Comparison of Postoperative Bleeding in Total Hip and Knee Arthroplasty Patients Receiving Rivaroxaban or Enoxaparin.

BACKGROUND: The Regulation of Coagulation in Orthopedic Surgery to Prevent Deep Venous Thrombosis and Pulmonary Embolism (RECORD) 1 to 4 trials compared rivaroxaban 10 mg daily with commonly used doses of enoxaparin and demonstrated similar rates of VTE and bleeding. OBJECTIVE: To evaluate bleeding events between patients who received enoxaparin or rivaroxaban for prevention of venous thromboembolism (VTE) following total hip arthroplasty (THA) or total knee arthroplasty (TKA). METHODS: Retrospective cohort that compared patients undergoing THA and TKA who received enoxaparin (enoxaparin) with those who received rivaroxaban (rivaroxaban) and also with those who received enoxaparin in the RECORD 1 to 4 trials (enoxaparin RECORD). The primary outcome was any postoperative bleeding, defined as a composite of major and clinically relevant nonmajor bleeding based on the definitions in the RECORD 1 to 4 trials. RESULTS: There was a lower rate of any postoperative bleeding (2.2% vs 6.8%, P = 0.004) in patients who received enoxaparin compared with rivaroxaban, and bleeding rates between the enoxaparin group and the enoxaparin RECORD groups were similar (2.2% vs 2.5%, P = 0.085). Major bleeding in the enoxaparin group (0.2%) was not significantly different from that in the rivaroxaban group (1.4%, P = 0.12) or the RECORD group (0.2%, P = 0.93). Clinically relevant nonmajor bleeding was also lower in the enoxaparin group compared with the rivaroxaban group (2.0% vs 5.5%, P = 0.012). CONCLUSIONS: The use of enoxaparin for VTE prophylaxis following THA and TKA was associated with a lower rate of the primary outcome (any postoperative bleeding) compared with the use of rivaroxaban in a similar cohort of patients.

Correlates associated with the desire for PEG tube placement at the end of life among community-dwelling older Mexican Americans: a pilot study.

BACKGROUND AND AIMS: Use of percutaneous endoscopic gastrostomy (PEG) tubes in older adults remains controversial. This cross-sectional study examines community-dwelling Mexican American older adults' attitudes toward PEG tube placement in the hypothetical event of a terminal illness. METHODS: Interviews were conducted with 100 community-dwelling Mexican American (MA's) adults, age 60 and over, in San Antonio, Texas. Subjects were screened for cognitive competence using Folstein's mini-mental examination. This was followed by an evaluation of socioeconomic status, depressive symptoms, religiosity, health status and attitudes toward end-of-life care, including PEG tube feeding. RESULTS: Higher income MA's, professionals, those without a living will, those who saw religious belief as not important and those who attended church less than once a month were more likely to agree with PEG placement (all P < 0.05). Logistic regression analysis revealed that higher income (OR = 3.16, CI = 1.13-8.83), lack of a living will (OR = 3.34, CI = 1.03-20.87) and low importance of religious beliefs (OR = 7.14, CI = 1.25-41.67) were all independently associated with the desire for insertion of a PEG tube at the end of life. CONCLUSIONS: This is the first community-based study to describe older Mexican American's attitudes toward PEG tube placement at the end of life. Older community-dwelling Mexican Americans with higher incomes, lack of a living will or low religious involvement might be more likely to choose PEG tube placement even in the context of a terminal condition.

Association of knowledge, attitudes, and behaviors for colon cancer screening in Hispanic patients.

PURPOSE: The purpose of our cross-sectional study was to examine the association between sociodemographic, knowledge, attitude and behavior factors with colon cancer screening among low-income Hispanic patients from an urban family medicine clinic in San Antonio, Texas. METHODS: Using random stratified sampling, 804 patients were surveyed with 274 Hispanic patients meet the eligibility criteria for colon cancer screening (aged > or = 50 years). A 10-page self-administered questionnaire in Spanish or English completed in the clinic waiting room included self-reported colonoscopy, sociodemographic characteristics, health status, knowledge, attitudes, and behaviors toward colon cancer screening. Associations between colonoscopy and patient characteristics were assessed using logistic regression. RESULTS: 62% of patients reported having been tested for colonoscopy. Older Hispanics (age mean=59 + 6.1 SD) were more likely to have a colonoscopy than younger Hispanics (age mean = 56 +/- 4.8 SD) (P < .001). Bivariate analysis showed that patients who discussed colon cancer risk with their doctor (P = .001), did not smoke (P = .004), or encouraged family members or friends to be tested for colon cancer (P < .001) were more likely to be screened. Multiple variable logistic regression analysis showed that older age, having cancer, discussing the risk factors with their doctor, and encouraging family members or friends to get tested were significant predictors for colonoscopy testing in Hispanics. CONCLUSIONS: Colonoscopy screening in a sample of low-income Hispanic patients differed by age and health experience. Intervention programs that increase colon cancer screening in Hispanics patients should concentrate on those aged < 60. Patient education for knowledge, positive attitude, and behaviors may improve colon cancer screening.

Attitudes regarding the use of ventilator support given a supposed terminal condition among community-dwelling Mexican American and non-Hispanic white older adults: a pilot study.

PURPOSE: To determine the factors that are associated with Mexican Americans' preference for ventilator support, given a supposed terminal diagnosis. METHODS: 100 Mexican Americans, aged 60-89, were recruited and screened for MMSE scores above 18. Eligible subjects answered a questionnaire in their preferred language (English/Spanish) concerning ventilator use during terminal illness. Mediator variables examined included demographics, generation, religiosity, occupation, self-reported depression, self-reported health, and activities of daily living. RESULTS: Being first or second generation American (OR = 0.18, CI = 0.05-0.66) with no IADL disability (OR = 0.11, CI = 0.02-0.59) and having depressive symptoms (OR = 1.43, CI = 1.08-1.89) were associated with preference for ventilator support. IMPLICATIONS: First and second generation older Mexican Americans and those functionally independent are more likely to prefer end-of-life ventilation support. Although depressive symptoms were inversely associated with ventilator use at the end of life, scores may more accurately reflect psychological stress associated with enduring the scenario. Further studies are needed to determine these factors' generalizability to the larger Mexican American community.

He Said, She Said: Comparing Men's and Women's Descriptions of Men's Partner Violence.

More than one in three women and one in four men in the United States report victimization by intimate partner violence. Women and men often disagree about the frequency or severity of violent acts, and researchers have proposed various reasons for discordant reports. Using daily surveys and qualitative interviews, we compared men's and women's reports about men's partner aggression and examined language they used to describe their experiences. Fifteen heterosexual couples in violent relationships completed an 8-week study that involved daily telephone surveys about violent behaviors and household environment; baseline and end-of-study surveys addressing predictors and outcomes of violence; and qualitative end-of-study interviews to provide perspective about their relationships. Most participants were Latinos with low income. Relationship length was 5.5 years, median. In daily surveys, both partners reported similar frequencies of men's physical violence (4% of days), but men reported more physical violence by women than women did (8% vs. 3% of days). The qualitative analysts compared men's and women's accounts of male-to-female violence and observed gender-specific variations in style of reporting. Men used indirect language to describe their violent behavior, implied definitions of abuse, and justified their aggression. These findings have implications for clinical guidelines to screen and intervene with victims and perpetrators of intimate partner violence in primary care and emergency settings. Future research should focus on perpetrators of violence and examine effective ways for health care providers to identify and manage their care.

Early response to ErbB2 over-expression in polarized Caco-2 cells involves partial segregation from ErbB3 by relocalization to the apical surface and initiation of survival signaling.

In several human cancers, ErbB2 over-expression facilitates the formation of constitutively active homodimers resistant to internalization which results in progressive signal amplification from the receptor, conducive to cell survival, proliferation, or metastasis. Here we report on studies of the influence of ErbB2 over-expression on localization and signaling in polarized Caco-2 and MDCK cells, two established models to study molecular trafficking. In these cells, ErbB2 is not over-expressed and shares basolateral localization with ErbB3. Over-expression of ErbB2 by transient transfection resulted in partial separation of the receptors by relocalization of ErbB2, but not ErbB3, to the apical surface, as shown by biotinylation of the apical or basolateral surfaces. These results were confirmed by immunofluorescence and confocal microscopy. Polarity controls indicated that the relocalization of ErbB2 is not the result of depolarization of the cells. Biotinylation and confocal microscopy also showed that apical, but not basolateral ErbB2 is activated at tyrosine 1139. This phosphotyrosine binds adaptor protein Grb2, as confirmed by immunoprecipitation. However, we found that it does not initiate the canonical Grb2-Ras-Raf-Erk pathway. Instead, our data supports the activation of a survival pathway via Bcl-2. The effects of ErbB2 over-expression were abrogated by the humanized anti-ErbB2 monoclonal antibody Herceptin added only from the apical side. The ability of apical ErbB2 to initiate an altered downstream cascade suggests that subcellular localization of the receptor plays an important role in regulating ErbB2 signaling in polarized epithelia.

Mini-mental state exam domains predict falls in an elderly population: follow-up from the Hispanic Established Populations for Epidemiologic Studies of the Elderly (H-EPESE) study.

OBJECTIVES: Assessment of the predictive ability of the Mini-Mental Status Exam (MMSE) domains (orientation to time, orientation to place, registration, attention and calculation, recall, language, and visual construction) for falls in Mexican American elders tested the hypothesis that low MMSE domain scores are related to an increased number of falls. DESIGN: Data were obtained from the 1998-99 re-survey (Wave 3) Hispanic Established Populations for the Epidemiologic Study of the Elderly (H-EPESE), a population-based study of older Mexican Americans residing in the southwestern United States. METHODOLOGY: We used a retrospective case control study design; 926 subjects who were aged > or = 77 years at Wave 3 were examined. MMSE scores were utilized to predict falls two years later. Measurements included sociodemographic characteristics, MMSE scores, activities of daily living (ADL), instrumental activities of daily living (IADL), and fall rates. MAIN OUTCOME MEASURES: Relationships between MMSE domain scores and falls. RESULTS: Of the 681 subjects examined two years later, 35.7% experienced at least one fall. Subjects with errors on orientation to place (OR = 2.01) and visual construction (OR = 1.9) were most likely to fall. CONCLUSIONS: MMSE domains with poor scores and most predictive of falls in Mexican Americans elders were orientation to place and visual construction. Further evaluation for confusion level and visual ability in elders presenting with dysfunction on these domains may lead to a reduction of falls in this ethnic group.

Total anticholinergic burden and survival within a cohort of elderly Mexican Americans.

AIM: Studies examining the association between mortality and anticholinergic burden in the geriatric population are conflicting and are absent in the Mexican American population. The present study aimed to determine whether higher anticholinergic burden increases mortality in a cohort representative of community-based older Mexican Americans in the USA. METHODS: This retrospective cohort database study used the Hispanic Established Populations for the Epidemiologic Study of the Elderly cohort. The primary outcome, mortality, was assessed beginning at the second interview in 1995 until the fifth interview in 2005. Medications were classified for anticholinergic burden according to the modified-Anticholinergic Drug Scale and were summed across all reported medications creating a measure of total anticholinergic burden. Anticholinergic burden was tested for association with mortality using survival analysis. RESULTS: The 1497 older adults reporting medication usage were included. Survival analysis showed a statistically significant (P < 0.05) relationship between anticholinergic burden and increased mortality. CONCLUSIONS: Anticholinergic burden is associated with increased mortality in Southwestern Mexican American older adults who report taking prescription or non prescription medications. These findings suggest that anticholinergic burden might be a risk factor for mortality in this selected population, with additional studies required to further define the risk. Geriatr Gerontol Int 2017; 17: 1515-1521.

Research or intervention or both? Women's changes after participation in a longitudinal study about intimate partner violence.

INTRODUCTION: The tensions between risk and benefit in research are particularly evident in studies about intimate partner violence. Recalling and relating traumatic experiences may deepen posttraumatic stress or relieve the burden of terrible events long borne in secret. In this article, we examine the effects of study participation in a longitudinal investigation of intimate partner violence using both qualitative and quantitative data. METHOD: Researchers enrolled 200 women in moderately violent intimate relationships and asked them to report about their relationships every day for 12 weeks. Daily, participants telephoned an automated survey and responded to 34 survey questions. They also completed baseline and end-of-study surveys and maintained telephone contact with 1 researcher weekly. Forty-2 participants completed qualitative end-of-study interviews to describe their relationships and their experiences in the study. RESULTS: Over 12 weeks, participants showed improvements in coping strategies, hope, and mental health, and increased readiness to leave their partners. In qualitative interviews, women reported gaining insight, feeling better emotionally, making behavioral changes, finding comfort in daily surveys, learning resources for help, and taking action to improve their lives. Fourteen percent left their partners by end-of-study; 35% sought counseling. DISCUSSION: The study's daily survey invited the participant to become more reflective about her relationship, which changed how she saw herself and her situation. The study methods also included weekly conversations with a compassionate researcher, allowing women to tell their stories. These 2 strategies may be incorporated into brief interventions for intimate partner violence in primary care settings. (PsycINFO Database Record

Using complexity science to examine three dynamic patterns of intimate partner violence.

INTRODUCTION: The partner violence literature describes 3 dominant models of dynamics of partner aggression: cycle of violence, family systems theory, and Duluth model (power and control wheel). Complexity science describes 3 patterns of system dynamics: periodic, chaotic, and random. Are these parallel patterns? In this analysis, investigators calculated dynamic patterns (periodic, chaotic, and random) using 84 daily reports of male-to-female aggression and assessed the "fit" between time-series-derived patterns of male partners' violent behaviors and literature-based models of violence dynamics. METHOD: Participants were 200 women in moderately violent intimate relationships who completed a telephone survey about their relationships every day for 12 weeks. They also completed baseline and end-of-study surveys and maintained telephone contact with the study team weekly. Of 200 participants, 135 women provided enough data to be assigned to period, chaotic, or random groups. RESULTS: Group membership included 16 women in periodic, 40 in chaotic, and 79 in random groups. Consistent with the cycle of violence, periodic women found violence to be predictable and controllable. Consistent with the Duluth model, women in the random group found violence to be unpredictable and out of their control, occurring with high frequency. The chaotic group had the lowest frequency and severity of violence, lowest stress and arguments, and the highest marital satisfaction. DISCUSSION: The most common dynamic pattern in partner violence is random, which exhibits high frequency and unpredictability of aggression. Complexity science suggests interventions in random systems have unpredictable outcomes, posing great challenges for clinicians who work with victims of violence.

Coping with intimate partner violence: Qualitative findings from the study of dynamics of husband to wife abuse.

INTRODUCTION: Coping can be defined as an individual's efforts to manage a problem. In Intimate Partner Violence (IPV), coping depends heavily on relationship context, circumstances, and resource availability. The range of coping strategies utilized by women experiencing violence are not fully understood. METHOD: Two hundred female patients who screened positive for verbal or physical abuse were recruited from 6 primary care clinics in San Antonio. Subjects were instructed to complete a baseline survey, which included the COPE scale, as well as daily telephone reports, weekly contact with research staff, and an end-of-study survey. A total of 42 women completed an in-depth qualitative interview at the end of 3 months. RESULTS: Using a template approach to qualitative analysis, interview transcripts were analyzed and coded. "Coping" as a theme emerged independently and was categorized into 14 subcategories, according to the COPE scale; the most commonly endorsed themes from interviews were "avoidance" and "active coping." Previously undescribed methods of coping with IPV were also discovered using this approach, including "preventing escalation" and "ignoring." DISCUSSION: In a qualitative study of women living with IPV, coping emerged as an independent theme. We found that the women used methods not listed on the COPE standardized scale at least as often as more traditional categories. It is important for family medicine clinicians to be aware of the wide variety of coping mechanisms to best address safety planning.

Retrospective Evaluation of Postoperative Bleeding Events in Patients Receiving Rivaroxaban After Undergoing Total Hip and Total Knee Arthroplasty: Comparison with Clinical Trial Data.

STUDY OBJECTIVE: Although data from the Regulation of Coagulation in Orthopedic Surgery to Prevent Deep Venous Thrombosis and Pulmonary Embolism (RECORD) 1-4 trials have shown a similar postoperative bleeding risk between rivaroxban and enoxaparin in patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA), anecdotal observations from local institutions have suggested that postoperative bleeding rates seemed higher in patients who received rivaroxaban than those reported in the RECORD trials. Thus, the objective of this pilot study was to assess postoperative bleeding events observed in clinical practice in patients receiving rivaroxaban after undergoing THA and TKA and to compare their results with those published in the RECORD trials. DESIGN: Retrospective cohort study with a comparator group of patients from the RECORD 1-4 trials. SETTING: Two institutions within a regional health care system. PATIENTS: Four hundred forty adults who received at least one dose of rivaroxaban 10 mg daily after undergoing THA or TKA in the two institutions between August 2011 and October 2013 (cohort group), and 6183 patients who received rivaroxaban in the RECORD 1-4 trials (comparator group). MEASUREMENTS AND MAIN RESULTS: Postoperative bleeding was assessed in the cohort patients versus the patients in the RECORD trials. The primary outcome, occurrence of any postoperative bleeding, was a composite of major and clinically relevant nonmajor bleeding as defined in the RECORD trials. Any postoperative bleeding occurred in 6.8% of the cohort patients versus 3.2% of the RECORD trial patients (p<0.0001); 1.4% of the cohort patients versus 0.38% of the RECORD trial patients suffered a major bleed (p=0.013). Within defined major bleeding, bleeding leading to reoperation and clinically overt extrasurgical site bleeding resulting in either a hemoglobin level decrease of at least 2 g/dl or transfusion of 2 units or greater of packed red blood cells were reported in 0.68% versus 0.19% (p=0.073) and 0.68% versus 0.13% (p=0.032), respectively, of the cohort patients versus the RECORD trial patients. CONCLUSION: Overall, any postoperative bleeding in the cohort patients occurred significantly more frequently than that observed in the RECORD trial patients. The major bleeding rate was also significantly higher in the cohort patients, influenced by higher rates of bleeding leading to reoperation and clinically overt extrasurgical site bleeding resulting in either a hemoglobin decrease of at least 2 g/dl or transfusion of two units or greater of packed red blood cells. These findings from our pilot study are thought provoking and, thus, invite further investigation.

A new dose-response curve for bilateral medial rectus recessions for infantile esotropia.

PURPOSE: In 1982, Mims et al generated the first rigorous dose-response curve for bilateral medial rectus recessions for infantile esotropia (ET). Curve fitting calculations were hampered by substantial variability of surgical effect for the larger angles of ET, and an exponential curve was chosen for angles below 30 ET and a straight line for angles above 30 ET. In a continuing effort to improve the surgical success rate, a new series of results of 113 bilateral medial rectus recessions performed from 1990 to 1998 for infantile ET has been analyzed to produce a new dose-response curve and to study other potentially useful variables. METHODS: The amount of medial rectus recession performed in this series was the original dose-response curve from 1982, with conjunctival recessions performed for angles above 35 ET. RESULTS: The best curve that could be fitted to the effect versus millimeters of bilateral medial rectus recession was a single exponential curve. Other parameters explored with multivariate analysis, including head circumference, developmental delay, and intraoperative angles under anesthesia were not helpful in predicting effect of surgery at 6 weeks postoperative. A total of 87% were aligned at 6 months after surgery. Surgical failure at 6 months was more prevalent with larger preoperative angles (P =.0007) and with developmental delay (age when child first sat alone; P =.0078). CONCLUSION: Between 1982 and 1990, decreased variability of results of bilateral medial rectus recessions for larger angles of infantile ET enabled the generation of a single exponential dose-response curve for the entire range of angles of infantile ET.

Outcome of a surgical treatment protocol for late consecutive exotropia following bilateral medial rectus recession for esotropia.

PURPOSE: To describe a specific protocol for the surgical treatment of Late Consecutive Exotropia (LCXT) following bilateral medial rectus (MR) recessions, and to report the results of surgery, performed according to this protocol, in a series of 119 children followed 6 months to 15 years after surgery for consecutive exotropia. METHOD: The senior author (JLM) performed a retrospective chart review of 15 years of his experience following a specific protocol for the surgical treatment of LCXT. In individual cases, following this protocol led to recessions of the overacting inferior oblique (IO) with anterior transposition if dissociated vertical deviation (DVD) was also present, weakening of the overacting superior oblique (SO) with simultaneous 10 mm recessions of the superior rectus (SR) with 3 mm of nasal transposition (to ameliorate DVD which might be aggravated by SO tenotomies), graded recessions of one lateral rectus (LR) 7.0 to 8.5 mm if the distance deviation was equal to or less than 23 prism diopters (PD) of XT, and advancement of one previously recessed MR to the insertion if the distance deviation was equal to or greater than 24 PD XT. RESULTS: "Success" was defined as 8 PD ET to 6 PD XT, with both distance and near fixation. Among 14 patients receiving SR recessions, SO tenotomies, and recession of one LR, 12 of the 14 were "successes" at 6 months postop' and 10 of 14 at an average of 3 years postop'. Among 26 receiving advancement of one MR, "successes" were 23 of 26 at 6 months postop' and 20/26 at two years after surgery. Among 22 receiving IO recession with anterior transposition if DVD was present, "successes" were 18 of 22 at 6 months and 12 of 22 at 3.6 years. Among 57 receiving only recession of one LR, 53 of 57 were "successes" at 6 months postop' and 45 of 57 at 4 years postop'. The overall "success" rate for this protocol for these 119 patients was 89% at 6 months and 74% at 2 to 4 years postop'. Treatment of simultaneous IO overaction and LCXT was associated with the highest long term "failure" rate in this protocol. CONCLUSION: This specific surgical protocol for treatment of late consecutive exotropia is reasonably safe and effective and comparable to the few other reported protocols of various surgical treatments for consecutive exotropia.

Proportional (fractional) displacement of the Hirschberg corneal light reflection (test): a new easily memorized aid for strabometry; photogrammetric standardization (calibration).

PURPOSE: To improve the usefulness of the Hirschberg Corneal Light Reflection Test (CLRT), using a photogrammetric technique independent of the size of the pupil, and to devise an easily remembered sequence of numbers corresponding to the fractional displacement of the reflection in various approximate angles of esotropia. METHOD: Photographs (slides) were taken of the right eye of 25 young adults using a centered strobe light source to produce the corneal light reflection in 5 prism diopters (PD) increments of adduction from 0 to 90 PD to standardize the Hirschberg CLRT for esodeviations. On a large, dual-projection screen, the eye of the subject looking straight ahead (primary position) was projected on one side and the various slides of the same eye of that subject looking into various degrees of adduction were projected on the other side of the screen. Measurements of the distance between the lateral limbus and the corneal reflection were made with a centimeter rule on the screen. The displacement (shift) of the corneal light reflection was expressed as a fraction of the distance between the lateral limbus and the position of the reflection (in relation to the lateral margins of the pupil) with the eye fixing in the primary position. RESULTS: The values found were 1/4 = 30 +/- 3 PD; 1/3 = 41 +/- 4 PD; 1/2 = 59 +/- 4 PD; 2/3 = 75 +/- 6 PD; and 3/4 = 80 +/- 6 PD. CONCLUSIONS: An easily memorized similar series of values is 30, 40 60, 75 and 80 PD corresponding to 1/4, 1/3, 1/2, 2/3 and 3/4 PD. This is useful to know which prism to pick up to begin the prism alternate cover test efficiently in a small child.

Pharmacokinetic interactions between rebamipide and selected nonsteroidal anti-inflammatory drugs in rats.

Nonsteroidal anti-inflammatory drugs (NSAIDs) cause gastrointestinal and renal side effects. Rebamipide is a mucoprotective agent that reduces gastrointenstinal side effects when administered concomitantly with NSAIDs. In this study, we investigated the pharmacokinetic drug interactions of rebamipide with two selected NSAIDs, celecoxib or diclofenac. Rats were randomly divided into five groups. Two groups received placebo and three groups were administered rebamipide (30 mg/kg) orally twice daily for two days. On day 3, the animals treated with placebo received celecoxib (40 mg/kg) or diclofenac (10mg/kg) and rats receiving rebamipide were administerd rebamipide followed by a single dose of placebo, celecoxib, or diclofenac. To investigate drug protein interactions, blank rat plasma was spiked with known concentrations of rebamipide, diclofenac plus rebamipide, or celecoxib plus rebamipide then dialyzed through a Rapid Equilibrium Dialysis device. AUC (139.70±24.97 µg h/mL), Cmax (42.99±2.98 µg/mL), and CLoral (0.08±0.02 L/h/kg) values of diclofenac in diclofenac plus rebamipide group altered when compared to those of diclofenac treated groups. Treatment with rebamipide showed no significant change in pharmacokinetic parameters of celecoxib treated rats. Cmax (7.80±1.22 µg/mL), AUC (56.46±7.30 µg h/mL), Vd/F (7.55±1.37 L/kg), and CLoral (0.58±0.09 L/h/kg) of rebamipide were significantly altered when diclofenac was co-administered with rebamipide. Pharmacokinetic parameters of rebamipide plus celecoxib group were not significantly different from those of rebamipide group. Plasma protein binding was not affected by concomitant administration of another drug. These results indicate alteration of pharmacokinetic parameters of both rebamipide and diclofenac when co-administered and cannot be explained by a variation in plasma protein binding.

Safely examining complex dynamics of intimate partner violence.

The overall goal of this study is to use complexity science to gain a deeper understanding of the nonlinear day-to-day dynamics of intimate partner violence, with implications for clinical interventions. This report describes research methods for gathering information about partner violence in real time and assesses recruitment and retention, adherence to study protocol, data validity, and participant safety. Research assistants enrolled 200 women in moderately violent intimate relationships and asked them to report about their relationships every day for 12 weeks. Daily, participants telephoned an Interactive Voice Response (IVR) system and responded to 34 survey questions. They also completed baseline and end-of-study surveys and maintained telephone contact with the study team weekly. Forty-two participants completed qualitative end-of-study interviews to describe their relationships and the impact of the study on their lives. Of 200 enrollees, 145 women provided enough data for nonlinear analyses, averaging 63.5 daily reports of 84 possible. Participants submitted 9,201 daily reports, documenting partner's verbal or physical aggression on 39.4% of days, and their own aggression on 23.1%. Two women were withdrawn from the study for safety reasons; the remainder reported that study participation posed no additional threat. Eighty women sought assistance from community resources. Violence severity did not appear to change over the 12 weeks. The research team successfully and safely recruited and retained 145 women who provided valuable data for a study of complex dynamics of intimate partner violence.

Characteristics of Mexican American elders admitted to nursing facilities in the United States: data from the Hispanic Established Populations for Epidemiologic Studies of the Elderly (EPESE) study.

OBJECTIVES: The purpose of the current study was to describe the factors associated with Mexican American elders in the Southwestern United States who have spent time in a skilled nursing facility (SNF) compared with those who have not. DESIGN: Data were collected on the Mexican American elders who reported an SNF stay within 10 years of baseline. PARTICIPANTS: A probability sample of 3050 Mexican American elders from five Southwestern states followed from 1993 to 2005 were examined. MEASURES: Variables examined included sociodemographics, language of interview, disabilities with instrumental activities of daily living, activities of daily living, self-reported health, cognitive status, and depression. RESULTS: A total of 78 (3.9%) of 2020 subjects resided in SNFs. Using univariate analyses, older age, English-language interview, poorer cognitive status, and functional disabilities were independently associated with SNF admissions. Logistic regression analyses controlling for age revealed that SNF patients were older (OR = 1.08, P = .001), had an activities of daily living disability (OR = 4.94, P < .001), scored in the depressed range in the Geriatric Depression Scale (OR = 2.72, P = .001), and were more likely to interview in English (OR = 1.95, P = .042), when compared with community counterparts. CONCLUSIONS: Mexican American elders who resided in an SNF at some point in the previous 10 years were older, and were more likely to be functionally impaired. They also were more likely to prefer English as their primary language, indicating they were more likely to agree to an SNF stay than their Spanish-speaking counterparts.

Effects of rebamipide on nephrotoxicity associated with selected NSAIDs in rats.

Use of nonsteroidal anti-inflammatory drugs (NSAIDs) is primarily limited by renal and gastrointestinal adverse effects. Rebamipide suppresses gastric mucosal injury when administered with NSAIDs. This study aimed to determine rebamipide's influence upon renal effects following concomitant use with celecoxib or diclofenac. On day 0, rats were randomly divided into 6 groups (n≥6). On days 1 and 2, three groups received placebo and three groups were administered rebamipide (30 mg/kg) twice daily. On day 3, the rats treated with placebo received another dose of placebo and ten minutes later a single dose of celecoxib (40 mg/kg), diclofenac (10mg/kg), or placebo, respectively. The rats treated with rebamipide received one more dose of rebamipide and ten minutes later one single dose of celecoxib, diclofenac, or placebo, respectively. Urine and blood samples were collected on days 0, 2, and 3. Sodium and potassium excretion rates decreased significantly in the rats treated with celecoxib, diclofenac, rebamipide plus celecoxib, or rebamipide plus diclofenac on day 3. Blood urea nitrogen (BUN) levels significantly increased in placebo plus diclofenac and rebamipide plus diclofenac groups on day 3. Comparing the two groups, the levels of BUN was significantly higher in the rebamipide plus diclofenac group compared to that of placebo plus diclofenac group. Concomitant administration of rebamipide with either NSAID caused a rise in concentrations of urinary kidney injury molecule-1. Histopathological evaluations revealed an intensified NSAID-induced tubular necrosis by rebamipide. Based upon the results obtained, concomitant administration of rebamipide with NSAIDs enhances the effect of NSAIDs on tubular injury.

Cultural Considerations: Pharmacological and Nonpharmacological Means for Improving Blood Pressure Control among Hispanic Patients.

Cardiovascular disease is a leading cause of morbidity and mortality in the United States, and its prevention and treatment remain a priority for the medical community. Ethnic variations account for some differences in the prevalence of hypertension and blood pressure (BP) control rates among Hispanics, indicating the need for culturally appropriate management models. Aggressive treatment strategies are key to achieving optimal BP control in high-risk Hispanic patients. Hypertension in this ethnic group continues to be a major health concern. Of note, when provided access to comprehensive care, Hispanics demonstrate similar response rates to treatment as the majority of non-Hispanic whites. This highlights the importance of effective, culturally responsive hypertension management among high-risk Hispanic patients for achieving observable, positive health outcomes.