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Urinary incontinence, a common morbid, and costly phenomenon, is frequently viewed by both patient and clinician as an inevitable consequence of aging. However, we are learning that, with careful evaluation and therapy, incontinence can be improved or even cured in a high percentage of cases. The benefits of appropriate diagnostic and therapeutic programs to both patient and society are highly significant.
The shipscrapping industry in Taiwan is located at Kaohsiung harbor. The scrapping yard at Kaohsiung can be divided into the "Da-Jen" area and the "Da-Lin" area, including 23 and 13 docks respectively. About 5000-8000 dock workers are employed in the yard. Because shipscrapping has been considered to be a "temporary" industry by the secondary metal dealers, so the dealers did not well equip and offer the appropriate safety and health programs for the industry. Of those who work on the docks the metal burners are those most continuously exposed to substantial amounts of inorganic lead and other unidentified metals along with health stresses such as noise, asbestos, explosions and accidents. In this study, 140 oxyacetylene torch metal burners (83 working on scrapping ships and 57 working at the yard) and 21 dock workers without direct lead exposure as the control group were included. The mean values of blood lead and urine lead were 63.22 +/- 22.04 micrograms/d1 and 122.15 +/- 44.10 micrograms/1 for metal burners on the ship, and 65.25 +/- 37.11 micrograms/d1 and 101.54 +/- 37.11 micrograms/1 for the metal burners at the yard, values for the control group were 37.24 +/- 20.63 micrograms/d1 and 67.62 +/- 38.39 micrograms/1 respectively. The subjective symptoms mainly were fatigue, numbness over extremities, headache and dizzness. There were 49 metal burners, 35% of the total burners examined in this study, whose blood lead exceeded 80 micrograms/d1 with more than 2 suspicious intoxication symptoms. The precautions in terms of environmental mornitoring, medical surveillance and engineering control should be taken.
Noncompliance of hypertensive patients to their treatment program is a common problem. The basis of this noncompliance is multifactorial, but a large component is related to the adverse symptoms produced by the commonly prescribed antihypertensive agents. There is increasing evidence that one can use social and behavioral science techniques to quantitate the effect of antihypertensive agents on a patient's quality of life. Thus, in addition to efficacy, serious side effects, and cost, the physician also now will be able to add impact on quality of life as a fourth dimension in determining which antihypertensive program is the most appropriate.
Five years have passed since the Alma Ata meeting, and with 17 years remaining in this century, one has to ponder whether the goal of health for all by the year 2000 through primary health care is achievable. This article explores the general situation of health and primary health care, especially in the developing world, where health problems are more acute. The slogan "health for all by the year 2000" has succeeded in creating an awareness of the problems throughout the world. The path toward this goal is not necessarily smooth or paved. Nevertheless, with goodwill and planned actions it can be achieved, though not necessarily by all nations or by the year 2000. This is the biggest challenge facing nations, professionals, international health organizations, and humanity. To achieve this goal they will need to improve and better use national resources, both physical and human. Developing physical resources entails comprehensive and integrated socioeconomic growth, improved health budgeting with multisectorial programming, the use of appropriate technology, and the adoption of scientific managerial processes; but what is even more important is the development of human resources at all levels.
Voluntary drinking responses to an alternating three-bottle, two-choice paradigm to tap water or to 5% ethanol were measured in adult male Fisher (Fshr; N = 14) and spontaneously hypertensive (SP; N = 16) rats for 6-9 days. All animals were singly caged and housed separately in isolation chambers. The animals received light from 0600 to 1800 (CST) daily (LD 12:12) or remained in constant darkness (DD) at room temperature (23 degrees C). Food was freely available. Water and ethanol bottles were changed daily, and volumes of the respective fluids consumed by each rat were measured. A dim red light (approximately 0.5 lux) was used in handling animals in the dark. SP rats demonstrated significant (P less than 0.05) circadian drinking patterns of water and ethanol consumption under LD and DD lighting conditions. Fshr rats, however, exhibited a circadian pattern (P less than 0.02) only with regard to water consumption under an LD 12:12 lighting schedule; they did not exhibit circadian patterns of drinking water (P less than 0.054) in DD or ethanol in LD (P less than 0.24) or in DD (P less than 0.67) conditions. Volumes of ethanol consumption were also greater (P less than 0.05) in SP rats than in Fshr rats. It is concluded that differences exist in circadian drinking behaviors for both water and ethanol intake in two strains of rats. Perhaps variation in circadian patterns is an evolutionary mechanism that programs behavior over an appropriate time span for differences in physiological needs of nocturnal animals.(ABSTRACT TRUNCATED AT 250 WORDS)
In 1979 Verdan wrote, "whatever the situation may be, adhesions are until now certainly not a technically avoidable accident, but rather a consequence of the physiological healing process. As long as we have no technical solution to the problem of accurately maintaining the two cut ends in an intact synovial sheath without interfering with the blood supply, adhesions will remain a biologic inevitability." Although his admonition remains applicable, advances are occurring in our understanding of tendon healing and nourishment, the pulley system, techniques of repair, and the modification of adhesions. Armed with this information, each surgeon dealing with interruptions of flexor tendons must develop a rational, systematic approach to the management of these difficult injuries. The principles of atraumatic technique, as set down many years ago by Bunnell, remain inviolate. Repair procedures should be carried out by surgeons who are thoroughly knowledgeable and well trained in the area of flexor tendon surgery. Primary or delayed primary tendon repair of both the profundus and superficialis tendons should be carried out in almost all patients in all zones of flexor tendon interruption. The use of nonabsorbable sutures with a modified Kessler or Tajima "core suture" has proved to be effective, and, whenever possible, repair of the flexor tendon sheath seems to be appropriate. A well supervised program of early motion utilizing either active or passive techniques is also beneficial in suitable individuals. The restoration of function to a digit following flexor tendon interruption may be a long and tedious undertaking, requiring strong rapport between surgeon, therapist, and patient. When initiating the care of a patient with such an injury, the surgeon should spend considerable time explaining the problems related to the particular injury, the likelihood of achieving success, and the number of procedures that may be required. A high degree of patient motivation must be established to insure the proper participation in the demanding postoperative regimen associated with these procedures. With the important advances occurring in many areas of flexor tendon surgery, it is realistic to believe that in the future the techniques described in this article will be substantially altered and modified. Results should continue to improve until the patient and surgeon can expect all digits to return to nearly full function after flexor tendon interruption.
Physicians attempting to rationally select appropriate Continuing Medical Education programs or conferences to attend are faced with an unending barrage of brochures, letters and other advertisements regarding available CME experiences. If they make their choice on the basis of felt needs rather than convenience, then the accuracy of this perception is of considerable importance.
Word processing makes the writing and altering of scientific articles faster, easier, and more accurate. Personal computers that are ideally suited to this use are now available. Certain factors must be taken into consideration when a system is selected with word processing in mind. A small business computer or a suitable transportable computer, linked to a printer, provides all the hardware, or machinery, necessary. This, along with a sufficiently powerful word processing program, and all the essential accessories, can be purchased for between $2,300 and $6,000. The editors of all (with one uncertain) 29 clinical veterinary and medical journals surveyed will accept articles written by the dense dot matrix or near-correspondence quality printers that frequently accompany personal computers. The major problem affecting the veterinarian who wishes to purchase a personal computer word processing system is that of spending the time to acquire sufficient information in order to choose the computer and the programs that will be appropriate to his or her requirements. These will include the specialized word processing demands of scientific article writing and many other applications, as appropriate.
This study compared the effect of teaching methods on patient anxiety after leaving the coronary care unit. Twenty myocardial infarction patients were studied; half received from the investigator structured pretransfer teaching designed to orient them to differences in the environment and care in the progressive unit. All subjects received unstructured pretransfer teaching by CCU nurses. Data were analyzed using a two-tailed t test for independent groups with a .05 alpha. As measured by a psychological questionnaire, no statistical differences were found in patient anxiety between groups at the time of transfer. However, the anxiety level of subjects who received structured pretransfer teaching was significantly lower than the anxiety level of control subjects on each of four physiological parameters measured: systolic blood pressure the day and time of transfer and heart rates the day and time of transfer. An indication exists, therefore, that a structured pretransfer teaching program is a more appropriate type of nursing intervention than an unstructured one.
Cancer in the neonate is a rare event, constituting only 0.2% of all childhood malignancies. Depsite unique therapeutic challenges posed by patients in this age group, the malignancies occurring in the neonate are often responsive to the same multimodality treatment approach used in older children, and long-term survival can often be achieved. Chemotherapy is a key component of treatment. The pharmacology of these chemotherapeutic agents in the neonate parallels developmental changes in the liver, kidney, gut, and fluid compartments. These developmental changes must be considered in the design of chemotherapeutic schedules and in the selection of drug dosages for the neonate. The factors known to be important in neonatal drug distribution and metabolism are discussed and recommendations are made for appropriate modification of chemotherapy programs based on these considerations.
It has previously been shown that albumin costs in a Veterans Administration Hospital constituted a large portion of the pharmacy drug budget and that much albumin was prescribed inappropriately. Therefore, a program of education and use monitoring was instituted to improve understanding and prescribing of this product. Inappropriate use declined from 41% to 26% of total albumin units and, more dramatically, total cost of albumin used had decreased by 90% one year after this program was initiated. Projected yearly savings from decreased use was more than $85,000. These results demonstrate that such a program can promote more appropriate use of albumin and effect a cost savings for hospitals.
Trajectories of the center of pressure and center of gravity projections were studied in dynamic conditions during learned movement and movement evoked by the motor cortex stimulation (induced movement) in dogs and cats. The learned movement began with initial displacement of the center of pressure towards the limb performing movement. It corresponded often with initial increasing of the performing limb pressure on support and it was a reason of initial acceleration of the center of gravity in the opposite direction. Induced movement began with decrease of the performing limb pressure on support. It could result in the initial displacement of the center of pressure in the wrong direction but usually it was corrected quickly and the general trajectories of the center of pressure and the center of gravity were similar to ones observed during learned movement. Results suggest different programs for movement and appropriate postural adjustment.
A recent nationwide cancer survey provided data for an analysis of future cancer mortality in the People's Republic of China. Aging of the population is projected to increase annual cancer mortality from 691,000 deaths in 1975 to 1,169,000 in the year 2000, a rise of 69 percent. Approximately 20,000 more patients will die of cancer each year during this period, placing substantial burdens on limited medical and economic resources in China. Carcinogenesis research and cancer prevention programs are examined as appropriate strategies for cancer control in this populous nation.
Available contraceptive implants appeal to women of diverse cultural and socioeconomic background because they offer long-term contraception, safety, effectiveness, reversibility and lack of estrogenic side-effects. Experience with Norplant I indicates that despite some side-effects the continuation rate is the highest for any reversible method of contraception. Disruption of the menstrual cycle is the main reason for discontinuation, hence research effort needs to focus on the mechanism of progestogen-induced endometrial bleeding and appropriate therapy. Implant service programs should have trained and skilled personnel who can provide adequate counseling that complements any public education effort and also provides effective services. Because contraceptive implants offer no protection against sexually transmitted infections, those who engage in high-risk sexual behavior should be encouraged to use condoms as well.
This article reviews available research studies of high-conflict divorce and its effects on children. Interparental conflict after divorce (defined as verbal and physical aggression, overt hostility, and distrust) and the primary parent's emotional distress are jointly predictive of more problematic parent-child relationships and greater child emotional and behavioral maladjustment. As a group, children of high-conflict divorce as defined above, especially boys, are two to four times more likely to be clinically disturbed in emotions and behavior compared with national norms. Court-ordered joint physical custody and frequent visitation arrangements in high-conflict divorce tend to be associated with poorer child outcomes, especially for girls. Types of intervention programs and social policy appropriate for these kinds of families are presented.
Recent research has identified fragile X syndrome as the second leading cause of mental retardation. A unique profile of behavioral patterns and cognitive deficits associated with this disorder has gradually emerged. Current published literature has become repetitive with physical and clinical characteristics of this syndrome. Educators, however, have failed to adequately address or clarify learning approaches and remediation strategies that are necessary to develop appropriate training and educational programs. Current research on cognition among individuals with fragile X syndrome was reviewed and intervention strategies discussed that should be considered in the development of programs for these individuals.
The purpose of this study was to identify factors associated with male workers' participation in different kinds of physical activity, noting differences between white collar and blue collar workers. This study examined the variables, perceived health status, self efficacy, perceived barriers, age, education, income, and job category (Pender, 1987) for their association with physical activity. Self efficacy and perceived health status were the cognitive-perceptual factors that predicted physical activity. Job category (e.g., blue collar vs. white collar) was found to be a highly significant predictor of physical activity. Comparing physical job requirements with the individual worker capacity can suggest to the occupational health nurse physical fitness programs that are most appropriate for individual workers.
Latina women are overrepresented among AIDS cases in the United States. To assist in developing appropriate prevention and intervention programs, information regarding HIV risk behaviors is needed on the many diverse Latina subgroups. This study examined sociodemographic characteristics and HIV risk behaviors of Dominican female prostitutes, comparing those who worked primarily in brothels with those who were street workers. A total of 77 Dominican prostitutes (54 brothel; 23 street) were recruited in New York City to participate in a structured interview and were offered HIV testing. Ethnographic interviews were conducted with a subscale. Results indicated that there were many significant differences in demographics and risk behaviors between the two groups, and those working in brothels engaged in lower levels of risk behaviors. In addition, those working in brothels had closer ties to the Dominican and Spanish cultures. Implications for AIDS prevention efforts are discussed.