Effect of environmental pollution on medical visits for respiratory infections in children in Mexico City

OBJECTIVE: To model the variability of medical visits by children for respiratory reasons as a consequence of the daily changes in environmental pollution observed in the emergency and family medicine departments of a hospital of the Instituto Mexicano del Seguro Social located in the southwest of Mexico City during 1993. MATERIALS AND METHODS: The correlation between the presence of upper and lower respiratory tract infections and exposure to ozone and nitrogen dioxide was studied. To model this association, the authors used multivariate Poisson regression models with linear and non-linear risk, with lag periods between the environmental measurements and the medical visits of one, two and three days, as well as the average of the measurements of three, five and seven days previous to the visit. RESULTS: The model estimates that an increment of 50 ppb in the daily average of ozone would cause an increase of 9.9% in emergency visits due to high respiratory tract infections during the winter, which could rise to 30% if the increment would last five consecutive days in average. CONCLUSIONS: Results suggest that exposure of children younger than 15 years of age to ozone and nitrogen dioxide significantly affect the number of medical visits for respiratory causes in this part of Mexico City.     

Pleural effusions in the medical ICU: prevalence, causes, and clinical implications

OBJECTIVE: To determine the prevalence and causes of pleural effusions in patients admitted to a medical ICU (MICU). DESIGN: Prospective. SETTING: MICU in a tertiary care hospital. PATIENTS: One hundred consecutive patients admitted to the MICU at the Medical University of South Carolina whose length of stay exceeded 24 h had chest radiographs reviewed daily and chest sonograms performed within 10 h of their latest chest radiograph. RESULTS: The prevalence of pleural effusions in 100 consecutive MICU patients was 62%, with 41% of effusions detected at admission. Fifty-seven of 62 (92%) pleural effusions were small. Causes of pleural effusions were as follows: heart failure, 22 of 62 (35%); atelectasis, 14 of 62 (23%); uncomplicated parapneumonic effusions, seven of 62 (11%); hepatic hydrothorax, five of 62 (8%); hypoalbuminemia, five of 62 (8%); malignancy, two of 62 (3%); and unknown, three of 62 (5%). Pancreatitis, extravascular catheter migration, uremic pleurisy, and empyema caused an effusion in one instance each. Heart failure was the most frequent cause of bilateral effusions (13/34 [38%]). When compared with patients who never had effusions during their MICU stay, patients with pleural effusions were older (54+/-2 years, mean+/-SEM, vs 47+/-2 years [p=0.04]), had lower serum albumin concentration (2.4+/-0.1 vs 3.0+/-0.01 g/dL [p=0.002]), higher acute physiology and chronic health evaluation II scores during the initial 24 h of MICU stay (17.2+/-1.1 vs 12+/-1.2 [p=0.010]), longer MICU stays (9.8+/-1.0 vs 4.6+/-0.7 days [p=0.0002]), and longer mechanical ventilation (7.0+/-1.3 vs 1.9+/-0.7 days [p=0.004]). No patient died as a direct result of his or her pleural effusion. Chest radiograph readings had good correlation with chest sonograms (p<0.0001). CONCLUSION: Pleural effusions in MICU patients are common, and most are detected by careful review of chest radiographs taken with the patient in erect or semierect position. When clinical suspicion for infection is low, observation of these effusions is warranted initially, because most are caused by noninfectious processes that should improve with treatment of the underlying disease.     

Decisions about confidentiality in medical student mental health settings.

Investigated orientations toward confidentiality of 59 mental health practitioners in US medical schools who were requested to respond to 10 case vignettes representing a range of students' problems by indicating the action they would take. Results suggest that Ss were generally unwilling to break confidentiality in response to cluster of presenting problems that involved suicidal tendencies, sexual coercion/seduction, nonviolent social transgressions, and falsifying data. This was most pronounced when risk of suicide was evident. Only a bomb threat scenario clearly elicited responses suggesting a likely breach of confidence. (19 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The physician perspective of health psychologists in medical settings.

Examined physician attitudes and utilization of psychologists in medical settings by administering a 15-item questionnaire to 397 26–78 yr old physicians (84% male) practicing family/general practice, surgery, internal medicine, or miscellaneous clinical medicine. Although differences in attitudes were associated with age, sex, and specialty, generally favorable attitudes toward psychologists were found among Ss. Results show a recognition by the majority of Ss of the role that psychological factors play in medical disease and an appreciation of clinical psychological skills by a large majority. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The MBHI: A new inventory for the psychodiagnostician in medical settings.

The Million Behavioral Health Inventory (MBHI), a 150-item self-report inventory, was constructed and validated to provide a wide range of measures relevant to psychological assessment and decision making in a variety of medical settings. The rationale, development, and uses of the MBHI are briefly described; the focus of each of the instrument's 20 scales (e.g., Sociable Personality, Recent Stress, and Emotional Vulnerability) is also outlined. (37 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Driving patterns and medical conditions in older women

OBJECTIVES: To describe driving patterns (e.g., driving frequency) in older women drivers and to evaluate the impact of medical conditions and comorbidity on driving patterns. DESIGN: Cross-sectional examination of the association between medical conditions and driving patterns. SETTING: Population-based cohort from the Pittsburgh Center of the Study of Osteoporotic Fractures (SOF). PARTICIPANTS: A total of 1768 women aged 71 years or older. MAIN MEASUREMENTS: Driving information was obtained through a driving questionnaire, including driving status, weekly mileage, longest trip in the past year, etc. Data for demographics, lifestyle behavior, and medical conditions were collected through the SOF study. RESULTS: Among the participants, 1103 (62.3%) were current drivers, 337 (19.1%) had stopped driving, and 329 (18.6%) had never driven in their lifetime. The proportion reporting driving cessation and decline in driving amount increased with age. The prevalence of most medical conditions was higher among former drivers than in current or never drivers. Even after controlling for age and other demographic variables, fractures, heart disease, diabetes, self-reported poor vision or hearing, as well as comorbidity were found to be associated independently with decreased driving amount, including driving cessation, decline in mileage, and avoiding long trips. CONCLUSION: Both individual medical conditions and comorbidity influence driving patterns in older drivers. Because it is common for older people to have several medical conditions simultaneously, comorbidity might be a more comprehensive measure of medical impact on driving.     

Validation of a cognitive test for delirium in medical ICU patients

Patients with delirium, dementia, depression, and schizophrenia were administered a newly developed test designed to identify delirium in an intensive care unit (ICU) setting. Two alternate forms of the Cognitive Test for Delirium (CTD) were highly correlated. The delirium patients performed least well, and an optimal cutoff score derived from relative-operating characteristic analysis resulted in a sensitivity of 100% and a specificity of 95%. In a follow-up study, the Mini-Mental State Exam could not be administered to 42% of the ICU patients who completed the CTD. Early identification of delirium with the CTD may lead to timely treatment of specific etiologic conditions and a reduction in mortality and morbidity.     

Management of specific medical conditions in the perioperative period

BACKGROUND: Reversal of ischemia after myocardial infarction by revascularization is worthwhile only if viability exists in a sufficiently large portion of the left ventricle. METHODS AND RESULTS: To determine myocardial hypoperfusion reversibility and its influence on segmental and global function, we studied 50 patients after myocardial infarction. Three technetium 99m-tetrofosmin scintigraphies were performed: 1 at rest, 1 after 0.6 mg sublingual nitroglycerin (NTG), and 1 after injection at peak stress. First-pass multigated radionuclide angiography was obtained at rest and after NTG. Each patient also underwent a stress redistribution-reinjection thallium-201 scintigraphy. During stress 99mTc-tetrofosmin, 104 segments had normal uptake, 51 showed moderately reduced uptake, and 186 had severely reduced uptake. Of these 186 segments, 33 (18%) improved at rest, and 41 (22%) improved only after NTG. Fifty-nine (79%) of these segments with improved uptake were also found to have reversible defects on 201TI imaging. In the 26 patients with ventricular dysfunction, a 73% agreement was found between the functional and 99mTc-tetrofosmin uptake post-NTG improvement, whereas a 69% agreement was found with thallium reinjection. No significant differences were seen between 99mTc-tetrofosmin and 201T1 imaging. CONCLUSION: Nitroglycerin administration during 99mTc-tetrofosmin scintigraphy improves the detection of myocardium with reversible hypoperfusion in patients with a previous myocardial infarction.     

Looking ahead: Preparing psychologists for administrative roles in medical settings.

As psychologists increasingly pursue administrative positions, training in management and business systems becomes a pressing need. In response to this need, a unique rotation in administration offered through a predoctoral internship at a Department of Veterans Affairs Medical Center was formed. This article describes the rotation and its objectives. Although initial results from the rotation suggest it offers promise as a model of administrative training, future research assessing the longitudinal career trajectory of persons completing the rotation is needed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Management of chronic medical conditions in children and adolescents

The care of children and adolescents with chronic medical conditions is an area of great interest for primary care physicians. With longer lives and more "mainstreaming" of care, the primary care physician often finds an increased role in the management of children and adolescents with chronic conditions such as mental retardation, Down syndrome, and diabetes mellitus. This article discusses familiarity with the most common chronic conditions and common pitfalls of management.     

Physicians' and medical students' perception of environmental risks

Evaluation of environmental risks involves several subjective elements, including the individual reaction to the mere presence of such risks. We have carried out a study of students participating in postgraduate courses in environmental and occupational medicine and of medical students. They received a form that contained twelve statements and were asked to indicate whether they agreed or disagreed with these statements. Almost half of the medical students agreed that one must count on developing cancer if one is exposed to a carcinogenic chemical. Responses to other statements were also contrary to the basic principle of the dose-response relationship. A majority in both groups disagreed with the statement that people are unnecessarily concerned about small amounts of pesticides in the environment. Compared to the medical students, the postgraduate students were more sceptical and less concerned regarding environmental risks. These results are in general agreement with a study carried out in the US using the same statements. The results are an indication that we do not necessarily react the same way with regard to information on risks. When communicating such information, the needs and the background of the audience must be appreciated.     

Treatment of hypertension in the presence of coexisting medical conditions

Treating hypertension reduces morbidity and mortality. Unfortunately, hypertension often exists in patients with other medical conditions. In these patients, the selection of an antihypertensive agent is often influenced by the presence of the coexisting condition. Conversely, the treatment of the coexisting medical condition may be influenced by the presence of hypertension. Given the vast array of antihypertensive medications available today, appropriate treatment of both hypertension and coexisting conditions can be achieved with careful selection of medications. This review discusses factors to consider when treating elderly patients with hypertension with the following coexisting conditions: dyslipidaemia, glucose intolerance, sexual dysfunction, cardiovascular disease, pulmonary disease, renal disease and neuropsychiatric disorders. Hypothyroidism, hyperthyroidism and various states of high cardiac output may cause hypertension. These conditions should be identified, since they are often treatable with subsequent resolution of the hypertension.     

Molecular typing of environmental and patient isolates of Aspergillus fumigatus from various hospital settings

Fingerprinting of more than 700 clinical and environmental isolates of Aspergillus fumigatus from four differential hospital settings was undertaken with a dispersed repeated DNA sequence. The analysis of the environmental isolates showed that the airborne A. fumigatus population is extremely diverse, with 85% of the strains being represented as a single genotype isolated once. The remaining 15% of the strains were isolated several times and were able to persist for several months in the same hospital environment. No strains were found to be associated with a specific location inside the hospital, and identical strains were isolated from different buildings of the hospital and outdoors. Isolation of the same strain both from patients and from the environment of the same hospital is highly suggestive of a nosocomial infection. The characteristics of the environmental fungal population explains the two main results obtained from the typing of the clinical isolates: (i) the absence of a common strain responsible for an invasive aspergillosis outbreak results from the extreme diversity of the environmental population of A. fumigatus in contact with the patients, and (ii) patients hospitalized in different wards of the same hospital can be infected with the same strain since every patient might inhale the same spore population.     

Questionnaire items that predict asthma and other respiratory conditions in adults

The International Union Against Tuberculosis and Lung Disease questionnaire is widely used in epidemiologic studies of adult asthma. We examined whether the symptom questions could be classified into groups that represent different "syndromes," and whether some questions are better for predicting asthma than others. We analyzed questionnaire data from a population sample of 1,527 adults aged 18 to 55 years using factor analyses to classify the 17 respiratory symptom questions into four different groups that we termed asthma, cough, breathlessness, and urgent medical visit. The urgent medical visit was a subset of asthma. These four "syndromes" had good validity when measured against airway responsiveness to histamine, atopy to common allergens, lung function, smoking status, and body mass index. Questions that predicted asthma syndrome were those that asked about wheeze at rest or following exercise, asthma attack, chest tightness, and shortness of breath at rest. Questions about cough identified a different group of subjects who apparently did not have asthma. Questions of breathlessness did not aggregate with "asthma" or with "cough syndrome." The identification of particular questions that measure different respiratory conditions is important for epidemiologic studies when short questionnaires or more precise definitions are required.     

The role of environmental ammonia in respiratory mycoplasmosis of rats

Young adult, pathogen-free rats of Sherman and Fischer (F344) substrains were inoculated intranasally with 10(8) colony-forming units (GFU) of M. pulmonis and housed for 4 to 6 weeks in environments with ammonia maintained at specific concentrations from 25 to 250 ppm. All levels of NH3--whether produced naturally from soiled bedding or derived from a purified source--significantly increased the severity of the rhinitis, otitis media, tracheitis, and pneumonia (including bronchiectasis) characteristic of murine respiratory mycoplasmosis (MRM). The prevalence of pneumonia, but not that of other respiratory lesions of MRM, showed a strong tendency to increase directly with environmental NH3 concentration. In contrast, NH3 exposure of rats not infected with M. pulmonis caused anatomic lesions that were unlike those of MRM and were limited to the nasal passages. It was concluded that environmental NH3, at concentrations commonly encountered in present day cage environments for rats, plays an important role in pathogenesis of MRM.     

Accuracy demands, environmental structure and viewing conditions in interception tasks

30 subjects performed an interception task in which the accuracy demands were varied under binocular vs monocular viewing conditions and under different conditions of environmental structure. The pattern of results suggests that the advantage of binocular viewing is due to the concordance of information detected by both eyes rather than to binocular vision per se. The presence of static environmental structure enhances performance because it provides a stable external basis against which optical changes can be evaluated.