Food Insecurity and Peripheral Arterial Disease in Older Adult Populations.

OBJECTIVES: Food insecurity, defined as the limited or uncertain availability of nutritious and safe foods, is a complex phenomenon and is linked to poor nutrition and diet-sensitive chronic diseases. Dietary patterns that include saturated fats and meat products are potential risk factors for the progression of peripheral arterial disease (PAD). This study explored whether there is a relationship between food insecurity and PAD among a national sample of older adults. DESIGN: We conducted a cross-sectional data analysis using data from the 1999-2004 National Health and Nutrition Examination Survey (NHANES). Food security was assessed using the US Household Food Security Survey Module. Bivariate analyses were conducted using the Rao-Scott Chi-square test to examine associations between PAD and sociodemographic variables. Multivariable generalized logistic regression was employed to assess the effect of food security on the presence of PAD, with adjustment for respondent's socio demographic characteristics. PARTICIPANTS: A total of 2,027 adults with PAD were included (Ankle Brachial Index (ABI) score ≤ 0.90).We excluded participants less than 60 years of age. RESULTS: Compared to older adults who are food secure, those who are food insecure have an increased risk for PAD. Food insecurity is associated with peripheral arterial disease among older adults (adults adjusted odds ratio, 1.50 [95% CI 1.11-2.03). CONCLUSION: Older adults with peripheral arterial disease are experiencing food insecurity. While nutrition and PAD are not well-defined, previous literature indicates there is a connection between food insecurity and diet-sensitive chronic diseases (diabetes and hypertension) which are risk factors for PAD. Food insecurity should be taken into consideration when treating older adults with PAD to help decrease poor health outcomes that are linked to an insufficient amount of nutritious foods.

Evaluating practice at an Irish tertiary level fertility clinic 1995/98.

This paper audits patients patterns and the diagnostic activities of the Rotunda Hospital, Infertility Clinic by following 186 new patients first attending between 1st March 1995 and 28th February 1996 and their progress in the clinic through to 28th February 1998. Sixty-four percent of patients came from the Eastern Health Board. Sixty-nine per cent had been previously investigated elsewhere. The non-notified drop-out rate was 23%. Of the 158 patients fully investigated, the male partner was the major factor in 27% of couples. Tubal problems accounted for 20% and endometriosis 13%. An ovulation factor was found in 13%. Twenty-seven percent of couples were given the label of unexplained infertility. In 8% more than one factor was present. Fifty-five percent were referred on for IVF/ICSI. Many at this tertiary referral centre had already attended elsewhere. A very high proportion of these had repeat investigations to complete the fertility profile. This policy is questioned as it is not cost effective. The incidence of cause of infertility in the main has little changed in 15 years.

No show is a major problem in planning appointments for infertility patients.

We examined the pattern of bookings for and actual visits undertaken by patients attending the Infertility Clinics at the Rotunda Hospital Dublin as well as the accuracy of systems in place for recording such events. The data provided by the Hospital Patient Administration System (PAS), clinic worksheets and clinic record chart of first visit couples attending initially over a 12 month period 1995/1996 and their subsequent records to February 1998 was analysed. Comparable figures were provided from the corresponding private clinic over the same time frame. Sixty-nine percent had already had investigations and treatment elsewhere. Discrepancies were noted between the PAS and manual systems as confirmed by the patient records. The manual proved more accurate. We found 32% (88 of 276) patients failed to turn up for a first appointment compared with 17% of private patients. Un-notified no-show provides great logistic difficulties in planning clinic management. Waiting lists grow, staff and patients alike are greatly inconvenienced. This apparent recklessness makes the Charter of Rights for Hospital Patients difficult to comply with. A possible answer is to demand reconfirmation near to the clinic date and in it's absence reassign the appointment to another. Population education is clearly needed.

The influence of age on the severity of peritonitis.

OBJECTIVE: To evaluate the influence of age on the evolution and severity of peritonitis. DESIGN: A chart review. SETTING: An adult university hospital. PATIENTS: One hundred and twenty-two patients with acute appendicitis and 100 patients with acute colonic diverticulitis requiring operation or percutaneous drainage. MAIN OUTCOME MEASURES: Patient age and sex, presence of perforation or gangrene (appendicitis), extent of peritonitis (diverticulitis); duration of symptoms prior to admission; admission leukocyte count; duration of hospitalization before surgery; length of hospital stay; and death rate. RESULTS: Patients with acute appendicitis who were aged 65 years or older were three times more likely than younger patients to have a gangrenous or perforated appendix (odds ratio 3.1, 95% confidence interval 1.1 to 8.4, p < 0.05); older patients with perforated diverticulitis were three times more likely than younger patients to have generalized peritonitis than localized (pericolic or pelvic) peritonitis (odds ratio 2.9, 95% confidence interval 1.2 to 7.5, p < 0.05). CONCLUSION: These findings are consistent with the hypothesis that the biologic features of peritonitis differ in the elderly, who are more likely to present with an advanced or severe process than young patients.

Cardiopulmonary bypass with circulatory arrest in swine: echocardiographic evaluation of left ventricle function and pulmonary vein flow.

Complete two-dimensional echocardiography and Doppler flow studies were performed on 17 swine as part of an experimental protocol involving cardiopulmonary bypass with circulatory arrest. Indices of left ventricular function and pulmonary vein morphology and flow velocity were taken before (17/17) and after bypass (11/17). A total of 70 measurements were available for analysis. Doppler flow velocity within the right pulmonary vein was 0.5 +/- 0.06 m/sec and was 0.52 +/- 0.05 m/sec in the left pulmonary vein. The swine were found to have a marked reduction in left ventricle function compared with that in previous reports, though no statistical difference was seen between pre- and post-cardiopulmonary bypass studies (preoperative shortening fraction was 21 +/- 5% and ejection fraction was 41 +/- 8%; postoperative shortening fraction was 23 +/- 5% and ejection fraction was 42 +/- 7%). Swine with shortening and ejection fractions of < 20% were found to have more unstable hemodynamics during cardiopulmonary bypass.

Primary pulmonary artery sarcoma. A method of resection.

Primary pulmonary artery sarcoma classically presents with symptoms and findings suggestive of acute pulmonary artery occlusion. An angiocentric mass or the finding of spindling neoplasm on needle biopsy should suggest this neoplasm. The rare unilateral location in the present case permitted resection by pneumonectomy. An endarterectomy technique was used to extract loosely adherent tumor-thrombus from the more proximal portions of the left pulmonary artery.

Effects of age and body composition on the metabolic responses to elective colon resection.

Advancing age tends to be accompanied by predictable changes in organ-system function and body composition, as well as an increased prevalence of various diseases. Our knowledge of the metabolic responses to surgical stress is derived largely from studies of young and middle-aged individuals. Whether these responses are altered in the elderly is not well established; the characteristic changes in metabolic function and body composition that occur in the elderly may limit their ability to respond adequately and to survive severe or complicated surgical procedures. To evaluate the effects of age and differences in body composition on the metabolic responses to surgery, we studied 20 active and otherwise healthy men aged 43 to 77 years, before and after elective colon resection. Age was not related to weight or total body water (TBW) in the patients studied. Resting preoperative energy expenditure was strongly dependent on TBW (reflecting lean body mass) and age (r2 = 0.80, p less than 0.001), and to TBW and creatinine excretion (reflecting muscle mass) (r2 = 0.85, p less than 0.001). Energy expenditure increased 18 +/- 2% (range, 4% to 40%) after operation but this response was unrelated to age. Postoperative urine nitrogen was related to body weight or TBW, but not to age. Serum glucose, cortisol, white blood cell count count, and C-reactive protein responses were also independent of patient age. The metabolic responses of generally healthy men to a moderate surgical stress do not vary with age in the range studied. The metabolic responses to more severe or prolonged stress may be altered with advancing age and changes in body composition, and in patients with concomitant diseases.

Quantitative ecology of psychrophilic microorganisms.

To obtain information on the importance of psychrophiles in nature, 95 samples of soil, water, mud, and various foods were quantitatively assayed for their content of psychrophilic bacteria and fungi and also for mesophilic and thermophilic bacteria and fungi. Thousands to millions of psychrophilic bacteria were present per gram of soil and represented 0.5 to 86% of the bacterial population. Also, about 25% of the fungi in uncultivated soil were psychrophilic. In stream and river water, psychrophilic bacteria constituted 16 to 47% of the bacterial population; in lake water, 41 to 76%; and in lake mud, 11 to 33%. Large numbers of psychrophilic bacteria were present in dairy products, meats, and other foods, and accounted for 35 to 93% of the bacterial population of meats. In contrast, thermophilic bacteria usually comprised 1% or less of the bacterial population in all of the materials examined. The data indicate that psychrophiles are both ubiquitous and numerous in nature, and probably play important roles in the cycles of matter.