“Support People the Way in Which They Want to Be Supported”: Best Practices for Incorporating Client-Centeredness in Representative Payee Programs

Community Mental Health Journal - Nearly 1 million Social Security beneficiaries have representative payees to manage their funds. Although coercion and paternalism are historically associated with...     

Functional central nervous system myelin repair in an adult mouse model of demyelination caused by proteolipid protein overexpression

Two types of interventions to remyelinate the adult demyelinated central nervous system were investigated in heterozygous transgenic mice overexpressing the proteolipid protein gene. 1) A cocktail of trophic factors, “TS1,” was directed toward the activation of the endogenous pool of neural progenitors to increase the number of myelinating oligodendrocytes (OL) in the brain. 2) A combinatorial approach in which OL progenitors were coinjected with TS1 into the corpus callosum of wild‐type and He4e transgenic mice that displayed hindlimb paralysis. The levels of locomotor ability in these mice were evaluated after a single treatment. The data showed that a single administration of either one of the interventions had similar therapeutic effects, alleviating the symptoms of demyelination and leading to the recovery of hindlimb function. Histological and immunofluorescent examination of brain sections showed extensive remyelination that was sufficient to reverse hindlimb paralysis in transgenic mice. When the interventions were administered prior to hindlimb paralysis, He4e mice were able to walk up to 1 year of age without paralysis. © 2010 Wiley‐Liss, Inc.     

Perceived source of anabolic-androgenic steroids and the construal of users’ personality

Users obtain anabolic-androgenic steroids (AAS) from various sources and it is unclear if observers’ perception of these sources has an effect on their construal of users’ personality. We investigated the influence of observers’ perceived source of AAS on their construal of users’ personality. A total of 283 individuals (209 females; mean age = 26.84 years) recruited online were randomized to three independent experimental scenarios or vignettes differing only in the source of AAS used by the protagonist: the Internet (n = 91), trainer/coach (n = 91), and physician/doctor (n = 101). Participants in all three conditions rated their protagonist on the NEO Five-Factor Inventory. Multivariate analysis of variance results indicated no significant between-group differences on personality ratings of the protagonists. It is evident that observers’ perceived source of AAS does not influence their construal of users’ personality.     

Hematological assessment of health status of African catfish Clarias gariepinus (Burchell 1822) experimentally challenged with Escherichia coli and Vibrio fischeri

Clarias gariepinus were challenged with one of the following treatments: 1?×?10⁵ colony-forming units (CFU)/ml of Escherichia coli (EC1), 2?×?10⁵ CFU/ml of E. coli (EC2), 1?×?10⁵ CFU/ml of Vibrio fischeri (V1), 2?×?10⁵ CFU/ml of V. fischeri (V2), gavaged with distilled water (CW), and not gavaged (C). Fish inoculation with bacteria was done via oral gavage. Fish were maintained in the laboratory for 7 days after the bacterial inoculation, after which various hematological parameters such as percentage packed cell volume (PCV), percentage red blood cell lysis, white blood cell (WBC) counts, and differential white blood cell counts (neutrophils, lymphocytes, monocytes, and eosinophils) were determined. Fish challenged with bacteria have a significantly reduced percentage PCV but a significantly higher percentage of red blood cell lysis, WBC counts, neutrophils, lymphocytes, monocytes, and eosinophils compared to the controls. In all cases, effects tend to be strongly dependent on the CFU of the bacteria with effects generally more pronounced in fish infected with 2?×?10⁵ CFU/ml of either E. coli or V. fischeri. The results of this study indicate that the health status of C. gariepinus is seriously compromised by bacterial infection, and hematological parameters are reliable enough in the assessment and quick diagnosis of the health status of fish infected with bacteria.     

CPAP adherence reduces cardiovascular risk among older adults with obstructive sleep apnea

Study objectives

To examine (1) the impact of adherence to continuous positive airway pressure (CPAP) therapy on risk for cardiovascular (CVD) events among a nationally representative sample of older adults with obstructive sleep apnea (OSA), and (2) the heterogeneity of this effect across subgroups defined by race, sex, and socioeconomic status.

Methods

We conducted a retrospective cohort study among Medicare beneficiaries aged ≥?65 years with OSA (2009–2013). Monthly indicators of CPAP adherence (charges for machines, masks, or supplies) were summed over 25 months to create a CPAP adherence variable. New CVD events (ischemic heart disease, cardiac and peripheral procedures) were modeled as a function of CPAP adherence using generalized estimating equations. Heterogeneity of the effect of CPAP on new CVD events was evaluated based on race, sex, and socioeconomic status.

Results

Among 5024 beneficiaries diagnosed with OSA who initiated CPAP, 1678 (33%) demonstrated new CVD events. Following adjustment for demographic and clinical characteristics, CPAP adherence was associated with reduced risk of new CVD events (hazard ratio 0.95; 95% confidence interval 0.94, 0.96) over 25 months. When analyses were stratified by time since the first CPAP charge, the protective effect remained significant for the 12- and 6-month, but not 3-month, outcome models. No significant differences were observed in the protective effect of CPAP based on race, sex, or socioeconomic status.

Conclusions

In this national study of older adult Medicare beneficiaries with OSA, CPAP adherence was associated with greatly reduced risk for CVD events. This risk reduction was consistent across race, sex, and socioeconomic subgroups.

     

Clinical and demographic risk factors associated with chronic suppurative otitis media

BACKGROUND: The incidence of chronic suppurative otitis media (CSOM) is high worldwide but increasing occurrence of complications appear peculiar to West Africa. However, knowledge of associated risk factors is sparse, we report the sociodemographic risk factors of CSOM with the aim of control of the disease and complications; and possible preventive strategies. METHOD: This is a survey of children with CSOM in five sites spread in two suburban cities in two states in Nigeria. Questionnaire was administered on the informants followed by examination of the children. RESULT: Of the 189 children, 114 (60%) had developed ear suppuration before 6 months of age, the number of attacks within the previous 18 months ranged between 2-12 with average of 7. Sociodemographic risk factors included low socioeconomic class in 153 (81%), 136 (72%) live in congested houses with more than 10 people and 79 (42%) belonged to families with more than 5 children. Indoor-cooking and infant daycare attendance were 117 (62%) while supine bottlefeeding was 115 (61%) and 34 (18%) of subjects had smoking father. The clinical risk factors were upper respiratory tract infection (URI) 85 (45%), allergy 53 (28%), adenoid 54 (28%) and malnutrition 65 (34%). The univariate analysis revealed that low social class (OR=7.33, CI=4.18-12.83, P=0.0001), malnutrition (OR=3.57, CI=1.88-6.76, P=0.00001), bottlefeeding (OR=2.93, CI=1.63-5.28, P=0.0001), indoor-cooking (OR=1.35, CI=0.88-2.10, P=0.161) and high number of people in a household (OR=0.59, CI=0.34-0.98, P=0.04) are significant in development of OM; while multivariate logistic regression analysis showed malnutrition (OR=3.48, CI=1.633-7.425, P=0.001), low social status (OR=7.74, CI=4.15-14.43, P=0.0001) and indoor-cooking (OR=2.34, CI=1.18-4.66, P=0.014), second table. Parental smoking, daycare attendance, allergy, adenoiditis/adenoidal hypertrophy and upper respiratory tract infection were not found significant. CONCLUSION: Low socioeconomic class, malnutrition, congestion from high number of children in the household and bottlefeeding constitute significant risk factor. The early onset of disease (<6 months) may suggest a prenatal predisposition. We need further research for the understanding of the biologic effect of these factors while this remains a database for prevention and control of disease.     

Efficacy of acoustic otoscope in detecting middle ear effusion in children

The sensitivity and specificity of the acoustic otoscope in detecting middle ear effusion (MEE) was determined for 200 children. Based upon results from otoscopy, tympanometry, pure tone audiometry, and myringotomy, 100 of the children (175 ears) had MEE. The remaining 100 (200 ears) had no MEE. Using acoustic otoscope reflectivity (AOR) units 4 through 9 to indicate pathologic ears, its sensitivity and specificity were found to be 93.14% and 83%, respectively. These findings led to the conclusion that the acoustic otoscope may provide a simple and cost-effective way of detecting MEE in children. Suggestions are provided for improving the effectiveness of this new device as a clinical tool.