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PubMed2006

Review of the evidence for interventions to increase young people's use of health services in developing countries.

OBJECTIVE: This chapter reviews the evidence base for interventions that aim to increase young people's use of health services in developing countries. METHODS: We identified published and unpublished studies and reports from developing countries that provided information about interventions designed to increase young people's use of health services. The studies were classified into six different types based on whether they included some or all of the following characteristics: training for service providers and clinic staff; making efforts to improve the quality of the facilities; implementing community activities to generate demand and support for the services; and involving other sectors, notably schools and the media. The levels of evidence required to make decisions about policies and programmes were defined for each of these types. FINDINGS: Despite the lack of detailed descriptions of interventions in the studies and difficulties interpreting the data reported in the evaluations, the studies provided evidence of increased use of health services by young people for those types of interventions that included training for service providers, making improvements to clinic facilities and implementing activities in the community, with or without the involvement of other sectors. CONCLUSION: The evidence for the effectiveness of interventions to increase young people's use of health services was sufficient to recommend that interventions that include training for service providers, making improvements to clinics and using activities in the community should be widely implemented with careful monitoring of quality and coverage and that those that additionally involve other sectors should also be widely but cautiously implemented, provided they include a strong evaluation component. Operations research is also required to better understand the content of the interventions and their mechanisms of action.

Adolescent↗
PubMed1990

Children's explanation of leukemia: a Hispanic perspective.

Children of differing cultural backgrounds experience, interpret, and respond to illness differently. This exploratory descriptive study investigated those explanations of their illness offered by 23 Hispanic children diagnosed with acute lymphoblastic leukemia. Content analysis of their interviews disclosed the following information: (a) culturally based treatment interventions were an important component of care, (b) Hispanic parents disclosed little information about the disease process to their children, (c) children tended to explain their illness in terms of symptomatology and side effects, and (d) all physician advice was held in high esteem.

Attitude to Health↗
PubMed1989

[Embryologic and anatomic considerations on the normal and pathologic formation of the cardiac septum. I. Interauricular septum].

A brief presentation of the normal embryological development of the human interatrial septum is made. The anatomical expression of each of its embryological components is described. Our classification of interatrial septal defect is enriched by their more precise anatomical description and by making a more correct morphogenetic interpretation, based on new information obtained by means of experimental embryology. Emphasis is made that absence of the interatrial septum does not preclude the diagnosis of viscero-atrial situs.

Heart Atria↗
PubMed1988

Kinetics of disposition of xenobiotics and their metabolites.

The principles of pharmacokinetics, which have evolved over the last quarter of a century and are now regarded as a major tool in quantifying and rationalizing drug action, are outlined. These are presented within a broad context to allow application to all xenobiotics and hence, to aid toxicological as well as pharmacological investigations. The trend away from descriptive models towards biologically based systems allowing mechanistic interpretation is stressed. In particular the development of kinetic approaches to characterise the formation and disposition of metabolites is described.

Absorption↗
PubMed1986

[Symptoms of acute cerebral hernia following induction of anesthesia in hydrocephalus--malignant hyperthermia in reality].

We report the case of a 4.9-year-old boy with congenital hydrocephalus and obstruction of his shunt who just after the induction of anaesthesia suddenly developed generalized muscle rigidity that made intubation impossible. Because of temporary mydriasis the situation could hardly be differentiated from acute cerebral herniation. The lack of any decrease in muscle tone after emergency trephination and drainage of the right lateral ventricle and the immediate improvement following intravenous dantrolene left no doubt about the diagnosis of malignant hyperthermia. The diagnosis was confirmed by the increase in serum creatine phosphokinase and the documentation of massive myoglobinuria. Reconstruction of the course of the first anaesthetic necessary for shunt implantation at the age of 62 days revealed that the same symptoms already had occurred. However, they then were not attributed to malignant hyperthermia but interpreted as symptoms of acute herniation. A detailed description of this first anaesthetic is given which again elucidates the problems associated with the abrupt onset of muscular hypertonus in a patient with neurologic disorder; moreover this may well be the first published case report of malignant hyperthermia at the age of just 2 months.

Anesthesia, General↗
PubMed1975

[Diagnostic staged program in thyroid diseases].

After some physiological principal remarks the modern possibilities of the in-vitro-diagnostics specific for the thyroid gland are briefly explained. The essential factors of disturbance which are necessary for the avoidance of false interpretations are mentioned. From the sequence of the description (BEJ, T4-test, T3-test, FT4-index, RIA-T3 and RIA-TSH) results the diagnostic step programme proposed by us, by means of which the majority of the functional disturbances of the thyroid gland existing may certainly be classified. Only after exhaustion of the in-vitro-diagnostics the radio-iodine-test should be performed.

Female↗
PubMed1994

[Interventions in symbolic psychotherapy].

Symbolic Psychotherapy is a psychotherapeutical technique based on the use of images produced in a patient's mind during a guided daydream. Later on, a symbolic interpretation of daydream is performed by patient. A description of a psychotherapist's tasks during patient's imaginary re-creation--bases and aims of such tasks--are discussed.

Humans↗
PubMed1993

The epidemiology of contact lens related diseases in the United Kingdom.

This review evaluates the epidemiologic methods used to study contact lens related diseases in the United Kingdom. The results of these studies are compared to major US studies. The advantages and limitations of various epidemiologic study designs are discussed. The role of noncomparative cohort studies, particularly premarket studies, in underestimating lens related disease is examined. Descriptive studies and the difficulties related to their interpretation are also described. The use of case control studies for investigating both the risks and causes of lens related diseases is evaluated and compared to the cohort study design. The results of these studies in the investigation of the complications of contact lens wear, including keratitis, are summarized. Finally, the relevance of these findings to contact lens wearers and practitioners is explored.

Acanthamoeba Keratitis↗
PubMed1993

Extended school year programs: a community-driven curriculum model.

Appropriate education guaranteed to children with disabilities under P.L. 94-142 has been translated by the courts to mean more than 180 days of education. There is now a strong legal precedent establishing the right to an extended school year (summer school) for students with severe disabilities. The courts have left open to interpretation, however, issues related to the program implementation. Descriptions of extended school year programs vary widely and include respite for parents, continuation of the regular school year curriculum, and remediation in skill areas. The only consensus seems to be that these programs should be tailored to individual needs. In the present article a systematic approach to curriculum development for students with severe disabilities enrolled in extended school year programs was described. This approach is (a) community driven, (b) consistent with each student's IEP objectives for the regular school year, (c) tailored to the individual student, and (d) consistent with current best practices of teaching functional skills performed by individuals without disabilities in a variety of integrated nonschool settings. Student progress data were presented.

Activities of Daily Living↗
PubMedDate not supplied

Potential salmon sperm origin of the E3 region insert of the adenovirus 5 dl309 mutant.

The plasmid pJM17 is a commonly used adenoviral backbone derived from the dl309 mutant virus. It contains unknown sequences inserted in the E3 region during construction of the dl309 mutant. Complete description of the backbone sequence is required for interpretation of potential vector effects and for regulatory approval of a vector to be used in clinical trials. The anonymous E3 insert was sequenced and analyzed. The insert fragment is 646 base pairs (bp) long and is 100 bp shorter than the vector sequences it replaces. It interrupts the expression of the E3B 10.4K, 14.6K, and 14.7K genes, but not the E3A glycoprotein (gp) 19K gene. Sequence analysis and Southern blotting suggest that the insert might originate from salmon sperm DNA used as carrier during the construction of dl309. Transcription from the insert was not detected by Northern blot analysis of vector-transduced cells but was detected by reverse transcriptase polymerase chain reaction.

Adenovirus E3 Proteins↗
PubMed2005

A comparison of vertical versus transverse sections in the evaluation of alopecia biopsy specimens.

BACKGROUND: Both vertical and transverse sections are used in the histologic interpretation of alopecia biopsy specimens. Although a combination of the two may be optimal, the pathologist is frequently only provided with a single specimen. Even though the trend in recent years has been toward transverse sections in this setting, we are not aware of any published data directly comparing the two methods. METHODS: One hundred two consecutive archived hair biopsy accessions that demonstrated comparable vertical and transverse sections were examined twice, each time in a random order. The pathologist's interpretation based only on the vertical sections and an interpretation based only on the transverse sections were compared with the original biopsy report, which had been based on the combination of vertical and transverse sections. RESULTS: In 76 cases, all 3 diagnoses were concordant (ie, the diagnosis made with vertical sections alone, the diagnosis made with transverse sections alone, and the original diagnosis were all in agreement). In 2 cases, neither the diagnosis made with vertical sections alone nor the diagnosis made with transverse sections alone were in full agreement with the original diagnosis. In 20 cases, only the diagnosis made with vertical sections was concordant with the original diagnosis. In 4 cases, only the diagnosis made with transverse sections alone was concordant with the original diagnosis. LIMITATIONS: Our practice is heavily weighted toward scarring alopecia, and the results of our study may not be applicable to practices weighted toward other forms of alopecia. Because the cases had been signed out over a period of several years, the nomenclature for some entities changed. For the purposes of our study, we counted the diagnoses of follicular degeneration syndrome and idiopathic pseudopelade to be subtypes of (and concordant with) a diagnosis of central centrifugal cicatricial alopecia. In some cases, a definitive diagnosis was not possible at the time of the original diagnosis, but rather the pathologist had provided a histologic description and a differential diagnosis. For purposes of this study, an interpretation was considered to be concordant with the original descriptive diagnosis if all of the important histologic features were identified that had been described in the original report. Sampling error could have contributed to discordant diagnoses, but would be expected to affect both vertical and transverse samples in a random manner. CONCLUSION: The combination of vertical and transverse sections is superior to either alone. Although transverse sections have revolutionized the evaluation of alopecia, in this study, the diagnosis made with vertical sections alone had a higher concordance rate with the combination than did transverse sections alone. As there are advantages and disadvantages inherent in either method, when only a single biopsy specimen is submitted, it may be sectioned either vertically or transversely, at the discretion of the pathologist. With either method, serial step sections should be obtained to reduce the risk of missing important histologic findings.

Alopecia↗
PubMed2005

Critical volume model analysis of lung complication data from different strains of mice.

The critical volume (CV) normal tissue complication probability (NTCP) model was used to fit experimental data on radiation pneumonitis in mice to test the model and determine the values of the model parameters characterizing the lung structure: relative critical volume and cell radiosensitivity. The entire lungs of mice from ten different strains were irradiated acutely and homogeneously to different doses. The experimental animals from the different strains expressed different radiation sensitivities, forming ten well-defined dose-response curves. The most widely accepted biological NTCP model (the individual CV NTCP) readily applicable to cases of acute uniform irradiation was used to fit all the individual dose-response curves simultaneously. To account for the apparent difference in the response of the different strains, it was assumed that the strains differed in their (cell) radiosensitivity. The maximum likelihood method of fitting was used. The obtained fit was statistically highly acceptable. The best-fit value of the relative critical volume, mu, was 78%, which is extremely close to the histologically observed value of around 72%. The values of radiosensitivity, alpha, ranged between 0.26 and 0.37 Gy(-1) for the different strains. The best-fit numbers of functional subunits (FSU) constituting the lung, N, and the number of cells in an FSU, N(o), were implausibly low: N = 9 and N(o) = 23, respectively. The best-fit value of N(o)N was a very small number that was unlikely to correspond to the total number of cells comprising the lung, suggesting that a different interpretation of N and N(o) was required. The individual CV model provided a simultaneous description of the individual responses of different mouse strains through assumed interindividual variability in alpha only. A new interpretation is given to the entities corresponding to N(o) and N. N(o)N is interpreted as the number of certain elementary structures. These structures are considered to be equivalent to the classical functional subunit, which is much larger than a cell and plays a fundamental role in determining the radiation response of the organ. N is identified as the number of the few large subdivisions of the lungs, M = microN is the number that have to be damaged for the lung to fail. N(o) is interpreted as the mean number of elementary structures (FSU) per large subdivision. This imposes a picture of damage to large, contiguous subdivisions containing many FSU, which is consistent with the histological appearance of the lungs of mice in respiratory distress. This picture is in marked contrast to the random distribution of small areas of damage expected for the small size of an FSU. This random distribution is characteristic of earlier stages of the development of radiation pneumonitis, suggesting that some additional process spreads injury from damaged FSU to adjacent, undamaged FSU during the terminal phase.

Animals↗
PubMed2005

[Assistance to the deaf in the health area as a factor of social inclusion].

The purposes of this article are to discuss the assistance to deaf people in the health area as a factor of social inclusion; to investigate with the deaf how the link with health workers is established; and to verify the deaf people's perception of the presence of sign language interpreters when they get health assistance. This is a descriptive and analytical survey with a qualitative approach carried out at a special school in Goiânia. The sample was comprised of 20 deaf students, and semi-structured interviews were used to collect the data. It was verified that the link is established when health workers are able to communicate with the deaf. The inclusion of the deaf in the health services is an evidence of difficulties in communication. It was concluded that the professional-client relationship must be improved, that the link occurs when the client feels himself/ herself understood, and that the presence of an interpreter improves but is not enough to ensure the inclusion of the deaf.

Adult↗
PubMed2006

Systematically describing gross lesions in corals.

Many coral diseases are characterized based on gross descriptions and, given the lack or difficulty of applying existing laboratory tools to understanding causes of coral diseases, most new diseases will continued to be described based on appearance in the field. Unfortunately, many existing descriptions of coral disease are ambiguous or open to subjective interpretation, making comparisons between oceans problematic. One reason for this is that the process of describing lesions is often confused with that of assigning causality for the lesion. However, causality is usually something not obtained in the field and requires additional laboratory tests. Because a concise and objective morphologic description provides the foundation for a case definition of any disease, there is a need for a consistent and standardized process to describe lesions of corals that focuses on morphology. We provide a framework to systematically describe and name diseases in corals involving 4 steps: (1) naming the disease, (2) describing the lesion, (3) formulating a morphologic diagnosis and (4) formulating an etiologic diagnosis. This process focuses field investigators on describing what they see and separates the process of describing a lesion from that of inferring causality, the latter being more appropriately done using laboratory techniques.

Animals↗
PubMed1996

Dynamics of participation in a community health project.

Although the term 'participation' is widely used in discussing community development strategies, there has been relatively little said about the characteristics of 'participatory relationships', i.e. the interactions between community developers and those who stand to benefit from community development initiatives. There is seen to be a need for case studies which attempt to understand the relational and communicative processes involved in participatory development. The paper presents an analysis of the participatory dynamics of a community health development project. The principal source of data is interviews conducted with thirteen selected participants in the project. Analysis of interview data using a structured hermeneutic method led to a description of the meaning of participation for each of the participants interviewed. Further interpretation led to the identification of a number of modes of participation in the project as a whole. For each mode of participation descriptions were developed of how it was perceived by others not participating from that mode. An attempt was made to understand the dynamics of the project in terms of the relationship between the different modes of participation and in terms of the discrepancies between how participants saw themselves and how others saw them. Finally, these problems were discussed at a general theoretical level and suggestions were made about how such problems might be alleviated.

Communication Barriers↗
PubMed1998

Procurement, interpretation, and value of postmortem cultures.

The procurement, interpretation, and value of postmortem cultures is reviewed from the microbiologist's perspective. A brief description of the various procurement techniques is included and the factors involved in the contamination of specimens discussed. The interpretation of culture results is discussed by comparing postmortem specimens to routine laboratory samples such as blood cultures and sputum. The value of performing these cultures is discussed relevant to the individual postmortem examination and the research capabilities of the facility.

Bacteria↗
PubMed1984

Drug-nutrient interactions and their implications for safety evaluations.

In order to assess the relevance of the drug-nutrient interactions described in this chapter to routine toxicologic studies, the range of nutrient concentrations within which these interactions may occur must be compared to the range of nutrient concentrations found in routinely used rodent diets. While obviously deficient levels of some nutrients were supplied to demonstrate some of the interactions, others occur when the nutrients are present in adequate or excess levels, such as might be found in commercially available diets. These diets are known to vary from batch to batch in nutrient content. A lifetime toxicity/carcinogenicity bioassay using rodents may last longer than 2 years, during which time several batches of diet will be used. The variation in diet composition, coupled with inadequate diet description, makes nutrient-toxin interactions not only possible, but difficult to recognize. These considerations raise the practical and philosophical question as to what type of diet is most appropriate for rodents used for safety evaluation of drugs and chemicals. Is it appropriate to use diets that vary unpredictably in nutrient content, that infer a degree of protection against chemical carcinogenesis and which supply some nutrients such as protein in great excess of dietary needs? Is the increase in sensitivity to chemical carcinogens of animals fed purified diets desirable or does this increased sensitivity of the bioassay exceed that required to assess the risk of human exposure? In other words, is the use of purified diets likely to increase the number of false positive results? Proper interpretation and extrapolation of safety evaluation studies requires adequate description of the test system. Given the profound influence of diet on the response to some toxins, the composition of the diet should, ideally, be defined with the same rigor as are the test compound and the strain, age, sex, and housing conditions of the animals. It is likely, however, that natural ingredients diets will continue to be the diets of choice in safety evaluation studies. This is largely due to economic reasons. It is possible, however, to use these diets with greater confidence if open-formula diets are used and the concentration of each nutrient is reported. Consideration should also be given to preparing diets for use in adult and aging rodents, diets in which protein content is reduced.(ABSTRACT TRUNCATED AT 400 WORDS)

Animal Feed↗