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Psychogenic movement disorders (PMD) are abnormal movements not explained by organic lesions in the nervous system such as tremors, myoclonus, or dystonia. This project aims to study cortisol levels and heart rate variability (HRV) as biomarkers of stress and autonomic function in patients with PMD. Cortisol is the final effector hormone of the hypothalamic pituitary adrenal (HPA) axis and functions as a measure of stress. The secretion of cortisol is altered in patients with depression, a trauma history, and other psychiatric disorders. HRV is a measurement of beat-to-beat variation in heart rate. It is controlled by parasympathetic and sympathetic nervous system input. In previous studies, a reduced HRV has been linked to increased cardiac morbidity and mortality. Reduced HRV has also been connected to patients with depression, anxiety disorders, and other psychiatric illnesses. In this study, subjects were hospitalized overnight for continuous electrocardiogram (ECG) recording, and saliva samples were taken 5 times throughout the duration of their stay. Based on the data, PMD patients showed a reduced HRV in comparison to healthy volunteers that was statistically significant. HRV did not appear to correlate with depression. In addition, PMD subjects’ cortisol levels were higher than those of healthy volunteers, although this was not statistically significant. The data analysis is in an interim stage; data collection is not complete.
MEDICAL COMMUNICATION PREFERENCES OF PEDIATRIC PATIENTSJaymus Lee, Elisabeth Guenther, Maija Holsti, Victoria Wilkins.
University of Utah, Salt Lake City, UT.
In 2005, approximately 29 million children (0 to 17 years) were admitted into emergency departments nationwide.
Little research exists regarding child and parental preferences concerning medical communication and associated barriers. The purpose of this project was to better define parental and child factors which may affect successful medical communication practices in a pediatric emergency department (PED) patient. A convenience sample of children ages 9 to 17 years presenting to the PED for care of noncritical conditions and their parents were eligible.
Two prospective surveys, one for parents (DTI) and a similar survey adapted for children (DTIp), were developed.
Both captured demographic information and general medical communication preferences. The DTI was also designed to measure a parent’s threshold for disclosure using escalating clinical vignettes. The DTIp seeks to determine whether children wish unintended outcomes to be disclosed to them and by whom. A total of 358 adults and 322
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children completed the survey. Fifty-six percent of the children wanted to give the reason for their visit, while 68% of parents wished to do so themselves. If a painful procedure is necessary, 46% of children preferred that their doctor inform them, while parents wanted both doctor and parent to inform the child (66%). When an error occurred, parents wanted to be told independent of severity (100%), but 49% did not want their child informed. Forty-four percent of children preferred that the disclosure of error be made by both medical provider and parents. In general, children wish to be involved in medical discussions, including disclosure of unanticipated outcomes. Further study is needed to characterize cultural differences in the disclosure process.
PHYSICAL ACTIVITY AND ITS ASSOCIATION WITH METABOLIC SYNDROME AMONG OBESE ADOLESCENTSCharles Neher1, M. Nazeem Nanjee2, Nicole Mihalopoulos3.
University of Wisconsin-Madison, Madison, WI,2Cardiovascular Genetics Research Center, University of Utah, Salt 1 Lake City, UT, 3University of Utah, Salt Lake City, UT.
Metabolic syndrome (MetS) affects almost 30% of obese US adolescents. Little is known about the influence of physical activity on MetS among obese adolescents. We hypothesized that obese adolescents who are more physically active will not meet the criteria for metabolic syndrome. We enrolled 21 boys and girls (9 boys, 12 girls), aged 8-17 years with BMI 95th percentile for age and sex. Data collection included height, weight, waist Health circumference, systolic and diastolic blood pressures, fasting triglycerides, high-density lipoprotein cholesterol, and glucose. Physical activity was measured using the physical activity questionnaire (PAQ-child or PAQ-adolescent).
Possible scores range from 1 to 5 where 5 is maximum physical activity. Means and standard deviations were calculated. Statistical analyses were performed to determine the relationship between physical activity and metabolic syndrome among males and females. Statistical significance was set at P 0.05. Preliminary results reveal that 14 participants had PAQ 2.5, and 9 had MetS (5 boys, 4 girls). Among boys with PAQ scores 2.5, 5 had MetS; 2 boys with PAQ 2.5 did not have MetS. There were 7 girls with PAQ 2.5; 5 of these did not have MetS. Boys did not differ from girls for any of the metabolic syndrome criteria or for BMI. Obese girls who are more physically active may be less likely to develop MetS compared to obese boys. Early interventions to increase physical activity among obese adolescents, especially girls, could have significant public health implications.
ORAL ITRACONAZOLE AND ARSENIC TRIOXIDE FOR BASAL CELL CARCINOMA TREATMENTMelika Rezaee1, Jean Tang2.
Children’s Hospital Oakland Research Institute, Oakland, CA, 2Stanford University School of Medicine, Stanford, CA.
1 The Hedgehog (Hh) signaling pathway, when activated, regulates embryonic development. Post-embryonically, Hh signaling is activated during tissue homeostasis through effects on stem or progenitor cells but is downregulated in most normal human tissues. However, aberrant activation of Hh signaling is known to underlie most basal cell carcinomas (BCC). Currently, the most common treatment is surgical excision which is costly, deforming, and dangerous. Therefore, development of molecules blocking the Hh pathway could be beneficial for patients with basal cell carcinoma. Oral itraconazole and arsenic trioxide (ATO) have been identified as Hh pathway inhibitors.
Our goal is to identify how itraconazole and ATO either as single agents or in combination inhibit the growth of BCC tumors in vivo. We created mice with BCC allografts using a fresh, single-cell suspension of BCC cells to establish subcutaneous tumors in NOD/SCID mice. Palpable tumors were observed in 1 month. These tumors were then treated with oral itraconazole and ATO. Tumor size was measured weekly and BCC tumors were collected for measuring GLI mRNA (Hedgehog target gene) via Q-PCR. The combination treatment of itraconazole and ATO inhibited tumor growth compared to control cyclodextrin. In addition, the combination treatment inhibited tumor growth more potently than either itraconazole or ATO alone. The additive inhibitory effect of the itraconzaole and ATO allows for the use of lower doses of each drug. The combination of lower drug doses can maintain or improve antitumor efficacy while decreasing the likelihood of adverse toxicities from the drugs.
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TREATMENT OF ACUTE AGITATION IN EMERGENCY DEPARTMENTS USING B52 THERAPY IS INFREQUENT
AND CAUSES A HIGH PROPORTION OF PATIENTS TO FALL ASLEEPAshleigh Campillo, Kai MacDonald, Gary Vilke, Michael Wilson.
University of California San Diego Health System, San Diego, CA.
Acute agitation is a common problem in emergency departments (EDs) and can be treated using first-generation antipsychotics (FGAs) such as haloperidol or droperidol. Anecdotally, EDs commonly treat acute agitation by administering the B52 drug cocktail, which includes an anticholinergic (e.g., Benadryl), an FGA (e.g., 5mg haloperidol), and a benzodiazepine (e.g., 2mg lorazepam). However, the ED-prescribing patterns of these medications, the need for additional medications after treatment with this combination, or the rate of sedation in patients have been poorly described in the literature. We used a structured, retrospective chart review to assess and analyze medication dose and combinations, vital signs, patient alcohol use, restraint use, and patient sleep status of all ED patients treated with B52 therapy from 2004 to 2010 in 2 university EDs. Of 1,253 cases of agitation treated with FGAs, only a minority (2.3%) received B52 therapy. The most frequent B52 therapy combination included IM haloperidol, lorazepam, and diphenhydramine. Many patients (32%) had ingested alcohol and the majority of patients (71%) were placed in restraints. Of the patients with complete vital signs (64%), we found no effect of ethanol on drops in systolic blood pressure, heart rate, or oxygen saturation (p = ns). Regardless of ethanol, a large proportion (57%) were sleeping within 3 hours after B52 treatment (p = ns). Despite the notion that B52 combination therapy is popular in the ED, the use of this treatment is rare. When used, slightly more than half of patients fall asleep after administration, potentially hindering psychiatric evaluation or discharge.
BARRIERS AND SOLUTIONS TO MAINTAINING AND ACHIEVING A HEALTHY WEIGHT IN SCHOOL-AGED
CHILDREN: A QUALITATIVE STUDY AND ANALYSISKarine Soto1, Noe C. Crespo2, Lorraine Hirani1, Susan Ringler1.
College of Nursing and Health Innovation, Arizona State University, Nogales, AZ, 2Arizona State University, Phoenix, 1 AZ.
Childhood obesity affects 1 in 3 American children and has both short-term and long-term physical and psychological health consequences. Recognizing barriers that prevent children from obtaining and maintaining a healthy weight can facilitate the development of effective programs. The purpose of this study was to conduct key informant interviews and review the scientific literature regarding barriers and solutions to overcome the health disparity of obesity. A total of 8 key informant interviews were conducted with 2 school nurses, 2 community clinic nurses, 1 registered dietician, and 3 parents. Data from the interviews were extracted using recurrent themes and common responses from the interviewees. Barriers identified included limited access to healthy foods, limited physical activity opportunities, and unhealthy parental behaviors. Solutions identified included increasing physical activity opportunities, limiting access to unhealthy foods, and modeling healthy behaviors to children. Increasing access to parks, school playgrounds, recreational facilities, and physical education could increase physical activity in children. Funding school nutrition programs, serving more fruits and vegetables in schools, and removing unhealthy foods from the menu can limit children’s access to unhealthy foods. Educating parents about the importance of physical activity and healthy eating could encourage parents to model healthier behaviors to children. The next steps are to develop programs that incorporate the qualitative information from this study. Working with members of the community will be an important first step. The perspectives of key stakeholders such as teachers, administrators, policy makers, and children should also be considered.
IMPROVING ATTITUDES TOWARD BREASTFEEDING PEER COUNSELING PROGRAMS IN LATINASIsabel Contreras, Donna Plonczynski.
Northern Illinois University, Dekalb, IL.
Breastfeeding initiation rates and duration are lower in low-income women such as Latinas. This is important because many Latinas may not be educated concerning the benefits and importance of maintaining breastfeeding for at
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least one year. The purpose of this project is to measure the attitudes of Latinas on breastfeeding peer counseling, comparing those with contact with peer counselors (PC) to those without contact. English-speaking Latinas from greater Elgin, Illinois, will participate in the study by answering a questionnaire. Latina responses will be compared to non-Latina responses on questions concerning demographics and attitudes toward breastfeeding. Nurses at Sherman Hospital will distribute the questionnaire to appropriate participants. We expect attitudes toward breastfeeding to improve following contact with PC, thus increasing the initiation and duration of breastfeeding. The results demonstrated that, out of 96 participants, 76.2% of Hispanics are more likely to breastfeed and/or maintain longer duration than non-Hispanics. There were also low numbers for contact with a PC in the Hispanic group, so there is not a clear answer if there was an impact by the PC in the Hispanic population. The next step would be to have a culturally and language-appropriate PC address the needs of this under-served population.