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The presbyopic add. I. Magnitude and distribution in a historical context.

The presbyopic addition or 'add' is the (binocular) spherical positive power supplement superimposed on any distance refractive correction to counter near vision difficulties associated with the physiological age-related loss of accommodation and consequent recession of the near point: its necessity is first encountered in middle age. The continuous (linear) ascending trend in near lens power versus increasing age advocated since the seventeenth century is at odds with the twentieth-century clinical observation that there is a deceleration in add requirement beyond an individual's mid-fifties. It is shown here that this difference is reconciled--in broadly qualitative terms if not in magnitude-when typical clinical near addition data are superimposed on the accepted distance hypermetropic refractive base recorded from early middle age onwards: a continuous rising function is produced spanning most of the three decades beyond 40 years of age. This result is considered in the context of the age markings found on certain eighteenth-century antique near vision glasses and the recommendations attached to the self-selection of ready-made reading glasses in the late twentieth century.

Adult↗

Cardiorespiratory responses during exercise in competitive in-line skaters.

This study describes the cardiorespiratory responses of 12 male (age = 30 +/- 6 yr) competitive in-line skaters during peak and submaximal skating. We hypothesized that velocities of 22.5 and 27.4 km.h-1 would elicit heart rate (HR) and oxygen consumption (VO2) responses consistent with the American College of Sports Medicine's guidelines for developing cardiorespiratory fitness. Using a 644-m indoor cement course, subjects completed 10 trials comprised of various velocities, stroke frequencies, and body positions. At 22.5 km.h-1, HR and VO2 were 74 and 51% of peak, respectively. At 27.4 km.hr-1, HR and VO2 were 85 and 72% of peak, respectively. When compared to the College's guidelines, regression analysis revealed a leftward shift in the VO2-HR relationship, evidenced by a disproportionately higher HR at a VO2 approximating 60 vs 80% of peak. At 22.5 km.h-1 our skaters self-selected a stroke frequency which resulted in less of an increase in both HR and VO2, when compared to the imposed stroke frequencies of 50 min-1 and 70 min-1. Also, skating at 27.4 km.h-1 in the bent vs upright position resulted in less of an increase in HR and VO2. Competitive in-line skaters are capable of safely skating at velocities sufficient to stimulate an increase in cardiorespiratory fitness. These athletes select a stroke frequency and utilize a body position which results in favorable HR and VO2 responses.

Adult↗

[Effects of natural mood changes on discrimination performance and response trends in pattern recognition].

The effects of mood on thinking and behavior are characterized by "loosening" in the case of positive feeling states and "tightening" for negative ones (Fiedler, 1988). Style of cognitive processing, effort expenditure, and capacity models are discussed as explanatory concepts. To compare these approaches, the theory of signal detection provides methods for the independent evaluation of parameters of response bias and discrimination (and also efficiency). A laboratory experiment (Klauer et al., 1991) was replicated and supplemented by a field study. In the sense of convergent and discriminant validation of the insufficient techniques of mood induction, the naturally occurring mood changes of everyday life were used as mood manipulations. 13 subjects (M = 25.9 years of age, SD = 3.8) reported their feeling states on 18 days for self-selected episodes, which represented the range of their mood changes. Immediately after each mood report, they worked on a visual discrimination task. The indices of signal detection theory for response bias, discrimination, and efficiency were calculated in each cases, and correlated with measures of emotional and unspecific feeling states. Along with a shift from negative to positive feeling states, a trend towards a liberal response bias, a higher discrimination rate, and a greater efficiency resulted. Our findings replicate the laboratory experiment and support the effort expenditure and cognitive processing style view, rather than the reduced-capacity explanation. Speculations are offered concerning the emotional and cognitive processes which led to these results.

Adult↗

Predictive testing for Huntington's disease: risk perception, reasons for testing and psychological profile of test applicants.

In the Center for Human Genetics in Leuven, predictive DNA-testing for Huntington's disease is available as a clinical service since November 1987, initially by DNA-linkage and since mid 1993 by direct mutation analysis. The multidisciplinary approach as well as the detailed test protocol are described. The present paper gives a sociodemographic description of the test applicants, their subjective evaluation of the risk and their motives for requesting the predictive test. Major attention is paid to the personality profile of the applicants who proceeded with testing. Psychometric testing revealed that this group of test applicants did not differ significantly from the general population for most characteristics and even had a number of more positive characteristics e.g. a higher ego-strength. The latter may reflect a self-selection of a more resourceful and emotionally healthier subgroup of at-risk persons. Nevertheless psychological evaluation also has identified a number of applicants with extremely high anxiety levels and other problems, who needed extra pretest and posttest counseling. The relatively high number of withdrawals from the test programme is another indication of the importance of adequate pretest counseling.

Adult↗

Standardization of glycohemoglobin results and reference values in whole blood studied in 103 laboratories using 20 methods.

We investigated the effect of calibration with lyophilized calibrators on whole-blood glycohemoglobin (glyHb) results. One hundred three laboratories, using 20 different methods, determined glyHb in two lyophilized calibrators and two whole-blood samples. For whole-blood samples with low (5%) and high (9%) glyHb percentages, respectively, calibration decreased overall interlaboratory variation (CV) from 16% to 9% and from 11% to 6% and decreased intermethod variation from 14% to 6% and from 12% to 5%. Forty-seven laboratories, using 14 different methods, determined mean glyHb percentages in self-selected groups of 10 nondiabetic volunteers each. With calibration their overall mean (2SD) was 5.0% (0.5%), very close to the 5.0% (0.3%) derived from the reference method used in the Diabetes Control and Complications Trial. In both experiments the Abbott IMx and Vision showed deviating results. We conclude that, irrespective of the analytical method used, calibration enables standardization of glyHb results, reference values, and interpretation criteria.

Calibration↗

Effect of carbohydrate ingestion on performance of non-fasted cyclists during a simulated 80-mile time trial.

The purpose of this study was to determine the effect of carbohydrate supplementation on finishing time of a realistically simulated 80 mile bicycle time trial. Fourteen trained cyclists pedalled at self-selected pace on their own bicycles on windload simulators. Two trials were performed one week apart. Each trial was preceded by two days of prescribed diet, with a final feeding 3-4 h prior to exercise. Following each 10 mile segment, subjects ingested either a non-caloric placebo (PL) or the carbohydrate maltodextrin supplement (MD; 5% maltodextrin +2% fructose) at dosage of 0.25 g.kg-1 body weight (mean intake rate, total: 37 g.h-1, 148 g) in a double blind, counter-balanced design. Mean (+/- SEM) finishing times were faster by 5% with MD (241.0 +/- 2.1 minutes versus 253.2 +/- 2.1 minutes), p < 0.05. With MD, serum glucose levels rose sharply after 40 miles and were significantly higher than PL (p < 0.05). Final glucose values were 6.0 +/- 0.2 mmol.l-1 and 4.1 +/- 0.2 mmol.l-1 for MD and PL, respectively. With MD, free fatty acid levels were significantly lower (p < 0.05), and riders sustained higher average intensity over the entire distance. At the finish, intensities were 64.7 +/- 1.9% VO2max and 55.3 +/- 1.9% VO2max for GP and PL, respectively. Mean carbohydrate oxidation was significantly higher (p < 0.05) for MD, 2.01 +/- 0.2 g.min-1 and 1.64 +/- 0.2 g.min-1 for MD and PL, respectively. These data show that ingestion of MD, during ultraendurance exercise, in comparison to PL, decreases the time to finish a self-paced bicycle time trial.

Adult↗

[Accommodation function and its clinical evaluation].

One subjective examination in accommodation, we found fundamental fault in the self-selection of clear vision against stimulus target and the time control of examination. On the other hand, it was difficult to objectively judge clear vision or check subjects consciousness for the tests. In this study, we made a trial instrument called new accommodometer which was able to confirm the time limit for clear vision, and measured response time for accommodation in constriction and relaxation. Young healthy subjects could obtain clear vision within 0.5 seconds on the new accommodometer, but this took over 0.8 seconds with scattered distribution on an accommodopolyrecorder. The required time for clear vision tended to increase in diabetic cases, and also in pseudophakia corrected bifocal lenses, over 0.6 seconds. We analyzed the form of accommodative response under clear vision, using on infrared optometer with stimulus-targets prepared outside, meanwhile changing the size of targets and amplitude of accommodative stimulus. When we compare these results to those of the new accommodometer, it will be easily seen that accommodative clear vision may be acquired in a rapid response stage after a latent period of constrictive accommodation, and usually with a steady running time under 4 D stimulus. For getting clear vision in far and near objects simultaneously, in pseudophakia, moderate astigmatism plays an important part, but it tends to cause deteriorated quality of clear vision. In diffractive intraocular lenses, we can find patients who are able to see using arbitrarily both areas, the refractive or diffractive part. We analyzed microfluctuation of accommodation by the maximum entropy method, and one of the typical cases revealed three-dimensional drawings reconstructed from it. In analyzing the spectral power of young healthy subjects, the response waves tend to increase in blurred conditions for targets.

Accommodation, Ocular↗

Exercise reduces fat selection in female Sprague-Dawley rats.

This study investigates the relationship between exercise and dietary macronutrient selection. Female Sprague-Dawley rats (5 months old) were placed on a macronutrient self-selection diet for 15 wk. Three food cups, each containing a separate vitamin and mineral supplemented macronutrient, i.e., fat, carbohydrate, or protein, were placed in the cage. Animals were either sedentary (Sed) or treadmill exercised (Ex) at 20 m.min-1, 60 min.d-1, for 6 d.wk-1. Cumulative daily energy and macronutrient intake were determined during this period. Energy intake was not different between Sed and Ex, 211.4 vs 213.5 kjoules.d-1, respectively. However, macronutrient intake differed with less fat eaten for Ex than Sed (81.5 kjoules and 38% for Ex; 114.0 kjoules and 47% for Sed). Carbohydrate and protein intake did not differ significantly between groups. Fifteen weeks of exercise training decreased dietary fat selection, but daily energy intake was not affected.

Animals↗

Serum lipid concentrations in the Koki community: a preliminary report.

Serum cholesterol and triglyceride concentrations were estimated in a self-selected sample of 9% of the adults over the age of 18 years in the urban community of Koki in Port Moresby, in which there is a high prevalence of diabetes. There were 84 males and 58 females in the sample. The mean age was 32.6 years, with the males significantly older than the females. Mean cholesterol and triglyceride levels were 4.7 mmol/l and 1.2 mmol/l respectively, and significant sex differences were observed, with males demonstrating higher levels, even in the younger age group. A high prevalence of obesity was observed in both males (40%) and females (55%). The prevalence of hyperlipidaemia was higher in males than females and was also more frequently observed in obese than non-obese subjects of either sex. A significant number (25%) of young subjects (18-30 years) exhibited serum lipid concentrations in excess of recommended levels. Our results suggest that, in contrast to previous reports, elevated serum cholesterol and triglyceride levels are present in this community, and may represent an increased risk for the development of ischaemic heart disease.

Adolescent↗

An investigation into the management of patients with erection problems in general practice.

In a study on the diagnosis and treatment of erectile dysfunction (ED) in general practice, a self-selected sample of 90 general practitioners (GPs) (76 males, 14 females) from a predominantly urban population of 525 GPs were interviewed. It appeared that 59% would not actively interrogate a patient when an erection problem was suspected, either because of lack of time or lack of competence. A specific strategy for the management of erection problems was reported by 60% of the GPs. In practice, most GPs treated their own patients. About 60% of the GPs tried to keep up to date through reading and postgraduate courses. Impediments acknowledged in the interaction with patients were the experience of lack of knowledge and skills (63%) and emotional inhibitions to detailed questioning (49%). None of the GPs in this study had as yet utilized more recent treatment methods such as intracavernous drug injections and vacuum constriction devices. It is recommended that in postgraduate training courses GPs receive practical training in proper history taking and in the application of modern treatment methods.

Adult↗

Metabolic and hemodynamic responses to walking with hand weights in older individuals.

The purpose of this study was to examine metabolic and hemodynamic responses of older adults (age = 66.2 +/- 5.6 yr) to walking with hand-held weights (HHW). Nineteen volunteers participated in eight randomly assigned, 10-min, submaximal, self-selected constant speed (CSP) or constant heart rate (CHR) exercise bouts using the following HHW conditions: no weight, W0; 0.45 kg, W1; 1.36 kg, W3; 2.27 kg, W5. Oxygen uptake (VO2) was recorded every 30 s, heart rate (HR) each minute, and blood pressure (BP) every 2 min. Mean values for the last 5 min of exercise were analyzed using repeated measures ANOVA. Contrast comparison tests were used to determine differences among means. During CS, significant differences between means (P < or = 0.05) existed for: VO2 (W0, W1 < W3, W5); HR, SBP, DBP, SBPmax, DBPmax (W0 < W1, W3, W5); HR, rate pressure product (RPP), DBPmax (W1 < W5); SBP, DBP, SBPmax, RPP (W3 < W5). During CHR, significant differences (P < or = 0.05) between means existed for: SBP, DBP, RPP (W0, W1, W3 < W5); DBP (W0 < W3; W1, W3 < W5). These results indicate that the use of HHW significantly increases metabolic responses at W3 and W5 during CS exercise in older adults, while hemodynamic responses increase significantly across HHW for both CS and CHR. Due to the increases in hemodynamic responses, the use of HHW may be contraindicated for older individuals with suspected or diagnosed cardiovascular disease.

Aged↗

[Health economic analysis of the effects of offered complementary medical procedures on health insurance].

A randomized trial is being conducted to determine whether the offer of unconventional medicine as a health benefit by the health insurance funds has a substitutional or additional effect on the use of conventional medicine. For this purpose, a stratified random sample of 5000 enrollees of the largest Swiss health insurance fund is receiving, as an experiment group, an insurance supplement for unconventional medicine during the next three years free of charge. The rest of the insured population with comparable health insurance but without coverage of unconventional medicine is the control group. The third group to be examined are insured persons who have already chosen the unconventional health insurance supplement on their own account. Data of inpatient and outpatient costs and use of conventional and unconventional health services will be collected and analyzed. The third group with self-selected insurance supplement for unconventional medicine will be compared systematically with the other two groups. A further random sample of persons from each of the three groups will be interviewed at different points of time about their health perceptions.

Complementary Therapies↗

Effects of early discharge from hospital after surgery for primary breast cancer.

OBJECTIVE: To evaluate the effects of early discharge from hospital on women being operated on for primary breast cancer. DESIGN: Open study in self-selected patients. SETTING: Karolinska and Sabbatsberg Hospitals, Stockholm. SUBJECTS: 169 consecutive patients operated on for primary breast cancer. MAIN OUTCOME MEASURES: All patients were asked to fill in a questionnaire about their perception of their disease and factors associated with the operation. RESULTS: 118/169 patients participated, and of these 28 (24%) chose early discharge with the drain still in place. They were compared with the 90 patients (76%) who were discharged without a drain. The median stay in hospital for those who chose early discharge was 2 days, and for those who remained in hospital until the drain was removed, 6 days. There were no differences between the groups in type or incidence of complications, and the groups were equally satisfied with their length of hospital stay and their treatment in hospital. Those who opted for early discharge were significantly younger than those who did not (mean SD) 52 (14) compared with 62 (13) years, p = 0.001). CONCLUSION: Early discharge from hospital with the drain still in place after operation for primary breast cancer was not found to be associated with any untoward events.

Age Factors↗

Personality types of oncology nurses.

Personality type influences the choice of occupation. The breadth of specialty areas within oncology nursing allows for divergent activities and relationships and, thus, the accommodation of different personality characteristics. This exploratory study examined personality types for a convenience sample of oncology nurses predominantly employed in hospitals. According to the personality typology defined by Carl Jung, a person demonstrates a preference among four dimensions, i.e., extraversion/introversion, sensory/intuition, thinking/feeling, and judging/perceiving. The type with the strongest self-selection for these oncology nurses was ISFJ, where feeling is introverted and perception is practical, so that helping others is both a responsibility and a pleasure. The discussion relates the personality types to Jung's theory and their impact in clinical practice. Strengths and weaknesses of each personality type are described.

Adult↗

Combined mother and baby care: does it meet the needs of families?

Combined mother/baby care is thought to be an effective way to prepare a family for the changing roles and added responsibilities that the arrival of a new baby entails, but few studies have evaluated this care delivery system. Therefore, the postpartum staff at Sudbury General Hospital conducted a post-test control group study design with a self-selected sample of postpartum mothers when the unit was changing from traditional to combined mother/baby care. One hundred and three mothers who received traditional care and 102 who had combined mother/baby care completed a questionnaire to assess perceptions of their own competence and satisfaction with the type of care administered. There were no significant differences between the two study groups. Factors that may have confounded the results include: insufficient time between institution of the program and its evaluation, and the quality of prenatal education received. Multiparous mothers scored higher on self care, infant care, and maternal competence than did primiparous mothers regardless of the care delivery system. Maternal concerns related to immediate needs. Future research should take the differences between primiparas and multiparas into account, and focus on the less immediate needs of mothers.

Adolescent↗

Comprehensive analysis of energy storing prosthetic feet: Flex Foot and Seattle Foot Versus Standard SACH foot.

This study compared the mechanical and biomechanical functions, metabolic demand, and shock absorption of two dynamic elastic response (DER) prosthetic foot designs with the SACH foot. Nine individuals who had undergone unilateral below knee amputation were studied. Mechanical properties of the feet were related to gait biomechanics. Forefoot compliance is greatest for the Flex Foot and least for the SACH foot, hence, Flex Foot demonstrates (1) the longest midstance phase, (2) the greatest ankle angle range, and (3) greater forward movement of the center of pressure. There was some evidence that the DER feet produced a better push-off. However, neither the self-selected walking speed nor the metabolic rate or efficiency over a spectrum of walking speeds (73 to 120m/min) and running speeds (140 to 200m/min) was significantly different. Because no energy savings resulted for the DER feet, the release of stored energy in the flexible feet may not occur at the proper time to assist in ambulation as a result of the natural frequency of oscillation.

Adult↗

A comparison of university and community-based family practice physician educators.

BACKGROUND: Differences in satisfaction with training and perceived preparation for practice have been observed among residents trained in community and university family practice residency programs. Our study was undertaken to determine the degree to which faculty training, experience, or practice patterns may contribute to these different resident experiences. METHODS: Questionnaires addressing prior training, experience, current practice content, motivation for entering academic medicine, and satisfaction with current teaching position were sent to full-time physician faculty at 60 family practice residency programs. RESULTS: The 208 faculty responses showed no differences in faculty at various types of residency programs with respect to demographic factors, prior training, or past experience. Only small differences were found in the proportion of time devoted to most professional activities or in the content of clinical practice. CONCLUSIONS: Few differences were found between faculty at university- and community-based family practice residency programs. This implies that differences in residents' perceptions of training may be due to other factors, such as institutional philosophy or self-selection. However, qualitative differences in family practice faculty activities that were not measured in this research cannot be ruled out as factors influencing residents' perceptions of their training experiences.

Attitude of Health Personnel↗

Enrollment choice in a mutli-HMO setting:the roles of health risk, financial vulnerability, and access to care.

Results of an analysis of enrollment decisions in HMO-type plans are reported. Previous studies concern dual-choice situations; this paper deals with a quadruple-choice situation involving one open- and two closed-panel HMO-type plans as well as Blue Cross/Blue Shield (BC/BS). The risk-vulnerability hypothesis is disaggregated into its components and the results show that there is no adverse health risk self-selection in an employed population. The hypothesis of economic vulnerability is maintained when tested in terms of per capita income rather than the previously used measure of family income. It is shown that those who enroll in any HMO-type plan are younger and have younger and larger families and lower per capita income than those who do not. No meaningful differences in terms of health status, health concerns, or prior utilization are found. Of the few differences found between those who enroll in closed- and open-panel HMO-type plans, having a private physician as the usual source of care is the most significant: those with an established physician relationship who join any HMO-type plan tend to follow their physician into the open-panel plan. The results should not be generalized to situations involving premium differences since the premium cost to subscribers in any of the plans considered here was fully paid by the employer. The validity of the results in terms of nonfinancial factors, on the other hand, is enhanced by the removal of cost considerations.

Adolescent↗