Parents' knowledge of respiratory disease: A comparison of inner-city and suburban parents

The difference in knowledge of common diseases between inner-city parents and suburban parents may be even greater than generally thought. Measuring this difference should serve to emphasize the general neglect of the subject of parent (or patient) education in medical schools, residency programs, and in pediatric texts and journals. The present study of parents' knowledge of respiratory disease shows that inner-city parents scored 20 points lower than suburban parents (67% vs. 87%). In the inner-city group Spanish-American parents scored 11 points lower than non-Spanish-American parents (61% vs. 72%). Thus, the urgent need for better health education, especially in the inner city, is emphasized. Several basic reviews of articles on health education show clearly that this subject is very complex and poorly understood by many investigators. Adequate controls are hard to establish, and long-term benefits are hard to prove. Hospitals are reluctant to spend additional funds on health education unless a convincing cost-benefit relationship can be shown. However, the costs of ignoring the problems of health education are probably much greater than the costs of conducting a well-organized program.     

Loneliness among the oldest old, a comparison between residents living in nursing homes and residents living in the community

To ascertain whether membrane signal transduction is induced by bullous pemphigoid (BP) antibody and whether cell lysis is induced by its complement activation, we assessed the intracellular Ca2+ concentration ([Ca2+]i), intracellular pH, membrane potential and morphology of living cells by following the time course of fluorescence intensity of Fluo-3/AM, Snaff-1/AM, Dioc-5 and Luciffer yellow, respectively. A transient increase of Fluo-3 fluorescence intensity in DJM-1 cells (a squamous cell carcinoma line) was revealed when the cells were incubated with 2 of five IgG1 BP antibodies. However, no transient increase of Fluo-3 fluorescence intensity was revealed when the cells were incubated with IgG2 and IgG4 BP antibodies. A transient increase of Fluo-3 fluorescence intensity was revealed in DJM-1 cells incubated with 3 of seven IgG1 and 1 of four IgG2 BP antibodies in an EGTA-containing low-Ca2+ medium. On the other hand, the Dioc-5 fluorescence intensity did not change significantly, though the increase of Fluo-3 fluorescence intensity was observed. The increase of Snarf-1 fluorescence intensity was revealed in DJM-1 cells incubated with 2 of five IgG1 BP antibodies, but was not revealed in the cells incubated with IgG2 or IgG4 of BP antibodies. Study of complement activation by BP IgG1 showed a transient increase of Fluo-3 fluorescence intensity of with 3 of five IgG1 BP antibodies when DJM-1 cells were incubated with complement-supplemented normal-Ca2+ medium. At the same time, however, endocytosis and cell lysis were not observed with 2 IgG1 BP antibodies which did induce an increase of Fluo-3 fluorescence intensity when Lucifer-yellow-loaded DJM-1 cells were incubated with complement-supplemented normal-Ca2+ medium. We examined next whether anti-180 kD BP antigen monoclonal antibodies (mAbs R-223 and 233) induce an increase of Fluo-3 fluorescence intensity. MAb R-223 did not induce any increase of Fluo-3 fluorescence intensity in DJM-1 cells, when incubated with normal- and low-Ca2+ media However, mAb R-223 induced a transient increase of Fluo-3 fluorescence intensity in DJM-1 cells when incubated with complement-supplemented normal-Ca2+ medium. MAb 233 did not induced an increase of Fluo-3 fluorescence intensity in DJM-1 cells when incubated with normal- and low-Ca2+ media. These results suggest that the BP IgG1 induces Ca2+ release from intracellular storage sites, however, the complement activated by BP IgG1 does not induce cell lysis. It could not be confirmed that anti-180 kD BP antigen antibody induced Ca2+ release from intracellular storage sites.     

A comparison of the characteristics of incontinent and continent stroke patients in a rehabilitation program

BACKGROUND: A retinal image performance distorted by an asymmetric or irregular corneal surface cannot be compensated for with spherocylindric glasses completely. The best-corrected visual acuity is markedly decreased and contact lens fitting often impossible. The purpose of this study was to calculate the differential height between corneal topography raw data and any regular surface with mathematical methods in order to ablate the differential height with a computer-controlled laser beam, thereafter. METHODS: A Zernike decomposition of radial degree n = 16 was realized within a clinically relevant central corneal area of 8 mm in diameter based on corneal topography raw height data of a commercially available topographer (TMS-1, Tomey, Erlangen). Any target surface could be defined by varying weighting of the Zernike coefficients. The calculated differential height ablation between the raw data and the target surface given in a polar grid was transformed to a Cartesian grid to evaluate the sleeping time at each grid position considering the characteristic ablation curve for the intended ablation of the height difference. Subsequently, differential height ablation was simulated using an automated laser beam control for a modified excimer laser (MEL60, Aesculap-Meditec, Jena). We developed software tools for Zernike decomposition of corneal topography raw height data and time-regulated automatic laser beam control of the grid positions in the higher programming language C (Borland C++ 3.1, Borland Inc., München). RESULTS: Definition of a target surface can be realized alternatively by selecting a set of Zernike coefficients or defining a spherical or spherocylindrical surface by superposition of parabolic terms in a fixed proportion creating a best-fit target surface to the raw data. In originally "relatively flat" areas, the differential height profile indicates a "relatively deep" ablation resulting in relative steepening towards the periphery of the ablation zone. The resolution of the mechanical unit of the laser beam control consisting of two linear stepping motors is 9 microns in the focal plane with a reproducibility of 5 microns. The software unit is guiding the laser beam in a meandering fashion within the ablation area considering the calculated sleeping time for each grid position. Mean overlap of the 1 mm laser spots is 70%. The laser beam diameter of 1 mm effects a peripheral transition zone of 0.5 mm. CONCLUSIONS: Zernike decomposition of corneal topography height data is an efficient tool for localizing and quantifying superficial irregularities and for directly calculating an ablation profile from created differential height data. With an automatic laser beam control a well-defined laser ablation of superficial corneal irregularities is possible, subsequently.     

A comparison of the induction characteristics of sevoflurane and halothane in children

The induction characteristics of sevoflurane and halothane were compared in 81 children aged 6 months to 6 years. The mean time taken to achieve loss of eyelash reflex was significantly shorter with sevoflurane than with halothane (sevoflurane, mean time (SD) 1 min 41 s (35 s), halothane, mean time (SD) 2 min 17 s (43 s), t = 4.11, p = < 0.01). The mean time taken to complete induction (to achieve steady spontaneous ventilation and small pupils with central gaze) was also shorter in children induced with sevoflurane (sevoflurane, mean time (SD) 3 min 58 s (1 min 8 s), halothane, mean time (SD) 4 min 50 s, (1 min 27 s), t = 2.29, p = 0.027). Effects on heart rate, blood pressure and oxygen saturation during induction were similar for both agents. There were no major complications during induction with either halothane or sevoflurane.     

The epidemiology, clinical characteristics, and natural history of older nursing home residents with a diagnosis of Parkinson''s disease

This study investigated the occlusal stress distribution to the implant and soft tissue for the implant-retained overdenture. The stress at the molar residual ridge and the strain around the implant were measured on an experimental resin cast using static and dynamic loading. The influence of connecting structures of stud attachments on stress distribution was discussed. The occlusal stress had a tendency to concentrate on the implant, especially in the areas distal to the implant. The modified magnetic attachment system, using a silicone-covered magnet, provided the optimal stress distribution.     

The public and private problem of euthanasia. A comparison of The Netherlands and the United States

We present a 24 case-study of intact ossicular chain cholesteatomas among 158 first-look procedures performed between august 93 and april 96 (15%). The eradication of the disease was achieved via canal wall up technique without disrupting the ossicular chain in 20 cases (84%). Technical procedures are described. This new surgical attitude has enabled us to achieve better functional results. Second look procedures have not been necessary in all cases and occurrence of residuals has not been increased on a 14 months follow up period (2 cases out of 24 patients: 8%). Therefore, a longer follow up period is necessary to validate the results obtained using this recent concept.     

The perception of social-environmental characteristics in kibbutz families with family-based and communal sleeping arrangements.

Compared the perception of social-environmental characteristics in 38 families from kibbutzim with family-based sleeping arrangements (FBA) with those of 47 families from kibbutzim with communal sleeping arrangements (CA), using the Family Environment Scale—Form R. In the FBA families, the mean age of fathers was 42.2 yrs and of mothers, 37.9 yrs. The 38 children of these families were primarily in Grades 5 and 6. In the CA families, the mean age of fathers was 42.1 yrs and of mothers 38.6 yrs. Their 47 children were also primarily in Grades 5 and 6. Significant differences were obtained between the family profiles of the 2 groups. FBA families were higher in cohesion and expressiveness than were CA families. FBA families were also lower in active-recreational orientation and organization. In both groups of families, there were no differences in the perception of family climate between the husbands and wives, whereas children's perceptions differed significantly from those of their parents. (35 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of clinical and structured interview diagnoses in a homeless mental health clinic

OBJECTIVE: This study compared psychiatric diagnoses ascertained by independent clinicians with structured research interviews of homeless psychiatric patients assessed in a mental health clinic and in the community. Problems of both overdiagnosis and underdiagnosis in structured research interviews compared to clinician assessment were predicted. METHOD: Over a period of a year, 97 patients referred to a mental health clinic for homeless people were assessed with the Diagnostic Interview Schedule (DIS) administered by a clinical social worker who then completed a full clinical psychiatric social work assessment. These same patients received a thorough and systematic clinical psychiatric evaluation by a psychiatrist or psychologist, both experienced with this population. These clinicians gathered data from multiple sources, often with extended observation over time. The DIS and clinician diagnoses were made blind to one another and then compared; the clinician was often made aware of some of the symptoms that the social worker had elicited, but not whether the elicited material was from the DIS or from the clinical assessment. Diagnoses of 33 clinic patients previously assessed by trained nonclinician DIS interviews in an epidemiologic study of the homeless population in the community were also compared to clinician diagnoses, and no information from these patients' survey DIS interviews was made available to the clinicians. RESULTS: Compared to clinician assessment, structured interviews underdiagnosed antisocial personality disorder (ASPD) and overdiagnosed major depression. Alcohol use disorder and schizophrenia showed only small discrepancies by assessment method. Drug use disorder revealed no bias according to method of ascertainment, but showed very discrepant kappa levels comparing DIS to clinician assessment in the two different comparison contexts. CONCLUSIONS: If structured research methods assessing the homeless population actually overestimate depression, underestimate ASPD, and misclassify drug abuse, then policies stemming from structured interview research recommendations may call for levels and types of services not optimally suited to the reality of this population's needs. Because mental illness and substance abuse are thought to be critical factors in the generation and perpetuation of homelessness, the issue of accurate diagnosis is tantamount to understanding and providing workable solutions to the problem of homelessness. Further research is needed to untangle potential confounders of the homeless situation to psychiatric diagnosis.     

A study on behavior towards injection among residents and physicians in Kaohsiung & Ping-tung area

To understand why people in Taiwan preferred iatrogenic injection as their medical therapy, we surveyed the knowledge, attitude, and behavior of iatrogenic injection for people and doctors in Kaohsiung and Ping-tung area by questionnaire. The results of the survey are drawn below: 1. More than 91.7% of the interviewed people would like to receive iatrogenic injection as their medical therapy, and 78.1% of the parents would choose iatrogenic injection for their children. The reason majority were because doctors suggested that and the parents believed iatrogenic injection is a quicker way of recovery. 2. In this study, 72.1% of the people received injection as their usual mode of medical treatment, and 74.9% of them had received injection during the previous month. When they brought their children to the clinics, the percentages of the above two conditions were 60.4% and 59.7% respectively. The factors influencing the reception of injection for people were the efficacy of the injection, education level and medical insurance. The influencing factors for children were the parents' medical behavior and the parents' willingness to accept injection. 3. About 83% of the interviewed doctors preferred iatrogenic injection as treatment for their patients. Almost 60% of them agreed that more patients would receive injection after National Health Insurance. About 72% of the doctors would not change the treatment for their patients, no matter how the system of the medical insurance changes. They would choose the right treatment for the distinct disease.     

A comparison of the MMPI-2 restructured clinical (RC) and clinical scales in a substance abuse treatment sample.

The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) restructured clinical (RC) scales were designed to assess the underlying distinctive core components of the MMPI-2 clinical scales in order to enhance discriminant and convergent validity. Analyses utilizing inpatient and outpatient mental health treatment samples (Tellegen et al., 2003) have demonstrated improvements in the psychometric functioning of the RC scales in comparison with the original clinical scales. The current study extends these analyses by comparing the RC and original clinical scales in a sample of 1,284 men assessed at intake to a substance abuse treatment program in a VA setting. Results indicate that the RC scales demonstrate a general improvement in psychometric properties, with some increases in convergent and discriminant validity compared to their clinical scale counterparts. These results replicate Tellegen et al.'s (2003) findings in a different type of treatment setting and with different criteria, and complement their report by examining the validity of scales RC3 and RC9, for which Tellegen et al. (2003) did not have appropriate criteria. Implications for deliverers of psychological services in public sector settings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Handwashing: still a neglected practice in the clinical area

This article is an adaptation of the winning essay in the preregistration section of the National Board for Northern Ireland Research Awards 1996. The authors conducted a literature review of handwashing after discovering during clinical placements that, despite being well documented, handwashing is still not performed as necessary. The aim of handwashing is to remove transient microorganisms and prevent their transfer to susceptible patients. Inadequate training, lack of resources, chapped hands and poor reinforcement were identified by nurses as factors that accounted for poor handwashing. The Code of Professional Conduct states that 'the professional has a duty to promote and safeguard the interests of clients.' It is only a matter of time before major litigation occurs because of poor handwashing practice. It is concluded that all staff (trained and untrained) require regular educational updating to sustain good handwashing practices. Managers are responsible for ensuring the provision of adequate facilities and supplies of handwashing agents for all nurses in all clinical settings.     

Distribution of serum pepsinogen I, II values and their ratios in residents of a rural area

Coloboma of the lens is characterized by notching of the equator of the lens. The cause of the condition is faulty development of the zonule. The lens deprived of its normal pull in the defective region is thicker and more spherical as if there were no loss of its substance. We report five cases of lens coloboma and localized zonular defect without any associated systemic anomalies. One case included retinal detachment; another included an iris coloboma; and a third included iris, choroid and optic disk colobomas and retinal detachment with lens coloboma. The remaining two cases were without associated ocular anomalies. The pathogenic mechanisms and relationship of this defect with the differentiation of the tertiary vitreous and development of the zonule is discussed. The defect most likely occurs in the third to fourth months of gestation during differentiation of the tertiary vitreous in response to toxic, inflammatory or genetic factors.     

A comparison of various estimators of a treatment difference for a multi-centre clinical trial

When a clinical trial is conducted at more than one centre it is likely that the true treatment effect will not be identical at each centre. In other words there will be some degree of treatment-by-centre interaction. A number of alternative approaches for dealing with this have been suggested in the literature. These include frequentist approaches with a fixed or random effects model for the observed data and Bayesian approaches. In the fixed effects model, there are two common competing estimators of the treatment difference, based on weighted or unweighted estimates from individual centres. Which one of these should be used is the subject of some controversy and we do not intend to take a particular methodological position in this paper. Our intention is to provide some insight into the relative merits of the indicated range of possible estimators of the treatment effect. For the fixed effects model, we also look at the merits of using a preliminary test for interaction assuming a 10 per cent significance level for the test. In order to make comparisons we have simulated a 'typical' trial which compares an active drug with a placebo in the treatment of hypertension, using systolic blood pressure as the primary variable. As well as allowing the treatment effect to vary between centres, we have concentrated on the particular case where one centre is out of line with the others in terms of its true treatment difference. The various estimators that result from the different approaches are compared in terms of mean squared error and power to reject the null hypothesis of no treatment difference. Overall, the approach that uses the fixed effects weighted estimator of overall treatment difference is recommended as one that has much to offer.     

The establishment of the maximum permissible concentration of orlok in the air of a work area when used in agriculture

Inhaled Orlok causes changes in the CNS, blood morphology, renal function. The threshold concentration of Orlok is 0.17 mg/m3, its subthreshold concentration is 0.023 mg/m3, MAC in the workplace air is 0.05 mg/m3.     

Preoperative anxiety and fear: a comparison of assessments by patients and anesthesia and surgery residents

We sought to compare self-assessment of preoperative anxiety levels and selection of worst fears by surgical patients with the assessments made by the anesthesia and surgery residents providing intraoperative care for those patients. One hundred inpatients at a Veterans Affairs hospital (Group 1) and 45 patients at a University hospital (Group 2) were asked to complete a brief questionnaire; the residents were asked to complete the same questionnaire. Group 1 results showed that median patient visual analog scale (VAS) scores were lower for anxiety about anesthesia compared to surgery (16 vs 22, P < or = 0.05). Anesthesia resident VAS scores were higher than patient or surgery resident scores. Neither type of resident was able to predict their individual patient's VAS score (Kendall's tau). The fear chosen with the greatest incidence by Group 1 patients and residents was "whether surgery would work". A significant number of residents (34%, anesthesia or surgery, P < or = 0.05) matched their patient's fear choice. Residents commonly chose fears related to their specialty (e.g., anesthesia residents chose anesthesia-related fears more often than surgery residents, 50% vs 28%, P < or = 0.001). In Group 2, residents demonstrated an improved ability to predict patient scores. For instance, both surgery and anesthesia residents were able to predict individual University patient VAS scores (P < or = 0.01). The fear chosen with the greatest frequency by Group 2 patients was "pain after the operation". Sixty percent of anesthesia residents matched their patients' fear choice (P < or = 0.001). This study indicates a variable ability of anesthesia and surgery residents to predict patient anxiety and fear which may be due, in part, to difficulty in understanding a Veterans Affairs hospital patient population.     

A comparison of stool characteristics from normal and constipated people

In people with constipation, it is not known if decreased frequency of defecation is associated with abnormalities in the weight or in the consistency of stools or if the weight or the consistency of stools correlates with the severity of various discomforts associated with bowel movements. In neither normal nor constipated subjects has the consistency of stools been carefully correlated with their relative contents of water and solids. Our aim was to gain insight into these questions. Twenty subjects with idiopathic chronic constipation and 20 age- and sex-matched control subjects were recruited by advertisement. Stools were collected for one week. After each bowel movement, the subject's perception of various discomforts associated with the bowel movement were recorded. The stools were then analyzed. The results and conclusions were as follows: (1) Stool weight per bowel movement was similar in the two groups but stool weight per week was markedly reduced in constipated subjects. (2) Reduced stool weight per week in constipated subjects was due to a nearly proportional reduction in stool water and stool solids output. (3) Using data from both groups, there was a curvilinear correlation between percent insoluble stool solids and stool hardness, as measured by a texture analyzer; hardness increased only slightly as percent insoluble solids increased between 7 and 20%, but hardness increased dramatically when percent insoluble solids exceeded 25%. (4) Only 6% of stools from constipated subjects (2 of 34) had abnormally high values for percent stool solids and physical hardness. (5) In subjects with constipation, the severity of various discomforts associated with bowel movements (such as straining) correlated poorly with the weight or the hardness of stool that was produced by the bowel movement.