286 research outputs found
An Exploration of the Baby Boomer Crisis
No full textThe baby boomer demographic, approximately 74 million Americans, will be eligible to enroll in Medicare by 2030. This large older adult population is expected to place high demand on the already strained United States healthcare system. With more chronic conditions and higher rates of disability the impact of this impending crisis will be both complicated and costly. Hospital capacity has been decreasing in recent years in contrast to the increase in technology advancements in healthcare. Supporting baby boomers’ independence will be a crucial part of the overall solution. The personnel shortage must also be addressed when considering the supply side of the equation. Above all, the effect on Medicare must be explored as costs are expected to increase and the program’s strength will be impacted due to the large beneficiary increase.
This paper examines various perspectives and subtopics that affect the problem. A multipronged approach will be needed to find innovative solutions to support the health and wellness of older adults. Healthcare industry leaders, public health experts, and policymakers need to create a strategy to confront the upcoming challenge or baby boomers are not going to receive the quality care they have come to expect. The Covid-19 pandemic has contributed to the changing healthcare landscape and the consequences of it will also need to be carefully considered when contemplating solutions. Overall, this complex issue is going need all hands-on deck to ensure a healthy future for this adult population and the healthcare system
Cardiovascular risk in patients without known cardiovascular disease
No full textUnderstanding the risks of atherosclerotic cardiovascular disease (CVD) allows for better patient education and management. Multiple risk models have been validated in large patient populations and provide insights into the risks associated with CVD. When assessing such risks, we suggest using a model that predicts myocardial infarction, cardiovascular death, and/or cerebrovascular events. In this review, we analyze several risk models and stratify the risks associated with CVD. We suggest that appropriate profiling of patients at-risk of CVD will lead to better physician recognition and treatment of modifiable risk factors, appropriate application of ATP III treatment for hyperlipidemia, and achieving optimal blood pressure control.Understanding the risks of atherosclerotic cardiovascular disease (CVD) allows for better patient education and management. Multiple risk models have been validated in large patient populations and provide insights into the risks associated with CVD. When assessing such risks, we suggest using a model that predicts myocardial infarction, cardiovascular death, and/or cerebrovascular events. In this review, we analyze several risk models and stratify the risks associated with CVD. We suggest that appropriate profiling of patients at-risk of CVD will lead to better physician recognition and treatment of modifiable risk factors, appropriate application of ATP III treatment for hyperlipidemia, and achieving optimal blood pressure control
Ischemic Conditioning Increases Strength and Volitional Activation of Paretic Muscle in Chronic Stroke: A Pilot Study
No full textIschemic conditioning (IC) on the arm or leg has emerged as an intervention to improve strength and performance in healthy populations, but the effects on neurologic populations are unknown. The purpose of this study was to quantify the effects of a single session of IC on knee extensor strength and muscle activation in chronic stroke survivors. Maximal knee extensor torque measurements and surface EMG were quantified in 10 chronic stroke survivors (>1 year post-stroke) with hemiparesis before and after a single session of IC or Sham on the paretic leg. IC consisted of five minutes of compression with a proximal thigh cuff (inflation pressure = 225 mmHg for IC or 25 mmHg for Sham) followed by five minutes of rest. This was repeated five times. Maximal knee extensor strength, EMG magnitude, and motor unit firing behavior were measured before and immediately after IC or Sham. IC increased paretic leg strength by 10.6plus minus8.5 Nm while no difference was observed in the Sham group (change in Sham = 1.3plus minus2.9 Nm; p = 0.001 IC vs. Sham). IC-induced increases in strength were accompanied by a 31plus minus15% increase in the magnitude of muscle EMG during maximal contractions and a 5% decrease in motor unit recruitment thresholds during sub-maximal contractions. Individuals who had the most asymmetry in strength between their paretic and non-paretic legs had the largest increases in strength (r2= 0.54). This study provides evidence that a single session of IC can increase strength through improved muscle activation in chronic stroke survivors
Developing the SHRS Wellness Pavilion: Strengthening Communities through Health & Wellness Promotion
No full textThe SHRS Wellness Pavilion is a student-led space at the University of Pittsburgh, Homewood Community Engagement Center. The Wellness Pavilion aims to provide free services/programs to improve, promote and maintain our guests’ health and wellness through the use of evidence-based practices, interprofessional collaborations, person-centered approaches to care and community partnerships
Clinical effects of long-term cardiac contractility modulation (CCM) in subjects with heart failure caused by left ventricular systolic dysfunction
No full textINTRODUCTION: Heart failure is a major cause of morbidity and mortality throughout the world. Despite advances in therapy, nearly half of patients receiving guideline-directed medical therapy remain limited by symptoms. Cardiac contractility modulation (CCM) can improve symptoms in this population, but efficacy and safety in prospective studies has been limited to 12 months of follow-up. We report on the first 2 year multi-site evaluation of CCM in patients with heart failure. METHODS: One hundred and forty-three subjects with heart failure and reduced ejection fraction were followed via clinical registry for 24 months recording NYHA class, MLWHFQ score, 6 min walk distance, LVEF, and peak VO2 at baseline and 6 month intervals as clinically indicated. Serious adverse events, and all cause as well as cardiovascular mortality were recorded. Data are presented stratified by LVEF (all subjects, LVEF <35%, LVEF ≥35%). RESULTS: One hundred and six subjects from 24 sites completed the 24 month follow-up. Baseline parameters were similar among LVEF groups. NYHA and MLWHFQ improved in all 3 groups at each time point. LVEF in the entire cohort improved 2.5, 2.9, 5.0, and 4.9% at 6, 12, 18, and 24 months, respectively. Insufficient numbers of subjects had follow-up data for 6 min walk or peak VO2 assessment, precluding comparative analysis. Serious adverse events (n = 193) were observed in 91 subjects and similarly distributed between groups with LVEF <35% and LVEF ≥35%, and similar to other device trials for heart failure. Eighteen deaths (7 cardiovascularly related) over 2 years. Overall survival at 2 years was 86.4% (95% confidence intervals: 79.3, 91.2%). CONCLUSION: Cardiac contractility modulation provides safe and effective long-term symptomatic and functional improvement in heart failure. These benefits were independent of baseline LVEF and were associated with a safety profile similar to published device trials
Pneumonias comunitárias: estudo de oitenta e um casos.
No full textTrabalho de Conclusão de Curso - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Departamento de Clínica Médica, Curso de Medicina, Florianópolis, 199
The Relationship Between Blood Flow and Motor Unit Firing Rates in Response to Fatiguing Exercise Post-stroke
No full textWe quantified the relationship between the change in post-contraction blood flow with motor unit firing rates and metrics of fatigue during intermittent, sub-maximal fatiguing contractions of the knee extensor muscles after stroke. Ten chronic stroke survivors (>1-year post-stroke) and nine controls participated. Throughout fatiguing contractions, the discharge timings of individual motor units were identified by decomposition of high-density surface EMG signals. After five consecutive contractions, a blood flow measurement through the femoral artery was obtained using an ultrasound machine and probe designed for vascular measurements. There was a greater increase of motor unit firing rates from the beginning of the fatigue protocol to the end of the fatigue protocol for the control group compared to the stroke group (14.97 ± 3.78% vs. 1.99 ± 11.90%, p = 0.023). While blood flow increased with fatigue for both groups (p = 0.003), the magnitude of post-contraction blood flow was significantly greater for the control group compared to the stroke group (p = 0.004). We found that despite the lower magnitude of muscle perfusion through the femoral artery in the stroke group, blood flow has a greater impact on peripheral fatigue for the control group; however, we observed a significant correlation between change in blood flow and motor unit firing rate modulation (r2 = 0.654, p = 0.004) during fatigue in the stroke group and not the control group (r2 = 0.024, p < 0.768). Taken together, this data showed a disruption between motor unit firing rates and post-contraction blood flow in the stroke group, suggesting that there may be a disruption to common inputs to both the reticular system and the corticospinal tract. This study provides novel insights in the relationship between the hyperemic response to exercise and motor unit firing behavior for post-stroke force production and may provide new approaches for recovery by improving both blood flow and muscle activation simultaneously
Characterization of a gp130 Signaling Receptor Polymorphism
No full textWe previously reported an association between human herpesvirus 8 (HHV-8) seroprevalence and increased prostate cancer risk among men on the Caribbean island of Tobago. More recently, we have found a single nucleotide polymorphism (SNP) in the IL-6 gp130 signaling receptor at position 148 associated with increased prostate cancer risk among HHV-8 seropositive men. The high risk genotype (Gly) was associated with increased prostate cancer risk among HHV-8 seropositive men (OR= 3.1) compared to the low risk genotype (Arg). This research aims to further explore the effect of this SNP on gp130 function.
The gp130 genotype at position 148 was determined in lymphoblastoid B cell lines (LCLs) derived from Tobago men (representing high and low risk genotypes) and two prostate cancer cell lines (PC3 and DU 145; high risk and low risk respectively). Growth curves were performed by Dr. Jill Henning for LCLs by using 25ng/mL of Interleukin-6 (IL-6), Interleukin-11 (IL-11), or Oncostatin M (OSM). It was discovered that IL-6 had an effect on the growth of LCLs, but IL-11 and OSM did not. I repeated growth curves on LCLs using a concentration of 10ng/mL, and found that there was still a difference in growth at this lower concentration. Levels of phosphorylated STAT3 were measured on cells treated with 10 or 100ng/mL IL-6, IL-11, or OSM for various times (2-60 minutes). Comparative IL-6-mediated downstream signaling between the two genotypes was analyzed in LCLs at 10 minutes post-treatment using the JAK/STAT Pathway PCR Array Plates (SABiosciences, Valencia, CA), and the Human IL-6 Pathway PCR Array Plates (Life Technologies, Grand Island, NY).
LCLs homozygous for the high-risk gp130 genotype grew significantly faster compared to LCLs homozygous for the low-risk genotype in response to IL-6 but not IL-11 or OSM. LCLs homozygous for both high-risk gp130 genotype as well as LCLs homozygous for the low-risk genotype both showed activation of STAT3 in response to IL-6 by 10 minutes post-treatment. DU 145 (low-risk genotype) cells showed STAT3 activation following IL-6 treatment while PC3 (high-risk genotype) failed to show any STAT3 activation even after 1hr of IL-6 treatment. Both cell lines showed STAT3 activation after OSM treatment while neither line showed activation following IL-11 treatment. RT-PCR analyses of JAK/STAT pathway genes and IL-6 pathway genes in LCLs following IL-6 treatment showed differential gene regulation between genotypes. For example, using the IL-6 pathway plates, the high-risk genotype showed a down-regulation of TP53BP2 (apoptosis stimulating protein of p53-2), while the low-risk genotype showed an up-regulation of this gene. This protein is known to inhibit cell growth and stimulate apoptosis, and is frequently suppressed in human cancers. This differential gene regulation of TP53BP2 is one example of a gene that is differentially regulated between the high- and low-risk genotypes. These data suggest that the G148R SNP of gp130 is involved in cell proliferation mediated by IL-6 downstream signaling.
The public health relevance observed by these results suggests that the resulting genotypes in the G148R polymorphism exhibit different biological affects upon treatment with cytokines that utilize the gp130 signaling receptor. The high-risk genotype could result in an increase in inflammation, which could ultimately contribute to the development or advancement of prostate cancer
Cardiac contractility modulation improves long‐term survival and hospitalizations in heart failure with reduced ejection fraction
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