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PubMedDate not supplied

Variations in the quality of care for very-low-birthweight infants: implications for policy.

Much of the decline in childhood mortality over the past two decades is attributable to improvements in neonatal intensive care for very-low-birthweight infants. Yet large and persistent disparities persist in the quality of neonatal intensive care across hospitals. Improving care for infants now served by hospitals with poor outcomes can greatly reduce infant mortality, particularly among minority infants who are more likely to be very low birthweight and cared for by hospitals with poor outcomes. Referral of high-risk births to hospitals with the best outcomes is another promising strategy.

Evidence-Based Medicine↗

PubMed2004

A review of neurophysiological testing.

The rapid advances in the technology of, and accumulation of pertinent data in, electrophysiological testing has increased exponentially in the past decade. This is attributable to continued advances in computer technology, biomedical engineering, and now the coregistration of the electrophysiological data with neuroimaging results. Knowledge of normal function and electrophysiological response at rest or on stimulation of the central and peripheral nervous systems is important to the neurosurgeon. Only by a basic understanding of normal and abnormal recordings may diagnoses and localizations be achieved. Intraspinal and intracranial surgical procedures are predicated on nontrauma to the neuraxis. This can be accomplished by performing electrophysiological testing to monitor the function of the spinal and cranial nerves, spinal cord, brainstem, basal ganglia, and cerebrum. If the surgeon cannot delineate critical cortex or pathways, he or she will be unable to avoid these areas in the patient.

Basal Ganglia↗

PubMed1991

Comparison of methods for the biomonitoring of nurses handling antitumor drugs.

Urinary mutagenicity, thioethers in urine, and sister chromatid exchanges and micronuclei in peripheral lymphocytes were determined for 60 nurses handling cytostatic drugs and 60 referents matched for sex, age, and smoking habits. Safety hoods were used by most of the nurses. The exposed nurses had more sister chromatid exchanges and higher urinary mutagenicity, as measured by Salmonella typhimurium TA 98, than the referents. There were no differences in the other tests. No dose-response relationship was established for any parameter. It was concluded that urinary mutagenicity with the Salmonella strain is the most sensitive test for monitoring nurses handling cytostatic drugs. Determining sister chromatid exchanges may also be a viable test, but it has the drawback of uncertainty as to whether the changes are attributable to present or past exposure. Only comparisons of rather large groups are useful, and a study design requiring matched referents would seem to be optimal.

Adult↗

PubMed1986

The spurious dilemma: reconciling medical progress and cost control.

In Canada, a health care system has developed that is both responsive to the health needs of the Canadian people and has shown financial stability over the past decade. The Canadians attribute their success in maintaining stable health care costs to regulation of physician fee levels and hospital services. Yet even though there exists regulation in the Canadian health care system, the effect of this government intervention has not resulted in rationing of health care. This suggests Americans should examine closely this alternative model of a health care system.

Canada↗

PubMed2000

Flow cytometry: principles and clinical applications in hematology.

The use of flow cytometry in the clinical laboratory has grown substantially in the past decade. This is attributable in part to the development of smaller, user-friendly, less-expensive instruments and a continuous increase in the number of clinical applications. Flow cytometry measures multiple characteristics of individual particles flowing in single file in a stream of fluid. Light scattering at different angles can distinguish differences in size and internal complexity, whereas light emitted from fluorescently labeled antibodies can identify a wide array of cell surface and cytoplasmic antigens. This approach makes flow cytometry a powerful tool for detailed analysis of complex populations in a short period of time. This report reviews the general principles in flow cytometry and selected applications of flow cytometry in the clinical hematology laboratory.

Blood Cells↗

PubMed2001

[Tuberculous meningitis in AIDS--diagnosis and treatment].

The increase in prevalence of tuberculous meningitis during the past decade has been attributed in part to the increase of AIDS. Failure to diagnose HIV can cause irreversible damage and even death. We describe a man with AIDS admitted through the emergency room because of high fever and headaches for more than a month, He was cachectic and had nuchal rigidity without major neurological deficit. Brain imaging was normal and lumbar puncture showed neutrophils, lymphocytes, hypochloremia, elevated protein, and decreased glucose; cryptococcal antigen was negative but acid-fast staining was positive. Anti-TB chemotherapy was started using 4 drugs and dexamethasone was also given. Considerable improvement in his general condition followed rapidly. Use of corticosteroids in tuberculous meningitis has been a major issue. They are added to antimicrobial agents in order to decrease reactivity of inflammatory mediators and thus reduce central nervous system damage. We review several controlled studies in which steroids were added to treat tuberculous meningitis. The conclusions of most were that they decrease morbidity and mortality, especially of those moderately to severely ill. Most considered as ungrounded the possibility of exacerbating latent tuberculous, or any other opportunistic infection outside the central nervous system. However, it is currently recommended to add prednisone, 1 mg/kg/d for 2-4 weeks when initiating anti-tuberculous treatment.

AIDS-Related Opportunistic Infections↗

PubMed2002

Impaired beta-cell and alpha-cell function in African-American children with type 2 diabetes mellitus--"Flatbush diabetes".

UNLABELLED: The incidence of type 2 diabetes mellitus (T2DM) in children and adolescents has substantially increased over the past decade. This is attributed to obesity, insulin resistance and deficient beta-cell function. In children a pubertal increase in insulin resistance and an inability to mount an adequate beta-cell insulin response results in hyperglycemia. Adults with T2DM have a diminished first phase response to intravenous glucose and a delayed early insulin response to oral glucose. Long-term studies show progressive loss of beta-cell function in T2DM in adults; however, such long-term studies are not available in children. To characterize beta- and alpha-cell function in African-American adolescents with established T2DM, we used mixed meal, intravenous glucagon and oral glucose tolerance testing and compared them to obese non-diabetic controls. T2DM was defined as fasting C-peptide >0.232 nmol/l and absent autoimmune markers. BETA-CELL FUNCTION: Meal testing in 24 children and adolescents with T2DM, mean age 14 years, BMI 30 kg/m2, Tanner stage II-V, HbA1c 8.9%, were compared with BMI- and age-matched controls. Forty percent presented with DKA. Half were treated with insulin and half with diet/oral anti-diabetic agents. Although absolute C-peptide response in both groups was similar, the incremental rise in C-peptide relative to plasma glucose in the patients with T2DM compared to controls was 40% and 35% lower 30 and 60 min after the meal, p <0.007 and p <0.026. Glucagon testing in 20 pediatric patients with T2DM compared with 15 matched controls showed significantly lower 6 min stimulated C-peptide relative to the ambient plasma glucose in patients with T2DM compared to controls (0.039 +/- 0.026 vs 0.062 +/- 0.033, p <0.05). The clinical utility is that 78% of patients with a 6 min C-peptide <1.4 nmol required insulin, while 81% of those >1.4 nmol required oral anti-diabetic agents, p <0.0001. Furthermore, the duration of T2DM up to 5 years after diagnosis was associated with lower fasting and glucagon-stimulated C-peptide levels, implying worsening beta-cell function over time, even in children and adolescents. ALPHA-CELL FUNCTION: During meal testing, children and adolescents with T2DM had less suppression of plasma glucagon than non-diabetic controls; this was more severe with longer duration of T2DM and poorer glycemic control. BETA-CELL RECOVERY: In African-American and Hispanic adults, intensive treatment of blood glucose may achieve beta-cell recovery with 35-40% of newly diagnosed patients going into remission after 6 months treatment. They remain off anti-diabetic pharmacological agents in remission for a median of over 3 years with normal HbA1c levels. We hypothesize this to be due to removal of a critical component of glucose or lipotoxicity at the level of the beta-cell and/or peripheral tissue. Four of 20 African-American children presenting with mean glucose 650 mg/dl maintained normal HbA1c levels on small doses of metformin after initial treatment with multiple insulin injections with or without metformin. This suggests a marked recovery of beta-cell function, similar to that in adults. SUMMARY: T2DM in children, as in adults, is characterized by insulin deficiency relative to insulin resistance. Plasma C-peptide levels may be clinically useful in guiding therapeutic choices, since patients with lower levels required insulin treatment; beta-cell function is also diminished with longer duration of T2DM. The possibility exists that in children, as in adults, intensive glycemic regulation may allow for beta-cell recovery and preservation. Thus, optimum beta- and alpha-cell function are central to the prevention of DM and maintenance of good glycemic control in African-American and Hispanic children and adolescents with T2DM.

Adolescent↗

PubMed1995

[Transformations in the transition between work activity and retirement in Europe: new stakes for social security].

"The tendency towards early retreat from the work force observed in Europe over the past years can be attributed to social security measures other than old age security, and is not simply due to an advancing retirement age. Two programmes have been especially favoured for protecting ageing workers: disability insurance and unemployment insurance. Preretirement compensation packages have also facilitated the early departure of these workers from the labour force, whether employed or not. Such emerging models in the transition from work activity to retirement are revealing, both in terms of the social restructuring of the life cycle, and the overhaul of the social safety net. These transformations are analyzed in conclusion in relation with their potential role in new stakes for social security." (SUMMARY IN ENG AND SPA)

Developed Countries↗

PubMed2004

[Advances in the research of all-ceramic FPD].

The all-ceramic restoration has no metal base,no need to mask, and it also has perfect esthetic attribute. But in the past, lower strength restricted its clinical use. With the development of high strength ceramics, all-ceramic restoration has been widely used than before. Recently, more and more research on all-ceramic materials, laboratory test and clinical test showed good prospect in prosthodontics field.

Dental Porcelain↗

PubMedDate not supplied

[Medical errors in the continuous improvement of quality].

The increase in medical errors during the last four decades of past centuries can be attributed to several causes: the human fallibility always present, concern in quality and continuity of physician-patient relationship and to the increased advance in technology innovation. These errors attract the attention of Agencies and Organizations involved in Healthcare Quality. From the work of these a series of recommendations were issued for the prevention of medical errors. The action level is a systemic one, due to the characteristic of the healthcare services.

Humans↗

PubMed1990

A 10-year review of maternal mortality in a municipal hospital in Rio de Janeiro: a cause for concern.

A 10-year review of maternal mortality was conducted at the Municipal Hospital Miguel Couto in Rio de Janeiro. Thirty-two deaths occurred between January 1978 and December 1987. In the same period there were 18,071 live births, giving an overall maternal mortality ratio of 177 per 100,000 live births. Maternal mortality increased from 128 per 100,000 live births in 1978 to 462 per 100,000 in 1987. Abortion-related deaths accounted for 47% of the total mortality, followed by toxemia (19%) and hemorrhage (13%). The contribution of abortion-related mortality to maternal mortality increased 172% over the 10-year period studied. These results indicate that maternal mortality has been increasing in a population of urban poor and that the leading cause of death is induced abortion. In a setting where access to abortion is highly restricted and desire to regulate fertility is high, death due to illegal abortion is a major contributor to maternal mortality. The rise in abortion-related mortality over the past 10 years is attributed to a lack of family planning services in conjunction with urban socioeconomic conditions conducive to smaller families.

Abortion, Induced↗

PubMed1984

Reconstructive operations for esophagogastric corrosive lesions.

Corrosive esophagogastric lesions are common in Algeria and France. Within the past 14 years, our overall mortality has decreased to 6% as compared to 12% in the best results from elsewhere. This report describes our operative experience with 68 patients from 1974 to 1982. According to a prospective interdisciplinary program, lesions in 351 patients were staged by emergency esophagoscopic findings: Stage I, ulceration; Stage II, hemorrhage and ulceration; Stage III, mucosal necrosis, hemorrhage, and ulceration. Total parenteral nutrition or jejunal feeding was given to patients with Stage II lesions for 3 weeks and to those with Stage III lesions for 3 months before repeat esophagoscopy. Operations were required by 68 patients who had Stage III lesions and severe stenosis. Procedures done included 39 retrosternal colon interpositions, 11 partial or total gastrectomies, nine esophagogastrectomies, four esophagoenteral colonic bypasses, six esophagogastric colonic interpositions following partial gastric resection, and one gastrojejunostomy. Eleven of the cervical anastomoses were to the pharynx. There were no operative deaths and no anastomotic leaks. All patients have satisfactory nutrition and rehabilitation. Our operative experience in the preceding 5 years included an 11% mortality; improved results in the past 8 years are attributed to early and accurate staging, planned multidisciplinary management, good nutritional support, and better timing of operations. Stage III esophagogastric corrosive lesions may be treated within 4 to 5 months of injury with low mortality and good functional outcome.

Adolescent↗

PubMed1994

[Immunophenotyping of leukemia: overview].

Leukaemias that cannot be classified properly by morphological/cytochemical parameters may be diagnosed clearly by immunophenotyping. In this way, the neoplastic cells can be designated to either the myeloid or the lymphatic line of blood cells. Furthermore, myeloid leukaemias can be subtyped immunophenotypically in cases of type M0, M6, and M7, leukaemias, as well as in cases of mixed lineage or undifferentiated leukaemias. In patients with non-Hodgkin-lymphomas the cells can be characterized as being of B- or T-cell origin, and their activational or proliferative state can be assessed. Notably with acute lymphatic leukaemias, the prodigious therapeutical progress over the past years must be attributed to the refined definition of subtypes by immunophenotyping.

Antibodies, Monoclonal↗

PubMed2004

Psychosocial predictors of successful delivery after unexplained recurrent spontaneous abortions: a cohort study.

OBJECTIVE: To examine psychosocial predictors of successful pregnancy after recurrent spontaneous abortions (RSA). METHOD: We administered two waves of semi-structured interview and self-report questionnaire battery to a consecutive series of 46 couples who had had two RSAs (baseline before third pregnancy, and immediately after third pregnancy was ascertained), and followed them through their third pregnancy. RESULTS: Of the 46 couples, four miscarried for karyotypal abnormalities and six without any known cause. When the latter six were compared with the remaining 36 women, they reported less social support satisfaction, a more stable attribution for the causes of past abortions, and more depressed mood in the preceding year. Taken altogether, this psychosocial model was able to predict 93% of the pregnancy outcomes correctly. CONCLUSION: Psychosocial variables (depression, attribution and social support) are robust predictors of the prospective pregnancy and suggest possible points of intervention in couples with RSA.

Abortion, Spontaneous↗

PubMed1997

Sex differences, attributional style, and depressive symptoms among adolescents.

This study examined attributional style, sex and depressive symptoms and diagnosis in high school students. The results revealed that (1) for females and males, higher levels of depressive symptoms correlated with a more depressive attributional style; (2) females and males who met diagnostic criteria for a current depressive disorder evidenced more depressogenic attributions than psychiatric controls, and never had past depressed adolescents; (3) although no sex differences in terms of attributional patterns for positive events, negative events, or for positive and negative events combined emerged, sex differences were revealed on a number of dimensional scores; (4) across the Children's Attributional Style Questionnaire (CASQ) subscale and dimensional scores, the relation between attributions and current self-reported depressive symptoms was stronger for females than males; and (5) no Sex x Diagnostic Group Status interaction effects emerged for CASQ subscale or dimensional scores. Implications of the complex findings from this large-scale, methodologically sophisticated study was addressed.

Adolescent↗

PubMed1999

Nutritional and sensory evaluation of akara made from blends of cowpea and hard-to-cook mottled brown dry beans.

The effect of replacing cowpea with hard-to-cook beans on the nutritional and sensory properties of akara were evaluated. Cowpea (Vigna unguiculata), traditionally used for making akara, was substituted 0%, 25%, 50%, 75%, and 100% with hard-to-cook (HTC) mottled brown beans (Phaseolus vulgaris). Cowpea (CP) soaked for 60 min HTC beans soaked for 18 h were separately decorticated, ground to a paste, and mixed in the following CP:MBB ratios: 0:100, 25:75, 50:50, 75:25, and 100:0. The paste mixtures were each whipped and fried into akara. The samples were analyzed for bulk density, nutritional composition, carbohydrate and protein digestibility, alpha-amylase inhibitor and trypsin inhibitor activity, and sensory attributes. The bulk density of paste as well as of akara increased with the increasing content of HTC bean. Akara made from composite paste had a relatively better amino acid profile. Frying beyond 5 min destroyed the alpha-amylase inhibitors as well as the trypsin inhibitor activity. No significant difference was observed in the overall acceptability of akara made from cowpea substituted up to 50% with HTC beans. Hence, this approach permits the utilization of hard-to-cook beans.

Amino Acids↗

PubMed1998

Long-term effects of childhood maltreatment history on gender-related personality characteristics.

OBJECTIVE: The aim of the study was to test the hypothesis that different types of gender-related personality attributes are associated with a past history of different types of childhood maltreatment. METHOD: A survey was administered to 1,060 male soldiers and 305 female soldiers in the U.S. Army. The survey instrument included the Extended Personal Attributes Questionnaire (EPAQ) which is a self-assessment instrument of personality characteristics associated with gender, and includes measures of positive masculinity (self-assertive/instrumental traits), positive femininity (expressive/interpersonal traits), negative masculinity (hyper masculine/macho traits), and negative femininity (subordination of self to others). The survey instrument also included the Childhood Trauma Questionnaire (CTQ), which contains scales measuring sexual abuse, physical-emotional abuse, physical neglect, and emotional neglect, and four questions on childhood sexual abuse developed for a national survey of U.S. adults. RESULTS: Negative masculinity was predicted by male gender, younger age, and childhood physical-emotional abuse. Negative femininity was predicted by physical-emotional abuse and sexual abuse. The relationship to sexual abuse was mainly evident for males. Positive femininity was positively correlated with sexual abuse for females and negatively correlated with sexual abuse for males. Positive masculinity was negatively correlated with emotional neglect for males but not for females. Positive femininity was negatively correlated with emotional neglect for both genders. CONCLUSIONS: Childhood abuse was associated with the presence of negative gender-related attributes; childhood neglect was associated with absence of positive gender-related attributes. Childhood physical abuse was associated with negative masculine attributes in both genders. Childhood sexual abuse was associated with positive feminine attributes in females, and negative feminine attributes in males. The finding for females is counterintuitive, and is discussed in the light of the clinical literature on certain types of adaptation to incest.

Adult↗

PubMed1993

In search of the "hot" cognitions: attributions, appraisals, and their relation to emotion.

Two studies examined the hypothesized status of appraisals, relative to attributions, as proximal antecedents of emotion. In Study 1, which looked at 6 emotions (happiness, hope-challenge, anger, guilt, fear-anxiety, and sadness), undergraduates (N = 136) reported on their attributions, appraisals, and emotions during past encounters associated with a variety of situations. In Study 2, which was focused on anger and guilt, undergraduates (N = 120) reported on these same variables in response to experimenter-supplied vignettes that systematically manipulated theoretically relevant attributions. The results of both studies indicated that the emotions were more directly related to appraisals than they were to attributions, and Study 2 provided evidence that appraisal serves as a mediator between attribution and emotional response. These findings lend support to the hypothesized status of appraisal as the most proximal cognitive antecedent of emotion.

Anger↗