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Biomedical subjects

Robert Burns

Publications and source records attributed to Robert Burns.

16 recordsLinked to original sources
PubMed2006

Enhancing the quality of life of dementia caregivers from different ethnic or racial groups: a randomized, controlled trial.

BACKGROUND: Caring for a family member with dementia is extremely stressful, contributes to psychiatric and physical illness among caregivers, and increases the risk for caregiver death. Finding better ways to support family caregivers is a major public health challenge. OBJECTIVE: To test the effects of a structured multicomponent intervention on quality of life and clinical depression in caregivers and on rates of institutional placement of care recipients in 3 diverse racial or ethnic groups. DESIGN: Randomized, controlled trial. SETTING: In-home caregivers in 5 U.S. cities. PARTICIPANTS: 212 Hispanic or Latino, 219 white or Caucasian, and 211 black or African-American caregivers and their care recipients with Alzheimer disease or related disorders. INTERVENTION: Caregivers within each racial or ethnic group were randomly assigned to an intervention or to a control group. The intervention addressed caregiver depression, burden, self-care, and social support and care recipient problem behaviors through 12 in-home and telephone sessions over 6 months. Caregivers in the control group received 2 brief "check-in" telephone calls during the 6-month intervention. MEASUREMENTS: The primary outcome was a quality-of-life indicator comprising measures of 6-month caregiver depression, burden, self-care, and social support and care recipient problem behaviors. Secondary outcomes were caregiver clinical depression and institutional placement of the care recipient at 6 months. RESULTS: Hispanic or Latino and white or Caucasian caregivers in the intervention group experienced significantly greater improvement in quality of life than those in the control group (P < 0.001 and P = 0.037, respectively). Black or African-American spouse caregivers also improved significantly more (P = 0.003). Prevalence of clinical depression was lower among caregivers in the intervention group (12.6% vs. 22.7%; P = 0.001). There were no statistically significant differences in institutionalization at 6 months. LIMITATIONS: The study used only a single 6-month follow-up assessment, combined heterogeneous cultures and ethnicities into a single group, and excluded some ethnic groups. CONCLUSIONS: A structured multicomponent intervention adapted to individual risk profiles can increase the quality of life of ethnically diverse dementia caregivers. ClinicalTrials.gov identifier: NCT00177489.

Aged↗
PubMed2006

Cognitive abilities of Alzheimer's patients: perceptions of Black and White caregivers.

This study compared Black (n = 97) and White (n = 143) family caregivers regarding the relationship between subjective and objective cognitive assessments of Alzheimer's patients from the Memphis site of the NIA/NINR Resources for Enhancing Alzheimer's Caregivers Health (REACH) randomized clinical trial. Black and White caregivers' subjective ratings (Pearlin Cognitive Status Scale) of their care recipients' cognitive abilities were equivalent, but White Alzheimer's patients had higher objective cognitive performance (Mini-Mental State Examination). In simple regression analysis, race was significantly related to differences between subjective and objective cognitive assessments and remained so when caregiver age, sex, income, education, relationship to care recipient, caregiver bother (burden), and care recipient sex were statistically controlled in multiple regression analysis. Compared to the other group, Black caregivers generally overrated, and White caregivers underrated, their care recipient's cognitive ability. This difference in caregiver's appraisal may affect clinical and behavioral interventions for dementia patients and their caregivers.

Aged↗
PubMed2005

Keratinocyte-derived, CD80-mediated costimulation is associated with hapten-specific IgE production during contact hypersensitivity to TH1 haptens.

Background B7-1 transgenic mice exhibit exaggerated and persistent contact hypersensitivity responses compared with normal mice. Objective Because B7-1 and B7-2 deliver different costimulatory signals to T cells during antigen presentation, the purpose of this study was to compare B7-1 and B7-2 on keratinocytes and to compare their effects on contact hypersensitivity. Methods Contact hypersensitivity was studied in transgenic mice whose keratinocytes constitutively expressed B7-1, B7-2, or no costimulatory molecules (nontransgenic mice). Results B7-1 transgenic mice, and to a lesser extent B7-2 transgenic mice, developed exaggerated ear swelling responses after sensitization and challenge with haptens such as trinitrochlorobenzene or dinitrofluorobenzene. Ear swelling responses in B7-1 transgenic mice were characterized by the presence of markedly elevated inflammatory cytokine transcripts (IL-6, TNF-alpha, and lymphotoxin beta) as well as IL-10 compared with either B7-2 or nontransgenic mice. Hapten-specific IgE was detected by ELISA in B7-1 transgenic mice but not B7-2 transgenic or nontransgenic mice. Only B7-1 transgenic mice exhibited significant immediate type ear swelling responses to the hapten trinitrochlorobenzene. In addition, their sera can passively transfer cutaneous anaphylaxis to naive C57BL/6 mice, indicating that the hapten-specific IgE was relevant to the immediate ear swelling responses. Conclusion These data suggest that keratinocyte-derived costimulation mediated by B7-1 but not B7-2 results in the emergence of T H 2-lymphocyte immune responses to T H 1 haptens. Because human keratinocytes have been noted to express B7-1-like molecules in certain inflammatory skin diseases, this model may be important in understanding the pathophysiology of T H 2-lymphocyte-mediated skin diseases such as atopic dermatitis.

Animals↗
PubMed2005

Caregiver appraisals of functional dependence in individuals with dementia and associated caregiver upset: psychometric properties of a new scale and response patterns by caregiver and care recipient characteristics.

UNLABELLED: To evaluate psychometric properties and response patterns of the Care-giver Assessment of Function and Upset (CAFU), a 15-item multidimensional measure of dependence in dementia patients and caregiver reaction. METHOD: 640 families were administered the CAFU (53% White, 43% African American, and 4% mixed race and ethnicity). We created a random split of the sample and conducted exploratory factor analyses on Sample 1 and confirmatory factor analyses on Sample 2. Convergent and discriminant validity were evaluated using Spearman rank correlation coefficients. RESULTS: A two-factor structure for functional items was derived, and excellent factorial validity was obtained. Convergent and discriminant validity were obtained for function and upset measures. Differential response patterns for dependence and caregiver upset were found for caregiver race, relationship, and care recipient gender but not for caregiver gender. DISCUSSION: The CAFU is easily administered, reliable, and valid for evaluating appraisals of dependencies and upsetting care areas.

Activities of Daily Living↗
PubMed2005

Immunization strategies for antibody production.

A range of immunization techniques can be used for the successful production of antibodies. The choice of method used is dependent on the nature of the antigen and the type of antibody needed by the user.

Animals↗
PubMed2005

Making hybridomas.

Hybridomas are derived from the fusion of spleen and myeloma cells and produce monoclonal antibodies. Each hybridoma cell line produces an antibody with a unique specificity allowing the production of highly defined reagents that can be used in many branches of immunochemistry.

Animals↗
PubMed2004

The NEAT Project: Nursing Engineering Ambassador Team.

The physical facilities of patient care units must be maintained to ensure an environment conducive to recovery of patients and the efficient delivery of patient care. Often this is a challenge for engineering and nursing departments. The authors describe the development, implementation, and evaluation of the Nursing Engineering Ambassador Team (NEAT), a unique collaboration between these 2 departments.

Connecticut↗
PubMed2004

Social marketing as a framework for recruitment: illustrations from the REACH study.

OBJECTIVE: Recruitment is often the most challenging aspect of research with older persons. Social marketing--applying marketing techniques to influence the behavior of target audiences to improve their welfare--can help researchers identify factors that influence recruitment. METHODS: Illustrations of social marketing principles are provided from the Resources for Enhancing Alzheimer's Caregiver Health project, a national Alzheimer's caregivers study that targeted ethnic and racial minorities. RESULTS: Social marketing principles--the six Ps of participants, product, price, place, promotion, and partners--provide a theoretical framework for organizing and planning recruitment activities, including developing varying strategies to define the target audience (participants), develop the intervention (product), manage time and trouble (price), target the audience, improve accessibility (place), promote the study, and develop and work with partners. DISCUSSION: Strategies to enhance recruitment are often undertaken without a comprehensive plan. A social marketing plan provides a framework to map out the steps in recruitment that will be needed and to plan for allocations of time, staff, and resources.

Black or African American↗
PubMed2003

Effect of multicomponent interventions on caregiver burden and depression: the REACH multisite initiative at 6-month follow-up.

Meta-analysis was used to examine pooled parameter estimates of 9 active compared with 6 control conditions of the Resources for Enhancing Alzheimer's Caregiver Health (REACH) project at 6 months on caregiver burden and depressive symptoms. Associations of caregiver characteristics and outcomes were examined. For burden, active interventions were superior to control conditions (p = .022). Also, active interventions were superior to control conditions for women versus men and for caregivers with lower education versus those with higher education. For depressive symptoms, a statistically significant association of group assignment was found for Miami's family therapy and computer technology intervention (p = .034). Also, active interventions were superior to control conditions for Hispanics, nonspouses, and caregivers with lower education. Results suggest interventions should be multicomponent and tailored.

Aged↗
PubMed2003

The Resources for Enhancing Alzheimer's Caregiver Health (REACH): project design and baseline characteristics.

The Resources for Enhancing Alzheimer's Cargiver Health (REACH) project was designed to test promising interventions for enhancing family caregiving for persons with dementia. The purpose of this article is to describe the research design, interventions, and outcome measures used in REACH and to characterize the sample recruited for the study. Nine interventions and 2 control conditions were implemented at 6 sites; 1,222 dyads were randomly assigned to an intervention or a control condition. The caregiver sample was 18.6% male with an average age of 62.3 years (56% Caucasian, 24% Black, and 19% Hispanic). Caregivers reported high levels of depressive symptoms and moderate burden. Care recipients were older, with a mean age of 79, and were moderately to severely impaired with mean Mini-Mental State Exam scores of 13/30.

Adaptation, Psychological↗
PubMed2003

Psychometric analysis of the Revised Memory and Behavior Problems Checklist: factor structure of occurrence and reaction ratings.

A modified version of the Revised Memory and Behavior Problems Checklist (RMBPC; L. Teri et al., 1992) was administered across 6 different sites to 1,229 family caregivers of community-dwelling adults with dementia. The total sample was divided randomly into 2 subsamples. Principal components analyses on occurrence responses and reaction ratings from the first subsample resulted in a 3-factor solution that closely resembled the originally proposed dimensions (memory-related problems, disruptive behaviors, and depression). Confirmatory factor analyses on data from the second subsample indicated adequate fit for the 3-factor model. Correlations with other caregiver and care-recipient measures supported the convergent and discriminant validity of the RMBPC measures. In addition, female caregivers and White caregivers reported more problems, on average, than male caregivers and African American caregivers, respectively.

Adult↗
PubMed2003

Thalidomide inhibits UVB-induced mouse keratinocyte apoptosis by both TNF-alpha-dependent and TNF-alpha-independent pathways.

BACKGROUND: Thalidomide is an anti-inflammatory pharmacologic agent that has been utilized as a therapy for a number of dermatologic diseases. Its anti-inflammatory properties have been attributed to its ability to antagonize tumor necrosis factor-alfa (TNF-alpha) production by monocytes. However, its mechanism of action in the skin is not known. PURPOSE: To test our hypothesis that thalidomide may antagonize TNF-alpha production in the skin, we used a mouse model for acute ultraviolet-B (UVB) exposure, a known stimulus for inducing this cytokine. RESULTS: A single bolus dose of thalidomide (either 100 or 400 mg/kg) given immediately before UVB exposure (40-120 mJ/cm2) inhibited, in a dose-dependent manner, sunburn cell formation (i.e. keratinocyte (KC) apoptosis as defined by histologic appearance and confirmed by terminal transferase mediated biotinylated dUTP nick end labelling staining) in mouse skin biopsy specimens. However, this agent did not affect the formation of cyclobutane pyrimidine dimers, a measure of UVB-induced DNA damage, which is an early event associated with apoptosis. RNase protection assays confirmed that high (400 mg/kg), but not low (100 mg/kg), doses of thalidomide inhibited the UVB-induced increase in steady-state TNF-alpha mRNA. Additionally, our in vitro data using neonatal mouse KCs showed that thalidomide prevented UVB-induced cell death (JAM assay). The antiapoptotic effects of thalidomide can be reversed by the addition of exogenous recombinant mouse TNF-alpha and hence reconstituting UVB-induced programmed cell death. The inhibition of sunburn cell formation by low-dose thalidomide in the absence of TNF-alpha inhibition suggests that other, unidentified mechanisms of apoptosis inhibition are active. CONCLUSIONS: These data suggest that the anti-inflammatory effects of thalidomide can affect UVB injury, and may, in part, explain its action in photosensitivity diseases such as cutaneous lupus erythematosus.

Animals↗
PubMed2003

Primary care interventions for dementia caregivers: 2-year outcomes from the REACH study.

PURPOSE: This study developed and tested two 24-month primary care interventions to alleviate the psychological distress suffered by the caregivers of those with Alzheimer's disease. The interventions, using targeted educational materials, were patient behavior management only, and patient behavior management plus caregiver stress-coping management. We hypothesized that the addition of the stress-coping component would improve caregiver outcomes. DESIGN AND METHODS: A randomized clinical trial of 167 caregiver-care recipient dyads was run, of whom 76 completed the study without bereavement or placement. RESULTS: During 24 months, caregivers who received the patient behavior management component only, compared with those who also received the stress-coping component, had significantly worse outcomes for general well-being and a trend toward increased risk of depression (i.e., a score of >16 on the Center for Epidemiological Studies Depression scale). There was a studywide improvement for bother associated with care recipient behaviors (according to the Revised Memory and Behavior Problems Checklist). IMPLICATIONS: Our data suggest that brief primary care interventions may be effective in reducing caregiver distress and burden in the long-term management of the dementia patient. They further suggest that interventions that focus only on care recipient behavior, without addressing caregiving issues, may not be as adequate for reducing caregiver distress.

Activities of Daily Living↗
PubMed2002

Dementia caregiver intervention research: in search of clinical significance.

PURPOSE: We reviewed intervention studies that reported dementia caregiver outcomes published since 1996, including psychosocial interventions for caregivers and environmental and pharmacological interventions for care recipients. Our goal was to focus on issues of clinical significance in caregiver intervention research in order to move the field toward a greater emphasis on achieving reliable and clinically meaningful outcomes. DESIGN AND METHODS: MEDLINE, PsycINFO, and Cumulative Index to Nursing & Allied Health databases from 1996 through 2001 were searched to identify articles and book chapters mapping to two medical subject headings: caregivers and either dementia or Alzheimer's disease. Articles were evaluated on two dimensions, outcomes in four domains thought to be important to the individual or society and the magnitude of reported effects for these outcomes in order to determine if they were large enough to be clinically meaningful. RESULTS: Although many studies have reported small to moderate statistically significant effects on a broad range of outcomes, only a small proportion of these studies achieved clinically meaningful outcomes. Nevertheless, caregiving intervention studies have increasingly shown promise of affecting important public health outcomes in areas such as service utilization, including delayed institutionalization; psychiatric symptomatology, including the successful treatment of major and minor depression; and providing services that are highly valued by caregivers. IMPLICATIONS: Assessment of clinical significance in addition to statistical significance is needed in this research area. Specific recommendations on design, measurement, and conceptual issues are made to enhance the clinical significance of future research.

Aged↗
PubMedDate not supplied

Use of cognitive enhancement medication in persons with Alzheimer disease who have a family caregiver: results from the Resources for Enhancing Alzheimer's Caregiver Health (REACH) project.

OBJECTIVE: Aging populations show increased prevalence of cognitive impairment and dementia. Recent efficacy studies report on prescription medications and herbal preparations that affect cognitive functioning, but the prevalence and correlates of cognitive-enhancement (CE) medication use among community-dwelling older persons is not well studied. The authors examined the frequency and appropriateness of use, the importance of a family caregiver in medication decisions for dementia patients, and differences in access to medical care. METHODS: REACH is a multisite feasibility study of several approaches to reducing the negative impacts of caregiving on those living with a family member with dementia. Data on medication use by care-recipients were collected at baseline and 1 year later. RESULTS: At baseline, 31% of 1,222 care-recipients were using a CE medication. Factors independently related to CE use were age, education, functional status, and caregiver vigilance. Within 1 year, 14% started and 30% quit taking CE. Care-recipients more likely to be Starters had spouse-caregivers, more education, and fewer baseline ADL impairments. Quitters had more ADL deficits at baseline and became less able to perform ADL at follow-up than those who continued on CE. CONCLUSIONS: CE medication use among dementia patients with a family caregiver is relatively common, though there is substantial geographic variability. Our findings are mixed with respect to appropriate use of CE medications, suggesting areas for physician education. Our data indicate the importance of the caregiver in CE medication use and suggest that there may be disparities in access to healthcare among people with cognitive impairment.

Adult↗