Measurement of subjective quality of life of elders

There are two aims in this article, to define subjective quality of life and to suggest a way to standardize its measurement to enable comparisons to be made across studies. One of the unresolved issues in gerontological research has concerned the definition and measurement of quality of life (Lawton, 1991). This article focuses on subjective well-being, one of the four components proposed by Lawton (1991). There seems to be a growing consensus that most scales of well-being have at least two concepts in common, positive and negative affect. To test this hypothesis, two well-being scales, the Philadelphia Geriatric Center Morale Scale (Lawton, 1975) and the Center for Epidemiological Studies-Depression Scale (Radloff, 1977), were subjected to confirmatory factor analyses, using data on 1717 participants in the Australian Longitudinal Study of Ageing aged between 70 and 103 years. Each scale was shown to contain factors of positive and negative affect. The article concludes with a suggestion that the measurement of quality of life in elders should include, at a minimum, scales of positive and negative affect as well as other measures relevant to the aspect of quality of life under consideration.     

Effectiveness of early invasive strategy of treatment of angina of new onset

Aim of the study was to assess effectiveness of early invasive strategy of treatment of angina of new onset (ANO). We conducted comparative assessment on invasive and noninvasive risk estimation in 106 patients admitted to N.V.Sklifosofsky Institute of Urgent Aid in 2003-2007. Percutaneous coronary interventions (PCI) on symptom related artery (SRA) within single procedure were carried out in 74 cases (70%), indications to coronary artery bypass surgery were detected in 16 cases (15%), in 16 more cases conservative treatment was used. The data obtained showed that it is rational to consider ANO as unstable angina in all cases including those without progression. Visualization of coronary arteries gives possibility to define significance of SRA and zone at risk of injury, determine indications to myocardial revascularization, and avoid inadequacy of noninvasive assessment of risk and choice of treatment tactics. The method of choice in the treatment of patients with ANO is PCI performed during single procedure. Detection of indications to coronary artery bypass surgery in low risk patients and in absence of progression confirm necessity of routine use of invasive strategy which provides timely pathogenetic treatment. Absence of indications to myocardial revascularization detected in sporadic cases provides possibility to avoid groundless hospitalizations.     

38例主动脉窦瘤破裂的外科治疗

目的 :通过研究 38例主动脉窦瘤破裂治疗经过 ,总结主动脉窦瘤破裂外科治疗经验。方法 :1987年 1月至 2 0 0 1年 9月 ,对 38例主动脉窦瘤破裂病人行手术治疗 ,及时准确闭合主动脉窦瘤及矫正合并的心脏畸形。对于合并主动脉瓣关闭不全病例 ,轻度不予处理 ,中度行成形术 ,重度行主动脉瓣置换术。结果 :早期死亡 1例 ,死亡率为 2 6 %。术后随访 2个月～ 14年 ,随访者心脏功能恢复到Ⅰ～Ⅱ级 (NYHA)。结论 :主动脉窦瘤破裂一经诊断 ,应及早手术 ,同时矫正合并的心脏畸形 ,可获得满意的近期和远期效果。     

Mechanisms of action of antiresorptive therapies of postmenopausal osteoporosis

In the treatment of osteoporosis, the aim of the antiresorptive therapy is to restore bone density by decreasing bone remodeling. The process of bone remodeling plays a role in plasma calcium homeostasis and serves to modify bone architecture in order to meet changing mechanical needs, to maintain osteocyte viability, and to repair microdamage in bone matrix. Estrogen deficiency results in a number of detrimental effects on bone, including suppression of osteocyte survival as well as impairment of osteoblast response to mechanical stimuli and repair of ageing bone. In this review, effects of available antiresorptive therapies on endocrine regulations of bone metabolism in postmenopausal osteoporosis are compared. The aim of antiresorptive treatment is to ensure adequate bone remodeling, reparation of microdamage of bone, and increased bone strength. Ideally, this effect should be maintained long-term. Several agents are approved for the treatment of osteoporosis. Calcitonin transiently inhibits osteoclast activity without decreasing osteoblast collagen synthesis. Aminobisphosphonates decrease bone remodeling by decreasing osteoclast activity and by inducing osteoclast apoptosis. This allows more time for secondary mineralization to proceed to completion in the existing bone tissue mass, so increasing the mechanical resistance of bone to loading. Estrogens and raloxifene (a selective estrogen receptor modulator that acts as an estrogen agonist in bone) suppress bone remodeling to the premenopausal range, maintaining the function of osteoblasts and osteocytes. In the placebo-controlled osteoporosis treatment trials, all the above treatments reduced the risk of fractures. Raloxifene therapy was also associated with a favorable or neutral effect in the cardiovascular system, and a reduced incidence of breast cancer. Selection of appropriate drug for treatment of postmenopausal osteoporosis should take into account the long-term effect of the antiresorptive agent on bone. Moreover, the effects on other tissues ++should also be considered, and this encompasses both safety concerns, as well as the potentially beneficial effects on other tissues. Further investigation is needed to evaluate the different modes of action of these agents, and their long-term effects on bone and other tissues.     

Hierachy of needs of geriatric patients

BACKGROUND: The aim of the study is to contribute to the improvement of the quality of care of geriatric patients. In order to be able to improve the geriatric care we have to know clearly the needs of the elderly patients. OBJECTIVE: The hierarchy of needs of geriatric patients in clinical circumstances had to be assessed by a psychometric technique based on a motivational approach. METHODS: The process was based on the method of paired comparisons, and a duly composed questionnaire was administered to the geriatric patients who were proven to have consistent thinking and surpassed a pre-established threshold in the Mini Mental State Examination. The evaluation of the responds leads to a numerical derivation (on an interval scale) of the hierarchy of needs. RESULTS: The received hierarchy of needs proved to oppose the general hypothesis of Maslow's motivation theory. CONCLUSION: This may induce a necessary shift in the approach to the care of the elderly, and accentuate the self-actualization and esteem needs beside the overtly emphasized physiological care.     

Investigation of mode of action of biofeedback in treatment of fecal incontinence

A study was carried out in 25 incontinent patients to evaluate some of the factors thought to be responsible for the success of retraining for fecal incontinence. Subjects were initially allocated to one of two groups; one group was trained to perceive small rectal volumes (active retraining), the other group carried out the same maneuvers but were not given any information or instruction. Active sensory retraining reduced the sensory threshold from 32 +/- 8 to 7 +/- 2 ml (P less than 0.001), corrected any sensory delay that was present (P less than 0.004), and reduced the frequency of incontinence from 5 +/- 1 to 1 +/- 1 episodes per week (P less than 0.01). Sham retraining caused a modest reduction in the sensory threshold (from 29 +/- 9 to 20 +/- 8; P less than 0.05) but did not significantly reduce the frequency of incontinence. Subsequent strength and coordination training did not significantly improve continence, although at the end of the study, 50% of patients had no incontinent episodes at all and 76% of patients had reduced the frequency of incontinence episodes by more than 75%. This improvement in continence was not associated with any change in sphincter pressures or in the continence to rectally infused saline but was associated with significant improvements in rectal sensation. The functional improvement was sustained over a period of two years in 16 of the 22 patients available for follow-up. In conclusion, the results support the use of retraining in the management of fecal incontinence and suggest that retraining may work by enhancing rectal sensitivity and instilling confidence.     

医学寄生虫学教学方法的改革与完善探讨

本文总结了寄生虫学教学过程中所运用的教学方法。建立以学生为中心的自主学习模式,培养学生理论联系实际以及独立分析问题与解决问题的能力。在教学过程中不断改革和完善教学方法,以适应医学教育的发展,培养高素质医学人才。     

Possibilities of using of crystal-optic qualities of bile in early diagnostic stage of cholelithiasis

The aim of our investigation was to study the changes of bile morphology and possibilities of its using in early diagnostic stage of cholelithiasis. We spent the complex investigation of biochemical and crystal-optic qualities of bile in 207 patients with cholelithiasis stage I with different disease duration. The revealed crystal-optic morphotypes have selective morphology due to the bile lithogene level that allows to determine the disease duration and the bile instability to make in-time adequate profilactic.     

Management of musculoskeletal complications of hemophilia

Prophylactic treatment from ages 2 to 18 years could prevent the development of hemophilic arthropathy if the concentration of the patient's deficient factor is kept from falling below 1% of normal. Early treatment is of paramount importance because the immature skeleton is very sensitive to the complications of hemophilia. Major hemarthrosis and chronic hemophilic synovitis should be treated aggressively to prevent hemophilic arthropathy. When advanced hemophilic arthropathy is present with severe disability, the aim should be to restore function while minimizing the risk to the patient. Joint debridement is an effective method to achieve this goal, especially around the elbow or ankle, and can be considered an alternative to knee replacement in the younger age groups. Proximal tibial valgus osteotomy is a reliable treatment method for painful genu varum of the mobile hemophilic knee. Supramalleolar tibial varus osteotomy is an attractive alternative to the more commonly used surgical option of arthrodesis. Finally, joint replacement can usually be relied on to restore both mobility and function in a diseased joint. The potential benefits of joint replacement must always be weighed against the long-term sequelae, however, especially loosening and consequent revision surgery.     

Accuracy of reporting of family history of colorectal cancer

BACKGROUND AND AIMS: Family history is used extensively to estimate the risk of colorectal cancer but there is considerable potential for recall bias and inaccuracy. Hence we systematically assessed the accuracy of family history reported at interview compared with actual cancer experience in relatives. METHODS: Using face to face interviews, we recorded family history from 199 colorectal cancer cases and 133 community controls, totalling 5637 first and second degree relatives (FDRs/SDRs). We linked computerised cancer registry data to interview information to determine the accuracy of family history reporting. RESULTS: Cases substantially underreported colorectal cancer arising both in FDRs (sensitivity 0.566 (95% confidence interval (CI) 0.433, 0.690); specificity 0.990 (95% CI 0.983, 0.994)) and SDRs (sensitivity 0.271 (95% CI 0.166, 0.410); specificity 0.996 (95% CI 0.992, 0.998)). There was no observable difference in accuracy of reporting family history between case and control interviewees. Control subjects similarly underreported colorectal cancer in FDRs (sensitivity 0.529 (95% CI 0.310, 0.738); specificity 0.995 (95% CI 0.989, 0.998)) and SDRs (sensitivity 0.333 (95% CI 0.192, 0.512); specificity 0.995 (95% CI 0.991, 0.995)). To determine practical implications of inaccurate family history, we applied family history criteria before and after record linkage. Only two of five families reported at interview to meet surveillance criteria did so after validation, whereas only two of six families that actually merited surveillance were identified by interview. CONCLUSIONS: This study has quantified the inaccuracy of interview in identifying people at risk of colorectal cancer due to a family history. Colorectal cancer was substantially underreported and so family history information should be interpreted with caution. These findings have considerable relevance to identifying patients who merit surveillance colonoscopy and to epidemiological studies.     

Role of parents in the determination of the food preferences of children and the development of obesity

The role of parental behaviour in the development of food preferences is considered. Food preferences develop from genetically determined predispositions to like sweet and salty flavours and to dislike bitter and sour tastes. Particularly towards the second year of life, there is a tendency to avoid novel foods (neophobia). Food aversions can be learnt in one trial if consumption is followed by discomfort. There is a predisposition to learn to like foods with high-energy density. However, from birth genetic predispositions are modified by experience and in this context during the early years parents play a particularly important role. Parental style is a critical factor in the development of food preferences. Children are more likely to eat in emotionally positive atmospheres. Siblings, peers and parents can act as role models to encourage the tasting of novel foods. Repeated exposure to initially disliked foods can breakdown resistance. The offering of low-energy-dense foods allows the child to balance energy intake. Restricting access to particular foods increases rather than decreases preference. Forcing a child to eat a food will decrease the liking for that food. Traditionally, educational strategies have typically involved attempts to impart basic nutritional information. Given the limited ability of information to induce changes in behaviour, an alternative strategy would be to teach parents about child development in the hope that an understanding of the characteristic innate tendencies and developmental stages can be used to teach healthy food preferences.     

Effectiveness of various schedules of drug therapy of patients with sarcoidosis of the respiratory organs

One hundred and seventeen patients with active sarcoidosis of the respiratory organs were treated according to 4 therapy regimens based on the use of corticosteroid drugs. Intermittent use of the corticosteroids was shown to be the most efficient (in 98.5 per cent). It allowed to lower the course dose by 25-30 per cent and to reduce the frequency of complications to 1.5 per cent. Inspite of high efficacy of kenalog 40, its use was limited because of adverse reactions in 19.2 per cent of the patients. It was difficult to eliminate the adverse reactions because of the drug prolonged action. The use of presocyl provided improvement in 62 per cent of the patients having contraindications for corticosteroid therapy. Patients with marked pneumosclerotic lesions should be treated with simultaneous use of corticosteroids and azathioprine.     

Preparation of stabilized solutions of hemoglobin

It is possible to prepare self-stabilizing solutions of hemoglobin from humanerythrocytes by the use of dextrose, nicotinic acid amide and ammonia during thepreparation and in the final solutions themselves. Co⁺⁺, Mn⁺⁺ and Mg⁺⁺ ions,nile blue and hexose diphosphate contribute to the speed of stabilization of thesesolutions. Stabilization is obtained by the faculty of the solutions, presumablyby enzymic action, to convert the hemoglobin to the reduced form and to maintainit in this form. The hemoglobin solutions described are suitable for intravenousadministration.

Note: ACKNOWLEDGMENTWe wish to acknowledge our deep indebtedness to Miss Lois Priester and to Mr. Edward Smith fortheir technical assistance in this work. We wish also to express our gratitude to the Biological ProductionDivision and to the Biological Control Division of Sharp and Dohme for assistance in many phases of thework.

     

Results of treatment of fistula-in-ano

To evaluate the application of Parks' classification in the management of patients with fistula-in-ano, a study was undertaken to assess the outcome of surgery, especially with respect to the recurrence rate and alteration of continence. A retrospective analysis of 160 consecutive patients who were classified at the time of operation was conducted. The distribution of fistulas was as follows: intersphincteric, 41.9 percent, transsphincteric, 52.1 percent, suprasphincteric, 1.3 percent, extrasphincteric, 0. A horseshoe extension occurred in 8.8 percent of the fistulas and 3.8 percent did not exactly conform to the classification as they were either complex or combinations of more than one type of fistula. The sole immediate postoperative complication was bleeding, which occurred one week postoperatively and ceased spontaneously (0.7 percent). Alteration in continence occurred in 6 percent of patients with 2.6 percent experiencing temporary incontinence to flatus, 1.3 percent to liquid stool, and 0.7 percent to solid stool. Permanent loss of control for flatus occurred in one patient (0.7 percent) and for liquid stool in one patient (0.7 percent). No patients suffered loss of control for solid stool. Recurrence developed in 6.3 percent of patients, all between five and 25 months postoperatively. Classifcation was found to be a useful guide in the operative management of patients with fistula-in-ano. Read at the joint meeting of the American Society of Colon and Rectal Surgeons with the Section of Colo-Proctology, Royal Society of Medicine, and the Section of Colonic and Rectal Surgery, Royal Australasian College of Surgeons, New Orleans, Louisiana, May 6 to 11, 1984.     

Principles of psychoneuroendocrinoimmunotherapy of cancer

Recent advances in the knowledge of the mechanisms responsible for antitumor immunity have stimulated the elaboration of new cancer immunotherapeutic strategies. Moreover, more recent discoveries have demonstrated that immune responses are under a physiological modulatory control played by several neuroendocrine pathways, which explain the differences between the in vivo and in vitro immune responses. While until a few years ago the evaluation of the immune status of cancer patients was substantially established on the basis of clinical empirical criteria, recent discoveries of the antitumor cytokine network have allowed the biochemical bases of anticancer immunity to be defined, leading to new anticancer immunotherapeutic strategies, on the basis of patient neuroendocrine and neuroimmune status, in an attempt to correct the great number of cancer-related alterations on the basis of knowledge of the physiopathology of anticancer immunity. The rationale for cancer neuroimmunotherapy consists of the possibility to enhance the efficacy of the various immunotherapeutic strategies by a concomitant administration of antitumor cytokines (namely IL-2), in addition to neuroendocrine endogenous molecules (namely the pineal indole hormones), able to stimulate the anticancer immunoresponse by amplifying the anticancer reaction and/or by counteracting the generation of immunosuppressive events.     

上海地区2004年至2008年甲型流行性感冒病毒亚型的分布

目的 分析近5年上海地区甲型流行性感冒(流感)病毒亚型的分布并探究其原因.方法 对上海地区流感监测哨点流感样患者和聚集性流感暴发患者,采集咽拭子标本接种犬肾细胞(MDCK),直接荧光免疫法鉴定阳性分离株型别,多重RT-PCR鉴定亚型.结果 2004年至2005年初的季节性流感以A/H3N2为主;2005年末至2006年中期的季节性流感以A/H1N1为主;2006年末到2007年10月份分离到的流感毒株基本为A/H3N2亚型;2008年1月至5月份,人群流感病毒分离株仍以A/H3N2处于优势地位,但从2008年7月开始的季节性流感则以A/H1N1占绝对优势.结论 近5年上海地区季节性流感主要为甲型流感病毒H3N2和H1N1亚型,但在不同年份的季节性流感中流行强度有所不同.     

Time of onset of symptoms of acute myocardial infarction

Several studies have observed an increased occurrence of acute myocardial infarction (AMI) in the morning based on subjective self-reports and objective confirmation. Evidence has also been collected to suggest a circadian variation in the onset of sudden cardiac death and silent myocardial ischemia. No published reports have examined the time of onset of AMI in relation to time after awakening. The present study examines the times of onset of AMI in relation to awakening in 137 patients with confirmed AMI. Information concerning time of awakening on the day of AMI revealed a marked increase in the onset of initial AMI symptoms within the first hour after awakening. Of the patients studied, approximately 23% reported onset of the initial symptoms of AMI within 1 hour after awakening. An increased onset of symptoms of AMI soon after awakening was also observed when patients in whom the acute cardiac symptoms were known to or may have caused awakening were excluded from consideration. This was also noted in subgroups of AMI patients classified according to age, order and location of AMI. These results extend previous observations of the circadian morning increase of AMI onset and assist in narrowing the search for potential triggers of the circadian variation of onset of AMI to physiologic changes that may occur soon after awakening.     

Implications of measures of quality of life for policy development

Quality of life measurements can lead to legislative programs for health, new policies for the health care system, and possibly new attitudes in the courts. Clinical decisions, public health evaluations, and advice for legislatures and courts require diverse measures. We illustrate potential use of such measures with reimbursement problems, programs like Head Start, mainstreaming the handicapped, day care and prenatal care, terminal care for the elderly, monitoring programs, and chronic disabilities. The many treatment policies discussed at the Portugal Conference show the need for quality of life measures in clinical trials. The courts, although considering quality of life, do not seem to consider quality of life measures. If scientists and medical experts wish to establish or change the positions of the courts, consensus conferences appear more effective than regulation or new legislation. To contribute more than they now do to policy, workers measuring quality of life need to develop a variety of measures and methods. They, then, must apply them to medical and health problems, build up a substantial literature, and set priorities for the research needs of the field.