Taking medicines: concordance is not compliance.
Explore the source record for details and available documents.
Choice Behavior↗
Biomedical subjects
D Dickinson
Publications and source records attributed to D Dickinson.
Creating a new environment of ambulatory care: community health centers and the Planetree philosophy.
This article provides an overview of the approach, programming, and methodology for the renovation of the Peekskill Area Health Center, an urban based non-profit community health center in the Hudson Valley. The impetus of the renovation is in response to changes in the health care environment and overcrowding of the existing facility. The model development, which is reflected in the physical renovation, employees key elements of the Planetree approach to patient-centered care. Consistent with the national Community Health Center philosophy, the project is dedicated to vitalizing an economically depressed area through construction opportunities and links with local commercial businesses.
Community Health Centers↗
Alcohol-specific socialization, parenting behaviors and alcohol use by children.
OBJECTIVE: This panel study examined the relations between alcohol-specific socialization by parents (monitoring of alcohol use by children, allowing alcohol use by children at home, communicating against alcohol use and setting rules against alcohol use), general dimensions of parenting behavior (responsiveness and demandingness) and alcohol use by children. METHOD: A sample of 488 fifth-grade children reported their perceptions of alcohol-specific socialization by parents, parental responsiveness and parental demandingness. These variables were used to predict alcohol use when children in the panel were in seventh grade. RESULTS: Nineteen percent of seventh-grade children reported alcohol use in the past 30 days. Logistic regression analyses indicated that, after accounting for children's age, sex, single parent status, prior use of alcohol and exposure to parental modeling of alcohol use, the odds of alcohol use were significantly greater among children who perceived no parental monitoring of alcohol use, who had been allowed by parents to have a drink with alcohol at home and who perceived relatively low levels of parental demandingness. Rules against alcohol use, parental communication against alcohol use and parental responsiveness were unrelated to the study outcome. CONCLUSIONS: Parental monitoring of alcohol use by children, family norms regarding alcohol use by children at home and parental ability to set and enforce behavioral rules merit consideration as factors that should be modified by prevention programs. There is a need, however, for additional research that further examines the relations between exposure to such parenting behaviors during childhood and alcohol use during adolescence.
Alcohol Drinking↗
New tools for learning.
In the last twenty-five years more has been learned about the human brain than in the past history of mankind. Through the use of new technologies such as PET and CAT scans and functional MRI's, it is now possible to see and learn much about the human brain while it is in the process of thinking. The research of neuroscientists, such as Marian Diamond, has demonstrated that the brain changes physiologically as a result of learning and experience--for better or worse--and that plasticity can continue throughout the lifespan. It appears that there are particular kinds of environments that are most conducive to the development of good mental equipment. They are positive, nurturing, stimulating, and encourage action and interaction. Many of the most effective schools and training programs have created such high-challenge low-threat environments. It is also very clear that intelligence is not a static structure, but an open, dynamic system that can continue to develop throughout life. This understanding is being utilized not only in school systems but in the workplace, where training programs show that even at the adult level people are able to develop their intelligence more fully. Corporations such as Motorola have implemented programs in which they are training their employees, managers, and executives to think, problem-solve and create more effectively using strategies developed by such educational innovators as Reuven Feurstein, J.P. Guilford, and Edward de Bono. A most recent development is in the new kinds of technology that make it possible for people to take responsibility for their own learning as they access and process information through the internet, communicate with experts anywhere in the world, and use software that facilitate higher order thinking and problem-solving. Computers are in no way replacing teachers, but rather these new tools allow them to spend more time being facilitators, mentors, and guides. As a result, teachers and students are able more often to collaborate on creating new knowledge as well as mastering the basics. As technology becomes more ubiquitous, there is growing recognition of the importance of the arts in humanizing the curriculum. "More high-tech, more need for high-touch" is becoming the by-word of many schools. They recognize that the arts are not only culturally important and civilizing influences, but they can facilitate the learning of almost any subject. I believe that these four concepts--the plasticity of the brain, the modifiability of intelligence, the use of technology as a powerful new tool for learning, and the renaissance of the arts in education--have major implications specifically for educational systems and generally for the future of our world. In this time of rapid change, leading-edge educational systems are equipping people with the ability to learn, unlearn, and relearn continually. They are giving students meaningful opportunities to apply what they have learned in order to turn information into knowledge. And--of critical importance if any of this is to lead to a healthy future--they are helping students to learn to use knowledge responsibly, ethically, and with integrity. Furthermore, they are involving students in experiences that develop compassion and altruism in the process of their education. Our complex world urgently needs more people who have developed their fullest potential in mind, body, and spirit.
Adult↗
Partnership with patients. Health professionals need to identify how much information patients want.
Explore the source record for details and available documents.
Communication↗
Extension of Drosophila lifespan by overexpression of human SOD1 in motorneurons.
Reactive oxygen (RO) has been identified as an important effector in ageing and lifespan determination. The specific cell types, however, in which oxidative damage acts to limit lifespan of the whole organism have not been explicitly identified. The association between mutations in the gene encoding the oxygen radical metabolizing enzyme CuZn superoxide dismutase (SOD1) and loss of motorneurons in the brain and spinal cord that occurs in the life-shortening paralytic disease, Familial Amyotrophic Lateral Sclerosis (FALS; ref. 4), suggests that chronic and unrepaired oxidative damage occurring specifically in motor neurons could be a critical causative factor in ageing. To test this hypothesis, we generated transgenic Drosophila which express human SOD1 specifically in adult motorneurons. We show that overexpression of a single gene, SOD1, in a single cell type, the motorneuron, extends normal lifespan by up to 40% and rescues the lifespan of a short-lived Sod null mutant. Elevated resistance to oxidative stress suggests that the lifespan extension observed in these flies is due to enhanced RO metabolism. These results show that SOD activity in motorneurons is an important factor in ageing and lifespan determination in Drosophila.
Aging↗
Methanotrophs, Methylosinus trichosporium OB3b, sMMO, and their application to bioremediation.
One of the most problematic groups of the USEPA and EU priority pollutants are the halogenated organic compounds. These substances have a wide range of industrial applications, such as solvents and cleaners. Inadequate disposal techniques and accidental spillages have led to their detection in soil, groundwater, and river sediments. Persistence of these compounds in the environment has resulted from low levels of biodegradation due to chemical structural features that preclude or retard biological attack. Research has indicated the idea that treatment systems based on methanotrophic co-metabolic transformation may be a cost-effective and efficient alternative to physical methods because of the potential for high transformation rates, the possibility of complete compound degradation without the formation of toxic metabolites, applicability to a broad spectrum of compounds, and the use of a widely available and inexpensive growth substrate. A substantial amount of work concerning methanotrophic cometabolic transformations has been carried out using the soluble form of methane monooxygenase (sMMO) from the obligate methanotroph Methylosinus trichosporium OB3b. This NADH-dependent monooxygenase is derepressed when cells are grown under copper stress. sMMO has a wider specificity than the particulate form. sMMO has been shown to degrade trichloroethylene (TCE) at a rate of at least one order of magnitude faster than obtained with other mixed and pure cultures, suggesting it has a wider application to bioremediation. Furthermore, sMMO catalyzes an unusually wide range of oxidation reactions, including the hydroxylation of alkanes, epoxidation of alkenes, ethers, halogenated methanes, cyclic and aromatic compounds including compounds, that are resistant to degradation in the environment. However, the practical application of methantrophs and Methylosinus trichosporium OB3b to the treatment of chlorinated organics has met with mixed success. Although oxidation rates are rapid, compound oxidation with M. trichosporium OB3b is difficult. This fastidious organism grows relatively slowly, which limits the speed with which sMMO expressing biomass can be generated. Furthermore, product toxicity toward the cell, affecting the stability of the enzyme when transforming certain compounds has been observed, for example, by the products of 1,2,3 trichlorobenzene hydroxylation (2,3,4- and 3,4,5-trichlorophenol) and of TCE degradation (chloral hydrate). Because of this toxicity and the inability of sMMO to further oxidize its own hydroxylation products, the ability of methane monoxygenase to carry out the monooxygenation of a wide variety of substituted aromatics and polyaromatics cannot be fully exploited in M. trichosporium OB3b. Many of these problems could be overcome by the use of either a mixed downstream heterotrophic population of organisms that could accommodate the products of hydroxylation or to express sMMO in an organism that could metabolize the products of hydroxylation. The latter of these two approaches would have several advantages. The main benefit would be the removal of the need for methane, which is required to induce sMMO in M. trichosporium OB3b, and supply carbon and energy to the cells that continuously oxidise the target compound, but also acts as a competitive inhibitor of sMMO. Instead, the recombinant could utilize the products of sMMO-mediated hydroxylation as a carbon source.
Biodegradation, Environmental↗
TGF-beta1 is essential for the homeostasis of the dentin-pulp complex.
Among the complex network of cytokines that influence odontoblast function during development and repair, TGF-beta1 is unique in its dual abilities to function as a potent immunosuppressant and as an inducer of extracellular matrix production. These properties underscore the importance of this molecule in maintaining the homeostasis of the dentin-pulp complex after injury. The purpose of this paper is to describe new findings of our phenotypic analysis of dentition in mice in which the TGF-beta1 gene has been disrupted. The major phenotype of TGF-beta1(-/-) offspring is one of diffuse immune system activation with progressive inflammation, wasting and death. Our studies of adult TGF-beta1(-/-) dentition show widespread pulpal and periapical inflammation and necroses. In addition, the coronal surfaces of occluding molars show marked attrition. To determine whether the phenotypic changes in TGF-beta1(-/-) dentition are directly linked to the loss of TGF-beta1 rather than the inflammatory process itself, we studied adult dentition in TGF-beta1(-/-) mice backcrossed into immunodeficient backgrounds. Results of our histopathologic and radiographic analyses show that teeth of TGF-beta1(-/-) immunodeficient mice retain vitality in pulpal and periapical regions but show excessive wear of occlusal surfaces.
Animals↗
Residual and recurrent shunts after implantation of Cook detachable duct occlusion coils.
OBJECTIVE: To assess the presence and outcome of Doppler detectable shunts following implantation of the Cook detachable PDA coil. DESIGN: Prospective study. SETTING: Tertiary paediatric cardiac centre. PATIENTS: 76 consecutive patients undergoing coil implantation (80 procedures). MAIN OUTCOME MEASURES: Detection and colour Doppler echocardiographic appearance of residual or recurrent shunts, the timing of the appearance of recurrent shunts, and the time taken for spontaneous resolution of these shunts. RESULTS: Immediate occlusion was achieved in 52 patients. At one month 63 patients had complete occlusion and after three months the duct was completely occluded in 67 patients. In 27 cases small residual shunts were detected on echocardiography 10 minutes after the completion of the implantation procedure; 15 of these had resolved by 24 hours and 20 had resolved by three months. Recurrent shunts were detected after apparent initial complete occlusion in 11 cases 24 hours after coil implantation and in two cases one month after the procedure. Six recurrent shunts resolved on later follow up. Residual shunts appeared as single jets after implantation of a single coil, but up to three separate jets were detected after implantation of multiple coils. CONCLUSIONS: Spontaneous resolution of small residual shunts occurs in most patients. The recurrence of small shunts after apparent complete occlusion suggests that recanalisation of the duct may occur in a small percentage of patients up to one month after occlusion. Residual shunts may take the form of multiple residual jets that may require implantation of further coils to achieve complete duct occlusion.
Ductus Arteriosus, Patent↗
A longitudinal study predicting patterns of cigarette smoking in late childhood.
Early initiation of cigarette smoking so strongly predicts future smoking that several investigators have advocated delaying the age of initiation as a prevention strategy. To complement retrospective studies of early initiation, this study assessed prospectively patterns of smoking behavior in a sample of 401 children who were surveyed in the fifth, sixth, and seventh grades. The principal findings were (1) modeling of smoking by parents and friends is sufficient to influence children to initiate smoking, particularly when children also have low behavioral self-control, and (2) when modeling occurs in combination with poor adjustment to school, low parental monitoring, easy access to cigarettes, and other risk attributes, early initiators are significantly more likely to continue smoking. The results suggest that delaying initiation of smoking without also modifying child attributes and socialization factors that predict early initiation and persistent smoking is unlikely to reduce the proportion of children who become habitual smokers.
Adolescent↗
EMEA and consumer representation. European Medicines Evaluation Agency.
Explore the source record for details and available documents.
Drug Approval↗
The early use of alcohol and tobacco: its relation to children's competence and parents' behavior.
OBJECTIVES: Use of tobacco and alcohol during childhood predicts heavy use of these substances and use of illicit drugs during adolescence. This study aims to identify developmental correlates of tobacco and alcohol use among elementary-school children. METHODS: Cross-sectional surveys were used to measure tobacco and alcohol use, multiple indicators of child competence, parenting behaviors, and parental modeling of tobacco and alcohol use in a sample of 1470 third- and fifth-grade children. Both self-report and teacher-rated assessments were obtained, which allowed collateral testing of study hypotheses. RESULTS: Children's tobacco and alcohol use was strongly related to low scores on several measures of child competence, both self-reported and teacher rated. Children's tobacco and alcohol use was also associated with less effective parenting behaviors and with parental use of tobacco and alcohol. CONCLUSIONS: Children's early experience with tobacco and alcohol is associated with weak competence development and exposure to socialization factors that promote risk taking. Interventions to prevent early use of tobacco and alcohol are needed.
Adolescent↗
Can elderly residents with memory problems be prepared for relocation?
Relocation of elderly clients between residential establishments can be unsettling, although good preparation can help reduce negative effects and contribute to successful transfer. However, it is less clear whether preparation is feasible for residents with cognitive deficits and clarification of this issue was the objective of the study. Results indicated that with the exception of those with severe cognitive deterioration, residents generally retained awareness of impending relocation and reported feelings appropriate to the situation. Implications for the types of preparation are discussed.
Adaptation, Psychological↗
Does hospital rundown affect long-stay clients?
In order to examine what happens to long-stay clients who remain in hospital, a retrospective analysis of annual surveys between 1984 and 1992 was undertaken. Data were derived from the REHAB scale, which provides measures of patient Total General Behaviour (TGB) and Deviant Behaviour (DB), together with data from the Supplementary Information Questionnaire (SIQ). Results indicate that skills and behaviour, as measured by TGB, do not deteriorate as a function of continuous length of stay or increasing age. However, TGB for certain clients is adversely affected by a reduction in the level of structured activity occurring during major episodes of contraction leading up to closure. In contrast, DB, which is relatively high for this group, fluctuates independently of rundown. The implications for hospital services in transition are discussed.
Aged↗
AIDS: a nurse's responsibility. Care plan for home care.
Explore the source record for details and available documents.
Acquired Immunodeficiency Syndrome↗
Dexamethasone vs. placebo for cisplatin-induced emesis. A randomized cross-over trial.
A randomized cross-over trial of dexamethasone (10 mg I.V. before therapy, and 4 mg I.V. q 4 h X 6 doses) vs. placebo as antiemetic therapy was conducted in 19 patients receiving high-dose cisplatin. Sixteen patients and 32 treatment courses were fully evaluable. There was no significant difference between regimens in the number of emesis-free patients or the number of emetic episodes, though the duration of nausea symptoms may have been reduced. We conclude that dexamethasone as used in our trial is not an effective antiemetic in patients receiving cisplatin.
Aged↗
A prospective evaluation of indirect methods for detecting carotid atherosclerosis.
The statistical efficacy of three indirect techniques for noninvasive diagnosis of carotid artery disease was assessed in a prospective, blind study of 103 persons. Oculoplethysmography-carotid phonoangiography, periorbital Doppler examination and supraorbital photoplethysmography were acceptably sensitive only to carotid artery occlusions and preocclusive carotid artery stenoses exceeding a 75 per cent diameter reduction. Less pronounced lesions could not be reliably detected by any of the techniques used either singly or in combination. Supraorbital photoplethysmography proved inferior to the other methods because of its poor specificity rate.
Arteriosclerosis↗
Pelvic disruption in the polytraumatized patient: a management protocol.
This article reviews the experience with the management of 79 polytraumatized patients with pelvic fractures. The incidence of involvement of other systems was measured by the injury severity score. The average severity score was 33.5, and the mortality was 19%. Patients with a posterior disruption of the pelvis had a higher mortality, a higher "injury severity score," and required greater resuscitation efforts. Resuscitation of these patients requires efficient effective action. Adherence to our management algorithm, based on assessment of the patient's response, should help achieve that end.
Adolescent↗