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Low psychosocial resources during early pregnancy are not associated with prolonged labour.

OBJECTIVES: To examine if a low level of psychosocial resources in early pregnancy is associated with the occurrence of prolonged labour. STUDY DESIGN: A cross sectional study of 644 women expecting their first child. Participants were asked to complete a questionnaire at their first antenatal visit, measuring psychosocial resources defined as social network and support, work-related psychosocial factors, control of daily life and health characteristics. Outcome was prolonged labour at the end of the pregnancy. RESULTS: A low level of psychosocial resources was not associated with prolonged labour. The majority of women reported that the degree of support was high in early pregnancy. CONCLUSIONS: A perceived low level of psychosocial resources in early pregnancy did not increase the risk of prolonged labour at the subsequent delivery.

Adult↗

Association of hospital resource use with comorbidity status and patient age among hip fracture patients in Japan.

OBJECTIVES: This study examined the association of resource use with comorbidity status and patient age among hip fracture patients who underwent surgical treatment. DESIGN: We used a database from the Voluntary Hospitals of Japan Quality Indicator Project that involved 10 privately owned leading teaching hospitals in Japan. SETTING: Four of these hospitals in Japan. PARTICIPANTS: We selected 778 operable hip fracture patients aged 65 or older who were admitted to these hospitals between January 1996 and August 2000 (mean age: 80.3 +/- 7.3 years). MEASUREMENTS: A linear mixed model was performed to identify factors associated with the resource use, such as total length of stay (LOS), LOS before surgery, LOS after surgery, total hospital charges, charges for diagnostic examinations, charges for surgery, and length of theater time, among operable hip fracture patients. RESULTS: The mean LOS was 45.9 days, and the mean total hospital charges were US dollars 14,495.0. Results from linear mixed models revealed that higher age was significantly associated with shorter length of theater time (P < 0.01), and that the presence of comorbidity among hip fracture patients was significantly associated with longer total LOS (P < 0.01), longer LOS after surgery (P < 0.001), higher charges for diagnostic examinations (P < 0.001), and shorter length of theater time (P < 0.01). CONCLUSION: These results suggest that the presence of comorbidity among operable hip fracture patients requires greater resource use during their hospital stay, but higher age is not significantly associated with greater resource use at all.

Aged↗

Ultrasensitive quantitative HIV-1 p24 antigen assay adapted to dried plasma spots to improve treatment monitoring in low-resource settings.

BACKGROUND: Our group has previously developed a quantitative and ultrasensitive HIV-1 p24 antigen assay that is inexpensive, easy-to-perform, and can be carried out in low-resource settings. Since antiretroviral therapies are becoming more accessible in resource-constrained countries, methods to assess HIV-1 viraemia are urgently needed to achieve a high standard of care in HIV-1 management. OBJECTIVES: To adapt our quantitative assay to dried plasma spots (DPS), in order to further simplify this test and make it more accessible to resource-constrained countries. STUDY DESIGN: DPS from 47 HIV-seropositive, treated or untreated adult individuals and 30 healthy individuals were examined. RESULTS: A specificity of 100% was observed when p24 antigen was measured using DPS, and no differences of p24 concentration could be seen between DPS and venous plasma. The correlation between DPS and venous plasma p24 was excellent (R=0.93, CI(95%)=0.88-0.96, p<0.0001). Similarly, p24 antigen concentrations using DPS were well correlated with RNA viral load (R=0.53, CI(95%)=0.27-0.72, p=0.0002). CONCLUSIONS: This quantitative p24 antigen test has similar sensitivity and specificity using DPS and venous plasma, and has the potential to improve health care delivery to HIV-affected individuals in resource-constrained countries.

AIDS Serodiagnosis↗

Interdisciplinary resources optimize Evidence-Based Dental Practice.

Evidence-Based Dental Practice (EBDP) is the most appropriate and best patient-centered care because it uses the evidence derived from interdisciplinary resources. These resources include the integration of the clinical and basic science researcher, clinician, and patient in the clinical decision-making process. Best evidence has different meanings to each of the interdisciplinary decision makers and, thus, defines their individual roles accordingly. Implementing EBDP requires an organizational structure and process that involve evidence-based dentistry databases in centralized repositories that are shared nationally and internationally. Facilitating the inclusive and reciprocal transfer of information from all resources requires use of information technology and computerized decision-making support programs. However, the potential lack of financial resources and incentives will diminish the universal adoption of EBDP.

Journal Article↗

Do "savanna" chimpanzees consume C4 resources?

Several stable carbon isotopic studies have shown that South African australopiths consumed significant quantities of C(4) resources (tropical grasses, sedges, or animals that eat those foods), but relatively little is known about the consumption of such resources by chimpanzees. Here, we present stable carbon isotopic data for 36 chimpanzee hair samples from Fongoli, one of the driest and most open areas inhabited by chimpanzees. These data suggest that the Fongoli chimpanzees consume little in the way of C(4) vegetation or animals that eat such vegetation, even though these resources are locally abundant and preferred fruits are more widely scattered than at most chimpanzee study sites. The homogeneity of the Fongoli results is especially striking and recalls the narrow isotopic distribution of stenotopic savanna mammals. This is in stark contrast to what has been observed for australopiths, which had highly variable diets and consumed about 35% C(4) vegetation on average. Carbon isotope data for modern and fossil Papio depict a dietarily variable genus with a tendency to consume C(4) vegetation. This trophic flexibility, or willingness to consume C(4) savanna resources, may make Papio a more profitable ecological analog for australopiths than chimpanzees.

Animals↗

Sexual victimization: incidence, knowledge and resource use among a population of college women.

STUDY OBJECTIVE: To assess the incidence of sexual victimization among a convenience sample of college women and evaluate both victims and non-victims' knowledge and use of available on and off campus resources. DESIGN: Written questionnaire distributed to students in lobbies of two campus libraries and large computing center SETTING: A private northeastern university PARTICIPANTS: Upper-class undergraduate women (sophomores, juniors and seniors) MAIN OUTCOME MEASURES: Respondents (n=234) were asked to complete demographic information, report instances of sexual victimization (including rape, sexual coercion and unwanted sexual contact) that occurred during the 1999-2000 academic year and indicate whether they would or did use either university and/or outside resources available to sexual assault victims. RESULTS: Of the women who participated, 38% (90/234) affirmed one or more episodes of sexual victimization, with 6% (14/234) reporting a completed rape and 4% (9/234) an attempted rape. Drug or alcohol-related impairment leading to unwanted sexual activity was reported by 15% (35/234) of women. Utilization of available on- and off-campus resources was uncommon among victims (22% and 6%, respectively); 12% contacted health services, while only 4% reported an event to university security. Victims cited fear, embarrassment and guilt, as well as lack of confidentiality, as the most common reasons for failure to use resources. CONCLUSIONS: Increasing campus awareness of sexual victimization and removing barriers to access for victims should remain university goals.

Adolescent↗

Severity of AD/HD symptoms and efficiency of attentional resource allocation.

This study investigated the mechanism that underlies the inefficient allocation of attentional resources in Attention-Deficit/Hyperactivity Disorder (AD/HD). The P300 event-related brain potential (ERP) was elicited from 24 healthy adults using a visual three-stimulus oddball paradigm (standard, 70%; target, 15%; non-target, 15%) and the degree of their AD/HD symptoms was assessed by using AD/HD symptom scales. Target stimulus was a circle and standard stimulus was an "X". Two task conditions were defined according to the non-target stimulus type (typical or novel): a triangle for the typical condition and colored non-repetitive novel stimuli for the novel condition. In both conditions, target and non-target elicited P300s. A ratio of non-target P300 to target P300 amplitude was used to assess the efficiency of attentional resource allocation; low ratio indicates the efficient allocation of attentional resource. The correlation analysis revealed a strong positive correlation between the AD/HD symptom score and the P300 amplitude ratio in the typical condition (r=.80), while only a weak positive correlation was observed in the novel condition (r=.23). The present study found that the commonality of task-relevant and task-irrelevant information, rather than the stimulus novelty of task-irrelevant information, induces the inefficient allocation of attentional resources in AD/HD.

Adult↗

Impact of the British Thoracic Society chronic obstructive pulmonary disease guidelines on patients' health status, healthcare resource use and health-related quality of life.

BACKGROUND: British Thoracic Society (BTS) guidelines for chronic obstructive pulmonary disease (COPD) management are a consensus view and their impact on patients is unknown. AIM: To determine the impact of the BTS COPD guidelines on patients' health status, healthcare resource use and health-related quality of life (HRQL). DESIGN AND SETTING: This was an observational, parallel group, cluster-controlled study comparing patients who were managed in general practices according to BTS guidelines (active practices) or usual care (control practices). METHODS: 13 active and 13 matched control practices participated in the study. Patients completed the St. George's Respiratory Questionnaire (SGRQ) and Short Form 36 (SF-36) at their screening visit and 12 months later during which time their airway function was measured. Healthcare resource use and drug utilisation data during the study period were also recorded. MAIN OUTCOME MEASURES AND RESULTS: 279 and 230 patients from active and control practices respectively were eligible for analysis. No significant differences in airway function were detected between patients managed at active and control practices. There were no significant differences in healthcare resource use and disease-specific quality of life indicators as measured by the SGRQ. There were some significant differences in health status between patients managed at active practices compared with controls as measured by the SF-36. CONCLUSION: Patients managed in general practice according to BTS guidelines experienced minor improvements in health status. Treatment strategy had no detectable impact on patients' airway function and healthcare resource use.

Journal Article↗

Learned resourcefulness and smoking cessation revisited.

OBJECTIVE: Even though many young addicted smokers profess a desire to quit, majority of them are unsuccessful in their attempts. A major goal was to determine whether successful quitters are better equipped cognitively and behaviorally to deal with the adverse effects associated with the cessation process than unsuccessful quitters, because they possess a larger repertoire of learned resourcefulness skills. METHOD: Undergraduate university students, consisting of 69 never-smokers, 59 successful quitters and 61 unsuccessful quitters, completed Rosenbaum's (1980) Self-Control Schedule assessing one's general repertoire of learned resourcefulness skills. Daily smoking rate, age started smoking, years smoking, quit attempts, difficulty quitting, quitting importance, motivation, self-efficacy and use of smoking self-regulatory strategies also were compared for the smoking groups. RESULTS: Never-smokers and successful quitters were significantly more resourceful than unsuccessful quitters. Even though both smoking groups smoked the same daily rate and started smoking at the same age, unsuccessful quitters in comparison to successful quitters viewed quitting smoking as less important and as more difficult, were more extrinsically motivated to quit, less efficacious, and used fewer self-regulatory strategies during their quit attempts. DISCUSSION: The discussion highlights the prominent role that SCS scores, self-efficacy and especially perceived quitting difficulty play in the smoking cessation process. CONCLUSIONS AND PRACTICAL IMPLICATIONS: Low resourceful smokers having difficulty quitting may find workshops on general life skills beneficial. Concurrently providing them with specific smoking cessation strategies may further serve to enhance these smokers' self-efficacy.

Adult↗

Demands and resources: parents of school-age children with asthma.

Asthma is one of the most common chronic diseases in children and is frequently noted as the reason for school absences. The purpose of this pilot study was to determine the differences in demands and resources reported by African American (AA) and European American (EA) parents of school-age children with asthma. A convenience sample of 37 parents participated in the study. Data were collected from 19 AA and 18 EA parents. Family stress theory provided the framework for this study. All subjects completed a demographic questionnaire, the Care of My Child With Asthma Scale, and the Family Inventory of Resources for Management (FIRM). Descriptive statistics were used to analyze the data. The most time-consuming caregiving demand reported by EA parents was providing emotional support for the child. For AA parents, the most time-consuming caregiving demand was managing work or school outside the home and organizing asthma treatments at the same time. AA parents had limited resources in the area of extended family social support. The Mann-Whitney U test found no statistically significant differences between AA and EA parents in relation to demands and resources. Nursing implications are presented.

Adaptation, Psychological↗

Food management practices used by people with limited resources to maintain food sufficiency as reported by nutrition educators.

The food management practices used by people with limited resources to ensure food sufficiency have not been fully characterized. Semistructured interviews were conducted with 51 nutrition educators from the New Jersey Expanded Food and Nutrition Education Program and Food Stamp Nutrition Education Program, regarding the food management practices of program participants. Practices were grouped into two categories using the constant comparative method: manage food supply (n = 14) and regulate eating patterns (n = 15). Well-documented stratagems, such as overeating when food is available and cycling monthly eating patterns, were confirmed. Novel practices were identified. Practices causing food safety or nutritional risks included removing spoiled sections, slime, mold, and insects from food; eating other people's leftovers; and, eating meat found as road kill. A foundation was formed for a grounded theory concerning food management practices by people with limited resources. Verification of these results with audiences with limited resources and determination of prevalence and relative risk of these practices is necessary. This research is important for nutrition professionals who work with people with limited resources because it elucidated a spectrum of safe and risky food management practices, proposed methods to ameliorate monthly eating pattern cycles, and exposed the possibility of food insecurity in unsuspected cases.

Adolescent↗

Applying the resource-based relative value scale to the Emory angioplasty versus surgery trial.

The resource-based relative value scale developed for use in the Medicare fee schedule can also be very useful in profiling and comparing physicians' cardiovascular utilization across different medical activities. This article applies relative value units (RVUs) to data from the Emory Angioplasty versus Surgery Trial. The Emory Angioplasty versus Surgery Trial was a randomized clinical trial to determine the efficacy of percutaneous transluminal coronary angioplasty (PTCA) versus coronary artery bypass surgery (CABG). All physician services in the clinical trial provided to 2 groups of patients--those undergoing CABG and those receiving PTCA-over the course of 4 years were assigned physician work RVUs (representing the intensity of physician work required) and total RVUs (representing both the intensity and practice costs). Physician charges were also compiled. These data were used to profile and compare physician services to the 2 groups of patients by type of service, distribution over time, and clinical department. Comparisons based on RVUs contrast sharply with differences based on charges. Mean physician charges, in 1996 dollars, were $27,158 for CABG patients and $21,491 for PTCA patients, a 26% difference (p <0.001). Physician work RVUs generated an 18.3% difference (p = <0.001). Using total RVUs, the difference between the 2 groups was 3.3% (p = 0.249). Resource-based relative value weights are a valuable tool for analyzing and comparing physicians' use of cardiovascular resource. The results suggest that conclusions about physician resource utilization based on physician charges should be carefully evaluated. When possible, physician work RVUs should be compiled and evaluated along with physician charges.

Angina Pectoris↗

A comparison of generalist and pulmonologist care for patients hospitalized with severe chronic obstructive pulmonary disease: resource intensity, hospital costs, and survival. SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment.

PURPOSE: Both generalist and pulmonologist physicians care for patients with severe chronic obstructive pulmonary disease (COPD). We studied patients hospitalized with severe COPD to explore whether supervision of care by pulmonologists is associated with greater costs or better survival. SUBJECTS AND METHODS: We studied 866 adults with severe COPD enrolled in the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT), a prospective study at five academic medical centers. Patients were admitted to the hospital or transferred to an intensive care setting for treatment of severe COPD, defined by hypoxia (PaO2 <60 mm Hg) and hypercapnia (PaCO2 >50 mm Hg) or hypercapnia alone if on supplemental oxygen. Resource intensity was measured using a modified version of the Therapeutic Intervention Scoring System and estimated hospital costs. To account for differences in the patient case mix, propensity scores were developed to represent each patient's probability of having a pulmonologist as attending physician and each patient's probability of being in an intensive care unit (ICU) at study admission. RESULTS: Of the 866 patients studied, 512 had generalists and 354 pulmonologists as their attending physicians. The median patient age was 70 years; 52% were male; 14% died within 30 days. After adjusting for baseline differences in patient characteristics, there were no differences in resource intensity and hospital costs in those treated by pulmonologists or generalists. Adjusted average resource intensity scores for the entire hospitalization were 16.5 for pulmonologists and 17.0 for generalists (P = 0.34). Estimated hospital costs were the same ($6,400) for patients treated by pulmonologists and generalists (P = 0.99). Patients with pulmonologists as attending physicians did not experience better survival. Comparing patients of pulmonologists to patients of generalists, the adjusted hazard ratio for 30-day mortality was 1.6 (95% confidence interval: 0.98, 2.5); the hazard ratio for 180-day mortality was 1.2 (0.9, 1.7). CONCLUSIONS: Our findings suggest that for patients hospitalized with exacerbation of severe COPD, those with pulmonologist attending physicians do not have higher hospital resource use or better survival than those with generalist attending physicians.

Adult↗

A six-week, resource-efficient mobility program after discharge from rehabilitation improves standing in people affected by stroke: placebo-controlled, randomised trial.

Although intervention is effective in reducing the disability associated with stroke, limited resources mean that physiotherapy services often cease by six months after stroke. The purpose of this clinical trial was to investigate the efficacy of resource-efficient physiotherapy services in improving mobility and quality of life after stroke. Twenty-six people with residual walking difficulties after stroke were randomised into an experimental or control group after discharge from physiotherapy services. The experimental group participated in a six-week, home-based mobility program. The control group participated in a six-week, home-based program of upper-limb exercises (i.e. 'sham' mobility exercises). Subjects met with the therapist for prescription of exercises only three times during the six weeks. Strategies used to offset potential problems associated with minimal subject-therapist interaction included videotaped instructions to encourage correct performance of exercises, modification of the environment and involvement of carers to enhance safety, and telephone contact and self-monitoring to promote compliance. Standing (Functional Reach), walking (MAS Item 5) and quality of life (SA-SIP30) were measured prior to, immediately after, and two months after intervention ceased by an assessor who was blinded to group allocation. Subjects in the experimental group demonstrated significant improvement in standing compared to the control group (p = 0.01) which was maintained two months after the cessation of intervention (p = 0.04). There was no difference between the groups in walking (p = 0.50) or quality of life (p = 0.70). The six-week, resource-efficient mobility program was effective in improving some of the mobility in people after discharge from stroke rehabilitation. The provision of resource-efficient programs is recommended wherever possible so that people affected by stroke may continue rehabilitation for longer.

Aged↗

Usage analysis of a primary care medical resource on the Internet.

Physicians and patients need convenient access to quality medical information. This study's goal was to place a medical resource on the World-Wide Web (WWW), allow access to it through a simple to use interface, and analyze the usage of such a resource. The Family Practice Handbook (TFPH) was digitized and placed onto the WWW. Usage data was obtained from June 1995-June 1996. 118,804 individuals accessed TFPH viewing 409,711 pages of information. A broad spectrum of topics was accessed. TFPH proved to be an extremely popular resource, servicing the broad information needs of an international audience. These preliminary findings suggest the future promise of Internet medical resources.

Arthritis, Rheumatoid↗

[Inhibition and resource capacity during normal aging: a confrontation of the dorsal-ventral and frontal models in a modified version of negative priming].

BACKGROUND: Over the past decades, cognitive psychology contribution to our understanding of aging relies on two major perspectives, focusing on the selective impact of age on either cognitive multiple-systems or global factors of cognition: slowing, working memory and inhibition. In the latter, reduction in inhibitory control during aging (in its access, deletion or restraint functions) is associated with poorer performance on a variety of tasks referring to memory, comprehension or language [Hasher, Zacks and May (16)]. The attractiveness of inhibition as an explanatory factor results in part in the absence of negative priming during aging. Negative priming refers to the slow down of latencies when individuals have to respond to recently ignored informations, compared to unrelated informations. The dissociation, between a preserved location negative priming and an absence of identity negative priming during aging, supports the dorsal-ventral model of inhibition which suggests that spatial and identity inhibition are supported by different and independent visual pathways. An alternative model, directly at odds, is that inhibitory mechanisms are supported by the frontal lobe. In this perspective, inhibition is not a central process responsible for the control of working memory contents, but an automatic and local mechanism whose triggering depends on controlled attention. Therefore, working memory drives efficient inhibition by sustaining task instructions and appropriate responses throughout task execution. This hypothesis is consistent with Houghton and Tipper's (17) architecture of selective attention. According to the authors, the presence or absence of automatic inhibition is very closely linked to a Match/Mismatch field whose function is to compare the present stimulus to an internal self-generated internal template. When an information fails to match the subject's current goals, the match/mismatch field causes an automatic inhibitory imbalance which reduces the to-be-ignored properties' responsiveness. In contrast, information matching subjects' goal is enhanced through an automatic excitatory imbalance. The accurate functioning of the Match/Mismatch field requires efficient executive functioning responsible for the uphold of goals and correct responses. In the case of negative priming, manipulating the efficiency of working memory is of interest as it should affect the triggering of slowing, ie, an indirect inhibitory deficit, when the task is resource demanding [Conwayet al. (6)]. Moreover, if inhibition, as reflected by negative priming, is mediated by individual resource capacity, then NP should disappear during aging only when individuals are engaged in a resource-demanding task. OBJECTIVES: To address this issue, we examine whether cognitive control load in a gender decision task contributed to the presence or absence of NP during aging. According to the dorsal-ventral model, task complexity should not have any impact on performance, since gender decision task relies on a conceptual analysis of information. In turn, the frontal model predicts that age differences in performance profile will only differ when individual resource capacity is overloaded. DESIGN OF THE STUDY: Sixty-four participants (32 young and 32 older adults) performed a gender categorisation task through two experiments. Trials involved two stimuli presented successively at the same location. A word served as a prime and a word as a target. Both prime and target could be male or female. When prime and target matched on gender, we talked about VALID pairs (or compatible). When prime and target mismatched on the manipulated features, we talked about INVALID pairs (or incompatible). Participants' task was to identify the gender of the target. They were explicitly instructed not to respond to primes but to read them silently. Our interest was in response latencies for valid versus invalid pairs. We manipulated task complexity by the absence (experiment 1) or presence (experiment 2) of a distractor during probe trials. RESULTS: For younger adults, primes presented before targets gave rise to behavioural costs when pairs were mapped to the same response compared to pairs that were mapped to opposite ones. This slowing, called Negative Compatibility Effect (NCE), was independent of the presence or absence of a distractor. NCE was reliable for the elderly patients only under condition of no interfering information during the probe trial: pattern of performance of older participants was identical to that of young adults (experiment 1). This effect disappeared as task complexity increased (experiment 2). DISCUSSION: This result suggests that NCE triggering is dependant on the amount of cognitive control engaged by the task, and therefore that the ability to inhibit irrelevant information is secondary to a general capacity of the working memory. CONCLUSION: The implications of our data are consistent with the level of processing account, as well as the recent neuroimaging contributions which suggest, for example, the involvement of the dorso-lateral prefrontal cortex (sensitive to aging) when task demands are high, and a ventro-lateral prefrontal implication when demands are low [see Eenshuistra et al. for a review (10)].

Adult↗

A comparison of four toxicology resources in respect to rates of retrieval and time required.

An evaluation was conducted fo four periodically updated poison control resources widely used by pediatricians, emergency room personnel, and poison information/control centers; i.e., Poisindex, ToxiFile, Clinical Toxicology of Commercial Products, and the National Clearinghouse for Poison Control Centers' cards. The frequency of finding entries for substances known to be involved in accidental pediatric ingestions, the extent of the content and management information, and the time required to obtain the information were determined for the four resources. Poisindex was more complete than the other resources. ToxiFile was more useful than the remaining two resources, although the latter should be useful in over 70% of accidental toxic ingestions by children.

Humans↗

Resource-dependent selection.

This paper presents a resource-dependent viability selection differential equation model of continuously reproducing diploid population with two alleles at one locus for a single limiting resource. This model assumes that the genotypic fitness is only a function of the limiting resource. The conditions that the interior equilibrium point of the system exists are that the heterozygote fitness is positive and the homozygote fitness is negative, or the heterozygote fitness is negative and the homozygote fitness is positive at the point. The sufficient and necessary conditions of locally asymptotical stability of the interior equilibrium point are that the heterozygote fitness is positive at the point, or the locally asymptotically stable equilibrium corresponds to the point at which the level of the limiting resource is locally minimized on the zero mean fitness curve, f = 0.

Animals↗