Longitudinal relationships between neighboring behavior and depressive symptoms in Hispanic older adults in Miami,Florida

This study examines the relationship between neighboring behavior and depressive symptoms across 3 years in a prospective study of 273 community‐dwelling, Hispanic older adults in Miami, Florida. The analyses extend the literature by testing for a bidirectional or reciprocal relationship between neighboring behavior and depressive symptoms over time and examining the relationship between these variables in Hispanic older adults, a group at risk of developing depressive symptoms. Structural Equation Modeling with a cross‐lagged panel design showed that depressive symptoms were unrelated to subsequent neighboring behavior. However, neighboring behavior was related to subsequent depressive symptoms at every time point, such that higher levels of neighboring behavior were related to lower levels of depressive symptoms. Findings suggest that neighboring behavior may be a protective factor against depressive symptoms in community‐dwelling Hispanic older adults. © 2009 Wiley Periodicals, Inc.     

Interpretation of occupational peak flow records: level of agreement between expert clinicians and Oasys-2

BACKGROUND: Oasys-2 is a validated diagnostic aid for occupational asthma that interprets peak expiratory flow (PEF) records as well as generating summary plots. The system removes inconsistency in interpretation, which is important if there is limited agreement between experts. A study was undertaken to assess the level of agreement between expert clinicians interpreting serial PEF measurements in relation to work exposure and to compare the responses given by Oasys-2. METHOD: 35 PEF records from workers under investigation for suspected occupational asthma were available for review. Records included details of nature of work, intercurrent illness, drug therapy, predicted PEF, rest periods, and holidays. Simple plots of PEF and the Oasys-2 generated plots were available. Experts were advised that approximately 1 hour was available to review the records. They were asked to score each work-rest-work (WRW) period and each rest-work-rest (RWR) period for evidence of occupational effect. At the end of each record scores of 0-100% were given for evidence of "asthma" and "occupational effect" for the whole record. Kappa values were calculated for each scored period and for the opinions on the whole record. The scores were converted into four groups (0-25%, 26-50%, 51-75%, 76-100%) and two groups (0-50% and 51-100%) for analysis. This is relevant to scores produced by Oasys-2. Agreement between Oasys-2 scores and each expert was calculated. RESULTS: 24 of 35 records were analysed by seven experts in the allotted time. For whole record occupational effect, median kappa values were 0.83 (range 0.56-0.94) for two groups and 0.62 (0.11-0.83) for four groups. For asthma, median kappa values were 0.58 (0-0.67) and 0.42 (0.15-0.70) for two and four groups respectively. For all WRW and RWR periods kappa values were 0.84 (0.42-0.94) and 0.70 (0.46-0.87) respectively. Agreement between Oasys-2 and individual experts showed a median kappa value of 0.75 (0.50-0.92) for two groups and 0.50 (0.39-0.70) for four groups. Kappa values for the median expert score v Oasys-2 were 0.75 for two groups and 0.67 for four groups. Agreement was poor for records with intermediate probability, as defined by Oasys-2. CONCLUSION: Considerable variation in agreement was seen in expert interpretation of occupational PEF records which may lead to inconsistencies in diagnosis of occupational asthma. There is a need for an objective scoring system which removes human variability, such as that provided by Oasys-2.     

Initial Engagement in Parent-Centered Preventive Interventions: A Family Systems Perspective

This article examines factors predicting participant engagement in a parent-centered, substance abuse preventive intervention. One hundred forty-three families assigned to the experimental condition were identified as either initially engaged (having attended at least one of the first three sessions) or not initially engaged. The groups were compared on demographics, family need for the intervention, barriers to participation, and family systems level variables. Results from hierarchical logistic regression analyses indicate that caregiver need for the intervention and family systems variables significantly predicted initial engagement in the intervention, while demographic variables, stressful life circumstances, and family stress failed to significantly influence engagement. Family systems variables were the strongest predictors of engagement within the full model. Furthermore, ethnic and racial background significantly moderated the effects of family systems variables on engagement in the intervention. For instance, African American families with low levels of family organization were less likely to be engaged than those with high levels of organization. This effect was not as strong for Hispanic caregivers. Implications for recruitment and engagement strategies are discussed.     

Screening for IgE-Mediated Allergy

Sera from 425 patients were analysed with Phadebas RAST reagents against a panel of 19 allergens and the most commonly positive results were to grass pollen, Dermatophagoides pteronyssinus and cat epithelium. Of the 275 sera RAST-positive to any allergen, 26l were positive by a RAST technique which used a mixture of the three most common U.K. allergens; the remainder were usually positive to a mould. We conclude that 1) when a positive result is obtained after screening by the mixed-allergen RAST and a representative mould RAST, then other positive RAST results are possible, but that the extent of the investigation can be guided by a knowledge of the total serum IgE level and a computer-based history analysis; 2) when the mixed-allergen RAST and a representative mould RAST is negative, then a more specified RAST including all 19 allergens used in this investigation will be negative; 3) a positive mixed-allergen RAST result is likely to be associated with a total serum IgE level over 40 U/ml and a positive symptom pattern score derived from the computer-based history analysis.     

Hypothermia and the approximate entropy of the electroencephalogram

BACKGROUND: The electroencephalogram is commonly used to monitor the brain during hypothermic cardiopulmonary bypass and circulatory arrest. No quantitative relationship between the electroencephalogram and temperature has been elucidated, even though the qualitative changes are well known. This study was undertaken to define a dose-response relationship for hypothermia and the approximate entropy of the electroencephalogram. METHODS: The electroencephalogram was recorded during cooling and rewarming in 14 patients undergoing hypothermic cardiopulmonary bypass and circulatory arrest. Data were digitized at 128 Hz, and approximate entropy was calculated from 8-s intervals. The dose-response relationship was derived using sigmoidal curve-fitting techniques, and statistical analysis was performed using analysis of variance techniques. RESULTS: The approximate entropy of the electroencephalogram changed in a sigmoidal fashion during cooling and rewarming. The midpoint of the curve averaged 24.7 degrees C during cooling and 28 degrees C (not significant) during rewarming. The temperature corresponding to 5% entropy (T 0.05 ) was 18.7 degrees C. The temperature corresponding to 95% entropy (T 0.95 ) was 31.3 degrees C during cooling and 38.2 degrees C during rewarming ( P < 0.02). CONCLUSIONS: Approximate entropy is a suitable analysis technique to quantify the electroencephalographic changes that occur with cooling and rewarming. It demonstrates a delay in recovery that is of the same magnitude as that seen with conventional interpretation of the analog electroencephalogram and extends these observations over a greater range of temperatures.     

Elective versus symptomatic antibiotic treatment in cystic fibrosis patients with chronic Pseudomonas infection of the lungs

BACKGROUND: A previous retrospective study suggested that a policy of regular anti-pseudomonal antibiotic treatment improved pulmonary function and increased survival in patients with cystic fibrosis chronically infected with Pseudomonas species. The results of a prospective multicentre study to compare the effects on pulmonary function and mortality of three monthly elective anti-pseudomonal antibiotic treatment with conventional symptomatic treatment are reported. METHODS: Sixty patients with cystic fibrosis, chronically infected with P aeruginosa, were randomised to the two treatment arms (elective or symptomatic) and followed clinically at yearly reviews. The major end points were changes in forced expiratory volume in one second (FEV(1)) and forced vital capacity (FVC). Survival was a secondary end point. RESULTS: Patients in the symptomatic group received a mean of three antibiotic treatments each year and those in the elective group received four antibiotic treatments during each year of the study. No significant differences in FEV(1) and FVC were found between the two groups after three years. There was a statistically non-significant higher rate of deaths in the elective group (n = 4), three of which were associated with B cepacia infection, compared with the symptomatic group (n = 0). CONCLUSIONS: This study did not demonstrate an advantage of a policy of elective antibiotic treatment over symptomatic treatment in patients with cystic fibrosis chronically infected with Pseudomonas species.     

Computer analysis of allergic histories taken by questionnaire

We report the development of a detailed allergy questionnaire designed so that the answers can be typed into a mini-computer. Computer programmes have been written to file and to retrieve these answers, and to print a summary which is then 'weighed', so as to produce a clinical atopy score which is then further broken down into indoor and outdoor scores. In a pilot survey of ninety patients, their clinical atopy scores and immunoglobulin E (IgE) profiles have been compared, and additional computer programmes have been written which will (a) assess if a more detailed IgE investigations is warranted, and (b) suggest which allergens, if any, are likely to be responsible for the patients' symptoms.