Demography and spatial distribution of a threatened species from the Atlantic Forest in southern Brazil: differences between urban and rural remnants

Logging and agricultural exploitation have led to the degradation of Araucaria Forest remnants and the alteration of its last preserved patches. This forest typology contains many endangered plant species, as is the case of the tree Oreopanax fulvus Marchal. To support conservation of this species and understand how different landscape matrices can influence its populations, we evaluated the demographic structure and spatial distribution of O. fulvus in two Araucaria Forest remnants in Paraná state. We delimited two plots (urban and rural population), each with 1 ha, subdivided them into 100 subplots (10 x 10 m), and recorded diameter at ground level (DGL), height, and coordinates of two post-germinative developmental stage of individuals. In each subplot, we measured slope, luminosity, and canopy height. We used Ripley's K function analysis to describe distribution patterns of the species and the spatial relationship between mature and juvenile trees. We performed correlations between abundance and environmental and structural variables of the O. fulvus populations. Abundance varied between remnants, from 183 individuals/ha (12 mature and 171 juvenile) to 1306 individuals/ha (10 and 1296). The remnants varied in abundance and plant frequency. The species showed an investment in seedling banks. Most juvenile had DGL up to 3.0 cm and height up to 1.0 m and presented aggregated spatial distribution, while adults had random distribution. In the rural population juvenile abundance were correlated with canopy height (positively) and distance to mature trees (negatively). The slope was correlated for both sites, but oppositely, indicating that other factors might have interfered in the regeneration abundance. The urban remnant showed a high abundance of this endangered species, calling attention for potential studies in urban arborization, management and conservation of these remnants.

A Gut Feeling: Isolated Small Bowel Angioedema due to Angiotensin-Converting Enzyme Inhibitor

Isolated angioedema of the small intestine is a rare adverse event in patients taking angiotensin-converting enzyme inhibitors. Here, we present a case of visceral angioedema in a 32-year-old woman who presented with left upper quadrant pain, nausea, vomiting, diarrhea, and characteristic radiographic signs of small bowel angio-edema, six months after starting lisinopril. Her symptoms improved within 48 hours of withholding the offending agent and with supportive care. We discuss the epidemiology, pathophysiology, diagnosis, and management of angiotensin-converting enzyme inhibitor- induced angioedema.

Predicting mortality in traumatic intracranial hemorrhage

OBJECTIVE

Traumatic intracranial hemorrhage (tICH) is a significant source of morbidity and mortality in trauma patients. While prognostic models for tICH outcomes may assist in alerting clinicians to high-risk patients, previously developed models face limitations, including low accuracy, poor generalizability, and the use of more prognostic variables than is practical. This study aimed to construct a simpler and more accurate method of risk stratification for all tICH patients.

METHODS

The authors retrospectively identified a consecutive series of 4110 patients admitted to their institution's level 1 trauma center between 2003 and 2013. For each admission, they collected the patient's sex, age, systolic blood pressure, blood alcohol concentration, antiplatelet/anticoagulant use, Glasgow Coma Scale (GCS) score, Injury Severity Score, presence of epidural hemorrhage, presence of subdural hemorrhage, presence of subarachnoid hemorrhage, and presence of intraparenchymal hemorrhage. The final study population comprised 3564 patients following exclusion of records with missing data. The dependent variable under study was patient death. A k-fold cross-validation was carried out with the best models selected via the Akaike Information Criterion. These models risk stratified the study partitions into grade I (< 1% predicted mortality), grade II (1%-10% predicted mortality), grade III (10%-40% predicted mortality), or grade IV (> 40% predicted mortality) tICH. Predicted mortalities were compared with actual mortalities within grades to assess calibration. Concordance was also evaluated. A final model was constructed using the entire data set. Subgroup analysis was conducted for each hemorrhage type.

RESULTS

Cross-validation demonstrated good calibration (p < 0.001 for all grades) with a mean concordance of 0.881 (95% CI 0.865-0.898). In the authors' final model, older age, lower blood alcohol concentration, antiplatelet/anticoagulant use, lower GCS score, and higher Injury Severity Score were all associated with greater mortality. Subgroup analysis showed successful stratification for subarachnoid, intraparenchymal, grade II-IV subdural, and grade I epidural hemorrhages.

CONCLUSIONS

The authors developed a risk stratification model for tICH of any GCS score with concordance comparable to prior models and excellent calibration. These findings are applicable to multiple hemorrhage subtypes and can assist in identifying low-risk patients for more efficient resource allocation, facilitate family conversations regarding goals of care, and stratify patients for research purposes. Future work will include testing of more variables, validation of this model across institutions, as well as creation of a simplified model whose outputs can be calculated mentally.

Customer satisfaction and consumer responsibility: toward an alternative model of medical service quality

In the increasingly competitive environment of medical services and patient care, physicians feel a strong pressure for increasing efforts to improve patient satisfaction with the goal of creating a loyal patient base. These steps to promote patient satisfaction have typically involved developing new programs and services, as medical offices seek to attract and keep their patients by continually enhancing service features. While patient satisfaction is a worthy goal, this paper argues that we often make mistakes and incur expensive costs in pursuing satisfaction as an end unto itself. This paper proposes an alternative model, based on creating a doctor-patient therapeutic alliance which has the dual benefits of enhancing patient satisfaction while improving the critical personal relationship between doctors and their patients, so necessary for the delivery of optimal care.

Effect of cyclooxygenase-2 inhibition on renal function in elderly persons receiving a low-salt diet. A randomized, controlled trial

BACKGROUND

Most nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit both cyclooxygenase-1 (COX-1), whose inhibition is associated with gastrointestinal ulceration, and COX-2, whose inhibition is associated with therapeutic benefits. Although agents that do not produce COX-1 activity may have fewer adverse effects, targeted disruption of the COX-2 allele in mice has resulted in severe renal problems, suggesting that COX-2 inhibition may also produce adverse effects.

OBJECTIVE

To determine the effect of rofecoxib, a member of the coxib class of drugs and a specific inhibitor of the COX-2 enzyme, on renal function in elderly patients.

DESIGN

A randomized, three-period, single-dose crossover study and a randomized, parallel-group, multiple-dose study.

SETTING

Clinical research units.

PATIENTS

75 patients 60 to 80 years of age.

INTERVENTION

In the first study, single doses of rofecoxib, 250 mg (about 5-fold to 20-fold the recommended dose); indomethacin, 75 mg; and placebo were administered to 15 patients. In the second study, multiple doses of rofecoxib, 12.5 or 25 mg/d; indomethacin, 50 mg three times daily; or placebo were administered to 60 patients. Patients in both studies received a low-sodium diet

MEASUREMENTS

Glomerular filtration rate, creatinine clearance, and urinary and serum sodium and potassium values.

RESULTS

Compared with placebo, single doses of rofecoxib and indomethacin decreased the glomerular filtration rate by 0.23 m/s (P < 0.001) and 0.18 mL/s (P = 0.003), respectively. In contrast, respective decreases of 0.14, 0.13, and 0.10 mL/s were observed after multiple doses of rofecoxib, 12.5 mg/d (P = 0.019); rofecoxib, 25 mg (P = 0.029), and indomethacin (P = 0.086) were administered. Changes in creatinine clearance and serum and urinary sodium and potassium were less pronounced.

CONCLUSIONS

The effects of COX-2 inhibition on renal function are similar to those observed with nonselective NSAIDs. Thus, COX-2 seems to play an important role in human renal function.

On the nature and properties of appeals used in direct-to-consumer advertising of prescription drugs

The past decade has seen a steady rise in expenditures for direct-to-consumer pharmaceutical advertising. While total revenues across all media are approaching the $1 billion dollar mark, surprisingly little is known about the effectiveness of these types of advertisements, including the appropriateness of various forms of emotional and informational appeal. A content analysis of direct-to-consumer advertising in 24 popular magazines shows that these advertisements are found in every category of magazine, the advertisements employ a mix of informational and emotional appeals, all types of emotional appeals are used, and to date, the type of appeal (emotional and/or informational) tends not to be based on the type of drug advertised. Implications of this content analysis are considered and directions for research on appeals used in direct-to-consumer advertising are suggested.

Materialism and credit card use by college students

Much has been written in the popular press on credit card use and spending patterns of American college students. The proliferation of credit cards and their ease of acquisition ensure that students today have more opportunities for making more credit purchases than any other generation of college students. Little is known about the relationship between students' attitudes towards materialism and their use of credit cards. A study was conducted at three college campuses in the northeastern part of the United States where a total of 1,022 students were surveyed. Students' attitudes toward use of credit and their credit card balances were evaluated relative to their scores on Richins and Dawson's Materialism Scale (1992). Our findings suggest no significant difference between those individuals scoring high versus low on the Materialism Scale in terms of the number of credit cards owned and the average balance owed. Individuals high on materialism, however, significantly differed in terms of their uses for credit cards and their general attitude toward their use.

Assessing the viability of situationally driven segmentation opportunities in the health care market

The impact of situational factors has typically been investigated in the context of goods marketing. Very few studies have investigated the influence of situational factors on services marketing. This study demonstrates the importance of situational influence on services marketing by delineating a consumer-based, situationally characterized competitive market structure for health care services. The competitive structure of the health care market is delineated in terms of the similarity/substitutability of the three-factor, situational characterizations of ten health care alternatives. The general marketing implications of the market-structure delineation procedure and the health care-specific implications of the findings are discussed.

The impact of pharmaceutical direct advertising: opportunities and obstructions

The recent dramatic increase in direct-to-consumer advertising of prescription drugs has important implications for the pharmaceutical industry, physicians, and patients. One goal of direct advertising is to increase patient awareness of specific brands of medications while hoping to promote a greater frequency in office visits, presumably to specifically request these medicines. This paper will examine some of the benefits as well as drawbacks of the new, direct-to-customer pharmaceutical advertising, suggesting that in an era increasingly defined by the demands of managed care, such direct advertising may prove to have limited long-term effects.

Guilt appeals in advertising: what are their effects?

This study examined consumers' emotional responses, their attitudes toward advertisements and brands, attributions about the companies promoting the brands, and purchase intention for ads varying on level of guilt appeal. Sixty working mothers, a prime target of guilt appeals, participated in the study. Results indicated that moderate guilt appeals elicited more felt guilt in the working mothers than did low or high guilt appeals. Furthermore, emotional responses, particularly anger, mediated the relationship between level of guilt appeal and consumers' attitudes and corporate attributions, and an inverse relationship occurred between level of guilt appeal and attitudes and attributions. Purchase intention was affected by the level of the guilt appeal and by anger.

Guilt appeals in advertising: what are their effects?

This study examined consumers' emotional responses, their attitudes toward advertisements and brands, attributions about the companies promoting the brands, and purchase intention for ads varying on level of guilt appeal. Sixty working mothers, a prime target of guilt appeals, participated in the study. Results indicated that moderate guilt appeals elicited more felt guilt in the working mothers than did low or high guilt appeals. Furthermore, emotional responses, particularly anger, mediated the relationship between level of guilt appeal and consumers' attitudes and corporate attributions, and an inverse relationship occurred between level of guilt appeal and attitudes and attributions. Purchase intention was affected by the level of the guilt appeal and by anger.

The impact of office characteristics on satisfaction with medical care: a "before and after" analysis

A great deal of research has examined the impact that tangible cues can play in influencing patients' satisfaction with their physician. Because most people are not able to assess the technical expertise of their doctor, they often rely on tangible "surrogates" as standards of assessment for what is essentially an intangible product. While the research to date has helped us better understand the nature of this problem, it has often been characterized by some important design flaws. This paper reports on the results of a recent study that assessed patient satisfaction with a physician through the tangible cue of physical (office) surroundings. We sampled two sets of patients: one set prior to the doctor's move to newer facilities and the other after the relocation. Our findings offer mixed support for the hypothesis that physical cues influence attitudes toward and satisfaction with the medical care we receive.

Note on guilt appeals in advertising: covariate effects of self-esteem and locus of control

A 1991 study by Pinto and Priest demonstrated the effectiveness of advertisements employing moderate levels of guilt in inducing guilt responses in subjects. Because individuals' responses to guilt are often influenced by their specific personality characteristics, researchers have pointed to the potential moderating effects of individual difference variables such as level of self-esteem and locus of control on individuals' susceptibility to guilt appeals. A study was conducted to evaluate the possibility that self-esteem and locus of control can act as covariates across three treatment levels of guilt advertising. From a sample of 57 working mothers, advertisements stimulating medium and high levels of guilt elicited significantly greater feelings of guilt in subjects than the control advertisement stimulating low guilt. However, the relationship between susceptibility to guilt appeals and self-esteem and locus of control was not observed to covary.

Guilt appeals in advertising: an exploratory study

A two-stage exploratory study was conducted to assess the effect of guilt as an advertising appeal. A sample of 46 working mothers were asked to respond to three advertisements for a microwavable dinner product in which the message intent was to create guilt (i.e., low, medium, and high). The advertisements were constructed following a content analysis of several popular women's magazines. A set of 18 adjectives covering both guilt- and nonguilt-related items was provided for each advertisement. The adjective sets had a five-point response range, with endpoints labeled “Not at All” to “Very.” A varimax factor analysis yielded a three-factor solution, including factors of guilt, anger, and happiness. An analysis of variance identified significant changes in subjects' perceived guilt, anger, and happiness across the three advertisements. Further, medium guilt appeals were more effective in inducing guilt in respondents than those either low or high in guilt. Finally, as the level of guilt represented in an advertisement increased, the subjects' anger also increased.

The impact of situational factors on health care preferences: exploring the prospect of situationally based segmentation

Health care marketing research has examined the relationship between health care utilization and (1) client demographic characteristics and (2) service characteristics. The impact of situational factors on health care utilization has received limited attention. The authors find that the influence of situational factors in the health care market is substantial and suggest some preliminary situational segmentation strategies.

The do-it-yourself health care consumer: preliminary identification and marketing implications

Although the presence of do-it-yourself (DIY) segments in some service-markets have long been taken for granted (e.g., home improvement and auto repair), the recent emergence of DIY segments in law, health, and other service-markets has been surprising to many observers. This paper examines the DIY segment in the health service market. The emergence of a DIY segment may be misconstrued by some service-marketers as being synonymous with lost clientele. This paper (1) explains some of the marketing implications of a DIY health services segment and (2) provides a brief profile of the DIY health services consumer. The paper concludes that the DIY segment represents new opportunity rather than lost clientele to service-marketers.

An exploration of the applicability of situational segmentation in the health care market: development of a situational taxonomy

Competition in the health care market has intensified in recent years. Health care providers are increasingly adopting innovative marketing techniques to secure their positions in the marketplace. This paper examines an innovative marketing technique, situational segmentation, and assesses its applicability to the health care market. Situational segmentation has proven useful in many consumer goods markets but has received little attention in the context of health care marketing. A two-stage research process is used to develop a taxonomy of situational factors pertinent to health care choice. In stage one, focus group interviews are used to gather information which is instrumental to questionnaire development. In stage two, the responses of 151 subjects to a 51 item questionnaire are factor analyzed. The results demonstrate that situational segmentation is a viable strategy in the health care market.