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One-third
Kinds of One-third Selected AbstractsOne-Third of a Campus: Ruth Crawford Mitchell and Second-Generation Americans at the University of PittsburghHISTORY OF EDUCATION QUARTERLY, Issue 1 2008Harold S. Wechsler First page of article [source] Gait disturbance interpreted as cerebellar ataxia after MMR vaccination at 15 months of age: a follow-up studyACTA PAEDIATRICA, Issue 1 2000A-M Plesner Measles, mumps and rubella (MMR) vaccination was included in the Danish childhood vaccination programme in 1987. During the following 10-y period, 550 notification records of adverse events after MMR vaccination at 15 mo of age have been registered, and a total of 41 notifications have included "gait disturbance". This corresponds to a frequency of 8 per 100 000 doses of MMR vaccine used for 15-mo-old children. The symptoms and signs are characteristic of cerebellar ataxia. In 28 notifications, the descriptions by the doctors included only "gait disturbance", while in 13 an additional interpretation was included. Thirty-two parents (78%) filled in a questionnaire and 26 (63%) agreed to participate in a clinical follow-up study. The gait disturbance symptoms mainly occurred 7,14 d after the vaccination, and the duration was median 1,2 wk (range 1 d to more than 4 mo). One-third of the children had symptoms lasting more than 2 wk. Significantly more children with long duration of symptoms had some kind of complaint or clinical signs at the follow-up in 1997. Gait disturbance registered after MMR vaccination seems to be more frequent than hitherto reported. Most cases are mild and short-lasting and a longer duration of symptoms seems to be predictive of late sequelae. A clinical diagnosis of cerebellar ataxia after MMR and the exact frequency of this adverse event remains to be tested in prospective studies. [source] Trigeminal Trophic Syndrome,Report of Four Cases and Review of the LiteratureDERMATOLOGIC SURGERY, Issue 5 2004Parrish Sadeghi MD Background. Trigeminal trophic syndrome is a unilateral, frequently crescent-shaped neurotrophic ulceration of the face occurring after injury to the trigeminal nerve. The appearance of the ulcers resembles other disease entities such as granulomatous disease, neoplasm, vasculitis, infection, and factitial dermatitis. Objectives. The objectives of this study are to increase awareness of this disorder and to emphasize the importance of eliciting a thorough neurologic history when evaluating facial ulcerations. Methods. Four cases are reported and, using MEDLINE, the English and non-English literature from 1982 to 2002 is reviewed. Results. Including this report, there have been 60 cases of trigeminal trophic syndrome reported from 1982 to 2002. The age at presentation ranged from 14 months to 93 years. Time of onset from injury to the trigeminal ganglion or its branches and the development of the ulcers ranged from 2 weeks to 30 years. One-third of the patients had undergone trigeminal nerve ablation for the treatment of trigeminal neuralgia and another third had a history of stroke. Other causes included craniotomy, head trauma, herpes infection. Conclusion. The majority of cases of trigeminal trophic syndrome are associated with a history of stroke or trigeminal nerve ablation. Successful surgical outcome can be achieved if the underlying neurologic pathology is addressed before the reconstructive procedure. [source] Management of scoliosis in Duchenne muscular dystrophy: a large 10-year retrospective studyDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 6 2006M Kinali MD Scoliosis affects 75 to 90% of patients with non-ambulant Duchenne muscular dystrophy (DMD). Spinal surgery is the treatment of choice but the indication varies among centres. Some offer surgery to all non-ambulant patients, irrespective of scoliosis severity. Early surgery has the advantage of targeting DMD when cardiorespiratory function is preserved, but not all patients develop scoliosis. We report our 10-year experience of scoliosis management in 123 patients with DMD who were at least 17 years old at the time of the study. Scoliosis was absent in 10%, and mild, non-progressive (at least 30°) in 13% of patients. Another 13% had moderate scoliosis (31,50°) and were managed conservatively. Surgery was considered in 57% (70/123) of patients with scoliosis greater than 50° and eventually performed in 35%. The remaining patients either refused surgery (9%) or were unfit because of cardiorespiratory compromise (13%). In a further 7%, scoliosis (greater than 50°), first noted after 14 years of age, was progressing slowly and surgery was not performed. At 17 years there was no difference in survival, respiratory impairment, or sitting comfort among patients managed conservatively or with surgery. One-third (44/123) of our patients were managed satisfactorily without receiving spinal surgery. We provide insight into the natural history of scoliosis in DMD that should help families and clinicians with decision-making when surgery is considered. [source] Glucose intolerance and associated factors in Mongolia: results of a national surveyDIABETIC MEDICINE, Issue 6 2002J. Suvd Abstract Aims Prevalence of glucose intolerance,diabetes and impaired glucose tolerance (IGT),and of related conditions such as obesity and hypertension, was studied in six population samples in Mongolia in 1999. Methods Diagnosis of glucose intolerance was made on the basis of 2-h blood glucose concentration, according to criteria recommended by the latest report of a WHO Expert Group. Results Crude prevalence of diabetes was 2.9% (2.6% in men and 3.2% in women). Prevalence of IGT was 10.2% (9.3% in men and 10.8% in women). Age standardization to the standard world population of Segi resulted in a total sample prevalence of 3.1% for diabetes and 9.2% for IGT. Prevalence of abnormal glucose tolerance differed according to district of residence. Approximately one-third of the subjects with diabetes were diagnosed prior to the survey. Of those who were diagnosed previously, approximately one-half were not under any form of treatment. Subjects with abnormal glucose tolerance were older, more obese and had higher blood pressure and prevalence of hypertension than those with normoglycaemia. One-half of men and almost one-half of women were hypertensive. Three-quarters of the diabetic subjects were hypertensive. One-third of all subjects were centrally obese. Considering the conditions of principal interest,glucose intolerance, hypertension and obesity,one-half of all subjects demonstrated one or more of these conditions. Central obesity was the most common condition, followed by hypertension and then glucose intolerance. Central obesity and hypertension was the most common combination (17% of all subjects) and 4% exhibited all three conditions. Conclusions Non-communicable diseases are already a threat to public health in Mongolia. Although the prevalence of diabetes is not high by international standards, the relatively high prevalence of IGT suggests that the situation may deteriorate in the future in the absence of concerted action to prevent and control diabetes and related conditions. [source] Joint liaison psychiatry,diabetes clinic: a new specialist serviceDIABETIC MEDICINE, Issue 6 2000C. Mitchell Summary Aims Specialist diabetes clinics have an established role in prevention and management of complications. As psychological problems are usually treated separately from diabetes centres, the role of a specialist psychiatrist within a teaching hospital was assessed. The aims of the study were to describe referral patterns, specific psychiatric conditions and treatments offered. Results During weekly outpatient sessions over a 12-month period, 31 patients were referred with a wide range of psychiatric diagnoses. One-third of patients were seen on the day and two-thirds within 2 weeks of referral. Treatments included anti-depressant medication, counselling and cognitive behaviour therapy. Successful discharge was obtained in 10 subjects and eight were undergoing continued treatment. Conclusions The range of specific diagnoses requiring psychiatric supervision supported the role of specifically trained personnel as seen in a joint liaison psychiatry,diabetes service. Keywords diabetes mellitus, joint clinic, liaison psychiatry [source] Self-expandable metallic stents for palliation of malignant esophageal obstruction: special reference to quality of life and survival of patientsDISEASES OF THE ESOPHAGUS, Issue 1 2004K. Yajima SUMMARY., Self-expandable metallic stents (EMS) provide a common option for malignant esophageal stenosis because of the low complication rate and high dysphagia improvement rate. However, there are few studies on the functional duration of EMS and the extent of improvement of the quality of life. We retrospectively analyzed 18 patients who received EMSs in our division from 1996 to 2002. The median duration of possible food intake and the median survival period were 94.5 and 108 days. The median duration of domiciliary treatment was 56 days. Six of the 18 patients were not discharged from hospital after EMS insertion. The Karnofsky index was found to be a significant determinant of the feasibility of domiciliary treatment. One-third of the patients are incapable of obtaining the benefits of the palliative therapy. EMS deployment should be prudently selected for patients exhibiting low performance status. [source] Prescribing drug of choice to opiate dependent drug users: a comparison of clients receiving heroin with those receiving injectable methadone at a West London drug clinicDRUG AND ALCOHOL REVIEW, Issue 3 2001NICKY METREBIAN Abstract Fifty-eight long-term treatment resistant opiate-dependent drug users were offered the choice of receiving injectable heroin or injectable methadone at a West London drug clinic. Drugs were dispensed on-site at the clinic with weekend take-home. There was no routine ongoing supervised injecting. A ceiling dose of 200mg/day of heroin or methadone was set. One-third chose injectable methadone. Compared to those choosing heroin, these drug users were less likely to have used heroin or crack/cocaine before entering treatment, and were more likely to have previously received treatment with injectable methadone. Drug users reported choosing methadone because it was their primary drug of addiction, and compared with heroin has a longer duration of action and increased strength. Problems with each drug were reported: those choosing heroin complained that the upper dose limit was too low to maintain them adequately, and some receiving methadone complained of discomfort while injecting intravenously. While those choosing each drug had different baseline characteristics, both groups were well retained in treatment and at 3 months made significant reductions in drug use and crime, which were sustained over the 12-month follow-up period. There was no significant difference between treatment outcome between each group. There is an urgent need to conduct randomized controlled trials to establish the effectiveness of prescribing injectable methadone and heroin to inform policy and practice. [source] Associations between tobacco and cannabis use in remote indigenous populations in Northern AustraliaADDICTION, Issue 3 2005Alan R. Clough ABSTRACT Aims To assess whether cannabis use, recently taken up by many indigenous Australians in remote communities, has reinforced tobacco use. Design Cross-sectional study. Setting Three eastern Arnhem Land communities (Northern Territory, NT); total population = 3384, in 2001. Participants From 1247 people aged 17,36 years, 190 (120 males, 70 females) were opportunistically recruited. Measurements Self-reported life-time and current tobacco, cannabis and other substance use were confirmed by local health workers and using clinic records. Participants reported level of substance use, frequency and duration (years used). Associations with tobacco use were calculated (odds ratios: OR) using logistic regression with age, sex, alcohol use and a history of petrol sniffing as confounders. Findings In univariate analyses current tobacco users were more likely than non-users to be using cannabis (OR = 3.1, 1.5,6.2, P = 0.002) and this association remained in multivariate analyses (OR = 3.0, 1.4,6.8, P = 0.006). Tobacco use was associated with the number of years of cannabis use (P = 0.035). The likelihood that tobacco users were also cannabis users increased as quantity of cannabis used increased (P = 0.008). Current tobacco use was no more likely in those who initiated cannabis from 1998 onwards than in those who initiated cannabis before 1998 (OR = 1.1, 0.4,3.2, P = 0.881). One-third of life-time users of both tobacco and cannabis initiated their use at or near the same time, and very few of these (12%) had discontinued either cannabis or tobacco. Conclusions Cannabis appears to have influenced the continued use of tobacco in these populations with possible additional burdens for cardiovascular and respiratory diseases and challenges for interventions. [source] Diversity and functional importance of coral-feeding fishes on tropical coral reefsFISH AND FISHERIES, Issue 3 2008Andrew J. Cole Abstract Fishes that feed from live corals (corallivores) are a conspicuous component of healthy coral reef environments. However, knowledge of the occurrence and ecological significance of this feeding mode is fragmentary. Historically, very few fish were considered capable of feeding from live coral, and those few that did were considered ecologically insignificant. More recently, the role of corallivores has been re-evaluated; published records document 128 corallivorous fish species from 11 different families, with 69 of these belonging to the family Chaetodontidae. Other families, including the Labridae, Tetraodontidae, Balistidae, Monacanthidae, Pomacentridae and Scaridae, all have between seven and ten coral-feeding species. One-third of coral-feeding fishes feed almost exclusively on corals, with more than 80% of their diet based on coral. Corallivorous fish show distinct prey preferences and consume only a small subset of available corals, usually the genera Acropora, Pocillopora and Porites. This selective predation by corallivores can limit abundance and distribution of preferred corals. Chronic predation by corallivores may also exacerbate effects of coral disturbance (e.g. climate-induced coral bleaching), impeding reef recovery and causing further coral loss. Conversely, the cover of preferred corals can be a primary determinant of corallivore abundance and physiological condition. Owing to this close association, obligate corallivores invariably decline in response to loss of coral cover. Increased knowledge of the number of corallivores and their diets suggest that this feeding mode is more important to coral reef food webs than traditionally thought. [source] Migration of rheophilic fish in the large lowland rivers Meuse and Rhine, the NetherlandsFISHERIES MANAGEMENT & ECOLOGY, Issue 5-6 2008J. J. DE LEEUW Abstract, Large-scale migratory patterns of adult rheophilic fish [barbel, Barbus barbus (L.), chub, Leuciscus cephalus (L.), ide, Leuciscus idus (L.), nase, Chondrostoma nasus (L.)] were studied in relation to habitat quality and possible migration barriers in the lower rivers Meuse and Rhine, the Netherlands, using a telemetry system with transponders and detection stations based on inductive coupling. Most fish moved over short distances (<10 km), especially those residing in river stretches with high habitat diversity year-round. About 16% of fish used river stretches over 50 km and two ide moved more than 200 km along free-flowing river stretches. One-third of barbel, chub and nase from a Weir-regulated river stretch moved upstream during the spawning season to spawning habitats. Some fish resided in the areas immediately downstream of weirs and fishways during the spawning season, although it was unclear to what extent these observations reflected habitat choice or barriers to migration. [source] Discontinuation of prophylactic therapy in severe haemophilia: incidence and effects on outcomeHAEMOPHILIA, Issue 6 2001K. Fischer A cohort study was performed to assess adherence to early prophylactic therapy and its effects on outcome in 49 patients with severe haemophilia born 1970,1980. Median age at start of prophylaxis was 5.5 years. The majority (69%) of patients interrupted prophylactic treatment one or more times of their own accord (median total interruption 2.2 years). Patients who discontinued prophylaxis at any point tended to have more arthropathy as measured by the Pettersson scale (median 8 points versus 4 points). One-third of these patients interrupted prophylaxis for longer periods and had permanently stopped taking prophylaxis at a mean age of 20.1 years (mean ± SD duration 4.1 ± 4 years) and consequently experienced 5.4 ± 3.4) joint bleeds per year. This subgroup could be identified by a predictive score based on age at start of prophylaxis, weekly dose of prophylaxis, and joint bleed frequency on prophylaxis. In conclusion, while on prophylaxis, more than two-thirds of patients with severe haemophilia try to discontinue treatment, resulting in slightly more arthropathy. One-third of these patients permanently discontinue prophylaxis in adulthood, while maintaining a low number of joint bleeds. [source] Psychosocial Impact of Headache and Comorbidity with Other Pains among Swedish School AdolescentsHEADACHE, Issue 8 2002Åsa Fichtel MSc Background.,The psychosocial impact of headache combined with other pains has previously been insufficiently investigated. Objective., The present study examined the prevalence of headache, its comorbidity with other pains and psychosocial impact among adolescents. Methods., 793 adolescents in a sample recruited from 8 schools in the middle of Sweden were assessed. Results.,Forty-five percent of the adolescents reported ongoing pain during assessment and more than half of the adolescents reported at least one frequent pain during the previous 6 months. The most common pain among girls was headache (42%), but for boys muscle pain (32%) was most prevalent. Number of pains and perceived pain disability were also higher among girls than boys. One-third of the headache sufferers had headache only, while one-third reported one other frequent pain and the others had at least two other frequent pains. Overall, adolescents with frequent headaches had higher levels of anxiety or depressive symptoms, in addition to functional disability and usage of analgesic medication. Frequent headache sufferers reported more problems in everyday life areas than those with infrequent headaches. Conclusions.,It is recommended that adolescents suffering from recurrent headaches routinely should be asked about the presence of other pains, anxiety and depressive symptoms, medication usage, in addition to psychosocial consequences in their everyday life activities. Longitudinal research is also needed to delineate causal relationships between psychosocial factors and recurrent pains, in particular regarding possible sex differences. [source] Antimicrobial Susceptibility of Helicobacter pylori Strains in a Random Adult Swedish PopulationHELICOBACTER, Issue 4 2006Tom Storskrubb Abstract Background and Aim:, Antimicrobial resistance in Helicobacter pylori is a growing problem and has become an important factor leading to eradication failure. Information on antimicrobial susceptibility is important for selection of an optimum treatment regimen. The resistance rate in a random population has not been studied previously. Methods:, A random Swedish population sample (n = 3000, age 20,81 years) was surveyed using a mailed validated questionnaire assessing gastrointestinal symptoms (response rate of 74%). One-third of the responders was invited, in random order, and accepted an esophagogastroduodenoscopy with biopsies for H. pylori culture and histology. Subjects were not treated for their H. pylori infection but a minimum inhibitory concentration of metronidazole, clarithromycin, amoxicillin, and tetracycline for the H. pylori isolates (n = 333) was determined by agar dilution. Prescribed antibiotic in the area was recorded. Results:, Irrespective of symptomatology, 16.2% of the isolated H. pylori strains were resistant to metronidazole, 1.5% to clarithromycin, 0% to amoxicillin, and 0.3% to tetracycline. The antibiotic consumption was low from an international perspective. Conclusion:, The resistance to the antibiotics was lower than expected from patient sample studies, especially for clarithromycin, most probably due to a restrictive prescription policy in the area. Introduction of a test-and-treat strategy in Sweden would only marginally affect the usage of clarithromycin. [source] Consortium for osteogenesis imperfecta mutations in the helical domain of type I collagen: regions rich in lethal mutations align with collagen binding sites for integrins and proteoglycans,,HUMAN MUTATION, Issue 3 2007Joan C. Marini Abstract Osteogenesis imperfecta (OI) is a generalized disorder of connective tissue characterized by fragile bones and easy susceptibility to fracture. Most cases of OI are caused by mutations in type I collagen. We have identified and assembled structural mutations in type I collagen genes (COL1A1 and COL1A2, encoding the pro,1(I) and pro,2(I) chains, respectively) that result in OI. Quantitative defects causing type I OI were not included. Of these 832 independent mutations, 682 result in substitution for glycine residues in the triple helical domain of the encoded protein and 150 alter splice sites. Distinct genotype,phenotype relationships emerge for each chain. One-third of the mutations that result in glycine substitutions in ,1(I) are lethal, especially when the substituting residues are charged or have a branched side chain. Substitutions in the first 200 residues are nonlethal and have variable outcome thereafter, unrelated to folding or helix stability domains. Two exclusively lethal regions (helix positions 691,823 and 910,964) align with major ligand binding regions (MLBRs), suggesting crucial interactions of collagen monomers or fibrils with integrins, matrix metalloproteinases (MMPs), fibronectin, and cartilage oligomeric matrix protein (COMP). Mutations in COL1A2 are predominantly nonlethal (80%). Lethal substitutions are located in eight regularly spaced clusters along the chain, supporting a regional model. The lethal regions align with proteoglycan binding sites along the fibril, suggesting a role in fibril,matrix interactions. Recurrences at the same site in ,2(I) are generally concordant for outcome, unlike ,1(I). Splice site mutations comprise 20% of helical mutations identified in OI patients, and may lead to exon skipping, intron inclusion, or the activation of cryptic splice sites. Splice site mutations in COL1A1 are rarely lethal; they often lead to frameshifts and the mild type I phenotype. In ,2(I), lethal exon skipping events are located in the carboxyl half of the chain. Our data on genotype,phenotype relationships indicate that the two collagen chains play very different roles in matrix integrity and that phenotype depends on intracellular and extracellular events. Hum Mutat 28(3), 209,221, 2007. Published 2006 Wiley-Liss, Inc. [source] Revaccination of bone marrow transplant recipients: a review of current practices in AustraliaINTERNAL MEDICINE JOURNAL, Issue 4 2009Adrienne Torda Abstract Background: Vaccination following bone marrow transplant (BMT) is an important part of ongoing care and disease prevention. The aim of the study was to investigate vaccination procedures in BMT recipients and identify what systems are in place throughout Australia to remind and alert patients concerning their need for vaccination. Methods: Questionnaires were sent to haematologists managing BMT recipients in Australia to examine post-BMT vaccination practices in hospitals and outpatient clinics. Questionnaires were also sent to BMT recipients in New South Wales, who had their transplants (either allogeneic or autologous) in the past 5 years to determine what vaccinations they had received and what vaccination reminder systems had been used. Results: Vaccine recommendations and practices by BMT physicians showed little consensus. They also differed greatly between autologous and allogeneic transplant recipients. Only just more than half of the physicians had an effective reminder system in place and only 12 of 34 patients had received vaccination reminders. One-third of all patients were not aware of any need for revaccination. Conclusion: The disparity in physician practice regarding revaccination is significant and may reflect the lack of data available regarding efficacy of revaccination in this setting and/or a lack of knowledge about recommendations. Because of this, a national immunization schedule for post-BMT patients founded on evidence-based studies is required to provide optimal patient care. The lack of effective follow up and reminder systems ensuring patient completion of vaccination schedules is also an area needing improvement. [source] Do patients with diabetes wear shoes of the correct size?INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 11 2007S. J. Harrison Summary Background:, Fifteen per cent of patients with diabetes will develop a foot ulcer at some point in their life. Ill-fitting footwear frequently contributes to foot ulceration. A good fitting shoe is an essential component in the management of the diabetic foot. The objective of this study was to assess the feet and footwear of patients with diabetes to determine whether they are wearing the correct-sized shoes. Methods:, One-hundred patients with diabetes who were attending the general diabetic clinic had their foot length measured using a ,Clarks' shoe shop device and foot width using a pair of callipers. Measurements were taken whilst seated and standing. Shoe dimensions were also assessed by recording the manufactured shoe length and using callipers to assess shoe width. A calibrated measuring stick standardised shoe lengths. Neurovascular status and the presence of deformities in the foot were also recorded. Results:, One-third of diabetic patients were wearing the correct shoes on either foot whilst seated or whilst standing. However, only 24% of patients were wearing shoes that were of the correct length and width for both feet whilst seated and 20% upon standing. Seventeen per cent of patients appeared in both groups. No significance was found between any other variables, such as sensory neuropathy. Conclusions:, Many patients with diabetes wear shoes that do not fit, particularly, shoes that are too narrow for their foot width. Assessing the appropriateness of footwear maybe an important part of foot examination. [source] Changes in family food habits: the role of migrationINTERNATIONAL JOURNAL OF CONSUMER STUDIES, Issue 3 2000Clara Opare-Obisaw Abstract The food habits of people generally dictate their nutritional well-being, which subsequently affects their physical and mental health. A change in environment is one of the major factors that could bring about positive or negative changes in food consumption patterns. The food habits of 50 migrant families living in a suburb of Accra were studied to find out what changes have taken place as a result of a change in living environment. The homemaker in each family was interviewed to obtain information on socioeconomic characteristics, past and present food procurement and consumption patterns, food avoidances and factors that influence food selection and consumption. The findings revealed that, although the majority stuck to foods they were accustomed to, there were striking changes in sources of food procurement, the number of meals prepared at home and the relative frequency of consumption of some staple foods. One-third of the study group felt that their diets had become poorer as a result of the change in environment. Two factors, time and money, were associated with the changes that had taken place. The study provides some evidence for the existence of inadequate diets among migrant families. This might even reflect a more serious situation facing the numerous migrant youth, who have no families to cater for them and, hence, put their health at risk. Home economists and other related professionals could be instrumental in drawing up intervention programmes to ensure adequate selection and consumption of food to promote good health among migrants to the city. [source] Change in pattern of skin disease in Kaduna, north-central NigeriaINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 9 2007Husain Yahya MSc Background, We report our experience on the pattern of skin disease in Kaduna, north-central Nigeria over a 6-year period, and compare it with a similar survey conducted in the same area 30 years ago and with surveys from Nigeria and from other parts of Africa. Methods, The medical records of new patients attending the dermatology outpatient clinics of Barau Dikko Specialist Hospital and Habbat Medical Center from March 2000 to December 2005 were retrieved. Demographic data (age and sex) and the diagnoses of skin disease were extracted and analyzed. Results, A total of 5982 cases was seen. Forty-nine per cent were males and 51% were females. One-third of the patients were aged under 20 years, and three quarters were aged below 40 years. Eczematous dermatitis was the most common skin disorder seen, making up 35% of cases, and had replaced dermatophyte infections and scabies, which were the most dominant skin diseases 30 years previously (now constituting 6% and 1.4% of cases, respectively). Atopic dermatitis had more than doubled in frequency (13.8% vs. 5.2%), and contact dermatitis had tripled in frequency (5.8% vs. 1.8%). Acne vulgaris (6.7%), pigmentary disorders (3.9%), urticaria (3.6%), papular urticaria (3.6%), hair disorders (3.3%), lichen simplex chronicus (3%), viral warts (2.9%), and drug eruptions (2.7%) had also increased. Human immunodeficiency virus-related skin disease constituted 4.3% of cases, with pruritic papular eruption being the most common condition. Conclusion, These changes in skin disease can be attributed mainly to an increase in urbanization and improved socio-economic conditions. [source] Depressive symptoms and suicidal ideation among older adults receiving home delivered mealsINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 12 2008Jo Anne Sirey Abstract Objective Homebound older adults may be vulnerable to the deleterious impact of untreated depression. Yet because these elders are difficult to reach, there is little data on the rates of depressive symptoms and suicidal ideation among this group. The objective of this study is to document the rates of depression and correlates among a population of homebound elders. Methods Using a community based participatory research partnership, we implemented a routine screening for depressive symptoms and suicidal ideation among older recipients of Westchester County's home meal program. Older adults enrolled in the home delivered meal program were administered the Physician Health Questionnaire,9 (PHQ-9), and questions to assess pain, falls, alcohol abuse and perceived emotional distress. Results In our sample of 403 meal recipients, 12.2% of older adults reported clinically significant depression (PHQ-9,>,9) and 13.4% reported suicidal thoughts. One-third of recipients with significant depressive symptoms were currently taking an antidepressant. Almost one-third of older adults who endorsed suicide ideation did not report clinically significant depressive symptoms. Among men, suicidal thoughts were associated with chronic pain and greater depression severity, whereas pain was not a predictor of suicidal thoughts among women. Conclusion More than one in nine elders suffer from depression; most are untreated with one-third undertreated. Through partnerships between public agencies that provide age related services and academic investigators there is an opportunity for improved detection of unmet mental health needs. Future research should explore innovative models to improve access to mental health services once unmet need is detected. Copyright © 2008 John Wiley & Sons, Ltd. [source] Geriatric rehabilitation nursing: Developing a modelINTERNATIONAL JOURNAL OF NURSING PRACTICE, Issue 5 2004Pirkko Routasalo RN PhD In this paper, we describe a geriatric rehabilitation nursing model developed on the basis of the nursing and rehabilitation literature. That literature comprised some 120 articles addressing the rehabilitation of elderly patients and the work done by nurses in that process, various philosophical questions and the results of geriatric rehabilitation. One-third of these articles has been evaluated on the strength of the articles' evidence, and these are discussed in this paper. The findings show that the main factors in geriatric rehabilitation nursing are the patient with health or functional problems and the nurse with professional values, knowledge and skills. The patient is part of a family and the nurse works as part of a multidisciplinary team. In the geriatric rehabilitation process, the patient and the nurse work in close interaction. The aims of rehabilitation depend upon the patient's commitment to the objective and upon the nurse's commitment to help the patient achieve that objective. A health orientation, goal-oriented work, nursing decision-making and a rehabilitative approach to work are all central to this effort. Work is organized in multidisciplinary teams where nurses have equal responsibilities with other professional staff. Testing and development of the model is ongoing. [source] Danish dentists' knowledge, attitudes and management of procedural dental pain in children: association with demographic characteristics, structural factors, perceived stress during the administration of local analgesia and their tolerance towards painINTERNATIONAL JOURNAL OF PAEDIATRIC DENTISTRY, Issue 3 2005J. K. RASMUSSEN Summary., Objective., The aim of the present study was to describe Danish dentists' knowledge of, attitudes towards and management of procedural pain during paediatric dental care, and to assess the importance of demographic characteristics, structural factors, perceived stress during administration of local analgesia and the dentists' own tolerance towards procedural dental pain. Design., A cross-sectional questionnaire study was conducted in Denmark in May 2001. Subjects and methods., The subjects were a random sample of 30% of Danish dentists treating children. Usable information was obtained from 327 (80·3%) of the dentists in the sample. Results., One-quarter of the respondents answered that a 3,5-year-old child could report pain only with uncertainty. More than 80% of the dentists stated that they never compromised on painlessness. Very few agreed to the statement that children forget pain faster than adults. One-third agreed to, or were neutral to, the statement that all restorative care in primary teeth could be performed painlessly using N2O-O2 sedation alone. The majority of the respondents reported using three or more methods to assess the effect of their pain control methods. Almost 90% reported using local analgesia for restorative work ,always' or ,often'. A similar proportion reported using topical analgesia before injection ,always' or ,often'. Administering a mandibular block to preschool children was the procedure perceived as the most stressful (33·6%) pain control method. Demographic factors (gender), structural factors (always working alone and treating 3,5-year-old children daily), perceived stress during the administration of a mandibular block in preschool children and the dentists' own willingness to accept potentially painful dental treatment without local analgesia were associated with knowledge of, attitudes towards and management of procedural dental pain in children. Conclusions., Danish dentists treating children demonstrate concern about procedural dental pain in children. Factors amenable to change via training and reorganization into larger clinical units seem to determine their knowledge of, attitudes towards and management of procedural dental pain in children. [source] Pharmacy support staff involvement in, and attitudes towards, pharmacy-based services for drug misusersINTERNATIONAL JOURNAL OF PHARMACY PRACTICE, Issue 6 2009Jenny Scott Abstract Objective This study aimed to examine involvement of pharmacy support staff in delivering services to drug misusers; to quantify their participation in related training; and to examine relationships between attitudes, practice experience and training. Methods The setting was a random sample of 10% of UK community pharmacies (n = 1218) using a postal questionnaire with two reminders. Pharmacy managers were used as gate-keepers to access pharmacy support staff, which included dispensary technicians and medicines counter assistants. Key findings Six hundred and ninety (56.7%) pharmacies responded, and 1976 completed questionnaires were returned from 610 (50.1%) pharmacies. A further 80 (6.6%) opted out. Three-fifths of staff had no input into decisions about whether their pharmacy provided services for drug misusers. One-third working in pharmacies that provide services were uncertain or negative about whether their pharmacy should do so. Staff were more involved in needle exchange (91%) and decisions to sell needles (95%) than supervising consumption of therapies (64%) or handing out dispensed medicines to drug misusers (73%), suggesting managers perceive needle exchange and sales as appropriate roles. Three-quarters of those working in pharmacies that provide services had not received any training to do so. Those who had undertaken training and who worked in pharmacies that provided services had significantly more positive attitudes compared to those had not undertaken training but also worked in pharmacies that provided services, or those who had undertaken training but did not provide services. Conclusions Pharmacy support staff were involved extensively in drug-misuse services but the majority had not been trained to do so. Attitudes were more positive in those who were involved in service provision and had undertaken training. The findings suggest a need for more extensive training and for further exploration of the views of managers on appropriate roles, particularly the clinical versus supply nature of needle exchange. This is timely given the recent publication of guidelines by the National Institute of Health and Clinical Excellence (NICE) on needle exchange. [source] Characteristics of river floods and flooding: a global overview, 1985,2003,,IRRIGATION AND DRAINAGE, Issue S1 2006Klaas-Jan Douben inondation; victims; dommages; stratégies de protection contre les inundations Abstract Since ancient times people have settled in flood-prone areas due to favourable geographic conditions which facilitate economic growth, such as accessibility (transportation) and food production (fertile land). This fact forces societies all over the world to protect valuable assets against flooding. Nevertheless flooding is still the most damaging of all natural disasters. One-third of the annual natural disasters and economic losses and more than half of all victims are flood related. Flood mitigation policies and measures have been implemented, enabling societies to increase their resilience to flood hazards. With increasing population densities, often associated with improved living standards and consequently higher values of property and infrastructure, flood defence receives more importance and the consequences of flooding become less acceptable. Trends in flood frequencies and flooding damage seem to be increasing, primarily due to a growing vulnerability arising from societal changes such as interference by occupation, developments, investments and land-use changes in flood-prone areas. The Asian continent was particularly affected by floods and flooding between 1985 and 2003. It recorded nearly half of all flooding events; together with Europe and North America it was confronted with the majority of flooding damage and it incurred nearly three-quarters of all casualties. Copyright © 2006 John Wiley & Sons, Ltd. Depuis toujours les populations se sont installées dans les zones à risque d'inondation du fait de conditions géographiques favorables à la croissance économique, telles que l'accessibilité (transport) et la production de nourriture (terre fertile). Ceci oblige les sociétés partout dans le monde à protéger les biens contre les inondations. Mais celles-ci sont toujours les plus préjudiciables de tous les désastres naturels. Chaque année, un tiers des désastres naturels et des dommages économiques ainsi que plus de la moitié des victimes sont liés aux inondations. Des politiques et des actions de protection contre les inondations ont été mises en oeuvre, permettant aux sociétés d'augmenter leur résistivité aux risques d'inondation. Avec l'augmentation des densités de population, souvent liée à la progression des niveaux de vie et donc à la valeur plus élevée des habitations et des infrastructures, la protection contre les inondations devient plus importante et leurs conséquences moins acceptables. La fréquence des inondations et de leurs dommages semble en augmentation, principalement en raison d'une vulnérabilité croissante résultant de changements sociaux tels que les interférences des activités, aménagements, investissements et occupation de l'espace dans les zones à risque. Le continent asiatique a été particulièrement affecté entre 1985 et 2003. Il a enregistré presque la moitié de tous les événements d'inondation, a dû faire face à la majorité des dommages avec l'Europe et l'Amérique du Nord et a compté presque trois quarts de toutes les victimes. Copyright © 2006 John Wiley & Sons, Ltd. [source] Screening of glucose/insulin metabolic alterations in men with multiple skin tags on the neckJOURNAL DER DEUTSCHEN DERMATOLOGISCHEN GESELLSCHAFT, Issue 10 2008Emilio Sudy Summary Multiple skin tags appear associated with abnormalities in glucose/insulin metabolism. Clinical and metabolic glucose/insulin characteristics of men with multiple (8 or more) skin tags on the neck were compared with a control group with few or none. Both groups were divided in two subgroups according to normal or abnormal laboratory findings. In the study subgroup with normal laboratory findings the number of skin tags varied from 8,33, whereas in those with abnormal laboratory findings the range was 9,65. Eight or more skin tags were related with statistically significant laboratory glucose/insulin abnormalities: basal hyperinsulinemia (p<0.002), postprandial hyperinsulinemia (p<0.003), and postprandial hyperglycemia (p<0.01). In the multiple skin tag group 77 % had diverse laboratory abnormalities, including insulin resistance, basal hyperinsulinemia, postprandial hyperinsulinemia, glucose intolerance or type 2 diabetes, in contrast with the control group, where only 33 % showed laboratory abnormalities. One-third of the study group had acanthosis nigricans. Only 15 % of patients with metabolic abnormalities did not show any cutaneous expression of glucose/insulin alterations (9 or more skin tags on the neck, acanthosis nigricans, or waist circumference greater than 95 cm). Multiple skin tags were more sensitive than acanthosis nigricans in identifying those with alterations in the glucose/insulin metabolism (77 vs. 32 % respectively), although less specific (68 vs.100%). Multiple skin tags should raise suspicion of insulin resistance or hyperinsulinemia. [source] Chronic urticaria , which clinical parameters are pathogenetically relevant?JOURNAL DER DEUTSCHEN DERMATOLOGISCHEN GESELLSCHAFT, Issue 1 2007A retrospective investigation of 339 patients Summary Background: Urticaria is a clinical reaction pattern triggered by many factors causing liberation of vasoactive substances such as histamine, prostaglandins and kinins. It presents as transient itching wheals which are either limited to the local stimulus area or more widespread. Urticaria is classified according to its duration into acute (duration , 6 weeks) and chronic (duration 6 weeks) forms. Various clinical investigations may be initiated to diagnose the cause. This study critically evaluates the relevance of frequently performed laboratory investigations and searches for infectious foci, as well as the results of physical provocation testing and oral provocation with food additives. Patients and Methods: The laboratory and clinical data of 339 patients who had been treated for urticaria at the Christian-Albrechts-University in Kiel over a period of four years were collected in a data entry form and statistically evaluated. Nominal values were analyzed by their relative and absolute quantities, quantitative parameters with the help of statistical data such as minimum, maximum, median and 25th and 75th percentiles. Results: Chronic recurrent urticaria was most common, accounting for 52% of cases. Women were affected 1.8 times more often than men. One-third of the patients also had angioedema. The medians of all laboratory parameters evaluated were within normal values. Only rarely were elevated antinuclear antibody titers, abnormal thyroid function tests or active infections such as hepatitis B or borreliosis detected. The search for infectious foci identified tonsillitis or sinusitis in almost 50% of analyzed patients. Positive reactions to physical testing occurred in 30% of patients and in 11% to oral provocation with various food additives. Conclusions: This study of a large patient group stresses the relevance of individually- tailored evaluations in patients affected with urticaria rather than an expensive initial broad diagnostic testing. More specific searches should be based on individual clues. [source] Pattern recognition as a caring partnership in families with cancerJOURNAL OF ADVANCED NURSING, Issue 3 2000Emiko Endo RN PhD Pattern recognition as a caring partnership in families with cancer The purpose of this study was to address the process of a caring partnership by elaborating pattern recognition as nursing intervention with families with cancer. It is based on Newman's theory of health as expanding consciousness within the unitary-transformative paradigm and is an extension of a previous study of Japanese women with ovarian cancer. A hermeneutic, dialectic method was used to engage 10 Japanese families in which the wife-mothers were hospitalized because of cancer diagnosis. The family included at least the woman with cancer and her primary caregiver. Each of four nurse-researchers entered into partnership with a different family and conducted three interviews with each family. The participants were asked to describe the meaningful persons and events in their family history. The family's story was transmuted into a diagram of sequential patterns of interactional configurations and shared with the family at the second meeting. Evidence of pattern recognition and insight into the meaning of the family pattern were identified further in the remaining meetings. The data revealed five dimensions of a transformative process. Most families found meaning in their patterns and made a shift from separated individuals within the family to trustful caring relationships. One-third of them went through this process within two interviews. The families showed increasing openness, connectedness and trustfulness in caring relationships. In partnership with the family, each nurse-researcher grasped the pattern of the family as a whole and experienced the meaning of caring. Pattern recognition as nursing intervention was a meaning-making transforming process in the family,nurse partnership. [source] Eggload dynamics and oviposition rate in a wild population of a parasitic waspJOURNAL OF ANIMAL ECOLOGY, Issue 2 2000Jérôme Casas Summary 1.,This paper develops and tests in the field a model that predicts the oviposition rate and the rate of egg maturation of a synovigenic parasitic wasp during a foraging period. The parasitoid is Aphytis melinus, the highly successful biological control agent of California redscale (Aondiniella aurantii), a pest of citrus worldwide. 2.,Females were sampled in the interior canopy of grapefruit trees either just before and at the end of the foraging period over 2 days and were dissected to determine the starting and ending eggload distributions. A group of females was caught before the onset of activity and kept in vials in the field in trees with honey but without access to hosts during the foraging period. Their eggload at the end of the day was used to estimate the egg maturation rate during the foraging period. 3.,Two stochastic models are used to predict the eggload distribution at the end of the day. Both use the observed starting eggload distribution, the observed length of the foraging period and the estimated rate of egg maturation. The model providing the better fit uses an oviposition rate which is an increasing function of the eggload. 4.,The eggload does not attain a steady state distribution during a foraging period. One-third to one-half of the population is predicted to experience egg-limitation at some time during the foraging period. Five percent of the population will experience egg-limitation a second time within a single day. 5.,The common occurrence of egg-limitation over a single day and the relatively high rate of change of states between egg- and time-limitation imply that the rate of nutrient acquisition and use are likely to be subject to strong evolutionary pressures. [source] Mental Health and Social Care Needs of Older People with Intellectual DisabilitiesJOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES, Issue 3 2005Andre Strydom Background, Older people with intellectual disabilities (ID) are a growing population but their age-related needs are rarely considered and community services are still geared towards the younger age group. We aimed to examine the mental health and social care needs of this new service user group. Methods, We identified all adults with ID without Down syndrome (DS) aged 65+ living in the London boroughs of Camden and Islington. The Psychiatric Assessment Schedule for Adults with a Developmental Disability (PASADD) checklist was used to detect psychiatric disorder, the Vineland behaviour scale (maladaptive domain) for problem behaviours and the Dementia Questionnaire for persons with Mental Retardation (DMR) to screen for dementia. Carers reported health problems and disability. Needs were measured with the Camberwell Assessment of Need for adults with Intellectual Disabilities (CANDID-S). Results, A total of 23 older people with ID (13 had mild ID and nine more severe ID) and their carers participated in the survey. In which, 74% had one or more psychiatric symptoms; 30% were previously known with a diagnosis of mental illness. One-third of the older people screened positive for dementia (range: 17,44%, depending on sensitivity of DMR scores used). Three quarters of the group had physical health problems, 74% had poor sight, 22% had hearing loss and 30% had mobility problems. Carers rated unmet needs for accommodation (22%), day activities, and eyesight and hearing. The people with ID rated unmet needs to be social relationships (44%), information and physical health. Conclusion, Older people with ID without DS have considerable prevalence of health problems and psychiatric disorders, including symptoms of functional decline and dementia. Such symptoms are often not recognised and further research into their needs is a priority. [source] Smoking behaviour modulates pharmacokinetics of orally administered clopidogrelJOURNAL OF CLINICAL PHARMACY & THERAPEUTICS, Issue 4 2008A.-M. Yousef PhD Summary Background and objectives:, Clopidogrel is an important antiplatelet drug that is effective in preventing thrombotic events, especially for patients undergoing percutaneous coronary intervention. The therapeutic usefulness of clopidogrel has been limited by documented inter-individual heterogeneity in platelet inhibition, which may be attributable to known clopidogrel pharmacokinetic variability. The objective of this study was to assess the influence of smoking cigarettes and abnormal body weight on the pharmacokinetics of clopidogrel. Methods:, Seventy-six healthy adult male volunteers were selected randomly. Each subject received a single 75 mg oral dose of clopidogrel after overnight fast. Clopidogrel carboxylate plasma levels were measured and non-compartmental analysis was used to determine peak plasma concentration (Cmax), time to peak plasma concentration (Tmax), elimination half-life (t1/2e), and area under the curve (AUC0,,). Results:, One-third of volunteers were smokers (n = 27) and one-half had abnormal body weight (n = 39). Smokers had lower AUC0,, (smokers: 6·24 ± 2·32 ,g/h/mL vs. non-smokers: 8·93 ± 3·80 ,g/h/mL, P < 0·001) and shorter half-life (smokers: 5·46 ± 2·99 vs. non-smokers: 8·43 ± 4·26, P = 0·001). Smoking behaviour had no influence on Cmax (P = 0·3) and Tmax (P = 0·7). There was no statistically significant difference in Cmax, AUC0,,, Tmax and t1/2e between volunteers with abnormal body weight and normal body weight. However the difference in body weight of the two groups was relatively narrow (mean ± SE; 26·93 ± 0·16 vs. 23·11 ± 0·27). In general, the pharmacokinetic parameters were characterized by considerable inter-individual differences (Cmax = 3·09 ± 0·99 ,g/mL, CV = 32%), (Tmax =0·76 ± 0·24 h, CV = 31·6%), (AUC0,, = 7·98 ± 3·58 ,g/h/mL, CV = 44·8%), and (t1/2e = 7·38 ± 4·10 h, CV = 55·6%). Conclusion:, Smoking is a significant factor affecting the pharmacokinetics of clopidogrel, following administration of a single 75 mg dose in healthy young volunteers. The study supports smoking-cessation recommendations. Further studies are required to evaluate the influence of smoking and body weight on the pharmacokinetics of the active metabolite of clopidogrel and on the clinical effects of any differences observed. [source] | |||||||||||||||||||||||||||||||