Ten principles for geriatric health promotion

The concept of health promotion for elderly people holds promisefor countries faced with limited resources and the unprecedentedgrowth of their elderly populations. This article draws on thework of David Werner and on research in health education, communitydevelopment, health promotion and gerontological health to discussten principles underlying the concept of geriatric health promotion.By stressing empowerment, the strengths and not merely the needsof aged people, community participation and the role of publicpolicy, geriatric health promotion is seen as embracing theWorld Health Organization approach to health promotion as abroad, enabling process. Similarly, in its attention to functionalhealth status, the needs of informal caregivers and the socialas well as the health needs of elderly people, it complementsand draws upon recent trends in the fields of geriatrics andgerontological health. The need for further development of the conceptual base of geriatrichealth promotion is stressed, as is the importance of surveyingexisting efforts in this area. Finally, the article underscoresthe need for developing a theoretical basis for action thatwould take account of the diversity of settings and conditionsin which the model might be applied.     

HIV risk of transmission behaviour amongst HIV-infected prisoners and its correlates

Thirty-eight from a total of 42 known HIV-positive prisoners in the Irish prison system voluntarily cooperated in a survey of psychological attitudes, knowledge of risk behaviour, intentions with respect to future risk behaviour, and actual past risk behaviour Of this group, 65% reported that they had put others at risk of HIV, since they became aware of their own HIV + status. Only 16% stated that they would definitely not share their drug-taking equipment in the future and 32% that they would always use a condom in sexual intercourse. In general, psychological and biographical variables were not strongly related to whether or not the respondents had put others at risk of HIV. Nor were there any significant differences in knowledge of at risk behaviour between those who had and those who had not put others at risk. However, there was some evidence for considerable independence between risk-taking behaviour in the sexual and in the drug-taking domains, in that risk-taking in one area was not highly predictive of risk-taking in the other.     

Interferon Alfa-2b or Not 2b? Significant Differences Exist in the Decision-Making Process between Melanoma Patients Who Accept or Decline High-Dose Adjuvant Interferon Alfa-2b Treatment

BACKGROUND: Patients with thick (Breslow>4 mm) primary melanoma and/or regional nodal metastasis have a high risk of tumor recurrence. High-dose adjuvant interferon (IFN) alfa-2b offers/=50% risk of recurrence/disease-related mortality and offered IFN. Telephone surveys delineated reasons behind patients' decisions to accept IFN. RESULTS: Acceptors, 60 of 135 (45%), decided to take IFN alfa-2b whereas 75 of 135 (55%) declined. Being female (OR, 2.4; 95% CI, 1.17-5.03; p=.017) and positive SLN status (OR, 2.2; 95% CI, 1.01-4.97; p=.048) were strongly associated with patients who chose IFN. Acceptors of IFN were younger, more influenced by physicians, and less affected by depression and side effect profile (p<.05 for all). Decliners were more concerned by strained relationships with family and social life (p<.05). CONCLUSIONS: Gender and positive SLN were predictive of high-risk melanoma patients' acceptance of IFN treatment. Physician insight into melanoma patients' therapeutic decision-making process can guide patients through this difficult disease.     

The cold pressor test: Vascular and myocardial response patterns and their stability

The purposes of the present study were to compare the cardiovascular response patterns evoked by three versions of the cold pressor test (either forehead stimulation or hand or foot immersion) and to determine the reproducibility of the responses over a 2-week interval. Blood pressure, heart rate, stroke volume, cardiac output, total peripheral resistance, and systolic time intervals were obtained during rest and during the cold pressor test in 42 young men. Across conditions, the pressor response was supported by peripheral resistance increases with concomitant stroke volume decreases. Although the response panerns were generally similar across sites, exceptions were apparent for heart rate. Forehead stimulation was characterized by no significant change in heart rate, whereas limb (hand or foot) immersion was associated with significant heart rate acceleration. The responses elicited by the three cold pressor test conditions were reliable and showed little evidence of attenuation over the test-retest interval.     

Aetiology of Acute Pharyngitis and Clinical Response to Empirical Therapy with Erythromycin Versus Amoxicillin

Guthrie R M, Ruoff G E, Rofman BA, Ginsberg D, Karp R R, BrownS M and Schulz GA. Aetiology of acute pharyngitis and clinicalresponse to empirical therapy with erythromycin versus amoxicillin.Family Practice 1988; 5: 29–35. One hundred and eighty-nine adults with acute pharyngitis hadculture and serological evaluation for groupA beta haemolyticstreptococci (GABHS), Mycoplasma pneumoniae, and Branhamellacatarrhalis. Sixteen patients had evidence for infection withGABHS, none for M. pneumoniae, and one for B. catarrhalis. Forthose with GABHS, there was no significant difference betweenempirical treatment by erythromycin or amoxicillin. For thosewithout GABHS, empirical treatment with erythromycin appearedto result in a statistically significant reduction in coughand a noticeable but less than significant reduction of othersymptoms when compared to empirical treatment with amoxicillin.The new formula tion of erythromycin utilized in this study(PCE) may be associated with a reduction in gastrointestinalintolerance from that reported with other erythromycin products.     

Adaptive changes in cerebral blood flow and oxygen consumption during ethanol intoxication in the rat

Cerebral blood flow (CBF) and oxygen consumption (CMRO₂) were measured during acute and long-term ethanol intoxication in the rat. The purpose was to investigate whether the adaptive changes (development of tolerance) occurring in the CNS during ethanol intoxication were associated with changes in CBF and/or CMRO₂. Consistent with other studies we found that acute severe ethanol intoxication (median blood alcohol concentration (BAC=5.4 mg/ml)) caused a significant decrease in CBF and CMRO₂. After 3–4 days of severe intoxication (BAC of 6.6 mg/ml) these physiological variables were less affected indicating that functional tolerance had developed: CMRO₂ and CBF during acute ethanol intoxication were 9.3 ml/100 g/min and 60 ml/100 g/min respectively; after the long term intoxication period these variables reached 11.2 ml/100 g/min and 78 ml/100 g/min respectively, i.e. values not significantly lower than those of the control group. After induction of hypercapnia (PaCO₂ about 80 mmHg) CBF increased by 360% in the control group; in the acutely intoxicated group CBF increased by only 127% and in the long term intoxicated group by 203 % indicating that the cerebrovascular CO₂-reactivity had also adapted to the ethanol intoxication. It is concluded that adaptive changes of the CNS to chronic ethanol intoxication comprise alterations in CMRO₂, CBF and cerebrovascular reactivity.     

Ozone-Induced Pulmonary Functional, Pathological, and Biochemical Changes in Normal and Vitamin C-Deficient Guinea Pigs

Since Vitamin C (ascorbate, AH₂) is an important airway antioxidantand is an essential component of tissue repair, and since acute(4 hr) O₃ toxicity is enhanced by AH₂ deficiency, we hypothesizedthat longer-term O₃ effects might also be increased. FemaleHartley guinea pigs (260–330 g) were fed either an AH₂-sufficientor an AH₂-deficient diet 1 week prior to exposure, and weremaintained on their respective diets during 1 week of continuousexposure to O₃ (0, 0.2, 0.4, and 0.8 ppm, 23 hr/day), and during1 week postexposure recovery in clean air. The AH₂-deficientdiet caused lung AH₂ to drop to about 30% of control in 1 week,and to below 10% by the end of exposure and recovery. Body weightgains during exposure were decreased in the 0.8 ppm O₃ group,while the AH₂ deficiency began to affect body weights only duringrecovery. O₃ caused a concentration-dependent decrease in totallung capacity, vital capacity, carbon monoxide diffusing capacity,nitrogen washout, and static compliance, while increasing forcedexpiratory flow rates and residual or end-expiratory volume(suggestive of pulmonary gas-trapping). The lung/body weightratio and fixed lung displacement volume were also increasedin O₃-exposed animals. Lung pathology consisted of mononuclearcell and neutrophil infiltration, airway as well as alveolarepithelial cell hyperplasia, and general decrease in epithelialcell cytoplasm. Thickening of the interstitium and an apparent increase in collagenstaining were seen at the terminal bronchiolar regions. Someof these effects were marginally exacerbated in AH2-defi- cientguinea pigs. One week postexposure to air reversed all O₃-inducedabnormalities, irrespective of AH₂ deficiency. Whole lung hydroxyprolineand desmosine were not changed at any time by either 0₃ or AH₂deficiency. Measurement of lung prolyl hydroxylase activitysuggested that AH₂ deficiency as well as 0₃ exposure may haveincreased the tissue levels of this enzyme. The lack of a significantincrease in toxicity with the longer-term exposure scenariosuggests that AH₂ has minimal influence on other compensatorymechanisms developed over time.