Publications

Abstract

Mutations in LRRK2 were first reported as causing Parkinson's disease (PD) in late 2004. Since then, approximately a dozen LRRK2 substitutions have been identified that are believed to be pathogenic mutations. The substitution of adenine for guanine at nucleotide 4541 (4541G>A) in LRRK2 was recently reported. This substitution resulted in the replacement of an arginine at position 1514 with a glutamine (R1514Q). Although this substitution was not found in a large cohort of controls, its pathogenicity could not be verified. We have now genotyped the R1514Q substitution in a sample of 954 PD patients from 429 multiplex PD families. This substitution was identified in 1.8% of the PD patients; however, the majority of the PD sibships segregating this substitution were discordant for this putative mutation. In addition, the R1514Q substitution was detected in 1.4% of neurologically evaluated, control individuals. These data suggest that the R1514Q variant is not a pathogenic LRRK2 mutation. We believe it is imperative that the causative nature of any newly identified genetic variant be determined before it is included in any panel for diagnostic testing.

Abstract

This exploratory study of patients in Pennsylvania (PA) and Virginia (VA) hospitals in 1998-1999 measures the segregation of care for Black patients receiving inpatient care for specific medical and surgical conditions. It also examined inpatient mortality risk for Black patients and the impact of treatment in heavily segregated hospitals on mortality for Blacks and non-Blacks. Segregation of hospital care was found across both states but was more pronounced in PA. Blacks did not experience higher mortality rates than non-Blacks either before or after controls for clinical risk factors in either state and for certain admission types had lower mortality. Both Black and non-Black surgical, heart failure, and lung disease patients treated in VA hospitals with more Black patients had poorer outcomes. Future research should examine how access, patient choice, hospital organization, processes of care, and factors related to nursing care might influence hospital outcomes for patients from different racial backgrounds.

Abstract

OBJECTIVE - The purpose of this study was to assess whether the prevalence of inducible myocardial ischemia increases over time in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS - Participants enrolled in the Detection of Ischemia in Asymptomatic Diabetics (DIAD) study underwent repeat adenosine-stress myocardial perfusion imaging 3 years after initial evaluation. Patients with intervening cardiac events or revascularization and those who were unable or unwilling to repeat stress imaging were excluded. RESULTS - Of the initial 522 DIAD patients, 358 had repeat stress imaging (DIAD-2), of whom 71 (20%) had ischemia at enrollment (DIAD-1). Of 287 patients with normal DIAD-1 studies, 259 (90%) remained normal in DIAD-2, whereas 28 (10%) developed new ischemia in DIAD-2. Of the 71 patients with abnormal DIAD-1 studies, 56 (79%) demonstrated resolution of ischemia, whereas 15 (21%) remained abnormal. During this 3-year interval, medical treatment was intensified, with more patients using statins, aspirin, and ACE inhibitors than at baseline. Patients with resolution of ischemia had significantly greater increases in these medications than patients who developed new ischemia (P = 0.04). CONCLUSIONS - Thus, the majority of asymptomatic patients with type 2 diabetes demonstrated resolution of ischemia upon repeat stress imaging after 3 years. This resolution was associated with more intensive treatment of cardiovascular risk factors.

Abstract

OBJECTIVE. To compare sharp-device injury rates among hospital staff nurses in 4 Western countries. DESIGN. Cross-sectional survey. SETTING. Acute-care hospital nurses in the United States (Pennsylvania), Canada (Alberta, British Columbia, and Ontario), the United Kingdom (England and Scotland), and Germany. PARTICIPANTS. A total of 34,318 acute-care hospital staff nurses in 1998-1999. RESULTS. Survey-based rates of retrospectively-reported needlestick injuries in the previous year for medical-surgical unit nurses ranged from 146 injuries per 1,000 full-time equivalent positions (FTEs) in the US sample to 488 injuries per 1,000 FTEs in Germany. In the United States and Canada, very high rates of sharp-device injury among nurses working in the operating room and/or perioperative care were observed (255 and 569 injuries per 1,000 FTEs per year, respectively). Reported use of safety-engineered sharp devices was considerably lower in Germany and Canada than it was in the United States. Some variation in injury rates was seen across nursing specialties among North American nurses, mostly in line with the frequency of risky procedures in the nurses' work. CONCLUSIONS. Studies conducted in the United States over the past 15 years suggest that the rates of sharp-device injuries to front-line nurses have fallen over the past decade, probably at least in part because of increased awareness and adoption of safer technologies, suggesting that regulatory strategies have improved nurse safety. The much higher injury rate in Germany may be due to slow adoption of safety devices. Wider diffusion of safer technologies, as well as introduction and stronger enforcement of occupational safety and health regulations, are likely to decrease sharp-device injury rates in various countries even further.

Abstract

PROBLEM: Homeless families headed by young mothers are increasing. This preliminary study describes the characteristics of 17 homeless teenage mothers (HTM). METHODS: HTMs completed questionnaires researching depression, self-esteem, maternal competence, and sources of stress and support. FINDINGS: HTMs had positive maternal competence and self-esteem scores. When compared to housed mothers, HTMs were younger, had more depressive symptoms and negative life events, and fewer social supports. CONCLUSIONS: HTMs represent a high-risk group with fewer available supports and many complex life stressors. School-based programs can benefit HTMs by offering support, helping them continue their education, and assisting with on-site school-based childcare.

Abstract

This study examines the antecedent factors affecting the quality of life of African Americans. A theoretical model is proposed that identifies the effects of culture-specific coping and spiritual well-being as predictors of quality of life. A sample of 281 African Americans was administered a battery of questionnaires that examined the constructs of interest. The theoretical model was tested within a structural equation - modeling framework to identify both direct and indirect effects. Results indicate overall model fit, with both culture-specific coping and spiritual well-being as significant predictors of quality of life. Spiritual well-being partially mediated the effects of culture-specific coping on quality of life. The article concludes with a discussion of the study's findings in relation to quality of life issues for African Americans.

Abstract

To promote evidence-based decision making regarding hospital staffing, the authors examined the characteristics of supplemental nurses, as well as the relationship of supplemental staff to nurse outcomes and adverse events. The use of supplemental nurses to bolster permanent nursing staff in hospitals is widespread but controversial. Quality concerns have been raised regarding the use of supplemental staff. Data from the 2000 National Sample Survey of Registered Nurses were used to determine whether the qualifications of supplemental nurses working in hospitals differed from permanent staff nurses. Data from Pennsylvania nurse surveys were analyzed to examine whether nurse outcomes and adverse events differed in hospitals with varying proportions of nonpermanent nurses. Temporary nurses have qualifications similar to permanent staff nurses. Deficits in patient care environments in hospitals employing more temporary nurses explain the association between poorer quality and temporary nurses. Negative perceptions of temporary nurses may be unfounded.

Abstract

The epidermal growth factor receptor (EGFR) (ErbB1) and HER-2/neu (ErbB2) are members of the ErbB family of receptor tyrosine kinases. These receptors are overexpressed in a variety of human tumors and overexpression generally correlates with poor prognosis and decreased survival. Lapatinib, a reversible inhibitor of both EGFR and HER-2/neu, has shown some success in achieving clinical responses in heavily pretreated advanced cancer patients. GW2974 is a reversible dual inhibitor similar to lapatinib, but GW2974 was not progressed to clinical trials due to pharmacokinetic issues. Bcl-2, an anti-apoptotic protein, is also overexpressed in a number of human tumors. Bcl-2 inhibitors induce apoptosis and sensitize cancer cells to other therapies. The purpose of this study was to assess the effects of combining ErbB and Bcl-2 inhibitors on the growth of human breast cancer cell lines. EGFR/HER-2/neu tyrosine kinase inhibitors (lapatinib and GW2974) were combined with Bcl-2 inhibitors (HA14-1 or GX15-070) and the anti-proliferative effects were determined by the MTT tetrazolium dye assay. Combinations were tested in MCF-7 human breast cancer cells, a HER-2/neu transfected MCF-7 cell line (MCF/18), and a tamoxifen-resistant MCF-7 cell line (MTR-3). A synergistic inhibitory effect was observed with the combination of inhibitors of EGFR-HER-2/neu (lapatinib or GW2974) and Bcl-2 (GX15-070 or HA14-1) on the growth of the MCF-7, MCF/18, and MTR-3 human breast cancer cell lines. This study suggests that simultaneously blocking the ErbB family of receptor tyrosine kinases and Bcl-2 family of proteins may be a benefit to breast cancer patients.

Abstract

Objectives. We examined the mechanisms by which living in a disadvantaged minority community influences smoking and illegal cigarette sale and purchasing behaviors after a large cigarette tax increase. Methods. Data were collected from 14 focus groups (n=104) that were conducted during the spring of 2003 among Blacks aged 18 years and older living in New York City. Results. A large tax increase led to what focus group participants described as a pervasive illegal cigarette market in a low-income minority community. Perceived pro-smoking community norms, a stressful social and economic environment, and the availability of illegal cigarettes worked together to reinforce smoking and undermine cessation. Conclusions. Although interest in quitting was high, bootleggers created an environment in which reduced-price cigarettes were easier to access than cessation services. This activity continues to undermine the public health goals of the tax increase.

Abstract

Key informant interviews, in-depth interviews and focus groups were conducted to examine ways in which social context influenced the behavior of Brazilian, Colombian and Dominican men who have sex with men. First, we investigated how the social context in the home country affected motivation for migration. Findings suggest that Latino men who have sex with men frequently reported coming to the USA to escape homo-negativity and to achieve greater sexual freedom. The study also examined how the social context encountered in the early years after migration shaped sexual behavior and risk. A majority of the participants reported easy access to sex partners and frequent sexual encounters. The anonymity of living in a gay epicentre such as New York City, often without social connections from the past, was experienced as liberating and conducive to sexual exploration. Moreover, sex in public venues, such as parks and sex cabins, was readily available to those who do not speak English. The tendency to engage in high levels of sexual activity during the early period after arrival in New York City was particularly evident among younger men. Implications for future programme development are discussed alongside prevention efforts targeting migrants during this critical period.

Abstract

Although the concept of the coagulation cascade represented a significant advance in the understanding of coagulation and served for many years as a useful model, more recent clinical and experimental observations demonstrate that the cascade/waterfall hypothesis does not fully and completely reflect the events of hemostasis in vivo. The goal of this article is to review the evolution of the theories of coagulation and their proposed models to serve as a tool when reviewing the research and practice literature that was published in the context of these different theories over time.

Abstract

Respecting and understanding religious and cultural influences of gender-based violence improves the care provided by forensic nurses.

Abstract

The validity of baseline dietary intake data in women participating in a culturally competent intervention study for black women with type 2 diabetes was assessed. The relationship of sociodemographic and physiologic factors with underreporting of dietary intake was determined. Criterion validity of dietary intake, which had been assessed using the Nutritionist Five Collection Form, a combination of a standard 2-day dietary recall and a modified, culturally appropriate food frequency questionnaire, was determined. Data were analyzed using First Data Bank Nutritionist Five (version 2.3, 2000, First Data Bank, San Bruno, CA) software. Validation of baseline dietary data in 109 women was performed by calculating the ratio of energy intake to resting metabolic rate. χ2 and t tests were used to assess relationships between underreporting and sociodemographic and physiologic factors. Mean ratio of energy intake to resting metabolic rate was 1.46 (±0.4). Using a lower limit of 1.35, the prevalence of underreporting was 46.8%. Underreporting was significantly associated with body mass index (P≤0.001) and waist circumference (P<0.001). Use of this combined dietary recall and modified food frequency questionnaire might, therefore, provide more accurate dietary assessment in this population. Additional modification and validity testing is warranted in this and other populations.

Abstract

Background: Financial constraints and other forces affecting health care in many countries have led to nurses implicitly limiting their care in some instances. In the absence of an accepted definition and theoretical framework of implicit rationing of nursing care, a framework and the Basel Extent of Rationing of Nursing Care (BERNCA) instrument were developed. This instrument was used in the Swiss part of the International Hospital Outcome Study, in which implicit rationing of nursing care was studied. Objective: To examine the validity and reliability of the newly developed BERNCA instrument. Methods: Psychometric analysis was performed on data from 957 nurses in five Swiss acute care hospitals enrolled in a larger hospital organization study. An explanatory factor analysis with varimax rotation was used to investigate the instrument's internal structure, Spearman correlations were used to test relationships between implicit rationing and two related concepts, and Cronbach's alpha and interitem correlations were used to test the reliability of the scale. Results: Expert feedback confirmed that the BERNCA covered the implicit rationing of nursing care domain adequately and that its questions were fully comprehensible. The single-factor solution confirmed the instrument's unidimensional internal structure. A moderate to strong correlation in the expected direction was found between the BERNCA implicit rationing data and the quality of the nurse work environment as measured by the Nursing Work Index-Revised, particularly the perceived adequacy of nursing resources, although a significant but low correlation was also shown with patient-to-nurse ratios. Cronbach's alphas (.93) and interitem correlations indicated internal consistency and homogeneity. Discussion: Initial evidence of the validity and reliability of the BERNCA instrument was provided.

Abstract

Using data collected from 1,906 RNs from Metropolitan Statistical Areas in 29 states, the purpose of this study was to examine the characteristics and work attitudes of older RNs compared to RNs less than age 50 at two time periods, and compare among the older RNs those who are working in nursing, working outside nursing, and not working. Older RNs reported more distributive justice (fairness of rewards), work group cohesion, and supervisory support and less organizational constraint, and quantitative workload than younger RNs. Overall, older RNs were more satisfied, had greater organizational commitment, and had less desire to quit than younger RNs. There were no significant differences between older and younger RNs for autonomy, mentor support, or variety. Strategic efforts by employers and government could be used to retain older workers, attract RNs working in nonnursing settings back into nursing, and recruit retired RNs into the nursing workforce.