Impact of pain in overweight to morbidly obese women: preliminary findings of a cross-sectional study.

OBJECTIVES: To evaluate the effect of body mass index (BMI) on the prevalence, intensity and interference of pain in women, and how it affects quality of life and level of physical activity; and to determine independent predictors of pain intensity. DESIGN: Cross-sectional observational study. SETTINGS: Obesity treatment clinic, community and university laboratory. PARTICIPANTS: Seventy-three of 133 women aged 25-75 years reported the presence of pain for at least 2 weeks and were categorised according to BMI (normal weight, overweight, obese or morbidly obese). MAIN OUTCOME MEASURES: BMI and questionnaires [McGill Pain Questionnaire (MPQ), Brief Pain Inventory (BPI), Short-Form Health Survey-36 (SF-36) and Baecke Physical Activity Questionnaire]. RESULTS: Pain intensity was 3 and 4.5 times higher in the MPQ and BPI, respectively, in morbidly obese women compared with women of normal weight. Morbidly obese women had 10.7 times higher pain interference and lower scores on the SF-36 domains of physical function and role function-physical compared with women of normal weight. Obese and morbidly obese women had less pain relief from treatment. Regression analysis showed that high BMI and low level of physical activity contributed to the intensity of pain, and these variables explained 16% of the variance of pain intensity. CONCLUSIONS: This study found that the prevalence and intensity of pain are greater in morbidly obese women than women of normal weight, and pain is negatively associated with physical activity. The causal inter-relationships between pain, obesity and physical activity are complex and require further study.

Efeitos do Método Mãe Canguru nos sinais vitais de recém-nascidos pré-termo de baixo peso / Effects of Kangaroo Mother Care on the vital signs of low-weight preterm newborns

OBJETIVO: Avaliar as freqüências cardíaca e respiratória, a pressão arterial média, a temperatura e a saturação periférica de oxigênio dos recém-nascidos pré-termo (RNPT) de baixo peso, antes e após a aplicação do MMC. MÉTODOS: Foram avaliados 22 RNPT de baixo peso, saudáveis, de ambos os sexos, não portadores de deficiências neurológicas, cardíacas e/ou respiratórias. A avaliação foi realizada após trinta minutos de permanência do RNPT em berço comum e após trinta minutos de aplicação do MMC, por 3 dias consecutivos. Para a avaliação, foram utilizados monitor cardíaco com dispositivo para medida da pressão arterial média de forma não invasiva e sensor para a oximetria de pulso, termômetro e cronômetro. RESULTADOS: Os resultados não mostraram alterações significativas quanto à pressão arterial média (p> 0,05) e freqüência cardíaca (p> 0,05) após a aplicação do MMC, mas, por outro lado, houve aumento significativo da temperatura axilar (p< 0,05) e da saturação periférica de oxigênio (p< 0,05) e diminuição significativa da freqüência respiratória (p< 0,05). CONCLUSÃO: O MMC promove a melhora da temperatura corporal, o aumento da saturação periférica de oxigênio, melhorando a oxigenação tecidual, e a redução na freqüência respiratória, trazendo maior conforto respiratório aos RNPT, sugerindo que o MMC contribui para alterações benéficas nos sinais vitais dos RNPT.

OBJECTIVE: The aim of this study was to evaluate the heart and respiration rates, mean arterial pressure, temperature and peripheral oxygen saturation of low-weight preterm newborns, before and after the application of kangaroo mother care. METHOD: Twenty-two healthy low-weight preterm newborns of both sexes were studied. None of them had neurological, cardiac and/or respiratory deficiencies. Assessments were made after the newborn had been left in an ordinary cot for 30 minutes and after 30 minutes of kangaroo mother care, on three consecutive days. For these evaluations, a heart monitor with a device for non-invasively measuring mean arterial pressure, a sensor for pulse oximetry, a thermometer and a chronometer were utilized. RESULTS: There were no significant changes in mean arterial pressure (p> 0.05) or heart rate (p> 0.05) after applying kangaroo mother care. However, there were significant increases in axillary temperature (p< 0.05) and peripheral oxygen saturation (p< 0.05), and a significant decrease in respiration rate (p< 0.05). CONCLUSION: Kangaroo mother care promotes improvement in body temperature, increased peripheral oxygen saturation (thus improving tissue oxygenation), and decreased respiration rate (thus providing greater respiratory comfort for the newborns). This suggests that kangaroo mother care contributes towards beneficial alterations in the low-weight newborns' vital signs.

Palmitate induced lipoapoptosis of exocrine pancreas AR42J cells.

Chronic surplus of dietary consumption, typical to obesity, results in overflow of fat to non-adipose tissues. Intracellular accumulation of fat in non-adipose tissues is associated with cellular dysfunction and cell death and ultimately contributes to the pathogenesis of chronic diseases. The influence of fat overflow on the exocrine pancreas is not known. The purpose of this research was to study the lipotoxic and lipoapoptotic effect of prolonged (72 h) long chain saturated palmitic fatty acid (0.1 mM) on the survival of exocrine pancreas AR42J cells. We demonstrate that chronic exposure of AR42J cells to palmitic acid results in significant increase in triglycerides accumulation (up to 25% of cells area), compared to untreated cultures. Lipid accumulation prompted a typical apoptotic process, demonstrated by both DNA fragmentation and condensed chromatin appearance (DAPI staining). Quantitative real-time PCR studies demonstrated that prolonged palmitic acid supplementation induced down-regulation of the anti-apoptotic Bcl2 mRNA levels (22%) and up-regulation of the pro-apoptotic Bax mRNA levels (300%), leading to disruption of the pro/anti apoptotic balance (Bax/Bcl2=3). No major change was detected in iNOS mRNA expression. In conclusion, prolonged exposure to saturated palmitic acid induces lipoapoptosis in exocrine pancreatic AR42J cells, through disturbance of the Bax/Bcl-2 balance.

A eficacia da aplicacao de pressao positiva continua nas vias aereas (CPAP), com utilizacao do Bird Mark 7, em pacientes em pos-operatorio de cirurgia de revascularizacao do miocardio / The Effectiveness of aplication of Continuous Positive Airway Pressure using the Bird Mark 7 in patients submeted to revascularization of the myocardium

Das cirugias cardiacas, decorrem alternacoes fisiologicas que promovem o aparecimento da hipoxemina. O objetivo deste estudo foi avaliar a eficacia da aplicacao de pressao positiva continua nas vias aereas(CPAP),com 10cm H O, utilizando o Bird M ark 7,na reversao da hipoxemia, em pacientes submetido a revascularizacao do miocardio. Foram estudados 14 individuos (11 homens e 3 mulheres), com idade entre 50 e 70 anos (x=57 + 7,3), que recebem CPAP por 30 minutos no primeiro dia pos-operatorio. A gasometria arterial foicolhida cinco minutos antes e cinco minuos depois da aplicacao da tecnica,permitindo-nos observar que antes a pressao parcial de oxigenio nosangue arterial(PaO )encontrava-se menor do que o esperado para a idade, caracterizando a hipoxemia. A saturacao de oxigenio (SaO) foi verificada a cada cinco minutos, por meio deum oximetro de pulso, e o indice de troca gasosa foi verificado por intermedio da relacao PaO fracao inspirada de oxigenio(FiO), antes e depois da aplicacao do CPAP.O metodo estatistico empregado foi o teste e os resultados obtidos revelaram um aumento significativo nos valores da PaO (p=0,0079), no indice de troca gasosa (p=0,0058)e na SaO (P=0,0001),enquanto os valores da CO nao apresentam alteracoes significativas(p=0,81).Os resultados obtidos sugerem que a aplicacao do CPAP, com a utilizacao do Bird Mark 7, se mostrou um recurso da fisioterapia respiratoria eficaz na reversao da hipoxemia, evidencial pelo indice de troca gasosa, e na melhoria da perfusao tecidual, evidenciada pelo aumento da saturacao da hemoglobina

A rural service-learning model for health administration education.

Service learning for students in the health professions can best be described as an educational methodology based on the collaboration between an academic discipline and a community agency to link student learning with community-based service. This paper describes a service-learning model in rural and medically underserved communities used in a master in health administration program in a rural Southern state. It presents the process, components, outcomes, and challenges. Over the past five years, 56 students completed 116 experiences involving internships, field projects, or special projects in rural and medically underserved communities. A total of 27 percent of our graduates who completed rural and medically underserved experiences accepted job positions in rural health care entities. Strategies utilized by this rural service-learning model include interdisciplinary team training, partnerships among rural and medically underserved community health care entities and academic institutions, faculty-preceptor retreats, and involvement in local community initiatives. These experiences prepare future health administrators to contribute in a meaningful way toward building an effective rural health care delivery system.

Predictors of rural critical care nurses' willingness to care for people with AIDS.

The purpose of this study was to examine the relationship between rural critical care nurses' attitudes about acquired immunedeficiency syndrome (AIDS) and people with AIDS (PWAs), and their willingness to provide care to AIDS patients. Sixty-one critical care nurses in nine rural counties in the northeastern USA completed a mailed questionnaire as part of a larger study of 957 rural nurses. A bivariate logistic regression analysis revealed a relationship between willingness to provide care and positive attitudes about homosexuality, nursing care concerns, and professional-societal concerns. However, a multivariate logistic regression indicated that the most significant factors influencing rural critical care nurses' willingness to care were their feelings of not being prepared to care for people with AIDS, and their anxiety and fears about contracting the disease from their patients. These findings add insight into the care of critically ill AIDS patients and support the need for continuing educational efforts in rural areas of the USA to address critical care nurses' concerns.

Personal and social determinants of rural nurses' willingness to care for persons with AIDS.

The purpose of this study was to investigate the individual and social determinants of rural nurses' willingness to care for people with AIDS (PWAs). Willingness to care was viewed as a function of nurses' personal attitudes about AIDS care and PWAs; the influence of normative (significant others), comparative (the nursing profession), and generalized (the rural community) reference group norms on these attitudes; and how much importance respondents placed on membership in these reference groups. Responses to a mailed questionnaire from 615 rural nurses were analyzed. Individual determinants were nurses' feelings of preparedness and favorable attitudes about their personal safety when administering care. Social determinants were the degree of upset of respondents' significant others about their caring for AIDS patients and favorable attitudes of the respondents about professional and social concerns related to AIDS.

Aging in America: challenges and strategies for health care delivery.

This article delineates the current and future trends related to aging in the United States. The demographic and economic forces outlined are ones that will clearly challenge health services leaders and policy-makers in the coming decades. Various policy interventions and strategies currently underway to address the needs of the aging population are described. Shifts in caregiving patterns, the delivery of long-term care services, economics, choices in living arrangements, and managed care programs for the elderly are a few of the issues presented in this article. Health and human services for the elderly will undergo a profound change as the health system continues to adapt itself to the demands of an aging society.

First Report of Root and Collar Rot by Sclerotium rolfsii on Apple Trees in Italy.

Sclerotium rolfsii Sacc. (teleomorph Athelia rolfsii (Curzi) Tu & Kimbrough) is a polyphagous, soilborne plant pathogen. In summer 1998, a sudden death of 2-year-old apple trees (Malus domestica Borkh.) cv. Royal Gala grafted on M9 rootstock was observed in an orchard near Rome, Italy. Symptoms were stunted vegetation, leaf chlorosis, and root and collar rot. A fungus identified as S. rolfsii was observed producing sclerotia and whitish mycelial strands on root and collar bark. Isolations from roots and at the margin of subcortical necrosis on the collar consistently yielded S. rolfsii colonies on potato dextrose agar (PDA); sclerotia developed within 7 days. Koch's postulates were fulfilled by inoculating 10 1-year-old apple tree cv. M9 rootstocks, grown in 3.5-liter pots, with an S. rolfsii isolate grown for 1 week on PDA at 25°C. One ground plate per plant was used, placed around collar and main roots. Five control plants were treated with PDA only. Rootstocks were kept in the greenhouse at 26 ± 2°C. Within 2 months, 70% of inoculated plants died, with marked necrosis girdling the collar. The other inoculated plants showed a general decline, with widespread necrosis on collars and main roots. Control plants remained healthy. S. rolfsii was reisolated from collars and roots of symptomatic plants. S. rolfsii has been recorded on apple trees in the U.S., India, China, and Israel. In Italy, it is destructive on several crops, and was recently recorded on walnut (1). This first outbreak of S. rolfsii on apple in Italy may have been favored by exceptionally warm late spring and summer temperatures. Reference: (1) A. Belisario and L. Corazza. Plant Dis. 80:824, 1996.

First Report of Alternaria alternata Causing Leaf Spot on English Walnut.

A foliar disease of English walnut (Juglans regia L.) was observed in 1998 in an orchard in northern Italy. Symptoms consisted of circular, necrotic spots bordered with concentric zones of darker tissue. Average lesion diameter was 20 mm, although lesions could extend to half of the leaflet lamina. A fungus identified as Alternaria alternata (Fr.:Fr.) Keissl. (1) was observed on the necrotic tissue and was consistently isolated from the margins of the necrosis. Conidia from leaves were brown, ellipsoid to ovoid (primary conidia 28 to 60 × 8 to 15 µm; secondary conidia 10 to 30 × 7 to 13 µm), with walls often ornamented, 1 to 6 transversely septate and 0 to 3 longitudinally septate. For pathogenicity tests, three isolates were grown on potato dextrose agar for 2 weeks. Inoculations were performed on detached, surface-sterilized, healthy J. regia leaflets. Four drops (5 µl each) of a sterile water suspension of 1 × 105 conidia per ml were placed on each leaflet; three leaves per isolate were used. Leaves were incubated in a moist chamber. After 10 days, leaf spots similar to the original symptoms developed on all the inoculated points for all three isolates, and the pathogen was reisolated. Control leaflets inoculated with sterile, distilled water remained symptomless. The experiment was performed three times and the results were similar. Alternaria alternata is a well-known pathogen on many crops but a few records report this fungus as a causal agent of leaf spot on deciduous trees. This is the first report of A. alternata on English walnut. Reference: (1) E. G. Simmons. Mycotaxon 37:79, 1990.

First Report of Myrothecium verrucaria from Muskmelon Seeds.

Myrothecium verrucaria (Albertini & Schwein.) Ditmar:Fr. was isolated from muskmelon (Cucumis melo L.) seeds of Charentais-T, a culti var used as a differential host with no resistance to Fusarium oxysporum f. sp. melonis races. A white floccose mycelial mat developed on melon seeds during incubation on moist blotters. Mycelia were mass transferred from melon seeds onto potato dextrose agar (PDA) medium. At 25°C in the dark, a mycelial mat with characteristic annelations of greenish-black sporodochia, without setae, was produced. Conidia (2 to 3 × 6 to 10 µm) were lemon shaped, with a typical conical mucous appendage at one end, which was visible with Loeffer's flagella stain (1). Based on these characteristics, the fungus was identified as M. verrucaria. For pathogenicity studies, surface sterilized seeds of C. melo cv. Charentais-T were coated with M. verrucaria conidia by gently rubbing the seeds on sporodochia produced on 15-day-old cultures on PDA. Once coated, seeds were plated onto water agar and on sterile moist blotters in 9-cm-diameter petri dishes. Plates were incubated at 28°C in the dark. Five seeds per plate and three plates per experiment were used. Experiments were replicated three times. Control seeds were plated without coating. After 7 days, on water agar, 90% of melon seeds failed to germinate while the remaining 10% produced young seedlings that died from root rot and necrotic lesions on the hypocotyl. After 12 days on moist blotters, 100% of the melon seedlings died, showing necrotic lesions on the hypocotyl and on the main root. The pathogen was reisolated from symptomatic melon seedlings. All control seeds germinated and grew into healthy seedlings. M. verrucaria, known to be a seed-borne pathogen, has been isolated from soil and plants worldwide (2). This is the first report of M. verrucaria pathogen on muskmelon. This fungus is not a serious concern when seeds are dressed with fungicides. References: (1) K. V. A. Thompson and S. C. Simmens. Nature. 193:196, 1962. (2) S.-M. Yang and S. C. Jong. Plant Dis. 79:994, 1995.

Rural school nurses' attitudes about AIDS and homosexuality.

The AIDS epidemic has spread to rural areas of the United States. Conservative rural communities are facing the challenge of having children with HIV entering school. School nurses, as the only health care providers in the schools, are in a strong position to facilitate the education of children with HIV and to provide AIDS education to students, faculty, and parents. School nurses' knowledge and attitudes about AIDS and people with AIDS influence their effectiveness in prevention activities and care of HIV-infected children. This study examined the relationship between specific demographic, practice, and cultural variables and rural school nurses' attitudes about AIDS and homosexuality. Sixty-nine school nurses responded to a mailed questionnaire as part of a larger study of rural nurses. Results indicate attitudes about homosexuality were related to nurses' homosexual knowledge and religious beliefs while attitudes about AIDS were related to nurses' willingness to care for people with AIDS and feeling prepared to do so.

An assessment of practice support and continuing medical education needs of rural Pennsylvania family physicians.

Family physicians provide the greatest proportion of care in rural communities. Yet, the number of physicians choosing family practice and rural practice has continued to decline. Undesirable aspects of rural practice, such as professional isolation and a lack of or inadequate resources, are assumed to be associated with this decline. This article reports on the practice support and continuing medical education needs of rural family physicians. A mail survey was conducted in 1993 on a purposive sample of family physicians in 39 of 67 rural-designated or urban Pennsylvania counties with low population densities. The physicians identified needs that included patient education materials and programs, community health promotion, federal regulation updates, technical assistance with computers and business management, database software and a videotape lending library, a drug hotline, and mini-fellowships on clinical skill development. A majority of respondents were willing to participate in clinical educational experiences for students and residents. Some physicians indicated a lack of interest in access to information through telecommunications, e.g., video conference referrals and consultations. Overall, findings revealed that family physicians need and are receptive to a variety of practice support and continuing education programs. A practice support program coupled with policy coordination among public and private organizations is likely to lessen complaints by rural primary care physicians.

Rural nurses' use of universal precautions in relation to perceived knowledge of patient's HIV status.

The increased incidence of AIDS in rural areas of the United States has called attention to the practice of universal precautions by rural nurses. The purpose of this research was to determine protective barrier use by 555 nurses living in rural counties in Pennsylvania and New York State and the effect on this use of their knowledge of their patients' HIV status. Findings suggest that nurses increased their use of protection if they knew their patients were HIV-positive. However, if they thought that their patients were HIV-negative or if they did not know their patients' HIV status, they did not always use adequate protection. Findings are discussed as they relate to the context of rural nursing practice.

Factors influencing retention of rural Pennsylvania family physicians.

BACKGROUND: Rural areas suffer from a lack of primary care physicians. Efforts to retain physicians should focus on modifying or changing attributes of rural practice that are considered by physicians to be undesirable. A practice support outreach program (PSOP) is one initiative expected to enhance retention in rural areas by addressing negative aspects of rural practice. The purpose of this study was to assess factors related to satisfaction and retention of family physicians to develop and implement a PSOP in rural areas of Pennsylvania. METHOD: In 1993 a mail survey was conducted on a convenience sample of 398 family physicians practicing in 39 counties in Pennsylvania. RESULTS: Twenty percent of respondents were considering leaving rural practice. Bivariate analyses indicated that professional isolation, lower reimbursements, and sharing on-call with only 1 other physician were associated with physician's reasons for considering leaving rural practice. A multiple logistic regression revealed that sharing on-call rotation with only 1 other physician and having a solo practice were significant influences in considering leaving rural practice. CONCLUSIONS: Findings suggest support strategies that minimize perceptions of professional isolation and policy efforts that address reimbursement differentials and compliance issues are needed to minimize many complaints of rural family physicians.

The Nurses' Attitudes About AIDS Scale (NAAS): development and psychometric analysis.

This article describes the development and psychometric evaluation of the Nurses' Attitudes About AIDS Scale (NAAS). Based on a review of the literature on attitude theory and measurement and on HIV/AIDS, 273 items were developed for inclusion in the scale. Content validity was established by a panel of ten nurses in current practice, six experts in AIDS education and adult health nursing, and one expert in attitude and scaling theory and measurement. On this basis, 60 items were selected and pilot tested for face validity on 33 practicing nurses. Responses from a purposive sample of 731 working RNs were evaluated. A factor analysis yielded a single homosexuality factor explaining 53% of the variance in the 2 1 -item measure. This subscale was labeled attitudes about people with AIDS. Alpha reliability coefficient was .96. Two subscales were identified in the AIDS dimension: attitudes about nursing care concerns (12 items; alpha = .83) and attitudes about social-professional concerns (8 items; alpha = .72). These subscales explained 38.5% of the variance. Additional evidence of construct validity as well as predictive validity were established.

Lymphocyte subsets and natural killer cell activity in healthy old people and centenarians.

The contribution of the immune system to healthy aging and longevity is still an open question. For this reason, several immune parameters (T, B, and natural killer [NK] cell subsets; non-major histocompatibility complex [MHC]-restricted cytotoxic activities, ie, natural and redirected killing [RDK] activities) were studied in a total of 138 healthy subjects of different ages, from 4 to 106 years of age, including 26 centenarians. The major age-related modifications were the following: (1) a decrease in the absolute number of T lymphocytes (CD3+), involving both CD4+ and CD8+ subsets, accompanied by a marked concomitant increase in the number of activated T cells (CD3+, HLA-DR+); (2) a marked decrease in the number of B lymphocytes (CD19+); and (3) an increase in the number of cells with markers of NK activity and of T lymphocytes able to mediate non-MHC-restricted cytotoxicity. These modifications linearly progressed with age and centenarians followed the trend, suggesting that their immune system did not escape the aging process. However, other immunohematologic parameters (number of red blood cells, platelets, and leukocytes) and important immune functions, such as cytotoxic activities (NK and RDK cell activities), were well preserved throughout life until the last decades of life. Unexpectedly, in apparently healthy middle-aged subjects, a decrease of cytotoxic activities was observed in comparison with those of both young controls and centenarians. In conclusions, our data suggest that in centenarians some immune responses are kept at a high level of efficiency, likely contributing to their successful aging. However, this selected group of people does not escape the aging process, as shown by the progressive derangement of a variety of immune parameters.

Cytofluorimetric identification of two populations of double positive (CD4+,CD8+) T lymphocytes in human peripheral blood.

Two different subsets of CD4+,CD8+ T lymphocytes have been identified in peripheral blood collected from normal subjects and from patients with different diseases. The subpopulations differed in the degree of CD4 and CD8 antigen expression. Hence, it was possible to distinguish by cytofluorimetric analysis cells with a low (dim) or with a high (bright) fluorescence intensity after the staining with anti-CD4 or anti-CD8 mAbs. CD4+dim,CD8+bright lymphocytes were found in patients with EBV-infectious mononucleosis and were present for less than a month. CD4+bright,CD8+dim T cells were observed in neoplastic patients as well as in healthy subjects and were continuously present in similar percentages over a long period of time (at the moment, about 3 years). Both the subpopulations expressed CD2, CD3, CD5 antigens and had an alpha beta-TCR, but did not express CD1a or CD7. Only CD4+dim,CD8+bright cells expressed HLA-DR antigen and the activation marker CD38, while only CD4+bright,CD8+dim lymphocytes expressed CD56 and CD57 molecules. The hypothesis may be put forward that these two subsets represent an effort of the immune system to cope with different requirements, i.e., of viral or neoplastic origin, while it is not clear the meaning of these cells in healthy subjects.

Age-related expansion of functionally inefficient cells with markers of natural killer activity in Down's syndrome.

Peripheral blood lymphocyte subsets of two groups of patients affected by Down's syndrome (DS), ie, 28 children and nine adults of relatively advanced age (greater than 34 years), were investigated and compared with those of age- and sex-matched healthy controls (13 children and 20 adults). Particular attention was devoted to cells with markers of natural killer (NK) activity. Double- and triple-color cytofluorimetric analysis was used to better characterize the phenotypic features of the different subsets. Apart from a reduced number of T lymphocytes (CD3+) in DS children and of B lymphocytes (CD19+) in both DS groups, the major alteration we found was a marked age-related increase of the percentage of cells bearing markers associated with NK activity, such as CD16, CD56, and CD57. These DS cells were apparently severely defective as far as their function was concerned, because NK activity was significantly reduced in comparison with age-matched controls, but still capable of responding to cytokines such as interleukin-2, interferon-beta, and interferon-gamma, and to the modulation of lytic activity exerted by the anti-CD16 monoclonal antibody. On the whole, our data stress the importance of studying DS subjects of different ages to fully appreciate the immunologic derangement characteristic of this syndrome.