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Perinatal mortality in an Egyptian maternity hospital.

The factors affecting perinatal mortality during a period of 21 months were studied at Al-Galaa Teaching Hospital, using the International Fertility Research Program's Maternity Record 903 to collect the data. There were 6990 deliveries during the 21 months and 580 hospital perinatal deaths. Certain high-risk factors associated with perinatal mortality were identified including both biosocial and biomedical factors. The biosocial factors affecting perinatal mortality in this study are discussed, including maternal education, marital status, residence, hospital status as paying or non-paying patient, maternal age, registration status, outcome of last pregnancy, parity/family size, antenatal care, maternal hemoglobin, and the weight and sex of the baby.

Adult↗

Laparoscopic training on bench models: better and more cost effective than operating room experience?

BACKGROUND: Developing technical skill is essential to surgical training, but using the operating room for basic skill acquisition may be inefficient and expensive, especially for laparoscopic operations. This study determines if laparoscopic skills training using simulated tasks on a video-trainer improves the operative performance of surgery residents. STUDY DESIGN: Second- and third-year residents (n= 27) were prospectively randomized to receive formal laparoscopic skills training or to a control group. At baseline, residents had a validated global assessment of their ability to perform a laparoscopic cholecystectomy based on direct observation by three evaluators who were blinded to the residents' randomization status. Residents were also tested on five standardized video-trainer tasks. The training group practiced the video-trainer tasks as a group for 30 minutes daily for 10 days. The control group received no formal training. All residents repeated the video-trainer test and underwent a second global assessment by the same three blinded evaluators at the end of the 1-month rotation. Within-person improvement was determined; improvement was adjusted for differences in baseline performance. RESULTS: Five residents were unable to participate because of scheduling problems; 9 residents in the training group and 13 residents in the control group completed the study. Baseline laparoscopic experience, video-trainer scores, and global assessments were not significantly different between the two groups. The training group on average practiced the video-trainer tasks 138 times (range 94 to 171 times); the control group did not practice any task. The trained group achieved significantly greater adjusted improvement in video-trainer scores (five of five tasks) and global assessments (four of eight criteria) over the course of the four-week curriculum, compared with controls. CONCLUSIONS: Intense training improves video-eye-hand skills and translates into improved operative performance for junior surgery residents. Surgical curricula should contain laparoscopic skills training.

Clinical Competence↗

The structural context of college drinking.

The drinking settings and companions of college students were studied in relation to the students' gender, year in school, academic standing, work status and residence status. The relationship between year in school and the quantity and frequency of consumption of specific types of alcoholic beverages was also studied.

Age Factors↗

Status of residency training in mammography.

OBJECTIVE: The purpose of this study was to survey the status of residency training in mammography, including mammography quality assurance, and to compare the results with previous surveys from 1990 and 1992. MATERIALS AND METHODS: A telephone interview was conducted with 213 chief residents and 11 other senior residents representing all 224 accredited residency programs in diagnostic radiology. RESULTS: Compared with 1990, more programs had exclusive mammography rotations (74% versus 40%). The number of fellowships in breast imaging increased from 17 to 76. More training programs differentiated screening from diagnostic examinations (50% versus 35%). Compared with 1992, the percentage of residents who knew recommended frequencies of quality control procedures increased by 30% and the percentage who knew the maximum allowable radiation dose increased by 50%. Residents lacked fundamental knowledge about conducting medical audits, such as calculating the positive predictive value for biopsies. CONCLUSION: More time is being devoted to breast imaging in diagnostic radiology residency training, and residents show greater knowledge about mammography quality assurance.

Accreditation↗

Vitamin D status of residents of an old people's home and long-stay patients.

The vitamin D status of residents of an old people's home and long-stay patients was assessed by means of plasma 25-hydroxycholecalciferol (25-OHD) estimations. The residents of the old people's home had a higher mean plasma 25-OHD concentration than long-stay patients. Both groups had diets with vitamin D intakes of less than 2.5 micrograms (100 IU) per day and the conclusion is that solar exposure is the major determinant of the concentration of circulating 25-OHD.

Aged↗

Nutritional status and mortality of refugee and resident children in a non-camp setting during conflict: follow up study in Guinea-Bissau.

OBJECTIVE: To study the effects on children of humanitarian aid agencies restricting help to refugee families (internally displaced people). DESIGN: Follow up study of 3 months. SETTING: Prabis peninsular outside Bissau, the capital of Guinea-Bissau, which has functioned as a refugee area for internally displaced people in the ongoing war, and the study area of the Bandim health project in Bissau. PARTICIPANTS: 422 children aged 9-23 months in 30 clusters. MAIN OUTCOME MEASURES: Mid-upper arm circumference and survival in relation to residence status. RESULTS: During the refugee situation all children deteriorated nutritionally, and mortality was high (3.0% in a 6 week period). Rice consumption was higher in families resident in Prabis than in refugees from Bissau but there was no difference in food expenditure. Nutritional status, measured by mid- upper arm circumference, was not associated with rice consumption levels in the family, and the decline in circumference was significantly worse for resident than for refugee children; the mid-upper arm circumference of refugee children increased faster than that of resident children. For resident children, mortality was 4.5 times higher (95% confidence interval 1.1 to 30.0) than for refugee children. Mortality for both resident and refugee children was 7.2 times higher (1.3 to 133.9) during the refugee's stay in Prabis compared with the period after the departure of the refugees. CONCLUSION: In a non-camp setting, residents may be more malnourished and have higher mortality than refugees. Major improvements in nutritional status and a reduction in mortality occurred in resident and refugee children as soon as refugees returned home despite the fact that there was no improvement in food availability.

Eating↗

The search for medical care: an exploration of urban black behavior.

Results are presented of a study of the medical care-seeking behavior of black adult residents of lower and middle socioeconomic status in two predominantly black, yet geographically and socioeconomically distinct communities within the District of Columbia. Against a varied distribution of primary medical care opportunities within the District, substantial differences are demonstrated in their use by lower- and middle-status residents of a lower-class community. These differences are not, however, manifested among lower- and middle-status residents of an essentially middle-class neighborhood. The patterns of medical care-seeking behavior are observed within a framework of an almost total avoidance of the available medical care personnel and facilities in the proximate suburbs.

Adult↗

Prevalence of hepatitis B surface antigen carrier status among residents in the endemic area of chronic arsenicism in Taiwan.

Residents in the endemic area of blackfoot disease (BFD), a unique peripheral artery disease associated with long-term arsenic exposure, have been reported to have a significantly high mortality from hepatocellular carcinoma (HCC). A total of 129 BFD patients and 374 age-sex-residence-matched community controls were studied to examine their hepatitis B surface antigen (HBsAg) carrier status by radioimmunoassays. Residents in the endemic area had a HBsAg carrier rate (20.2%) similar to that of the general population in Taiwan. The rate was the same among BFD patients (20.9%) and matched controls (20.1%). There was no significant difference in HBsAg carrier rate among subjects who have consumed high-arsenic artesion well water for different periods of time. The rate was also similar in villages with differences in blackfoot disease prevalence, in type of wells for drinking water, as well as in arsenic content in well water. Arsenic seems to increase HCC risk of residents in this endemic area where the HBsAg carrier status is homogeneously prevalent with a rate similar to that of the general population in Taiwan.

Adult↗

Nutrient content of served food, nutrient intake and nutritional status of residents with dementia in a finnish nursing home.

PURPOSE: The aim of this study was to determine the energy and nutrient content of the served food, the actual energy and nutrient intake and the nutritional status of elderly residents in a nursing home. METHODS: The nutritional status of 23 individuals aged 69 to 89 years with dementia were assessed by Mini Nutrition Assessment -test (MNA). The nutrient content of the served food was calculated from all meals during a 14-day period. Food consumption was determined by precise weighing method. RESULTS: Of 23 residents, 20 were at risk of malnutrition and three were malnourished according to MNA. The mean energy content of the served food was 1665 kcal (7.4 MJ) per day. The amount of vitamin D in served food was too little and the amounts of vitamin E, folic acid, and fibre were somewhat lower than the recommended level. The amounts of other nutrients were sufficient or substantial. However, the true mean intake of energy in the whole group was only 1205 kcal (5.4 MJ) per day. The mean protein intake was 59 g. Intakes of vitamin D, E, and folic acid were clearly less than recommended whereas intakes of calcium, magnesium and zinc were as recommended. CONCLUSIONS: It may be possible to get enough energy and most nutrients from the served food, but many elderly nursing home residents did not eat enough. It may be helpful to individually assess, assist and monitor those residents who eat very little in a variety of ways to promote their quality of life.

Aged↗

Effect of United States residence on birth outcomes among Mexican immigrants: an exploratory study.

Adverse pregnancy outcomes such as low birth weight are increased among US-born mothers of Mexican descent compared with immigrant mothers born in Mexico. It is unknown whether adverse reproductive outcomes change among Mexican immigrants after only 5 years of US residence. The authors conducted a study of 1,114 Mexican immigrant mothers and their infants in two California counties. The relation between US residence status and birth outcomes was examined, controlling for sociodemographic factors and maternal behaviors. Long-term immigrants who have lived in the United States for more than 5 years were more likely to deliver preterm infants (odds ratio (OR) = 1.9, 95% confidence interval (CI) 1.1-3.3) and low birth weight infants (OR = 1.5, 95% CI 0.8-2.7) than newcomers who have lived in the United States for 5 years or less. Long-term immigrants had higher parity, more pregnancy complications, and fewer planned pregnancies, and were more likely to smoke than newcomers. After controlling for confounders, the effect of residence status on preterm delivery was of borderline significance (adjusted OR = 1.8, 95% CI 1.0-3.2). Pregnancy complications was an intervening variable between residence status and preterm delivery. Length of US residence is associated with an increase in low birth weight via a decrease in gestational age rather than intrauterine growth retardation.

Birth Weight↗

Effect of resident call status on ABSITE performance. American Board of Surgery In-Training Examination.

BACKGROUND: Long work hours that result in fatigue may adversely affect cognitive function. Chronically sleep-deprived surgical residents fear that being on call the night before sitting for a standardized test puts them at a potential disadvantage. We examined American Board of Surgery In-Training Examination (ABSITE) scores to assess the effect of call status on exam performance. METHODS: Results of the 1994 ABSITE for 424 residents in 15 New England general surgery programs were collected. We compared standard scores of residents for the total test, clinical management, and basic science components with resident call status (on/off) for the night before the exam. RESULTS: Differences were apparent in total test scores (mean: off, 496.1; on, 466.0; P <.03) and clinical management scores (mean: off, 504.3; on, 470.6; P <.02) (t test, Mann-Whitney U test). Multivariate analyses revealed that differences in postgraduate year level and training track were significant contributors to differences in scores in all test components (analysis of covariance). Call status was not a significant factor in score variation after adjusting for these 2 factors. CONCLUSIONS: Differences in ABSITE scores of residents were related to postgraduate year level and training track. Call status had no significant effect on ABSITE performance.

Cognition↗

Impact of geriatric nurse practitioners on nursing-home residents' functional status, satisfaction, and discharge outcomes.

This study evaluated the impact of geriatric nurse practitioners (GNP) employed by nursing homes on quality of patient care and residents' outcomes during a 12-month study period. Quality of care was assessed in standardized interviews of 525 residents in five nursing homes with GNPs and 323 residents in five other nursing homes without GNPs. Each resident was interviewed up to four times during the study period (at baseline, and 3, 6, and 12 months later) to determine functional status, satisfaction with care, and physical condition at each of these points. The only significant difference between groups was that fewer newly admitted residents were hospitalized from GNP homes than from those without a GNP. The results of this interview study showed that the GNP as a nursing home employee had little impact on residents' functional status, physical condition, or satisfaction.

Activities of Daily Living↗

Oral status and resident well-being in a skilled nursing facility population.

We studied the relationship between oral status and well-being in dentate and edentulous institutionalized residents through interviews with and dental examinations on 58 men and women. Oral status (measured by oral function, dental problem self report, soft tissue anomalies, and dry mouth) and well-being (measured by affect balance, self-esteem, health status, and nurse's ratings) were similar for dentate and edentulous subjects. Multiple regression analyses indicated oral status was significantly related to well-being. Unexpectedly, the extent of caries and plaque was also positively related to well-being, suggesting complex relationships between oral status markers and well-being in institutional settings.

Aged↗

Testing the feasibility and initial effects of iron and vitamin C to enhance nursing home residents' immune status following an influenza vaccine.

Influenza infections pose a serious threat to residents living in nursing homes and are a major cause of morbidity and mortality in older adults. It is estimated that influenza vaccination is only 30%-40% effective in the frail elderly. This 2-group experimental design study examined the efficacy of giving iron supplements to nursing home residents aged 65 and older to improve immune response following influenza vaccination. Specific aims of the study were to test study procedures and explore initial immune response. A number of barriers were encountered during the recruitment and consent phase limiting subject recruitment. Only serum transferrin was significantly different following the 30-day administration of iron supplementation. It was concluded that to achieve sufficient power to examine the effect of the intervention on immune response and infection rates, aggressive recruiting strategies at multiple sites are necessary.

Aged↗

General health status of residents of the Selebi Phikwe Ni-Cu mine area, Botswana.

Residents of the Selebi Phikwe area, Botswana where nickel-copper (Ni-Cu) is being exploited often exhibit symptoms of varied degrees of ailments, sicknesses and diseases. A need to investigate their general health status was therefore eminent. Primary data was obtained by means of a questionnaire and structured interviews conducted with individuals, health service providers, business enterprises and educational Institutions. The generated data revealed common ailments, sicknesses and diseases in the area with the four most frequent health complaints being frequent coughing headaches, influenza/common colds and rampant chest pains. Research findings indicated that residents had respiratory tract-related problems, suspected to be linked to the effects of air pollution caused by the emission of sulphur dioxide (SO2) from mining and smelting activities. Residents were frequently in contact with SO2 and related gases and fumes, mineral and silica dust generated from the mining processes. No clearly demarcating differences were noticed in the health status of residents living in the control site from those in the main study area. However, sites most affected were those close to where Ni-Cu is exploited. Environmental factors resulting from mining and smelting activities, among others, could be contributory to the negative health effects occurring at Selebi Phikwe.

Air Pollutants↗

Residues of nortestosterone esters at injection sites. Part 2. Behavioural effects.

Anecdotal evidence in man suggests that abuse of anabolic androgenic steroids (AAS) is linked with increased aggression. In order to test the hypothesis that administration of nortestosterone (beta-NT) esters may increase aggression, behavioural effects following beta-NT phenylpropionate (NTPP) administration were assessed in male mice using the isolation-induced aggression paradigm. Mice (n = 80) were individually caged and randomly assigned to 'resident' or 'intruder' status. Residents received one of four treatments: subcutaneous (s/c) injection of oil of arachis (OILINJ), s/c injection of NTPP in oil of arachis (NTINJ), oil of arachis per os (OILOS) and NTPP in oil of arachis per os (NTOS). After treatment, weight-matched intruders were introduced into each resident's cage and the encounter was videotaped to allow the frequency (f) and duration (d) of social, non-social, offensive and defensive behaviours displayed by residents and intruders to be measured. The latency of bite attack for residents was significantly shorter in NTOS compared to OILOS. There was no difference in either f or d of aggressive behaviours between NTINJ and OILINJ. Because OILINJ residents demonstrated similar levels of aggression to NTOS, it is possible that the aggression in NTOS mice may be mediated by a different biochemical pathway. Extrapolation of these results indicate that ingestion of beta-NT esters may have a role in the induction of aggression in consumers.

Administration, Oral↗

[Many psychiatric disorders in Afghan refugees with residential status in Drenthe, especially depressive disorder and post-traumatic stress disorder].

OBJECTIVE: To assess the prevalence of psychiatric disorders and help-seeking behaviour of Afghan refugees with a residence status in the province of Drenthe, the Netherlands. DESIGN: Cross-sectional prevalence study. METHOD: By means of a modified multiflex snowball sampling with 3 primary informants, 55 Afghan households in 16 towns and villages in Drenthe were selected. After informed consent had been obtained, 51 adults completed a sociodemographic questionnaire and a culturally validated shortened 'Composite international diagnostic interview' (CIDI), DSM-IV version. Help-seeking behaviour was recorded. RESULTS: Half of the sample had resided in the Netherlands for at least 3 years. There was a high level of education, an unemployment level of 88% and moderate to poor language skills in 92% of the respondents. The prevalence of psychiatric disorders was 65% (95% CI: 52-78); depressive disorder occurred in 57% and posttraumatic stress disorder in 35%. Psychopathological findings were related to poor language skills, a lower level of education and unemployment. A total of 56% received treatment from a general practitioner and 4% were under psychiatric treatment. CONCLUSIONS: The prevalence of psychiatric disorders among adult Afghan refugees in Drenthe with a residence status was considerably higher than among the general population in the Netherlands.

Adult↗

Effectiveness of dynamic cognitive intervention in rehabilitation of clients with schizophrenia.

OBJECTIVE: To examine the efficacy of dynamic cognitive treatment in rehabilitation of schizophrenic clients. SUBJECTS: Fifty-eight schizophrenic clients that were matched equally into two groups: a study group (n = 29) (treated by Instrumental Enrichment) and a control group (treated with traditional occupational therapy methods). SETTING: The subjects were treated in a day rehabilitation centre in the community. STUDY DESIGN: The programme lasted one year, the same schedule was provided for both groups. Subjects were randomly assigned and assessed before and after intervention with the same battery and at a follow-up six months later, work and residence status were evaluated. MAIN OUTCOME MEASURES: Instruments included: (1) memory and thought processes, measured by a battery of structured tests from the Learning Potential Assessment Device (LPAD), Raven Progressive Matrices and General Aptitude Test Battery (GATB); (2) functional outcomes, instrumental activities of daily living (IADL), measured by a questionnaire; work and residence status; (3) self-concept measured with Fitts questionnaire. RESULTS: Results showed significant differences between the groups on almost all the cognitive tests (MANOVA revealed significant differences between the two groups for both memory and thought process (F(2.52) = 13.75, p < 0.001; and F(1.46) = 7.28, p < 0.001, respectively) as well as in work (chi2 = 14.30, p < 0.001), and residence (chi2 = 3.86, p < 0.05) status. There were no significant differences in IADL questionnaire or the self-concept scale. CONCLUSIONS: The successful outcome points to the importance of including long-term cognitive intervention in rehabilitation of schizophrenic clients. This work suggests that the classic view of schizophrenia as a progressive irreversible decline that cannot be altered may be wrong.

Activities of Daily Living↗