Antiepileptic drug use in nursing home residents: effect of age, gender, and comedication on patterns of use.

PURPOSE: Examine antiepileptic drug (AED) use in nursing homes by age, gender, and use of comedication that can interact with AEDs. METHODS: Two point-prevalence evaluations of AED use from computerized medical records of nursing home residents throughout the United States (set 1, 43,757; set 2, 41,386) 65 years and older serviced by PHARMERICA. RESULTS: 10.5% of residents received an AED. Of the age group 65-84 years, 15 % received an AED compared with 6.1% of those 85 years or older (p < 0.001). Gender differences were present; 13.4% of the male residents and 9.4% of the female residents were treated with an AED (p < 0.001). The most frequently prescribed AEDs were phenytoin, carbamazepine, clonazepam, or phenobarbital. The average number of routine medications taken by AED recipients was 5.6, greater than the average of 4.6 for other residents. CONCLUSIONS: AEDs are extensively prescribed for elderly nursing home residents. Men and persons aged 65-85 years were more likely to receive AEDs than were women or those older than 85 years. AED recipients receive more routine medications than do other residents, including co-medications that alter hepatic metabolism and clinical response. The reasons for age and gender differences are unclear and require further study.

Paternalistic welfare reform: current perceptions and behavioral models.

Most of the current welfare reform incentives make assumptions about the behavior of AFDC clients. Among these assumptions are that clients will seek to maximize their financial resources; that they understand the requirements of the welfare reform; and that they can control the behaviors targeted by the welfare reform effort. Using survey data gathered from AFDC clients involved in Maryland's welfare reform initiative, the authors suggest that the assumptions underlying these welfare reform initiatives may be too simplistic. For welfare reform to be effective, the authors argue that these initiatives must reflect the complexity of the problems and concerns faced by the AFDC client.

A critical feminist perspective of the health belief model: implications for nursing theory, research, practice, and education.

The health care system is in a state of crisis, and nursing is in a unique position to influence the decisions that are made regarding health care reform. However, without transforming our ways of knowing and being, the changes that are needed to meet the challenges of the future may not become a reality. Nursing theory, research, and practice reflect the historical, social, and political ideologies of western tradition. Consequently, the knowledge gained from the majority of nursing research has primarily developed from an empiricism or logical positivist philosophy. The underlying assumption of this school of thought is that only empirically quantifiable and measurable matters yield the truth, suggesting that there is only one reality. Because one cannot be socially critical as an empiricist, nurse educators have begun to question the adequacy of the empiricist philosophy and method of research for meeting changing societal demands. Social behavioral theories in general and the Health Belief Model in particular have frequently guided nursing research in an attempt to increase knowledge of health-related behaviors. Too often these theories have done little to increase our knowledge of women and people of color. For the most part, they have contributed to the oppression of individuals and groups. A critical feminist perspective can be useful in the understanding of health practices that are based on contextual knowledge. The purpose of this article is to increase awareness and understanding of the underlying assumptions, constraints, and contradictions that are embedded within social behavioral theories such as the Health Belief Model.(ABSTRACT TRUNCATED AT 250 WORDS)

Chlordiazepoxide antinociception: cross-tolerance with opiates and with stress.

Chlordiazepoxide (CDP) has been previously shown to possess antinociceptive properties that are resistant, except at high doses, to the opiate antagonist naloxone. The present study evaluated whether CDP's antinociceptive effects were subject to tolerance following repeated injections and whether cross-tolerance might develop between the antinociceptive action of CDP and that of either morphine or cold water swins. CDP increased flinch-jump thresholds following acute administration and exhibited tolerance following repeated injections. Neither morphine-tolerant nor cold water swim-adapted rats displayed an antinociceptive effect when tested with CDP. On the other hand, chronic pretreatment with CDP attenuated the antinociceptive effects of cold water swims, but did not produce any clear effect upon morphine analgesia.