Evaluation of spouse abuse treatment: description and evaluation of the Air Force Family Advocacy Programs for spouse physical abuse

Data are reported from a sample of 2,991 spouse physical abusers who received Air Force Family Advocacy Program (FAP) services and who volunteered to complete program evaluation measures that were administered before and after treatment and at a 6-month follow-up. As expected, after treatment compared with before treatment, professionals rated offenders as less at risk, and the offenders indicated general satisfaction with the Family Advocacy Program services. Additionally, as predicted, objective measures indicated that offenders showed significant (p < 0.001) decreases in family conflict and child abuse risk and significant increases (p < 0.001) in family cohesion, family expression, and marital satisfaction. An analysis of the available follow-up data indicated that each of the post-treatment improvements were maintained at the time of the follow-up evaluation.     

Elevated luteinizing hormone expression colocalizes with neurons vulnerable to Alzheimer's disease pathology

In individuals with Alzheimer's disease (AD), there is a two-fold elevation in the serum concentrations of the gonadotropins, luteinizing hormone (LH), and follicle stimulating hormone compared to age-matched controls. Whether this plays a role in disease pathogenesis is unclear. Nonetheless, gonadotropins are known to cross the blood brain barrier and the highest density of gonadotropin receptors in the brain are found within the hippocampus. We report for the first time the localization of LH in the cytoplasm of pyramidal neurons. In addition, we find a significant increase in LH in the cytoplasm of pyramidal neurons and neurofibrillary tangles of AD brain compared to age-matched control brain. Whereas the functional consequences of increased neuronal LH are unknown, it is notable that LH is primarily localized to those neurons that are known to be vulnerable to Alzheimer's disease-related neurodegeneration. Elevated serum and cortical neuron levels of LH, coupled with the decline in sex steroid production, could play important roles in the pathogenesis of AD.     

Engraftment of sorted/expanded human central nervous system stem cells from fetal brain

Direct isolation of human central nervous system stem cells (CNS-SC) based on cell surface markers yields a highly purified stem cell population that can extensively expand in vitro and exhibit multilineage differentiation potential both in vitro and in vivo. The CNS-SC were isolated from fetal brain tissue using the cell surface markers CD133(+), CD34(-), CD45(-), and CD24(-/lo) (CD133(+) cells). Fluorescence-activated cell sorted (FACS) CD133(+) cells continue to expand exponentially as neurospheres while retaining multipotential differentiation capacity for >10 passages. CD133(-), CD34(-), and CD45(-) sorted cells (approximately 95% of total fetal brain tissue) fail to initiate neurospheres. Neurosphere cells transplanted into neonatal immunodeficient NOD-SCID mice proliferated, migrated, and differentiated in a site-specific manner. However, it has been difficult to evaluate human cell engraftment, because many of the available monoclonal antibodies against neural cells (beta-tubulin III and glial fibrillary acidic protein) are not species specific. To trace the progeny of human cells after transplantation, CD133(+)-derived neurosphere cells were transduced with lentiviral vectors containing enhanced green fluorescent protein (eGFP) expressed downstream of the phosphoglycerate kinase promoter. After transduction, GFP(+) cells were enriched by FACS, expanded, and transplanted into the lateral ventricular space of neonatal immunodeficient NOD-SCID brain. The progeny of transplanted cells were detected by either GFP fluorescence or antibody against GFP. GFP(+) cells were present in the subventricular zone-rostral migrating stream, olfactory bulb, and hippocampus as well as nonneurogenic sites, such as cerebellum, cerebral cortex, and striatum. Antibody against GFP revealed that some of the cells displayed differentiating dendrites and processes with neurons or glia cells. Thus, marking human CNS-SC with reporter genes introduced by lentiviral vectors is a useful tool with which to characterize migration and differentiation of human cells in this mouse transplantation model.     

GM-CSF and M-CSF modulate beta-chemokine and HIV-1 expression in microglia

Significant numbers of patients with acquired immunodeficiency syndrome (AIDS) develop CNS infection primarily in macrophages and microglial cells. Therefore, the regulation of human immunodeficiency virus type 1 (HIV-1) infection and activation of the brain mononuclear phagocytes subsequent to infection are important areas of investigation. In the current report, we studied the role of granulocyte-macrophage colony-stimulating factor (GM-CSF) and macrophage-CSF (M-CSF) in the expression of antiviral beta-chemokines and HIV-1 p24 in cultures of primary human fetal microglia. We found that stimulation with GM-CSF or M-CSF induced macrophage inflammatory proteins (MIP-1alpha and MIP-1beta) and augmented RANTES expression, after HIV-1 infection of microglia. This was not due to the effect of GM-CSF on viral expression because GM-CSF was neither necessary nor stimulatory for viral infection, nor did GM-CSF enhance the expression of env-pseudotyped reporter viruses. Blocking GM-CSF-induced microglial proliferation by nocodazole had no effect on beta-chemokine or p24 expression. The functional significance of the GM-CSF-induced beta-chemokines was suggested by the finding that, in the presence of GM-CSF, exogenous beta-chemokines lost their anti-HIV-1 effects. We further show that although HIV-1-infected microglia produced M-CSF, they failed to produce GM-CSF. In vivo, GM-CSF expression was localized to activated astrocytes and some inflammatory cells in HIV-1 encephalitis, suggesting paracrine activation of microglia through GM-CSF. Our results demonstrate a complex interplay between CSFs, chemokines, and virus in microglial cells and may have bearing on the interpretation of data derived in vivo and in vitro.     

Measuring consumer perceptions of quality differences among competing health benefit plans

In this paper, we combine revealed preference and survey data on attribute importance to estimate parameters that represent average perceived differences in the quality and convenience of competing health benefit plans. We find that consumers do not perceive differences in provider quality across options. though they do perceive differences related to waiting time and access to specialists. In order to validate our approach, we estimate parameters representing perceived premiums and compare the estimates to actual premium differences. The results suggest that consumers correctly perceive the high-premium option to cost more than the low-premium option. These results increase our confidence in the use of stated importance data to identify and interpret parameters measuring the effect of otherwise unobservable attributes of choice alternatives.     

Achieving improvement through nursing home quality measurement

CMS has initiated the Nursing Home Quality Initiative (NHQI) to improve the quality of nursing home care. Central to the NHQI is the public reporting of nursing home quality measures that serve as the basis for the Initiative's communication and quality improvement program. This article provides an overview of the NHQI, focusing on the role of nursing home quality measures in achieving improvements in nursing home care. We also describe the evolution of quality measurement in nursing homes, a recent CMS project to improve measures through risk adjustment and other refinements, the use of these measures in a pilot of the NHQI, and the lessons learned for future work in this area.     

Identification and evaluation of existing nursing homes quality indicators

We summarize work done to identify and evaluate existing quality indicators (QIs) for long-term care (LTC) settings. Indicators operationally defined using routinely collected and computerized patient assessments were identified and then aggregated to characterize the performance of the nursing facility over a specific period of time. Of 143 indicators reviewed, only 22 were recommended for use in comparing performance across facilities. Conceptual and technical issues influence the appropriateness of QIs for different audiences.     

Mammography uptake predictors in older women

BACKGROUND: In women aged under 65 years, socio-economic factors and general health behaviours are important predictors of mammography uptake. Little is known about whether these factors are important in older women. OBJECTIVE: To examine a broad range of mammography uptake predictors in women aged 65 and older registered with a London (UK) practice. METHODS: A survey of all female patients aged 65 and over (n = 613) in a south London practice included questions on mammography and cervical screening, general health and functional ability, socio-economic factors, mental health, health behaviours, and attitudes to health. Associations between mammography uptake and other factors were examined using logistic regression. RESULTS: The response rate was 70% (432/613). Increased age was strongly associated with decreased mammography uptake. Additionally, socio-economic factors and general health behaviours (previous cervical smear, drinking alcohol and being a non-smoker) were independently predictive of mammography uptake. Measures of physical and mental health and health attitudes were not independent predictors. Restricting analyses to the oldest women, outside the national screening programme, gave very similar results. CONCLUSIONS: In this sample of older women, socio-economic factors and general health behaviours were more predictive of mammography uptake than measures of physical and mental health or attitudes to health. Knowledge of these predictors is of increasing importance as the screening programme in the UK is extended up to age 70.