What affects pleasure in persons with advanced stage dementia?

We examined the impact of environmental, person, and stimulus characteristics on pleasure in persons with dementia. Study participants were 193 residents of 7 Maryland nursing homes who were presented with 25 stimuli from these categories: live human social stimuli, live pet social stimuli, simulated social stimuli, inanimate social stimuli, a reading stimulus, manipulative stimuli, a music stimulus, task and work-related stimuli, and two different self-identity stimuli. Systematic observations of pleasure in the natural environment were conducted using Lawton's Modified Behavior Stream.

Candidate gene analysis in israeli soldiers with stress fractures.

To investigate the association of polymorphisms within candidate genes which we hypothesized may contribute to stress fracture predisposition, a case-control, cross- sectional study design was employed. Genotyping 268 Single Nucleotide Polymorphisms- SNPs within 17 genes in 385 Israeli young male and female recruits (182 with and 203 without stress fractures). Twenty-five polymorphisms within 9 genes (NR3C1, ANKH, VDR, ROR2, CALCR, IL6, COL1A2, CBG, and LRP4) showed statistically significant differences (p < 0.

Women's decision making regarding choice of second trimester termination method for pregnancy complications.

Objective: To describe how women terminating a pregnancy for fetal or maternal complications decide between surgical (dilation and evacuation [D&E]) and medical abortion.

Methods: A qualitative study was conducted among women who underwent D&E or medical abortion before 24 weeks of gestation for fetal anomalies or pregnancy complications at an academic medical center where both methods are offered. Women were interviewed by phone 1 week after the procedure about their counseling experiences and reasons for choosing a particular method.

The relationships of environment and personal characteristics to agitated behaviors in nursing home residents with dementia.

Objective: To explore the impact of personal attributes, environmental attributes, and the presentation of 9 categories of stimuli on agitation in nursing home residents with dementia.

Method: Participants in this randomized, controlled, observational cross-sectional study were 193 residents of 7 nursing homes, all with a diagnosis of dementia, for whom we obtained data pertaining to cognitive functioning (via the Mini-Mental State Examination), performance of activities of daily living (Minimum Data Set), and role-identity/activities of past interest (Self-Identity Questionnaire). Environmental attributes (eg, noise, lighting) and direct observations of agitation (primary outcome) were recorded via the Agitation Behavior Mapping Inventory.

Using regression calibration equations that combine self-reported intake and biomarker measures to obtain unbiased estimates and more powerful tests of dietary associations.

The authors describe a statistical method of combining self-reports and biomarkers that, with adequate control for confounding, will provide nearly unbiased estimates of diet-disease associations and a valid test of the null hypothesis of no association. The method is based on regression calibration. In cases in which the diet-disease association is mediated by the biomarker, the association needs to be estimated as the total dietary effect in a mediation model.

Childhood exposure to ionizing radiation to the head and risk of schizophrenia.

While the association between exposure to ionizing radiation and cancer is well established, its association with schizophrenia is unclear. The aim of our study was to assess risk of schizophrenia after childhood exposure to ionizing radiation to the head (mean dose: 1.5 Gy).

Using a GIS to model interventions to strengthen the emergency referral system for maternal and newborn health in Ethiopia.

Objectives: To show how GIS can be used by health planners to make informed decisions about interventions to increase access to emergency services.

Methods: A combination of data sources, including the 2008 national Ethiopian baseline assessment for emergency obstetric and newborn care that covered 797 geo-coded health facilities, LandScan population data, and road network data, were used to model referral networks and catchment areas across 2 regions of Ethiopia. STATA and ArcGIS software extensions were used to model different scenarios for strengthening the referral system, defined by the structural inputs of transportation and communication, and upgrading facilities, to compare the increase in access to referral facilities.

The comprehensive process model of engagement.

Background: Engagement refers to the act of being occupied or involved with an external stimulus. In dementia, engagement is the antithesis of apathy.

Objective: The Comprehensive Process Model of Engagement was examined, in which environmental, personal, and stimulus characteristics impact the level of engagement.

Resistance and vulnerability to stigmatization in abortion work.

The stigma surrounding abortion in the United States commonly permeates the experience of both those seeking this health service as well as those engaged in its provision. Annually there are approximately 1.2 million abortions performed in the United States; despite that existing research shows that abortion services are highly utilized, women rarely disclose their use of these services.

Integrating HIV and maternal health services: will organizational culture clash sow the seeds of a new and improved implementation practice?

Drawing on an analysis by Pritchett et al of the "techniques of persistent implementation failure" common across many development sectors, this commentary suggests that health systems attempting to integrate maternal health and HIV services may need to contend with a profound clash of organizational cultures. For decades, countries have been pressed to implement global "best practices" in maternal health without attention to the systemic capacity building needed to support complex interventions. The result is often form without function, a kind of "isomorphic mimicry" in which policy documents and program plans that meet global standards ultimately camouflage deep dysfunction in the actual delivery of lifesaving services.

A NEW MULTIVARIATE MEASUREMENT ERROR MODEL WITH ZERO-INFLATED DIETARY DATA, AND ITS APPLICATION TO DIETARY ASSESSMENT.

In the United States the preferred method of obtaining dietary intake data is the 24-hour dietary recall, yet the measure of most interest is usual or long-term average daily intake, which is impossible to measure. Thus, usual dietary intake is assessed with considerable measurement error. Also, diet represents numerous foods, nutrients and other components, each of which have distinctive attributes.

Dealing with dietary measurement error in nutritional cohort studies.

Dietary measurement error creates serious challenges to reliably discovering new diet-disease associations in nutritional cohort studies. Such error causes substantial underestimation of relative risks and reduction of statistical power for detecting associations. On the basis of data from the Observing Protein and Energy Nutrition Study, we recommend the following approaches to deal with these problems.

Validating an FFQ for intake of episodically consumed foods: application to the National Institutes of Health-AARP Diet and Health Study.

Objective: To develop a method to validate an FFQ for reported intake of episodically consumed foods when the reference instrument measures short-term intake, and to apply the method in a large prospective cohort.

Design: The FFQ was evaluated in a sub-study of cohort participants who, in addition to the questionnaire, were asked to complete two non-consecutive 24 h dietary recalls (24HR). FFQ-reported intakes of twenty-nine food groups were analysed using a two-part measurement error model that allows for non-consumption on a given day, using 24HR as a reference instrument under the assumption that 24HR is unbiased for true intake at the individual level.

The effect of medical clowning on pregnancy rates after in vitro fertilization and embryo transfer.

This experimental prospective quasi-randomized study examining the impact of a medical clowning encounter after embryo transfer (ET) after in vitro fertilization (IVF) found that the pregnancy rate in the intervention group was 36.4%, compared with 20.2% in the control group (adjusted odds ratio, 2.

Fitting a bivariate measurement error model for episodically consumed dietary components.

There has been great public health interest in estimating usual, i.e., long-term average, intake of episodically consumed dietary components that are not consumed daily by everyone, e.

Counseling women with early pregnancy failure: utilizing evidence, preserving preference.

Objectives: To apply principles of shared decision-making to EPF management counseling. To present a patient treatment priority checklist developed from review of available literature on patient priorities for EPF management.

Methods: Review of evidence for patient preferences; personal, emotional, physical and clinical factors that may influence patient priorities for EPF management; and the clinical factors, resources, and provider bias that may influence current practice.

Informing abortion counseling: an examination of evidence-based practices used in emotional care for other stigmatized and sensitive health issues.

Objective: Emotional care is an important component of abortion services. Evidence-based counseling for other stigmatized and sensitive health issues may be informative for the improvement of abortion counseling.

Methods: We searched the literature for practices used in emotional care for stigmatized and sensitive health issues.

Obstacles to the integration of abortion into obstetrics and gynecology practice.

Context: Obstetrics and gynecology residents who are trained in family planning and intend to provide abortions after residency often do not ultimately do so. The extent of the professional barriers physicians face trying to integrate abortion into their practice is unknown.

Methods: In 2006, in-depth interviews were conducted with 30 obstetrician-gynecologists who had graduated 5-10 years earlier from residency programs that included abortion training.

A mixed-effects model approach for estimating the distribution of usual intake of nutrients: the NCI method.

It is of interest to estimate the distribution of usual nutrient intake for a population from repeat 24-h dietary recall assessments. A mixed effects model and quantile estimation procedure, developed at the National Cancer Institute (NCI), may be used for this purpose. The model incorporates a Box-Cox parameter and covariates to estimate usual daily intake of nutrients; model parameters are estimated via quasi-Newton optimization of a likelihood approximated by the adaptive Gaussian quadrature.

Identification of 5α, 6α-epoxycholesterol as a novel modulator of liver X receptor activity.

The liver X receptors (LXRα and LXRβ) are members of the nuclear receptor superfamily that function as key transcriptional regulators of a number of biological processes, including cholesterol homeostasis, lipid metabolism, and keratinocyte differentiation. Natural ligands that activate LXRs include oxysterol derivatives such as 25-hydroxycholesterol, 27-hydroxycholesterol, 22(R)-hydroxycholesterol, 20(S)-hydroxycholesterol, and 24(S),25-epoxycholesterol. Related oxysterols, such as 5α,6α-epoxycholesterol (5,6-EC) are present in a number of foods and have been shown to induce atherosclerosis in animal models.

Gains in statistical power from using a dietary biomarker in combination with self-reported intake to strengthen the analysis of a diet-disease association: an example from CAREDS.

A major problem in detecting diet-disease associations in nutritional cohort studies is measurement error in self-reported intakes, which causes loss of statistical power. The authors propose using biomarkers correlated with dietary intake to strengthen analyses of diet-disease hypotheses and to increase statistical power. They consider combining self-reported intakes and biomarker levels using principal components or a sum of ranks and relating the combined measure to disease in conventional regression analyses.

Can agitated behavior of nursing home residents with dementia be prevented with the use of standardized stimuli?

Objectives: To assess the relative effect of different types of stimuli on agitated behaviors of nursing home residents with dementia.

Design: Repeated-measures design with randomized assignment of conditions.

Setting: Seven Maryland nursing homes.

A population's distribution of Healthy Eating Index-2005 component scores can be estimated when more than one 24-hour recall is available.

The USDA's Healthy Eating Index-2005 (HEI-2005) is a tool to quantify the quality of diet consumed by individuals in the U.S. It comprises 12 components expressed as ratios of a food group or nutrient intake to energy intake.