Collaborative relationship in preventive home visits to older people

yamada y., vass m., hvas l., igarashi a., hendriksen c. & avlund k. (2010) Collaborative relationship in preventive home visits to older people. International Journal of Older People Nursing 6 , 33–40
doi: 10.1111/j.1748‐3743.2010.00213.x Aim. To describe what characterizes preventive home visits with collaborative relationships among non‐disabled home‐dwelling older people in Japan. Background. Preventive home visits have the potential to result in improved health outcomes among older people. Collaboration, mutual understanding and trust between visitor and the visited person seem to work as a vehicle, but little is known about which part of the encounters contributes to a collaborative relationship. Methods. We performed a retrospective qualitative analysis of visiting records written by preventive home visitors immediately after the visits were made. A collaborative relationship was predefined as a favourable change in behaviour seen in the visited person during the study period. Visitor characteristics were analysed from 248 records where 37 cases of collaborative relationships were documented. Results. The three most important elements associated with a collaborative relationship were (i) visitor communication skills i.e. mastering ‘enhancing motivation’ and ‘having patience and coping with frustrations’ in difficult and problematic situations, (ii) professionalism, which includes ‘professional instruction and guidance’ based on documented knowledge in health and social domains combined with an overall ‘caring approach’ and (iii) practical actions which imply an ‘immediate concrete response to identified needs or problems’ and ‘individually tailored advice’ to suit the older person’s daily life. Conclusions. Preventive home visitor communication skills and professionalism, and practical actions after the visits characterized cases, where favourable changes in behaviour were obtained in non‐disabled home‐dwelling older people in Japan. Relevance to clinical practice. Education should be emphasized, because preventive home visitor competence may be the most important element of proactive assessment schemes to obtain beneficial outcomes.     

Y-STR Frequency Surveying Method: A critical reappraisal

Reasonable formalized methods to estimate the frequencies of DNA profiles generated from lineage markers have been proposed in the past years and were discussed in the forensic community. Recently, collections of population data on the frequencies of variations in Y chromosomal STR profiles have reached a new quality with the establishment of the comprehensive neatly quality-controlled reference database YHRD. Grounded on such unrivalled empirical material from hundreds of populations studies the core assumption of the Haplotype Frequency Surveying Method originally described 10 years ago can be tested and improved. Here we provide new approaches to calculate the parameters used in the frequency surveying method: a maximum likelihood estimation of the regression parameters (r(1), r(2), s(1) and s(2)) and a revised Frequency Surveying framework with variable binning and a database preprocessing to take the population sub-structure into account. We found good estimates for 11 metapopulations using both approaches and demonstrate that the statistical basis of the method is well supported and independent of the population under study. The results of the estimation process are reliable and robust if the underlying datasets are large and representative and show small average and pairwise genetic distances.     

Flow-induced [Ca2+]i increase depends on nucleotide release and subsequent purinergic signaling in the intact nephron

Flow induces cytosolic Ca(2+) increases ([Ca(2+)](i)) in intact renal tubules, but the mechanism is elusive. Mechanical stimulation in general is known to promote release of nucleotides (ATP/UTP) and trigger auto- and paracrine activation of P2 receptors in renal epithelia. It was hypothesized that the flow-induced [Ca(2+)](i) response in the renal tubule involves mechanically stimulated nucleotide release. This study investigated (1) the expression of P2 receptors in mouse medullary thick ascending limb (mTAL) using P2Y(2) receptor knockout (KO) mice, (2) whether flow increases induce [Ca(2+)](i) elevations in mTAL, and (3) whether this flow response is affected in mice that are deplete of the main purinergic receptor. [Ca(2+)](i) was imaged in perfused mTAL with fura-2 or fluo-4. It is shown that luminal and basolateral P2Y(2) receptors are the main purinergic receptor in this segment. Moreover, the data suggest presence of basolateral P2X receptors. Increases of tubular flow were imposed by promptly rising the inflow pressure, which triggered a marked increase of [Ca(2+)](i). This [Ca(2+)](i) response was significantly reduced in P2Y(2) receptor KO tubules (fura-2 ratio increase WT 0.44 +/- 0.09 [n = 28] versus KO 0.16 +/- 0.04 [n = 13]). Furthermore, the flow response was greatly inhibited with luminal and basolateral scavenging of extracellular ATP (apyrase 7.5 U/ml) or blockage of P2 receptors (suramin 300 microM). The flow response could still be elicited in the absence of extracellular Ca(2+). These results strongly suggest that increase of tubular flow elevates [Ca(2+)](i) in intact renal epithelia. This flow response is caused by release of bilateral nucleotides and subsequent activation of P2 receptors.     

Coccidioidomycosis with cerebral and cerebellar granulomas

We discuss the diagnosis, treatment and prognosis of a Danish male with disseminated coccidioidomycosis. He presented with headaches and slight fever. Examination showed pulmonary, cutaneous and cerebral and cerebellar granulomas, a rare complication. He was treated with intravenously and subsequently orally administered fluconazole. Symptoms and clinical findings regressed during treatment.     

Predicting risk for radiographic damage in rheumatoid arthritis: comparative analysis of the multi-biomarker disease activity score and conventional measures of disease activity in multiple studies

Objective: To compare the multi-biomarker disease activity (MBDA) score with the DAS28-CRP and CRP for predicting risk of radiographic progression in patients with rheumatoid arthritis.

Methods: Published studies of the MBDA score and radiographic progression with ≥100 patients per cohort were evaluated. Rates of radiographic progression over 1?year were determined across the low/moderate/high categories for MBDA score (low/moderate/high: <30, 30–44, >44), DAS28-CRP (low/moderate/high: ≤2.67, >2.67–4.09, >4.09) and CRP (low/moderate/high: ≤10, >10–30, >30?mg/L), with positive and negative predictive value (PPV, NPV) and relative risk (RR) determined for high vs. not-high (i.e. low and moderate combined) categories. Patient-level data from studies having all three measures was pooled to: (1) determine a combined RR for radiographic progression in the high vs. not-high categories for each measure; and (2) compare the predictive ability of MBDA score vs. DAS28-CRP by comparing the rates of radiographic progression observed in subgroups created by cross-classifying the high and not-high categories of each measure.

Results: Five cohorts were identified for inclusion (total N=929). In each, radiographic progression was more frequent with increasing MBDA scores. Among the three cohorts with requisite data, PPVs were generally similar using categories of MBDA score, DAS28-CRP or CRP but NPVs were greater for MBDA score (93–97%) than DAS28-CRP or CRP (77–87%). RRs for radiographic progression were greater when based on categories of MBDA score than DAS28-CRP or CRP and the combined RR was greater for MBDA score (4.6, p?<?.0001) than DAS28-CRP (1.7, p?=?.02) or CRP (1.7, p?=?.002). For patients cross-classified by MBDA score and DAS28-CRP, high vs. not-high MBDA score significantly predicted radiographic progression independently of DAS28-CRP.

Conclusions: High and not-high MBDA scores were associated with increased and low risk, respectively, for radiographic progression over one year. MBDA score was a better predictor of radiographic progression than DAS28-CRP or CRP.     

Mortality following treatment for cannabis use disorders: Predictors and causes

The aim of the study was to determine excess mortality associated with cannabis use disorders. Individuals entering treatment for cannabis use disorders were followed by use of Danish registers and standardized mortality ratios (SMRs) estimated. Predictors of different causes of death were determined. A total of 6445 individuals were included and 142 deaths recorded during 26,584 person-years of follow-up. Mortality was predicted by age, comorbid use of opioids, and lifetime injection drug use. For different causes of death the SMRs were: accidents: 8.2 (95% CI 6.3–10.5), suicide: 5.3 (95% CI 3.3–7.9), homicide/violence: 3.8 (95% CI 1.5–7.9), and natural causes: 2.8 (95% CI 2.0–3.7). Following exclusion of those with secondary use of opioids, cocaine, amphetamine, or injection drug use, SMRs for all causes of death remained significantly elevated except for homicide/violence. The study underlines the need to address mortality risk associated with cannabis use disorders.