Evidence and outcomes: agendas, presuppositions and power.

This paper explores philosophical and methodological issues involved in determining 'What counts as making a meaningful difference?'--the fundamental question in health outcomes research and evidence-based practice. Eight diverse stakeholders are identified along with the competing agendas they bring to the debate. The power to define what counts as meaningful change in health status is typically rooted in disciplinary socialization, linguistic traditions and an orthodox consensus that circumscribes acceptable research foci and methods.

The influence of noncognitive factors on the Mini-Mental State Examination in older Mexican-Americans: findings from the Hispanic EPESE. Established Population for the Epidemiologic Study of the Elderly.

Mini-Mental State Examination data from the Hispanic Established Population for the Epidemiologic Study of the Elderly baseline survey, a population-based study of community-dwelling Mexican Americans aged 65 and older, were used to examine the relationship between cognitive impairment, sociodemographics, and health-related characteristics. The rate of cognitive impairment found in this group of older Mexican Americans, using the conventional cut point of 23/24 on the MMSE, was 36.7%.

Stenting for atherosclerotic occlusive disease of the subclavian artery.

The purpose of this study was to evaluate the results of stenting subclavian artery pathologic lesions. Between July 1991 and December 1995, 69 patients (36 males: mean age 67 years, range 34-87 years) underwent intraluminal balloon dilatations followed by stent implantations in 70 subclavian arteries to treat primary atherosclerotic stenoses > 70%. Twenty-three patients (34%) were treated for vertebrobasilar insufficiency (VBI), 25 patients (36%) were treated for upper limb ischemia (ULI), and 10 patients (15%) were treated for both VBI and ULI.

Renal artery stenosis treated with stent deployment: indications, technique, and outcome for 108 patients.

From January 1993 to May 1996, 108 patients (64 men, 44 women; mean age, 72 years; age range, 37 to 87 years) underwent 125 percutaneous transluminal angioplasties and stent implantations primarily for atherosclerotic lesions of the renal artery. Sixty-four patients underwent treatment for renovascular hypertension (two antihypertensive medications or more), 32 patients underwent treatment for a combination of hypertension and renal failure (serum creatinine level >/=1.6 mg/dL), and a small group of six patients (5%) without hypertension or diminished renal function underwent treatment to prevent the progression to renal artery occlusion and kidney loss.

The prevalence and health burden of self-reported diabetes in older Mexican Americans: findings from the Hispanic established populations for epidemiologic studies of the elderly.

Objectives: The prevalence and health burden of self-reported adult-onset diabetes mellitus were examined in older Mexican Americans.

Methods: Data from the Hispanic Established Populations for Epidemiologic Studies of the Elderly were used to assess the prevalence of self-reported diabetes and its association with other chronic conditions, disability, sensory impairments, health behaviors, and health service use in 3050 community-dwelling Mexican Americans 65 years and older.

Results: The prevalence of self-reported diabetes in this sample was 22%, and there were high rates of obesity, diabetes-related complications, and diabetic medication use.

Changes in the smoking behavior of elderly Mexican Americans in the Southwest from 1982-1984 to 1993-1994.

Objectives: The aim of this work was to examine changes in the smoking behavior of elderly Mexican Americans in the southwestern United States from the early 1980s to the early 1990s.

Methods: Data from the 1993-1994 Hispanic EPESE study (n = 2,809) on persons ages 65 to 74 and 75 to 84 residing in the five southwestern states were compared with data from the 1982-1984 Hispanic HANES study (n = 753, persons ages 55 to 74), which included a Mexican American sample from the same five southwestern states.

Results: Rates of current smoking in 1993-1994 for persons ages 65 to 74 were approximately half the rates for persons of the same age a decade earlier.

Exercise to improve spinal flexibility and function for people with Parkinson's disease: a randomized, controlled trial.

Objectives: The effectiveness of an exercise intervention for people in early and midstage Parkinson's disease (stages 2 and 3 of Hoehn and Yahr) in improving spinal flexibility and physical performance in a sample of community-dwelling older people is described.

Design And Setting: Fifty-one men and women, aged 55-84 years, identified through advertisement, local support groups, and local neurologists were enrolled into a randomized, controlled trial. Subjects were assigned randomly to an intervention or a usual care arm (i.

Stability of somatropin stored in plastic syringes for 28 days.

The stability of somatropin stored in two types of plastic syringes was studied. Reconstituted somatropin at high (3.33-mg/mL) and low (1.

Characteristics of the healthy worker effect: a comparison of male and female occupational cohorts.

The healthy worker effect (HWE) poses a serious methodological problem to investigators of occupational cohorts in that it may mask mortality excesses that result from occupational exposures. This problem is further complicated by the fact that the strength of the HWE generally varies according to sociodemographic, employment, and time-related factors. While the HWE has been well documented among numerous cohorts of male workers, little is known about its expression among female occupational workers.

Post-communism: postmodernity or modernity revisited?

Coinciding with the popularity of postmodern theory, the fall of communism appeared to offer further evidence of the exhaustion of modernity. Such analysis is grounded in a view that the Soviet system was the epitome of modernity. An alternative approach regards post-communism as opening new terrains of struggle for modernity.

Measures of shoulder protraction and thoracolumbar rotation.

Physical therapists need objective measures that can be used reliably with a variety of subject groups to document upper quadrant function. Two aspects of upper quadrant motion, shoulder protraction and thoracolumbar rotation, are assessed routinely in clinical practice, but no standard measurement techniques have been reported. We hypothesized that there would be significant differences, by age and state of health, for both shoulder protraction and thoracolumbar rotation.

Epidemiology of self-reported past heavy drinking in Hispanic adults.

Objectives: Self-reports of past heavy drinking correlate with the current drinking practices and with risk of mortality in non-Hispanic males. The prevalence of past heavy drinking has not been reported in Hispanic populations.

Methods: Using data from the Hispanic Health and Nutrition Examination Survey (HHANES) we (1) report on the prevalence, duration and severity of past heavy drinking in three Hispanic groups, (2) compare the current alcohol consumption patterns among past heavy drinkers and those who do not report a history of past heavy drinking and (3) compare the risk factor profiles and health indicators in these two groups.

Combined percutaneous transluminal angioplasty, iliac stent deployment, and femorofemoral bypass for bilateral aortoiliac occlusive disease.

Background: We examine the technique of combining percutaneous transluminal angioplasty and secondary intravascular stent deployment with femorofemoral bypass graft in patients with bilateral aortoiliac occlusive disease.

Study Design: Retrospective review.

Results: During the 5-year period from June 1988 to October 1993, 18 patients with iliac occlusion and a hemodynamically significant contralateral iliac stenosis were treated using a combination of endovascular and open surgical techniques.

Stenting for occlusion of the subclavian arteries. Technical aspects and follow-up results.

We report the results of stenting in 17 patients who underwent treatment for total occlusions in the subclavian arteries between July 1991 and December 1995. Fourteen of the lesions were located in the left side; 15 patients had a subclavian steal syndrome. The indications for treatment were vertebrobasilar insufficiency (n = 7); arm claudication (n = 5); vertebrobasilar insufficiency and upper-limb ischemia (n = 3); protection of a left internal mammary artery coronary bypass (n = 1); and an isolated subclavian steal syndrome (n = 1).

The effect of medical conditions on the functional limitations of Mexican-American elderly.

We examined the relationship of self-reported functional status to common medical conditions using a probability sample of 3050 noninstitutionalized Mexican-American men and women aged 65 or older and residing in the Southwestern United States (Arizona, California, Colorado, New Mexico, and Texas). All subjects were interviewed in person (n = 2,873) or by proxy (n = 177) in their homes during late 1993 and early 1994. The questionnaire obtained information on self-reported functional status and prevalence of arthritis, cancer, diabetes, stroke, heart attack, and hip fracture.

Religious attendance and psychological well-being in Mexican Americans: a panel analysis of three-generations data.

This study examined the effects of religious attendance on three dimensions of psychological well-being using panel data from a three-generations study of Mexican Americans from Texas (N = 624). Well-being dimensions included life satisfaction (the 13-item LSIA), and respective seven- and four-item depressed and positive affect subscales of the CES-D. Two-wave path analyses revealed a cross-sectional association between religious attendance and life satisfaction in the two oldest generations, and a salutary longitudinal effect of religious attendance on subsequent depressed affect in the youngest generation.

Catalytic activity of poly(ADP-ribose) polymerase is necessary for repair of N-methylpurines in nontranscribed, but not in transcribed, nuclear DNA sequences.

The role of poly(ADP-ribose) polymerase (PADPRP) in nuclear DNA repair and other nuclear processes has been intensely studied and debated for decades. Recent studies have begun to shed new light on these arguments with firm experimental data for its role, primarily, as a remodeler of chromatin structure. Those studies imply that PADPRP plays an indirect role in DNA repair, serving to expose DNA to repair enzymes through chromatin remodeling.

Isolation and identification of alkaline thermostable lipase producing microorganism and some properties of crude enzyme.

A bacterial strain isolated from soil and identified as Enterococcus faecalis was found capable of producing alkaline thermostable lipase. Optimum pH, temperature and time for enzyme substrate reaction were found to be 8.0, 60 degrees C and 10 min respectively.

Treatment of childhood dermatomyositis with high dose intravenous immunoglobulin.

Two children with chronic dermatomyositis who were treated with intravenous immunoglobulin (IVIG) for 28 and 12 months, respectively, are reported. Both patients had received prednisone and immunosuppressive agents prior to IVIG treatments and had experienced significant side effects. Strength and functional abilities improved in both patients in a gradual stepwise fashion with IVIG treatment.