ABSTRACT
Nearly one in four U.S. households (an estimated 22.4 million) are caring for elderly family members or friends; as the nation's population ages, more and more workers will take on elder caregiving responsibilities. As this trend continues, employers will face increasing concerns about lost productivity and many employees will struggle to balance the demands of work and caregiving responsibilities. To help resolve the situation, many employers may look to a comprehensive work/life program, which incorporates an intensive focus on elder-care issues, to help boost morale, improve employee productivity and job performance, and reduce stress and absenteeism associated with caregiving.
Subject(s)
Caregivers/psychology , Health Services for the Aged , Social Support , Absenteeism , Aged , Case Management , Efficiency , Family Leave , Humans , Morale , Occupational Health Services/organization & administration , Program Development , Psychology, Industrial , United StatesABSTRACT
We report on two patients in whom the anomalous left main coronary artery arising from the right sinus of Valsalva with a septal course could be visualized by transthoracic echocardiography. It appeared as a small echo-free space, anterior to the aorta in the short parasternal axis. If the left main coronary artery arises anomalously from the right sinus of Valsalva, it can take four different courses until it branches into the left anterior descending and the circumflex coronary artery. The course between aorta and pulmonary trunk can be differentiated into an interarterial and a septal course using angiographic criteria. The interarterial course is a potentially life-threatening anomaly due to a high rate of myocardial infarction and sudden cardiac death. Echocardiography alone seems not to be able to distinguish between the potentially life-threatening interarterial and the benign septal course, as in our patients.
Subject(s)
Coronary Vessel Anomalies/diagnostic imaging , Echocardiography , Sinus of Valsalva/abnormalities , Coronary Angiography , Female , Humans , Male , Middle AgedABSTRACT
To determine whether nitroglycerin is just as effective as nifedipine in lowering the blood pressure in excessive hypertension and hypertensive crisis, two groups of 20 patients received in random sequence either 1.2 mg of nitroglycerin sublingually or a 10 mg nifedipine capsule, which was chewed and swallowed. The blood pressure fell after 5 min in the nitroglycerin group from 211/122 mm Hg to 171/95 mm Hg and after nifedipine from 210/118 to 185/102 mm Hg. The greater effect of nitroglycerin results from faster absorption through the oral mucosa than through the small intestinal mucosa where nifedipine is primarily absorbed. After 15 to 20 min a satisfactory reduction in blood pressure was reached in both groups: 157/91 and 158/92 mm Hg, respectively. After 30 min the heart rate in the nitroglycerin group had decreased from 83 to 80/min, but in the nifedipine group it had increased from 84 to 90/min. The reduction in blood pressure persisted up to 6 h. No significant difference in side-effects was determined. Since a hypertensive crisis is usually accompanied by left-ventricular failure, pulmonary edema or angina pectoris and infarction, and nitroglycerin has been definitively shown to positively influence these conditions, preference should be given to nitroglycerin in the treatment of hypertensive crisis.
