Life transitions and health insurance coverage of the near elderly

OBJECTIVES: This study addresses three issues. (1) What are demographic wealth, employment, and health characteristics of near-elderly persons losing or acquiring health insurance coverage? Specifically, (2) what are the effects of life transitions, including changes in employment status, health, and marital status? (3) To what extent do public policies protect such persons against coverage loss, including various state policies recently implemented to increase access to insurance? METHODS: The authors used the 1992 and 1994 waves of the Health and Retirement Study to analyze coverage among adults aged 51 to 64 years. RESULTS: One in five near-elderly persons experienced a change in insurance coverage from 1992 to 1994. Yet, there was no significant change in the mix of coverage as those losing one form of coverage were replaced by others acquiring similar coverage. CONCLUSIONS: Individuals whose health deteriorated significantly were not more likely than others to suffer a subsequent loss of coverage, due to substitution of retiree or individual coverage for those losing private coverage and acquisition of Medicaid and Medicare coverage for one in five uninsured. State policies to increase access to private health insurance generally did not prevent individuals from losing coverage or allow the uninsured to gain coverage. Major determinants of the probability of being insured were education, employment status of person and spouse, and work disability status. Other measures of health and functional status did not affect the probability of being insured, but had important impacts on the probability of having public coverage, conditional on being insured.     

American Cancer Society perspective on the American College of Preventive Medicine''s policy statements on skin cancer prevention and screening

Six surgical procedures, consisting of tendon transfers and releases, were performed in five patients with idiopathic focal dystonia involving the lower extremity. All patients were female. Surgical management was performed to correct clinically significant foot abnormalities. The goal of each procedure was functional improvement and obtaining a plantigrade foot. The SPLATT (split anterior tibial tendon transfer) procedure was performed in each foot with a flexible equinovarus foot abnormality. Follow up at a mean of 27.2 months (range, 8-40 months) yielded satisfactory clinical results without significant complications. Clinical equinovarus has not recurred after this procedure. All patients remain brace-free ambulators.     

Membrane potential synchrony of simultaneously recorded striatal spiny neurons in vivo

The basal ganglia are an interconnected set of subcortical regions whose established role in cognition and motor control remains poorly understood. An important nucleus within the basal ganglia, the striatum, receives cortical afferents that convey sensorimotor, limbic and cognitive information. The activity of medium-sized spiny neurons in the striatum seems to depend on convergent input within these information channels. To determine the degree of correlated input, both below and at threshold for the generation of action potentials, we recorded intracellularly from pairs of spiny neurons in vivo. Here we report that the transitions between depolarized and hyperpolarized states were highly correlated among neurons. Within individual depolarized states, some significant synchronous fluctuations in membrane potential occurred, but action potentials were not synchronized. Therefore, although the mean afferent signal across fibres is highly correlated among striatal neurons, the moment-to-moment variations around the mean, which determine the timing of action potentials, are not. We propose that the precisely timed, synchronous component of the membrane potential signals activation of cell assemblies and enables firing to occur. The asynchronous component, with low redundancy, determines the fine temporal pattern of spikes.     

Mid-clavicle fractures in adults: end result study after conservative treatment

OBJECTIVE: The aim of the present study was to analyze the long-term outcome of mid-clavicle fractures in adults and to evaluate the clinical importance of displacement and fracture comminution. DESIGN: Two hundred twenty-five mid-clavicular fractures that had been nonsurgically treated at Malm? University Hospital were retrospectively evaluated, both clinically and radiographically, an average of seventeen years after injury. There were seventy-one undisplaced fractures, sixty-nine displaced two-fragment fractures, and eighty-five displaced and comminuted fractures. The average patient age at the time of trauma was thirty-three years (range 15 to 70 years). Patients were interviewed, and careful clinical and radiological examination of their shoulders was performed. Two patients had experienced transient neuritis, and another two underwent operative treatment because of progressive neuropathy. SETTING: All 225 consecutive patients were treated primarily at the Malm? University Hospital, which serves the Malm? city population (250,000). PATIENTS/PARTICIPANTS: Since the beginning of this century, all radiographs taken at the Malm? University Hospital have been classified and filed for easy retrieval. In this retrospective study, all patients treated between 1970 and 1979 were identified, and those still living were called for follow-up examination. INTERVENTION: Of the 225 fractures reviewed, 197 fractures were originally treated with a figure-of-eight splint for an average period of three weeks without any attempt to reduce the displaced fractures; twenty-four patients were allowed immediate free shoulder mobilization. MAIN OUTCOME MEASUREMENTS: Clinical rating and healing were the main outcome measurements. RESULTS: At follow-up, 185 shoulders were asymptomatic. Thirty-nine shoulders had moderate pain and were rated as fair, and one patient was rated as poor. One hundred twenty-five of the fractures had healed normally, fifty-three were malunited with persistent fracture displacement, and seven were nonunions; nonunion was significantly more prevalent in cases with displaced fractures. Forty malunited fractures and three nonunions were rated as good. CONCLUSIONS: This review demonstrates that few patients with fractures of the mid-part of the clavicle require operative treatment.     

Genetic heterogeneity of adrenocorticotropin (ACTH) resistance syndromes: identification of a novel mutation of the ACTH receptor gene in hereditary glucocorticoid deficiency

Hereditary primary adrenal insufficiency syndromes due to ACTH resistance include hereditary glucocorticoid deficiency (HGD) and Allgrove's syndrome (AS). Patients with both conditions present in childhood with failure to thrive, weakness, and fatigue or adrenal crisis; patients with AS in addition have alacrima and achalasia (triple A syndrome). We studied four kindreds with HGD and four kindreds with AS for abnormalities of the ACTH receptor (ACTHR) gene. The ACTHR coding sequence in all AS kindreds and two HGD kindreds was normal. Analysis of the ACTHR gene of the proband in one of the HGD kindreds showed him to be homozygous for the previously described G221T transition causing a Ser74Ile substitution of the protein, which has been shown to inactivate the ACTHR in signal transduction. The proband in another HGD kindred was found to be a compound heterozygote with the G221T transition in one allele and a novel C818A transition in the other allele of ACTHR. The C818A transition caused the substitution of the highly conserved Pro273 by His in the receptor protein. In vitro expression of the mutated ACTHR in mouse melanoma M3 cells showed that at a medium ACTH concentration of 3 nM, cells transfected with the wild-type ACTHR produced twofold and threefold, respectively, of the amount of intracellular cAMP when compared to cells transfected with the ACTHR carrying the Pro273His and the Ser74Ile mutation, respectively, confirming that HGD in this kindred is caused by loss-of-function mutations of the ACTHR. These results showed that the genetic cause of the ACTH-resistant syndromes is heterogeneous.     

Measurement of medullation in wool and mohair using an Optical Fibre Diameter Analyser

OBJECTIVE: Our purpose was to determine whether the continuation of antibiotics postoperatively after cesarean section in patients whose labors were complicated by chorioamnionitis would reduce the incidence of endometritis. STUDY DESIGN: Patients with a clinical diagnosis of chorioamnionitis treated with ampicillin during labor and who required cesarean delivery for obstetric indications received preoperative intravenous clindamycin and gentamicin and were randomized into 2 groups. Group 1 received no scheduled postoperative antibiotics and group 2 continued to receive clindamycin 900 mg every 8 hours and gentamicin 1.5 mg/kg every 8 hours until afebrile for a minimum of 24 hours (temperature 相似文献   

Non-neuronal acetylcholine, a locally acting molecule, widely distributed in biological systems: expression and function in humans

Acetylcholine acts as a neurotransmitter in the central and peripheral nervous systems in humans. However, recent experiments demonstrate a widespread expression of the cholinergic system in non-neuronal cells in humans. The synthesizing enzyme choline acetyltransferase, the signalling molecule acetylcholine, and the respective receptors (nicotinic or muscarinic) are expressed in epithelial cells (human airways, alimentary tract, epidermis). Acetylcholine is also found in mesothelial, endothelial, glial, and circulating blood cells (platelets, mononuclear cells), as well as in alveolar macrophages. The existence of non-neuronal acetylcholine explains the widespread expression of muscarinic and nicotinic receptors in cells not innervated by cholinergic neurons. Non-neuronal acetylcholine appears to be involved in the regulation of important cell functions, such as mitosis, trophic functions, automaticity, locomotion, ciliary activity, cell-cell contact, cytoskeleton, as well as barrier and immune functions. The most important tasks for the future will be to clarify the multiple biological roles of non-neuronal acetylcholine in detail and to identify pathological conditions in which this system is up- or down-regulated. This could provide the basis for the development of new therapeutic strategies to target the non-neuronal cholinergic system.     

Anesthesia for pediatric herniorrhaphy or hydrocelectomy: comparison of propofol/ketamine and thiopentone/halothane

In this study we have measured exposure levels to quartz in different parts of the slate industry in Alta, Northern Norway. Full shift personal samples were collected from the breathing zones of outdoor and indoor workers in the slate quarries and a slate factory. The quartz content of respirable dust was between 7 and 41%. The slate factory had the lower quartz levels although 41% of total and 73% of respirable samples were above the Norwegian TLV for quartz. The average concentration of total quartz in the slate factory was 0.27 mg/m3 and the average concentration of respirable quartz was 0.12 mg/m3. Outdoor in the quarries the average levels of quartz were 0.58 and 0.13 mg/m3 for total and respirable quartz, respectively. From the beginning of the last decade most of the quarry-workers have built quarry halls to protect themselves against a cold winter climate. Inside in these quarry halls the average levels were 1.74 mg/m3 total quartz and 0.46 mg/m3 respirable quartz. Assessment of historical exposure showed that 32 of totally 45 quarry workers with available exposure history had a lifetime inhaled quartz dose of more than 10 g. There is reason to fear that silicosis will be an increasing problem among quarry workers if efforts to reduce quartz exposure are not put into effect.