Disparities in health care: minority elders at risk.

Minority elders are at great risk for missed diagnoses, greater disabilities, and higher death rates unless health care providers acknowledge that disparities in healthcare do exist and adjust their way of providing care. In the next 30 years, the current elderly population of 35 million is predicted to increase to 72 million. Minority elders are expected to account for 50% of this population. Research has shown that minority elders have a higher incidence of certain diseases but do not receive the same care as their white counterparts (Baldwin, 2003). Differences in the incidence, prevalence, mortality, and burden of disease among minority elders indicate that disparities in healthcare are consistently found in a variety of settings (Jett, 2006). Poor communication and distrust in the health care system have been found to be major factors affecting the quality of healthcare for these individuals. This article discusses healthcare disparities experienced by minority elders and suggests ways to curtail this problem. Culturally sensitive care is suggested to save lives and improve quality of life for these vulnerable individuals. Understanding the cultural practices of minority elders and negotiating a plan of care that respects their beliefs will increase patient compliance, improve care, improve outcomes, and decrease healthcare disparities among minority elders.     

Lateral impact injury. A source of occult hip pathology.

Arthroscopy has helped greatly in understanding the nature of many intra-articular disorders of the hip. It also has provided a better understanding of the pathomechanics and natural progression. This knowledge has aided in improving interpretative clinical skills and investigative techniques. Isolated traumatic chondral injury can occur as a result of impact loading over the greater trochanter. There seems to be a particular propensity for this injury in young physically fit adult males apt to incur this type of blow as a consequence of sport or activity. Initially, this injury may appear innocuous with variable dysfunction. When present, arthroscopy can reliably discern the pathology and often result in significant symptomatic improvement. The long-term consequences of these lesions are still concerning. Although symptomatic improvement from arthroscopic intervention is encouraging, for some cases the long-term influence may only be the knowledge provided for counseling the patient. Nonetheless, arthroscopy can be valuable in both the assessment and management of chondral injuries.     

Worksite Interventions: A Methodological Exploration and Pilot Study Promoting Behavior Change

This paper explores the methodological implications of using multiple methods in conducting preventive interventions, employing the stages of change model as a conceptual framework. We discuss the issues involved in using three empirically supported interventions (expert systems, group support, and self-help manuals) in the context of promoting smoking cessation. Although these methods have been assessed in different contexts, they have not been combined using the worksite as the location of intervention. Worksite interventions have the potential to reach large numbers of people and facilitate changes in social and environmental norms, yet there is a need to further examine how various methods can be combined to facilitate behavior change. Implementation of two pilot studies in the worksite provides initial evidence of the feasibility of a theoretically-based multi-method approach to intervention.     

Histomorphometric analysis of the intramedullary bone response to titanium particles in wild-type and IL-1R1 knock-out mice: a preliminary study

Aseptic loosening of implants following total joint arthroplasty remains a major cause of implant failure. Particulate debris generated primarily from wear results in inflammatory mediated periprosthetic osteolysis. Titanium is a commonly utilized metal in joint arthroplasty and titanium debris induces the production of the pro-inflammatory cytokine IL-1. To further elucidate the role of IL-1, this study examined the response of murine femora to the presence of titanium particles following implantation of an intramedullary rod in mice lacking the receptor for IL-1. We hypothesized that the inflammatory effects of wear debris on bone would be mitigated in IL-1R1 deficient mice with a resultant decrease in resorption. Femora receiving titanium particles demonstrated a marked inflammatory response in wild-type mice with increased endocortical resorption, periprosthetic membrane formation, and significant histomorphometric changes. Femora exposed to titanium particles in the knockout mice also demonstrated osteolysis with irregular deposition of trabecular bone and increased cortical porosity. The persistence of inflammation and osteolysis, despite the lack of functional IL-1R1, suggests a multi-factorial role for IL-1 in the proinflammatory cascade resulting from wear debris. This intramedullary murine model provides the ability to evaluate and quantify the proinflammatory cascade in an in vivo model approximating prosthesis failure.     

A preclinical post laminectomy rat model mimics the human post laminectomy syndrome

Chronic low back pain with sciatica complicating post laminectomy surgery is poorly understood. It is likely that some aspects of persistent pain of the syndrome results from spinal facilitation in which there is lowering of pain excitation levels. A small animal preclinical model is needed that mimics the clinical condition to permit detailed studies of the underlying altered neurochemistry of the sensory pathways. We propose herein a rat laminectomy model containing the elements required for study of the neurobiology of the condition. The model consists of a surgical laminectomy that includes L5 spinal nerve manipulation and disc injury, elements necessarily employed in human disc herniation surgery. At 8 weeks post laminectomy the proposed model demonstrates paraspinous muscle spasm, tail contracture, behavioral pain behavior, tactile allodynia, epidural and nerve root scarring, and nerve root adherence by scar to the underlying disc and adjacent pedicle. Two underlying pain facilitation states are invoked in the clinical condition: (1) an inflammatory state required to achieve wound healing; and (2) a nerve injury state resulting from nerve manipulation and subsequent epidural scarring, spinal nerve scarring, and spinal nerve tethering to the adjacent disc and pedicle. Both pain facilitation states are active in the model.     

Alterations in the pattern of mastication after ablations of the lateral precentral cortex in rhesus macaques

Patterns of mandibular movement and jaw muscle activity in two monkeys were recorded during mastication of natural foods before and after ablations of the lateral precentral cortex. Bilateral, but not unilateral, lesions that included the “face” area of the precentral cortex produced permanent changes in patterns of mandibular movement during mastication, including decreased jaw opening and lateral deviation. The basic chewing rate, however, was not greatly altered. Paresis of the tongue and facial muscles, possibly combined with loss of the ability to produce complex jaw movements, hindered manipulation and positioning of food required for mastication. Bilateral lesions of the far-lateral precentral cortex, a region that evokes rhythmic jaw movement when electrically stimulated, initially produced symptoms like those described above, but after a period of recovery, patterns of mastication became normal. The results indicate that the precentral cortex, particularly the face area, is involved in coordination of the tongue, jaw, and facial muscles necessary for normal, efficient mastication. At the same time, the results confirm the existence, in the nonhuman primate, of a subcortical pattern generator capable of producing a pattern of rhythmic jaw movement similar in some respects to masticatory jaw movements of normal monkeys.     

Tomographic assessment of nasal septal changes following surgical-orthodontic rapid maxillary expansion

Nine adult patients with transverse maxillary deficiency were examined for incidence of nasal septal deviation following surgical-orthodontic rapid maxillary expansion. The osteotomies for facilitation of maxillary expansion did not include sectioning of the nasal septum. The procedure did include sectioning of the lateral maxillary walls, the pterygomaxillary suture, and the midpalatal sutures. For each patient, four graduated coronal tomograms through the incisal, molar, tuberosity, and pterygoid areas were taken prior to and not less than 4 months after surgical intervention. Results showed no significant change in the nasal septal position from before to after surgery. Analysis of the nature of maxillary movement in the coronal plane revealed rotational as opposed to bodily expansion, with inferior rotation of the palatal vault. Significant increases in the available nasal airway space were recorded. These increases were attributed primarily to shrinkage of inflamed nasal mucosa. In view of the recorded data, surgical sectioning of the nasal septum to prevent septal deviation by surgical-orthodontic rapid maxillary expansion is not warranted.     

Pneumomediastinum, pneumopericardium, and epidural pneumatosis in DKA

Pneumomediastinum (PM) is an uncommon condition characterized by the presence of air in the mediastinum. It is associated with alveolar rupture that allows air to traverse along the bronchovascular bundle into the mediastinum. A review of the world medical literature identified 50 additional cases of PM and pneumopericardium (PC) associated with diabetic ketoacidosis (DKA). We report the occurrence of PM, PC, as well as epidural pneumatosis occurring simultaneously in a patient with DKA. Epidural pneumatosis in association with this metabolic derangement has not been previously described.