Socioeconomic inequalities in quality of life and psychological outcomes among cardiac patients

Objectives:  The aim of this article is to explore socioeconomic inequalities in the psychological characteristics (psychological well-being, perceived mental health status) and perceived quality of life among cardiac patients. Methods:  A structured interview was conducted with 362 patients (32% women, mean age 56 ± 7.3 years) referred for coronary angiography. The GHQ-28 was used to measure psychological well-being, the SF-36 for perceived mental health status. Income and education indicated socioeconomic position. Logistic regressions were employed, adjusted for age, gender, functional status and severity of disease. Results:  Patients with low income or education had a higher probability of having poor psychological well-being compared to participants with high income or education (OR 5.5,CI 2.32-12.80; OR 3.1,CI 1.52-6.37 resp.), and were also more likely to have worse mental health status (OR2.9,CI 1.02-8.51;OR 4.8,CI 1.36-16.99 resp.), and low quality of life (OR 2.9,CI 1.02-8.51; OR 4.8,CI 1.36-16.99 resp.). Conclusions:  Socioeconomic status was found to be negatively associated with the psychological outcomes and quality of life among cardiac patients. Socioeconomic inequalities should be taken into account when designing suitably-adapted interventions focusing on psychosocial factors among cardiac patients. Submitted: 27 September 2007; revised: 08 January 2009, 16 March 2009; accepted: 18 March 2009     

Cost Implications of Organizing Nursing Home Workforce in Teams

Objective. To estimate the costs associated with formal and self-managed daily practice teams in nursing homes.
Data Sources/Study Setting. Medicaid cost reports for 135 nursing homes in New York State in 2006 and survey data for 6,137 direct care workers.
Study Design. A retrospective statistical analysis: We estimated hybrid cost functions that include team penetration variables. Inference was based on robust standard errors.
Data Collection. Formal and self-managed team penetration (i.e., percent of staff working in a team) were calculated from survey responses. Annual variable costs, beds, case mix-adjusted days, admissions, home care visits, outpatient clinic visits, day care days, wages, and ownership were calculated from the cost reports.
Principal Findings. Formal team penetration was significantly associated with costs, while self-managed teams penetration was not. Costs declined with increasing penetration up to 13 percent of formal teams, and increased above this level. Formal teams in nursing homes in the upward sloping range of the curve were more diverse, with a larger number of participating disciplines and more likely to include physicians.
Conclusions. Organization of workforce in formal teams may offer nursing homes a cost-saving strategy. More research is required to understand the relationship between team composition and costs.     

Hurdles at work: perceptions of hospital food handlers

Background  

Food handlers have a very important role in preventing food contamination during its preparation and distribution. This responsibility is even greater in hospitals, since a large number of patients have low immunity and consequently food contamination by pathogenic bacteria could be particularly harmful. Therefore, a good working environment and periodic training should be provided to food handlers by upper management.     

Bradykinin receptor antagonists and cyclooxygenase inhibitors in vincristine-and streptozotocin-induced hyperalgesia

Pain that accompanies neuropathy is difficult to treat. Analgesics administered as monotherapies possess low activities in relieving this kind of pain.The effect of the simultaneous administration of indomethacin (a preferential inhibitor of cyclooxygenase-1; COX-1) or celecoxib (a relatively selective inhibitor of cyclooxygenase-2; COX-2), with selective antagonists of bradykinin₂ (B₂) bradykinin1 (B₁) receptors (HOE 140 or des-Arg¹⁰-HOE 140) on the eleviation of diabetic and toxic neuropathic pain was investigated.Pretreatment with indomethacin (0.1 mg/kg, sc) increased the antihyperalgesic activity of low daily doses of HOE 140 or des-Arg¹⁰HOE 140 (70 nmol/kg, ip) in a diabetic (streptozotocin(STZ)-induced) neuropathy/hyperalgesia experimental model. Premedication with celecoxib before HOE 140 or des-Arg¹⁰HOE 140 administration resulted in a gradual reduction of STZ hyperalgesia. Furthermore, on days 23–24, almost complete abolishment of STZ hyperalgesia was observed. After cessation of drug administration, hyperalgesia quickly returned to the baseline threshold.The results of this study suggest that inhibitors of cyclooxygenases can increase the antihyperalgesic activity of selective antagonists of B₂ and B₁ receptors in diabetic and toxic neuropathic pain models. These observations may be clinically relevant.     

Magnesium ions and opioid agonists in vincristine-induced neuropathy

Neuropathic pain is difficult to treat. Classic analgesics (i.e., opioid receptor agonists) usually possess low activity. Therefore other agents such as antidepressants, anticonvulsants, and corticosteroids are used. It is commonly known that NMDA antagonists increase analgesic activity of opioids. Unfortunately, clinical use of NMDA antagonists is limited because of the relatively frequent occurrence of adverse effects e.g., memory impairment, psychomimetic effects, ataxia and motor in-coordination. Magnesium ions (Mg²⁺) are NMDA receptor blockers in physiological conditions. Therefore, in this study the effect of opioid receptor agonists and the influence of Mg²⁺ on the action of opioid agonists in vincristine-induced hyperalgesia were examined. Opioid agonists such as morphine (5 mg/kg, ip), and fentanyl (0.0625 mg/kg, ip), as well as the partial agonist buprenorphine (0.075 mg/kg, ip) administered alone on 5 consecutives days did not modify the hyperalgesia in vincristine rats. In contrast, pretreatment with a low dose of magnesium sulfate (30 mg/kg, ip) resulted in a progressive increase of the analgesic action of all three investigated opioids. After discontinuation of drug administration, the effect persisted for several days.     

Ascorbic acid retaining using a new calcium alginate-Capsul based edible film

This work aimed to produce a new calcium alginate-Capsul edible film with antioxidant incorporated in matrix. The vitaminic stability was evaluated in the films during their storage under different conditions for 140 days. The films were characterized with respect to their mechanical properties and surface morphology. The results indicated a 25.6% of vitamin C incorporation in matrix during the film preparation. The films stored under refrigeration in the dark did not show a decrease in the vitaminic retention. The films stored under room temperature in the dark and in the bright/dark cycles exhibited significant decreases in the vitamin retaining from the 84th and 70th days, respectively. The vitamin C addition significantly decreased the tensile strength in the new pellicle. The results of the microscopy revealed a cohesive matrix in the new edible films. These results support the utilization of the new pellicle to protect ingredients, although more studies are necessary.     

In vitro release and characterization of chitosan films as dexamethasone carrier

Chitosan, a biodegradable and biocompatible polysaccharide, is a potentially useful material in various fields. We produced mono and bilayer chitosan films containing dexamethasone as a drug carrier for controlled release. The chitosan drug-loaded films were produced by a casting/solvent evaporation technique using 2 wt% acetic acid solution and distilled water and they were dried at room temperature. These films were characterized by release and swelling studies, DSC and ATR-FTIR. The total profile for water absorption was similar for the types of films developed. ATR-FTIR analysis showed little change in the band position of the O--H and N--H stretching from dexamethasone and chitosan, respectively. DSC analysis from bilayer film indicates that the dexamethasone peak was shifted from 256 to 240 degrees C. These results suggested an interaction between hydroxyl and amino groups of chitosan and hydroxyl groups of dexamethasone. In the drug release studies it was observed 89.6% release from the monolayer film in 8h and 84% from the bilayer film in 4 weeks. These results suggested that the chitosan sheet prepared in this study is a promising delivery carrier for dexamethasone.     

Bioequivalence assay between orally disintegrating and conventional tablet formulations in healthy volunteers

The purpose of this study was to evaluate bioequivalence of two commercial 8 mg tablet formulations of ondansetrona available in the Brazilian market. In this study, a simple, rapid, sensitive and selective liquid chromatography-tandem mass spectrometry method is described for the determination of ondansetron in human plasma samples. The method was validated over a concentration range of 2.5-60 ng/ml and used in a bioequivalence trial between orally disintegrating and conventional tablet ondansetron formulations, to assess its usefulness in this kind of study. Vonau flash (Biolab Sanus Farmacêutica, Brazil, as test formulations) and Zofran (GlaxoSmithKline, Brazil, as reference formulation) were evaluated following a single 8 mg dose to 23 healthy volunteers of both genders. The dose was administered after an overnight fast according to a two-way crossover design. Bioequivalence between the products was determinated by calculating 90% confidence interval (90% CI) for the ratio of C(max), AUC(0-t) and AUC(0-infinity) values for the test and reference products, using logarithmically transformed data. The 90% confidence interval for the ratio of C(max) (87.5-103.8%), AUC(0-t) (89.3-107.2%) and AUC(0-infinity) (89.7-106.0%) values for the test and reference products is within the 80-125% interval, proposed by FDA, EMEA and ANVISA. It was concluded that two ondansetron formulations are bioequivalent in their rate and extent of absorption.     

AID expression levels determine the extent of cMyc oncogenic translocations and the incidence of B cell tumor development

Immunoglobulin (Ig) isotype switching is a recombination event that changes the constant domain of antibody genes and is catalyzed by activation-induced cytidine deaminase (AID). Upon recruitment to Ig genes, AID deaminates cytidines at switch (S) recombination sites, leading to the formation of DNA breaks. In addition to their role in isotype switching, AID-induced lesions promote Igh-cMyc chromosomal translocations and tumor development. However, cMyc translocations are also present in lymphocytes from healthy humans and mice, and thus, it remains unclear whether AID directly contributes to the dynamics of B cell transformation. Using a plasmacytoma mouse model, we show that AID^+/− mice have reduced AID expression levels and display haploinsufficiency both in the context of isotype switching and plasmacytomagenesis. At the Ig loci, AID^+/− lymphocytes show impaired intra- and inter-switch recombination, and a substantial decrease in the frequency of S mutations and chromosomal breaks. In AID^+/− mice, these defects correlate with a marked decrease in the accumulation of B cell clones carrying Igh-cMyc translocations during tumor latency. These results thus provide a causality link between the extent of AID enzymatic activity, the number of emerging Igh-cMyc–translocated cells, and the incidence of B cell transformation.