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Articles by R Smith
Total Records ( 3 ) for R Smith
  R Smith , R. M Mathews and M. Gresham
 

Concerns about negative outcomes associated with relocating residents are common. Fifty-five residents of a traditional high-care nursing home moved to new, purpose-built, dementia-specific cottages; 35 additional residents moved into the cottages within the first 8 months of operation. Direct-care staff participated in workshops on engaging residents in life-skill activities. Resident behavior was observed using a time sampling and a de-identified behavior mapping procedure. Results showed increases in resident engagement following the move and further increases after staff training. Staff engagement in resident interactive tasks similarly increased both after the move and again after staff training. The newly built cottages scored higher across all domains of 3 different types of environmental assessment, and family satisfaction ratings also improved. These results suggest that relocation need not negatively affect residents with dementia and that this environment provides an attractive model of care for dementia facilities.

  R Smith , J. I Smith , X Shen , P. J Engel , M. E Bowman , S. A McGrath , A. M Bisits , P McElduff , W. B Giles and D. W. Smith
 

Context: Clinical prediction of preterm delivery is largely ineffective, and the mechanism mediating progesterone (P) withdrawal and estrogen activation at the onset of human labor is unclear.

Objectives: Our objectives were to determine associations of rates of change of circulating maternal CRH in midpregnancy with preterm delivery, CRH with estriol (E3) concentrations in late pregnancy, and predelivery changes in the ratios of E3, estradiol (E2), and P.

Design and Setting: A cohort of 500 pregnant women was followed from first antenatal visits to delivery during the period 2000–2004 at John Hunter Hospital, New South Wales, Australia, a tertiary care obstetric hospital.

Patients: Unselected subjects were recruited (including women with multiple gestations) and serial blood samples obtained.

Main Outcome Measures: CRH daily percentage change in term and preterm singletons at 26 wk, ratios E3/E2, P/E3, and P/E2 and the association between E3 and CRH concentrations in the last month of pregnancy (with spontaneous labor onset) were assessed.

Results: CRH percentage daily change was significantly higher in preterm than term singletons at 26 wk (medians 3.09 and 2.73; P = 0.003). In late pregnancy, CRH and E3 concentrations were significantly positively associated (P = 0.003). E3/E2 increased, P/E3 decreased, and P/E2 was unchanged in the month before delivery (medians: E3/E2, 7.04 and 10.59, P < 0.001; P/E3, 1.55 and 0.98, P < 0.001; P/E2, 11.78 and 10.79, P = 0.07).

Conclusions: The very rapid rise of CRH in late pregnancy is associated with an E3 surge and critically altered P/E3 and E3/E2 ratios that create an estrogenic environment at the onset of labor. Our evidence provides a rationale for the use of CRH in predicting preterm birth and informs approaches to delaying labor using P supplementation.

  P Huezo Diaz , R Uher , R Smith , M Rietschel , N Henigsberg , A Marusic , O Mors , W Maier , J Hauser , D Souery , A Placentino , A Zobel , E. R Larsen , P. M Czerski , B Gupta , F Hoda , N Perroud , A Farmer , I Craig , K. J Aitchison and P. McGuffin
 

Background

There have been conflicting reports on whether the length polymorphism in the promoter of the serotonin transporter gene (5-HTTLPR) moderates the antidepressant effects of selective serotonin reuptake inhibitors (SSRIs). We hypothesised that the pharmacogenetic effect of 5-HTTLPR is modulated by gender, age and other variants in the serotonin transporter gene.

Aims

To test the hypothesis that the 5-HTTLPR differently influences response to escitalopram (an SSRI) compared with nortriptyline (a noradrenaline reuptake inhibitor).

Method

The 5-HTTLPR and 13 additional markers across the serotonin transporter gene were genotyped in 795 adults with moderate-to-severe depression treated with escitalopram or nortriptyline in the Genome Based Therapeutic Drugs for Depression (GENDEP) project.

Results

The 5-HTTLPR moderated the response to escitalopram, with long-allele carriers improving more than short-allele homozygotes. A significant three-way interaction between 5-HTTLPR, drug and gender indicated that the effect was concentrated in males treated with escitalopram. The single-nucleotide polymorphism rs2020933 also influenced outcome.

Conclusions

The effect of 5-HTTLPR on antidepressant response is SSRI specific conditional on gender and modulated by another polymorphism at the 5' end of the serotonin transporter gene.

 
 
 
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