Zarit burden interview among caregivers of community-dwelling older adults in a caribbean setting (Jamaica): Reliability and factor structure

The Zarit Burden Interview has been the most popularly used tool for measuring caregiver burden and with the 60 years and over population in Jamaica and developing countries expected to increase, caregiver burden and its assessment assume increased importance. Establishing the reliability and underlying factor structure of instruments such as the ZBI is critical. This study sought to determine the reliability of the Zarit Burden Interview and to assess its underlying factor structure. The ZBI was administered to 180 caregivers of community dwelling older persons in Jamaica in a nationally representative sample across four geographic health regions in 2016. The factor structure was identified using exploratory factor analysis (EFA) with Varimax rotation. Cronbach's alpha was used to assess internal consistency/reliability of the instrument. The internal consistency/reliability of the ZBI instrument was high (Cronbach's α = 0.859) and the corrected item-total correlations ranged from 0.134 to 0.730. The ZBI mean score was found to be 16.92 ± 12.04. EFA produced a six-factor model comprised of 19 items which explained 48.97% of total variance, and was subsequently reduced to four (37.27% of total variance) via the use of parallel analysis and scrutiny of confidence intervals. The four factors identified were ‘personal strain’, ‘social relations disruption’, ‘resource strain/imbalance’ and ‘role intensity’. The ZBI-22 tool is a reliable instrument for evaluating caregiver burden among community dwelling older persons in Jamaica. A four factor model has emerged providing greater insights on the underlying constructs of the ZBI, the most widely used caregiver burden assessment tool.     

Chrysotile as a Cause of Mesothelioma: An Assessment Based on Epidemiology

There has been a longstanding debate about the potential contribution of chrysotile asbestos fibers to mesothelioma risk. The failure to resolve this debate has hampered decisive risk communication in the aftermath of the collapse of the World Trade Center towers and has influenced judgments about bans on asbestos use. A firm understanding of any health risks associated with natural chrysotile fibers is crucial for regulatory policy and future risk assessments of synthesized nanomaterials. Although epidemiological studies have confirmed amphibole asbestos fibers as a cause of mesothelioma, the link with chrysotile remains unsettled. An extensive review of the epidemiological cohort studies was undertaken to evaluate the extent of the evidence related to free chrysotile fibers, with particular attention to confounding by other fiber types, job exposure concentrations, and consistency of findings. The review of 71 asbestos cohorts exposed to free asbestos fibers does not support the hypothesis that chrysotile, uncontaminated by amphibolic substances, causes mesothelioma. Today, decisions about risk of chrysotile for mesothelioma in most regulatory contexts reflect public policies, not the application of the scientific method as applied to epidemiological cohort studies.     

Aldehyde Sources,Metabolism, Molecular Toxicity Mechanisms,and Possible Effects on Human Health

Aldehydes are organic compounds that are widespread in nature. They can be formed endogenously by lipid peroxidation (LPO), carbohydrate or metabolism ascorbate autoxidation, amine oxidases, cytochrome P-450s, or myeloperoxidase-catalyzed metabolic activation. This review compares the reactivity of many aldehydes towards biomolecules particularly macromolecules. Furthermore, it includes not only aldehydes of environmental or occupational concerns but also dietary aldehydes and aldehydes formed endogenously by intermediary metabolism. Drugs that are aldehydes or form reactive aldehyde metabolites that cause side-effect toxicity are also included. The effects of these aldehydes on biological function, their contribution to human diseases, and the role of nucleic acid and protein carbonylation/oxidation in mutagenicity and cytotoxicity mechanisms, respectively, as well as carbonyl signal transduction and gene expression, are reviewed. Aldehyde metabolic activation and detoxication by metabolizing enzymes are also reviewed, as well as the toxicological and anticancer therapeutic effects of metabolizing enzyme inhibitors. The human health risks from clinical and animal research studies are reviewed, including aldehydes as haptens in allergenic hypersensitivity diseases, respiratory allergies, and idiosyncratic drug toxicity; the potential carcinogenic risks of the carbonyl body burden; and the toxic effects of aldehydes in liver disease, embryo toxicity/teratogenicity, diabetes/hypertension, sclerosing peritonitis, cerebral ischemia/neurodegenerative diseases, and other aging-associated diseases.     

Retrospective study of total healthcare costs associated with chronic nonvalvular atrial fibrillation and the occurrence of a first transient ischemic attack,stroke or major bleed

Abstract

Objective:

To determine the direct healthcare costs associated with the onset of chronic nonvalvular atrial fibrillation (CNVAF), warfarin utilization and the occurrence of cerebrovascular events in a commercially-insured population.     

The direct costs of untreated comorbid insomnia in a managed care population with major depressive disorder

Abstract

Objectives:

Previous research has shown that untreated insomnia has significant direct and indirect burden. Despite the high comorbidity of insomnia and Major Depressive Disorder (MDD), no studies have attempted to determine the economic costs among patients diagnosed with MDD and insomnia. The purpose of this study was to estimate the economic burden of comorbid untreated insomnia within an adult and elderly population with MDD.     

浙江省2013年2型糖尿病伤残调整寿命年分析

目的 定量估计浙江省人群2013年2型糖尿病的疾病负担。方法 使用2010年全球疾病负担研究(GBD 2010)方法,利用浙江省人群2型糖尿病发病率、患病率和死亡率数据,借助DISMODⅡ软件计算伤残调整寿命年(DALY)、伤残损失寿命年(YLD)和损失寿命年(YLL)。结果 2013年浙江省2型糖尿病每千人DALY值为5.36人年,女性(5.49人年)高于男性(5.24人年),城市(5.47人年)高于农村(5.42人年);DALY强度主要集中在老年组,其中以80～84岁人群最高(32.63人年/1 000人)。2型糖尿病主要引起伤残负担,YLL/YLD=0.62。结论 浙江省2型糖尿病平均YLL率高于全国水平。     

1990年与2013年中国人群白血病疾病负担分析

目的 分析1990年与2013年中国人群白血病的疾病负担及其变化情况。方法 利用中国分省疾病负担研究结果,分析和比较1990年与2013年全国白血病的发病、死亡情况及伤残调整寿命年(DALY)、过早死亡损失寿命年(YLL)和伤残损失寿命年(YLD)。描述2013年各省份白血病标化死亡率及与1990年相比白血病标化死亡率的变化情况。结果 2013年中国人群白血病标化发病率为6.70/10万,标化死亡率为4.05/10万,较1990年分别降低8.84%和36.22%。2013年白血病标化DALY率、标化YLL率分别为174.58/10万和170.42/10万,较1990年分别下降44.68%和45.32%。2013年白血病标化YLD率为4.16/10万,与1990年相比,升高6.94%。年龄别数据显示,2013年,35岁以下人群因白血病死亡人数占因癌症死亡总数的比例高于10%,5岁以下儿童白血病DALY率最高,为317.61/10万。2013年与1990年相比,各省份人群白血病标化死亡率均出现下降,2013年白血病标化死亡率最高的前3个省份为新疆(4.72/10万)、宁夏(4.56/10万)和福建(4.50/10万)。结论 中国人群白血病标化发病率、死亡率、DALY率和YLL率下降,但YLD率升高,儿童、青少年因白血病死亡占因癌症死亡的构成比较高。各省份白血病标化死亡率均下降,但仍存在差异。     

失能调整生命年在煤矿职业性疾病负担分析中的应用

为估计煤矿外伤性截瘫疾病负担,采用横断面抽样调查,共抽样调查全国５ 个统配矿务局的２６ 个煤矿。以煤矿外伤性截瘫的患病和死亡资料为基础,用失能调整生命年（ＤＡＬＹ） 估计煤矿外伤性截瘫疾病负担。结果表明：煤矿外伤性截瘫疾病负担为每千人口３２２５ＤＡＬＹ。各矿务局比较：铜川矿务局外伤性截瘫疾病负担最重,每千人口５４４７ ＤＡＬＹ,高于５ 个矿务局的平均水平每千人口３２２５ＤＡＬＹ。其次为阳泉、峰峰矿务局、三路安矿务局和晋城矿务局,分别为每千人口２７ ．８５ 、２６ ．６０ 、１５１０ 和１１ ．７１ＤＡＬＹ。结果提示：ＤＡＬＹ 可用于煤矿职业性疾病负担分析。各统配矿务局外伤性截瘫的ＤＡＬＹ 差异较大     

应用伤残调整生命年评价疾病负担的方法学探究

疾病负担是确定卫生资源配置优先权的基础,疾病负担的评价与分析正在逐渐成为疾病预防控制和卫生行政决策部门的常规工作,而选择适合的疾病负担研究方法才能保证疾病负担测算的科学性。该研究拟系统评价伤残权重、年龄变量、贴现率等伤残调整生命年（DALY）重要参数的本土化合理性,并探索在现有疾病监测系统基础上建立我国完善的常规疾病负担测算体系。     

Assessment reactivity to follow-up in a study of women's treatment for alcohol dependence

Little research has been conducted on symptom reductions in response to assessments in clinical trials, despite the impact such reactivity may have on interpretation of outcomes. Reactivity to data collection procedures during post-treatment follow-up may obscure treatment effects. The current study examined whether female participants (n=102) in a trial of cognitive-behavioral treatment for alcohol dependence had lower drinking quantity and frequency immediately after participating in follow-up assessments. Repeated measures ANOVAs were used to compare each participant's drinking among two-week time periods immediately before the follow-up, directly after the follow-up, and between follow-ups. No assessment reactivity was found for 9 or 15 month follow-up interviews, but was suggested at a 12 month in-person interview.