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PubMed1995

Dietary factors related to preservation of oral and skeletal bone mass in women.

Skeletal bone loss in adults increases the risk of bone fractures and may contribute to the loss of teeth in healthy postmenopausal women. The relationship of skeletal osteopenia to residual ridge resorption is unclear. Low bone mass in women is attributed to heredity, estrogen deficiency, a low lifetime calcium intake, and lack of regular physical activity. A high calcium intake will promote optimal bone growth in youth and decrease the rate of bone loss in the later postmenopausal period. In early menopause, estrogen is the only effective therapy for conserving bone in women. In older women, a high plasma level of vitamin D enhances calcium absorption, whereas high sodium, protein, alcohol, and caffeine intakes will cause increased urinary losses and negative calcium balance. Women who have a low intake of dairy foods may benefit from a refined calcium carbonate supplement that contains vitamin D. This article focuses on the nutritional factors that influence bone health.

Adult↗

PubMed1984

Current concepts in the rehabilitation of the injured athlete.

A comprehensive approach to the rehabilitation of injured athletes necessitates that an injury be treated specifically with appropriate measures to achieve comfort and that early prescription of various exercises be designed to promote optimal healing and a return to function. In addition, the athlete must be assisted to regain and maintain a proper fitness level before returning to a sport. Finally, the prevention of athletic injuries becomes an ongoing concern that necessitates monitoring and education of those involved in sports activities.

Athletic Injuries↗

PubMed2002

Caring for children with advanced cancer integrating palliative care.

The care of children with advanced cancer is multifaceted. Treatment should focus on continued efforts to control the underlying illness whenever possible. At the same time, children and their families should have access to interdisciplinary care aimed at promoting optimal physical, psychological and spiritual wellbeing. Open and compassionate communication can best facilitate meeting the goals of these children and families. However, there remain significant barriers to achieving optimal care related to lack of formal education, reimbursement issues and the emotional impact of caring for a dying child. Future research efforts should focus on ways to enhance communication, symptom management and quality of life for children with advanced cancer and their families. As efforts to break down barriers and create the evidence base continue, we conclude as follows: this is a most rewarding part of the practice of medicine. A kind word and caring attitude are remembered for decades.

Age Factors↗

PubMed1993

Neonatal transport. Outreach educational program.

Neonatal transport is an integral part of a regionalized system of perinatal health care delivery. An effective outreach educational program promotes early identification of high-risk neonates, consultation, communication, and referral. The education offered in several formats also promotes optimal pretransport and intratransport stabilization of referred neonates. This improved stabilization may favorably influence the overall neonatal outcome. The impact of education in the region can be determined by a systematic review of referral patterns, standard of care during stabilization, and neonatal outcome. An organized outreach educational effort is therefore an essential aspect of any neonatal transport program.

Documentation↗

PubMedDate not supplied

Assessing nighttime vigilance through a three-letter cancellation task (3-LCT): effects of daytime sleep with temazepam or placebo.

Nocturnal sleepiness is a common complaint suffered by night-shift workers, especially in conditions of an abrupt shift of the wake-sleep cycle. Alertness management strategies can minimize the adverse effects of sleep loss and circadian rhythm desynchronization and promote optimal vigilance in operational settings. Within these strategies. one possibility is to use short periods of "prophylactic sleep" (before long periods of work), which can be facilitated by hypnotics. Vigilance can be evaluated by means of several tests which, sometimes, imply procedures and devices not easily employable in operational settings. In such conditions pencil and paper tests of vigilance can be very useful in the assessment of attentional performance degradation due to sleep loss and/or inversion of the sleep-wake cycle. In this study we evaluated the sensitivity of a three-Letter Cancellation Task (3-LCT) in revealing nighttime variations of vigilance in a laboratory simulation of acute night shift, after a diurnal sleep with placebo (PLC) or temazepam (TMZ). Nocturnal levels of vigilance were also assessed using the Maintenance of Wakefulness Test (MWT) and the Multiple Sleep Latency Test (MSLT). All tests were administered four times at 2-h intervals during nighttime after a daytime sleep. Results show that the 3-LCT is sensitive to variations of vigilance occurring during a laboratory simulation of acute night shift. We also found some effects of TMZ, which in the first nocturnal session caused a slowing down of visuoattentive performance. Nocturnal variations of vigilance detected through the 3-LCT were similar to those revealed by means of MSLT, while the ability to maintain wakefulness was substantially spared during the night.

Adult↗

PubMedDate not supplied

The importance of self-efficacy expectations in elderly patients recovering from coronary artery bypass surgery.

OBJECTIVE: To describe and test a model of recovery in the elderly after coronary artery bypass surgery derived from Self-Care and Self-Efficacy Theory. DESIGN: Prospective, longitudinal, repeated measures. SETTING: Two large urban teaching hospitals on the East Coast. PATIENTS: One hundred thirty-three adults over the age of 65 years who had coronary artery bypass surgery on hospital admission. There were 32 women and 101 men with an age range of 65 to 87 years (M = 71.8 years +/- 4.8 years) in whom 77.5% were in a New York Heart Association class of 3 or 4, indicating significant functional limitations. OUTCOME MEASURES: Self-care agency, self-efficacy expectations, and the performance of self-care/recovery behaviors at discharge, 6, and 12 weeks after coronary artery bypass surgery. INSTRUMENTS: The exercise of self-care agency was measured with the Exercise of Self-Care Agency Scale, self-efficacy expectation, and the performance of self-care/recovery behavior by the Jenkins Self-Efficacy Expectation Scales and Activity Checklists. Data were collected at discharge, 6 weeks, and 12 weeks after surgery for the specific behaviors of walking, climbing stairs, resuming general activities, and the performance of roles. RESULTS: Repeated measures analysis of variance revealed significant changes in self-care agency, the self-efficacy expectations for all behaviors, and the performance of the behaviors for walking, resuming general activities, and performance of roles over the recovery period (p < 0.01). CONCLUSIONS: In support of the model, self-efficacy expectations mediated between self-care agency and all self-care/recovery behaviors at selected times. Comparison of the performance of self-care/recovery behaviors with other samples from the literature found recovery in the elderly to be protracted. Nurses can be pivotal in providing the elderly with accurate projections of recovery and an environment to support the initial mastery of self-care/recovery behaviors to promote optimal health in this vulnerable population.

Activities of Daily Living↗

PubMed2002

Tactical emergency medical support.

As increases in criminal activity collide with more aggressive law enforcement postures, there is more contact between police officers and violent felons. Civilian law enforcement special operations teams routinely engage suspects in these violent, dynamic, and complex interdiction activities. Along with these activities comes the substantial and foreseeable risk of death or grievous harm to law officers, bystanders, hostages, or perpetrators. Further, law enforcement agencies who attempt to apprehend dangerous, heavily armed criminals with a special operations team that lacks the expertise to treat the medical consequences that may arise from such a confrontation may be negligent of deliberate indifference. Meanwhile, evidence exists within the military, civilian law enforcement, and medical literature that on-scene TEMS serves to improve mission success and team safety and health, while decreasing morbidity and mortality in the event of an injury or illness suffered during operations. National professional organizations within law enforcement and emergency medicine have identified and support the fundamental need for mission safety and the development of a standard model to train and incorporate TEMS into law enforcement special operations. The overall objective of TEMS is to minimize the potential for injury and illness and to promote optimal medical care from the scene of operations to a definitive care facility. The design, staffing, and implementation of a TEMS program that maximally uses the community resources integrates previously disparate law enforcement, EMS, and emergency medical/trauma center functions to form a new continuum of care [55].

Emergency Medical Services↗

PubMed1996

Rehabilitation of the cancer patient at home.

OBJECTIVES: To provide a framework for considering home nursing care of the cancer patient within the context of cancer rehabilitation and to briefly review various aspects of cancer rehabilitation. DATA SOURCES: Review articles and reference books of current and classic works that discuss cancer rehabilitation. CONCLUSIONS: Rehabilitation is an important concept that should transcend cancer care in all settings, and one that naturally fits with home care. The effects of cancer and cancer treatment on the individual's quality of life, eg, psychological and social factors, sexual functioning, nutrition, fitness and exercise, symptom management, and physical disabilities are important considerations in the rehabilitation needs of persons with cancer. IMPLICATIONS FOR NURSING PRACTICE: It is the challenge of the home health nurse to promote optimal functioning of cancer patients in their home environment. Assessment of the cancer patient's rehabilitation needs, skilled interventions, establishment of realistic goals, and coordinating care between members of the rehabilitation team are major responsibilities.

Activities of Daily Living↗

PubMed1990

Alzheimer's disease: a disabling neurophysiological disorder with complex nursing implications.

Alzheimer's Disease (AD) is a very complex and devastating disorder of the brain that affects over 2 million people in the United States, mostly over age 65. Approximately one-half are taken care of at home by family members; the remainder are in institutions. Nearly 120,000 deaths are attributed to AD annually. While biomedical research continues to make headway in uncovering factors related to the disease, the causes, and therefore, the treatment remain just beyond our reach. In the meantime, persons with AD, their family members, and professional caregivers must learn to cope with this disabling disease on a day-to-day basis while waiting for a breakthrough. AD is characterized by a gradual decline in mental status and functional abilities over an extended period of time, from as short as 1 year to as long as 10 years or more. Eventually, all components of cerebral functioning are altered, with the neuronal losses exhibited at the cognitive and behavioral level. The nature and degree of decline depends on the extent of the progression of neuronal deterioration and, therefore, varies widely from patient to patient. The complex interactional patterns of pathophysiological brain changes and the concomitant cognitive/behavioral manifestations present careplanning and caregiving dilemmas. On the one hand, it is our responsibility as nurses to treat patients and teach others to care for patients in the least restrictive environment possible, while maintaining a choice of options, promoting optimal functioning, and fostering independence in the patient.(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗

PubMed1996

Psychological approaches to the management of pain in patients with advanced cancer.

Although extremely valuable, cognitive-behavioral interventions are always integrated with and should never be a substitute for appropriate and comprehensive medical management. Cancer-related pain and associated distress significantly challenge the physical and mental well-being of patients with advanced cancer and their families. As patient demands require greater vigilance in the management of noxious symptoms, families have a parallel need for emotional support and the acquisition of coping skills. Under ideal circumstances, coping skills are taught to the patient and family when psychic and physical energy are relatively high. Consequently, these skills should be incorporated into the early phases of care, prior to advanced diseases or the final stages of the illness. Cognition, behaviors, and feelings are negatively affected by chronic illness, resulting in an overall diminution of psychic energy, coping, and adaptation. Patients frequently manifest symptoms and maladaptive behaviors that require specialized interventions to restore a sense of focus and control. Cognitive-behavioral interventions are uniquely suited to address the most common psychological and emotional problems of patients with advanced cancer and their families. As an adjunct to medical care, cognitive-behavioral interventions promote optimal functioning through the encouragement of active participation in the control of symptoms and acquisition of specific skills that increase self-efficacy and hope.

Adaptation, Psychological↗

PubMed2003

The role of the critical care nurse in the assessment and management of the patient with severe sepsis.

Sepsis with acute organ dysfunction is common, frequently fatal, and expensive. The critical care nurse is involved in the continuous bedside care of the critically ill patient; consequently, he or she has the opportunity to prevent sepsis through infection control practices and general nursing care, to identify patients at risk for the disease, to monitor these patients for the clinical signs of sepsis, and to detect developing organ dysfunction as a manifestation of severe sepsis. In addition, the nurse is responsible for monitoring the patient's response to organ support measures and specific antisepsis interventions. The role of the critical care nurse in the assessment and management of severe sepsis is significant and can greatly improve outcomes for the patient with this disease. Drotrecogin alfa (activated) is a promising new therapy in the treatment of severe sepsis. Nurses caring for patients with this disease need to understand the issues related to the administration of drotrecogin alfa (activated) and the monitoring of patients receiving this drug to promote optimal and appropriate use of this innovative therapy.

Anti-Infective Agents↗

PubMed2000

Effects of epigallocatechin gallate and quercetin on oxidative damage to cellular DNA.

Phenolic phytochemicals are thought to promote optimal health, partly via their antioxidant effects in protecting cellular components against free radicals. The aims of this study were to assess the free radical-scavenging activities of several common phenolic phytochemicals, and then, the effects of the most potent phenolic phytochemicals on oxidative damage to DNA in cultured cells. Epigallocatechin gallate (EGCG) scavenged the stable free radical, alpha,alpha-diphenyl-beta-picrylhydrazyl (DPPH), most effectively, while quercetin was about half as effective. Genistein, daidzein, hesperetin, and naringenin did not scavenge DPPH appreciably. Jurkat T-lymphocytes that were pre-incubated with relatively low concentrations of either EGCG or quercetin were less susceptible to DNA damage induced by either a reactive oxygen species or a reactive nitrogen species, as evaluated by the comet assay. More specifically, control cells had a comet score of only 17+/-5, indicating minimal DNA damage. Cells challenged with 25 microM hydrogen peroxide (H(2)O(2)) or 100 microM 3-morpholinosydnonimine (SIN-1, a peroxynitrite generator) had comet scores of 188+/-6 and 125+/-12, respectively, indicating extensive DNA damage. The H(2)O(2)-induced DNA damage was inhibited with 10 microM of either EGCG (comet score: 113+/-23) or quercetin (comet score: 82+/-7). Similarly, the SIN-1-mediated DNA damage was inhibited with 10 microM of either EGCG (comet score: 79+/-13) or quercetin (comet score: 72+/-17). In contrast, noticeable DNA damage was induced in Jurkat T-lymphocytes by incubating with 10-fold higher concentrations (i.e., 100 microM) of either EGCG (comet score: 56+/-17) or quercetin (comet score: 64+/-13) by themselves. Collectively, these data suggest that low concentrations of EGCG and quercetin scavenged free radicals, thereby inhibiting oxidative damage to cellular DNA. But, high concentrations of either EGCG or quercetin alone induced cellular DNA damage.

Antioxidants↗

PubMed2004

Towards a systems biology understanding of human health: interplay between genotype, environment and nutrition.

Sequencing of the human genome has opened the door to the most exciting new era for the holistic system description of human health. It is now possible to study the underlying mechanisms of human health in relation to diet and other environmental factors such as drugs and toxic pollutants. Technological advances make it feasible to envisage that in the future personalized drug treatment and dietary advice and possibly tailored food products can be used for promoting optimal health on an individual basis, in relation to genotype and lifestyle. Life-Science research has in the past very much focused on diseases and how to reestablish human health after illness. Today, the role of food and nutrition in human health and especially prevention of illness is gaining recognition. Diseases of modern civilization, such as diabetes, heart disease and cancer have been shown to be effected by dietary patterns. The risk of disease is often associated with genetic polymorphisms, but the effect is dependent on dietary intake and nutritional status. To understand the link between diet and health, nutritional-research must cover a broad range of areas, from the molecular level to whole body studies. Therefore it provides an excellent example of integrative biology requiring a systems biology approach. The current state and implications of systems biology in the understanding of human health are reviewed. It becomes clear that a complete mechanistic description of the human organism is not yet possible. However, recent advances in systems biology provide a trajectory for future research in order to improve health of individuals and populations. Disease prevention through personalized nutrition will become more important as the obvious avenue of research in life sciences and more focus will need to be put upon those natural ways of disease prevention. In particular, the new discipline of nutrigenomics, which investigates how nutrients interact with humans, taking predetermined genetic factors into account, will mediate new insights into human health that will finally have significant positive impact on our quality of life.

Environment↗

PubMed1997

Is group selection a factor modulating the virulence of RNA viruses?

RNA viruses consist of populations of extremely high genetic heterogeneity called quasispecies. Based on theoretical considerations, it has been suggested that the unit of selection in such complex genetic populations is not the single viral particle but a set of genetically related particles which form the quasispecies. In the present study we carried out a set of experiments with the vesicular stomatitis virus (VSV) dealing with the evolution of life-history characters under selection acting at two factors either in the same or in opposite directions. The two factors at which selective pressure is applied are the individual and the group. We show evidence that group selection modulates the virulence of VSV populations, in opposition to an unlimited increase in virulence by competitive optimization promoted by individual selection. The results are of relevance for understanding the evolution of parasite virulence.

Genetics, Population↗

PubMed2000

The role of early experience in shaping behavioral and brain development and its implications for social policy.

This article provides a targeted review of the scientific literature on the effects of experience on early brain and behavioral development and later outcome as it pertains to risk for some forms of child psychopathology. It is argued that ample evidence exists indicating that the prenatal and early postnatal years likely represent a sensitive period with respect to the effects of stress on the developing nervous system and behavioral outcome, and with respect to the long-term beneficial effects of early interventions on brain and behavioral development for some genetically based disorders, such as phenylketonuria and autism. Moreover, evidence suggests that parental mental health during the first years of life has a significant influence on early brain activity and behavior, and long-term behavioral outcome. It is concluded that, although prevention and early intervention efforts should not exclusively focus on the earliest years of development, such efforts should begin during this period. By directing such efforts toward promoting optimal prenatal and infant-toddler development, the long-term negative consequences of factors that have their greatest influences during early development and which set the stage for future development can be minimized or avoided entirely. Several recommendations for public policy and future research pertaining to the effects of early experience on child outcome are offered.

Age Factors↗

PubMed1986

Correlation between sites of limited proteolysis and segmental mobility in thermolysin.

Limited proteolysis or autolysis of thermolysin under different experimental conditions leads to fission of a small number of peptide bonds located in exposed surface segments of the polypeptide chain characterized by highest mobility, as given by the temperature factors (B values) determined crystallographically [Holmes, M.A., & Matthews, B.W. (1982) J. Mol. Biol. 160, 623-639]. Considering also similar findings observed previously with other protein systems, it is proposed that this correlation between segmental mobility and sites of limited proteolysis in globular proteins is quite general. Thus, flexibility of the polypeptide chain of a globular protein at the site of proteolytic attack promotes optimal binding and proper interaction with the active site of the protease. These findings emphasize that apparent thermal motion seen in protein crystals is relevant to motion in solution and appear to be of general significance in protein-protein recognition processes.

Amino Acid Sequence↗

PubMed1990

Mechanism of activation of cholera toxin by ADP-ribosylation factor (ARF): both low- and high-affinity interactions of ARF with guanine nucleotides promote toxin activation.

Activation of adenylyl cyclase by cholera toxin A subunit (CT-A) results from the ADP-ribosylation of the stimulatory guanine nucleotide binding protein (GS alpha). This process requires GTP and an endogenous guanine nucleotide binding protein known as ADP-ribosylation factor (ARF). One membrane (mARF) and two soluble forms (sARF I and sARF II) of ARF have been purified from bovine brain. Because the conditions reported to enhance the binding of guanine nucleotides by ARF differ from those observed to promote optimal activity, we sought to characterize the determinants influencing the functional interaction of guanine nucleotides with ARF. High-affinity GTP binding by sARF II (apparent KD of approximately 70 nM) required Mg2+, DMPC, and sodium cholate. sARF II, in DMPC/cholate, also enhanced CT-A ADP-ribosyltransferase activity (apparent EC50 for GTP of approximately 50 nM), although there was a delay before achievement of a maximal rate of sARF II stimulated toxin activity. The delay was abolished by incubation of sARF II with GTP at 30 degrees C before initiation of the assay. In contrast, a maximal rate of activation of toxin by sARF II, in 0.003% SDS, occurred without delay (apparent EC50 for GTP of approximately 5 microM). High-affinity GTP binding by sARF II was not detectable in SDS. Enhancement of CT-A ADP-ribosyltransferase activity by sARF II, therefore, can occur under conditions in which sARF II exhibits either a relatively low affinity or a relatively high affinity for GTP. The interaction of GTP with ARF under these conditions may reflect ways in which intracellular membrane and cytosolic environments modulate GTP-mediated activation of ARF.

ADP-Ribosylation Factors↗

PubMed1999

Factor VIIa's first epidermal growth factor-like domain's role in catalytic activity.

Factor VIIa-tissue factor complex formation initiates the extrinsic blood coagulation pathway. We investigated factor VIIa's first epidermal growth factor-like (egf1) domain's role in the catalytic activity increase caused when factor VIIa binds tissue factor. Starting with a factor VIIa with factor IX's egf1 domain (factor VII(IXegf1)a), we made 4 proteins with egf1 residues changed to those in factor VIIa, including E51A, D64Q, FG74-75PA, and K79R. We measured each enzyme's affinity for tissue factor and determined the enzymes' kinetic constants with and without tissue factor. The Kd for factor VII(IXegf1)a binding to tissue factor was 60-200-fold higher than that of factor VIIa depending on the assay employed. Only factor VII(IXegf1)a with the K79R (K79Ra) mutation, among all the mutants, had an effect on binding with a Kd 3-8-fold lower than that of factor VII(IXegf1)a. In kinetic analyses with a small peptide substrate, in the absence of tissue factor, factor VIIa, factor VII(IXegf1)a, and K79Ra had similar kcat's and Km's. With tissue factor, due to a kcat decrease, factor VII(IXegf1)a's catalytic efficiency (kcat/Km) was 2-fold lower than factor VIIa's. K79Ra's catalytic efficiency was intermediate between those of factor VIIa and factor VII(IXegf1)a. With factor X as substrate, in the absence of tissue factor, K79Ra and factor VII(IXegf1)a had catalytic efficiencies 1.5-fold and 2-fold lower than that of factor VIIa. In contrast, with tissue factor and with factor X as substrate, due to higher Km's, factor VII(IXegf1)a and K79Ra had only 9% and 33% of factor VIIa's catalytic efficiency. Our results suggest the egf1 domain's role in tissue factor binding involves critical alignment of tissue factor with factor VIIa's catalytic domain. Proper alignment in turn promotes optimal catalytic activities.

Amino Acid Substitution↗