The Demographic Assessment for Health Literacy (DAHL): A New Tool for Estimating Associations between Health Literacy and Outcomes in National Surveys

Objective  To impute limited health literacy from commonly measured socio-demographic data and to compare it to the Short-Test of Functional Health Literacy in Adults (S-TOFHLA) for estimating the influence of limited health literacy on health status in the elderly. Methods  The Prudential Medicare Study assesses the S-TOFHLA score, leading to a “reference standard” classification of 25% of people with inadequate literacy; the National Health Interview Survey has no such assessment. We estimated a regression of S-TOFHLA on sex, age, years of schooling, and race/ethnicity in The Prudential Medicare Study data to derive a Demographic Assessment for Health Literacy (DAHL) score, and imputed inadequate literacy to the 25% with the lowest DAHL scores. Using regression, we then examined associations between several health status measures (including hypertension, diabetes, physical and mental SF-12) and inadequate literacy (imputed or test-based). Results  Estimates of association using imputed inadequate literacy closely approximate those obtained using S-TOFHLA-based inadequate literacy for most outcomes examined. Conclusions  As few population surveys measure health literacy, the DAHL, a readily calculated health literacy proxy score, may be useful for expanding the scope of health literacy research in national survey data.     

Development of novel N-(6-methanesulfonyl-benzothiazol-2-yl)-3-(4-substituted-piperazin-1-yl)-propionamides with cholinesterase inhibition,anti-β-amyloid aggregation,neuroprotection and cognition enhancing properties for the therapy of Alzheimer's disease

A novel series of benzothiazole–piperazine hybrids were rationally designed, synthesized, and evaluated as multifunctional ligands against Alzheimer''s disease (AD). The synthesized hybrid molecules illustrated modest to strong inhibition of acetylcholinesterase (AChE) and Aβ_1-42 aggregation. Compound 12 emerged as the most potent hybrid molecule exhibiting balanced functions with effective, uncompetitive and selective inhibition against AChE (IC₅₀ = 2.31 μM), good copper chelation, Aβ_1-42 aggregation inhibition (53.30%) and disaggregation activities. Confocal laser scanning microscopy and TEM analysis also validate the Aβ fibril inhibition ability of this compound. Furthermore, this compound has also shown low toxicity and is capable of impeding loss of cell viability elicited by H₂O₂ neurotoxicity in SHSY-5Y cells. Notably, compound 12 significantly improved cognition and spatial memory against scopolamine-induced memory deficit in a mouse model. Hence, our results corroborate the multifunctional nature of novel hybrid molecule 12 against AD and it may be a suitable lead for further development as an effective therapeutic agent for therapy in the future.

A novel series of benzothiazole–piperazine hybrids were rationally designed, synthesized, and evaluated as multifunctional ligands against Alzheimer''s disease (AD).     

A part of the ulnar nerve as an alternative donor nerve for functioning free muscle transfer: a case report.

A patient with no active elbow flexion because of poliomyelitis-like syndrome underwent functioning free muscle transfer for elbow flexion reconstruction in which a part of the ulnar nerve was used as a donor motor nerve. Fourteen months after surgery the patient had achieved 120 degrees of active elbow flexion against gravity without functional deficit of the donor ulnar nerve. A part of the ulnar nerve can be used as an alternative donor motor nerve for reconstruction of chronic C5-C6 (or C5-7) brachial plexus injury.     

Variations in perforators of anterolateral thigh flap

In our study of anterolateral thigh flaps, ten patients had musculocutaneous perforators (58%), four patients had septocutaneous perforators (24%), and three patients had both types of perforators (18%). Average number of perforators found in each flap was 1.9 (range 1–4). The maximum number of perforators in a single case was four. A single perforator was found in seven patients. In patients with both types of perforators, larger flaps could be harvested and there were no complications. The study was carried out over a period of 3 years and included 17 patients treated with free anterolateral thigh flaps in our hospital from April 2004 to August 2007. All age groups and both sexes were included in the study. A cadaveric study was done on ten fresh cadavers in the anatomy department of the same hospital. Although the majority of free anterolateral thigh free flaps are based on musculocutaneous perforators and fewer flaps are based on septocutaneous perforators, our study shows that this versatile free flap can be based on a combination of both septocutaneous and musculocutaneous perforators. Though our cadaveric study did not show any flap to be based on the combination of both types of perforators, our clinical study in which we had three cases of this type definitely shows that the ALT flap can be based on a combination of both septocutaneous and musculocutaneous perforators. Further in these cases with both types of perforators, larger flaps could be harvested and with greater flap success.     

Role of Phosphodiesterase-5 Inhibitors in Heart Failure: Emerging Data and Concepts

Novel treatment of congestive heart failure (HF) involves utilizing unique pathways to improve upon contemporary therapies. Increasing the availability of cyclic guanosine monophosphate (cGMP) by inhibition of phosphodiesterase-5 (PDE5) is a relatively new, but promising therapeutic strategy. Preclinical studies suggest a favorable myocardial effect of PDE5 inhibitors by blocking adrenergic, hypertrophic and pro-apoptotic signaling, thereby supporting their use in HF. The clinical benefits of acute and chronic PDE5 inhibition on lung diffusion capacity, exercise performance and ejection fraction in humans are emerging and appear promising. Larger, controlled trials are now on-going to assess the safety, efficacy and tolerability of PDE5 inhibitors on morbidity and mortality in patients with both systolic and diastolic heart failure. If the results of these trials are positive, a new avenue for the treatment of HF will open, which will help curtail the societal effects of this costly and morbid disease.     

Comparing Safety Climate between Two Populations of Hospitals in the United States

Objective. To compare safety climate between diverse U.S. hospitals and Veterans Health Administration (VA) hospitals, and to explore the factors influencing climate in each setting.
Data Sources. Primary data from surveys of hospital personnel; secondary data from the American Hospital Association's 2004 Annual Survey of Hospitals.
Study Design. Cross-sectional study of 69 U.S. and 30 VA hospitals.
Data Collection. For each sample, hierarchical linear models used safety-climate scores as the dependent variable and respondent and facility characteristics as independent variables. Regression-based Oaxaca–Blinder decomposition examined differences in effects of model characteristics on safety climate between the U.S. and VA samples.
Principal Findings. The range in safety climate among U.S. and VA hospitals overlapped substantially. Characteristics of individuals influenced safety climate consistently across settings. Working in southern and urban facilities corresponded with worse safety climate among VA employees and better safety climate in the U.S. sample. Decomposition results predicted 1.4 percentage points better safety climate in U.S. than in VA hospitals: −0.77 attributable to sample-characteristic differences and 2.2 due to differential effects of sample characteristics.
Conclusions. Results suggest that safety climate is linked more to efforts of individual hospitals than to participation in a nationally integrated system or measured characteristics of workers and facilities.     

Gastroprotective effects of ethanolic extract from <Emphasis Type="Italic">Cissampelos pareira</Emphasis> in experimental animals

Ethanolic extract of Cissampelos pareira (L.) Hirsuta (Menispermaceae) roots have been examined in various acute and chronic ulcers in validated experimental models in rats. C. pareira extract of 25–100 mg/kg administered orally, twice daily for 5 days showed a dose-dependent, ulcer-protective effect. The extract demonstrated significant protection against 100% ethanol- (P < 0.05), aspirin- (P < 0.001), cold-restraint stress- (P < 0.01) and pylorus ligation- (P < 0.001) induced acute gastric ulcers in rats. A flavonoid Quercetin, isolated from C. pareira, showed significant antiulcer property (P < 0.05 to P < 0.001) against gastric ulcers in different acute models. In chronic ulcers induced by 50% acetic acid, C. pareira significantly (P < 0.001) reduced the ulcer index with decreased perforations after 5- and 10-day treatment. C. pareira significantly enhanced the defense factors as total hexose and sialic acid while significantly reducing the ulcer index in the lipid peroxidase product malondialdehyde in ethanol-induced ulcers.