This study was designed to determine the clinical characteristics of hypertensive patients whose blood pressures are substantially higher in the medical office than in their natural environments. Thirty-nine percent of patients enrolled in a nonpharmacologic hypertension treatment program had systolic or diastolic office blood pressures (OBPs) that were at least 10 mm Hg higher than their ambulatory blood pressures (ABPs). Although these white-coat responders (WCRs) had higher systolic OBPs than did non-white-coat responders (NRs), both their systolic (p less than 0.02) and their diastolic (p less than 0.0001) ABPs were significantly lower than those of NRs. Furthermore, patients with white-coat hypertension did not have greater blood pressure reactivity in their natural environments, suggesting that their blood pressure elevations may be specific to the medical setting. White-coat hypertensives were older (p less than 0.005), had less angry dispositions (p less than 0.01), and reported less overt anger expression (p less than 0.005). They were also taking more antihypertensive medications than were the other patients in the study (p less than 0.001).

Antihypertensive Agents↗

PubMedDate not supplied

Patient perception of involvement in medical care: relationship to illness attitudes and outcomes.

OBJECTIVE: The purpose of this study was to explore the relationships among patients' perceptions about the roles they played during medical visits, their subsequent attitudes about their illnesses and treatments, and their self-rated improvement. DESIGN: Questionnaires were completed by patients before, one day after, and one week after their medical visits, and by their physicians following the visits. SETTING: The study was conducted in a general internal medicine faculty practice that provided adult primary care to a largely HMO population. PARTICIPANTS: Adult patients with new or increased symptoms who were capable of reading and understanding the study questionnaire. MAIN RESULTS: Fifty-five patients (47%) reported playing an active role; 62 patients (53%) reported playing a passive role. After adjusting for age, sex, baseline illness ratings, and physician-rated prognosis, "active" patients reported less discomfort (p = 0.04), greater alleviation of symptoms (p = 0.008), and more improvement in their general medical condition (p = 0.04) one week after the visits than did "passive" patients. These differences were not influenced by the roles patients desired to play. Active patients also reported less concern with their illnesses (p = 0.04), a greater sense of control of their illnesses (p = 0.04), and more satisfaction with their physicians (p = 0.02) one day after the visit. Post-visit dysfunction ratings were not related to patients' role perceptions. CONCLUSIONS: Patients' perceptions about their involvement in care appeared to be related to their attitudes about their illnesses as well as to recovery. Further research is needed, however, to determine the factors that influence these role perceptions and to define the types of patients, illnesses, and settings in which the benefits of active-role perceptions are most likely to be realized.

Adult↗

PubMedDate not supplied

Patients' Perceived Involvement in Care Scale: relationship to attitudes about illness and medical care.

This report describes the development of the Perceived Involvement in Care Scale (PICS), a self-report questionnaire for patients, and its relation to primary care patients' attitudes regarding their illnesses and the management of them. The questionnaire was administered to three independent samples of adult primary care patients. Patients' satisfaction and their attitudes regarding their illnesses are evaluated after their medical visits. This instrument is designed to examine three relatively distinct factors: 1) doctor facilitation of patient involvement, 2) level of information exchange, and 3) patient participation in decision making. Of these factors, doctor facilitation and patient decision making were related significantly to patients' satisfaction with care. Doctor facilitation and information exchange related consistently to patients' perceptions of post-visit changes in their understanding, reassurance, perceived control over illness, and expectations for improvement in functioning. The role of physicians in enhancing patient involvement in care and the potential therapeutic benefits of physician facilitative behavior are addressed.

Adult↗

PubMedDate not supplied

Long-term effects of alcohol drinking on cerebral glucose utilization in alcohol-preferring rats.

The 2-[14C]deoxyglucose (2-DG) quantitative autoradiography technique was used to determine rates of local cerebral glucose utilization (LCGU) in discrete brain regions in alcohol-chronic (A-C), alcohol-deprived (A-D) and alcohol-naïve (A-N) adult, male alcohol-preferring (P) rats. The hypothesis to be tested is that neuronal alterations occur as a result of chronic alcohol drinking and some of these alterations persist for long periods in the absence of alcohol. Following 6 weeks of daily 4-h scheduled access sessions to 15% (v/v) ethanol and water, group A-D received only water during the sessions over the next 2 weeks, whereas groups A-C and A-N continued to receive ethanol-water and water-water, respectively. On the 14th day of the deprivation interval, LCGU rates were measured 1 h prior to the scheduled access period. Mean ethanol intake for the A-D and A-C groups was 1.5+/-0.1 g ethanol/kg body weight per 4 h. LCGU rates were significantly decreased in 49 of 57 regions or subregions examined in the A-C group compared to the A-N group, including subregions of the cerebral cortex, hippocampus and structures in the mesocorticolimbic and nigrostriatal systems. Following alcohol deprivation, LCGU values in the A-D group were partially or completely returned to A-N levels in many, but not all, regions. In several limbic regions (e.g., ventral tegmental area, olfactory tubercle, medial prefrontal cortex, ventral pallidum and lateral septum), no recovery of LCGU rates was observed after 2 weeks of alcohol deprivation. This study demonstrates that chronic alcohol consumption produces significant reductions in functional neuronal activity in P rats, some of which persist in the absence of ethanol. The extent to which LCGU rates returned to normal levels following 2 weeks of alcohol deprivation varied among brain regions, suggesting that there are imbalanced interactions among and within several CNS sites, which do not reflect either the alcohol-naïve or chronic alcohol-exposed state. Such neuronal imbalances may underlie relapse of alcohol drinking following prolonged abstinence.

Alcohol Drinking↗

PubMedDate not supplied

Envelope protein changes, autoagglutination, sensitivity to hydrophobic agents and a conditional division lesion in Escherichia coli strains carrying ColV virulence plasmids.

The presence of the virulence plasmids ColV,I-K94 or ColV-K30 in Escherichia coli produces a number of cell membrane and envelope changes. The most striking of these are (1) the presence of the 33K VmpA outer membrane protein and (2) the ColV-associated occurrence of autoagglutination. The VmpA protein is a plasmid-encoded outer membrane protein which is synthesized from a larger precursor. It is distinct from the chromosomally-encoded OmpA protein but resembles it in a few respects. The VmpA protein does not appear to be involved in colicin synthesis or immunity, or in plasmid transfer. This protein was found in 6 out of 8 new ColV+ isolates, but not in 2 ColIa+ strains. ColV-induced autoagglutination occurred for strains grown in static culture at 37 but not at 25 degrees C. Detergents prevented agglutination, as did the presence in a ColV+ strain of a fi+ plasmid, ColB. Autoagglutination may be a virulence phenotype. Associated with the ability of ColV+ bacteria to agglutinate was inhibition of motility. ColV+ bacteria also showed changes in envelope permeability indicated by inhibitor sensitivity and by a ColV-associated suppression of the lac Y lesion. Some ColV,I-K94+ strains showed a mucoid colonial phenotype and this ability to form mucoid colonies was efficiently transferred with ColV but apparently not without it. The mucoid ColV+ strains resembled lon mutants in UV-sensitivity, division behaviour and sensitivity to lambda phage.

Bacterial Outer Membrane Proteins↗

PubMedDate not supplied

A motility lesion in ColV+ Escherichia coli strains and its possible clinical significance.

The introduction of the ColV-K30 or ColV,I-K94 plasmid into Escherichia coli strains produced derivatives which had a motility lesion if grown without shaking at 37 degrees C. Although most ColV+ organisms from shaken cultures were motile, 80-90% of free unclumped organisms from static cultures were flagellate but non-motile. This plasmid effect was temperature-dependent with only those ColV+ organisms grown at 37 degrees C being affected; ColV+ organisms grown at 30 degrees C or below were predominantly motile. The motility lesion depended on the presence, in the ColV+ organisms, of transfer and colicin components together but not of the VmpA protein. Aside from the changed motility, there was extensive autoagglutination (clumping) of ColV+ organisms in static cultures, and the two phenomena (clumping and motility lesion) appeared to be governed by the same factors. The Flac plasmid of FI incompatibility group had a slight inhibitory effect on motility of strain 1829 and caused slight clumping, but representative plasmids of groups FII, FIII, FIV, C, H, I, K, M, N, P, W and X had no appreciable effect on either parameter. Non-motile ColV+ organisms regained motility on incubation with buffered detergent solutions, suggesting that an envelope change might be responsible for the altered motility. It can be hypothesized that ColV+ organisms in the intestine would be motile and hence able to reach the intestinal epithelium for invasion but that, once such organisms had reached the tissues and bloodstream, they would be predominantly non-motile and hence might be less susceptible to phagocytosis.

Blood↗

PubMedDate not supplied

Chemical conversion of anthramycin 11-methyl ether to didehydroanhydroanthramycin and its utilization in studies of the biosynthesis and mechanism of action of anthramycin.

Reaction of anthramycin 11-methyl ether (AME) with trifluoroacetic acid results in formation of (1,11a)-didehydroanhydroanthramycin (DAA). Anthramycin biosynthetically labelled from DL-[3'RS(3'-3H)]; DL-[3'S(3'-3H)] and DL-[3'R(3'-3H)] tyrosine each lose approximately 50% of their tritium during this conversion to DAA confirming the labelling pattern of 3'-tritiated species of tyrosine in AME. As expected negligible losses of tritium occurred from AME biosynthetically labelled fron L-[2- or 6-3H] or L-[3- or 5-3H]tyrosine. DAA did not form a stable adduct with DNA in accord with the postulated mechanism of action of anthramycin.

Animals↗

PubMedDate not supplied

Admixture and population replacement of the Sells Papago indians: three strategies.

Explore the source record for details and available documents.

Adolescent↗

PubMedDate not supplied

A low-cost environmental control system for quadriplegics.

This paper describes a low-cost environmental control system for quadriplegics. With a single custom designed input switch, a disabled patient can turn up to three electrical devices on or off. The design could easily be extended to handle additional devices. The system can be constructed in one day for approximately $40.00 in parts cost, plus the cost of labor.

Environment, Controlled↗

PubMedDate not supplied

A mobile physiological data acquisition system for clinical research.

The S.R. Powers Trauma Research Center at Albany Medical Center makes a wide variety of standard and specially designed physiological measurements on injured patients. To overcome the disadvantages of admitting patients to a single bed research unit, a mobile data acquisition system was designed to study patients in the Intensive Care Unit, Burn Unit, Emergency Room, and Recovery Room. This mobile system acquires data using microcomputer controlled data acquisition and communicates via modem with a larger computer located in the Trauma Unit Research Center. The laboratory computer performs data analysis and returns results to the instrument cart at the bedside. A dry spirometer, which is reset on inspiration by the mechanical ventilators, was designed, built, and incorporated into the cart for measuring expired gas volumes and flows.

Computers↗