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101.
Per Jensen M.D. Søren Buus Jensen M.D. Per Soelberg Sørensen M.D. Birgitte D. Bjerre M.D. Dominick A. Rizzi M.D. Anne Stub Sørensen M.D. Rene Klysner M.D. Kim Brinch M.D. Bo Jespersen M.D. Henrik Nielsen M.D. 《Archives of sexual behavior》1990,19(1):1-14
Sexual dysfunction is a well-known complication of chronic somatic illness. Eighty-six consecutive epileptic outpatients, 38 men and 48 women, without accompanying disorders, were studied. The frequency and symptoms of sexual dysfunction were compared with results from previous studies using identical sexological methodology. The previous studies were of diabetic patients and healthy controls. Eight percent of the epileptic men reported a sexual dysfunction compared to 44% of the diabetics and 13% of the controls. Epileptic women, diabetic women, and controls showed no significant differences in sexual dysfunction (29%, 28%, and 25%, respectively). In both sexes, the sexual function measured by frequencies of coitus and masturbation was normal. Most patients had good control of epileptic attacks on a treatment of monotherapy. Hormonal status was generally within normal limits in both men and women; only a few minor differences were found and they showed no correlation with sexual dysfunction. Psychologically and socially the patients did not differ appreciably from normals, and they exhibited a high degree of disease acceptance. This study, using a biopsychosocial approach in understanding sexual dysfunctions, is in contrast with previous, mainly uncontrolled, studies of epileptic patients that reported high frequencies of hyposexuality in males. We conclude that epilepsy does not necessarily increase the risk of sexual dysfunction in male or female. 相似文献
102.
Objective: Children with special health care needs are increasingly enrolling in managed care arrangements. However, existing managed care organizations, including traditional HMOs, are often poorly suited for caring for this population. In the adult health care area, new managed care entities, called Social HMOs (S/HMO) and Programs for the All-inclusive Care for the Elderly (PACE), have been created to integrate health and health-related services for chronically ill and disabled adults. We describe these models and assess their potential for serving children with special health care needs. Method: We reviewed the literature on managed care for children with special health care needs and evaluation findings from the S/HMO and PACE models for the elderly. Results: Evaluations of the S/HMO and PACE models have yielded mixed findings. Some of the more positive accomplishments include lower use and expenditures for long-term care services compared to other demonstration projects, greater integration of primary care physicians in decision making concerning long-term care, and improved management of transitions between care levels. On the negative side, start-up has been slow, prospective members have been hesitant to enroll, intermittent and sometimes frequent operating deficits have emerged, no discernible positive effects on health or social outcomes are apparent, and no significant overall savings have emerged. Conclusions: With mixed results so far, caution is required in applying these or similar models for vulnerable child populations. However, given the inadequacies of traditional managed care for this population, we believe experimentation with new models of care that integrate health and health-related services is important. Such experimentation should be fostered only to the extent that the models are carefully designed and then implemented in a manner that protects the interests of children with special health care needs. 相似文献
103.
The Relationship Between Choice of Outcome Measure and Hospital Rank in General Surgical Procedures: Implications for Quality Assessment 总被引:3,自引:0,他引:3
104.
AB-type amphiphilic copolymers (abbreviated as LE) composed of poly (L-leucine) (PLL) as the A component and poly (ethylene
oxide) (PEO) as the B component were synthesized by the ring-opening polymerization of L-leucine N-carboxy-anhydride initiated
by methoxy polyoxyethylene amine (Me-PEO-NH2) and characterized. Core-shell type nanoparticles were prepared by the diafiltration method. Particle size distribution obtained
by dynamic light scattering was dependent on PLL composition and the size for LE-1, LE-2 and LE-3 was 369.6±267, 523.4±410
and 561.2±364 nm, respectively. Shapes of the nanoparticles observed by transmission electron microscope (TEM) were almostly
spherical. The critical micelle concentration (CMC) of the nanoparticles determined by a fluorescence probe technique was
dependent on the composition of hydrophobic PLL, and the CMC for LE-1, LE-2 and LE-3 was 2. 0×10−6, 1.7×10−6 and 1.5×10−6 (mol/l), respectively. Clonazepam release from core-shell type nanoparticles in vitro was dependent on PLL composition and
drug loading content. 相似文献
105.
106.
Dr Miguel A. Asenjo Lluisa Baré José M. Bayas Andreu Prat Rafel Lledó Joan Grau Lluis Salleras 《European journal of epidemiology》1994,10(5):625-632
The results of the prospective application of Horn's Severity of Illness Index in a teaching hospital during 1987, 1989, and 1990 constitute the basis of the present report. The average overall severity of illness scores for the three years were 1.42 in 1987, 1.65 in 1989, and 1.46 in 1990. Most of the processes evaluated in the three periods showed an overall distribution among severity levels 1 and 2, both overall and when the seven dimensions of the severity of illness index were analyzed. A statistically significant correlation between the overall severity of illness and average length of stay was found for patients in 1989 and 1990. The length of stay differed significantly in the different severity levels. When the four levels of the seven dimensions of the severity of illness index for 1987, 1989, and 1990 were compared, it was observed that figures were not uniformly distributed. There was a statistically significant association between severity of illness for hospital service and pharmacy charges per hospital stay for both 1989 and 1990, as well as a statistically significant inverse relationship between severity of illness and the number of claims per hospital service in both periods of time. Case-mix methods that account for the severity of patients constitute a useful indicator of quality for the management of different hospital services and of the hospital as a whole. 相似文献
107.
Venoarterial extracorporeal membrane oxygenation (ECMO) was performed in five dogs without systemic heparinization to assess the feasibility of heparin-free ECMO. The surfaces of the inverted hollow-fiber-type oxygenator and circuit of the ECMO system were coated with heparin by the endpoint-attached (covalent-bonded) technique. No heparin was administered to the animal except for a small dose to maintain patency of the arterial line (1 IU/h). ECMO was run for 24 h at a pump flow of 50 ml/kg · min and was successful throughout the experiment in four of the five dogs. Scanning electron microscopy did not detect any blood clots in the oxygenator or circuit except for inside and outside the cannulas that were not coated with heparin in the carotid artery and jugular vein. Activated clotting time (ACT), fibrinogen, and anti-thrombin III (AT-III) activity remained within the normal physiological range. Serum heparin concentrations were low throughout the experiment, indicating minimal heparin release. Platelet levels decreased and fibrinopeptide B 15–42 (FPB 15–42) increased significantly after 6 h ECMO. D-dimer levels did not change throughout the experiment. ECMO was discontinued in one case after successful a 23-h run because of macroscopic clot formation at the oxygenator blood inlet. ACT had suddenly increased to 160 s approximately 1 h prior to this clot formation. These results suggest that the amount of systemic heparinization required can be substantially reduced by a heparin-coated ECMO system. Total abolishment of heparin administration in pediatric venoarterial ECMO may be possible by refinement of this technique. Monitoring of AT-III and FPB 15–42 in addition to ACT may be useful for early diagnosis of latent but ongoing coagulopathies during ECMO. 相似文献
108.
N. Singewald A. Pfitscher A. Philippu 《Naunyn-Schmiedeberg's archives of pharmacology》1992,345(2):181-186
Summary Inactivation of GABA was inhibited by -vinyl GABA (GVG) and the effects of the increased GABA level in the brain on blood pressure and body weight of spontaneously hypertensive rats (SHR) and normotensive rats (WKY) were investigated.When started at the age of 8 weeks or 5 weeks, treatment of SHR and WKY with GVG (150 mg/kg, s.c.) for several weeks did not influence systolic blood pressure. In 1-week old SHR, treatment with GVG (up to 150 mg/kg, s.c.) abolished the rise in blood pressure until animals were 8 weeks old. Thereafter, arterial blood pressure started to increase but it remained distinctly lower than that in untreated animals. When started at the age of 1 week, treatment with GVG for 7 weeks did not influence arterial blood pressure in WKY. GVG delayed increase in body weight in SHR and WKY, irrespective of their age. GVG greatly increased GABA levels in the hypothalamus, frontal cortex, brainstem and rest of the brain in both WKY and SHR.It is concluded that an increase in the GABA level in the brain leads to a delay in the development of hypertension in young SHR. Hence, development of genetic hypertension seems to be susceptible to activation of the GABAergic system in a very early critical phase only.
Send offprint requests to N. Singewald at the above addressThis work was supported by the Fonds zur Förderung der wissenschaftlichen Forschung 相似文献
109.
110.
Suwa K 《Journal of anesthesia》1992,6(1):51-56
We propose a model which combines oxygen transport system from blood to tissue with oxygen utilization system at the tissue.The model consists of 3 equations; the relationship between tissue PO
2 (PtsO
2) and O2 utilization (VrcO
2), diffusion from vessel to tissue, and Fick equation. This model has two advantages. First, it is self-consistent. Varying VrcO
2 varies the oxygen transport. Second, it enables to analyze the effects of various factors of oxygen transport/utilization on other factors.We applied this model to the brain tissue. Following values were assumed. Critical tissue PO
2 (PcritO
2) 2mmHg; oxygen utilization above this level 3ml·min–1·100g–1; diffusion coefficient from blood vessel to tissue (D) 0.2ml·min–1·mmHg–1·100g–1; cerebral blood flow (CBF) 50ml·min–1·100g–1; hemoglobin 15g·100ml–1. Hill equation was used for oxygen dissociation curve with n of 2.7 and P50 of 27.0mmHg.From these, the following values were obtained; PvO
2, PtsO
2 and VrcO
2. The changes were analyzed for the 5 input values, PaO
2, CBF, D, P50 and Hb, changing from zero to their respective normal values. A reduction of a single parameter down to 50% of normal barely affected oxygen utilization. A further reduction resulted in significant oxygen utilization. Under conditions studied, a decrease in P50 reduced oxygen utilization faster than that in any other parameters.(Suwa K: Analysis of oxygen transport and oxygen utilization combined. J Anesth 6: 51–56, 1992) 相似文献