1,110 research outputs found

    Contraceptive use and intent in Guatemala

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    Guatemala is characterized by low contraceptive use rates and one of the highest fertility rates in the Western Hemisphere. These rates are particularly extreme for the poorest segment of the population and for the indigenous population. The purpose of this research is to enhance understanding of the modern contraceptive revolution in Guatemala through identification of the segments of the Guatemalan population at most need for contraceptive and family planning services. Using the most recently available survey data, the 2002 Reproductive Health Survey data set (RHS), classification trees will be used to determine the women with greatest need for reproductive health services. The results highlight the persistent marginalization of the poor and the indigenous and provide further insight into the impact of education, place of residence and couple characteristics on contraceptive use and intent.contraceptive use, family planning, fertility

    Modeling Treatment Outcomes in Eating Disorders

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    Eating disorders are notoriously difficult and costly to treat, with only 40% of individuals with an eating disorder making a full recovery. Individually Tailored Service Allocation provides a dynamic treatment model defined by empirically accepted theory and consistently informed by data provided by the patient. The use of patient feedback allows for the tailoring of individual treatment plans to meet the unique and varied needs of each patient. Hierarchical Linear Modeling was used to examine the effect of Individually Tailored Service Allocation on eating disorder treatment outcomes. A total of 51 adult women meeting diagnostic criteria for an eating disorder participated in this study. Participants were randomly assigned to treatment as usual or individually tailored treatment groups. Changes in psychological dysfunction and distress were measured biweekly throughout the course of treatment using the Outcome Questionnaire 45. The results of this study indicate variability in levels of global psychological dysfunction (both within and between subjects) throughout the course of treatment appear to be the norm, rather than an exception, and this variability is related to eating disorder treatment outcomes. The choice of treatment methodology and level of Individually Tailored Service Allocation has the ability to drastically shift treatment outcomes

    Understanding the Role of Androgen Receptor Signaling in Modulating p38-alpha Mitogen-Activated Protein Kinase in Experimental Autoimmune Encephalomyelitis

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    Multiple Sclerosis (MS) is an inflammatory autoimmune disease of the central nervous system, characterized by axonal demyelination and multifocal inflammation. Like many autoimmune diseases, it is a sexually dimorphic disease, being 3-4 times more common in females than in males. p38α MAP kinase (MAPK) has an integral role in modulating inflammatory processes in autoimmunity. Conditionally ablating p38α MAPK in myeloid cells in B6 mice shows a sex difference in the animal model of MS, experimental autoimmune encephalomyelitis (EAE). In the absence of sex hormones, this sex difference was reversed, suggesting a role for sex hormones in modulating p38α MAPK signaling in EAE. Based on these findings, we hypothesized that pro-inflammatory functions in EAE is p38-indepdendent in the presence of androgens and p38-dependent in the presence of estrogens. For the purposes of this project, the role of androgens was evaluated. Both in vivo and in vitro techniques were used to assess how androgen receptor (AR) signaling: 1) impacts EAE pathogenesis, and 2) impacts the role of p38α in EAE pathogenesis and macrophage function. To this end, using Cre-Lox technology, we generated mice deficient in: 1) AR globally or conditionally in macrophages, as well as 2) mice doubly deficient in AR and p38α. In vivo results from p38α-sufficient global AR knockout mice show no effect of global AR deletion on EAE pathogenesis. Surprisingly, results from p38α-sufficient conditional AR knockout mice showed significant worsening in disease compared to WT counterparts, suggesting that AR signaling in myeloid cells has a protective role in EAE pathogenesis. These findings implicate a protective role for AR signaling in EAE. Studies with mice doubly deficient in p38α and AR to determine whether AR regulates the role of p38α in EAE are ongoing, but so far show no effect on AR deletion on the role of p38α MAPK. Further studies with larger cohorts of mice are needed elucidate the relationship between AR and p38α MAPK signaling in myeloid cells in EAE pathogenesis. In vitro studies using the immortalized macrophage cell line RAW 264.7 showed that pharmacologic inhibition of p38 MAPK after stimulation with LPS reduced the production of classic pro-inflammatory cytokines IL-6 and TNFα, and effect that was not affected by treatment with 5-dihydrotestosterone, suggesting that the AR does not modulate the role of p38α in cytokine production. These findings implicate no direct role of AR signaling on the functional role of p38α MAPK in the myeloid cell lineage in inflammatory and autoimmune responses

    Reading Comprehension in the Secondary Classroom

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    Reading is important for the mind and the success of students\u27 academic career (Cunningham, 1998). To read, one must comprehend what has been read; otherwise, there would be no purpose in reading. Comprehension is one of the most important reading skills adolescent students need to possess (Underwood, 1994). Students who have excellent reading comprehension are able to master academic content, read for pleasure, and are more likely to succeed in post-secondary goals. Unfortunately, comprehension strategy skills are not natural skills of students, but rather must be self-taught or taught by someone else. In view of the impact that reading comprehension has on secondary students\u27 success in content area classes, it is essential that effective comprehension strategies be taught by all secondary teachers

    IMPROVING HEALTH LITERACY AS A METHOD OF INCREASING ADHERENCE IN INSTITUTIONALIZED GERIATRIC PHYSICAL THERAPY PATIENTS

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    The global population of long-term care facility (LTCF) residents \u3e 65 years of age has high rates of sedentary behavior, and is expected to increase in number in the coming years. LTCF residents benefit from physical therapy, which can increase patients’ activity levels while treating symptoms of the inevitable aging process. A novel method is needed to increase LTCF resident adherence to physical therapy programs (PTPs). Health literacy (HL), which is the ability to interpret and understand health related information, presents as one such method to increase patient adherence. The geriatric population has the lowest HL rates out of all adult age groups, but LTCF physical therapists are in a prime position to successfully educate their patients. Within this paper are recommendations to increase the health literacy and consequent PTP adherence of elderly LTCF patients. Recommendations were organized within the Social-Ecological Model to account for the unique influence of the LTCF environment. Four Intrapersonal, one Interpersonal, two Organization and three Community recommendations were produced to increase patients’ health literacy. The substantiating evidence for the Intrapersonal and Interpersonal recommendations were strong overall, while the Organization and Community recommendations had a wider range of evidence strength ratings. Health literacy offers a promising intervention to increase the program adherence of elderly physical therapy patients in LTCFs, though all levels of recommendations require further validation before being implemented in a clinical setting

    Bridges and Barriers: Patients\u27 Perceptions of the Discharge Process Including Multidisciplinary Rounds on a Trauma Unit

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    Discharge planning is a complex process and ideally begins early in the patient stay. Despite evidence about the importance of discharge readiness, there is limited literature about the patient\u27s view during this transition. The goal of this study was to explore patient perspectives about the discharge process, including multidisciplinary rounds. Multidisciplinary rounding is a process where care providers from various specialties meet to communicate, coordinate patient care, make decisions, and manage responsibilities. The theme found was “bridges and barriers to discharge.” Participants identified timelines and tasks, communication, social support, and motivation as helpful and medical setbacks, insurance limitations, and infrequent communication as hindrances to the discharge. Future research is recommended examining efficacy of various discharge models and examination of communication and support throughout hospitalization
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