Reading difficulties as a cause of behavior problems in adolescence.

It is difficult to state whether the learning and reading problems cause the socially deviant behaviour, or whether the emotional problems lead to the reading and learning problems in adolescents of normal intelligence. This may be a difficult question to answer in general, but in a given specific case with proper assessment, it is not hard to decide which came first. It has been stated that no deviant child among exceptional children suffers more in the way of retaliatory and rejecting attitudes on the part of those around him than does the delinquent youngster. It has also been found that teachers and youth workers do not like to deal with a delinquent child. This is in fact a sad state of affairs because though these youngsters may be difficult and lack motivation however, they do possess the potential to become successful criminals or tax paying citizens of our Community of tomorrow. Very much depends upon the help provided during the difficult years of adolescence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Risk factors for drug-related problems in elderly ambulatory patients

Medication use among elderly patients in ambulatory care, home health care, and long-term care settings has become increasingly complicated during the past decade. Home intravenous therapy, multiple drug regimens to treat multiple chronic diseases, increased acuity of nonhospitalized patients, and increased longevity have placed elderly patients at increased risk for drug-related problems.     

Factors associated with multiple admissions to a public psychiatric hospital

The purpose of this study was to identify the psychiatric and social factors associated with multiple admissions, especially for psychotic patients. Demographic and diagnostic information (based on the DSM-III-R) was collected on a computerized database for all patients admitted to the only psychiatric hospital in Geneva, Switzerland. Patients who had had at least three admissions over a period of 1 year were compared with a control group drawn from the total clinic population. In 1994, a total of 1575 patients were hospitalized, and 18% of these patients were readmitted for the third or more time. The principal diagnoses were psychotic disorders (25%), affective disorders (35%) and substance-related disorders (24%). The predictors of multiple admissions for psychotic patients were a comorbidity of substance-related disorder, longer duration of illness, female sex, younger age and poorer psychosocial adjustment during the past year. These results highlight the usefulness of a computerized psychiatric database. Indeed, early identification of the types of psychiatric patient who are likely to be readmitted is necessary to enable the planning and implementation of specific programmes of ambulatory care to prevent rehospitalization.     

The rapid access paediatric clinic: a way to reduce inappropriate admissions to hospital

With documented evidence of increased numbers of paediatric admissions to a reduced number of beds, it is important that children are admitted to hospital for appropriate reasons. Some hospitals have set up rapid access or emergency consultation clinics to try to avoid unnecessary paediatric admissions. This study examined the presenting problem of 451 patients referred by general practitioners (GPs) to the paediatric emergency clinic at Southampton General Hospital over a five month period, and the outcome for the children in terms of investigation, admission or follow-up. The most common presenting problems were gastrointestinal (26.8%), respiratory (22.8%) or infectious (19.1%). Cough or "chestiness" was the single most common presenting symptom. A total of 328 investigations was performed. After the clinic visit, 35.3% of children were discharged, 18.8% were asked to return to the clinic for a follow-up visit and 19.1% were admitted to the ward. 16.4% were given a future paediatric outpatient appointment, 7.3% were referred for specialist opinion in a different speciality, and 6.7% were advised to return to the GP for follow-up. The authors consider that the emergency paediatric clinic is appropriately used by GPs referring acute and sub-acute problems and believe that local satellite clinics run along similar lines would be welcomed by GPs, health visitors and parents. Although there is little documented evidence that rapid access paediatric clinics reduce admission, the authors consider that unnecessary admission was avoided for many of the children seen in the emergency clinic. Prospective studies are needed to confirm this.     

A regional evaluation of variation in low-severity hospital admissions

OBJECTIVE: Determine patient and hospital-level variation in proportions of low-severity admissions. DESIGN: Retrospective cohort study. SETTING: Thirty hospitals in a large metropolitan region. PATIENTS: A total of 43,209 consecutive eligible patients discharged in 1991 through 1993 with congestive heart failure (n = 25,213) or pneumonia (n = 17,995). MEASUREMENTS AND MAIN RESULTS: Admission severity of illness was measured from validated multivariable models that estimated the risk of in-hospital death; models were based on clinical data abstracted from patients' medical records. Admissions were categorized as "low severity" if the predicted risk of death was less than 1%. Nearly 15% of patients (n = 6,382) were categorized as low-severity admissions. Compared with other patients, low-severity admissions were more likely (p < .001) to be nonwhite and to have Medicaid or be uninsured. Low-severity admissions had shorter median length of stay (4 vs 7 days; p < .001), but accounted for 10% of the total number of hospital days. For congestive heart failure, proportions of low-severity admissions across hospitals ranged from 10% to 25%; 12 hospitals had rates that were significantly different (p < .01) than the overall rate of 17%. For pneumonia, proportions ranged from 3% to 22%; 12 hospitals had rates different from the overall rate of 12%. Variation across hospitals remained after adjusting for patient sociodemographic factors. CONCLUSIONS: Rates of low-severity admissions for congestive heart failure and pneumonia varied across hospitals and were higher among nonwhite and poorly insured patients. Although the current study does not identify causes of this variability, possible explanations include differences in access to ambulatory services, decisions to admit patients for clinical indications unrelated to the risk of hospital mortality, and variability in admission practices of individual physicians and hospitals. The development of protocols for ambulatory management of low-severity patients and improvement of access to outpatient care would most likely decrease the utilization of more costly hospital services.     

Current problems with intrahepatic bile duct stones in Japan--congenital biliary malformations as a cause

BACKGROUND/AIMS: In patients with primary intrahepatic bile duct stones, strictures of the biliary duct are often present, but the relationship between these strictures and the formation of the stones remains controversial. Intrahepatic bile duct carcinoma in association with intrahepatic bile duct stones has recently been reported. The present study attempted to ascertain whether bile stasis induced by congenital biliary strictures is the basis for the formation of stones and occurrence of carcinoma. MATERIALS AND METHODS: We analyzed the location of strictures in 58 patients with strictures in the upper portion of the biliary tract including 38 patients with intrahepatic bile duct stones and 9 with intrahepatic bile duct carcinoma. The cell cycle of epithelial cells from the intrahepatic bile duct were analyzed with using proliferating cell nuclear antigen, which is a immunohistochemical staining method. RESULTS: Fifty six of 58 patients had congenital cystic dilatation of the common bile duct (two infant type and 54 adult type). Thirty eight patients had intrahepatic bile duct stones proximal to the strictures at the hepatic hilum. The location of the strictures were classified into four types. Nine patients had intrahepatic bile duct carcinoma and eight of the 9 carcinomas coexisted with intrahepatic bile duct stones. In the nine patients with intrahepatic bile duct carcinoma, the expression of proliferating cellular nuclear antigen (PCNA) in the carcinoma and the normal bile duct epithelium adjacent to the carcinoma was higher than that of patients with hepatocellular carcinoma without anomaly of the biliary duct. CONCLUSION: Considering the location of the strictures and clinical features, the strictures may have been formed congenitally. Furthermore, adult type cysts of the common bile duct with strictures in the upper portion of the biliary tract are thought to be the basis for the formation of primary intrahepatic bile duct stones. The most appropriate treatment for intrahepatic bile duct stones is thus suggested to be removal of the affected hepatic segment including the region of strictures, combined eventually with hepaticoenterostomy.     

Age as a factor in critical care unit admissions

BACKGROUND: Although the aged occupy a high proportion of critical care beds nationwide, few multicenter studies have been undertaken to specifically determine physician attitudes toward the elderly in a critical care setting. We attempt to determine the importance of patient age as a factor in the admission of acutely ill medical patients to critical care units. METHODS: In response to a hypothetical case scenario, physicians were asked to admit one of two patients to a last available critical care unit bed. An accompanying questionnaire was used to gain a ranking of several admission factors as compared with age, and to gain demographic data regarding the study population. Data were subjected to nonparametric statistical analysis. RESULTS: When age was the only difference between two patients in a hypothetical case scenario, 80.7% of respondents chose the younger patient (age 56 years) for admission, 13.2% chose the older patient (age 82 years), and 6.2% abstained. Following the provision of more detailed medical and social information, however, only 53.5% chose the younger patient, 41.2% chose the older patient, and 5.3% continued to abstain. In a ranking of several admission factors, age was found to be of less importance than severity of presenting illness, previous medical history, and do not resuscitate status, but of more importance than patient motivation, ability to contribute to society, family support, and ability to pay for care. When asked if they supported a definitive age criterion that would restrict all patients over a certain age from access to critical care units, 95.1% responded that they did not. CONCLUSIONS: Age is a factor considered by physicians in the admission of acutely ill medical patients to critical care units. Other medical and social factors, however, can affect the impact of patient age on treatment decisions. Further study and discussion are needed to clarify the appropriate role of age and other factors in critical care unit admissions.     

Subglottic hemangioma as the cause of laryngostenosis in young children

The amount of plasma cells synthesizing different class immunoglobulins in the gallbladder wall in 9 practically healthy people and in 19 patients with different forms of cholecystitis was studied by a complex of histological, histochemical and immunofluorescent methods. It was established that catarrhal cholecystitis was accompanied by activated production of immunoglobulins of all classes by plasmocytes of the gallbladder wall. In patients with destructive forms of cholecystitis the level of secretory immunoglobulin A was substantially decreased as well as the amount of plasmocytes synthesizing IgA. The amount of immunocytes producing IgM and IgG became disproportionally greater, there appeared immune IgM complexes and IgG and IgG in the wall of blood vessels and perivascular stroma. The author considers that local immune reactions play an important role in protection of the gallbladder mucosa and pathomorphogenesis of cholecystitis.     

Pressure ulcer prevalence and incidence in a rehabilitation hospital

Pressure ulcers remain a serious health problem, especially in terms of personal suffering and economics. The study described here, conducted in a rehabilitation setting, investigated the prevalence (number of persons with pressure ulcers at a given time) and the incidence (number of persons developing pressure ulcers over a given time) of pressure ulcers. Skin assessments and risk assessments of the subjects were completed using the Braden Scale for Predicting Pressure Sore Risk. Demographic data were obtained. The prevalence rate was 25%, although there was no incidence during the time of this study. Factors associated with the prevalence of pressure ulcers are discussed.     

Anti-diabetic drugs as a cause of hypoglycaemia among acute medical admissions in Hong Kong and Singapore--relationship to the prescribing patterns in diabetic patients

By a reaction of salicylaldehyde (Scl) with the corresponding amino acids and by the next complexation reaction of the formed Schiff bases with Cu2+ ions in an aqueous-alcoholic medium, aqua (N-salicylideneaminoalkanoato)copper(II) complex chelates of the composition Cu(Scl-DL-Asp(2-)) (H2O)2, Ip and Cu(Scl-L-Asn(2-)(H2O), In were prepared. The monodiazole complexes with pyrazole IIp and IIn (as monohydrate) as well as with 3,5-dimethylpyrazole IIIp a IIIn were prepared by replacing the molecule of H2O in the parent aquacomplexes with the diazoles under the same reaction conditions. Using a routine dilution micromethod, the antimicrobial activity of the prepared complexes and free diazoles was tested against Staphylococcus aureus, Escherichia coli and Candida albicans. Only a significant antistaphylococcus activity was found (highest for the complex IIn; MIC = 39 micrograms/cm3). All chelates (Ip,n-IIIp,n) were more effective (MIC = 39-156 micrograms/cm3) than both pyrazole (312 micrograms/cm3)and 3,5-dimethylpyrazole (625 micrograms/cm3) alone. The relationship between the coordination-chemical properties and the biological effects of the complexes studied is discussed.     

Emergency admissions of older people to hospital: a link with material deprivation

Nonproductive cough is a frequent and distressing symptom in patients with lung cancer, and it is not even relieved by palliative chemotherapy. A double-blind, randomized clinical trial regarding the treatment of nonproductive cough was performed in 140 adults with primary lung cancer or metastatic cancer of the lungs. The therapeutic efficacy and the tolerability of a 7-day treatment with levodropropizine drops (75 mg t.i.d.) were evaluated in comparison with dihydrocodeine drops (10 mg t.i.d.; 7 days). Efficacy was assessed on the basis of cough severity scores, number of night awakenings due to cough, and overall estimate of antitussive efficacy. Tolerability was evaluated by laboratory results, vital signs and any adverse event occurring during the clinical trial, including presence or absence of somnolence. Subjective cough severity was significantly reduced during treatment with either levodropropizine and dihydrocodeine, the antitussive effect and its time-profile being similar for both drugs. Also, according to the investigator's evaluation, both levodropropizine and dihydrocodeine produced a significant decrease in cough severity. Concurrently with the relief of cough, the number of night awakenings was decreased significantly by both drugs, with no difference between the two treatments. No change in laboratory test values was considered clinically relevant, and vital signs were not clinically affected. The number of patients reporting adverse events was similar in the levodropropizine (n=6) and dihydrocodeine (n=4) group. However, the percentage of patients experiencing somnolence in the group receiving levodropropizine (8%) was significantly lower as compared with that of the dihydrocodeine group (22%). These results confirm the antitussive effectiveness of levodropropizine and suggest a more favourable benefit/risk profile when compared to dihydrocodeine.     

Management of psychiatric problems in a Kenyan mission hospital

Many psychiatric conditions are found in the rural general hospital in Kenya and are recognisable and manageable along standard Western lines. An essential element in management is the training of the nursing staff. The psychiatric patient should be actively managed and can benefit from the unsophisticated treatment possible at the mission hospital.     

Peroral sustained-release film-coated pellets as a means to overcome physicochemical and biological drug-related problems. I. In vitro development and evaluation

In vitro preformulation testing has shown that the solubility and dissolution rate of the model drug compound ucb 11056 are highly pH dependent. Considering this, different sustained-release (SR) oral dosage forms of ucb 11056 were developed aiming to obtain the most constant and complete release of the drug during transit in the gastrointestinal (GI) tract. Classical approaches based on the use of SR formulations such as hydrophilic matrix tablets or pellets coated with one film-forming polymer (Eudragit NE30D or L30D-55) did not fulfill all expectations on the basis of their in vitro evaluation, i.e., the drug release and pattern remained highly dependent on the pH of the dissolution medium. Therefore, taking advantage of the flexibility of release adjustment obtainable from coating of pellets with different kinds of pH-sensitive film layers, a quite satisfactory pH independence of the release characteristics was obtained using formulation blends of neutral and anionic acrylic polymers. For the selected SR pellets batch 15 coated with NE30D/L30D-55 (7:3), the tridimensional topographic representation of the drug release versus time and pH showed that, notwithstanding the pH-dependent aqueous solubility of the drug, the release profiles were relatively homogeneous for any pH value ranging between 1 and 7.     

Effectiveness of influenza vaccine in reducing hospital admissions in people with diabetes

By radioligand binding followed by Scatchard analysis, we characterized and quantitated the specific binding sites for bFGF on cultured trabecular meshwork cells obtained from freshly enucleated porcine eyes. We detected two binding sites: 1.67 x 10(4) +/- 5.75 x 10(2) high-affinity receptors per cell with a Kd of 33.4 +/- 7.90 pM, and 1.70 x 10(4) +/- 7.57 x 10(5) low-affinity binding sites per cell with a Kd of 3.84 +/- 1.41 nM. At low concentrations of 125I-bFGF (< 1.50 ng ml-1), binding was primarily determined by the high-affinity receptors and, at high concentrations (> 2.50 ng ml-1), binding was dependent on the low-affinity binding sites. By phase-contrast time-lapse video micrography and sequential photomicrography, we demonstrated that at a concentration of 1 ng ml-1, bFGF significantly stimulated the rate of mitosis of the trabecular meshwork cells in G0-phase compared with control cultures maintained in serum-free medium alone. Treatment with higher concentrations of bFGF did not reveal more potent effects on these cells. Our findings demonstrate that trabecular meshwork cells do possess low- and high-affinity receptors for bFGF and that bFGF induces these cells in vitro to re-enter the cell cycle. Because the low-affinity interactions of 125I-bFGF were reduced by 75% following pretreatment of the trabecular meshwork cells with heparinase, these sites represent cell-associated heparin-like molecules and heparan sulfate proteoglycans, and may control the bioavailability of bFGF to ocular tissues. Heparinase treatment also resulted in a 30% reduction in high-affinity binding, which may be secondary to the decreased low-affinity binding. This finding agrees with the well-established scheme for bFGF-receptor interaction. We conclude that bFGF at the concentration present in aqueous humor is capable of stimulating the mitotic activity of trabecular meshwork cells in vitro, suggesting a possible paracrine role of aqueous humour bFGF in vivo. The results obtained in this study, together with our previous findings on bFGF mRNA expression by trabecular meshwork cells and protein deposition in this tissue, also indicates that trabecular cells of the eye may utilize bFGF by an autocrine mechanism.     

The teacher-student relationship as a developmental context for children with internalizing or externalizing behavior problems.

Children with significant behavior problems are at risk for poor school adaptation and a host of deleterious school outcomes. Given the time children spend in school, there is a need to better understand the normative contexts and processes within schools that may enhance the positive adaptation of children with significant behavior problems. This study evaluated one such context, the teacher-student relationship, specifically, the degree of closeness and conflict in the relationship, between urban, American elementary schoolchildren with significant externalizing or internalizing behavior problems and their teachers. The results suggest that the qualities of the teacher-student relationship predict children's successful school adjustment. Having a relationship with a teacher characterized by warmth, trust, and low degrees of conflict was associated with positive school outcomes. Some moderation effects were noted, including differential effects for warmth on the reading achievement of children with externalizing distress, and conflict on the school adaptation of children with internalizing problems. Results are discussed in light of theory and school-based intervention and prevention efforts. (PsycINFO Database Record (c) 2010 APA, all rights reserved)