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Widespread Problem (widespread + problem)
Selected AbstractsUniversal newborn screening and adverse medical outcomes: A historical noteDEVELOPMENTAL DISABILITIES RESEARCH REVIEW, Issue 4 2006Jeffrey P. Brosco Abstract Universal newborn screening programs for metabolic disorders are typically described as a triumph of medicine and public policy in the US over the last 50 years. Advances in science and technology, including the Human Genome Project, offer the opportunity to expand universal newborn screening programs to include many additional metabolic and genetic conditions. Although the benefits of such screening programs appear to outweigh their costs, some critics have claimed that historical examples of inadvertent harm ensuing from false-positive screening results and subsequent inappropriate medical treatment should make us wary of expanding universal newborn screening. In this essay, we report the results of a review of the published literature to assess whether the extension of screening from at risk populations to all newborns led to substantial morbidity and mortality from misguided medical treatment. We provide a historical overview of universal newborn screening programs in the United States, and then focus on six early NBS programs: congenital hypothyroidism, phenylketonuria, congenital adrenal hyperplasia, galactosemia, sickle cell disease, and maple syrup urine disease. Our comprehensive search of published sources did not reveal a widespread problem of harm ensuing from medical treatment of children with false positive screening test results. © 2006 Wiley-Liss, Inc. MRDD Research Reviews 2006;12:262,269. [source] The management of severe dental phobia in an adolescent boy: a case reportINTERNATIONAL JOURNAL OF PAEDIATRIC DENTISTRY, Issue 4 2000J. Levitt Dental fear is a widespread problem that represents one of the major barriers to dental care. This report describes a case study of a 12-year-old boy who presented with dental phobia characterized as ,fear of catastrophe', ,generalized dental fear' and ,fear of specific stimuli'. The referral came from his general dental practitioner who had been unable to carry out even the simplest dental procedure on him. The patient required prevention, conservation and root canal therapy. The case illustrates the use of physical strategies, including muscle relaxation and relaxation breathing; practice strategies, including graded exposure and cognitive strategies, combined with individual control methods and inhalation sedation to successfully complete the dental treatment plan. [source] Surmounting City Silences: Knowledge Creation and the Design of Urban Democracy in the Everyday EconomyINTERNATIONAL JOURNAL OF URBAN AND REGIONAL RESEARCH, Issue 1 2009NANCY ETTLINGER This essay presents segregation as a fundamental, longstanding and widespread problem that impedes democratic urban life and is intelligible from a critical geographic perspective. Ignorance is spatially produced by segregation at multiple scales so as to legitimize and perpetuate silence about problems among marginalized groups. This spatialized understanding explains inequality, problematizes and difference prompts an agenda that forefronts the creation of new social knowledges. The focus here is on the everyday economy as a crucial but commonly overlooked context for developing such knowledges. I re-present a theory of knowledge creation developed for the pursuit of commercial competitiveness and reconfigure it to mesh socio-political and economic goals. A central challenge is to change prevailing discourses by cultivating new practices that entail meaningful interaction among people otherwise segregated. Efficiency becomes a means to social as well as economic ends, as respect and trust grow from collaborative experience among people who might otherwise not interact. Résumé Ce travail présente la ségrégation comme un problème fondamental, persistant et généralisé qui handicape la vie urbaine démocratique et qui peut être appréhendé d'un point de vue critique géographique. L'ignorance est le résultat, sur le plan spatial, d'une ségrégation à plusieurs échelons aux fins de justifier et de perpétuer le silence sur les problèmes qui existent dans les groupes marginalisés. Cette appréhension spatiale explique l'inégalité, tandis que la problématisation de la différence conduit à mettre en évidence la création de nouveaux savoirs sociaux. L'intérêt porte ici sur l'économie du quotidien, considérée comme un contexte essentiel, quoique très souvent négligé, pour le développement de ces savoirs. L'auteur revisite une théorie de la création du savoir élaborée dans le but d'accroître la compétitivité commerciale, et la reconfigure pour qu'elle concorde avec des objectifs sociopolitiques et économiques. L'un des principaux défis consiste à changer la rhétorique dominante en cultivant de nouvelles pratiques qui supposent une interaction porteuse de sens entre des gens par ailleurs ségrégués. L'efficience devient un moyen à des fins sociales et économiques, le respect et la confiance se nourrissant de la collaboration vécue entre des personnes qui, autrement, n'auraient peut-être pas été en relation. [source] A survey of staff attitudes to increasing medical undergraduate education in a district general hospitalMEDICAL EDUCATION, Issue 7 2005John Macdonald Introduction, Medical student numbers in Britain are increasing rapidly, beyond the capacity of most teaching hospitals, with more clinical teaching taking place in district general hospitals (DGHs). Surveys show that students value the intensive clinical teaching, smaller student numbers and perceived greater friendliness in DGHs. This paper explores DGH staff attitudes to teaching , their level of initial enthusiasm, their attitudes to current teaching, its effect on the hospital and to the sustainability of DGH undergraduate teaching , as both student numbers and service workloads continue to rise. Methods, Semi-structured interviews with 6 key informants were used to generate themes for a 19-question pre-piloted anonymous postal questionnaire sent to all 68 staff involved in undergraduate medical teaching in Northampton General Hospital. Results, The total response included 85% of consultants. Responses in the 3 staff groups were similar. Most respondents felt enthusiastic at the prospect of medical students, although they realised that this would be intellectually challenging and increase time pressures. These predictions were largely fulfilled. Respondents felt that in comparison to teaching hospitals the DGH teaching was more clinically based and consultant-led, with more approachable staff. Currently 41 respondents (82%) felt that they had inadequate teaching time. A majority felt that the arrival of students had improved patient care and that their department had benefited. Thirty-seven responders (74%) felt that the planned doubling of student numbers would impose an unsustainable departmental load, and would compromise teaching quality. The change felt most necessary to support additional teaching was increased clinical medical staff. Better co-ordination between the DGH and the medical school was also felt necessary. The most popular choice for the distribution of extra teaching finance was to the teacher's directorate, i.e. speciality [33 (66%)]. Forty-four (86%) felt that increased student numbers would have a significant impact on the character of the hospital. The 108 free-text comments (2.1 per respondent) centred on hospital character and the benefits of students. Conclusions, This study shows a considerable initial enthusiasm for teaching in DGH staff, which is persisting despite increasing student numbers. However, the current teaching load is seen to be substantial. Teaching more students is likely to produce major problems, based on lack of teaching time and increasingly heavy service commitments rather than lack of patients. This is likely to be a widespread problem for DGHs. Failure to ensure adequate teaching staff and facilities as well as co-ordination could threaten the sustainability of this potentially valuable teaching initiative. [source] Are therapeutic ultrasound units a potential vector for nosocomial infection?PHYSIOTHERAPY RESEARCH INTERNATIONAL, Issue 2 2006Siobhan Schabrun Abstract Background and Purpose.,Nosocomial infections present a widespread problem in today's healthcare environment, with a significant number of patients acquiring an infection annually. With the contemporary transition of immunocompromised and high-risk patients to community-based care, therapeutic ultrasound has the potential to be a vector of infection in the physiotherapy setting. The purpose of the present study was to determine the degree of contamination on therapeutic ultrasound transducer heads and ultrasound gel after routine clinical use, and to evaluate the efficacy of recommended infection control procedures.,Method.,The study consisted of two phases. Using a prospective cross-sectional design, microbiological cultures were obtained from 44 transducer heads and 43 gels. Subjects were drawn from a variety of physiotherapy practice settings. All samples containing more than five colony forming units per cm2 were considered contaminated. Following these measurements, a repeated-measures design was used to re-evaluate the 44 transducer heads for the amount and type of bacteria present after cleaning with a 70% alcohol wipe.,Results.,Twenty-seven per cent of transducer heads and 28% of gels were contaminated. Transducer heads showed fairly low levels of contamination across the sample, with the majority of organisms isolated found in normal skin and environmental flora. Gels were heavily contaminated with opportunistic and potentially pathogenic organisms, including Stenotrophomonas maltophilia, Staphylococcus aureus, Acinetobacter baumannii and Rhodotorula mucilaginosa. No multi-resistant organisms were identified. Cleaning with 70% alcohol significantly reduced the level of contamination on transducer heads (p < 0.01).,Conclusions.,Therapeutic ultrasound equipment is a potential vector for nosocomial infection in physiotherapy patients. The risk of infection from transducer heads can be effectively removed by cleaning with 70% alcohol between patients. Further research into possible strategies to reduce the risk of infection from ultrasound gels is needed. Copyright © 2006 John Wiley & Sons, Ltd. [source] An assessment of the effects of increased regulatory enforcement and legislative reform on occupational hearing loss workers' compensation claims: Oregon 1984,1998AMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 5 2004Brian P. McCall PhD Abstract Background Hearing loss from occupational exposures is a serious and widespread problem. This study measured the outcomes that increased enforcement of regulations and legislative interventions had on hearing loss workers' compensation claims. Methods Workers' compensation claim data from Oregon was analyzed for the period of 1984,1998 to examine trends and severity of hearing loss claims. In 1987 and 1990, Oregon enacted legislative reforms to improve enforcement and promulgation of safety standards in the state. This study examined hearing loss claims between the periods of pre- and post-legislative reforms. Results It was found that hearing loss claims decreased significantly following the legislative reforms, although the average cost per claim increased. Age and tenure effects, and evidence of moral hazard were also discovered. Conclusions Increased enforcement of regulations and legislative interventions by Oregon improved working conditions leading to occupational hearing loss. Nevertheless, hearing loss remains problematic, and continued efforts are required to improve worker safety. Am. J. Ind. Med. 45:417,427, 2004. © 2004 Wiley-Liss, Inc. [source] Persistent iodine deficiency in a cohort of Tasmanian school children: associations with socio-economic status, geographical location and dietary factorsAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 5 2004Kristen L. Hynes Objective: To determine the adequacy of iodine nutrition of Tasmanian primary school-aged children and to examine possible associations with socio-economic status (SES), location and dietary factors. Methods: Urinary iodine levels and measures of SES, geographical information and dietary habits were surveyed in a population-based sample of 170 children (4 to 12 years) at baseline (1998/99) and at follow-up (2000/01). Results: Median urinary iodine concentration in 1989-99 and 2000-01 were 75 ,g/L (range 15 ,g/L to 240 ,g/L) and 76 ,g/L (range 18 ,g/L to 480 ,g/L) respectively. No significant associations with SES or geographical location were found. More frequent or recent intake of foods that are likely to be dietary sources of iodine tended to be associated with greater prevalence of adequate urinary iodine, particularly consumption of yoghurt and ,fruche' (p=0.04). Conclusions: After several decades of iodine sufficiency, Tasmanian primary school-aged children are again mildly iodine-deficient by WHO criteria. Despite reduction in iodophor use by the dairy industry in the past decade, consumption of dairy products continues to be associated with higher levels of iodine nutrition. Implications: The lack of association of iodine levels with SES and geographical location within Tasmania found in our study, and the results of studies of iodine levels in Melbourne and Sydney, suggest that inadequate iodine nutrition is a widespread problem in south-eastern Australia. Our study suggests that milk-containing products continue to be an important source of iodine for children. [source] Silicon-mediated resistance of sugarcane to Eldana saccharina Walker (Lepidoptera: Pyralidae): effects of silicon source and cultivarJOURNAL OF APPLIED ENTOMOLOGY, Issue 8 2006M. G. Keeping Abstract:, The effects of four silicon sources , a USA calcium silicate, a local (South African) calcium silicate, Slagment® and fly ash , on the resistance of sugarcane cultivars (two resistant and two susceptible) to Eldana saccharina Walker (Lepidoptera: Pyralidae) were studied in a potted sugarcane trial. Silicon sources were applied at 5000 or 10 000 kg/ha for the calcium silicates and Slagment; fly ash was applied at 15 000 or 30 000 kg/ha. The greatest increase in plant silicon content (particularly in stalks) was recorded for plants treated with local calcium silicate. Silicon uptake did not vary significantly between the susceptible and resistant cultivars, although the resistant cultivars had inherently higher silicon content than the susceptible ones. Treatment with silicon significantly reduced borer damage and borer performance at the higher treatment level. In general, borer damage and performance decreased with increasing rates of applied silicon and both variables were inversely related with per cent stalk silicon. On average, the higher silicon rate reduced damage by 34% in the susceptible cultivars and by 26% in the resistant cultivars, supporting the argument that susceptible cultivars benefit more from silicon treatments than resistant ones. We propose that calcium silicate amendments could be employed in the integrated, area-wide management of E. saccharina and in the management of soil acidity, both of which are widespread problems in the South African sugar industry. [source] Discount Rates in Disarray: Evidence on Flawed Goodwill Impairment TestingAUSTRALIAN ACCOUNTING REVIEW, Issue 4 2009Wayne Lonergan The onset of the Global Financial Crisis (GFC) will focus even more attention on the inadequacies in impairment testing by reporting entities. However, experience with the corporate sector, even before the GFC, indicated that there were widespread problems in practice with impairment testing. The article by Carlin and Finch is therefore both timely and particularly relevant to the current capital markets. [source] Conceptual analysis of critical moments in Victoria Climbié's lifeCHILD & FAMILY SOCIAL WORK, Issue 1 2005Margaret Rustin ABSTRACT Victoria Climbié was a West African child sent to Europe in the care of her aunt, Kouao. She died as a consequence of cruelty and neglect at the hands of her aunt and her aunt's boyfriend, Manning, in particularly extreme circumstances. A major inquiry by Lord Laming into the failings of the statutory services revealed widespread problems and made many recommendations to government. Drawing on the Victoria Climbié Inquiry Report, the paper aims to describe and understand Victoria's states of mind during her time in England. The report contains many clues to the meaning of what happened, but their significance for learning from the entire tragedy is missed. The paper explores why professionals found it impossible to see what was happening, despite the evidence being available. Both Victoria's states of mind and those of the professionals who came into contact with her are analysed in terms of defences against extreme mental pain. The importance of the right kind of training and organizational support being available for child protection staff is discussed. [source] | |||||||||||||