Effects of attachment bereavement and pre-event conditions on subsequent depressive symptoms in older adults.

A sample of 1,411 older adults (age 55+) who had been interviewed both prior to and after bereavement was studied, allowing for pre-event controls. Those who had lost a parent, spouse, or child had the strongest depressive reactions, as predicted by an attachment-bonding hypothesis; however, material losses were also related to depression. Although bereavement/loss events were clearly related to subsequent depression even after pre-event depression, resources, and events were controlled, certain pre-event characteristics were predictive of the bereavement/loss events, including prior undesirable events, age, and urban/rural residency. A further analysis of 1,007 persons with two post-event interviews (at 6-month to 1-year follow-up) revealed an initial depressive reaction to a bereavement/loss event, which then dissipated completely within 1 year's time. Generally, bereavement appeared to have limited etiologic importance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social desirability and the randomized response technique.

The randomized response technique (RRT) is designed to increase respondents' willingness to answer truthfully questions of a sensitive or socially undesirable nature. This study tested the hypothesis that the difference between the proportion of "yes" responses obtained under self-administered direct questioning and the proportion of "yes" responses obtained under an RRT procedure would be related to the social desirability of a "yes" response to the question. The hypothesis was confirmed by data from 404 undergraduates; the RRT may provide more valid responses to items of a socially desirable and undesirable nature. The RRT deserves more attention because it can circumvent biases due to untruthful responding, demand characteristics, and evaluation apprehension as well as assure the confidentiality of the data. (29 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An initial evaluation of work fatigue and circadian changes as assessed by multiplate posturography

The sensitivity of postural responses to the effects of work fatigue and circadian changes was explored in a pilot study using a specific method of multiplate posturography based on the differential assessment of vertical pressure on four separate platforms for each heel and set of toes of each foot, respectively 8 normal subjects, M.D.s, were given six posturographic examinations immediately before and after three 8-hr. work shifts in the emergency room of a major hospital in Tel-Aviv. 3 posturographic measures (stability, spectral power of postural sway at low frequency of 0.1-0.25 Hz, and unilateral weakening of heel-toe synchronisation) were significantly affected by work fatigue whilst also showing interaction with circadian rhythm. 2 additional measures (power of sway at high frequency of 1.00-3.00 Hz and dysharmonic distribution of weight over the four platforms) were not related to workload but showed significant circadian changes. These effects appeared only on positions involving restricted visual and somatosensory feedback causing vestibular stress. Results justify the application of multiplate posturography as an ancillary tool in measuring objectively the effects of fatigue and circadian changes as well as the interaction between endogenous chronobiological processes and their external conditioning factors (Zeitgebers). Pragmatic implications of the findings in the context of industrial medicine and interdisciplinary efforts to prevent road and air accidents are discussed.     

What do you do when the control group doesn't fit into the factorial design?

Considers a number of approaches to the problem of analyzing the data of experiments involving multifactor designs plus an additional control or comparison condition. Two simple solutions are proposed. When the desired comparison between control and experimental conditions is a qualitative one, subtracting the control mean from the experimental treatment scores and performing a multifactor analysis of variance on the difference scores is suggested. When 1 of the factors is a quantitative variable, and a trend analysis which includes the control condition is desired, a procedure which involves an artificial crossing of the control conditions with the other factors in the design by splitting the control condition into several groups is recommended. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Statistical efficiency of using two quantitative randomized response techniques to estimate correlation.

Used Monte Carlo techniques to generate sampling distributions of the correlation coefficient between 2 variables, each measured by 2 quantitative models of the randomized response technique (RRT)—the additive constants model and the unrelated question model. As expected, the RRT models yielded less statistically efficient estimates of the population correlation coefficient, and inefficiency increased as the population correlation increased. Comparisons of efficiency between the 2 models favored the additive constants model for constants less than certain limiting values. (13 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Anticoagulation,delivered dose and outcomes in CRRT: The program to improve care in acute renal disease (PICARD)

Delivered dialysis dose by continuous renal replacement therapies (CRRT) depends on circuit efficacy, which is influenced in part by the anticoagulation strategy. We evaluated the association of anticoagulation strategy used on solute clearance efficacy, circuit longevity, bleeding complications, and mortality. We analyzed data from 1740 sessions 24 h in length among 244 critically ill patients, with at least 48 h on CRRT. Regional citrate, heparin, or saline flushes was variably used to prevent or attenuate filter clotting. We calculated delivered dose using the standardized Kt/V_urea. We monitored filter efficacy by calculating effluent urea nitrogen/blood urea nitrogen ratios. Filter longevity was significantly higher with citrate (median 48, interquartile range [IQR] 20.3–75.0 hours) than with heparin (5.9, IQR 8.5–27.0 hours) or no anticoagulation (17.5, IQR 9.5–32 hours, P < 0.0001). Delivered dose was highest in treatments where citrate was employed. Bleeding complications were similar across the three groups (P = 0.25). Compared with no anticoagulation, odds of death was higher with the heparin use (odds ratio [OR] 1.82, 95% confidence interval [CI] 1.02–3.32; P = 0.033), but not with citrate (OR 1.02 95% CI 0.54–1.96; P = 0.53). Relative to heparin or no anticoagulation, the use of regional citrate for anticoagulation in CRRT was associated with significantly prolonged filter life and increased filter efficacy with respect to delivered dialysis dose. Rates of bleeding complications, transfusions, and mortality were similar across the three groups. While these and other data suggest that citrate anticoagulation may offer superior technical performance than heparin or no anticoagulation, adequately powered clinical trials comparing alternative anticoagulation strategies should be performed to evaluate overall safety and efficacy.     

Patterns of hearing loss in non-explosive blast injury of the ear

OBJECTIVE: To characterize ambulance utilization in a pediatric population and pediatric emergency physicians' judgement of the medical need for ambulance transport. METHODS: A convenience sample of ambulance transports were studied prospectively during a 5-week period. Exclusion criteria included transfer from another medical facility, study physician not available, need for immediate resuscitation, or trauma team activation. A questionnaire completed by the physician assessed medical need for the ambulance based on chief complaint, general appearance, vital signs, and ambulance run sheet information. A separate questionnaire was administered to the parents regarding reasons for ambulance use and other available means of transportation. Caregivers were contacted by telephone 2-3 days later to determine the mode of transportation home and the clinical outcome. RESULTS: Of 172 eligible patients, 92 (53%) were enrolled. Most (61%; 56/92) transports were considered medically unnecessary. Interestingly, 40% (37/92) of the subjects had no other means of transportation; 86% (32/37) of ambulance transports for this group were judged medically unnecessary. Overall, 86% (79/92) of families had not called their physician. There was no association between having spoken with the physician and medical need for an ambulance. Many (82%; 46/56) Medicaid transports were judged medically unnecessary Overall, follow-up was achieved for 91% (85/92) of the patients. No patient for whom transport was medically unnecessary had a repeat ED visit for the same complaint or required admission. Most patients (74%; 68/92) returned home without any assistance. Among the medically unnecessary transports, 52% (32/60) of the caregivers cited no other means of transportation, yet 34% (11/32) of these patients returned home by private car. CONCLUSIONS: Most pediatric ambulance transports in this sample, which excluded patients requiring immediate resuscitation or trauma team care, were judged to be medically unnecessary. Caregivers often use an ambulance as a convenience or as the only means of transportation. An alternate, less resource-intensive transportation system may be more appropriate for this population.     

Age and sex differences in the mental health of older persons.

Administered the Trait Anxiety scale of the State-Trait Anxiety Inventory, a depression scale, and a general well-being scale to 2,051 respondents (aged 55+ yrs) to explore the age and sex relationships in the scales and the effects of age and sex when other correlated variables are considered. Results show that mental health was curvilinearly related to age with high symptom scores obtained in both 55–59 and 85–89 yr olds and lowest in 60–69 yr olds. Sex interacted with marital status, with higher symptoms among males in the never-married category and in females among the widowed and the married categories. When data were adjusted for correlations among these and other variables, the relationships between mental health with age and sex changed. In males, symptoms were unrelated to age, and in females, symptoms decreased with age down to the 80–84 yr old group. In the adjusted data, married females had lower symptoms than males. (43 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)