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St. Vincent's Catholic Medical Centers of New York initiated a study in 2009 to assess the health needs of residents of New York City (NYC) municipal housing at the Robert Fulton public housing complex in Manhattan. The aim of this project was to provide valid data on perceived health services needs of the residents of a NYC housing project. These data may also be used to support hospital and community collaborative strategic decisions for developing resident-appropriate health and social services and would be valuable for use informulating policies and programs by other interested nonprofit health and social services organizations and government. We designed a 28-item instrument and pilot tested it with our research team and members of the population under study. The English and Spanish surveys were designed as an in person surveyor-administered instruments addressing four domains: demographics, access and barriers to health care services, risk behaviors, and perceived health needs. The sampling was an apartment-level strati led random sampling. A 20%, 188 apartment sample was drawn from the population of 944 housing units. Our response rate was 92% (173/188 apartments). Background. methods, and demographic results are reported in this article. A second article will report on the needs assessment results. [ABSTRACT FROM AUTHOR]

The article offers information on a comparative study on the health conditions of older and younger homeless persons in the U.S. It offers a chart review survey of homeless patients which testifies the high prevalence of chronic medical conditions of aged homeless than younger aged people. Moreover, it relates the health care reform legislation proposed by U.S. President Barack Obama to expand Medicaid in the country.

The authors surveyed former medical resident physicians who participated in long-term home health care program services during training. Forty-four physicians who had served in a home visit program were surveyed after an average of ten years since completion of medical training (range: 1 to 18 years). The majority of the 43 respondents (56%) make house calls in their current medical practices and most of the 36 now involved in medical house staff training (83%) incorporate their home care experience into their teaching today. Working at a home health care program can have educational value for medical residents, influence later practice, and result in personal and professional rewards. [ABSTRACT FROM PUBLISHER]

A large proportion of hospital stays stem from rapid readmission of elderly patients. These patients represent high cost users of inpatient care. Intervention in the hospital admission-readmission cycle may serve the interests of patients and payors alike Data collected through comprehensive geriatric assessment can be useful in identifying those patients at high risk of readmission and who might benefit from more intensive in-hospital or post hospital attention. However, risk factors for readmission are largely unknown. We conducted a prospective study of elderly patients admitted to a metropolitan teaching hospital medical service and assessed by a geriatric team, to increase our knowledge of the factors associated with hospital readmissions. The most powerful predictor of hospital readmission within 6 months proved to be prior hospitalization. Attempts to reduce rehospitalizations in elderly patients must focus on those with prior recent hospitalizations. [ABSTRACT FROM PUBLISHER]

Objectives: To examine the clinical utility of prehospital code status discussions in a nursing home (NH) setting and the health care outcomes of the decisions made. Also to identify patient factors and other variables associated with these decisions., Design: Retrospective uncontrolled observational study carried out through record review., Setting: A single skilled-level teaching NH and its affiliated university hospital., Patients: All of the 350 individuals who resided at the NH during a 2-year period., Main Results: Code status decisions were routinely sought through discussion involving primary care physician/social worker teams and residents or surrogates of demented patients. Choices were made for 80% of the NH residents, most (73%) by surrogates and most (80%) for do-not-resuscitate (DNR) orders, usually within 10 weeks of NH admission. Neither short-term measures of NH care intensity nor hospital use changed after a DNR decision. Most (80%) hospital transfer records included code status documentation. At the NH, both the likelihood of decisions and their directions were associated with involvement by specific physician/social worker teams. Additionally, a dementia diagnosis, white race, and older age were associated with a nursing home DNR decision. At the hospital, a DNR order was associated with white race, the presence of nursing home DNR documentation in the transfer records, hospital attending care by certain NH physicians, and a terminal hospital stay. Hospital inpatient medical and surgical therapy use, except for intensive care procedures, was similar for DNR and non-DNR inpatients. Residents with DNR orders had a higher mortality rate, yet most survived at least 1 year after the order. In the short term, a DNR order had no impact on measured health care resource consumption, but, for those in the final months of life, in-patient hospital use was less for the DNR group, and most of these died at the nursing home., Conclusions: Prehospital code status decisions can be made effectively within the NH setting. Outside of medical intensive care, DNR orders have no impact on NH and hospital care intensity in the short term. In the final 6 months of life, however, hospital use is less for the DNR subgroup.

Background: Engaging older persons in consideration of use of life-sustaining measures, such as cardiopulmonary resuscitation, tube feeding, and urgent intubation, is widely recommended, yet uncommon., Methods: We studied the short-term impact of a physician-initiated discussion, geared toward guiding informed decision-making, with 20 frail elderly homebound patients. A battery of psychologic rating scales was administered in a pre-post design. Eighteen subjects completed the protocol. Fifteen of the mentally capable surviving subjects were reinterviewed 18 months following the initial discussion to evaluate durability of their decisions., Results: Most welcomed the discussion and clear choices regarding future care usually emerged. Depression rating scales decreased slightly for the entire sample. For the subgroup having relatively internal locus of control, there was an increase in life satisfaction scores. No patient demonstrated signs of emotional trauma consequent to the discussion. On follow-up, several patients were indecisive about their choices., Conclusion: Involvement of these patients in decision-making appeared to have no adverse effects, and, for some, it was therapeutic, possibly through enhancement of personal control. Durability of their decisions was not a consistent finding, however.

Examination of 700 northern bobwhites (Colinus virginianus), 50 each February from 1971 through 1984, from Tall Timbers Research Station, Leon County, Florida, disclosed 15 species of helminth parasites. Nine species (Raillietina cesticillus, R. colinia, Aproctella stoddardi, Cheilospirura spinosa, Cyrnea colini, Dispharynx nasuta, Heterakis isolonche, Tetrameres pattersoni, and Trichostrongylus tenuis) generally were found on an annual basis and were considered characteristic components of the helminth fauna. Infrequently found species were Brachylecithum nanum, Rhabdometra odiosa, Capillaria sp., Gongylonema ingluvicola, H. gallinarum, and Oxyspirura matogrosensis. Intensities of C. colini and H. isolonche differed among host sex and age classes, and prevalences and/or intensities of A. stoddardi, C. spinosa, T. pattersoni, and T. tenuis differed between host age classes. Prevalences and/or abundances of seven species (R. cesticillus, R. colinia, C. spinosa, C. colini, H. isolonche, T. pattersoni, and T. tenuis) varied with bobwhite density, apparently because bobwhites were either the primary or only definitive host on the area. Two species (A. stoddardi and D. nasuta) did not vary with bobwhite density, apparently due to the buffering effect of a broad range of definitive hosts on the area. Prevalences and/or intensities of R. colinia, C. spinosa, and T. tenuis differed with agricultural fields status (cultivated versus fallow) suggesting that land use and its attendant habitat changes influenced transmission of these species. The occurrence of C. spinosa and T. pattersoni in individual bobwhites was not independent and was attributed to utilization of the same species of grasshoppers as intermediate hosts. Localized tissue damage and inflammation were associated with A. stoddardi, D. nasuta, C. spinosa, C. colini and T. pattersoni. Decreases in body weight in juvenile bobwhites were associated with increasing intensities of H. isolonche and T. tenuis. The observed relationships to bobwhite density and other variables are discussed with regard to known aspects of life histories of the nine most common species.

Helminthologic examination of 120 adult and 65 juvenile bobwhites (Colinus virginianus) from Leon County, Florida, during a one-year period revealed seven common (> 30% prevalence) species including Raillietina cesticillus, R. colinia, Cheilospirura spinosa, Cyrnea colini, Heterakis bonasae, Tetrameres pattersoni, and Trichostrongylus tenuis. Less frequently found helminths included Hymenolepis sp., Rhabdometra odiosa, Mediorhynchus papillosis, Aproctella stoddardi, Dispharynx nasuta, Gongylonema ingluvicola, Strongyloides avium, and Subulura sp. Juvenile bobwhites had acquired infections of 6 of the 7 common helminths by July and all seven species by August. A shift from a predominance of immature to mature parasites was noted with increasing age of juvenile bobwhites followed both linear and non-linear (plateau effect) trends when compared to age of the host. By mid-winter total helminth burdens of juvenile birds approached levels in adults. Cheilospirura spinosa, C. colini and T. pattersoni showed marked peaks in transmission between June and September. The two cecal nematodes, H. bonasae and T. tenuis, showed seasonal shifts in relative abundance with H. bonasae predominating during the summer and T. tenuis predominating during the winter. Lesions attributable to helminths were rare and involved minimal tissue damage.

Screening of newborn infants could provide information needed to evaluate the effects of early treatment on the course and prognosis of cystic fibrosis (CF). Two procedures of screening meconium for CF were compared: increased albumin levels, detected by a commercial test strip; and increased lactase activity, detected by glucose production after incubation of meconium with lactose. Specimens positive by the lactase test were retested for albumin. Low-birth-weight infants accounted for more than half the positive test results with both procedures. Sweat chloride measurements were carried out only on infants whose meconium specimens had albumin concentration greater than 12 mg/g (wet weight), measured by radial immunodiffusion. Twelve infants with CF were identified through screening, six while testing 44,816 specimens by lactase activity test. Three additional infants with CF were missed because meconium specimens were negative to both tests.

An outbreak of avian pox, with an estimated 12-fold increase in the incidence of infection, occurred among wild bobwhites (Colinus virginianus) in the southwestern Georgia/northcentral Florida region. The outbreak was first detected in July, 1978, and continued at least until March, 1979. During this period, 26 separate clinical case accessions involving 43 bobwhites from 8 counties in Florida and Georgia were diagnosed as avian pox. A survey of 2,586 bobwhites from 6 southeastern states revealed avian pox infections in 312 bobwhites from Florida, Georgia, North Carolina, and Tennessee. Seventy-seven percent of the infected birds in the survey had only mild lesions on the legs and feet; however, 23% had more extensive lesions on the head. Severely affected birds had lesions around the eyes, nares, and in the mouth which impaired vision, respiration, and/or feeding. Infection rates were not related to age or sex of the birds but varied greatly among locales, even on adjoining properties. A morbidity rate of approximately 2% and a mortality rate between 0.6 and 1.2% were estimated for a 13,000 km2 region in Georgia and Florida.

St. Vincent's Hospital and Medical Center of New York has been caring for homebound frail elderly persons since 1973 through a comprehensive network of professional, paraprofessional, and community services that allows many older persons to remain in their homes and communities and avoid institutionalization. The staff consists of physician-nurse-social worker teams that bring to each patient their individual skills as professional practitioners. In addition, working together, they create and attempt to carry out a complete, flexible plan of care. The Chelsea-Village Program (CVP) is open to all persons who the team believes are capable of being maintained independently or who can obtain the necessary additional support of family, friends, or neighbors. The patients, whose average age is 83, are homebound due to orthopedic disorders, arthritis, stroke, chronic cardiac and pulmonary disease, or generalized debility and weakness. St. Vincent's and donations from foundations and individuals fund the program, which is free of charge to its patients. In 1988 about 10 physicians, some in private practice, participated during a typical month; subspecialists have made themselves available; and resident physicians share in the work. The staff has come to understand that human beings are most fulfilled when they are able to use their personal resources in independence and that they must ask the patients for their own definitions of life's goals and serve them as they seek those goals.

The relationships of familial hypertension and height, weight, and blood pressure (BP) were studied in two adolescent populations. Subjects having hypertensive first-degree relatives were matched to control subjects without such a family history. The group with familial hypertension demonstrated a slightly higher average BP but also had a greater mean body weight and ponderal index than the control group. After controlling for weight, male but not female subjects with a family history of hypertension had a greater prevalence of elevated BP and higher average pressures than controls. The factors of above-average weight and familial hypertension appear to interact so as to produce an excessive prevalence of elevated BP. These trends suggest that teenagers with hypertensive first-degree relatives constitute a special risk group that should be closely monitored.

Bile acid malabsorption in cystic fibrosis reduces intraluminal bile acid concentration and may impair fat absorption. The cause of this malabsorption is unknown but it is believed due to intraluminal inhibition of uptake by undigested dietary nutrients. The purpose of this study was to determine the bile acid absorptive capability of cystic fibrosis intestine in a physiologic environment. Direct ileal mucosal taurocholic acid uptake was examined in vitro in seven patients with cystic fibrosis, and seven children and adolescents with ileostomies as controls. Jejunal uptake was studied in five normal individuals. A Crosby-Kugler biopsy capsule was used to obtain all tissues. Tissue was incubated in Krebs buffer, 10 mM glucose, and taurocholic acid at 0.1, 1.0 and 10.0 mM with shaking at 37 degrees C. Significant reduction of taurocholic acid uptake was present in every cystic fibrosis patient with mean uptake rates being 24%, 38%, and 29% of control ileum, respectively, at the three concentrations. Values paralleled those for passive jejunal taurocholic acid uptake in controls. These data illustrate a marked reduction in taurocholic acid uptake capability of cystic fibrosis ileal mucosa and may indicate a cellular defect suggestive of a primary lesion in this disease.

Helminth infections among free-ranging, intermingling populations of white-tailed deer (Odocoileus virginianus), cattle (Bos taurus), and swine (Sus scrofa) on an island off the Georgia coast were studied. Of 39 species of helminths collected, 19 were found in deer, 17 in cattle, and 13 in swine. Of 28 species of helminths recovered from ruminants, 8, viz, Capillaria bovis, Cooperia punctata, Dictyocaulus viviparus, Gongylonema pulchrum, G verrucosum, Haemonchus contortus, Moniezia benedeni, and Trichostrongylus axei, occurred in both deer and cattle. Common liver flukes (Fasciola hepatica) infected cattle and swine but not deer. Only 1 helminth, G pulchrum, infected deer, cattle, and swine. The findings suggested that helminths harbored by the host species are distinct, with little exchange occurring.

Immunoglobulin E antibodies to Psuedomonas aeruginosa were demonstrated in patients with cystic fibrosis colonized with the bacterium.

Assessment of nutritional status of patients with cystic fibrosis of the pancreas (CFP) showed that poor growth was associated with low concentrations of albumin, urea nitrogen, and cholesterol in serum and with elevated white blood cell (WBC) counts. Patients with CFP maintained weight approximately 1 standard deviation below the mean until 8 years, after which there was a progressive decline in growth rate compared to normal. A complete dietary supplement consisting of a beef serum hydrolysate, a glucose polymer, and medium-chain triglycerides was given to 15 patients for a year. Patients who received the diet showed significant gains in weight, significant increase in clinical score, significant increase in serum albumin level, and a significant drop in the WBC count compared to control patients who did not receive the supplement.

Twenty-one species of ectoparasites representing 19 genera were collected from 481 bobwhite quail (Colinus virginianus) from nine areas in four southeastern states. Sixteen species, Amblyomma americanum, Haemaphysalis chordeilis, Haemaphysalis leporispalustris, Eutrombicula alfreddugesi alfreddugesi, Neoschoengastia americana, Boydaia colini, Pterolichus sp., Colinophilus wilsoni, Megninia sp., Apionacarus wilsoni, Colinoptes cubanensis, Menacanthus pricei, Colinicola numidiana, Gonoides ortygis and Oxylipeurus clavatus were previously known from bobwhites, whereas five species, Ixodes minor, Neotrombicula whartoni, Dermoglyphus sp., Microlichus sp. and Rivoltasia sp. (near coturnicola) represented new host-parasite associations. Data are presented giving prevalence, geographic location, host age and numbers of quail infested with each species. Significant lesions were not associated with any species.

An investigation of the pulmonary fibrinolytic enzyme system in 31 infants who died with hyaline membrane formation was reviewed. There was complete lack of plasminogen activator activity in the lungs of 84 per cent of these infants. This phenomenon was shown to result from an abnormal inhibitor. A comparable inhibitor was found in normal placental tissue, and it is postulated that this inhibitor is released into the circulating blood as the result of placental infarction. Fibrin, a basic component of the hyaline membrane, is probably precipitated from a physiological capillary transudate associated with the formation of amniotic fluid by the lungs. The presence of an inhibitor of fibrinolysis would then result in the accumulation of intrapulmonary fibrin and the formation of hyaline membranes.