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.     

Tuberculous splenomegaly with the hypersplenism syndrome; a case report

A case of tuberculous splenomegaly with leukopenia and anemia followingmiliary tuberculosis has been presented. Splenectomy was required after streptomycin failed to control the cytopenias, progressive emaciation, and splenic infection. However, following what appeared to be six weeks of marked improvement,the patient developed a fulminating tuberculous meningitis and died.

Note: ACKNOWLEDGMENTThe authors are indebted to Dr. Byrd S. Leavell for his suggestions in the preparation of this paper.

     

Short-Term and Long-Term Changes of Left Ventricular Volumes During Rate-Adaptive and Single-Rate Pacing

To evaluate the adaptation of the heart to exercise during pacing, 15 patients with permanent endocardial pacemakers were studied; nine patients had atrioventricular universal (DDD) pacemakers (Symbios 7005) and six patients had activity detecting rate-responsive ventricular (VVIR) pacemakers (Activitrax 8403). Left ventricular function in each patient during rate variable pacing was compared to ventricular function during VVI single-rate pacing. End-systolic and end-diastolic volume changes during exercise were measured by radionuclide angiography and the amount of volume change was used to assess left ventricular function. Both short-term (within 4 hours) and long-term measurements (after at least 4 weeks) were made at rest and at 50% of the maximal exercise capacity in DDD or VVIR mode and were compared with VVI single-rate pacing. All patients, when changed from DDD or VVIR mode to VVI single-rate pacing showed a significant increase of the end-diastolic volume during exercise, which increased even more after long-term VVI pacing. During long-term rate variable pacing, there was no increase of the end-diastolic volume during exercise. DDD or VVIR pacing initially showed a substantial increase of the end-systolic volume during exercise combined with a decrease of left ventricular ejection fraction, suggesting a decrease of the left ventricular contractility. After 4 weeks, contractility improved both with DDD and VVIR pacing. We conclude that short-term DDD and VVIR pacing induces a temporary impairment of left ventricular function that improves after 4 weeks, whereas long-term VVI pacing is associated with left ventricular dilatation even at moderate levels of exercise.     

The use of qualitative questionnaires in patients having and being considered for cochlear implants

Within this study we have examined the particular hearing complaints of patients being considered for a cochlear implant and the specific benefits/shortcomings experienced by implanted patients using open-ended questionnaires. As we expected, the difficulty of hearing general conversation was the most common individual hearing complaint. However, 45% of complaints were concentrated in the ‘psychosocial’ category, which was significantly higher than that found among general audiological rehabilitation patients. The average number of benefits listed by patients having implants was significantly higher than that of the shortcomings. Moreover, the main benefits listed were focused on the acoustical and psychological factors, e.g. ‘environmental sound awareness’, ‘general conversation easier’ and ‘feeling of self-confidence’. The main shortcomings were related to the acoustical and practical areas, e.g. hearing difficulty in noisy background, processor being cumbersome.     

Variations in the Relationships Between Total 59Fe Uptake and the Uptakes Into Heme and Nonheme Fractions of Spleen and Bone Marrow in Irradiated Mice and Mouse Radiation Chimeras

A chemical method for the separation ofheme and nonheme iron-containing fractions in mouse tissues has been used tostudy the uptake of ⁵⁹Fe into both theheme and nonheme iron fractions inspleen and femoral bone marrow, in orderto investigate the possible relationshipsbetween the total uptake into spleen tissue and the rate of uptake into the hemefractions. In control mice, only aboutone third of the ⁵⁹Fe is directly associated with heme during the first dayafter administration, and this fraction decreases as radioactive red cells are released from the spleen into blood. Tendays after X-irradiation of mice, the proportion of ⁵⁹Fe in the spleen heme fraction 6 hr after intraperitoneal administration decreased from about 30 to 10%of the total splenic activity as the radiation dose was increased from 500 to 750rads. A similar alteration in the proportion of ⁵⁹ Fe in the spleen haem fractionoccurred in mouse radiation chimeras asthe dose of injected syngeneic bonemarrow cells was reduced from 5 x 10⁵to zero. Similar results were found infemoral bone marrow. These results indicate that in this system the rate of uptake into whole tissue is not a measureof the uptake into heme; it is necessary,therefore, to use the method involvingthe measurement of iron uptake intoheme, rather than the total tissue uptake,when estimating hemoglobin synthesisor erythropoiesis.

Submitted on February 15, 1971 Revised on April 5, 1971 Accepted on April 8, 1971