Mismanaging prescription medications among rural elders: the effects of socioeconomic status, health status, and medication profile indicators

PURPOSE

This study assessed the extent to which community-dwelling rural older adults mismanage their prescription medication regimens and predicted mismanagement of medications from selected socioeconomic, health status, and medication profile characteristics.

DESIGN AND METHODS

Personal interviews with 499 community-dwelling adults aged 66 and over taking at least one prescription medication and living in a rural region of the Southeast. With approximately equal numbers of African American and white men and women, the SUDAAN multiple logistic regression procedure was used to predict the mismanagement of prescription medications.

RESULTS

The mismanagement of prescribed medication regimens is relatively common among older adults. Those more likely than others to mismanage their regimens are African American, younger, in poorer mental health, with more acute care physician visits, and those who find payment for their medications to be problematic.

IMPLICATIONS

The implications of the findings for what is known about the self-modification of drug regimens, targeting prescription drug cost benefits or interventions, and the limitations of the study are discussed.

Estimating energy expenditure by heart-rate monitoring without individual calibration

Heart rate monitoring has been shown to be a valid method for measuring free-living energy expenditure at the group level, but its use in large-scale studies is limited by the need for an individual calibration of the relationship between heart rate and energy expenditure.

PURPOSE

To determine whether energy expenditure can be estimated from heart rate monitoring without individual calibration in epidemiological studies.

METHODS

Our previously validated heart rate monitoring method relies on measuring individual calibration parameters obtained from resting energy expenditure and the regression line between energy expenditure and heart rate during exercise. We developed prediction equations for these parameters using easily measured variables in a population-based study of 789 individuals. The predictive ability of these parameters was tested in a separate population-based sample (N = 97).

RESULTS

Physical activity level (PAL = total energy expenditure/basal metabolic rate) using the four estimated parameters was correlated with PAL using the measured parameters (r = 0.82, P < 0.01). Comparison of measured and estimated PAL showed that 97.9% of the scores were placed in the same or adjacent quartile.

CONCLUSION

A combination of simple measurements and heart rate monitoring produces estimates of energy expenditure that are highly correlated with those obtained using full individual calibration. This simplification of the heart rate monitoring method could extend its use in ranking individuals in epidemiological studies.

Qualitative methodologies and community participation in examining reproductive experiences: the Harlem Birth Right Project

OBJECTIVES

Racial disparities in health present a challenge to public health because of the complexity of interacting social forces. The Harlem Birth Right Project sought to improve understanding of these forces by using qualitative and community participatory methods. In this paper we 1) describe the process of qualitative inquiry and community involvement, 2) evaluate the impact of community participation, and 3) present a brief summary of the findings on social context as it relates to pregnancy outcomes of women in Harlem.

METHODS

We operationalized the qualitative method by combining participant observation, longitudinal case studies, and focus groups. An ethnographic survey was used to verify and triangulate findings across methods of data collection. We involved the community in the design, implementation, and analysis by collaborating with community-based organizations, setting up a community advisory board, and the use of dialogue groups and community meetings.

RESULTS

The use of qualitative methods and community partnership uncovered important aspects of the social context of women's lives that may not have emerged through traditional epidemiologic research. We found that pregnancy may serve as a catalyst to increase perception of the magnitude of preexisting social stressors. Several stressors and chronic strains associated with structural forces were identified. For example, the high percentage of households headed by women is seen as one consequence of larger structural forces. While social support networks serve as an important coping mechanism to buffer against the stress caused by these structural forces, the types of support women seek differs by social strata, and some strategies were identified as being substantially more effective than others.

CONCLUSIONS

Qualitative and community participatory research can be successfully conducted to support public health goals and can derive important new information on the social context of women's lives.

Creating a Comprehensive System of Community Services for People with Dementia

Through a literature review, this article aims to identify the needs of those people with dementia who wish to remain at home, and those of their carers. It goes on to model a range of services that can be linked together to meet these needs comprehensively.

Midrapidity antiproton-to-proton ratio from Au+Au collisions at sqrt [s(NN)]=130 GeV

We report results on the ratio of midrapidity antiproton-to-proton yields in Au+Au collisions at sqrt[s(NN)] = 130 GeV per nucleon pair as measured by the STAR experiment at RHIC. Within the rapidity and transverse momentum range of /y/<0.5 and 0.4<p(t)<1.0 GeV/c, the ratio is essentially independent of either transverse momentum or rapidity, with an average of 0.65+/-0.01((stat))+/-0.07((syst)) for minimum bias collisions. Within errors, no strong centrality dependence is observed. The results indicate that at this RHIC energy, although the p-p pair production becomes important at midrapidity, a significant excess of baryons over antibaryons is still present.

A model of visual-spatial memory across saccades

This paper describes a neural network model that directs saccades back to targets after they disappear and other saccades intervene. This is a simple example of knowing where something is after it is no longer visible and the observer has moved. These tasks require a short-term memory that can store continuous values of spatial location. The model was generated by training a neural network with a recurrently connected hidden layer to specify memory-guided saccades. The trained network maintains stored locations accurately for a few seconds. It uses a leaky integrator mechanism in which there is a slow decay of the stored value to a small number of fixed point attractors. Similar mechanisms have been used to model oculomotor integration (Cannon, S., Robinson, D., & Shamma, S. (1983). A proposed neural network for the integrator of the oculomotor system. Biological Cybernetics, 49, 127-136; Seung, H. (1998). Continuous attractors and oculomotor control. Neural Networks, 11, 1253-1258). The mechanism is robust to parameters such as the input and output format and the constraints in training. However, the receptive field properties of the hidden units do depend on these parameters. It was possible to find biologically plausible parameters that produced hidden unit behavior similar to that of real neurons involved in saccade memory. In particular, training the model to simultaneously represent the target location in both eye- and head-based reference frames produces units similar to neurons in parietal saccade areas.

Polarization measurements in high-energy deuteron photodisintegration

We present measurements of the recoil proton polarization for the d(gamma-->,p-->)n reaction at straight theta(c.m.) = 90 degrees for photon energies up to 2.4 GeV. These are the first data in this reaction for polarization transfer with circularly polarized photons. The induced polarization p(y) vanishes above 1 GeV, contrary to meson-baryon model expectations, in which resonances lead to large polarizations. However, the polarization transfer Cx does not vanish above 1 GeV, inconsistent with hadron helicity conservation. Thus, we show that the scaling behavior observed in the d(gamma,p)n cross sections is not a result of perturbative QCD. These data should provide important tests of new nonperturbative calculations in the intermediate energy regime.

Two- and three-dimensional TEE differentiation of lymphoma involving the atrial septum from lipomatous hypertrophy

In this case report we present two-dimensional (2-D) and three-dimensional (3-D) transesophageal echocardiographic (TEE) findings of a patient with lipomatous atrial septal hypertrophy and a patient with Hodgkin's lymphoma with atrial septal involvement. The echocardiographic characteristics that differentiate these two lesions are discussed.

Pathways mediating sexual abuse and eating disturbance in children

OBJECTIVE

To examine the relationship between childhood maltreatment and eating disorders in a sample of children.

METHOD

Twenty 10-15-year-old female children who were receiving treatment following reported childhood sexual abuse and 20 age-matched controls were compared on a series of measures assessing eating disorder behaviors, body image concerns, substance use, mood, impulsive behavior, and self-concept.

RESULTS

Sexually abused children reported higher levels of eating disorder behaviors, impulsive behaviors, and drug abuse than controls. Furthermore, behavioral impulsivity provided the strongest mediational effect between a history of childhood sexual abuse and purging and restrictive dieting behavior. Drug use proved to be a significant secondary mediator of the childhood sexual abuse eating disorder behavior association.

DISCUSSION

These data support the hypothesis that childhood sexual abuse is related to disordered eating in children, and extend similar findings that have been previously reported with adults. Behavioral impulsivity and drug use appear to be significant mechanisms that influence eating disorder behavior following childhood sexual abuse.

A randomized trial of nelfinavir, ritonavir, or delavirdine in combination with saquinavir-SGC and stavudine in treatment-experienced HIV-1-infected patients

PURPOSE

To evaluate the 24-week impact of saquinavir-enhancing antiretroviral therapy on viral replication in patients previously treated with nucleoside analogues with or without prior saquinavir hard-gel capsules (HGC).

METHOD

Patients were randomized in three groups to receive the following: Group 1-nelfinavir (750 mg tid), saquinavir soft-gel capsule (SGC) (800 mg tid), and stavudine (40 mg bid); Group II-ritonavir (400 mg bid), saquinavir-SGC (400 mg bid), and stavudine (40 mg bid); or Group III-delavirdine (400 mg tid), saquinavir-SGC (800 mg tid), and stavudine (40 mg bid). Viral loads, CD4 count, and safety were assessed over a 24-week period with an additional 6-month follow-up.

RESULTS

73 patients received randomized therapy; 14 of whom were SQV naïve, with a median baseline viral load of 3.6 log(10) and a CD4 count of 370 cells/mm(3). By 6 months, the median decreases in plasma viral loads were 0.26, 0.71, and 0.29 log(10) copies/mL for groups I, II, and III, respectively. The median increases in CD4 counts, for groups I, II, and III, were 52, 40, and 69 cells/mm(3) at 6 months, respectively. Changes in viral load and CD4 counts at 6 months and 1 year were not significantly different between the treatment groups. More patients discontinued therapy in the ritonavir arm (35%) for drug intolerance or toxicity compared to either the nelfinavir or delavirdine arms (15% and 5%, respectively). In a multivariate analysis, baseline viral load, younger age, and baseline saquinavir resistance were significantly associated with detectable viral load at 24 weeks.

CONCLUSION

The use of antiretroviral agents that pharmacokinetically boost saquinavir levels has a modest benefit in saquinavir-experienced patients.

Measurement of the charged pion electromagnetic form factor

Separated longitudinal and transverse structure functions for the reaction 1H(e,e(')pi(+))n were measured in the momentum transfer region Q2 = 0.6--1.6 (GeV/c)(2) at a value of the invariant mass W = 1.95 GeV. New values for the pion charge form factor were extracted from the longitudinal cross section by using a recently developed Regge model. The results indicate that the pion form factor in this region is larger than previously assumed and is consistent with a monopole parametrization fitted to very low Q2 elastic data.

Elliptic flow in Au+Au collisions at square root(S)NN = 130 GeV

Elliptic flow from nuclear collisions is a hadronic observable sensitive to the early stages of system evolution. We report first results on elliptic flow of charged particles at midrapidity in Au+Au collisions at square root(S)NN = 130 GeV using the STAR Time Projection Chamber at the Relativistic Heavy Ion Collider. The elliptic flow signal, v2, averaged over transverse momentum, reaches values of about 6% for relatively peripheral collisions and decreases for the more central collisions. This can be interpreted as the observation of a higher degree of thermalization than at lower collision energies. Pseudorapidity and transverse momentum dependence of elliptic flow are also presented.

The association of race/ethnicity, socioeconomic status, and physician recommendation for mammography: who gets the message about breast cancer screening?

OBJECTIVES

This study investigated the association between physician recommendation for mammography and race/ethnicity, socioeconomic status, and other characteristics in a rural population.

METHODS

In 1993 through 1994, we surveyed 1933 Black women and White women 52 years and older in 10 rural counties.

RESULTS

Fifty-three percent of the women reported a physician recommendation in the past year. White women reported recommendations significantly more often than did Black women (55% vs 45%; odds ratio = 1.49). Controlling for educational attainment and income eliminated the apparent racial/ethnic difference. After control for 5 personal, 4 health, and 3 access characteristics, recommendation for mammography was found to be more frequent among women who had access to the health care system (i.e., had a regular physician and health insurance). Recommendation was less frequent among women who were vulnerable (i.e., were older, had lower educational attainment, had lower annual family income).

CONCLUSIONS

Socioeconomic status, age, and other characteristics--but not race/ethnicity--were related to reports of a physician recommendation, a precursor strongly associated with mammography use. Efforts to increase physician recommendation should include complementary efforts to help women address socioeconomic and other barriers to mammography use.

Clearance of barium from the oesophagus with diet cola and metoclopramide: a one stop approach to patients with dysphagia

AIM

To establish a "one-stop" dysphagia service in which a consultation, barium swallow and endoscopy can all be performed in the same hospital visit.

MATERIALS AND METHODS

In order to allow both barium swallow examination and endoscopy to be performed on the same day, a novel technique for clearing barium from the upper gastrointestinal tract was established. Following the barium swallow examination, patients were given diet cola and metoclopramide syrup. If appropriate, an upper gastrointestinal endoscopy was then performed shortly afterwards. The service was piloted for 6 months in which time 25 patients were investigated in this way.

RESULTS

All patients were seen within 2 weeks of referral. The mean time between barium swallow and endoscopy was 3 h 38 min (range, 1 h 50 min to 5 h 20 min). In all 24 patients in whom an endoscopy was performed, barium had been satisfactorily cleared from the oesophagus and stomach.

CONCLUSION

This technique allows both barium swallow and upper gastrointestinal endoscopy to be performed on the same day, providing a rapid, safe and accurate diagnosis with minimum patient inconvenience. Mitchell, J., (2001). Clinical Radiology56, 64-66

Architectural support for copy and tamper resistant software

Although there have been attempts to develop code transformations that yield tamper-resistant software, no reliable software-only methods are know. This paper studies the hardware implementation of a form of execute-only memory (XOM) that allows instructions stored in memory to be executed but not otherwise manipulated. To support XOM code we use a machine that supports internal compartments---a process in one compartment cannot read data from another compartment. All data that leaves the machine is encrypted, since we assume external memory is not secure. The design of this machine poses some interesting trade-offs between security, efficiency, and flexibility. We explore some of the potential security issues as one pushes the machine to become more efficient and flexible. Although security carries a performance penalty, our analysis indicates that it is possible to create a normal multi-tasking machine where nearly all applications can be run in XOM mode. While a virtual XOM machine is possible, the underlying hardware needs to support a unique private key, private memory, and traps on cache misses. For efficient operation, hardware assist to provide fast symmetric ciphers is also required.

Architectural support for copy and tamper resistant software

Although there have been attempts to develop code transformations that yield tamper-resistant software, no reliable software-only methods are known. This paper studies the hardware implementation of a form of execute-only memory (XOM) that allows instructions stored in memory to be executed but not otherwise manipulated. To support XOM code we use a machine that supports internal compartments---a process in one compartment cannot read data from another compartment. All data that leaves the machine is encrypted, since we assume external memory is not secure. The design of this machine poses some interesting trade-offs between security, efficiency, and flexibility. We explore some of the potential security issues as one pushes the machine to become more efficient and flexible. Although security carries a performance penalty, our analysis indicates that it is possible to create a normal multi-tasking machine where nearly all applications can be run in XOM mode. While a virtual XOM machine is possible, the underlying hardware needs to support a unique private key, private memory, and traps on cache misses. For efficient operation, hardware assist to provide fast symmetric ciphers is also required.

Teleradiology at the tertiary-level Women's and Children's Hospital in South Australia

This article relates to a teleradiology trial undertaken in 1998-1999 at the Women's and Children's Hospital (WCH) in Adelaide, the capital of South Australia. The trial involved linking the hospital to a range of rural and remote sites in South Australia and the Northern Territory. The main aim of the project was to evaluate the advantages, limitations, benefits, and costs of a teleradiology service provided by WCH. The major finding from the study is that for a tertiary hospital providing second opinions in complex medical cases, a new form of business justification is required for teleradiology. The justification would include an emphasis on the range of high-level services that a subspecialist hospital such as the WCH can provide. The justification would also include the range of benefits to different parties, particularly the patient, and the intangible nature of many of the benefits.

An evaluation of satisfaction with telemedicine among health-care professionals

A survey was conducted among non-doctor health-care professionals in six rural counties in Missouri. The purpose of the survey was to establish baseline data to evaluate the effect of changes in the health-care sector, especially technology changes, on the job satisfaction, career satisfaction, relationships and communication activities of health professionals. The survey included three rural counties in which integrated telecommunication and interactive video telemedicine services were being installed, but before significant activities had begun, and three comparator counties without substantial integrated telecommunications infrastructure and telemedicine services. During a one-month study period, 1108 questionnaires were distributed. The total response rate was 50.1% (n = 555). Of the respondents, 30.3% indicated that technology in health-care was having a large effect on their work, although only 18.2% indicated that telemedicine and telecommunications were having a large effect. No systematic differences were found among the health professionals in the two communities at the time telemedicine equipment was being installed.

The incidence and dimensions of the retroarticular canal of the atlas vertebra

The retroarticular canal has been implicated in compression of the vertebral artery, where it passes over the posterior arch of the atlas vertebra, during extreme rotational movements of the head and neck. The incidence of this retroarticular canal is not known in the South African population. The aim of the present study was to record the incidence and the dimensions of the retroarticular canal in South African white and black adults, aged 20-80 years. In a total of 1,354 atlas vertebrae, 9.8% of sides (264 left and/or right sides) were classified as having complete retroarticular canals, of which 11.7% (31 sides) were right-only, 24.6% (65 sides) left-only and 31.8% (84 left plus right sides) bilateral canals. This incidence did not increase with age and was lower in whites than blacks, with white males having the lowest and white and black females alike having the highest incidence of the canal. Measurements of the retroarticular canal showed that there was no difference between left and right sides. However, the superoinferior diameter was significantly less than the anteroposterior diameter, in all but the right canals in the white female subgroup. This difference in the dimensions of the retroarticular canal will decrease the cross-sectional area of the space available for the vertebral artery passing through it and may compromise blood flow in the vessel.

An evaluation of a network for professional development in child and adolescent mental health in rural and remote communities

In 1998 a telemedicine network was established in South Australia and the Northern Territory to deliver educational material to professionals working in child and adolescent mental health in remote areas. The network involved a wide range of health professions, from psychiatrists to psychologists and social workers. The first 12 months of network activity were evaluated by quantitative and qualitative techniques. Four sources of data were used: an activity log, questionnaires, interviews and action research. A total of 36 telemedicine sessions were held, ranging in duration from 45 to 90 min (average 56 min) and involving a total of 45 different professionals, who participated an average of four times each (range 1-15). The most common types of session were case discussions (47%), followed by specialist seminars (36%) and administrative and introductory sessions (17%). The benefits of the network included: networking and peer support; improved efficiency and reduced travel costs; and improved efficiency of health services. The problems included: costs; lack of access to technical support; and the need for staff induction and training.

Dissociation of G-protein alpha from rhabdomeric membranes decreases its interaction with rhodopsin and increases its degradation by calpain

Photoactivation of invertebrate rhodopsin activates a GTP-binding protein, Gq, which in turn activates a phospholipase C (PLC) enzyme. Gqalpha is a membrane-associated protein that is progressively released from the membrane by washing with buffers containing increasing concentrations of beta-mercaptoethanol (beta-ME). Isolated, soluble Gqalpha showed a decreased ability to be activated by rhodopsin but was more active in stimulating PLC when compared with the membrane-associated form of Gqalpha. The calcium-activated protease, calpain, selectively cleaved the soluble but not the membrane-bound form of Gqalpha. Calpain cleaved a small peptide from the amino-terminus of Gqalpha reducing the ability of the G-protein to bind GTP. The uncoupling of Gqalpha from rhodopsin and subsequent calcium-dependent proteolysis to further inactivate the G-protein may therefore be a regulatory mechanism of light adaptation in rhabdomeric photoreceptors.