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PubMed1997

Aspiration in a patient receiving enteral nutrition.

This case was selected to illustrate the advantages of an interdisciplinary team approach when the aspiration risks of enteral tube feeding are examined for patients with multisystem involvement. The case reviews a 79-year-old widowed woman with a cervical 6 to 7 spinal cord injury requiring mechanical ventilation and enteral feeding. The patient had multiple complications that prolonged her hospital course and required interdisciplinary involvement of medical, nutrition, nursing, respiratory, and speech pathology services. After an initial stay at another hospital, she was admitted to Providence Saint Joseph Medical Center (PSJMC) Acute Rehabilitation and Intensive Care Units. The patient was transferred home with PSJMC Home Health Services, and her case was part of a continuous quality improvement (CQI) project population group of ventilator-dependent patients. The purpose of the interdisciplinary CQI team was to enhance nutrition intervention, improve patient outcomes, and reduce costs. This teaching case has added to the body of information being evaluated by the CQI team on nutrition intervention of ventilator-dependent patients.

Aged↗
PubMed1991

Differences in the luteinizing hormone and prolactin responses to multiple injections of kainate, as compared to N-methyl-D,L-aspartate, in cycling rats.

We have previously reported that repetitive iv injections of NMA [N-methyl-D,L-aspartate, the mixed analog acting on the N-methyl-D-aspartate (NMDA) receptor] can induce a consistent increase in LH and PRL secretion in cycling rats, but not in lactating rats. To further explore the use of excitatory amino acids (EAAs) as tools for understanding the regulation of the neuroendocrine reproductive axis, we have examined the effects of multiple injections of kainate, an agonist to another subclass of EAA receptor, on LH and PRL secretion in cycling rats. Recent studies suggest that kainate receptors may be more abundant than NMDA receptors in the hypothalamus. Five iv injections of kainate were administered at 50-min intervals to diestrous or estrous rats. Blood samples were collected every 10 min and assayed for LH and PRL. LH, but not PRL secretion, was stimulated by this regimen of kainate treatment. Surprisingly, the LH response to kainate, unlike NMA, decreased with repetitive injections of the drug. The response to the last pulse of kainate was approximately 30-40% of the first pulse. This decline in LH responsiveness to kainate was not due to desensitization at the level of the pituitary or to refractoriness of GnRH neurons, since further stimulation of LH release could be obtained by the administration of GnRH or NMA. The mechanisms responsible for the diminishing GnRH response to kainate remain unclear. However, we speculate that it might be due to the delayed activation of inhibitory inputs to GnRH neurons or to the desensitization of kainate receptors. On the other hand, the absence of a PRL response to kainate, in contrast to the stimulatory effect of NMA, most likely reflects differences in the distribution of kainate and NMDA receptors on dopamine neurons and neurons containing PRL-releasing factors, or on extrahypothalamic afferent neuronal populations projecting to the hypothalamus. In conclusion, the effects of systemic injections of kainate on LH and PRL secretion differed from NMA in that the LH response could not be sustained with multiple injections and PRL was unresponsive to kainate stimulation.

Animals↗
PubMed1990

Morphological aspects of the human vestibular nerve.

A quantitative study was made of the number of fibers, their diameters, and distribution in the nerves innervating individual vestibular receptor organs of three human temporal bones. The specimens were obtained from autopsies conducted within 4 hours postmortem. The temporal bones containing the nerves were fixed in 3% glutaraldehyde and decalcified with EDTA until they were soft enough to allow dissection of the nerve branches to the individual receptors. The nerve branches were processed for osmium staining, embedded in plastic, and cut serially in 1-micron-thick sections for light-microscopic histologic evaluation of their fiber composition. Quantitative evaluation of nerve-fiber characteristics was made with the aid of a laboratory computer and programs for graphic representation and statistical analysis. In the nerves to the individual cristae the number of fibers ranged between 1416 and 2335. Fibers with diameters between 2.5 microns and 3 microns were the most numerous. The number of fibers decreased exponentially with increased size. The thickest fibers had diameters up to 11.5 microns. The distribution of fibers in the nerve of each crista was different for the central and intermediate areas of the crista than it was for the ends. Thin fibers with diameters less than 2.5 microns, which represented 36% of the population, projected to the ends of the receptor area. Thick fibers with diameters greater than 4.5 microns, which represented 8% of the fibers, were distributed relatively uniformly except for the extreme ends of the crista, where they were nearly absent. Fibers with intermediate diameters were distributed throughout the crista, although they were more concentrated at the ends. In the nerves to three maculae, the number of fibers ranged from 3744 to 5538. The percentage of fibers of each size, however, was similar to that in the cristae. The greater portion of fibers had diameters between 3.0 microns and 3.5 microns. Because of the anatomical configuration of the maculae, it was not possible to compare fiber diameters from one area to another. The composition and differential projection of fibers to the crista in the human labyrinth were similar to those found earlier in squirrel monkeys and bullfrogs. On the basis of these similarities in the pattern of innervation, it is suggested that the physiological properties in humans must be similar to those in animals.

Aged↗
PubMed2005

Anticipating change: how many acute care hospital beds will Manitoba regions need in 2020?

Being able to anticipate future needs for health services presents a challenge for health planners. Using existing population projections, two models are presented to estimate the demand for hospital beds in regions of Manitoba in 2020. The first, a current-use projection model, simply projects the average use for a recent 3-year period into the future. The second, a 10-year trend analysis, uses Poisson regression to project future demand. The current-use projection suggests a substantial increase in the demand for hospital beds, while the trend analysis projects a decline. The last projections are consistent with ongoing increases in rates of day surgeries and declines in lengths of stay. The current-use projections need to be considered in the context of relatively low occupancy rates in rural hospitals and previous research on appropriateness of stays in acute care hospitals. If measures are taken to ensure more appropriate use of acute care hospital beds in the future, then the current-use projections of bed shortages are not a cause for concern.

Acute Disease↗
PubMed1989

[A questionnaire about the dental treatment for visiting patients at welfare center for the aged people].

A questionnaire about the dental treatment for visiting patients at Welfare center for the aged people. Nowadays, 11 percent of the population is over 65 in Japan. According to the Minister of Health and Welfare's Population Projection for Japan, it will grow to 20% at the beginning of the 21st century. Problems concerning old people will become some of Japan's biggest challenges. In that situations, the dental treatments for visiting aged patients will become more important. Then, authors sent out a questionnaire about it on aged people who have no need of anyone's assistance in their home lives. And we examined concrete countermeasures and problems about the dental treatments for visiting patients. The findings were as follows: 1. Even the aged people who have no need of anyone's assistance in their home lives, they hope much carrying out the dental treatments for visiting them. 2. The dental treatments for visiting aged patients have some problems. But it will become one of the most important way to supply their demand for dental treatments, in spite of their latent requirements, a lot of old people give up to undergo dental treatments.

Aged↗
PubMed2001

Comparison of F1 Bos indicus x Hereford cows in central Texas: II. Udder, mouth, longevity, and lifetime productivity.

Postpartum udder characteristics, aged mouth condition scores, and cow survival, longevity, and productivity were evaluated for 15 yr on F1 cows in central Texas (temperate winters and subtropical summers). The cows (n = 116) were progeny of Angus, Gray Brahman, Gir, Indu-Brazil, Nellore, and Red Brahman sires and Hereford dams. Crossbred cows sired by Nellore had smaller (P < 0.05) postpartum teat length than cows of all other crossbred groups and smaller (P < 0.10) postpartum teat diameter than Indu-Brazil and Red Brahman crossbreds. The Nellore crossbred cows had larger (P < 0.10) postpartum udder support scores (more well-supported udders) than Gir, Indu-Brazil, and Red Brahman crossbreds. As 14-yr-old cows, Angus crossbreds had lower (P < 0.05) mouth scores (indicative of one or more missing incisors) than Bos indicus crossbreds. Under actual and artificial (records were removed) culling procedures, Nellore crossbreds had the highest cow survival to age 14 and the highest longevity. Indu-Brazil crossbreds tended to be the lowest for both survival and longevity. Curves were fitted by nonlinear regression procedures to the adjusted frequencies of cows remaining at each age; scale and shape parameters were estimated and compared for the different breed groups. Breed group cow survival rates, calf crop weaned, and calf weaning weights were used 1) to construct population projection and production matrices for each breed group and 2) to generate breed group vectors containing projected age distributions and production information. Cows sired by Nellore and Gir were projected to require the fewest purebred cows to generate replacement heifers and to have the most calves and the largest total calf weight sold per year.

Animals↗
PubMed2000

Methods for estimating the number of "hard-core" drug users.

This article reviews methods used to estimate the number of "hard-core" drug users. Synthetic estimation methods include the population projection method, which extrapolates from areas where prevalence is known to other areas, and the principal component method, which uses relationships observed among multiple indicators to obtain a single indicator of drug use. Small area estimations project risk estimates developed from small area surveys to larger areas, and capture-recapture methods provide reliable estimates only if the underlying assumptions are met. In making estimates, researchers should understand the limitations of the data and changes in drug use patterns. The challenge for future research is to refine each method and then to combine the strengths of each to produce the best estimates possible.

Epidemiologic Studies↗
PubMed1998

Health promotion partnerships: service and education addressing the health needs of vulnerable groups.

This paper describes partnerships between service and education that can assist in meeting the health care needs of vulnerable population groups. Baccalaureate nursing students learn about population-based nursing practice as a means of addressing health needs. Each semester, groups of 8-10 senior students work with a community agency serving a population at risk. Students assess health needs and plan, implement, and evaluate a health promotion intervention with the population and the agency. Emphasis is placed on designing culturally appropriate interventions that are accomplished in partnership with the agency and population. Projects which illustrate the generalizability of this approach will be discussed. Such experiences reduce barriers that separate education from practice. Community agencies benefit as health needs that might not otherwise be met are addressed.

Alaska↗
PubMed1989

Geriatric health care. Older patients and medical consumerism.

Aging of the "baby-boom" generation and increased life expectancy will mean a projected population increase of persons 65 and older from 39 to 65 million between 2010 and 2030. Surveys conducted among members of the American Association of Retired Persons (AARP) reflect their wish to establish a more equal part in the physician-patient relationship and to participate in local and federal health care monitoring and reform. Accordingly, many are asking for health information and are prepared to change heretofore ineffectual communication with the health care system--whether in their personal physician's office or at the federal level. Only a fraction of practicing physicians report geriatrics as a primary or secondary specialty. Family practitioners and internists are likely to continue to provide the major share of medical care to the elderly in the future.

Aged↗
PubMed2000

Incidence of erectile dysfunction in men 40 to 69 years old: longitudinal results from the Massachusetts male aging study.

PURPOSE: We estimated the incidence of erectile dysfunction in men 40 to 69 years old at study entry during an average 8.8-year followup, and determined how risk varied with age, socioeconomic status and medical conditions. MATERIALS AND METHODS: Data from a randomly sampled population based longitudinal study of Massachusetts men were analyzed. A total of 1,709 men completed the baseline interview during 1987 to 1989 and 1,156 survivors completed followup from 1995 to 1997. The analysis sample consisted of 847 men without erectile dysfunction at baseline and with complete followup information. Erectile dysfunction was assessed by discriminant analysis of 13 questions from a self-administered sexual function questionnaire and a single global self-rating question. RESULTS: The crude incidence rate for erectile dysfunction was 25.9 cases per 1,000 man-years (95% confidence interval [CI] 22.5 to 29.9). The annual incidence rate increased with each decade of age and was 12.4 cases per 1,000 man-years (95% CI 9.0 to 16.9), 29.8 (24.0 to 37.0) and 46.4 (36.9 to 58.4) for men 40 to 49, 50 to 59 and 60 to 69 years old, respectively. The age adjusted risk of erectile dysfunction was higher for men with lower education, diabetes, heart disease and hypertension. Population projections for men 40 to 69 years old suggest that 17,781 new cases of erectile dysfunction in Massachusetts and 617,715 in the United States (white males only) are expected annually. CONCLUSIONS: Although prevalence estimates and cross-sectional correlates of erectile dysfunction have recently been established, incidence estimates were lacking. Incidence is necessary to assess risk, and plan treatment and prevention strategies. The risk of erectile dysfunction was about 26 cases per 1,000 men annually, and increased with age, lower education, diabetes, heart disease and hypertension.

Adult↗
PubMed1978

[Not Available].

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Bulgaria↗