Knowledge Gaps Identified in a Survey of Maine Physicians' Firearm Safety Counseling Practices.

Numerous medical associations have identified firearm injuries as a public health issue, calling on physicians to provide firearm safety counseling. Data suggest that while many physicians agree with this, few routinely screen and provide counseling. We aimed to survey Maine physicians to assess their current firearm safety counseling practices and knowledge of a new state child access prevention (CAP) law.

High-resolution analysis of differential gene expression during skeletal muscle atrophy and programmed cell death.

Skeletal muscles can undergo atrophy and/or programmed cell death (PCD) during development or in response to a wide range of insults, including immobility, cachexia, and spinal cord injury. However, the protracted nature of atrophy and the presence of multiple cell types within the tissue complicate molecular analyses. One model that does not suffer from these limitations is the intersegmental muscle (ISM) of the tobacco hawkmoth .

Acheron/Larp6 Is a Survival Protein That Protects Skeletal Muscle From Programmed Cell Death During Development.

The term programmed cell death (PCD) was coined in 1965 to describe the loss of the intersegmental muscles (ISMs) of moths at the end of metamorphosis. While it was subsequently demonstrated that this hormonally controlled death requires gene expression, the signal transduction pathway that couples hormone action to cell death is largely unknown. Using the ISMs from the tobacco hawkmoth , we have found that mRNA is induced ∼1,000-fold on the day the muscles become committed to die.

Characteristics of Future Models of Integrated Outpatient Care.

Replacement of fee-for-service with capitation arrangements, forces physicians and institutions to minimize health care costs, while maintaining high-quality care. In this report we described how patients and their families (or caregivers) can work with members of the medical care team to achieve these twin goals of maintaining-and perhaps improving-high-quality care and minimizing costs. We described how increased self-management enables patients and their families/caregivers to provide electronic patient-reported outcomes (i.

Timely Interventions for Children with ADHD through Web-Based Monitoring Algorithms.

The aim of this study was to evaluate an automated trigger algorithm designed to detect potentially adverse events in children with Attention-Deficit/Hyperactivity Disorder (ADHD), who were monitored remotely between visits. We embedded a trigger algorithm derived from parent-reported ADHD rating scales within an electronic patient monitoring system. We categorized clinicians' alert resolution outcomes and compared Vanderbilt ADHD rating scale scores between patients who did or did not have triggered alerts.

Caring electronically for young outpatients who have epilepsy.

Purpose: The purpose of this study was to review electronic tools that might improve the delivery of epilepsy care, reduce medical care costs, and empower families to improve self-management capability.

Method: We reviewed the epilepsy-specific literature about self-management, electronic patient-reported or provider-reported outcomes, on-going remote surveillance, and alerting/warning systems.

Conclusions: The improved care delivery system that we envision includes self-management, electronic patient (or provider)-reported outcomes, on-going remote surveillance, and alerting/warning systems.

Mothers' vagal regulation during the Still-Face Paradigm: normative reactivity and impact of depression symptoms.

This study examined mothers' physiological reactivity in response to infant distress during the Still-Face Paradigm. We aimed to explore normative regulatory profiles and associated physiological and behavioral processes in order to further our understanding of what constitutes regulation in this dyadic context. We examined physiological patterns--vagal tone, indexed by respiratory sinus arrhythmia (RSA)--while mothers maintained a neutral expression over the course of the still face episode, as well as differential reactivity patterns in mothers with depression symptoms compared to non-depressed mothers.

The relationship of anxiety disorders, anxiety sensitivity and pulmonary dysfunction with dyspnea-related distress and avoidance.

Little is known about factors that mediate the relationship between anxiety and respiratory-related distress and disability. We hypothesized that elevations in anxiety sensitivity would be associated with greater severity of dyspnea, greater dyspnea-related avoidance, and poorer subjective assessment of health in patients with dyspnea referred for pulmonary function testing, regardless of objective evidence of pulmonary dysfunction. A total of 182 consecutive patients receiving pulmonary function tests to evaluate dyspnea were screened with a patient-rated Primary Care Evaluation of Mental Disorders and completed the Anxiety Sensitivity Index and questionnaires assessing symptom severity and avoidance.

Olanzapine augmentation of fluoxetine for refractory generalized anxiety disorder: a placebo controlled study.

Background: There has been little systematic study of "next-step" interventions for patients with generalized anxiety disorder (GAD) who remain symptomatic despite initial pharmacotherapy. We present one of the first randomized controlled trials for refractory GAD, comprising double blind augmentation with olanzapine or placebo for patients remaining symptomatic on fluoxetine.

Methods: Patients remaining symptomatic after 6 weeks of fluoxetine (20 mg/day) were randomized to 6 weeks of olanzapine (mean dose 8.

Fluoxetine for vestibular dysfunction and anxiety: a prospective pilot study.

Anxiety states and disorders amplify the symptoms and impairment associated with vestibular dysfunction. Five patients with inner ear vestibular dysfunction and anxiety were prospectively treated with fluoxetine, 20-60 mg/day, and received an extensive battery of assessments at baseline and after 12 weeks of treatment. Fluoxetine led to significant or near significant reductions in anxiety measures and in impairment due to dizziness; improvements in clinical balance function and vestibular function were less clear.

Religion, spirituality, and chaplains in the biomedical literature: 1965-2000.

In recent years, several prominent medical journals have published articles addressing the relationship between religion/spirituality and medicine, and recognizing the importance of religion in the lives of most Americans, especially in times of illness. We hypothesized that the publication of these articles reflected a trend in the biomedical literature in which greater attention is being given to the role of religion and spirituality in health-care. A correlational design was used, based on an electronic survey of all articles in MEDLINE for the years 1965 through 2000.

A systematic review on chaplains and community-based clergy in three palliative care journals: 1990-1999.

A systematic review of all articles appearing between 1990 and 1999 in the American Journal of Hospice and Palliative Care, the Hospice Journal, and the Journal of Palliative Care was conducted. Articles citing at least one reference were categorized as scholarly, included in the study, and divided into either research or nonresearch categories. Scholarly articles were classified as research if they contained clearly defined methods and results sections, even if these headings were not used.

An evaluation of the quantity and quality of empirical research in three pastoral care and counseling journals, 1990-1999: has anything changed?

This article summarizes a review of all articles published in Pastoral Psychology, The Journal of Rleigion and Health, and The Journal of Pastoral Care between 1900 and 1999, identifying a total of 737 scholarly articles, of which 165 (22.4%) were research studies. The proportion of research studies, especially quantitative studies, increased significantly between the first and second half of the study period (p < .