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Objective. To evaluate Health-Related Quality of Life (HRQoL), medication used, and Stock of Health Capital (SHC) in physically active elderly participants in Community Exercise Programs (CEPs) compared to a sedentary group. Methods. EuroQol standardized instrument was completed by physically active elderly (n = 2,185) who participated in CEPs. Common items were compared to HRQoL data of 1,874 sedentary elderly people, taken from the Catalan Health Survey 2006 (CHS'06). Visual Analogue Scale (VAS) outcomes and medication used were assessed through parametric statistics. Dimensions of health conditions were compared, between sedentary people and physically active elderly participants in CEPs. SHC results were obtained combining the EuroQol scores and Life Expectancy (LE) values. An economic value of €34,858.70 was assigned to these years of LE. Results. Physically active subjects had better HRQoL values (75.36 in males and 70.71 in females) than CHS'06 sedentary subjects (58.35 in males and 50.59 in females). Medication used was different between physically active subjects (1.89 in males and 2.87 in females) and CHS'06 sedentary subjects (4.34 in males and 4.21 in females). SHC data for physically active elderly (€465,988.31/QALY in males and €522,550.31/QALY in females) were higher than for CHS'06 sedentary subjects (€363,689.33/QALY in males and €346,615.91/QALY in females).

Introduction: This pre-experimental study analyses the Functional Capacity (FC), Body Mass Index (BMI), Health Related Quality of Life (HRQoL) and Health Capital Stock (HCS) of elderly people participating in a Walking program in Granollers (Barcelona)., Material and Methods: One hundred and seventy-three participants were invited to participate. One hundred and one of them were users of the Municipal Program for Elderly People, and 72 received information by the communication media. One hundred and thirty-one (76.3%) of the participants completed the Program. The intervention consisted of a 6-month program, supervised by a specialist instructor once a week and controlled daily by a pedometer. The 6-minute walk test (6MWT) was analysed for the FC, and the EuroQoL for the HRQoL. The preferences derived from the EuroQoL scores and the Life Expectancy were used to calculate the FC. The monetary data were obtained using a fixed value., Results: An increase in the average number of steps was observed after the program, especially in men. The results also showed a decrease in the BMI. The participants showed a improvement in overall health perception at the end of the program. The HCS scores confirmed the improvement in the HRQoL in men., Conclusions: The Program was positive for increasing the number of steps and improving physical condition and health. The usefulness of the pedometer as a motivational tool of physical exercise is discussed., (Copyright © 2010 SEGG. Published by Elsevier Espana. All rights reserved.)

Background: Intracranial subdural hematoma is an exceptionally rare complication of spinal anesthesia. We report a case of this infrequent event and consider the influence of cerebral atrophy as a predisposing factor., Methods and Results: This 18-year-old woman with severe headaches was admitted to the hospital 42 days after delivery. She had a history of normal pregnancy and uneventful labor and delivery. The epidural anesthesia was satisfactory. Computed tomography showed bilateral chronic subdural hematomas that were surgically removed. An early follow-up scan showed marked resolution of the hematomas and a small sized brain with large subarachnoid space. A late follow-up scan confirmed the diagnosis of brain atrophy., Conclusions: Persistence of headache and gradual progression despite treatment must be regarded as a sign of intracranial complication following spinal anesthesia. In this case, cerebral atrophy is considered to be a contributory factor for the development of subdural hematoma following dural puncture.

Algodystrophy is a common entity which may present in many clinical contexts. Its early diagnosis and therapy are of great prognostic interest. Apart from the typical complete forms there are some other atypical forms, such as partial knee algodystrophy, of difficult diagnosis. Its inclusion in the differential diagnosis of gonalgia occurring in patients attended under many medical specialties is therefore necessary. Two atypical cases of knee algodystrophy in its partial form are reported. One of these cases relapsed at the heterolateral knee after 18 months of the initial presentation; this second episode was also a partial form, a fact which we have not seen reported. The reported cases are here discussed and the scarce literature is reviewed, commenting on the difficulty of the early diagnosis compared with other entities which may mimic the clinical picture, radiological and scanning features of algodystrophy, such as aseptic osteonecrosis or stress fracture. The diagnostic algorithm is discussed, pointing to the usefulness of magnetic resonance (MR) in difficult cases to rule out other entities which would entail different therapeutic modalities.

While the regulations are revolutionary in their use of "substantial compliance," the interpretation and application of HCFA's new remedial scheme are still uncertain, as states are given broad discretion in defining important terms and in applying and interpreting the criteria to select remedies. Further complicating the issue is the fact that some states, including California, intend to seek waivers from HCFA to substitute their own state enforcement systems for most, if not all, of the new federal system. Based upon these uncertainties, the enforcement of nursing facility standards will likely be in a state of flux for some time to come.

As this article goes to press, it is nearly impossible to predict what sort of health reform plan will ultimately be passed, if any, and whether any form of long-term care coverage will be included. The need for such coverage will not, however, diminish with the close of the current congressional session and is likely to be a topic of debate for some time. The entire process of health reform legislation has been one of paring down initial hopes and expectations, and it may take many more years, until an even larger segment of our population is aged, before log-term care coverage becomes politically and fiscally desirable enough to withstand the political process.

The purpose of this study was to determine the blood lead levels (Pb-B) of urban pregnant women with low incomes and/or living in areas with heavily traveled roads, dilapidated housing, and industrial plants. We measured blood lead in 1,055 pregnant Minneapolis-area women at entry to prenatal care and in one-third of the sample during the second half of pregnancy. The mean Pb-B level of the first sample (n = 1,055) was 1.83 +/- 1.83 micrograms/dL; of the second sample (n = 375), 1.99 +/- 1.92 micrograms/dL. Only one woman had a Pb-B level greater than 12.0 micrograms/dL, which was the result of occupational exposure. The low lead levels found in this study indicate that it is not necessary to routinely screen pregnant women for elevated Pb-B levels in our geographic area. Rather, women should be screened via an environmental questionnaire to ascertain the risk of lead exposure.

A nutrition assessment survey was undertaken among 566 preschool children from randomly selected low income households located within an urban county. The purpose of the survey was to determine the prevalence of selected nutrition problems and to identify relationships among ethnic and economic variables and nutritional status. Underweight was identified in 1.8%, overweight in 15.4%, and short stature in 13.1% of children. Southeast Asian children had a higher prevalence of short stature than the other ethnic groups. Low hemoglobin values were identified in 4.3%, low hematocrit in 6.9%, and elevated erythrocyte protoporphyrin in 6.0% of children. The prevalence of elevated EP was significantly higher among Southeast Asian children than non-Southeast Asians and likely was due to iron deficiency. Results of the survey suggest that Southeast Asian children constitute the group at highest nutritional risk in the low income areas surveyed.

From 23 to 26 August 1982, a gastrointestinal illness occurred among 129 of 248 (52%) persons interviewed who had attended four social events in the Minneapolis-St. Paul area. The median incubation period was 36 hours, and symptoms included diarrhea, nausea, headache, and vomiting. Findings of a food-specific questionnaire given to attendants of the four events confirmed that consumption of cake and frosting was significantly associated with development of the illness (odds ratio, 7.9 to 48.3; p = 0.006 to 0.00001). All cake items were purchased from a single bakery, where the employee who had prepared the frosting had had onset of diarrhea and vomiting on August 20. Given an approximate 60% attack rate among persons who ate frosted items, we estimate that 3000 outbreak-associated cases occurred. Serologic analysis confirmed that 17 of 25 ill persons had fourfold or greater rises in their antibody titer to Norwalk virus. Thus, foodborne transmission of Norwalk virus can result from contamination by a single foodhandler.

This paper reports the findings of a national cost survey of 369 nonmilitary family practice graduate education programs in the United States, 1981-82. The purpose of the study was to develop a reliable revenue and cost information data base to enable an understanding of current family practice education costs and funding. The availability of this information will be of assistance in the development of future budgetary plans for family practice graduate education. The results presented are based on 147 programs associated with hospitals using a non-cost center accounting protocol. These programs provided 100 percent complete revenue and cost data (40 percent of the targeted programs). Major sources of income were hospital support (35 percent), patient income (31 percent), and public dollars (28 percent). The mean cost per accredited position was $57,471. Expenses, each at approximately one third of the total, were resident stipends, faculty salaries, and clinic expenses. Statistically significant differences were found only for source of income when program structure, program size, and geographic location were examined. Recommendations for future family practice funding include modification of present reimbursement formulas and other third-party payment mechanisms, increasing hospital support, maintenance of public subsidies, and development of a uniform system of monitoring and evaluating costs of residency programs operated under both cost center and non-cost center accounting protocols.

We review asymptomatic splenomegaly in Indochinese refugees and provide recommendations for evaluation of the problem. Prevalence of splenomegaly in newly arrived Indochinese refugees was 2.5%, three times more prevalent in the Hmong than in the non-Hmong refugees. Male Hmong refugees aged 15 to 29 years had the highest prevalence (10%). For the 50 Hmong refugees studied, there was no evidence that their splenomegaly was caused by clonorchiasis, schistosomiasis, tuberculosis, syphillis, lymphoma, tropical splenomegaly syndrome, or clinical malaria. Cases were more likely to have hepatomegaly, hepatitis B surface antigen positivity, and a low mean corpuscular volume than a reference population of Hmong refugees. Malaria antibody titers were elevated in all but one of the 41 cases (98%) tested.