Barriers to care among persons living with HIV/AIDS in urban and rural areas

Phenols constitute an important toxic component of the main stream (MS) of cigarette smoke. The content of volatile fraction of that group of compounds in MS depends on the tobacco type and conditions in which cigarettes are smoked, as well as on the filters applied. The purpose of the research was to determine the content of volatile in steam phenols in the MS of selected brands of cigarettes produces in Poland, as well as imported ones, and the assessment of the toxicity of doses of the phenols that smokers were exposed to. Cigarettes conditioned in constant humidity were smoked in standard conditions in the simulator of smoking, designed by the authors, while MS was absorbed in Zaitcev washers, filled with methanol. The absorbed phenols were distilled in steam and extracted with ethyl acetate. Then the phenols were separated by the method of overpressure thin-layer chromatography on DC Alufolien Polyamid 11F254 Merck chromatoplates, in the developing system chloroform-methanol 99:1 v/v, were induced with sodium diazofluoroborate, and after eultuion the separated phenol, and o-cresol were determined, as well as the non-separated mixture of p- and m-cresols, by the spectrophotometric method. The determined contents of phenols in MS were assessed regarding their toxicity applying the criteria of environmental exposure. When calculating the results, the efficiencies of the applied in the analytical procedures processes of absorption, distillation and extraction of the investigated phenols previously determined experimentally, were taken into consideration. The content of determined compounds in the brands of the cigarettes examined was in the case of phenols, changing within the range from 41.25 +/- 1.15 to 7.60 +/- 0.93 (the average of 20.31 +/- 9.61 micrograms per cigarette); in the case oo-cresol it was within the range from 28.16 +/- 0.95 to 5.72 +/- 0.53 (the average of 11.56 +/- 6.7), while for the non-separated p- and m-cresols the range was from 21.12 +/- 0.5 to 7.31 +/- 0.45 (the average amounted to 11.48 +/- 4.98 micrograms per cigarette The conclusions of the study were the brands of cigarettes significantly influences the content of the phenols examined in the cigarette smoke the phenols determined coexist in the MS of examined cigarettes in similar proportions the doses of phenols inhaled by a smoker during a day with the MS of examined brands of cigarettes participate essentially in the toxicity of the cigarette smoke and smoking 20 cigarettes a day causes the smoker's organism to be exposed to incomparably larger doses of phenols than those from unpolluted atmospheric air.     

Barriers to effective psychiatric emergency services for elderly persons

OBJECTIVE: To evaluate the etiology and outcome of fetal hydrops of nonimmune origin diagnosed in utero during the first half of pregnancy. METHODS: We reviewed 45 cases of nonimmune fetal hydrops presenting between 11 and 17 weeks' gestation over a 4-year period. RESULTS: The median gestational age at diagnosis of fetal hydrops was 14 weeks. Placental edema was most commonly associated with generalized skin edema. Ascites was also observed in four cases, but no case presented with pleural or pericardial effusion. The fetal karyotype was abnormal in 35 cases (77.8%). Of the ten fetuses with a normal karyotype, four were classified as idiopathic, three had isolated atrioventricular septal defect, two were associated with maternal infection, and one had multiple pterygium. Fetal heart rate anomalies were found in both chromosomally normal and abnormal fetuses. All but one of the karyotypically abnormal pregnancies and five of ten euploid pregnancies were terminated. In all six pregnancies that continued, resolution occurred before mid-gestation. Three continuing euploid pregnancies resulted in fetal death, and only two had a normal outcome. CONCLUSION: Nonimmune fetal hydrops diagnosed before 18 weeks' gestation is associated with a higher incidence of aneuploidy than hydrops diagnosed during the second half of pregnancy. In most affected fetuses with a normal karyotype, spontaneous resolution occurred before 24 weeks' gestation, although the outcome was generally unfavorable.     

Homicide-suicide in older persons

The plant vacuole has long been suspected of being a site for accumulation of Ni in plant roots, but testing this hypothesis directly by vacuole isolation is technically difficult and has not been reported. Here, we have attempted to determine if Ni can be transported into isolated oat (Avena sativa L.) root tonoplast vesicles as an alternative approach toward understanding the importance of the vacuole in Ni accumulation in roots. We found that, in contrast to Ca and Cd, Ni did not affect the proton gradient of vesicles (MgATP energized or artificially created), and further, that Cd/H antiport activity was not affected by the presence of Ni. Nickel was associated with vesicles, but relative rates of accumulation/association of metals with vesicles were Ca > Cd > Ni. Protonophores and the potential Ni ligands citrate and histidine, and nucleoside triphosphates or PPi did not stimulate Ni association with vesicles. Comparison of Ni versus Ca and Cd associated with vesicles using various membrane perturbants indicated that while Ca and Cd are rapidly and principally antiported to the vesicle sap, Ni is only slowly associated with the membrane in a not-easily dissociated condition. Our results indicate the absence of an Ni/H antiport or Ni-nucleotide-dependent pump in oat root tonoplasts, and support the contention that the vacuole is not a major compartment for Ni accumulation in oat roots.     

Obesity in older persons

The prevalence of obesity among older persons is growing. This trend has adverse medical, functional, psychosocial, and health care resource consequences. Many obese older persons were obese middle-aged adults. A sedentary lifestyle may be the dominant contributing factor. Intervention should focus on moderate weight reduction through the modification of diet, exercise, and behavior. Improvements in health and quality of life can be achieved with moderate weight reduction. Strategies tailored to the older population will facilitate successful interventions. Dietitians must be key participants in the effort to raise awareness of obesity as a serious health concern for older persons. The focus must be on achieving a more healthful weight.     

Diabetes mellitus in older persons

The relative importance and mechanisms of deficient insulin secretion versus deficient action during aging are still debated. Whatever mechanisms eventually explain the emergence of impaired glucose tolerance during aging, the clinically important extrinsic modifiers of glycemic levels include diet, medications, activity, and chronic illness and stress. Although prospective studies are not available in the elderly, retrospective studies suggest that good blood glucose control reduces the likelihood and severity of stroke, cardiovascular disease, visual impairment, nephropathy, infections, and even cognitive dysfunction. Good control also seems to reduce nocturia, polyuria, and hypovolemia. Therapy of older persons begins with diet, exercise, and oral agents, failing which, insulin is employed. Since many of the newer oral agents carry less risk of hypoglycemia, achieving tighter control in the elderly has become more feasible.     

Barriers to nutritional well-being for rural elders: community experts' perceptions

Older adults use public and private services, as well as personal resources, to meet nutritional needs. In-depth interviews conducted with 73 service providers and community experts in two rural North Carolina counties were analyzed for these experts' perceptions of barriers to adequate nutrition for older adults. Perceived barriers included characteristics of the county and programs, transportation, and kin, as well as older adult medical and economic conditions, food habits, knowledge, and attitudes. The importance given each of these domains varied by respondents' area of expertise. Community experts and providers may not see the connection between their services and nutritional well-being of older adults.     

Primary care and case management of persons with HIV/AIDS

The nurse practitioner can meet the multiple needs of people living with HIV disease. Given the broad scope and integration of services required to care for clients with HIV/AIDS, the skill of a nursing case manager is also an integral part of the health care team. Together, these nursing clinicians can enhance the quality of care provided to HIV-infected individuals as each plays numerous roles with specific competencies and skills. This article discusses primary care services and the role of health care providers in working with persons with HIV/AIDS.     

An interpersonal approach to psychotherapy with older persons with dementia.

This article presents theoretical and practical information about the application of Sullivanian interpersonal concepts of psychotherapy with persons with dementia. The approach focuses on management of anxiety in a therapeutic relationship. Anxiety is construed as the underlying cause of catastrophic reactions of dementia. The patient's premorbid personality and history affects manifestation of the dementia in terms of affect, cognition, and behavior. Thus, understanding the dementia in the context of the patient's entire life is seen as crucial for effective therapy. Case material and suggestions for conducting this form of treatment are offered. Finally, special problems in assessing the efficacy of psychotherapy for older persons with dementia are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Response to urinary incontinence by older persons living in the community

PURPOSE: To investigate the responses to urinary incontinence (UI) of older persons living in the community. DESIGN: Detailed interviews were completed on a sample of 42 independent, community-dwelling persons who were at least 60 years of age. Nineteen participants reported UI, and their experiences are reported in detail. SETTING AND SUBJECTS: Subjects were recruited from 3 sources: volunteers who acknowledged having UI, those with known UI who were invited by their doctors to participate, and those who selected "Loss of bladder control" in a 20-card sort of common ailments. All interviews were conducted in a private setting at a seniors center or at participants' church or home. INSTRUMENTS: Twenty cards with a common ailment printed in large type and an interview schedule with questions relating to the ailment selected as having the most impact were used; demographic data were collected on a standardized form. METHODS: Interviews were recorded on audiotape and lasted from 20 to 60 minutes. These recordings were analyzed for themes with use of Ethnography software. MAIN OUTCOME MEASURES: Demographic and other data from the interview schedule were tabulated. The communication style of the 19 subjects with UI was analyzed to determine how freely they spoke about problems with bladder control to family and friends and their sources of information for managing urinary leakage. Analysis was done both by the researcher and a faculty member; an interrater reliability of 1.00 was achieved. RESULTS: There was little difference in the self-rating of health for those with or without UI. Subjects recruited by letters sent to doctors' patients ranked the impact of loss of bladder control higher than other subjects did. Of the 19 subjects with UI, 10 spoke freely to family and friends, but 9 seldom discussed the subject--and then only to a family member. Four of the 9 with a closed communication style reported no current source of information about UI or its management. CONCLUSION: Though UI had a major effect on the lives of these subjects, they were more willing to admit having "loss of bladder control" than "urinary incontinence." Communication style is related to prior sources of information about UI, but not its perceived impact on health. This relationship helps to determine the teaching methods that are most likely to influence elderly persons with UI who have either on open or closed communication style.     

Respiratory syncytial virus infection in older persons

Respiratory Syncytial Virus (RSV) is an increasingly recognized cause of serious disease in older adults. RSV causes excess morbidity and mortality in older persons residing in nursing homes and in the community. The study of RSV in adults has been hampered by the lack of sensitive methods for the diagnosis of acute infections. Such tools are needed to better understand the epidemiology and immunology of RSV in adults. The immune status of older adults has begun to be explored and preliminary data indicates that low serum neutralizing antibody may predispose to symptomatic RSV infection and that a greater diversity of antibody titres may be seen in the elderly compared to young adults. PFP-2, a candidate RSV subunit vaccine, has been evaluated in healthy and institutionalized elderly and been found to be safe and immunogenic.     

Local Medicare policies: A pathway for providing mental health services to older adults.

Inconsistent local Medicare service coverage policies constitute one of the most prominent barriers encountered by mental health professionals who provide services to older adults. In this study, the authors analyzed the scope and delineation of local Medicare policies for 19 types of psychiatric and psychological services in 2003 and again in 2006. Results indicated policies now exist for all Medicare services in all the states, and many of the local policies provide definitive statements to guide practice. However, some policies lacked delineation and variability persists from one region to the next. While researchers ascertain how local policies can impact service outcomes, providers should form issue networks and resolve current problems such as the inequities surrounding service documentation requirements and the lack of guidance in providing mental health care to older persons with dementia. Given that the Medicare administrative structure will undergo substantive changes in the next five years, there is an exceptional opportunity for providers to address these problems successfully and pave a pathway for providing specialty mental health services to older adults. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The helping alliance in case management for homeless persons with severe mental illness

This study examined the role of the helping alliance in case management with homeless persons who have a severe mental illness. A strong alliance after two months of treatment was marginally associated with three outcomes: higher consumer satisfaction, less severe global symptom severity, and greater hostility. The only outcome associated with the alliance after fourteen months of treatment was consumer satisfaction. Several variables predicted a strong helping alliance at month two, including: being African American, low hostility, more perceived needs, and more program contacts. The only variable that predicted a strong alliance at month fourteen was a strong alliance at month two.     

Recognizing and helping older persons with vision impairments

We report three cases of mycotic aortic aneurysms due to Yersinia enterocolitica. In all cases, serogroups are O:9. The three patients more than 70 year-old men with immunodeficiency underlying conditions allowing bacterial graft (neoplasia, diabetes mellitus, dysimmunitary syndrome, hematologic diseases). The six cases of the literature were clinically, biologically and epidemiologically similar. The strains of Y enterocolitica responsible for septicemia are especially serogroups O:9. This is probably due to particular virulence factors in this serogroup (phagocytosis resistance gene: yopH, ypkA et yop E) (yop: Yersinia outer membrane proteins). The presence of a pYV plasmid (plasmid yersinia virulence), found in Yersinia pathogen strains, lead to bacterial proliferation in the tissues. The authors discuss pathophysiological mechanisms involved in arterial bacterial graft following an Y. enterocolitica infection.     

Therapy for acute myocardial infarction in older persons

OBJECTIVE: To review the early management of acute myocardial infarction (AMI) in older adults. METHODS: Recently published studies relevant to the early management of AMI were systematically reviewed. When possible, the impact of older age on complication rates and clinical outcomes was evaluated. RESULTS: In general, AMI therapies that are effective in younger patients are also effective in older patients. Conversely, older age is associated with an increased risk of complications from therapy, implying that careful patient selection is required to optimize outcomes while minimizing risks. The principal limitation of currently available data is that relatively few patients older than the age of 80 have been enrolled in prospective randomized clinical trials. CONCLUSIONS: Thrombolysis and primary angioplasty are effective in establishing reperfusion and improving clinical outcomes in older patients with AMI. In the absence of contraindications, aspirin and beta blockers should be considered standard therapy in AMI patients of all ages, whereas heparin, nitrates, and angiotensin converting enzyme inhibitors are indicated in selected subgroups. At the present time, calcium channel blockers, magnesium, and antiarrhythmic agents are not recommended for routine use in the AMI setting, and the role of glycoprotein IIb/IIIa inhibitors, low molecular weight heparin, and other newer agents await the results of ongoing clinical trials.     

Nonpharmacologic interventions successfully treat hypertension in older persons

A randomized controlled multicenter trial of nonpharmacologic intervention in elderly with treated hypertension concluded that reduced sodium intake and weight loss are feasible, effective, and safe nonpharmacologic treatments for hypertension. This and other trials provide compelling evidence that a variety of dietary interventions are important in the prevention and treatment of hypertension in all age groups.     

Overcoming obstacles in providing mental health treatment to older adults: Getting in the door.

Older adults significantly underutilize mental health services relative to their numbers in the population. Barriers that impede their access include physical, financial, cognitive, emotional, and attitudinal issues. This article discuss strategies for overcoming these barriers including physical adaptations such as in-home psychotherapy and telephone sessions, use of support groups, strong community outreach, and liaisons with other professionals. Adaptations that help to increase older adults' use of mental health services are discussed, including education about treatment, nontraditional "pursuit" of clients, and use of alternative terminology. Informed consent is discussed as a special issue. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Improving quality of sexually transmitted disease case management in rural South Africa

OBJECTIVE: To measure quality of sexually transmitted disease (STD) syndromic case management and aspects of health-seeking behaviour at baseline in an intervention trial. SETTING: Ten rural primary care clinics, Hlabisa district, South Africa. DESIGN: Simulated patients (fieldworkers trained to present with STD syndromes) made a total of 44 clinic visits; 49 STD patients were interviewed when exiting clinics; facilities were assessed for availability of necessary equipment and drugs; 10 focus group discussions were held with staff; and STD syndrome surveillance was performed in all 10 clinics. RESULTS: A total of 9% of simulated patients were correctly managed (given correct drugs, plus condoms and partner notification cards), recommended drug treatment was given in only 41% of visits, and appropriate counselling was given in 48% of visits. Among patients leaving the clinic, although 39% waited over an hour to be seen and only 37% were consulted in private, all reported staff attitudes as satisfactory or good. Only six clinics had syndromic management protocols available, three reported intermittent drug shortages, and seven lacked partner notification cards. Focus group discussions revealed good staff knowledge about STD, but showed lack of training in syndromic management and low morale. Surveillance data showed that while 75% of those presenting for care did so within 1 week of symptom onset, 27% had been treated for an STD in the preceding 3 months, and only 6% of those treated were contacts. CONCLUSIONS: Quality of STD case management was poor despite good staff knowledge and availability of most essential resources. An intervention comprising staff training and STD syndrome packets has been designed to improve quality of case management.     

Chronically depressed mood and cancer risk in older persons

BACKGROUND: Depression has been proposed as a predisposing factor for cancer, but prospective studies have been inconclusive. We examined whether a high level of depressive symptoms, present for a long time, is associated with increased risk of cancer in the elderly. METHODS: Data were obtained and analyzed from persons who lived in three communities (Massachusetts, Iowa, and Connecticut) of the Established Populations for Epidemiologic Studies of the Elderly, a prospective cohort study with a mean follow-up of 3.8 years that included 4825 persons (1708 men and 3117 women) aged 71 years and older. Chronically depressed mood was defined as present when the number of depressive symptoms exceeded specific cut points on the Center for Epidemiologic Studies-Depression scale at baseline (1988) and 3 and 6 years before baseline. New cases of cancer were identified from Medicare hospitalization records and death certificates. RESULTS: Of the 4825 persons studied, 146 (3.0%) were chronically depressed. The incidence rate of cancer was 30.5 per 1000 person-years for the 146 persons with chronic depression and 21.9 per 1000 person-years for the 4679 nonchronically depressed persons. After adjustment for age, sex, race, disability, hospital admissions, alcohol intake, and smoking, the hazard ratio for cancer associated with chronically depressed mood was 1.88 (95% confidence interval = 1.13-3.14). The excess risk of cancer associated with chronic depression was consistent for most types of cancer and was not specific to cigarette smokers. CONCLUSION: When present for at least 6 years, depression was associated with a generally increased risk of cancer.