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This study evaluates the utility of a stress and coping paradigm for explaining individual differences in psychological adjustment to chronic illness. Using data from the first wave of a longitudinal study of 170 middle-aged and elderly adults faced with one of four chronic illnesses (hypertension, diabetes mellitus, cancer and rheumatoid arthritis), this paper examines the relationship between the stresses of chronic illness and coping, and the ability of coping to explain psychological adjustment. Results show coping strategy use tends to be minimally explained by medical diagnosis. Cognitive strategies, including information seeking, are related to positive affect while emotional strategies, particularly those involving avoidance, blame and emotional ventilation, are related to negative affect, lowered self-esteem and poorer adjustment to illness. While the findings suggest that a stress and coping model may be valuable in understanding adjustment among the chronically ill, the general modesty of coping effects and the failure of the stress buffering hypothesis to explain adjustment indicates a need for new research approaches and some modification of current theories of coping.
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PMID:Stress and coping in the explanation of psychological adjustment among chronically ill adults. 672 17

Evidence is accumulating to suggest that selenium (Se) is an essential trace element for man and is reviewed with emphasis on those aspects peculiar to New Zealand. The extremely low Se levels in New Zealand soils results in a low Se content of foods, low dietary intakes, low urinary excretions, and low blood Se concentrations and glutathione peroxidase activities. Of these, plasma Se gives a short-term index of nutritional status while erythrocyte Se and glutathione peroxidase activities give a long-term index. The consequences of the low Se status of New Zealanders are not immediately apparent as a deficiency disease has not been detected in residents consuming a normal diet. However a Se-responsive muscular syndrome has been described in a surgical patient on total parenteral nutrition. Similar groups that might be vulnerable to a Se deficiency are children with metabolic disorders consuming synthetic protein diets, premature babies and infants during the first few months of life, and patients with cancer whose lowered dietary intake is coupled with the traumatic nature of their disease. Other groups that have been studied in relation to a possible role for Se in specific illnesses are patients with cardiovascular disease and hypertension, rheumatoid arthritis and other muscular syndromes and surgical patients with or without cancer. It is not yet possible to predict a minimum Se requirement for health but it appears that the intake of New Zealanders might be on the borderline. At present supplementation by the general population is not justified, but may be necessary for certain vulnerable groups such as patients on restricted diets. The most effective means of supplementation for increasing the Se status of New Zealanders is under study.
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PMID:Selenium in human health and disease with emphasis on those aspects peculiar to New Zealand. 676 57

Disalcid, a salicylic acid pro-drug, was administered for 3 months to eighteen rheumatoid arthritis patients, with monitoring of clinical response, side-effects and laboratory changes. The drug produced a satisfactory to excellent response in fourteen patients and was unsatisfactory in four. Gastric side-effects occurred in three patients and allergic reaction in one. Serum salicylic acid concentrations were adequately maintained between 15 to 25 mg/100 ml. Funduscopic monitoring revealed one retinal defect in a patient with hypertension. Laboratory examinations, blood chemistry and urine analyses remained within normal limits during the 12-week trial.
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PMID:Long-term management of rheumatoid arthritis with disalcid. 677 3

1. One hundred and ninety-five patients undergoing low-dose prednisone or prednisolone therapy were investigated. Blood pressure, weight, serum urea, sodium and potassium were recorded before therapy and again after at least 1 year of therapy. 2. The rise in both mean systolic and mean diastolic blood pressure was paralleled by an increase in the prevalence of arbitrarily defined hypertension. 3. There was no relationship between change of blood pressure and either dose of corticosteroid or duration of therapy. Blood pressure before therapy was the main determinant of the change in blood pressure. 4. Mean serum sodium levels rose slightly but serum potassium levels did not change during the follow-up period. There was no significant weight gain. 5. These results indicate that treatment of asthma and rheumatoid arthritis with prednisolone or prednisolone in low dose does not cause hypertension or biochemical features suggestive of mineralocorticoid excess.
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PMID:Does long-term low-dose corticosteroid therapy cause hypertension? 679 77

Diseases of the terminal vascular system are of particular diagnostic and differential-diagnostic importance in clinical angiology. While in the functional microangiopathies of the skin as a rule disturbances of the vasomotor function without an essential value of the disease are concerned, secondary organic changes of the wall of the vessel not infrequently determine the course and the prognosis of the basic disease (rheumatoid arthritis, collagenoses, hypertension and diabetes). Vasomotor trophic disturbances are observed also post-traumatically, post-operatively, after exposition to cold, in a lesion of the central nervous system and vertebra nerve irritations. For the allergic hyperergic vasculitides, which show an extraordinary polymorphism in the clinical picture in characteristic histological findings, an auto-immune pathogenesis is to be supposed. The chronic arterial hypertension leads to arteriolosclerosis and necrosis with adequate organic symptoms. In the diabetic microangiopathy we may demarcate functional pre-stages from irreversible structural changes of the vessels, in which case apart from the peripheral microangiopathy of the skin the retinopathy and nephropathy are to be classified as particularly important clinical manifestations.
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PMID:[Clinical aspects and differential diagnosis of primary and secondary microangiopathies]. 686 7

To clarify the etiology of atherosclerosis in collagen disease, the prevalence and quality of coronary arterial lesions was examined histopathologically. The materials consisted of 68 autopsy cases, including 10 of rheumatoid arthritis (RA), 28 of systemic lupus erythematosus (SLE), 8 of progressive systemic sclerosis (PSS), 5 of dermatomyositis (DM) and 17 of miscellaneous collagen disease (MD). As a control group (C), 9 age-matched cases of hematologic disorders were chosen. In order to conduct systematic research on coronary arteries, tissue blocks were taken, according to the method proposed by the "Vascular Lesion of Collagen Disease Research Committee" in Japan. To estimate the narrowing of the coronary arterial lumen quantitatively, the coronary stenosis index (CSI), which was the sum of the grade of three main coronary arterial narrowing scores, were used. Significant coronary stenosis (more than 75% occlusion of the lumen) was observed in 8 cases of SLE, one of PSS, 2 of DM and 4 of MD. Stenosis was due to atherosclerosis except in 3 cases of MD. The degree of stenosis expressed by the CSI was higher in MD, SLE and DM than in C (p less than 0.05). Atherosclerotic lesions in collagen disease tended to have a higher population of cellular components than did those in C. There were no statistical correlations between the CSI and some risk factors (age, hypertension, hypercholesterolemia and long-term corticosteroid administration). In the 12 cases with significant stenosis due to atherosclerosis, only 4 patients received corticosteroid hormone for more than one year. Active vasculitis with prominent inflammatory cell infiltration was observed in 2 cases of RA, 3 of SLE and 9 of MD. In cases of vasculitis in SLE examined by the serial section method, luminal narrowing caused by intimal fibrocellular proliferation seemed to have a close relationship with inflammatory cell infiltration in the media and the adventitia. It was concluded that prolonged stimulation of the injured intima by the common risk factors played an important role in the acceleration of coronary atherosclerosis and this intimal change should be reconsidered as a preceding lesion of coronary atherosclerosis.
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PMID:Atherosclerosis of the coronary arteries in collagen disease and allied disorders, with special reference to vasculitis as a preceding lesion of coronary atherosclerosis. 713 12

During the 20 years since the oral contraceptive was introduced, it has been used by some 150 million women around the world, and is perhaps the most carefully monitored medication in history. This vast body of research shows that for the overwhelming majority of healthy women under 30, the benefits of the pill continue to outweigh the risks. The most serious life threatening risks are those involving the cardiovascular system: heart attack, stroke, and throboembolism. However, deaths from these causes would be reduced by 1/2 if women using the pill did not smoke; further reductions would result if women with high blood pressure, high chloresterol levels and diabetes millitus did not use the pill. There is no evidence thus far to justify fears that the pill might be associated with an increased risk of cancer. Most studies show that not only is there no association between pill use and cancer of the ovaries, uterus and breast, but pill use may protect against ovarian and endometrial cancer. Women taking the pill are 1/4 as likely to develop benign breast lumps as nonusers, 1/14 as likely to develop ovarian cysts, 2/3 as likely to develop iron deficiency anemia, and 1/2 as likely to develop rheumatoid arthritis -- all relatively common conditions. In addition, pelvic inflammatory disease, a major cause of infertility, appears to occur only 1/2 as often among pill users as among nonusers. The risk to life among pill users younger than 30 who do not smoke is very small (virtually the same as that of users of the IUD, diaphragm, or condom) and is much lower than the risk of birth-related deaths among women who use no birth control.
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PMID:The pill at 20: an assessment. 720 90

Subungueal splinter hemorrhage (S.U.S.H.) has been reported in various conditions and may herald a serious systemic disease. It has been related to miscellaneous conditions such as: subacute bacterial endocarditis, severe rheumatoid arthritis, uninfected mitral stenosis, trichinosis, peptic ulcer, hypertension, neoplasm, trauma, and in some cases, is considered idiopathic. Some dermatologic conditions such as psoriasis, dermatitis, and fungal infections may also produce S.U.S.H. It consists of "a homogeneous mass of blood in a layer of squamous cells, adherent to the under surface of the nail, considered to be of embolic origin." In a brief review of pertinent medical literature on thromboangiitis obliterans, we were unable to find a description of its occurrence in this disease. The earliest lesions described in this condition are "painful vesicles on the pulp of digits with intense hyperemia and hypersensitivity of the surrounding skin." It is our opinion that S.U.S.H. is an earlier and quite useful sign of arterial involvement as seen in the following cases observed in our vascular disease section.
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PMID:Subungueal-splinter hemorrhage an early sign of thromboangiitis obliterans. 723 12

We studied 76 patients with rheumatoid arthritis who had autopsies performed at the University of Utah and Salt Lake Veterans Administration Medical Center. The most common pathological finding in the kidney was interstitial fibrosis (46%) and internal proliferation of the arterioles in the absence of hypertension (54% of the cases). Renal amyloidosis was only found in 7% of the patients. Azotemia (creatinine above 2 mg/dl) was found in 9% of the patients but was not clinically significant. In addition uremia was not a frequent cause of death in patients with rheumatoid arthritis.
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PMID:Renal pathology in patients with rheumatoid arthritis. 730 Sep 97

During the past decade the World Health Organization (WHO) has embarked on a $17 million program to study different kinds of contraceptive methods and their effect on maternal health. More than 600 scientists from 85 countries are participating. These investigations have implicated abortion as a factor in miscarriage, perinatal morbidity, and perinatal mortality due to isthmus-cervical inadequacy. It is also implicated in sterility and extrauterine pregnancy, as well as other disorders of pregnancy. Hence WHO emphasizes other birth control methods, in particular the pill. But the birth control pill also has side effects, as this is the first time that hormones have been used not to treat some illness but in healthy women. Their incidence increases with age (after 30-35 years of age) and also is enhanced by smoking, high blood pressure, hyperlipoproteinemia, and diabetes. Oral contraceptives (OCs) also reduce the incidence of benign tumors of the breast, ovarian cysts, iron-deficiency anemia, and rheumatoid arthritis. They have a beneficial effect also in endometriosis, dysfunctional hemorrhages, polyposis and endometrial hyperplasia, ovulatory problems, and inflammatory conditions of the genitals. Many of the longterm effects of these contraceptives are still unknown, such as their influence on cancer or on the fetus. The WHO investigation has shown that 1/2 stop taking the birth control pill after 1 year, and 2/3 after 2 years. Another widespread technique is the IUD, used by over 60 million women. But this causes hemorrhage in some, especially the women of India, Pakistan, and other countries. Work is now being done on ways to minimize the hemorrhage associated with the IUD, to clarify its presence as a cause of inflammatory processes of the genitals, extrauterine pregnancies, and subsequent sterility. The WHO also studied the rhythm method of preventing conception and found that 35% of women ceased employing it after 13 months, while 20% became pregnant. It was decided to work on elucidating new methods of determining the onset of ovulation. The WHO is also studying the use of prostaglandins to interrupt pregnancy. A major task for the future is determining which women are at greatest risk from the various birth control techniques.
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PMID:[Modern methods of regulating generative function]. 733 55


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