Epidemiology, appropriateness, and cost of vancomycin use

OBJECTIVE: Our purpose was to compare the estimated maternal cerebral perfusion pressure and an index of vascular resistance, the resistance area product, in nonpregnant women with hypertensive pregnant women. STUDY DESIGN: The maternal middle cerebral artery was evaluated by transcranial Doppler ultrasonography in 17 nonpregnant women, 17 pregnant normotensive patients, 20 pregnant patients with chronic hypertension, and 21 pregnant patients with pre-eclampsia (defined by The American College of Obstetricians and Gynecologists criteria) and cerebral blood flow velocities were determined. We calculated estimated cerebral perfusion pressure as [Estimated cerebral perfusion pressure = V mean/(V mean = V diastolic) (Mean blood pressure - Diastolic blood pressure)] modified from Aaslid et al, 1986. Because the diameter of the vessels could not be measured directly, an index of resistance, the resistance area product, was calculated. Resistance area product = Mean blood pressure/mean velocity (Evans et al, 1988). We calculated an index of cerebral blood flow (Cerebral blood flow index) = Estimated cerebral perfusion pressure/resistance area product. RESULTS: Women who were chronically hypertensive and those with pre-eclampsia showed a significant increase in estimated cerebral perfusion pressure and resistance area product compared with nonpregnant and pregnant normotensive women. An estimate of cerebral blood flow (cerebral blood flow index) in nonpregnant women showed that pregnancy resulted in a nonsignificant 18% increase in cerebral blood flow. CONCLUSIONS: Women with chronic hypertension and pre-eclampsia behave similarly by demonstrating significant increases in cerebral perfusion pressure (estimated cerebral perfusion pressure) and cerebrovascular resistance (resistance area product) compared with normotensive and nonpregnant women. Pregnant patients have a minimal increase in cerebral blood flow (18%).     

The consequences of universalizing health services: children's use of health services in Catalonia

The purpose of this study was to assess the role of needs and social factors in the use of health services among children under age 15 in Catalonia, Spain, where health care reform was explicitly designed to facilitate universal access to primary care according to health needs. Data from the Catalan Health Interview Survey of 1994, a multistage probability sample (2,433 children under 15 years old), were analyzed. Multiple regression examined the relationship between health needs and number of visits in the last year, controlling for the effect of sociodemographic characteristics. Two logistic regression equations were selected to predict heavy (more than seven visits per year) and light (less than two visits) utilization of services. The multiple regression model explained 14.3 percent of the variance in number of visits, with health status perception, disability, reported chronic condition, restriction of activities, and having had a recent accident by far the most important determinants. No familial socioeconomic characteristics, including social class, education, or family size, influenced the extent of use. In contrast to health systems not designed to achieve either universal access according to need or strong primary care, universal access to health services in Catalonia appears to enhance the use of services among children with health needs, regardless of socioeconomic characteristics.     

Seroprevalence of Babesia ovis in sheep in Catalonia, northeastern Spain

Matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOFMS) can be used to determine number- and weight-average molecular weights of narrow polydispersity polymers. In this work, several possible sources of error in determining molecular weights of polymers with narrow polydispersity by MALDI-TOFMS are rigorously examined. These include the change in polymer distribution function, broadening or narrowing of the overall distribution, and the truncation of selected oligomer peaks within a distribution (i.e., the oligomer peaks at the high- and low-mass tails expected to be observed are not detected). These variations could be brought about by a limited detection sensitivity, background interference, and/or mass discrimination of oligomer analysis in MALDI-TOFMS. For narrow polydispersity polystyrenes, it is shown that by using an appropriate MALDI matrix and sample preparation protocol and a sensitive ion detection instrument, no systematic errors from these possible variations were detected within the experimental precision (0.5% relative standard deviation) of the MALDI method. It is concluded that MALDI mass spectrometry can provide accurate molecular weight and molecular weight distribution information for narrow polydispersity polymers, at least for polystyrenes examined in this work. The implications of this finding for polymer analysis are discussed.     

The use of unproven methods of treatment by cancer patients. Frequency, expectations and cost

Recent research into motivation and achievement behaviour in sport has focused on achievement goal theory. This theory states that two goal orientations manifest themselves in achievement contexts and impact on the motivation process. These two goals have been defined as 'task' and 'ego' goal orientations. This paper traces the development of the Perception of Success Questionnaire as a measure of achievement goals developed specifically for the sport context. The early development of the questionnaire is documented, in which the scale was shortened from the initial 29 to the current 12 question format. We demonstrate that task and ego goals are orthogonal, internal reliabilities for the orientations are high, with strong construct and concurrent validity. We conclude by reporting results from two recent confirmatory factor analyses that were conducted on the Children's and Adult versions of the questionnaire; these results show the Perception of Success Questionnaire to be a reliable and valid instrument to measure achievement goal orientations in sport.     

The impact of AIDS in the global mortality in Catalonia, 1981-1993

OBJECTIVES: To compare the evolution of the principal causes of death in Catalonia, Spain and to assess the impact of AIDS as a contributing factor to the increase of mortality in young people in Catalonia. METHODS: Data from the mortality register of Department of Health in Catalonia has been used. We have compared the principal causes of death in Catalonia for the global population and for the group of 20 to 39 year olds. We have calculated the potential years of life lost (PYLL) between the ages of 13 to 65. RESULTS: Since the first case of AIDS in 1981, AIDS has been the cause of death with the most important increase for the global population in Catalonia. AIDS is the sixth cause of death and the first cause of PYLL. For the young population in Catalonia (aged 20-39) AIDS became, in 1993, the first cause of death. From 1992 to 1993 the PYLL due to AIDS increased 5% in men and 51% in women. CONCLUSIONS: The present situation has led AIDS being the first cause of death among young population. The collaboration between mortality registers and AIDS registers is absolutely essential to assess more accurately the impact of AIDS on the mortality of population.     

Trends of morbidity and mortality in chronic heart failure in Catalonia

INTRODUCTION: The epidemiology of chronic heart failure, specifically its morbidity and mortality, is insufficiently known, despite the fact that it has an important economic impact because of the pharmacological treatment and the high hospitalization rate. OBJECTIVE: To analyze the trends of mortality and morbidity of chronic heart failure in Catalonia during the periods 1975-1994 and 1989-1994 respectively. PATIENTS AND METHODS: Specific mortality and morbidity rates (ages 45-65, and older than 65) were calculated for both sexes. Standardised mortality rates were also calculated for mortality rates using the European population as the reference. RESULTS: The trend of mortality of chronic heart failure in the population of 45-65 is stable, the rates being higher for men than for women. The trend in the age group older than 65 shows an important increase from 1983 on, higher in women than in men. Morbidity (hospitalization discharge rates) increases slightly in the population of 45-65 years, especially in men; in the population older than 65 an important increase is observed for both sexes. CONCLUSIONS: Trend of mortality is increasing specifically in women older than 65, while trends of morbidity are clearly increasing for both age groups.     

Availability of PSC833, a substrate and inhibitor of P-glycoproteins, in various concentrations of serum

BACKGROUND: P-glycoproteins are membrane-associated transporters that can render cells resistant to a variety of chemotherapeutic drugs. Reversal agents are (preferably nontoxic) drugs that can inhibit these P-glycoproteins and thereby overcome multidrug resistance. PSC833, a cyclosporin A analog, is a reversal agent that has shown potential in in vitro experiments and in clinical trials. We tested PSC833 to determine whether it is a transported substrate of human and murine P-glycoproteins associated with multidrug resistance (encoded by the human MDR1 gene and its murine homolog, mdr1a) and whether it can completely inhibit these P-glycoproteins under simulated in vivo conditions. METHODS: Monolayers of polarized LLC-PK1 pig kidney cells transfected with complementary DNA containing either MDR1 or mdr1a sequences were used to measure the directional transport of P-glycoprotein substrates under various serum conditions. RESULTS: In contrast to two previous studies, we found that PSC833 is transported by both the MDR1 and the mdr1a P-glycoproteins, albeit at a low rate. PSC833 has a very high affinity for the MDR1 P-glycoprotein, and its Michaelis constant (Km) for transport is 50 nM, fourfold lower than for cyclosporin A. Inhibition of drug transport by PSC833 is approximately eightfold less effective in 100% fetal bovine serum than in tissue culture medium containing 10% serum. The concentration of PSC833 necessary to fully inhibit transport of digoxin and paclitaxel (Taxol) under complete (i.e., 100%) serum conditions is higher than the plasma concentrations achieved in clinical trials. CONCLUSIONS: Although PSC833 binds efficiently to the MDR1 P-glycoprotein and is released only sluggishly, the high concentrations of PSC833 necessary to inhibit this P-glycoprotein under complete serum conditions in our in vitro system suggest that it may be difficult for PSC833 alone to produce total inhibition of P-glycoprotein activity in patients.     

Potential risk factors for vertical HIV-1 transmission in Catalonia, Spain: the protective role of cesarean section. The Working Group on HIV-1 Vertical Transmission in Catalonia

OBJECTIVE: To evaluate the roles of certain potential risk factors on the vertical transmission of HIV-1. DESIGN: Prospective registry of infants born to HIV-1-infected women in Catalonia (north-east Spain) from 1987 to 1992. METHODS: A total of 599 infants, born in Catalan hospitals to 520 women who were identified as being HIV-1-infected during gestation or at delivery, were included. Data on mode of delivery, birth weight, gestational age and breast-feeding as well as the mother's age, her route of HIV-1 infection, clinical stage and p24 antigenaemia, were recorded. HIV-1 infection status of 489 (82%) of the infants was determined according to the criteria of the US Centers for Disease Control and Prevention. Risk estimates and odds ratio (OR) were calculated and logistic regression was performed. RESULTS: The overall rate of vertical transmission was 18.6% (95% confidence interval, 15.2-22.0%). Multivariate analyses revealed that Cesarean section was associated with a lower rate of vertical transmission (OR = 0.3; P = 0.001), as was maternal HIV-1 infection via injecting drug use (OR = 0.44; P = 0.02). Breast-feeding (OR = 6.9; P = 0.001), very low birth weight (< 1500 g; OR = 6.3; P = 0.001) and p24 antigenaemia (OR = 4.6; P = 0.04) were all related to increased risk. The crude rate of HIV-1 transmission was 6% among Cesarean births compared with 21% for infants born via vaginal deliveries. The population-attributable risk for vaginal deliveries was 61.7%. CONCLUSIONS: The results show a protective effect of Cesarean section in the absence of zidovudine prophylaxis. However, current research should be directed towards the individual and combined effects that antiretroviral agents and Cesarean section may have on mother-to-child HIV-1 infection.     

Development of use and cost measures in a nursing intervention for family caregivers and frail elderly patients

The purpose of this pilot study was to refine and evaluate methods of measuring costs of an innovative home-health nursing intervention designed to support frail, older persons and their family caregivers. We evaluated a multifaceted strategy to collect a detailed utilization profile from 22 caregiver/care receiver dyads for hospital, ambulatory, home health, nursing home, and community services. The strategy was feasible for most participants, maximized accuracy of cost data, and minimized research burden on study participants. Lower overall costs were found in the intervention group, but the difference was not significant. Approaches to the measurement of costs in this study can serve as models for evaluating other innovations in nursing, home care, and long-term care.     

Maternal-fetal transfers: indications, appropriateness, and cost

The objective of this study was to assess the indications, appropriateness, and cost of maternal-fetal transfers to a tertiary care facility in an era of managed care. Our perinatal database was reviewed from January 1, 1996 through June 30, 1997 to determine maternal and fetal indications for transfer, referring institution characteristics, utilization of tertiary level services, and cost of transfer. There were 273 transfers from 53 referring hospitals ranging in distance from <20 miles (n = 102) to >100 miles (n = 41). Thirty-one patients were transferred by air (average cost $7656), 238 by ground (average cost $920), 4 by private car. The referring diagnosis was preterm premature rupture of membranes (PPROM) (n = 80), preterm labor (n = 76), preeclampsia (n = 42), medical complications (n = 25), or other (n = 50). Mean gestational age (GA) at transfer was 28.5+/-5.5 weeks. Patients were referred from hospitals with a self-designated nursery level I (n = 115), II (n = 111), III (n = 45), or none (n = 2). In 42 patients, (15%) no maternal or fetal indication for hospital transfer was identified after evaluation at the tertiary center. The most common referring misdiagnoses were preterm labor (n = 25), PPROM (n = 10) and preeclampsia (n = 3). One hundred and sixty-five patients delivered during transfer admission (mean GA = 29.6+/-4.8 weeks); 79 infants (48%) required admission to a level III, and 52 (31%) to a level II nursery. Most patients require the services of a tertiary facility after maternal fetal transfer. If delivered during transfer admission, the majority of neonates require care in an intermediate or intensive care nursery.     

Power of nonverbal cues in counseling interactions: Availability, vividness, or salience?

Tested 3 explanations for the differential impact of verbal and nonverbal cues on perceptions of counselor expertness, attractiveness, and trustworthiness. These explanations involved cue availability (abundance of nonverbal over verbal cues), vividness (concreteness and imagery-provoking nature of nonverbal cues), and salience—vividness (an interaction between the vividness of the cues and the level of arousal of the perceiver). 45 male and 45 female undergraduates were divided into 6 experimental groups to view tapes of counseling interactions. The tapes included 3 expertness tapes representing 3 levels of verbal/nonverbal cues and 3 attractiveness tapes representing the same 3 levels. The independent variables studied were arousal and number of verbal and nonverbal cues. After viewing both an expertness tape and an attractiveness tape, Ss completed an adjective checklist and an instrument designed to measure dimensions of perceived expertness, attractiveness, and trustworthiness. Findings suggest that cue availability is not a compelling explanation for the power of nonverbal communications, that vividness accounts for differential cue effectiveness with certain dependent variables, and that salience is not a prerequisite for the vividness effect to occur. (49 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effect of pharmacist interventions on medication use and cost in hospitalized patients with or without HIV infection

Pharmacotherapeutic interventions and drug acquisition costs in HIV-positive and HIV-negative patients on a hospital medical service were studied. In November and December 1995, HIV-positive and HIV-negative patients were randomly selected and matched on the basis of admission date. Pharmacotherapeutic interventions were recorded by a pharmacist until the time of discharge. Drug acquisition costs were obtained through records of medications ordered. The two patient groups were compared with respect to length of stay (LOS), number and cost of medications, and number of interventions. HIV-positive patients had significantly more medication orders and required more interventions than HIV-negative patients. Mean LOS was not significantly different. HIV status and number of medications were significantly associated with requiring five or more interventions. Drug acquisition costs were significantly higher in the HIV-positive group. The mean pharmacist-attributed cost saving per patient was $134 for HIV-positive patients and $27 for HIV-negative patients. HIV-positive patients required more interventions and consumed more medication resources than HIV-negative patients. Pharmacist interventions produced drug acquisition cost savings for both groups, with more savings being realized for positive patients.     

Cyclamate consumption in Catalonia, Spain (1992): relationship with the body mass index

The dietary intake of cyclamate was evaluated in the north-east of Spain in 1992. In a random sample of the Catalan population consisting of 2450 people aged 6-75 years, two 24-h recalls at different seasons were collected; the amount and type of all foods, drinks and drugs consumed were obtained and the total daily intake of cyclamate was expressed in mg/kg body weight (bw), as the average of both 24-h recalls. Eighteen percent of the population consumed cyclamate, and the highest percentage was in men aged 35-44 years (33%). Average daily intake of cyclamate was 0.44 mg/kg bw in the whole population and 2.44 mg/kg bw among consumers. Subjects following a diet reported highest intakes, especially diabetics, and only 0.16% of the sample studied had levels above the Acceptable Daily Intake (ADI). Among consumers, the intake of cyclamate was negatively correlated with Body Mass Index (BMI). The results show the pattern of cyclamate intake in the Spanish population.     

Availability of amino acids in high-oil corn

True digestibility of amino acids, bioavailability of Lys, and TMEn in three types of high-oil corn (HOC) and one conventional corn (CC) were determined. The CC, HOC1, HOC2, and HOC3 contained 4.3, 5.9, 6.6, and 9.5% ether extract, respectively, on a DM basis. True digestibility of amino acids was determined using the precision-fed cecectomized rooster assay in which each corn sample was tube-fed (30 g) to nine roosters and excreta were collected for 48 h. True digestibility of most amino acids in HOC2 and HOC3 were significantly higher (P < or = 0.05) than those in CC and HOC1. Mean digestibility of 15 amino acids in HOC2 and HOC3 was 91% compared to 80% for CC and HOC1. The TMEn values (kilocalories per gram DM) of CC, HOC1, HOC2, and HOC3 were 3.883, 4.024, 4.038, and 4.140, respectively. Lysine bioavailability was assessed using a slope-ratio chick growth assay in which a Lys-deficient crystalline amino acid diet was supplemented with 0, 0.1, or 0.2% L-Lys from L-Lys x HC1 to provide a standard curve. Six additional dietary treatments consisted of supplementing the basal diet with 28 or 56% of CC, HOC2, or HOC3. The nine diets were fed to four replicate groups of six chicks from 8 to 18 d posthatching. Lysine bioavailability was calculated using multiple regression slope-ratio methodology where Y was weight gain and X was intake of Lys from the L-Lys x HC1 or a corn. Supplementation of the basal diet with L-Lys x HC1, CC, HOC2, or HOC3 yielded linear (P < or = 0.001) growth responses. Bioavailability values (percentage) for the Lys in CC, HOC2, and HOC3 relative to the Lys in L-Lys x HC1 were 65 +/- 10, 72 +/- 10, and 91 +/- 8, respectively. The results of this study indicated that digestibility of amino acids and bioavailability of Lys in HOC are equal to or greater than those in CC.