Malaria: progress, perils, and prospects for eradication

There are still approximately 500 million cases of malaria and 1 million deaths from malaria each year. Yet recently, malaria incidence has been dramatically reduced in some parts of Africa by increasing deployment of anti-mosquito measures and new artemisinin-containing treatments, prompting renewed calls for global eradication. However, treatment and mosquito control currently depend on too few compounds and thus are vulnerable to the emergence of compound-resistant parasites and mosquitoes. As discussed in this Review, new drugs, vaccines, and insecticides, as well as improved surveillance methods, are research priorities. Insights into parasite biology, human immunity, and vector behavior will guide efforts to translate parasite and mosquito genome sequences into novel interventions.     

Demands,values, and burnout: Relevance for physicians

OBJECTIVE

T o explore the interaction between workload and values congruence (personal values with health care system values) in the context of burnout and physician engagement and to explore the relative importance of these factors by sex, given the distinct work patterns of male and female physicians.

DESIGN

National mailed survey.

SETTING

Canada.

PARTICIPANTS

A random sample of 8100 Canadian physicians (response rate 40%, N = 3213); 2536 responses (from physicians working more than 35 hours per week) were analyzed.

MAIN OUTCOME MEASURES

Levels of burnout, values congruence, and workload, by sex, measured by the Maslach Burnout Inventory—General Scale and the Areas of Worklife Scale.

RESULTS

Results showed a moderate level of burnout among Canadian physicians, with relatively positive scores on exhaustion, average scores on cynicism, and mildly negative scores on professional efficacy. A series of multiple regression analyses confirmed parallel main effect contributions from manageable workload and values congruence. Both workload and values congruence predicted exhaustion and cynicism for men and women (P = .001). Only values congruence provided a significant prediction of professional efficacy for both men and women (P = .001) These predictors interacted for women on all 3 aspects of burnout (exhaustion, cynicism, and diminished efficacy). Howevever, overall levels of the burnout indicators departed only modestly from normative levels.

CONCLUSION

W orkload and values congruence make distinct contributions to physician burnout. Work overload contributes to predicting exhaustion and cynicism; professional values crises contribute to predicting exhaustion, cynicism, and low professional efficacy. The interaction of values and workload for women in particular has implications for the distinct work-life patterns of male and female physicians. Specifically, the congruence of individual values with values inherent in the health care system appeared to be of greater consequence for women than for men.     

Codependency: Characteristics, Risks, Progression, and Strategies for Healing

Codependency and caring are issues concerning nurses practicing in the 1990s. Questions about "caring" and "caring too much" at one's own expense are examined. Characteristics, roles, and risk factors for codependency are identified. Strategies for healing are suggested for nurses who "care too much."     

Migraine: Epidemiology, Impact, and Risk Factors for Progression

Migraine is a chronic and sometimes progressive disorder characterized by recurrent episodes of headache and associated symptoms. This article reviews the epidemiology of and the risk factors for migraine described in population studies, and discusses the burden of disease and the socioeconomic costs of migraine. In the years prior to puberty, migraine is more common among boys than girls. By the onset of puberty, migraine is more prevalent in girls, and by the late teens, females are about twice as likely to suffer from migraine as males. The prevalence of migraine peaks in both sexes during the most productive years of adulthood (age 25 to 55 years) and, in the United States, the prevalence is higher in individuals of lower socioeconomic status. Direct costs of migraine include the cost of migraine medications and health care expenses. Indirect costs associated with migraine include reduced productivity due to absenteeism and reduced performance while at work. Recent evidence suggests that a subgroup of migraine patients may have a clinically progressive disorder. Future epidemiologic studies should focus on identifying patients who are at higher risk for progression and on assessing the impact of intervention strategies on disease progression.     

Studies of play: implications for growth, development, and for clinical practice

The clinical yields of studies of play conducted by graduate students in occupational therapy are identified, and the boundaries of the studies are described. The theme of change in play over time is acknowledged as prominent in all the studies. Open systems and hierarchy are helpful concepts for understanding the process of change in growth and development through play. Clinical tasks to facilitate the change process are cited.     

Beta-blockers for heart failure: why,which, when,and where

Beta-blockers are a highly effective treatment for patients with all grades of heart failure secondary to LV systolic dysfunction. Beta-blockers are best deployed as a form of tertiary prevention in heart failure but have a very limited role for the treatment of a heart failure crisis. Physicians and patients need to understand the time course of the effects of beta-blocker therapy. The initial effects are often neutral or adverse, though the benefits, at least of carvedilol, may be apparent within days in patients with severe heart failure. Benefits accumulate gradually over a period of weeks to months. Some patience, perseverance, and education are required in order to allow patients to reap the full benefits of beta-blocker therapy for this malignant disease. Initiation of treatment early in the course of the disease maximizes the effectiveness and acceptance of therapy. Trials are under way to determine whether the benefits of beta-blockers extend to patients over 80 years of age and to those with preserved LV systolic function. It is likely that important differences exist between beta-blockers in terms of their clinical benefit, though whether differences exist between the agents that have been reported to be effective so far awaits the outcome of a large clinical trial. It is unclear whether the target doses of beta-blockers currently recommended are optimal.     

Exercise for methamphetamine dependence: Rationale,design, and methodology

BackgroundEffective pharmacotherapies to treat methamphetamine (MA) dependence have not been identified, and behavioral therapies are marginally effective. Based on behavioral studies demonstrating the potential efficacy of aerobic exercise for improving depressive symptoms, anxiety, cognitive deficits, and substance use outcomes, the study described here is examining exercise as a potential treatment for MA-dependent individuals.MethodsThis study is randomizing 150 participants with MA dependence at a residential treatment facility for addictive disorders to receive either a thrice-weekly structured aerobic and resistance exercise intervention or a health education condition. Recruitment commenced in March, 2010. Enrollment and follow-up phases are ongoing, and recruitment is exceeding targeted enrollment rates.ConclusionsSeeking evidence for a possibly effective adjunct to traditional behavioral approaches for treatment of MA dependence, this study is assessing the ability of an 8-week aerobic and resistance exercise protocol to reduce relapse to MA use during a 12-week follow-up period after discharge from residential-based treatment. The study also is evaluating improvements in health and functional outcomes during and after the protocol. This paper describes the design and methods of the study.     

Glaucoma: genes,phenotypes, and new directions for therapy

Glaucoma, a leading cause of blindness worldwide, is characterized by progressive optic nerve damage, usually associated with intraocular pressure. Although the clinical progression of the disease is well defined, the molecular events responsible for glaucoma are currently poorly understood and current therapeutic strategies are not curative. This review summarizes the human genetics and genomic approaches that have shed light on the complex inheritance of glaucoma genes and the potential for gene-based and cellular therapies that this research makes possible.     

Internet for clinical trials: past, present, and future

The Internet and World Wide Web have recently been introduced into the management of some aspects of large-scale clinical trials such as remote randomization and data entry and the distribution of information on trial progress. Electronic mail and websites have also been used to enhance communication among people involved in a clinical trial. The Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto miocardico acuto (GISSI) used telecommunications and the Internet in some recent large-scale clinical trials. GISSI constructed a website to keep the medical and cardiology community informed about the progress of its studies. Websites for clinical trials could play an important role in the future, especially in international clinical trials. The website could provide information such as study material and study news and tools such as electronic forums on protocol application for use by investigators around the world. This article describes the GISSI experience and outlines an appropriate structure for a clinical trial website.     

Interdisciplinary Priorities for Dissemination,Implementation, and Improvement Science: Frameworks,Mechanics, and Measures

Much of dissemination, implementation, and improvement (DII) science is conducted by social scientists, healthcare practitioners, and biomedical researchers. While each of these groups has its own venues for sharing methods and findings, forums that bring together the diverse DII science workforce provide important opportunities for cross‐disciplinary collaboration and learning. In particular, such forums are uniquely positioned to foster the sharing of three important components of research. First: they allow the sharing of conceptual frameworks for DII science that focus on the use and spread of innovations. Second: they provide an opportunity to share strategies for initiating and governing DII research, including approaches for eliciting and incorporating the research priorities of patients, study participants, and healthcare practitioners, and decision‐makers. Third: they allow the sharing of outcome measures well‐suited to the goals of DII science, thereby helping to validate these outcomes in diverse contexts, improving the comparability of findings across settings, and elevating the study of the implementation process itself.     

Agenda for Children and Youth: Linking Research, Policy, and Practice

issues and purpose. In this past century, we have made significant strides in our understanding of children's needs, but there is still much to learn as we enter the coming century. We must seek this new knowledge not only for the sake of knowing, but also for the sake of making change, ensuring that what we learn helps improve the future for our children and youth. These efforts require a strong link between policy, practice, and research.

conclusions.

conclusions. Research partnerships can build our base of knowledge and help answer emerging policy and practice questions. Through research that focuses on the diversity and developmental phases of children, we can bring policy and practice into line with an increasingly refined understanding of children and their needs.

practice implications.

practice implications. Because nurses look at the holistic needs of individuals, it is critical that they are involved in setting the social service research agenda and seeking ways that policy and practice can both inform and be informed by this research.