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[Placebo: its hypotensive effect and influence on certain psychological parameters and dependency on dosage prescribed to patients].

The main purpose of this study is to estimate the influence of taking a number of placebo tablets to obtain hypotensive effects and some psychological parameters with essential hypertension. 197 patients (102F/95M) aged between 18-80 years (average age 52.3) with essential hypertension were included in the research in two outpatients clinics. The patients who participated in research, stayed for at least seven days without any pharmacological treatment. They had a diastolic pressure (DBP) between 95-114 mm Hg and systolic pressure (SBP) up to 200 mm Hg. 92 patients had taken one tablet a day and 105 patients had taken two tablets in the morning. This was before the placebo was included and two weeks after their blood pressure had been taken by standard methods (sphygmomanometer). They were monitored daily throughout the period using traditional methods and ABPM (SpaceLabs 90121). The patients completed two psychological tests. 97 records (52F/45M) qualified for statistical analysis (80% of measurements were undertaken properly, and the time between measurements was less than two hours). Psychological questionnaires were correctly completed by 92 patients. The visible results of decreasing systolic and diastolic value of blood pressure were obtained after using one (group 1) and two (group 2) placebo tablets. They were monitored by a standard method and recorded by ABPM. In group 1 SBP decreased from 164 +/- 11.4 mm Hg to 158 +/- 8.8 mm Hg (p < 0.01, on standard method) and from 149.5 +/- 17.8 to 144.5 +/- 8.3 mm Hg daily (p < 0.05, ABPM). DBP in this examined group decreased from 106.2 +/- 2.8 to 102 +/- 3.9 mm Hg (p < 0.01, stand. method), and from 103.2 +/- 2.6 to 98.6 +/- 1.2 mm Hg daily (p < 0.05, ABPM). In the second group SBP decreased from 169 +/- 12.8 to 157.6 +/- 17.9 mm Hg (p < 0.001, stand. method), and in ABPM from 148.5 +/- 15.8 to 139.6 +/- 16.2 mm Hg (p < 0.01). In this same group, DBP decreased from 104.4 +/- 2.6 to 98 +/- 3.4 mm hG (p < 0.001, stand. method), and from 107.4 +/- 5.8 mm Hg to 95.5 +/- 4.2 mm Hg-daily (p < 0.001, ABPM). There were no differences between heart rate in all groups of patients. In both groups there were significant statistical differences in negative symptoms, physical symptoms and anexity, but a more optimistic mood was observed by group 2. More effective hypertensive treatment was observed within the group which was treated with two placebo tablets. This group was characterized by more optimistic mood compared to the group which was treated with one placebo tablet a day.

Adolescent↗

[Qualitative and quantitative evaluation of nourishment of middle school pupils from Bialystok].

Qualitative and quantitative evaluation of nourishment of gymnasium pupils from Białystok and its vicinity was conducted on 294 schoolchildren of both sexes, drawn by lot from two public middle schools. Their nourishment was qualitatively assessed according to Szewczyński's classification. The quantitative analysis used the previous day 24-hour history method. Caloricity of meals and the content of basic nutrients were calculated using a computer program FOOD 2. The results were compared with the recommended sex and age norms for moderate physical activity and subjected to statistical analysis using t-Student test. The study has shown that the majority of meals consumed by young people are incorrect. The menus are characterized by too high fat content. The diets of boys from the country exceed the norm of caloricity, and like the menus of boys from town, contain too much protein.

Adolescent↗

[A prospective study of the anterior cruciate ligament reconstruction: allograft versus autograft].

OBJECTIVE: To compare the clinical outcomes and differences of arthroscopic anterior cruciate ligament (ACL) reconstruction by using allografts and autografts. METHODS: Fifty-three patients with grade III ACL injuries were divided randomly into 2 groups. Twenty-five cases of group A with autografts of patellar bone-tendon-bone (B-PT-B;n = 15) and 4 strands of semitendinosus/gracilis (n = 10); 28 patients of group B with allografts of B-PT-B (n = 18), 4 strands of semitendinosus/2 strands of gracilis tendons (n = 6) and double tibialis posterior (n = 4) as well as Achilles bone-tendon (n = 2). All procedures were performed endoscopically by some surgeons. All patients were followed up for 12 to 31 months, average 19 months. RESULTS: There were statistically significant differences revealed in physical examination. IKDC and Lysholm-Tegner Score as well as KT-2000 testing was used preoperation and postoperation for both group, but there were no significant differences between the two groups except that group B had less time in operation and longer time in postoperative fever comparing with group A. (2-sample t test, P < 0.05). The KT-2000 side to side difference less than 3 mm were 88% and 86% and more than 5 mm were 4% and 7.1% respectively. The infection rates were 0% and 3.5% for the two groups. CONCLUSION: The clinical outcomes of the allografts and autografts in ACL reconstruction is almost the same. Allografts are a reasonably alternative choice for ACL reconstruction in patients over middle ages and for multiple ligament surgery as well as revision procedures.

Adult↗

Quality of life during one-year observation of patients with idiopathic pulmonary fibrosis awaiting lung transplantation.

The aim of the study was to evaluate the quality of life and its changes in patients with idiopathic pulmonary fibrosis (IPF), waiting for lung transplantation. Sixteen IPF patients, who qualified for lung transplantation, and 14 chronic obstructive pulmonary disease (COPD) patients on long term oxygen therapy, taken as a reference group, were assessed. The quality of life was estimated twice, using an SF-36-questionnaire, at the time of qualification for lung transplantation and 12 months later. The IPF and reference patients had similarly profound disturbances in lung function and arterial blood gas content. The IPF patients had a statistically greater score in their physical functioning (PF; 45 vs. 18), the role of limitations due to physical problems (RP; 43 vs. 11), social functioning (SF; 58 vs. 30), and the role of emotional limitations in everyday life (RE; 65 vs. 12) than the reference ones. After a year's observation, there were no differences in SF-36 questionnaire results, except for the role of limitations due to physical problems (RP). A correlation was noted between spirometry and blood gas results and SF-36 questionnaire results in IPF patients qualified for lung transplantation. There was a positive correlation between the partial pressure of oxygen (PaO(2)), on one side, and mental and general health, on the other. There also were positive correlations between FEV1 and SF and FEV1 and the level of bodily pain (BP). We conclude that the SF-36 questionnaire is a sensitive tool to assess the quality of life in IPF patients qualified for lung transplantation. The information gained can help assess the severity of the disease, clinical symptoms, and functional impairment in these patients.

Activities of Daily Living↗

[Tendency and mathematical model of relationship of blood ATP content with temperature and time of preservation].

To investigate the relationship of blood ATP content with temperature and time of preservation and to establish its mathematical model, adenosine triphosphate (ATP) concentration was applied as the index of the quality of erythrocytes; systematical study on variation of blood preserved in a series of different temperatures from 4 degrees C to 32 degrees C was performed, and a series of experimental data were obtained. The results showed that when the ATP concentration y = f (d, t, s) in preserved blood was given as the continuous function of the time (d), the temperature (t) and the initiate ATP concentration (s), the model was fitted with the theory of linearity regression in symbolic statistics, and the general mathematical physical equation of the variation of preserved blood quality was deduced. According to the equation, the whole blood in CPDA-1 solution could be efficiently stored for 35, 35, 29, 22, 18, 18, 13, 8, 7, 6, 6, 5, 4, 4 and 3 days in 4, 6, 8, 10, 12, 14, 16, 18, 20, 22, 24, 26, 28, 30 and 32 degrees C, respectively. In conclusion, the general tendency of the variation of preserved blood quality according to the temperature and the time was systematically disclosed for the first time, which would be propitious to estimate the blood quality in various temperatures and to instruct clinical blood transfusion.

Adenosine Triphosphate↗

TNF-alpha blockade induce clinical remission in patients affected by polymyalgia rheumatica associated to diabetes mellitus and/or osteoporosis: a seven cases report.

Polymyalgia rheumatica (PMR) is a chronic inflammatory condition of the elderly, characterized by aching and morning stiffness in the cervical region, shoulders and pelvic girdles. A steroid treatment course of 6-24 months is often required, but, due to important side effects, it is troublesome if the PMR patient is also affected by diabetes mellitus (DM) and/or osteoporosis. Aim of our study is to test anti-TNF alpha treatment as a steroid sparing tool in PMR patients affected by DM or osteoporosis. In particular, we hypothesise that TNF alpha blockade can be useful not only in remission maintaining, but also in the induction of clinical remission without corticosteroids in this kind of patients. In a six months follow up, patients had clinical improvement, confirmed by physical medical examination, and a statistically significant reduction in ESR and CRP mean values. Anti-TNF alpha treatment was well tolerated by all patients. These preliminary data suggest than Infliximab can be useful in the treatment of PMR patients, not only for steroid sparing purposes, but also as first line therapy in PMR patients with severe comorbidity, such as diabetes mellitus or osteoporosis.

Aged↗

[Typical findings of maltreated children].

Childhood maltreatment manifests in a variety of forms and the underlying causes are manifold. In contrast to other offences involving physical injury, reporting behavior has, statistically speaking, remained unchanged. Patterns of injury must first be established and documented, and this involves a complete examination of the child's body. Depending on the constellation of findings, a radiological diagnosis is usually necessary. When all the findings have been collected, the further steps to be taken--where indicated a report to the police--must be discussed. All the evidence must be recorded, and photos obtained of all externally visible injuries before they fade. It is not the task of the physician to develop criminalistic ambitions, for example, by grilling (a parent) on the cause of the injuries. However, he/she has a duty to do everything necessary to protect the well-being of the child.

Child↗

[The relationship between educational level, physical activity and mortality.].

OBJECTIVES: The relationship between educational level and mortality is well known. This has been shown in the Reykjavik Study and was only partly accounted for by unequal distribution of known risk factors. The objective of the present study was to explore the relationship between educational level and physical activity and whether that relationship could partly explain differences in mortality. MATERIAL AND METHODS: This is a part of the Reykjavik Study. Presented is data from 18,912 participants, divided into four groups by educational level. Physical activity was assessed by questionnaire. The relationship between physical activity and educational level was assessed by logistic regression and between mortality and educational level by Cox regression analysis. Adjustments were made for age, year of examination, known risk factors (serum lipids, blood pressure, height, weight, smoking, use of anti-hyertensive drugs and 90 min glucose tolerance) and physical activity. RESULTS: There was a positive relationship between physical activity and educational level (p<0.001). By adding adjustments for physical activity to a multiple regression analysis containing other known risk factors the relationship between total mortality and educational level was reduced. For highest versus lowest educational group hazard ratio was elevated from 0.77 to 0.80 for men and from 0.91 to 0.93 for women. Same trend existed for cardiovascular mortality and to a less extent for cancer mortality. CONCLUSION: The association between educational level and mortality can be partly explained by differences in leisure-time physical activity. In spite of adjustments for known risk factors and physical activity there remains a statistically significant relationship between educational level and mortality.

English Abstract↗

Psychogenic pain disorder in children.

The concept of psychogenic pain in children is by no means new; it has been researched for at least 3 decades. There is increasing recognition of the relationship between emotional factors and complaints of pain in the absence of organic disease. By their very nature these conditions warrant a team approach, incorporating both medical and psychological perspectives, to treatment. A study was undertaken that focused on identifying the incidence and related features of this problem at a general hospital. Over a 2-year period 46 children showed psychogenic pain disorder according to the criteria of Diagnostic and Statistical Manual of Mental Disorders. Physical examinations and basic investigations revealed no organic disease. The majority of the children (34, 73.9%) complained of abdominal pain, although limb and chest pains also featured. Marital problems between parents constituted the most common stressor, affecting 31 of the children (67.4%). Psychotherapeutic management was initiated with all the children and their families. Thirty-five (76.1%) had remission of symptoms after psychotherapy.

Adolescent↗

The epidemiology of gallstone disease in Rome, Italy. Part II. Factors associated with the disease. The Rome Group for Epidemiology and Prevention of Cholelithiasis (GREPCO).

The epidemiological associations of gallstone disease were evaluated in a population of 2,325 civil servants (1,244 men and 1,081 women) in Rome, Italy, which was enrolled in a cross-sectional survey on cholelithiasis. Participants were screened for the presence of gallstones by gallbladder ultrasonography, completed a questionnaire on family and personal history and underwent a physical examination and blood chemistry. Statistically significant associations were established by univariate analysis of the age-standardized data and by step-wise multiple logistic regression. At univariate analysis, increasing age, serum triglycerides and number of cigarettes smoked per day, and decreasing high-density lipoprotein-cholesterol were the conditions associated with the presence of gallstones in men. Age and parity were the correspondent associations in women. After controlling by multiple logistic regression, a different pattern of associated conditions emerged. In men, only age and serum triglycerides showed a significant positive association with gallstones, which was independent of other variables. In women, the presence of gallstones was independently associated with increasing age, number of pregnancies, body mass index and serum triglycerides, and with decreasing total (and low-density lipoprotein) cholesterol. The latter association was curvilinear in shape. The conditions associated with a history of cholecystectomy differed from those observed in subjects with gallstones, with the exceptions of age, in both sexes, and high serum triglycerides, in women. Fasting blood glucose levels were higher in women with a history of cholecystectomy than in those with or without gallstones, both at univariate and multiple logistic regression analyses.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Clinical findings and return to work after heart valve replacement.

One hundred and thirteen patients operated during the years 1971 to 1976, were re-examined at an average of 26.3 months after heart valve replacement. The functional capacity assessed by the NYHA-classification improved in about 40% of the patients. About 80% considered their symptoms and well-being to have improved after the operation. At the re-examination, heart size was most often enlarged in patients with mitral valve replacement. The average work load measured in bicycle ergometer test was higher in patients with aortic valve replacement compared to those with mitral valve replacement. Patients with aortic valve replacements were working more often (54%) than those with mitral valve replacements (37%). The mean age of patients who were working was significantly lower than in patients who were retired. There was a statistically significant relation between the physical working capacity and the working status. The employability assessed by history and clinical findings corresponded well to the actual work situation in individual patients.

Aortic Valve↗

[Population-based study of exercise habits in the counties of Alt Camp and Conca de Barvera (Tarragona)].

OBJECTIVE: To find the proportion of the adult population that practice physical exercise habitually. DESIGN: An observational study of a crossover nature. SETTING: The counties of Alt Camp and Conca de Barberà (Tarragona). PATIENTS AND OTHER PARTICIPANTS: A two-stage random sampling (stratified by age, gender and type of town) was performed on the different municipal registers in the counties and a representative sample of 672 people between 15 and 90 was extracted. INTERVENTIONS: By means of a home interview, a questionnaire to determine whether the interviewees practiced regular physical exercise was filled out (physical activity carried out in their free time, three or more days per week). MEASUREMENTS AND MAIN RESULTS: The most notable finding was that 47.3% of the whole sample practiced physical exercise (49.5% of men and 45.3% of women, NS). The youngest (15 to 29) were those who did most physical exercise (58.7%): this was statistically significant in comparison with the other age groups (p < 0.01). CONCLUSIONS: The results are comparable to those recorded in other studies in our country and could also serve as an indicator for those population-groups with similar demographic, socio-economic and cultural characteristics to our own.

Adolescent↗

Physiologic and psychologic factors related to depression in patients after myocardial infarction: a pilot study.

OBJECTIVE: To examine physiologic and psychologic factors contributing to depression in patients one year after myocardial infarction. DESIGN: Convenience, correlational design. SETTING: A university-affiliated cardiology clinic, a health maintenance organization, and a private cardiology group in a southwestern city. SUBJECTS: Fifteen men and six women 10 to 14 months after myocardial infarction. OUTCOME MEASURES: Oxygen saturation, somatic symptoms, and functional status in three areas (social, physical, and emotional) were correlated to depression scores by use of the Zung Self-rating Depression Scale (SDS) and the Symptom Questionnaire (SQ). RESULTS: Spearman rho correlations showed that depression measured with the Zung SDS and SQ depression subscale were inversely related to somatic symptoms, social function, physical function, emotional function, and total function. There was a significant inverse relationship between depression 9as measured by the Zung SDS) and both oxygen saturation and physical function. Although there was an inverse relationship between depression (as measured by the SQ subscale) and both oxygen saturation and physical function, it was not statistically significant. A Mann-Whitney U test for differences showed that mean SDS scores for Hispanic subjects (n = 5) and white subjects (n = 16) differed significantly. Stepwise multiple regression showed that overall functional status accounted for 56% of the variance for depression in the SDS and for 59% in the SQ depression subscale. Oxygen saturation accounted for less than 1% of the variance in both depression scales. CONCLUSIONS: The results of this study indicate that depression is negatively correlated with overall functional status in a select group of patients one year after myocardial infarction. A moderate negative correlation was also found between depression and hypoxia. Hispanic subjects had significant differences in their mean Zung SDS scores as compared with white subjects.

Depression↗

Exercise classes in rest homes: effect on physical function.

AIM: To determine if regular exercise classes, planned and supervised by a physiotherapist, improved physical function in a sample of frail institutionalised elderly. METHOD: Weekly one hour and twice weekly 10 minute exercise classes were given by a physiotherapist, to a group of 34 residents who consented from randomly selected rest homes. The study took place over a period of one year. At entry, 4, 9 and 12 months the physical function was compared with the matched control group who received regular rest home activities, without physiotherapy input. The study used a sit stand test to measure change in physical function. This was indicated by recording (a) the time taken and (b) the hand assistance required to stand up. RESULTS: Compared with the control group, the study group showed statistically significant improvement (p < 0.05) in physical function as measured by sit stand time. The sit stand hand assistance test was found to be too insensitive to measure improvement or to differentiate between the two groups. The programme was enjoyable and had no health complications. CONCLUSION: Regular exercise classes planned and supervised by a physiotherapist are safe and improve the physical functioning and daily activity levels of the frail, institutionalised elderly. They are a cost effective use of the physiotherapist's limited time.

Aged↗

[Relationship between unwanted urine loss to other limitations in function].

A limited analysis of the data of the continuous health enquiry of the Central Statistics Office regarding forms of physical impairment of the non-institutionalized Dutch population and of some data on physical ability of nursing home patients, carried out in 1991 by the Health Care Information Centre Foundation, confirmed the supposition that the risk of unwanted urine loss is substantially higher in patients with disability with respect to locomotion, changing posture, purposeful action, communication and condition. This proved to be the case at all ages, in both sexes, and in those living alone and together with others. Further investigation is necessary to determine the connection of these various forms of impairment with each other and with involuntary urine loss, with a view to promoting efficient diagnostic and therapeutic coping with involuntary urine loss; special attention should be paid to the question to what extent the disorders and limitations contribute to the actual handicap.

Activities of Daily Living↗

Parsimonious modelling of water and suspended sediment flux from nested catchments affected by selective tropical forestry.

The ability to model the suspended sediment flux (SSflux) and associated water flow from terrain affected by selective logging is important to the establishment of credible measures to improve the ecological sustainability of forestry practices. Recent appreciation of the impact of parameter uncertainty on the statistical credibility of complex models with little internal state validation supports the use of more parsimonious approaches such as data-based mechanistic (DBM) modelling. The DBM approach combines physically based understanding with model structure identification based on transfer functions and objective statistical inference. Within this study, these approaches have been newly applied to rainfall-SSflux response. The dynamics of the sediment system, together with the rainfall-river flow system, were monitored at five nested contributory areas within a 44 ha headwater region in Malaysian Borneo. The data series analysed covered a whole year at a 5 min resolution, and were collected during a period some five to six years after selective timber harvesting had ceased. Physically based and statistical interpretation of these data was possible given the wealth of contemporary and past hydrogeomorphic data collected within the same region. The results indicated that parsimonious, three-parameter models of rainfall-river flow and rainfall-SSflux for the whole catchment describe 80 and 90% of the variance, respectively, and that parameter changes between scales could be explained in physically meaningful terms. Indeed, the modelling indicated some new conceptual descriptions of the river flow and sediment-generation systems. An extreme rainstorm having a 10-20 year return period was present within the data series and was shown to generate new mass movements along the forestry roads that had a differential impact on the monitored contributory areas. Critically, this spatially discrete behaviour was captured by the modelling and may indicate the potential use of DBM approaches for (i) predicting the differential effect of alternative forestry practices, (ii) estimating uncertainty in the behaviour of ungauged areas and (iii) forecasting river flow and SSflux in terrain with temporal changes in rainfall regime and forestry impacts.

Ecosystem↗

Simple statistics for intensity data from twinned specimens.

The statistics of intensity data from hemihedrally twinned specimens are analyzed in terms of a new parameter and are shown to take a simple form in both the centrosymmetric and non-centrosymmetric cases. This analysis provides a sensitive method for determining the twinning fraction. The effects of intensity measurement errors on the observed statistics are discussed.

Chemical Phenomena↗

Mental representations of physically and sexually abused latency-aged females.

The mental representations and self-concept of 20 sexually abused, 20 physically abused, and 20 nonabused but distressed females, ages 7-12, were studied using the TAT and the Piers-Harris Children's Self-Concept Scale. Results were analyzed both statistically from objective scoring systems, and clinically from direct observations and from an analysis of the interaction of abused children with the examiner. The results show that while the mental representations did not statistically differ between the sexually and physically abused children, the abused groups did differ in their internal images compared to nonabused but distressed children. Also, abused children tended to split off from consciousness the more negative aspects of their perceptions. The results demonstrate that it is abuse per se, and not simply family distress, that results in impaired object relations. Implications of these results are discussed.

Child↗