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PubMed2003

Chronic allograft nephropathy uniformly affects recipients of cadaveric, nonidentical living-related, and living-unrelated grafts.

BACKGROUND: Chronic allograft nephropathy (CAN) remains a major barrier to long-term allograft survival. The authors retrospectively compared the development of CAN in recipients of cadaveric (CAD), living-related donor (LRD), and living-unrelated donor (LURD) transplants at their center. METHODS: The authors retrospectively examined the impact of various factors on the incidence of CAN using univariate and multivariate proportional hazards analysis in a single-center kidney transplant population. RESULTS: Between 1 January 1990 and 31 May 2000, 2,140 kidney-alone transplants were performed at the authors' center. The overall 5-year incidence of biopsy-proven CAN was 12.2% (n=203). Risk factors for CAN included the number of transplants (P=0.0001), acute rejection (P=0.0001), panel reactive antibody (P=0.0001), discharge creatinine (P=0.0001), 1-year creatinine (P=0.0015), delayed graft function (P=0.007), total human leukocyte antigen (HLA)-B and -DR mismatches (P=0.0005), recipient age (P=0.003), black donor race (P=0.001), black recipient race (0.0457), donor age (P=0.0053), cold storage time (P=0.019), and cytomegalovirus infections (P=0.002). Interestingly, although the LRD HLA-identical recipients had a significantly lower incidence of CAN (P=0.0015), the incidence of CAN in CAD and HLA-nonidentical LRD recipients did not differ. Graft survival was significantly worse in CAD recipients compared with all other groups (P<0.001). CONCLUSIONS: These results demonstrate the importance of immunologic and nonimmunologic factors on the development of CAN. The disparities in overall graft survival, despite the similarities in CAN rates, suggests that other factors, in addition to CAN, influence the increase in graft loss in CAD transplant recipients.

Adult↗
PubMed2002

Estimating paid and unpaid hours of personal assistance services in activities of daily living provided to adults living at home.

OBJECTIVE: To estimate the total hours of paid and unpaid personal assistance of daily living provided to adults living at home in the United States using nationally representative household survey data. DATA SOURCES: The Disability Followback Survey of the National Health Interview Survey on Disability (NHIS-D) conducted from 1994 to 1997. DATA COLLECTION/EXTRACTION METHODS: Data were obtained on persons receiving help with up to 5 ADLs and 10 IADLs, for up to 4 helpers, including the activities they helped with, whether the helper was paid or not, and the number of hours of help provided in the two weeks prior to the survey. The sample consists of 8,471 household-resident adults ages 18 and older receiving help with personal assistance. About 22 percent of the sample has missing data on hours, which we impute by multiple regression models using demographic, ADL, and IADL variables. FINDINGS: We estimate that 13.2 million noninstitutionalized adults receive an average of 31.4 hours per week of personal assistance in ADLs and IADLs per week, with 3.2 million people receiving an average of 17.6 hours of paid help and 11.7 million receiving an average of 30.7 hours of unpaid help. More persons ages 18-64 received help than those ages 65 and older (6.9 versus 6.2 million), but working-age recipients had fewer hours (27.4 versus 35.9) per week, due in part to less severe levels of disability. CONCLUSIONS: Personal assistance provided to adults with disabilities amounts to 21.5 billion hours of help per year, with an economic value in 1996 approaching $200 billion. Only 16 percent of this total is paid, representing $32 billion in home health services spent annually. This study, the first to estimate hours of assistance for both working-age and older adults, documents that older persons are more likely to receive paid personal assistance, while working-age people rely to a greater extent on unpaid help. This study begins to articulate the division of labor in the provision of personal assistance. Estimates of paid and unpaid hours of help by number of ADLs should inform policy concerning eligibility boundaries in long term care.

Activities of Daily Living↗
PubMed1983

Assessing self-maintenance: activities of daily living, mobility, and instrumental activities of daily living.

The aging of the population of the United States and a concern for the well-being of older people have hastened the emergence of measures of functional health. Among these, measures of basic activities of daily living, mobility, and instrumental activities of daily living have been particularly useful and are now widely available. Many are defined in similar terms and are built into available comprehensive instruments. Although studies of reliability and validity continue to be needed, especially of predictive validity, there is documented evidence that these measures of self-maintaining function can be reliably used in clinical evaluations as well as in program evaluations and in planning. Current scientific evidence indicates that evaluation by these measures helps to identify problems that require treatment or care. Such evaluation also produces useful information about prognosis and is important in monitoring the health and illness of elderly people.

Activities of Daily Living↗
PubMed2005

The nondirected living donor program: a model for cooperative donation, recovery and allocation of living donor kidneys.

We describe an altruistic nondirected (ND) and live donor/deceased donor list exchange (LE) donor program administered by an organ procurement organization (OPO) in the Washington, DC area. Screening eliminated 25 donors (17 NE; 8 LE) from the 97 donor applications (62 ND; 35 LE) completed. Twenty-one donors (16 ND; 5 LE) failed to follow through with the psychiatric evaluation, which eliminated 13 donors (9 ND; 4 LE). Two donors dropped out and 12 (9 ND; 3 LE) were medically unsuitable after final clinical evaluation. Twenty donor procedures were performed (10 ND; 10 LE) with four pending (2 ND; 2 LE). This resulted in a modest 3-5% increase in the OPO-procured kidney organ pool. The average cold ischemia time of the grafts not transported between transplant centers was 205 +/- 66 min compared with 243 +/- 48 min for transported grafts. With no documented adverse outcomes, donors had a hospital stay of length 2.9 days and at home recuperation of 12.3 days. Three- and 6-month creatinines were 1.44 +/- 1.36 and 1.68 +/- 0.61 for grafts not transported between transplant centers, and 1.6 +/- 0.27 and 1.6 +/- 0.44 for transported grafts. An OPO-administered altruistic donor program can serve as a model for cooperative donation, recovery and allocation of living donor kidneys.

Adult↗
PubMed2005

Long-term consequences of live kidney donation follow-up in 93% of living kidney donors in a single transplant center.

Live kidney donation is increasing rapidly. Increases of blood pressure and proteinuria but no accelerated loss of renal function in kidney donors have been described. The credibility of this research is hampered by retrieval rates of only 50-70% of donors. We studied renal function, blood pressure, proteinuria, parathyroid hormone, 1,25(OH)2 cholecalciferol and calcium and phosphate excretion in a live kidney donor cohort with a 93% retrieval rate. A comprehensive physical and laboratory examination including 24-h urine collection was conducted. None of the 152 donors had renal failure. Mean time after uninephrectomy was 11 +/- 7 (range: 1-28) years. GFR had declined by 25%. Blood pressure had increased from 125 +/- 15/79 +/- 11 to 134 +/- 19/81 +/- 9 mmHg (p < 0.01) but remained significantly below normal. Fifty six percent of donors developed proteinuria (>150 mg/day), but only 10% had albuminuria. Nineteen percent had increased PTH, 30% had a decreased tubular reabsorption rate of phosphate. Regarding risk factors for a higher loss of GFR, greater increases in blood pressure or proteinuria no consistent picture emerged. Because of the high incidence of proteinuria and possible changes in bone metabolism inclusion of kidney donors in registries appears worthwhile.

Adult↗
PubMed2007

Cold ischemia time and allograft outcomes in live donor renal transplantation: is live donor organ transport feasible?

One of the greatest obstacles to the implementation of regional or national kidney paired donation programs (KPD) is the need for the donor to travel to their matched recipient's hospital. While transport of the kidney is an attractive alternative, there is concern that prolonged cold ischemia time (CIT) would diminish the benefits of live donor transplantation (LDTx). To examine the impact of increased CIT in LDTx, 1-year serum creatinine (SCr), delayed graft function (DGF), acute rejection (AR) and allograft survival (AS) were analyzed in 38 467 patients by 2 h CIT groups (0-2, 2-4, 4-6 and 6-8 h) using data from the United Network for Organ Sharing/Organ Procurement and Transplantation Network (UNOS/OPTN). Adjusted probabilities of DGF and AR were estimated in multivariate logistic regression models and AS was examined in multivariate Cox proportional hazards models. Although some increase in DGF was observed between the 0-2 h (4.7%) and 4-6 h (8.3%) groups, prolonged CIT did not result in inferior SCr, increased AR or compromised AS in any group with >2 h CIT compared with the 0-2 h group. Comparable long-term outcomes for these grafts suggests that transport of live donor organs may be a feasible alternative to donor travel in KPD regions where CIT can be limited to 8 h.

Cold Ischemia↗
PubMedDate not supplied

Living in it, living with it, and moving on: dimensions of meaning during chemotherapy.

PURPOSE/OBJECTIVE: To explore the meanings assigned to the experience of receiving chemotherapy. DESIGN: Descriptive exploratory. SETTING: An oncology outpatient clinic in a university hospital in Montreal, Quebec, Canada. SAMPLE: Ten women with breast cancer who experienced chemotherapy for the first time. METHODS: Semistructured interview using a grounded theory approach. FINDINGS: Women described three dimensions of their experience with breast cancer and chemotherapy: "living in it," "living with it," and "moving on." Existential and situational meanings were an integral part of their experience. The existential meaning seemed to be present in varying degrees of intensity throughout the treatment, whereas the situational meanings were predominant at the beginning of the treatment phase and became less important as the treatment progressed. CONCLUSIONS: The intrapersonal and interpersonal dimensions of the chemotherapy experience as well as the capacity to move on evolve within a context of both situational and existential meanings. IMPLICATIONS FOR NURSING PRACTICE: The study results suggest the potential value of exploring each woman's inner world of meanings in relation to her sense of self, relationships with others, resources, and coping strategies during treatment for breast cancer. Because existential and situational meanings are an integral part of women's experience, the nurse's role is to create an environment that permits and facilitates dialogue about these dimensions of meaning.

Activities of Daily Living↗
PubMed2006

Rhythm of daily living and detection of atypical days for elderly people living alone as determined with a monitoring system.

We have developed a system for monitoring the health of elderly people living at home. Infrared and other sensor outputs are collected using a monitoring program installed on a personal computer (PC) in the home at a sampling rate of 1 Hz. Once each day, the data are transferred to a server through the Internet using a cable television (TV) connection. An elderly subject was monitored for a 12-day baseline period and completed a daily questionnaire about her activities. This enabled us to identify the rhythm of daily living (sleeping, 23:00-04:59; getting up/breakfast, 05:00-08:59; indoor activities/going out, 09:00-16:59; and dinner/going to bed, 17:00-22:59) and the average outputs from the sensors in the rooms. The subject was then monitored for a further six months. By identifying sensor output counts outside the limits of mean +/- 3SD, we were able to detect atypical days. During the six-month monitoring period, 29 atypical days were detected. We suggest that the monitoring system may be effective in tele-rehabilitation.

Activities of Daily Living↗
PubMed1992

[On the daily living and development of infants living in urban and rural regions].

Temporal pattern of daily living behavior and development in infants aged 3-6 yr were compared between urban and rural regions at Fukuoka-prefecture. The present study consisted of questionnaire on behavior of daily living and tests for development in intelligence and motor function. Rural infants got up and went to bed earlier than urban infants. Urban infants with less physical activity were inferior to rural infants in motor skill. It is suggested that manual dexterity and intelligence may be related.

Activities of Daily Living↗
PubMed2004

[The dependence medical index (DMI): validation and comparison with the activity daily living and the instrumental activity daily living].

AIM: The aim of this study was the validation of the dependence medical index (DMI), a disability medical assessment tool in the elderly. METHODS: Study sample included 1054 subjects aged 65 and over, consecutively admitted to the University Department of Geriatric Medicine of Turin, Italy. A total of 356 of these subjects was classified as dependent to activity of daily living (ADL) and instrumental activity of daily living (IADL) scales. Some conditions causing medical dependence were detected, such as strength and/or motility impairment, incontinence, pressure sores, disturbances in speech and communication, decline in sight and/or hearing, terminal illness (death expected within 6 months), need for multiple and complex therapies, episodic disorientation, dizziness with tendency to fall, use of the wheel-chair. The relationship between dependence and the DMI was studied by discriminant analysis. A scale was created using the discriminant scores of each 15 medical indications for disability. RESULTS: The discriminant model of DMI was validated by cross-validation statistical method: its application permitted to classify correctly 73.1% of the sample. The DMI permitted to classify the dependent subjects in variable percentages: from 67% (DMI score > or =1) to 90% (DMI score > or =7). The best ratio between specificity and sensibility was for score 4 to DMI. CONCLUSION: The conclusion is drawn that DMI can be used to detect and evaluate the disability for medical reasons in elderly people.

Activities of Daily Living↗
PubMed1991

[Measurement of activities of daily living in patients with dementia living at home: development of a questionnaire].

In clinical practice and for scientific research a method is needed for the assessment of changes in functioning in daily life of dementia patients living at home. As existing methods have their limitations, a questionnaire was developed (the Interview for Deterioration in Daily life in Dementia: IDDD), to be answered by caregivers. The questionnaire concerns self-care and complex activities, that are usually performed by men as well as women. Attention is paid to the difference between lack of initiative and impaired performance itself. Caregivers are interviewed in a structured interview. A study among 30 caregivers of dementia patients living at home, showed the relevance and usefulness of the questions. The questionnaire shows high internal consistency, which may be the result of our structured interview technique.

Activities of Daily Living↗
PubMedDate not supplied

Living arrangement options for young people preparing for independent living.

Innovative living arrangement options are being developed around the country to provide both preparation and practical experience in independent living for older youths unable to return home. This article describes in detail the full continuum of existing options and their general characteristics.

Activities of Daily Living↗
PubMed1987

[Normalized living--an accident? A study of the Task Force on Normalized Living on nursing homes and group care departments of nursing homes].

This article describes a research project in 17 long-stay geriatric wards (13 psychogeriatric nursing homes and 4 special wards in old people's homes), designed to establish the proportion of residents which could be capable of living in experimental, normalized nursing homes. We used an existing group of residents, living in normalized care provisions, that belong to a nursing home in the Netherlands as a reference group. In two ways we tried to answer the research question. First we applied the criteria for selection of the normalized care provisions to our random sample. In the nursing homes, 8.6% of the residents conformed to all requirements. In the old people's homes, this percentage was 10.7%. These requirements are very strict, regarded the fact that in the experimental homes six months after admission only 65% of the inhabitants met all criteria. Second, we tried to establish the overlap between the long-stay geriatric wards and the normalized, experimental care provisions. For this purpose we used the behaviour observation scale 'Observation Psychogeriatrics' (OPG). With regard to their level of impairment, 11.6% of the nursing home residents were comparable to the experimental residents. In the special wards of the old people's homes this percentage was 14.6%. The result of both methods are the same. This study proves, that the experimental homes are a serious alternative, and that the traditional psychogeriatric long-stay wards all contain a number of residents for whom alternative ways of care are possible.

Activities of Daily Living↗
PubMed1975

Enzymatic differences between short-lived and long-lived Drosophila strains.

The activities of acid and alkaline phosphatase were measured. The activity of acid phosphatase increased during the whole onto- genesis of both Drosophila strains studied--the short-lived vestigial and the long-lived white. This increase was more marked in the more rapidly ageing vestigial flies. The activity of alkaline phosphatase decreased in both strains of flies simultaneously from the larval stage to young imagos. A slight increase of the activity as in old vestigial as in adult white flies appeared.

Acid Phosphatase↗
PubMed1984

[Hydrophobic acridine dyes for fluorescence staining of mitochondria in living cells. 2. Comparison of staining of living and fixed Hela-cells with NAO and DPPAO].

The hydrophobic fluorescence dyes NAO and DPPAO (see scheme of structural formulae) stain the mitochondria of living HeLa-cells. The trans-membrane potential favours the dye accumulation of the cation NAO and supports the hydrophobic interaction of the dye with the mitochondrial membrane lipids and proteins. The lecithin-like dye DPPAO is electrical neutral. Its binding to mitochondria of living cells is only caused by hydrophobic interaction. NAO and DPPAO stain also the mitochondria of glutaraldehyde fixed HeLa-cells in aqueous medium. Fluorescence staining occurs even after extraction of the lipids of the cell with acetone. We suppose that the dye accumulation in the mitochondria of the fixed cells is caused by the hydrophobic interaction between the dyes and the very hydrophobic mitochondrial lipids and proteins.

1,2-Dipalmitoylphosphatidylcholine↗
PubMed1977

The clinical profile of male transsexuals living as females vs. those living as males.

The clinical profiles of five male groups were compared: transsexuals who live as females (FEM), those who live as males (MAL), homosexual patients (HOP), homosexual controls (HOC), and heterosexual controls (CON). The MAL group showed psychotic features on the MMPI and a greater frequency of suicide attempts than the other groups. Their sexual behavior was incongruous in that they have substantial sexual contact with men but less often desired sexual contact with men. They also less often desired to handle the penis of an adult man or to kiss him on the lips. They were more likely to find handling another's penis disgusting. However, they showed considerable involvement of their penis in sex relations with men. The FEM group, in contrast, had MMPI profiles suggestive of character disorders and tended to engage in antisocial behavior. Both MAL and FEM groups were similar in MMPI and 16 PF "femininity." The HOP group showed overall similarity to MAL but was not as pathological. The HOC and CON groups were similar in being normal but their sexual behavior differed, as expected. The paradoxical behavior of MAL is discussed as well as the parallel of the FEM group's behavior to that of criminals.

Adaptation, Psychological↗
PubMed2002

Development of a low-cost technology for mass production of the free-living nematode Panagrellus redivivus as an alternative live food for first feeding fish larvae.

The free-living nematode Panagrellus redivivus is a suitable food source for first feeding fish. In the present report, a new method for the mass production of P. redivivus is presented. The technique involves multiplication of the nematode in monoxenic (single microorganism: Saccharomyces cerevisiae) solid culture (fluid media supported by 1- to 4-cm(3) sponge cubes) in autoclavable plastic bags (size range: 50 x 30 cm to 75 x 67 cm). Two growing media were tested: oat-meal medium (OM), which is an oat-based medium (16.7% oat-meal flour in 0.8% saline solution), and purified ingredient medium (PIM), a semi-synthetic medium (1.64% meat peptone, 0.94% yeast extract, 12.6% corn starch, 0.24% glucose, 1.48% sunflower oil, in 0.8% saline solution). The bags were inoculated with 350 nematodes/g medium. After an average period of 12 days (11-13 days) at 25 degrees C, the average yield (number of nematodes/g medium) was 241 x 10(3) for OM and 333 x 10(3) for PIM in 12-l bags (50 x 30 cm). The production scale has currently reached a bag volume of 50 l (75 x 67 cm); using PIM and the conditions described above, it was possible to harvest more than 1.3 x 10(9) nematodes/bag (291 x 10(3) nematodes/g medium). In PIM, when sun flower oil was replaced with the same amount of fish oil or cod liver oil, yields of 259 x 10(3) and 290 x 10(3) nematodes/g medium, respectively, were attained. The technology for mass production and formulation of P. redivivus should enable fish-hatchery operators to rely on a cheap, standardised, and permanently available live food product for first feeding fish larvae.

Animals↗
PubMed1996

Attenuated Salmonella as live oral vaccines against typhoid fever and as live vectors.

Attenuated Salmonella typhi vaccine strain CVD 908, which harbors deletion mutations in aroC and aroD, has been shown to be well-tolerated and highly immunogenic, eliciting impressive serum antibody, mucosal IgA and cell-mediated immune responses. A further derivative prepared by introducing a deletion in htrA (which encodes a heat-shock protein that also has activity as a serine protease in CVD 908 (Chatfield et al., unpublished data) resulted in CVD 908-htrA. In phase 1 clinical trials, CVD 908-htrA appears very attractive as a live oral vaccine candidate. Both CVD 908 and CVD 908-htrA are useful as live vector vaccines to deliver foreign antigens to the immune system. Conditions that enhance the expression and immunogenicity of foreign antigens carried by CVD 908 and CVD 908-htrA are being investigated.

Administration, Oral↗