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 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A survey of 140 low-income, urban consumers of primary health care services provided by the public sector at Santiago, Chile's Villa O'Higgins Clinic suggested that organizational factors are more significant predictors of frequency of clinic use and patient satisfaction than demographic characteristics of the clinic population. 73% of respondents interviewed were female; the mean family size was 5, most were from families that fell well below the official poverty level, and 76% of household income went toward food. 29% of the households represented lacked adult men or had unemployed male workers. 66% were acute care patients; the remainder were receiving treatment for chronic conditions such as diabetes, high blood pressure, and alcoholism. 70% had been attending the clinic for the past few years; the mean number of visits per year was 6.4. 53% indicated a preference for a public rather than a private doctor, even if the latter were affordable. Only 51% expressed a dislike of any aspect of the clinic (long waits, 24%; discourteous staff, 19%; and lack of cleanliness, 5%). 84% perceived the quality of the care they received as good; this perception was strongly associated with satisfaction with the physician and receipt of prescription drugs. Multiple regression analysis indicated that 4 organizational variables (travel time to clinic, distance from home to clinic, waiting time at clinic, and travel time-travel distance) and 3 demographic factors (mother bringing child for care, presence of children under 5 years of age, and acute rather than chronic illness) were the best predictors of the frequency of clinic visits. Changes in clinic management by Chile's military government may jeopardize this pattern of high satisfaction with public health services by the poor.
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PMID:Help-seeking behavior, use, and satisfaction among frequent primary care users in Santiago de Chile. 324 Oct 63

The personality trait of alexithymia was assessed in 100 male inpatients with alcohol dependence using the Schaling-Sifneos Personality Scale. The score indicative of alexithymia (below 50 points) was found in 78 patients, a prevalence which exceeds that found in psychosomatic subjects. Patients with alexithymia did not differ from non-alexithymics in regard to demographic factors and severity of alcohol dependence. They were younger and had a shorter duration of illness what may indicate that alexithymia is not a result of the dependence. Alcoholic patients with concomitant hypertension had greater alexithymic scores. It is hypothesized that psychological and biological features of alexithymic subjects may render them more vulnerable to alcohol and more prone to subsequent development of the dependence.
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PMID:High prevalence of alexithymia in male patients with alcohol dependence. 326 48

Magnesium is an important element for health and disease. Magnesium, the second most abundant intracellular cation, has been identified as a cofactor in over 300 enzymatic reactions involving energy metabolism and protein and nucleic acid synthesis. Approximately half of the total magnesium in the body is present in soft tissue, and the other half in bone. Less than 1% of the total body magnesium is present in blood. Nonetheless, the majority of our experimental information comes from determination of magnesium in serum and red blood cells. At present, we have little information about equilibrium among and state of magnesium within body pools. Magnesium is absorbed uniformly from the small intestine and the serum concentration controlled by excretion from the kidney. The clinical laboratory evaluation of magnesium status is primarily limited to the serum magnesium concentration, 24-hour urinary excretion, and percent retention following parenteral magnesium. However, results for these tests do not necessarily correlate with intracellular magnesium. Thus, there is no readily available test to determine intracellular/total body magnesium status. Magnesium deficiency may cause weakness, tremors, seizures, cardiac arrhythmias, hypokalemia, and hypocalcemia. The causes of hypomagnesemia are reduced intake (poor nutrition or IV fluids without magnesium), reduced absorption (chronic diarrhea, malabsorption, or bypass/resection of bowel), redistribution (exchange transfusion or acute pancreatitis), and increased excretion (medication, alcoholism, diabetes mellitus, renal tubular disorders, hypercalcemia, hyperthyroidism, aldosteronism, stress, or excessive lactation). A large segment of the U.S. population may have an inadequate intake of magnesium and may have a chronic latent magnesium deficiency that has been linked to atherosclerosis, myocardial infarction, hypertension, cancer, kidney stones, premenstrual syndrome, and psychiatric disorders. Hypermagnesemia is primarily seen in acute and chronic renal failure, and is treated effectively by dialysis.
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PMID:Magnesium metabolism in health and disease. 328 51

Arterial hypertension is the most important risk factor in all types of stroke. The significance of alcohol in the pathogenesis of stroke is less well defined. Chronic alcoholism leads to an elevation of blood pressure. Thus, the association between alcohol and stroke might be the blood pressure effect of alcohol. However, some studies have shown a significant influence of alcohol on the incidence of stroke--especially of intracerebral haemorrhage and subarachnoid haemorrhage--even after adjustment for blood pressure. Many possible pathomechanisms are discussed. Alcohol inhibits aggregation of thrombocytes, and chronic alcohol abuse may induce thrombocytopenia, which could lead to a haemorrhagic stroke. Alcohol withdrawal leads to rebound thrombocytosis. Acute alcohol ingestion induces a decrease in fibrinolytic activity and an increase in factor VIII activity, which enhances the thrombotic potential. Additionally, alcohol increases plasma osmolarity, erythrocyte aggregability, haematocrit and blood viscosity, and decreases deformability of erythrocytes. The effects of alcohol on cerebral blood flow are still under debate; there is a deterioration in autoregulation of cerebral blood flow anyway. In animal studies alcohol induced dose-dependent vasospasm of the cerebral blood vessels, which could be a possible pathomechanism in ischaemic, as well as in haemorrhagic stroke. Chronic alcoholism is the most common cause of secondary non-ischaemic cardiomyopathy, which can lead to cerebral embolism via rhythm disorders or intracardiac thrombus formation.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Does alcohol consumption promote the manifestation of strokes? Considerations on pathophysiology]. 328 8

Placement of an intracaval device is the treatment of choice for failure of, or contraindication to, anticoagulation therapy. A retrospective study of 111 patients from 1980 to 1986 was undertaken to identify the incidence and degree of related complications or problems regarding placement of the device. Ninety seven of 111 (87.4%) patients had no complications or problems in placement; 14/111 (12.6%) patients did have problems. Of the latter group, mechanical problems included eccentric filter placement, insertional difficulty, problems in filter carrier removal, premature discharge, and misplacement. A total of four patients required a second filter. A single instance of worsening renal insufficiency was noted. Of the total group (ages 24 to 97 [means = 62.4] years), other medical problems including diabetes, smoking, malignancy, sepsis, hypertension, and alcoholism had no influence on the complications or problems. The Greenfield filter remains the method of choice for the listed indications; however, an awareness of potential problems may lessen the technical complications. The operative problems did not adversely impact hospital morbidity or cost.
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PMID:Problems in placement of the Greenfield inferior vena cava filter. 341 96

In a clinical and follow-up study of the progeny of alcoholic parents the author investigated embryopathic/dysontogenetic disorders ("oligosymptomatic" forms of alcoholic embryopathy, mental infantilism, hyperdynamic syndrome and the syndrome of cerebrospinal fluid hypertension) exerting a pathoplastic effect on the deviant behaviour of adolescents. The author has developed approaches toward a multiple modality therapy and rehabilitation of these patients in conditions of a special school for adolescents with deviant behaviour. A hypothesis is advanced as to the relationship between embryopathic/dysontogenetic disorders with embryofetotoxic effect of the mother's alcoholism on the fetus during pregnancy.
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PMID:[Embryopathic-dysontogenetic syndromes in pathocharacterological disorders in the progeny of alcoholic parents]. 343 79

Previous studies have shown good clinical results following anterior transposition of the ulnar nerve for compression neuropathy. However, no studies have examined all patients pre- and post-operatively with both clinical and electrophysiological studies to determine if a correlation exists. Twenty-three of 24 (96%) anterior transpositions performed consecutively over 6 years were followed up at a mean of 33.2 months with clinical and electrophysiological examinations. All patients were male "blue-collar" workers with a mean age of 52.1 years. The mean duration of preoperative symptoms was 11.3 months. Preoperatively, 30% were graded moderate and 70% severe. The motor conduction velocity (MCV) across the elbow and electromyography (EMG) correlated with the severity of the clinical findings. Postoperatively, 70% of patients improved, with 40% having a good result and 30% fair, and the MCV improved to a highly significant degree (P less than 0.0005). Thirty percent had a poor result with no clinical improvement, yet the MCV improved to a significant degree (P less than 0.05). There was no correlation between the clinical result and the distal motor or sensory latencies, MCV below the elbow, or EMG. Advanced age, duration of preoperative symptoms, diabetes, hypertension, alcoholism, etiology, type of transposition, tourniquet time, and atrophy did not correlate with a poor result, either clinically or electrophysiologically. Severe clinical findings confirmed by electrophysiological studies do not contraindicate surgery and have a reasonable success rate. In conclusion, preoperative electrophysiological studies correlate with the clinical findings but postoperative ones do not, including the MCV. The MCV improves after anterior transposition of the ulnar nerve regardless of the clinical outcome.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:A clinical and electrophysiological investigation of anterior transposition for ulnar neuropathy at the elbow. 343 38

The present study investigates the clinical significance of several possible causative or conditioning factors which have been proposed to be involved in the pathogenesis of dilated cardiomyopathy (DCM). By reviewing the medical records of 68 patients with DCM, we found a definite, and suggestive family history in 16%, and 28%, respectively, and antecedent flu-like symptoms in 43%. A history of hypertension was observed in 35%, habitual alcoholism in 49% and diabetic pattern on glucose tolerance test in 37%. We then classified the study patients into three groups; familial, myocarditic and acquired groups. The familial group showed advanced myocardial damage with the poorest prognosis. Abnormal T-cell subsets in this group suggested that genetically determined abnormal immune response is involved in the development of DCM. In the myocarditic group, endomyocardial biopsy demonstrated mononuclear cell infiltration in 53% and the myocardial damage and prognosis were of intermediate severity. The acquired group showed significantly more frequent histories of hypertension, habitual alcoholism or diabetes than their age- and sex-matched controls, suggesting that they developed the disease in association with these factors. The severity of hemodynamic impairment and myocardial damage was the least extensive and prognosis was relatively favorable in this group. These different clinical features in the three groups may provide evidence that these factors actually contribute to the development of myocardial damage in DCM and that the condition is a clinical syndrome associated with heterogeneous etiologies or conditioning factors. Determination and management of these factors would be of practical value in treating patients with DCM that has no established therapy against underlying etiologies.
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PMID:Dilated cardiomyopathy: clinical significance of possible related factors. 349 25

A large-scale US survey has shown that the dietary magnesium intake tends to be lower than recommended. The suboptimal intake prevalent among US adults is consistent with the pattern observed in other North American and European surveys. Several factors are discussed, including the waterborne magnesium factor, the loss of magnesium during food refining and the magnesium content of vegetarian diets, as well as various metabolic situations, e.g., hypertension, pregnancy, osteoporosis, drug therapy, alcoholism, stress and cardiac trauma. The benefits of magnesium supplementation among those with sub-RDA intakes are illustrated.
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PMID:Magnesium content of the food supply in the modern-day world. 351 57

The clinical symptoms and signs, certain metabolic aspects (including ethanol, acetaldehyde and glucose concentrations in plasma) and hemodynamic parameters (cardiac rate, blood pressure and cardiac output) were assessed in 16 ambulatory alcoholics (3 female, 13 male, average age 46 years) following pretreatment with disulfiram (total dose 1.2 to 2.4 g) and oral administration of 0.2 g ethanol 94% per kg body weight. Since the only selection criterion for inclusion was a diagnosis of alcohol dependence (DSM III, 303.9), the group was heterogeneous and exhibited a variety of concomitant diseases such as alcoholic liver disease in 9, chronic bronchitis in 5 and arterial hypertension in 3. Whereas peak plasma alcohol concentrations were comparable (median: 0.33 mg/ml; range: 0.19 to 0.40) in all subjects, peak acetaldehyde levels varied over 40-fold (median 5.1 micrograms/ml; range: 0.2 to 8.8). In consequence, there were marked interindividual differences in cardiovascular reaction, in contrast to the virtually constant finding of flush, palpitations and dyspnoea. Since the decrease in peripheral vascular resistance (to a median of 46% of control) was only in part compensated by increased cardiac output (median: 161%), both systolic and diastolic blood pressures were reduced by 30 and 45 mm Hg respectively. In 4 patients systolic pressure fell to shock levels (less than 70 mm Hg). The presumed toxic effect of acetaldehyde is again supported by close correlations between acetaldehyde plasma concentrations and the changes in blood pressures and peripheral resistances. We were able to demonstrate that disulfiram-induced inhibition of hepatic microsomal function - measured with the aminopyrine breath test - predicts the expected acetaldehyde peak levels following ethanol administration.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Cardiovascular and metabolic changes in the antabuse-alcohol reaction: basis for the diagnosis of degree of severity]. 354 9


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