Nutritional rehabilitation of developmentally disabled residents in a long-term-care facility.
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Adolescent↗
Biomedical subjects
S Evers
Publications and source records attributed to S Evers.
Diet-disease relationships: public health perspectives.
Recent nutrition recommendations are directed towards prevention of chronic degenerative diseases, particularly coronary heart disease and cancer. This focus is in response to morbidity and mortality trends during this century. The evidence supporting such dietary changes remains inconclusive because of difficulties inherent in the measurement of usual dietary intake. The association between dietary fat and breast cancer is reviewed as an example of the problems faced in assessing whether a dietary component does alter the risk of disease. Current recommendations suggest a population-based approach to dietary modifications; the public health implications of this approach are discussed.
Breast Neoplasms↗
[The case of Maria Theresia Paradis (1759-1824). On the treatment of (hysterical?) amaurosis in a musician with music and suggestion].
The musician and composer Maria Theresia Paradis (1759-1824) blind since her earliest childhood was treated in 1777 by the physician Dr. Franz-Anton Mesmer (1734-1815). The treatment he used was the so-called "magnetic therapy". This was a suggestive psychotherapeutical method by which, as he thought, the amaurosis could be cured. The most essential agency of this "magnetic therapy" was music. However, the resistance of both his colleagues and the patient's family forced him to break off the therapy. Maria Theresia Paradis remained blind till the end of her life. The genesis of the amaurosis, the problem of a real therapeutical influence by Mesmer and, especially, the relationship between the music as a therapeutical medium and the musical personality of the patient are discussed in detail. The whole care cannot be cleared up definitively. There are many indications that Mesmer succeeded in improving temporarily a hysterical amaurosis of Maria Theresia Paradis.
Austria↗
Geographical distribution of diabetes among the native population of Canada: a national survey.
The prevalence of diagnosed diabetes was determined for 76% of the registered Indian and Inuit (Eskimo) population of Canada from case registers maintained by the federal agency responsible for Indian health services. A total of 5324 cases were ascertained. The age-sex adjusted rate varied among the Indians from a low of 0.8% in the Northwest Territories to a high of 8.7% in the Atlantic region. Among Inuit, the prevalence was 0.4%. Most cases occur in middle-aged or older individuals, with a higher prevalence among Indian (but not Inuit) females. An ecologic analysis was performed with the crude prevalence of individual communities regressed upon independent variables that included longitude, latitude, geographic isolation, culture area, and language family. Stepwise regressions were also carried out within the Algonkian, Athapaskan, and Eskimoan language families. For the national sample, composite language phylum-culture area predictors were used. The results in the national sample confirmed most findings in the individual language family analysis. Six predictors: latitude, Northeast-Algonkian, Northeast-Iroquoian, Subarctic-Algonkian, Plains-Siouan, and Plains-Algonkian, ranked here in decreasing order of importance, explained 48.4% of the variation in diabetes prevalence. All the named groups had rates significantly greater than found in the reference group of Arctic-Eskimoans. We conclude that the distribution of diabetes among Canadian natives is determined by both genetic and environmental factors.
Aged↗
Public awareness of organ donation.
A telephone survey of public attitudes toward organ donation and transplantation was conducted in a community in southwestern Ontario. The subjects were selected at random; the response rate was 57%. Of the 50 respondents 62% stated that they had signed the organ donor card accompanying their driver's licence. These respondents were more likely than those who did not sign it to have discussed organ donation with their families. At least 80% of the respondents said they would agree to donate their organs and those of their next-of-kin, and 80% said that the organ donor card should be considered a legal document. Organ transplantation was regarded by all but one respondent as an acceptable medical procedure. Also discussed were concerns about organ donation and possible strategies to improve the availability of organs for transplantation.
Adult↗
Alternatives in drug treatment of chronic paroxysmal hemicrania.
Indomethacin is the drug of first choice in chronic paroxysmal hemicrania with clear relief of pain as a diagnostic criterion. In a few cases, indomethacin is not tolerated because of side effects. Therefore, the efficacy of carbamazepine, verapamil, sumatriptan, acetylsalicylic acid, and oxygen as drugs in the prophylactic or acute treatment of chronic paroxysmal hemicrania was studied in a prospective open trial with 10 patients suffering from chronic paroxysmal hemicrania. The trial results, in accordance with a review of the literature, suggest that acetylsalicylic acid (and probably naproxen and diclofenac) and verapamil are the most effective drugs of second choice in chronic paroxysmal hemicrania. The efficacy of sumatriptan in this condition needs still to be clarified, although there is evidence for partial efficacy. Carbamazepine and oxygen did not show any significant influence on chronic paroxysmal hemicrania.
Adolescent↗
Headache caused by a sphenoid mucocele but presenting as an ergotamine-induced headache.
In a 65-year-old woman, symptomatic headache caused by a mucocele of the sphenoid sinus led to ergotamine abuse and subsequent ergotamine-induced headache. Since there were no neurological symptoms initially and the patient previously suffered from migraine, the mucocele was not recognized. Only after unsuccessful drug withdrawal therapy and an MRI, was the correct diagnosis made. Surgical removal of the mucocele led to complete relief of headache within 3 weeks. We conclude that ergotamine-induced headache can develop on the basis of symptomatic headache. In spite of the effectiveness of ergotamine tartrate, an MRI should be performed if focal neurological symptoms occur.
Aged↗
Pharmacologic treatment of central post-stroke pain.
OBJECTIVES: Almost 100 years after the first report of the thalamic syndrome, the scientific basis for the treatment of central post-stroke pain (CPSP) is remarkably small. Therefore, the authors aimed to provide evidence-based recommendations for the treatment of CPSP. METHODS: The authors performed a systematic review of the literature on the pharmacologic treatment of CPSP. All studies and case series were included and evaluated according to their level of evidence. Only CPSP was considered, not other types of central pain. RESULTS: Amitriptyline and lamotrigine are the only oral drugs proven to be effective in the treatment of CPSP in a placebo-controlled study. IV drugs such as lidocaine, propofol, and ketamine have shown efficacy for short-term control of CPSP, but their application and potential side effects make them unsuitable for long-term treatment. The novel antiepileptic drug gabapentin has been reported to control CPSP in a few patients. CONCLUSIONS: Amitriptyline, lamotrigine, and gabapentin provide a more favorable efficacy and safety profile than the classic antiepileptic drugs carbamazepine and phenytoin, for which no placebo-controlled evidence of efficacy was found. Clinical trials are urgently needed to optimize pharmacologic treatment of CPSP.
Administration, Oral↗
The usefulness of ratios for allocation decisions: the case of stroke.
Economic evaluation is becoming increasingly important in the field of stroke as well. The results of economic evaluation can be expressed in cost per quality-adjusted life years (QALY) gained, which enables policy makers to compare the relative efficiency of different interventions regarding different diseases. Although using the concept of QALY is preferable from a theoretical point of view, in medical practice more often cost-effectiveness analysis (CEA), and not cost-utility analysis, is applied for practical reasons. One of the main limitations of CEA is that the results may be compared only with results of other CEAs, using the same effect parameter. The calculation of cost-effectiveness ratios (CERs) in many cases is misleading for resource allocation. Effects should be expressed in interval or ratio scales in order to calculate CERs, which is rarely the case. The calculation of a CER in a CEA should only be performed if, and only if, the investigator is convinced that there is a constant relation between the specific effect parameter and the ultimate gain in health.
Cost-Benefit Analysis↗
Peripartal temporal course of endothelin 1, angiotensin II, and atrial natriuretic peptide in pre-eclampsia and normotensive pregnancy.
OBJECTIVE: To investigate the temporal peripartal course of plasma endothelin 1 (ET-1), angiotensin II (ANG II), and atrial natriuretic peptide (ANP) in patients with pre-eclampsia as compared to women with normotensive pregnancy. METHODS: Levels of ET-1, ANG II, and ANP were measured by means of radio-immunoassay twice a week in 17 patients with pre-eclampsia and in 17 women with normotensive uncomplicated pregnancy during four different periods: (a) from admission to 1 week before delivery, (b) 1st week before delivery, (c) 1st week after delivery, and (d) 2nd week after delivery. RESULTS: ET-1 levels were not statistically different between the two groups. ANG II concentrations were lower in the pre-eclampsia group than in the control group with statistical significance in period c (2.8 +/- 3.0 vs. 7.1 +/- 5.9 pg/ml, mean +/- SD). ANP levels were higher in pre-eclamptic women than in the control group, the difference being statistically significant in period a (54 +/- 46 vs. 11 +/- 16 pg/ml) and in period c (122 +/- 134 vs. 39 +/- 22 pg/ml). CONCLUSIONS: There are considerable differences in ANP and ANG II concentrations during the peripartal period between patients with pre-eclampsia and normotensive pregnant women. Decreased ANG II and elevated ANP levels in the 1st week postpartum may reflect the clinical observation that some women deteriorate in this period.
Adult↗
Drug treatment of migraine in children: a comparative review.
Migraine according to the criteria of the International Headache Society, occurs in about 3 to 7% of all children. Despite this high incidence, and unlike the situation with adult migraine, only a very few controlled trials have investigated the acute and prophylactic treatment of migraine in children. In the acute migraine attack, ibuprofen 10 mg/kg and paracetamol (acetaminophen) 15 mg/kg have been shown to be effective, with only a few adverse effects. In severe migraine attacks, dihydroergotamine mesylate (dihydroergotamine) administered orally (20 to 40 microg/kg) or intravenously (maximum 1 mg/day) may be helpful, but there have been no large placebo-controlled trials of this treatment. Oral sumatriptan has not been effective in several double-blind and placebo-controlled trials; administered subcutaneously, this drug might be helpful but the only data for this application come from open trials. For migraine prophylaxis, only flunarizine 5 mg/day has been shown to be effective in more than 1 double-blind, placebo-controlled trial. Some evidence also exists that propranolol >60 mg/day and pizotifen 0.5 to 1.5 mg/day are effective; however, the results from different trials are contradictory. For all other drugs studied in migraine prophylaxis, the results remain vague (e.g. amitriptyline, nimodipine, trazodone) or suggest inefficacy (e.g. timolol, clonidine, tryptophan). In migraine-related disorders, pizotifen 0.5 to 0.75 mg/day for abdominal migraine and flunarizine 10 to 25 mg/day for alternating hemiplegia have been shown to be effective. Most of the drugs used in the treatment of migraine in children are well tolerated and without relevant adverse effects. In migraine prophylaxis, the most common adverse effects are drowsiness and bodyweight gain.
Child↗
Sumatriptan and ergotamine overuse and drug-induced headache: a clinicoepidemiologic study.
Drug-induced headache, particularly ergotamine-induced headache, is a common problem in migraine treatment. Some case reports suggest that even the new serotonergic antimigraine drugs such as sumatriptan can lead to overuse and subsequent drug-induced headache. We performed a controlled study to identify the rate of sumatriptan overuse and sumatriptan-induced headache and compared it to the rate of ergotamine overuse and ergotamine-induced headache. Two thousand sixty-five consecutive heachache patients, all experienced in intake of sumatriptan (n = 631) or ergotamine (n = 620), were enrolled over a three-year study period. The rates of overuse and drug-induced headache and the clinical features of the subgroups were compared. Risk factors for sumatriptan overuse were identified. The rates of ergotamine and sumatriptan overuse were 14.2% and 3.5%, respectively (p < 0.001). Drug-induced headache could be found more frequently in cases of ergotamine overuse than in cases of sumatriptan overuse (68% versus 32%; p < 0.01). Development of sumatriptan overuse was most common in patients with previous drug-induced headache (68%), combined headache as the primary headache type (45%), and subcutaneous application of sumatriptan (45%). We conclude that sumatriptan intake can lead to overuse and subsequent drug-induced headache. The risk for overuse and drug-induced headache is significantly lower than in patients with ergotamine intake. This might be caused in part by the relatively short period of sumatriptan availability on the market. The new generation of serotonin-1B/D-receptor agonists in the treatment of headache should have a potential for overuse similar to that of traditional headache drugs.
Adult↗
Eating and smoking behaviours of school children in southwestern Ontario and Charlottetown, PEI.
We conducted in-class written surveys of fourth to eighth grade children's eating and smoking behaviours in southwestern Ontario (n = 870) and Charlottetown (n = 423) in order to facilitate local school boards' and health units' planning of health education initiatives. Using chi-square analysis, we examined sex, grade, provincial and rural-urban differences in behaviours. No rural-urban differences emerged. While students reported few gender differences in food group consumption, more PEI students consumed French fries, snack foods, cakes and cookies, and regular soft drinks daily. Only 60.1% (379/630) of girls and 70.0% (462/660) of boys (chi 2 = 13.8; p < 0.001) ate breakfast every day, falling to 53.2% (115/216) among eighth grade girls, and 32.9% (25/76) among students who smoked. The prevalence of smoking was 4.8% (n = 40) in Ontario and 8.5% (n = 36) in PEI (chi 2 = 6.8; p < 0.01). Compared to non-smokers, a higher proportion of students who smoked consumed snack foods and regular soft drinks daily. The results emphasize the need to promote healthy eating behaviours and anti-smoking messages among school children.
Adolescent↗
[Music for rheumatism--a historical overview].
The history of the use of music to lessen the pain of rheumatism is seen in the use of musical therapy in medicine as a whole. Sources citing the use of music specifically in rheumatism are rare; often, rather than rheumatism, terms like "gout (podagra)" or "joint-pain" are mentioned. This is connected with the obscure and pathognomic perceptions of rheumatism. In the archeo-medicine and for primitive cultures the considered potency of music was primarily dominated by animistic thinking. In antiquity humoral pathology developed a philosophy that tried to explain the benefits of music, even for rheumatism, but found little acceptance. In the Middle Ages and in the Baroque period iatromechanistic conceptions determined music as useful in fight against pain. In the Romantic period there was speculation about music as a causal therapy, but it was shortlived. In the 20th century music is applied as an active therapy in the care of persons suffering from rheumatism; its empiric success as a remedy in rehabilitative and palliative therapy is recognized.
Arthritis, Gouty↗
The prevalence of diabetes in Indians and Caucasians living in southwestern Ontario.
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Adolescent↗
Lower respiratory disease in Indian and non-Indian infants.
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Child↗
[Epidemiology and therapy of Parkinson disease in inpatient nursing homes].
In 12 nursing homes for older people epidemiological and therapeutic data of patients with Parkinson's disease were collected. The mean rate of Parkinson's disease in all inhabitants was 12.5%, the mean clinical disability was 15.3 +/- 4.5 (Webster score). The mean age was very old (81.3 +/- 7.8 years). All patients showed one or more different diseases. The medical treatment was often not in agreement with symptoms. Physical therapy was applied only in 33% of patients. These and further data support the thesis that patients with Parkinson's disease in nursing homes may benefit from therapeutic patterns.
Activities of Daily Living↗
Influences on breastfeeding rates in low income communities in Ontario.
The purpose of this paper was to identify factors associated with breastfeeding among mothers of children born in 1994 in five of the low income communities participating in the longitudinal prevention initiative "Better Beginnings, Better Futures." Household income was < or = poverty line for 76%, 63% had completed high school or beyond, and 29% were born outside of Canada. The breastfeeding initiation rate was 77% (380 of 493). Of the 270 women who initiated breastfeeding and were interviewed up to five months postpartum, 63% continued for at least three months. Women with higher education, married, not experiencing financial stress and who attended prenatal classes were more likely to initiate breastfeeding. Continuation of breastfeeding was associated with older age, higher education, not smoking, and participation in a home visitor program. Breastfeeding promotion strategies should include ongoing support as well as education components.
Breast Feeding↗