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From ICD9-CM to MeSH using the UMLS: a how-to guide.

One purpose of the Unified Medical Language System (UMLS) is to facilitate conversion of terms from one controlled medical vocabulary to another. We examined our ability to convert International Classification of Diseases, 9th Edition, Clinical Modifications (ICD9-CM) to Medical Subject Headings (MeSH) using the UMLS. We describe a method which mapped 30.4% of ICD9-CM to UMLS. Of these, 95.0% were linked to MeSH, of which translation was straightforward in 90.4%. We discuss the use of these translations for retrieval from MeSH-indexed databases, such as Medline.

Disease↗

Applications of the International Classification of Diseases.

A brief outline is given of how various types of adaptation of the ICD for use in different situations have arisen. The application includes condensed lists, national adaptations, studies of morbidity, specialty adaptations (including for primary care), and augmentation by supplementary material. The major purposes of different applications are reviewed and an indication is given of factors influencing selection of the condition of primary interest in such situations. The article concludes by suggesting guidance for the development of applications and adaptations of the ICD.

Disease↗

[Discreet follies. Variations on Don Quixote's folly].

Physicians and psychiatrists have been discussing through centuries about the madness of Don Quixote. The first in doing that was Philippe Pinel, followed immediately by many others. They all agreed in diagnosing Don Quixote as "monomaniac". Cervantes was considered an excellent "nosographer", and the novel a paradigmatic description of this mental disorder. After the Kraepelin's work, the old Pinelian nosography was substituted by a new system of classification of mental diseases, and Don Quixote was considered "paranoid". Finally, after the DSM IV, the usual diagnostic is "delusional disorder". Throughout history there have been two different types of mental disorders, being only one of them considered pathological. This difference appears in English in words like "crazy" and "mad." The thesis of this essay is that Don Quixote is more a crazy than a mad man. He is trying to achieve a world full of peace, justice and love. His moral ideal is to make possible the triumph of this perfect world. This crazy goal was deeply influenced by the Erasmian ideology. And Erasmus of Rotterdam was the author of a very famous book entitled The Praise of Folly, published the year 1509, almost a century before the novel of Cervantes. In this work, the word opposite to "loco" (crazy, mad, insane) is "discreto", a word of difficult translation to English, which means at the same time "shrewd," "discreet" and "ingenious". Cervantes says at the beginning of the second part of his work, that Don Quixote is doing in it "discretas locuras" ("discreet follies", trans. Thomas Shelton, 1620; "ingenious follies", trans. Tobias G. Smollet, 1755; "shrewd lunacies", trans. John Ormsby, 1885). This mixture of cleverness and lack of moderation is considered by the author the interpretation's key of the work.

Diagnosis, Differential↗

The effect of cooperative hydrogen bonding on the OH stretching-band shift for water clusters studied by matrix-isolation infrared spectroscopy and density functional theory.

Infrared spectra of the water clusters have been measured in the N2 + O2 matrix. The aggregation process of water in the matrix has been monitored by annealing the deposited samples up to 40 K and UV irradiation. The monomer, dimer, cyclic trimer and cyclic pentamer are found as water clusters in the matrix. For the hexamer, several structures such as chair, cage, prism, bag 1 and/or book 1 are likely to exist. By UV irradiation, the cyclic pentamer is predominantly formed from the monomer and dimer. On the other hand, by annealing the deposited sample, several hexamers are formed. The theoretical calculation for water clusters has revealed that the formation of one hydrogen bonding in a hydrogen-bonded chain cooperatively enhances or diminishes the strength of another hydrogen bond. Both proton donor (D) and acceptor (A) participating in a hydrogen-bonding pair DA are capable of forming hydrogen bonding with the other water molecules; D can additionally accept two protons and donate one proton, and A can additionally donate two protons and accept one proton. We have proposed the classification of hydrogen-bonding patterns considering the cooperativity, denoting as d'a'DAd''a'', where d and a are integers indicating the number of proton donors and acceptors to D (the single prime) and A (the double prime), respectively. Then, a magnitude given by MOH = -d' + a' + d'' - a'' has been introduced, which is very useful for connecting the hydrogen-bonding patterns to their OH wavenumbers. As a result, it is revealed that the OH stretching bands of water clusters are characterized by eight indicators (free and MOH = -2, -1, 0, 1, 2, 3 and 4). The classification proposed here is applicable to the OH band analysis for the hydrogen-bonded water and alcohols in a condensed phase.

Computer Simulation↗

The pelvic external fixation: the mid-term results of 41 patients treated with a newly designed fixator.

The purpose of this study was to evaluate the clinical and radiological results of unstable pelvic fractures treated with a new external fixation device. Between May 1992 and May 1998, 43 patients with unstable pelvic fractures were treated with a new anterior pelvic external fixator. Two died, and therefore 41 patients' results were evaluated. There were 29 men and 12 women, and their average age was 34 years (range 12-70 years). Traffic accidents accounted for 34 injuries. Three patients fell from a height, 3 were injured in industrial accidents, and 1 was hit by a train. According to the Tile classification, there were 24 type B pelvic injuries and 17 type C. Associated injuries were observed in 21 patients. A considerable reduction of the pelvic pain was noted after application of the fixator in all patients. Excessive blood transfusion was not required in any patient. The average follow-up was 24 months (range 12-50 months). Clinical results at final evaluation were good according to the criteria of Matta and Saucedo in 34 patients and poor in 7. In conclusion, the new pelvic external fixator is effective, safe, and easy to apply in the treatment of unstable pelvic fractures. The fixator can be used alone in patients with type B pelvic injuries such as open book and lateral compression. However, it does not provide sufficient stability for severely displaced type C injuries when applied alone. Nevertheless, it may be helpful for fixing type C injuries like a posterior iliac fracture without dislocation of the sacroiliac joint.

Adolescent↗

Paraphilias in U.S. pornography titles: "pornography made me do it" (Ted Bundy).

In 1986, the U.S. Commission on pornography reviewed 3,050 separate magazine and book titles sold in "adults only" pornographic outlets randomly selected in Washington, DC; Baltimore, MD; Miami, FL; Philadelphia, PA; New York, NY; and Boston, MA. Of these, 746 titles could be assigned to a DSM III-R paraphilia category (513 titles if the category partialism is excluded). Incest was listed as a category separately from pedophilia. Thus, 16.8 percent of the titles could be assigned to a paraphilia category (24.4% of all titles, if partialism is included as a category). Paraphilia distribution is discussed. Sadomasochism was by far the most common paraphilia (49.9%) while incest titles comprised 21.4 percent of the perversions. The frequency distribution for the U.S. material is compared with titles reviewed by the Victoria (Australia) State Classification of Publications Board and previously reported by the author.

Erotica↗

[Study of the categorization process among patients with eating disorders: a new cognitive approach to psychopathology].

Anorexic and bulimic patients have a highly distorted relationship with food and eating, even though they tend to be knowledgeable about diet and nutrition. The progress of this disease, as well as its complications and associated difficulties, are increasingly understood, while the etiopathogeny of eating disorders remains obscure. The approach that we are proposing involves the study of one of the most fundamental cognitive functions of human reasoning--the cognitive process of categorization. The purpose of this study is to understand the procedures used by these patients to construct representations of food. Categorization, one of the basic features of human cognition, allows individuals to organize their subjective experience of the surrounding environment by structuring its contents. This ability to group different objects into the same category based on their common characteristics is important for explaining the major cognitive activities of planning, memorization, communication and perception. Indeed, our categories reflect our conceptions of the world. They depend on our experiences and representations, as well as the expertise acquired in a specific field. The differences that appear in the categories created by subjects when they are asked to classify objects reveal the properties that are most salient to them and, as a result, the interests, values and ideas associated with these properties. There are three types of properties: perceptive properties, which describe the object's shape, color, odor and texture; structural properties, which relate to the object's components; and functional properties, which specify the way in which the object is used and provide an answer to the question, "What is it used for?". Subjects attribute these functional properties by means of knowledge or inference according to their representation of the object's role; such properties are especially likely to emerge during top-down (theory-driven) processing. The type of processing used (bottom-up or top-down) is dependent on a certain number of factors. We hypothesize, within the context of food product categorization, that patients suffering from eating disorders largely resort to processing based on acquired information or beliefs about the objects, i.e. top-down processing. We present two studies: a naturalistic and exploratory pilot study whose goal is to identify whether the various categorization processes used by eating disorder patients differ from those employed by subjects not suffering from an eating disorder. A second study aims to identify the different categorization procedures. During the first experiment, 68 women (17 control subjects, 17 anorexics, 17 anorexic bulimics and 17 bulimics) aged 18-39 (average age: 26.6) verbalize all representations that come to mind during a limited time period as the name of a food item is read. Eighty-nine food items are presented in alphabetical order. The list is read out loud and all comments are recorded. The data is processed in three ways : an analysis based on the positive or negative valence of each representation, an analysis based on each categories of food and an analysis of representations based on themes expressed. The three analyses (valence, categories of food and theme assigned to the representations) show differences between the representations of the four experimental groups. In fact, the anorexics and anorexic bulimics mainly express strongly negative representations about food, whereas bulimics and control produce representations whose positive and negative valences balances. These negative cognitions concern mainly meat for the control subjects and cakes for the subjects reached of TCA. Concerning theme assigned to the representations, the control subjects produce mainly cognitions relating to the hedonism, the flavor of food and their purpose on health. The anorexics and anorexics-bulimics evoke mainly the fat and sugar content of the foods. The bulimics evoke mainly cognitions relating to the effect on health and the intestinal transit time of food. These results lead one to believe that it is not the bulimic binging and purging of these patients, but rather their restrictive behavior that is the determining factor in the differences in food representations observed between the two experimental groups. During the second experiment, 60 women (15 controls, 15 anorexics, 15 anorexic bulimics and 15 bulimics) aged 18-32 (average age: 25.6) classified 27 food names according to their similarities and differences, and then explained the reasons for their categorizations. The data were analyzed in terms of similarity/difference, and the verbalizations were analyzed by content. The results indicate that 10 of the 27 foods were categorized differently by the controls and the subjects with eating disorders. Subjects classified the following foods: camembert cheese, cold cuts, cheese spread, fruit in syrup, whole milk, mayonnaise, bread, fresh fish, potatoes and plain yogurt. Bulimics and controls use similar classifications for food names, while anorexics and atypical bulimics classify foods in a similar way. Examining the categorization criteria used during verbalizations allows us to better understand these differences. The control group's major criterion seems to be the succession of dishes. These subjects group into separate categories entry foods (beef, eggs, fish, etc.), vegetables, cheese or dairy foods, and finally desserts. Additional foods, like bread and mayonnaise, belong to the same category. Other categories are nutritional criteria (for example, dairy products contain calcium) and biological criteria (for example, bananas and apples are fruits). These categorization criteria include structural properties (which describe what the object is made of) and functional, "academic" properties, those which describe how foods are used, "as in cookbooks or diet books." On the other hand, the categorization criteria expressed by anorexic patients are very different from those used by control subjects: foods that are hard to eliminate, rich, high-fat and therefore indigestible are considered to be similar. Some examples are cold cuts, potatoes, mayonnaise and prepared desserts. A second categorization criterion involves the concept of natural foods : certain foods "are unhealthy because they're processed, so they're bad for you"--one such example is cheese spread. A third criterion concerns the notion of familiar foods: poultry and eggs, for example, are "familiar to us." We are clearly seeing here the importance of functional properties in the categorization of food names: certain foods are indigestible, hard to eliminate, cause heartburn or reflux, are not natural, and thus are avoided. The categorization criteria mentioned by bulimic patients also clearly take into account the functional properties of foods. The criteria are of the following type: "it's filling, it relieves a bulimic attack, it helps prevent heartburn and constipation, etc." It appears that bulimics' categorization criteria are solely associated with these foods' imagined or real effect on the body. The categorization criteria used by anorexic bulimics seem to be especially associated with weight gain or the consumption of such foods during bulimia attacks because "they make you feel full." On the other hand, light foods, which patients allow themselves to eat, are placed in the same category. This study, which seeks to understand the cognitive functioning of eating disorder patients with anorexia and bulimia, has brought new elements to light. All patients exhibit food categorization processes that differ greatly from those displayed by control subjects. Patients also attribute greater significance to the functional properties of foods as compared to controls, who give priority to structural properties. Anorexic and bulimic patients base their food categorizations on the consequences of ingestion, in terms of health, digestion and weight gain. Their processing of food stimuli is therefore radically different and gives a dominating place to top-down processes. Additional studies should supplement these findings in order to gain a better understanding of patients' disturbed processing of information.

Adolescent↗

Unruly hair.

One of the difficulties dermatologists encounter when attempting to diagnose rare scalp hair abnormalities is knowing where to start. Faced with a patient presenting with 'frizzy' hair it is helpful to have a systematic approach rather than simply 'thumb through the books'. Price (1979) classifies anomalies of the hair shaft in to those associated with increased fragility which consequently give rise to alopecia, and those which are not thus associated. There is a significant group of disorders which present with unruly hair, and these have been described under all manner of titles, including crinkly, woolly, kinky, crimped, frizzly, steely, spunglass, in an attempt to define their clinical appearance. This only serves to confuse the issue as no one word adequately describes many of these abnormalities. I would like to suggest an approach for categorizing and diagnosing unruly hair forms, based on a review of the literature as well as on experience with such cases. This is a modified and extended version of the only previous classification of unruly hair proposed by Lantis and Pepper (1978). I accept that there are some individual cases which are difficult to classify and remain unique.

Adolescent↗

Collapsed ultraendurance athlete: proposed mechanisms and an approach to management.

OBJECTIVE: To review the common conditions causing collapse in ultraendurance athletes, to propose appropriate treatment protocols for the more common medical conditions that are encountered, and to provide practical guidelines for the management of the medical facilities at these endurance events. DATA SOURCES: Books published on the subject, abstracts of the American College of Sports Medicine Annual Congress dealing with the subject over the last 5 years, and electronic search of the Medline and Current Contents databases (last searched May 1995). German articles were included in the search criteria. STUDY SELECTION: Articles dealing generally with the management of medical facilities at endurance events were chosen. Articles dealing more specifically with the common medical conditions encountered at these events were then sourced and included in this review. DATA EXTRACTION: Multiple reader extraction of relevant data. DATA SYNTHESIS: A practical guideline to the management of the medical facility at an endurance event is detailed, expanding specifically on the nature of the conditions causing collapse during or after endurance exercise with a proposed classification of causes of collapse for optimizing immediate management and management protocols for specific conditions such as heatstroke, hyponatremia, hypoglycemia, exercise-associated collapse, and muscle cramps. CONCLUSION: The most commonly encountered medical condition at endurance athletic events is collapse after the event. The popular view that all persons who collapse have dehydration-induced hyperthermia has been challenged. Here we extend that argument and provide diagnostic and management protocols and propose a triage system that considers the most common causes of collapse in ultraendurance athletes. These protocols can optimize the efficient and safe management of large numbers of collapsed ultraendurance athletes. It is proposed that these protocols can optimize the efficient and safe management of large numbers of collapsed ultra endurance athletes.

Adult↗

Effects at age nine of maternal smoking in pregnancy: experimental and observational findings.

OBJECTIVES: To compare long term outcomes of a randomised controlled trial of anti-smoking education in pregnancy and to examine the same outcomes according to maternal pregnancy smoking behaviour. DESIGN: Follow up of the population included in the randomised controlled trial nine years later and of ex-smokers and non-smokers within the same hospital population. SETTING: A maternity hospital in Birmingham with follow up of children in schools and mothers at home. POPULATION: 1218 smokers recruited to the trial; also 191 ex-smokers at booking and 414 non-smokers throughout pregnancy. METHODS: Children were assessed individually by psychologists in schools, and mothers interviewed at home to obtain additional information relevant to cognitive development and growth. Information on smoking during pregnancy was obtained from mothers and obstetric data from computerised case-notes, both recorded immediately following delivery. MAIN OUTCOME MEASURES: Height, weight, IQ and neurological soft signs at 9.4 years. RESULTS: Differences in birthweight and length between the intervention and control groups were confirmed but no intervention-control differences were found at age 9.4 for weight, height, IQ or neurological soft signs. Differences were found for height and IQ according to mothers pregnancy smoking behaviour, but smoking did not remain an independent predictor after taking account of confounding factors. Alternative classifications of smoking behaviour, taking account of the gestation at stopping and mean cigarette consumption throughout pregnancy likewise showed no effect. CONCLUSIONS: The well established early hazards of smoking during pregnancy seem to be resolved by later childhood, with no evidence of direct long term effects on growth or cognitive functioning.

Birth Weight↗

Concordance of severity ratings provided in four drug interaction compendia.

OBJECTIVE: To evaluate the agreement among drug-drug interaction (DDI) compendia as to designation of interactions as having the greatest clinical importance ("major" DDIs). DESIGN: Cross-sectional, one-time evaluation. SETTING: United States in fall 2001. PARTICIPANTS: Not applicable. INTERVENTIONS: Major DDIs involving prescription medications likely to be dispensed in the community and ambulatory pharmacy settings were identified as listed in four compendia that provide specific, detailed information about DDIs (Drug Interaction Facts, Drug Interactions: Analysis and Management, Evaluations of Drug Interactions, and the MicroMedex DRUG-REAX program). MAIN OUTCOME MEASURE: Level of agreement between DDI compendia as assessed by the intraclass correlation coefficient (ICC). RESULTS: Overall, 406 major DDIs were listed in one or more of the four compendia. Only 9 (2.2%) of these major DDIs were listed in all four compendia; in fact, the majority of interactions were listed in only one compendium (291 DDIs, 71.7%), despite these interactions being considered of greatest clinical relevance by at least one compendium. The ICC among the compendia was -0.092, indicating low agreement on the classification of major DDIs. CONCLUSION: Little agreement exists among commonly used drug interaction COMPENDIA for DDIs that were classified in fall 2001 as having the highest clinical relevance and importance. A concerted effort to identify DDIs of the highest clinical importance is needed to design effective strategies to avoid and manage them.

Adverse Drug Reaction Reporting Systems↗

Nuclear power: levels of safety.

The rise and fall of the nuclear power industry in the United States is a well-documented story with enough socio-technological conflict to fill dozens of scholarly, and not so scholarly, books. Whatever the reasons for the situation we are now in, and no matter how we apportion the blame, the ultimate choice of whether to use nuclear power in this country is made by the utilities and by the public. Their choices are, finally, based on some form of risk-benefit analysis. Such analysis is done in well-documented and apparently logical form by the utilities and in a rather more inchoate but not necessarily less accurate form by the public. Nuclear power has failed in the United States because both the real and perceived risks outweigh the potential benefits. The national decision not to rely upon nuclear power in its present form is not an irrational one. A wide ranging public balancing of risk and benefit requires a classification of risk which is clear and believable for the public to be able to assess the risks associated with given technological structures. The qualitative four-level safety ladder provides such a framework. Nuclear reactors have been designed which fit clearly and demonstrably into each of the possible qualitative safety levels. Surprisingly, it appears that safer may also mean cheaper. The intellectual and technical prerequisites are in hand for an important national decision. Deployment of a qualitatively different second generation of nuclear reactors can have important benefits for the United States. Surprisingly, it may well be the "nuclear establishment" itself, with enormous investments of money and pride in the existing nuclear systems, that rejects second generation reactors. It may be that we will not have a second generation of reactors until the first generation of nuclear engineers and nuclear power advocates has retired.

Accidents↗

Rational evaluation of urinary stone disease.

This article outlines the recent state of the art in the metabolic diagnosis of stone disease. The current literature in the field of urolithiasis-including the existing German and EAU-Guidelines as well as the Conference Book of the 1st International Consultation on Stone Disease-was critically reviewed. As far as possible the references were rated according to the EBM criteria. The occurrence of stone disease in the western world is increasing greatly. Modern lifestyle, dietary habits and excess weight-problems of affluent societies-are emerging as the important promoters of the "stone boom" in the new millennium. This even affects children, whose stone prevalence is otherwise significantly less than that of adults. Criteria for the high-risk group of stone formers were clearly defined. A diagnostic standard is formulated for the basic and the elaborate metabolic evaluation of a stone patient. The diagnostic pathways for the most important stone types and metabolic disorders, respectively, are described. The present concept allows a precise risk classification of each stone former and facilitates the decision whether stone-specific measures in addition to the basic metaphylaxis are recommendable or not.

Adult↗

Albinism, or the NOACH syndrome (the book of Enoch c.v. 1-20).

UNLABELLED: After a 4-year multidisciplinary study of albinism our findings will be presented here. Over a hundred albinos were examined, together with their heterozygote family members. Given this substantial patient and subject sample we were provided with the opportunity to: evaluate the results of standard diagnostic procedures, for example pedigree analysis, ocular and clinical examination; determine the diagnostic value of biochemical, and ultrastructural tests; and develop a new and viable albino diagnostic protocol, particularly for electrophysiological examination. In the conclusions the following subjects are in order: DIAGNOSIS: Our most important finding up till now is that normally pigmented people who do not look like albinos can in fact be albinos. DIFFERENTIAL DIAGNOSIS: It appears that patients with autosomal recessive albinism can be normally pigmented, and patients with X-linked albinism can be severely hypopigmented. We therefore propose to abandon the terms oculo-cutaneous albinism (OCA), and X-linked ocular albinism (XOA), and use the terms autosomal recessive albinism, and X-linked albinism instead. X-linked albinism Forsius-Eriksson type (XOAF): We assume that XOAF does not represent a true form of albinism. CLASSIFICATION: Our results indicate that the phenotypical albino classification, which was a base for Witkop et al. (1978) to also obtain a genetical classification, supported by the hairbulb test, has not proved to be useful for the classification of tyrosinase negative (TNOCA), tyrosinase positive oculocutaneous albinism (TPOCA), and autosomal recessive ocular albinism (AROA) as genetically distinct forms. Prevalence: Our prevalence estimate for all forms of albinism is at least 1:15,000, about 10% of the albinos have X-linked albinism. DEFINITION: We want to modify the albino definition as a hereditary and congenital inborn error of metabolism related to the pigment cell, and resulting in a systemic disorder that is characterized by anomalies of eyes, and hypopigmentation in most cases or absence of pigment in skin, hair, and eyes, and of which the neuro-anatomical consequences are the most characteristic.

Albinism↗

Recent advances towards a meta-typology of human relationships.

After less than four decades, the field of family therapy has largely abandoned the search for a typology of interaction between persons or between groups. Granted no single typology can conceivably fathom the hyper-dimensionality of human interaction. However, mankind's earliest recorded efforts to explicate the structures of human family systems are perceived by examining two of the earliest books known to man. These documents, The Book of Genesis of The Old Testament and the ancient Chinese Book of Changes or I Ching, can be viewed as loosely integrated modules of a single framework that help explain one another. The author suggests that these linked, family oriented sources also were the basis of modern symbolic logic and information (or switching) theory. Together they can provide the foundation of a hyper-dimensional meta-typology of human interaction. This could integrate interactions at and between levels of neuronal synapses and networks, the cerebral hemispheres, self and other, family and disparate social systems, and various human groups, national, racial, ethnic or religious.

China↗

References to contemporary papers on acoustics.

In most of the following references, the author's name is followed by the title of the paper or book in boldface, the journal, the volume number in boldface, the issue number in parentheses, the page reference, and lastly, in parentheses, the year. Where reference is made to abstract journals that number their abstracts, the abstract number is given instead of a page reference. Abstracts in Annales des Tèlècommunications are in French and those for Referativnyi Zhurnal, Fizika (three series, E, I, Zh) are in Russian [where, e.g., Ref. Zh. Fiz. 7 E425 (1979) means: July issue, E, abstract no. 425, year 1979.] When possible, the abbreviations for the names of the journals follow those in Bibliographic Guide for Editors & Authors (1974). A number preceded by the letters AD, DE, PB, or N refers to the accession/report number of the Government Reports Announcements & Index. The numbers to the left of the sections and sub-sections in this volume correspond to those that appear in the Classification of Subjects preceding the index in the June 1983 issue of JASA. Compiled from various sources. For many of the journals referred to here, those interested will find their addresses in either the semi-annual Author Index of Physics Abstracts or the annual Physics Briefs: List of Abstracted Periodical and Serial Publications.

Acoustics↗

A review of risk factors for child pedestrian injuries: are they modifiable?

PURPOSE: To identify modifiable risk factors for child pedestrian injuries. DATA SOURCES: (1) MEDLINE search from 1985 to 1995; search term used was traffic accidents; (2) review of reference lists from retrieved articles and books; (3) review of reference lists from three systematic reviews on childhood injuries and (4) consultation with 'key informants'. STUDY SELECTION: All studies that examined the risk factors for child pedestrian injuries were targeted for retrieval. Seventy potentially relevant articles were identified using article titles, and, when available, abstracts. Of the 70 retrieved articles, 44 were later assessed as being relevant. QUALITY ASSESSMENT: Articles were classified on the basis of study design as being either descriptive (hypothesis generating) (26) or analytical (hypothesis testing) (18) studies. Consensus was used for difficult to classify articles. DATA EXTRACTION: Variables judged to be risk factors for child pedestrian injuries were extracted by one author. DATA SYNTHESIS: A qualitative summary of the information extracted from relevant articles is presented in tabular form. RESULTS: Risk factors for child pedestrian injuries were classified as: (1) child, (2) social and cultural, (3) physical environment, and (4) driver. Risk factors within each classification are summarized and discussed.

Accidents, Traffic↗

The status and use of the International Classification of Impairments, Disabilities and Handicaps (ICIDH).

International monitoring of the ICIDH has begun in earnest. The momentum from these new activities and organizations has worked towards the unification and harmonization of statistics and information devoted to the study of disablement, further enhancing the interdisciplinary nature of the study of disability and advancing its recognition both at the national and international level. This article introduces the reader to the definitions and concepts of the ICIDH. In addition, problems confronted when applying the ICIDH in policy formulation, programme implementation and evaluation and in research are reviewed. There are three main types of problem: (i) the difficulty in differentiating each of the concepts of impairment, disability and handicap at the operational level of human function and behaviour; (ii) the diversity of training and instructions required in order to orchestrate the use of the codes and classification schemes with persons having a wide range of expertise and analytical interests; and (iii) the need for consistency of use of the ICIDH for model-building and testing of different theoretical frameworks. Increased institutional development at the global level through the establishment of international networks, and regional and interregional programmes, have further clarified strengths and weaknesses of the ICIDH and have increased support of its use. These efforts suggest the increasing importance of the ICIDH for the future development of international statistical standards and recommendations in the field of disablement.

Activities of Daily Living↗