Geriatric care in the late 1990s

Geriatric health care remains a virtually untapped area in spite of changing public views and scientific knowledge on aging. The number of older dogs and cats will continue to grow into the next century. Owners of older dogs and cats are willing to invest in quality health care services. A geriatric health care program can expand veterinary services in a practice and is a natural extension of pediatric and adult maintenance programs.     

The professions in the 1990s

As they did when they were formed 150 years ago, the professions must again convince the public and a cost-conscious and competition-orientated Government that they should be entrusted with the provision of services their training has made them fit to offer. This article explains why.     

Hypospadias repair in the 1990s

Hypospadias is a congenital anomaly in which the urethral meatus is abnormally located anywhere from the glans to the perineum. Refinements in pediatric anesthesia, surgical technique and instrumentation, and a greater understanding of the psychologic and emotional issues related to hypospadias repair have led to this procedure being performed at an earlier age. The goal of reconstruction is to bring the urethral meatus to the tip of the penis, to correct associated penile curvature if present, to create a conical-shaped glans, and to achieve cosmetically acceptable penile shaft skin coverage. The surgical technique employed varies with the penile anatomy and surgeon's preference. Complications may occur both immediately and long after the surgical procedure, and thus follow-up is necessary.     

Selective shunts in the 1990s

Venous thrombosis is a well-known complication of permanent cardiac pacemaker implantation, particularly, chronic occlusion of the subclavian vein is reported to occur in 20-33% of the cases where the percutaneous approach is performed. We examined 135 asymptomatic patients with digital venography to asses the frequency of venous thromboses causing stenosis and occlusion of the subclavian or anonymous arteries in pacemaker carriers. We considered both one- (44) and two-chamber (91) pacemakers and investigated a possible statistically significant difference between them: we found 21 venous thromboses (15%), seven of them in one-chamber pacemakers (15.9%) and 14 two-chambers pacemakers (15.3%). None of our 94 male and 41 female patients was on anticoagulants or had any evidence of coagulation disorders. Venography was performed 39.3 months (mean) after pacemaker implantation (range: 3-120 months). We conclude that digital venography is a simple and relatively noninvasive method permitting better depiction of subclavian, anonymous and caval veins than Doppler US and also showing some vascular abnormalities which may complicate pacemaker implantation.     

Addiction and AIDS in the 1990s.

Predicts that psychologists treating addiction will be vigorously involved with combating acquired immune deficiency syndrome (AIDS) in the 1990s. Psychologists will need to be committed to preventing the spread of human immunodeficiency virus (HIV), understanding the AIDS–drug use connection, and devising means to minimize the effects of infection on drug users, staff members who treat them, and the general population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Life changes scaling for the 1990s

Three decades ago, results from a proportionate scaling study of life change events was published in this journal. The events, listed by rank order of their mean life change values, comprised the Social Readjustment Rating Scale (SRRS). Ten years later, 42 of the 43 original events were rescaled. In this second study, an additional 44 events were added to the original list. In the present report, the original plus the later-developed events were scaled once again by persons chosen to closely approximate subjects enrolled in the initial study. Comparing the average life change intensity scores across 30 years, a 45% increase in mean values was seen. These recently derived life change magnitudes, for both the original list of events plus the later-developed events, provide values appropriate for use in the 1990s. In the original study, effects of subjects' demographic characteristics were noted briefly in a table. In the present investigation, varying influences of gender, age, marital status, and education were explored in more detail. Several significant differences were discovered, with gender showing a very pronounced influence on scaling results. Discussion of these results included composition requirements for a life changes questionnaire.     

Value of the American College of Cardiology/American Heart Association stenosis morphology classification for coronary interventions in the late 1990s

We have reported that norepinephrine but not K+ induced a sustained and dose-dependent contraction without extracellular Ca2+ and Mn2+ in Ca2+-depleted Mn2+-loaded vas deferens from the guinea-pig. In the present study, we determined the phosphorylation of the 20-kDa myosin light chain and examined the effects of inhibitors of calmodulin and myosin light chain kinase on the Mn2+-dependent norepinephrine-induced contraction in order to evaluate the contribution of phosphorylation to this contraction. W-7 [N-(6-aminohexyl)-5-chloro-1-naphthalenesulfonamide], ML-9 [1-(5-chloronaphthalene-1-sulfonyl)-homopiperazine] and wortmannin inhibited this contraction. However, the Mn2+-dependent norepinephrine-induced contraction developed without a significant increase in the phosphorylation of the 20-kDa myosin light chain. In beta-escin-permeabilized preparations, Mn2+ induced contractions that were inhibited by ML-9. These results suggest that the activation of myosin light chain kinase is essential for the development of Mn2+-dependent norepinephrine-induced contractions and that the phosphorylation of myosin light chain may act as a trigger for these contractions.     

Prevention and control of tuberculosis in the 1990s

Beginning in 1984, the long-term decline in tuberculosis (TB) cases stopped, and since 1985 the number of cases has actually increased by 18%, from 22,201 new cases in 1985 to 26,283 in 1991. The change in the morbidity trend appears to be primarily due to three factors: HIV coinfection, TB occurring in persons from countries where this disease is prevalent, and deterioration of the health care infrastructure with resultant outbreaks of TB. This article presents six interventions that address major areas where action is needed. These efforts will require coordinated action by health care providers, public health departments, and other public and private organizations. Protection of all workers and patients in health care settings is one important goal of these efforts.     

Occupational medicine in Canada and Poland in the 1990s

The protocol describes (i) methods for the investigation of neuropeptide catabolism in the central nervous system (CNS), (ii) the identification of the neuropeptidases involved, and (iii) methods for the determination of neuropeptide stability in vitro. These methods are applicable also to study the degradation of peptide hormones by peripheral cells or tissues. To identify peptide degradation products, nanomolar amounts (micromolar concentrations) of peptides are incubated in synthetic media with cell or tissue cultures. Aliquots of the supernatants are withdrawn after different times, peptide fragments separated and fractionated by reversed-phase HPLC, and identified by peptide chemical methods. The peptidases responsible for this degradation can be identified by the use of specific inhibitors listed in the protocol. For receptor binding assays or the study of peptide effects in physiological, nanomolar concentrations the stability of the peptides in an in vitro system should be checked by addition of radiolabeled peptides (femtomolar or nanomolar concentrations) and monitoring the peptide degradation by a procedure analogous to that established for unlabeled peptides. The addition of more or less specific peptidase inhibitors enhances peptide stability in vitro, and thus it can be assured that a given peptide concentration is maintained during biological assays.     

Unraveling the role of forgiveness in family relationships.

Testing the idea that the process of forgiveness is intrinsically different across diverse relationships, this study examined the role of forgiveness in different family relationships. In 2 laboratory sessions 1 year apart, 114 families (each including 2 parents and 1 child) completed a new measure of family forgiveness and many individual-level, relationship-level, and family-level variables that have been previously linked with forgiveness. After validating the measure of family forgiveness in cross-sectional analyses, investigators performed longitudinal analyses to examine the role of forgiveness in each family relationship over the 1-year interval. Results indicated many important positive consequences of forgiveness on individual traits, aspects of each family relationship, and general family environment. However, there were also important asymmetries in associates of forgiveness across parent-child and parent-parent relationships, demonstrating the relationship-bound nature of forgiveness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Understanding attachment security in family context.

Attachment theory (J.. Bowlby, 1969) is not just about how internalized models of relationships affect interpersonal outcomes; it is primarily a theory about how interpersonal processes affect social and cognitive development. This study tested 3 hypotheses about the interpersonal sources of adult attachment security: (a) attachment security is relationship specific, (b) characteristics of partners affect attachment security, and (c) security of attachment is reciprocated. Measures of attachment security were obtained from 2 parents and 2 children (adolescent or older) in 208 middle-class families. Results of social relations model analysis (D. A. Kenny & L. La Voie, 1984) supported all 3 hypotheses. The author concludes that internal working models of relationships may not be so "internal" after all and that greater emphasis on the interpersonal sources of adult attachment security is warranted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dynamic cost shifting in hospitals: evidence from the 1980s and 1990s

The purpose of this paper is to determine whether dynamic cost shifting occurred among acute care hospitals during the period from the early 1980s to the early 1990s and, if so, whether market factors affected the ability to shift costs. Evidence from this study of California acute care hospitals during three time intervals shows that the hospital did practice dynamic cost shifting, but that their ability to shift costs decreased over time. Surprisingly, hospital competition and HMO penetration did not influence cost shifting. However, increasing HMO penetration (measured as the HMO percentage of hospital discharges) did decrease both net prices and costs for the early part of the study, but later was associated with increases in both.     

Catching patients: tuberculosis and detention in the 1990s

The resurgence of tuberculosis (TB) in the early 1990s, including multidrug-resistant strains, led health officials to recommend the use of involuntary detention for persistently nonadherent patients. Using a series of recently published articles on the subject, this paper offers some opinions on how detention programs have balanced protection of the public's health with patients' civil liberties. Detained persons are more likely than other TB patients to come from socially disadvantaged groups. Health departments have generally used coercion appropriately, detaining patients as a last resort and providing them with due process. Yet health officials still retain great authority to bypass "least restrictive alternatives" in certain cases and to detain noninfectious patients for months or years. Misbehavior within institutions may inappropriately be used as a marker of future nonadherence with medications. As rates of TB and attention to the disease again decline, forcible confinement of sick patients should be reserved for those persons who truly threaten the public's health.