Hospital to home: Improving internal medicine residents' understanding of the needs of older persons after a hospital stay.

Physicians-in-training discharge many older patients from the hospital, but few have any knowledge of what happens to the patients they send home, of how discharge plans are applied, or of the difficulties patients and their families face. The authors describe a pilot program, Hospital to Home, at the University of Rochester School of Medicine and Dentistry's internal medicine residency program, which uses home visits as an educational tool in geriatrics training. The program was begun in July 2001, and 23 residents have participated.

Clinical efficacy and tolerability of grepafloxacin in lower respiratory tract infection.

Studies in community-acquired pneumonia (CAP) have compared grepafloxacin, 600 mg o.d. for 7--10 days, with amoxycillin, 500 mg t.

Effective delivery of particles with the HandiHaler dry powder inhalation system over a range of chronic obstructive pulmonary disease severity.

The HandiHaler is a dry powder breath activated inhaler system developed for inhalation therapy for patients with airway disease. Its operation is based on the evacuation of powder from a pierced capsule. We sought to document the inspiratory flow rates attained by patients inspiring through the HandiHaler with various degrees of airflow limitation.

Wartime stressors and health outcomes: women in the Persian Gulf War.

This descriptive correlational study of war time stressors and stress responses of women from the Persian Gulf War examined numerous stressors both physical and psychological. The psychological stressors more directly impacted postwar physical and psychological symptoms than did physical stressors. These findings add to our understanding of women's reactions to wartime stress and the types of stressors affecting women.

Effects of relaxation training on glucose tolerance and diabetic control in type II diabetes.

The present study examined the effects of progressive relaxation training and EMG biofeedback on acute glucose disposal in diabetic subjects, as measured by glucose tolerance and three other measures of diabetic metabolic control. Twenty subjects with non-insulin-using Type II diabetes took part in progressive relaxation training and EMG biofeedback in a pre-post treatment versus wait-list experimental design. Treatment effects were assessed on glucose tolerance along with three measures of diabetic control: fasting blood glucose, two-hour postprandial blood glucose, and fructosamine.

Hereditary adult-onset Alexander's disease with palatal myoclonus, spastic paraparesis, and cerebellar ataxia.

We describe a progressive neurologic disorder in three sisters characterized clinically by palatal myoclonus, spastic weakness, hyperreflexia, mild cerebellar dysfunction, and ocular motor abnormalities. Postmortem examination of one patient demonstrated widespread Rosenthal fiber deposition associated with demyelination. The father previously was reported to have similar pathologic findings and carried a clinical diagnosis of multiple sclerosis.

Urges to smoke during the first month of abstinence: relationship to relapse and predictors.

The urges to smoke reported by 215 former smokers were measured 1 day, 7 days, 14 days and 30 days after they quit to examine: (a) the time course of smoking urges, (b) the relationship of urges to relapse, and (c) predictors of urges to smoke. Urges to smoke were strongest 1 day after quitting, and decreased at each subsequent measurement point. Urges were a powerful predictor of relapse.

The rise and fall in information-processing rates over the life span.

We surveyed studies that measured information-processing durations in groups of experimental subjects (children or elderly adults) and a group of college-aged control subjects. Some studies varied the type of processing while keeping the age of a subject group fixed. Process-durations in experimental subjects could be described by a multiplicative function of the control durations, regardless of the type of processing.

Generalized slowing in Brinley plots.

The logic of generalized slowing theories is explored. Existing theories are reviewed briefly and put in a common format. The format is readily generalized to define a class of one-dimensional aging theories, a tiny subset of all possible aging theories.

Relationship of dietary saturated fatty acids and body habitus to serum insulin concentrations: the Normative Aging Study.

The purpose of this study was to examine the relationship of body mass index, abdomen-hip ratio, and dietary intake to fasting and postprandial insulin concentrations among 652 men aged 43-85 y, followed in the Normative Aging Study. Log-transformed fasting insulin was significantly associated with body mass index, abdomen-hip ratio, total fat energy, and saturated fatty acid energy, with correlation coefficients ranging from 0.14 for total fat to 0.

Change in social support after retirement: longitudinal findings from the Normative Aging Study.

Although retirement is generally thought to lead to a decline in social support due to a loss of social contacts with coworkers, the evidence for this is at best contradictory. This longitudinal study examined change in social support among 1,311 men, participants in the Veterans Administration Normative Aging Study, over a 3-year period. In general, long-term retirees reported the least quantitative social support, and the continuing full-time workers the most; however, change in workforce status produced no apparent effect on quantitative support over the duration of this study.

Accumulation of lipid peroxidation products in human myotonic dystrophic muscle.

The possibility of oxygen radical-induced injury contributing to the pathogenesis of muscle disorders was studied. Significant increases in fluorescent lipid peroxidation products was found in the muscle samples of myotonic dystrophy (MyD) patients as compared to controls as well as patients with Duchenne Muscular dystrophy (DMD), Amyotrophic Lateral Sclerosis (ALS), Polymyositis and Limb Girdle Dystrophy (LGD). The results demonstrate the possibility that in MyD the primary genetic disorder leads to the rapid generation of oxygen radicals, tissue depletion of antioxidants followed by peroxidation of membrane lipids, impaired calcium homeostasis and finally atrophy of the muscle.

Efficacy of fleroxacin versus amoxicillin in acute exacerbations of chronic bronchitis.

In a multicenter study the efficacy and safety of oral fleroxacin at 400 mg once a day and amoxicillin at 500 mg three times daily for 7 days were compared for the treatment of patients with acute bacterial exacerbations of chronic bronchitis due to drug-susceptible bacteria. A total of 194 patients were enrolled, 102 in the fleroxacin group and 92 in the amoxicillin group. Of those enrolled, 22 in the fleroxacin group and 30 (29 for clinical efficacy) in the amoxicillin group were included in the efficacy analysis.

A prospective evaluation of the utility of clinical data in distinguishing acute large vessel from lacunar cerebral infarctions.

A stroke registry of 290 patients was developed to determine the value of various clinical data in discriminating acute large vessel from lacunar infarctions. Clinical or computed tomography (CT) localization was achieved in 98% of patients with infarcts. Among 216 localizable supratentorial infarcts, CT demonstrated the responsible lesion in 22 of 54 lacunes (42%) and 109 of 162 large vessel infarcts (67%).

Effects of detergent on the sulphation of chondroitin by cell-free preparations from chick-embryo epiphyseal cartilage.

The effects of the non-ionic detergent Triton X-100 on 6-sulphation of two species of endogenous nascent proteochondroitin by a chick-embryo cartilage microsomal system was examined. Sulphation of the larger (Type I) species with adenosine 3'-phosphate 5'-phosphosulphate was slightly diminished when Triton X-100 was present, whereas sulphation of the smaller (Type II) species was slightly enhanced. An ordered rather than random pattern of sulphation was obtained for the smaller proteoglycan, but with a considerably lower degree of sulphation than that of the larger proteochondroitin.

Calcium, calmodulin and 3',5'-cyclic nucleotide phosphodiesterase activity in human muscular disorders.

3',5'-Cyclic nucleotide phosphodiesterase (PDE) is known to play an important role in the regulation of cyclic nucleotide levels in various tissues including the muscle. Previous studies have estimated the level of this enzyme in several neuromuscular disorders but the results have been variable. Moreover, there was no attempt made to correlate the enzyme levels with the levels of calcium and calmodulin, both of which regulate diverse biological processes including muscle contraction.

Temafloxacin compared with ciprofloxacin in mild to moderate lower respiratory tract infections in ambulatory patients. A multicenter, double-blind, randomized study.

The efficacy and safety of oral temafloxacin (600 mg) and ciprofloxacin (500 mg) twice daily for seven days were compared in patients with mild to moderate lower respiratory tract infections. Fifty-eight of 64 (91 percent) patients who received temafloxacin and 63 of 67 (94 percent) patients who received ciprofloxacin had clinical cure or improvement; bacteriologic cure occurred in 61 (95 percent) and 63 (94 percent), respectively. All 14 patients with pneumonia were clinically cured or improved and bacteriologically cured; 11 had complete resolution of roentgenographic evidence of pneumonia.

Age effects may be global, not local: comment on Fisk and Rogers (1991).

A series of analyses of variance on target search times allowed Fisk and Rogers (1991) to reject the null hypothesis that age had a uniform, additive effect across search conditions. It does not, however, follow that age affected some conditions in an exceptional way, as Fisk and Rogers concluded. Age may have had a uniform but nonadditive effect across conditions.

The influence of age and level of pulmonary function on nonspecific airway responsiveness. The Normative Aging Study.

The relationship of age and prechallenge FEV1 to methacholine airway responsiveness was examined among 914 male participants of the Normative Aging Study (age range 41 to 86 yr). Methacholine airway responsiveness was analyzed as both a continuous (dose-response slope) and categorical (PD20 FEV1 greater than 8.6 mumol; PD20 FEV1 less than or equal to 8.

Relation of obesity and diet to sympathetic nervous system activity.

The hypothesis that dietary intake and obesity stimulate the sympathetic nervous system was investigated in a cross-sectional study of 572 men aged 43-85 years from the Normative Aging Study. Habitus was represented by body mass index, as a measure of overall adiposity, and by the ratio of abdomen-to-hip circumference (abdomen/hip ratio), as a measure of centripetal fat distribution. Sympathetic activity was assessed by measurement of 24-hour urinary norepinephrine excretion.

Cigarette smoking, dietary intake, and physical activity: effects on body fat distribution--the Normative Aging Study.

Studies have indicated that although smokers weigh less than nonsmokers, smokers have greater waist-to-hip circumference ratios after adjustment for age and body mass index (BMI). The purpose of this investigation was to determine whether factors associated with smoking, such as dietary intake, alcohol intake, and physical activity, modified or confounded the relationship between smoking and body fat distribution. The study used cross-sectional data for 765 men aged 43-85 y from the Normative Aging Study.

Effects of sulfate deprivation on the production of chondroitin/dermatan sulfate by cultures of skin fibroblasts from normal and diabetic individuals.

Human skin fibroblast monolayer cultures from two normal men, three Type I diabetic men, and one Type I diabetic woman were incubated with [3H]glucosamine in the presence of diminished concentrations of sulfate. Although total synthesis of [3H]chondroitin/dermatan glycosaminoglycans varied somewhat between cell lines, glycosaminoglycan production was not affected within any line when sulfate levels were decreased from 0.3 mM to 0.

How stressful is retirement? Findings from the Normative Aging Study.

The stressfulness of retirement both as a transitional event experienced during the past year and as a life stage was investigated. Transitional stress was assessed using a life events approach, and stage stress using a "hassles" approach. Respondents were 1,516 male participants in the Normative Aging Study, 45% of whom were retired.