Health-related predictors of falls and fractures in women over 40.

SUMMARY: A longitudinal study of women aged 40-80 predicted single falls from a previous fall history and deficient vestibular integration. Multiple falls were predicted by a fall history, low activity levels, more medical conditions and deficient vestibular integration. Low bone mineral density, more medical conditions and fall history predicted fractures. INTRODUCTION: The purpose of this study was to identify potentially modifiable health-related factors predicting falls and fractures, focussing on women over 40. METHODS: Four hundred and forty-nine women aged 40-80 years from the Longitudinal Assessment of Women study participated. Demographic information (age, BMI, medications, medical conditions and activity level), balance assessments (including timed up & go and modified clinical test for sensory interaction of balance) and measurements of bone mineral density and body composition were collected in 2001; fall and fracture data were gathered in 2003, 2005, 2007, 2008 and 2010 to determine incidence. RESULTS: Multinomial logistic regression revealed that single falls could be predicted by a history of previous falls (OR 3.08) and being unsteady in bipedal stance on foam with eyes closed (OR 1.99). Multiple falls were predicted by a history of falls at baseline (OR 4.69), low levels of activity (OR 2.17), greater number of medical conditions (OR 1.12) and being unsteady in bipedal stance on foam with eyes closed (OR 4.21). Low bone mineral density (OR 3.13), greater number of medical conditions (OR 1.32) and a history of falls (OR 3.04) were predictive of fractures. CONCLUSIONS: Poor health, decreased balance, and inactivity are predictive of falls and low bone mineral density, low activity level and poor health predictive fractures. Results suggest failing the balance test bipedal stance on foam with eyes closed in the presence of low activity and poor health is a valid quick screening tool for detecting potential fallers for referral for in-depth balance assessment and intervention.

Early intraocular pressure rise after trabeculectomy.

Intraocular pressure (IOP) was measured 4 to 6 hours after surgery and on the first postoperative day in 35 eyes of 35 consecutive patients undergoing initial trabeculectomy. In 27 eyes, the anterior chamber was re-formed at the completion of surgery with balanced salt solution, and in eight eyes it was reformed with hyaluronate sodium. A total of six eyes (17%) had an IOP of 40 mm Hg or greater 4 to 6 hours after surgery. Patients who received hyaluronate to maintain the depth of the anterior chamber had a significantly greater chance of experiencing a marked postoperative IOP rise, both at 4 to 6 hours (P = .005) and on the first postoperative day (P = .0038). There was no correlation between the postoperative IOP rise and the patient's age, sex, glaucoma diagnosis, preoperative IOP, use of 5-fluorouracil, or the number of sutures used to close the scleral flap. Hyaluronate may contribute to an early increase in IOP that could result in further visual field loss in eyes with severe glaucomatous damage. We recommend early monitoring of IOP after trabeculectomy and avoiding the routine use of hyaluronate.

Study of chart designs and optotypes for preschool vision screening--I. Comparability of chart designs.

Design variations in children's distance vision screening charts contribute to inconsistencies noted in preschool vision screening programs. This study compares children's distance visual acuity on two chart designs: logarithm of the minimal angle of resolution (LOGMAR) vs a chart of 'standard' design. In theory, the LOGMAR chart offers the advantages of improved precision in measuring inter-patient differences and greater consistency of follow-up measurements. Our findings indicate the following: 1) the ability to complete a test depends upon the child's age, not on chart design; 2) isolation of symbols is required more frequently for the LOGMAR charts than for the standard charts; and 3) on average, children have slightly poorer visual acuity scores on LOGMAR charts than on standard charts.

Improving dietary practices of elderly individuals: the power of prompting feedback, and social reinforcement.

Three intervention packages consisting of (a) enhanced prompts, feedback, and social reinforcement; (b) a lottery; and (c) serving as a confederate were added and removed in sequence as adjacent conditions in an extended withdrawal design to assess their effects on the dietary choices of elderly persons. Participants were 3 elderly residents of an independent living facility who were identified as making consistently poor dietary choices and who had medical conditions that necessitated changes in their eating habits. All 3 participants demonstrated a marked increase in healthy choices of food items in response to the package of enhanced prompts, feedback, and social reinforcement. No additional increase occurred with the introduction of the lottery and serving as a confederate. Food-choice data indicated that most of these improvements could be attributed to healthier entree and dessert choices. Group data for all residents suggested small improvements in dietary practices during the three intervention conditions, with the largest proportion of the group's healthy choices occurring when the lottery was added to enhanced prompts, feedback, and social reinforcement. Food-choice data indicated that most of these improvements could be attributed to healthier dessert choices alone.

Personalities of women reporting incestuous abuse during childhood.

Previous studies of adult females reporting incestuous sexual abuse in childhood, using the Apperceptive Personality Test and Draw-a-Person Questionnaire, indicated abusees attributed more negative traits to their characters than did controls. No differences were found by type of abuse or relation to the abuser. In these studies abusees and controls were obtained from different sources, although matched on several characteristics. The present study compared 79 incestuous abusees to 79 matched controls all drawn from the same subject pool. Multivariate analysis of variance identified significant differences between the groups. In contrast with earlier studies questionnaire scores distinguished rape victims from those abused without rape and distinguished those abused by older relatives from those abused by peers in two additional multivariate analyses of variance.

Hardware to hard hats: training workers for action (from offices to construction sites).

A university-based labor education program provides training to unionists, emphasizing the skills needed by workers and their representatives in order to promote their rights to health and safety on the job. The article describes two examples of this training approach. The first example is a training program for video display terminal (VDT) operators which prepares them to take a leadership role in advancing policies to regulate working conditions for VDT users. The second is a program designed to improve the quality of safety, or "tailgate" meetings in the construction industry by promoting an approach that encourages active worker participation in identifying potential hazards and developing solutions. The methodologies used to achieve action-oriented outcomes are described.

Development of an enzyme-linked immunosorbent assay for studying Pseudomonas aeruginosa cell surface antigens.

An enzyme-linked immunosorbent assay for the measurement of antibodies directed against Pseudomonas aeruginosa cell surface antigens was developed. Formalin-killed whole cells of P. aeruginosa, adsorbed to polystyrene acrylic copolymer cuvettes, were used as immobilized antigens. Antisera to P. aeruginosa mucoid strain 144M and to its spontaneous nonmucoid derivative, 144NM, were raised in rabbits by immunization with Formalin-killed bacteria. By using this enzyme-linked immunosorbent assay, anti-144M serum was found to have a ca. 10-fold-higher antibody titer to 144M than did anti-144NM serum, suggesting that 144M may have either immunogenic determinants not present on 144NM or perhaps simply more antigenic determinants. In contrast, anti-144M and anti-144NM immune sera were found to have nearly identical antibody titers to 144NM, suggesting that these strains share many determinants. Anti-P. aeruginosa immune serum was found to contain Pseudomonas-specific antibodies as well as antibodies which cross-reacted with other gram-negative bacteria. Finally, absorption studies demonstrated that this assay can detect both LPS and non-LPS surface-exposed antigenic determinants. Thus, this whole bacterial cell enzyme-linked immunosorbent assay should prove useful in monitoring patient sera and secretions for potentially protective immunoglobulins directed at P. aeruginosa cell surface antigens.

Study of hydrodynamics in microcarrier culture spinner vessels: A particle tracking velocimetry approach.

Three-dimensional particle tracking velocimetry (3-D PTV), a modern, quantitative, visualization tool, has been applied to the characterization of the flow field in the impeller region of cell culture reactor vessels. The experimental system used here is a 250-mL microcarrier spinner vessel. The studies were conducted at three different agitation rates, 90, 150, and 210 rpm, corresponding to healthy, mildly damaging, and severely damaging shear intensities, respectively. The flow can be classified into three regions: a predominantly tangential (azimuthal) flow generated by the impeller; a trailing vortex region coming off the impeller tip; and a converging flow region close to the center of the vessel. The latter two are the regions of highest velocity gradients. Energy dissipation rates due to mean velocity gradients were also calculated to characterize the impeller stream. Local specific energy dissipation rates > 10,000 erg/(cm(3)sec) . have been measured. It is proposed that the critical regions for microcarrier culture damage due to impeller hydrodynamics are the trailing vortex region and the high energy converging flow region. Graphical representation of the mean velocity flow fields and the distribution of energy dissipation rates in the impeller region are also presented here. The merits of using the dissipation function (measure of specific energy dissipation rate) as a possible scale-up parameter are also discussed. (c) 1996 John Wiley & Sons, Inc.

Personality of rape survivors as a group and by relation of survivor to perpetrator.

Adult survivors of rape were compared to controls on 34 scales of the Apperceptive Personality Test and Draw-A-Person Questionnaire. They also reported on present or past weight problems, alcohol or drug problems, and psychotherapy. They differed on 12 scales and on alcohol, weight problems, and therapy. These survivors more frequently reported problems or therapy and differed on personality scales in the direction of assigning fewer positive or more negative attributes to their characters. Those raped by relatives, dates, or acquaintances were more negative than those raped by strangers on four scales, but did not differ on alcohol or weight problems or participation in psychotherapy.

Studies of blood pressure in Tecumseh, Michigan. I. Blood pressure in young people and its relationship to personal and familial characteristics and complications of pregnancy in mothers.

Relationships between blood pressures (BPs) of young people and a number of personal, parental and familial characteristics have been assessed in the population of Tecumseh, Michigan. Systolic and fifth phase diastolic BPs were measured in 4500 persons under 20 years of age at the time of their first examination. Body size, fatness and heart rates of the subjects themselves were significantly related to their age- and sex-adjusted BP scores. The parents' BP scores were also correlated with those of the young subjects, and scores were significantly higher in those whose mothers had had high BP or toxemia in pregnancy of a stillbirth. A weak association between BP and socioeconomic circumstances was suggested by the slightly higher mean BP scores found in sons and daughters of men in blue collar jobs and of men and women with the least education. BP levels were not associated with birth order, sibship size or birth weight nor with the numbers of pregnancies, live births or abortions experienced by the mothers of young subjects. In a stepwise multiple regression, the most important determinants of BP were weight/height ratios of the subjects themselves and BP levels of their parents; a small additional effect of complications of pregnancy in the mother was detectable in the offspring 0--19 years laters.

Ras related oncogene protein as a tumor marker in transitional cell carcinoma of the bladder.

An oncogene related protein has been detected in the urine of patients with transitional cell carcinoma (TCC). This is a 55 kilodalton protein (p55) which is immunologically related to the ras oncogene product p21. Sixteen patients with TCC (55%) and none of the controls exhibited high level of p55 expression (greater than or equal to 3X the level of background). There were ten cancer patients (35%) who had 2X the level of background and three patients (10%) who had the level of background. In contrast, there were two non-cancer patients with 2X level of expression (9%) and the remainder (91%) had the background level of p55 expression. The expression of the marker (p55) tends to correlate with tumor grade and stage and is elevated in patients with a history of multiple recurrences. The ras oncogene has been identified in the tissues of a wide variety of cancers and is not a marker which is specific for any single cancer. The identification of its related gene product in the urine may be useful as a marker for TCC.

Patients who leave emergency departments without being seen by a physician: magnitude of the problem in Los Angeles County.

STUDY OBJECTIVES: To determine the hospital characteristics associated with patients leaving emergency departments prior to physician evaluation. DESIGN: Cross-sectional design with data collection by mail and telephone survey. SETTING: Los Angeles County, California. TYPE OF PARTICIPANTS: Convenience sample of four public and 26 private hospital EDs with a combined monthly volume of 92,570. INTERVENTIONS: None. RESULTS: Questionnaires were returned from 83% of EDs surveyed. During 1990, 4.2% of patients at these EDs left without being seen by a physician. In all, 7.3% of public hospital patients left without being seen, and 2.4% of private hospital patients left without being seen (P < .001). The percentage of patients who left without being seen was significantly higher at EDs with longer waiting times, higher fraction of uninsured patients, and at hospitals with accredited residency training programs (P < .001 for each comparison). A logistic regression model, used to simultaneously evaluate the effects of multiple correlated factors, revealed that waiting time, fraction of patients uninsured, and teaching status had independent positive associations with patients who left without being seen. CONCLUSION: More than 4% of patients who seek care at EDs in Los Angeles County leave without being seen by a physician. A greater proportion of patients leave without medical evaluation from EDs with long waiting times for ambulatory patients and from those that serve uninsured populations. These findings should be interpreted in light of existing data on the health consequences faced by patients who leave hospital EDs without treatment.

Detection of onco-fetal bladder antigen in urine of patients with transitional cell carcinoma.

Studies of antigens associated with transitional cell carcinoma were extended by using murine IgM monoclonal antibody E7, developed earlier by this laboratory. These antibodies react preferentially with human bladder tumors and transitional cell carcinoma (TCC) cell line 647V. We now report that monoclonal antibody E7 detected the presence of antigen in midgestational and third trimester amniotic fluids, and in urine of patients with advanced transitional cell carcinoma. Western blot analysis showed that the antigen present in amniotic fluids consists of a sharp band with molecular weight greater than 200 kdaltons. A similar molecular weight pattern was seen with the solubilized membrane of 647V. A sensitive and convenient sandwich ELISA was developed and the urine of patients with bladder cancer was assayed for the presence of the E7 antigen. Antigen was detected in the urine of patients with advanced transitional cell carcinoma but not in the urine of normal adults or in urine from patients with prostate cancer, renal cell carcinoma, or benign prostate hyperplasia. An inhibition enzyme immunoassay was developed with monomeric forms of the E7 antibody and confirmed the presence of antigen in the urine of patients with TCC. We conclude that the E7 antigen is an onco-fetal antigen expressed in patients with transitional cell carcinoma of the bladder.

Hernia de Amyand: presentación de un caso y revisión de la literatura / Amyand hernia: report of one case

La presencia de apendicitis aguda en una hernia inguinal es un hecho infrecuente, con un 0,13% de los casos. Esta rara condición se conoce como Hernia de Amyand. La forma de presentación habitual es la de una hernia inguinal complicada. Es por este motivo que el diagnóstico preoperatorio de apendicitis aguda requiere de una alta sospecha clínica, realizándose mayoritariamente durante la cirugía. El estudio de imágenes, en particular la Tomografía Axial Computada, ha sido utilizado para plantear este diagnóstico. El tratamiento recomendado es la apendicectomía y la reparación primaria de la hernia en el mismo tiempo operatorio. No se debe utilizar prótesis por el riesgo de infección y fístula del muñón apendicular. Debido a lo excepcional de esta patología, presentamos el caso de un hombre de 75 años que se manifestó como una hernia inguinal complicada y cuyo diagnóstico de apendicitis se realizó en pabellón luego de abrir el saco.

The presence of an acute appendicitis in an incarcerated inguinal hernia, termed Amyand's hernia, is an uncommon and rare condition estimated to be found in approximately 0.13% of adult inguinal hernia repairs. The usual clinical presentation is as a complicated inguinal hernia; this is why the preoperative diagnosis of acute appendicitis requires a high clinical suspicion, even though the diagnosis of Amyand's hernia is done mainly during surgery. Computed tomography is a good diagnostic method. The treatment is surgical, and consists of an appendectomy with primary repair of the hernia. Synthetic mesh should not be used in the repair of contaminated abdominal wall defects, because the prosthetic material can increase the inflammatory response and result in wound infection and a possible appendiceal stump fistula. We report a 75 years old man who presented with a complicated inguinal hernia, in whom the diagnosis of acute appendicitis was made during surgery after opening the hernia sac.