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Biomedical subjects

R Hogan

Publications and source records attributed to R Hogan.

At least 19 recordsLinked to original sources
PubMed2006

Radioactive materials in biosolids: dose modeling.

The Interagency Steering Committee on Radiation Standards (ISCORS) has recently completed a study of the occurrence within the United States of radioactive materials in sewage sludge and sewage incineration ash. One component of that effort was an examination of the possible transport of radioactivity from sludge into the local environment and the subsequent exposure of humans. A stochastic environmental pathway model was applied separately to seven hypothetical, generic sludge-release scenarios, leading to the creation of seven tables of Dose-to-Source Ratios (DSR), which can be used in translating from specific activity in sludge into dose to an individual. These DSR values were then combined with the results of an ISCORS survey of sludge and ash at more than 300 publicly owned treatment works, to explore the potential for radiation exposure of sludge workers and members of the public. This paper provides a brief overview of the pathway modeling methodology employed in the exposure and dose assessments and discusses technical aspects of the results obtained.

Environmental Monitoring↗
PubMed2001

Experience of the first pelvic examination.

OBJECTIVES: To analyze women's experiences of the first pelvic examination and identify positive and negative components. To learn lessons, and build on and incorporate the positive components into a model of good clinical practice. METHOD: The open, cross-sectional study was carried out in community family planning and young persons clinics. A self-administered questionnaire was offered to all women under 25 years of age who attended a family planning or young persons clinic during the study period. The questionnaire was constructed to determine how experience compared with expectations and which components showed a significant trend towards a positive or negative effect. It also aimed to find what women considered to be important aspects of an internal examination. RESULTS: A total of 167 evaluable questionnaires were completed in which experience of the first pelvic examination was reported from family planning clinics (41%), general practice (39%) and hospital/genitourinary medicine faculties (20%). These first pelvic examinations occurred at a mean age of 17.3 years (range 11-23 years). Significant trends of a positive experience were found when the examination was conducted by a female doctor (p = 0.02), when it was conducted in a family planning clinic as opposed to general practice (p = 0.04), after permission was sought (p = 0.001) and with increasing age at first examination (Mann-Whitney, p = 0.003). There were no significant differences in outcome with offer of, or presence of, a chaperone. CONCLUSIONS: A friendly, female doctor who seeks permission before the examination, which should be uninterrupted, were considered to be important aspects for an internal examination.

Adolescent↗
PubMed2000

Findings from case studies of state and local immunization programs.

BACKGROUND: As part of its examination of federal support for immunization services during the past decade, the Institute of Medicine (IOM) Committee on Immunization Finance Policies and Practices (IFPP) commissioned eight case studies of the states of Alabama, Maine, Michigan, New Jersey, North Carolina, Texas, and Washington; and a two-county study of Los Angeles and San Diego in California. Specifically, the IOM Committee and these studies reviewed the use of Section 317 grants by the states. Section 317 is a discretionary grant program that supports vaccine purchase and other immunization-related program activities. These studies afforded the Committee an in-depth look at local policy choices, the performance of immunization programs, and federal and state spending for immunization during the past decade. METHODS: The case-study reports were developed through interviews with state and local health department officials, including immunization program directors, Medicaid agency staff, budget analysts, and Centers for Disease Control and Prevention public health advisors to the jurisdiction. Other sources included state and federal administrative records and secondary sources on background factors and state-level trends. The case studies were supplemented by site visits to Detroit, Houston, Los Angeles, Newark, and San Diego. OBSERVATIONS: The nature of immunization "infrastructure" supported by the Section 317 program is shifting from primarily service delivery to a broader set of roles that puts the public effort at the head of a broad immunization partnership among public health, health financing, and other entities in both the public and private sectors. The rate and intensity of transition vary across the case-study areas. In the emerging pattern, service delivery increasingly takes place in the private sector and is related to managed care. "Infrastructure" is moving beyond supporting a core state staff and local health department service delivery to include such activities as immunization registries, quality improvement, and coordination with programs outside public health agencies. At the same time, the recent decline in federal Section 317 support is forcing difficult choices between old and new activities at the state and local levels. CONCLUSIONS: Immunization programs function as an organic component of the local health care financing and delivery systems of which they are a part. Immunization efforts are organized and conducted within distinctive state and local fiscal, economic, and health care contexts. Section 317 Financial Assistance grants, while playing a vital role in supporting immunization "infrastructure," have been too unstable and unpredictable to elicit the strategic planning, programming, and own-source spending that would be optimal for state and local programs. The predominant immunization function of state and local public health agencies is becoming assurance of age-appropriate immunization throughout the lifespan. To be successful in this emerging role, the health agencies must be supported with appropriate staffing, interagency collaboration, and clearly articulated authority.

Adult↗
PubMed1998

Solitary plasmacytoma of the epiglottis: a case report and review of the literature.

A 59-year-old white male presented with a two-month history of dry cough and shortness of breath. At bronchoscopy, a 1 cm mass on the laryngeal surface of the epiglottis was found. Immunohistochemical stain of the biopsy specimen revealed a monoclonal proliferation of plasma cells. Serological tests revealed normal serum immunoglobulin levels, and a bone marrow aspirate and biopsy was also normal; no abnormalities were found on serum or urine electrophoresis. He received radiotherapy (50 Gy), and was doing well three years following therapy without evidence of disease.

Epiglottis↗
PubMed1996

The impact of face-to-face educational outreach on diarrhoea treatment in pharmacies.

Private pharmacies are an important source of health care in developing countries. A number of studies have documented deficiencies in treatment, but little has been done to improve practices. We conducted two controlled trials to determine the efficacy of face-to-face educational outreach in improving communication and product sales for cases of diarrhoea in children in 194 private pharmacies in two developing countries. A training guide was developed to enable a national diarrhoea control programme to identify problems and their causes in pharmacies, using quantitative and qualitative research methods. The guide also facilitates the design, implementation, and evaluation of an educational intervention, which includes brief one-on-one meetings between diarrhoea programme educators and pharmacists/owners, followed by one small group training session with all counter attendants working in the pharmacies. We evaluated the short-term impact of this intervention using a before-and-after comparison group design in Kenya, and a randomized controlled design in Indonesia, with the pharmacy as unit of analysis in both countries (n = 107 pharmacies in Kenya; n = 87 in Indonesia). Using trained surrogate patients posing as mothers of a child under five with diarrhoea, we measured sales of oral rehydration salts (ORS); sales of antidiarrhoeal agents; and history-taking and advice to continue fluids and food. We also measured knowledge about dehydration and drugs to treat diarrhoea among Kenyan pharmacy employees after training. Major discrepancies were found at baseline between reported and observed behaviour. For example, 66% of pharmacy attendants in Kenya, and 53% in Indonesia, reported selling ORS for the previous case of child diarrhoea, but in only 33% and 5% of surrogate patient visits was ORS actually sold for such cases. After training, there was a significant increase in knowledge about diarrhoea and its treatment among counter attendants in Kenya, where these changes were measured. Sales of ORS in intervention pharmacies increased by an average of 30% in Kenya (almost a two-fold increase) and 21% in Indonesia compared to controls (p < 0.05); antidiarrhoeal sales declined by an average of 15% in Kenya and 20% in Indonesia compared to controls (p < 0.05). There was a trend toward increased communication in both countries, and in Kenya we observed significant increases in discussion of dehydration during pharmacy visits (p < 0.05). We conclude that face-to-face training of pharmacy attendants which targets deficits in knowledge and specific problem behaviours can result in significant short-term improvements in product sales and communication with customers. The positive effects and cost-effectiveness of such programmes need to be tested over a longer period for other health problems and in other countries.

Adult↗
PubMed1994

What we know about leadership. Effectiveness and personality.

Although psychologists know a great deal about leadership, persons who make decisions about real leaders seem largely to ignore their accumulated wisdom. In an effort to make past research more accessible, interpretable, and relevant to decision makers, this article defines leadership and then answers nine questions that routinely come up when practical decisions are made about leadership (e.g., whom to appoint, how to evaluate them, when to terminate them.

Humans↗
PubMed1994

Osmotic blood-brain barrier disruption: CT and radionuclide imaging.

PURPOSE: To compare CT and radionuclide imaging of osmotic blood-brain barrier disruption. To develop a quantitative method for imaging osmotic blood-brain barrier disruption and to see if iopamidol could be safely given intravenously in conjunction with blood-brain barrier disruption. METHODS: Forty-five blood-brain barrier disruption procedures were imaged with CT and radionuclide scans. The scans were evaluated with visual and quantitative scales. Patients were observed for adverse effects after blood-brain barrier disruption. RESULTS: There was a 4% rate of seizures in this study. There was good agreement between visual CT and radionuclide grading systems. Quantitative methods to grade disruption did not add useful information to visual interpretations. CONCLUSIONS: Nonionic iodine-based contrast medium has a lower incidence of seizures when injected intravenously in conjunction with osmotic blood-brain barrier disruption than ionic contrast material. Contrast-enhanced CT is the preferred method to image disruption because it has better spatial resolution than radionuclide techniques.

Adolescent↗
PubMed1994

Common bile duct evaluation in the era of laparoscopic cholecystectomy. 1050 cases later.

OBJECTIVE: The authors documented the evolution of common bile duct (CBD) evaluation after the development of laparoscopic cholecystectomy (LC) and CBD exploration. Emphasis was placed on stratification of CBD stone risk so that subgroups could be selected appropriately for no further studies, preoperative endoscopic retrograde cholangiogram (ERC), or intraoperative intervention. METHODS: Data were accumulated by the authors on presentation, findings, and outcomes of 1050 patients who underwent cholecystectomies. Risk stratification was based on the history, ultrasound findings, biochemical derangements, and operative findings. RESULTS: Fifty-seven per cent of patients met criteria to be "no/low" risk for CBD stones (CBD diameter < 5 mm, normal liver enzymes, and no history of acute cholecystitis, jaundice, or pancreatitis); in these patients, cholangiograms were not obtained, and there was no clinical evidence of CBD stones observed in follow-up at 45 months (sensitivity = 100%). As techniques developed for laparoscopic CBD exploration, there was a decreased incidence of open cholecystectomy (p < 0.05) and preoperative ERC (p < 0.05). The rate of operative cholangiogram increased from 13% to 23% during the series (p < 0.01). There were no CBD injuries or late strictures. The only bile leak occurred from a peripheral segmental duct in the gallbladder bed and was resolved with a laparotomy and suture. There were no transfusions. Three retained stones were documented in patients who had false-normal operative cholangiograms. CONCLUSIONS: Criteria were defined that delineate a "no/low" risk group of LC patients for whom operative cholangiograms were not indicated for excluding CBD stones. The routine use of operative cholangiography as a means of preventing CBD injury was not substantiated by this study. The indications for preoperative ERC should continue to decrease as laparoscopic techniques evolve.

Adolescent↗
PubMed1991

Narcissism, self-esteem, and defensive self-enhancement.

This study investigates the relationships among narcissism, self-esteem, and defensive self-enhancement in samples of 60, 84, 300, and 57 subjects. Using various self-report indices of these constructs we found that (a) defensive self-enhancement is composed of two orthogonal components: grandiosity and social desirability; (b) grandiosity and social desirability independently predict self-esteem and may represent distinct confounds in the measurement of self-esteem, (c) narcissism is positively related to grandiose self-enhancement (as opposed to social desirability), (d) narcissism is positively associated with both defensive and nondefensive self-esteem, and (e) authority, self-sufficiency, and vanity are the narcissistic elements most indicative of nondefensive self-esteem. The results are consistent with several theories that postulate a two-component model for self-esteem regulation and personality development.

Adult↗
PubMed1990

Breastfeeding as an intervention within diarrheal diseases control programs: WHO/CDD activities.

The Control of Diarrhoeal Diseases Programme (CDD) at the World Health Organization (WHO) is looking at ways to prevent diarrhea and has identified breastfeeding as an important factor. CDD is studying the protective effects of exclusive breastfeeding and the morbidity and mortality risks for infants exclusively, partially, or not breastfed. CDD has identified trials of interventions for breastfeeding promotion and the evaluation of approaches for the implementation of tested interventions among its research priorities. CDD also has included breastfeeding promotion information in modules in its two management training courses. The Programme plans to monitor the effectiveness of the training and develop future activities based on that feedback.

Breast Feeding↗
PubMed1989

Managing local government opposition to community-based residential facilities for the mentally disabled.

"Prior Notification" policies have elicited fears of community opposition from agencies who have adopted a "low profile" approach in locating community-based residential facilities. Nevertheless, data from a survey of New Jersey community care providers indicate that local government officials express less opposition when informed of the proposed location and invited to meet with the provider. Arranging to meet with local officials is most important when neighbors have leadership, since officials express more intense opposition when neighbors invite them to a meeting. The literature has already established the fact that meeting with neighbors can facilitate mobilization and thereby engender more intense opposition, both from neighbors and from local officials. Hence, the available evidence suggests that providers should meet with local officials to discuss the community care program but should attempt to deal with neighbors individually. This strategy is compatible with the policy of "prior notification" adopted in New Jersey.

Attitude↗
PubMed1989

Knowledge and health beliefs regarding phosphate-binding medication in predicting compliance.

Successful treatment of end stage renal disease depends on the individual's compliance with a complex medical regimen. The purpose of the present research was to determine the extent to which knowledge and health beliefs relating to phosphate-binding medications predict compliance of individuals on hemodialysis. Scores from the questionnaire used indicated that perceived barriers, namely forgetting and being away from home, were the most significant predictors of compliance. The conclusions suggest that nurses need to plan interventions that reduce barriers to taking medication.

Adult↗
PubMed1986

Gaining community support for group homes.

Data from a telephone survey of New Jersey group home providers, contracting with the State Division of Mental Retardation and Mental Health and Hospitals, evidence the assertions that providers who follow a standard public relations policy, arrange to meet with municipal officials, inform neighbors before moving-in, use local contacts, and invite the community to an open house generally enjoy greater support for their group home programs. In the medium to long run, neighbors who choose to become involved in the group home location effort (often because of concern if not opposition) generally offer more support.

Community-Institutional Relations↗