Epidural ketamine for postoperative pain relief.
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Adult↗
Biomedical subjects
K Liu
Publications and source records attributed to K Liu.
Need to prevent and control high-normal and high blood pressure, particularly so-called "mild" hypertension: epidemiological and clinical data.
The need to prevent and control high blood pressure (HBP), including so-called "mild" hypertension [diastolic blood pressure (DBP) 90-104 mm Hg in adults age 30+] stems from the extensive data on the increased risks due to these common blood pressure (BP) levels, including risk of catastrophic cardiovascular events (coronary, cerebrovascular, etc.), both nonfatal and fatal. Prospective population data from the national cooperative Pooling Project and the Chicago Heart Association Detection Project in Industry illustrate the extensively documented facts. They also show that only a small minority of middle-aged and older Americans have optimal low-normal BP levels, i.e., DBP less than 80 mm Hg (SBP less than 120). Thus, the problem of BP above optimal level for health over a long life span is a population-wide problem. The data also show that the great majority of excess catastrophic events attributable to elevated BP occur among people with DBP 90-104 and 80-89 mm Hg, levels very common in the population. Most people with such BP levels also have one or more other major risk factors (e.g., hypercholesterolemia, cigarette use, ECG abnormalities) and thus are at markedly increased risk, both relative and absolute. In addition to these excess risks for major illness, disability, and death, people with BP above optimal levels are more highly prone to other events, clinical and subclinical, that have adverse effects on long-term prognosis, including development of target organ damage and severe hypertension. These data lead to the following inferences about medical care and public health strategy: (a) A key task is, by safe nutritional-hygienic means, to shift the entire population distribution of BP downward, for both primary and secondary prevention of HBP. Such means include prevention and control of obesity, high sodium and alcohol intake, and sedentary habit, from early childhood on. (b) People with DBP 80-89 mm Hg need to be identified promptly, with institution of nutritional-hygienic measures to prevent development of frank hypertension and to correct other risk factors. (c) People with DBP 90-104 and higher need to be identified promptly, with institution of measures to normalize BP and control other major risk factors, by nutritional-hygienic means alone whenever possible or in combination with drug treatment for HBP when necessary to prevent organ system damage, serious illness, disability, and premature death.(ABSTRACT TRUNCATED AT 400 WORDS)
Adult↗
An analysis of the heterogeneity of U.S. nursing home patients.
Research has shown that the nursing home patient population is quite heterogeneous in terms of both individual patient characteristics and service needs. Furthermore, existing administrative classifications do a poor job of representing this heterogeneity. As a consequence we have conducted an analysis of the individual and service characteristics of two types of patients represented in the National Nursing Home Survey of 1977 (i.e., patients whose primary source of payment was Medicare and patients whose primary payment source was not Medicare). In this analysis we identified patterns of individual characteristics within the two patient groups and showed how these patterns related to their service needs. The logic of the model permitted us both to establish patterns of characteristics within the two payment types and to examine the implications of individual heterogeneity remaining in the classification. This makes the methodology useful both as a research tool for understanding the nature of the nursing home population and as a tool for studying the consequences of various classification schemes for questions of identifying service patterns and needs as well as the evaluation of policy options.
Aged↗
Epidemiological studies of hemorrhagic fever with renal syndrome: analysis of risk factors and mode of transmission.
During an outbreak of hemorrhagic fever with renal syndrome in the Anhui Province of China, a door-to-door survey was conducted of all of the 10,024 residents of eight village communities. The incidence rates were higher in males than in females and higher in adults than in children. Of all the residents surveyed, however, those who had slept on the ground or had been engaged in heavy farm work were at a significantly higher risk of illness than were those who slept on wooden beds or did light work. Among men who did heavy farm work and who gave a history of sleeping in straw huts on the drained swamp, the attack rate was 2.33 times higher than it was for those sleeping exclusively in their permanent homes. Among both sexes, threshers had a significantly higher attack rate than did nonthreshers. Suspicions that trombiculid mites or gamasoid mites act as vehicles of transmission cannot be accepted as an explanation for the association of the risk of illness with the type of work done and with sleeping arrangements. Circumstantial evidence supports our hypotheses of airborne transmission and transmission by inoculation of infectious materials into skin lesions.
Adolescent↗
Ethnic differences in blood pressure and heart rate of Chicago school children.
In 1975-1978, the Chicago Department of Health conducted a screening program that included measurements of blood pressure, heart rate, height, weight, triceps skinfold thickness, and arm circumference, and calculation of body mass index and muscle circumference for non-public school children. Based on data on 4,086 boys and girls aged 5-10 years from the program, this study examined the ethnic differences in blood pressure and heart rate among children of white, black, Latino, and Oriental ethnicity. Mean levels for both systolic and diastolic blood pressure were higher for Oriental and black children than for white and Latino children. These differences were independent of age, height, weight, and skinfold thickness. The black children had a much lower mean heart rate than the other children. A seasonal variation was observed for systolic blood pressure, i.e., with each sex group, the mean systolic blood pressure adjusted for age, skinfold thickness, and height tended to be higher in spring than in fall and winter. (Note-- no child was screened during the summer because of summer break.) With control for season, ethnic differences in systolic blood pressure disappeared, but not the ethnic differences in diastolic blood pressure and heart rate.
Blood Pressure↗
Day-to-day pneumogram variability.
To determine day-to-day variability in respiratory pattern, we obtained 188 comparisons of pneumograms performed during two successive 24-h intervals. The respiratory pattern values calculated were total duration of brief apnea (apnea density), periodic breathing episodes, longest apnea, number of apneas greater than 11 s, and number of apneas greater than 15 s. For day 1 values for apnea density, periodic breathing, and longest apnea which were within the 90th percentile for normal infants at age 1 month, day 2 values fell outside that range in 4.3, 3.5, and 18% of comparisons, respectively. There was a systematic tendency for the day 2 values to be less than the day 1 values. For each parameter, the day 2 range was lower, the slope of the day 2 versus day 1 regression line was significantly less than 1 (p less than 0.01) and the y-intercept was significantly greater than zero (p less than 0.01). Knowledge of day-to-day pneumogram variability should be helpful in interpreting individual pneumogram results and in assessing the clinical usefulness of pneumogram recordings.
Apnea↗
An overview of long-term care.
Long-term care (LTC) refers to health, social, and residential services provided to chronically disabled persons over an extended period of time. Especially during the last 20 years, State and Federal Governments have played an increasing role in the financing of long-term care. The aging of the population underlines the future importance of this topic. This article provides background data on need, supply, and expenditures; discusses government financing programs; and addresses quality of care concerns and options for LTC reform.
Aged↗
Home care expenses for the disabled elderly.
This article presents descriptive statistics from the 1982 Long-Term Care Survey on noninstitutionalized elderly Americans with limitations in activities of daily living (ADL) and instrumental activities of daily living (IADL). The focus of this article is on private expenses for home-based care related to ADL and IADL limitations. We describe the amounts of out-of-pocket payments expended relative to the characteristics of the home-based, disabled elderly population. We also discuss several possible implications of the findings for policymakers and further research.
Activities of Daily Living↗
[Changes in gastric secretion and serum gastrin concentration after partial esophagectomy and esophagogastrostomy: preliminary study].
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Adolescent↗
Prevalence of diabetes/hyperglycemia and associated cardiovascular risk factors in blacks and whites: Chicago Heart Association Detection Project in Industry.
Prevalence rates of diabetes, asymptomatic hyperglycemia, and cardiovascular risk factors were examined in an employed population of 28,895 whites and 2607 blacks, ages 25 to 64 years. Diabetes had been previously diagnosed in this population among approximately 3% of the males of both races and 2% of the females. Plasma glucose 1 hour after a 50 gm oral load was highest among white males (141 mg/dl), similar and at intermediary levels among black males (134 mg/dl) and white females (135 mg/dl), and lowest among black females (126 mg/dl). A divergent pattern of obesity was observed, however, with black females being by far the most overweight. Preliminary mortality data for males suggest that both blacks and whites with diabetes have sizably higher death rates than those without diabetes; a black-white differential is not apparent.
Adult↗
Life table methods for assessing the dynamics of U.S. nursing home utilization: 1976-1977.
One likely consequence of the aging of the U.S. population is the growth of the number of persons in nursing homes. As the numbers of persons in nursing homes increase so will the amount of resources required to keep them in those homes. This will make it increasingly important to understand the dynamics of nursing home utilization so that we can more effectively plan the allocation of resources. Unfortunately, we lack direct information on the dynamics of nursing home utilization both because of the expense of implementing longitudinal studies to gather such information and because the available data on current residents are inappropriate to study the dynamics of utilization because of several types of bias. Demographic methods are presented that can be applied to survey data to remove sample biases from the data and permit study of the dynamics of the utilization of facilities for the total U.S. nursing home population and for various of its components.
Actuarial Analysis↗
The characteristics and utilization pattern of an admission cohort of nursing home patients (II).
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Actuarial Analysis↗
Projecting chronic disease prevalence.
Health and long-term care planning for an aging population is an important and necessary function for both the public and private sector. Unfortunately, efforts at planning have often been limited by difficulties in making estimates and forecasts of chronic disease prevalence in the population. These difficulties are a direct result of the natural history of chronic diseases that normally have long presymptomatic stages. Because of this characteristic, predictions of the magnitude of chronic disease prevalence in the United States often fail to reflect an important dimension of the health state of the population: that there is a sizeable proportion of chronic disease prevalence and risk existing in the population in a preclinical phase. The authors present a strategy for obtaining more complete estimates of chronic disease prevalence. This approach entails the creation of an illness--death model representing the natural history of individual chronic diseases and the application of the model to infer morbidity incidence and prevalence patterns from national mortality statistics. They illustrate the approach with an example of lung cancer and discuss the applications of the outputs of the modeling strategy for health care resource planning.
Actuarial Analysis↗
Assessment of sodium intake in epidemiological studies on blood pressure.
Previous studies suggested that seven to fourteen 24-hour urine collections are necessary to minimize the attenuation due to the large day-to-day variation in an individual's Na intake and due to inadequate numbers of 24-hour urinary collections. Difficulties and inconveniences in collecting such a large number of 24-hour urine specimens are likely to result in a relatively large proportion of people who will either refuse to participate in the study or will collect incomplete specimens. The latter problem is especially serious since no satisfactory criteria are currently available to determine the completeness of urine specimen. There is no perfect solution to the problem of feasibility of multiple 24-hour specimens. Suggestions given in this paper can only help to partially solve the problem. The average Na/K and Na/creatinine ratios calculated from multiple, timed overnight urine specimens deserve some attention in future research.
Adolescent↗
A randomized trial on the effect of decreased dietary sodium intake on blood pressure in adolescents.
A randomized crossover trial on the effect of salt restriction on blood pressure was carried out involving 124 adolescents (mean age 16 years). Dietary sodium was reduced from approximately 110 to 45 mEq/24 h for a period of 24 days. Blood pressure was non-significantly lower at the end of the experimental diet for all participants. A slight (0.7 kg), yet statistically significant fall in weight was observed (P less than 0.05). Subgroup analysis demonstrated that participants whose body mass index was below the median had a statistically significant fall in systolic blood pressure (P less than 0.05); fall in weight and increase in heart rate were also more pronounced in the less obese individuals. It would appear that moderate sodium reduction does not have an overall short-term effect on blood pressure in normotensive adolescents. However, body size as reflected in body mass index may influence blood pressure response to sodium reduction.
Adolescent↗
Learning to live with controlled ventricular tachycardia: utilizing the Johnson model.
In view of the multifaceted needs of both patients and families, the role of the nurse lies in assessing system instability and in prioritizing efforts for stabilization within the hospital. Since the problems are so complex, it may be impossible to resolve all of them before discharge. Therefore, follow-up referrals to counseling services and visiting nurse associations are helpful. Of added benefit is an ongoing, supportive relationship with a physician and/or a nurse specialist who is familiar with the needs of these special patients and their families. The use of a behavioral systems model such as Johnson's assists the nurse in organizing assessments of patient and family needs and in planning nursing strategies to meet those needs. The patient's very realistic fears of dying coupled with the frequently occurring loss of cardiac function present an enormous challenge to the nurses who work with them. The close professional relationships that result from this process are extremely rewarding.
Achievement↗
Seventh-Day Adventist adolescents--life-style patterns and cardiovascular risk factors.
The life-style of adolescents attending a Seventh-Day Adventist boarding school was evaluated as it related to cardiovascular risk factors. The diet contained 34% calories as fat, with 11% derived from saturated fat. Total serum cholesterol levels were low (mean, standard deviation=138+/-15 mg per dl), and apolipoprotein B level was low as well (46+/-9 mg per dl). The high-density lipoprotein cholesterol level was within the usual range (52.4+/-13.3 mg per dl). Mean blood pressures were also low (systolic, 104.1+/-9.6 mm of mercury; diastolic, 65.7+/-9.7 mm of mercury). There was no self-reported use of cigarettes. If this life-style were to continue through adulthood, the incidence of premature atherosclerotic disease, particularly coronary artery disease, for this group might well be reduced, compared with other North Americans, as suggested by findings from previous studies of adult Seventh-Day Adventists.
Adolescent↗
Dietary salt and blood pressure.
Research evidence on the role of dietary sodium in the etiology and pathogenesis of hypertension is briefly reviewed. This matter is assuming new importance at present, given new data on the efficacy of normalization of blood pressure for adults with so-called "mild" hypertension (average diastolic 90-104 mm Hg), hence the need for safe nutritional-hygienic alternatives to years-long drug treatment for millions of people with such hypertension. Two trials by the authors deal with some unresolved questions in this area. The first, a preliminary study, involved 21 lacto-ovo-vegetarian high school students living in a boarding school. With decrease in daily Na intake from 216 to 72 meq for the experimental compared with the control group, red blood cell Na concentration was significantly lower in the former; systolic pressure was slightly but not significantly lower. The second trial, the Primary Prevention of Hypertension, involves over 200 hypertension-prone persons aged 30-44, and explores the ability in the experimental group to reduce blood pressure and prevent development of hypertension by safe nutritional-hygienic means (weight reduction, dietary Na decrease, avoidance of excess alcohol, rhythmic exercise). Initial results at 6 months are presented. Trials on the prevention and control of hypertension by nonpharmacologic means, including reduced Na intake, and involving analyses of the inter-relationships among dietary Na, other dietary factors, Na metabolism, and blood pressure in samples from different population strata, are an important present-day research need.
Adolescent↗