Npas4 deficiency and prenatal stress interact to affect social recognition in mice.

Neurodevelopmental disorders such as autism spectrum disorders and schizophrenia have an expansive array of reported genetic and environmental contributing factors. However, none of these factors alone can account for a substantial proportion of cases of either disorder. Instead, many gene-by-environment interactions are responsible for neurodevelopmental disturbances that lead to these disorders. The current experiment used heterozygous knock-out mice to examine a potential interaction between 2 factors commonly linked to neurodevelopmental disorders and cognitive deficit: imbalanced excitatory/inhibitory signaling in the cortex and prenatal stress (PNS) exposure. Both of these factors have been linked to disrupt GABAergic signaling in the prefrontal cortex (PFC), a common feature of neurodevelopmental disorders. The neuronal PAS domain protein 4 (Npas4) gene is instrumental in regulation of the excitatory/inhibitory balance in the cortex and hippocampus in response to activation. Npas4 heterozygous and wild-type male and female mice were exposed to either PNS or standard gestation, then evaluated during adulthood in social and anxiety behavioral measures. The combination of PNS and Npas4 deficiency in male mice impaired social recognition. This behavioral deficit was associated with decreased parvalbumin and cFos protein expression in the infralimbic region of the PFC following social stimulation in Npas4 heterozygous males. In contrast, females displayed fewer behavioral effects and molecular changes in PFC in response to PNS and decreased Npas4.

Associations of self-reported oral health with physical and mental health in a nationally representative sample of HIV persons receiving medical care.

BACKGROUND: The impact of oral health on HIV patients has not been sufficiently documented. OBJECTIVE: To estimate the associations between measures of oral and generic health-related quality of life in persons receiving medical care for HIV. DESIGN: This is a longitudinal study of interview data collected in a probability sample of adults with HIV receiving health care in the US. The data were collected at three points in time. PATIENTS: Two thousand eight hundred and sixty-four HIV-infected adults using medical care. MEASUREMENTS: Physical and mental health were assessed using 28 items and oral health was assessed using seven items on oral-related pain and discomfort, worry, appearance, and function. Clinical measures included CD4 count, oral symptoms, physical symptoms, and stage of HIV. Physical functioning and emotional well-being were measured on a 0-100 scale with higher scores indicating better health. Oral health was measured using seven items with a five point scale. RESULTS: In multivariate analyses, oral symptoms had the strongest association with oral health-related quality of life. Each additional oral symptom was associated with an average decrease in oral health (0-100 possible range) of 3.97 points (p = 0.000). In addition, oral health was significantly associated with both physical and mental health. A one-point increase in oral health was associated with a 0.05 (p = 0.000) increase in mental health and 0.02 increase in physical health (p = 0.031). CONCLUSIONS: Oral health is strongly associated with physical and mental health but provides noteworthy unique information in persons with HIV infection. Thus, physical and mental health measures of HIV patients should incorporate indicators of oral functioning and well-being.

Oral health is important, but often overlooked.

Providers sometimes neglect to examine HIV patients thoroughly for oral infections, mouth ulcers, and other severe dental problems that are associated with HIV infections, according to a new study. Primary care providers and HIV specialists may assume that patients are receiving regular dental treatment, when this often is not the case.

A comparison of unmet needs for dental and medical care among persons with HIV infection receiving care in the United States.

OBJECTIVE: Oral health conditions associated with HIV disease are frequently more severe than those of the general population, making access to both dental and medical care important. Using the domains specified in the Behavioral Model of Health Services Use, this paper examines the correlates of unmet needs for dental and medical care in a nationally representative sample of patients with HIV. METHODS: This investigation is a cross-sectional study using baseline data from the HIV Cost and Services Utilization Study (HCSUS), the first nationally representative study of persons in care for HIV. Using probability-based techniques, 4,042 people were randomly selected in January 1996, and 2,864 (71%) completed a structured interview that included questions on unmet needs for dental and medical care. Regression analysis was used to identify variables associated with having unmet needs for dental care only, medical care only, and both medical and dental care. RESULTS: Of the estimated 230,900 people in treatment for HIV in the United States, approximately 58,000 had unmet medical or dental needs based on self-reported data. Unmet dental needs were more than twice as prevalent as unmet medical needs (32,900 vs 14,300), and 11,600 people were estimated to have both types of unmet needs. Multinomial logit regression showed that persons with low income had increased odds of reporting unmet needs for both dental and medical care. The uninsured and those insured by Medicaid without dental benefits had more than three times the odds of having unmet needs for both types of care than did the privately insured. CONCLUSIONS: To serve both the dental and medical needs of diverse populations affected by HIV disease, greater coordination of services is needed. In addition, state insurance programs for people with HIV should consider the feasibility of expanding their benefit structure to include dental care benefits.

Access of vulnerable groups to antiretroviral therapy among persons in care for HIV disease in the United States. HCSUS Consortium. HIV Cost and Services Utilization Study.

OBJECTIVE: To employ the behavioral model of health services use in examining the extent to which predisposing, enabling, and need factors explain the treatment of the HIV-positive population in the United States with highly active antiretroviral therapy (HAART). DATA SOURCE: A national probability sample of 2,776 adults under treatment for human immunodeficiency virus (HIV) infection. STUDY DESIGN: The article uses data from the baseline and six-month follow-up surveys. The key independent variables describe vulnerable population groups including women, drug users, ethnic minorities, and the less educated. The dependent variable is whether or not a respondent received HAART by December 1996. DATA COLLECTION: All interviews were conducted using computer-assisted personal interview instruments designed for this study. Ninety-two percent of the baseline interviews were conducted in person and the remainder over the telephone. PRINCIPAL FINDINGS: A multistage logit regression shows that the predisposing factors that have previously described vulnerable groups in the general population with limited access to medical care also define HIV-positive groups who are less likely to gain early access to HAART including women, injection drug users, African Americans, and the least educated (odds ratios, controlling for need, ranged from 0.35 to 0.59). CONCLUSIONS: Those HIV-positive persons with the greatest need (defined by a low CD4 count) are most likely to have early access to HAART, which suggests equitable access. However, some predisposing and enabling variables continue to be important as well, suggesting inequitable access, especially for African Americans and lower-income groups. Policymakers and clinicians need to be sensitized to the continued problems of African Americans and other vulnerable populations in gaining access to such potentially beneficial therapies. Higher income, anonymous test sites, and same-day appointments are important enabling resources.

The staff nurse employment interview: predicting performance outcomes. Part II.

The Employment Standards Act of Ontario and Labour Relations policy in health care organizations require that employment decisions be based on the comparative level of knowledge, skills, abilities, and experience of job applicants. Reliable and valid employment interviews guide employers in that process. A semistructured staff nurse employment interview tool was developed and tested for reliability and validity (content and predictive) on a medical unit in an acute-care hospital setting. Of 25 interview questions evaluated as having content validity based on comparison with the job analysis and Standards of Practice, five (holistic care, assessments of patient's ability to cope, teaching, collaboration, and problem-solving) were identified as having statistically significant relationships with performance outcomes evaluated one year after the initial interview. Total interview test scores were predictive of overall competency in job performance. Those questions evaluated as content valid and as attaining predictive validity were used as the basis for the development of a structured staff nurse employment interview questionnaire.

The staff nurse employment interview selection process: judgment and decision errors and how to avoid them. Part I.

The employee interview is a complex decision-making process which has a potential effect on the future of the organization. It is in the organization's best interest to ensure that the interview process results in the selection of candidates who most clearly meet predetermined selection criteria. Reliable and valid interviews improve the probability of selecting candidates who are most likely to succeed. A review of employment interview literature is discussed relating to judgement and decision errors, and the reliability and validity of the employment interview. Part II will review the development of a semistructured, employment interview questionnaire which was based on College of Nurses of Ontario Standards of Practice (1984) and staff nurse position description.

The supportive role of the staff nurse in the hospital palliative care situation.

The supportive comforting role of the nurse is complex. Comprehensive supportive role behaviours need to be described for nurses in the hospital setting in order to identify actual role competencies, enhance the definition of professional practice, and evaluate clinical competence. As a first step in definition of this supportive role, an exploratory study was conducted with five registered nurses on a four bed palliative primary nursing unit in a hospital setting. Their supportive role behaviours were elicited in order to answer the following research question: What supportive nursing interventions are identified and described by staff nurses to promote physical, psychological, and spiritual comfort for palliative care patients? A model of supportive nursing care in the palliative care setting was generated from study findings and presented for testing through further research.

Extracapsular cataract extraction and primary posterior chamber lens implantation.

We reviewed the charts of 420 consecutive extracapsular cataract extraction cases in which the surgeon's primary intention was to implant a posterior chamber lens. Posterior chamber lens implantation was precluded in eight cases (1.9%) because of vitreous loss or capsule dehiscence. A visual acuity of 20/40 or better was achieved by 83.8% of patients. When nonoperative causes of poor vision were eliminated, this result was achieved by 96.7% of patients. The percentage of patients achieving 20/40 or better acuity decreased with increasing age but remained constant despite varying follow-up periods. The most common complication was opacification of the posterior capsule, occurring in 25.7%; 83.8% of the complications occurred during the first two postoperative years. We conclude that extracapsular cataract extraction with primary posterior chamber lens implantation is an efficient way to restore good vision after cataract formation and that the results appear to remain stable over time.

Phacoemulsification with the Heslin/Mackool Ocusystem: a follow-up report.

The experience of one surgeon (KBH) with phacoemulsification and the Heslin/Mackool Ocusystem is reported. In a study involving 350 cases with a mean follow-up period of 20.1 months, 88.6% of the patients achieved a visual acuity result of 20/40 or better, and when nonoperative causes of poor vision were eliminated, 97.2% of the study group achieved such a result. The most common complication cited was opacification of the posterior capsule, occurring 20.0% of the time. The authors conclude that the Heslin/Mackool Ocusystem is a safe and efficient instrument for phacoemulsification.

Scanning electron microscopy of an irrigation/aspiration tip following a posterior capsular rupture.

The first use of a new irrigation/aspiration tip resulted in a posterior capsular rupture. Scanning electron microscopy of the tip revealed burrs on the aspiration portion of the tip, as well as poor finishing around the irrigation ports.

Clinical retrospective study comparing planned extracapsular cataract extraction and phakoemulsification with and without lens implantation.

We conducted a clinical retrospective study in which the records of 350 consecutive extracapsular cataract operations were reviewed in order to compare two cataract extraction techniques: planned extracapsular cataract extraction (PECCE) and phakoemulsification (PKE) with and without intraocular lens implantation. The patients in the PKE group experienced significantly better vision overall. However, when an adjustment was made for the difference in age between patient populations there was no significant difference in the percentage of patients achieving good vision between the two groups. Similarly, there was no statistically significant difference in the total number of operative or postoperative complications. The patients in the PKE group required less time for refraction to stabilize and averaged less postoperative astigmatism. Both of these differences were statistically significant even after an adjustment was made for the difference in age between populations. The presence or absence of an intraocular lens had no effect on the findings.

Phacoemulsification with the Heslin/Mackool Ocusystem: results of a retrospective study.

One surgeon's experience with phacoemulsification and the Heslin/Mackool Ocusystem is reported. The visual results and intraoperative and postoperative complications are comparable to those reported by surgeons using other phacoemulsification instruments. The authors conclude that the Heslin/Mackool Ocusystem is an efficient instrument for phacoemulsification.

Combined phacoemulsification and closed pars plana vitrectomy capability in a single computerized instrument.

The Heslin/Mackool Ocusystem allows either phacoemulsification or pars plana vitrectomy in a maximally controlled closed system. A unique flow control system maintains a constant balance between infusion and evacuation. Low flow rates and high suction levels are therefore possible without surging of intraocular contents or ocular collapse. The ultrasonic handpiece has reusable tips and is air-cooled, self-tuning, lightweight and autoclavable. The vitrectomy handpieces have a guillotine cutting mechanism or a self-sharpening rotational cutting mechanism and are as small as 0.79 mm in diameter (21 gauge). One and two-handed techniques for phacoemulsification and vitrectomy are possible through limbal or pars plana approaches.