Younger Adults Initiating Hemodialysis: Antidepressant Use for Depression Associated With Higher Health Care Utilization

Objective

To examine associations between antidepressant use and health care utilization in young adults beginning maintenance hemodialysis (HD) therapy.

The relationship of locus of control, age, and sex to life satisfaction and death anxiety in older persons

The present study examined Rotter's Internal-External (I-E) locus of control (LOC) concept in relation to life satisfaction and death anxiety in an aged population. Age and sex of the individual were also considered. In the case of life satisfaction, a strong sex and a strong locus of control effect were found. For death anxiety, again a strong sex effect was found, but there was also a significant interaction between locus of control and age. The article suggests the need for a life span developmental perspective in LOC research. Studies which explore the influence of life experiences, situational and environmental variables, and their effect on control orientation are also needed.     

Epidemiology of paediatric minor head injury: Comparison of injury characteristics with Indices of Multiple Deprivation

Background

Head injury (HI) is a common presentation to Child Emergency Departments (CEDs), but the actual number of children attending with minor HI is unclear. Most research has focussed on admitted patients, often relying on hospital-coded admission data. We studied the incidence of minor HI presenting to the CED of a major teaching hospital in Coventry and Warwickshire. HI attendances were compared with population data to identify injury patterns relating to deprivation.

Methods

All CED admissions were screened by the research team, and data on minor head injuries (GCS 13–15) collected prospectively from 1st January until 31st August 2011. Information was collected on demographics, ethnicity, cause and severity of injury, injury location (in or outside the home), other injuries and mode of arrival. Deprivation data were obtained by cross-referencing postcodes with English Indices of Multiple Deprivation (IMD 2010). For comparison, the hospital audit department provided figures for coded head injuries during the same period.

Results

During the 8 month period, hand-searching identified 1747 children with minor HI, aged between 0 and 16 years. Of these 99% had minimal HI (GCS 15 or ‘alert’). In the same period, hospital-coded minor HIs numbered only 1081. HIs formed 9% of all CED attendances. Thirteen children returned to the CED with worrying symptoms after discharge home. Approximately 3.4% of the local paediatric population attend the CED with HI per year (3419/100,000 population). Falls accounted for 62% of HIs overall, rising to 77% in children aged 0–5. Most in-home head injuries (81%) were the result of falls (p < 0.0001). Significantly more injuries took place inside the home for 0–5 year olds (58%) than for older children (20%) (p < 0.0001). Children living in the most deprived areas were more likely to attend the CED with HI (RR: 1.19; CI: 1.06–1.35, p = 0.004), and arrive using emergency services (OR: 1.77; CI: 1.30–2.40, p < 0.001). There were no significant differences between the deprived and non-deprived groups for location or cause of injury.

Conclusions

Young children are particularly at risk of HI and parents should be offered information on injury prevention. More children from deprived areas attended with HI and these families may benefit most from targeted interventions.     

Guidelines for Best Practice in the Audiological Management of Adults with Severe and Profound Hearing Loss

Individuals with severe to profound hearing loss are likely to present with complex listening needs that require evidence-based solutions. This document is intended to inform the practice of hearing care professionals who are involved in the audiological management of adults with a severe to profound degree of hearing loss and will highlight the special considerations and practices required to optimize outcomes for these individuals.     

Multiple mechanisms of resistance in a series of human testicular teratoma cell lines selected for increasing resistance to etoposide

Mechanisms of resistance to VP-16 were monitored in a series of sublines of the human testicular teratoma cell line (SuSa) derived following exposure either to fractionated X-irradiation (DXR-10) or to VP-16 using pulsed 24-hr exposures (VP 10) or continuous exposure conditions (VPC2, VPC3 and VPC4). Orders of resistance expressed (ranging from 3- to 33-fold based on ICS0 values derived from colony forming assays) were comparable with those likely to be encountered clinically, All of these resistant sublines showed some cross -resistance to VCR, and the 3 drug-selected sublines tested also proved cross-resistant to ADR. Resistance was not associated with modified ³H-VP-16 accumulation. However, decreased VP-16-induced SSBs were detectable in all the resistant sublines and a strong positive correlation was noted between the extent of SSB formation and VP-16 resistance by linear regression analysis. Topo IIα protein content, as judged by Western blotting, was significantly decreased only in the sublines derived by continuous exposure to VP-16, but this was not progressive with increasing levels of resistance expressed. RNase protection assays also showed no significant differences in Topo IIα expression in the low-level resistant DXR-10 and VP 10 sublines, contrasting with the 2-fold decreases identified in the VPC2, VPC3 and VPC4 sublines. Significantly, however, mRNA levels of two alternately spliced Topo IIβ mRNAs were markedly decreased (2- to 9-fold) in all the drug-selected resistant sublincs. No mutations in consensus ATP-binding sequences or in the DNA-binding region of Topo Ma were detected by single strand conformations I polymorphism analysis. Significant Pgp over express ion was only identified in the most highly resistant sublines VPC3 and VPC4, which both showed 4-fold cross-resistance to VCR. Decreased ³H-VCR accumulation and partial reversal of resistance by VPM (6.6 μM) addition was also identified, consistent with a functional Pgp being overexpressed in these sublines. Modifications of Topo II expression therefore appear to precede Pgp overexpression in this series of sequentially derived VP-16 resistant sublines and to represent the predominate mechanism underlying low level (< 10-fold) resistance. © 1994 Wiley-Liss, Inc.     

Compensation under the National Childhood Vaccine Injury Act

The purpose of this article is to look at the effect of the federal compensation scheme under the National Childhood Vaccine Injury Act on the people and institutions involved in the administration of vaccinations. More vaccine-injured children will probably receive compensation than would have been true under state law, but each child will probably receive less money for damages. Manufacturers will pay excise taxes to fund the compensation scheme and receive, in return, substantial immunity from liability under state law. Although these provisions create incentives that work in opposite directions, producers likely will still have reason to improve the safety and efficacy of vaccines. The situation for those who administer vaccinations is less clear. Freeing them from the threat of litigation would leave them with little incentive to use immunizations appropriately because they do not contribute to the compensation scheme. Although Congress intended to make those who give vaccines immune from state claims, it may have failed to do so, leaving providers with their liability largely unchanged. The most pervasive uncertainty is that the Act is designed to self-destruct and may soon return vaccine-injured children, manufacturers, and providers to the state of the law before Congress acted.     

Relationship between expression of topoisomerase II isoforms and intrinsic sensitivity to topoisomerase II inhibitors in breast cancer cell lines.

Topoisomerase II is a key target for many anti-cancer drugs used to treat breast cancer. In human cells there are two closely related, but differentially expressed, topoisomerase II isoforms, designated topoisomerase II alpha and beta. Here, we report the production of a new polyclonal antibody raised against a fragment of the C-terminal domain of the 180 kDa form of topoisomerase II (the beta isoform), which does not cross-react with the 170 kDa form (the alpha isoform). Using this antibody, together with a polyclonal antibody specific for the 170 kDa isoform of topoisomerase II, we have examined the relationship between the sensitivity of a panel of human breast cancer cell lines to different classes of topoisomerase II inhibitors and cellular levels of the topoisomerase II alpha and beta proteins. We found that sensitivity to amsacrine showed a correlation with the level of expression of topoisomerase II alpha protein, and that sensitivity to etoposide showed a similar correlation with the level of expression of topoisomerase II beta protein. There was also a relationship between sensitivity of these cell lines to mitoxantrone and the cellular level of both isoforms of topoisomerase II. No relationship was found between the level of mRNA for topoisomerase II alpha or beta, and either sensitivity of breast cancer cell lines to topoisomerase II inhibitors or the level of topoisomerase II protein expression.     

Physician reimbursement by salary or fee-for-service: effect on physician practice behavior in a randomized prospective study

We used a resident continuity clinic to compare prospectively the impact of salary v fee-for-service reimbursement on physician practice behavior. This model allowed randomization of physicians into salary and fee-for-service groups and separation of the effects of reimbursement from patient behavior. Physicians reimbursed by fee-for-services scheduled more visits per patient than did salaried physicians (3.69 visits v 2.83 visits, P less than .01) and saw their patients more often (2.70 visits v 2.21 visits, P less than .05) during the 9-month study. Almost all of this difference was because fee-for-service physicians saw more well patients than salaried physicians (1.42 visits and .99 visits per enrolled patient, respectively, P less than .01). Evaluating visits by American Academy of Pediatrics' guidelines indicated that fee-for-service physicians saw more patients for well-childcare than salaried physicians because they missed fewer recommended visits and scheduled visits in excess of those recommendations. Fee-for-service physicians also provided better continuity of care than salaried physicians by attending a larger percentage of all visits made by their patients (86.6% of visits v 78.3% of visits, P less than .05), and by encouraging fewer emergency visits per enrolled patient (0.12 visits v 0.22 visits, P less than .01). Physicians' interest in private practice, as determined by their career plans, correlated significantly with total number of patients enrolled (r = .48, P less than .05) and total clinic patients seen by each resident during the study (r = .40, P less than .05).(ABSTRACT TRUNCATED AT 250 WORDS)