Burden of caregiving in mild to moderate dementia: an Asian experience

This survey sought to determine (a) the prevalence of carer stress in patients with mild to moderate dementia, (b) whether caregiver burden was already associated with plans to institutionalize patients, and (c) which patient-related and caregiver-related variables best predicted caregiver burden. The principal caregivers of 93 Asian patients with mild to moderate dementia attending an outpatient cognitive assessment clinic were interviewed via a structured questionnaire that focused upon (a) patient-related variables such as their behavioral and functional abnormalities; and (b) caregiver-related variables such as whether they were having problems looking after the patients, the duration of their caregiving, their associated feelings of anger and/or depression, and their financial status as well as intentions to institutionalize patients. Forty-nine percent of caregivers reported problems in looking after the patients, and their perception of difficulties was significantly associated with institutionalization plans for the patients. Logistic regression analysis using a forward variable selection procedure showed two of the patients' behavioral abnormalities (repetition, agitation) and one of their functional impairments (urinary incontinence) as well as the carers' depressed feelings to be predictive of the carers' problematic status, explaining 40% of the variance. It is important that even in the early stages of dementia, the medical assessment also evaluate behavioral, functional, and social dimensions of the illness, so that appropriate interventions can be implemented to reduce caregiving burden and delay institutionalization.     

Increase in signal intensities on T1-weighted magnetic resonance images in asymptomatic manganese-exposed workers

OBJECTIVES: To clarify the clinical significance of increased signal intensities on T1 weighted magnetic resonance imaging (MRI) we performed a large-scale epidemiological study on asymptomatic manganese (Mn)-exposed workers with its focus on MRI. METHODS: We randomly selected 121 male workers out of a total of 750 workers including Mn-exposed, non-exposed manual, and non-exposed clerical workers in the factories. We studied environmental and biological monitoring, neurological examination, and MRI. RESULTS: The proportion of workers with increased signal intensities among the exposed, the non-exposed manual workers, and the non-exposed clerical workers was 46.1%, 18.8%, and 0%, respectively. Especially, 73.5% of the welders showed increased signal intensities. In no subject, were clinical signs of manganism observed. The pallidal index correlated with blood Mn concentration. CONCLUSION: Increase in signal intensities on the T1-weighted image reflect recent exposure to Mn, but not necessarily manganism. At which increase of signal intensity, the progression of manganism from Mn exposure occurs, remains to be solved.     

Interactive risk factors for treatment adherence in a chronic psychotic disorders population

This study identified the unique and primary contributions of several concurrent risk factors for poor adherence to treatment recommendations in a clinic population of individuals with chronic psychotic disorders, i.e. 48% had DSM-IV diagnoses of schizoaffective disorder, 38% had schizophrenia, paranoid type, 12% had schizophrenia, undifferentiated type, and 2% had affective disorder with psychotic features. The target cohort consisted of 87 consecutive admissions to a continuing day treatment program. As part of a services-oriented quality assurance program, clinical staff completed rating scales for all patients. These included the BASIS-32 rating scale, which consisted of the following five subscales: psychosis; depression/anxiety; impulsive/addictive behavior; relation to self and others; and daily living and role functioning, and the Working Alliance Inventory-short form (therapist version), which consisted of the following three subscales: goal; task; and bond. These data were used to identify risk factors that weaken a patient's adherence to medication and non-medication treatment during the first 2 weeks of treatment in the clinic. Medication treatment consisted of both typical and atypical neuroleptic medications, with most patients being on multiple medications. Correlational analyses suggested that many of the risk factor variables were significantly associated with poor treatment adherence. Regression analyses suggested that the degree of psychoticism was most strongly associated with poor adherence to medication treatment and that difficulties relating to self and others were the strongest predictor of poor adherence to non-medication treatment. A large-sample services research design such as this can begin to determine patterns of associations between previous identified risk factors and poor treatment adherence in individuals with chronic psychotic disorders.     

Neonatal footshock stress alters adult behavior and hippocampal corticosteroid receptors

To determine the effects of stress early in life on adult behavior and hippocampal corticosteroid receptors, rats were exposed to footshocks (0.8 mA, 60 times/day, randomly apart) on postnatal days 14, 17 and 20. When they reached 6 months of age, neurobehavioral alterations were measured. The footshock-experienced rats learned more rapidly in the autoshaped learning test than similarly handled controls. They also stabilized more quickly after exposure to a novel environment than the handled controls, but only at the same rate as animals which had not been handled except for weighing. The density of [3H]dexamethasone binding sites increased and that of [3H]corticosterone binding sites decreased in the hippocampi of these rats. These results indicate that early life stress results in altered behavior and hippocampal corticosteroid receptors at adulthood, and suggest that the mineralocorticoid and the glucocorticoid receptors are differentially regulated by early life stress.     

Seroconversion rates in healthcare workers using a latex agglutination assay after varicella virus vaccination.

OBJECTIVES: To determine the seroconversion rate after varicella immunization of healthcare workers (HCWs) and the effect of seroconversion rate on current cost-based recommendations for universal vaccination. METHODS: A voluntary vaccination program for HCWs was performed at a tertiary-care cancer center in New York City. A commercial latex agglutination assay was used to test postvaccination antibody response. Costs for vaccination and postvaccination serological testing were compared to potential costs of postexposure employee furloughs. RESULTS: Of 263 seronegative HCWs, 96 (36.5%) began the vaccine program. Thirty-nine HCWs received only one dose of vaccine. Seven returned for follow-up antibody testing, of whom 4 were seropositive. Of the 57 HCWs who received two doses, 38 returned for follow-up serology. Thirty-one (81.6%) HCWs were seropositive for varicella-zoster virus antibodies, and seven HCWs (18.4%) remained seronegative. Total cost of vaccination for all 263 seronegative HCWs was estimated and compared to the cost of varicella-related furloughs at our institution. CONCLUSIONS: We found a considerably lower rate of vaccine-induced seroconversion at our hospital compared to that of the published literature. Despite this finding, universal varicella vaccination remained an extremely cost-effective alternative to the furloughing of exposed, seronegative HCWs. Projected hospital savings exceeded $53,000 in the first year after vaccination alone.     

Contact lens wear after photorefractive keratectomy: comparison between rigid gas permeable and soft contact lenses.

PURPOSE: To determine if rigid gas permeable (RGP) or soft contact lenses can be successfully worn after photorefractive keratectomy (PRK) to correct residual refractive errors. METHODS: Patients with residual stable ametropia after PRK were fit with RGP or soft lenses. Manifest refraction, corneal topography, and keratometry were performed, and post-PRK corneal haze was graded during the study visits. Contact lens fit characteristics and comfort were assessed. Lens centration, visual quality, and ocular surface status were graded, and visual acuity with contact lenses was charted. RESULTS: Eighteen patients were recruited for RGP lens fitting. The mean refractive error post-PRK was +0.80 D +/- 2.03 (range: -3.50 to+3.00 D). The mean contact lens power was -3.90 D +/- 2.03 (range: 0 to -7.00 D), and the mean contact lens base curve was 7.88 mm +/-0.16. A significant positive tear film at the site of the central ablation was noted, contributing to excessive minus lens power in all cases. Despite mild to moderate lens instability and de-centration, 14 patients reported excellent visual quality with the lenses, and pre-PRK best-corrected acuity was achieved in all patients. Twenty-five percent (4 of 16) of the patients were able to wear the lenses all day. Eleven patients were recruited for soft contact lens fitting-five from the RGP trial. The mean refractive error post-PRK was -0.64 D +/- 2.01 (range: -3.50 to +1.75D). The mean contact lens power was -0.60 D +/- 2.07 (range: -3.75 to +2.5 D), and the mean contact lens base curve was 8.33 mm +/- 0.42. Eight patients were corrected with lenses to their pre-PRK best-corrected acuity, and nine patients reported excellent visual quality with the lenses. All the patients had excellent lens centration. Thirty-six percent (four of 11) of patients were wearing the lenses all day. CONCLUSIONS: Fitting RGP lenses after PRK results in good visual acuity but may be associated with mild to moderate lens instability and decentration. Soft contact lens fitting also results in good visual acuity. Soft lenses were better tolerated by the subjects in our study because of improved lens centration and stability.     

Sulindac derivatives inhibit growth and induce apoptosis in human prostate cancer cell lines.

We examined the activity of two metabolites of sulindac (a nonsteroidal anti-inflammatory drug), sulindac sulfide and sulindac sulfone (exisulind, Prevatec), and a novel highly potent analog of exisulind (CP248) on a series of human prostate epithelial cell lines. Marked growth inhibition was seen with the BPH-1, LNCaP, and PC3 cell lines with IC50 values of about 66 microM, 137 microM, and 64 nM for sulindac sulfide, exisulind, and CP248, respectively. DNA flow cytometry and 4',6'-diamido-2-phenylindole (DAPI) staining indicated that these three compounds also induced apoptosis in all of these cell lines. Similar growth inhibition also was seen with the PrEC normal human prostate epithelial cell line, but these cells were resistant to induction of apoptosis at concentrations up to 300 microM, 1 mM, and 750 nM of sulindac sulfide, exisulind, and CP248, respectively. Derivatives of LNCaP cells that stably overexpress bcl-2 remained sensitive to growth inhibition and induction of apoptosis by these compounds. In vitro enzyme assays indicated that despite its high potency in inhibiting growth and inducing apoptosis, CP248, like exisulind, lacked cyclooxygenase (COX-1 and COX-2) inhibitory activity even at concentrations up to 10 mM. Moreover, despite variations of COX-1 and COX-2 expression, the three benign and malignant prostate cell lines showed similar sensitivity to growth inhibition and induction of apoptosis by these three compounds. Therefore, sulindac derivatives can cause growth inhibition and induce apoptosis in human prostate cancer cells by a COX-1 and -2 independent mechanism, and this occurs irrespective of androgen sensitivity or increased expression of bcl-2. These compounds may be useful in the prevention and treatment of human prostate cancer.