Search

Depression is common in people with fibromyalgia (FM) and osteoarthritis (OA) and has been linked to adverse health outcomes in these conditions. The purpose of this study was to examine differences in predictors of depression among individuals with FM and OA using a range of health, demographic, and psychological variables. Of the total 963 participants, 600 were diagnosed with FM, and 363 with OA. The Quality of Well-Being Scale (QWB) was used to assess health status. The Fibromyalgia Impact Questionnaire (FIQ) and the Arthritis Impact Measurement Scale (AIMS) were used to measure disease-specific impact. Additionally, participants completed self-efficacy and helplessness assessments. Depression was measured using the Center for Epidemiological Studies Scale (CES-D). The results of a moderated linear regression showed that higher depression scores were associated with lower health status and a greater condition impact, especially in the FM group. Self-efficacy and helplessness predicted depression in both groups, but more strongly in FM. White participants with OA were more depressed than their non-White counterparts, while the opposite was true for FM. These findings indicate that improving health status and psychological well-being might alleviate depression in both FM and OA.

Faith-based organizations (FBOs) can play an important role in improving health outcomes. Lay community health advisors (CHAs) are integral to these efforts. This paper assesses the sustainability of a CHA training program for congregants in African-American and Latino FBOs and subsequent implementation of educational workshops. The program is unique in that a health care chaplain in an academic medical center was central to the program's development and implementation. Forty-eight CHAs in 11 FBOs were trained to teach workshops on cardiovascular health, mental health, diabetes, and smoking cessation. Two thousand four hundred and forty-four participants attended 70 workshops. This program has the potential to be a model to educate individuals and to address health inequities in underserved communities. Health care chaplains in other medical centers may use this as a model for enhancing community engagement and education.

Food insecurity among college students is becoming a more widely recognized issue across the country. Recent studies report between 30-50% of college students experience some level of food insecurity, a rate that is nearly two-fold higher than the general public. Although food insecurity has likely existed among this population for many years, it has recently become more intensely studied potentially due to the changing demographic characteristics of the average student. More than ever before, students are single parents, full-time employees, and/or first generation college students. These nontraditional students often experience financial obligations that can impact their ability to access an adequate amount of nutritious food for themselves and their families. This is especially concerning considering food insecurity among college students has been associated with overall poor health, poor eating behaviors, and adverse academic outcomes.

During the “Standards Development and International Harmonization: AOAC INTERNATIONAL Mid-Year Meeting” held on June 29, 2011, an Expert Review Panel (ERP) reviewed the method “Determination of Vitamin B12 in Infant Formula and Adult Nutritionals by HPLC.” Under the new pathway to Official MethodsSM, the ERP adopted the method as Official First Action. The method is applicable to the determination of vitamin B12 in infant formula and adult nutritionals. Data showed an average overall intermediate precision of 6.64% RSD, an estimated quantitation limit of 0.8 μg/kg, and a detection limit of 0.2 μg/kg in prepared samples. The standard range of the method is 2 to 200 μg/L, which corresponds to an analytical range of 0.8 to 500 μg/kg.

Previously we reported that compared to iterative reconstruction with ordered subset expectation maximum (OSEM), wide beam reconstruction (WBR), which incorporates resolution recovery and controls noise during reconstruction without applying a post-processing filter, allows half-time SPECT acquisition with preserved diagnostic quality. We now postulate that with further Poisson noise treatment, quarter-time acquisition is possible.The half-time WBR algorithm was optimized for quarter-time acquisition based upon anthropomorphic cardiac phantom data and a pilot group of 48 patients (pts). Then using the modified algorithm, 209 pts (91 men, 118 women, mean chest circumference = 40 in) were imaged at rest (R) and stress (S) (9/32 mCi (99m)Tc-sestamibi) full-time with OSEM, and again quarter-time with the modified WBR algorithm. The 180 degrees , 64-stop, full-time single-day rest (R) (25 second-per-stop, sps) and 8-frame per cardiac cycle post-stress (S) (20 sps) gated SPECT, and then quarter-time R (6 sps) and post-S (4 sps) gated SPECT were acquired. Blinded observers graded scan quality (1 = poor to 5 = excellent) based on myocardial uniformity, endocardial/epicardial edge definition, and background noise. Perfusion defects were scored using a 17-segment model. Using three commercially available software methods, end-diastolic volume (EDV), end-systolic volume (ESV), and left ventricular ejection fraction (LVEF) were calculated.For the 209 prospective pts, mean image quality for R full-time OSEM and quarter-time WBR were similar (3.5 +/- 0.9 vs 3.6 +/- 0.7, p NS). For S, quarter-time WBR quality was superior to full-time OSEM (4.3 +/- 0.7 vs 3.9 +/- 0.7) (P = 1.78 x 10(-17)). In 35 pts with chest circumferences44 inches a longer, 10 sps WBR acquisition improved resting image quality. Of 48 pts with abnormal scans (SSSs2 by OSEM) mean summed stress scores, summed rest scores, and summed difference scores were not significantly different with quarter-time WBR vs full-time OSEM (11.2 vs 10.9), (9.1 vs 9.0), (2.0 vs 1.9) (P NS). For the three software methods, there was a good correlation of LVEF, EDV, and ESV determined by WBR vs OSEM (all r0.92). ESVs were generally higher with WBR, primarily due to better delineation of the valve plane at end-systole, whereas EDVs were similar. Thus, EFs were significantly lower with WBR.For perfusion SPECT quarter-time WBR affords image quality, defect characterization, and functional assessment equivalent to full-time OSEM.

Compared to filtered back projection (FBP), OSEM with resolution recovery (OSEM-RR) and wide beam reconstruction (WBR)(UltraSPECT Ltd.), which resolve resolution and suppress noise simultaneously during reconstruction, have been shown to maintain/improve myocardial perfusion SPECT quality, even with low count density half-time acquisitions. We postulated that their characteristics would be advantageous for gated SPECT, where each frame is only 1/8th the count density of the summed perfusion images.An 9 mCi rest/32 mCi (333/1184 MBq) stress Tc(99m) sestamibi protocol was used. 15-min FBP, and additional 7-min OSEM-RR and WBR post-stress 8-frame/cardiac cycle SPECT scans were acquired with 90 degrees -angled dual-headed detectors equipped with high resolution collimators in 156 patients. In 82 patients (48F, 34M) (123-252 lbs) with perfusion defects gated image quality was graded visually: 1 (poor)-5 (excellent) Regional LV wall motion (WM) was scored: 0 (normal)-4 (dyskinesis) in a total of 50 vascular territories with defects. Using Myometrix software (GE Healthcare), post-stress EDV, ESV, and EF were calculated for each method. Additionally, for purposes of comparison, the FBP gated tomograms were processed with other commercially available packages, Emory Toolbox and Cedars QGS.Despite half-time acquisitions, compared to FBP, image quality increased marginally with OSEM-RR (P = .09) but very significantly with WBR (P = 1.9 x 10(-21)). The WM score was greater only for WBR (P = 4.8 x 10(-8)). Although quantitative parameters correlated well with those determined by FBP (all EF r's0.85; all volume r's0.93), EFs were significantly lower (P = .0001 for OSEM-RR, 3.4 x 10(-14) for WBR), primarily due to a decrease in EDV with OSEM-RR (P = 7.3 x 10(-13)) and an increase in ESV with WBR (P = 9.2 x 10(-5)). However, inter-method differences in these parameters were of similar magnitude to differences encountered among the commercially available software methods.Half-time OSEM-RR and particularly WBR improve gated SPECT diagnostic quality compared to full-time FBP due to increased resolution and reduced noise. However, these attributes, which affect endocardial edge detection, result in a systematic offset in EDV, ESV, and EF.

This normal-phase HPLC method with postcolumn reduction and fluorescence detection allows for the quantitative determination of trans vitamin K1 in infant, pediatric, and adult nutritionals. Vitamin K1 is extracted from products with iso-octane after precipitation of proteins and release of lipids with methanol. Prepared samples are injected onto a silica HPLC column where cis and trans vitamin K1 are separated with an iso-octane–isopropanol mobile phase. The column eluent is mixed with a dilute ethanolic solution of zinc chloride, sodium acetate, and acetic acid, and vitamin K1 is reduced to a fluorescent derivative in a zinc reactor column. The resulting hydroquinone is then detected by fluorescence at an excitation wavelength of 245 nm and an emission wavelength of 440 nm. During a single-laboratory validation of this method, repeatability and intermediate precision ranged from 0.6 to 3.5% RSD and 1.1 to 6.0% RSD, respectively. Mean overspike recoveries ranged from 91.9 to 106%. The method demonstrated good linearity over a standard range of approximately 2–90 μg/L trans vitamin K1 with r2 averaging 0.99995 and average calibration errors of

Depression is a common mental disorder affecting individuals. Although many strides have been made in the area of depression, little is known about depression in special populations, especially African American men. African American men often differ in their presentation of depression and are often misdiagnosed. African American men are at greater risk for depression, but they are less likely to participate in mental health care. This article explores depression in African American by looking at environmental factors, sigma, role, and other unique to this populations, such as John Henryism. Interventions to encourage early screening and participation in care are also discussed.

Human neutrophil peptides (HNPs) are cysteine-rich antimicrobial peptides stored in neutrophils. The similar structure of HNPs -1, -2, and -3 renders them impossible to study individually in biological samples. For the first time, we describe a method of individually identifying the HNPs -1–3 from exudative neutrophils using matrix-assisted laser desorption ionization/time-of-flight (MALDI-TOF) mass spectrometry, and we demonstrate the ability to quantify the relative changes in the peptides found in biological samples. The study includes tracheal aspirates (TA) from infants with respiratory syncytial virus (RSV) illness at intubation for respiratory failure (acute illness) and at extubation (convalescence). In vitro, convalescent and acute illness TAs are labeled with d 0 - and d 3 -acrylamides, respectively, and mixed 1:1. TA proteins are separated by one-dimensional gel electrophoresis and then identified by mass spectrometry-based peptide mass fingerprinting. The ratio of signal intensities for the isotopically normal (d 0 -labeled) and heavy (d 3 -labeled) forms of the peptide reveals the relative increase in each peptide with illness.

The method presented is for quantification of α-tocopherol (vitamin E), vitamin E acetate, vitamin A acetate, and vitamin A palmitate in infant formula and adult/pediatric nutritionals. The entire lipid fraction, including vitamins A and E, is extracted from product with iso-octane after products are mixed with methanol, which precipitates proteins and disrupts micelles freeing lipids for extraction. Vitamin A palmitate, vitamin A acetate, and vitamin E acetate are separated from α-tocopherol on a 3 cm silica column with a 1% methylene chloride, 0.06% isopropanol in iso-octane mobile phase; eluted onto a 20 cm silica column; and, after a column switch, further separated on the 20 cm column before UV detection at 325 nm (vitamin A palmitate and vitamin A acetate) and 285 nm (vitamin E acetate). α-Tocopherol is further separated from other extraneous compounds on the 3 cm silica column and detected by fluorescence at excitation and emission wavelengths of 295 and 330 nm, respectively. Quantification limits in ready-to-feed products were estimated to be 80 IU/L for vitamin A palmitate, 207 International Units (IU)/L for vitamin A acetate, 2.4 mg/L for vitamin E acetate, and

Myo-inositol is a 6-carbon cyclic polyalcohol also known as meso-inositol, meat sugar, inosite, and i-inositol. It occurs in nature in both free (myo-inositol) and bound (inositol phosphates and phosphatidylinositol) forms. For the determination of free myo-inositol, samples are mixed with dilute hydrochloric acid to extract myo-inositol and precipitate proteins, diluted with water, and filtered. For the determination of myo-inositol bound as phosphatidylinositol, samples are extracted with chloroform, isolated from other fats with silica SPE cartridges, and hydrolyzed with concentrated acid to free myo-inositol. Prepared samples are first injected onto a Dionex CarboPac PA1 column, which separates myo-inositol from other late-eluting carbohydrates. After column switching, myo-inositol is further separated on a CarboPac MA1 column using a 0.12% sodium hydroxide mobile phase; strongly retained carbohydrates are eluted from the PA1 column with a 3% sodium hydroxide mobile phase. Eluant from the CarboPac MA1 analytical column passes through an electrochemical detector cell where myo-inositol is detected by pulsed amperometry using a gold electrode. The method showed appropriate performance characteristics versus selected established standard method performance requirement parameters for the determination of myo-inositol: linear response; repeatability (RSDr) of 2%; and intermediate precision (RSDir) of 2.5%. Instrument LOD and LOQ were 0.0004 and 0.0013 mg/100 mL, respectively, and correspond to a free myo-inositol quantitation limit of 0.026 mg/100 g and a phosphatidylinositol quantitation limit of 0.016 mg/100 g. Correlation with the reference microbiological assay was good. The proposed method has been accepted by the Expert Review Panel as an AOAC First Action Method, suitable for the routine determination of myo-inositol in infant formula and adult nutritionals.

Given the economic turmoil facing the nation, the nursing profession has unique opportunities to lead the health-care sector and local communities toward economic recovery. Training more nurses and other health professionals can prepare the growing pool of unemployed and dislocated workers for high demand positions in the industry. Nursing can also be instrumental in creating healthier neighborhoods through disease prevention and early intervention initiatives; healthy communities can lead to significant savings in health-care costs and greater economic well being for all. Through such workforce development and community health initiatives, nursing can help to accelerate and propel economic revitalization.

OBSTRUCTIVE SLEEP APNEA (OSA) IS A COMMON DISORDER, AND ACCESS TO DIAGNOSIS AND TREATMENT IS DELAYED IN SOME AREAS BECAUSE OF limited capacity to perform polysomnography (PSG).1 Attended PSG has been the standard of care for diagnosis2,3 and CPAP titration.3,4 Portable monitoring (PM) using a limited number of bioparameters has been suggested as an alternative to PSG for the diagnosis of OSA.5–8 PM could shorten the time to diagnosis and effective treatment in locations where the access to PSG is limited or delayed and could also offer an alternative to patients who are not willing or unable to undergo an attended PSG. However, in populations with a high proportion of positive studies for moderate to severe OSA, this approach would still require PSG for CPAP titration. In such a circumstance, a clinical pathway consisting of PM for diagnosis followed by PSG for CPAP titration would not have much advantage compared to one using a single partial night (split) PSG consisting of an initial diagnostic portion followed by a CPAP titration. However, unattended autotitration is an alternative to CPAP titration with PSG.9,10 A recent large study11 in a group of patients with severe OSA found that CPAP treatment based on unattended autotitration can result in clinical outcomes similar to CPAP titration with PSG. In this study, patients were carefully selected, evaluated, and followed in a systematic manner. Another study found that diagnosis and treatment of patients with moderate to severe OSA using oximetry and autotitration resulted in equal treatment efficacy and greater CPAP adherence compared to an approach using PSG titration.12 In this study, patients were selected based on clinical evaluation and oximetry before being randomized to PSG or autotitration. A different study found that home monitoring using oximetry and PSG had similar utility in helping clinicians to predict which patients with OSA would benefit from CPAP treatment.13 Obstructive sleep apnea has a high prevalence in the patient population of the Veterans Administration Health Care System (VAHCS).14 In this population, many comorbid conditions in addition to OSA can impair sleep quality. This and a number of other factors such as an appreciable percentage of patients with a low socioeconomic status make this a challenging population to treat. Furthermore, the number of available PSG studies in many VAHCS locales is not sufficient to meet the demand. We hypothesized that a clinical pathway using (1) identification of symptomatic moderate- to high-risk patients, (2) PM for diagnosis, and (3) CPAP treatment based on unattended autotitration would provide equivalent outcomes compared to a clinical pathway using PSG. The goal was to use clinical pathways simulating real world conditions and including symptomatic patients with the entire range of OSA (AHI ≥ 5/h).

SynopsisThe ‘General Health Questionnaire’ was used to assess the psychiatric morbidity among 365 consecutive attenders at a general practice and to compare this with a systematic random sample of 213 patients drawn from the lists of the same practice. Those attending a general practitioner are shown to be more psychiatrically disturbed than a random sample of the practice population, and this difference remains when those attending for psychological symptoms are discounted. Various social and demographic characteristics which distinguish between those who do and those who do not attend a doctor with a given set of psychological symptoms are described.

Thrombophlebitis of the internal jugular vein, an anaerobic septicemia most frequently caused by fuso-bacteria, is rarely encountered in pediatrics. Indeed in two recent prospective studies of anaerobic infections in childhood, this entity was not observed in more than 200 cases of anaerobic disease.1,2 Significant morbidity is associated with embolic complications; mortality rates, which approach 20% in some series, have been caused in part by the failure of physicians to recognize this syndrome and the subsequent delay in the initiation of appropriate antibiotic therapy. This article reports our recent experience with three children with suppurative thrombophlebitis of the internal jugular vein and describes the use of ultrasonography and computed axial tomography in diagnosis and follow-up. We also analyze an additional nine cases gathered from the pediatric literature in the postantibiotic era.3–8

Efforts to assess the effects of a variety of stressors to which older adults are exposed will be no more successful than measuring instruments are valid and appropriately sensitive to change. Research springing from the trait-state distinction has led to some important clarifications regarding properties of measuring instruments, ways of conceptualizing among-persons variation, and the multidimensionality of individuals' response patterns. To examine the suitability of several extant state measures for use with the elderly, 111 older (age 60+) adults were measured, then remeasured two weeks later, with a battery covering five state dimensions. Data are analyzed to test their hypothesized factor structure of the measures and, from a construct validity perspective, to evaluate the short-term stability (test-retest coefficients) of both scales and underlying factors. Results support the factorial validity of instruments developed for the measurement of anxiety and fatigue states when used in older adult populations.

Peripheral blood from 1,000 newborn infants of black (641) and Southeast Asian (359) ancestry were screened for hemoglobin variants. Results obtained from the combination of cellulose acetate (CAC) and citrate agar (CAG) electrophoresis were compared with isoelectric focusing (IEF) electrophoresis. There was complete agreement between the two methods on assignment of Hb S trait, Hb C trait, Hb E trait, and homozygous Hb E. IEF identified small amounts of Hb A in two newborn infants with Hb S-beta + thalassemia; the CAC and CAG electrophoretic patterns were indistinguishable from sickle cell anemia. One hundred twenty newborn infants with Hb Bart's were detected by IEF; 51 of these were found on CAC. Although IEF was more sensitive in detecting small amounts of hemoglobin, it is not clear if the improvement in detection warrants adopting this form of electrophoresis for routine screening of newborn infants.