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At least 1,387 records · Page 77Linked to original sources

PubMed1996

The likely increase in maternal mortality rates in the United Kingdom and in France until 2005.

In the UK, the decline in maternal mortality rates has stopped. In France, where they are higher than in most European countries, maternal mortality rates have been increasing since 1990. Based on the population projections published by Eurostat, maternal mortality predictions have been made for 1995, 2000, 2005 and 2010. A rise in the level of maternal mortality rates of more than 0.5 per 100000 livebirths is expected between now and 2005, in both countries. In the present context of near stability, this rise could be viewed as an important increase. Maternal mortality rises with maternal age and the proportion of births to women over thirty is growing and will continue to rise until 2000-2005. This structural and demographic evolution explains the expected rise of maternal mortality rates and shows how the change in the maternal age distribution of births will affect these rates.

Adolescent↗

PubMed2005

Behavior of the layer compression elastic modulus near, above, and below a smectic C-hexatic I critical point in binary mixtures.

We present the first study of the layer compression modulus B carried out near, above and below the Smectic C-Hexatic I critical point in racemic mixtures of methylbutyl phenyl octylbiphenyl-carboxylate (8SI) and the octyloxy biphenyl analog (8OSI), at frequencies ranging from 0.2 Hz to 2 x 10(3) Hz. The behavior of B as a function of temperature shows a progressive evolution from a first order transition in 8SI to a continuous supercritical behavior in 8OSI. The latter is characterized by an increase in B, which appears above the transition, and which is followed by a leveling off when the temperature is decreased towards the transition. It is proposed that this behavior stems from the relaxation of the hexatic domains which are frozen in the frequency range studied. For the supercritical and near-critical compounds, B exhibits a small dip near the transition temperature, which is visible in the low frequency range only, indicating that the dynamics associated with the critical point is very slow. We also report measurements in the Crystal-J phase of the pure compounds, and show that 8SI behaves mechanically as a hexatic phase and 8OSI as a soft crystal phase.

Journal Article↗

PubMedDate not supplied

Photoprotection by Cichorum endivia extracts: prevention of UVB-induced erythema, pyrimidine dimer formation and IL-6 expression.

In the gradual process of evolution, plants have developed natural sun protecting substances that enable continuous survival under direct and intense ultraviolet (UV) radiation. As part of our studies of plant-derived pigments that might constitute an alternative to conventional sunscreens, we have tested the ethanolic extracts of roots, stalks, and inflorescences of populations of wild Cichorum endivia subsp. Divaricatum (Asteraceae) in terms of protection against sunburn, and in prevention of UVB-induced pyrimidine dimer formation and IL-6 mRNA expression in the human keratinocyte cell line, HaCaT. Using ELISA technique for detection of pyrimidine dimers and RT-PCR for detection of IL-6, we found that the ethanolic extract of C. endivia roots absorbs radiation in the UVB spectrum and partially prevents induction of pyrimidine dimers and IL-6 expression. Application of the root extract on the skin prior to UVB irradiation totally prevented erythema. Our findings suggest that C. endivia extracts might possess sun-protective qualities that make them useful as sunscreens.

Administration, Cutaneous↗

PubMed1991

The healthcare professional of the future: function based upon competence.

There is an ongoing evolution in healthcare in the U.S., a metamorphosis that may continue indefinitely. The most immediately identifiable change is an economic one that is generally classified as cost containment. Notwithstanding the important financial redirection in healthcare, there should be a functional reevaluation of various professionals as well. This is already ongoing and certainly will continue. In order to preserve authority and economic benefit, enhanced interprofessional boundaries are expected byproducts of a cost-containment approach. Hence, advancement toward the healthcare system of the future is destined to take a convoluted path that is influenced in an infinite number of ways by the professions themselves, the federal government, and society. We should be reminded that patients are best served by the competent performance of a task which is often independent of any given profession.

Clinical Competence↗

PubMed1996

Quality assessment tools add value.

The rapid evolution of the health care marketplace can be expected to continue as we move closer to the 21st Century. Externally-imposed pressures for cost reduction will increasingly be accompanied by pressure within health care organizations as risk-sharing reimbursement arrangements become more commonplace. Competitive advantage will be available to those organizations that can demonstrate objective value as defined by the cost-quality equation. The tools an organization chooses to perform quality assessment will be an important factor in its ability to demonstrate such value. Traditional quality assurance will in all likelihood continue, but the extent to which quality improvement activities are adopted by the culture of an organization may determine its ability to provide objective evidence of better health status outcomes.

Cost Control↗

PubMed2001

Ankle arthroscopy.

The speed of the evolution in ankle arthroscopy is staggering. Indications for the procedure continue to grow, and surgeons' skill in applying the latest technology to perform surgery better has advanced significantly in a short period of time. Certainly the biggest limitation to this point has been limited access to lesions in the posterior ankle joint. As proficiency and technology improve, better arthroscopic access will be gained to lesions that have traditionally required open arthrotomy.

Ankle Joint↗

PubMed2002

[Specialized tertiary care facilities for adults with congenital heart disease in North America and the United Kingdom: future directions in Japan].

Specialized tertiary care facilities have been established to care for the increasing numbers of adults with congenital heart disease. Because this cardiovascular subspecialty is relatively new, the dedicated facilities have evolved without preexisting guidelines. Therefore, a mini-review was conducted of specialized tertiary care facilities for adults with congenital heart disease in North America and the United Kingdom, to illuminate the future directions of continuous management of these patients in Japan. Specialized tertiary care was provided by integrated collaborative teams that involve medical and pediatric cardiologists, cardiac surgeons, and non-cardiac consultants. Continuing growth of this relatively new patient population and further evolution of specialized care facilities can be anticipated.

Adult↗

PubMed1975

[Thermogenesis of breast cancers. V. The effects of 60Co radiotherapy and the correlations with expectations of a cure].

The action of ionizing radiation on the metabolic heat production by cancers has been investigated on a group of 24 small breast carcinomas (T1 and T2), all treated exclusively by radiotherapy under equivalent conditions (60Co) and then followed up regularly (mean recall period of five years). Following techniques have been used: intratumoral thermometry and fluvography for computing the specific heat power of the tumour, infrared thermography for analysing the skin thermal pattern quantitatively. Comparison between clinical, radiographical and thermal findings has more especially shown; a) the constant agreement between the final loco-regional results of radiotherapy and the evolution of both the heat production by the tumour and the related hyperthermia on the skin; b) the early appearance of the thermal signs of either a regression or a recurrence of the tumour, compared with the corresponding morphological signs. The fundamental and practical consequences can be summarized as follows: 1 degree distinction between radiosensitive and radioresistant carcinomas accroding as the specific heat power of the tumour is reduced or not after irradiation; 2 degrees definition of three types of thermal evolution by normalization, regression followed by re-increase, and continuance of both tumour heat production and malignant skin hyperthemia, and corresponding to the clinical concepts of sterilization, recurrence and nonsterilization respectively; 3 degrees justification of the systematic use of thermal methods for post-irradiation follow-up, especially to detect a local recurrence earlier and to specify the nature of a doubtful remaining opacity; 4 degrees description of objective thermal criteria allowing to decide a repairing mastectomy within shorter delays.

Adult↗

PubMed2003

Phylogenetic relationships between Puerto Rico and continental USA HIV-1 pol sequences: a shared HIV-1 infection.

In order to investigate the existing notion that the human immunodeficiency virus type 1 (HIV-1) infection in Puerto Rico (PR) was imported from the continental United States of America (USA) we sequenced and analyzed 900 bases of the HIV-1 pol sequence from individuals in PR for comparison with pol sequences from the USA mainland. The sequences were derived by direct sequencing of reverse transcription-polymerase chain reaction products generated from plasma virus. The products were sequenced in both directions and the complementary strands were compared prior to analysis. These processed sequences and GenBank sequences from the continental USA were subjected to phylogenetic analyses. The PR and USA sequences did not form independent clusters, indicating a shared HIV-1 infection. This may be due to the continuous human traffic or, less likely, may indicate a similar evolution of a common source virus. Analysis of drug resistance mutations, fairly similar in frequency in the PR and USA sequences analyzed here, supports human traffic as a rationale for the common infection. This work indicates that an efficacious vaccine developed for use in the USA mainland will also be effective in prevention in PR and perhaps the other countries of the Caribbean region.

Drug Resistance, Viral↗

PubMedDate not supplied

[M.S. Gilyarov's Scientific School of Soil Zoology].

The role of M.S. Gilyarov's scientific school in the development of the subject and methodology of a new complex discipline formed in the mid-20th century--soil zoology--was considered. The establishment and evolution of the proper scientific school was periodized. The creative continuity and development of the basic laws and technical approaches included in the teacher's scientific program was demonstrated by scientific historical analysis.

History, 20th Century↗

PubMedDate not supplied

Success strategies for departments of family medicine.

Strong departments of family medicine in academic medical centers help assure the future scope and quality of family practice patient care, the ongoing evolution of family medicine as a scholarly discipline, and a continued flow of qualified medical school graduates into family practice residency programs and eventually into practice. This report presents key strategies of six successful departments of family medicine and describes the methods and skills considered important by the leaders of these departments. Common themes that emerge are (1) recruit and mentor the best faculty, (2) build a reputation for clinical excellence of faculty and residents, (3) become part of schoolwide curriculum activities, (4) establish a scholarly presence, and (5) develop networks of support.

Academic Medical Centers↗

PubMedDate not supplied

[Evaluation of the treatment with levodropropizine of respiratory diseases in children].

Sometimes, antitussives can be a valid adjuvant to respiratory tract infections treatment. Although not always needed, this therapeutic support can be extremely useful in selected cases, and when patient is resident and monitored. In this line, the efficacy of a new peripheral antitussive, levodropropizine (Dompé farmaceutici, Milan), has been evaluated in 70 children inpatients of the Pediatric Department at san Paolo Hospital - Milan University - from September 1987 to May 1988. Thirty one male and 29 female children, aged 4 years and 6 months +/- 3 years and 5 months, suffering from various respiratory tract diseases were included in the study. Underlying diseases were represented by 21 acute bronchitis, 20 asthmatic attacks, 18 bronchopneumonia, 11 tracheitis, 6 acute episodes of chronic bronchitis, 2 hypoglottis laryngitis, 1 pertussis, 1 spontaneous pneumothorax. All parents gave their oral informed consent. The basic treatments were antibiotics in 44 patients associated or not with beta 2 agonists (31), theophylline (15), corticosteroids via aerosol (9) or parenterally (3), immunomodulators (2). Treatment with levodropropizine in the oral drops formulation at 2 mg pro kg a day was continued for 5 days and withdrawn according to the clinical evolution. Cough was registered by means of appropriate record forms given to the parents as well as with 120' tape recording whenever possible, i.e. 60 minutes before and 60 minutes after drug administration, on day one and 2. At treatment end, parents and investigator gave an antitussive efficacy judgement. Tolerability was evaluated as per clinical evolution and laboratory parameters.

Adolescent↗

PubMedDate not supplied

[Mathematical models in epidemiological analysis. II. Typhoid fever: time series analysis (author's transl)].

In this paper the systematic analysis of oro-faecal infectious diseases is continued. In order to propose a dynamic model for the evolution of the endemic typhoid fever, we have studied the behaviour of the number of cases of this disease in the town of Bari (Italy) during the years 1955-1978, by the methods of time series analysis. The analysis has pointed out the typical seasonal character of such a disease, and in particular the presence of a main winter cycle followed by a less evident summer cycle. The stochastic model which has been identified on the basis of the data from 1964 to 1978 allows a forecast for the years after 1978.

Epidemiologic Methods↗

PubMed1994

The impact of health care reform on orthopaedic surgery in the United States and Canada.

Health care reform is not unique to the United States but reflects fundamental changes in attitudes to health care worldwide. Orthopaedic surgery must examine its role in the context of the overall health care delivery system, rather than in the narrow focus of our specialty, if we are to grow and continue to improve in the future. This lecture describes the evolution of the Canadian Health Care system and draws parallels to the current American environment from which valuable lessons may be learned. There are 5 reasons why health care costs more in the United States than in all other countries which are independent of the fact that the United States has the highest quality of medical care available in the world. These are excessive administrative costs and manpower; oversupply (and hence underutilization) of expensive technology and services; the "medicalization" of social costs; and the tremendous cost of medical liability and malpractice litigation. There are a number of steps that can be taken to enhance the role of orthopaedic surgery in health care without eliminating choice and impairing innovation, which are the critical elements in a high-quality health care system. The Canadian and American systems will be more similar in the future despite the different paths that we are taking in reform, and I believe we can look to the future with optimism and confidence if appropriate measures are taken to ensure that our contributions are effective and efficient.

Canada↗

PubMed1994

Analysis of Ig and T-cell receptor genes in 40 childhood acute lymphoblastic leukemias at diagnosis and subsequent relapse: implications for the detection of minimal residual disease by polymerase chain reaction analysis.

The rearrangement patterns of Ig and T-cell receptor (TcR) genes were studied by Southern blot analysis in 30 precursor B-cell acute lymphoblastic leukemias (B-ALLs) and 10 T-ALLs at diagnosis and subsequent relapse. Eight precursor B-ALLs appeared to contain biclonal/oligoclonal Ig heavy-chain (IgH) gene rearrangements at diagnosis. Differences in rearrangement patterns between diagnosis and relapse were found in 67% (20 cases) of precursor B-ALLs (including all eight biclonal/oligoclonal cases) and 50% (five cases) of T-ALLs. In precursor B-ALLs, especially changes in IgH and/or TcR-delta gene rearrangements were found (17 cases), but also changes in TcR-beta, TcR-gamma, Ig kappa, and/or Ig lambda genes (11 cases) occurred. The changes in T-ALLs concerned the TcR-beta, TcR-gamma, TcR-delta, and/or IgH genes. Two precursor B-ALLs showed completely different Ig and TcR gene rearrangement patterns at relapse, suggesting the absence of a clonal relation between the leukemic cells at diagnosis and relapse and the development of a secondary leukemia. The clonal evolution in the other 23 ALL patients was based on continuing rearrangement processes and selection of subclones. The development of changes in Ig and TcR gene rearrangement patterns was related to remission duration, suggesting an increasing chance of continuing rearrangement processes with time. These immunogenotypic changes at relapse occurred in a hierarchical order, with changes in IgH and TcR-delta genes occurring after only 6 months of remission duration, whereas changes in other Ig and TcR genes were generally detectable after 1 to 2 years of remission duration. The heterogeneity reported here in Ig and/or TcR gene rearrangement patterns at diagnosis and relapse might hamper polymerase chain reaction (PCR)-mediated detection of minimal residual disease (MRD) using junctional regions of rearranged Ig or TcR genes as PCR targets. However, our data also indicate that in 75% to 90% of ALLs, at least one major rearranged IgH, TcR-gamma, or TcR-delta band (allele) remained stable at relapse. We conclude that two or more junctional regions of different genes (IgH, TcR-gamma, and/or TcR-delta) should be monitored during follow-up of ALL patients for MRD detection by use of PCR techniques. Especially in biclonal/oligoclonal precursor B-ALL cases, the monitoring should not be restricted to rearranged IgH genes, but TcR-gamma and/or TcR-delta genes should be monitored as well, because of the extensive changes in IgH gene rearrangement patterns in this ALL subgroup.

Adolescent↗

PubMed1998

Development of a multidisciplinary primary care program at the Drew University of Medicine and Science.

This article describes a required primary care curriculum for all third and fourth year medical students at the Drew/UCLA Medical Education Program. The curriculum is a supplement to the traditional medical school clinical requirements. Key features of the primary care core curriculum in the third year include a weekly half-day multidepartmental continuity clinic in a community health center serving underrepresented minority populations, a weekly didactic conference on primary care and society, a weekly clinical workshop on primary care skills, a weekly case review conference, and an orientation to primary care research methods. Fourth year medical students select a primary care subinternship that extends half days for 10 weeks in a community-based ambulatory care clinic. Fourth-year students also are required to select a mentor and conduct a research project on a primary care topic. Continuity of care records suggest that this program has been successful in allowing medical students to assume primary responsibility for a set of patients and to maintain significant levels of continuity of care over the course of the year. The evolution of the program, problems encountered, and anticipated changes in the curriculum are discussed.

California↗

PubMed1990

[Development of serum cholesterol and frequency of hypercholesterolemia in children and adolescents: results of the Berlin-Pankow cohort study].

The age-related evolution of serum cholesterol has been studied in a cohort of 475 boys and girls born in 1964, living in Berlin-Pankow district; they have been followed up from age 13-14 to 20-21 (response rate after eight years: 66%). At age 13-14, mean total cholesterol was higher among boys (183 +/- 34 mg/dl) as well as among girls (187 +/- 33 mg/dl) as compared with those observed in other populations. About one third of the subjects at this age had values greater than 200 mn/dl. There was a marked decrease in mean total cholesterol around age 14 in both sexes, inversely related to the degree of sexual maturity. Between age 15 and 20 the serum cholesterol rose continuously. After puberty girls had higher mean values than boys. The evolution of serum cholesterol changes during adolescence should be taken into account when assessing preventive measures in children and young people.

Adolescent↗

PubMed1987

Progressive calcifying peritonitis: a new complication of CAPD? Report of two cases.

The authors report the history of two patients treated with CAPD who developed a progressive calcifying peritonitis (PCP). The symptoms include abdominal pain, impairment of bowel movements, sterile effluent dialysate and progressive development of peritoneal calcifications. The etiology of the PCP remains elusive, but dialysate with acetate, high peritonitis incidence and continuous lavage as treatment for peritonitis are suspected to play a role in its evolution.

Acetates↗