Is the risk of developing Alzheimer's disease greater for women than for men?

A large proportion of people with Alzheimer's disease (AD) are women; however, it is not clear whether this is due to higher risk of disease or solely to the larger number of women alive at ages when AD is common. Beginning in 1982, two stratified random samples of people aged > or =65 years in East Boston, Massachusetts underwent detailed, structured clinical evaluation for prevalent (467 people) and incident (642 people from a cohort previously ascertained to be disease-free) probable AD. The prevalence sample was followed for mortality for up to 11 years (through December 1992). The age-specific incidence of AD did not differ significantly by sex (for men vs. women, odds ratio = 0.92; 95% confidence interval (CI): 0.51, 1.67). Controlled for age, prevalence also did not differ significantly by sex (for men vs. women, odds ratio = 1.29; 95% CI: 0.67, 2.48). The increase in risk of mortality due to AD did not vary by sex. The odds ratio for women with AD compared with women without AD was 2.07 (95% CI: 1.21, 3.56). For men, the odds ratio was 2.22 (95% CI: 1.02, 4.81). These findings suggest that the excess number of women with AD is due to the longer life expectancy of women rather than sex-specific risk factors for the disease.     

Evaluation of Viability of Excised Rat Intestinal Segments in the Ussing Chamber: Investigation of Morphology,Electrical Parameters,and Permeability Characteristics

Purpose. To clarify relations between alterations in electrical and permeability data with time and to elaborate accompanying structural changes of intestinal segments in Ussing chamber experiments. Methods. Excised intestinal segments from the rat were studied in a modified Ussing chamber. Experiments were run up to 180 minutes during which the electrical parameters, PD, SCC, and R, were measured and the permeability coefficients (P_app) of mannitol and propranolol were determined. Each segment was observed under the light microscope for morphological evaluation. Results. PD and SCC values showed a decrease for most segments while the R values remained steady throughout the experiment. The P_app for propranolol increased aborally to the small intestine. For mannitol, the reversed was observed. In some cases, there was a time-dependent change in permeability for these marker molecules. The main morphological changes observed were a decreased nucleo-apical distance, decreased villi amplification factor, initial edema, cell sloughing, and epithelial restitution. Conclusions. The time-dependent changes in permeability coefficients of mannitol and propranolol are suggested to be related to changes in electrical parameters and morphological alterations. Presented data illustrates the importance of information regarding time-dependent structural changes for correct interpretation of permeability data.     

Growth in very preterm children: a longitudinal study

The knowledge about the long-term growth of very preterm children in relation to gestational age at birth is incomplete. Therefore, a retrospective study of longitudinal growth from birth to 7 y of age in 52 of 56 surviving children who were born at a gestational age of <29 wk between 1988 and 1991 to mothers resident in the city of G?teborg, Sweden, was performed. A majority of the children had an initial decrease in weight during the first months of life, followed by an increase, with a maximum weight gain occurring at 36-40 wk postmenstrual age. After a period of decreased weight and length velocity, a second increase in weight velocity was demonstrated from 6 mo to 2 y of corrected age. A corresponding increase in length velocity was found from 2 to 12 mo of corrected age. A later catch-up growth period was found at 4-5 y of age. At 7 y of age, all but two had reached the normal height range of the population. This long-term catch-up in height was established later in those who were born at an earlier gestational age. We conclude that all preterm infants had an initial period of poor growth, which rendered them growth retarded during the first years of life. It took approximately 4-7 y to overcome what the very preterm child lost in growth during the first months of life. However, as a group, they did reach normal height, weight, and weight for height before puberty.     

Chronic Granulomatous Disease-Like Presentation of a Child with Autosomal Recessive PKCδ Deficiency

Journal of Clinical Immunology - Autosomal recessive (AR) PKCδ deficiency is a rare inborn error of immunity (IEI) characterized by autoimmunity and susceptibility to bacterial, fungal, and...     

The use of oral sedatives in dental care

Oral administration of tranquillizing and anxiety-suppressing drugs has long been the commonest method of achieving light sedation. The benzodiazepines are the drugs of first choice. Benzodiazepines given orally may be indicated to avoid 'treatment stress', alleviate mild anxiety before dental treatment, and facilitate sleep on the night before the treatment. Furthermore, they could be used for the dental treatment of medically poor risk patients, particularly those with cardiovascular disease. The drug can be given either in a fractionated dose or a single dose. The recommended doses for diazepam vary from 0.1–0.8 mg/kg body weight, depending on age, with higher doses in children and lower doses in elderly patients. Few side effects are reported.     

Expanding the role of the nurse practitioner in the deployed setting

Today's military is experiencing rapid advances in technology and in manpower utilization. The Army Medical Department is redesigning the structure and function of deployable hospital systems as part of this effort. The transformation of deployable hospital systems requires that a critical analysis of manpower utilization be undertaken to optimize the employment of soldier-medics. The objective of this article was to describe the use of nurse practitioners as primary care providers during deployment. The lived experiences of five nurse practitioners deployed to Operation Iraqi Freedom are presented. Data gathered during the deployment and an analysis of the literature clearly support expanded and legitimized roles for these health care professionals in future conflicts and peacekeeping operations.     

Functional imaging in penile cancer: PET/computed tomography, MRI, and sentinel lymph node biopsy

PURPOSE OF REVIEW: The presence and extent of lymph node metastasis and primary tumor are among the most important prognostic factors in penile cancer. While inguinal lymphadenectomy is currently the most accurate means of staging, it is associated with severe morbidity and even mortality. Recent literature was reviewed for alternative means of staging. RECENT FINDINGS: Functional imaging modalities distinguish between inguinal lymph nodes with and without metastasis. The false-negative rate of dynamic sentinel lymph node biopsy has recently improved from approximately 20 to 5% in one study. In 13 patients with penile cancer, (18)F-fluorodeoxyglucose-PET/computed tomography was 80% sensitive and 100% specific for lymph node metastasis, but missed micro-metastasis. In seven patients with penile cancer, MRI with lymphotrophic nanoparticles was 100% sensitive and 97% specific for lymph node metastasis. SUMMARY: Combined PET/computed tomography and sentinel lymph node biopsy may help to detect both inguinal micrometastasis and pelvic and abdominal metastasis. Since MRI is highly accurate for staging of both primary penile cancer and its lymph node metastasis, however, it may turn out to be a powerful tool for a one-stop modality in the staging of penile cancer.     

Primary care physicians’ concerned voices on sickness certification after a period of reorganization. Focus group interviews in Sweden

Objective: This study explored the views of primary health care (PHC) physicians on sickness certification after reforms in 2005 prompted by the Swedish government to increase the quality and decrease the inequalities, and costs of sickness certification.Design: Qualitative design with focus group interviews. Data were analysed using qualitative content analysis.Setting: Urban and rural PHC centres in Region Västra Götaland, Sweden.Subjects: GPs, interns, GP trainees and locums working in PHC centres 2015. Six focus group interviews with 28 physicians were performed.Main outcome measures: Experiences and reflections about the sickness certification system.Results: The latent content was formulated in a theme: ‘The physicians perceived the sickness certification process as emotive and a challenge to master with differing demands and expectations from authorities, management and patients’. Sickness certification could be easy in clear-cut situations or difficult when other factors besides the pure medical were ruling the decisions. The physicians’ coping strategies for the task included both active measures (cooperation with health care staff and social insurance officers) and passive adaptation (giving in or not caring too much) to the circumstances. Proposals for the future were to transfer lengthy sickness certifications and rehabilitation to specialized teams and increase cooperation with rehabilitation coordinators and social insurance officers.Conclusions: Political decisions on laws and regulations for sickness certification impacted the primary health care making the physicians’ work difficult and burdensome. Their views and suggestions should be carefully considered in future organization of primary care. KEY POINTS In 2005 Swedish government introduced reforms to decrease the inequalities and costs of sickness certification and facilitate the physicians’ work.

• Focus group interviews with Swedish primary care physicians revealed that sickness certification was challenging due to differing demands from authorities, management and patients.
• Coping strategies for the sick-listing task included both active measures and passive adaptation to the circumstances.
• A proposal for future better working conditions for physicians was to transfer lengthy sickness certifications and rehabilitation to specialized teams.

     

Peak expiratory flow rate and 5-year mortality in an elderly population

During a population survey in 1982-1983 among all community-dwelling elderly aged 65 years and over in East Boston, Massachusetts, measurements of peak expiratory flow rate using the mini-Wright peak flow meter were made on 3,582 participants (80% of those eligible). The average peak flow rate was 315 liters/minute, and a measure of peak flow rate adjusted for age, sex, height, and weight was computed. This was a highly significant (p less than 0.0001) predictor of 5-year total mortality, whose ascertainment was virtually complete. The relative risk was 1.27 (95 percent confidence interval 1.19-1.36) per 100 liters/minute decrease in peak flow rate, using a proportional hazards model including terms for age, sex, and smoking. There was no apparent modification of the effect of this measure in various categories of smoking, with relative risks of 1.24 for nonsmokers, 1.29 for ex-smokers, and 1.26 for current smokers. This finding also persisted after adjustments for other covariates, including respiratory symptoms such as cough, phlegm, and wheeze; cardiovascular risk factors such as history of myocardial infarction and stroke; and systolic and diastolic blood pressures; socioeconomic status; scores on simple tests of cognitive function; measures of physical activity and functional ability; and self-assessed state of health. In a stepwise model including all of these variables, the relative risk was 1.16 (p less than 0.0001) per 100 liters/minute decrease in peak flow rate, indicating that peak flow rate is a strong independent predictor of total mortality in the elderly.