Factors associated with obesity and coronary heart disease in people with intellectual disabilities.

Advances in health care for people with intellectual disabilities (ID) that have resulted in increased longevity also force health care providers, researchers, and policymakers to question the adequacy of chronic disease management for the growing number of middle aged and elderly persons in this population. We report on sociodemographic and clinical factors associated with obesity, hypertension, hypercholesterolemia, and diabetes mellitus in an ethnically/racially diverse sample of people with ID in New York City. Administrative and chart review data were collected from a community-based specialty medical practice for people with intellectual disabilities. Adult subjects were included if they had an intellectual disability, lived in the community either independently or with relatives, received all of their planned, outpatient health care services though this practice, and had a primary care visit within the study period. One hundred twenty-six (43.0%) persons were obese, 58 (19.9%) had hypertension, 77 (26.5%) had hypercholesterolemia, and 13 (4.5%) had diabetes mellitus. Age, gender, and BMI (for the latter three conditions) were the most consistent risk factors. Intellectual functioning and behavioral problems were not associated with greater odds of these conditions. This study provides crucial information for improving community-based primary care for people with intellectual disabilities. Specifically, these findings highlight the importance of constructing innovative strategies to mitigate chronic disease risk factors in this population that involve community-based case management service providers who can help adults with ID and their families adopt needed lifestyle and behavior changes.

Corporate culture and employment of people with disabilities: role of social workers and service provider organizations.

Corporate culture reflects an organization's value system and impacts the recruitment, retention, and promotion of employees. Individuals with disabilities are positively impacted by a corporate culture that espouses and establishes a diverse workforce as a priority. This article provides an overview of corporate culture and the employment of individuals with disabilities, and presents a case example of the corporate culture of a large not-for-profit disability service organization. With an in-depth understanding of corporate culture and disability issues, social workers can be particularly helpful to applicants and employees with disabilities as well as employers.

Moving beyond misperceptions: the provision of workplace accommodations.

This mixed-methods study examined the provision of workplace accommodations in the health care, hospitality, and retail sectors. First, focus groups with administrators from each sector revealed that accommodations costs were viewed as minimal (although frontline managers were perceived as having misperceptions). Second, the provision of accommodations as documented through human resources records for health care and hospitality indicated that accommodations were infrequent, not costly, and provided to employees with disabilities. Finally, retail employees (irrespective of disability status) reported many more accommodations than health care and hospitality workers. To dispel misperceptions related to accommodations, education is critical and social workers are well-positioned for this role.

Examining outpatient health care utilization among adults with severe or profound intellectual disabilities living in an urban setting: a brief snap shot.

The present study examined the health status and outpatient health care utilization among 52 adults with severe or profound intellectual disabilities (IDs) living with their families or in group homes in New York City. Bivariate and regression analyses among demographic variables, medical conditions, health care utilization, and type of living situation were conducted. Findings indicate that demographic factors and health statuses were similar regardless of living situation, except for age and the presence of Down Syndrome, that is, younger people and people with Down Syndrome were more likely to live with family than in group homes. The results indicated that regardless of where they lived, individuals had high rates (70%) of overweight/obesity. The mean number of internal medicine, specialty medicine, nursing, and total clinic visits were significantly higher for those living in group homes compared to those living with their families. The findings and their implications are discussed with respect to social work policy and practice.

Interrater reliability of clinical ratings and neurocognitive diagnoses in HIV.

We examined the interrater (IRR) of clinical ratings of neuropsychological (NP) impairment and neurocognitive diagnoses in HIV. Thirty participants with advanced HIV-infection who were enrolled in a multicenter HIV brain banking research project underwent comprehensive NP and neuromedical evaluations. Using a standardized system of guidelines, neuropsychologists from six participating sites independently assigned clinical ratings of NP impairment, as well as multilevel diagnoses reflecting the inferred etiology of the impairments and their effects on everyday functioning. Findings indicated excellent IRR in rating the presence and severity of NP impairment, but overall modest IRR for neurocognitive diagnoses. Not surprisingly, most diagnostic disagreements concerned the etiology of impairments in persons with medical and neuropsychiatric risk factors in addition to HIV.

Olanzapine treatment for dopaminergic-induced hallucinations.

Atypical antipsychotic medications with lower affinities for D2 receptors are considered useful alternatives to treat drug-induced hallucinations in Parkinson's disease (PD). We conducted a double-blind, placebo-controlled, unforced titration, parallel design study (2:1 drug to placebo randomization ratio) using olanzapine (2.5-10 mg/day to effect) in 30 PD patients with drug-induced hallucinations. We performed an extensive battery of neuropsychological tests, the Unified Parkinson's Disease Rating Scale (UPDRS), assessments of on and off time at baseline and at 9 weeks after starting the medication. Sixteen patients on olanzapine (mean dose, 4.6 mg/night) and 11 on placebo completed the study. Compared with placebo, performance on the UPDRS item 2 (thought disorder), and a structured interview for hallucinations, both tended to improve on drug but neither reached statistical significance. A neuropsychological test battery did not show any significant differences. Total on UPDRS motor scores (P < 0.05) and timed tapping (P < 0.01) worsened while on drug compared to placebo. Bradykinesia (P < 0.01) and gait (P < 0.001) items on the UPDRS largely accounted for this deterioration. After completion of the study, 8 of 16 patients randomly assigned to drug continued olanzapine at a mean dose of 2.4 mg/day. However, at the last recorded visit only 5 of 24 (20.8%) of all patients exposed to drug (including those originally randomly assigned to placebo) remained on olanzapine. In patients with PD, low-dose olanzapine did not significantly improve hallucinations but did worsen motor function.

Vascular parkinsonism: clinical correlates predicting motor improvement after lumbar puncture.

Vascular parkinsonism (VP) is a poorly defined entity which has clinical, and perhaps pathological, overlap with other diagnoses. Although classical VP involves lesions of the basal ganglia, the majority of cases actually show diffuse subcortical white matter changes (SCWMC) on imaging. The exact pathologies of these white matter changes are debated and likely heterogeneous, but are generally thought to represent areas of chronic or recurrent partial ischemia. Cerebrospinal fluid (CSF) drainage is the treatment for NPH and has been reported to improve symptoms in some patients with idiopathic NPH and associated SCWMC. To determine whether historical, clinical, or radiographic factors predict improvement in VP patients after CSF drainage, we removed 35-40 ml of CSF via lumbar punctures (LP) from 40 patients and compared responders with nonresponders for a variety of demographics, clinical features, and blindly interpreted magnetic resonance images (MRI). Fifteen patients (37.5%) reported "significant and irrefutable" gait improvement after LP. Twelve (30.0%) reported no effect and 13 (32.5%) reported mild or very transient improvement. Timed gait in a subset of patients improved (P < 0.05) immediately after LP. Clinically, improvement after CSF removal was predicted by any positive response to levodopa (P < 0.001), the lack of vertical gaze palsies (P < 0.05), the lack of a pure freezing gait (P < 0.05), and the lack of hypotensive episodes (P < 0.05). Blinded MRI interpretation did not find features which clearly predicted response. Some patients diagnosed with VP improved after LP. Clinically, these patients tended to resemble idiopathic PD, whereas nonresponders more closely resembled progressive supranuclear palsy (PSP). These results warrant further investigation and also raise the possibility of testing CSF drainage in patients with idiopathic PD complicated by SCWMC.

Cirugia ano rectal por patologia benigna / Ano rectal surgery for bening pathology

Se realizó un estudio retrospectivo de los pacientes sometidos a intervenciones quirúrgicas anales por patología anal benigna, en el Centro Médico de Caracas entre los años 1988 y 1992 y prospectivo desde 1992 y 1994, con la finalidad de evaluar las causas que determinan la conducta quirúrgica en estos pacientes, los procedimietos efectuados y la evolución de dichos pacientes de acuerdo a cada procedimiento. Se incluyen en este estudio un total de 206 casos con una edad promedio de 40,2 años comprendidos entre los 13 meses de edad y los 79 años, de los cuales 56,3 por ciento fueron del sexo masculino y el 49,7 al sexo femenino; teniendo una relación de 1,3: 1. El promedio de estancia hospitalaria fue de 2,54 días con un tiempo quirúrgico promedio de 40 minutos

Norplant: una alternativa en anticoncepción hormonal / Norplant: alternative in hormonal contraceptive

Este estudio se realizó para conocer la eficacia y efectos colaterales de la implantación subdérmica de Norplant como método anticonceptivo en 100 mujeres venezolanas al primer año de uso. Nuestros resultados mostraron que es un método altamente eficaz (0 embarazos), los efectos colaterales fueron trastornos menstruales (90 por ciento), cefalea (12 por ciento), sensibilidad en el sitio del implante (4 por ciento), náuseas (11 por ciento). Las causas más frecuentes de retiro fueron las alteraciones menstruales. La rata de continuidad fue 88 por ciento. Los implantes pueden ser considerados una alternativa más en los métodos de planificación familiar

Citología durante la menstruación: una alternativa / Citology during menstrual period: an alternative

Consideramos que aunque el momento más adecuado sea el no mestrual ya que da mejor facilidad en la interpretación de la muestra, la toma de citología en época menstrual es una alternativa en aquellos lugares donde exista gran número de pacientes y no se pueda programar debidamente las citas, o que por razones sociales las pacientes no acudan con la debida frecuencia a la consulta y se debe aprovechar para realizar en cualquier momento que se presente. Nuestro estudio consistió en la toma de 2 citologías exoendocervicales a 50 pacientes, una en período mestrual y otra en la 2da. fase del ciclo. Los resultados del estudio mostraron que los reportes citológicos coincidieron en el 90 por ciento de los casos (p<0.1). De las 5 pacientes, con hallazgos diferentes entre las tomas, ninguna reporta lesiones sospechosas o malignas