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Hospice/palliative care, as the World Health Organization has recognized, is the active, total care of patients whose disease no longer responds to curative treatment, and for whom the goal must be the best quality of life for them and their families. St. Christopher's hospice London, the first modern hospice institution was founded by Dame Cicely Saunders in 1967. The fundamental principles are: stressing the value and dignity of any single human being, especially during his last period of life and continuing morphine analgesia given at regular intervals for full pain control. Since then Hospice has become a worldwide philosophy adapting to the needs of different cultures and settings--hospital, hospice and community--and is established in six continents. The number of books, journals, academies, instituts, international and national congresses and meetings is increasing steadily. At Croatia, during May 1994 in Zagreb, the First Croatian Hospice/Palliative Care Symposium was held. During the autumn of the same year the Croatian Hospice/Palliative Care Society was founded. The society has regular meetings and intends to organize the Second Croatian Hospice/Palliative Care Symposium with international contributions in September this year. Many articles and books are in print or prepared for print. The point is on the hospice workers education and organization of the first stationary hospice unit. The fundamental problem will be solved when our society will accept that hospice/palliative medicine is an imperative of actual moment and the part of croatian inclusion into european or worldwide trends. The acceptance of palliative medicine is the acceptance of new medicine directed to the whole man and his surroundings, instead of involving only single or two diseases.
BACKGROUND: Although obesity and poor dietary habits are complex multifactorial problems, away-from-home food has been identified as one likely and important contributor. Restaurants provide a growing and substantial portion of the average American's diet, yet the Nutrition Labeling and Education Act (NLEA), which went into effect in 1994, explicitly exempts restaurants from most labeling requirements. Thus, this study examined the availability of nutrition information from the largest chain restaurants in the United States. METHODS: Between January and August 2004, we surveyed the 300 largest chain restaurants by telephone, e-mail, or examining company websites (response rate was 96%). The top chains, as ranked by revenue, were selected based on 2002 ratings in Restaurants and Institutions. RESULTS: Fifty-four percent of the 287 largest chain restaurants made some nutrition information available. Forty-four percent had nutrition information for the majority of their standard menu items. We found no significant differences in the availability of nutrition information based on the size of the restaurant chain. Of those restaurants with nutrition information, 86% provided information on the company website. CONCLUSIONS: The number of restaurants providing nutrition information has increased over the last 10 years. However, making informed and healthful food choices is hampered by the absence of nutrition information at many restaurants. Given the growing and significant role that away-from-home foods play in Americans' diets, the Surgeon General and the National Academies' Institute of Medicine recommend that nutrition information be available to customers at restaurants, and state legislatures and the U.S. Congress are beginning to address the issue.
Despite nearly a half-century of research on aging and sex steroids in men, answers to key questions that would allow us to confidently assess risk:benefit ratios for androgen replacement in older men with the partial androgen deficiency of aging men (PADAM) syndrome remain uncertain. Although it is now reasonably clear that a significant percentage of otherwise healthy older men have decreases in testosterone and bioavailable testosterone to levels consistent with hypogonadism, the clinical implications of this change remain uncertain. Data suggest that low testosterone in older men is correlated to varying degrees with loss of lean body mass and muscle strength, and increased total and central body fat. Less certain, but suggestive, are data relating low testosterone levels to decreased bone density, loss of insulin sensitivity, and cognitive and affective deterioration, as well as reduced sexual function. Replacement of testosterone in older men has shown some positive effects on each of these variables, but findings have been inconsistent, perhaps because studies have employed different preparations and doses of androgens, treated for various durations, and defined their target populations in different ways. As important as beneficial effects is the potential for adverse effects, which may be greater in older men. Possible problems include sleep apnea, erythrocytosis, dyslipidemia with acceleration of atherosclerosis, and, of greatest concern, prostate cancer or hyperplasia. Studies to date have suggested that these outcomes are not major risks, but, in the absence of a large, randomized trial or trials, definitive information is not available. The US National Academies Institute of Medicine's recent report recommends that the National Institutes of Health support small efficacy trials aimed at treatment of androgen deficiency-related clinical conditions, but not a large, randomized trial to elucidate risk:benefit ratios. This recommendation, if adhered to, is likely to delay, rather than foster, progress in this important area.
OBJECTIVE: Spontaneously hypertensive rats (SHR) selected from Wistar Kyoto (WKY) strain represent an animal model of human essential hypertension. This strain of rats is known by excessive neuroendocrine and cardiovascular responses under stress. The aim of the present study was: 1. To compare the reactivity of hypothalamic-pituitary-adrenocortical axis (HPA) to acute mild stress of handling between SHR and WKY rats, 2. to compare the behavioral activity of both strains under basal conditions and during chronic unpredictable emotional stress. METHODS: Seven to eight weeks old male SHR and WKY rats bred in the Physiological Institute, Academy of Sciences of the Czech Republic (Prague) were used. Acute stress was induced by 2-minute handling of the animals in their cage. Blood plasma was analyzed for ACTH and corticosterone (CORT) by specific radioimmunoassay. Chronic unpredictable stress lasted 20 days and consisted of random exposures to following interventions: Light on or off for 24 h, overcrowding i.e. pooling the rats from two cages into one (size 24 x 39 x 23 cm) for 24 h, isolation by placing a single rat into one cage for 24 h, new hierarchy by mixing 4 rats from two different cages for 24 h, limited access to food or water for 1 hour in one day between 3 and 6 p.m., inescapable foot shock (20 shocks, duration 5 s, intensity 10 mA, intershock interval 30 s), tilting the cages for 24 h. The sequence of individual stress exposures was the same in all rats. On day 6, 10 and 20, behavioral activity was measured using the elevated plus-maze in non-stressed control and stressed rats. The results were evaluated by non parametrical Kruskal-Wallis test followed by Mann-Whitney U-test. RESULTS: The two-minute handling resulted in a significantly higher activation of HPA in the SHR than in the WKY rats (plasma ACTH: 350 +/- 65 pg/ml for SHR vs. 97 +/- 17 pg/ml for WKY p<0.01; plasma corticosterone: 2.8 +/- 1.4 mg/100 ml for SHR vs. 0.7 +/- 0.06 mg/100 ml for WKY p<0.05). In WKY rats no activation of HPA was observed. Elevated plus-maze anxiety test showed inverse behavioral pattern between SHR and WKY rats. In the first test of anxiety the number of open arm entries (OAE) as well as total mobility expressed as total arm entries of the SHR was lower than of the WKY rats (p<0.01) without any difference between stressed and non-stressed animals in either strain. It was gradually increasing in stressed and non-stressed SHR in subsequent sessions markedly exceeding the activity of WKY rats (p<0.01). Stressed WKY rats showed less OAE and total mobility than their controls (p<0.01). CONCLUSIONS: Our results show enhanced neuroendocrine response to acute handling and enhanced anxiety in acute novelty stress in SHR comparing to WKY rats which suggests a common mechanisms for neuroendocrine and behavioral changes. These results further underline the lack of anxiety related behavior of SHR under chronic emotional stress.
The study comprised 30 children aged 12 to 17 years, including 22 females and 8 males, treated or consulted in the Psychiatry Department of the Medical Academy Institute of Pediatrics in Warsaw due to the realized trial of suicide. The psycho-demographical and the biological factors as well as direct causes preceding the suicidal trial have been analysed. It has been stated that the suicidal trials are dominated by the family conflicts and the bad emotional contacts among both the parents and children which in a majority of cases are associated by problems of school education. The cognitive functions of subjects studied were on the whole within the normal range.
The authors treat the problem of lower respiratory tract foreign bodies in children on the basis of their own longterm experience. In the years 1972-1991 in the Pediatric E.N.T. Clinic of the Pediatric Institute, Academy of Medicine in Poznań, 147 foreign bodies were removed. A positive history of foreign body aspiration was obtained in 45.7% of the cases. 44.7% of the foreign bodies were removed during the first 24 hours after their aspiration. Broncho-pulmonary complications occurred in 59.1% of the cases.
Larval material on the Aedes mosquitoes of the complex punctor (Far East expeditions in 1976-1980) was compared to material preserved in the Zoological Institute, Academy of Sciences of Russia. 6 types of aberrations (presence-absence of accessory hairs on the surface of siphon, their parity, etc.) were found. The individual variability and absence of diagnostic validity of these accessory hairs are suggested.
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