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Biomedical subjects

S Engberg

Publications and source records attributed to S Engberg.

At least 19 recordsLinked to original sources
PubMed2001

Prevalence and recognition of depressive symptoms among homebound older adults with urinary incontinence.

Within a group of homebound elders with urinary incontinence, the objectives of this study were to (1) examine the prevalence of depressive symptoms, (2) examine the extent to which depression had previously been recognized by health care providers, (3) describe the type and intensity of antidepressant treatment prescribed for subjects, and (4) identify the demographic and functional characteristics associated with depressive symptomatology. A descriptive correlational design was used. The 15-item Geriatric Depression Scale (GDS-15) was administered to 345 homebound adults age 60 years and over referred to a study examining the effectiveness of behavioral therapy for urinary incontinence. Individuals were referred to the study by home care nurses from two large Medicare-approved home health agencies in a large metropolitan county in Pennsylvania. Data were collected during in-home assessments and by chart review. Measures included the GDS-15, structured medical history, in-home review of medications, Older Americans Research and Service Center Physical and Instrumental Activities of Daily Living scales, Mini-Mental State Examination (MMSE), Clock Drawing Test, Performance-Based Toileting Assessment, and bladder diaries. One half of the participants (n = 173; 50.1%) had significant depressive symptomatology, with 35.7% having scores suggesting mild depression and 14.5% severe depression. Only 26.4% and 34.7% of those with mild and severe depressive symptoms, respectively, had a previous diagnosis of depression and only 21.7% and 34.0%, respectively, had been prescribed an antidepressant. The most commonly prescribed class of antidepressants was tricyclic antidepressants, being taken by 9.0% (n = 31) of the total sample, 14 (11.4%) of those with mild symptoms and 4 (8.0%) of those with severe depressive symptomatology. A little over half (60.0%) of subjects being treated with antidepressants continued to exhibit significant depressive symptomatology. Greater dependence in physical activities of daily living, the need for assistance during ambulation, higher MMSE scores, and higher levels of comorbidity were associated (P < .05) with a GDS-15 score of 5 or higher. Depression symptoms are common in homebound older adults with urinary incontinence, but clinical recognition and treatment are limited.

Aged↗
PubMed1999

Effectiveness of behavioral therapy to treat incontinence in homebound older adults.

OBJECTIVES: To examine the (1) short-term effectiveness of behavioral therapies in homebound older adults and (2) characteristics of responders and nonresponders to the therapies. DESIGN: Prospective, controlled clinical trial with cross-over design. SETTING: Adults aged 60 and older with urinary incontinence and who met Health Care Financing Administration criteria for being homebound were referred to the study by homecare nurses from two large Medicare-approved home health agencies in a large metropolitan county in southwestern Pennsylvania. MEASURES: Structured continence and medical history, OARS Physical and Instrumental Activities of Daily Living scales, Folstein Mini-Mental State Examination Score, Clock Drawing Test, Geriatric Depression Scale, Performance-Based Toileting Assessment, bladder diaries, and physical examination. RESULTS: One hundred five subjects were randomized to biofeedback-assisted pelvic floor muscle training (53 to the treatment group and 52 to the control groups). Control subjects with complete pre- and post-control data (n = 45) experienced a median 6.4% reduction in urinary accidents in contrast to a median 75.0% reduction in subjects with complete pre- and post-treatment data (n = 48, P < .001). Following the control phase, subjects crossed over to the treatment protocol. Eighty-five subjects completed treatment, achieving a median 73.9% reduction in UI. Exercise adherence was the most consistent predictor of responsiveness to the behavioral therapy. CONCLUSIONS: Clinically significant reductions in urinary incontinence are achievable with behavioral therapies in many cognitively intact homebound older adults despite high levels of co-morbidity and functional impairment.

Aged↗
PubMed1998

Survival and 2-year outcome with expectant management of second-trimester rupture of membranes.

OBJECTIVE: To evaluate the perinatal and 2-year outcomes in pregnancies complicated by preterm premature rupture of membranes (PROM) during the second trimester. METHODS: Fifty-three consecutive singleton pregnancies with PROM at 14 to 28 weeks of gestation were studied retrospectively. Management goals were to prolong the pregnancies to 32 weeks through expectant management and to avoid fetal compromise through closer monitoring and active intervention, when necessary, after 23 weeks. Outcome of the surviving infants was based on neurologic, audiometric, and ophthalmologic examinations at 2 years of corrected age. RESULTS: Rupture of membranes occurred at 14-19 weeks (mean 17.4 weeks) in 10 women, at 20-25 weeks (mean 24.0 weeks) in 24, and at 26-28 weeks (mean 27.6 weeks) in 19. The median latency periods to delivery were 72 days, 12 days, and 10 days when rupture of membranes occurred at 14-19 weeks, 20-25 weeks, and 26-28 weeks, respectively. The overall incidence of chorioamnionitis was 28%. There were no fetal deaths and nine neonatal deaths. When rupture of membranes occurred at 14-19 weeks, 20-25 weeks, and 26-28 weeks, the perinatal survival rates were 40%, 92%, and, 100%, respectively. Pulmonary hypoplasia accounted for seven deaths. Of the live-born infants, 81% were alive at 2 years of corrected age. Survival without major impairment was observed in 75%, 80%, and 100% of the survivors when rupture of membranes occurred at 14-19 weeks, 20-25 weeks, and 26-28 weeks, respectively. CONCLUSION: Expectant management of second-trimester PROM offers better perinatal and long-term survival than previously thought.

Adult↗
PubMed1998

Health-related quality of life in chronic disorders: a comparison across studies using the MOS SF-36.

The purpose of this report is to examine health-related quality of life (HRQoL) as measured by the Medical Outcomes Study Short Form-36, across patient populations with chronic disorders and to compare quality of life (QoL) in these subjects with normative data on healthy persons. Six studies, within the Center for Research in Chronic Disorders at the University of Pittsburgh School of Nursing, in patients with urinary incontinence, prostate cancer, chronic obstructive pulmonary disease (COPD), acquired immune deficiency syndrome (AIDS), fibromyalgia and hyperlipidaemia provided the data for analysis. The results demonstrated that not only did the prostate cancer and hyperlipidaemia patients have the highest QoL across the chronic disorders, but their QoL was comparable to normative data on healthy persons. Homebound, elderly, incontinent patients had the lowest QoL for physical functioning, whereas patients hospitalized with AIDS had the lowest QoL in general health and social functioning. Patients with COPD had the lowest QoL in role-physical, role-emotional and mental health. Patients with fibromyalgia had the lowest QoL in bodily pain and vitality. Compared to normative data, patients with urinary incontinence, COPD, AIDS and fibromyalgia generally had lower QoL. Prostate cancer and hyperlipidaemia patients had QoL comparable to normative data. Compared to normative data, patients with urinary incontinence, COPD, AIDS and fibromyalgia had more variability for role-emotional. AIDS patients had more variability on physical functioning, bodily pain and social functioning compared to the normative data. These data suggest that patients with various chronic disorders may have QoL that is lower in most domains compared to a healthy population. However, there may be differences in the domains affected as well as the extent of variation across specific chronic disorders.

Aged↗
PubMed1998

In vitro digestion of proteins in human milk fortifiers and in preterm formula.

BACKGROUND: Knowledge about the digestibility of the proteins in new products designed for feeding preterm infants is limited. The purpose of this study was to observe in vitro the hydrolysis of the bovine and human whey proteins in such products. METHODS: Proteins in human milk, in human milk fortifiers (Presemp [Semper AB, Stockholm, Sweden] and Enfamil [Mead Johnson, Evansville, IN, U.S.A.] human milk fortifiers), in preterm formulas (Similac Special Care [Ross, Columbus, OH, U.S.A.] and Enfalac [Mead Johnson]), and whey protein concentrates with varying degrees of denaturation were digested by duodenal juice from healthy preterm infants, from a 3-year-old child, and from adults. Digestion was studied in vitro using polyacrylamide gradient gel electrophoresis, electroimmunoassay, and nonprotein nitrogen analysis. RESULTS: Casein was the protein most rapidly degraded in all products. Human and bovine whey proteins were more slowly digested; as much as 68% of human lactoferrin was still immunoreactive after 40 minutes of digestion. The corresponding figure for bovine serum albumin was 24-69%; for B-lactoglobulin, 20-40%; for bovine alpha-lactalbumin, 20-51%; and for human alpha-lactalbumin, 41%. Contrary to common belief, digestibility of bovine whey proteins decreased with a high degree of denaturation of the proteins. CONCLUSIONS: Bovine whey proteins in human milk fortifiers and in preterm formulas are relatively slowly digested in vitro by normal duodenal juice. The results may have implications for the design of products for feeding preterm infants.

Adult↗
PubMed1997

Digestion of proteins in human milk, human milk fortifier, and preterm formula in infant rhesus monkeys.

BACKGROUND: There is limited information in the literature on the capacity of the preterm infant to digest human and bovine milk proteins. We therefore studied in vivo the luminal phase of the hydrolysis of proteins in human milk, human milk fortifier, and preterm formula in preterm rhesus monkeys and in infant rhesus monkeys at 6 weeks and 7 months of age. METHODS: Protein hydrolysis was followed by polyacrylamide gradient gel electrophoresis and electroimmunoassay. The serum level of absorbed unhydrolyzed human alpha-lactalbumin was measured by a radioimmunoassay method. Trypsin and elastase activities in duodenal contents were measured before and after the meal. RESULTS: In 6-week-old monkeys, the enzyme activities decreased by 50% postprandially, whereas they increased in 7-month-old monkeys. In preterm and in 6-week-old monkeys, hydrolysis of human and bovine whey proteins was slow, and in 6-week-old monkeys, 30-50% of the proteins could still be detected immunochemically in duodenal contents after 60 min. At these ages, serum level of absorbed alpha-lactalbumin were high. At 7 months of age, no or small (lactoferrin and bovine serum albumin) amounts of the proteins could be detected in duodenal contents after 15 min. At this age alpha-lactalbumin was not measurable in serum. CONCLUSIONS: The low capacity to digest whey proteins in suckling monkeys may depend upon an immaturity of the exocrine pancreas to respond to secretogogues.

Age Factors↗
PubMed1997

Geropsychiatric restraint use.

OBJECTIVES: To investigate predictors and reasons for restraint use with geropsychiatric patients. DESIGN: A prospective, correlational study. SETTING: The geriatric unit of an acute-care psychiatric hospital. PARTICIPANTS: Twenty-one staff nurses and 131 patients admitted consecutively over a period of 6 months. MEASUREMENTS: Disruptive behaviors were measured with the Nursing Home Behavior Problem Scale (NHBPS), cognitive function was measured with the Mini-Mental State Examination (MMSE), mobility was measured with a Functional Mobility Screen (FMS), and reasons for restraint use were obtained with a questionnaire completed by nurses. RESULTS: Patients with a diagnosis of dementia, impaired mobility, or behavioral problems were more likely to be restrained. The most frequent reasons given by staff for restraint use were an unsteady gait and a risk of falling. The incidence of restraint use was 27.1%. CONCLUSIONS: The use of restraint with geropsychiatric patients may be more common than previously reported and requires further investigation.

Accidental Falls↗
PubMed1997

Assessment and management of urinary incontinence among homebound older adults: a clinical trial protocol.

Urinary incontinence is a common and costly problem among homebound older adults. This article describes the assessment and management protocols utilized in a clinical trial examining the effectiveness of behavioral interventions in treating urinary incontinence in homebound older adults. Individuals with urinary incontinence were identified and referred to the study by home care nurses from two large home health agencies. Following in-home assessment, eligible subjects were randomized to an immediate treatment group or a delayed treatment group (control group). Subjects who were cognitively intact were treated with biofeedback-assisted pelvic floor muscle training, while subjects with cognitive impairments were treated with a program of prompted voiding. Two nurse practitioners assessed and treated subjects participating in the study.

Aged↗
PubMed1991

Spread of Klebsiella in a neonatal ward.

The colonization of infants with Klebsiella pneumoniae was prospectively studied. Samples were taken from nose, throat, umbilicus and rectum on the day of arrival and thereafter once a week. Phage typing was performed the first time K. pneumoniae was found at any of these sites. Settle plates were exposed in the incubators and in the patient rooms 5 h/day. The study lasted for 32 weeks. The first 15 weeks was a control period with no information to the staff, the following 4 weeks was a period of intervention and education and the last 13 weeks was a second control period. In all, 603 infants were investigated. The number of infants nursed per week and severity of their disease was comparable in the 3 periods. The colonization rates were 65, 34 and 58%, respectively. The acquisition of new strains was 1.4 per infant in the first and last periods, but only 0.4 in the period of intervention. Thus, colonization rates decreased only during the period of continuous education in hygiene.

Air Microbiology↗
PubMed1984

Surface ultrastructure of the small intestine mucosa in children with celiac disease. I. Untreated disease and effects of long-term gluten elimination and challenge.

Forty-eight gut mucosa specimens from 27 children with celiac disease, diagnosed by means of conventional serial biopsies taken at different dietary conditions, were studied by means of scanning electron microscopy (SEM). The observations were correlated with those made by concomitant dissection microscope (DM), light microscope (LM), and transmission electron microscope (TEM) examinations. Five children with constitutional short stature served as controls. The results of the SEM analyses were in good conformity with the observations made by DM, LM, and TEM. In addition, SEM was found to offer further structural variables to be analyzed. In active celiac disease and after challenge with dietary gluten, which is necessary to establish the diagnosis of children, the lesions specifically observed by SEM were (1) a strikingly uniform destruction of the villi and a distortion of the enterocytes but with preserved extrusion zones, and (2) a decrease and disruption of the glycocalyx of the enterocytes with marked irregularity of the microvilli. After successful dietary treatment and despite a normalization of the gut mucosa by routine LM, SEM often disclosed persisting lesions of the enterocytes. It was concluded that by inclusion of SEM in the routine assessments of gut biopsy specimens in children with celiac disease, the diagnostic precision becomes increased.

Biopsy↗
PubMed1982

Influence of type of feeding on lymphocyte function and development of infantile allergy.

Symptom scores indicating infantile allergy were recorded longitudinally in a group of infants during the first year of life. The symptom scores were related to duration of breast-feeding. Lymphocyte function, measured as the proliferative responsiveness to PHA-stimulation, was related to feeding with breast-milk or cow's milk. Babies with a short duration of breast-feeding; i.e. 1 month or less had significantly higher symptom scores at the ages of 1 month (P less than 0.05), 3 months (P less than 0.05), 6 months (P less than 0.001) and 12 months (P less than 0.05), than babies who were breast-fed for more than 1 month. The lymphocyte responsiveness to PHA was significantly higher at 3 and 6 months in babies who were fed cow's milk compared with those who were solely or partially breast-fed (P less than 0.05 and P less than 0.01 respectively). There was no correlation between symptom scores and lymphocyte responsiveness. It is concluded that infantile allergy is more common in babies with a short duration of breast-feeding and that feeding with cow's milk, compared to breast-feeding, causes a changed lymphocyte reactivity to PHA, which latter finding indicates an altered T-cell function between the two feeding groups.

Bottle Feeding↗
PubMed1978

Treatment of infantile atopic dermatitis with a strict elimination diet.

Of twenty-one infants with atopic dermatitis, twenty were treated with a strict elimination diet for a period of up to 6 weeks. Seven infants healed and twelve improved. The infants who healed were less than 6 months old and had had a short duration of dermatitis. For one infant the skin condition was unchanged. Another infant was breast-fed throughout the period with dermatitis. Blood eosinophilia and/or elevated serum IgE commonly found on admission decreased significantly (P less than 0.01) during the diet period. On challenge with cows' milk, twelve infants were considered as intolerant. At the age of 2 years the dermatitis had cleared in all but four children. Of these four children, two were still cows' milk intolerant. Another two infants were also cows' milk intolerant, but without dermatitis.

Animals↗