Hematology and serum biochemistry of free-range brown-throated sloths in two urban areas in Brazil.

BACKGROUND AND AIM: The brown-throated sloth (Bradypus variegatus) is widely distributed in three biomes: The Amazon, Atlantic Forest, and Caatinga. Some subpopulations are isolated in urban areas in Brazil, usually in squares and small woods. Due to the scarcity of reference values, an investigation was carried out on the hematology and blood biochemistry of brown-throated sloths from urban areas. MATERIALS AND METHODS: Blood was collected by venipuncture in the femoral vein from 19 brown-throated sloths for hematological and biochemical analyses, living in two municipalities; Teófilo Otoni (TO) (Minas Gerais State) and Rio Tinto (RT) (Paraíba state), in the Atlantic Forest biome, Brazil. The samples were analyzed in specialized veterinary laboratories using automatic cell counters and slide fixation staining methods. RESULTS: The two subpopulations of brown-throated sloths had no significant differences in most hematological values, with the exception of a higher leukocyte concentration (p<0.01) in the RT sub-population. The difference in leukocyte concentration suggests an idiosyncratic effect, as the animals were healthy and the stress of the capture was acute, not chronic. The concentrations of urea, creatinine, and alkaline phosphatase (ALP) were similar (p<0.05) in brown-throated sloths from TO and RT. Likewise, the liver enzyme concentrations (ALP, alanine transaminase [ALT], and aspartate transaminase [AST]) did not differ between the two subpopulations (p<0.05). CONCLUSION: Compared to another study, brown-throated sloths from TO and RT have higher plasma concentrations of ALT and ALP, suggestive of a hepatic overload. Hematological and blood biochemical findings of TO and RT can be used as clinical reference values for brown-throated sloths living in an urban environment.

Análise da força muscular expiratória e respiração espontânea de indivíduos em ventilação mecânica: estudo transversal / El análisis de la fuerza muscular espiratoria y la respiración espontánea de los individuos en ventilación mecánica: el estudio transversal / Analysis of expiratory muscle strength and spontaneous breathing of individuals on mechanical ventilation: a cross-sectional study

RESUMO Os músculos da expiração têm funções em todo o ciclo respiratório, mas não são frequentemente avaliados no desmame da ventilação mecânica. Assim, revisões e consensos não mencionam a pressão expiratória máxima (PEmáx) e o treino expiratório. Objetivou-se investigar a relação da força muscular expiratória com a respiração espontânea de indivíduos ventilados mecanicamente. Trata-se de um estudo transversal com participantes de 18 a 79 anos de idade. Foram formados os grupos PEmáx satisfatória (GPES) e PEmáx baixa (GPEB) conforme o ponto de corte de 55cmH2O e comparados a parâmetros de desmame. O GPES (n=9) teve desempenho superior ao do GPEB (n=21) no índice de respiração rápida e superficial (IRRS) (40,6±17,6rpm/L e 75,3±44,1rpm/L, respectivamente; p=0,022) e na frequência respiratória (f) (19,1±6,2rpm e 26,1±9,4rpm; p=0,044). A prevalência de PEmáx satisfatória foi pequena, observada no tamanho dos grupos. Além disso, embora a PEmáx percentual do valor predito tenha sido menor no GPEB, como esperado (67,2±15,4% vs. 45,8±14,7%; p=0,001), a pressão inspiratória máxima percentual não diferiu significantemente (82,4±21,8% vs. 67,8±18,4%; p=0,077). A PEmáx se correlacionou moderadamente com o IRRS (r=-0,406; p=0,026) e com a f (r=-0,426; p=0,017). Conclui-se que a PEmáx≥55cmH2O esteve associada à melhores valores no IRRS e na f, e que a redução da força muscular expiratória foi mais prevalente e severa que a da força muscular inspiratória.

RESUMEN Los músculos de la espiración tienen funciones en todo el ciclo respiratorio, sin embargo, no son frecuentemente evaluados en el desmame de la ventilación mecánica. Así, revisiones y consensos no mencionan la tensión espiratoria máxima (PEmáx) y el entreno espiratorio. Se ha objetivado investigar la relación de la fuerza muscular espiratoria con la respiración espontánea de los individuos ventilados mecánicamente. Se trata de un estudio transversal con participantes de 18 a 79 años de edad. Han sido hechos los grupos PEmáx satisfactoria (GPES) y PEmáx baja (GPEB) de acuerdo con el punto de corte de 55cmH2O y han sido comparados a parámetros de destete. El GPES (n=9) ha tenido el desempeño superior al del GPEB (n=21) en el índice de respiración rápida y superficial (IRRS) (40,6±17,6rpm/L y 75,3±44,1rpm/L, respectivamente; p=0,022) y en la frecuencia respiratoria (f) (19,1±6,2rpm y 26,1±9,4rpm; p=0,044). La prevalencia de PEmáx satisfactoria ha sido pequeña, ha sido observada en el tamaño de los grupos. Además de eso, aunque la PEmáx porcentual del valor predicho haya sido menor en el GPEB, como ha sido esperado (67,2±15,4% vs. 45,8±14,7%; p=0,001), la presión inspiratoria máxima porcentual no ha diferido significantemente (82,4±21,8% vs. 67,8±18,4%; p=0,077). La PEmáx se ha correlacionado moderadamente con el IRRS (r=-0,406; p=0,026) y con la f (r=-0,426; p=0,017). Se concluye que la PEmáx≥55cmH2O ha estado asociada a los mejores valores en el IRRS y en la f, y que la reducción de la fuerza muscular espiratoria ha sido más prevalente y severa que la de la fuerza muscular inspiratoria.

ABSTRACT The expiratory muscles have functions throughout the respiratory cycle, but they are not often evaluated in the weaning from mechanical ventilation. Thus, reviews and consensus do not mention the maximal expiratory pressure (MEP) and the expiratory training. The aim of this study was to investigate the relationship of expiratory muscle strength with the spontaneous breathing of individuals on mechanical ventilation. This is a cross-sectional study with participants aged between 18 and 79 years. The groups satisfactory MEP (SMEPG) and low MEP (LMEPG) were formed according to the cut-off point of 55 cmH2O and compared to weaning parameters. The SMEPG (n=9) had better performance than LMEPG (n=21) in the rapid shallow breathing index (RSBI) (40.6±17.6 bpm/L and 75.3±44.1 bpm/L, respectively; p=0.022) and in the respiratory rate (RR) (19.1±6.2 bpm and 26.1±9.4 bpm; p=0.044). Prevalence of satisfactory MEP was low, as observed in the size of groups. In addition, although the MEP percentage of the predicted value was lower in LMEPG, as expected (67.2±15.4% vs. 45.8±14.7%; p=0.001), the percentage for maximal inspiratory pressure was not significantly different (82.4±21.8% vs. 67.8±18.4%; p=0.077). The MEP was moderately correlated with the RSBI (r=−0.406; p=0.026) and with the RR (r=−0.426; p=0.017). It was concluded that MEP≥55 cmH2O was associated with better values in RSBI and RR and that the reduction of expiratory muscle strength was more prevalent and severe than that of inspiratory muscle strength.

Validity of one-repetition maximum predictive equations in men with spinal cord injury.

STUDY DESIGN: Cross-sectional study. OBJECTIVES: The study aimed (a) to test the cross-validation of current one-repetition maximum (1RM) predictive equations in men with spinal cord injury (SCI); (b) to compare the current 1RM predictive equations to a newly developed equation based on the 4- to 12-repetition maximum test (4-12RM). SETTING: SARAH Rehabilitation Hospital Network, Brasilia, Brazil. METHODS: Forty-five men aged 28.0 years with SCI between C6 and L2 causing complete motor impairment were enrolled in the study. Volunteers were tested, in a random order, in 1RM test or 4-12RM with 2-3 interval days. Multiple regression analysis was used to generate an equation for predicting 1RM. RESULTS: There were no significant differences between 1RM test and the current predictive equations. ICC values were significant and were classified as excellent for all current predictive equations. The predictive equation of Lombardi presented the best Bland-Altman results (0.5 kg and 12.8 kg for mean difference and interval range around the differences, respectively). The two created equation models for 1RM demonstrated the same and a high adjusted R2 (0.971, P<0.01), but different SEE of measured 1RM (2.88 kg or 5.4% and 2.90 kg or 5.5%). CONCLUSION: All 1RM predictive equations are accurate to assess individuals with SCI at the bench press exercise. However, the predictive equation of Lombardi presented the best associated cross-validity results. A specific 1RM prediction equation was also elaborated for individuals with SCI. The created equation should be tested in order to verify whether it presents better accuracy than the current ones.

Occurrence of Ehrlichia canis in free-living primates of the genus Callithrix / Ocorrência de Ehrlichia canis em primatas de vida livre pertencentes ao gênero Callithrix

Bacteria of the genus Ehrlichia are Gram-negative and coccoid-shaped microorganisms that cause ehrlichiosis a serious infectious disease that often leads to death. These bacteria present a strong zoonotic potential and primates may act as reservoir hosts. This study involved a molecular analysis to detect these microorganisms in blood samples collected from nineteen primates of the genus Callithrix living free in an Atlantic Forest fragment in the municipality of Viçosa, state of Minas Gerais, Brazil. One of the 19 primates was found to be infected with Ehrlichia canis. This finding points to a new wild host of E. canis with a strong potential for transmission to humans because of its increasing contact with people. This is the first report of Ehrlichia spp. in primate of the genus Callithrix.

Bactérias do gênero Ehrlichia são gram-negativas em forma de cocos. Provocam uma doença infecciosa grave denominada erliquiose que, muitas vezes, causa morte. Essas bactérias apresentam grande potencial zoonótico, e os primatas podem agir como reservatórios. Este estudo objetivou a detecção molecular desse microorganismo em amostras de sangue coletadas de dezenove primatas de vida livre num fragmento de Mata Atlântica pertencentes ao gênero Callithrix, no município de Viçosa, Minas Gerais, Brasil. Entre os 19 espécimes de sagui, um estava infectado com Ehrlichia canis. Esse achado aponta para um novo hospedeiro selvagem para E. canis com grande potencial de transmissão ao homem, devido ao seu crescente contato com pessoas. Este é o primeiro relato de primata do gênero Callithrix infectado com Ehrlichia spp.

Hematology and blood biochemistry in wild hybrid marmosets from the Atlantic Forest, Brazil / Hematologia e bioquímica sanguínea de saguis selvagens híbridos da Mata Atlântica, Brasil

This paper aims to describe the hematological and biochemical values of wild hybrid marmoset (Callithrix penicillata and C. geoffroyi) found in a forest zone of Southeastern Brazil. The marmosets were anaesthetized using ketamine and xylazine hydrochloride. Blood samples (0.5-1mL) were collected through the venipuncture of the femoral vein. Hematological and biochemical analyses were performed using automated counters and biochemical kits. The comparison for sex (adult males vs. adult females) and age class (juvenile vs. adult) physiological data and weight were analyzed through Student's t-test for independent samples. Significant differences between sex were observed in erythrocytes (P<0.01) and hemoglobin (P<0.05). The present study provides essential baseline information on the normal blood values of wild hybrid marmosets, the data of which are not readily accessible from the existing body of scientific literature on nonhuman primates.

Este artigo objetiva descrever os valores hematológicos e bioquímicos de saguis híbridos selvagens (Callithrix penicillata e C. geoffroyi) encontrados em uma zona florestal do Sudeste do Brasil. Os saguis foram anestesiados usando cetamina e hidrocloridrato de xilazina. As amostras de sangue (0,5-1mL) foram coletadas por punção da veia femoral. As análises hematológicas e bioquímicas foram realizadas por meio de contadores automáticos e kits bioquímicos. A comparação dos dados fisiológicos e pesos para o gênero (machos vs. fêmeas) e a classe de idade (juvenil vs. adulto) foram analisados através do teste t de Student para amostras independentes. Observaram-se diferenças significativas de gênero para eritrócitos (P<0,01) e hemoglobina (P<0,05). O presente estudo fornece informação básica essencial sobre os valores hematológicos normais de saguis híbridos selvagens, dados que não são prontamente disponíveis na literatura científica atual sobre primatas não humanos.

Helminths of wild hybrid marmosets (Callithrix sp.) living in an environment with high human activity / Helmintos de saguis (Callithrix sp.) híbridos de vida livre vivendo em ambientes com alta atividade humana

The objective of this study was to identify the helminth fauna in hybrid, non-native marmosets, through analysis of fecal samples. The study involved 51 marmosets (genus Callithrix) from five groups living in places with levels of human impact in Viçosa-MG. The marmosets were caught using a multiple-entrance trap and were anaesthetized. Feces were collected, refrigerated and analyzed by means of the sedimentation technique (Hoffmann-Pons-Janner). Eggs and parasites were identified, but not counted. Most of the marmosets (86%) were parasitized by at least one genus of helminths. Among the infected marmosets, 37% presented co-infection. The intestinal helminths comprised four different taxa: Primasubulura jacchi, Ancylostomatidae, Prosthenorchis sp. and Dilepididae.P. jacchi and Ancylostomatidae had higher prevalences (> 80% and > 40%, respectively) and were found in all marmoset groups. Dilepididae species were found in almost all the groups, but only accounted for around 30% of the marmosets. Prosthenorchis sp. showed a relatively low prevalence (< 10%) and was only found in one group. Although two parasites are commonly found in marmosets and other primates (P. jacchi and Prosthenorchis sp.), our study is the first record for Ancylostomatidae and Dilepididae. Factors like marmosets' feeding behavior and their contact with humans and other species of nonhuman primates seem to be determinants of infection among marmosets.

O objetivo do presente estudo foi a identificação da helmintofauna em saguis híbridos e introduzidos, por meio de análises de amostras fecais. O estudo envolveu 51 saguis do gênero Callithrix, de cinco grupos que ocupam áreas com diferentes impactos humanos. Os saguis foram capturados com armadilha de múltiplas entradas e anestesiados. Fezes foram colhidas, refrigeradas e analisadas pela técnica de sedimentação (Hoffmann-Pons-Janner). Ovos e parasitas foram identificados, mas não contados. A maior parte dos saguis (86%) estava parasitado por, pelo menos, uma espécie de helminto. Do grupo infectado, 37% apresentou coinfecção. A diversidade helmíntica intestinal incluiu quatro táxons diferentes: Primasubulura jacchi, Ancylostomatidae, Prosthenorchis sp. e Dilepididae. P. jacchi e Ancylostomatidae apresentaram as maiores prevalências (> 80% e > 40%, respectivamente) e foram encontrados em todos os grupos. As espécies de Dilepididae apresentaram aproximadamente 30% da prevalência e foram encontrados em quase todos os grupos. A espécie Prosthenorchis sp. apresentou prevalência relativamente baixa (< 10%) e foi encontrado somente em um grupo. Considerando que duas das espécies são parasitas comumente descritos para saguis e primatas (P. jacchi e Prosthenorchis sp.), este estudo consiste no primeiro registro para Ancylostomatidae e Dilepididae. Fatores como o comportamento alimentar e o contato com o homem e outras espécies de primatas não humanos, parecem ser determinantes na contaminação dos saguis.

Coadministration of sodium alginate pellets containing the fungi Duddingtonia flagrans and Monacrosporium thaumasium on cyathostomin infective larvae after passing through the gastrointestinal tract of horses.

The predatory nematophagous fungi have been used as an alternative control of gastrointestinal nematodes of domestic animals in natural and laboratory conditions. However, it is unclear if the association of some of these species could bring some kind of advantage, from a biological standpoint. In this context, this study consisted of two tests in vitro: in assay A, the assessment of the viability of the association of pellets in sodium alginate matrix containing the fungus Duddingtonia flagrans (AC001) and Monacrosporium thaumasium (NF34) and its predatory activity on infective larvae (L3) of cyathostomin after passing through the gastrointestinal tract of horses and assay B, assessment of the cyathostomin L3 reduction percentage in coprocultures. Twelve crossbred horses, females, with a mean weight of 356 kg and previously dewormed were divided in three groups with four animals each: group 1, each animal received 50 g of pellets containing mycelial mass of the fungus D. flagrans and 50 g of pellets of the fungus M. thaumasium, associated and in a single oral dose; group 2, 100 g of pellets containing D. flagrans and 100 g of pellets containing M. thaumasium, associated and in a single oral dose; group 3, control. Faecal samples were collected from animals in the treated and control groups at time intervals of 12, 24, 36, 48, 60 and 72 h after the administration of treatments and placed in Petri dishes containing 2% water-agar (assay A) and cups for coprocultures (assay B). Subsequently, 1000 cyathostomin L3 were added to each Petri dish (assay A) and 1000 cyathostomin eggs were added to each coproculture (assay B) of fungi-treated and control groups. At the end of 15 days, there was observed that the two associations of pellets containing the fungi tested showed predatory activity after passing through the gastrointestinal tract of horses (assay A). In assay B, all the intervals studied showed reduction rate in the number of L3 recovered from coprocultures exceeding 80%. However, no difference (p>0.01) was seen in recovery of not predated L3 between the fungi-treated groups in the time intervals studied. The results obtained showed that the associations of pellets (50 or 100 g of each fungal isolate) were viable after passage through the gastrointestinal tract in horses and could be used in natural conditions.

Immunocharacterization of the DNA puff BhC4-1 protein of Bradysia hygida (Diptera: Sciaridae).

The DNA puff BhC4-1 gene is amplified and highly expressed in the salivary gland of Bradysia hygida late larvae. Using affinity-purified polyclonal antibodies we have identified the product of the BhC4-1 gene as a 43 kDa polypeptide which is present in extracts of salivary glands from late fourth instar larvae and in the corresponding gland secretion, but not in glands from earlier stages. We also demonstrate that this protein is produced mainly in the S1 and S3 regions of the salivary gland, where BhC4-1 amplification levels are more pronounced and larger amounts of mRNA are produced. By immunoelectron microscopy the BhC4-1 protein was detected in secretory granules of the S1 and S3 regions, and localized in fibrous structures present in the saliva.

High-impact therapy for smoking cessation.

Cigarette smoking is the leading cause of preventable death and disability-and thus an issue of considerable importance to psychotherapists. The majority of smoking-cessation programs available to the public uses an effective group format, but it remains underused. Many smokers who seek treatment request individual counseling; however, empirically based individual treatments are still in the early stages of development. High-impact therapy is a form of short-term dynamic psychotherapy adapted by the authors for the treatment of the hard-core smoker. It recognizes that the relationship among smoking, life stressors, personality factors, and psychological disorders is complex, and it intervenes using motivational and defense-challenging techniques. One of the main and distinctive features of this model is the emphasis on emotional arousal to facilitate the mastery of emotional conflict, making this a high-impact form of psychotherapy.

Validity of a brief measure of post-hospital adjustment for psychiatric patients.

This study examined the psychometric properties of a 14-item self-administered outcome measure of post-hospital adjustment for former psychiatric inpatients. Such scales are frequently used in follow-up assessment, often without knowledge of scale reliability or validity. Responses to the scale items were factor analyzed for two samples, former patients and their therapists, each group rating the patient's post-hospital adjustment. Two strong factors emerged and were consistent across both samples: an anxiety-depression (intrapsychic) dimension and a functioning/productivity (external adjustment) dimension. Both scales showed good convergent validity with longer, standardized measures. Agreement between patients and therapists was adequate for anxiety-depression, indicating good consensual validity, but poor for functional adjustment. For the expatients, discriminant validity was not evident.

Characteristics of people lost to attrition in psychiatric follow-up studies.

In a large (N = 1,744) study of previously hospitalized psychiatric patients, multiple follow-up attempts were made to contact the ex-patients over a 1-year period after their discharges. When contacted they were asked to provide information about their posthospital adjustment; 59.5% of the sample was reached at least once and usable data obtained either in a telephone interview or from a mailed survey form. The contacted and noncontacted people represented very different subpopulations, both demographically and in terms of typical psychiatric descriptors. Those who were of lower socioeconomic status, male, unmarried, racial minorities, and those with records of substance abuse or assaultiveness, and who were generally more severely impaired during the baseline hospitalization were underrepresented in the contacted group. Possible reasons for these sample biases, the implications for hospitals conducting outcome assessments (i.e., for research and program evaluation purposes), and strategies for dealing with this kind of methodological problem are discussed.

A randomized controlled trial of smoking cessation counseling after myocardial infarction.

BACKGROUND: Smoking cessation after myocardial infarction (MI) has been associated with a 50% reduction in mortality but in-hospital smoking cessation interventions are rarely part of routine clinical practice. METHODS: One hundred cigarette smokers consecutively admitted during 1996 with MI were assigned to minimal care or to a hospital-based smoking cessation program. Intervention consisted of bedside cessation counseling followed by seven telephone calls over the 6 months following discharge. Primary outcomes were abstinence rates measured at 6 months and 1 year post-discharge. RESULTS: At follow-up, 43 and 34% of participants in minimal care and 67 and 55% of participants in intervention were abstinent at 6 and 12 months. respectively (P<0.05). Abstinence rates were calculated assuming that participants lost to attrition were smokers at follow-up. Intervention and self-efficacy were independent predictors of smoking status at follow-up. Low self-efficacy combined with no intervention resulted in a 93% relapse rate by 1 year (P<0.01). CONCLUSIONS: A hospital-based smoking cessation program consisting of inpatient counseling and telephone follow-up substantially increases smoking abstinence 1 year after discharge in patients post-MI. Patients with low self-efficacy are almost certain to relapse without intervention. Such smoking cessation programs should be part of the management of patients with MI.

[Study of lung involvement in patients with cystic fibrosis] / Estudo do quadro pulmonar de pacientes com fibrose cística.

OBJECTIVE: To characterize the involvement of the respiratory apparatus of patients with cystic fibrosis in order to obtain a comprehensive view of their pulmonary picture.METHODS: Data were obtained retrospectively from the medical records of 16 patients with cystic fibrosis; arterial gas and spirometry data were obtained prospectively for the same patients, who were not in an acute pulmonary situation. The patients were subjects of both sexes aged 6 years or older who were followed up at the Pediatrics Outpatient Clinic of the University Hospital, Faculty of Medicine of Ribeirão Preto, USP.RESULTS: Median patient age was 114 months (9 years and 6 months) ranging between 72 - 360 months, and 68.75% were males. Productive cough was the most frequent symptom observed in 75% of the population studied. All patients had positive sputum culture obtained at least one year before, with Pseudomonas aeruginosa being detected in 81.25% of the cases. Arterial gases revealed some abnormalities in 81.25% of the patients and spirometry revealed abnormalities in 56.25%.CONCLUSION: All patients presented at least one type of pulmonary alteration. Measurement of arterial gases detected a larger number of patients with altered pulmonary function than did spirometry, but the two examinations complemented each other for a good evaluation of pulmonary function.

Predicting service utilization after psychiatric hospitalization.

The purposes of this study were to determine (1) the extent of service utilization in the posthospitalization period and (2) the probability of specified service utilization outcomes for patients with given characteristics, using ordered logit models. The sample consisted of former inpatients who were evaluated for 6 months and responded to a mailed questionnaire or telephone interview at both the 3- and 6-month follow-up points. Significant independent predictors of service utilization at 6 months were the diagnosis, length of hospital stay, history of suicide attempts, perceived stress, and medication compliance at 3 months. High service utilization was evident in a sizable proportion of the sample and could be predicted using this model.

The DIET study: long-term outcomes of a cognitive-behavioral weight-control intervention in independent-living elders. Dietary Intervention: Evaluation of Technology.

OBJECTIVE: To describe the long-term outcomes of a cognitive-behavioral weight-control intervention implemented in a community-based sample of independent-living, older adults. DESIGN: A quasi-experimental design was used to compare an intervention community with a wait-listed control community. Comparisons between the communities were made at 40 weeks (J Am Diet Assoc. 1994;94:37-42). The controlled trial ended at 40 weeks; then both communities received 2 years of intervention. Two-year data from both communities were combined and are presented in this article. Three-year outcome data from the initial intervention community were available and are also presented. SUBJECTS: A total of 247 overweight (> 4.5 kg of age-adjusted weight), older (mean age = 71 years) adults in 2 independent-living retirement communities participated in the study. INTERVENTION: The Dietary Intervention: Evaluation of Technology (DIET) study consisted of an intensive 10-week psychoeducational approach focused on lifestyle change, followed by a less intensive 2-year phase focusing on relapse prevention and maintenance of lifestyle changes. OUTCOME MEASURES: Physiologic and behavioral variables were analyzed at baseline and at 2 years after baseline. This article reports the combined 2-year outcome data from both retirement communities. Results of an additional follow-up 1 year after intervention was withdrawn are reported for the initial intervention community. STATISTICAL ANALYSIS: A within-subjects repeated measures analysis of variance design was used to test for significant changes in weight and lipid values over time. RESULTS: At 2 years, 70% of those who started the intervention remained actively enrolled. This group showed significant decreases in body mass index (-1.2, P < .001) and glucose level (-0.80 mmol/L, P < .001). Although high-density lipoprotein cholesterol (HDL-C) levels had increased at 40 weeks after baseline, this was not maintained at 2 years. At the 3-year follow-up, changes in body mass index and glucose level were maintained. APPLICATIONS/CONCLUSIONS: The purpose of this article was to describe the long-term outcomes of a community-based weight-reduction intervention for older adults. The findings may be of interest to clinicians who design community or worksite weight-reduction programs. Although the intervention was designed to be a low-intensity program, attrition over the length of the study was still problematic. Nevertheless, our follow-up study indicates that this intervention was efficacious in maintaining reductions in weight and glucose levels for overweight older adults for 3 years.

Assessing outcomes: identifying psychiatric patients with severe and persistent illness.

BACKGROUND: Identification of psychiatric patients with severe and persisting impairments can facilitate treatment, aid in program planning, and provide data for cost-of-care projections. METHODS: In this prospective study of patient outcomes, 1,679 inpatients were classified on admission using a functional status measure developed by the authors. Consenting subjects were reassessed at discharge and at 3, 6, and 12 months postdischarge to determine what proportion of patients classified as low functioning on admission remained so at follow-up. RESULTS: Patients classified as low functioning on admission represented 23.4% of the sample; the proportion that remained low functioning at the follow-ups ranged from 56.1% to 65.2%. Compared to the high functioning group, three times more low functioning patients were rehospitalized within 12 months of discharge (9.4% vs 32%). CONCLUSIONS: Patients with increased risk of persisting disability can be identified on admission using commonly available clinical measures. Of patients with low functioning on admission, more than half will have long-term impairment.

A cluster analytic study of functional outcome after psychiatric hospitalization.

We report the initial results from a prospective study designed to assess patients' functional outcome and level of service utilization following psychiatric hospitalization. All patients admitted between March 31, 1993 and April 1, 1994 were interviewed at admission and discharge, and 350 consenting patients were reassessed 3 months postdischarge. Subgroups were created using cluster analysis (measures of outcome were rehospitalization, self-rated productivity and functioning, and satisfaction with living situation and employment/daily activities at the 3-month follow-up study), and these clusters were then validated using other variables. Four distinct outcome categories were identified. Cluster I contained patients with the greatest functional impairment and the highest rate of rehospitalization (28%). Cluster IV patients reported superior functioning and satisfaction and the lowest rate of rehospitalization (8%). Clusters II and III had intermediate outcomes, the first characterized by greater satisfaction with living situation, and the other by higher ratings for functioning and productivity. Outcome data are important to providers for program evaluation and patient care; if replicated in other samples, the four outcome categories reported may be useful for national mental health care policy and planning.

A weight reduction intervention that optimizes use of practitioner's time, lowers glucose level, and raises HDL cholesterol level in older adults.

OBJECTIVE: The effects of a cognitive-behavioral weight control intervention were compared in two independent-living, older adult (mean age = 70.5 years) communities. DESIGN: The research design compared the experimental community (n = 163), which received the intervention, with the control community (n = 162). SUBJECTS: Overweight individuals (> 4.5 kg of age-adjusted weight according to height-weight tables) were recruited from both communities. INTERVENTION: Components of the Dietary Intervention: Evaluation of Technology (DIET) program included a video-tape, a workbook, computerized tracking of participants, a telephone hot line, educational group discussions, and individual consultation. OUTCOME MEASURES: Changes in body weight, body mass index, and lipid and glucose measures were selected to evaluate the effectiveness of the intervention. STATISTICAL ANALYSIS: One-way analysis of variance by group was done to compare changes in continuous variables between the intervention and control communities. RESULTS: Baseline body mass index and weight were 30.8 and 79.5 kg, respectively, in the experimental community and 28.8 and 75.8 kg, respectively, in the control community. Mean weight change in the experimental community was -3.2 kg after 40 weeks of intervention, compared with no weight change in the control community (P < .0001). Mean plasma glucose level decreased -0.3 mmol/L and mean high-density lipoprotein cholesterol level increased 0.15 mmol/L in the experimental community, compared with no change in lipid parameter and a +0.3 mmol increase in glucose level in the control community (P < .0001). APPLICATIONS: Our findings suggest that an intervention that optimizes use of the practitioner's time can achieve a moderate weight loss and metabolic improvement in a community of older adults.