Expression of cytokine and chemokine genes by human middle ear epithelial cells induced by formalin-killed Haemophilus influenzae or its lipooligosaccharide htrB and rfaD mutants.

To define the role of nontypeable Haemophilus influenzae (NTHI) lipooligosaccharide (LOS) in the induction of proinflammatory cytokine gene expression during otitis media, we compared the abilities of formalin-killed NTHI strain 2019 and its LOS htrB and rfaD mutants to stimulate human middle ear epithelial (HMEE) cell cytokine and chemokine gene expression and production in vitro. Strain DK-1, an rfaD gene mutant, expresses a truncated LOS consisting of only three deoxy-D-manno-octulosonic acid residues, a single heptose, and lipid A. Strain B29, an isogenic htrB mutant, possesses an altered oligosaccharide core and an altered lipid A. HMEE cells were incubated with formalin-killed NTHI 2019, B29, or DK-1. The supernatants and the cells were collected at 2, 4, 8, and 24 h after stimulation. Expression of genes for the cytokines tumor necrosis factor alpha (TNF-alpha), interleukin lbeta (IL-1beta), and IL-6 and for the chemokines macrophage inflammatory protein 1beta (MIP-1beta), monocyte chemotactic peptide 1 (MCP-1), and IL-8 was quantitated by real-time PCR. NTHI B29 did not significantly stimulate any cytokine or chemokine mRNA expression in HMEE cells. In striking contrast, NTHI 2019 induced up to 105-, 139-, and 187-fold increases in HMEE cell expression of IL-1beta, TNF-alpha, and MIP-1beta, respectively (P < 0.01 [2019 versus B29]). NTHI 2019 also induced upregulation of IL-8, IL-6, and MCP-1 mRNA expression (by 26-, 44-, and 14-fold, respectively [P < 0.05 (2019 versus B29)]). The significant induction of cytokine genes was confirmed by quantitating the secretion of cytokines in culture supernatants with an enzyme-linked immunosorbent assay. There were no significant differences in mRNA expression of IL-8, IL-6, and MCP-1 between the 2019- and DK-1-treated groups. The low levels of gene transcripts observed after incubation of HMEE cells with B29 indicate that products of the disrupted NTHI htrB LOS gene may play a major role in induction of these particular inflammatory mediators.

Relation of perceptual and body image dysfunction to activities of daily living of persons after stroke.

Perceptual and body image disturbances are common sequelae in persons who have had stroke. There is much evidence to substantiate a relationship between impaired perceptual functioning and impaired functioning in activities of daily living (ADL). In regard to body image dysfunction, the linking of unilateral neglect and poor ADL functioning has been widely examined; however, the relationship of other body image disturbances, such as somatoagnosia, to ADL has received little examination. Research on the above relationships are reviewed in this article. The Behavioral Inattention Test and Arnadottir OT-ADL Neurobehavioral Evaluation are discussed as two assessments that determine perceptual and body image dysfunction through ADL. The literature on intervention for perceptual and body image dysfunction in relation to ADL primarily concerns the difference between the restorative and functional retraining approaches and treatment suggestions. Because specific gaps are noted in this area of study, future research ideas are suggested.

Construct validation of an acute care occupational therapy cerebral vascular accident assessment tool.

This study was the last in a series of six investigations of the construct validity of the St. Marys CVA evaluation, a clinician constructed test composed of items designed to evaluate sensory, perceptual, motor, and self care performance in cerebral vascular accident patients. Data for the present study were obtained from 250 new patients referred for occupational therapy services from 1983 to 1988. Factor analysis with varimax orthogonal rotation was performed on 22 items of the evaluation including perception, recovery stages, measures of grasp and pinch strength and other functional variables. Three factors emerged - Right Function, Recovery Stage, and Left Hand Strength. The results of the study, combined with results of previous research, indicate that this CVA Evaluation has reasonable construct validity as an occupational therapy assessment tool in an acute care setting.

Alcohol abuse and perceptual-motor dysfunction: the occupational therapist's role.

A review of the literature on perceptual-motor deficits in alcoholic patients is presented. Studies show that there is a relationship between perceptual-motor dysfunction and alcoholism. Because occupational therapists treat perceptual-motor deficits in other kinds of patients, they may have a role in treating these deficits in alcoholic patients as well. To assume such a role, however, occupational therapists must document a relationship between dysfunction in activities of daily living and perceptual-motor dysfunction in the alcoholic patient. Unless such a relationship is established, treatment of perceptual-motor dysfunction in alcoholic patients would not fall within the scope of occupational therapy.

Unilateral neglect: suggestions for research by occupational therapists.

This paper reviews the research literature pertinent to the evaluation of and therapy for patients having unilateral neglect. Emphasis is on areas in need of research by occupational therapists. Specific suggestions are made for studies to relate evaluation tools to functional criteria, to adapt the environment, and to investigate the effectiveness of compensatory or neurologically based treatment.

Continued construct validation of the St. Marys CVA Evaluation: Bilateral Awareness Scale.

Previous research suggested that scores on the Schenkenberg Line Bisection Test of unilateral neglect should correlate significantly with bilateral awareness ratings on the St. Marys CVA Evaluation, but that scores on both of these instruments should not correlate with St. Marys perceptual scores. To test this hypothesis, occupational therapists at St. Marys Hospital Medical Center administered the Schenkenberg test and St. Marys CVA Evaluation to 26 cerebral vascular accident (CVA) patients. Spearman rho coefficients were computed. As hypothesized, the correlation between the Schenkenberg test scores and St. Marys bilateral awareness ratings reached statistical significance, and no significant relationship was found between Schenkenberg scores and St. Marys perceptual scores. However, there was a significant relationship between the St. Marys bilateral awareness ratings and perceptual scores. This result may indicate that clinical observations are not adequate to discriminate between unilateral neglect and perceptual impairments. The results further the construct validation process of the St. Marys CVA Evaluation. The data also support the position that unilateral neglect is not primarily a perceptual phenomenon.

The efficacy of the ROM Dance Program for adults with rheumatoid arthritis.

This study examined the efficacy of an exercise and relaxation program for adults with rheumatoid arthritis. The program integrates principles of occupational therapy and T'ai-Chi Ch'uan and was expected to be more effective than traditional exercise and rest regimens because of its expressive and pleasurable elements. There were significant differences between 17 experimental and 16 control subjects on two categories of dependent variables after the former group's participation in the experimental program. These dependent variables were range of motion measures and subject self-reports of frequency, enjoyment, and benefits of home exercise and rest routines. Pretest, posttest, and 4-month follow-up data were analyzed. Program participants showed significantly greater upper extremity range of motion 4 months after completing the program although the reported frequency of exercise and rest was greater in the control group. Postprogram reports of enjoyment were significantly higher for experimental than for control subjects. If these initial results are confirmed in further studies, the efficacy of the use of purposeful activity for exercise and rest will be supported. This study also supports the integration of Eastern and Western frames of reference in the treatment of patients with chronic illness.

Continued construct validation of the St. Marys CVA evaluation: Brunnstrom arm and hand stage ratings.

The purpose of the study was to test whether evaluations of cerebral vascular accident (CVA) patients show a significant relationship between ratings of Brunnstrom's arm and hand stages and scores on Schenkenberg's Line Bisection Test of unilateral neglect. Spearman rho correlation coefficients for 20 acute care right CVA subjects showed a highly significant relationship between performances on the two measures. Results can be interpreted to further the construct validity of the St. Marys CVA evaluation.

Some issues related to research utilization in occupational therapy.

The importance of research in the rehabilitation fields, including occupational therapy, has been widely recognized in the past decade. The production of credible research literature has received high priority as occupational therapy strives to achieve professional status within the hierarchy of rehabilitation service providers. To accomplish this goal, research that establishes a scientific basis for therapy must be produced, and this research must be integrated with clinical practice. Occupational therapy appears to be making progress in producing research literature related to clinical practice; however, the issue of research utilization has remained largely unexplored. This paper discusses methods of applying research findings and procedures in practice environments and explores some issues related to research utilization. Research utilization is viewed as a complex process involving multiple components related to individual decision making, theory development, and the documentation of clinical practice.

Performance of female adults on the Southern California Visual Figure-Ground Perception Test.

This study was conducted to assess adult female performance on the Southern California Visual Figure-Ground Perception Test (FGP) and to obtain an estimate of the test's reliability. Data were obtained for two scoring formats. The first format was the score for all items on the test (TOTAL), and the second format was the score through the fifth error (FIRST-FIVE). The mean scores were 38.24 (SD = 3.2) for TOTAL and 29.71 (SD = 10.14) for FIRST-FIVE. For each format, mean, standard deviation, kurtosis, and skewness values are presented (N = 124). Both formats were reliable over time (.90 and .71, respectively), and scores of the even-numbered items correlated moderately with the odd-numbered items, indicating split-half reliability (.70 and .87 for both administrations of the test). Although the sample was representative across the socioeconomic variable, moderate correlations were obtained between the performance scores and the age and education level variables. We concluded that the FGP is a reliable assessment tool for use with adults; however, a subject's age and education must be considered when interpreting the scores.

Construct validation of the St. Marys CVA evaluation: perceptual measures.

This study was conducted to continue the construct validation of the occupational therapy Cerebral Vascular Accident (CVA) evaluation used at St. Marys Hospital Medical Center in Madison, Wisconsin. From the previous factor analysis of this battery, a perception factor emerged that is defined by high loadings on measures of body scheme, figure ground, position in space, spatial relations, and stereognosis. From the literature review it was hypothesized that scores on these tests should be related to patient discharge disposition. Results of this study supported the hypothesis, thus providing further evidence of the construct validity of the St. Marys CVA Evaluation Battery.

Steroid-induced diabetes in pediatric renal transplant recipients.

Seven patients in a series of 79 children receiving 101 kidney transplants developed steroid-induced diabetes. Black children, recipients of cadaveric allografts, and patients receiving higher average daily prednisone dosage were more likely to develop hyperglycemia. The diabetes was transient and easily controlled. No patient developed permanent insulin dependence. No patients exhibited is let cell autoantibodies or an HLA haplotype associated with diabetes. Oral glucose tolerance testing demonstrated significant hyperglycemia with an inadequate insulin response. Three patients also exhibited unusual complications; two had cerebral vascular accidents (CVA) and one developed aspergillosis in a native kidney. Pediatric patients exhibiting steroid-induced diabetes following kidney transplantation may constitute a group at greater risk for complications.

Engaging "resistant" families in treatment. I. Getting the drug addict to recruit his family members.

For family therapy to have any effect on correcting drug problems, the family must obviously be involved. However, such families are often resistant to treatment. This paper describes techniques in working with the addicted member toward recruiting his family for therapy. A sequential approach to the initial interview is presented. Interview rationale, structure, and strategy are outlined, along with examples of common resistances and therapeutic counters. The model and techniques are potentially applicable to other types of symptomatic families as well.

Heroin addiction as a family phenomenon: a new conceptual model.

The chronic relapsing nature of heroin addiction can be explained from a family systems viewpoint. The addiction cycle is part of a family pattern involving a complex homeostatic system of interlocking feedback mechanisms. These serve to maintain the addiction and consequently the overall family stability. Drug-taking usually starts at adolescence. It is related to an intense fear of separation experienced by the family in response to the addict's attempts at individuation. The family becomes stuck at a particular developmental stage. Heroin provides a solution at several levels to the dilemma of whether or not to allow him independence. Paradoxically, it permits him to simultaneously be both close and distant, "in" and "out", competent and incompetent, relative to his family of origin. This is pseudoindividuation. An understanding of these concepts, and their integration into a homeostatic model, can provide the basis for effective treatment.