1/11. The Mt. Tyndall incident.The authors describe the 53-hour rescue of a 6-foot, 1-inch tall, 250-pound hiker in the face of harsh environmental conditions in sequoia National Park. This 43-year-old man fell 25 feet, injured his leg, and was noted to be hypothermic and hypovolemic. weather, altitude, and the patient's size delayed and complicated his evacuation. After being carried down 1,500 vertical feet, he was hoisted into a hovering helicopter and flown to University Medical Center in Fresno, california. On arrival, the patient was determined to have a comminuted subtrochanteric right femur fracture, which was ultimately repaired surgically. The authors also discuss some of the unique aspects of wilderness and National Park Service EMS.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
2/11. Causes of insulin resistance in childhood.The increasing incidence of type 2 diabetes worldwide is causing concern. Genetic and environmental influences have been put forward to explain the origins of this disease, but perhaps the most convincing contributory factor is high body weight. The authors review the literature on the subject to identify some of the predisposing factors influencing healthcare practitioners' concerns about the issue.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
3/11. Psychological aspects of diabetes mellitus.diabetes mellitus (DM) presents itself in two forms: insulin-dependent (type 1 DM) and non-insulin-dependent (type 2 DM). Although type 2 DM usually has an adult onset, in recent years there has been a significant rise in the number of children diagnosed with type 2 DM in the united states. Reasons for this increased frequency are believed to be a larger percentage of children who are overweight, a family history of diabetes, and a considerable increase in the use of psychotropic medication in children. The diagnosis of DM is a significant stressor not only for patients but also for their environment. Children with DM are sometimes stigmatized by their peers and relatives who do not understand the illness or are frightened by it. Some children also may need to alter several of their customary routines and are often scared to participate in activities in which they were previously engaged. The family's response to the diagnosis of DM may have a negative effect on glycemic control. Differences have been found in the way patients with type 1 DM and type 2 DM cope with and adapt to their diagnosis.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
4/11. Mirror image of environmental deprivation: severe childhood obesity of psychosocial origin.We report 12 children with severe obesity in very early childhood who had no evidence of organic causes for their obesity and whose families evidenced psychosocial dysfunction comparable to that often seen in growth failure of psychosocial origin. Features seen include family disorganization, separation of mother and child, displacement of child care to others, maternal depression, denial of the growth abnormality, hostility towards health care providers, and inconsistent medical follow-up. In all cases, parental limit setting was impaired. We suggest that this condition should be called "severe obesity of psychosocial origin." Very severe obesity of early childhood may be conceptualized as the mirror image of growth failure. Like growth failure, it requires evaluation and management focused on psychosocial issues. research is needed to clarify the prevalence, diagnostic features, and optimal treatment of obesity of psychosocial origin.- - - - - - - - - - ranking = 4keywords = environment (Clic here for more details about this article) |
5/11. Investigation of a fatal heatstroke.On June 30, 1981, a young, apparently healthy, obese white male suffered a fatal heatstroke. This was the beginning of summer in southern ohio, when mid-day temperatures can reach into the 30s degrees C (90s degrees F) and the humidity can climb above 70%. The predisposition of the individual in terms of acclimatization, physical size and dietary intake, along with strong motivation to perform well on a job requiring a heavy workload in a hot environment, pushed him beyond his physiologic capacity. Of those people who attended him, only professional rescue personnel recognized the illness and properly treated the man. The death may have prevented by acclimatization and training as to the hazards, recognition and treatment of heat illness.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
6/11. Total parenteral nutrition in pregnancy.Total parenteral nutrition has been used infrequently during pregnancy. Because of the special nutritional needs and hormonal environment of the maternal-fetal unit, there is uncertainty as to the optimal composition and quantity of total parenteral nutrition therapy. In this report two important questions are examined: whether or not a protein replacement commonly used in total parenteral nutrition provides adequate levels of essential amino acids to fetus and mother, and whether or not the daily use of fat emulsion as part of total parenteral nutrition is associated with unwanted side effects. The authors' data suggest that certain adjustments have to be made in the quantity and composition of total parenteral nutrition constituents to provide the necessary nutritional requirements for metabolic and anabolic needs without increasing the overall risk for complications.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
7/11. Reduction of food theft and long-term maintenance of weight loss in a Prader-Willi adult.Behavioral interventions have had limited success in managing the chronic hyperphagia and obesity that are of presumed organic etiology in prader-willi syndrome. Thus, frequent foraging for food and covert consumption continue to be health-threatening problems for many Prader-Willi individuals. This case study was designed to replicate methods for assessment and treatment of food theft. A token program based on differential-reinforcement-of-other-behavior and response-cost eliminated theft in three hospital settings. Prior to discharge, the program was expanded to include contingencies on exercise behavior and weight loss, and staff from the subject's group home residence were trained to implement a modified program in the natural environment. Reduced food theft and continued weight loss were maintained in the group home and an apartment-living arrangement. A total of 81 lb (37 kg) was lost during a 2-yr period.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
8/11. The variable effect of posterior urethral valves as illustrated in identical twins.To our knowledge, we report the second instance of posterior urethral valves in identical twin boys. Initial symptoms, age at presentation and radiographic findings were different in each boy, and reflect the varying nature of this congenital anomaly. Although the brothers are identical twins from the same environment with identical Rh and ABO blood groupings and identical HLA haplotypes, developmental differences have been marked.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
9/11. Extrinsic allergic alveolitis in a sawmill worker. A case report.Extrinsic allergic alveolitis, with acute attacks of the disease, developed in a sawmill worker. The diagnosis was based on the history of exposure to moldy wood, on the symptoms and clinical signs, and on physiological and radiographic findings. A microbiological analysis of the ambient air of the patient's work environment showed that the air contained a considerable number of spores, both of fungi and actinomycetes. The most common fungal genus was Aspergillus. thermoactinomyces vulgaris predominated the actinomycetal flora. The patient's serum contained precipitins to thermoactinomyces vulgaris and aspergillus fumigatus. Based on the microbiological and serological data, it was concluded that the causative agent(s) of the disease was either T vulgaris or species of the genus Aspergillus.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
10/11. Dietary treatment and growth of hyperchylomicronemic children severely restricted in dietary fat.OBJECTIVE--We followed the clinical course of four patients with type I hyperlipidemia from two kindreds who presented at an early age. patients--Two propositi presented with severe abdominal pain and bloody diarrhea at 8 and 10 weeks of age. They also exhibited delayed growth. We compared their course with that of two siblings (one sibling of each proband) who also have familial hyperchylomicronemia but were diagnosed and have subsequently shown normal growth. MAIN RESULTS--Although each sibling pair possesses the same lipoprotein lipase gene defect and resides in a similar environment, significant differences in stature are apparent. CONCLUSION--Specific structural defects in the lipoprotein lipase gene alone do not define phenotypic presentation. However, severity of clinical presentation may influence future growth characteristics.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
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