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This is the author's fifth revision of a geriatrics bibliography. Approximately one-third of the previous references have been replaced by more current or more delimited articles. Because the literature pertinent to geriatrics has continued to grow ever more rapidly, it has been necessary to omit many informative articles from the bibliography. Preference is given to recent publications; almost all of the reference data from the past four years. Some articles were selected to highlight current controversies or changes in viewpoint. Most of the references deal specifically with an elderly patient population, though few use a multidisciplinary approach. Studies of the elderly are confounded by concomitants of aging frequent but not universal in our society: inactivity, obesity, malnutrition, and psychosocial trauma. The articles cited are primarily concerned with medical ailments of the elderly; legal, ethical, and sociological topics receive more limited coverage. The references are divided into categories. The first set (I) deals with some possible causes of aging; the second (II) with physiologic decline accompanying aging; the third (III) with the atypical and nonspecific characteristics of illness among geriatric patients; the fourth (IV) with the elderly and society; and the fifth (V) with care options. The remainder of the references are cited by pertinent medical specialty. Within each category, references are divided by disease process. Articles are further subgrouped by aspects of those diseases such as evaluation or therapy.
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PMID:Geriatrics: an updated bibliography. 266 86

The idea of representing obesity or degree of malnutrition using a weight-for-height power index has existed for many years and several authors believe that such an index should be uncorrelated with height. Data from the 1958 National Child Development Study and the 1970 Child Health and Education Study have therefore been used to determine the values of the constant k which lead to the weight-for-height power index weight/[height]k being uncorrelated with height for specific age groups. Different values of k were needed both for the various age groups, and for the two sexes. For boys and girls respectively, the values of k needed at age 7 years were 2.02 and 2.12, at age 10 the values were 2.53 and 2.58, at age 11, 2.53 and 2.50 and at age 16, 2.42 and 1.71. Different values were also needed for West Indians and Asians and pubertal and pre-pubertal children. The relationships between this power index and other measurements of weight-for-height (including weight/height; weight/[height]2--the Quetelet index; weight/[height]3--the Ponderal index; relative weight for height, and standardized weight for height), the examining doctor's assessment of obesity and weight and height themselves were investigated for 10-year-old children born in 1970 to determine which of them could be thought of as best at estimating obesity. We found that there was little to choose between the index which was uncorrelated with height (using derived values of the power), and the Quetelet index.
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PMID:Weight-for-height in two national cohorts with particular reference to 10-year-old children. 272 88

The nutritional status was assessed in a group of 220 patients with rheumatoid arthritis from three communities (coloured 89 patients, white 88 and black 43). The triceps skinfold (TSF) thickness, upper arm muscle circumference (UAMC), body mass index (BMI) and percentage of ideal body weight (% IBW) were measured and the serum albumin value determined. The mean age of the coloured patients was 49.8 years, white 57.7 years and black 44.8 years. Forty-five patients (20.5%) had a reduction of one or more anthropometric measurements (TSF, UAMC and/or %IBW) and a further 6 patients (2.7%) had a reduction of the serum albumin value alone. These 51 patients were considered to be malnourished and had a higher mean erythrocyte sedimentation rate and more severe functional disability than the remainder of the patients. The prevalence of malnutrition was lower if diagnosed only on abnormality of the TSF, UAMC and %IBW, since 25 patients (11.4%) had a reduction of only one measurement, 12 (5.5%) had a reduction of 2 and 8 (3.6%) had a reduction of all three measurements. Obesity (BMI greater than 30) was noted in 10.5% and there were no differences in the functional disability, disease activity and use of steroid therapy in the obese patients compared with the rest of the patients.
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PMID:Nutritional assessment in rheumatoid arthritis. 278 22

GH is secreted episodically. Its pattern is regulated by the interplay of a releasing and a release-inhibiting hormone of hypothalamic origin. Modulation occurs by metabolic factors (glucose, free fatty acids, ketone bodies, amino acids). Altered GH secretion has been observed in states of metabolic derangement such as diabetes mellitus, malnutrition and obesity. Further modulation occurs by extrahypothalamic CNS structures. In man--but not in animals, including subhuman primates--sleep has an important effect on GH secretion. A defective GH secretory pattern has been found to occur in several states of sleep disturbance, such as sleep deprivation, narcolepsy, severe psychosocial derangement, the apallic syndrome. Other CNS influences on GH secretion are related to stress, emotional changes and psychiatric disturbances. The exact mechanisms by which most of these influences are relayed to the GH secretory apparatus of the hypothalamus remain yet to be investigated.
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PMID:Hypothalamic control of GH secretion: pathophysiology and clinical implications. 285 44

Destruction of the ventromedial hypothalamus produces hyperphagia, hyperinsulinemia and hypertriglyceridemia. These changes appear to be partly the result of increased firing rate of the vagus nerve and reduced firing rate of the sympathetic nerves. These reciprocal changes in the function of the autonomic nervous system appear to provide an adequate explanation for the hyperinsulinemia in this syndrome, and for the reduced heat expenditure. Destruction of the lateral hypothalamus, has effects opposite to those of the ventromedial hypothalamus with a reduction in food intake, a decrease in body fat, and an increase in the activity of the sympathetic nervous system. These reciprocal functions of the hypothalamus are associated with different adrenergic receptors. A medial hypothalamic alpha-adrenergic system mediates the epinephrine stimulation of feeding, and a beta-adrenergic system mediates the lateral hypothalamic inhibition of eating. Peptides from the endorphin family can stimulate food intake, but most other peptides are inhibitory. Growth hormone and thyroid hormone stimulate food intake under appropriate conditions. Insulin and adrenal steroids appear to play the most important role of all the hormones in regulating food intake. Deficiency of adrenal glucocorticoids is associated with decreased food intake and a wasting of body flesh. Increased levels of glucocorticoids, on the other hand, produce a variety of truncal obesity. In animals with ventromedial hypothalamic lesions and obesity, adrenalectomy will reverse the obesity. In genetically obese rats and mice, adrenalectomy will attenuate the progression of the syndrome. These effects appear to be through a reduction of food intake, and an increase in energy expenditure. Injections of insulin will stimulate food intake and may lead to obesity.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Autonomic and endocrine factors in the regulation of food intake. 286 66

In this Fourth Ruth Langton Memorial Lecture, the author highlights some of the major health problems in children, mentally and physically handicapped people, and in the growing numbers of elderly people in society. Nurses' roles are discussed. He identifies many major areas of concern and points out that many of the afflictions affecting people throughout the world, such as infectious diseases, blindness and malnutrition, could so easily be prevented. The author also focuses on the diseases caused by unhealthy lifestyles, in particular heart disease, cancers, drug addiction and obesity. He argues that a redirection of resources spent on arms and defense could do much to alleviate disease and suffering throughout the world. He also questions the present effectiveness of nursing education programmes and community care programmes. The paper concludes with a challenge to all nurses to explode the myth that society is becoming healthier, to face the reality of the urgent need for more primary health care and health education programmes, and to heal the dichotomy between present nursing and health care provision and the actual health needs of society.
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PMID:Nursing and health care in the twentieth century: myth, reality and dichotomy. 294 Feb 78

Recent studies of vegetarian diets and their effects on morbidity and mortality are reviewed. Vegetarian diets are heterogeneous as are their effects on nutritional status, health, and longevity. Mortality rates are similar or lower for vegetarians than for nonvegetarians. Risks of dietary deficiency disease are increased on vegan but not on all vegetarian diets. Evidence for decreased risks for certain chronic degenerative diseases varies. Both vegetarian dietary and lifestyle practices are involved. Data are strong that vegetarians are at lesser risk for obesity, atonic constipation, lung cancer, and alcoholism. Evidence is good that risks for hypertension, coronary artery disease, type II diabetes, and gallstones are lower. Data are only fair to poor that risks of breast cancer, diverticular disease of the colon, colonic cancer, calcium kidney stones, osteoporosis, dental erosion, and dental caries are lower among vegetarians. Reduced risks for chronic degenerative diseases can also be achieved by manipulations of omnivorous diets and lifestyles.
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PMID:Health aspects of vegetarian diets. 304 2

The 1970s saw a revolution in the nutritional welfare of the suckling but half way through the 1980s we have yet to achieve the same success with the weanling. In the developing world the malnutrition/diarrhoea complex is a major threat to the weanling's life. Throughout the world rickets and iron deficiency are common problems. These three, protein-energy malnutrition/diarrhoea, rickets and iron deficiency anaemia are the major nutritional problems of the weanling but there are others e.g. zinc deficiency, allergy, obesity. As the weanling crosses the bridge from suckling to schoolchild he will eat the suckling's food, specially prepared weaning foods, and eventually "sensible" family foods. Beneath this bridge we need to erect a safety net of fortified foods ensuring an adequate supply of such nutrients as iron and vitamin D.
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PMID:Food for the weanling: the next priority in infant nutrition. 309 66

The immune system plays a key role in the body's ability to fight infection and reduce the risk of developing tumors, autoimmune and degenerative disease. Nutritional deficiencies and excesses influence various components of the immune system. Early studies investigating the association between nutrition and immunity focused on generalized protein-energy malnutrition, particularly in children in developing countries. The extent of immunological impairment depends not only on the severity of malnutrition but on the presence of infection and on the age of onset of nutritional deprivation, among other factors. In industrialized nations, immune function has been shown to be compromised in many malnourished hospitalized patients, small-for-gestational age infants, and the elderly. Obesity also may adversely influence immune function. Imbalances of single nutrients are relatively uncommon in humans, and investigations of protein and amino acids and specific vitamins, minerals, and trace elements generally are carried out in experimental animals. Deficiencies of protein and some amino acids, as well as vitamins A, E, B6 and folate, are associated with reduced immunocompetence. In contrast, excessive intake of fat, in particular polyunsaturated fatty acids (e.g. linoleic and arachidonic acids), iron, and vitamin E are immunosuppressive. Trace elements modulate immune responses through their critical role in enzyme activity. Both deficiency and excess of trace elements have been recognized. Although dietary requirements of most of these elements are met by a balanced diet, there are certain population groups and specific disease states which are likely to be associated with deficiency of one or more of these essential elements. The role of trace elements in maintenance of immune function and their causal role in secondary immunodeficiency is increasingly being recognized. There is growing research concerning the role of zinc, copper, selenium, and other elements in immunity and the mechanisms that underlie such roles. The problem of interaction of trace elements and immunity is a complex one because of the frequently associated other nutritional deficiencies, the presence of clinical or subclinical infections which in themselves have a significant effect on immunity, and finally the altered metabolism due to the underlying disease. There are many practical applications of our recently acquired knowledge regarding nutritional regulation of immunity.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Nutrition, immune response, and outcome. 309 56

Nine patients (4F, 5M) aged 12-17 years with "fear of obesity" were studied with a sequential stimulation test utilizing insulin, LRH, TRH, and L-dopa. The comparative groups were nine female with classic anorexia nervosa, five males with undifferentiated nutritional dwarfing, and nine children (1F, 8M) with constitutional growth delay. The serum TSH, glucose, cortisol, somatotropin, prolactin, LH, and FSH were sampled periodically over 2 hours. Basal T3, T4, transferrin, and Somatomedin-C levels were also obtained. The "fear of obesity" patients did not have any pituitary function changes that were unique. These patients, as well as the comparison groups, revealed a delayed TSH response in proportion to the weight deficit which, when expressed as an integrated response, correlated well to the weight deficit for height (P less than 0.001) and to the ability to recover from hypoglycemia (p less than 0.001). The Somatomedin-C level was low and correlated to the T3 level (p less than 0.05) and not correlated to the elevated Somatotropin levels. The pituitary response to combined stimulation in patients with fear of obesity was determined to be a component of the spectrum starting at normal and proceeding to the extreme undernutrition of anorexia nervosa. Pituitary responsiveness, therefore, changes not as a function of the etiology of the malnutrition, but simply as a function of its severity.
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PMID:Pituitary-hypothalamic response in adolescents with growth failure due to fear of obesity. 310 48


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