Disparities of care in veterans with Parkinson's disease.

BACKGROUND: Disparities of Parkinson's disease (PD) care have not been assessed. METHODS: We examined the medical records of 309 (83%) non-Hispanic White and 65 (17%) non-White Los Angeles veterans with PD from 1998 to 2004 to determine if care quality as measured by 10 PD indicators different by race/ethnicity. RESULTS: In multivariate modeling, adherence to indicators was higher among non-Hispanic Whites (71% vs. 65%, risk ratio 1.15, 95% CI [1.07-1.32]) compared to non-Whites. Differences in adherence by race/ethnicity were greatest for depression treatment (p<0.05). CONCLUSIONS: We detected disparities in quality of PD care, particularly in depression treatment. Future research should determine causes for these so that interventions can be designed to reduce such disparities.

An electroencephalographic study comparing maximum blink rates in schizophrenic and nonschizophrenic psychiatric patients and nonpsychiatric control subjects.

BACKGROUND: We did a retrospective electroencephalographic (EEG) analysis of blink rates in patients with psychiatric disorders and control subjects to determine whether maximum blink rates under different conditions were higher in patients with psychiatric disorders. METHODS: Maximum blink rates in those with schizophrenia (n = 23), those with nonschizophrenic psychiatric illnesses (n = 21), and nonpsychiatric control subjects (n = 35) were obtained from patients' EEGs and compared with one-way analysis of variance and post hoc tests. In addition, correlation analysis was performed to determine if patients' medications affected maximum blink rates. RESULTS: Patients with schizophrenic and nonschizophrenic psychiatric disorders had twofold higher maximum resting blink rates compared to controls (p < .05 respectively). No difference was found between those with schizophrenic and nonschizophrenic psychiatric disorders. The maximum blink rate during cognitive testing was also twofold higher in those with nonschizophrenic psychiatric disorders (n = 11) compared to controls (n = 16; p < .05). Within each group, maximum blink rates during quiet rest and cognitive testing did not differ, nor were there differences between groups in the duration of high-frequency blinking (greater than 40 blinks per minute) during quiet rest. In psychiatric patients, none of the medications taken at the time of EEG recording correlated with maximum blink rates. CONCLUSIONS: High maximum blink rates recorded by EEG may suggest the presence of a psychiatric disorder.

US neurologists in the 1990's: trends in practice characteristics.

BACKGROUND: The American Academy of Neurology (AAN) conducts periodic surveys of its members to profile and monitor changes in the characteristics of US neurologists and their practices. OBJECTIVE: To assess neurologists' characteristics, geographic distribution, practice arrangements, professional activities, practice volume, procedures performed, sources of revenue, involvement with managed care and capitation, and other selected topics. METHODS: The AAN Member Census survey was sent to US neurologists in the fall of 1996 (response rate = 89%), and the Practice Profile survey was sent to a random sample of 1,986 US neurologists in the summer of 1997 (response rate = 55%) who had completed a Member Census survey. The results of the Practice Profile survey were compared with those of two prior surveys conducted in 1991 to 1992 and 1993 to 1994. RESULTS: The mean age of US neurologists is 48 years, 18% are women, 93% are US citizens, and 24% are international medical graduates. The proportion of neurologists in solo practices, group practices, and medical schools/universities has not changed. The weekly hours worked has remained stable (58 hours), but the time spent in administrative activities has increased (p < 0.001). The average number of patient visits per week to neurologists appears to have increased (p < 0.001), as has the proportion of neurologists performing procedures (p < 0.05). The majority of neurologists have contracts with managed care organizations (82%), and a minority (32%) have capitated payment arrangements. Medicare continues to be the largest source of clinical revenue. Nearly 50% of all respondents have experience in developing clinical practice guidelines or critical pathways, and >20% of respondents employed physician extenders to assist in their practices. CONCLUSION: Neurologists are spending more time in administrative activities, are performing or interpreting more procedures, and are seeing more patients. Neurologists' involvement with capitation is comparable with that in a nationally representative sample of physicians, and they are exploring innovative ways, such as developing practice guidelines and using physician extenders, to improve the quality and efficiency of providing neurologic care.

Immunosuppression by anti-CD4 treatment in vivo. Persistence of secondary antiviral immune responses.

Elimination of CD4+ helper T cells by treatment with monoclonal antibodies (mcAb) in vivo has been used as a new mode of immunosuppression in organ transplantation and autoimmune diseases. To explore the potential risks of this therapeutic approach we have studied antiviral responses in mice depleted of CD4+ T cells. Depletion of CD4+ T cells in vivo completely suppressed the generation of a primary virus-specific cytotoxic response. Injection of high doses of recombinant interleukin-2 (rIL-2) given after virus immunization restored the responsiveness of helper cell-depleted mice to virus-expressing target cells, suggesting a crucial role of IL-2 in antiviral defense mechanisms. In contrast to primary responses, memory cytolytic responses to viral antigens persisted despite depletion of greater than 90% of CD4+ helper T cells. The generation of such memory cytotoxic responses was dependent upon help provided by CD4+ lymphocytes surviving the antibody therapy. After antibody treatment, frequencies of virus-specific helper cells were minimal in primed mice, excluding insufficient helper cell elimination as the reason for the persistence of memory responses. Data presented here suggest that there exist distinct helper pathways in primary and secondary cytolytic antiviral responses that might represent several subsets of helper T cells as well as differences in helper signals required by distinct effector cells.

Immunosuppression by anti-CD4 treatment in vivo. Cellular and humoral responses to alloantigens.

Antibody-mediated elimination of CD4+ lymphocytes in vivo has been successfully used to suppress the humoral response to foreign antigens and to induce long-term tolerance. However, secondary humoral responses, as well as secondary cytolytic responses specific for viral antigens, could not be prevented, providing evidence for functional heterogeneity within the helper cell compartment. Data presented here support the notion that helper cell requirements for cellular responses to alloantigens are unique and do not involve CD4+ T lymphocytes. While the administration of anti-CD4 mcAb failed to suppress allospecific CTL responses, the formation of alloantibodies was initially inhibited in parallel to the deficiency in CD4+ helper cells. After regeneration of CD4+ T cells, the animals regained the ability to produce specific IgG alloantibodies. The dichotomy of helper pathways in humoral and cellular alloreactive responses challenges the concept of a single CD4+ helper cell population. Insights into the functional heterogeneity of helper cells for primary, secondary, and allospecific responses might open new avenues for selective manipulation of helper subpopulations.

Nonhemolytic group B streptococcal osteomyelitis: identification and treatment in a five-week-old infant.

This article details the first reported case of neonatal osteomyelitis caused by a nonhemolytic group B streptococcus. The identification of the organism was delayed due to the lack of hemolysis on blood agar plates. Therefore, the infant was treated with a more toxic regimen of antibiotics than would have otherwise been indicated. Successful treatment of this nonhemolytic group B streptococcal osteomyelitis included a combination of both parenteral and oral antibiotics. Proper identification of nonhemolytic streptococcal infections in the infant is essential to ensure safe and accurate antibiotic treatment.