Higher serum C-reactive protein predicts short and long-term outcomes in peritoneal dialysis-associated peritonitis.

We examined the association between C-reactive protein (CRP) and short- and long-term adverse outcomes in peritoneal dialysis (PD)-associated peritonitis. Serum CRP levels were measured at baseline and 3 weeks after initiation of treatment in 209 patients with an incident episode of peritonitis between 1 January 1999 and 31 March 2005. Patients were followed until 31 May 2005. Short-term adverse outcomes included switch to hemodialysis, death, persistent infection beyond planned therapy duration, and relapse; long-term adverse outcomes included a subsequent peritonitis event or death. After adjustment for age, gender, diabetes, duration of renal replacement therapy and causative organism, patients with higher CRP levels at diagnosis had a greater odds of an adverse short-term outcome (odds ratio 1.57 (95% confidence interval (CI): 0.61-4.02), 2.73 (95% CI: 1.09-6.87), and 3.38 (95% CI: 1.36-8.42) in the second, third, and highest quartiles). In patients who met criteria for resolution of peritonitis 3 weeks after diagnosis, those with higher CRP levels had a greater risk of a long-term adverse outcome (hazard ratio 1.79 (95% CI: 1.05-3.07)). In conclusion, higher levels of CRP are independently associated with adverse outcomes in PD-associated peritonitis. Serial measurement of this marker during the course of peritonitis may facilitate earlier identification of individuals at greater risk of complications.

The effects of event rate and signal probability on children's vigilance.

Using the study of vigilance in adults as their model, the researchers examined task parameters and their interactions in a study of sustained attention in children from a non-clinical population. Two levels of event rate (low and high) were combined with two levels of signal probability (low and high) in 14-minute vigilance tasks in which children viewed small and large squares presented successively on a computer screen. Seven- and eight-year-old children were instructed to press a button whenever a small square appeared. Signal detection analyses were employed, as well as the traditional measures identifying hits, false alarms, and reaction time. The results support the traditional findings in adult tasks: participants performed most accurately and quickly in the high event rate and high probability condition; low probability elicited a more conservative decision-making criterion, a standard characterized by less willingness to risk false alarms; such conservatism increased over the periods of watch; and the vigilance decrement emerged over time. However, the finding that the high event rate condition improved perceptual sensitivity reversed the event rate effect consistently reported in the adult literature. The above findings are discussed in light of both research and clinical implications.

Sustained attention and unintentional injury among preschool-aged children.

This study examined vigilance in preschool-aged children and explored the relationship between vigilance and unintentional injury. There were 28 participating children, aged 4 and 5 years, who completed a computerized vigilance task for two 5-min sessions. The task generated measures of correct detections, false alarms, reaction time, and the signal detection indices of d' and c. Primary caregivers completed daily injury phone journals for a 4-week period. Results indicated that age and signal probability affected vigilance. Older children made more correct detections, had greater perceptual sensitivity, and performed in patterns similar to adults. Performance was enhanced in the high signal probability condition. In addition, vigilance indicators of perceptual sensitivity and response bias were predictive of injury, while age was not. Specifically, children with lower perceptual sensitivity scores, and who were less responsive to the vigilance task, experienced more unintentional injuries over the course of the study.

Radioactivity in two tide-washed marsh areas in the eastern Irish Sea: a radiological assessment.

The doses received by man from exposure to artificial radionuclides deposited onto marsh land during tidal inundation on the English side of the Solway Firth and the Dee Estuary have been assessed. The range of total doses received by the different marsh user groups was similar in both study areas, varying from < 1 microSv year-1 to approximately 55 microSv year-1, with total dose dominated by the contribution from external exposure (generally 80% of the total). The maximum doses in both study areas were received by people working on the marshes and are well below the annual dose limit recommended by ICRP for members of the public (1 mSv year-1). The largest dose estimated (56 microSv year-1) is only 6% of the recommended dose limit.

Effects of pulsed Nd:YAG laser energy on human teeth: a three-year follow-up study.

This study of laser use on dental hard tissues evaluated restorations and tooth vitality in teeth treated three years earlier. All teeth remained vital and asymptomatic. Restorations placed after caries removal were intact and clinically serviceable.

Patient characteristics and outcomes in institutional and community long-term care.

This paper examines the three-way relationships among patient characteristics, type of care (admission to a nursing home or community setting), and 6-month outcomes of 352 long-term care patients. The study found that patient characteristics influenced the type of care received and that substantial portions of the variance in the outcomes were attributable to initial differences among patients in the two types of care. Controlling for the effect of selective admission, type of care had no significant impact on patients' ADL scores, mobility scores, or disposition after 6 months in the long-term care setting.

Use of the pulsed Nd:YAG laser for intraoral soft tissue surgery.

Application of a neodymium:yttrium-aluminum-garnet (Nd:YAG) laser was compared to conventional scalpel in dental soft tissue surgery. Two surgery sites on 29 patients were randomly selected and treated. An additional 41 patients were exclusively treated with the Nd:YAG laser. The surgical technique was then evaluated for periodontal pocket depths, degree of pain perceived, bleeding, inflammation, procedure time, and anesthesia. Surgical prognosis was made at the time of surgery and compared to actual healing 1 week and 1 month after surgery. No differences were observed between laser and scalpel surgery in terms of pocket depth reduction, postoperative pain, post-operative inflammation, and treatment time. However, operative and postoperative bleeding with laser surgery were significantly less than with conventional surgery. Anesthesia is required for scalpel surgery, the majority of laser-treated sites evoked minimal pain without anesthesia. These results indicate that the Nd:YAG laser can be used successfully for intraoral soft tissue applications are well tolerated without anesthesia and minimal bleeding compared to scalpel surgery.

Consistent wound care and nutritional support in treatment.

A preliminary study was conducted on 80 patients with all stages of pressure ulcers to ascertain the seven-day effect on healing of four treatments: 1) consistent wound care, 2) carefully controlled nutritional support, 3) both consistent wound care and carefully controlled nutritional support, and 4) standard hospital treatment. Formal analysis confirmed that differences observed in the sample characteristics of treatment groups did not influence outcomes. There were no group differences in healing as shown by three indicators: 1) improvement in the ulcer stage, 2) decrease in ulcer size, and 3) a dichotomous clinical rating of improvement. In all groups a normal transferrin was correlated with improvement in stage and size of ulcers. This suggests a nutritional role in wound healing.

Why do they fall? Monitoring risk factors in nursing homes.

A pilot study identified 40 falls involving 29 patients from incident reports in a nursing home. About one fourth of the fallers fell more than once and accounted for about one fourth of the falls. The majority of research studies on falls were conducted in hospital settings on a one-time basis. Studies are needed in nursing homes to monitor risk factors on a continuous basis to design remedial nursing interventions. Age, male gender, mental impairment, and short stay were risk factors identified in this study. The association of dementia with falls is especially significant because of the increasing numbers of dementia patients in nursing homes. This pinpoints the need for special surveillance of these patients.

Goals and characteristics of long-term care programs: an analytic model.

A medico-social analytic model is presented, comprised of program goals, policies, tolerance of patients' functional dependence and behaviors, ability to manage nursing needs and medical conditions, and costs. Five long-term care programs were compared: SNF-ICF homes (with both SNF and ICF beds), ICF homes, foster homes, day hospital, and home care. Differences and similarities between programs were identified. Although the model needs further testing and refinement, preliminary findings suggested its usefulness in the evaluation and design of long-term care services.

Critical thinking and nursing education.

This study evaluated the impact of nursing education on students' critical thinking abilities, as measured by the Watson-Glaser Critical Thinking Appraisal (WG). In addition, the WG and the NLN Pre-Admission Test were related to GPA and NCLEX. A sample of 108 AS and BS students at the University of Hawaii School of Nursing were tested at entry and exit. AS and BS students showed comparable improvement in critical thinking ability. NCLEX was best predicted by the GPA, which in turn summed up effects of WG and NLN. The results confirm the efficacy of nursing education in improving critical thinking skills and suggest that the GPA is more important than the WG in predicting the NCLEX. The latter effect was more prominent in the BS group. Further investigation of the role of critical thinking in nursing and academic performance is suggested.

Geriatric patient outcomes and costs in three settings: nursing home, foster family, and own home.

Forty-nine matched triads of geriatric patients were compared after three months in their respective placement settings: nursing homes, geriatric foster homes, and own homes with supportive services. Compared to similarly disabled patients in nursing homes, patients in the two community settings made greater improvements in self-care skills and mobility, expressed greater well-being, had similar types and amounts of morbidity, and entailed lower costs. The results support the expansion of home and community-based services as alternatives to institutional care for a substantial number of geriatric patients.

A cross-cultural health study of Japanese and Caucasian elders in Hawaii.

A study of 1098 Japanese and 873 Caucasians sixty years of age and over from Hawaii State Department of Health data files revealed that better health was predicted not only by younger age, higher family income, and maintenance of work role, but also by Japanese ethnicity. Standardized partial regression coefficients showed ethnic membership per se to be as important as any of the demographic variables. Canonical correlation yielded the best correlation of the independent variables with a health index made up of number of chronic conditions, number of bed days and number of restricted days, with each of equal weight. Findings suggest the importance of ethno-cultural supports in health maintenance of the elderly, and have theoretical relevance for the role of culture in health.

Association between smoking different tobacco products and periodontal disease indexes.

Six indexes of periodontal health were recorded in cigarette smokers, pipe/cigar smokers and nonsmokers from the Veterans Administration Dental Longitudinal Study. These indexes included calculus deposition, plaque accumulation, gingival inflammation, periodontal pocket depth, alveolar bone loss and tooth mobility. Cigarette smokers had significantly more calculus deposition than pipe/cigar smokers, although both smoker groups had more calculus than nonsmokers. Cigarette smokers accumulated slightly less plaque than pipe/cigar smokers, and both smoker groups accumulated less plaque than nonsmokers. Gingival inflammation and tooth mobility did not differ between smokers and nonsmokers, nor between the two smoker groups. Cigarette smokers had significantly greater pocket depth than nonsmokers, in contrast to pipe/cigar smokers who were not different from nonsmokers. Radiographic measurements indicated that cigarette smokers had significantly more alveolar bone loss than either pipe/cigar or nonsmokers. After covariance adjustment for age and calculus, all smokers had less plaque, gingival inflammation and tooth mobility than nonsmokers, similar periodontal pocket depth, but only cigarette smokers had greater bone loss. This finding of greater alveolar bone loss in cigarette smokers suggests a tobacco product-related effect in systemic physiologic action.

Historical antecedents of normative vs pathologic perspectives in aging.

Differing concepts of aging, i.e., a normative versus a pathologic process, are presented in historical perspective and are traced through selected writings from ancient China, India, Egypt, and Greece into more modern times. These is no consistent shift across epochs from one to the other perspective, and mixed perspectives often appear. Ideas regarding the aging process and age-related disease are influenced by the changing medical state of the art in various areas. Because of the still incomplete knowledge of the basic mechanisms involved, the current status of medical knowledge has not yet resolved the "aging vs disease dilemma." History, however, does reveal insights that promote respect for prescientific observations and intuitions, provide a contextual background for progress achieved, and foreshadow current trends in the theory and practice of geriatrics.

Longitudinal effect of age and smoking cessation on pulmonary function.

Although it is well known that pulmonary function declines with age and that this decline is accelerated by cigarette smoking, it is not as clear what effect smoking cessation has on pulmonary function. The Normative Aging Study, a longitudinal aging study of 2,280 men, has assessed this question. Longitudinal data on smoking and pulmonary function were available on 850 healthy men. Of 452 who smoked at entry to the study, 98 quit during a 5-yr period. There were no significant differences between current and ex-smokers in FVC (p = 0.12) and FEV1 (p = 0.66) at entry into the study. However, significant differences were observed during the 5-yr period in FVC and FEV1 decline between current, former, and never smokers, after adjusting for age and initial pulmonary function. The decrease in FVC for men who quit smoking was significantly less than that for current smokers (p = 0.02). Similarly, FEV1 for former smokers decreased significantly less than for current smokers (p less than 0.001). When multiple regression was performed among former smokers, no significant effects of years since quitting on rate of decrease in FVC and FEV1 were seen. This study suggested a definite and rapid beneficial effect of smoking cessation.

Relationship of parotid saliva flow rate and composition with personality traits in healthy men.

A number of studies have investigated the relationship between parotid saliva flow rate and clinical depression. However, no comprehensive study of the intercorrelations between parotid gland secretion and normal personality traits has been reported. The stimulated flow rate, pH, osmolality, and eleven composition variables were measured in 390 normal men and correlated against eight personality dimensions derived from scores obtained from the Cattell Sixteen Personality Factor questionnaire (16PF) and a modified form of the Eysenck Personality Inventory. Flow rate, pH, osmolality, and eight of the eleven salivary components were significantly correlated with four personality traits: anxiety, conscientiousness, shrewsness, and introversion. The relationship of personality traits to the parotid gland flow rate and saliva composition is discussed in terms of both physiologic models and the possible mediating effect by the sympathetic and parasympathetic nervous systems.