Nutrition and Health for Older Persons in Rural America: A Managed Care Model

Health care services and resources for older persons living in rural areas may be highly variable, and integrated service-delivery models are often lacking. This article presents a managed-care model of nutrition risk screening and intervention for older persons in rural areas. Nutrition risk screening was implemented by the Geisinger Health Care System, Danville, Pa, to target all eligible enrollees in a regional Medicare risk program. A single remote clinic site participating in the managed health care system was chosen for further study of a linked screening and case-management effort for undernourished persons. Screening and intervention at the clinic site selected for this study were guided by centralized expertise and resources. Individualized evaluation and intervention plans were developed with the aid of a dietitian and implemented by the clinic case manager. Of the 417 subjects who completed screening at the remote site, 68 met the risk criteria for undernutrition and were selected for case management. Many of the targeted persons received interventions that included evaluations by a physician or physician extender (eg, physician assistant, nurse practitioner) at the clinic and consultations with nutrition, mental health, or social services professionals. Twenty-six of the subjects who took part in the intervention completed a follow-up screening 6 months later. Ten of those persons no longer exhibited risk criteria. This demonstrates the feasibility of a linked screening and case management program for nutrition risk in the managed-care setting. J Am Diet Assoc. 1997; 97: 885-888.     

吸烟、饮酒与胆道癌关系的全人群病例对照研究

 目的　探讨吸烟、饮酒与胆道癌的关系。方法　采用全人群病例对照研究 ,研究对象为 1997年6月 1日～ 2 0 0 1年 5月 31日期间确诊的、年龄在 35～ 74岁的上海市区 6 2 7例胆道癌新发病例以及按性别、年龄 (5岁一组 )频数配对的 95 9例人群对照。采用非条件logistic回归模型分析吸烟、饮酒与胆道癌的关系。结果　男性中 ,吸烟对肝外胆管癌和壶腹癌各组的调整OR均大于 1,现仍吸烟者的调整OR分别为 1.5 1(95 %CI:0 .86～ 2 .6 6 ) ,1.5 8(95 %CI:0 .6 9～ 3.5 8) ;OR随吸烟年限增加和开始吸烟年龄提早有所升高 ,但均未达显著水平。饮酒对胆道癌各组OR均无统计学意义。结论　吸烟也许与肝外胆管癌、壶腹癌有联系 ,未发现吸烟与胆囊癌的显著性关联 ;未发现饮酒与胆道癌的显著性关联。     

胆囊癌与妊娠关系的全人群病例对照研究

目的探讨胆囊癌与妊娠的关系.方法采用全人群病例对照研究,研究对象为1997年6月1日～2001年5月31日期间确诊、年龄在35～74岁的上海市区女性胆囊癌269例以及按年龄(5岁一组)频数配对的538名人群对照,采用非条件lo-gistic回归模型分析妊娠与胆囊癌的关系.结果胆囊癌合并胆石症者中,与妊娠次数≤2次者比较,妊娠次数(3次,4次,5次及≥6次)的各组调整OR分别为1.33(95%CI:0.59-2.99),1.34(95%CI:0.58-3.11),1.39(95%CI:0.57-3.43)和2.67(95%CI:1.12-6.41),趋势检验P=0.03.结论多次妊娠可能通过胆石症影响胆囊癌的发生,生育因素导致的女性体内雌、孕激素水平的升高可能在胆囊癌病因学中起一定的作用.     

身体质量指数及腰臀围比与胆道癌关系的探讨

目的:探讨身体质量指数(BMI)、腰臀围比(WHR)与胆道癌的关系.方法:采用非条件logistic回归模型分析身体质量指数、腰臀围比与胆道癌的关系.结果:与正常BMI组比较,胆囊癌女性20～29岁、30～39岁肥胖组的OR与趋势检验均达到或接近显著水平.与腰臀围比四分位最低组比较,胆囊癌和肝外胆管癌男女性最高四分位组OR和趋势检验均达到显著水平.结论:青年时期肥胖可能会增加胆囊癌的发病风险;腰臀围比也是胆囊癌和肝外胆管癌独立的危险因素.     

Studies on Agranulocytosis. II. The Effect of Chlorpromazine upon the Influx of S35 L-Cystine and L-Methionine into Human Leukocytes

1. When whole blood was incubated in vitro with S-35 L-cystine and L-methionine, the blood cells became radioactive.

2. Preincubation of whole blood from normals and from patients susceptibleto agranulocytosis with chlorpromazine showed no effect upon uptake of S-35L-cystine and L-methionine by leukocytes.

3. The in vivo administration of S-35 L-cystine was followed by the appearance of radioactive leukocytes. Peak radioactivity occurred in leukocytes in 5to 12 days.

4. Pretreatment of test subjects with large doses of chlorpromazine did notblock the uptake of S-35 L-cystine by leukocytes in vivo. Leukocytes of womenshowed an increase in the incorporation of S-35 L-cystine, in vivo. Studiesperformed in vivo on two persons during recovery from agranulocytosisshowed enhanced uptake of L-cystine in one and a normal uptake in the other.

Submitted on March 24, 1960 Accepted on July 13, 1960     

Paget's Disease of the Thoracic Spine A Case Report

A case of cord compression, secondary to Paget's disease, and responding to medical therapy is presented. The role of current imaging techniques in this condition is discussed.     

Female adolescent rheumatological presentations: The importance of chronic pain syndromes

Abstract The clinical features of 60 female adolescents (mean age 15 ± 0.3 years) presenting consecutively to a rheumatologist are reviewed. Thirty-five per cent met criteria for well-defined chronic pain syndromes, 19 having fibrositis syndrome and two having a reflex sympathetic dystrophy syndrome. Other diagnoses were inflammatory arthritis (30%), anterior knee pain syndromes (13.3%), tendinitis (8.3%) and miscellaneous conditions (13.3%). The high prevalence of chronic pain syndromes in this patient group is highlighted and an approach to management is suggested.     

Bone marrow fibrosis: histomorphometric analysis and interobserver reproducibility of a simple optical method of assessing its intensity

Summary A histomorphometric analysis of the length of reticulin fibres per area of haemopoietic bone marrow was performed on 59 trephine iliac crest biopsies. The values obtained were found to correlate with the degree of fibrosis as determined by a simple optical method based on the degree of microscopic magnification required for recognition of the presence of reticulin fibres. The mean length of fibre (μm/10000 μm²) for the three degrees of fibrosis defined by the optical method were: 241.8 ± 16.6 for grade I, 713 ± 85.6 for grade II, and 1827.9 ± 230.4 for grade III (P < 0.001). In a series of 67 biopsies, the overall interobserver agreement of the optical method was found to be good (Spearman's r= 0.99; P < 0.001) and there was good individual agreement for each of the three degrees of fibrosis (improved kappa test). There was a small amount of overlap between the extreme values of adjacent optical degrees. These results suggest that the optical method described here can be recommended as a practical technique for the routine evaluation of myelofibrosis.