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PubMedDate not supplied

Proliferation of electronic health records among obstetrician-gynecologists.

OBJECTIVE: To examine the current use of electronic health records (EHRs) and their key subfunctions among obstetrician-gynecologists and compare this trend with other doctors. METHODS: In this study, we examined responses to a large statewide study of EHR use among Florida physicians practicing in the ambulatory setting. For assessment purposes, we compared obstetrician-gynecologists with other primary care physicians (PCPs) and surgeons with respect to EHR utilization, the availability of key EHR functions, and time since adoption. In addition, we examined adoption intentions among non-EHR users. To compare differences among groups, the chi-square test was utilized with significance level set at P < .05. RESULTS: A total of 2428 responses (28.4% response rate), of which 454 were from obstetrician-gynecologists, were available for the current study. EHR use among obstetrician-gynecologists (18.3%) was significantly less (P < .001) than among PCPs (25.7%) and surgeons (20.5%). Among EHR users, obstetrician-gynecologists were significantly less likely than PCPs to have the following desirable EHR functions: problem lists (P < .001), medication lists (P < .001), allergy information (P = .014), electronic prescribing of medications (P = .001), electronic order entry (P = .009), electronically available laboratory results (P = .002), electronic connection to pharmacy information (P = .008), preventative service reminders (P < .001), and patient education material (P = .004). Moreover, obstetrician-gynecologists were significantly more likely to have adopted their system within the last 2 years. However, among nonusers, they were not more likely to indicate the intention to adopt EHR. CONCLUSION: Compared with peers, obstetrician-gynecologists are less likely to be using EHR in their practice. In addition, their systems tend to have fewer medical error preventing functions and fewer basic functions.

Adult↗
PubMed2005

Autogenous fascia lata grafts: clinical applications in reanimation of the totally or partially paralyzed face.

BACKGROUND: Although they are traditionally reserved for "aesthetic refinement" in the latter stages of facial reanimation surgery, the author uses a variety of autogenous fascia lata grafts in a very aggressive approach as the primary therapeutic option in static facial rebalancing and/or in conjunction with dynamic muscle transfers to achieve architectural integrity and functional restoration of the totally or partially paralyzed face. METHODS: Forty-nine autogenous fascia lata grafts, harvested through serial incisions in the lateral thigh, were placed in 35 totally or partially paralyzed faces. The grafts were categorized by anatomical location: I and II, lateral lip in totally paralyzed and partially paralyzed faces, respectively; III, nostril suspension; IV, lower eyelid suspension; V, bimalar lower lip sling; and VI, platysma transfer/autogenous fascia lata extension for lower lip invagination. RESULTS: In all group I and II cases, static balance of facial architecture was restored at 4 to 6 weeks (after swelling resolved). Average lip commissure displacement was corrected to within 0.5 cm of the horizontal axis. Subjective functional improvement in speech, fluid retention, and chewing was immediate in all cases. In group I (n = 10; median age, 10.5 years), a 60 to 100 percent symmetrical smile was achieved with voluntary gracilis contraction of 3 of 5 to 5 of 5. In group II (n = 20; median age, 33 years), with 16 sling only patients, one to two grades of voluntary risorius and lip elevator motion were achieved in most. When accompanied by a temporalis turnover flap, both risorius and lip elevator function improved two to three grades. In group III (n = 5), inspiratory collapse was ameliorated in all cases and nasal flow improved subjectively 80 to 100 percent. In group IV (n = 4), scleral show and keratitis were improved in all cases. In group V (n = 6), improved oral competence was achieved in all patients. In group VI (n = 4), static lip evagination was achieved in all cases; voluntary lip depressor function was two to four grades improved. CONCLUSIONS: Early placement of autogenous fascia lata restores static balance of the deeper facial architecture in repose. Functional improvement of chewing, fluid retention, speech articulation, smile symmetry, and ectropion is immediate. The psychological effect is also immediate, with achievement of self-esteem and acceptance by family and peers.

Adolescent↗
PubMed2001

An investigation of female adolescent twins with both major depression and conduct disorder.

OBJECTIVE: Conduct disorder (CD) and major depression (MDD) frequently co-occur in adolescents, but little is known about the characteristics and functioning of youths, especially females, with both disorders. This study describes the functioning of female adolescents with histories of both CD and MDD. METHOD: Subjects were selected from an epidemiological sample of 17-year-old female twins based on having a lifetime DSM-III-R diagnosis of MDD and/or CD; control subjects had no history of either disorder. RESULTS: In nearly all domains examined, including measures of academic success (including academic achievement and school adjustment), personality, quality of peer relationships, and high-risk behavior (including substance dependence and early sexual experience), main effects of one or both disorders were found and related to impaired functioning. In addition, interaction effects were found in the areas of substance dependence symptoms (for all classes of substances), negative school-related events, and a personality-based predisposition not to experience positive emotions, indicating that those with both diagnoses were especially impaired. CONCLUSIONS: In some domains, histories of MDD and CD interact and relate to particularly severe problems. The implications of these findings for research and treatment, including the high likelihood of substance and school adjustment problems in these youths, are discussed.

Adaptation, Psychological↗
PubMed2006

Evaluating the discriminant accuracy of a grammatical measure with Spanish-speaking children.

PURPOSE: The purpose of this study was to evaluate the discriminant accuracy of a grammatical measure for the identification of language impairment in Latino Spanish-speaking children. The authors hypothesized that if exposure to and use of English as a second language have an effect on the first language, bilingual children might exhibit lower rates of grammatical accuracy than their peers and be more likely to be misclassified. METHOD: Eighty children with typical language development and 80 with language impairment were sampled from 4 different geographical regions and compared using linear discriminant function analysis. RESULTS: Results indicated fair-to-good sensitivity from 4;0 to 5;1 years, good sensitivity from 5;2 to 5;11 years, and poor sensitivity above age 6 years. The discriminant functions derived from the exploratory studies were able to predict group membership in confirmatory analyses with fair-to-excellent sensitivity up to age 6 years. Children who were bilingual did not show lower scores and were not more likely to be misclassified compared with their Spanish-only peers. CONCLUSIONS: The measure seems to be appropriate for identifying language impairment in either Spanish-dominant or Spanish-only speakers between 4 and 6 years of age. However, for older children, supplemental testing is necessary.

Child Language↗
PubMedDate not supplied

Peer instruction of home glucose monitoring.

During a 2-wk summer camp for insulin-dependent children aged 9-15 yr, a voluntary program of home glucose monitoring using an Ames' Dextrometer was offered. The primary instructors were campers who had mastered the procedure and who, with limited staff assistance, tutored naive campers. By camp's end, 96% of all naive campers had practiced this new home glucose monitoring procedure. Procedural errors were infrequent and decreased as a function of practice. No significant differences were found in error rates as a function of either the age or sex of the user. The data suggest that home glucose monitoring could be incorporated into the treatment regimen of many young patients and that peer instruction is an effective method of introducing the procedure to young children.

Adolescent↗
PubMed2006

Testosterone levels and sexual maturation predict substance use disorders in adolescent boys: a prospective study.

BACKGROUND: This investigation determined whether testosterone level and sexual maturation in boys biased development of socially nonnormative behavior culminating in a substance use disorder (SUD). METHODS: The subjects were 179 boys recruited in late childhood through a high-risk paradigm. Path analysis was used to evaluate the influence of testosterone level and sexual maturation in early adolescence (age 12-14) on attitudes toward antisociality, affiliation with deviant peers, and social potency in middle adolescence (age 16), illicit drug use by late adolescence (age 19), and SUD in young adulthood (age 22). RESULTS: Testosterone level predicted social potency and approval of aggressive/antisocial behavior. Sexual maturation mediated the relation between testosterone level in early adolescence and later affiliation with deviant peers. Social potency, approval of aggressive/antisocial behavior, and deviant peer affiliations predicted illicit drug use by late adolescence that in turn predicted SUD in young adulthood. CONCLUSIONS: This study demonstrated that pubertal processes in early adolescence influence the risk for SUD via effects on psychosocial functioning.

Adolescent↗
PubMed1999

The impact of spinal cord injury on men's time use.

BACKGROUND: Despite evidence of the relationship between time use and health and well-being, and the World Health Organization's recognition of activity limitation as a measure of dis-ability, there has been limited investigation into the activity patterns of persons with disabilities. METHODS: Interviews and time diaries to provide preliminary descriptive and analytical information about the daily time use patterns of men with a spinal cord injury (SCI) living in the community (n=312) compared with the time use data of able-bodied men (n=3617) collected as part of the 1992 Canadian General Social Survey. The study also examined relationships between time use by men with SCI and selected factors (severity of disability and socioeconomic status). FINDINGS: Statistically different time use patterns between the SCI and able-bodied subjects. The men with spinal cord injury spent on average 7.2 h in leisure activities (able-bodied men=6.0 h); 4.7 (7.7) h in productivity; 3.7 (2.3) h in personal care; and 8.5 (8.0) h sleeping. The SCI men's lesser productivity time was accounted for largely by the lack of time spent in paid work. The average time use of the SCI sample showed the most time spent in passive leisure pursuits such as watching TV and listening to the radio. The sample rated their satisfaction with their time use as mediocre, but levels of adjustment to disability were moderate to high. Regression analysis revealed that severity of disability (lesion level, functional independence, environment) did not predict the amount of time spent in personal care, productivity, leisure, or sleep. Socioeconomic status had a mild predictive relationship with time allocation. IMPLICATIONS: The findings suggest men with SCI are socially isolated relative to their able-bodied peers. Recommendations are made and include both methodological considerations for further time use studies with persons with SCI, and policy recommendations. The latter focus on the need for rehabilitation, education and resources that go beyond functional independence such that persons with SCI can expand both their leisure and productivity roles and become better socially and economically integrated into society.

Activities of Daily Living↗
PubMed2004

Global analysis of bacterial transcription factors to predict cellular target processes.

Whole-genome sequences are now available for >100 bacterial species, giving unprecedented power to comparative genomics approaches. We have applied genome-context methods to predict target processes that are regulated by transcription factors (TFs). Of 128 orthologous groups of proteins annotated as TFs, to date, 36 are functionally uncharacterized; in our analysis we predict a probable cellular target process or biochemical pathway for half of these functionally uncharacterized TFs.

Bacteria↗
PubMed2003

Post-transcriptional control of human maxiK potassium channel activity and acute oxygen sensitivity by chronic hypoxia.

Various cardiorespiratory diseases (e.g. congestive heart failure, emphysema) result in systemic hypoxia and patients consequently demonstrate adaptive cellular responses which predispose them to conditions such as pulmonary hypertension and stroke. Central to many affected excitable tissues is activity of large conductance, Ca2+-activated K+ (maxiK) channels. We have studied maxiK channel activity in HEK293 cells stably co-expressing the most widely distributed of the human alpha- and beta-subunits that constitute these channel following maneuvers which mimic severe hypoxia. At all [Ca2+]i, chronic hypoxia (approximately 18 mm Hg, 72 h) increased K+ current density, most markedly at physiological [Ca2+]i K+ currents in cells cultured in normoxia showed a [Ca2+]i-dependent sensitivity to acute hypoxic inhibition ( approximately 25 mm Hg, 3 min). However, chronic hypoxia dramatically changed the Ca2+ sensitivity of this acute hypoxic inhibitory profile such that low [Ca2+]i could sustain an acute hypoxic inhibitory response. Chronic hypoxia caused no change in alpha-subunit immunoreactivity with Western blotting but evoked a 3-fold increase in beta-subunit expression. These observations were fully supported by immunocytochemistry, which also suggested that chronic hypoxia augmented alpha/beta-subunit co-localization at the plasma membrane. Using a novel nuclear run-on assay and RNase protection we found that chronic hypoxia did not alter mRNA production rates or steady-state levels, which suggests that this important environmental cue modulates maxiK channel function via post-transcriptional mechanisms.

Adaptation, Physiological↗
PubMed2003

Structural diversification and neo-functionalization during floral MADS-box gene evolution by C-terminal frameshift mutations.

Frameshift mutations generally result in loss-of-function changes since they drastically alter the protein sequence downstream of the frameshift site, besides creating premature stop codons. Here we present data suggesting that frameshift mutations in the C-terminal domain of specific ancestral MADS-box genes may have contributed to the structural and functional divergence of the MADS-box gene family. We have identified putative frameshift mutations in the conserved C-terminal motifs of the B-function DEF/AP3 subfamily, the A-function SQUA/AP1 subfamily and the E-function AGL2 subfamily, which are all involved in the specification of organ identity during flower development. The newly evolved C-terminal motifs are highly conserved, suggesting a de novo generation of functionality. Interestingly, since the new C-terminal motifs in the A- and B-function subfamilies are only found in higher eudicotyledonous flowering plants, the emergence of these two C-terminal changes coincides with the origin of a highly standardized floral structure. We speculate that the frameshift mutations described here are examples of co-evolution of the different components of a single transcription factor complex. 3' terminal frameshift mutations might provide an important but so far unrecognized mechanism to generate novel functional C-terminal motifs instrumental to the functional diversification of transcription factor families.

Amino Acid Motifs↗
PubMed1987

The effect of myasthenic syndrome antibody on presynaptic calcium channels in the mouse.

1. The action of immunoglobulin G obtained from patients with Lambert-Eaton myasthenic syndrome (LEMS IgG) was investigated by injecting mice, followed by intracellular recordings from the mouse diaphragm. 2. End-plate potential quantal content was studied over a range of Ca2+ concentrations. Curves of log quantal content versus log Ca2+ concentration were shifted to the right by LEMS IgG. For low Ca2+ concentrations, release continued to follow Poisson statistics after LEMS IgG treatment. 3. Miniature end-plate potential (m.e.p.p.) frequency was measured in solutions containing high K+ concentrations. LEMS IgG significantly reduced m.e.p.p. frequency at each K+ concentration studied. 4. M.e.p.p. frequency was measured at fixed high-K+ concentration (15.9 mM) for a range of Ca2+ concentrations. The log-log plot of m.e.p.p. frequency versus Ca2+ concentration was shifted downwards throughout by LEMS IgG. 5. M.e.p.p. frequency was not affected by LEMS IgG in Ca2+-free solutions (K+ concentration 15.9 mM) or in solutions of low Ca2+ concentration (K+ concentration 5.9 mM). 6. At each Ca2+ concentration studied, m.e.p.p. amplitudes were not affected by LEMS IgG. 7. The data suggest that LEMS IgG acts on presynaptic voltage-dependent Ca2+ channels to cause their loss of function, probably by down-regulation.

Action Potentials↗
PubMed2006

Evidence for a role of the cellular ND10 protein PML in mediating intrinsic immunity against human cytomegalovirus infections.

Several viruses, including human cytomegalovirus (HCMV), encode proteins that colocalize with a cellular subnuclear structure known as ND10. Since only viral DNA deposited at ND10 initiates transcription, ND10 structures were hypothesized to be essential for viral replication. On the other hand, interferon treatment induces an up-regulation of ND10 structures and viruses have evolved polypeptides that disperse the dot-like accumulation of ND10 proteins, suggesting that ND10 could also be part of an intrinsic defense mechanism. In order to obtain evidence for either a proviral or an antiviral function of ND10, we generated primary human fibroblasts with a stable, short interfering RNA-mediated knockdown (kd) of PML. In these cells, other ND10-associated proteins like hDaxx showed a diffuse nuclear distribution. Interestingly, we observed that HCMV infection induced the de novo formation of ND10-like hDaxx and Sp100 accumulations that colocalized with IE2 and were disrupted, in the apparent absence of PML, in an IE1-dependent manner during the first hours after infection. Furthermore, infection of PML-kd cells with wild-type HCMV at a low multiplicity of infection resulted in enhanced replication. In particular, a significantly increased plaque formation was detected, suggesting that more cells are able to support initiation of replication in the absence of PML. While there was no difference in viral DNA uptake between PML-kd and control cells, we observed a considerable increase in the number of immediate-early (IE) protein-positive cells, indicating that the depletion of PML augments the initiation of viral IE gene expression. These results strongly suggest that PML functions as part of an intrinsic immune mechanism against cytomegalovirus infections.

Adaptor Proteins, Signal Transducing↗
PubMed1992

Investigation of the role of sex hormones in alcoholics' visuospatial deficits.

This study investigated whether an alcohol-related disturbance in the functioning of the hypothalamic-pituitary-gonadal axis was a factor in alcoholics' visuospatial impairment. One month detoxified male alcoholics (n = 58) performed significantly poorer than peer controls (n = 30) on a battery of visuospatial and verbal tests. Serum concentrations of testosterone, estradiol, luteinizing hormone and follicle stimulating hormone were obtained at three times during cognitive testing. Previously reported correlations in healthy young male adults between visuospatial performance with testosterone and follicle stimulating hormone concentrations were replicated in control subjects. These correlations were not significant in the alcoholics. The results suggest that chronic alcoholism may disrupt the normal relationships between the hypothalamic-pituitary-gonadal axis and cognitive functioning.

Adult↗
PubMed1997

Users evaluate LupusLine, a telephone peer counseling service.

OBJECTIVE: To assess the impact of LupusLine during its pilot phase of operation by determining patterns of utilization and user satisfaction. LupusLine is a peer counseling service designed to provide ongoing emotional support from home to home by telephone appointment. METHODS: One hundred fifty-three respondents were surveyed, using a 72-item structured questionnaire administered over the telephone by interviewers separately trained and hired specifically for this purpose. The questionnaire was pilot tested on 10 volunteers with systemic lupus erythematosus (SLE), and a panel of related health professionals reviewed the questionnaire for face validity. RESULTS: Most users were women (94.5%) who had SLE themselves (87.5%) and who called the service because of recent changes in their physical functioning and reported feelings of depression and anxiety about their illness. Forty-one percent of respondents made 6 or more calls to their assigned peer counselor. Respondents reported high levels of satisfaction across 5 highly correlated measures, with 92% of callers reporting at least moderate satisfaction with the service. Over 60% of respondents who reported a change in 6 "feeling" categories attributed this change to using LupusLine. Fewer users reported a change in 4 specific behaviors since using the service, but more respondents attributed changes, when they occurred, to LupusLine. CONCLUSIONS: Based on these initial findings, we believe that telephone networks similar to the LupusLine model may be able to offer substantial benefit to people coping with the complex, ongoing psychosocial challenges of SLE. Further, the at-home accessibility and low cost of such volunteer-based interventions may play an ever more needed role in the present health care environment.

Adult↗
PubMed1995

[Intellectual and psychosocial functions in children treated with radiation for brain tumor].

Modern treatment has increased the survival rate for children with brain tumour, but treatment with radiation may lead to late adverse neuropsychologic effects. Also, peer problems may follow long periods away from school, and painful treatment and anxiety about the disease may mobilize emotional stress reactions. 16 brain tumour children with a mean age of 11 years (range 6-16 years), all of them treated with radiation, were tested with WISC-R. The mean time between diagnosis and study was five years (range 2-11 years). Parents and teachers completed the Achenbach check lists CBCL and TRF. Children below age four years at diagnosis achieved the lowest WISC-R IQs, the highest problem scores and the lowest social adaptive scores on CBCL and TRF. More problems were reported among the youth group aged 12-16 years than among the child group aged 6-11 years. Hypoactivity and low psychomotor speed seemed to have an adverse effect on both intellectual and psychosocial functioning. An almost normal communicative and reasoning ability was a resource for most of the children.

Adaptation, Psychological↗
PubMed1999

Surveillance for sensory impairment, activity limitation, and health-related quality of life among older adults--United States, 1993-1997.

PROBLEM/CONDITION: Increases in life expectancy in the United States are accompanied by concerns regarding the cumulative impact of chronic disease and impairments on the prevalence of disability and the health status and quality of life of the growing number of older adults (defined as persons aged > or =65 years). Although older adults are the focus of these surveillance summaries, persons aged 55-64 years have also been included, when data were available, as a comparison. One important public health goal for an aging society is to minimize the impact of chronic disease and impairments on the health status of older adults, maintain their ability to live independently, and improve their quality of life. This report examines three dimensions of health status: sensory impairments, activity limitations, and health-related quality of life among older adults. REPORTING PERIOD: This report examines data regarding activity limitations and sensory impairments for 1994 and health-related quality of life for 1993-1997. DESCRIPTION OF SYSTEM: The 1994 National Health Interview Survey (NHIS) Core, NHIS disability supplement (NHIS-D1), and the 1994 NHIS Second Supplement on Aging (SOA II) were used to estimate vision impairments, hearing loss, and activity limitation. Data from the Behavioral Risk Factor Surveillance System (BRFSS) for 1993 through 1997 were used to estimate two general measures of health-related quality of life: a) the prevalence of self-rated fair or poor general health and b) the number of days during the preceding 30 days when respondents reported their physical or mental health was "not good." RESULTS: Sensory impairments are common among older adults. Among adults aged > or =70 years, 18.1% reported vision impairments, 33.2% reported hearing impairments, and 8.6% reported both hearing and vision impairments. Although older adults who reported vision and hearing impairments reported more comorbidities than their non-hearing-impaired and nonvisually impaired peers, impaired adults with sensory loss were able to sustain valued social participation roles. Advancing age was associated with increased likelihood of difficulty in performing functional activities and instrumental and basic activities of daily living, regardless of race/ethnicity, sex, and region of residence in the United States. Unhealthy days (a continuous measure of population health-related quality of life) was consistent with self-rated health (a commonly used categorical measure) and useful in identifying subtle differences among sociodemographic groups of older adults. An important finding was that adults aged 55-64 years with low socioeconomic status (i.e., less than a high school education or an annual household income of <$15,000) reported substantially greater numbers of unhealthy days than their peers aged 65-74 years. INTERPRETATION: Sensory impairments are common in adults aged > or =70 years, and prevalence of activity limitations among older adults is high and associated with advancing age. Health-related quality of life is less closely related to age, particularly when health-related quality of life includes aspects of mental health.

Activities of Daily Living↗
PubMed1997

Psychosocial characteristics of subtle and blatant racists as compared to tolerant individuals.

Studies in psychology have demonstrated that tolerant individuals demonstrate good psychological health and prejudiced individuals demonstrate poor psychosocial functioning. Past investigations have shown disturbances in interpersonal relationships for prejudiced individuals in childhood. Blatant racists aggressively assert that members of minority groups are inferior. Subtle racists blame social inequities on minority group cultures and customs. A questionnaire to distinguish tolerant individuals from blatant and subtle racists was employed. Tolerant individuals were shown to be psychologically healthier than both blatant and subtle racists. Both blatant and subtle racists show maladaptive patterns in psychosocial functioning. Both blatant and subtle racists report predicted disturbances in parental relationships, as well as insecure and hostile ties with peers.

Adult↗
PubMed1996

Rearing experience and biogenic amine activity in infant rhesus monkeys.

In this report we present evidence that early social experience influences aspects of the function of brain biogenic amine systems, most notably the noradrenergic system. Biogenic amine activity was studied in mother- vs. peer-reared monkey infants over the first 6 months of life and in response to two housing transitions. Norepinephrine (NE), 3-methoxy-4-hydroxyphenylglycol (MHPG), dihydroxyphenylacetic acid (DOPAC), homovanillic acid (HVA), and 5-hydroxyindoleacetic acid (5-HIAA) levels in cerebrospinal fluid (CSF) were measured. Peer-reared monkeys showed significantly higher CSF levels of norepinephrine and MHPG than mother-reared animals over early development, but showed an attentuated NE response to separation and group formation compared to mother-reared animals. Peer-reared monkeys showed a greater developmental decline in 5-HIAA levels than mother-reared monkeys. There were no rearing effects for DOPAC or HVA over early development; however, peer-reared monkeys showed significantly lower HVA and DOPAC concentrations at 6-8 months of age. The results add to evidence for the influence of primate mothers on the psychobiological development of central nervous system neurotransmitter systems in their infants, and suggest that the noradrenergic system is among the more sensitive of these to early experience.

Aging↗