Stress,Frequency of Challenges,and Coping for Partners of Individuals with Mental Health Conditions

This study applied Lazarus and Folkman’s stress and coping framework to understand how romantic partners cope with the challenges of a significant other’s mental health condition at three levels (i.e., individual, dyadic, and social), how coping at each of these three levels contributes to the association between stress and relational quality for these partners, and how these associations depend upon the frequency of challenges partners experience. We predicted that stress would be negatively associated with relational quality, and that individual (i.e., emotion and problem-focused), dyadic, and social coping would mediate this association. We also posited that the extent to which partners cope would depend on the frequency of challenges they face. We analyzed data from 325 individuals with a moderated multiple-mediation model. Findings provided support for the mediating role of dyadic coping and its positive association with relational quality; partial support for the mediating role of emotion-focused coping and its negative association with relational quality; and partial support for the moderating role of frequency of challenges. We discuss the study’s findings and contributions.     

Association of G-protein-coupled receptor 154 with asthma and total IgE in a population of the Caribbean coast of Colombia

Background G protein‐coupled receptor 154 was described as an asthma susceptibility gene by positional cloning. It has been subsequently associated with asthma and other inflammatory diseases in several populations with different ethnic origin. Replication of associations adds reliability to these findings. Objective To analyze the association of G protein‐coupled receptor 154 with asthma and total and mite‐specific IgE levels in a population of the Caribbean Coast of Colombia. Methods We genotyped seven single nucleotide proteins (SNPs) in GPR154 in 475 asthmatics, 394 controls and 116 families from Cartagena, Colombia using either SnaPshot or TaqMan. Total and specific IgE against Blomia tropicalis and Dermatophagoides pteronyssinus were determined by ELISA. Hardy–Weinberg equilibrium was assessed and case–control and family‐based analyses were performed to evaluate the association between the SNPs and their haplotypes and asthma and IgE. Association analyses in the case–control dataset were corrected by population stratification using 52 ancestry informative markers. Results Allelic distribution was similar to that described in other populations. Two SNPs were associated with the same direction of the effect in both datasets. Allele A of Hopo546333 was protective for asthma (case–control OR: 0.42; 95% CI: 0.17–0.99, P=0.042; P=0.043; families Z score=?2,236; P=0.025). Similarly, allele C of rs740347 conferred low risk for asthma (OR: 0.44; 95% CI: 0.28–0.70, P=0.00017; P_c=0.00037) and total IgE (OR: 0.29; 95% CI: 0.09–0.88, P=0.015; P_c=0.030) in the case–control study and families (Z score=?3.207, P=0.0013; Z score=?3.182, P=0.0014, respectively). Haplotype CCAGGT was associated with total IgE (OR: 1.76; 95% CI: 1.14–2.71, P=0.006, P_c=0.007) in the case–controls group and CGCGGT with both phenotypes (P=0.044 and P=0.032, respectively) in families. Neither SNPs nor haplotypes were associated with levels of mite‐specific IgE. Conclusions Our findings in a sample of asthmatics from Colombia suggest a relevant role of G protein‐coupled receptor 154 in the pathogenesis of asthma and allergy.     

Rapid improvement of thrombotic thrombocytopenic purpura with vincristine and plasmapheresis

Many patients with thrombotic thrombocytopenic purpura (TTP) fail to respond to daily plasmapheresis and the results of alternative treatments have been inconsistent. Vincristine was given weekly with continued plasmapheresis to eight patients who were refractory to plasmapheresis, antiplatelet agents, and/or corticosteroids. A rapid response to the vincristine occurred in all eight patients in 5 days with a marked rise in the platelet count and resolution of symptoms. The results in these patients suggest that early initiation of vincristine therapy in conjunction with plasmapheresis is useful in TTP.     

Comparison of the effect of rofecoxib (a cyclooxygenase 2 inhibitor), ibuprofen, and placebo on the gastroduodenal mucosa of patients with osteoarthritis: a randomized, double-blind, placebo-controlled trial. The Rofecoxib Osteoarthritis Endoscopy Multinational Study Group

OBJECTIVE: This randomized, double-blind study tested the hypothesis that rofecoxib, a drug that specifically inhibits cyclooxygenase 2, would cause fewer gastroduodenal ulcers than ibuprofen (in a multicenter trial), and its side effects would be equivalent to those of placebo (in a prespecified analysis combining the results with another trial of identical design). METHODS: Seven hundred seventy-five patients with osteoarthritis were randomized to receive rofecoxib at a dosage of 25 mg or 50 mg once daily, ibuprofen 800 mg 3 times daily, or placebo. Gastroduodenal ulceration was assessed by endoscopy at 6, 12, and (for active treatment) 24 weeks. The primary and secondary end points were the incidence of gastroduodenal ulcers at 12 and 24 weeks, respectively. RESULTS: Ulcers were significantly less common (P < 0.001) following treatment with rofecoxib (25 mg or 50 mg) than with ibuprofen after 12 weeks (5.3% and 8.8% versus 29.2%, respectively) or 24 weeks (9.9% and 12.4% versus 46.8%, respectively). In the combined analysis, the 12-week ulcer incidence with 25 mg rofecoxib (4.7%) and with placebo (7.3%) satisfied prespecified criteria for equivalence. CONCLUSION: At 2-4 times the therapeutically effective dose, rofecoxib caused fewer endoscopically detected ulcers than did ibuprofen. Rofecoxib at a dose of 25 mg (the highest dose recommended for osteoarthritis) satisfied prespecified criteria for equivalence to placebo.     

Distal Medial Collateral Ligament Grade III Injuries in Collegiate Football Players: Operative Management,Rehabilitation, and Return to Play

ContextManagement of isolated grade III medial collateral ligament injuries is controversial, as both nonoperative and operative management can result in return to play. However, operative management is recommended in elite athletes who have a grade III injury with distal avulsion.ObjectiveWe present a standardized rehabilitation protocol in a case series of 7 National Collegiate Athletic Association Division I American football athletes who sustained grade III distal medial collateral ligament tears that were repaired operatively, with emphasis on return to play.ResultsMedian time to surgery was 4 days (range = 2–67 days). Median time from surgery to noncontact drills was 120.5 days (range = 104–168 days), and median time from surgery to full-contact sport was 181 days (range = 139–204 days). All athletes returned to play at their preinjury level of competition.ConclusionsOur study highlighted how operative management with a standardized rehabilitation protocol can be applied to Division I football players and result in safe return to play.     

Effects of high-intensity exercise on leptin and testosterone concentrations in well-trained males

Objective: A number of investigations have examined the effect of exercise on leptin concentrations, because leptin is associated with obesity, satiety, and reproductive function. High-intensity exercise is known to increase testosterone, an inhibitor of leptin. The objective of the study was to determine whether the leptin responses to a progressive, intermittent exercise protocol were related to serum testosterone concentrations. Most previous studies have examined leptin responses to low or moderately high exercise intensities. A second objective was to determine whether leptin responses were different than previous experiments using intermittent moderate and high-intensity exercise. Methods: Well-trained runners completed strenuous intermittent exercise consisting of treadmill running at 60, 75, 90, and 100% VO _2max and a subsequent resting control trial was also conducted. Results: There were significant increases in mean serum levels of leptin and testosterone with both quickly returning to baseline during recovery, but no relationship between the two hormones was found. After examining individual data for both hormones, it was discovered that subjects could be classified as leptin responders or nonresponders, whereas testosterone increased in all subjects. Responders had elevated serum leptin levels at baseline and exhibited increases after high-intensity exercise, whereas nonresponders did not show changes in leptin during exercise. Conclusions: Data suggest testosterone levels do not acutely affect leptin responses to exercise or 1-h of recovery. Moreover, varied leptin responses to intense exercise in comparable well-trained runners was observed and was associated with baseline leptin concentrations.     

Abilities,skills and knowledge in measures of health literacy

Objective

Health literacy has been recognized as an important factor in patients’ health status and outcomes, but the relative contribution of demographic variables, cognitive abilities, academic skills, and health knowledge to performance on tests of health literacy has not been as extensively explored. The purpose of this paper is to propose a model of health literacy as a composite of cognitive abilities, academic skills, and health knowledge (ASK model) and test its relation to measures of health literacy in a model that first takes demographic variables into account.

Methods

A battery of cognitive, academic achievement, health knowledge and health literacy measures was administered to 359 Spanish- and English-speaking community-dwelling volunteers. The relations of health literacy tests to the model were evaluated using regression models.

Results

Each health literacy test was related to elements of the model but variability existed across measures.

Conclusion

Analyses partially support the ASK model defining health literacy as a composite of abilities, skills, and knowledge, although the relations of commonly used health literacy measures to each element of the model varied widely.

Practice implications

Results suggest that clinicians and researchers should be aware of the abilities and skills assessed by health literacy measures when choosing a measure.     

Improving COPD Care in a Medically Underserved Primary Care Clinic: A Qualitative Study of Patient Perspectives

We conducted a focus group study in an urban hospital-based primary care teaching clinic serving an indigent and Hispanic (predominantly Puerto Rican) population in New England in order to learn how patients with Chronic Obstructive Lung Disease (COPD) perceive their disease, how they experience their medical care, and the barriers they face managing their disease and following medical recommendations. The research team included medical doctors, nurses, a medical anthropologist, a clinical pharmacist, a hospital interpreter, and a systems analyst. Four focus groups were conducted in Spanish and English in April and May 2014. The demographic characteristics of the 25 focus group participants closely reflected the demographics of the total COPD clinic patients. The participants were predominantly female (72%) and Hispanic (72%) and had a median age of 63. The major themes expressed in the focus groups included: problems living with COPD; coping with complexities of comorbid illnesses; challenges of quitting smoking and maintaining cessation; dealing with second-hand smoke; beliefs and myths about quitting smoking; difficulty paying for and obtaining medications; positive experiences obtaining and managing medications; difficulties in using sleep machines at home; expressions of disappointment with the departure of their doctors; and overall satisfaction with the clinic health care providers. The study led to the creation of an action plan that addresses the concerns expressed by the focus study participants. The action plan is spearheaded by a designated bilingual and bicultural nurse and is now in operation.     

Dental caries and fluorosis in children consuming water with different fluoride concentrations in Maiquetia, Vargas State, Venezuela

The objective of this study was to determine the experience of fluorosis and dental caries in 8- 12 year old children that drink water with different fluoride concentrations, from Maiquetía, Vargas State. Four hundred and twenty-one children were evaluated and divided in groups of 84 children each, according with their age (8-9-10-11) but 85 for the age 12. This evaluation was developed by a calibrated dentist using Dean's Index for dental fluorosis examining only the six upper anterior teeth and DMFT/dmft index to determine dental caries, following the criteria established by the WHO. In addition, a social status questionnaire was given to the subjects and samples of water and salt from the communities were collected. Thirty-three per cent of the children in this study were males and 67% were females. Results indicated that the mean DMFT and dmft were 0.91 and 1.88, respectively, showing a total of 2.17 teeth with dental caries being the decayed component, the highest component observed in both dentitions. The mean prevalence of dental fluorosis for the studied population was 16.6%, where the very mild category (8.5%) predominated. Maria May was the most affected school with dental fluorosis (41.5%) and the fluoride concentration in drinking water after analyses was 1.58%. The results of this study indicate the presence of an inverse relationship between fluoride concentrations in the water collected at the schools and the prevalence of dental fluorosis in the permanent dentition of school children, but not in the primary dentition.     

Scanning electron microscope assessment of several resharpening techniques on the cutting edges of Gracey curettes

AIM: Treatment of periodontal diseases is based on efficient scaling and root planing (SRP) and adequate maintenance of the patient. The effectiveness of SRP is influenced by operator skill, access to the subgingival area, root anatomy, and the quality and type of instrument used for SRP. The aim of this study was to evaluate the cutting edges of Gracey curettes after manufacturing and after resharpening using several techniques. METHODS AND MATERIAL: The cutting edges of a total of 41 new #5-6 stainless steel Gracey curettes were evaluated blindly using scanning electron microscopy (SEM). The quality of the cutting edges was evaluated blindly by a calibrated examiner using micrographs. Data were analyzed using a Kruskal Wallis test and non-parametric two-way multiple comparisons. RESULTS AND CONCLUSIONS: Different sharpening techniques had significantly different effects on the sharpness of cutting edges (p<0.05). Sharpening by passing the lateral face of curettes over a sharpening stone and then a #299 Arkansas stone produced a high frequency of smooth, sharp edges or slightly irregular edges between the lateral and coronal faces of the curettes. Sharpening by passing a blunt stone over the curette's lateral face produced the poorest quality cutting edge (a bevel). Sharpening of the coronal curette face produced extremely irregular cutting edges and non-functional wire edges. Sharpening with rotary devices produced extremely irregular cutting edges.