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Biomedical subjects

B T Engel

Publications and source records attributed to B T Engel.

At least 37 records · Page 2Linked to original sources
PubMed1991

Prevalence, incidence and correlates of urinary incontinence in healthy, middle-aged women.

The prevalence, incidence and correlates of urinary incontinence were studied in a community-based sample of 541 healthy, middle-aged women 42 to 50 years old. Participants were evaluated on 2 occasions approximately 3 years apart. Of the participants 58% reported urine loss at some time and 30.7% reported incontinence on a regular basis at least once per month. During 3 years the cumulative incidence of regular incontinence in previously continent women was 8.0%. Among those with regular incontinence 64.9% said the volume of loss was 1 or 2 drops, while 35.1% reported that they needed to change their garments. Only 25.5% of the patients had sought treatment. Continence status was significantly related to body mass index and race but not to patient age, parity, caffeine or alcohol intake, smoking, physical activity, prior gynecological surgery or several psychological variables. The results indicate that urinary incontinence is common among middle-aged women. That few seek treatment suggests a need for more information about women's attitudes toward incontinence and more attention to this problem by health care providers.

Adult↗
PubMed1991

Normative patterns of diurnal urination across 6 age decades.

The patterns and frequency of diurnal urination were studied in 412 male and 244 female participants in the Baltimore Longitudinal Study of Aging. Men urinated less often (mean 4.8 voids per day) than women (mean 5.6 voids per day). There was no main effect for age decade. However, an age by sex interaction showed that voiding in men increased across the decades and in women it decreased. The highest frequency was found in women in their 30s (mean 6.2) and the lowest was in men in their 30s (mean 4.3). Men and women in the 70 and older age group had the same voiding frequency (mean 5.0). In men frequency of urination was related to benign prostatic enlargement and 2 of 4 symptoms of urinary obstruction (change in the force of the urinary stream and having to urinate again shortly after voiding). In women frequency was related negatively to a history of pregnancy complications but not to parity. In both sexes frequency was unrelated to the reported daily ingestion of coffee, tea or diuretics, and no relationships were found with a history of an anxiety disorder.

Adult↗
PubMed1991

Hemodynamic and respiratory concomitants of learned heart rate control during exercise.

Each of three monkeys was trained to slow its heart, to exercise (lift weights), and to attenuate the tachycardia of exercise by combining these two skills. During all experiments, heart rate, stroke volume, intra-arterial blood pressure, O2 consumption, and CO2 production were recorded on a beat-to-beat basis. All animals reliably attenuated the tachycardia of exercise, indicating that this expression of central command is, at least in part, a learned motor skill. Double-product (heart rate X systolic pressure) was attenuated during combined sessions relative to exercise only sessions, and heart rate was always lower at similar levels of cardiac output, indicating that under the combined conditions, animals were performing with better cardiac efficiency at comparable levels of mechanical effort. Analyses of O2 consumption, CO2 production, and respiratory quotient (the ratio of CO2 production to O2 consumption) suggested that the animals also might have been delivering more O2 to their working muscles during combined sessions.

Animals↗
PubMed1991

Diurnal variations in central venous pressure.

We analysed the haemodynamic patterns of seven monkeys (Macaca mulatta) during a one-month period during which we monitored beat-to-beat levels of heart rate, stroke volume, intra-arterial pressure and central venous pressure 7 days/week, 18 h/day. We replicated an earlier finding that cardiac output falls and total peripheral resistance rises throughout the night: the fall in cardiac output was mediated by a fall in heart rate since stroke volume did not change; and the rise in peripheral resistance reflected a homeostatic adjustment to the fall in cardiac output since blood pressure was stable throughout the night although it fell early in the evening. In addition, we have shown for the first time that central venous pressure also falls throughout the night; this occurs even in the presence of alpha- and beta-adrenergic sympathetic blockade. Since stroke volume does not change overnight this indicates that the nocturnal fall in cardiac output is not due to a shift of blood volume into the venous compartment. These findings support our hypothesis that there is a nocturnal decline in plasma volume.

Animals↗
PubMed1991

Assessing toileting skills and habits in an adult day care center.

In a structured assessment of mobility and toileting skills, all the continent clients but only 46.2% of incontinent clients were able to toilet themselves, even with verbal and physical guidance. Unobtrusive observation of toileting habits indicated that incontinent clients used the toilet less often than continent clients and used more staff assistance to do so. On mental status examination, incontinent clients scored significantly lower than continent clients. Incontinence in this population is a multidimensional disorder in which physical disability is a predominant factor.

Aged↗
PubMed1991

Cardiovascular responses as behavior.

Exercise is a ubiquitous, biologically and clinically significant behavior. Although the somatomotor responses are generally regarded as "behavior," the cardiovascular adjustments that accompany these responses are generally considered to be reflexes that are elicited by neurally mediated stimuli and metabolites arising from working muscles. We report experimental evidence that monkeys can be trained to exercise, to slow heart rate, and to combine these two skills. Furthermore, some animals will emit more physical work at slower heart rates (at comparable levels of cardiac output) and lower left ventricular work during the combined condition relative to an exercise-only condition. Thus, these findings show that the cardiovascular and somatomotor responses of exercise can be dissociated and that both sets of responses should be considered behaviors. Also included are results that show these animals can perform these behaviors during sympathetic or vagal blockade. These findings are further evidence that the cardiovascular adjustments to exercise are, in part, learned behaviors because they show that the behavior--attenuation of the tachycardia of exercise--is not a reflex that is specifically tied to any neuroeffector system; rather, this behavior is emitted to achieve a contingent reward, and the nervous system will use whatever mechanisms are available to attain that consequence.

Animals↗
PubMed1990

Nocturnal hemodynamic patterns in dogs.

Several species which have a single daily wake-sleep cycle show a progressive fall in cardiac output and rise in total peripheral resistance during sleep, a cardiovascular response which may reflect a progressive decrease in plasma volume. The present study showed that no such progressive overnight changes in cardiac output or total peripheral resistance occur in the dog, a carnivore which tends to be awake and to drink intermittently during the night. Progressive overnight bradycardia (-12.7 +/- 3.1%) and compensatory increase in stroke volume (14.8 +/- 6.0%) were observed in this species, however. These findings are consistent with the view that differences between primates and carnivores in overnight hemodynamic function are related to species differences in sleep and ingestive behavior.

Animals↗
PubMed1990

Cost-effectiveness of treating incontinence in severely mobility-impaired long term care residents.

Severely mobility-impaired residents in long term care facilities are usually incontinent. The incontinence and immobility predispose this group to decubitus ulcers and urinary tract infections that have been described as adding to the "consequence costs of incontinence" of $80 million per year. In this quasi-experimental study of ten subjects, a mechanical lift (Clinilift) was used with a two-hour schedule to improve incontinence. Subjects showed improvement in not only dryness but also volume of urine voided and the frequency of decubitus ulcers and UTIs. Because this incontinence treatment is labor intensive, the costs of treating incontinence increased by $2.90 over the cost of providing incontinent care. When the costs of decubitus ulcers and urinary tract infections are considered, however, the treatment savings were $13.38 per patient per day.

Activities of Daily Living↗
PubMed1990

A descriptive analysis of nursing staff behaviors in a teaching nursing home: differences among NAs, LPNs, and RNs.

Various staff behaviors in a nursing home were sampled seven times a day, 5 days a week over 37 months and were coded separately for LPNs, RNs, and NAs. The behavior most frequently observed was patient care, which occurred during 56.9% of the samples. We observed staff interacting with patients during 10.7% and with other staff during 19.5% of the samples. The LPNs displayed significantly more patient care behaviors and NAs significantly more nonwork behaviors than other nursing staff. RNs displayed the least nonwork behavior. We conclude that nursing staff devote most of their time to patient needs and relatively little time to nonproductive activities.

Behavior↗
PubMed1990

An improved method for recording blood pressure in the tethered monkey.

Existing tethering systems intended for continuous recording of blood pressure incur two major problems: 1) vertical movements of the animal in the cage produce a significant error in measured pressure introduced by the change in distance between the pressure transducer and the highest point of the infusion system and 2) the necessity for repeated zero adjustment of the pressure transducer requires sedation of the animal and disconnection of the catheter. Continuous infusion and a one-way valve in the infusion line in proximity to the pressure transducer will eliminate the error of measurement related to vertical movement of the animal. A remotely controlled, two-way solenoid valve can close the catheter line and open the pressure transducer to atmospheric pressure, thereby permitting repeated zero adjustment without sedation of the animal and disconnection of the catheter. Eliminating the need to disconnect the catheter will significantly reduce the risk of adventitious infection.

Animals↗
PubMed1990

A staff management system for maintaining improvements in continence with elderly nursing home residents.

We developed a staff management system for maintaining treatment gains achieved on a specialized continence unit located in a geriatric nursing home. Geriatric assistants learned to use a prompted voiding procedure to maintain improved dryness for 4 elderly residents. The staff management system included self-monitoring and recording of prompted voiding activities and supervisory monitoring and feedback based on group performance of these activities. Results show that the system was effective in maintaining prompted voiding activities with corresponding maintenance of improved patient continence. However, a gradual decline in staff performance was noted 4 to 5 months after the initiation of the system. During a subsequent phase of the study, provision of individual feedback restored staff performance to previous levels. Results are discussed in relation to the practicality of prompted voiding interventions in nursing home environments and the applicability of staff management systems in this setting.

Aged↗
PubMed1989

Biofeedback in treatment of urinary incontinence in stroke patients.

Urinary incontinence can occur poststroke owing to weakness or incoordination of sphincter muscles, impaired bladder sensation, or hyperreflexic, neurogenic bladder. Four male subjects who had urinary incontinence associated with a stroke that had occurred 8 months to 10 years earlier, and who averaged 1.6 to 7.5 accidental voidings per week, participated in an outpatient study with a 4-week scheduled-voiding baseline, 2 to 5 sessions of biofeedback-assisted bladder retraining, and 6- to 12-month follow-up. Training sessions included stepwise filling of the bladder and manometric feedback display of bladder pressure, abdominal pressure, and external anal sphincter pressure. Training procedures were designed to teach subjects to attend to bladder sensations, inhibit bladder contractions, and improve voluntary sphincter muscle control. All four subjects achieved and maintained continence regardless of substantial differences in subject characteristics, including laterality of stroke, degree of sensory impairment, and independence in daily activities.

Aged↗
PubMed1989

Behavioral treatment of isolated systolic hypertension in the elderly.

Fifteen hypertensive patients were recruited from a geriatric medicine clinic for a "research project designed to evaluate a Behavioral Stepped-Care treatment program of high blood pressure (HBP)." All patients met the selection criteria of the Isolated Systolic Hypertension (ISH) in the Elderly (SHEP) clinical trial. During baseline, subjects recorded BP at home 9 times/day (3 times each, shortly after awakening, during the middle of the day, and within an hour of retiring) for 1 month and mailed that data to us daily. In addition, they came to the clinic weekly and had their BP recorded by a nurse. During treatment 1, systolic (SBP) feedback, they were trained to lower SBP at home using their sphygmomanometers. They also continued to monitor BP and to obtain weekly professional BP readings. During treatment 2 (relaxation), they were trained to relax; they followed the self-administration and data-collection protocol as in treatment 1. Each treatment phase lasted 3 months. Average monthly self-determined BP fell significantly from 166.4/85.8 (SBP/DBP) mm Hg during baseline to 153.3/81.2 by the end of the relaxation phase; average monthly professionally measured BP fell significantly, from 164.7/87.1 to 156.9/81.5. These findings show that a nurse-supervised, patient-administered behavioral treatment program of ISH can yield sustained, significant falls in BP.

Aged↗
PubMed1989

Effect of electrical stimulation of "rewarding" areas of the hypothalamus on habituation and dishabituation to repeated mild cold exposures in C57BL/6J mice.

Four groups of 12-month-old C57BL/6J male mice had chronic electrodes implanted in the median forebrain bundle. In three groups the "rewarding" property of electrical stimulation was determined during a single 30-min session of self-stimulation (ISS) before the beginning of the experiment. In the fourth group this test was postponed until the end of experiment. Every two weeks for 12 weeks all animals were subjected to repeated 3-hr cold stress tests consisting of partial physical restraint at an ambient temperature of 10 degrees C. The time interval between tests No. 3 and No. 4 was intentionally delayed up to four weeks. During the 4-week interval, animals of one of the groups tested for ISS remained in their home cages; mice of the second ISS-tested group received daily 30-min sessions of brain stimulation; and animals of the third ISS-tested group were placed daily for 30 min in the experimental chamber where they had been tested for ISS previously but received no brain stimulation. Animals of the fourth group, which were not tested for ISS prior to the experiment, also were placed daily in the experimental chamber without brain stimulation. Repeated cold testing resulted in improvement of cold tolerance (decrease of the rate of decline of colonic temperature during cold exposure) in the second and third tests relative to the first cold test in all groups (cold habituation).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1989

Behavioral training for post-prostatectomy urinary incontinence.

We treated 20 men with persistent post-prostatectomy incontinence by biofeedback-assisted behavioral training procedures. Initially, scheduled 2-hour voiding resulted in a mean 33.1 per cent increase in urge incontinence, a mean 28.5 per cent decrease in stress incontinence and no change in continual leakage. Subsequently, biofeedback was used to teach selective control of the sphincter muscles and/or inhibition of detrusor contractions. Individualized home practice included a voiding schedule, sphincter exercises, active use of the sphincter to prevent urine loss and strategies to manage urgency. After 1 to 5 biofeedback sessions patients with urge incontinence demonstrated an average 80.7 per cent decrease in incontinence, while stress incontinence was decreased an average 78.3 per cent and patients with continual leakage were less successful, with a mean 17.0 per cent improvement. The findings indicate that biofeedback training is an effective intervention for episodic stress or urge incontinence after prostatectomy. However, its usefulness appears to be limited in patients with postoperative incontinence characterized by continual leakage.

Aged↗
PubMed1989

Effect of sympathetic blockade on diurnal variation of hemodynamic patterns.

Heart rate, stroke volume, and intra-arterial blood pressure were monitored continuously in each of four monkeys, 18 consecutive h/day for several weeks. The mean heart rate, stroke volume, cardiac output, systolic and diastolic blood pressure, and total peripheral resistance were calculated for each minute and reduced to hourly means. After base-line data were collected for approximately 20 days, observation was continued for equal periods of time under conditions of alpha-sympathetic blockade, beta-sympathetic blockade, and double sympathetic blockade. This was achieved by intra-arterial infusion of prazosin, atenolol, or a combination of both in concentration sufficient for at least 75% reduction of response to injection of agonists. The results confirmed previous findings of a diurnal pattern characterized by a fall in cardiac output and a rise in total peripheral resistance throughout the night. This pattern was not eliminated by selective blockade, of alpha- or beta-sympathetic receptors or by double sympathetic blockade; in fact, it was exacerbated by sympathetic blockade, indicating that the sympathetic nervous system attenuates these events. Because these findings indicate that blood volume redistribution is probably not the mechanism mediating the observed effects, we have hypothesized that a diurnal loss in plasma volume may mediate the fall in cardiac output and that the rise in total peripheral resistance reflects a homeostatic regulation of arterial pressure.

Animals↗