Exploring the enigmas of frontal lobe dysfunction

The clues vary, and many of the "typical" signs are misleading or even contradictory. One patient acts impetuously while another seems to have lost his spontaneity. Still another shows aggressive, animalistic behavior--or becomes apathetic, perhaps curling up in the fetal position or sucking, rooting, or grasping as an infant does. Some patients can memorize and recite a long list of numbers, remember events of the day before, and recall many of their childhood experiences--yet they "forget to remember" why they went to the store. When this happens, it's likely that the frontal lobe isn't performing its goal-orienting function as it should. If a patient takes small steps, has trouble initiating a step, or can't seem to find and keep his center of gravity--or if he involuntarily resists or aids an attempt to move his neck, arms, or legs--he doesn't necessarily have Parkinson's disease; he may have a frontal lobe lesion instead. Usually--but not always--the easiest way to find out is to check for a resting tremor.     

Health care policy and long-term care.

Discusses changes in the age structure of the nation, the locus of care, the nature of disease, and the cost of care as factors that have led to recent proposed revisions in health-care policy. The need for increased future involvement of a rehabilitation philosophy as a response to the current crisis in policy is examined. (8 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health care report cards

PURPOSE: A decreased concentration of magnesium in the urine is a risk factor for renal calcium stone disease that may be caused by decreased enteral absorption of magnesium. We analyze the possible reciprocal influences of enteral absorption of calcium and magnesium in patients with renal stone disease. MATERIALS AND METHODS: We measured the fractional enteral absorption of 47calcium and 28magnesium in 11 patients with renal calcium stone disease, including 8 with and 3 without hypercalciuria. Two tests were performed using calcium and magnesium, respectively, followed by another test in which the enteral absorption of calcium and magnesium was measured after both cations were administered together. RESULTS: We noted no clear influence of either cation on the absorption of the other in the 3 patients without hypercalciuria. However, in the 8 hypercalciuric patients enteral calcium absorption decreased after the concurrent administration of magnesium and enteral magnesium absorption increased after the concurrent administration of calcium. Each effect was proportional to the other. CONCLUSIONS: The results of this study indicate that the oral supplementation of magnesium in patients with hyperabsorptive hypercalciuria and renal calcium stone disease is favorable because it decreases calcium absorption and increases magnesium absorption. Both factors may reduce risk factors for renal calcium stone formation.     

Health care of adolescents

Partial trisomy 6p with duplications ranging from 6p21 to 6p25 is emerging as an established syndrome. A case of duplication of segment p22-p25 of the short arm of chromosome 6 as the result of a maternal t (1;6)(q44;p22.2) translocation in a mentally retarded girl with congenital anomalies is reported here. The associated phenotypic anomalies are compared with other reported cases of duplication 6p involving adjacent regions.     

Health care reform in Chile

This is a document presented to the Chilean Academy of Medicine by the Health Minister, the economist Carlos Massad, First of all, he refers to the general context of the reform, that he considers a process and not a breakpoint. Afterwards, he enumerates the change task: a) to generate awareness of the change and to convert health in a State issue; b) to adequate programs to population's new health profile; c) to install new management instruments in the health system; d) to decentralize decisions and to promote the participation of beneficiaries; e) to establish incentives and to flexibilize the Health System and f) to introduce correctives to private health insurance. He believes that Chile must drift to a economical protection system for universal and solidary health events. The additional assurances that people wants to buy, must be delimited.     

Health care reform is coming.

During my career in Congress, we have achieved some success in expanding health insurance coverage and keeping services affordable, but the problem of 46 million uninsured and 25 million underinsured must be addressed. In February 2009, I introduced the Healthy Americans Act (S. 391/H.R. 1321; Wyden, 2009), a comprehensive bipartisan health care reform bill that covers all Americans without breaking the bank, by weaving together the Democratic idea that we need to give every single person in the country health care coverage and the Republican belief in a private-market approach. This bill would favorably affect providers in nonprofit institutions, public institutions, and school systems, by ending cost shifting from public program underpayments to the privately insured. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health care administration and the law

Eighty-six feral cats from a sheep grazing area in the Tasmanian Midlands and 21 from King Island were examined for internal parasites. Major food items in order of decreasing prevalence in stomach contents were insects, lizards, birds, rodents and frogs in the Midlands, and rodents, birds, insects, and lizards on King Island. Feral cats from the Midlands had 4 cestode, 7 nematode, 2 trematode and 3 protozoan parasites as follows: Spirometra erinacei (66.3%), Taenia taeniaeformis (2.3%), Dipylidium caninum (1.2%), Toxocara cati (86.0%), spiruroid nodules containing Cylicospirura felineus and Cyathospirura dasyuridis (57.0%), Ollulanus tricuspis (11.4%), Uncinaria stenocephala (2.3%), Aelurostrongylus abstrusus (39.2%), Capillaris aerophila (30.0%), Echinoparyphium sp (27.1%), Fibricola minor (6.8%), Isospora felis (12.7%), I. rivolta (5.4%), and Sarcocystis sp (1.8%). Antibodies to Toxoplasma gondii were found in 51 of 53 serums. Three cestode and 5 nematode parasites were found in cats from King Island: T. taeniaeformis (49.2%), D. caninum (23.8%), S. erinacei (19.0%), T. cati (90.5%), C. felineus (42.9%), C dasyuridis (9.5%), O. tricuspis (4.8%) and C. aerophila (9.5%). This is the first record of Cylicospirura felineus, Fibricola minor and Echinoparyphium sp in cats in Australia.     

Health care research and policy studies

Health economic studies in rheumatology have never been of greater policy importance, but unfortunately there are only a small number of researchers examining issues in this area. This paper reviews studies relating to economics and rheumatology as well as some important methodologic issues relating to conducting such studies. The topics covered include cost-identification analysis, physician variation, specialty versus subspecialty care, utility assessment, decision analysis, quality of life, time preferences and discounting, and sensitivity analysis. More than ever, now is the time to provide policy makers with evidence that rheumatologists provide medical care that is not only the finest from a medical perspective but the most cost effective from society's perspective.     

Health care workers and workplace violence

Laser bronchoscopy allows reestablishment of patent airways in patients with exophytic intraluminal tracheobronchial obstruction from malignancy. Patients with benign strictures can also be treated, thereby avoiding open surgical repair in selected instances. Because of laser-tissue interactions, and because patients often have terminal illness or severe underlying medical problems, these are potentially high-risk procedures. Proper resection techniques, experience, and repetitive performance are necessary to ensure satisfactory patient safety and outcome.