Because of the financial incentives of prepaid care, the quality of care for Medicare enrollees in Health Maintenance Organizations (HMOs) is a concern. Therefore, the care in 150 newly diagnosed cases of colorectal cancer in eight HMOs was compared with that in 180 similar fee-for-service (FFS) cases. As part of the diagnostic workup, HMO patients were more likely to have had fecal occult blood tests (74% vs 52%, p less than 0.01) and endoscopy or barium enemas (97% vs 90%, p less than 0.05). FFS patients were more likely to have had preoperative imaging studies (54% vs 38%, p less than 0.01). Although there were longer diagnostic delays for HMO enrollees with gastrointestinal bleeding, there were no significant differences in disease stage or clinical status, and postoperative follow-up was similar. The authors conclude that enrollees in Medicare HMOs with colorectal cancer receive medical and surgical care at least equal to that received in FFS settings.

Aged↗

PubMedDate not supplied

Evidence that nerve cell bodies in the zona incerta influence ingestive behavior.

Iontophoretic applications of the neurotoxin kainic acid to the rostromedial zona incerta deplete this region (but not neighboring areas of the diencephalon) of nerve cell bodies. These injections reproduced many of the regulatory deficits typical of rats with large electrolytic lesions of the area (transient hypophagia and hypodipsia, persisting impairments in drinking responses to acute cellular dehydration and feeding responses to cellular glucoprivation). Since kainic acid appears to spare fibers of passage these results indicate that cellular components of the zona incerta contribute significantly to the regulation of food and water intake.

Animals↗

PubMedDate not supplied

The ethics of health care for profit.

Explore the source record for details and available documents.

Delivery of Health Care↗

PubMedDate not supplied

The social competence of children following burn injury: a study of resilience.

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Adaptation, Psychological↗

PubMedDate not supplied

Adult psychosocial adjustment following childhood injury: the effect of disfigurement.

The literature investigating the psychosocial adjustment of burn survivors is limited and that addressing such adjustment in burned children is contradictory. Forty-two adults, burned in childhood, were assembled into burn severity cohorts and compared as to burn severity, intensity of stress, and extent of disfigurement and disability. The findings substantiated the hypothesis that the biologic variables of years since burn and severity would not explain psychosocial adjustment in adulthood; lower adjustment correlated with visible disfigurement and less peer support rather than with severity of burn.

Adaptation, Psychological↗

PubMedDate not supplied

Management issues in automating medical systems.

The nontechnical aspects of medical computing systems are as important as the technical. In order to understand why, it is important to consider the social context of systems, the human engineering necessary for medical systems to work, and the specifics of the man-machine interface. It is also necessary to plan for the change which comes with any new method. This paper contains a discussion of these topics, concluding with a set of guidelines for change-management which we feel organizes the data of years of experience into a systematic approach.

Computers↗

PubMedDate not supplied

Developing a teaching portfolio in nursing education: a reflection.

Presenting teaching accomplishments through a portfolio promotes self-reflection and provides direction for improvement and advancement decisions. The authors examine experiences, insights, and reflections about their participation in a pilot project introducing teaching portfolios. Themes of taking stock, documenting practice, and reflecting emerge. Their experiences of completing teaching portfolios and personal growth as educators and colleagues are described.

Attitude of Health Personnel↗

PubMedDate not supplied

Maternity-patient teaching--a nursing priority.

The overall positive response of the parent participants has validated the utility of the program. Future program expansion and revision will be based on social and technological change. Participant responses to the program will be monitored continually to determine whether their needs are being met. The program clarified the role nursing personnel have in teaching maternity patients. It serves to increase the new parents' self-confidence in being able to adjust to their new roles. One possible future expansion of the program might be post-discharge group discussion sessions, supervised by nursing personnel. During those sessions, mothers could discuss feelings that they are experiencing, any difficulties they may have adapting to their new roles, and other topics they feel are relevant. Nurses would attend these sessions to serve as resource persons and group facilitators. The need for patient teaching in obstetrics is being recognized increasingly as a priority by health professionals in the field of maternal-child health. A concise and accurate means of documentation is necessary to ensure that consistent, comprehensive instructions are given to all new parents.

Female↗

PubMedDate not supplied

Anatomical and physiologic characteristics to predict football ability. Report of study methods and correlations, University of Arkansas, 1976.

In a prospective study of 56 scholarship players at the University of Arkansas in 1976, 14 anatomical and physiologic measurements were carried out on each of the 56 players, to include certain orthopaedic strength, power, and balance tests, and compared to the coaches' subjective ratings of football ability in an effort to determine which characteristics best correlate to the athlete's true performance. The correlation matrix for the criterion measure and the predictor variables of selected anatomical strength, balance, and power measures are presented, and the results of the study indicate that genu varum (0.445) and tibial torsion (-0.33) had the highest correlation with the coaching criterion variable. The average tibial torsion was 42.6 for these scholarship athletes, while normal average tibial torsion among a nonscholarship group was 27.40 degrees. Other anatomical characteristics measured, as well as strength and power measure, could not reach the critical level of +/- 0.263 to be significant at the 0.05 level, although horsepower was close (0.255). The Margaria-Kalamen power test was significantly related to the 40-yard dash, and a moderately good measure of football ability.

Anthropometry↗

PubMedDate not supplied

Effective cryopreservation and long-term storage of primary human hepatocytes with recovery of viability, differentiation, and replicative potential.

Despite reports of successful cryopreservation of primary human hepatocytes, existing methods do not produce sufficient recovery of viable cells to meet the needs of basic research or clinical trials of hepatocellular transplantation. We now describe a protocol for efficient cryopreservation of primary human hepatocytes using University of Wisconsin (UW) solution, fetal bovine serum, and dimethyl sulfoxide (DMSO). This method provides > 90% viability of differentiated, primary human hepatocytes 8 mo after cryopreservation as measured by trypan blue exclusion, preserves hepatocyte morphology, liver-specific gene expression (alpha 1 antitrypsin), and replication. The effectiveness of UW solution as a cryopreservative agent suggests that metabolic as well as ultrastructural factors may be important in the effective cryopreservation of primary human hepatocytes. The present method represents an effective protocol for cryopreserving differentiated primary human hepatocytes for research. This method may allow characterization and banking of human hepatocytes for clinical applications, including hepatocellular transplantation and hepatic assist devices.

Cell Differentiation↗

PubMedDate not supplied

Noise and health in the urban environment.

Noise, including noise from transport, industry, and neighbors, is a prominent feature of the urban environment. This paper reviews the effects of environmental noise on the non-auditory aspects of health in urban settings. Exposure to transport noise disturbs sleep in the laboratory, but generally not in field studies, where adaptation occurs. Noise interferes with complex task performance, modifies social behavior, and causes annoyance. Studies of occupational noise exposure suggest an association with hypertension, whereas community studies show only weak relations between noise and cardiovascular disease. Aircraft and road-traffic noise exposure are associated with psychological symptoms and with the use of psychotropic medication, but not with the onset of clinically defined psychiatric disorders. In carefully controlled studies, noise exposure does not seem to be related to low birth weight or to congenital birth defects. In both industrial studies and community studies, noise exposure is related to increased catecholamine secretion. In children, chronic aircraft noise exposure impairs reading comprehension and long-term memory and may be associated with increased blood pressure. Noise from neighbors causes annoyance and sleep and activity interference health effects have been little studied. Further research is needed for examining coping strategies and the possible health consequences of adaptation to noise.

Adolescent↗

PubMedDate not supplied

Metabolic and hormonal alterations in cats with hepatic lipidosis.

Hepatic lipidosis in cats is a commonly diagnosed hepatobiliary disease of unknown cause. The purpose of this prospective study was to characterize the blood hormone and lipid status of cats with hepatic lipidosis, and to compare this status to that of cats with other types of liver disease and to control cats. Twenty-three cats with hepatic disease were assigned to 1 of 2 groups on the basis of cytopathologic or histopathologic examination of the liver: group 1, hepatic lipidosis (n = 18); or group 2, cholangiohepatitis (n = 5). Ten healthy young adult cats were used as controls. Food was withheld from control animals for 24 hours before blood collection. Concentrations of plasma glucagon and serum insulin, cortisol, thyroxine, triglycerides, cholesterol, phospholipids, and nonesterified fatty acids (NEFAs) were determined in all cats, in addition to routine hematologic and serum biochemical testing. Cats with hepatic lipidosis had higher serum NEFA concentrations than cats with cholangiohepatitis or control cats (P < .05). Cats with cholangiohepatitis had higher serum cholesterol and phospholipid concentrations than those of cats with lipidosis or control cats (P < .05); their plasma glucagon concentrations were higher than those of control cats (P < .05), but were not different from those of cats with hepatic lipidosis. Serum insulin concentrations were significantly higher in control cats than in diseased cats (P < .05), but neither serum insulin nor the insulin to glucagon ratio was significantly different among the cats with hepatic disease. The high concentration of NEFAs in cats with hepatic lipidosis suggests that at least 1 factor in the pathogenesis of this syndrome may involve the regulation of hormone-sensitive lipase.

Animals↗

PubMedDate not supplied

Wellness education for individuals with chronic mental illness living in the community.

The article reports a wellness education program developed to enhance and promote healthy life-style behaviors for individuals with chronic mental illness living in the community. Theoretical concepts from health promotion, wellness, and social learning were used in the development of this program. The program comprised three components: wellness education sessions, exercise/activity sessions, and a smoking reduction course.

Adult↗