Obesity is a known risk factor for preeclampsia, but the reason for this risk is unknown. We sought to demonstrate how obese individuals are predisposed to preeclampsia by mechanisms involving inflammation and the innate immune system. First, we used immunohistochemical studies to identify neutrophil infiltration, NF-κB activation and COX-2 expression in vascular tissue of obese women. We then demonstrated similar neutrophil infiltration and vascular inflammation in preeclamptic women.We used in vitro experiments to test if neutrophils and their products, reactive oxygen species (ROS) and tumor necrosis factor-alpha (TNFα) can activate NF-κB and cause expression of its inflammatory products, COX-2, thromboxane (TX) and IL-8. Co-culture of neutrophils or treatments of ROS or TNFα caused activation of NF-κB and expression of COX-2, TX and IL-8 in vascular smooth muscle cells.This investigation is the first to demonstrate activation of NF-κB and expression of COX-2 coincident with neutrophil infiltration in systemic vascular tissue of obese and preeclamptic women. These data implicate neutrophils as a cause of vascular inflammation. They also suggest that if an obese woman's vasculature was in an inflamed state she is at increased risk for preeclampsia when exposed to the additional burden of oxidative stress and neutrophil activation imposed by the placenta, causing her to develop vascular dysfunction and clinical symptoms of PE (hypertension and edema).

The purpose of this study was to determine the effects of needle play in reducing pre-school children's anxiety concerning injections. The Pre-school Observational Scale of Anxiety was used to measure the degree of anxiety experienced by the children. The hypothesis stated that there would be a significant decrease in anxiety of pre-school children who participated in needle play as compared with the anxiety scores of pre-school children who did not participate in needle play.The sample consisted of 20 pre-school children who were receiving routine health care and injections for immunizations or PPDs (purified protein derivative) at a county health department in the southeast. After obtaining informed consent, children were randomly assigned to either a control group (n = 10) or experimental group (n = 10). The control group was involved in putting together a puzzle with the investigator prior to their injection. The experimental group participated in needle play with the investigator prior to their injection. The Pre-school Observational Scale of Anxiety (POSA) which specifies behavioral indicators of anxiety in children was used on all subjects immediately prior to the actual needle penetration and a score was given to each subject.The scores on the Pre-school Observational Scale of Anxiety showed no statistically significant difference between the control group and the experimental group when analyzed using the Mann-Whitney U Test. On the basis of these findings, the hypothesis that pre-school children who participate in needle play immediately prior to receiving an injection would show a significant decrease in anxiety when compared to pre-school children who did not-participate in needle play prior to an injection was not accepted.

There are no reliable tools that evaluate pain in adult critical care patients who cannot communicate as a result of sedation or illness. This was an observational study in which postoperative cardiothoracic intensive care patients were assessed for pain using both the newly devised Corbett Pain Scale (CPS) and the Numerical Pain Scale (NPS). The CPS was evaluated for content validity, criterion validity, construct validity, test re-test reliability and internal consistency. Thirteen male and seven female patients (n=20) were enrolled and underwent a maximum of five pain assessments each. The mean total scores of the CPS (.740, SD+1.03) and the NRS (.000, SD+1.00) were compared using a paired t-test. No significant differences were found. There was poor internal consistency (-.1225) and there was insignificant correlation between the scales. Pain measurement of sedated, non-communicative patients continues to be problematic.

A large percentage of Americans own pets which may impact their health. This study examines pet ownership’s effect on well being in older adults looking at race/ethnicity. A sample of 6,565 older adults (>60) was selected from the Third National Health and Nutrition Survey. Pet owners comprised 28.3% of the sample. The theories of symbolic interaction and social integration were used to examine pet ownership’s effect on physical components of well-being. The descriptive results showed statistically significant differences in age, education, income, and marital status between pet owners and non-pet owners. Pet owners were younger, more educate, higher income and married. Similar results were found for Caucasians, African Americans and Mexican Americans. Logistic regression for the entire sample revealed pet owners were more likely to have a positive self perception of health, normal blood pressure, improved function, less chronic conditions, improved function and more falls. Multiple regression revealed pet owners had more hospital stays, but fewer physician visits and nursing home stays than non-pet owners. When examined by race/ethnicity differences were found between pet owners and non-pet owners that differed from the general sample results. This research revealed that pets overall positively impact their owners’ health but it appears to differ based on race/ethnicity. Further research is needed on pet ownership’s effect on older adults specifically in regards to race.

This study deals with the development of the number and the age and sex structure of Czech physicians according their medical specialty in the period 2000-2010. The aim of the study is to identify which medical specialties are already problematic or could face the lack of physicians and demographic ageing in the future and on the other hand which medical specialties are popular among young physicians. Firstly, the Czech health system and particular groups of health workforce are introduced. After that follows the analysis of the number and the sex and age structure according their medical specialty. The cluster analysis which produces groups of medical specialties with similar characteristics of development of the number and the structure was used for schematic overview. The second part of the study is focused on the most numerous fourteen medical specialties. The number of medical school graduates, the number of attestations and the development of workload of physicians regarding the number of ambulant treatment and hospitalization is taken into account.

The book distills the available information on osteoporosis into an easily comprehensible format that serves as a practical guide for busy clinicians. Contents:Definition & epidemiology -- Basic bone pathophysiology -- Bone densitometry -- Diagnosis -- Identifying patients at risk of fractures -- Non-pharmacologic management of osteopenia and osteoporosis -- Pharmacologic management of osteoporosis, part 1 -- Pharmacologic management of osteoporosis, part 2 -- Monitoring patients on treatment -- Vertebral augmentation procedures -- Corticosteroid-induced bone loss -- Primary hyperparathyroidism -- Premenopausal women -- Men -- Atypical femoral shaft fractures -- Osteonecrosis of the jaw -- Osteoporosis in children and adolescents. / https://dc.etsu.edu/etsu_books/1077/thumbnail.jpg

Three experiments examined normal-hearing and cochlear-implant listeners' abilities to perceive and use talker-specific information in the speech signal. In Experiment 1 voice similarity judgments were gathered from normal-hearing listeners to maximize variability across talkers used in Experiment 2. These judgments were submitted to a multidimensional scaling (MDS) analysis; this solution was used to select the talkers of Experiment 2. Experiment 2 was an approximate replication of Nygaard and Pisoni's (1998) work. In this study cochlear-implant and normal-hearing listeners were trained to recognize 6 different voices. The cochlear-implant users recognized the voices with 59.31% accuracy and the normal-hearing listeners achieved 92.64% accuracy. After training the listeners completed a sentence recognition task in noise. In the task 6 familiar talkers spoken half of the sentences and 6 novel talkers spoke the other half. It was predicted that sentences spoken by the familiar talkers would be more accurately perceived than those spoken by the novel talkers. However, there was no difference in accuracy, nor was there a difference in performance across the groups of listeners. The factors contributing to these null results were discussed at length. Experiment 3 gathered voice similarity judgments from the normal-hearing and cochlear-implant listeners of Experiment 2. These data were submitted to both classical and weighted MDS analyses. The voice maps showed notable differences in the perceptual spaces of the two groups of listeners. The participant space yielded from the weighted MDS showed great variation across all of the participants' judgments, but no clear trend supporting the listeners' group membership. In conclusion, despite listening via a constrained, electric signal, the cochlear-implant users were trained to recognize voices with notable accuracy (as were the normal-hearing listeners). Nevertheless, Experiment 2 failed to provide insight into talker familiarity's effect on the sentence recognition skills of cochlear-implant and normal-hearing listeners. These results are contrary to research with normal-hearing listeners that suggests talker familiarity facilitates speech processing in noise. The present studies did show, though, that cochlear-implant users appear to perceive and use talker-specific information differently than normal-hearing listeners.

Obstetric analgesia and anesthesia is an important concern today. The purpose of this study was to evaluate the effects of analgesia used in labor and delivery on the mother and newborn. The information obtained in this study evaluated the amount, time and types of analgesia and the effects on the mother and the newborn. Previous research has indicated adverse effects of analgesia and anesthesia on both mother and newborn, but conclusive results have not been obtained. Depressed respiratory function, increased use of oxygen, and low Apgar scores are among the effects reported for the newborn. Decreased uterine function, decreased satisfaction of the birth process, and risks attendant upon analgesia and anesthesia have been reported regarding the mother. Apgar scores, oxygen administered, and length of hospitilization for mother and newborn were the dependent variables measured by this study. The independent variables were amount, time, and administration of medication during labor and delivery. The control variables were the number of prenatal visits, number of previous pregnancies, and the stage of pregnancy at first visit to the physician. The subjects were grouped according to the amount of Demerol (the most commonly prescribed analgesia) administered, and comparisons were made between the highest and lowest groups. No significant differences were observed between the high and low Demerol groups in any of these variables. Significant differences were found in the area of Apgar scores and oxygen administration. These findings support the conclusion that analgesia and anesthesia administered during labor and delivery can have adverse effects in the newborn. Thus, the null hypothesis of no significant differences of effects of analgesia or anesthesia on mother and newborn was partially rejected. This research lends support to findings which suggest adverse effects of medication during labor. These supportive results could serve as a basis for future research investigating the amount of medication given in labor and delivery.

The National Quality Award Program, sponsored by the American Healthcare Association National Center for Assisted Living, was implemented to cultivate continuous quality improvement in nursing homes and assisted living facilities. Based upon the Baldridge Criteria for Performance Excellence, the program utilizes a systems-based or Big “Q” approach to quality and requires applicants to examine seven categories of their organizational environment including: 1) leadership, 2) strategy, 3) customers, 4) measurement, analysis, and knowledge management, 5) workforce, 6) operations, and 7) results. The subsequent dissertation examines whether award status is associated with better performance on publicly reported quality measures and financial performance within the nursing home setting. Findings suggest implementation of Baldridge principles may promote improved quality; however, further research is warranted to fully understand the relationship.

In November 1999, financial losses led the University of California at San Francisco Medical Center (UCSF) to close all inpatient services at Mount Zion Hospital, a community teaching hospital affiliated with UCSF since 1990. As a result of the closure, Mount Zions primary care residency program (MZPC) was merged with UCSFs university-based primary care program. We examined these events in the context of three major currents in U.S. health care: containment of rising health care costs, financial pressures on teaching hospitals, and the shifting priorities in graduate medical education with respect to subspecialty medicine and primary care. As part of this descriptive study, we investigated the impact of the Mount Zion closure on all UCSF internal medicine residents who were in training at the time. Using a cross-sectional survey, we found that a majority of residents felt the closure was harmful to their training, but that reasons varied by program affiliation. Many specific areas of training remained unaffected. Low morale correlated with abandonment of generalist career plans among some primary care residents (p=0.02). We concluded that the perception of harm reflected a temporary reaction to change rather than actual harm to the quality of the programs, and that while attrition from generalism may have resulted from disillusionment by some residents, it more likely reflected a national decline in interest in primary care since 1997. We also concluded that the closure of Mount Zion and its residency program was a consequence of the shifting emphasis toward subspecialization in the U.S. and is a harbinger of further changes in that direction.