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1.
Phytopathology ; 96(6): 630-6, 2006 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-18943181

RESUMO

ABSTRACT Planting material with superior resistance to Armillaria root disease was identified in a field trial established to investigate variation in Armillaria infection among different Pinus radiata nursery stock types. At stand age 6.4 years, total infection incidence, mortality, and degree of root collar girdling by Armillaria spp. were all significantly lower among trees derived from both rooted stool bed cuttings (physiological age 1 to 3 years) and rooted field cuttings (physiological age 3 to 6 years) than among those grown from seedlings. Cutting types did not differ significantly from one another. No significant differences were found between stock types in stem diameter, but trees from stool bed cuttings were significantly taller than seedling trees. Whether these differences remain detectable later in the rotation, initial results suggest that it may be advantageous to plant robust stock, of either cuttings or seedlings, on Armillaria-infested sites. The incidence of infection in living, green-crowned trees was unevenly distributed across the trial site, and was greater nearer to trees killed by Armillaria spp. than further away (significant within a radius of 10 m). By mapping visible Armillaria-caused mortality prior to thinning, it may be possible to delineate areas with a higher incidence of concealed chronic infection, thus defining infested sites for postharvest treatment.

2.
J Mol Biol ; 191(2): 181-9, 1986 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-2949082

RESUMO

The phage lambda attachment site, attP, contains three binding sites for an Escherichia coli protein, IHF, that is needed for efficient integrative recombination. We have used synthetic oligodeoxyribonucleotides to direct multiple base changes at each of these three sites. Alteration by two base-pairs of the consensus sequence for the leftmost binding site specifically interferes with IHF binding to that site and modestly depresses recombination in vitro. For each of the three binding sites, alteration of the consensus sequence by four base-pairs strongly depresses recombination in vitro, indicating that all three sites are important for attP function. The mutated attP sites are also depressed for recombination in vivo but some of the mutants are less affected than they are in vitro. The disparity between effects in vivo and in vitro for some mutants but not others suggests that the three binding sites are not functionally equivalent and that at some sites additional E. coli factors may replace or assist IHF. The non-equivalence of the three IHF sites is also indicated by the behavior of prophage attachment sites carrying mutations in the binding sites.


Assuntos
Proteínas de Bactérias/genética , Bacteriófago lambda/genética , Recombinação Genética , Sítios de Ligação Microbiológicos , Sítios de Ligação , DNA Viral , Escherichia coli/genética , Fatores Hospedeiros de Integração , Mutação
3.
J Mol Biol ; 281(4): 651-61, 1998 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-9710537

RESUMO

The bacteriophage lambda excisionase (Xis) protein is required for excisive site-specific recombination. Xis is composed of 72 amino acids and binds cooperatively to two DNA sites (X1 and X2) that are arranged as direct repeats. Alternatively, Xis binds cooperatively with the host-encoded factor for inversion stimulation (FIS) protein at the X1 and F sites, respectively. Here we analyzed the effects of missense substitutions from codon 57 to the carboxyl end of the protein and nonsense mutations that truncate the protein at various positions from residues 60 to 69. We find that all of the mutant proteins promote excision to some extent and interact cooperatively with FIS. Some mutants have no detectible phenotype while others are altered in their abilities to promote excision or to interact cooperatively with integrase (Int). Computer modeling predicts that amino acids from residues 59 to 65 are in an alpha-helix conformation. Mutants with substitutions on one side of the helix at residues 57, 60, 63 and 64 as well as truncated mutants containing 60, 61 or 63 amino acids, fail to interact cooperatively with Int suggesting that this region of the protein forms the interface with Int. Mutants with substitutions at other positions in the putative helix have no detectible phenotype. Residues 66 to 68 may form a reverse turn and the last four amino acids (69 to 72) may not be crucial for the structure or function of the protein.


Assuntos
Bacteriófago lambda/enzimologia , DNA Nucleotidiltransferases/química , Sequência de Aminoácidos , Sequência de Bases , Clonagem Molecular , Simulação por Computador , DNA Nucleotidiltransferases/genética , Proteínas de Ligação a DNA/química , Lisogenia/fisiologia , Dados de Sequência Molecular , Mutagênese/genética , Óperon/genética , Fragmentos de Peptídeos/genética , Fenótipo , Estrutura Secundária de Proteína , Recombinação Genética/genética , Proteínas Virais/química
4.
J Mol Biol ; 183(4): 529-41, 1985 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-2410621

RESUMO

Mutations that map in or delete the attenuator of the threonine (thr) operon of Escherichia coli were isolated and characterized. These mutations disrupt or delete the transcription termination structure encoded by the attenuator leading to increased transcriptional readthrough into the thr operon structural genes. Most of the base substitutions and single base-pair insertions and deletions map in the G + C-rich region of dyad symmetry in the attenuator and decrease the calculated stabilities of the attenuator RNA secondary structures to similar extents (from -30.8 kcal/mol to approximately -21 kcal/mol). Most of the mutants showed a three- to fourfold increase in homoserine dehydrogenase (thrA gene product) synthesis relative to the wild-type parent strain. The mutation in one mutant (thrL153 + G) lowered the calculated stability of the RNA secondary structure only slightly (from -30.8 to 27.8 kcal/mol) but the mutant still exhibited high levels of homoserine dehydrogenase synthesis. In addition, three base substitution mutants (thrL135U, thrL139A and thrL156U) showed only slightly (1.5 to 2-fold) elevated levels of homoserine dehydrogenase activity, even though the calculated stabilities of the attenuator RNA secondary structures were reduced as much as most of the other mutants. Two of the mutations (thrL135U and thrL156U) mapped in the G + C-rich-A + T-rich junction of the attenuator. The third mutation (thrL139A) creates an A X C pair in the center of the G + C-rich region of the attenuator stem. The results obtained for these mutants show that the stability of the RNA secondary structure does not always correlate with the efficiency of transcription termination. Finally, analysis of the base changes in the substitution mutations showed that the mutational changes do not appear to be random.


Assuntos
Genes Reguladores , Mutação , Óperon , Regiões Terminadoras Genéticas , Treonina/genética , Transcrição Gênica , Sequência de Bases , DNA Bacteriano/genética , Escherichia coli/enzimologia , Escherichia coli/genética , Genes , Genes Bacterianos , Homosserina Desidrogenase/metabolismo , Temperatura Alta , Lisogenia , Conformação de Ácido Nucleico , RNA Bacteriano/genética
5.
J Mol Biol ; 235(3): 908-25, 1994 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-8289327

RESUMO

Bacteriophage lambda encodes a site-specific recombination system that promotes the movement of the phage genome into and out of the host bacterial chromosome. The phage-encoded integrase (Int) is composed of 356 amino acid residues and carries out the required strand exchanges by means of a type I topoisomerase activity. Int also contains two distinct DNA-binding domains that interact with two different, specific sequences (arm-type and core-type sites) on DNA. In order to help understand the mechanism of site-specific recombination, we have used a genetic approach to isolate mutants defective in different steps in the recombination reaction. We developed a genetic screen for Int mutants that are defective in catalyzing excisive recombination in vivo. These mutants were screened for proficiency in binding to the P'123 arm-type sites using the bacteriophage P22 challenge-phage assays. In all, 78 such mutants were isolated and the mutational changes mapped and sequenced. These mutants have been further characterized (1) for their ability to bind the P'1 and P'123 arm-type sites and for their ability to form the attL complex in vivo, (2) for negative dominance in vitro, (3) for the presence of type I topoisomerase activity, and (4) for the ability to resolve artificially constructed recombination intermediates. We found that (1) residues in a stretch of 88 amino acids in the middle of the protein may be involved in Int-Int interactions, (2) a region around Arg212 is involved in the catalytic site, (3) residues near the carboxyl terminus play a role in enhancing Int binding to its arm-type sites, possibly by interacting with the small amino-terminal region that has been shown to be responsible for specific recognition of the arm-type sites, and (4) residues at the very carboxyl end of the protein may be involved in modulating the cleavage or religation activities of the Int protein.


Assuntos
Bacteriófago lambda/genética , DNA Nucleotidiltransferases/química , Lisogenia , Recombinação Genética , Proteínas Virais/química , DNA Topoisomerases Tipo I/metabolismo , Integrases , Mutagênese , Relação Estrutura-Atividade , Especificidade por Substrato
6.
J Mol Biol ; 181(2): 187-97, 1985 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-3157003

RESUMO

Bacteriophage lambda integration and excision occur by reciprocal recombination within a 15-base homologous core region present in the recombining attachment (att) sites. Strand exchange within the core occurs at precise nucleotide positions, which define an overlap region in which the products of recombination contain DNA strands derived from different parents. In order to define the role of sequence homology during recombination we have constructed point mutations within the core and assayed their effects in vivo and in vitro on site-specific recombination. Two of the mutations are located at position -3 of the core, which is one base-pair outside of the overlap region where strand exchange occurs. These mutations do not affect integrative or excisive recombination, thereby suggesting that homology outside the overlap region is not required for recombination. Two other mutations are located at position -2 of the core, which is one base-pair within the overlap region. These mutations show severely depressed integrative and excisive recombination activities in vitro and in vivo when recombined against wild-type att sites. However, the -2 mutations show normal recombination activity when recombined against att sites containing the homologous mutation, thereby suggesting that homology-dependent DNA interactions are required within the overlap region for effective recombination. In vitro recombination between homoduplex attP sites and heteroduplex attB sites demonstrated that the DNA interactions require only one strand of the attB overlap region to be homologous to attP in order to promote recombination.


Assuntos
Bacteriófago lambda/genética , DNA Viral/genética , Recombinação Genética , Sítios de Ligação Microbiológicos , Sequência de Bases , Eletroforese em Gel de Poliacrilamida , Lisogenia , Mutação , Ácidos Nucleicos Heteroduplexes/genética
7.
J Mol Biol ; 192(3): 513-27, 1986 Dec 05.
Artigo em Inglês | MEDLINE | ID: mdl-2951525

RESUMO

Integrative recombination between specific attachment (att) regions of the bacteriophage lambda genome (attP) and the Escherichia coli genome (attB) results in a prophage flanked by the hybrid recombinant sites attL and attR. Each att site contains sequences to which proteins involved in recombination bind. Using site-directed mutagenesis, we have constructed a related set of point mutations within each of the five Int "arm-type" binding sites located within attP, attL and attR. Footprint analyses of binding demonstrate that mutating the arm-type sites significantly disrupts the binding of Int. Recombination analyses of mutant att sites in vivo and in vitro demonstrate that only three wild-type arm-type sites within attP are required for efficient integrative recombination. Similar analyses demonstrate that efficient excision can occur with two other different sets of wild-type arm-type sites in attL and attR. These results demonstrate that integrative and excisive recombination may involve interactions of Int with distinct and different subsets of arm-type sites.


Assuntos
Sítios de Ligação Microbiológicos , Bacteriófago lambda/genética , Lisogenia , Mutação , Sítios de Ligação , DNA Nucleotidiltransferases/genética , DNA Viral/análise , Escherichia coli/genética , Integrases , Modelos Genéticos , Recombinação Genética , Proteínas Virais/genética
8.
J Mol Biol ; 194(1): 59-69, 1987 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-3112412

RESUMO

Expression of the threonine (thr) operon enzymes of Escherichia coli is regulated by an attenuation mechanism. The regulatory portion of the operon contains a region coding for a leader peptide that contains consecutive threonine and isoleucine codons. It is thought that translation of the leader peptide controls the frequency of transcription termination at the attenuator site. Using oligonucleotide-directed site-specific mutagenesis we have altered the putative control codons of the leader peptide coding region. In two of the mutants the threonine and isoleucine codons were changed to produce peptides containing histidine and tyrosine codons. Both mutants showed loss of regulation by threonine and isoleucine. A hisT mutation, which leads to an undermodification of tRNA(His), increased thr operon expression in the mutants threefold but did not affect expression of the wild-type thr operon. Two other mutants were constructed that contained two histidine codons early in the leader peptide. Expression in both of these mutants was unaltered by the presence of the hisT allele or by the addition of threonine and isoleucine to the growth medium. In addition, a wild-type strain containing a temperature-sensitive threonyl-tRNA synthetase mutation showed increased thr operon expression at the non-permissive temperature, whereas none of the mutants showed any change. Taken together these data indicate that the specificity of the attenuation response is effected by specific control codons within the thr leader peptide coding region. We have also directly demonstrated thr leader peptide synthesis in vitro using a plasmid encoding the wild-type thr leader region to direct the synthesis of a peptide of the appropriate molecular weight when labeled with [3H]threonine but not with [3H]histidine or [3H]tyrosine. Conversely, when extracts were incubated with templates containing the mutated DNAs, peptides were labeled that showed patterns consistent with the expected amino acid compositions. These data indicate that the thr leader RNA is translated into the predicted leader peptide.


Assuntos
Códon , Escherichia coli/genética , Isoleucina/genética , Óperon , RNA Mensageiro , Treonina/genética , Transcrição Gênica , Escherichia coli/metabolismo , Regulação da Expressão Gênica , Mutação , Plasmídeos , Biossíntese de Proteínas , Sinais Direcionadores de Proteínas/biossíntese , Sinais Direcionadores de Proteínas/genética , Temperatura
9.
Genetics ; 143(3): 1069-79, 1996 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-8807282

RESUMO

Site-specific recombination in bacteriophage lambda involves interactions among proteins required for integration and excision of DNA molecules. We have analyzed the elements required to form an in vivo nucleoprotein complex of integrase (Int) and integration host factor (IHF). Interaction of Int with the core (the site of strand exchange) is stabilized by the flanking arm region of attL. IHF, in addition to Int, is required for efficient Int-core binding. We used the in vivo attL binding assay to characterize several Int variants for their abilities to form stable attL complexes. Substitution of Int active site tyrosine 342 by phenylalanine had no effect on the ability of the protein to form attL complexes. Three other amino acids that are completely conserved in the integrase family of recombinases (arginine 212, histidine 308, and arginine 311) were separately substituted by glutamine, leucine, and histidine, respectively. In each case, the mutant protein was altered in its ability to form attL complexes while retaining its ability to bind to the lambda arm-type sites. We propose that, in addition to their role in catalysis, this triad of amino acids helps the Int protein to interact with the lambda core sites.


Assuntos
Bacteriófago lambda/genética , Nucleoproteínas/genética , Proteínas Virais/genética , Proteínas de Bactérias/metabolismo , Sítios de Ligação , Fatores Hospedeiros de Integração , Mutagênese , Proteínas Repressoras/metabolismo , Proteínas Virais Reguladoras e Acessórias
10.
Genetics ; 122(4): 727-36, 1989 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-2527180

RESUMO

Recombination of phage lambda attachment sites occurs by sequential exchange of the DNA strands at two specific locations. The first exchange produces a Holliday structure, and the second resolves it to recombinant products. Heterology for base substitution mutations in the region between the two strand exchange points (the overlap region) reduces recombination; some mutations inhibit the accumulation of Holliday structures, others inhibit their resolution to recombinant products. To see if heterology also alters the location of the strand exchange points, we determined the segregation pattern of three single and one multiple base pair substitution mutations of the overlap region in crosses with wild type sites. The mutations are known to differ in the severity of their recombination defect and in the stage of strand exchange they affect. The three single mutations behaved similarly: each segregated into both products of recombination, and the two products of a single crossover were frequently nonreciprocal in the overlap region. In contrast, the multiple mutation preferentially segregated into one of the two recombinant products, and the two products of a single crossover appeared to be fully reciprocal. The simplest explanation of the segregation pattern of the single mutations is that strand exchanges occur at the normal locations to produce recombinants with mismatched base pairs that are frequently repaired. The segregation pattern of the multiple mutation is consistent with the view that both strand exchanges usually occur to one side of the mutant site. We suggest that the segregation pattern of a particular mutation is determined by which stage of strand exchange it inhibits and by the severity of the inhibition.


Assuntos
Sítios de Ligação Microbiológicos , Bacteriófago lambda/genética , Troca Genética , DNA Viral/genética , Lisogenia , Recombinação Genética , Sequência de Bases , Cruzamentos Genéticos , Genótipo , Mutação
11.
Gene ; 118(1): 13-9, 1992 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-1511875

RESUMO

Transcriptional regulation of the put operon is mediated by a unique mechanism involving autogenous regulation by the PutA protein, a membrane-associated dehydrogenase. The 420-bp put control region contains the putP and putA promoters, multiple operator sites, multiple catabolite repression protein binding sites, and several potential integration host factor (IHF)-binding sites (ihf). In this study, we show that IHF facilitates repression of the put operon in vivo, and IHF binds specifically to two ihf sites in the put control region in vitro. DNA gyrase mutants that alter the degree of chromosomal supercoiling do not affect put regulation, indicating that the effect of IHF on put expression is in this case independent of supercoiling.


Assuntos
Proteínas de Bactérias/genética , Repressão Enzimática/genética , Óperon/genética , Prolina/metabolismo , Sequências Reguladoras de Ácido Nucleico/genética , Salmonella typhimurium/genética , Sequência de Aminoácidos , Proteínas de Bactérias/metabolismo , Sequência de Bases , DNA Bacteriano/metabolismo , Proteínas de Ligação a DNA/metabolismo , Regulação Bacteriana da Expressão Gênica , Fatores Hospedeiros de Integração , Dados de Sequência Molecular , Conformação de Ácido Nucleico , Regiões Operadoras Genéticas/genética , Regiões Promotoras Genéticas/genética , Homologia de Sequência do Ácido Nucleico
12.
Gene ; 157(1-2): 119-21, 1995 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-7607471

RESUMO

A method for selecting mutants of site-specific DNA-binding proteins has been applied to the study of the EcoRI and RsrI restriction-modification enzymes. Catalytically inactive variants of both endonucleases are shown to function as pseudo-repressors in the bacteriophage P22 challenge-phage assay, and, upon further mutagenesis of the gene encoding R.EcoRI, a variant of that enzyme has been selected which appears to bind EcoRI-methylated GAATTC sequences to the exclusion of unmethylated sites: this specificity is the opposite of that belonging to the native enzyme. Variants of the EcoRI methylase have also been found that lack either catalytic activity or both binding and catalytic activities.


Assuntos
Bacteriófago P22/metabolismo , Proteínas de Ligação a DNA/metabolismo , Mutagênese Sítio-Dirigida , DNA Metiltransferases Sítio Específica (Adenina-Específica)/metabolismo , Sequência de Bases , Sítios de Ligação , Catálise , Proteínas de Ligação a DNA/biossíntese , Variação Genética , Mutação Puntual , Especificidade por Substrato
13.
Gene ; 37(1-3): 73-81, 1985.
Artigo em Inglês | MEDLINE | ID: mdl-4054630

RESUMO

A genetic enrichment procedure for mutations constructed by oligodeoxynucleotide(oligo)-directed mutagenesis of DNA cloned in M13mp vectors is described. The procedure uses an M13 vector that contains the cloned target DNA and amber (am) mutations within the phage genes I and II. This vector cannot replicate in a suppressor-free (sup degrees) bacterial strain. A gapped heteroduplex is formed by annealing portions of a complementary (-)strand containing wild-type copies of genes I and II to the am-containing template (+)strand. The oligo is annealed to the single-stranded (ss) region and the remaining gaps and nicks are repaired enzymatically to form a closed circular heteroduplex structure. By transfecting the DNA into a sup degrees host we promote the propagation of heteroduplexes with the oligo-containing (-)strand since only this construction contains the wild-type copies of genes I and II. This procedure eliminates the need for any physical separation of the covalently closed circular DNA that contains the oligo from the ss template. Using this technique we have constructed 17 point mutations with mutation frequencies ranging from 2-20% for single base changes and from 0.3-9% for multiple base changes. In addition, we found that the mutation frequencies were affected by the state of DNA methylation in the (+) and (-)strands.


Assuntos
Mutação , Oligodesoxirribonucleotídeos/genética , Colífagos/genética , Reparo do DNA , DNA Viral/genética , Vetores Genéticos
14.
Biochimie ; 76(10-11): 1030-40, 1994.
Artigo em Inglês | MEDLINE | ID: mdl-7748924

RESUMO

Integration host factor (IHF) is a protein encoded by Escherichia coli, which was first discovered as a requirement for bacteriophage lambda site-specific recombination. In this study, we characterized mutants of IHF for their ability to bind to various IHF binding sites in vivo and to promote recombination of lambda in vitro. DNA-binding in vivo was monitored using the challenge-phage system. If IHF binds to its DNA-binding site that has been placed into the P(ant) region of bacteriophage P22, it acts as a repressor of the ant (antirepressor) gene, leading to the formation of lysogens of Salmonella typhimurium. If IHF cannot bind to its site, antirepressor is made leading to cell lysis. Challenge phages containing chimeras of different lambda IHF binding sites were constructed to test the contribution to the binding of a dA+dT-rich region, found in the sequence of the H' site but not in the H' site. In one case, the binding of mutant IHF proteins was enhanced by the presence of the dA+dT-rich region, indicating that IHF may be affected by neighboring bases and local DNA structure when it binds to its site. A subset of the mutant proteins retained the ability to form a looped attL complex in vivo, representing part of a higher-order protein-DNA complex (the 'intasome'). Additionally, this same subset of proteins also promoted the integration and excision of bacteriophage lambda in vitro. Thus, these mutant proteins not only retain their DNA-bending ability but make any protein-protein contacts necessary to form a recombination-proficient intasome.


Assuntos
Proteínas de Bactérias/genética , Proteínas de Ligação a DNA/genética , Escherichia coli/genética , Recombinação Genética , Sequência de Bases , Sítios de Ligação , Dados de Sequência Molecular , Mutação
15.
J Clin Epidemiol ; 53(1): 79-85, 2000 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-10693907

RESUMO

The purpose of this study was to determine whether patients with end stage renal disease treated with hemodialysis were correlated in dialysis adequacy within facilities. This was a retrospective analysis of dialysis adequacy based on urea reduction ratio (URR) values from 6969 patients dialyzed at 154 facilities. The within-center correlation was quantified using the between-center variation and the parameter p that was derived using ANOVA tables and mixed effects models. The variation in center means for URR was wider than expected for independent observations (52.9-76.1 versus 60.7-73.8, respectively). Furthermore, there was a significant within-center correlation in URR values across all facilities (p = 0.136, P<0.0001), which persisted after adjusting for patient specific covariates, facility characteristics, and state. In conclusion, there was a substantial within-center correlation in dialysis adequacy that reflected important center effects on the outcome of ESRD patients.


Assuntos
Nitrogênio da Ureia Sanguínea , Unidades Hospitalares de Hemodiálise/normas , Falência Renal Crônica/terapia , Avaliação de Resultados em Cuidados de Saúde , Feminino , Humanos , Masculino , Mid-Atlantic Region , Pessoa de Meia-Idade , Estudos Retrospectivos
16.
Arch Pediatr Adolesc Med ; 153(12): 1257-63, 1999 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-10591302

RESUMO

OBJECTIVES: (1) To describe temporal patterns of office visits for attention-deficit/hyperactivity disorder (ADHD) and stimulant treatment for 5- to 14-year-old US youths; (2) to compare youth visits for ADHD with and without melication according to patient demographics, physician specialty, reimbursement source, and comorbid diagnoses; and (3) to compare office visits for youths with ADHD in relation to common medication patterns (stimulants alone, stimulants with other psychotherapeutic medication, and nonstimulant psychotherapeutic medications alone). DESIGN: Survey based on a national probability sample of office-based physicians in the United States. SETTING: Physician offices. PARTICIPANTS: A systematically sampled group of office-based physicians. MAIN OUTCOME MEASURES: National estimates of office visits for ADHD and psychotherapeutic drug visits for ADHD for each year and for a combined 8-year period. RESULTS: Youth visits for ADHD as a percentage of total physician visits had a 90% increase, from 1.9% in 1989 to 3.6% in 1996. Stimulant therapy within ADHD youth visits rose from 62.6% in 1989 to 76.6% in 1996. While the majority of non-ADHD youth visits were conducted by primary care physicians, one third of ADHD youth visits were managed by psychiatry and neurology specialists. Health maintenance organization insurance was the reimbursement source for 17.9% of non-ADHD youth visits but only 11.7% of ADHD youth visits. Complex medication therapy was more likely to be prescribed by psychiatrists and less likely to be related to visits with health maintenance organization reimbursement. CONCLUSIONS: National survey estimates in the 1990s confirm the substantial increase in visits for youths diagnosed as having ADHD, with more than three quarters of these visits associated with psychotherapeutic medication treatment. Physician specialty and reimbursement source variables identify distinct patient populations with a gradient in psychotherapeutic medication patterns from single-drug standard (stimulant) therapy to complex multidrug treatment regimens for which evidence-based scientific information is lacking.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Estimulantes do Sistema Nervoso Central/uso terapêutico , Padrões de Prática Médica/estatística & dados numéricos , Psicotrópicos/uso terapêutico , Adolescente , Criança , Pré-Escolar , Quimioterapia Combinada , Feminino , Humanos , Reembolso de Seguro de Saúde , Masculino , Medicina , Visita a Consultório Médico/estatística & dados numéricos , Especialização , Fatores de Tempo , Estados Unidos
17.
Work ; 5(2): 107-14, 1995.
Artigo em Inglês | MEDLINE | ID: mdl-24441114

RESUMO

The Accreditation Council, a national accreditation organization since 1969, has developed a set of Outcome Based Performance Measures that can be used to assess the quality of services and supports for people with disabilities. The development of the Outcome Based Performance Measures signals a change in the definition of quality from compliance with organizational processes to responsiveness to the individual. Based on individual and focus group interviews with individuals with disabilities, the new measures of quality indicates the outcomes that people expect from services and supports. These generic outcomes apply to work and employment settings. The new approach to quality assessment treats work and employment as methods or organizational processes which facilitate outcomes for people. Work and employment are important for the outcomes they facilitate.

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