Reluctance to care: a systematic review and development of a conceptual framework

Primary lay carers are increasingly important in the care of patients with cancer, but their role can be complex and extended. Potential carers may feel anything from highly committed to not at all interested in caregiving, but powerful social norms pressure them to accept the role, and reluctance may be hidden to avoid censure. The purpose of this review was to gain insights into caregiving reluctance and its consequences. The findings were organized into 4 major dimensions: demographic, physical, psychological, and social. Three major outcomes were identified: deterioration in the carer-patient relationship, reduced quality of care, and institutionalization. Definitive answers to the review questions remain elusive. Choice seems to be a major indicator of caregiving reluctance, although reluctance may not remain static over the caregiving trajectory. Caregiving reluctance remains an underexplored topic, particularly in the context of cancer.     

Susceptibility of acinetobacter strains isolated from deployed U.S. military personnel

The susceptibilities of 142 Acinetobacter baumannii-calcoaceticus complex isolates (95 from wounded U.S. soldiers deployed overseas) to 13 antimicrobial agents were determined by broth microdilution. The most active antimicrobial agents (> or =95% of isolates susceptible) were colistin, polymyxin B, and minocycline.     

A Chronic Bile Duct and Intravenous Cannulation Model in Conscious Rabbits for Pharmacokinetic Studies

In the development of novel pharmaceutical compounds, pharmacokinetic parameters, such as the extent of biliary excretion, must be characterized. Pharmacokinetic studies in nonrodent species, typically dogs, are generally required for new drug approvals. However, in some cases, rabbits may be a more desirable model. We developed a surgical procedure for the intermittent or continuous collection of bile for long-term use. This surgery involves the removal of the gallbladder and cannulation of the proximal and distal aspects of the common bile duct using a 40 cm flexible surgical-grade cannula. The cannula loop is passed subcutaneously and exteriorized between the scapulae to divert bile flow. During use, the proximal cannula segment is attached to a collection container placed in a nylon torso jacket worn by the animal, and the distal segment of catheter is sealed with a stainless-steel adapter. An auricular catheter, secured by ligatures, is placed aseptically into the lateral ear vein and the tip is advanced to the cranial vena cava for serial blood collection. Daily infusions of a heparinized saline "lock" ensure patency. These procedures have been used in 18 rabbits for up to 1 month without clinical complications. Complete blood counts, biochemical profiles, body weights, and bile flow were monitored weekly and reflected normal enterohepatic circulation.     

Body Image Satisfaction in Heterosexual,Gay, and Lesbian Adults

Does the prevalence and degree of body dissatisfaction differ among heterosexual and homosexual men and women? Some theorists have suggested that, compared to their heterosexual peers, gay men are at greater risk for body dissatisfaction and lesbians at lower risk. Past studies examining this issue have generally relied on small samples recruited from gay or lesbian groups. Further, these studies have sometimes produced conflicting results, particularly for comparisons of lesbian and heterosexual women. In the present research, we compared body satisfaction and comfort with one’s body during sexual activity among lesbian women, gay men, heterosexual women, and heterosexual men through two large online studies (Ns = 2,512 and 54,865). Compared to all other groups, heterosexual men reported more positive evaluations of their appearance, less preoccupation with their weight, more positive effects of their body image on their quality of life and the quality of their sex life, more comfort wearing a swimsuit in public, and greater willingness to reveal aspects of their body to their partner during sexual activity. Few significant differences were found among gay men, lesbian women, and heterosexual women. Many gay men (42%) reported that their feelings about their body had negative effects on the quality of their sex life, as did some lesbian women (27%), heterosexual women (30%), and heterosexual men (22%). Overall, the findings supported the hypothesis that gay men are at greater risk than heterosexual men for experiencing body dissatisfaction. There was little evidence that lesbian women experience greater body satisfaction than heterosexual women.     

Is propylene oxide induced cell proliferation in rat nasal respiratory epithelium mediated by a severe depletion of water-soluble non-protein thiol?

Propylene oxide (PO) concentrations ≥300 ppm induced cell proliferation and tumors in rat nasal respiratory epithelium (NRE). Cell proliferation was suggested to result from depletion of glutathione (GSH) in NRE. In order to substantiate this hypothesis, cell proliferation – measured by bromodeoxyuridine incorporation into DNA of the epithelium lining middle septum, dorsal medial meatus, and medial and lateral surfaces of the nasoturbinate in transverse nasal sections taken immediately posterior to the upper incisor teeth – and water-soluble non-protein thiol (NPSH) in NRE were determined after exposing male Fischer 344 rats to 50 ppm, 100 ppm, 200 ppm, or 300 ppm PO (6 h/day, 3 days). Both parameters were also investigated after treating rats for 3 days with diethylmaleate (DEM; 2 × 250 mg/kg/day or 500 + 150 mg/kg/day) or buthionine sulfoximine (BSO; 500 mg/kg/day). Exposure to 50 ppm PO and treatment with 2 × 250 mg/kg/day DEM resulted in NPSH levels approximating 50% and 80% of the level in untreated controls, respectively. Cell proliferation did not increase. After exposures to ≥100 ppm PO or treatment with BSO or 500 + 150 mg/kg/day DEM, NPSH was depleted to ≤1/3 of the control level and cell proliferation increased 2.0–3.7-fold the control value. In conclusion, profound perturbation of the GSH status may represent a crucial step in PO induced rat nasal tumorigenicity.     

Mental illness surveillance among adults in the United States

Mental illnesses account for a larger proportion of disability in developed countries than any other group of illnesses, including cancer and heart disease. In 2004, an estimated 25% of adults in the United States reported having a mental illness in the previous year. The economic cost of mental illness in the United States is substantial, approximately $300 billion in 2002. Population surveys and surveys of health-care use measure the occurrence of mental illness, associated risk behaviors (e.g., alcohol and drug abuse) and chronic conditions, and use of mental health-related care and clinical services. Population-based surveys and surveillance systems provide much of the evidence needed to guide effective mental health promotion, mental illness prevention, and treatment programs. This report summarizes data from selected CDC surveillance systems that measure the prevalence and impact of mental illness in the U.S. adult population. CDC surveillance systems provide several types of mental health information: estimates of the prevalence of diagnosed mental illness from self-report or recorded diagnosis, estimates of the prevalence of symptoms associated with mental illness, and estimates of the impact of mental illness on health and well-being. Data from the CDC 2005-2008 National Health and Nutrition Examination Survey indicate that 6.8% of adults had moderate to severe depression in the 2 weeks before completing the survey. State-specific data from the CDC 2006 Behavioral Risk Factor Surveillance System (BRFSS), the most recent BRFSS data available, indicate that the prevalence of moderate to severe depression was generally higher in southeastern states compared with other states. Two other CDC surveys on ambulatory care services, the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey, indicate that during 2007-2008, approximately 5% of ambulatory care visits involved patients with a diagnosis of a mental health disorder, and most of these were classified as depression, psychoses, or anxiety disorders. Future surveillance should pay particular attention to changes in the prevalence of depression both nationwide and at the state and county levels. In addition, national and state-level mental illness surveillance should measure a wider range of psychiatric conditions and should include anxiety disorders. Many mental illnesses can be managed successfully, and increasing access to and use of mental health treatment services could substantially reduce the associated morbidity.