Medicine and Health Sciences Commons^™

Alcohol And Environmental Justice: The Density Of Liquor Stores And Bars In Urban Neighborhoods In The United States, John Romley, Deborah Cohen, Jeanne Ringel, Roland Sturm

Roland Sturm

Objective: This study had two purposes: (1) to characterize the density of liquor stores and bars that individuals face according to race, economic status, and age in the urban United States and (2) to assess alternative measures of retailer density based on the road network and population. Method: We used census data on business counts and sociodemographic characteristics to compute the densities facing individuals in 9,361 urban zip codes. Results: Blacks face higher densities of liquor stores than do whites. The density of liquor stores is greater among nonwhites in lower-income areas than among whites in lower- and higher-income areas …

Identifying Methods Nurse Managers Can Implement To Foster A Supportive Environment For Staff Where Disruptive Behavior Exists, Kathleen Leavitt

Critical and Creative Thinking Capstones Collection

We can all imagine the ideal work environment, where you are respected, empowered, and provided with the resources to perform to the best of your ability everyday. Your skills would be acknowledged and the challenging work that is accomplished each day would be appreciated by peers, team members, and managers. However, in my work environment, an operating room, a phenomenon called "disruptive behavior" often interrupts the ability of achieving this desired state. Initially I was focused on this behavior being displayed by physicians but was awakened to the fact that they are not the only offenders and that many caregivers …

Illness Stories: From Recognizing The Significance In Care To Planning My Own Storied Practice, Jane Lachance

Critical and Creative Thinking Capstones Collection

In this paper, stories of illness are identified as belonging to a specific genre of story that represents an ill person's interpretation of experience and hence the meaning(s) of illness. The ill person is recognized as member of a family embedded in a social setting with cultural mores that contribute to experience and meanings. The meaning of illness is significant because it affects the care of illness. This paper focuses on chronic illness, an illness without cure that is managed over a lifetime and is characterized by remission and exacerbation of symptoms. Our current bio-medical health care system reframes the …

Annual Report, 2006-2007, David B. Nash

College of Population Health Annual Reports

No abstract provided.

A Psuedo-Mass Of Shoulder Girdle Due To Spinal Accessory Nerve Injury After Neck Lymph Node Biopsy: A Casereport, Yen-Nung Lin, Jing-Hwa Wey, Mei-Chun Huang, Kwang-Hwa Chang, Chun-Chieh Chiu

Rehabilitation Practice and Science

Shoulder problems such as pain, weakness, limited range of motion and palpable mass are common complaints in PM&R clinic. This casereport describes a less common but not rare condition: iatrogenic accessory nerve injury after neck lymph node biopsy. The patient in this study presented symptoms of shoulder girdle pain and weakness and also complained of a ”hard palpated mass” over her shoulder girdle.A 49-year-old female complained of gradually worsening left shoulder pain accompanied by weakness and limited range of motion in her left shoulder for many months. She had sought medical advice for many times and rotator cuff pathology was …

A Novel Runx2 Missense Mutation Predicted To Disrupt Dna Binding Causes Cleidocranial Dysplasia In A Large Chinese Family With Hyperplastic Nails, Shaohua Tang, Qiyu Xu, Xueqin Xu, Jicheng Du, Xuemei Yang, Yusheng Jiang, Xiaoqin Wang, Nancy Speck, Taosheng Huang

Dartmouth Scholarship

Background: Cleidocranial dysplasia (CCD) is a dominantly inherited disease characterized by hypoplastic or absent clavicles, large fontanels, dental dysplasia, and delayed skeletal development. The purpose of this study is to investigate the genetic basis of Chinese family with CCD.

Methods: Here, a large Chinese family with CCD and hyperplastic nails was recruited. The clinical features displayed a significant intrafamilial variation. We sequenced the coding region of the RUNX2 gene for the mutation and phenotype analysis.

Results: The family carries a c.T407C (p.L136P) mutation in the DNA- and CBFβ-binding Runt domain of RUNX2. Based on the crystal structure, we predict this …

Argininosuccinic Acidemia: A Casereport, Chih-Wei Lin, Huey-Jen Lay, I-Ju Chen

Rehabilitation Practice and Science

Urea cycle disorder (UCD) is one of inborn error diseases. Citrullinemia is the most common disease (1/57000) among them, followed by argininosuccinic acidemia (ASA) (1/70000). The common characteristic of UCD is hyperammonemia induced by the abnormal liver function. Common symptoms at the onset of diseases include altered consciousness, respiratory insufficiency and seizures. Developmental delay, mental retardation, cerebral palsy, and learning disability are common findings in long-term follow-ups. In this report, we give an account of a patient with ASA. Besides the aforementioned symptoms and long-term sequelae, this patient also has the problem of ataxia. However, the patient's conditions and developments …

Computer Alert System That Promotes Patient Safety By Identifying Possible Contraindications Of Prescribed Physical Agents, Hong-Nan Shih, Jing-Hwa Wey, Chun-Chieh Chiu, Po-Wei Lin, Tsan-Hon Liou, Chi-Hsien Chen

Rehabilitation Practice and Science

This study investigated and analyzed the prevalence of contraindications that can co-exist with a prescribed physical agent. To prevent likely complications, this study implemented a computer warning system, which prompts physiatrists to possible contraindications. Once a physical agent is prescribed, the system automatically reviewarticles the ICD-9 codes in the patients’ medical chart. Two pre-established databases are used in the warning system: one contains contraindications for each physical agent and the other has possible contraindications for each selected ICD-9 code. By cross-referencing between ICD-9 codes in a patient's chart and the two databases, the warning system was able to identify possible …

Intensive Cardiopulmonary Rehabilitation Program For Patients With Severe Heart Failure And Acute Stroke: A Report Of Two Cases, Chyi-Yann Wang, Jue-Long Wang, Ai-Lun Yang, Ko-Long Lin

Rehabilitation Practice and Science

Cardiovascular disease is a major factor restricting successful outcomes after stroke rehabilitation. While neurological recovery after stroke has been extensively investigated, cardiovascular adaptations to physical activities poststroke have received little attention. Severe heart failure patients have been well known for limitation of ambulation, but the influence over acute poststroke patients have rarely been investigated. Exercise testing has become a mainstay for the prognostic assessment of patients with heart failure. Various studies have shown that patients with impaired exercise capacity, as measured by low peak oxygen consumption (Vo2), have an unfavorable outcome, independent of other parameters. Whether parameters from submaximal test …

Exercise Training May Enhance Functional Capacity And Improve Heart Rate Impairment In Coronary Artery Disease Patients With Chronotropic Incompetence, Chen-Jung Hsu, Ssu-Yuan Chen, Ching Lan, Der-Sheng Han, Jin-Shin Lai

Rehabilitation Practice and Science

This study investigated whether coronary artery disease patients with chronotropic incompetence (CI) can significantly improve their functional capacity after exercise training. Forty-two men (mean age: 55.3±9.3yr) underwent coronary revascularization and without beta-blockade participated in a threemonth outpatient exercise training program. Patients were separated into a CI group (n=18) and a non-CI group (n=24) based on whether they could reach 85% of the age-predicted peak heart rate (HR). Chronotropic incompetence was defined as failure to achieve 85% of the age-predicted maximal HR. Bicycle exercise workouts were conducted three times weekly. The exercise duration was 30 minutes per session included 5 minutes …

Effects Of A Lateral Wedged Insole In Patients With Medial Compartment Osteoarthritis Of The Knee, Li-Wei Chou, Mu-Jung Kao, Pey-Yu Yang, Nai-Hsin Meng, Sui-Foon Lo, Hong-Wen Wu, Horng-Chaung Hsu

Rehabilitation Practice and Science

Background: Medial compartment osteoarthritis (OA) of the knee is one of the most prevalent and disabling chronic conditions affecting older adults. This study assesses the efficacy of an inserted lateral wedged insole for the conservative treatment of medial compartment knee OA.Methods: Thirteen outpatients (9 females and 4 males with a mean age of 71.0 and a standard deviation of 5.5) with medial compartment knee OA were prospectively treated with an inserted lateral wedged insole with an elevation of 12 mm for three months. The baseline and three-month visual analog scale (VAS) scores for subjective knee pain and the remission score …

Exploring The Relationship Between Body Build And Pressure Under The Ischial Tuberosity, Li-Ru Chen, Kuo-Hu Chen, Chia Lee, Ming-Shin Wang, Ting-Chang Chen, Cheng-Hsun Hsieh

Rehabilitation Practice and Science

Pressure ulcers usually occur over the ischial tuberosity of the people bound in wheelchairs. The objective of the study is to make a comparison between age, genders, and different factors of body build, including height, weight, body mass index, body fat percentage, waist circumference, buttock circumference, and mid-upper arm circumference, on their influences upon pressure under the ischial tuberosity.This experiment is a cross-sectional comparison study. We recruited 38 participants, including twenty-five males and thirteen females aged from 24 to 57. Our results showed that there were no differences on pressure under the ischial tuberosity among people of different age and …

Bilateral Putaminal Hemorrhage In A Young Female: A Casereport, Ke-Vin Chang, Wen-Shiang Chen, Huey-Wen Liang

Rehabilitation Practice and Science

Background: The etiology of spontaneous intracerebral hemorrhage (ICH) in young adults may include causative factors such as vascular abnormality, hypertension, anticoagulant therapy, brain tumor, and others. Hypertension is the most common cause of ICH in young adults in Taiwan. Simultaneous or multiple intracerebral hemorrhages are uncommon, and symmetrical distribution is even rarer. Most cases reported in the literature are in the elderly.Case: We report the case of a 29 years old female with a history of hypertension and elevated blood pressure, who presented with an acute onset of right side limb weakness. Results: Brain computed tomography (CT) showed hemorrhage in …

Rehabilitation Of Transtibial Amputation Caused By Necrotizing Soft Tissue Infections: A Casereport, Shih-Kun Chang, Wai-Keung Lee, Huei-Yu Lo, Yau-Wai Wai, Won-Jean Lin, Kien-Jung Wang

Rehabilitation Practice and Science

Necrotizing soft tissue infections is an infrequent disease. Although many studies and casereports have been presented in recent years, none have described the impact of this disease on prosthetic fitting, ambulation training, and rehabilitation for patients with transtibial amputation.A 50 year-old man suffered from left transtibial amputation and received operation of split thickness skin grafts due to necrotizing soft tissue infections. He was trained to overcome the following problems: 1. Poor endurance, cardiopulmonary function and muscle strength of bilateral lower limbs. 2. The loss of dorsiflexion in the right ankle that resulted from excision of the anterior tibialis muscle. 3. …

Self-Assessment Examination For Residents In Physical Medicine And Rehabilitation: First Experience In Taiwan, I-Nan Lien, Tyng-Guey Wang, Shin-Liang Pan, Rai-Chi Chan

Rehabilitation Practice and Science

Objective: The national Self-Assessment Examination (SAE) for residents has been held in the United States for many years. However, no similar test has been held by any medical specialty association in Taiwan. The first national SAE in Physical Medicine and Rehabilitation (PM & R) aimed to provide a benchmark for residents and medical institutes.Material and Methods: The written questions of the Certification Examination 2005 of the Taiwan Board of PM & R were used in the SAE for residents. Participants were first to third year residents in PM & R from various medical institutes and candidates for the board examination …

Medical Service Needs Of Special Education Students In Chiayi County, Taiwan, Shu-Yi Wang, Yuh-Chin Jean

Rehabilitation Practice and Science

The Buddist Tzu Chi Dalin Hospital was responsible for providing medical services to special education students of Chiayi County in 2004. We evaluated the cognitive skills, activities of daily living, language skills, and gross and fine motor functions of 160 disabled students, 113 male and 47 female. Students with mental retardation were the most frequent, followed by students with dyslalia, then autism, and attention deficit and hyperactivity disorder. A needs assessment revealed that 155, 132, and 107 students fed, dressed, and bathed themselves independently, respectively. Ninety-three students had a language disorder, 75 students had fine motor impairment, and 52 students …

Bone Mineral Density In Subjects With Cerebral Palsy: A Preliminary Study In Taiwan, Hsin-Chi Wu, Ming-Chuan Lin, Yi-Shiung Horng, Hong-Yi Chen, Kwang-Hwa Chang

Rehabilitation Practice and Science

Objective: Children with cerebral palsy (CP) have complicated disabilities, and also have the tendency to suffer from osteoporotic fractures. The aim of this study was to explore the bone mineral density (BMD) and to estimate the fracture rate in Taiwanese CP subjects.Materials and methods: To study the BMD and its related factors in 28 Taiwanese CP subjects (16 males, 12 females; age range, 2-24 years; mean age, 9.8 years), we evaluated their BMD in the lumbar spine (LS-BMD) with dual energy x-ray absorptiometry, clinical characteristics, biochemical bone metabolism-related factors, and nutritional status. The fracture rate was evaluated during a three-year …

Analysis Of Hospitalization-Related Factors Among Nursing Home Residents: A Preliminary Report, I-Chun Chen, May-Lien Liu, Cheng-Hsiu Lin

Rehabilitation Practice and Science

There are increasing numbers of elderly people spending the last years of their lives in a nursing home (NH) or other long-term care institution, mostly because of physical and/or mental disabilities. NH residents may have a variety of acute illnesses; hospitalization is an important treatment option for the frail NH resident owing to the insufficient resources of NHs. The purpose of this study is to investigate the cause of hospitalization, and to analyze the correlation between the NH residents’ characteristics and hospitalization.Residents staying in the participating NH for more than one year were recruited into this study, and from September …

Cerebellar Mutism Syndrome Following Arteriovenous Malformation Rupture Of The Cerebellum: A Report Of Two Cases, Shih-Chung Chang, Su-Ju Tsai, Wei-Liang Nieh

Rehabilitation Practice and Science

Cerebellar mutism syndrome is a rare but devastating consequence following posterior fossa surgery or lesion. It tends to occure predominantly in children, and is characterized by transient mutism, oromotor apraxia, apathy, hypokinesis, irritability and mood lability. The vermis, paravermian region and deep cerebellar nuclei are important structures which are highly correlated with the occurrence of cerebellar mutism syndrome. We report two cases, aged 11 and 15 years, who developed cerebellar mutism after rupture of posterior fossa arteriovenous malformation. Swallowing difficulty, irritability and aggressive behavior occurred concomitant with mutism. For the two cases, their symptoms of mutism lasted for 6 months …

Effects Of Standing, Bicycling, And Running On The Foot Arch Index, Gwo-Chi Hu, Yao-Chia Chuang, Jiann-Perng Chen, Chien-Shen Chen, Tzu-Kai Su, Ying-Fang Chen

Rehabilitation Practice and Science

The functions of the foot and leg depend on several structural characteristics of the foot, of which the height of the medial longitudinal arch is the most important. This height is most commonly measured by using the arch index. However, the relation between arch height and leg injury in athletes is unclear. The purpose of this study was to determine the effect of various sport-related activities on the foot arch index.Seventeen college students (nine women and eight men) with no history of leg surgery or trauma were recruited for this study. Each subject participated in three 20-minute sessions over a …

Botulinum Toxin Type A Treatment For Drooling In Taiwanese Children With Cerebral Palsy: Three Casereports, Yu-Ching Lin, I-Ling Lin, Yu-Te Chiu, Jeng-Yi Shieh

Rehabilitation Practice and Science

Botulinum toxin is a promising treatment option for the management of drooling in patients with cerebral palsy. However, the effect of botulinum toxin type A in treating drooling of Taiwanese children with cerebral palsy has not been reported thus far. We injected single dose botulinum toxin into bilateral parotid glands of three children with cerebral palsy, and followed the results over a 9-month period. Drooling improved in all three patients without significant adverse effects during follow up. There were individual differences in terms of efficacy and duration of effect. Two patients had longer duration of effect than that reported in …

Choreoathetosis As Side Effect Of Gabapentin Therapy In A Patient With Spontaneous Spinal Epidural Hematoma: A Casereport, Min-Hsin Lai, Tzu-Yun Wang, Tsung-Ying Li, Cheng-Chiang Chang, Shin-Tsu Chang

Rehabilitation Practice and Science

Spontaneous spinal epidural hematoma (SSEH) is attributed to a spinal epidural hematoma which is not caused by incidental, traumatic, or iatrogenic (for example, lumbar puncture) procedures. SSEH is an uncommon condition causing spinal cord lesion and subsequent neurologic deficits. Spinal cord pathology is often followed by neuropathic pain which may be treated with a combination of drug regimens, such as gabapentin, tricyclic antidepressants, topic lidocaine, opioids and serotoninnorepinephrine reuptake inhibitor. We present a case of SSEH with neuropathic pain that was treated with gabapentin, morphine and imipramine. The patient developed choreoathetosis temporally related to adjunctive therapy with gabapentin at dosages …

The "Crossroads" And Beyond, David B. Nash

College of Population Health Faculty Papers

No abstract provided.

Mice Deficient In Involucrin, Envoplakin, And Periplakin Have A Defective Epidermal Barrier., Lisa M Sevilla, Rachida Nachat, Karen R Groot, John F Klement, Jouni Uitto, Philippe Djian, Arto Määttä, Fiona M Watt

Department of Dermatology and Cutaneous Biology Faculty Papers

The cornified envelope is assembled from transglutaminase cross-linked proteins and lipids in the outermost epidermal layers and is essential for skin barrier function. Involucrin, envoplakin, and periplakin form the protein scaffold on which the envelope assembles. To examine their combined function, we generated mice deficient in all three genes. The triple knockouts have delayed embryonic barrier formation and postnatal hyperkeratosis (abnormal accumulation of cornified cells) resulting from impaired desquamation. Cornified envelopes form but are ultrastructurally abnormal, with reduced lipid content and decreased mechanical integrity. Expression of proteases is reduced and the protease inhibitor, serpina1b, is highly upregulated, resulting in defective …

Report On The U.S. Summit: "Chronic Care At The Crossroads: Exploring Solutions For Chronic Care Management", Janice L. Clarke

College of Population Health Faculty Papers

On Tuesday, July 17, 2007 in Washington, DC, Intel Corporation assembled a group of the nation’s most respected health leaders to discuss the issues surrounding chronic care and an aging population and explore solutions to these highly complex and increasingly urgent challenges for the US health care system. The highlevel summit, hosted by Intel Chairman Craig Barrett, was held in the auditorium of the National Museum for Women in the Arts and attended, either in person or via the simultaneous webcast, by presidents, chairmen, and executive directors of influential organizations including the National Business Coalition on Health, the National Medical …

Hereditary Neuropathy With Liability To Pressure Palsies: A Report Of Two Cases, Chu-Hsu Lin, Long-Sun Ro, Hung-Chih Hsu, Wei-Chi Hsieh, Chih-Jung Lin, Jian-Der Lee

Rehabilitation Practice and Science

Hereditary neuropathy with liability to pressure palsies (HNPP) is an autosomal-dominant disorder characterized by self-limited, recurrent compressive mononeuropathies at common entrapment sites precipitated by trivial injuries. This disorder typically develops in early adulthood. Electrodiagnostic studies revealed diffuse mild demyelinating neuropathies with entrapment over common entrapment sites. Nerve biopsies frequently show segmental demyelination and thickening of the myelin sheath which is mostly caused by 1.5 Mb deletion of the 17p 11.2 site containing the peripheral myelin protein 22 (PMP22) gene on the 17(superscript th) chromosome. This report describes the clinical features, electrodiagnostic studies, and genetic studies of a Taiwanese family. Among …

Bickerstaff's Brainstem Encephalitis Combined With Guillain-Barré Syndrome: A Casereport, Yi-Ping Cheng, Jo-Tong Chen, Ta-Shen Kuan

Rehabilitation Practice and Science

Bickerstaff's brainstem encephalitis is a post-infectious brainstem inflammatory disorder of unknown etiology. The characteristic symptoms include: acute ophthalmoplegia with diplopia, ataxia, disturbed consciousness, and extensor plantar response. In this report we describe a 33-year-old woman with Bickerstaff's brainstem encephalitis combined with Guillain-Barré syndrome that presented 25 days after a Cesarean section. After five treatments with plasmapheresis and intravenous immunoglobin for 5 days, the patient's muscle strength recovered to MRC 4/5. The ophthalmoplegia and bilateral extensor plantar responses also disappeared. The patient then was transferred to the PM&R department for persistent slurred speech, ataxia, and diplopia. The rehabilitation program included training …

Quality Of Life And Peak Oxygen Consumption In Patients With Congestive Heart Failure, Chen-Liang Chou, Chia-Ling Chang, Chantelle Wu, Su-Ying Hung, Shun-Ping Chen, Tcho-Jen Liu

Rehabilitation Practice and Science

Although the physical consequences of congestive heart failure are well known, its effects on patient well-being, severity of exercise intolerance, and quality of life are largely unknown. The purpose of this study was to examine the relationship of physical fitness (as measured by O2 peak), quality of life (as measured with the WHOQOL-BREF in Taiwan), and severity of left ventricle dysfunction (as measured by left ventricle ejection fraction) in patients with congestive heart failure.Twenty patients were enrolled in this study, but only 11 had completed the ”WHOQOL-BREF”. We used the Statistical Package for Social Science (SPSS14.0) for statistical analysis. The …

Modified Constraint-Induced Movement Therapy In Spastic Cerebral Palsy: A Pilot Study, Hsuan-Ju Lin, Ching-Yi Wu, Chia-Ling Chen

Rehabilitation Practice and Science

Children with spastic cerebral palsy (CP) usually exhibit motor deficits and limited daily activities. Studies in recent years indicated that constraint-induced movement therapy (CIMT) might improve motor performance in CP patients. Combining kinematic analysis with clinical assessments, this study investigated the effect of modified CIMT (mCIMT) in four children with spastic CP immediately and one month after treatment. During the 3-week intervention, subjects underwent task-related training using the affected hand with restraint of the unaffected hand.The experimental results revealed significant improvements of the affected hand in use frequency, movement quality, grasping pattern, and bimanual coordination, both immediately and one month …

Healing The Health Care System: Summaries From The Department Of Health Policy Summer Seminar, David B. Nash, Nora Dowd Eisenhower, Rosemarie Greco, Deborah C. Meiris

College of Population Health Faculty Papers

Editorial Introduction:
The disease management field continues to evolve. The range of chronic diseases treated has expanded to include such conditions as obesity and pain management, and the care continuum now encompasses wellness, prevention, and population health. One population that is an ideal candidate for our collective efforts is that of older adults. Global and national population projections reveal the impending staggering increase in the age 65+ cohort, which will cause a sharp increase in the demand for health care and other services due to such age-related issues as multiple chronic conditions, falls, and depression.

To begin to address these …