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1.
Phys Occup Ther Pediatr ; 40(1): 31-46, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31282292

RESUMO

Aim: To examine the effects of an upper-extremity, community-based, and power-training intervention.Methods: Twelve participants with cerebral palsy (CP) [8 males, 4 females; mean age 14 years 6 months (SD 5 years 4 months), range 7-24] were randomly assigned to a rest-training (RT; n = 6) or training-rest (n = 6) group in this randomized, cross-over design. Training took place in participants' home or school, three times per week for 6 weeks. We examined changes in upper extremity average power output (Pavg) in watts (W) and changes in function via the Pediatric Outcomes Data Collection Instrument (PODCI).Results: Each participant completed at least 15 of the 18 total training sessions (91.2% adherence). Pavg increased 92.2% on average among participants (p < .05). There was a significant three-way interaction among treatment, sequence, and period with the data stratified by (Bimanual Fine Motor Function [BFMF]) level on the pain subscale of the PODCI (p = 0.0118). All participants decreased pain after training with the exception of individuals with lower functioning (BFMF II-V) in the RT group.Conclusion: A community-based upper extremity power-training intervention was feasible and effective at improving power among young people with CP and has the potential to improve pain.


Assuntos
Paralisia Cerebral/fisiopatologia , Paralisia Cerebral/reabilitação , Terapia por Exercício/métodos , Extremidade Superior/fisiopatologia , Adolescente , Adulto , Criança , Estudos Cross-Over , Feminino , Humanos , Masculino , Medição da Dor , Projetos Piloto , População Rural , Adulto Jovem
2.
Fam Community Health ; 40(1): 11-17, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-27870748

RESUMO

Physical activity rates in rural women are very low. The purpose of this study was to explore the determinants of physical activity in rural women aged 20 to 44 years. A survey was used to collect data on a cluster sample of 184 participants. This study was guided by Self-Determination Theory. Survey data suggest that the highest type of motivation was identified regulation, and husband's support had the strongest effect on physical activity. Findings suggest that a history of sports participation can lead to the formation of intrinsic motivation. The results will assist in developing effective physical activity interventions.


Assuntos
Exercício Físico/fisiologia , Adulto , Feminino , Georgia , Humanos , População Rural , Apoio Social , Estados Unidos , Adulto Jovem
3.
Am Surg ; 82(1): 59-64, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26802859

RESUMO

Modern concepts of patient-centered care emphasize effective communication with patients and families, an essential requirement in acute trauma settings. We hypothesized that using a checklist to guide the initial family conversation would improve the family's perception of the interaction. Institutional Review Board-approved, prospective pre/post study involving families of trauma patients admitted to our Level I trauma center for >24 hours. In the control group, families received information according to existing practices. In the study group, residents gave patient information to a first-degree family member using a checklist that guided the interaction. The checklist included a physician introduction, patient condition, list of known injuries, admission unit or intensive care unit, any consultants involved, plans for additional studies or operations, and opportunity for family to ask questions. An 11-item survey was administered 24 to 48 hours after admission to each group that evaluated the trauma team's communication in the areas of physician introduction, patient condition, ongoing treatment, and family perception of the interaction. Responses were on a Likert scale and analyzed using the Wilcoxon-Mann-Whitney test. There were 130 patients in each group. The study group had significantly (P < 0.05) better responses in 8 of 11 items surveyed: physician spoke to family, physician introduction, understanding of their relative's injuries, admitting unit, consultants involved, urgent surgical procedures required, ongoing diagnostic studies, and understanding of the treatment plan. In conclusion, using a checklist improves the perception of the initial communication between the trauma team and family members of trauma patients, especially their understanding of the treatment plan.


Assuntos
Lista de Checagem , Comunicação , Equipe de Assistência ao Paciente/organização & administração , Melhoria de Qualidade , Centros de Traumatologia/organização & administração , Ferimentos e Lesões/terapia , Adolescente , Adulto , Estudos de Coortes , Feminino , Mortalidade Hospitalar , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Relações Profissional-Família , Estudos Prospectivos , Estatísticas não Paramétricas , Resultado do Tratamento , West Virginia , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/mortalidade , Adulto Jovem
4.
J Low Genit Tract Dis ; 18(4): 298-303, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24633170

RESUMO

OBJECTIVE: This study explores the prevalence and provider- and practice-related correlates of physician recommendation and administration of the quadrivalent human papillomavirus (HPV) vaccine, Gardasil, to 11- to 12-year-old girls and the intention to recommend the HPV vaccine to 11- to 12-year-old boys in Georgia. The study also describes physician knowledge about and barriers to HPV vaccination. MATERIALS AND METHODS: This cross-sectional study was conducted from December 2010 to February 2011. The study sample was drawn using the Georgia Vaccines for Children (VFC) provider list as a sampling frame and probability 1-stage cluster sampling with counties as clusters. The final analytic sample was restricted to 206 provider locations. Weighted percentages and corresponding statistics were calculated accounting for selection probabilities, nonresponse, and the cluster sample design. RESULTS: Among Georgia VFC providers attending to 11- to 12-year-old girls, 46% had always recommended that their patients get the HPV vaccination and 41% had vaccinated their female patients. Among Georgia VFC providers attending to 11- to 12-year-old boys, 20% would always recommend that their male patients get vaccinated.Physicians most frequently endorsed costs of stocking the vaccine (73%), upfront costs (69%), vaccination (68%), and insurance reimbursements (63%) as barriers to their HPV vaccination practices. CONCLUSIONS: Despite the Advisory Committee on Immunization Practices' recommendations on HPV vaccination, the prevalence of recommending and administering the HPV vaccine to female and male patients, aged 11 to 12 years, by VFC providers is an ongoing challenge in Georgia.


Assuntos
Comunicação em Saúde/métodos , Infecções por Papillomavirus/prevenção & controle , Vacinas contra Papillomavirus/administração & dosagem , Vacinação/estatística & dados numéricos , Criança , Estudos Transversais , Feminino , Georgia , Pessoal de Saúde , Vacina Quadrivalente Recombinante contra HPV tipos 6, 11, 16, 18 , Humanos , Masculino , Infecções por Papillomavirus/complicações , Vacinas contra Papillomavirus/imunologia
5.
J Sch Nurs ; 30(1): 75-80, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23632964

RESUMO

Literature provides evidence that school attendance correlates with academic performance and student success. Influenza is a contributing factor to school absences. Primary prevention for influenza includes immunization. School-located influenza vaccine (SLIV) programs provide greater access for students to be immunized. A retrospective review of preexisting data from four academic years was conducted to examine the relationship between SLIV participation and absenteeism among students at eight public elementary schools in Effingham County, Georgia. Results identified differences in average frequency of absences between SLIV and non-SLIV years as well as between SLIV participants and nonparticipants for the 2 SLIV years. Implications for practice include the potential for increased herd immunity among students, which may also extend to other parties within the school community and at home, thus promoting overall wellness and future student success.


Assuntos
Absenteísmo , Influenza Humana/prevenção & controle , Vacinação em Massa/métodos , Vacinação em Massa/estatística & dados numéricos , Serviços de Saúde Escolar/estatística & dados numéricos , Estudantes/estatística & dados numéricos , Criança , Feminino , Georgia , Humanos , Masculino , Estudos Retrospectivos
6.
Eur J Pharmacol ; 724: 102-11, 2014 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-24374007

RESUMO

Glucocorticoids are used widely in the treatment of inflammatory diseases, but use is accompanied by a significant burden of adverse effects. It has been hypothesized that gene- and cell-specific regulation of the glucocorticoid receptor by small molecule ligands could be translated into a therapeutic with an improved risk-benefit profile. MK-5932 is a highly selective glucocorticoid receptor modulator that is anti-inflammatory in vivo with an improved profile on glucose metabolism: Bungard et al. (2011). Bioorg. Med. Chem. 19, 7374-7386. Here we describe the full biological profile of MK-5932. Cytokine production following lipopolysaccharide (LPS) challenge was blocked by MK-5932 in both rat and human whole blood. Oral administration reduced inflammatory cytokine levels in the serum of rats challenged with LPS. MK-5932 was anti-inflammatory in a rat contact dermatitis model, but was differentiated from 6-methylprednisolone by a lack of elevation of fasting insulin or glucose levels after 7 days of dosing, even at high exposure levels. In fact, animals in the vehicle group were consistently hyperglycemic at the end of the study, and MK-5932 normalized glucose levels in a dose-dependent manner. MK-5932 was also anti-inflammatory in the rat collagen-induced arthritis and adjuvant-induced arthritis models. In healthy dogs, oral administration of MK-5932 exerted acute pharmacodynamic effects with potency comparable to prednisone, but with important differences on neutrophil counts, again suggestive of a dissociated profile. Important gaps in our understanding of mechanism of action remain, but MK-5932 will be a useful tool in dissecting the mechanisms of glucose dysregulation by therapeutic glucocortiocids.


Assuntos
Anti-Inflamatórios/uso terapêutico , Artrite Experimental/tratamento farmacológico , Benzamidas/uso terapêutico , Dermatite de Contato/tratamento farmacológico , Edema/tratamento farmacológico , Indazóis/uso terapêutico , Receptores de Glucocorticoides/metabolismo , Animais , Anti-Inflamatórios/sangue , Anti-Inflamatórios/farmacocinética , Anti-Inflamatórios/farmacologia , Benzamidas/sangue , Benzamidas/farmacocinética , Benzamidas/farmacologia , Linhagem Celular Tumoral , Colágeno , Citocinas/sangue , Cães , Feminino , Células HeLa , Humanos , Indazóis/sangue , Indazóis/farmacocinética , Indazóis/farmacologia , Insulina , Lipopolissacarídeos , Masculino , Metilprednisolona/farmacologia , Ratos , Ratos Endogâmicos Lew , Ratos Sprague-Dawley
7.
Adv Neonatal Care ; 12(2): 112-9, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-22469966

RESUMO

PURPOSE: Maternal breast milk is considered the nutritional "gold standard" for all infants, especially premature infants. However, preterm mothers are at risk of not producing adequate milk. Multiple factors affect the production of milk, including stress, fatigue, and the separation of the breastfeeding dyad-for example, when mother or infant is hospitalized. The purpose of this study was to examine the effects of listening and visual interventions on the quantity and quality of breast milk produced by mothers using a double electric breast pump. SUBJECTS: Mothers of 162 preterm infants were randomly assigned to 1 of 4 groups. METHODS: The control group received standard nursing care, whereas mothers in the 3 experimental groups additionally listened to a recording of 1 of 3 music-based listening interventions while using the pump. RESULTS: Mothers in the experimental groups produced significantly more milk (P < .0012). Mothers in these groups also produced milk with significantly higher fat content during the first 6 days of the study.


Assuntos
Aleitamento Materno/psicologia , Gorduras/análise , Recém-Nascido Prematuro , Leite Humano/química , Mães/psicologia , Musicoterapia , Terapia de Relaxamento , Adulto , Análise de Variância , Aleitamento Materno/métodos , Estado Terminal , Feminino , Humanos , Imagens, Psicoterapia , Fenômenos Fisiológicos da Nutrição do Lactente , Recém-Nascido , Leite Humano/fisiologia , Enfermagem Neonatal/métodos , Estresse Psicológico/terapia
8.
Hum Mol Genet ; 21(1): 163-74, 2012 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-21972245

RESUMO

Mutations in the leucine-rich repeat kinase 2 gene (LRRK2) are the most common genetic cause of Parkinson's disease (PD) and cause both autosomal dominant familial and sporadic PD. Currently, the physiological and pathogenic activities of LRRK2 are poorly understood. To decipher the biological functions of LRRK2, including the genes and pathways modulated by LRRK2 kinase activity in vivo, we assayed genome-wide mRNA expression in the brain and peripheral tissues from LRRK2 knockout (KO) and kinase hyperactive G2019S (G2019S) transgenic mice. Subtle but significant differences in mRNA expression were observed relative to wild-type (WT) controls in the cortex, striatum and kidney of KO animals, but only in the striatum in the G2019S model. In contrast, robust, consistent and highly significant differences were identified by the direct comparison of KO and G2019S profiles in the cortex, striatum, kidney and muscle, indicating opposite effects on mRNA expression by the two models relative to WT. Ribosomal and glycolytic biological functions were consistently and significantly up-regulated in LRRK2 G2019S compared with LRRK2 KO tissues. Genes involved in membrane-bound organelles, oxidative phosphorylation, mRNA processing and the endoplasmic reticulum were down-regulated in LRRK2 G2019S mice compared with KO. We confirmed the expression patterns of 35 LRRK2-regulated genes using quantitative reverse transcription polymerase chain reaction. These findings provide the first description of the transcriptional responses to genetically modified LRRK2 activity and provide preclinical target engagement and/or pharmacodynamic biomarker strategies for LRRK2 and may inform future therapeutic strategies for LRRK2-associated PD.


Assuntos
Doença de Parkinson/enzimologia , Doença de Parkinson/genética , Proteínas Serina-Treonina Quinases/metabolismo , Transcrição Gênica , Animais , Encéfalo/enzimologia , Feminino , Humanos , Serina-Treonina Proteína Quinase-2 com Repetições Ricas em Leucina , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Camundongos Transgênicos , Proteínas Serina-Treonina Quinases/genética
9.
J Trauma ; 70(6): 1485-8, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-21817987

RESUMO

BACKGROUND: High cervical spinal cord injury (CSCI) can cause life-threatening bradycardia from autonomic instability that may be resistant to pharmacologic interventions. Placement of a cardiac pacemaker, traditionally reserved for patients refractory to drug therapy, may be lifesaving. METHODS: Our Level I trauma center registry found all patients with CSCI from 2003 to 2009. A retrospective chart review identified major events involving the circulatory system: those exhibiting bradycardia (minor, heart rate 40-60/min; major, heart rate <40/min), hypotension (systolic blood pressure <80 mm Hg), asystole, and cardiac arrest. Records of pharmacological interventions (e.g., atropine) and details of pacemaker placement (e.g., timing and any complications) were reviewed. Statistical differences were determined by Wilcoxon signed-rank test, with p < 0.05 as significant. RESULTS: Of the 106 patients with CSCI, 15 (14%) had bradycardia and 7 of those (47%) underwent cardiac pacemaker placement. Six of seven patients had reviewable data. A total of 35 events occurred in these six patients before pacemaker placement. Subsequent to placement, there were zero events of cardiovascular instability (p = 0.0135). Major bradycardic episodes were reduced from 9 to 0 (p = 0.0206) and incidents requiring atropine administration from 9 to 0 (p = 0.0197). Four survived; two patients died from pulmonary complications. There were no complications related to pacemaker insertion. CONCLUSIONS: Patients with CSCI life-threatening complications of bradycardia benefit from early placement of a cardiac pacemaker. Early stabilization may facilitate transfer out of the intensive care unit, mobilization, physical therapy, rehabilitation, and outcome.


Assuntos
Bradicardia/etiologia , Bradicardia/terapia , Marca-Passo Artificial , Traumatismos da Medula Espinal/complicações , Adulto , Bradicardia/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Estudos Retrospectivos , Traumatismos da Medula Espinal/fisiopatologia , Estatísticas não Paramétricas , Resultado do Tratamento
10.
J Med Pract Manage ; 26(1): 21-4, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20839506

RESUMO

A lawsuit under the federal False Claims Act can threaten the survival of a medical practice. The Act prohibits a range of misconduct involving the submission of false claims to the government, as well as the knowing and improper retention of overpayments of government funds. Violations of the Act result in liability for treble damages and civil penalties of as much as $11,000 per violation. Although the Act imposes liability only on persons who act "knowingly," the "knowing" requirement is met if the person acts with deliberate ignorance or reckless disregard of the circumstances. The Act contains a "qui tam provision under which a whistleblower, acting on behalf of the government, may file suit to enforce the Act's terms, and if the lawsuit is successful, can receive a substantial percentage of the government's recovery.


Assuntos
Financiamento Governamental/legislação & jurisprudência , Formulário de Reclamação de Seguro/legislação & jurisprudência , Reembolso de Seguro de Saúde/legislação & jurisprudência , Administração da Prática Médica/legislação & jurisprudência , Humanos , Responsabilidade Legal , Decisões da Suprema Corte , Estados Unidos
11.
Subst Use Misuse ; 45(13): 2185-202, 2010 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-20388009

RESUMO

This 2002 Medcen Foundation-funded study explored characteristics of problem drinking among 211 urban Venezuelan Native Americans of Arawak origin. Prevalence of problem drinking using Alcohol Use Disorders Identification Tests was 88.5% among men and 17.3% among women. Periodic binge drinking was marked by loss of control, failure to meet obligations, and alcohol-related trauma. Focus group participants noted that previous occasional binge drinking by men has been replaced by frequent male and female heavy weekend drinking, violence, and death. Limitations and implications are discussed. Awareness of high levels of problem drinking and desire for assistance present compelling mandates for community intervention efforts.


Assuntos
Alcoolismo/epidemiologia , Grupos Populacionais , População Urbana , Adulto , Alcoolismo/etnologia , Feminino , Grupos Focais , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Venezuela/epidemiologia
12.
J Biol Chem ; 285(22): 17054-64, 2010 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-20356837

RESUMO

Selective androgen receptor modulators (SARMs) are androgen receptor (AR) ligands that induce anabolism while having reduced effects in reproductive tissues. In various experimental contexts SARMs fully activate, partially activate, or even antagonize the AR, but how these complex activities translate into tissue selectivity is not known. Here, we probed receptor function using >1000 synthetic AR ligands. These compounds produced a spectrum of activities in each assay ranging from 0 to 100% of maximal response. By testing different classes of compounds in ovariectomized rats, we established that ligands that transactivated a model promoter 40-80% of an agonist, recruited the coactivator GRIP-1 <15%, and stabilized the N-/C-terminal interdomain interaction <7% induced bone formation with reduced effects in the uterus and in sebaceous glands. Using these criteria, multiple SARMs were synthesized including MK-0773, a 4-aza-steroid that exhibited tissue selectivity in humans. Thus, AR activated to moderate levels due to reduced cofactor recruitment, and N-/C-terminal interactions produce a fully anabolic response, whereas more complete receptor activation is required for reproductive effects. This bimodal activation provides a molecular basis for the development of SARMs.


Assuntos
Androgênios/metabolismo , Azasteroides/farmacologia , Antagonistas de Hormônios/farmacologia , Receptores Androgênicos/química , Transcrição Gênica , Animais , Azasteroides/química , Células COS , Linhagem Celular Tumoral , Química Farmacêutica/métodos , Chlorocebus aethiops , Desenho de Fármacos , Feminino , Humanos , Ligantes , Masculino , Modelos Biológicos , Estrutura Terciária de Proteína , Ratos , Receptores Citoplasmáticos e Nucleares/metabolismo , Esteroides/metabolismo , Ativação Transcricional
13.
J Mol Endocrinol ; 44(1): 55-73, 2010 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-19726620

RESUMO

Androgens promote anabolism in the musculoskeletal system while generally repressing adiposity, leading to lean body composition. Circulating androgens decline with age, contributing to frailty, osteoporosis, and obesity; however, the mechanisms by which androgens modulate body composition are largely unknown. Here, we demonstrate that aged castrated rats develop increased fat mass, reduced muscle mass and strength, and lower bone mass. Treatment with testosterone or 5alpha-dihydrotestosterone (DHT) reverses the effects on muscle and adipose tissues while only aromatizable testosterone increased bone mass. During the first week, DHT transiently increased soleus muscle nuclear density and induced expression of IGF1 and its splice variant mechano growth factor (MGF) without early regulation of the myogenic factors MyoD, myogenin, monocyte nuclear factor, or myostatin. A genome-wide microarray screen was also performed to identify potential pro-myogenic genes that respond to androgen receptor activation in vivo within 24 h. Of 24 000 genes examined, 70 candidate genes were identified whose functions suggest initiation of remodeling and regeneration, including the type II muscle genes for myosin heavy chain type II and parvalbumin and the chemokine monocyte chemoattractant protein-1. Interestingly, Axin and Axin2, negative regulators of beta-catenin, were repressed, indicating modulation of the beta-catenin pathway. DHT increased total levels of beta-catenin protein, which accumulated in nuclei in vivo. Likewise, treatment of C2C12 myoblasts with both IGF1Ea and MGF C-terminal peptide increased nuclear beta-catenin in vitro. Thus, we propose that androgenic anabolism involves early downregulation of Axin and induction of IGF1, leading to nuclear accumulation of beta-catenin, a pro-myogenic, anti-adipogenic stem cell regulatory factor.


Assuntos
Androgênios/farmacologia , Composição Corporal/efeitos dos fármacos , Fator de Crescimento Insulin-Like I/metabolismo , Músculo Esquelético/metabolismo , Transcrição Gênica , beta Catenina/metabolismo , Androgênios/metabolismo , Animais , Proteína Axina , Células Cultivadas , Perfilação da Expressão Gênica , Regulação da Expressão Gênica/efeitos dos fármacos , Humanos , Masculino , Camundongos , Análise em Microsséries , Dados de Sequência Molecular , Contração Muscular/efeitos dos fármacos , Orquiectomia , Ratos , Ratos Sprague-Dawley , Proteínas Repressoras/genética , Proteínas Repressoras/metabolismo
14.
J Biol Chem ; 284(52): 36367-36376, 2009 Dec 25.
Artigo em Inglês | MEDLINE | ID: mdl-19846549

RESUMO

Androgen replacement therapy is a promising strategy for the treatment of frailty; however, androgens pose risks for unwanted effects including virilization and hypertrophy of reproductive organs. Selective Androgen Receptor Modulators (SARMs) retain the anabolic properties of androgens in bone and muscle while having reduced effects in other tissues. We describe two structurally similar 4-aza-steroidal androgen receptor (AR) ligands, Cl-4AS-1, a full agonist, and TFM-4AS-1, which is a SARM. TFM-4AS-1 is a potent AR ligand (IC(50), 38 nm) that partially activates an AR-dependent MMTV promoter (55% of maximal response) while antagonizing the N-terminal/C-terminal interaction within AR that is required for full receptor activation. Microarray analyses of MDA-MB-453 cells show that whereas Cl-4AS-1 behaves like 5alpha-dihydrotestosterone (DHT), TFM-4AS-1 acts as a gene-selective agonist, inducing some genes as effectively as DHT and others to a lesser extent or not at all. This gene-selective agonism manifests as tissue-selectivity: in ovariectomized rats, Cl-4AS-1 mimics DHT while TFM-4AS-1 promotes the accrual of bone and muscle mass while having reduced effects on reproductive organs and sebaceous glands. Moreover, TFM-4AS-1 does not promote prostate growth and antagonizes DHT in seminal vesicles. To confirm that the biochemical properties of TFM-4AS-1 confer tissue selectivity, we identified a structurally unrelated compound, FTBU-1, with partial agonist activity coupled with antagonism of the N-terminal/C-terminal interaction and found that it also behaves as a SARM. TFM-4AS-1 and FTBU-1 represent two new classes of SARMs and will allow for comparative studies aimed at understanding the biophysical and physiological basis of tissue-selective effects of nuclear receptor ligands.


Assuntos
Anabolizantes/farmacocinética , Androgênios , Congêneres da Testosterona/farmacologia , Anabolizantes/química , Animais , Antígenos Virais de Tumores/metabolismo , Masculino , Regiões Promotoras Genéticas , Próstata/crescimento & desenvolvimento , Próstata/metabolismo , Ratos , Ratos Sprague-Dawley , Receptores Androgênicos/metabolismo , Congêneres da Testosterona/química , Proteínas do Core Viral/metabolismo
15.
J Med Chem ; 52(15): 4578-81, 2009 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-19606870

RESUMO

A novel series of 16-substituted-4-azasteroids has been identified as potential tissue-selective androgen receptor modulators. These ligands display potent hAR binding and agonist activity, low virilizing potential, and good pharmacokinetic profiles in dogs. On the basis of its in vitro profile, 21 was evaluated in the OVX and ORX rat models and exhibited an osteoanabolic, tissue-selective profile.


Assuntos
Azasteroides/síntese química , Receptores Androgênicos/efeitos dos fármacos , Androgênios , Animais , Azasteroides/farmacologia , Cães , Desenho de Fármacos , Canal de Potássio ERG1 , Canais de Potássio Éter-A-Go-Go/metabolismo , Feminino , Humanos , Masculino , Especificidade de Órgãos , Ratos , Ratos Sprague-Dawley , Relação Estrutura-Atividade
16.
J Adv Nurs ; 54(6): 676-82, 2006 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-16796659

RESUMO

AIM: This paper reports an investigation of the effectiveness of nutritional counselling as an intervention to improve health outcomes for HIV-positive patients in Ghana, West Africa. BACKGROUND: In Ghana, like many developing countries, more patients with HIV and AIDS die because of their poor nutritional status than from the disease itself. With the lack of highly active anti-retroviral therapy for most HIV-infected patients in developing countries, nutritional counselling about high protein diet can be an essential intervention to reduce weight loss and improve weight gain and survival outcomes. METHOD: We used secondary-analytic data collected in summer 2003. Recorded monthly weights of HIV-positive patients were obtained and analysed for 25 people, whose ages ranged from 21 to 60 years, with a mean of 39.4 years (sd = 10.13). RESULTS: HIV-positive patients responded favourably to nutritional counselling about protein dietary intake as an intervention to improve weight gain. Repeated measures showed a statistically significant weight gain (P = 0.008). CONCLUSION: In the absence of anti-retroviral therapy, high protein nutrition can be an effective intervention for HIV-positive patients in developing countries. The health and nutritional status of the patients can be improved through nutritious food, allowing them to lead longer and better quality lives.


Assuntos
Aconselhamento/métodos , Proteínas Alimentares/administração & dosagem , Soropositividade para HIV/reabilitação , Adulto , Atitude Frente a Saúde , Serviços de Dietética/métodos , Feminino , Gana/epidemiologia , Soropositividade para HIV/epidemiologia , Educação em Saúde/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação Nutricional , Aumento de Peso
17.
J Surg Res ; 133(1): 55-60, 2006 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-16631198

RESUMO

BACKGROUND: Impedance cardiography (ICG) technology has improved dramatically, and at least one device now can give a measurement of fluid status by using thoracic fluid content (TFC), along with cardiac output (CO) and cardiac index (CI). With a built-in sphygmomanometer cuff, it can also provide blood pressure (BP) and systemic vascular resistance index (SVRI). A currently available small portable ICG that provides reliable measures of fluid status could be an ideal noninvasive monitor for hemodialysis (HD), with the potential of helping avoid significant hemodynamic instability during HD. METHODS: A case series of patients with chronic renal failure was studied while undergoing HD using ICG (BioZ, CardioDynamics, Int. Corp., San Diego, CA). Parameters recorded at 15-min intervals included TFC, CI, BP (systolic, diastolic, and mean arterial), SVRI, and heart rate. Using the Pearson method, the percentage changes in each of the parameters during the HD session were correlated to the amount of fluid removed (FR), normalized to body weight. RESULTS: Forty-one patients were enrolled, but six patients were excluded due to incomplete data; therefore, 35 patients (13 men and 22 women) formed the basis of the analysis. The age range was 28 to 87 (mean 55.1 +/- 16.1) years. The amount of FR was 2.88 +/- 1.13 L (37.3 +/- 14.6 ml/kg). TFC decreased in all patients during the HD session (average reduction 12.7 +/- 8 kohms(-1)); whereas all other hemodynamic parameters showed both increases and decreases. The correlation of change in TFC with FR was moderate (r = 0.579, P = 0.0003); other hemodynamic parameters showed a poor correlation with FR. Neither the standard hemodynamic parameters nor the ICG device's special parameters were able to identify the five patients in this series who experienced significant hemodynamic instability or intradialytic hypotension. CONCLUSION: TFC, measured easily and noninvasively using ICG, correlates with the amount of fluid removed during HD. In comparison with the other hemodynamic parameters measured, TFC changed most consistently with fluid removal. Whether or not serial TFC measurements in a given patient at different HD sessions can guide the extent of FR will require additional study. This compact, easily operated, and nonobtrusive ICG device with the capability for continuously providing the standard hemodynamic parameters plus CO, TFC, and standard limb lead electrocardiography could replace current monitoring systems.


Assuntos
Cardiografia de Impedância , Monitorização Fisiológica/métodos , Diálise Renal/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Pressão Sanguínea/fisiologia , Líquidos Corporais/fisiologia , Débito Cardíaco/fisiologia , Feminino , Frequência Cardíaca/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Resistência Vascular/fisiologia
19.
Ethn Dis ; 15(4): 562-7, 2005.
Artigo em Inglês | MEDLINE | ID: mdl-16259477

RESUMO

PURPOSE: Although the prevalence of diabetes among various racial/ethnic groups has been well studied, little is known about the racial/ ethnic differences in Hemoglobin A1c (HbA1c) in diagnosed and undiagnosed diabetes. HbA1c correlates with morbidity and mortality in diabetes. Knowledge of the racial/ethnic differences in HbA1c would impact screening and intervention in primary care settings. This study describes racial/ethnic differences in HbA1c among US Black, Hispanic, and White diagnosed and undiagnosed persons with diabetes. METHODS: This study included participants in the 1999-2000 National Health and Nutrition Examination Survey who were > or =20 years old with a HbA1c measurement. The association between HbA1c and race in diagnosed and undiagnosed persons with diabetes (with body mass index [BMI] and age as covariates) was determined. The distribution of HbA1c and mean HbA1c in diagnosed and undiagnosed diabetes and the rates of diagnosed and undiagnosed diabetes with their corresponding HbA1c levels are described by race/ethnicity. RESULTS: Estimated diabetes prevalence in US persons > or =20 years is 8.2%, with 2.3% having undiagnosed diabetes. Whites with diabetes had lower mean HbA1c levels (7.6%, standard error [SEI 0.2) than Blacks (8.1%, SE 0.3) or Hispanics (8.2%, SE .3). Whites with diagnosed diabetes were less likely to have HbA1c> or =11% (1.7%) than Blacks (11.1%) or Hispanics (10.4%). Hispanics with undiagnosed diabetes were more likely to have HbA1c-7% (60.5%) than Blacks (39.3%) or Whites (37.8%). CONCLUSIONS: Significant numbers of persons with diabetes are undiagnosed. There are significant racial/ethnic differences in HbA1c levels, which are significantly higher in Blacks and Hispanics. Comprehensive risk-based screening and intervention for diabetes is needed in order to address racial and ethnic disparities, especially in minorities.


Assuntos
População Negra , Diabetes Mellitus/sangue , Hemoglobinas Glicadas/metabolismo , Hispânico ou Latino , População Branca , Análise de Variância , Biomarcadores/sangue , Glicemia/metabolismo , Índice de Massa Corporal , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/etnologia , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Prevalência , Estados Unidos/epidemiologia
20.
World J Surg ; 29 Suppl 1: S95-8, 2005.
Artigo em Inglês | MEDLINE | ID: mdl-15815820

RESUMO

Clinical parameters alone have repeatedly been proven unreliable in assessing cardiopulmonary status, especially in hemodynamically unstable patients. To learn if we had a diagnostic problem in our hospital, we compared physician assessment of cardiac index (CI) and thoracic fluid content (TFC) to values obtained using impedance cardiography (ICG). We selected the newest available ICG monitor, the BioZ, which employs this noninvasive technology. For CI measurements we have shown it to be equivalent to thermodilution and to be more reproducible (variability: 6.3% vs. 24.7%). Physician assessment of CI and TFC (high, normal, or low) was compared to the BioZ monitor's results in 186 patients, considered to be hemodynamically unstable, from the emergency room, the intensive care units, and the floors. Normal values were defined for CI (2.5-4.2 L/min m(2)) and for TFC (males: 30-50 kohm(-1) and females: 21-37 kohm(-1)). The concordance between physician assessment and the BioZ was 51% for CI with Kappa of 0.14 and 58% for TFC with Kappa of 0.19. Attendings did slightly better than the surgical residents with CI (52% vs. 48%) but slightly worse with TFC (57% vs. 61%). The potentially serious conditions of low CI and high TFC were misdiagnosed 42% and 46% of the time, respectively, by all physicians. Analysis of the data revealed that physician use of clinically available objective hemodynamic data, such as heart rate, blood pressure, and pulse pressure index, would not have been helpful. Furthermore, assistance from the pulmonary artery catheter (PAC) is often not available in our hospital, which has experienced a 90% decrease in its utilization over the past six years. Considering the increasing acuity of our aging patient population, accurate assessment of cardiopulmonary status is needed. The use of ICG could be a valuable addition to the physician's armamentarium.


Assuntos
Débito Cardíaco , Doenças Cardiovasculares/diagnóstico , Hidrotórax/diagnóstico , Pneumopatias/diagnóstico , Adulto , Cardiografia de Impedância , Doenças Cardiovasculares/complicações , Cateterismo de Swan-Ganz , Competência Clínica , Feminino , Humanos , Hidrotórax/etiologia , Pneumopatias/complicações , Masculino , Corpo Clínico Hospitalar , Reprodutibilidade dos Testes
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