outcomes. CONCLUSIONS: Niacin and bile acid sequestrants should be considered as add-on therapy when therapeutic goals cannot be attained with a hydroxymethyl glutaryl-coenzyme A reductase inhibitor (stain). Estrogen therapy cannot be recommended solely for cardioprotection. Fibrates are most effective in patients with high baseline triglycerides, low baseline high-density lipoprotein cholesterol, and low to average low-density lipoprotein cholesterol (LDL). Statins are considered first line for the treatment of elevated LDL in both the primary and secondary prevention of coronary heart disease. They are well tolerated, have the strongest data to support their use, and have been shown to decrease total mortality.

Informing patients of diagnostic mammography results: mammographer's opinions.

PURPOSE: The authors' purpose was to determine mammographers' practices and attitudes regarding disclosing results of diagnostic mammograms to patients. MATERIALS AND METHODS: In 1995, the authors mailed a questionnaire to 500 members of the Society of Breast Imaging; 399 (80%) responded to the survey. RESULTS: Three-quarters of respondents stated that mammographers should disclose results to their patients, and approximately half were already doing so (52% for normal results, 51% for abnormal results). A sizable minority (25%) said that not telling patients was the best practice and identified several barriers to direct disclosure, including lack of time. Although bivariate analysis showed direct disclosure to be more common among female mammographers, the sex difference did not persist in multivariate analysis. In both bivariate and multivariate analyses, reading more than 100 mammograms per week and having a radiology practice in a university or academic setting were each strongly associated with direct disclosure. CONCLUSION: Implementation of the Mammography Quality Standards Reauthorization Act of 1998 may not require a major change in mammographers' current practice. It remains critical to establish systems that help radiologists disclose results and communicate with referring physicians efficiently and effectively.

Screening behavior of women after a false-positive mammogram.

PURPOSE: To determine the effect of a false-positive mammogram that leads to open surgical biopsy on subsequent screening mammography behavior in women. MATERIALS AND METHODS: This study was performed with a retrospective cohort design, and data were collected by means of telephone interview. All participants were women aged at least 50 years, with no history of breast cancer. Study patients (n = 43) were women who had an abnormal mammogram followed within 6 months by benign excisional breast biopsy. Control subjects (n = 136) were randomly selected: They included women with a normal mammogram who had not undergone biopsy, as well as women with an abnormal mammogram and the recommendation to undergo 6-month follow-up mammography. RESULTS: Two differences between the study and control groups were statistically significant. Study patients were more likely than control patients to believe they had increased susceptibility to breast cancer (P = .039). Study patients were also more likely than control subjects to intend to undergo screening mammography annually in the future (P = .036). CONCLUSION: A false-positive mammogram that leads to open surgical biopsy does not inhibit most women from undergoing subsequent screening mammography. In fact, such an experience may increase their intentions to undergo regular screening.

Screening by nurses and junior doctors to detect malnutrition when patients are first assessed in hospital.

Four hundred and fifty four ward nurses and 319 junior doctors in 70 hospitals were interviewed about the last patient they had admitted, using a brief questionnaire. The availability of weighing scales and height measuring equipment was assessed by observers who visited the wards of 107 hospitals. Two thirds of nurses and doctors asked patients about recent food intake; half of the nurses and three quarters of the doctors asked about unintentional weight loss. Answers to the questions were recorded in the notes on 52-80 per cent of occasions. Two thirds of nurses weighed the patient, but only 11 per cent (%) measured height; approximately 80% of results were recorded. Most nurses and doctors who asked no questions about nutrition and made no measurements failed to do so because they regarded them as unimportant. Weighing scales were adequately provided, but height measuring equipment was available in only 17% of wards.

Characterization of a cis-acting regulatory element which silences expression of the class II-A beta gene in epithelium.

Class II major histocompatibility complex (MHC) genes encode for alpha/beta chain pairs that are constitutively expressed principally on mature B cells and dendritic cells in mice. These gene products are easily induced on macrophages with cytokines, and may also aberrantly appear on the surface of epithelium during immune injury. The appearance of class II determinants in parenchymal tissue potentially renders these somatic cells capable of antigen presentation to circulating CD4+ T lymphocytes, and their absence may be protective for normal tissues expressing self-antigens. The low surface class II expression observed on parenchymal cells generally correlates with low levels of mRNA, suggesting that transcription rate is a major element in class II regulation. To understand the transcriptional mechanism maintaining low basal surface expression of class II in somatic cells, we transiently transfected mini-gene reporter constructs to study the regulation of the murine A beta promoter in a cultured renal epithelial cell line. We describe here a negative cis-acting regulatory region located between -552 and -489 bp upstream of the A beta cap site that silences the transcriptional activity of the A beta promoter in epithelial cells in an orientation-dependent manner, and is also able to silence a heterologous promoter. This region is not active in class II-expressing B cells (BAL-17) in culture, but is functional in two other murine class II-negative cell lines, fibroblasts and thymoma T cells. Using competition electrophoretic mobility shift assays, we have localized the core protein binding site within this region to an 8-10-bp response element, designated A beta NRE, at -543 to -534 bp. A nuclear extract from BAL-17 cells does not bind to this element. Mutation of this site abrogates the transcriptional silencing activity of the region. We conclude that the transcription of class II-A beta in parenchymal cells, and some lymphocytes, can be actively repressed by an upstream silencing element.

Development of a parenteral formulation of trimelamol, a synthetic S-triazine carbinolamine-containing cytotoxic agent.

Trimelamol is a synthetic s-triazine carbinolamine-containing agent exhibiting poor aqueous solubility and stability characteristics. The present studies were conducted to provide a stable parenteral dosage form of trimelamol, which could be used for clinical evaluation of the drug and also be manufactured on a commercial scale without undue drug decomposition occurring. Solubility and stability of trimelamol were found to increase in the presence of aqueous-polyethylene glycol (PEG) solutions of increasing average PEG molecular weight (up to mol wt = 1000); PEG 1000 (75%) in water provided the optimum formulation vehicle. In contrast to the optimum liquid formulation of the drug (detailed above) it was necessary to make various compromises to the formulation in terms of drug solubility and stability, because of the problems encountered in processing (e.g., sterile filtration, lyophilization, and reconstitution). Freeze-drying of the formulation extended the product shelf-life relative to the liquid formulation. Differential Scanning Colorimetry (DSC) studies, to determine the freeze-drying cycle parameters, showed that the freezing and melting characteristics of the trimelamol-PEG formulations were dependent upon the rate of cooling, as well as the concentration and average molecular weight of PEG used. The prototype containing 30 mg/mL trimelamol in a 50% PEG 3400-aqueous vehicle was found to be the optimal formulation for sterile filtration, lyophilization, and subsequent reconstitution. Through the use of in vitro techniques, the possibility of hemolysis occurring upon injection resulting from the inclusion of high molecular weight PEGs in the vehicle, was shown to be unlikely.

Pharmacokinetics of cisplatin in patients receiving interleukin-2-containing treatment regimens.

Plasma cisplatin pharmacokinetics were determined in 6 patients enrolled in a phase I trial of combined high-dose cisplatin and Interleukin-2 (IL-2) therapy. Cisplatin (100 mg/m2) was given in 3% saline as a 3-h infusion on days 1 and 8 of each 28-day cycle; IL-2(2-4 x 10(6) units/m2) was given as an i.v. bolus on days 15-19 in a dose escalation trial. Peak total and ultrafiltrate plasma platinum concentrations were 1.15 and 0.172 micrograms/ml for cycle 1 and 1.2 and 0.124 micrograms/ml for cycle 3, respectively. The AUCs for total and ultrafiltrate plasma platinum were 7.33 and 0.965 micrograms/ml per hour for cycle 1 and 8.48 and 0.924 micrograms/ml per hour for cycle 3, respectively. Total body clearances for total and ultrafiltrate platinum were 0.051 and 0.525 ml/h for cycle 1 and 0.042 and 0.443 ml/h for cycle 3, respectively. These data demonstrate no significant effects of IL-2 on the plasma pharmacokinetics of cisplatin in the dose schedule given and support the feasibility of this combined modality therapy.

Topical dimethylsulfoxide may prevent tissue damage from anthracycline extravasation.

The optimal management of anthracycline extravasation remains unclear. Traditional topical measures to reduce local tissue damage, including corticosteroids, sodium bicarbonate, and ice applications, have not consistently demonstrated beneficial effects. This report describes our experience with four adult patients who suffered anthracycline extravasation and were treated with a regimen of ice, local glucocorticoid injection, and dimethylsulfoxide (DMSO) 55%-99% applied topically every 2-4 h after extravasation for a minimum of 3 days. In all four cases, pain and erythema resolved within 2 days; in no case did tissue necrosis or skin ulceration occur. Topical DMSO is a safe, inexpensive agent that appears to reduce the risk of anthracycline-induced tissue damage. Further studies are needed to determine the optimal dose and schedule of DMSO application and to assess its efficacy in extravasation injuries from other vesicants.

Inbreeding and immunoglobulin G1 concentrations in cattle.

Immunoglobulin G1 concentration (IgG1) was measured in presuckle colostrum and calf serum obtained at 36 h and at weaning from inbred and straightbred Angus, Brangus, Hereford, Red Angus and Simmental cattle. Sources of variation considered as dam traits examined for IgG1 in colostrum and 36-h calf serum included line of sire, sire within line, age, and linear regression of IgG1 on inbreeding of dam. Only line of sire and inbreeding of dam were significant in the analysis of 36-h calf serum. Sources of variation considered as calf traits examined for IgG1 in calf serum at 36 h and at weaning included line of sire, sire within line, sex of calf, age of dam, and regressions of calf serum IgG1 on inbreeding of the calf and on dam's colostral IgG1. Only sire within line and the regression on dam's colostral IgG1 were significant for calf serum IgG1 at 36 h. Large differences existed in 36-h calf serum IgG1 between sires both within lines and when lines were ignored. Calves with 36-h serum IgG1 of less than 10 mg/ml were two to four times more likely to die before weaning than calves with higher IgG1 levels. The heritability estimates of IgG1 by paternal half-sib analysis were .41 +/- .30 for colostrum measured as a trait of the dam and .56 +/- .25 for 36-h. calf serum and .05 +/- .17 for calf serum at weaning considered as a trait of the calf. These estimates indicate that IgG1 in colostrum and 36-h calf serum could be increased by selection.(ABSTRACT TRUNCATED AT 250 WORDS)