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Biomedical subjects

E McConnell

Publications and source records attributed to E McConnell.

At least 19 recordsLinked to original sources
PubMed1999

Pain in nursing home residents: an exploration of prevalence, staff perspectives, and practical aspects of measurement.

OBJECTIVE: To help rectify the underdiagnosis of chronic pain in frail nursing home residents by developing a new feasible pain self-report instrument, the structured pain interview; to use this new tool to estimate pain prevalence and staff's knowledge of residents' pain in two nursing homes; and to compare the performance differences of the structured pain interview and the commonly used 0-10 scale. DESIGN: Cross-sectional survey. SETTING: One 120-bed VA-affiliated and one 125-bed university-affiliated, community-based nursing home in Durham, North Carolina. PATIENTS: One hundred fifty-eight chronic care nursing home residents without aphasia, acute illness, persistent vegetative status, or severe hearing impairment and 3 1 nursing home nurses. OUTCOME MEASURES: Pain prevalence according to resident self-report and nurse report; stability of response to the structured pain interview and 0-10 scale over 1 month; agreement between residents and nurses on the structured pain interview and 0-10 scale. RESULTS: Fifty-eight percent of the VA and 45% of the community nursing home residents reported pain. Forty-two percent at the VA and 20% at the community home were unable to respond to the 0-10 scale, compared with 7.5% and 14% using the structured pain interview. Stability of response to the structured pain interview at 1 month was 0.56 at the VA (nurse-resident agreement 0.38) and 0.72 in the community (nurse-resident agreement 0.07), which was very comparable to the 0-10 scale. CONCLUSIONS: We have developed a highly feasible tool for examining pain prevalence in nursing homes. This tool uncovered considerable miscommunication regarding pain between residents and staff. Improvement in pain communication between nursing home residents and staff is needed, so that more effective pain treatment programs can be developed for this vulnerable population.

Attitude of Health Personnel↗
PubMed1999

Screening methods for thyroid hormone disruptors.

The U.S. Congress has passed legislation requiring the EPA to implement screening tests for identifying endocrine-disrupting chemicals. A series of workshops was sponsored by the EPA, the Chemical Manufacturers Association, and the World Wildlife Fund; one workshop focused on screens for chemicals that alter thyroid hormone function and homeostasis. Participants at this meeting identified and examined methods to detect alterations in thyroid hormone synthesis, transport, and catabolism. In addition, some methods to detect chemicals that bind to the thyroid hormone receptors acting as either agonists or antagonists were also identified. Screening methods used in mammals as well as other vertebrate classes were examined. There was a general consensus that all known chemicals which interfere with thyroid hormone function and homeostasis act by either inhibiting synthesis, altering serum transport proteins, or by increasing catabolism of thyroid hormones. There are no direct data to support the assertion that certain environmental chemicals bind and activate the thyroid hormone receptors; further research is indicated. In light of this, screening methods should reflect known mechanisms of action. Most methods examined, albeit useful for mechanistic studies, were thought to be too specific and therefore would not be applicable for broad-based screening. Determination of serum thyroid hormone concentrations following chemical exposure in rodents was thought to be a reasonable initial screen. Concurrent histologic evaluation of the thyroid would strengthen this screen. Similar methods in teleosts may be useful as screens, but would require indicators of tissue production of thyroid hormones. The use of tadpole metamorphosis as a screen may also be useful; however, this method requires validation and standardization prior to use as a broad-based screen.

Animals↗
PubMed1996

Pain measurement in elders with chronic low back pain: traditional and alternative approaches.

Pain evaluation typically relies upon the use of self-report instruments. The validity of these tools is questionable in many older adults, however, particularly those with cognitive impairment. Rating of pain behavior (e.g. grimacing, sighing) by an objective observer represents an alternative pain assessment strategy which has been validated in subjects of heterogeneous ages. The purpose of this study was to examine, in a group of community-dwelling elderly with low back pain and lumbosacral osteoarthritis, the concurrent validity of observational pain behavior rating techniques as compared with self-report instruments and the degree to which pain and pain behavior relate to disability. Thirty-nine cognitively intact subjects, age > 65 years, without depression, other sources of pain, or other known spinal pathology underwent the following measures: (1) pain self-report using the verbal 0-10 scale, vertical verbal descriptor scale, Arthritis Impact Measurement Scales and McGill Pain Questionnaire; (2) pain behavior was sampled during two protocols, one, identical to that used by Keefe and Block (Behav. Ther., 13 (1982) 363-375), that required subjects to sit, stand, walk, and recline for 1-2 minute periods (which we have labelled the traditional protocol), and a second, more demanding protocol that was designed to simulate activities of daily living that place a premium on axial movement (the 'ADL' protocol); (3) disability was assessed using the Roland questionnaire, a 6 month global disability question and the Jette Functional Status Index; and (4) radiographic evaluation of the lumbosacral spine; osteoarthritis was quantitated using a previously validated scoring system. Interrelationships among pain, pain behavior and disability measures were tested using canonical correlations. Self-reported pain was associated with pain behavior frequency; the association was stronger when the ADL protocol was used, as compared with the traditional protocol. The association between pain and disability was modestly strong with both self-report instruments and pain behavior observation when the ADL protocol was used, but not when the traditional protocol was used. Our findings suggest that pain behavior observation is a valid assessment tool in the elderly. In addition, it seems that observation of elders during performance of activities of daily living may be a more sensitive and valid way of assessing pain behavior than observing pain behavior during sitting, walking, standing, or reclining.

Activities of Daily Living↗
PubMed1996

The reliability, validity, and stability of a measure of physical activity in the elderly.

OBJECTIVE: To assess the reliability, validity, and stability of an accelerometer-based monitor of physical activity in an elderly population. DESIGN: Six studies were conducted to assess the Tritrac, a newly available accelerometer capable of storing three-dimensional activity data collected in minute epochs. After initial bench testing, the waist-worn devices were assessed for test-retest reliability during sitting and treadmill walking at 1mph and 2mph. Validity testing examined the Tritrac's ability to discriminate between different levels of physical activity and also compared the Tritrac with an established wrist-worn acclerometer, the Actigraph. Stability of the measure was examined over a period of 3 to 7 days, and in a subset of subjects this measurement was performed for a second week. SETTING AND SUBJECTS: Residents of a VA Nursing Home (n = 40; mean age = 76), participants in an in-home nonaerobic exercise program (n = 36; mean age = 77), and community participants in an aerobic exercise program (n = 10; mean age = 71). RESULTS: Intraclass correlation coefficients (ICC) for both the bench testing and test-retest reliability were .97. The device discriminated among subjects independently categorized as sedentary, moderately active, or active (F = 49.4, p = .0001) and between specific activities of varying intensity (F = 114.5, p = .0001). Tritrac and Actigraph measurement comparison showed a correlation of r = .77, p = .0001. Stability of the measure was demonstrated by ICCs = .81 and .78 for mean activity values and proportion of time spent in sedentary activity, respectively. No significant differences were observed when comparing activity measured for two separate weeks. CONCLUSION: The Tritrac is a reliable and valid instrument producing activity measurement that was stable over time in the elderly population we studied. During our longitudinal testing, 20% of the subjects did not comply with wearing the device; this noncompliance issue must be considered in any use of the Tritrac.

Aged↗
PubMed1991

Weight of the evidence on the human carcinogenicity of 2,4-D.

The phenoxy herbicide 2,4-dichlorophenoxyacetic acid (2,4-D) is widely used to control the growth of weeds and broadleaf plants. We convened a panel of 13 scientists to weigh the evidence on the human carcinogenicity of 2,4-D. The panel based its findings on a review of the toxicological and epidemiological literature on 2,4-D and related phenoxy herbicides. The toxicological data do not provide a strong basis for predicting that 2,4-D is a human carcinogen. Although a cause-effect relationship is far from being established, the epidemiological evidence for an association between exposure to 2,4-D and non-Hodgkin's lymphoma is suggestive and requires further investigation. There is little evidence of an association between use of 2,4-D and soft-tissue sarcoma or Hodgkin's disease, and no evidence of an association between 2,4-D use and any other form of cancer. Scientists on the panel were asked to categorize 2,4-D as a "known," "probable," "possible," or "unlikely" carcinogen or as a noncarcinogen in humans. The predominant opinion among the panel members was that the weight of the evidence indicates that it is possible that exposure to 2,4-D can cause cancer in humans, although not all of the panelists believed the possibility was equally likely: one thought the possibility was strong, leaning toward probable, and five thought the possibility was remote, leaning toward unlikely. Two panelists believed it unlikely that 2,4-D can cause cancer in humans.

2,4-Dichlorophenoxyacetic Acid↗
PubMed1983

Effect of 60Co-irradiation on the development and immunogenicity of Plasmodium berghei sporozoites in Anopheles stephensi mosquitoes.

Protection conferred to mice by Plasmodium berghei sporozoites increased significantly when the time interval between 60Co-irradiation of the infected mosquitoes and harvest of sporozoites increased. One thousand sporozoites conferred no protection against challenge if harvested on the day of irradiation, but protected 60% of recipient mice when harvested 28 days postirradiation. When the time between feeding of mosquitoes and irradiation was varied, sporozoites from mosquitoes irradiated 3 days after feeding were infective for mice. Sporozoites from mosquitoes irradiated on day 10 postfeeding were not infective, but were immunogenic. In all experiments a decline occurred in the number of recoverable sporozoites over a 28-day period postirradiation to less than 10% of the yield on the day of irradiation.

Animals↗
PubMed1979

Duration of immunity following a single vaccination with irradiated sporozoites of Plasmodium berghei.

A rodent model of sporozoite immunization against malaria based on a single immunizing dose is described. The duration of protective immunity was measured as a function of dose, and the results suggest that the percentage of protection follows a bimodal distribution. The first peak occurs between days 7-12 after immunization, while the second peak occurs at approximately 28 days. Although the percentage of protection declines steadily after the second peak, some immunity was detectable as long as 140 days after immunization with the higher doses.

Animals↗