Differences between African Americans and whites in their perceptions of Alzheimer disease

To design optimal health services and education programs for Alzheimer disease (AD), it is important to understand cultural differences in perceptions of the disorder. In this study, we investigated differences between African Americans and whites in their beliefs, knowledge, and information sources regarding AD. We distributed a written questionnaire through lay and professional organizations and meetings in the southeastern United States, yielding a sample of 452 adults (61% white, 39% African American; 78% female; mean age 47 years; 33% with family history of AD). The questionnaire assessed the following: (1) illness beliefs, (2) factual knowledge, (3) sources of information, and (4) perceived subjective threat of AD. African Americans and whites were generally similar in their beliefs about common symptoms, prominent risk factors, and the effectiveness of treatments for AD (although whites expressed greater certainty in these beliefs than African Americans). In comparison to whites, African Americans showed less awareness of facts about AD, reported fewer sources of information, and indicated less perceived threat of the disorder. These preliminary findings suggest important distinctions between African Americans and whites in their knowledge about, and conceptualization of, AD. Follow-up studies with more representative samples and more fully validated measures will be necessary to confirm these differences. Health psychologic research suggests that such differences in illness perceptions could shape response to disease burden, assessment and diagnosis, and available health care options.     

European multicenter study on LOH of APOC3 at 11q23 in 766 breast cancer patients: relation to clinical variables. Breast Cancer Somatic Genetics Consortium.

High frequencies of loss of heterozygosity (LOH) in chromosome 11q22-qter have been observed in various malignancies, including breast cancer. Previous studies on breast carcinomas by Winqvist et al (Cancer Res 55: 2660-2664) have indicated that a survival factor gene is located in band 11q23, and that the highly informative microsatellite polymorphism at the APOC3 locus would be a suitable tool to perform more extensive LOH studies. In this European multicentre study, we have examined the occurrence of APOC3 LOH and evaluated the effect of LOH of this chromosomal subregion on the clinical behaviour of the disease in a cohort of 766 breast cancer patients in more detail. LOH for APOC3 was found in 42% of the studied tumours, but it was not found to be significantly associated with any of the studied clinical variables, including cancer-specific survival time or survival time after recurrent/metastatic disease. According to the present findings, the putative survival factor gene on 11q23 is not located close enough to the APOC3 gene, but apparently at a more proximal location.     

Assessment of bone mineral density in adults and children with Marfan syndrome

Recent studies indicate that decreased bone mineral density (BMD) occurs in the spine, femoral necks and greater trochanters of some adults and children with Marfan syndrome. Because there is uncertainty regarding the BMD status of patients with Marfan syndrome, we undertook an analysis of BMD in both adults and children with Marfan syndrome. Dual energy X-ray absorptiometry analysis was performed on a convenience sample of 51 patients (30 adults and 21 children) with diagnosed Marfan syndrome from 1993 to 2000. T-Scores (i.e. the number of standard deviations above or below the average normal peak bone density) were determined for comparison of adults. Mean±SD of individual BMD values were used for comparison of the data of children. Compared to standard values obtained from normal adult patients, adult males with Marfan syndrome demonstrated significantly reduced femoral neck BMD with an average T-score of -1.54 (P<0.001), diagnostic of osteopenia. Although osteopenia and osteoporosis were observed in several middle aged and pre- and postmenopausal women, the average T-score value for adult females and children were within normal limits. The etiology and full significance of decreased BMD in adult male patients with Marfan syndrome remain uncertain at the present time. Our results lead us to question the value of aggressive BMD evaluations by DXA in these patients, particularly prior to reaching mid-age. Further investigations will be required to shed insights into the natural history of BMD in adults and children with Marfan syndrome. Any application of bone mineral replacement therapy such as bisphosphonate, selective estrogen receptor modulators, hormone replacement therapy and vitamin D in these patients may be premature based on the existing evidence.     

Loss of heterozygosity on the X chromosome in human breast cancer

The analysis of loss of heterozygosity (LOH) in tumours can be a powerful tool for mapping the sites of tumour suppressor genes in the human genome. A panel of breast cancer patients was assembled as pairs of tumour and lymphocyte DNA samples and LOH studies carried out by Southern hybridisation with polymorphic loci mapping to the X chromosome with appropriate controls. Deletion mapping revealed a high frequency of small regionalised deletions, defining at least three independent regions, one of which is particularly well mapped to a 500 kb stretch of DNA in the distal portion of the pseudoautosomal region of Xp. A second region has been identified within the pseudoautosomal region close to the pseudoautosomal boundary, and there is a third discrete site of loss on distal Xq. Perturbations of sequences at these regions represent independent events in a number of patients. This study represents the first detailed analysis of LOH on the X chromosome in human breast tumours, the results of which indicate that at least three regions of this chromosome are involved in the disease. © 1995 Wiley-Liss, Inc.     

Inhibition of exercise-induced asthma by nifedipine: a dose-response study.

1. The effect of three single doses of nifedipine on exercise-induced asthma has been examined in 11 asthmatic subjects. 2. On four separate days patients undertook 6 min of exercise on a treadmill 30 min after taking placebo or nifedipine 10, 20 or 30 mg administered double-blind and in random order. 3. Nifedipine had no significant effect on resting FEV1 measurements. 4. Nifedipine, in doses of 10, 20 and 30 mg, inhibited exercise induced bronchoconstriction, reducing the maximum fall in FEV1 from 30.8 +/- 3.5% after placebo to 21.9 +/- 3.4% (NS), 13 +/- 3.4% (P less than 0.01) and 15 +/- 3.9% (P less than 0.01) respectively. 5. This study has shown that the protective effect of nifedipine against exercise-induced asthma is dose related with the maximum inhibitory effect being observed with a single dose of 20 mg.     

Dementia Care Across a Tertiary Care Health System: What Exists Now and What Needs to Change

ObjectivesThis study explored the process of care for persons living with dementia (PLWDs) in various care settings across a tertiary care system and considers challenges and opportunities for change.DesignAimed at quality improvement, qualitative interviews were conducted with key stakeholders in dementia care across geriatric outpatient clinics, medical and psychiatric emergency departments, and the main hospital in 2016.Setting and participantsForty-nine interactive interviews were conducted with a purposive and snowball sampling of health care professionals (physicians, nurses, social workers, administrators) and families in a large, academic health care system.MeasuresQualitative interview guides were developed by the study team to assess the process of care for PLWDs and strengths and challenges to delivering that care.ResultsKey themes emerging from the interviews in each care setting are presented. The outpatient setting offers expertise, a multidisciplinary clinic, and research opportunities, but needs to respond to long waitlists, space limitations, and lack of consensus about who owns dementia care. The emergency department offers a low nurse/patient ratio and expertise in acute medical problems, but experiences competing demands and staff turnover; additionally, dementia does not appear on medical records, which can impede care. The hospital offers consultative services and resources, yet the physical space is confined and chaotic; sitters and antipsychotics can be overused, and placement outside of the hospital for PLWDs can be a challenge.Conclusions and implicationsFive key recommendations are provided to help health systems proactively prepare for the coming boom of PLWD and their caregivers, including outpatient education, a dementia care management program to link services, Internet-based training for providers, and repurposing sitters as Elder Life specialists.     

Use of Density-Equalizing Cartograms to Visualize Trends and Disparities in State-Specific Prevalence of Obesity: 1996–2006

Objectives. We used cartograms to visually communicate the state-specific prevalence of obesity and its association with socioeconomic variables over time to benefit and inform decisions by national health policymakers who address geographic and social inequities in health.Methods. We generated density-equalizing maps, known as cartograms (in which geographic regions are sized in proportion to some variable), that illustrate indicators of population and educational attainment. We also provide an innovative presentation of the obesity choropleth map (which presents values for areas by shading).Results. The maps depict the absolute burden of obesity, the inverse association between obesity and education, and geographic patterns in the prevalence of obesity over time.Conclusions. The prevalence of obesity in the United States continues to increase. These cartograms can help stakeholders interpret surveillance data and their relation to demographic and socioeconomic characteristics to inform decisions.Several national surveys have shown that prevalence rates for obesity continue to increase.^1,2 Not surprisingly, this prevalence is not uniformly distributed; obesity disproportionately affects some groups in the United States.^3,4 Among adult men, no significant differences in obesity prevalence are seen among racial/ethnic groups.^1,5,6 However, both non-Hispanic Black and Mexican American women have a higher prevalence of obesity.^1,5,6 Among adult women, poverty and low educational levels are also associated with a higher prevalence of obesity.⁵Data from public health surveillance, often summarized in large, traditional tables, can be difficult to interpret and may not show the information in a meaningful way. One common solution is to display trends in the prevalence of obesity via maps. For instance, researchers have used choropleth maps (which present percentages for areas through the use of color, saturation, and lightness) to show changes in state-specific prevalence of obesity over time.⁷ Several limitations and critiques have been noted for choropleth maps, however.^8,9 For example, large areas (often sparsely populated) tend to visually dominate smaller (often densely populated) areas,^10–14 leading to potential misinterpretation of the burden of obesity. Moreover, obesity is most highly concentrated among certain subpopulations, not only minorities but also the poor,¹⁵ and these related factors are difficult to depict on choropleth maps.The use of density-equalizing maps, or cartograms, minimizes such limitations by transforming the size and sometimes the shape of political areas (in this case, states) so they are proportional to another variable; traditionally, the variable is population, but other variables could be used. Cartograms are relatively new to public health but have been used successfully to map patterns of chronic disease, including the distribution of Wilms tumors in New York State,¹⁶ mortality patterns of cerebrovascular disease in North Carolina,¹⁷ and associations between both lung cancer and leukemia and the Rocky Flats plant site in Colorado.¹⁰ Other successful cartograms have been developed to analyze the spatial distribution of cryptosporidiosis among AIDS patients in San Francisco, California,¹⁸ and to characterize the spatial distribution of late-state and in situ breast cancer among women in the San Francisco Bay Area.¹⁹ Innovative mapping applications, including cartograms, can be used in public health to improve understanding of health problems and for exploratory analysis of data.^20,21For our exploratory study, we used cartograms and other cartographic techniques to visually communicate the pattern of obesity prevalence and its association with socioeconomic variables over time. Our density-equalizing cartograms of population and education indicators show the prevalence of obesity, and an innovative presentation of the choropleth map shows change in obesity prevalence over time.     

Pharmaceutical Evaluation of Gas-Filled Microparticles as Gene Delivery System

Purpose. To produce and characterize a nonviral ultrasound-controlled release system of plasmid DNA (pDNA) encapsulated in gas-filled poly(D,L-lactide-co-glycolide) microparticles (PLGA-MPs). Methods. Different cationic polymers were used to form pDNA/polymer complexes to enhance the stability of pDNA during microparticle preparation. The physico-acoustical properties of the microparticles, particle size, pDNA integrity, encapsulation efficiency and pDNA release behavior were studied in vitro. Results. The microparticles had an average particle size of around 5 m. More than 50% of all microparticles contained a gas core, and when exposed to pulsed ultrasound as used for color Doppler imaging create a signal that yields typical color patterns (stimulated acoustic emission) as a result of the ultrasound-induced destruction of the microparticles. Thirty percent of the pDNA used was successfully encapsulated and approximately 10% of the encapsulated pDNA was released by ultrasound within 10 min. Conclusions. Plasmid DNA can be encapsulated in biodegradable gas-filled PLGA-MPs without hints for a structural disintegration. A pDNA release by ultrasound-induced microparticle-destruction could be shown in vitro.