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Biomedical subjects

A Spitzer

Publications and source records attributed to A Spitzer.

At least 37 records · Page 2Linked to original sources
PubMed1998

Nursing in the health care system of the postmodern world: crossroads, paradoxes and complexity.

Entering the postmodern world in which society is confronting crossroads, paradoxes, and complexity, the health care system is encountering a transformation more comprehensive and revolutionary than has ever been seen before. Analysis of the state of nursing vis a vis these transformations indicates that the current paradigm does not ensure the existence of the profession in the postmodern health care system. That is because of increased difficulties in consolidating the economic and quality issues into the core of nursing, and in understanding the complexity inherent in health related situations.

Health Care Reform↗
PubMed1998

Sudden infant death syndrome rates subsequent to the American Academy of Pediatrics supine sleep position.

OBJECTIVES: In April 1992, the American Academy of Pediatrics (AAP) recommended that healthy infants be positioned for sleep on their side or back to reduce the risk of Sudden Infant Death Syndrome (SIDS). The authors hypothesized three different forms of the intervention to examine the impact of the recommendation according to theory such as technology diffusion. Seasonality was included in the models to control its effect when testing. METHODS: Box and Tiao time-series intervention methodology was used to examine the effect of the AAP recommendation on SIDS rates. Sudden Infant Death Syndrome mortality data from Philadelphia and Chicago were examined separately for white and nonwhite populations over 32 quarters. RESULTS: Overall SIDS rates dropped significantly according to an abrupt effect from the intervention. However, the effect appeared to be gradually declining in Philadelphia but permanent in Chicago. In Philadelphia, a decline of 62.3% was estimated in whites in the first quarter after the intervention but decreased to only 5% in the last quarter of 1994. A decline of 35.8% was estimated in nonwhites in the first quarter after the intervention but decreased to only 9.4% in the last quarter of 1994. An abrupt and permanent decrease of 26.7% and 16.5% was found in Chicago for whites and nonwhites, respectively. CONCLUSIONS: Evidence of an abrupt adoption of the recommendation can be explained by the authority innovation decision made by the AAP. Some evidence was found that the effect is temporary, perhaps because physicians are reversing earlier decisions. The demonstrated methodology provides a powerful way to test naturally occurring interventions from quasiexperimental designs to test the impact of policy guidelines.

Chicago↗
PubMed1997

[Iodine content of Bavarian consumer milk].

Over a period of one year the iodine content of the milk of 28 bavarian dairies was determined monthly by a gaschromatographical method. The annual mean value was 115 micrograms/l. In March, April and November, December, respectively a distinct increase of the concentration was observed. In the southern part of Bavaria the iodine contents were below 100 micrograms/l in contrast to the region Oberpfalz and Franken where contents up to 150 micrograms/l could be determined. Compared with concentrations in different tables the iodine content in bavarian milk could increase the iodine uptake up to 6%.

Adolescent↗
PubMed1997

Acquired renal cystic disease in children and young adults on maintenance dialysis.

Acquired renal cystic disease (ARCD) is a well-known complication of end-stage renal disease (ESRD). We studied 24 patients, aged 8-27 years (mean 19.8 +/- 5.3 years), on chronic maintenance dialysis in our service. The duration of dialysis ranged between 13 and 192 months (mean 77.8 +/- 44.3 months). High-resolution ultrasonography revealed ARCD in 11 (45.8%) patients. No cysts were seen in 7 (29.1%) patients and solitary cysts in one or both kidneys were seen in 6 (25%) patients. Renal malignancy was diagnosed in 2 patients. One, 15 years old, had renal cell carcinoma after being on dialysis for 6 years. She did well after bilateral nephrectomy, left salpingo-oophorectomy, and regional lymphadenectomy. The second patient, 23 years old, had been on dialysis for 16 years when she developed renal oncocytoma. She died of congestive cardiomyopathy 6 months later. We conclude that ARCD is common in children and young adults with ESRD. Neoplastic transformation, although rare, is a potential complication. Annual follow-up with ultrasonography with selective use of computed tomography or magnetic resonance imaging is advised.

Adolescent↗
PubMed1997

Sudomotor function in sympathetic reflex dystrophy.

Sudomotor functions were studied in 27 patients suffering from reflex sympathetic dystrophy (RSD) according to the criteria established by Bonica (18 women, 9 men; mean age 50 +/- 12.3 years; median duration of disease 8 weeks, range 2-468 weeks). To measure local sweating rates, two small chambers (5 cm2) were affixed to corresponding areas of hairy skin on the affected and unaffected limbs. Dry nitrogen gas was passed through the chambers (270 ml/min) and evaporation was recorded at both devices with hygrometers. Thermoregulatory sweating (TST) was induced by raising body temperature (intake of 0.5 1 hot tea and infra-red irradiation). Local sweating was also induced through an axon reflex (QSART) by transcutaneous iontophoretic application of carbachol (5 min, 1 mA). In addition, skin temperature was measured on the affected and unaffected side by infra-red thermography. Mean skin temperature was significantly higher on the affected side (P < 0.003). In spite of the temperature differences, there was no difference in basal sweating on the affected and unaffected side. However, both methods of sudomotor stimulation lead to significantly greater sweating responses on the affected compared to the unaffected side (TST: P < 0.05, QSART: P < 0.004). Latency to onset of sweating was significantly shorter on the affected side under both test conditions (P < 0.04 and P < 0.003, respectively). Sweat responses were not correlated to absolute skin temperature but were probably related to the increased blood flow on the affected side. Our findings imply a differential disturbance of vasomotor and sudomotor mechanisms in affected skin. Whereas vasoconstrictor activity is apparently lowered, sudomotor output is either unaltered or may even be enhanced.

Axons↗
PubMed1997

A putative growth-related renal Na(+)-Pi cotransporter.

The mRNA that encodes for NaPi-2, the renal Na(+)-Pi cotransporter that is upregulated by Pi depletion in the adult rat, is low in the young animal. Yet, renal Na-Pi cotransport rates are higher in rapidly growing than in fully grown rats. The aim of this study was to unravel the molecular basis of this apparent discrepancy. Poly(A) RNA obtained from the renal cortex of young animals induced higher rates of Na(+)-Pi cotransport in oocytes than equal amounts of poly(A) mRNA obtained from the renal cortex of mature rats. Moreover, poly(A) RNA obtained from renal cortex of rapidly growing animals treated with antisense NaPi-2 oligomers or depleted of NaPi-2 transcripts by subtractive hybridization with cDNA generated from the renal cortex of adult rats retained its ability to induce Na(+)-Pi cotransport in oocytes. In addition, renal poly(A) RNA of the young subjected to subtraction hybridization generated a 379-base pair reverse transcriptase-polymerase chain reaction product common to all known type II Na(+)-Pi cotransporters. These observations permit us to surmise that the high rates of Na(+)-Pi cotransport prevailing during growth are due, at least in part, to the expression of a specific mRNA that is only partially homologous to that of NaPi-2.

Aging↗
PubMed1997

Psychometric evaluation of the Russian Language version of the Resilience Scale.

The Resilience Scale (RS) was developed by Wagnild and Young (1993) to measure a personality characteristic or coping resource that facilitates adaptation. The RS, however, has not been evaluated with foreign-born populations. Therefore, the purpose of this study was to report the factor structure, internal consistency, and concurrent validity of a Russian language version of the RS in a sample of 450 recent former Soviet immigrants. The 25-item 2-factor solution obtained by Wagnild and Young (1993) was not supported by the Russian data. However, a modified 12-item Russian language version of the RS was, for the most part, reliable and valid: The standardized factor loadings and goodness of fit indices obtained from confirmatory factor analysis were acceptable, the internal consistency of one of the two subscales was very good, and the correlations between scores from the RS subscales and various measures of constructs that are theoretically linked with adaptation were in the expected direction and statistically significant.

Adaptation, Psychological↗
PubMed1996

The current approach to the assessment of fetal renal function: fact or fiction?

The wide use of ultrasonography during pregnancy has led to the identification of a relatively large number of renal and urinary tract abnormalities, particularly hydronephrosis. Uncertainty, however, exists regarding the indications for surgical intervention. Prominent among the variables currently used to assess fetal renal function and predict the long-term outcome are measurements of urinary concentration of electrolytes and low molecular weight proteins. It has become, therefore, imperative to examine the evidence on which the selection of these variables is based, before they become entrenched in medical practice. The analysis reveals that single measurements of any of these variables is unlikely to be reliable. Sequential measurements, albeit more dependable, are impractical due to the narrow window of opportunity for useful surgical intervention. It is therefore necessary to search for new, innovative approaches aimed at detecting changes in the kidney or urine that reflect the biological response of the developing kidney to injury. Such markers may be represented by renal metabolites or peptides involved in the maintenance of renal function under conditions of stress.

Animals↗
PubMed1996

Mechanism of renal phosphate retention during growth.

We have previously demonstrated that the retention of phosphate required for growth is due to a a high Vmax of the Na(+)-Pi cotransport system located in the brush border membrane of the proximal tubule. Because of this and other similarities between adaptation of the kidney to a high Pi demand (growth) and that to low Pi supply, we measured the levels of NaPi-2 mRNA and cDNA present in kidney cortex of 3- and > 12-week-old rats. Like in Pi depletion, Western blots revealed that a 80 to 85 kDa protein recognized by a polyclonal antibody directed against the N-terminal region of the NaPi-2 protein was 2.3-fold more abundant in renal microvilli of the young than of adult animals. However, unlike in Pi depletion, Northern blot analysis failed to reveal a significant difference between mRNA levels at the two ages. Furthermore, suppression of NaPi-2 mRNA activity by annealing with antisense oligomers, or removal of the NaPi-2 transcripts by subtractive hybridization did not affect the rate of Na(+)-Pi cotransport induced in oocytes by polyA RNA of rapidly growing animals, while abolishing the ability of the renal cortical polyA RNA of adult rats to encode for Na(+)-Pi cotransport. RT-PCR of subtracted polyA RNA using primers specific for a region conserved in NaPi type II (Pi modulated) cotransporters yielded a product that was 98% homologous with that region, despite the absence of NaPi-2 cDNA. The results of these experiments demonstrate that the polyA RNA from kidneys of young animals contains unique mRNA transcripts able to encode for a NaPi protein homologous to, but distinct from NaPi-2.

Age Factors↗
PubMed1996

Protein kinase C in intracellular pH regulation in alveolar type II cells.

The Na+/H+ exchanger and Na(+)-HCO3- cotransporter have been implicated in regulation of intracellular pH (pHi) in alveolar type II cells. This study demonstrates that activation of protein kinase C (PKC) stimulates both of these ion transporters in type II cells. Treatment of type II cells with 80 nM phorbol 12-myristate 13-acetate (PMA) increased the resting pHi in a time-dependent manner. Compared with control cells, the rates of recovery from an acid load increased with PMA treatment, reaching a maximum at 15 min, and returned to control levels by 3 h. The PMA-stimulated changes in recovery rate were sensitive to H-7, a PKC inhibitor. For PMA treatment up to 2 h, these recoveries were also sensitive to dimethylamiloride (DMA), an inhibitor of Na+/H+ exchanger activity, and to HCO3-, suggesting activation of both the Na+/H+ exchanger and the Na(+)-HCO3- cotransporter. After prolonged (3 h) treatment with PMA, however, the recovery was insensitive to DMA but was sensitive to HCO3-, suggesting that the Na+/H+ exchanger was no longer active and that most of the recovery was mediated by the Na(+)-HCO3- cotransporter. PMA treatment also altered the Na+ kinetics of the recovery from an acid load with respect to the Michaelis constant (Km) and maximal ion flux (Vmax), suggesting protein modifications of each transporter. We suggest that PKC activation in type II cells results in acute and long-term changes in pHi regulatory mechanisms mediated by the Na+/H+ exchanger and by the Na(+)-HCO3- cotransporter.

1-(5-Isoquinolinesulfonyl)-2-Methylpiperazine↗
PubMed1996

The moderating effect of age on self-care.

The study examined the moderating effect of age on the relations between symptom severity, self-care and others' care, patients' perception of the extent of problem solution, their satisfaction with the solution, and their perception of control over their health. Participating in the study were 121 female and 167 male chronically ill patients. Results indicated that age did play a major role in the relations between self-care and others' care and self-care outcomes. The young population sought maximum relief of symptoms with minimum effort from the self. The elderly, in contrast, could be said fo maximize control because what was important for them was not to depend on others but to be self-sufficient in solving their health problems.

Adult↗
PubMed1996

Pregnancy and delivery practices and beliefs of Ethiopian immigrant women in Israel.

This exploratory, qualitative study compared traditional and biomedical pregnancy and delivery practices from the perspective of Ethiopian immigrant women in Israel. Findings documented that certain beliefs, such as the belief that nonmedical factors (i.e., moral behavior, God, and proper nutrition) were responsible for pregnancy outcomes, were relatively unaffected by immigration. After immigration to Israel, Ethiopian women, however, chose to deliver their babies in the hospital rather than import traditional home delivery practices from their homeland. Despite many negative aspects of labor and delivery in Israel, Ethiopian immigrant women felt that it was worth enduring negative Israeli health care practices in order to have "clean," "safe," and expert deliveries. Findings from this study assist health care professionals to provide more culturally sensitive care to this immigrant group.

Adult↗
PubMed1996

Family stress and support among former Soviet immigrants.

The purpose of this qualitative descriptive study was to investigate types of family support and stress among former Soviet immigrants. Forty-two immigrants (14 males and 28 females) were interviewed about their immigration experiences, including description of current relationships with family in the resettlement country. Content analysis of interview data documented that immigrant families can be a valuable source of emotional and/or instrumental support. Immigrant families, however, can also be too overwhelmed by their own immigration demands to provide support or can generate additional stress for its members. Types of family stress included conflict from differing values and opinions, increased responsibility for family members who could not manage resettlement on their own, family members' emotional distress over immigration experiences, unmet expectations for family members' adjustment, and changes in household composition and living arrangements upon arrival in the United States.

Adult↗
PubMed1996

Learning about another culture: project and curricular reflections.

Over the past two years, an innovative collaborative project in the care of Ethiopian Jews who immigrated to Israel has been carried out. In this project, both students and faculty joined in activities of research and practice through a clinic at a trailer court that houses 96 Ethiopian immigrant families. This project brought about several favorable changes: a) Health of the underprivileged and underserved was enhanced through bi-weekly services provided to the poor and sick trailer court inhabitants; b) An educational program for learning in a cross-cultural community setting was developed. This curricula advanced recognition of the growing cultural and racial diversity of both individual and family lifestyles, as well as allowed for learning events that are based on substantive contact with, or participation by, persons at health risk; c) An educational milieu that fosters the use of research-based interventions was developed. This article describes the cross-cultural educational project which was designed as a pilot for a new baccalaureate program in nursing, and critiques it based on the criteria of the five major concepts--primacy of the teacher-student relationship, social responsibility, centrality of caring, interpretive stance and theoretical pluralism, proposed by the promoters of the "curriculum revolution."

Community Health Nursing↗
PubMed1995

Function of thick and thin nerve fibers in carpal tunnel syndrome before and after surgical treatment.

Present studies evaluated the functions of thick and thin nerve fibers in carpal tunnel syndrome (CTS) to determine whether data of thin nerve fibers can add further information to the diagnosis of CTS. Measurements were performed in 22 patients and 16 age-matched control subjects. Motor and sensory nerve conduction, vibratory testing, thresholds of warmth and cold sensations, suprathreshold magnitude of pain and flare response, as well as sympathetic reflexes induced by noxious mechanostimulation were examined before and 1, 3, 6, 12, and 18 months after decompression of the median nerve. Nerve dysfunction in CTS was mainly indicated by the electrophysiological parameters of thick myelinated nerve fibers. Impairment of thin nerve functions in CTS and postoperative recovery was demonstrated by quantitative somatosensory thermotesting. In contrast, assessment of flare response and sympathetic reflexes using infrared thermography and photoplethysmography did not add further information for the diagnosis of CTS.

Adult↗
PubMed1995

The moderating effect of demographic variables on coping effectiveness.

In spite of the theoretical recognition regarding the role of coping as a moderator, empirical findings indicate that it has only a modest effect as such. This study was designed, therefore, to examine the moderating effect of demographic variables (DV) on coping effectiveness, i.e. active cognitive coping, avoidance coping and active behavioural coping. The study sample was comprised of 12 male and 65 female patients with rheumatoid arthritis who were treated in three outpatient clinics of large hospitals in Israel. Findings suggest that demographic variables do play an important, and somewhat surprising, role in the effectiveness of coping strategies to temper psychological distress. Of the various demographic variables studied, marital status was found to have a significant effect on active cognitive coping and avoidance coping, and adherence to a religious belief system was found to have a significant effect on avoidance coping. The implications of the results for coping effectiveness are discussed.

Adaptation, Psychological↗
PubMed1995

Special considerations for the evaluation of renal function in the pediatric patient.

A reliable method for the determination of renal function in pediatric patients is crucial for the planning of therapy and the administration of therapeutic agents in a variety of conditions. Inulin clearance, the gold standard for the measurement of glomerular filtration rate, is cumbersome and expensive; moreover, inulin is no longer available for clinical use in the USA. The articles reviewed herein reflect the search for simpler laboratory methods suitable for clinical use, new markers of glomerular and tubular function, and more accurate predictors of renal outcome in infants diagnosed prenatally to have urinary tract obstruction.

Child↗