Prosopographic analysis of three gender-inclusive civic associations, the Union pour l'Action Morale (later Union pour la Vérité), the Société de Sociologie de Paris, and the Société pour l’Éducation Sociale, demonstrates that at the turn of the twentieth century intellectual sociability and the networks it fostered enabled certain well-connected women to practice citizenship without the right to vote. If gender inclusive, these enterprises were far from egalitarian. But their social composition and the sociability that characterized them facilitated women's access to the public sphere, an important dimension of citizenship. For this reason, the article concludes, models of citizenship without voting rights that emerged during the period appealed to contemporary women, to whom they seemed much less contradictory than we find them a century later.

OBJECTIVES:To explore the relationship between the extended postoperative use of indwelling urinary catheters and outcomes for older patients who have undergone cardiac, vascular, gastrointestinal, or orthopedic surgery in skilled nursing facilities and to describe patient and hospital characteristics associated with the extended use of indwelling urinary catheters.DESIGN:Retrospective cohort study.SETTING:US acute care hospitals and skilled nursing facilities.PATIENTS:A total of 170,791 Medicare patients aged 65 years or more who were admitted to skilled nursing facilities after discharge from a hospital with a primary diagnosis code indicating major cardiac, vascular, orthopedic, or gastrointestinal surgery in 2001.MAIN OUTCOME MEASURES:Patient-specific 30-day rate of rehospitalization for urinary tract infection (UTI) and 30-day mortality rate, as well as the risk of having an indwelling urinary catheter at the time of admission to a skilled nursing facility.RESULTS:A total of 39,282 (23.0%) of the postoperative patients discharged to skilled nursing facilities had indwelling urinary catheters. After adjusting for patient characteristics, the patients with catheters had greater odds of rehospitalization for UTI and death within 30 days than patients who did not have catheters. The adjusted odds ratios (aORs) for UTI ranged from 1.34 for patients who underwent gastrointestinal surgery (P<.001) to 1.85 for patients who underwent cardiac surgery (P<.001); the aORs for death ranged from 1.25 for cardiac surgery (P=.01) to 1.48 for orthopedic surgery (P=.002) and for gastrointestinal surgery (P<.001). After controlling for patient characteristics, hospitalization in the northeastern or southern regions of the United States was associated with a lower likelihood of having an indwelling urinary catheter, compared with hospitalization in the western region (P=.002 vs P=.03).CONCLUSIONS:Extended postoperative use of indwelling urinary catheters is associated with poor outcomes for older patients. The likelihood of having an indwelling urinary catheter at the time of discharge after major surgery is strongly associated with a hospital's geographic region, which reflects a variation in practice that deserves further study.

Background: Indwelling urinary catheters are used postoperatively in hip fracture care. Their use beyond the immediate postoperative period may result in excess nosocomial infections.Objectives: The objectives of this study were to explore the relationship between extended indwelling urinary catheterization and outcomes for patients sustaining hip fracture discharged to skilled nursing facilities (SNFs), and to describe patient and hospital predictors of extended indwelling urinary catheterization.Research Design: The authors conducted a retrospective cohort study. Subjects: This study consisted of Medicare admissions to SNFs of patients discharged from a hospital with a primary diagnosis of hip fracture in 2001 (n = 111,330).Measures: Dependent variables were the presence of urinary catheter at SNF admission and the patient-specific 30-day outcomes of rehospitalization for urinary tract infection, rehospitalization for sepsis, discharge to the community, and mortality. Independent variables were demographic, clinical, and hospital characteristics.Results: Thirty-two percent of hip fracture discharges to SNFs had urinary catheters. These patients had greater odds of rehospitalization for urinary tract infection (adjusted odds ratio [AOR] 1.6, P < 0.001) and death (AOR 1.3, P < 0.001) at 30 days than patients without catheters after adjusting for patient characteristics such as age and comorbid conditions. Western region and urban location were associated with a higher likelihood of having an indwelling urinary catheter, whereas northern region and teaching hospital status were associated with a lower likelihood of having an indwelling urinary catheter.Conclusions: Extended use of indwelling urinary catheters postoperatively is associated with poor outcomes. The likelihood of having an indwelling urinary catheter at hospital discharge after hip fracture is associated with hospital characteristics in addition to patient characteristics. This practice variation deserves further study.

Hyperhomocystinemia linked to B-vitamin deficiency is prevalent and associated with increased risk for stroke. While in vitro studies suggest homocysteine directly injures vascular endothelial thrombomodulin (TM), inhibits vonWillebrand factor (vWF) synthesis, and blocks tissue plasminogen activator (t-PA) receptor binding, these mechanisms and their reversibility by vitamin therapy are not established in humans. We investigated the effects of high-dose B-vitamin therapy on endogenous fibrinolysis and endothelial injury markers by randomizing 50 nonvitamin users with prior ischemic stroke to 3 months of treatment with multivitamins either containing folate (5 mg), B6 (100 mg), and B12 (1 mg), or lacking these components. Fasting before noon and post-methionine load plasma total homocysteine (tHcy), t-PA antigen levels, t-PA and plasminogen activator inhibitor (PAI) activities, total vWF antigen, and TM levels were measured before and after vitamin therapy. The primary analysis between treatment groups across time revealed no significant changes (P > .1) for any hematologic variables. However, within-groups analysis showed reductions of 23% in plasma TM (P < .005) and 27% in fasting tHcy levels (P < .0001) and a paradoxical 30% rise in vWF antigen levels (P < .05) after high-dose B-vitamin, treatment with no changes in controls. Pooled data revealed a significant and reproducible 20% to 28% decline in plasma t-PA activity after methionine load (n = 49, P < .02). Our findings demonstrate methionine load lowers plasma t-PA activity by a plasminogen activator inhibitor (PAI-1) independent mechanism that is not attenuated by 3 months of high-dose B-vitamin treatment. While not improving endogenous fibrinolysis profiles, these results provide initial evidence that B-vitamin treatment may selectively alter markers of vascular endothelial injury after stroke.

Background and Purpose —Abnormalities in endogenous fibrinolysis are associated with an increased risk for stroke in men and older adults. We tested the hypothesis that elevated plasma tissue plasminogen activator (tPA) antigen, a marker for impaired endogenous fibrinolysis, is an independent risk factor for stroke in young women. Methods —Subjects were 59 nondiabetic females ages 15 to 44 years with cerebral infarction from the Baltimore-Washington area and 97 control subjects frequency-matched for age who were recruited by random-digit dialing from the same geographic area. A history of cerebrovascular disease risk factors was obtained by face-to-face interview. Plasma tPA antigen was measured by enzyme-linked immunosorbent assay. Results —Mean plasma tPA antigen levels were significantly higher in stroke patients than control subjects (4.80±4.18 versus 3.23±3.67 ng/mL; P =0.015). After adjustment for age, hypertension, cigarette smoking, body mass index, and ischemic heart disease, there was a dose-response association between tPA antigen and stroke with a 3.9-fold odds ratio of stroke (95% CI, 1.2 to 12.4; P =0.03) for the upper quartile (>4.9 ng/mL) of tPA antigen compared with the lowest quartile. The dose-response relationship between tPA antigen and stroke was equally present in white and nonwhite women, and further adjustment for total and HDL cholesterol levels only modestly attenuated this association. Conclusions —This population-based case-control study shows that elevated plasma tPA antigen level is independently associated with an increased risk for ischemic stroke in nondiabetic females 15 to 44 years of age. These findings support the hypothesis that impaired endogenous fibrinolysis is an important risk factor for stroke in young women.

Copyright © 1999 American Heart Association. All rights reserved. Print ISSN: 0039-2499. Online Stroke is published by the American Heart Association. 7272 Greenville Avenue, Dallas, TX 72514 1999;30;7-11 Stroke Buchholz and Paul D. Stolley R. Price, Robert J. McCarter, Constance J. Johnson, Christopher J. Earley, David W. Thomas Wozniak, Robert J. Wityk, Barney J. Stern, Michael A. Sloan, Roger Sherwin, Richard F. Macko, Steven J. Kittner, Anne Epstein, D. Kim Cox, Marcella A. Prevention in Young Women Study Elevated Tissue Plasminogen Activator Antigen and Stroke Risk : The Stroke http://stroke.ahajournals.org/cgi/content/full/30/1/7 located on the World Wide Web at: The online version of this article, along with updated information and services, is